Background: In 2016, we started a project to produce a suite of Cochrane reviews for people with chronic otitis media (COM). COM is chronic inflammation of the middle ear with discharge through a tympanic membrane perforation. Incidence is higher among children and people in lower and middle-income countries, and from certain ethnic groups.
Objectives:To identify priority areas in COM for Cochrane reviews through a scoping process and stakeholder consultation.
Methods:There were four stages in the scoping process described in a companion paper. The first three stages found six possible review topics and key outcomes to be used across all reviews. In the final stage, stakeholders around the world were consulted on the proposed scope.
Results: The consultation confirmed the importance, and method of measurement, of outcomes. Patient input suggested complete resolution of ear discharge was more meaningful than reduction in discharge, with important psychological and lifestyle implications. This resolved our initial uncertainty about the most relevant outcome to measure improvement.
Engagement with stakeholders confirmed the priority of six proposed reviews, but another priority review was also identified. This topic was based on variations in practice, which had a greater influence on prioritisation than availability of evidence. Cost and accessibility of treatment options were highlighted as important during the process due to the epidemiology of the disease. The prioritised reviews were: 1) topical antiseptics vs. topical antibiotics; 2) topical antibiotics, with steroids; 3) topical antibiotics (without steroids); 4) aural toileting; 5) systemic antibiotics; 6) systemic vs. topical antibiotics; and, 7) topical antiseptics.
Conclusions:The scoping process identified 7 prioritised reviews that can be completed within available resources. The exercise showed that globally, factors other than efficacy and availability of evidence are important. Although most stakeholders believed that topical antibiotics are the most effective treatment, the variations in practice, often driven by resource constraints, show the need to consider other treatments.