GERT JAN VAN DER WILT AND PETER F. DE VRIES ROBBÉ
to End All Trials
"In fact, technology assessors are strongly interested in improving quality of care, as shown in their professional literature. They have not, however, found fully satisfactory pathways to this goal." 1
In the above statement, David Banta clearly expresses what he thinks is the major rationale and justification of medical technology assessment: the desire to improve the quality of medical care. He also observes that medical technology assessment has not fully lived up to this objective. In the present chapter we wish to pursue this inadequacy in a particular case: studies that have been carried out in the field of glue ear (otitis media with effusion, OME) and its medical management.
Glue ear is a common condition among children, many of whom receive medical treatment. In the United States, the prevalence rate of ventilation tubes (VTs) was estimated to be 13 per 1,000 children aged younger than eighteen years in 1988. 2 The question is whether, and in which cases, medical treatment is necessary. In spite of the fact that many clinical trials have been conducted in this area, many clinicians feel that this issue has as yet not been satisfactorily resolved. 3 The purpose of this chapter is to reflect on the possible causes of the current predicament and to discuss possibilities for amelioration. The chapter will summarize what is known about the natural history and treatment of glue ear, how it has been treated in the past and how it is currently treated. The nature of the controversies that have persisted to this day will be analyzed, and it will be argued that it is important to distinguish between disagreements over the credibility of the data and disagreements over the relevance of the data.
Glue ear is a condition characterized by the presence of fluid (effusion) in the middle-ear cavity without any signs or symptoms of ear infection (such