Disclaimer
is Guideline attempts to define principles of practice that should produce high-quality patient
care. It is applicable to specialists, primary care, and providers at all levels. is Guideline
should not be considered exclusive of other methods of care reasonably directed at obtaining the
same results. e ultimate judgment concerning the propriety of any course of conduct must be
made by the clinician aer consideration of each individual patient situation.
Neither IGC, the medical associations, nor the authors endorse any product or service associated
with the distributor of this clinical reference tool.
Source
Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical practice guideline (update): otitis
media with effusion. Otolaryngol Head Neck Surg. In press.
106 Commerce Street, Suite 105
Lake Mary, FL 32746
TEL: 407.878.7606 • FAX: 407.878.7611
Order additional copies at GuidelineCentral.com
Copyright © 2016 All rights reserved
AAOHNSOME16013a
Abbreviations
AOM, acute otitis media; OME, otitis media with effusion
Aggregate Grades of Evidence by Question Type
Grade Treatment Diagnosis Prognosis
A
Systematic review
a
of
randomized trials
Systematic review
a
of
cross-sectional studies
with consistently
applied reference
standard and blinding
Systematic review
a
of inception cohort
studies
b
B
Randomized trials, or
observational studies
with dramatic effects
or highly consistent
evidence
Cross-sectional studies
with consistently
applied reference
standard and blinding
Inception cohort
studies
b
C
Non-randomized or
historically controlled
studies, including
case- control and
observational studies
Non-consecutive
studies, case- control
studies, or studies
with poor, non-
independent, or
inconsistently applied
reference standards
Cohort study, control
arm of a randomized
trial, case series,
or case-control
studies; poor quality
prognostic cohort
study
D
Case reports, mechanism-based reasoning, or reasoning from first principles
X
Exceptional situations where validating studies cannot be performed and
there is a clear preponderance of benefit over harm
a
A systematic review may be downgraded to level B because of study limitations, heterogeneity, or
imprecision
b
A group of individuals identified for subsequent study at an early, uniform point in the course of
the specified health condition, or before the condition develops
