EARLY OTITIS AND LITERACY AND ATTENTION AT 9 TO 11 YEARS

这项研究将调查儿童头3年的持续性渗出性中耳炎(OME)是否会导致9-11岁儿童的识字、注意力或相关技能的损害，如果是这样的话，及时鼓膜造口术(TTP)在预防或减轻此类损害方面是否有效。这项拟议的研究建立在目前一项研究的基础上，该研究评估了早期持续性中耳积液(MEE)和TTP与3、4和6岁儿童的言语、语言、认知和心理社会发展之间的关系。在这项研究中，对6350名2个月大的正常婴儿进行了不同的样本调查，并对他们的中耳状况进行了前瞻性的密切监测。本研究的三组受试者将构成拟议研究的对象。一个队列由429名儿童组成，这些儿童在生命的头3年中持续了指定持续时间的较长时间，在此基础上，他们被随机分配接受即时TTP，或者如果他们的MEE持续，则在指定时间段后延迟接受TTP。第二组包括152名符合随机化标准但父母拒绝随机化的儿童。第三组包括241名注册儿童的样本，他们的范围从出生前3年没有发生MEE到MEE持续时间略低于随机标准。到目前为止的研究结果表明，在研究的持续时间范围内，MEE对这些队列在3岁和4岁时测量的发育结果没有可测量的影响。尽管如此，在9岁、10岁或11岁时对三组儿童进行发展评估是重要的，原因有四：(1)目前推荐幼儿进行TTP的官方指南在一定程度上是基于报告，即早期持续的MEE会导致儿童到学龄时识字、注意力和相关技能的损害。然而，相关研究存在着重要的局限性，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会在以后的年龄变得明显。(3)我们目前的研究在6岁时结束，不包括识字或注意力能力的测量。(4)这3个群体构成了一个宝贵而独特的研究群体，只有以高昂的成本才能复制。拟议的研究将提供新的知识，使更合理、更循证的中耳炎管理成为可能，从而使儿童受益，并对儿童保健实践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.