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Meta-Analysis
. 2014 Jun 29;2014(6):CD006639.
doi: 10.1002/14651858.CD006639.pub4.

Zinc supplements for preventing otitis media

Anjana Gulani  1 , Harshpal S Sachdev
Affiliations
Meta-Analysis

Zinc supplements for preventing otitis media

Anjana Gulani et al. Cochrane Database Syst Rev. .

Abstract

Background: Otitis media is inflammation of the middle ear and is usually caused by infection. It affects people of all ages but is particularly common in young children. Around 164 million people worldwide have long-term hearing loss caused by this condition, 90% of them in low-income countries. As zinc supplements prevent pneumonia in disadvantaged children, we wanted to investigate whether zinc supplements could also prevent otitis media.

Objectives: To evaluate whether zinc supplements prevent otitis media in adults and children of different ages.

Search methods: We searched CENTRAL (2014, Issue 1), MEDLINE (1950 to February week 4, 2014) and EMBASE (1974 to March 2014).

Selection criteria: Randomised, placebo-controlled trials of zinc supplements given at least once a week for at least a month for preventing otitis media.

Data collection and analysis: Two review authors independently assessed the eligibility and methodological quality of the included trials and extracted and analysed data. We summarised results using risk ratios (RRs) or rate ratios for dichotomous data and mean differences (MDs) for continuous data. We combined trial results where appropriate.

Main results: No new trials were identified for inclusion in this update. We identified 12 trials for inclusion, 10 of which contributed outcomes data. There were a total of 6820 participants. In trials of healthy children living in low-income communities, two trials did not demonstrate a significant difference between the zinc-supplemented and placebo groups in the numbers of participants experiencing an episode of definite otitis media during follow-up (3191 participants); another trial showed a significantly lower incidence rate of otitis media in the zinc group (rate ratio 0.69, 95% confidence interval (CI) 0.61 to 0.79, n = 1621). A small trial of 39 infants undergoing treatment for severe malnutrition suggested a benefit of zinc for the mean number of episodes of otitis media (mean difference (MD) -1.12 episodes, 95% CI -2.21 to -0.03). Zinc supplements did not seem to cause any serious adverse events but a small minority of children were reported to have vomited shortly after ingestion of the supplements. The trial evidence included is generally of good quality, with a low risk of bias.

Authors' conclusions: Evidence on whether zinc supplementation can reduce the incidence of otitis media in healthy children under the age of five years living in low- and middle-income countries is mixed. There is some evidence of benefit in children being treated for marasmus (severe malnutrition), but this is based on one small trial and should therefore be treated with caution.

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Conflict of interest statement

Harshpal Singh Sachdev: none known. Anjana Gulani: none known.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Zinc versus placebo, Outcome 1 Individuals who had at least one episode of definite otitis media of any duration.
1.2
1.2. Analysis
Comparison 1 Zinc versus placebo, Outcome 2 Individuals who had more than one episode of definite otitis media.
1.3
1.3. Analysis
Comparison 1 Zinc versus placebo, Outcome 3 Mean number of episodes of definite otitis media.
1.4
1.4. Analysis
Comparison 1 Zinc versus placebo, Outcome 4 Rate ratio of episodes of definite otitis media.
1.5
1.5. Analysis
Comparison 1 Zinc versus placebo, Outcome 5 Individuals who had at least one case of probable otitis media.
1.6
1.6. Analysis
Comparison 1 Zinc versus placebo, Outcome 6 Mean days with probable otitis media.
1.7
1.7. Analysis
Comparison 1 Zinc versus placebo, Outcome 7 Total number of days with ear discharge.
1.8
1.8. Analysis
Comparison 1 Zinc versus placebo, Outcome 8 Days with vomiting after supplementation.
1.9
1.9. Analysis
Comparison 1 Zinc versus placebo, Outcome 9 At least one episode of vomiting immediately after supplementation.
1.10
1.10. Analysis
Comparison 1 Zinc versus placebo, Outcome 10 Discontinued supplement due to vomiting.
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References to other published versions of this review

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