Article
Does early detection of otitis media with effusion prevent
delayed language development?
C C Butlera, H MacMillanb
a Department of Family
Medicine, McMaster University, Faculty of Health Sciences, 1200 Main Street West, HSC 2V14, Hamilton, Ontario L8N 3Z5, Canada, b Departments of Psychiatry and
Behavioural Neurosciences and Pediatrics, McMaster University
Correspondence to: Dr Butler email: cbutler{at}mcmaster.ca
Accepted 15 March 2001
OBJECTIVE
To consider
whether earlier detection of otitis media with effusion (OME) in
asymptomatic children in the first 4 years of life prevents delayed
language development.
METHODSMEDLINE and
other databases were searched and relevant references from articles
reviewed. Critical appraisal and consensus development were in
accordance with the methods of the Canadian Task Force on Preventive
Health Care.
RESULTSNo randomised
controlled trials assessing the overall screening for OME and early
intervention to prevent delay in acquiring language were identified,
although one trial evaluated treatment in a screened population and
found no benefit. The "analytic pathway" approach was therefore
used, where evidence is evaluated for individual steps in a screening
process. The evidence supporting the use of tools for early detection
such as tympanometry, microtympanometry, acoustic reflectometry, and
pneumatic otoscopy in the first 4 years of life is unclear. Some
treatments (mucolytics, antibiotics, steroids) resulted in the short
term resolution of effusions as measured by tympanometry. Ventilation
tubes resolved effusions and improved hearing. Ventilation tubes in
children with hearing loss associated with OME benefited children in
the short term, but after 18 months there was no difference in
comparison with those assigned to watchful waiting. Most prospective
cohort studies that evaluated the association between OME and language
development lacked adequate measurement of exposure or outcome, or
suffered from attrition bias. Findings with regard to the association
were inconsistent.
CONCLUSIONSThere is
insufficient evidence to support attempts at early detection of OME in
the first 4 years of life in the asymptomatic child to prevent delayed
language development.
Keywords: otitis media with effusion; language development disorders; speech disorders; child development
© 2001 by Archives of Disease in Childhood
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