Probiotic, Prebiotic, and Synbiotic Supplementation for the Prevention and Treatment of Acute Otitis Media: A Systematic Review and Meta-Analysis

Abstract

Background and aim: Probiotics, prebiotics, and synbiotics have been documented to modulate the microbiota, enhance immunity, and reduce antibiotic resistance, making them a promising alternative in the management of acute otitis media (AOM). Accordingly, the aim of this study was to determine their effectiveness in the prevention and treatment of AOM in patients.

Methods: A systematic review and meta-analysis of randomized controlled trials published between 2000 and 2024 was conducted using Science Direct, PubMed, LILACS, SCOPUS, Web of Science, and Cochrane Clinical Trials, following PRISMA guidelines. The methodological quality was evaluated using the Jadad scale, and the meta-analysis was performed with RevMan 5.4^® and Jamovi 2.3.28^®.

Results: A total of 16 trials with 4034 patients were included. The meta-analysis showed that the intervention did not affect the time to AOM presentation (MD: -7.98; 95% CI: -19.74 to 3.78; p = 0.18), the recurrence of the disease (RR: 0.99; 95% CI: 0.74-1.33; p = 0.96), or the requirement for antibiotics (RR: 1.31; 95% CI: 0.92 to 1.84; p = 0.13); however, it was associated with a reduced probability of developing AOM (RR: 0.80; 95% CI: 0.66 to 0.96; p = 0.02). Subgroup analysis suggests that the effect of probiotic supplementation on AOM incidence is influenced by treatment duration, patient age, and the number of probiotic strains in the product.

Conclusions: Supplementation with probiotics, prebiotics, or synbiotics is associated with a significant reduction in the incidence of AOM in children, although no significant impact was observed on other key clinical parameters. These interventions may be considered as a complementary strategy to conventional treatments; however, further high-quality, standardized trials are needed to confirm these findings and to define optimal protocols.

Keywords: acute otitis media; dysbiosis; microbiota; prebiotics; probiotics; systematic review.

Figure 1

PRISMA flow diagram of studies selected for the review.

Figure 2

Risk of bias assessment of the studies included in the review [34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50]. (a) The symbol “+” denotes a low risk of bias, “?” indicates an unclear risk of bias, and “−” represents a high risk of bias. The colors associated with each symbol are green for low risk, yellow for unclear risk, and red for high risk. (b) A summary of the risk of bias identified after evaluating each study, showing the corresponding percentages for each bias domain.

Figure 3

Forest plots of the effect of adjunctive therapy with probiotics, prebiotics, or synbiotics on the time to AOM episode [34,48].

Figure 4

Forest plots of the effect of adjunctive therapy with probiotics, prebiotics, or synbiotics on AOM recurrence [34,43,47,48].

Figure 5

Forest plots of the effect of adjunctive therapy with probiotics, prebiotics, or synbiotics on the use of antibiotics for the treatment of AOM [34,40,44,45,48].

Figure 6

Forest plots of the effect of adjunctive therapy with probiotics, prebiotics, or synbiotics on the incidence of acute otitis media [34,35,36,37,38,39,40,41,42,43,44,45,47,48,49,50].

Figure 7

Forest plots of the subgroup analysis on the effect of probiotics, prebiotics, or synbiotics on the incidence of AOM according to treatment duration [34,35,36,37,38,39,40,41,42,43,44,45,47,48,49,50].

Figure 8

Forest plots of the subgroup analysis on the effect of probiotics, prebiotics, or synbiotics on the incidence of AOM according to the number of strains included in the product [34,35,36,37,38,39,40,41,42,43,44,45,47,48,49,50].

Figure 9

Forest plots of the subgroup analysis on the effect of probiotics, prebiotics, or synbiotics on the incidence of AOM according to the age group of the patients [34,35,36,37,38,39,40,41,42,43,44,45,47,48,49,50].

Figure 10

Funnel plots on publication bias regarding the effect of probiotics, prebiotics, or synbiotics on the incidence of AOM [34,35,36,37,38,39,40,41,42,43,44,45,47,48,49,50].