|
Intervention |
Benefits‡ |
Harms‡ |
| Observation |
Base case |
Base case |
| Antibiotics |
Improved clearance of effusion at 1 month or |
Nausea, vomiting, diarrhea (2% to 32% depending on |
| |
less, 14.0% (95% CI [3.6%, 24.2%]); possible |
dose and antibiotic); cutaneous reactions (<= 5%); |
| |
reduction in future infections |
numerous rare organ system effects, including very |
| |
|
rare fatalities; cost; possible development of resistant |
| |
|
strains of bacteria |
| Antibiotics plus steroids |
Possible improved clearance at 1 month, 25.1% |
See antibiotics and steroids separately |
| |
(95% CI [-1.3%, 49.9%])§; possible reduction |
|
| |
in future infections. |
|
| Steroids alone |
Possible improved clearance at 1 month, 4.5% |
Possible exacerbation of varicella; long-term |
| |
(95% CI [-11.7%, 20.6%])§ |
complications not established for low doses; cost |
| Antihistamine/decongestant |
Same as base case |
Drowsiness and/or excitability¶; cost |
| Myringotomy with tubes |
Immediate clearance of effusion in all children; |
Invasive procedure; anesthesia risk; cost; |
| |
improved hearing |
tympanosclerosis; otorrhea; possible restrictions on |
| |
|
swimming |
| Adenoidectomy |
Benefits for young children have not been |
Invasive procedure¶; anesthesia risk; cost |
| |
established |
|
| Tonsillectomy |
Same as base case |
Invasive procedure¶; anesthesia risk; cost |