title: Developmental outcomes after early or delayed insertion of tympanostomy tubes.
abstract: BACKGROUND
  To prevent later developmental impairments, myringotomy with the insertion of tympanostomy tubes has often been undertaken in young children who have persistent otitis media with effusion. We previously reported that prompt as compared with delayed insertion of tympanostomy tubes in children with persistent effusion who were younger than three years of age did not result in improved developmental outcomes at three or four years of age. However, the effect on the outcomes of school-age children is unknown.
  
  
  METHODS
  We enrolled 6350 healthy infants younger than 62 days of age and evaluated them regularly for middle-ear effusion. Before three years of age, 429 children with persistent middle-ear effusion were randomly assigned to have tympanostomy tubes inserted either promptly or up to nine months later if effusion persisted. We assessed developmental outcomes in 395 of these children at six years of age.
  
  
  RESULTS
  At six years of age, 85 percent of children in the early-treatment group and 41 percent in the delayed-treatment group had received tympanostomy tubes. There were no significant differences in mean (+/-SD) scores favoring early versus delayed treatment on any of 30 measures, including the Wechsler Full-Scale Intelligence Quotient (98+/-13 vs. 98+/-14); Number of Different Words test, a measure of word diversity (183+/-36 vs. 175+/-36); Percentage of Consonants Correct-Revised test, a measure of speech-sound production (96+/-2 vs. 96+/-3); the SCAN test, a measure of central auditory processing (95+/-15 vs. 96+/-14); and several measures of behavior and emotion.
  
  
  CONCLUSIONS
  In otherwise healthy children younger than three years of age who have persistent middle-ear effusion within the duration of effusion that we studied, prompt insertion of tympanostomy tubes does not improve developmental outcomes at six years of age.
authors.affiliation: Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, USA. jpar@pitt.edu
authors.forename: Jack L
authors.initials: JL
authors.lastname: Paradise
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Campbell
authors.forename: Christine A
authors.initials: CA
authors.lastname: Dollaghan
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Feldman
authors.forename: Beverly S
authors.initials: BS
authors.lastname: Bernard
authors.forename: D Kathleen
authors.initials: DK
authors.lastname: Colborn
authors.forename: Howard E
authors.initials: HE
authors.lastname: Rockette
authors.forename: Janine E
authors.initials: JE
authors.lastname: Janosky
authors.forename: Dayna L
authors.initials: DL
authors.lastname: Pitcairn
authors.forename: Marcia
authors.initials: M
authors.lastname: Kurs-Lasky
authors.forename: Diane L
authors.initials: DL
authors.lastname: Sabo
authors.forename: Clyde G
authors.initials: CG
authors.lastname: Smith
mesh_terms: D002648:Child; D002653:Child Behavior Disorders; D002657:Child Development; D002663:Child Language; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006320:Hearing Tests; D006801:Humans; D007223:Infant; D007360:Intelligence; D008297:Male; D008876:Middle Ear Ventilation; D010034:Otitis Media with Effusion / Q000601:surgery*; D013997:Time Factors