In the most recent publication this week from a landmark study, young children with middle ear fluid who received tubes promptly were compared with children who received tubes 6-9 months later only if the fluid persisted. In this particular study, the development and language of children were assessed 9 to 11 years later! Children who had tubes early did no better than children who had tubes later if the fluid persisted; in other words, no harm was done to language or other areas of development by waiting to see if the fluid persisted before placing tubes. This is the fourth and final study from this research project. In previous reports, no difference was found at 3, 4, and 6 years of age either. The first of those studies was published in 2001.
Over the past few decades, research had suggested an association between ear infections, persistent ear fluid, and impairment of development, particularly speech and language development. These studies were retrospective and could only suggest a possible association; they could not prove an association, nor could they identify if one thing caused another. As a result, official guidelines have suggested that children receive tubes if fluid has persisted for as long as 3 or 4 months.
This current study, started in 1991, was designed to specifically address these kinds of questions. As a result of this study, in 2004 new guidelines were issued, recommending that children with persistent fluid be followed at 3-6 month intervals, and tubes be considered if complications develop, if speech and language delay occurs, or if there is significant hearing loss. Other recent studies have confirmed the findings of this study.
Now having followed children up to age 9 to 11 years old confirms that there is no benefit to tube placement simply for persistent fluid alone, compared with careful observation and follow-up.
Paradise J.L., Feldman H.M., Campbell T.F., et al. N Engl J Med 2007; 356:248-261
