Use of osteopathic manipulation techniques for management of acute otitis media in pediatric patients: a scoping review.

Objective: To map and summarize the existing literature on the use of osteopathic manipulative techniques (OMT) in the management of acute otitis media (AOM) in pediatric patients, with an emphasis on reported outcomes and identifying gaps in the current evidence.

Data sources: CINAHL, PubMed, and SCOPUS.

Review methods: A comprehensive literature search was conducted across multiple databases following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Studies were charted and summarized based on key characteristics, including study design, population, types of OMT applied, and reported outcomes on management of AOM and recurrent AOM in pediatric patients using OMT. No formal meta-analysis was performed, and all outcome measures were descriptively synthesized.

Results: Three randomized controlled trial (RCT) studies and one pilot cohort study (N = 205) pertaining to application of OMT in pediatric patients with otitis media were included. Mean age for OMT and control (either sham OMT or standard of care) groups were 19.1 months and 16.8 months; proportions of males were 53.2% and 55.9%, respectively. In the pilot cohort study done by Degenhardt and Kuchera, 62.5% of the subjects experienced no documented recurrence of AOM symptoms at one year post-OMT intervention follow-up; however, since no control group was available for this study, any statistical comparison of recurrence-free rate was unfeasible. In the RCT study by Mills et al., the OMT group showed statistically significant effects on reducing frequency of mean monthly AOM episodes, resulting in fewer surgical procedures, delaying surgical interventions, increasing resolution of middle ear effusion and better tympanogram readings based on mean sum of types A and C tympanograms, and higher parental satisfaction with overall experience and perceived effectiveness of the OMT on their children on a scale of 0 to 5 when compared to the control group. While statistical interpretation showed some significance in various aspects, OMT's clinical significance remained questionable, especially considering natural course of healing in AOM. In the other RCT study by Steele et al., at the second-week visit during the 3-week OMT intervention period, the OMT group showed a significantly higher likelihood of middle ear effusion resolution based on tympanogram findings and acoustic reflectometer measurements, respectively. However, at one month follow-up visit, there was no statistical significance, alluding to the limited effects of OMT. Finally, in the last RCT study by Whal et al., the OMT group failed to show any significant effects on prevention of recurrence of AOM.

Conclusion: Current literature on the use of OMT for acute and recurrent otitis media in pediatric patients suggests, with low certainty, that OMT may provide modest benefits in reducing recurrence rates and improving middle ear function. However, the existing evidence is limited in scope and quality. Further research with larger sample sizes and rigorous randomized controlled trial designs is needed to better understand the potential role of OMT in the management of AOM in pediatric patients.