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Results of hearing tests in young children are influenced by testing technique, age group, and middle-ear fluid

Next to the common cold, middle ear infection (otitis media, OM) is the most commonly diagnosed illness in U.S. children, with the peak incidence from ages 6 to 30 months. Although most OM episodes subside within several weeks, middle-ear effusion (MEE, fluid in the ear) can persist for 3 months or longer in up to one-fourth of children and may impair hearing. Studies are underway to determine if there are lasting effects of early-life OM on speech, language, cognition, and psychosocial development.

Children with MEE in both ears generally have worse hearing than those with MEE in one ear or no MEE on audiometric test results. However, test results are also influenced by the children's ages when tested and the testing technique, according to a study supported in part by the Agency for Healthcare Research and Quality and the National Institute for Child Health and Human Development (HD26026).

Researchers led by Jack L. Paradise, M.D., at the University of Pittsburgh and Children's Hospital of Pittsburgh, tested 1,055 otherwise healthy children younger than age 3 with no MEE, unilateral MEE, or bilateral MEE for age-specific hearing threshold levels. In general, hearing threshold levels were highest (indicating poorer hearing) in the youngest children tested with visual reinforcement audiometry (VRA, animated toys were activated after a child's head turn in response to sound) and lowest in the oldest children tested with conventional audiometry. Mean VRA thresholds were significantly higher in the 6- to 8-month age group than in older age groups.

Thresholds were lowest in children with normal middle-ear status, intermediate in children with unilateral MEE, and highest in children with bilateral MEE. On average, the presence of bilateral MEE was associated with 10 to 15 dB worse hearing than the normative values for the corresponding age group. These findings underscore the importance of taking into account not only the child's middle ear status, but also the technique used in audiometric testing and the child's age, when evaluating the clinical significance of hearing test results in young children.

See "Hearing levels in infants and young children in relation to testing technique, age group, and the presence or absence of middle-ear effusion," by Diane L. Sabo, Ph.D., Dr. Paradise, Marcia Kurs-Lasky, M.S., and Clyde G. Smith, M.S., in Ear & Hearing 24(1), pp. 38-47, 2003.

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