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Fluid in the Middle Ear: Still No Answers

Persistent middle ear effusion causes conductive hearing loss, and a link between effusion and speech and language delay has been suggested. Two studies address the implications of treatment options.

Pittsburgh investigators randomized 429 children (age range, 2 months to 3 years) with persistent effusion to have tympanostomy tubes inserted either as soon as possible or up to 9 months later if effusion persisted; 235 children actually received tubes during the 3-year study. Children were eligible if they had bilateral effusion (despite antimicrobial therapy) for 90 days or unilateral effusion for 135 days. During the first 24 months after randomization, the early-insertion group had significantly fewer days with effusion than did the delayed-insertion group (mean percentage of days, 30 percent vs. 40 percent). At age 3, there were no significant differences between groups in any of the tests for speech, language, cognition, or psychosocial development.

In a nonrandomized study, Canadian investigators assessed the effect of simultaneous adenoidectomy or adenotonsillectomy on 37,316 children who received tympanostomy tubes as their first surgical procedure. Compared with insertion of tympanostomy tubes alone, simultaneous adenoidectomy was associated with reduced likelihood of tube reinsertion (relative risk, 0.5). This risk was reduced further if simultaneous adenotonsillectomy was performed.

Comment: After 20 years of research, we still are not certain if fluid in the middle ear adversely affects speech and language development. Unfortunately, the results of the Pittsburgh study suggest that even if there is an adverse relation, early tube placement doesn't help. However, follow-up was to only age 3, and reduction in middle ear effusion may have been insufficient to improve speech and language development. If tympanostomy tubes are used, the Canadian results suggest that adding adenoidectomy, tonsillectomy, or both to tube placement may reduce the need for reinsertion.

— H Bauchner

Published in Journal Watch General Medicine May 4, 2001

Citation(s):

Paradise J et al. Effect of early or delayed insertion of tympanostomy tubes for persistent otitis media on developmental outcomes at the age of three years. N Engl J Med 2001 Apr 19 344 1179-1187.

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Coyte PC et al. The role of adjuvant adenoidectomy and tonsillectomy in the outcome of the insertion of tympanostomy tubes. N Engl J Med 2001 Apr 19 344 1188-1195.

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Perrin JM. Should we operate on children with fluid in the middle ear? N Engl J Med 2001 Apr 19 344 1241-1242.

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