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Children's Health

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Later effects of persistent middle-ear fluid in the first 3 years of life are questionable

Doctors and parents are concerned about the impact of early-life middle ear infections and the middle ear fluid (otitis media with effusion, OME) that often persists after the infections have resolved. They are worried that constant fluid in the ear will impair hearing and adversely affect children's language, speech, or cognitive development later in life, well after OME has resolved and hearing has returned to normal. A new study suggests that for most children these worries may be unfounded. The study did find, however, that scores on all measures of language, speech, and cognition were consistently highest among the most socioeconomically advantaged children and lowest among those most disadvantaged.

Although the researchers found, as expected, that children who had MEE (middle ear effusion) fared worse on audiometric tests than children who did not, they uncovered only weak to moderately significant negative correlations between children's cumulative durations of MEE in their first year of life (or in age periods that included their first year of life) and their scores at age 3 on formal tests of spontaneous expressive language, speech sound production and other verbal aspects of cognition. Variance in scores explained by cumulative time with MEE in the first year of life beyond that explained by sociodemographic variables ranged from only 1.2 percent to 2.9 percent, and the negative correlations were concentrated in the subgroup of children who had private health insurance (rather than Medicaid). Moreover, they found no significant correlations between time with MEE and children's scores on measures of expressive language, speech sound production, or other measured aspects of cognition.

These findings suggest either that persistent early-life MEE actually causes later, small circumscribed impairments of receptive language and verbal aspects of cognition in certain groups of children or that unidentified, confounding factors predispose children both to early-life otitis media and to certain types of developmental impairment.

These findings were based on a prospective study of 6,350 healthy infants obtaining primary care at one of two urban hospitals or one of two small town/rural and four suburban private pediatric practices. Jack L. Paradise, M.D., of the University of Pittsburgh School of Medicine, and his colleagues monitored the children's middle ear status for 3 years, treated them for otitis media, and tested their language and cognition at 3 years. The study was jointly funded by the Agency for Healthcare Research and Quality and the National Institute for Child Health and Human Development (HD26026).

See "Language, speech sound production, and cognition in three-year-old children in relation to otitis media in their first three years of life," by Dr. Paradise, Christine A. Dollaghan, Ph.D., Thomas F. Campbell, Ph.D., and others, in the May 2000 Pediatrics 105(5), pp. 1119-1130.

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