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Delayed Ear Tube Surgery Doesn't Delay Development

Speech, language unaffected by the timing of procedure in healthy kids, study finds

WEDNESDAY, Aug. 10, 2005 (HealthDay News) -- Putting off surgery to have ear tubes inserted in children who have persistent fluid build-up in their ears won't slow their development, a new study finds.

For years, there's been concern that children with fluid in their ears might show delays in speech or language development, or could be perceived as having behavior problems because the fluid in their ears causes slight hearing loss.

Because of this concern, past guidelines recommended the insertion of ear tubes sooner rather than later. However, the new study, which appears in the Aug. 11 issue of the New England Journal of Medicine, found that delaying the insertion of tubes didn't affect youngsters' developmental outcomes.

"If I had any words of advice for parents with children with this condition, it would be, 'Don't just do something, sit there,'" said Dr. Jack Paradise, a professor of pediatrics and otolaryngology at the Pittsburgh School of Medicine and Children's Hospital of Pittsburgh.

"If all your child has wrong is middle ear fluid, and they have no discomfort and aren't ill, and they're acting perfectly normal, it's OK to have a watch-and-wait attitude," he said, adding that parents should still "have their [child's] ears checked every few months, and have their hearing checked, too."

About 16 million children visit their physicians annually for fluid in their ears, according to the American Academy of Pediatrics. Besides causing some hearing loss, the fluid can also act as a breeding ground for bacteria, and can cause repeated ear infections. The surgical insertion of ear tubes helps fluid drain from the ear, reducing the amount of fluid and the incidence of infection.

According to Paradise, because the fluid can reduce the transmission of sound from the ear to the brain, and because that disruption occurs at such a formative time in a child's life, it was previously believed that children would be left with a "developmental scar" or some type of irreversible loss in development if the condition was left untreated.

But, he said, while there were many studies that showed an association between fluid in the ear and developmental problems, no study was able to prove a cause-and-effect relationship.

Hoping to clarify this relationship, Paradise and his colleagues recruited more than 6,000 infants during their first two months of life. The children were from eight different locations in Pittsburgh and surrounding suburban and rural communities.

By the age of three, 429 otherwise healthy children had persistent fluid in their ears for at least three or four months.

These children were randomized into two treatment groups -- one early and one delayed. The early treatment group included 216 children who received ear tubes as soon as possible when indicated, while the remaining 213 were assigned to the delayed treatment group. If fluid persisted in the delayed treatment group for more than six months in both ears, children were given ear tubes. If fluid was only in one ear, youngsters in the delayed group received ear tubes after nine months.

By the age of six, 85 percent in the early-treatment group had received ear tubes vs. 41 percent for the delayed-treatment group.

The researchers also compared the treated children to children with no ear problems.

At 3, 4 and 6 years old, all of the children were given a battery of developmental tests to measure their speech, language and reading skills, as well as tests to measure their behavior and emotions.

The researchers found no statistically significant differences in development between the groups.

"We concluded that it's highly unlikely that middle ear disease had any impact on children's later development," said Paradise. "Children are pretty resilient, and it's not as though there's no hearing. They might be turning up the TV or parents might have to speak louder, but these children aren't deaf. When their hearing gets better, they make up for the temporary loss."

"Even if there's a temporary delay because of effusion, at that age, the developing brain is so attuned to speech and language development that most kids catch up," said Dr. John Maddalozzo, an attending physician at Children's Memorial Hospital and an associate professor of otolaryngology and head and neck surgery at the Feinberg School of Medicine in Chicago.

Both Paradise and Maddalozzo point out that the study only looked at children who had no other health problems. Maddalozzo said that many children who undergo surgery for ear tubes have other problems, such as repeated ear infections, speech problems or craniofacial abnormalities.

The researchers have continued to follow the children until they were 9 or 10. While they are just beginning to sort through that data, Paradise said he doesn't believe any developmental problems will appear at this later age.

More information

To learn more about ear infections in children, visit the National Institute on Deafness and Other Communication Disorders.

SOURCES: Jack Paradise, M.D., professor, pediatrics and otolaryngology, Pittsburgh School of Medicine and Children's Hospital of Pittsburgh; John Maddalozzo, M.D., associate professor, otolaryngology and head and neck surgery, Feinberg School of Medicine at Northwestern University, and attending physician, Children's Memorial Hospital, Chicago; Aug. 11, 2005, New England Journal of Medicine
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