Tympanostomy tubes and developmental outcomes at 9 to 11 years of age
Tympanostomy tubes and developmental outcomes at 9 to 11 years of age
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DOI：
10.1056/nejmoa062980
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发表时间：
2007-01-18
影响因子：
158.5
通讯作者：
Pelham, William E., Jr.
中科院分区：
文献类型：
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作者：
Paradise, Jack L.;Feldman, Heidi M.;Pelham, William E., Jr.
背景：儿童的发育障碍被认为是由于他们生命早期持续的中耳积液。先前，我们报道了在3岁以下持续性中耳积液的儿童中，与延迟插入鼓膜造瘘管相比，及时插入鼓膜造瘘管并没有改善3岁、4岁或6岁时的认知、语言、言语或社会心理发展。然而，发展的其他重要组成部分要等到儿童长大后才能评估。方法：我们招募了6350名刚出生不久的婴儿，并定期评估他们的中耳积液。在3岁之前，429名持续性积液的儿童被随机分配接受鼓膜造瘘管的插入，如果积液持续存在，则立即或长达9个月。我们对391名9至11岁儿童的读写能力、注意力、社交技能和学业成绩进行了评估。结果：分配给早期插入鼓膜造瘘管组的儿童在48项发育指标上的平均（+/-SD）评分与分配给延迟插入鼓膜造瘘管组的评分无显著差异。这些测量包括Woodcock阅读掌握测试的文章理解子测试（平均得分，早期治疗组为98+/-12，延迟治疗组为99+/-12）；伍德科克-约翰逊三世成就测验的拼写、写作样本和计算子测试（分别为96+/-13和97+/-16；104+/-14和105+/-15；99+/-13和99+/-13）；以及视觉和听觉连续表现测试的注意力不集中评分。结论：在本研究中定义的持续性中耳积液的健康幼儿中，及时插入鼓室造瘘管并不能改善9至11岁的发育结局。
BACKGROUND:Developmental impairments in children have been attributed to persistent middle-ear effusion in their early years of life. Previously, we reported that among children younger than 3 years of age with persistent middle-ear effusion, prompt as compared with delayed insertion of tympanostomy tubes did not result in improved cognitive, language, speech, or psychosocial development at 3, 4, or 6 years of age. However, other important components of development could not be assessed until the children were older.METHODS:We enrolled 6350 infants soon after birth and evaluated them regularly for middle-ear effusion. Before 3 years of age, 429 children with persistent effusion were randomly assigned to undergo the insertion of tympanostomy tubes either promptly or up to 9 months later if effusion persisted. We assessed literacy, attention, social skills, and academic achievement in 391 of these children at 9 to 11 years of age.RESULTS:Mean (+/-SD) scores on 48 developmental measures in the group of children who were assigned to undergo early insertion of tympanostomy tubes did not differ significantly from the scores in the group that was assigned to undergo delayed insertion. These measures included the Passage Comprehension subtest of the Woodcock Reading Mastery Tests (mean score, 98+/-12 in the early-treatment group and 99+/-12 in the delayed-treatment group); the Spelling, Writing Samples, and Calculation subtests of the Woodcock-Johnson III Tests of Achievement (96+/-13 and 97+/-16; 104+/-14 and 105+/-15; and 99+/-13 and 99+/-13, respectively); and inattention ratings on visual and auditory continuous performance tests.CONCLUSIONS:In otherwise healthy young children who have persistent middle-ear effusion, as defined in our study, prompt insertion of tympanostomy tubes does not improve developmental outcomes up to 9 to 11 years of age.