Hui-Wen Chen, John M O'Donnell, Yu-Jui Chiu, Yi-Chun Chen, Yi-No Kang, Yueh-Ting Tuan, Shu-Yu Kuo, Jen-Chieh Wu
Comparison of learning outcomes of interprofessional education simulation with traditional single-profession education simulation: a mixed-methods study
BMC medical education
otitis media effusion ome accumulation fluid middle ear cavity common amongst young children may cause hearing loss persistent may lead developmental delay social difficulty poor quality life management includes watchful waiting autoinflation medical surgical treatment insertion ventilation tubes often used preferred treatment evaluate effects benefits harms ventilation tubes grommets ome children searched cochrane ent register central ovid medline ovid embase web science clinicaltrialsgov ictrp additional sources published unpublished trials 20 january 2023 included randomised controlled trials rcts quasircts children 6 months 12 years ome 3 months included studies compared ventilation tube vt insertion five comparators treatment watchful waiting ventilation tubes inserted later required myringotomy hearing aids nonsurgical treatments used standard cochrane methods primary outcomes determined following multistakeholder prioritisation exercise 1 hearing 2 omespecific quality life 3 persistent tympanic membrane perforation severe adverse effect surgery secondary outcomes 1 persistence ome 2 adverse effects including tympanosclerosis vt blockage pain 3 receptive language skills 4 speech development 5 cognitive development 6 psychosocial skills 7 listening skills 8 generic healthrelated quality life 9 parental stress 10 vestibular function 11 episodes acute otitis media used grade assess certainty evidence key outcomes although included measures hearing assessment proportion children returned normal hearing preferred method due challenges interpreting results mean hearing thresholds included 19 rcts 2888 children considered evidence uncertain due wide confidence intervals effect estimates participants risk performance detection bias report key outcomes longest reported followup limitations evidence studies investigated comparison ventilation tubes versus hearing aids identify data diseasespecific quality life however many studies conducted development specific tools assess otitis media shortacting ventilation tubes used studies thus specific data use longacting vts limited finally identify specific data effects vts children increased risk ome eg craniofacial syndromes ventilation tubes versus treatment four studies odds ratio return normal hearing 12 months 113 vts 95 confidence interval ci 046 274 54 versus 51 1 study 72 participants lowcertainty evidence six months vts may lead large reduction persistent ome risk ratio rr 030 95 ci 014 065 204 versus 680 1 study 54 participants lowcertainty evidence evidence uncertain chance persistent tympanic membrane perforation vts 12 months 085 95 ci 038 191 83 versus 97 1 rct 144 participants early ventilation tubes versus watchful waiting six studies little difference proportion children whose hearing returned normal 8 10 years ie age 9 13 years rr vts 098 95 ci 094 103 93 versus 95 1 study 391 participants lowcertainty evidence vts may also result little difference risk persistent ome 18 months 6 years rr 121 95 ci 084 174 15 versus 12 3 studies 584 participants lowcertainty evidence unable pool data persistent perforation one study showed vts may increase risk perforation followup duration 375 years rr 365 95 ci 041 3238 1 study 391 participants lowcertainty evidence actual number children develop persistent perforation may low demonstrated another study 126 1 study 635 ears lowcertainty evidence ventilation tubes versus nonsurgical treatment one study one study compared vts six months antibiotics sulphisoxazole data available return normal hearing final hearing thresholds reported four months mean difference 598 db hl lower better receiving vts evidence uncertain 95 ci 921 275 1 study 125 participants lowcertainty evidence evidence identified regarding persistent ome vts may result low risk persistent perforation 18 months followup events reported narrative synthesis 1 study 60 participants lowcertainty evidence ventilation tubes versus myringotomy nine studies uncertain whether vts may slightly increase likelihood returning normal hearing 6 12 months since confidence intervals wide included possibility effect rr 122 95 ci 059 253 74 versus 64 2 studies 132 participants lowcertainty evidence six months persistent ome may reduced receive vts compared laser myringotomy evidence uncertain 027 95 ci 019 038 1 study 272 participants lowcertainty evidence six months risk persistent perforation probably similar use vts laser myringotomy narrative synthesis 6 studies 581 participants moderatecertainty evidence may small short mediumterm improvements hearing persistence ome vts unclear whether persist longer followup rcts included allow us say much vts improve hearing specific child however interpretation evidence difficult many children control groups recover spontaneously receive vts followup vts may block extrude ome may recur limited evidence review also affects generalisabilityapplicability findings situations involving children underlying conditions eg craniofacial syndromes use longacting tubes consequently rcts may best way determine whether intervention likely effective individual child instead must better understand different ome phenotypes target interventions children benefit avoid overtreating spontaneous resolution likely