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Objective. In a long-term, prospective study, we set out to determine whether otitis media in the first 3 years of life persisting for periods currently considered developmentally threatening actually results in later impairments of children's cognitive, language, speech, or psychosocial development; whether prompt insertion of tympanostomy tubes prevents or lessens any such impairments; and whether, irrespective of causality, associations exist between persistent early-life otitis media and later developmental impairments. This report describes findings in study participants at the age of 4 years. Methods. We enrolled 6350 healthy infants from 2 to 61 days of age at urban hospitals and 2 small-town/rural and 4 suburban private pediatric practices. We regularly evaluated the children for the presence of middle-ear effusion (MEE) throughout their first 3 years of life by pneumatic otoscopy, supplemented by tympanometry; we monitored the validity of the otoscopic observations on an ongoing basis; and we treated children for otitis media according to specified guidelines. In the clinical trial component of the study, we randomly assigned 429 children who met specified minimum criteria regarding the persistence of MEE to undergo tympanostomy tube insertion either promptly or after a defined extended period if MEE remained present. In the associational component of the study, we selected a representative sample of 241 children who ranged from having no MEE to having MEE the cumulative duration of which fell just short of meeting randomization criteria for the clinical trial. In 397 (92.5%) of the children in the clinical trial and in 234 (97.1%) of the children in the representative sample, we assessed cognitive, language, speech, and psychosocial development at the age of 4 years, using formal tests, conversational samples, and parent questionnaires. Results. In children in the randomized clinical trial, there were no statistically significant differences in mean ([+ or -] standard deviation) scores (higher denotes more favorable) favoring the early-treatment group over the late-treatment group on the General Cognitive Index of the McCarthy Scales of Children's Abilities (97 [+ or -] 14 and 98 [+ or -] 14, respectively); the Peabody Picture Vocabulary Test-Revised, a measure of receptive language (90 [+ or -] 15 vs 92 [+ or -] 16); the Nonword Repetition Test, a measure of phonological memory (66 [+ or -] 12 vs 70 [+ or -] 12); the Number of Different Words, a measure of word diversity (150 [+ or -] 34 vs 150 [+ or -] 31); the Mean Length of Utterance in Morphemes, a measure of sentence length and grammatical complexity (3.4 [+ or -] 0.8 vs 3.4 [+ or -] 0.7); or the Percentage of Consonants Correct-Revised, a measure of speech-sound production (92 [+ or -] 5 vs 93 [+ or -] 5). There were also no significant differences in ratings (higher denotes less favorable) on the Parenting Stress Index-Short Form (Total Stress scores: 68 [+ or -] 18 vs 65 [+ or -] 17) or the Child Behavior Checklist (Total Problem T scores: 50 [+ or -] 10 vs 49 [+ or -] 10). In the associational component of the study, correlations between the children's durations of MEE and their developmental outcomes were generally weak and, in most instances, nonsignificant. Exceptions, after adjustment for sociodemographic variables and for hearing thresholds at the time of developmental testing, consisted of a significant negative correlation between children's cumulative durations of MEE in their first 3 years of life and scores on the McCarthy Verbal subscale, and significant positive correlations between durations of MEE and scores on 2 measures of parent-child stress. The percentage of variance in these scores explained by time with MEE beyond that explained by sociodemographic variables ranged from 1.6% to 3.3%. In both the randomized clinical trial and the associational component, sociodemographic variables seemed to be the most important factors influencing developmental outcomes, and in both components, the results at 4 years of age were consistent with the results that had been obtained at 3 years of age. Conclusions. In otherwise healthy children who are younger than 3 years and have persistent MEE within the duration limits that we studied, prompt insertion of tympanostomy tubes does not measurably improve developmental outcomes at 4 years of age. In such children, persistent MEE within the duration limits that we studied is negligibly associated with and probably does not affect developmental outcomes at 4 years of age. otitis media, middle-ear effusion, tympanostomy tube insertion, language, speech, cognition, parent-child stress, behavior, development., ABBREVIATIONS. OME, otitis media with effusion; MEE, middle-ear effusion; dB HL, decibels hearing level; SD, standard deviation; CBCL, Child Behavior Checklist; PSI-SF, Parenting Stress Index-Short Form. Two important, unresolved questions [...]

As part of a larger study of the potential impact of early-life otitis media (OM) on speech, language, cognition, and behavior, we studied the degree of association between parent-reported language scores at ages 1,2, and 3 years and the cumulative duration of middle-ear effusion (MEE) during the first 3 years of life in a demographically diverse sample of 621 children. We estimated the cumulative percentage of days with MEE from prospective monthly observations of middle-ear status and interpolations for periods between visits. For each child, parents completed the appropriate inventory of the MacArthur Communicative Development Inventories (CDI; L. Fenson et al., 1993) at ages 1, 2, and 3 years. We also evaluated the contribution of maternal education, as a proxy for socioeconomic status, to scores on the parent reports. Scores on the new CDI-III (B. Oliver et al., in press) varied positively with sociodemographic variables and were significantly correlated with scores from the CDI used when the children were younger. Unadjusted correlations between scores at ages 1 and 2 years and the percentages of days with MEE in the respective antecedent periods were statistically nonsignificant or of questionable clinical importance. The correlations between potent-reported scores at age 3 years and children's cumulative percentage of days with MEE in Years 1,2, and 3 combined ranged from -.187 to -.248 (all p values KEY WORDS: otitis media with effusion, child language, language development, parent reports, Otitis media (OM) is a common pediatric illness in which infective or noninfective effusion accumulates in the middle ear. A typical bout of OM persists for weeks to months. The [...]

The treatment of chronic ear infections in young children is reviewed. Topics include epidemiology, risk factors, bacteriology, antibiotics, tympanostomy tubes, and pneumococcal vaccine. Otitis media is the medical term for ear infections in children.

The use of antibiotics to treat middle ear infections should be minimized because it is helping to create a pool of antibiotic resistant Streptococcus pneumoniae. This is particularly concerning because, unlike other penicillin-resistant microbes, there is only one currently known antibiotic that will kill penicillin-resistant S. pneumoniae. For this reason, length of antibiotic treatment for ear infections should be individualized according to the prognosis for the case and in some cases, may be avoided altogether. Antibiotics should not be routinely used to treat fluid in the ears in children who do not have acute infections. Sustained, preventative use of antibiotics in children with repeated ear infections should be avoided in favor of alternative measures wherever possible. These strategies should protect the child's well being while minimizing the potential risk of creating antibiotic resistant strains of S. pneumoniae., ABBREVIATIONS. AOM, acute otitis media; OME, otitis media with effusion; URI, upper respiratory tract infection. Changing circumstances often call for reconsideration of established procedures. Such a circumstance is the increasing [...]

Acute otitis media, inflammation of the middle ear, has typically been treated with antibiotics for the last 40 years. However, the optimum treatment and the usefulness of myringotomy (surgery on the tympanic membrane) alone or with antibiotics are unclear. Routine antibiotic therapy is opposed by some who feel that such treatment hampers the body's systemic and immune response to bacterial infection, with recurrent infections possibly resulting. The effectiveness and outcome of treatment with antibiotics with or without myringotomy, or with myringotomy alone, was examined in a study of 536 infants and children. Antibiotic treatment resulted in significantly less treatment failure and development of effusion (escape of fluid into the ear), compared to placebo (inert) treatment for patients with episodes that were not severe. No difference in recurrence rate between amoxicillin and placebo treatments was found. Patients over two years old with severe episodes had more initial treatment failures when given placebo plus myringotomy. Children under two years old had poorer long-term outcomes than older children. Ultimate treatment failure and total duration of effusion were less frequent in children treated with amoxicillin. Children whose initial episodes were severe had similar outcomes regardless of treatment. Depressed hearing acuity in children over two was consistently associated with the presence of middle-ear effusion. The results indicate that amoxicillin should be used to routinely treat acute otitis media due to its effectiveness, and that myringotomy provides no benefit for acute cases of the infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Otitis media is a middle-ear infection that is common in children. The infection is frequently recurrent, and removal of the adenoids (adenoidectomy) is sometimes performed to control this condition. However, there has been some controversy as to the effectiveness of this procedure. Two parallel studies were conducted to assess the efficacy of adenoidectomy in children with recurrent otitis media. These children had been previously treated with tympanostomy-tube placement, a procedure in which tubes are placed through the tympanic membrane of the ear to allow ventilation; in all the children the infection developed again. Out of a total of 213 children who met the study criteria, 99 were randomly assigned to either the adenoidectomy or the control group. The other 114 children who participated had parents who did not agree to random assignment; in these cases the parents chose which treatment they preferred. The subjects were monitored over a period of up to three years. A bias occurred during both trials as a result of the withdrawal of very sick children from the control group; they were subsequently placed in the adenoidectomy group. In spite of this, the adenoidectomy group had better outcomes than the control group. During the first and second years, the patients who had adenoidectomies had 47 and 37 percent less time with otitis media, respectively, than the control group. Also for years one and two respectively, the adenoidectomy group had 28 and 35 percent fewer severe episodes of infection than the control subjects. These results are much more conclusive than those of other studies that have investigated the efficacy of adenoidectomy in the treatment of otitis media. In general, this procedure is recommended as treatment for otitis media after failure of tympanostomy-tube placement. However, caution is urged when determining whether or not adenoidectomy should be performed in children with chronic otitis media; some children outgrow this condition without surgical intervention. (Consumer Summary produced by Reliance Medical Information, Inc.)

Objective. One current practice guideline recommends myringotomy with tympanostomy tube insertion (M&T) for young children in whom middle-ear effusion (MEE) has persisted for 3 months, and another recommends the procedure after MEE has persisted for 4 to 6 months provided that a bilateral hearing loss of [greater than or equal to] 20 dB is present. Sequelae of M&T are not uncommon, but the extent to which these sequelae are attributable to M&T itself or to the middle-ear disease that prompted the procedure or to both has not been clear. Our objective in the present study was to examine the prevalence of various tympanic membrane (TM) abnormalities in otherwise healthy children at the age of 5 years and heating levels at the age of 6 years in relation to persistent MEE and M&T in the children's first 3 years of life. Methods. In a prospective study of child development in relation to early-life otitis media, we randomly assigned 429 children who met specified criteria regarding the persistence of MEE in their first 3 years of life to undergo M&T either promptly (the "early-treatment" group) or after a defined extended period if MEE remained present (the "late-treatment" group). We also followed a representative sample of 241 children who ranged from having no MEE to having MEE whose cumulative duration fell just short of meeting randomization criteria for the clinical trial (the "nontrial" group). Most of the children in each group underwent both otomicroscopic examination at the age of 5 years and audiometric testing at the age of 6 years, at times when they were free of MEE. Among these children, M&T had been performed in 82.3% of those in the early-treatment group, 38.1% of those in the late-treatment group, and 3.0% of those in the nontrial group. Results. At the age of 5 years, we found 1 or more types of TM abnormality in 1 or both ears in 70.7%, 42.5%, and 9.5% of the children in the early-treatment, late-treatment, and nontrial groups, respectively. Within the 3 groups, however, among children who received tubes, the proportions who had an abnormality of some type were similar, namely, 82.6%, 80.4%, and 83.3%, respectively. The corresponding proportions among children who had not received tubes were 15.4%, 19.3%, and 7.2%, respectively. Segmental atrophy and tympanosclerosis were the most common abnormalities found. At the age of 6 years, mean pure-tone average audiometric thresholds in the early-treatment, late-treatment, and nontrial groups, respectively, were 6.18 dB, 5.49 dB, and 4.63 dB in left ears and 6.17 dB, 6.02 dB, and 4.32 dB in right ears. The thresholds in the early- and late-treatment groups did not differ significantly, but the thresholds in the early- and late-treatment groups were each significantly higher than in the nontrial group. Within the early- and late-treatment groups, we found no significant relation between hearing levels and the presence or type of TM abnormalities. Conclusion. In otherwise healthy children who have persistent MEE during their first 3 years of life, ready resort to M&T results in far more TM abnormalities at age 5 than does selective management in which most children do not receive the procedure. With these differing approaches, however, hearing levels at age 6 do not differ. Regardless of whether children with persistent early-life MEE receive M&T, they have more TM abnormalities at age 5 and negligibly poorer hearing at age 6 than do children who had less or no otitis media. Longer term otologic and audiologic outcomes of persistent early-life MEE and of M&T remain to be determined. In view of 1) the present findings and the remaining uncertainties concerning sequelae, 2) the fact that M&T involves certain immediate risks--albeit minimal--and substantial cost, and 3) previously reported findings in the study's randomized clinical trial that show no developmental advantage at ages 3 and 4 years accruing from children's having received prompt M&T, a prolonged period of watchful waiting seems desirable in otherwise healthy children who are younger than 3 years and have persistent, asymptomatic MEE that is not complicated by sensorineural or severe conductive hearing loss, balance dysfunction, or severe TM retraction. Pediatrics 2004;114:e58-e67. URL: http://www.pediatrics.org/cgi/ content/full/114/1/e58; otitis media with effusion, middle-ear effusion, myringotomy, tympanostomy tube insertion, audiometric testing, tympanic membrane abnormality, tympanosclerosis, segmental atrophy, retraction pocket, hearing levels.