鼓室換気チューブ留置術の評価

―EBMの考えを用いた試み―

抄録

Objective: To determine the efficacy and side effects of ventilation tube insertion in the treatment of otitis media with effusion in preschool children. Data sources: MEDLINE search [“human” in TG and “otitis media with effusion” in MESH] from 1966 through March 1999, and bibliographies of selected articles. Study selection: Articles were selected for seven outcomes; cure rates, hearing loss, language development, educational attainment, balance disturbances, histopathological sequelae, and side effects, by reviewers assessing study quality and suitability for inclusion. Four articles met inclusion criteria for the cure rates, 9 for hearing loss, 7 for language development, 0 for educational attainment, 6 for balance disturbances, and 1 for histopathological sequelae. There were no appropriate articles on side effcts. Data extraction: We abstracted quantitative data for each outcome measure. Data synthesis: In all data for 4 articles, cure rates in the treatment group were not higher compared with controls. Hearing loss was resolved within 6 months after ventilation tube insertion. Otitis media with effusion in children aged under 4 years did not seem to affect language development in children aged over 4 years. In regard to educational attainment, there were no appropriate trials for this study. According to several case-control studies, there was a relationship between otitis media with effusion in young children and balance disturbance. In regard to histopathological sequelae, ventilation tube insertion did not seem to reduce attic retraction and atelectasis. In regard to side effects, high incidences of otorrhea and tympanosclerosis were reported. The utility analyses of clinical decision analysis were thought to be necessary to determine the meanings of these sequelae. Conclusion: Although the data was insufficient to be conclusive evidence, we speculated that the effectiveness of ventilation tube insertion was very limited, that indications of ventilation tube insertion should be modified, and that large multi-center trials in domestic institutes should be conducted as soon as possible.
Key words : meta-analysis, otitis media with effusion, middle ear ventilation, preschool child