Research indicates that in children younger than 3 years with persistent middle-ear effusion, prompt tympanostomy tube (PE tube) insertion does not improve cognitive, language, speech, or psychosocial development at 3 to 6 years of age compared with delayed insertion. Now a new study suggests that these findings also apply to developmental outcomes that can be assessed only when the child is older.
Investigators randomly assigned a large group of 3-year-old children from the Pittsburgh area who had a history of persistent ear effusion to one of two groups. In one group, PE tubes were inserted promptly (early-treatment group). In the other group, tubes were inserted six months later if bilateral effusion persisted, or nine months later if unilateral effusion persisted (delayed-treatment group). About half of the children with unilateral effusion and three quarters of the children with bilateral effusion had abnormal hearing.
Using 48 standardized developmental measures, investigators assessed literacy, attention, social skills, and academic achievement in 391 children in the two treatment groups when the youngsters were between 9 and 11 years of age. The scores in the early-treatment and delayed-treatment groups were similar. Also, in a group of children with effusion who were not eligible for the trial, the duration of effusion during various periods in the first three years of life and developmental outcomes at ages 9–11 were only weakly correlated; most of these children had not undergone tube insertion (Paradise JL et al: N Engl J Med 2007;356:248).
The 2004 practice guideline on otitis media with effusion (Pediatrics 2004;113:1412), sponsored by the American Academy of Pediatrics (AAP) and other organizations, recommends watchful waiting in many children with chronic middle-ear effusions. The patient and persistent work of the group that produced this study has influenced these recommendations, and should lead to far fewer PE tube placements.