title: Tympanostomy tube outcomes in children at-risk and not at-risk for developmental delays.
abstract: OBJECTIVE
  To assess outcomes after tympanostomy tubes in children at-risk or not-at-risk for developmental delays based on criteria from the American Academies of Pediatrics, Family Physicians, and Otolaryngology - Head and Neck Surgeons.
  
  
  METHODS
  Historical cohort study in a pediatric otolaryngology practice at an urban, not-for-profit hospital. All children had baseline audiometry followed by bilateral tube insertion with a Likert-type outcome questionnaire administered to the caregiver by telephone (86%) or mail (14%).
  
  
  RESULTS
  We identified 229 eligible children aged .5-13 years, of which caregivers of 168 children (73%) were available for follow-up at a median time of 2.0 years (range .7-3.1 years). Most children (55%) had at least one condition placing them at-risk for developmental delays. The mean pure-tone average at baseline for the better-hearing ear was 32dB HL (10.4 SD). After tube insertion most caregivers (89%) stated that their child's life "much better," and that expectations were met (60%) or exceeded (38%). Speech and language was "much better" for 55%, more often in at-risk children (odds ratio 4.6, 95% CI 2.4-8.8). Similarly, learning or school performance was "much better" after tubes for 55%, more often in at-risk children (odds ratio 3.1, 95% CI 1.6-5.9). Improved hearing was reported by 84% with no relationship to at-risk status.
  
  
  CONCLUSIONS
  Caregivers reported favorable outcomes regardless of their child's at-risk status, but children at-risk for delays had better reported outcomes for speech, language, learning, and school performance. Results are limited by lack of a control group and reliance on caregiver-report, but add to the very limited data currently available about predictors of benefit from tubes.
authors.affiliation: Department of Otolaryngology, State University of New York Downstate Medical Center and the Long Island College Hospital, 339 Hicks Street, Brooklyn, NY, United States. richrosenfeld@msn.com
authors.forename: Richard M
authors.initials: RM
authors.lastname: Rosenfeld
authors.forename: David W
authors.initials: DW
authors.lastname: Jang
authors.forename: Konstantin
authors.initials: K
authors.lastname: Tarashansky
mesh_terms: D000158:Acoustic Impedance Tests; D000293:Adolescent; D001299:Audiometry; D002648:Child; D002657:Child Development / Q000502:physiology; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D002658:Developmental Disabilities / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007859:Learning Disabilities / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008876:Middle Ear Ventilation / Q000009:adverse effects / Q000379:methods*; D015999:Multivariate Analysis; D016017:Odds Ratio; D010034:Otitis Media with Effusion / Q000175:diagnosis / Q000601:surgery*; D011788:Quality of Life; D018570:Risk Assessment; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome