EARLY OTITIS AND LITERACY AND ATTENTION AT 9 TO 11 YEARS

本研究将调查儿童3岁前持续性中耳炎伴积液（OME）是否会导致9 - 11岁儿童的读写能力、注意力或相关技能受损，如果是，鼓膜造瘘管置入术（TTP）是否能有效预防或减轻这种损害。该研究基于当前的一项研究，该研究评估了生命早期持续性中耳积液（MEE）、TTP与3岁、4岁和6岁时的言语、语言、认知和社会心理发展之间的关系。在该研究中，6350名正常婴儿在2个月大时入组，并对他们的中耳状况进行了前瞻性的深入监测。来自当前研究的三组受试者将构成拟议研究的受试者。其中一组包括429名儿童，他们的MEE在生命的前3年持续了一段特定的时间，在此基础上，他们被随机分配接受即时TTP，或在特定时期后接受延迟TTP，如果他们的MEE持续存在。第二组包括152名符合随机化标准但父母不允许随机化的儿童。第三个队列包括241名入组儿童的样本，他们的范围从生命的前3年没有MEE到MEE持续时间略低于随机化标准。迄今为止的研究结果表明，在研究的持续时间限制内，MEE对这些队列中3岁和4岁时测量的发育结果没有可测量的影响。然而，在9岁、10岁和11岁时对三个队列进行发展评估是很重要的，原因有4:(1)目前，官方指南建议在幼儿中实施TTP，部分是基于早期生活中持续的MEE导致儿童到达学龄时读写能力、注意力能力和相关技能受损的报告。然而，有关的研究有重要的局限性，其结果值得怀疑。(2)在我们目前的研究中，在3岁或4岁时不明显的关系可能在以后的年龄中变得明显。我们目前的研究在6岁结束，不包括读写能力和注意力能力的测量。(4)这3个队列构成了一个有价值的、独特的研究群体，只有付出巨大的代价才能复制。拟议的研究将提供新的知识，使中耳炎的循证管理更合理成为可能，从而使儿童受益，并对儿童保健做法和成本产生重大影响。

This study will investigate whether persistent otitis media with effusion (OME) during children's first 3 years of life results in impairments at ages 9 to 11 years of their literacy, attentional abilities, or related skills, and if so, whether prompt tympanostomy-tube placement (TTP) is efficacious in preventing or lessening such impairments. The proposed study builds on a current study that assesses relations between persistent middle-ear effusion (MEE) in early life, TTP, and speech, language, cognitive, and psychosocial development at ages 3, 4, and 6 yr. In that study, a diverse sample of 6350 normal infants was enrolled by age 2 months and their middle-ear status was intensively monitored prospectively. Three cohorts of subjects from the current study will constitute the subjects of the proposed study. One cohort consists of 429 children in whom MEE had persisted for extended periods of specified duration during the first 3 years of life and who on that basis were randomly assigned to receive either prompt TTP, or delayed TTP after a specified period if their MEE persisted. The second cohort consists of 152 children who met the criteria for randomization but whose parents withheld permission for randomization. The third cohort consists of a sample of 241 enrolled children who represented a spectrum ranging from no MEE in the first 3 years of life to having durations of MEE just short of meeting the randomization criteria. Findings to date indicate no measurable impact of MEE, within the duration limits studied, on the developmental outcomes measured in these cohorts at ages 3 and 4 years. Nonetheless, developmental assessment of the three cohorts at age 9, 10, or 11 yr is important for 4 reasons: (1) Current, official guidelines recommending performance of TTP in young children are based, in part, on reports that persistent MEE in early life results in impairments of literacy, attentional abilities, and related skills when children reach school age. However, the studies concerned have had important limitations and their results are questionable. (2) Relations that were not apparent in our current study at ages 3 or 4 might become apparent at later ages. (3) Our current study, which ends at age 6 yr, does not include measures of literacy or attentional abilities. (4) The 3 cohorts constitute a valuable and unique population for study that can be replicated only at great cost. The proposed study will provide new knowledge that will make possible more rational, evidence-based management of otitis media, and thereby benefit children and substantially influence child health care practices and costs.