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Researchers examine the impact of prolonged middle ear disease on children's speech and language development

Otitis media (OM) is a common childhood illness that peaks in the first 3 years of life, in which fluid (effusion) accumulates in the middle ear. Some children suffer from OM for months and have repeated episodes of OM. The middle ear effusion (MEE) dampens the transmission of sound waves from the environment to the inner ear and may result in variable, mild to moderate hearing loss.

Despite many studies on whether prolonged OM contributes to long-term impairments in cognitive, language, speech, and psychosocial development, no consensus has been reached. Three new reports on this topic from the Pittsburgh Child Development/Otitis Media Study are summarized here. The study is cofunded by the Agency for Healthcare Research and Quality and the National Institute of Child Health and Human Development (HD26026).

Paradise, J.L., Feldman, H.M., Campbell, T.F., and others (2003). "Early versus delayed insertion of tympanostomy tubes for persistent otitis media: Developmental outcomes at the age of three years in relation to prerandomization illness patterns and hearing levels." Pediatric Infectious Disease Journal 22, pp. 309-314.

Tympanostomy tubes often are surgically placed into the ear to drain accumulated fluid and to prevent fluid buildup in the ear in children with persistent MEE. Whether prompt insertion of tympanostomy tubes in the affected ears of these children protects against or minimizes subsequent developmental impairment has been the subject of conflicting opinions and differing approaches to managing the problem. Earlier, the researchers reported that prompt insertion of tympanostomy tubes in otherwise normal children with MEE did not measurably improve developmental outcomes at age 3 years. The present report provides details showing that this was true whether MEE had been continuous or discontinuous, unilateral or bilateral, and whether or not MEE was accompanied by mild to moderate hearing loss.

The researchers randomly assigned 429 children with persistent MEE before the age of 3 years to have tympanostomy tubes inserted either as soon as possible or up to 9 months later if MEE persisted. They found no significant differences at age 3 years between the two treatment groups (402 children) in mean scores on any measure of speech, language, or cognition, and in 401 of the children, no significant differences in measures of psychosocial development.

The researchers caution that these findings cannot be extrapolated to children with longer periods of effusion than those studied or to children whose effusion is consistently accompanied by moderately severe hearing loss. They also caution that associations not found at the age of 3 years might become apparent at later ages.

Feldman, H.M., Dollaghan, C.A., Campbell, T.F., and others (2003, April). "Parent-reported language skills in relation to otitis media during the first 3 years of life." Journal of Speech, Language, and Hearing Research 46, pp. 273-287.

As part of a larger study, this study found that longer duration (cumulative percentage of days) of MEE in young children was associated with lower scores at age 3 on three scales: vocabulary comprehension and production; sentence length and complexity; and language use. In contrast, a higher level of maternal education was associated with higher scores on these scales. In light of findings from the larger randomized trial, the researchers suggest that additional, unmeasured environmental or sociodemographic factors contribute both to the duration of MEE in young children and to their relatively poorer language skills.

As part of the larger study of the potential impact of early-life OM on speech, language, cognition, and behavior, they studied the degree of association between parent-reported language scores at ages 1, 2, and 3 years and the cumulative duration of MEE during the first 3 years of life in a demographically diverse sample of 621 children. They evaluated the contribution of maternal education, as a proxy for socioeconomic status, to scores on the parents' reports on the MacArthur Communicative Development Inventories.

Correlations between scores at ages 1 and 2 years and the percentage of days with MEE were nonsignificant or of questionable clinical importance. However, the percentage of days with MEE and maternal education each contributed independently to scores at age 3 years. Regardless of the sex of the child, within each stratum of MEE duration, scores increased as the level of maternal education increased, and within each maternal-education subgroup, scores decreased as the duration of MEE increased.

Campbell, T.F., Dollaghan, C.A., Rockette, H.E., and others (2003, March). "Risk factors for speech delay of unknown origin in 3-year-old children." Child Development 74(2), pp. 346-357.

Speech delay is diagnosed when a child's conversational speech sample either is less intelligible than would be expected for his or her age or is characterized by speech sound error patterns not appropriate for his or her age. This study did not find that prolonged OM significantly increased the likelihood of speech delay in 3-year-old children. However, it did find that low maternal education, male sex, and a family history of developmental communication disorder did increase the likelihood of speech delay. In fact, a child with all three factors was nearly eight times as likely to have speech delay as a child without any of the factors.

These results suggest that the accumulation of risk factors rather than the influence of an individual risk factor may pose the greatest threat to children's development, note the researchers. They compared 100 3-year-olds with speech delay (based on the Speech Disorders Classification System) of unknown origin and 539 same-age peers with respect to six variables considered in earlier studies as linked to speech delay: male sex, family history of developmental communication disorder, low maternal education, low socioeconomic status (indexed by Medicaid health insurance), black race, and persistent OM.

The researchers also examined abnormal hearing in a subset of 279 children who had at least two hearing evaluations between 6 and 18 months of age. Black race, cumulative duration of OM from 2 to 36 months of age, and two abnormal hearing tests from 6 to 18 months of age were not associated with increased risk of speech delay of unknown origin. Medicaid insurance was no longer significant after accounting for low maternal education, male sex, and family history of communication disorder.

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