Gulani Anjana, Sachdev Harshpal S
Department of Pediatrics, Max Multispeciality Centre, N-110, Panchsheel Park, New Delhi, India, 110017.
Cochrane Database Syst Rev. 2014 Jun 29;2014(6):CD006639. doi: 10.1002/14651858.CD006639.pub4.
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.
To evaluate whether zinc supplements prevent otitis media in adults and children of different ages.
We searched CENTRAL (2014, Issue 1), MEDLINE (1950 to February week 4, 2014) and EMBASE (1974 to March 2014).
Randomised, placebo-controlled trials of zinc supplements given at least once a week for at least a month for preventing otitis media.
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.
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.
中耳炎是中耳的炎症，通常由感染引起。它影响所有年龄段的人，但在幼儿中尤为常见。全球约有1.64亿人因这种疾病导致长期听力损失，其中90%在低收入国家。由于锌补充剂可预防弱势儿童患肺炎，我们想研究锌补充剂是否也能预防中耳炎。
评估锌补充剂是否能预防不同年龄成人和儿童的中耳炎。
我们检索了考克兰系统评价数据库（CENTRAL，2014年第1期）、医学文献数据库（MEDLINE，1950年至2014年2月第4周）和荷兰医学文摘数据库（EMBASE，1974年至2014年3月）。
每周至少服用一次锌补充剂、持续至少一个月以预防中耳炎的随机、安慰剂对照试验。
两位综述作者独立评估纳入试验的合格性和方法学质量，并提取和分析数据。我们使用风险比（RRs）或率比来汇总二分类数据的结果，使用平均差（MDs）来汇总连续性数据的结果。在适当情况下合并试验结果。
本次更新未识别出纳入的新试验。我们识别出12项纳入试验，其中10项提供了结局数据。共有6820名参与者。在低收入社区健康儿童的试验中，两项试验未显示锌补充剂组和安慰剂组在随访期间发生明确中耳炎发作的参与者数量有显著差异（3191名参与者）；另一项试验显示锌组中耳炎发病率显著较低（率比0.69，95%置信区间（CI）0.61至0.79，n = 1621）。一项对39名接受重度营养不良治疗的婴儿进行的小型试验表明，锌对中耳炎发作的平均次数有益（平均差（MD）-1.12次发作，95% CI -2.21至-0.03）。锌补充剂似乎未引起任何严重不良事件，但据报道少数儿童在摄入补充剂后不久出现呕吐。纳入的试验证据总体质量良好，偏倚风险低。
关于在低收入和中等收入国家五岁以下健康儿童中补充锌是否能降低中耳炎发病率的证据不一。有一些证据表明对患有消瘦症（重度营养不良）的儿童有益，但这基于一项小型试验，因此应谨慎对待。
