Does prompt tympanostomy improve speech, language, and cognitive development?

▸ Pediatricians have been haunted by concerns that chronic middle-ear effusion (MEE) – prevalent during the critical period for speech and language development – causes later impairment in learning and language skills. Although current practice sanctions placement of tympanostomy tubes for MEE persisting 3 months or longer, evidence to support this treatment is limited. In this long-term, prospective study, researchers enrolled 6350 infants (age range, 2 to 61 days) who were regularly evaluated for MEE throughout their first 3 years of life. Treatment was directed by established guidelines.

Children with persistent MEE were randomly assigned to early tube insertion (at 90 days of MEE) or late tube insertion (6 months later). Assessment of speech, language, and cognition was performed at age 4 years in both treatment groups (397 children) and in a control group of 234 children who did not receive tubes (because MEE was absent or because they did not meet criteria for tube placement).

There were no significant differences favoring early versus late tube placement in any tests of development. Correlations between MEE duration and developmental outcomes at 4 years of age were weak or nonexistent. In both treatment groups and the control group, sociodemographic variables were the most important factor in developmental outcomes.

Comment

▸ Old habits die slowly. This elegant study should help convince us that tympanostomy tube placement in normal circumstances does not improve cognitive, speech, language, or psychosocial outcomes. As the authors point out, however, caution should be observed in applying these findings to children with certain handicapping conditions, such as Down syndrome, …