Hearing Loss, Prognosis, and Long-Term Impact of Otitis Media with Effusion in Children

项目摘要/摘要 摘要渗出性中耳炎(OME)是一种常见的儿童疾病，其特征为非化脓性渗出。 在中耳空间。OME可导致传导性听力损失(CHL)，但听力状况差异很大 从正常听力到中度听力损失(0-55dBHL)，以及OME发作可以持续不同的长度 时间的流逝。对于是治疗OME(即放置外科导管)还是等待它解决，临床上存在着平衡 自然而然地。虽然幼儿手术有相关风险，但等待OME解决 自发地也可能带来风险。OME与言语、语言和语言方面的长期缺陷有关 听觉处理。然而，临床研究的结果是多种多样的，导致了持续的争论。 关于OME的长期后遗症。我们假设，长期赤字的一个关键风险因素是 累积性听力剥夺与OME相关的CHL相关，而不是由于OME本身的存在。如果这是 在这种情况下，只有部分患有OME的儿童(那些听力明显受损的儿童)将面临长期 赤字。因此，我们确定所有患有OME的儿童的听力状况以及了解 作为程度和对称性的函数，这种听力损失对长期结果的影响的可变性 损失的损失。虽然目前的诊断工具通常可以指示OME的存在或不存在，但有 我们确定CHL的存在、程度和对称性的能力受到显著限制 由于幼儿行为听力学测试的挑战，以及没有客观的替代方案 行为测试目前已经存在。此外，即使在可以从行为上确定听力状态的情况下， 在一个时间点进行听力测定并不表明听力阈值的稳定性或风险 长期赤字的规模。我们的长期目标是全面解决这些知识差距，以 通过确定长期缺陷风险最高的儿童来改进治疗，从而完善临床实践指南 建议。作为第一步，这项建议的主要目标是改善诊断和 了解OME及其相关听力损失，并调查累积变异性的影响 OME后遗症之一的听觉剥夺，双耳处理。在目标1中，我们将开发一种非侵入性 OME所致听力损失的客观评估在目标2中，我们将描述短期稳定性和 OME及其相关听力损失的持续性和非侵入性测量的预后价值 中耳机械师。在目标3中，我们将确定与OME相关的变异对CHL和MID的影响。 双耳加工中个体差异的耳力学研究。这些目标的实现将实现第一步 我们的长期目标是了解OME的后果并开发工具来识别儿童 通过提高我们客观判断预后和听力的能力，最有可能出现负面后遗症 状态随着时间的推移，并提高我们对这些因素如何在长期- 期限结果。

PROJECT SUMMARY/ABSTRACT Otitis media with effusion (OME) is a common childhood condition characterized by a non-purulent effusion in the middle-ear space. OME can cause conductive hearing loss (CHL), but hearing status varies substantially from normal hearing to moderate hearing losses (0-55 dB HL), and episodes of OME can last for variable lengths of time. Clinical equipoise exists as to whether to treat OME (i.e., surgical tube placement) or wait for it to resolve spontaneously. While there are risks associated with surgery in young children, waiting for OME to resolve spontaneously may also carry risks. OME has been associated with long-term deficits in speech, language, and auditory processing. However, findings from clinical studies are variable, resulting in a persistent debate regarding the long-term sequelae of OME. We hypothesize that a key risk factor for long-term deficits is the cumulative auditory deprivation associated with OME-related CHL, not by the presence of OME itself. If this is the case, only a subset of children with OME (those with notable hearing losses) would be at risk of long-term deficits. As such, it is critical that we determine the hearing status of all children with OME as well as understand the variability in the effects of this hearing loss on long-term outcomes as a function of the degree and symmetry of the loss. While current diagnostic tools can often indicate the presence or absence of OME, there are significant limitations in our ability to determine the presence, degree, and symmetry of the CHL associated with OME due to the challenges with behavioral audiological testing in young children, and no objective alternative to behavioral testing currently exists. Further, even in cases where hearing status can be determined behaviorally, determination of hearing at one time point does not indicate the stability of hearing thresholds or the risk and magnitude of long-term deficits. Our long-term goal is to address these knowledge gaps comprehensively to refine clinical practice guidelines by identifying children most at risk for long-term deficits to improve treatment recommendations. As a first step, the primary objective of this proposal is to improve the diagnosis and understanding of OME and its related hearing loss and investigate the influence of variability in cumulative auditory deprivation on one sequela of OME, binaural processing. In Aim 1, we will develop a non-invasive objective estimate of hearing loss due to OME. In Aim 2, we will characterize the short-term stability and persistence of OME and its related hearing loss and determine the prognostic value of a non-invasive measure of middle-ear mechanics. In Aim 3, we will determine the influence of OME-related variations in CHL and middle- ear mechanics on individual differences in binaural processing. Completion of these Aims will achieve a first step toward our long-term goal of understanding the consequences of OME and developing tools to identify children most at risk for negative sequelae by both improving our ability to objectively determine prognosis and hearing status over time and improving our understanding of how these factors contribute to individual variability in long- term outcomes.