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Middle-Ear Effusion, Tubes, and Developmental Outcomes: Is the Controversy Over?

Tympanostomy tubes are not indicated for young children with minimal hearing loss and normal speech and language development.

Controversy remains about the long-term developmental effects of middle-ear effusion associated with otitis media. Previously, when children with persistent middle-ear effusion (90 days of bilateral or 135 days of unilateral disease) were randomly assigned before 3 years of age to prompt or delayed insertion of tympanostomy tubes, investigators reported no significant differences in neurocognitive outcomes at ages 3 to 6.

In a follow-up study, 391 of 429 children in the original cohort were assessed at ages 9 to 11. Comprehensive assessment included speech and language development, intelligence, academic achievement, and parent and teacher ratings of behavior, including attention and impulsivity. Again, no significant differences were found between prompt and delayed treatment groups.

Comment: Does this study end the debate about the usefulness of tympanostomy tubes? For young children with normal speech and language development who develop persistent middle-ear effusion, with minimal hearing loss, tubes are not indicated. However, as an editorialist notes, this study did not assess the value of tube insertion in young children with speech and language delay, hearing loss of 40 dB or higher, or both. The American Academy of Pediatrics and the American Academy of Family Physicians recommend that tympanostomy tube insertion should be considered in children with substantial hearing loss or those at risk for language delay.

— Howard Bauchner, MD

Published in Journal Watch General Medicine February 1, 2007

Citation(s):

Paradise JL et al. Tympanostomy tubes and developmental outcomes at 9 to 11 years of age. N Engl J Med 2007 Jan 18; 356:248-61.

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• Medline abstract (Free)

Berman S. The end of an era in otitis research. N Engl J Med 2007 Jan 18; 356:300-2.

• Original article (Subscription may be required)
• Medline abstract (Free)