International Journal of Pediatric Otorhinolaryngology
REVIEW ARTICLEHealth-related quality of life in children with otitis media
Introduction
Otitis media (OM) is one of the most common disorders in childhood [1], [2], [3] and may have a considerable impact on health-related quality of life (HRQoL) [4], [5], [6] and functional health status (FHS) of children and their caregivers [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20]. Whereas functional health status reflects the physical, psychological or emotional and social functioning of a child, health-related quality of life adds a valuation or affective response to this functioning. Up to now, most studies have focussed on the effects of OM and its treatment on hearing, language and psychosocial development [7], [21], [22], [23], [24], [25], [26]. Only a few studies have addressed the broader scope of health-related quality of life as an outcome measure in OM [27], [28], [29], [30]. Growing interest in HRQoL in children in general and those with OM in particular, however, has brought the need for knowledge of currently available HRQoL instruments and their applicability in clinical practice and research [14], [31], [32], [33], [34]. Haggard et al. have previously reviewed some important studies [28]. Their narrative review was part of a discussion on general issues regarding HRQoL assessment in OM, such as generic versus disease-specific instruments and scaling, and focussed on methodology. We aimed to perform a meta-analysis of the available studies on various HRQoL and FHS assessments in children with recurrent OM, addressing both their methodology and outcome. Due to heterogeneity of the studies regarding population, follow-up, outcome measures and instruments used, pooling of the results in a meta-analysis proved impossible. Therefore, a systematic review was conducted, providing an overview of: (1) the effect of OM on HRQoL and FHS of children assessed with various HRQoL instruments; and (2) the applicability of these HRQoL instruments in research and clinical practice on the basis of their characteristics and contents.
Section snippets
Search strategy
A literature search was performed in EMBASE for articles dating from 1988 to November 2004 and on NLM Gateway from 1966 to November 2004, using the search terms that are proposed by EMBASE for otitis media (‘otitis media’ or ‘chronic otitis media’ or ‘mucoid otitis media’ or ‘secretory otitis media’ or ‘serous otitis media’) or ‘acute otitis media’ and ‘quality of life’ or ‘health status’ or ‘functional status’. Search terms were entered as MESH headings as well as text or keywords. Limitations
Results
The search resulted in 141 citations. The manual search and expert discussion yielded one extra article [28]. After applying the criteria for inclusion and exclusion, only 13 articles remained for inclusion [29], [30], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44]. In addition, we included results regarding reliability and validity of the TAIQOL from our own work published in a thesis [45]. Ninety-two articles were excluded because QoL in OM was not the subject of study, 16 were
Discussion
In recent years, various studies have aimed to assess health-related quality of life in children with OM. Some of them have been reviewed previously as part of a general discussion of methodological issues in HRQoL assessment in children with OM [28]. This is the first systematic review of both methodology and outcomes of HRQoL assessment in OM. Heterogeneity of the studies precluded pooling of results in a meta-analysis.
The negative impact of AOM on the child's functioning appeared to be
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