Skip Navigation U.S. Department of Health and Human Services
Agency for Healthcare Research Quality
Archive print banner

Children's Health

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to for current information.

Within broad limits, chronic middle-ear disease up to age 3 probably does not impair language and other development by age 4

When a child suffers chronic middle-ear inflammation with middle-ear effusion (MEE, fluid buildup) during the first 3 years of his or her life, the doctor may recommend surgical drainage of the fluid and placement of a tympanostomy tube within the affected ear. The primary goals are to relieve the attendant hearing loss and to keep the middle-ear cavity ventilated in an effort to prevent further inflammation and/or infection. Another goal is to prevent possible delays in later development that might result from prolonged spells of hearing loss during presumably formative early childhood periods.

However, in a recent study involving otherwise healthy children (that is, without potentially handicapping conditions) who had persistent MEE during the first 3 years of life, prompt insertion of tympanostomy tubes did not affect the children's language or other developmental outcomes at 4 years of age. The researchers concluded that MEE within the duration limits they studied probably does not affect developmental outcomes. The study was supported by the Agency for Healthcare Research and Quality and the National Institute of Child Health and Human Development.

Lead author, Jack L. Paradise, M.D., of the University of Pittsburgh School of Medicine, and his colleagues enrolled 6,350 healthy infants from diverse settings. They regularly evaluated the children for the presence of MEE throughout their first 3 years of life and treated them according to recommended care guidelines for middle ear infection. For this study, the researchers randomly assigned 429 children who had persistent MEE to undergo tympanostomy tube insertion either promptly or after a defined extended period if MEE remained present. They also selected a separate, representative comparison sample of 241 children who ranged from having no MEE to having MEE that fell just short of meeting criteria for the clinical trial.

The researchers assessed the cognitive, language, speech, and psychosocial development of children in all groups at age 4 using formal tests, conversational samples, and parent questionnaires. Among the randomized children, there were no significant differences in mean scores favoring the early-treatment group over the late-treatment group in all areas. In the representative comparison sample, correlations between the duration of MEE and developmental outcomes were generally weak and, in most instances, nonsignificant.

See "Otitis media and tympanostomy tube insertion during the first three years of life: Developmental outcomes at the age of four years," by Dr. Paradise, Christine A. Dollaghan, Ph.D., Thomas F. Campbell, Ph.D., and others, in the August 2003 Pediatrics 112(2), pp. 265-277.

Return to Contents
Proceed to Next Article

The information on this page is archived and provided for reference purposes only.


AHRQ Advancing Excellence in Health Care