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EBP Compendium: Summary of Systematic Review

Agency for Healthcare Research and Quality (AHRQ)
Management of Acute Otitis Media: Update

Shekelle, P.G., Takata, G., et al. (2010).
Agency for Healthcare Research and Quality (AHRQ), Evidence Report/Technology Assessment No. 198, Publication No. 11-E004.

Indicators of Review Quality:

The review addresses a clearly focused question Yes
Criteria for inclusion of studies are provided Yes
Search strategy is described in sufficient detail for replication Yes
Included studies are assessed for study quality Yes
Quality assessments are reproducible Yes

Description: This is a meta-analysis on the diagnosis and treatment of uncomplicated acute otitis media (AOM) in children.

Question(s) Addressed:

  1. What are the operating characteristics (sensitivity, specificity, and likelihood ratios) of clinical symptoms and otoscopic findings (such as bulging tympanic membrane) to diagnose uncomplicated AOM and to distinguish it from otitis media with effusion (OME).
  2. What has been the impact of the pneumococcal heptavalent immunization (PCV7) on AOM microbial epidemiology?
  3. What is the comparative effectiveness of different treatment options for treating uncomplicated AOM in average risk children?
  4. What is the comparative effectiveness of different management options for recurrent otitis media (uncomplicated) and persistent otitis media or relapse of AOM?
  5. Do treatment outcomes in question 3 and question 4 differ by characteristics of the condition, patient environment, and/or health care delivery system?
  6. What adverse effects have been observed for the treatments whose outcomes are addressed in questions 3 and 4?

Population: Children with suspected or confirmed AOM.


  • Antibiotics
  • Delayed antibiotic
  • Watchful waiting/placebo
  • Analgesics/non-antibiotic medical therapies (including pressure equalizing tubes)

Number of Studies Included: 72

Years Included: 1966-2009



  • Assessment/Screening
    • Assessment Instruments
      • Otoscopy
        • "There is limited evidence on clinicians' accuracy and precision in identifying each of the three clinical criteria necessary to diagnose AOM, or their accuracy and precision in identifying all three together" (p. 44).
        • "...[S]tudies comparing diagnostic accuracy between generalist or primary care physicians and otolaryngologists suggest that clinicians' accuracy in identifying all three clinical criteria in one patient is moderate, at best" (p. 44).
        • The quality of evidence is considered low and "high quality research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate" (p. 44).

Keywords: Otitis Media

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Added to Compendium: February 2012

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