Growth hormone treatment does not affect incidences of middle ear disease or hearing loss in infants and toddlers with Turner syndrome.
BACKGROUND
No randomized, controlled, prospective study has evaluated the effect of growth hormone (GH) on the rates of middle ear (ME) disease and hearing loss in girls with Turner syndrome (TS).


METHODS
A 2-year, prospective, randomized, controlled, open-label, multicenter, clinical trial ('Toddler Turner Study'; August 1999 to August 2003) was carried out.


METHODS
The study was conducted at 11 US pediatric endocrine centers.


METHODS
Eighty-eight girls with TS, aged 9 months to 4 years, were enrolled.


METHODS
The interventions comprised recombinant GH (50 microg/kg/day, n = 45) or no treatment (n = 43) for 2 years.


METHODS
The outcome measures included occurrence rates of ear-related problems, otitis media (OM) and associated antibiotic treatments, tympanometric assessment of ME function and hearing assessment by audiology.


RESULTS
At baseline, 57% of the girls (mean age = 1.98 +/- 1.00 years) had a history of recurrent OM, 33% had undergone tympanostomy tube (t-tube) insertion and 27% had abnormal hearing. There was no significant difference between the treatment groups for annual incidence of OM episodes (untreated control: 1.9 +/- 1.4; GH-treated: 1.5 +/- 1.6, p = 0.17). A quarter of the subjects underwent ear surgeries (mainly t-tube insertions) during the study. Recurrent or persistent abnormality of ME function on tympanometry was present in 28-45% of the girls without t-tubes at the 6 postbaseline visits. Hearing deficits were found in 19-32% of the girls at the annual postbaseline visits. Most of these were conductive deficits, however, 2 girls had findings consistent with sensorineural hearing loss, which was evident before 3 years of age.


CONCLUSIONS
Ear and hearing problems are common in infants and toddlers with TS and are not significantly influenced by GH treatment. Girls with TS need early, regular and thorough ME monitoring by their primary care provider and/or otolaryngologist, and at least annual hearing evaluations by a pediatric audiologist.
Davenport
Marsha L
ML
Department of Pediatrics, University of North Carolina, Chapel Hill, NC 27599-7039, USA. mld@med.unc.edu
Roush
Jackson
J
Liu
Chunhua
C
Zagar
Anthony J
AJ
Eugster
Erica
E
Travers
Sharon
S
Fechner
Patricia Y
PY
Quigley
Charmian A
CA
D001298:Audiology; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D034381:Hearing Loss / Q000150:complications / Q000188:drug therapy*; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008137:Longitudinal Studies; D010033:Otitis Media / Q000150:complications / Q000188:drug therapy*; D038781:Otoscopy; D011446:Prospective Studies; D012959:Socioeconomic Factors; D014424:Turner Syndrome / Q000150:complications / Q000188:drug therapy*
D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I