Secretory otitis media and language development: a six-year follow-up study with case-control.

The 2nd Hjørring Cohort Study, a prospective cohort study, comprised 94% of the 463 three-year-old children residing in the municipality. Among this cohort we found 40 children (9%) who had constant signs of secretory otitis media (SOM), in one or both ears, at 4 examinations in the course of 6 months. Five years later, 12 of the children who had previously had long-lasting SOM had left the municipality. At the age of 8 years the entire cohort had a Silent Reading Word Test (OS-400). Six months later, the 26 children with long-lasting SOM who were still residing in the municipality and 26 control children were tested with the Revised Peabody Picture Vocabulary Test and the verbal part of the Wechsler Intelligence Scale for Children (WISC) test. The controls were matched by sex, age, school, grade level, and controlled for classroom and social stratum. The children with long-lasting SOM did not score lower than the control children on the 3 tests. In a separate analysis children with long-lasting bilateral SOM did not score lower than their controls. On the WISC and PPVT-R tests the variability in the case group was greater than in the control group. More comprehensive and varied studies seem needed to elucidate the relationship between language development and SOM.

Audiological aspects on treatment of SOM. Indications and results.

Recent prospective epidemiology studies of unselected groups of children consistently show as main findings that up to 70-80% of all children will suffer from at least one episode of SOM, and that approx. 80% of them recover within a few months without any treatment at all. These facts call for quite new concepts in dealing with indication and treatment, and they highlight the complexity in deciding why, when, who, and how to treat the condition at the clinic. After a brief overview of the literature on record, some results are given from our long-term, still ongoing cohort-studies on SOM and related middle ear disorders, in which we have closely followed two full birth-cohorts (ca 1,000 children in the municipality of Hjørring, Denmark) from their 3rd to 10th year of life. Evaluating cost-benefit and cost-effectiveness of various treatment regimes, and taking the marked tendency to spontaneous cure into account, some guidelines for selecting, timing, and choice of therapy are set in order to minimize the imminent risk of both over- and undertreatment of children with SOM.

A 5-year prospective case-control study of the influence of early otitis media with effusion on reading achievement.

In a still ongoing prospective longitudinal study, more than 500 children--a total birth-cohort in a Danish municipality--were followed from their 3rd to their 9th year of life by multiple impedance tests in order to investigate a number of factors concerning epidemiology and long-term impacts of otitis media with effusion. This is a report on the influence of otitis media with effusion early in life on reading achievement. The study revealed no difference in school-class level between the 9% of the children (n = 46) who constantly had abnormal tympanometry during a 6-month period at the age of 3, and the other pupils in the municipality. At the Silent Reading Test (OS-400), done on 40 of the 46 case-pupils the results did not differ from (1) the other pupils in the municipality, (2) from other pupils of the same sex in the same classroom, or (3) from individual control-pupils matched by sex, social group and classroom.

Epidemiology of secretory otitis media. A descriptive cohort study.

To determine the prevalence, incidence, and course of secretory otitis media in an age-group population, 404 3-year-old children in a town in Denmark were examined at 6-, 8-, and 12-week intervals over a 6-month period. At each of the four examinations approximately 20% of the children had middle ear effusion (MEE); it was found at least once in 42% of the children, and 6% had persistent effusion at all four examinations. Average duration of MEE was 3 months. Since spontaneous recovery rarely occurred when MEE had been present for more than 3 months, active intervention is recommended after the condition has been followed for this length of time. The highly fluctuating course of MEE demonstrated in early childhood has important implications for concepts in pediatric middle ear disease and treatment.

Tympanometric prediction of the magnitude of hearing loss in preschool-children with secretory otitis media.

In 44 three-year-old children with chronic Eustachian tube dysfunction selected by repeated tympanometric screenings among all 3-year-old in a Danish region, the results from tympanometry, and pure-tone/speech audiometry were prospectively and blindly compared to the findings at paracentesis. The gradient of the tympanogram, and the magnitude of hearing loss separately correlated to the amount of middle ear effusion (MEE), but not to the viscosity of the MEE. At a gradient less than or equal to 0.1 no ear had a mean hearing threshold less than 20 dB (HL), and no ear with a gradient less than or equal to 0.2 had a mean hearing threshold greater than 25 dB (HL). As it has previously been shown that almost preschool-children can cooperate to tympanometry, the observations may constitute a needed, objective possibility for separating secretory otitis media (SOM) with from SOM without major hearing loss in young children, who cannot cooperate to conventional pure-tone audiometry.

Epidemiology and middle ear effusion and tubal dysfunction. A one-year prospective study comprising monthly tympanometry in 387 non-selected 7-year-old children.

In a Danish school district comprising 387 7-year-old pupils 10 electroacoustic otoadmittance tests showed in the course of one year a 31% total morbidity of middle ear effusion (MEE), while 30% constantly had normal tympanograms on both sides. The point prevalence of MEE ranged from 9 to 3%, highest during the winter and spring months. In most cases MEE was present only at one examination, but in one-quarter of the cases it persisted for 3 months or longer. Spontaneous recovery occurred in a mean of about 2 months. MEE setting in during the period september to February lasted longer than cases setting in at other times of the year. The middle ear status was extremely dynamic, about one-quarter of the children changing status (type of tympanogram) between consecutive tests and 17% 5 or more times. Spontaneous improvement was frequent (90%) and so was complete recovery (76%), but in about one-third of the cases there was recurrences. It is emphasized that an indication for treatment cannot as a rule be based on one test and should await observation for about 3 or 4 months.

Tympanometry in three-year-old children. The 3-year follow-up of a cohort study.

All 3-year-old children in a region were screened by tympanometry in January 1976 (503 children), and the 6-year-olds of the same region had tympanometric and tone audiometric screening in January 1979 (498 children), 70% being included both times. Significant improvement in middle ear status had occurred from the age of 3-6 years, but otherwise there was surprisingly little difference between the two age levels, e.g., about one-third of the tympanograms were abnormal in both age groups. Ears having a middle ear pressure of 0 to -99mm H2O at 3 years showed significantly better impedance audiology at 6 years, but as regards hearing loss they proved to be like cases who had previously had more or less negative pressure in the middle ear. Out of the flat tympanograms at 3 years a quarter were still flat at 6 years, and every sixth child did not pass tone audiometric screening. The subgroups boys/girls, nursery school/homecare children, urban/rural children that had exhibited differences in middle ear function at 3 years showed identical results at 6 years. A favourable effect of systematic tracing and active treatment of middle ear pathology from the age of 3 years could not be found at tone audiometry and impedance testing at 6 years. This must, inter alia, shake faith in adenoidectomy as a therapeutic or preventive procedure in dealing with middle ear pathology.

Adenoidectomy for middle ear disorders: a randomized controlled trial.

Repeated tympanometric screening of a regionally defined population of 3-year-old children defined a group of 42 children with middle ear disease which had persisted for at least 6 months. These children were treated by either myringotomy with adenoidectomy or myringotomy without adenoidectomy decided by random allocation. Postoperative observation during 6 months failed to disclose any difference in middle ear status between the two groups.

Tympanometry in three-year-old children. Prevalence and spontaneous course of MEE.

Tympanometric screening was performed in January 1976 and in August 1978 on 938 healthy three-year-old children (1,866 ears), constituting more than 95% of the total population of three-year-olds living in a Danish municipality at the time of testing. All children showing abnormalities were followed by tympanometry through the subsequent six months, or until spontaneous normalization had been ascertained. The study demonstrated a high prevalence and a common spontaneous recovery of secretory otitis media. In summer as well as in winter middle ear effusion was found in about 10% of all ears, or in every eighth child. Two thirds of the ears improved spontaneously, one third to complete normalization. Middle ear function, assessed by tympanometry, is extremely labile during the preschool years and must be evaluated from a dynamic point of view. This greatly restricts the predictive value of snapshots, such as screening results. Therefore, pending complementary information from long-term cohort studies, universal impedance screening of all preschool children should not be instituted.

Tympanometry and middle ear effusion: a cohort-study in three-year-old children.

Myringotomy was done on 44 three to four-year-old children out of a total of 463 three-year-olds in a geographically defined area, because these 44 children persistently showed abnormal screening-tympanometry over 6 months. The findings were correlated to middle ear pressure, absolute compliance, absolute gradient and relative gradient parameters. As regards the state of effusion in the middle ear, all parameters showed a high predictive value. A reverse proportionality of compliance parameters and the content of fluid in the tympanic cavity, each related to the magnitude of associated hearing loss, was demonstrated. The significance of the findings in the tympanometric diagnosis of middle ear disease in young children is outlined, and a revised classification system of the tympanogram, predicting middle ear effusion with a sensitivity of 91% and a specificity of 84%, is recommended.

Serial tympanometry and middle ear status in 3-year-old children.

Repeated tympanometric screening for middle ear disturbances in a regionally defined population of 3-year-old children singled out a group of 44 children in whom abnormal results persisted through 6 months. These children were treated by paracentesis, and the operative findings were compared with the preoperative serial tympanometry. A common finding in all these children was an extremely fluctuating tubal function which did not grow less labile during the preoperative observation despite successive exclusion of the spontaneously normalized cases. From the dynamic point of view, that flat tympanogram was the tympanometric equivalent of middle ear effusion, while a negative middle ear pressure had to be interpreted as a sign of transition to remission or progression. The viscosity of the effusion was no reliable parameter for the severity of the disease, unlike the quantity of effusion which much better reflected the preoperative duration of the tubal dysfunction as well as its tendency.

Tympanometry in three-year-old children. III. Correlation between tympanometry and findings at paracentesis in a prospectively followed population of otherwise healthy children aged 3--4 years.

Paracentesis was performed on 46 three- to four-year-old children out of all 523 three-year-olds in a geographically defined area, because these 46 children had persistently showed abnormal tympanograms over a 6-month period. The findings were correlated to the parameters middle ear pressure, absolute compliance, absolute gradient, and relative gradient. As regards the state of effusion in the middle ear, all these parameters--except for the middle ear pressure--showed a high predictive value. The significance of the findings in the tympanometric diagnosis of middle ear disease in the younger age groups is outlined.

Prospective tympanometry in 3-year-old children. A study of the spontaneous course of tympanometry types in a nonselected population.

For six months we observed all 3-year-old children showing type B or C tympanograms at a prevalence study in a geographically limited area (372 ears or 37.2% of the screened total) to study the spontaneous course of middle ear effusions. A considerable test-retest stability was found only for type B. In type C, such stability was equally rare whether the middle ear pressure was highly or only slightly negative. Conversion to type A was observed in about 70% of cases. Ears having a middle ear pressure from -100 to -199 mm H2O almost always returned to normal. The tendency for a negative middle ear pressure or middle ear effusion to develop was the same for both sexes. Conversely, the prognosis of an effusion, once formed, differed significantly, with only girls showing a brief course. Accordingly, a sex-differentiated evaluation appears to be needed in preschool tympanometric screening, and should be included in all clinical considerations when middle ear effusion is demonstrated in young children.

Tympanometry in three-year-old children. II. Seasonal influence on tympanometric results in non-selected groups of three-year-old children.

Screening tympanometry was performed in January 1976 and in August 1978 on 938 healthy 3-year-old children (1 868 ears), constituting more than 95% of the total population of 3-year-olds living in a Danish provincial municipality at the time of testing. Seasonal influence upon the occurrence of middle ear effusion and tubal dysfunction, not previously quantitated by systematic studies on pre-school children, was thus elucidated by comparing the prevalence of these conditions in winter and in summer. There was a statistically significant preponderance of pathological tympanometry in winter, but the difference was not overwhelming. The findings emphasize that problems relating to a disturbed middle ear function in early childhood are of great practical importance throughout the year.

Tympanometry in three-year-old children. A cohort study on the prognostic value of tympanometry and operative findings in middle ear effusion.

The operative findings in a homogeneous, preoperatively followed population of 46 3- to 4-year-old children with middle ear effusion treated by adenotomy and paracentesis were correlated with the results of pre- and postoperative tympanometry. Factors of prognostic value were only the immediate type of tympanogram and the quantity of the middle ear effusion, not its viscosity. The combination of the determinative factors divided the material into four groups showing a different course through a 6-month postoperative follow-up. A flat tympanogram and impacted fluid spelt the poorest prognosis, with about 60% recurrences. The influence of the results upon a differentiated treatment of secretory otitis media in the younger age groups is outlined.