General Methods and Literature Search

In developing an evidence-based clinical practice guideline on managing OME, the American Academy of Pediatrics (AAP), American Academy of Family Physicians, and American Academy of Otolaryngology-Head and Neck Surgery worked with the Agency for Healthcare Research and Quality (AHRQ) and other organizations. This effort included representatives from each partnering organization along with liaisons from audiology, speech-language pathology, informatics, and advanced-practice nursing. The most current literature on managing children with OME was reviewed, and research questions were developed to guide the evidence-review process.

The AHRQ report on OME from the Southern California Evidence-Based Practice Center (EPC) focused on key questions of natural history, diagnostic methods, and long-term speech, language, and hearing outcomes. Searches were conducted through January 2006 in Medline, Embase, and the Cochrane Library. Additional articles were identified by review of reference listings in proceedings, reports, and other guidelines. The EPC accepted 970 articles for full review after screening 3200 abstracts. The EPC reviewed articles by using established quality criteria and included randomized trials, prospective cohorts, and validations of diagnostic tests (validating cohort studies).

The AAP subcommittee on OME updated the AHRQ review with articles identified by an electronic Medline search through April 2003 and with additional material identified manually by subcommittee members. Copies of relevant articles were distributed to the subcommittee for consideration. A specific search for articles relevant to complementary and alternative medicine (CAM) was performed by using Medline and the Allied and Complementary Medicine Database through April 2009. Articles relevant to allergy and OME were identified by using Medline through April 2009. The subcommittee met 3 times over a 1-year period, ending in May 2009, with interval electronic review and feedback on each guideline draft to ensure accuracy of content and consistency with standardized criteria for reporting clinical practice guidelines.

In May 2009, the Guidelines Review Group of the Yale Center for Medical Informatics used the Guideline Elements Model to categorize content of the present draft guideline. Policy statements were parsed into component decision variables and actions and then assessed for decidability and executability. Quality appraisal using established criteria was performed with Guideline Elements Model-Q Online. Implementation issues were predicted by using the Implementability Rating Profile, an instrument under development by the Yale Guidelines Review Group (R. Shiffman, MD, written communication, May 2009). OME subcommittee members received summary results and modified an advanced draft of the guideline.

The final draft practice guideline underwent extensive peer review by numerous entities identified by the subcommittee. Comments were compiled and reviewed by the subcommittee cochairpersons. The recommendations contained in the practice guideline are based on the best available published data through April 2009. Where data are lacking, a combination of clinical experience and expert consensus was used. A scheduled review process will occur 5 years from publication or sooner if new compelling evidence warrants earlier consideration.