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Volume 344:1179-1187 April 19, 2001 Number 16 Next

	Full Text PDF Editorial by Perrin, J. M. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background A main indication for the insertion of tympanostomy tubes in infants and young children is persistent otitis media with effusion, reflecting concern that this condition may cause lasting impairments of speech, language, cognitive, and psychosocial development. However, evidence of such relations is inconclusive, and evidence is lacking that the insertion of tympanostomy tubes prevents developmental impairment.

Methods We enrolled 6350 healthy infants from 2 to 61 days of age and evaluated them regularly for middle-ear effusion. Before the age of three years 429 children with persistent effusion were randomly assigned to have tympanostomy tubes inserted either as soon as possible or up to nine months later if effusion persisted. In 402 of these children we assessed speech, language, cognition, and psychosocial development at the age of three years.

Results By the age of three years, 169 children in the early-treatment group (82 percent) and 66 children in the late-treatment group (34 percent) had received tympanostomy tubes. There were no significant differences between the early-treatment group and the late-treatment group at the age of three years in the mean (±SD) scores on the Number of Different Words test, a measure of word diversity (124±32 and 126±30, respectively); the Percentage of Consonants Correct–Revised test, a measure of speech-sound production (85±7 vs. 86±7); the General Cognitive Index of McCarthy Scales of Children's Abilities (99±14 vs. 101± 13); or on measures of receptive language, sentence length, grammatical complexity, parent–child stress, and behavior.

Conclusions In children younger than three years of age who have persistent otitis media, prompt insertion of tympanostomy tubes does not measurably improve developmental outcomes at the age of three years.

Source Information

From the Departments of Pediatrics (J.L.P., H.M.F., B.S.B.), Family Medicine and Clinical Epidemiology (J.E.J.), and Otolaryngology (C.G.S.), University of Pittsburgh School of Medicine; the Departments of Pediatrics (J.L.P., H.M.F., D.K.C., B.S.B.) and Audiology and Communication Disorders (T.F.C., D.L.P., D.L.S., C.G.S.), Children's Hospital of Pittsburgh; the Department of Communication Science and Disorders, University of Pittsburgh (H.M.F., T.F.C., C.A.D., D.L.S.); and the Department of Biostatistics, University of Pittsburgh Graduate School of Public Health (H.E.R., M.K.-L.) — all in Pittsburgh.

Address reprint requests to Dr. Paradise at Children's Hospital of Pittsburgh, 3705 Fifth Ave., Pittsburgh, PA 15213-2538, or at jpar{at}pitt.edu.

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