Skip to main content

Intranasal versus systemic corticosteroids in treatment of otitis media with effusion in the presence or absence of adenoid hypertrophy in children



Otitis media with effusion (OME) is defined as the presence of fluid in the middle ear without signs or symptoms of acute infection. The condition is common and affects ~90% of children before school age, who develop an average of four episodes of OME per year, most often between the ages of 6 months and 4 years.


The aim of this study was to investigate the role of systemic versus local corticosteroids in treatment of OME in the presence or the absence adenoid hypertrophy in children.

Patients and methods

In our study, 60 children who fulfilled the inclusion criteria were divided into two equal groups: group A included children with OME with adenoidal hypertrophy and group B included children with OME without adenoidal hypertrophy. Then, each group was subdivided into two groups, where one received topical intranasal steroids (A1 and B1), and the other one received oral steroids (A2 and B2). Tympanograms were done for all patients every 2 weeks.


The final result is that both topical intranasal and systemic steroids are effective in the treatment of OME in children, without significant difference between the two methods, so oral steroid complications could be avoided by using local steroid spray, and the effectiveness of steroids (oral or topical) in treatment of OME is better in absence of adenoidal hypertrophy than in the presence of adenoidal hypertrophy.


Both topical intranasal and oral steroids are effective adjunctive treatment for OME in children in the short term.


  1. 1

    Lieberthal AS, Carroll AE, Chonmaitree T. The diagnosis and management of acute otitis media. Pediatrics 2013; 131:e964–e999.

    Article  Google Scholar 

  2. 2

    Tewfik TL, MD. Eustachian tube function: Overview, embryology of the eustachian tube, anatomy of the eustachian tube; 2018. updated form 3/11.

  3. 3

    Lack G, Caulfield H, Penagos M. The link between otitis media with effusion and allergy: a potential role for intranasal corticosteroids. Pediatr Allergy Immunol 2011;22:258–266.

    Article  Google Scholar 

  4. 4

    Maris M, Wojciechowski M, van de Heyning P, Boudewyns A. A cross-sectional analysis of otitis media with effusion in children with Down syndrome. Eur J Pediatr 2014; 173:1319–1325.

    Article  CAS  Google Scholar 

  5. 5

    Rosenfeld RM, Goldsmith AJ, Tetlus L, Balzano A. Quality of life for children with otitis media. Arch Otolaryngol Head Neck Surg 1997; 123:1049.

    Article  CAS  Google Scholar 

  6. 6

    American Academy of Family Physicians, American Academy of Otolaryngology-Head and Neck Surgery and American Academy of Pediatrics, Subcommittee on Otitis Media with Effusion. Otitis media with effusion. Pediatrics 2004; 113:1412–1429.

    Google Scholar 

  7. 7

    Simon F, Haggard M, Rosenfeld RM, Jia H, Peer S, Calmels MN, et al. International Consensus (ICON) on management of otitis media with effusion in children. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135: S33–S39.

    Article  CAS  Google Scholar 

  8. 8

    Capaccio P, Torretta S, Marciante GA, Marchisio P, Forti S, Pignataro L. Endoscopic adenoidectomy in children with otitis media with effusion and mild hearing loss. Clin Exp Otorhinolaryngol 2016; 9: 33.

    Article  Google Scholar 

  9. 9

    Thomas CL, Simpson SA, Butler CC, van der Voort J, Lewis R. Oral or topical nasal steroids for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev 2006; 2006: CD001935.

    Google Scholar 

  10. 10

    Cengel S, Akyol MU. The role of topical nasal steroids in the treatment of children with otitis media with effusion and/or adenoid hypertrophy. Int J Pediatr Otorhinolaryngol 2006; 70: 639–645.

    Article  CAS  Google Scholar 

  11. 11

    El-Anwar MW, Nofal AA, Khazbak AO, Sayed AE, Hassan MR. The efficacy of nasal steroids in treatment of otitis media with effusion: a comparative study. Int Arch Otorhinolaryngol 2015; 19: 298–301.

    Article  Google Scholar 

  12. 12

    Simpson SA, Lewis R, van der Voort J, Butler CC. Oral or topical nasal steroids for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev 2011: CD001935.

  13. 13

    Shapiro GG, Bierman CW, Furukuwa CT, Pierson WE, Berman R, Donaldson J. Treatment of persistent Eustachian tube dysfunction with aerosolised nasal dexamethasone phosphate versus placebo. Ann Allergy 1982; 49: 81–85.

    PubMed  CAS  Google Scholar 

  14. 14

    Tracy JM, Demain JG, Hoffman KM, Goetz DW. Intranasal beclomethasone as an adjunct to treatment of chronic middle ear effusion. Ann Allergy Asthma Immunol 1998; 80: 198–206.

    Article  CAS  Google Scholar 

  15. 15

    Barati B, Omrani MR, Okhovat AR, Kelishadi R, Hashemi M, Hassanzadeh A, et al. Effect of nasal beclomethasone spray in the treatment of otitis media with effusion. J Res Med Sci 2011; 16: 509–515.

    PubMed  PubMed Central  CAS  Google Scholar 

  16. 16

    Menon SS, Rahman A, Balakrishnan R, Nayak DR, Pujary K. Efficacy of mometasone nasal spray in the treatment of otitis media with effusion in the pediatric age group: a preliminary study. Indian J Otol 2013; 19: 114.

    Article  Google Scholar 

  17. 17

    Lildholdt T, Kortholm B. Beclomethasone nasal spray in the treatment of middle-ear effusion –a double-blind study. Int J Pediatr Otorhinolaryngol 1982; 4:133–137.

    Article  CAS  Google Scholar 

  18. 18

    Williamson I, Benge S, Barton S. Topical intranasal corticosteroids in 4–11 year old children with persistent bilateral otitis media with effusion in primary care: double blind randomised placebo controlled trial. Clin Otolaryngol 2010; 35:125–133.

    Article  Google Scholar 

  19. 19

    Waldron CA, Thomas-Jones E, Cannings-John R, Hood K, Powell C, Roberts A, Tomkinson A, et al. Oral steroids for the resolution of otitis media with effusion (OME) in children (OSTRICH): study protocol for a randomised controlled trial. Trials 2016; 17:115.

    Article  CAS  Google Scholar 

  20. 20

    Christopher C, Butler BA, Judith H. Steroids for otitis media with effusion. Arch Pediatr Adolesc Med 2001; 155:641–647.

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Sayed M. S. Kadah.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kadah, S.M.S., Elkholy, T.A.E. & Tammam, H.K.E. Intranasal versus systemic corticosteroids in treatment of otitis media with effusion in the presence or absence of adenoid hypertrophy in children. Egypt J Otolaryngol 35, 288–299 (2019).

Download citation


  • otitis media with effusion
  • systemic steroids
  • topical nasal steroids