CHILD DEVELOPMENT IN RELATION TO EARLY OTITIS MEDIA

描述(申请人提供)：本申请是为了继续提供支持 一项始于1991年的研究，其主要目标是确定1) 持续性渗出性中耳炎(OME)发生在常见的 生命头三年的频率和持续时间会损害以后的语言能力， 语言、认知或心理社会发展；以及2)是否迅速 鼓膜造口置管(TTP)可预防或减轻任何此类损伤。 这项研究的主要内容和许多分析已经完成。超过4 在一年半的时间里，我们招募了6350名2岁以下正常婴儿的不同样本 在2家城市医院和6家私人儿科诊所，我们密集地 前瞻性地监测他们的中耳状况。在6350名儿童中，有429名 关于生命头3年持续性OME的特定标准和 被随机化，以立即或在定义的扩展之后接收TTP 如果OME持续存在，则为期间。此外，代表一个光谱的241名儿童 从没有MEE到具有累积持续时间和/或排序的MEE 不符合随机标准的人被随机选择并 在社会人口统计阶层中进行联合研究。这些产品中的损耗 有两组人一直处于低位。我们的研究1)表明，在患有 在我们研究的持续时间限制内持续早期OME，提示TTP 不会改善3岁或以下儿童的一系列发育结果 在4岁时可获得广泛的结果；并且2)提供了强有力的证据 在这些持续时间内，针对早期生活的OME之间的因果关系 限制，以及3岁时的发育障碍，如果 结果在4岁时可用。尽管如此，仍然重要的是 确定早期OME是否有不利的发育后果 6岁的儿童，他们面临着额外的认知，言语，语言， 和心理社会需求，在他们进入学校的时候，他们可能会受到损害 比早期更容易察觉。我们唯一的具体目标是 本申请旨在回答上述两个问题，涉及我们的 受试者年龄为6岁。我们最年轻的受试者将有资格达到6岁 2002年初开始测试，并对所有6岁年龄段的语言进行转录和分析 样本，以及随之而来的数据还原、数据分析和 手稿准备将需要额外的9个月。这项研究将 提供新知识，使之更合理、更循证 对幼儿中耳炎的管理，从而使儿童受益 并在很大程度上影响儿童保健做法和成本。

DESCRIPTION (provided by applicant): This application is for continuing support of a study, begun in 1991, whose main objectives are to determine 1) whether persistent otitis media with effusion (OME) occurring at common levels of frequency and duration during the first 3 years of life impairs later speech, language, cognitive, or psychosocial development; and 2) whether prompt tympanostomy-tube placement (TTP) prevents or lessens any such impairments. Major elements of this study and much analysis have been completed. Over a 4 1/2-year period we enrolled a diverse sample of 6350 normal infants by age 2 mo at 2 urban hospitals and 6 private pediatric practices, and we intensively monitored their middle-ear status prospectively. Of the 6350 children, 429 met specified criteria regarding persistent OME in the first 3 years of life and were randomized to receive TTP either promptly or after a defined extended period if OME persisted. In addition, 241 children who represented a spectrum from having no MEE to having MEE whose cumulative duration and/or sequencing fell just short of meeting randomization criteria were selected randomly and within sociodemographic strata for an associational study. Attrition in these two groups has been low. Our study 1) has shown that in children with persistent early-life OME within the duration limits we studied, prompt TTP does not improve a range of developmental outcomes at age 3 yr or, to the extent results are available, at age 4 yr; and 2) has provided strong evidence against a causal relationship between early-life OME, within those duration limits, and developmental impairment at age 3 yr and, to the extent that results are available, at age 4 years. Nonetheless it remains important to determine whether early-life OME has unfavorable developmental consequences for 6-year-old children, who are faced with additional cognitive, speech, language, and psychosocial demands as they enter school, and in whom impairments may be more readily detectable than at earlier ages. Our sole specific aim for the present application is to answer the two questions above with respect to our subjects at age 6 yerrs. Our youngest subjects will be eligible for age 6 yr testing early in 2002, and transcription and analysis of all age 6 yr language samples, and the ensuing attendant data reduction, data analysis, and manuscript preparation will require 9 additional months. This study will provide new knowledge that will make possible more rational, evidence-based management of otitis media in young children, and will thereby benefit children and substantially influence child health care practices and costs.