• Ear Development: Ear Tubes Do Not Improve

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    Contrary to conventional beliefs, a long-running study at Children’s Hospital of Pittsburgh of UPMC shows that fluid in the middle ear does not impair development of children. A key conclusion is that early insertion of ear tubes in otherwise healthy infants and young children with persistent fluid in the middle ear does not improve developmental outcomes up to 9 to 11 years of age.Dr. Paradise is a renowned expert in otitis media, or middle ear disease, the most common infection among children in the United States. Dr. Paradise and colleagues conducted a longitudinal study of 6,350 children enrolled before the age of 2 months. Among the group of those children who developed persistent middle ear fluid before age of 3 years, the researchers found no evidence that prompt insertion of ear tubes improved developmental outcomes compared with delayed insertion if the fluid eventually fails to clear up spontaneously. This finding reverses a decades-old belief held by many in the medical community that fluid in the middle ear may lead to developmental impairment.

    Watchful waiting or ear tube surgery? It is a decision faced by millions of families of children with recurrent or chronic otitis media with effusion (non-infected fluid in the middle ear) each year. Out of concern regarding long-term effects like hearing loss and potential developmental delays, about a million such families choose ear tubes annually, opting for surgery that carries risks of its own.

    New research by the RTI-University of North Carolina Evidence-based Practice Center, though, may have practitioners reconsidering their clinical recommendations to families. The systematic review of more than 40 studies found that implanting tubes in the ears of children who have persistent or recurrent episodes of otitis media with effusion (OME) improves hearing over a short period but is less likely to improve long-term cognitive and functional development.

    “Surgery can certainly help ease pain associated with ear pressure changes in the middle ear, and even improve hearing …

    However, these previous studies, because of their design, established no cause-and-effect relationship between otitis media and developmental impairments, according to Dr. Paradise. His cumulative findings played an important role in the 2004 decision by the American Academy of Pediatrics, the American Academy of Family Physicians and the American Academy of Otolaryngology–Head and Neck Surgery to revise these guidelines for the insertion of ear tubes.

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