CHILD DEVELOPMENT IN RELATION TO EARLY OTITIS MEDIA

描述（由申请人提供）：本申请用于持续支持 1991年开始的一项研究，其主要目标是确定1） 持续性渗出性中耳炎（OME）发生在常见水平， 在生命的前3年期间的频率和持续时间损害了以后的语言， 语言、认知或心理社会发展; 2）是否及时 鼓膜造口管放置（TTP）防止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1/2年的时间里，我们纳入了6350名2个月大的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， 前瞻性地监测他们的中耳状况。在6350名儿童中， 关于生命前3年内持续性OME的指定标准，以及 随机接受TTP，无论是立即或在定义的延长 如果OME持续存在。此外，241名儿童代表了一个光谱， 从没有连续性到连续性，其累积持续时间和/或顺序 不符合随机化标准的患者被随机选择， 在社会人口阶层中进行关联研究。在这些Atomic 两个群体都很低。我们的研究表明， 在我们研究的持续时间范围内持续性早期OME，提示TTP 在3岁时，或到 在4岁时可获得程度结果; 2）提供了强有力的证据 与早期OME之间的因果关系，在这些时间内， 限制，和发育障碍，在一定程度上， 4岁时可获得结果。尽管如此， 确定早期生活OME是否对发育产生不利影响， 6岁的孩子，他们面临着额外的认知，言语，语言， 和心理社会需求，因为他们进入学校，并在谁的障碍可能是 比早期更容易被发现。我们唯一的具体目标是 本申请的目的是回答关于我们的 受试者年龄为6岁。我们最年轻的受试者将有资格获得6岁 2002年初进行测试，并对所有6岁儿童的语言进行转录和分析 样本，以及随之而来的数据减少，数据分析， 手稿准备工作将需要额外的9个月。本研究将 提供新知识，使更理性、更循证成为可能 治疗幼儿中耳炎，从而使儿童受益 并极大地影响儿童保健实践和成本。

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.