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Do Tympanostomy Tubes Improve Developmental Outcomes?

Placement of tympanostomy tubes in otherwise healthy children with persistent middle-ear effusion does not appear to improve developmental outcomes

After development of middle-ear effusion, many children have tympanostomy tubes inserted to improve hearing and possibly to improve long-term developmental outcomes. Investigators in Pittsburgh randomized 395 children younger than 3 years who had persistent bilateral effusion (for 90 days) or unilateral effusion (for 135 days) to undergo insertion of tympanostomy tubes either promptly or up to 9 months later if effusion persisted.

At age 6, 85% of children in the prompt-insertion group versus 41% in the delayed-insertion group had received tubes. No differences were observed between groups in mean scores on 29 of 30 measures used to assess cognitive, language, speech, and psychosocial development. For example, mean verbal IQ scores were identical (98) in the two groups. No differences were observed in analyses adjusted for age at randomization, type of middle-ear effusion (continuous, bilateral, or unilateral), or degree of hearing loss.

Comment: These authors are to be congratulated for conducting an important and meticulous study. They are careful to note that the results cannot be generalized to children who are not otherwise healthy or who have effusion accompanied by moderate- to-severe hearing loss. Thus, placement of tympanostomy tubes in children with persistent middle-ear effusion does not appear to improve developmental outcomes, at least up to age 6.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine November 28, 2005

Citation(s):

Paradise JL et al. Developmental outcomes after early or delayed insertion of tympanostomy tubes. N Engl J Med 2005 Aug 11; 353:576-86.

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