Contrary to conventional beliefs, a long-running study at UPMC Children’s Hospital of Pittsburgh shows that fluid in the middle ear does not impair development of children.
A key conclusion is that early insertion of ear tubes in otherwise healthy infants and young children with persistent fluid in the middle ear does not improve developmental outcomes up to 9 to 11 years of age. In short, ear tubes may not be necessary, according to results of an important study led by researcher Jack Paradise, MD.
Dr. Paradise is a renowned expert in otitis media, or middle ear disease, the most common infection among children in the United States. Dr. Paradise and colleagues conducted a longitudinal study of 6,350 children enrolled before the age of 2 months.
Among the group of those children who developed persistent middle ear fluid before age of 3 years, the researchers found no evidence that prompt insertion of ear tubes improved developmental outcomes compared with delayed insertion if the fluid eventually fails to clear up spontaneously. This finding reverses a decades-old belief held by many in the medical community that fluid in the middle ear may lead to developmental impairment.
“These findings provide strong evidence that fluid persisting in the middle ear for periods as long as we studied does not affect developmental outcomes in children as old as 11,” said Dr. Paradise, a longtime pediatrician at Children’s and one of the founders of the hospital’s Clinical Research Program. “For otherwise healthy children with middle ear effusion, placement of ear tubes is ordinarily not necessary.”
Previous studies by other investigators had warned that hearing loss associated with persistent otitis media in young children might result in long-term impairment of their development. Because of this, official guidelines were developed recommending that young children with middle ear effusion lasting for as long as three or four months undergo insertion of ear tubes to clear the fluid and return the hearing to normal.
However, these previous studies, because of their design, established no cause-and-effect relationship between otitis media and developmental impairments, according to Dr. Paradise. His cumulative findings played an important role in the 2004 decision by the American Academy of Pediatrics, the American Academy of Family Physicians and the American Academy of Otolaryngology–Head and Neck Surgery to revise these guidelines for the insertion of ear tubes.
Results of Dr. Paradise study were published in the Jan. 18, 2007 issue of the New England Journal of Medicine. Alejandro Hoberman, MD, director of the Division of General Academic Pediatrics, also collaborated to continue the middle ear research pioneered by Dr. Paradise.
