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Systemic Corticosteroids in Pediatric Otitis Media: A Systematic Review and Meta-Analysis

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https://doi.org/10.54963/entu.v15i4.1670
Alshahrani, H., Alshammari, A., Alshammari, S., Alshaikh, Z., Alahamdi, L., Alqathanin, W., Alnujaimi, W., Alfaqih, F., Bandar, S., Malawi, L. A., Altuwijri, L., Almuzaini, R., Alhelali, Y. A., Alward, S., & Alshahrani, K. (2025). Systemic Corticosteroids in Pediatric Otitis Media: A Systematic Review and Meta-Analysis. ENT Updates, 15(4), 52–64. https://doi.org/10.54963/entu.v15i4.1670
Volume 15 Issue 4 (2025)
Copyright (c) 2025 Hayat Alshahrani, Areej Alshammari, Shoug Alshammari, Zainab Alshaikh, Lujain Alahamdi, Wajan Alqathanin, Wafaa Alnujaimi, Fatimah Alfaqih, Shahad Bandar, Leen Al Malawi, Lama Altuwijri, Raghida Almuzaini, Yazeed A. Alhelali, Sahar Alward, Kholoud Alshahrani
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This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors

  • Hayat Alshahrani

    Department of Doctor of Pharmacy, College of Clinical Pharmacy, King Khalid University, Abha 62521, Saudi Arabia
  • Areej Alshammari

    Home Health Care—Adult, King Abdulaziz Medical City, Ministry of National Guard, Riyadh 14611, Saudi Arabia
  • Shoug Alshammari

    Department of Doctor of Pharmacy, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
  • Zainab Alshaikh

    Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
  • Lujain Alahamdi

    Department of Doctor of Pharmacy, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia
  • Wajan Alqathanin

    Department of Doctor of Pharmacy, College of Pharmacy, King Khalid University, Abha 62521, Saudi Arabia
  • Wafaa Alnujaimi

    Dr Sulaiman Al Habib Medical Group, Riyadh 11643, Saudi Arabia
  • Fatimah Alfaqih

    Department of Medicine and Surgery, College of Medicine, Umm Al Qura University, Al Qunfudhah 28821, Saudi Arabia
  • Shahad Bandar

    Department of Doctor of Pharmacy, College of Pharmacy, King Khalid University, Abha 62521, Saudi Arabia
  • Leen Al Malawi

    Department of Doctor of Pharmacy, College of Pharmacy, King Khalid University, Abha 62521, Saudi Arabia
  • Lama Altuwijri

    Department of Doctor of Pharmacy, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia
  • Raghida Almuzaini

    Department of Doctor of Pharmacy, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia
  • Yazeed A. Alhelali

    College of Medicine, King Khalid University, Abha 62521, Saudi Arabia
  • Sahar Alward

    Department of Doctor of Pharmacy, College of Pharmacy, King Khalid University, Abha 62521, Saudi Arabia
  • Kholoud Alshahrani

    Pharmacy Department, Southern Region Armed Forces Hospital, Khamis Mushait 62413, Saudi Arabia

Received: 30 September 2025; Revised: 8 December 2025; Accepted: 17 December 2025; Published: 31 December 2025

Otitis media is a common childhood condition that affects public health because of its frequency, recurrence, and potential long-term consequences. This systematic review and meta-analysis assessed the efficacy and safety of systemic corticosteroids (SCS) in children with acute otitis media and otitis media with an effusion. A comprehensive search of PubMed, Scopus, and Web of Science identified relevant studies published between January 2018 and August 2025. The primary outcomes were effusion resolution, hearing loss, and otitis media recurrence. Secondary outcomes included pain relief, tympanostomy tube placement, speech and language development, quality of life, and adverse events. Four studies, including two Cochrane reviews, one randomized controlled trial, and one meta-analysis, were analyzed. The results showed that SCS provided short-term improvements in effusion clearance and hearing, with risk ratios from 1.08 to 1.20. However, these benefits were temporary, with no significant long-term effects on recurrence rates, persistent effusion, or developmental outcomes. Safety data were limited, with most adverse events being mild and self-resolving. The studies had moderate heterogeneity due to differences in population characteristics, intervention protocols, and outcome definitions. Results suggest that SCS may offer short-term symptom relief in certain cases but cannot be recommended for routine management of pediatric otitis media. Future research should prioritize large-scale multicenter trials with standardized outcomes, extended follow-up periods, and thorough safety assessments to identify the subgroups that might benefit the most from SCS treatment.

Keywords:

Otitis Media Acute Otitis Media Otitis Media with Effusion Intranasal Corticosteroids Systemic Corticosteroids

References

  1. Kenna, M.A. Acute Otitis Media—The Long and the Short of It. N. Engl. J. Med. 2016, 375, 2492–2493. DOI: https://doi.org/10.1056/NEJMe1614712
  2. Lieberthal, A.S.; Carroll, A.E.; Chonmaitree, T.; et al. The Diagnosis and Management of Acute Otitis Media. Pediatrics 2013, 131, e964–e999. DOI: https://doi.org/10.1542/peds.2012-3488
  3. Kaur, R.; Morris, M.; Pichichero, M.E. Epidemiology of Acute Otitis Media in the Postpneumococcal Conjugate Vaccine Era. Pediatrics 2017, 140, e20170181. DOI: https://doi.org/10.1542/peds.2017-0181
  4. Steele, D.W.; Adam, G.P.; Di, M.; et al. Effectiveness of Tympanostomy Tubes for Otitis Media: A Meta-analysis. Pediatrics 2017, 139, e20170125. DOI: https://doi.org/10.1542/peds.2017-0125
  5. Rosenfeld, R.M.; Tunkel, D.E.; Schwartz, S.R.; et al. Clinical Practice Guideline: Tympanostomy Tubes in Children (Update). Otolaryngol. Head. Neck. Surg. 2022, 166, S1–S55. DOI: https://doi.org/10.1177/01945998211065662
  6. Hoberman, A.; Paradise, J.L.; Rockette, H.E.; et al. Treatment of Acute Otitis Media in Children under 2 Years of Age. N. Engl. J. Med. 2011, 364, 105–115. DOI: https://doi.org/10.1056/NEJMoa0912254
  7. Hoberman, A.; Paradise, J.L.; Rockette, H.E.; et al. Shortened Antimicrobial Treatment for Acute Otitis Media in Young Children. N. Engl. J. Med. 2016, 375, 2446–2456. DOI: https://doi.org/10.1056/NEJMoa1606043
  8. Hoberman, A.; Preciado, D.; Paradise, J.L.; et al. Tympanostomy Tubes or Medical Management for Recurrent Acute Otitis Media. N. Engl. J. Med. 2021, 384, 1789–1799. DOI: https://doi.org/10.1056/NEJMoa2027278
  9. Wald, E.R. Management of Recurrent Acute Otitis Media. N. Engl. J. Med. 2021, 384, 1859–1860. DOI: https://doi.org/10.1056/NEJMe2104952
  10. Pichichero, M.E. Helping Children with Hearing Loss from Otitis Media with Effusion. Lancet 2018, 392, 533–534. DOI: https://doi.org/10.1016/S0140-6736(18)31862-2
  11. Coker, T.R.; Chan, L.S.; Newberry, S.J.; et al. Diagnosis, Microbial Epidemiology, and Antibiotic Treatment of Acute Otitis Media in Children: A Systematic Review. JAMA 2010, 304, 2161–2169. DOI: https://doi.org/10.1001/jama.2010.1651
  12. Jamal, A.; Alsabea, A.; Tarakmeh, M.; et al. Etiology, Diagnosis, Complications, and Management of Acute Otitis Media in Children. Cureus 2022, 14, e28019. DOI: https://doi.org/10.7759/cureus.28019
  13. Barzilay, J.R.; Jackson, M.A.; Tunkel, D. Watchful Waiting versus Antibiotics for Acute Otitis Media in Pediatric Patients. N. Engl. J. Med. 2024, 391, 1648–1650. DOI: https://doi.org/10.1056/NEJMclde2404416
  14. Spiro, D.M.; Tay, K.Y.; Arnold, D.H.; et al. Wait-and-See Prescription for the Treatment of Acute Otitis Media: A Randomized Controlled Trial. JAMA 2006, 296, 1235–1241. DOI: https://doi.org/10.1001/jama.296.10.1235
  15. McKinsey, J.; Lee, B.R.; Wyly, D.; et al. Increasing Safety Net Antibiotic Prescriptions for Acute Otitis Media in Urgent Care Clinics. J. Pediatr. Clin. Pract. 2024, 14, 200122. DOI: https://doi.org/10.1016/j.jpedcp.2024.200122
  16. Shafik, A.G.; Hassabalah, M.S.; Maarouf, A.M.; et al. Effect of Local versus Systemic Steroids in Treatment of Children with Otitis Media with Effusion. QJM 2020, 113, hcaa047.007. DOI: https://doi.org/10.1093/qjmed/hcaa047.007
  17. Rasheed, A.M. Is Topical Nasal Steroid Useful for Treatment of Otitis Media with Effusion in Children? Int. Tinnitus. J. 2023, 27, 62–67. DOI: https://doi.org/10.5935/0946-5448.20230011
  18. American Academy of Family Physicians; American Academy of Otolaryngology–Head and Neck Surgery; American Academy of Pediatrics Subcommittee on Otitis Media With Effusion. Otitis Media with Effusion. Pediatrics 2004, 113, 1412–1429. DOI: https://doi.org/10.1542/peds.113.5.1412
  19. Roberts, J.E.; Rosenfeld, R.M.; Zeisel, S.A. Otitis Media and Speech and Language: A Meta-analysis of Prospective Studies. Pediatrics 2004, 113, e238–e248. DOI: https://doi.org/10.1542/peds.113.3.e238
  20. Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; et al. The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews. BMJ 2021, 372, n71. DOI: https://doi.org/10.1136/bmj.n71
  21. Ranakusuma, R.W.; Pitoyo, Y.; Safitri, E.D.; et al. Systemic Corticosteroids for Acute Otitis Media in Children. Cochrane Database Syst. Rev. 2018, 3, CD012289. DOI: https://doi.org/10.1002/14651858.CD012289.pub2
  22. Mulvaney, C.A.; Galbraith, K.; Webster, K.E.; et al. Topical and Oral Steroids for Otitis Media with Effusion (OME) in Children. Cochrane Database Syst. Rev. 2023, 12, CD015255. DOI: https://doi.org/10.1002/14651858.CD015255.pub2
  23. Francis, N.A.; Cannings-John, R.; Waldron, C.A.; et al. Oral Steroids for Resolution of Otitis Media with Effusion in Children (OSTRICH): A Double-Blinded, Placebo-Controlled Randomised Trial. Lancet 2018, 392, 557–568. DOI: https://doi.org/10.1016/S0140-6736(18)31490-9
  24. Ikeda, R.; Hidaka, H.; Ito, M.; et al. Pharmacotherapy Focusing on the Management of Otitis Media with Effusion in Children: Systematic Review and Meta-analysis. Auris Nasus Larynx 2022, 49, 748–754. DOI: https://doi.org/10.1016/j.anl.2022.03.017
  25. Anwar, M.; Abdel-Aziz, M.; Nassar, A.; et al. A Comparative Study of the Efficacy of Topical Nasal Steroids versus Systemic Steroids in the Treatment of Otitis Media with Effusion in Children. Egypt. J. Otolaryngol. 2015, 31, 208–212. DOI: https://doi.org/10.4103/1012-5574.168210
  26. Berman, S. Otitis Media in Children. N. Engl. J. Med. 1995, 332, 1560–1565. DOI: https://doi.org/10.1056/NEJM199506083322307
  27. Ghaffar, A.; Feldman, W.; Dolovich, J. Otitis Media in Children. Can. Fam. Physician 1981, 27, 1399–1402.
  28. Ranakusuma, R.W.; McCullough, A.R.; Safitri, E.D.; et al. Oral Prednisolone for Acute Otitis Media in Children: A Pilot, Pragmatic, Randomised, Open-Label, Controlled Study (OPAL Study). Pilot Feasibility Stud. 2020, 6, 121. DOI: https://doi.org/10.1186/s40814-020-00671-5
  29. National Institute for Health and Care Excellence (NICE). Antimicrobial Stewardship: Systems and Processes for Effective Antimicrobial Medicine Use; NICE: London, UK, 2015.
  30. Castelli Gattinara, G.; Bergamini, M.; Simeone, G.; et al. Antibiotic Treatment of Acute and Recurrent Otitis Media in Children: An Italian Intersociety Consensus. Ital. J. Pediatr. 2025, 51, 50. DOI: https://doi.org/10.1186/s13052-025-01894-z
  31. Rosenfeld, R.M.; Shin, J.J.; Schwartz, S.R.; et al. Clinical Practice Guideline: Otitis Media with Effusion (Update). Otolaryngol. Head Neck Surg. 2016, 154, S1–S41. DOI: https://doi.org/10.1177/0194599815623467
  32. Allen, D.B. Systemic Effects of Inhaled Corticosteroids in Children. Curr. Opin. Pediatr. 2004, 16, 440–444. DOI: https://doi.org/10.1097/01.mop.0000129597.48138.e7