The effect of treatment with ventilating tubes on language development in preschool children with otitis media with effusion.

The effect of bilateral tube insertion on language development was studied in a randomized controlled trial of 43 preschool children with persistent bilateral otitis media with effusion (OME). Improvement in language scores was observed in both the treatment and non-treatment groups. There was a minor difference in favour of the treatment group which did not reach statistical significance. Although there is a growing consensus that otitis media with effusion can have negative effects on language development in young children, it has not yet been proved that this effect can be reversed by treatment with ventilating tubes.

Analysis and presentation of data on the natural course of otitis media with effusion in children.

Methods of analysing and presenting longitudinal data on health characteristics that have a fluctuating course are by no means standard. Several possibilities are discussed and tried out on longitudinal data on Otitis Media with Effusion (OME) in Dutch children. If the purpose of a study is descriptive, a graphical presentation based on an idea from Fiellau-Nikolajsen is preferred. For estimation purposes on the other hand, hazard functions are the most suitable. Further reduction of the data does not lead to a clear view into the complex nature of the course of a disease such as OME.

The occurrence of otitis media with effusion in Dutch pre-school children.

Published data on the frequency of otitis media with effusion in pre-school children do not give a uniform view about the age-specific rates. A cohort of 1439 2-year-old children in the Netherlands was followed using serial tympanometry on 9 consecutive occasions up to 4 years of age. The screening rate decreased from 87% on the first occasion to 73% on the last round. The prevalence rates in this study are high compared to results quoted in the literature. At least 80% of the children had otitis media with effusion on at least one occasion before the age of four. Distinct seasonal variation was found in the rates. It is postulated that middle ear effusion is a 'physiological' phenomenon at pre-school age with some pathological exceptions.

The choice of a balanced allocation method for a clinical trial in otitis media with effusion.

We review the choice of treatment allocation procedures in a specific small clinical trial of the effect of tympanostomy tubes on language development in patients with otitis media with effusion. The options for balanced allocation available at the planning stage are discussed. A clearly favourable method could not be identified. A simulation study was performed, and its results demonstrated least imbalance with the variance method. In practice this method produced considerable imbalance on relevant prognostic factors.

The natural course of otitis media with effusion in preschool children.

In order to gain an insight into the natural course of otitis media with effusion (OME), a prospective study was carried out on 1328 children out of a cohort of 1439 preschool children. These children were seen in follow-up for their OME every 3 months, at which times tympanometry was performed. The results show a fairly constant rate of improvement of about 50% every 3 months. The cumulative rate of recurrence of OME was about 50% in the study period. Two-thirds of all OME with flat tympanograms had a duration of less than 3 months. Some factors could be identified as having an effect on the natural history of OME. The season and patients' age and sex were found to be associated with the duration and the recovery rate. Risk factors for recurrences were the same as those already reported in the literature.

Otitis media with effusion and habitual mouth breathing in Dutch preschool children.

Habitual mouth breathing (HMB) is defined as the habit of in- and exhaling (part of) the air through the mouth, when an individual is at rest and the nose is sufficiently free. It is postulated that HMB is a risk factor for otitis media with effusion (OME) in preschool children. The results are presented of a prospective cohort study on 253 3-year-old children, free from OME, with a follow-up period of 3 months, to determine the role of HMB in the etiology of OME. The risk ratio for OME of habitual mouth breathers, compared to nose breathers, was found to be 2.4 (95% confidence interval (C.I.): 0.99-5.70). Moreover, there is a clear and significant linear trend in the proportion of OME in 3 breathing categories: nose breathing, intermediate and mouth breathing. This relation remains after correction for confounding. It is concluded that HMB is a risk factor for OME. It is estimated that about 20% of the incidence of OME is caused by HMB. The high incidence of OME means that HMB carries a great deal of impact. Suggestions are made for the prevention and treatment of HMB.

Environmental risk factors for otitis media with effusion in preschool children.

To ascertain risk factors for otitis media with effusion (OME), a cohort of 1439 preschool children, 2 years of age, was investigated by means of tympanometry at 3-monthly intervals until their fourth birthday. Parents were asked about potential risk factors for OME. Data were analysed in a case-control design with incident cases. Age, season, family size, siblings's history of OME, frequent swimming, duration of breast feeding and public day care appear to have a significant effect on OME, even after adjustment for nasal infection. Gender, race, birth weight and passive smoking were not related to OME incidence. With the exception of age and season, the relative risks of environmental factors for OME are always very low. It is concluded that the study of environmental risk factors for OME is necessary to increase the knowledge of the nature of this disease, but that it does not contribute much to medical care at the moment.

Screening for otitis media with effusion in preschool children.

1439 Dutch children were included in a randomised trial to evaluate the efficacy of preschool screening for otitis media with effusion (OME) by 3-monthly tympanometry. Children with bilateral OME on two consecutive occasions were referred for further investigation and then, if parents gave their consent, allocated at random to treatment or non-treatment groups. The effect of childhood screening for OME and subsequent treatment was evaluated by assessment of language performance; no benefit was found, mainly because of the large degree of spontaneous recovery.

The influence of chronic persistent otitis media with effusion on language development of 2- to 4-year-olds.

Literature is not conclusive about the effect of otitis media with effusion (OME) on language development in children. As part of a large epidemiological study on OME in preschool children, language development was measured in 52 children with known history of bilateral OME and in 13 children without OME. The test Reynell Developmental language scales-revised (RDLS-r) was performed by one speech therapist under standard conditions. Verbal comprehension scores were not or only slightly reduced in OME children. Expressive language, however, was significantly lower than the standard with the effect being larger when the OME had lasted for a longer period. This is one of the first prospective studies that confirms the hypothesis of an effect of persistent bilateral middle ear effusion on language development.