| Intratympanic Corticosteroid Therapy for Treatment-Resistant Otitis Media With Effusion: A Systematic Review and Meta-Analysis |
Mohamed Y. Al-Mahbashi1
, Ehab A. Abdu1
, Ahood A. Mahjari2
, Zainab J. Saleh3
, Amjad M. Majrashi3
, Meaad K. Alsaiari3
, Ghala M. Alalhareth3, Mohammed A. Lesloom3, Dhafer H. Alkhudhrah3
, Salem S. Al-Sharyah3
, Ali H. Al-Harshan3, Mutaz H. Alnajjar4 |
1Department of Otorhinolaryngology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
2Department of Neurosurgery, King Khalid Hospital, Najran, Saudi Arabia
3Faculty of Medicine, Najran University, Najran, Saudi Arabia
4Faculty of Medicine, Ulyanovsk State University, Ulyanovsk, Russia |
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Received: 13 May 2026; Revised: July 2, 2026 Accepted: 13 July 2026. Published online: 23 September 2026. |
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| ABSTRACT |
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This systematic review and meta-analysis evaluated the efficacy and safety of intratympanic (IT) corticosteroid therapy compared with that of standard management of patients with treatment-resistant otitis media with effusion (OME). PubMed, Scopus, Web of Science, and the Cochrane Library were searched from inception to March 2026. Randomized controlled trials and observational studies comparing IT corticosteroid therapy with standard treatment were included. The primary outcomes were changes in pure-tone average (PTA) hearing thresholds and Type A tympanogram normalization. Secondary outcomes included air-bone gap improvement, OME recurrence, tympanosclerosis, otorrhea, and tympanic membrane perforation. Pooled effect estimates were calculated using random-effects models. Six studies involving 312 patients and 417 evaluated ears were included. Overall, IT corticosteroid therapy significantly improved the PTA hearing thresholds compared with the standard treatment (mean differences [MD]=-5.57 dB; 95% confidence interval [CI], -8.15 to -2.99; p<0.001; I²=71.88%). Stratified analyses showed significant improvements in both pediatric patients receiving IT methylprednisolone plus ventilation tube insertion (VTI) (MD=-4.03 dB; 95% CI, -4.98 to -3.07) and in adult patients receiving IT dexamethasone without VTI (MD=-13.68 dB; 95% CI, -19.52 to -7.84). IT corticosteroid therapy also significantly improved the air-bone gap (MD=-7.06 dB; 95% CI, -10.94 to -3.17), reduced the OME recurrence (risk ratios [RR]=0.27), and reduced tympanosclerosis (RR=0.21). No significant differences were observed in Type A tympanogram normalization, otorrhea, or tympanic membrane perforation. IT corticosteroid therapy may improve hearing outcomes and reduce recurrence in patients with persistent or treatment-resistant OME with no statistically significant increase in treatment-related adverse events detected. However, larger size trials with patient-level analyses, standardized protocols, and clinically meaningful hearing outcomes are required. |
| Keywords:
Intratympanic steroidㆍ Meta-analysisㆍ Otitis media with effusionㆍ Pure-tone average |
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