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Evidence reviews for information for suspected or confirmed OME
Evidence review N
NICE Guideline, No. 233
Information for suspected or confirmed OME
Review question
What information is valued by children under 12 years with suspected or confirmed otitis media with effusion (OME) and their parents and carers?
Introduction
The aim of this review is to identify what information is valued by children under 12 years with suspected or confirmed otitis media with effusion (OME) and their parents and carers.
Summary of the protocol
See Table 1 for a summary of the Population, Phenomenon of interest and Context (PPC) characteristics of this review.
For further details see the review protocol in appendix A.
Methods and process
This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual. Methods specific to this review question are described in the review protocol in appendix A and the methods document (supplementary document 1).
Declarations of interest were recorded according to NICE’s conflicts of interest policy.
Qualitative evidence
Included studies
Two studies were included for this review (Gkiousias 2016; Tierney 2013).
The included studies are summarised in Table 2.
One study reported on the views and experiences of parents of children diagnosed with OME, excluding those with craniofacial anomalies, (Gkiousias 2016) and the other study reported on the views and experiences of parents of children with cleft palate diagnosed with OME (Tierney 2013).
Participants in 1 study (Gkiousias 2016) were parents of children who were receiving oral steroids as part of an ongoing trial, and participants in the other study (Tierney 2013) were parents of children who had received watchful waiting, or grommets and/or hearing aids.
The data from the included studies were synthesised and explored in a number of central themes and sub-themes (as shown in Figure 1).
See the literature search strategy in appendix B and study selection flow chart in appendix C.
Excluded studies
Studies not included in this review are listed, and reasons for their exclusion are provided in appendix K.
Summary of included studies
Summaries of the studies that were included in this review are presented in Table 2.
See the full evidence tables in appendix D. No meta-analysis was conducted (and so there are no forest plots in appendix E).
Summary of the evidence
The evidence generated 4 main themes in relation to the information valued by parents of children with confirmed OME. Two studies provided the evidence relating to information sources, which had 4 sub-themes (healthcare professionals, internet, personal experiences and lay sources). Two studies provided the evidence relating to information format, which had 3 subthemes (verbal, written and accessible). Two studies provided the evidence relating to information content, which had 2 subthemes (adequacy of information received and ambiguous information). Two studies provided the evidence relating to Communication, which had 2 subthemes (parental involvement and choice, and language). Figure 1 shows the themes and the subthemes.
A summary of the strength of evidence, assessed using GRADE-CERQual, is presented for each of the sub-themes. The main reasons for downgrading were due to concerns about methodological limitations of the primary studies (e.g., because of a lack of consideration of the relationship between researcher and participants and no justification for data collection methods as it relates to data saturation), and concerns about adequacy (e.g., for review findings when evidence offered no or moderate or only some rich data). For each of the subthemes, the overall quality of the evidence was judged to be:
Main theme 1: Information sources
- Subtheme 1.1: Healthcare professionals. The overall confidence in this sub-theme was judged to be moderate.
- Subtheme 1.2: Internet. The overall confidence in this sub-theme was judged to be moderate.
- Subtheme 1.3: Personal experiences. The overall confidence in this sub-theme was judged to be low.
- Subtheme 1.4: Lay sources. The overall confidence in this sub-theme was judged to be moderate.
Main theme 2: Information format
- Subtheme 2.1: Verbal. The overall confidence in this sub-theme was judged to be moderate.
- Subtheme 2.2: Written. The overall confidence in this sub-theme was judged to be moderate.
- Subtheme 2.3: Accessible. The overall confidence in this sub-theme was judged to be low.
Main theme 3: Information content
- Subtheme 3.1: Adequacy of information received. The overall confidence in this subtheme was judged to be moderate.
- Subtheme 3.2: Ambiguous information. The overall confidence in this sub-theme was judged to be low.
Main theme 4: Communication
- Subtheme 4.1: Parental involvement and choice. The overall confidence in this sub-theme was judged to be high.
- Subtheme 4.2: Language. The overall confidence in this sub-theme was judged to be low.
Findings from the studies are summarised in GRADE-CERQual tables. See the evidence profiles in appendix F for details.
Economic evidence
Included studies
A systematic review of the economic literature was conducted but no economic studies were identified which were applicable to this review question.
Economic model
No economic modelling was undertaken for this review because the committee agreed that other topics were higher priorities for economic evaluation as this review question did not explicitly address a decision between competing alternatives.
The committee's discussion and interpretation of the evidence
The outcomes that matter most
The review focused on the views and preferences about information provided when OME is suspected or confirmed. The committee did not pre-specify themes as they did not want to constrain the evidence. However, they identified a few potential themes as illustrative of the main themes to guide the review. These themes were information content, information format, language, and communication. The potential themes were not exhaustive, and an emergent approach was taken to the thematic synthesis.
The quality of the evidence
The evidence was assessed using GRADE-CERQual methodology and the overall quality ranged from low to high. Concerns about the methodological limitations of the primary studies were assessed with the CASP checklist was “minor concerns” for all the review findings. The issues identified were lack of consideration of the relationship between researcher and participants and no justification for data collection methods as it relates to data saturation. Concerns about relevance ranged from “no or very minor” to “minor”. The minor concerns were due to study focusing only on children with cleft palate as the population of the study. Concerns about coherence ranged from “no or very minor” to “minor”. Minor concerns were due to some ambiguity of findings across studies without a credible explanation of the difference. Concerns about adequacy ranged from “no or very minor” to “serious”. There were serious concerns for review findings when evidence offered no rich data, moderate concerns for review findings when evidence offered some rich data and minor concerns for review findings that were based on evidence offering moderately rich data. The number of studies used for each review finding ranged from 1 to 2.
Benefits and harms
There was high quality evidence from sub-theme 4.1 showing that parents felt that their views about their child’s illness were not taken into consideration by healthcare professionals and they were not given a choice about their child’s treatment but felt coerced into a decision. The committee considered the impact OME may have on children and their families and emphasised that the experience of OME is often different for each child. For example, for some children OME may have no or very minimal impact, while others may have a higher level of frustration, tiredness and behavioural concerns. As a result, any treatment decisions should be made in the context of the child’s experience of OME and any associated impact or concerns, the parents’ or carers’ knowledge and experience of their child, the family and their circumstances. Therefore, they agreed that it is crucial for health professionals to ask the child, their parents and/or carers about their experiences and listen to understand the impact of the illness on the child and the family and use this to inform treatment planning.
The committee considered the low quality evidence from sub-theme 3.2 of parents reporting that they receive conflicting and confusing information from healthcare professionals, as well as the low quality evidence from sub-theme 4.2 that information provided often included medical terms that were incomprehensible. The committee referred to the studies included in the review and recognised that although the participants could converse in English, they still found some information incomprehensible. The committee added that, based on their experience, this may be a particular problem for people who have English as a second language. The committee recognised the importance of parents and carers understanding the information they are given about their child’s illness so that they are aware of potential management options for OME and actions that can be taken to support a child with OME prior to an intervention, and to help empower them to make an informed decision and support their child throughout the process. Additionally, this understanding will help enable parents or carers to explain information to their children, as discussed below in relation to easy read formats. Therefore, the committee agreed that this information should be provided to parents and carers and should be clear, possibly in different languages and without medical terminology. The committee discussed the importance of information being consistent, and made a recommendation in support of this, but acknowledged that there are very few resources that present concise information on OME of varying degrees. For example, the National Deaf Children’s Society (NDCS) website contains information on OME and hearing loss, but there are barriers to accessing some of the information, such as having to join NDCS as a member.
There was moderate quality evidence from sub-theme 3.1 that parents were generally satisfied with information received about OME and different treatment options but there was little detail provided about the exact content of information that should be provided to parents and carers. The committee considered the need for parents or carers to be fully equipped with relevant information about their child’s illness in order to reduce anxiety, make informed choices about management options, and aid shared decision-making. This would also help parents or carers prepare their child for any interventions and for transition to school, including enabling the sharing of information with teachers. Additionally, the committee reiterated that the impact of OME on a child’s wellbeing is a major consideration as it impacts on their hearing, listening, anxiety, emotional, behavioural and social wellbeing. The committee agreed that parents need to understand that their child may not hear properly, and that this can affect their speech, language, social skills and behaviours. Understanding the impacts of OME will help parents understand what has been happening with their child and the potential need for intervention. The committee explained that unless parents understand OME and its impacts, they may not be receptive to potential management options. Therefore, the committee agreed that children, parents and carers need to be provided with comprehensive information about what OME is, its causes, its fluctuating nature and the potential impact on the child’s hearing, listening, wellbeing and development, as well as the different management options (including the option of no active treatment).
It is not current practice to intervene for OME unless there is an associated hearing loss. The committee agreed, based on their experience, that parents can find it distressing to be told that children with OME and no related hearing loss do not usually get treatment. Therefore, it is important to explain why treatment is unnecessary while there is no associated hearing loss, and to reassure parents that OME usually clears up by itself. However, the committee agreed it was also important to ensure that parents remained attentive to their child’s hearing and general behaviour in case hearing problems do develop. It is important that parents are aware that they should seek advice if they develop concerns about their child’s hearing, to reduce the risk of hearing problems being overlooked if they develop after an initial assessment.
The committee considered their experiences in caring for children with OME and agreed that involving children and their parents/ carers in discussions about their condition and care may help improve adherence to interventions and empower them to provide feedback about interventions and changes in their condition that can be used to inform ongoing management. Additionally, evidence from sub-theme 4.1 showed that parents wanted to be more involved in decisions made about their child’s care and were frustrated when they felt they had been coerced into a decision. The committee agreed that, in order to support shared decision-making, healthcare professionals should discuss different treatment and management options with children with OME and their parents/ carers. They agreed that this would empower people to feel supported in the decisions made about the child’s care. Discussing supportive strategies would also enable parents to support their children outside of healthcare environments, thereby aiding the child’s development and reducing the risk of behavioural problems and distress. The committee discussed information suitable for children, which can also be used by parents to support their child in understanding OME and mitigating its impacts. The committee gave particular consideration to children with learning disabilities such as children with Down’s syndrome, and therefore emphasised the need for information that is age and developmentally appropriate for children, especially considering the hearing difficulty the children may be experiencing. The committee discussed that information for parents or carers may not be age or developmentally appropriate for children and agreed that information will need to be tailored differently for children. Therefore, the committee agreed that information should also be provided using visually aided formats such as pictures, captioned videos and animations to make it easier for children to understand. The committee were aware that the 2021 NICE guideline on babies, children and young people’s experience of healthcare includes more general recommendations about caring for children and young people and how to provide information to children. Therefore, they agreed to include a cross-reference to this guideline to provide more detailed guidance on communicating information to children in the most appropriate ways.
There was low quality evidence from sub-theme 2.3 expressing parents’ needs for detailed information in accessible ways. The committee considered the different formats of providing information for parents that were highlighted in theme 2 of the evidence, along with other formats encountered in their experience and practice that were beneficial to parents, and deliberated on the most appropriate formats of information that parents will find useful. The committee discussed the benefit of providing information in easy read formats, without medical terminology, in order to ensure that the information is easily understood by parents or carers, and can also be used to explain information to their children. Similarly, the accessibility and convenience of getting adequate information was discussed. The committee explained that in their experience, some parents or carers are more able to access digital information than others. Therefore, the committee agreed that information should be provided to parents and carers in both digital and non-digital formats to cater for the varying proficiencies and requirements of parents and carers. Additionally, the committee considered the moderate quality evidence from subtheme 1.1 where parents reported a preference for receiving face-to-face information from health professionals. However, the moderate quality evidence from subtheme 2.2 also showed parents valued written information as a useful aid when discussing OME with their family members. The committee explained that in their experiences, information is mostly provided verbally face-to-face but recognised that parents and carers may not be able to take in all the information offered verbally and may have additional questions after leaving the healthcare professional. Therefore, the committee agreed that in addition to offering information verbally, having written information that parents could refer to later will be helpful in answering some of the parents’ and carers’ questions that arise, as well as explaining OME to other family members, schools and nurseries.
The committee agreed, based on their experience, that the timing of when information is shared with children, parents and carers is also important. They discussed that children and their families may feel anxiety when there in a lack of information. However, the committee agreed that parents should not be overloaded with information when OME has not been confirmed. Therefore, the committee agreed that this information should be shared with children, parents and carers as soon as OME is confirmed and before a management decision is made, to empower children, parents and carers to be involved in the management decision.
The committee drew on their experiences and considered parents’ lack of understanding of OME and its impacts on their child’s behaviours, speech and language and wellbeing. In addition to the importance of understanding the impact of OME in relation to management options described above, the committee agreed that parents or carers understanding the impact of OME is important for helping them to understand additional ways they can support their child while they are experiencing hearing loss in order to help mitigate the impact of OME. The committee described different scenarios where parents have expressed a lack of understanding about the impact of OME on the child’s listening and hearing (for example, parents seeing their children respond to some sounds and not to others and think that their children are choosing what they respond to), emotions (for example being dependent on siblings to understand things that are happening around them and feeling anxious when on their own), behaviour (for example, children having tantrums as they are unable to comprehend their environments well, which could sometimes be a result of continuous background noise as well as listening fatigue and frustration with communication) and social wellbeing (for example being unable to socialise with peers because they are unable to comprehend the relationship, hear what is being said, or understand the emotion conveyed in what is being said). The committee agreed, based on their experience, that using visual aids, being close to and facing the child when speaking to them and limiting background noise may be beneficial to reduce the distractions from conflicting sounds and aid the child’s hearing and understanding. These interventions were considered applicable in educational settings as well. The committee recognised that the biggest impact of hearing loss on children is having limited receptivity to education and agreed that support in the educational setting should be considered as part of the support to children with OME, their parents or carers. The committee highlighted that some educational settings, such as nurseries, have very limited knowledge of OME and being aware of OME would help them to be more aware of positive interventions that could support a child with OME.
The committee agreed that an important aspect of shared decision-making was ensuring that children with OME and their parents and carers understood the care and treatment options available, in order to promote confidence that the right decisions were being made. They agreed that people should always feel empowered to ask questions if they need more information to feel comfortable with any decisions being made, and therefore recommended that clinicians give children and their parents/ carers the time to ask questions and answer them in sufficient detail. The committee agreed this should lower the risk of parents feeling as though their information needs have not been met, and should improve service user satisfaction.
The committee also drew on their experiences and explained that parents may change their minds about a chosen management decision either because they want to try a different management option, or because they realise that a different option is better suited to their child. For example, in a situation where the child refuses to keep the hearing aid on, the parent may decide to try grommets instead. The committee therefore agreed that parents and carers should be aware that management decisions may need to be reviewed or changed depending on the child’s needs, and the child, parents or carers should be supported through such changes.
The recommendation that parents and carers should be advised not to expose their children to tobacco smoke was based on the committee’s knowledge and experience, as well as evidence from the review on modifiable risk factors for OME. See Evidence Review A for more information about why this recommendation was made.
There was moderate quality evidence from subtheme 1.2 and 1.4 that showed that parents used the internet and other lay sources for information. The committee considered this evidence and agreed that information could include signposting to relevant and appropriate resources such as NDCS website and shared stories. However, there were concerns that some shared stories may not be appropriate to share with parents because they could be more extreme examples (for example a published story of a child who had had grommets several times and was now awaiting surgery of his eardrum). The committee also discussed the difficulty in finding clear and succinct information that parents can be signposted to. Therefore, no recommendation was made about signposting children, parents and carers to internet resources. However, as indicated above, the committee agreed that parents should be provided with some written information that they could refer to after leaving the consultant and further suggested the possibility of developing clear and succinct information that parents can be signposted to.
Cost effectiveness and resource use
As no formal economic evaluation was undertaken the committee made a qualitative assessment of the likely cost effectiveness of their recommendations. The evidence reviewed was qualitative and therefore the effectiveness of information provision was not quantified but the committee noted that information provision is inexpensive and a requirement of health service interactions between healthcare professionals and parents and children. The committee considered that their recommendations on information and advice would be cost-effective as it was consistent with existing NICE guidance (Babies, children and young people's experience of healthcare [NG204]) and would promote treatment decisions that reflected the child’s individual experience of OME.
Other factors the committee took into account
The committee referred to research conducted by the NDCS that showed children with mild and moderate hearing loss underachieve when compared to children with severe and profound hearing loss, possibly because the parents or carers were not very aware of the impacts as they were not as obvious. This was used to inform the recommendation that children, parents and carers should be provided with comprehensive information about OME, its fluctuating nature, and the potential impact on the child’s hearing, listening, wellbeing and development.
Recommendations supported by this evidence review
This evidence review supports recommendations 1.1.1 to 1.1.9.
References – included studies
Gkiousias 2016
Vasileios Gkiousias, Christopher Collett Butler, Victoria Shepherd et al (2016) Parental perceptions and understanding of information provision, management options and factors influencing the decision-making process in the treatment of children with glue ear. International journal of pediatric otorhinolaryngology 89: 6–12 [PubMed: 27619020]Tierney 2013
Tierney S, O'Brien K, Harman N L et al (2013) Risks and benefits of ventilation tubes and hearing aids from the perspective of parents of children with cleft palate. International journal of pediatric otorhinolaryngology 77(10): 1742–8 [PubMed: 24007893]NICE 2021
National Institute for Health and Care Excellence (2021). Babies, children and young people's experience of healthcare. Available at: https://www.nice.org.uk/guidance/ng204 [Accessed 31/05/2022]
Qualitative
Other
Appendices
Appendix A. Review protocols
Appendix B. Literature search strategies
Appendix C. Qualitative evidence study selection
Appendix D. Evidence tables
Appendix E. Forest plots
Forest plots for review question: What information is valued by children under 12 years with suspected or confirmed OME and their parents and carers?
No meta-analysis was conducted for this review question and so there are no forest plots.
Appendix F. GRADE-CERQual tables
Appendix G. Economic evidence study selection
Appendix H. Economic evidence tables
Economic evidence tables for review question: What information is valued by children under 12 years with suspected or confirmed OME and their parents and carers?
No evidence was identified which was applicable to this review question.
Appendix I. Economic model
Economic model for review question: What information is valued by children under 12 years with suspected or confirmed OME and their parents and carers?
No economic analysis was conducted for this review question.
Appendix J. Excluded studies
Excluded studies for review question: What information is valued by children under 12 years with suspected or confirmed OME and their parents and carers?
Excluded qualitative studies
Table 9Excluded studies and reasons for their exclusion
| Study | Code [Reason] |
|---|---|
| Anonymous. (2005) Parent satisfaction OK with no treatment of otitis. Journal of Family Practice 54(9): 754 [PubMed: 16189891] |
- Study design not of interest for review Quantitative study |
| Arason, Vilhjalmur A, Sigurdsson, Johann A, Kristinsson, Karl G et al (2002) Tympanostomy tube placements, sociodemographic factors and parental expectations for management of acute otitis media in Iceland. The Pediatric infectious disease journal 21(12): 1110–5 [PubMed: 12488659] |
- Study design not of interest for review Results were presented quantitatively |
| Arens, A (2011) Treatment of acute otitis media in children under 2 years of age. Journal of emergency medicine 40(6): 722–723 |
- Study design not of interest for review Quantitative study |
| Chando, S., Young, C., Craig, J.C. et al (2016) Parental views on otitis media: systematic review of qualitative studies. European Journal of Pediatrics 175(10): 1295–1305 [PubMed: 27614962] |
- Context not of interest for review Study described parental experiences and perspectives of caring for a child with otitis media but no data on information for OME presented |
| Finkelstein, JA, Stille, CJ, Rifas-Shiman, SL et al (2005) Watchful waiting for acute otitis media: are parents and physicians ready?. Pediatrics 115(6): 1466–73 [PubMed: 15930205] |
- Study design not of interest for review Quantitative study |
| Fortnum, H., Leighton, P., Smith, M.D. et al (2014) Assessment of the feasibility and clinical value of further research to evaluate the management options for children with Down syndrome and otitis media with effusion: A feasibility study. Health Technology Assessment 18(60): 1–148 [PMC free article: PMC4781095] [PubMed: 25270051] | - Phenomenon of interest not of interest for review |
| Higson, J. and Haggard, M. (2005) Parent versus professional views of the developmental impact of a multi-faceted condition at school age: Otitis media with effusion (‘glue ear’). British Journal of Educational Psychology 75(4): 623–643 [PubMed: 16318682] |
- Study design not of interest for review Quantitative study |
| Kubba, H. (2000) An evidence-based patient information leaflet about otitis media with effusion. British Journal of Clinical Governance 5(2): 93–99 [PubMed: 11184057] |
- Study design not of interest for review Qualitatively collected data was analysed quantitatively |
| La Mantia, I; Varricchio, A; Ciprandi, G (2021) Allergen immunotherapy in children with otitis media with effusion: a preliminary experience. European annals of allergy and clinical immunology 53(6): 288–290 [PubMed: 33191718] |
- Study design not of interest for review letter to editor |
| Laplante-Lévesque, Ariane and Thorén, Elisabet Sundewall (2015) Readability of Internet Information on Hearing: Systematic Literature Review. American Journal of Audiology 24(3): 284–288 [PubMed: 26649531] |
- Context not of interest for review Study focuses on the readability of internet information on hearing for people with hearing impairment and their partners, which was not focused on OME alone. Findings were presented quantitatively |
| Lo, Phoebe S Y, Tong, Michael C F, Wong, Eric M C et al (2006) Parental suspicion of hearing loss in children with otitis media with effusion. European journal of pediatrics 165(12): 851–7 [PubMed: 16862437] |
- Study design not of interest for review Quantitative study |
| Marchbank, Alison Margaret (2011) Early Detection of Hearing Loss: The Case for Listening to Mothers. Deafness & Education International 13(4): 199–219 |
- Population not of interest for review Population was mothers of well-babies screened for hearing loss at birth |
| Margas, K, Exarchakos, G, Barkas, K et al (2004) Conservative treatment of otitis media with effusion: our experience. 5th european congress of oto-rhino-laryngology head and neck surgery (EUFOS). Rhodes, kos, greece, 11–16 september, 2004: 86abstractnofp143 |
- Study design not of interest for review Findings reported quantitatively |
| McAndrew, Lucy (2020) Parental Judgement of Hearing Loss in Infants With Cleft Palate. The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association 57(7): 886–894 [PubMed: 32013560] |
- Study design not of interest for review Quantitative study |
| Middleton, B. (2003) Reducing children’s hearing loss. Interview by Anne Manchester. Nursing New Zealand (Wellington, N.Z. : 1995) 9(2): 24 [PubMed: 15481183] |
- Study design not of interest for review Newspaper/Magazine article |
| Ryan, R, Harkness, P, Fowler, S et al (2001) Management of paediatric otitis media with effusion in the UK: a survey conducted with the guidance of the Clinical Effectiveness Unit at the Royal College of Surgeons of England. The Journal of laryngology and otology 115(6): 475–8 [PubMed: 11429071] |
- Study design not of interest for review Quantitative study |
| Smaka, C (2010) Interview with Shlomo Silman, Ph.D. AudiologyOnline: 6p–6p |
- Study design not of interest for review Interview transcript describing interviewee’s interest in OME |
| Tierney, Stephanie, O’Brien, Kevin, Harman, Nicola L et al (2015) Otitis media with effusion: experiences of children with cleft palate and their parents. The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association 52(1): 23–30 [PubMed: 24237229] |
- Phenomenon of interest not of interest for review Study focuses on the emotions from managing OME, with no data on information for OME. Also, same population as Tierney 2013 which has been included in the review. |
| Vlastos, I M; Hajiioannou, J; Houlakis, M (2008) Otitis media with effusion: what parents want to know. The Journal of laryngology and otology 122(1): 21–4 [PubMed: 17352846] |
- Study design not of interest for review Data was not qualitatively generated. Closed data generation asking for qualitative opinions on pre-existing data |
Excluded economic studies
No economic evidence was identified for this review.
Appendix K. Research recommendations – full details
Research recommendations for review question: What information is valued by children under 12 years with suspected or confirmed OME and their parents and carers?
No research recommendations were made for this review question.
Figures
Figure 1Theme map
OME: Otitis media with effusion
Tables
Table 1Summary of the protocol (PPC table)
| Population | All children under 12 years with suspected or confirmed otitis media with effusion (OME) and their parents and carers. |
|---|---|
| Phenomenon of interest |
Views and preferences about information provided in suspected or confirmed OME. Themes will be identified from the literature. The committee identified the following potential themes (however, not all of these themes may be found in the literature, and additional themes may be identified):
|
| Context | Studies sought will be those published in the English language from European high-income countries, Australia, New Zealand, and Canada from 2000 until the date the searches are run. |
OME: Otitis media with effusion
Table 2Summary of included studies.
| Study | Population | Methods | Themes applied after thematic synthesis |
|---|---|---|---|
|
General qualitative inquiry United Kingdom |
N=12 parents of children OME who attended an ENT outpatient clinic and had been recruited as part of the OSTRICH Study Participating parents: Age in years, mean (SD): NR Sex (male/female): 1/11 Children of participants: Age in years, mean (SD): NR, range: 3–7 Sex (male/female): 6/5 |
Setting: Convenience sampling of parents at a single site of the OSTRICH study, a hospital in South Wales, UK Data collection: Semi-structured interviews |
|
|
General qualitative inquiry United Kingdom |
N= 43 parents of children with OME and non-syndromic cleft palate (with or without cleft lip) who were able to converse in English Participating parents: Age in years, mean (SD): 34.9 (6.7) Sex (male/female): 7/36 Children of participants: Age in years, mean (SD): 6.5 (3.4) Sex (male/female): 21/16 |
Setting: Purposive sampling of parents from two cleft centres in Northern England Data collection: Semi-structured interviews |
|
ENT: ears, nose and throat; NR: not reported; OME: otitis media with effusion; OSTRICH: Oral STeroids for Resolution of otitis media with effusion In Children; SD: standard deviation
Final version
Evidence reviews underpinning recommendations 1.1.1 to 1.1.9 in the NICE guideline
This evidence review was developed by NICE
Disclaimer: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.
NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.