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Sirota SB, Doxey MC, Dominguez RMV, Bender RG, Vongpradith A, Albertson SB, Novotney A, Burkart K, Carter A, Abdi P, Abdoun M, Abebe AM, Abegaz KH, Aboagye RG, Abolhassani H, Abreu LG, Abualruz H, Abu-Gharbieh E, Aburuz S, Adane MM, Addo IY, Adekanmbi V, Adnani QES, Adzigbli LA, Afzal MS, Afzal S, Ahinkorah BO, Ahmad S, Ahmed A, Ahmed H, Ahmed SA, Akinosoglou K, Akkaif MA, Al Awaidy S, Alalalmeh SO, Albashtawy M, AlBataineh MT, Al-Gheethi AAS, Alhalaiqa FN, Alhassan RK, Ali A, Ali L, Ali MU, Ali SS, Ali W, Almazan JU, Alqahtani JS, Alrawashdeh A, Al-Rifai RH, Alshahrani NZ, Altartoor K, Al-Tawfiq JA, Alvis-Guzman N, Al-Worafi YM, Aly H, Aly S, Alzoubi KH, Al-Zyoud WA, Amhare AF, Amu H, Amusa GA, Anil A, Anvari S, Anyabolo EE, Arabloo J, Arafat M, Areda D, Aregawi BB, Aremu A, Athari SS, Aujayeb A, Aynalem ZB, Azadnajafabad S, Azzam AY, Badar M, Bahrami Taghanaki P, Bahramian S, Baig AA, Bajcetic M, Balakrishnan S, Banach M, Bardhan M, Barqawi HJ, Bastan MM, Batra K, Batra R, Behnoush 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TG, Getahun GK, Getie M, Ghadiri K, Ghasemzadeh A, Ghorbani M, Goldust M, Golechha M, Goleij P, Gorini G, Goyal A, Guan SY, Guarducci G, Gudeta MD, Gupta R, Gupta S, Gupta VB, Gupta VK, Hadei M, Hadi NR, Haj-Mirzaian A, Halwani R, Hamidi S, Hammoud A, Hanifi N, Hanna F, Haq ZA, Haque MR, Hasan SMM, Hasani H, Hasnain MS, Hassankhani H, Haubold J, Hayat K, Hegazi OE, Hezam K, Holla R, Hoogar P, Horita N, Hostiuc M, Huynh HH, Ibitoye SE, Ilesanmi OS, Ilic IM, Ilic MD, Imam MT, Isa MA, Islam MR, Islam SMS, Ismail NE, Iwagami M, J V, Jafarzadeh A, Jaggi K, Jairoun AA, Jakovljevic M, Jamshidi E, Jayaram S, Jeswani BM, Jha RP, Jose J, Joseph N, Joshua CE, Jozwiak JJ, K V, Kabir Z, Kandel H, Kanmodi KK, Kant S, Kantar RS, Karaye IM, Karimi Behnagh A, Kaur N, Khajuria H, Khalaji A, Khamesipour F, Khan G, Khan MN, Khan M, Khan MJ, Kim MS, Kimokoti RW, Kochhar S, Korshunov VA, Kosen S, Krishan K, Krishna H, Krishnamoorthy V, Kuate Defo B, Kuddus MA, Kuddus M, Kuitunen I, Kulimbet M, Kumar D, Kurmi OP, Kutikuppala LVS, Lahariya C, Lal DK, Lasrado S, Latifinaibin K, Le HH, Le NHH, Le TTT, Le TDT, Lee SW, Lee WC, Li MC, Li P, Lim SS, Liu G, Liu R, Liu W, Liu X, Liu X, Lorenzovici L, Luo L, Majeed A, Malakan Rad E, Malhotra K, Malik I, Manilal A, Mehta B, Mekene Meto T, Mekonnen MM, Meles HN, Memish ZA, Mendez-Lopez MA, Meo SA, Merati M, Mestrovic T, Mettananda S, Minh LHN, Mirrakhimov EM, Misra AK, Mohamed AI, Mohamed NS, Mohammed M, Mohammed M, Mokdad AH, Monasta L, Moni MA, Moodi Ghalibaf A, Moore CE, Morawska L, Motappa R, Mougin V, Mousavi P, Mustafa G, Naghavi P, Naik GR, Nainu F, Najafi MS, Najdaghi S, Najmuldeen HHR, Nargus S, Narimani Davani D, Naser M, Natto ZS, Nayak BP, Nejadghaderi SA, Nguyen DH, Nguyen HTH, Nguyen VT, Nikolouzakis TK, Noman EA, Nri-Ezedi CA, Nuñez-Samudio V, Nwatah VE, Odetokun IA, Okekunle AP, Okonji OC, Okwute PG, Olanipekun TO, Olufadewa II, Olusanya BO, Omer GL, Onyedibe KI, Ordak M, Orish VN, Ortiz-Prado E, Otstavnov N, Ouyahia A, P A MP, Padubidri JR, Pandey A, Pantazopoulos I, Pardhan S, Parija PP, Parikh RR, Park S, Parthasarathi A, Pasovic M, Pathan AR, Patil S, Pawar S, Peprah P, Perianayagam A, Perumal D, Petcu IR, Pham HN, Pham HT, Philip AK, Pigott DM, Piracha ZZ, Poddighe D, Polibin RV, Postma MJ, Pourbabaki R, Prates EJS, Puvvula J, Qazi AS, Qian G, Rafferty Q, Rahim F, Rahimi M, Rahimi-Movaghar V, Rahman MO, Rahman M, Rahman MA, Rahmanian M, Rahmanian N, Rahmanian V, Rahmati M, Rajput P, Ramadan MM, Ramasamy SK, Ramesh PS, Rao IR, Rao M, Rao SJ, Rashedi S, Rashidi MM, Rathish D, Ravikumar N, Rawaf S, Redwan EMM, Reyes LFF, Rezaei N, Rezaei N, Rezahosseini O, Rizvi SMD, Rodriguez JAB, Ronfani L, Roudashti S, Roy P, Ruela GDA, Saddik BA, Saeb MR, Saeed U, Saeedi P, Safari M, Saheb Sharif-Askari F, Saheb Sharif-Askari N, Sahebkar A, Sahu M, Sakshaug JW, Salam N, Salami AA, Saleh MA, Sallam M, Samodra YL, Sanjeev RK, Santric-Milicevic MM, Saravanan A, Sartorius B, Sathyanarayan A, Saulam J, Saxena S, Saya GK, 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Zielińska M, Zoladl M, Zyoud SH, Aravkin AY, Kassebaum NJ, Naghavi M, Vos T, Hay SI, Murray CJL, Kyu HH. Global, regional, and national burden of upper respiratory infections and otitis media, 1990-2021: a systematic analysis from the Global Burden of Disease Study 2021. THE LANCET. INFECTIOUS DISEASES 2024:S1473-3099(24)00430-4. [PMID: 39265593 DOI: 10.1016/s1473-3099(24)00430-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND Upper respiratory infections (URIs) are the leading cause of acute disease incidence worldwide and contribute to a substantial health-care burden. Although acute otitis media is a common complication of URIs, the combined global burden of URIs and otitis media has not been studied comprehensively. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to explore the fatal and non-fatal burden of the two diseases across all age groups, including a granular analysis of children younger than 5 years, in 204 countries and territories from 1990 to 2021. METHODS Mortality due to URIs and otitis media was estimated with use of vital registration and sample-based vital registration data, which are used as inputs to the Cause of Death Ensemble model to separately model URIs and otitis media mortality by age and sex. Morbidity was modelled with a Bayesian meta-regression tool using data from published studies identified via systematic reviews, population-based survey data, and cause-specific URI and otitis media mortality estimates. Additionally, we assessed and compared the burden of otitis media as it relates to URIs and examined the collective burden and contributing risk factors of both diseases. FINDINGS The global number of new episodes of URIs was 12·8 billion (95% uncertainty interval 11·4 to 14·5) for all ages across males and females in 2021. The global all-age incidence rate of URIs decreased by 10·1% (-12·0 to -8·1) from 1990 to 2019. From 2019 to 2021, the global all-age incidence rate fell by 0·5% (-0·8 to -0·1). Globally, the incidence rate of URIs was 162 484·8 per 100 000 population (144 834·0 to 183 289·4) in 2021, a decrease of 10·5% (-12·4 to -8·4) from 1990, when the incidence rate was 181 552·5 per 100 000 population (160 827·4 to 206 214·7). The highest incidence rates of URIs were seen in children younger than 2 years in 2021, and the largest number of episodes was in children aged 5-9 years. The number of new episodes of otitis media globally for all ages was 391 million (292 to 525) in 2021. The global incidence rate of otitis media was 4958·9 per 100 000 (3705·4 to 6658·6) in 2021, a decrease of 16·3% (-18·1 to -14·0) from 1990, when the incidence rate was 5925·5 per 100 000 (4371·8 to 8097·9). The incidence rate of otitis media in 2021 was highest in children younger than 2 years, and the largest number of episodes was in children aged 2-4 years. The mortality rate of URIs in 2021 was 0·2 per 100 000 (0·1 to 0·5), a decrease of 64·2% (-84·6 to -43·4) from 1990, when the mortality rate was 0·7 per 100 000 (0·2 to 1·1). In both 1990 and 2021, the mortality rate of otitis media was less than 0·1 per 100 000. Together, the combined burden accounted for by URIs and otitis media in 2021 was 6·86 million (4·24 to 10·4) years lived with disability and 8·16 million (4·99 to 12·0) disability-adjusted life-years (DALYs) for all ages across males and females. Globally, the all-age DALY rate of URIs and otitis media combined in 2021 was 103 per 100 000 (63 to 152). Infants aged 1-5 months had the highest combined DALY rate in 2021 (647 per 100 000 [189 to 1412]), followed by early neonates (aged 0-6 days; 582 per 100 000 [176 to 1297]) and late neonates (aged 7-24 days; 482 per 100 000 [161 to 1052]). INTERPRETATION The findings of this study highlight the widespread burden posed by URIs and otitis media across all age groups and both sexes. There is a continued need for surveillance, prevention, and management to better understand and reduce the burden associated with URIs and otitis media, and research is needed to assess their impacts on individuals, communities, economies, and health-care systems worldwide. FUNDING Bill & Melinda Gates Foundation.
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MacKeith S, Mulvaney CA, Galbraith K, Webster KE, Paing A, Connolly R, Marom T, Daniel M, Venekamp RP, Schilder AG. Adenoidectomy for otitis media with effusion (OME) in children. Cochrane Database Syst Rev 2023; 10:CD015252. [PMID: 37870083 PMCID: PMC10591285 DOI: 10.1002/14651858.cd015252.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND Otitis media with effusion (OME) is an accumulation of fluid in the middle ear cavity, common amongst young children. The fluid may cause hearing loss. When persistent, it may lead to developmental delay, social difficulty and poor quality of life. Management of OME includes watchful waiting, autoinflation, medical and surgical treatment. Adenoidectomy has often been used as a potential treatment for this condition. OBJECTIVES To assess the benefits and harms of adenoidectomy, either alone or in combination with ventilation tubes (grommets), for OME in children. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 20 January 2023. SELECTION CRITERIA Randomised controlled trials and quasi-randomised trials in children aged 6 months to 12 years with unilateral or bilateral OME. We included studies that compared adenoidectomy (alone, or in combination with ventilation tubes) with either no treatment or non-surgical treatment. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Primary outcomes (determined following a multi-stakeholder prioritisation exercise): 1) hearing, 2) otitis media-specific quality of life, 3) haemorrhage. SECONDARY OUTCOMES 1) persistence of OME, 2) adverse effects, 3) receptive language skills, 4) speech development, 5) cognitive development, 6) psychosocial skills, 7) listening skills, 8) generic health-related quality of life, 9) parental stress, 10) vestibular function, 11) episodes of acute otitis media. We used GRADE to assess the certainty of evidence for each outcome. Although we included all measures of hearing assessment, the proportion of children who returned to normal hearing was our preferred method to assess hearing, due to challenges in interpreting the results of mean hearing thresholds. MAIN RESULTS We included 10 studies (1785 children). Many of the studies used concomitant interventions for all participants, including insertion of ventilation tubes or myringotomy. All included studies had at least some concerns regarding the risk of bias. We report results for our main outcome measures at the longest available follow-up. We did not identify any data on disease-specific quality of life for any of the comparisons. Further details of additional outcomes and time points are reported in the review. 1) Adenoidectomy (with or without myringotomy) versus no treatment/watchful waiting (three studies) After 12 months there was little difference in the proportion of children whose hearing had returned to normal, but the evidence was very uncertain (adenoidectomy 68%, no treatment 70%; risk ratio (RR) 0.97, 95% confidence interval (CI) 0.65 to 1.46; number needed to treat to benefit (NNTB) 50; 1 study, 42 participants). There is a risk of haemorrhage from adenoidectomy, but the absolute risk appears small (1/251 receiving adenoidectomy compared to 0/229, Peto odds ratio (OR) 6.77, 95% CI 0.13 to 342.54; 1 study, 480 participants; moderate certainty evidence). The risk of persistent OME may be slightly lower after two years in those receiving adenoidectomy (65% versus 73%), but again the difference was small (RR 0.90, 95% CI 0.81 to 1.00; NNTB 13; 3 studies, 354 participants; very low-certainty evidence). 2) Adenoidectomy (with or without myringotomy) versus non-surgical treatment No studies were identified for this comparison. 3) Adenoidectomy and bilateral ventilation tubes versus bilateral ventilation tubes (four studies) There was a slight increase in the proportion of ears with a return to normal hearing after six to nine months (57% adenoidectomy versus 42% without, RR 1.36, 95% CI 0.98 to 1.89; NNTB 7; 1 study, 127 participants (213 ears); very low-certainty evidence). Adenoidectomy may give an increased risk of haemorrhage, but the absolute risk appears small, and the evidence was uncertain (2/416 with adenoidectomy compared to 0/375 in the control group, Peto OR 6.68, 95% CI 0.42 to 107.18; 2 studies, 791 participants). The risk of persistent OME was similar for both groups (82% adenoidectomy and ventilation tubes compared to 85% ventilation tubes alone, RR 0.96, 95% CI 0.86 to 1.07; very low-certainty evidence). 4) Adenoidectomy and unilateral ventilation tube versus unilateral ventilation tube (two studies) Slightly more children returned to normal hearing after adenoidectomy, but the confidence intervals were wide (57% versus 46%, RR 1.24, 95% CI 0.79 to 1.96; NNTB 9; 1 study, 72 participants; very low-certainty evidence). Fewer children may have persistent OME after 12 months, but again the confidence intervals were wide (27.2% compared to 40.5%, RR 0.67, 95% CI 0.35 to 1.29; NNTB 8; 1 study, 74 participants). We did not identify any data on haemorrhage. 5) Adenoidectomy and ventilation tubes versus no treatment/watchful waiting (two studies) We did not identify data on the proportion of children who returned to normal hearing. However, after two years, the mean difference in hearing threshold for those allocated to adenoidectomy was -3.40 dB (95% CI -5.54 to -1.26; 1 study, 211 participants; very low-certainty evidence). There may be a small reduction in the proportion of children with persistent OME after two years, but the evidence was very uncertain (82% compared to 90%, RR 0.91, 95% CI 0.82 to 1.01; NNTB 13; 1 study, 232 participants). We noted that many children in the watchful waiting group had also received surgery by this time point. 6) Adenoidectomy and ventilation tubes versus non-surgical treatment No studies were identified for this comparison. AUTHORS' CONCLUSIONS When assessed with the GRADE approach, the evidence for adenoidectomy in children with OME is very uncertain. Adenoidectomy may reduce the persistence of OME, although evidence about the effect of this on hearing is unclear. For patients and carers, a return to normal hearing is likely to be important, but few studies measured this outcome. We did not identify any evidence on disease-specific quality of life. There were few data on adverse effects, in particular postoperative bleeding. The risk of haemorrhage appears to be small, but should be considered when choosing a treatment strategy for children with OME. Future studies should aim to determine which children are most likely to benefit from treatment, rather than offering interventions to all children.
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Affiliation(s)
- Samuel MacKeith
- ENT Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Caroline A Mulvaney
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Kevin Galbraith
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Katie E Webster
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Aye Paing
- Guideline Development Team A, NICE, London, UK
| | | | - Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben Gurion University Faculty of Health Sciences, Ashdod, Israel
| | - Mat Daniel
- Nottingham Children's Hospital, Nottingham, UK
| | - Roderick P Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Anne Gm Schilder
- evidENT, Ear Institute, University College London, London, UK
- NIHR UCLH Biomedical Research Centre, University College London, London, UK
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