Otitis media is the most frequently diagnosed illness among
children in the United States. Otitis media with effusion (OME)
or fluid in the middle ear without evidence of ear infection is
one type of otitis media. OME differs from acute otitis media
(AOM), where there is middle ear fluid with rapid onset of one or
more signs or symptoms of middle ear inflammation. Annual
healthcare costs related to the diagnosis and management of
otitis media were recently estimated at $4 billion. A major
reason for medical management of OME in children, including the
use of tympanostomy tubes, is to prevent potential developmental
consequences related to persistent OME. However, there is
controversy as to whether children experiencing a history of OME
in early childhood will have later language and learning
Once OME has lasted for longer than 8 weeks, it is called
chronic OME. Studies have shown that 70% of children will
continue to have OME at 2 weeks, 40% at 1 month, 20% at 2 months,
and 10% at 3 months after an initial episode. Risk factors for
OME include being less than 2 years old, attending daycare, being
exposed to passive smoke, being a member of a special population
such as Down syndrome, and having craniofacial differences such
as cleft palate. OME generally results in a conductive hearing
loss of 25 dB HL, but the loss can range from none to 50 dB. When
OME resolves, hearing will generally return to normal.
Associations between OME and central auditory processing on
functions believed to originate in the lower brainstem and to
require equal (binaural) hearing in the two ears have been
reported, although these effects resolve over a period of years.
Similarly, a few studies have reported an association between OME
and central auditory processing skills. However, these studies
are retrospective in design and have methodological problems.
OME occurs most often during the first few years of life, a
time that is critical for early language development. The
mild-to-moderate hearing loss associated with an episode of OME
is hypothesized to impede children's ability to process
language. Children with prolonged or frequent OME are
hypothesized to have delays in their comprehension and production
of language, attention problems, and academic difficulties in
school. Over 100 studies during the past 3 decades have examined
whether children with frequent OME in early childhood score lower
on measures of speech, language, and academic achievement than
children without such a history.
We are conducting studies at the Frank Porter Graham Child
Development Institute at the University of North Carolina. These
studies will examine the linkages between OME and hearing loss in
early childhood and later auditory processing, language, and
academic skills. Innovative experimental studies, conducted at
the University of Pittsburgh, are examining whether prompt
insertion of tympanostomy tubes improved children's language
development as compared to delayed insertion of tubes. These and
other studies report that, on average for typically developing
children, OME may not be a substantial risk factor for later
speech and language development. The results of a recent
meta-analysis of several studies examining OME and associated
hearing loss on children's speech and language published in
Pediatrics in 2004 indicated that the negative association of OME
and associated hearing loss with children's later speech and
language development varied from none to a very small amount.
However, these findings should be interpreted cautiously, given
that almost all of these studies used OME rather than hearing
loss as the independent variable and many did not control for
important confounding variables such as socioeconomic
In May of 2004, new clinical practice guidelines for managing
children between 2 months and 12 years with or without
developmental disabilities were published in Pediatrics. The
committee that worked on these guidelines was selected by the
American Academy of Pediatrics, American Academy of Family
Physicians, and American Academy of Otolaryngology-Head and Neck
Surgery with experts in primary care; otolaryngology; infectious
diseases; epidemiology, hearing, speech and language, and
advanced practice. Some of these recommendations included: a)
testing hearing when OME persists for 3 months or longer, or when
language delay, learning problems, or a significant hearing loss
is suspected in a child with OME; b) differentiating the children
with OME who are at risk for speech, language, or learning
problems from other children with OME and providing for these
at-risk children a more prompt evaluation of hearing, speech, and
language to assess the need for intervention.
In summary, the author believes that, on average, OME may not
be a substantial risk factor for later speech and language
development for typically developing children. However, for some
children (children from special populations and children who have
experienced considerable persistent hearing loss caused by OME),
a history of hearing loss due to OME may be of concern.
Joanne E. Roberts, PhD
Frank Porter Graham Child Development Institute Professor of
Speech and Hearing Sciences
Chapel Hill, NC
American Academy of Family Physicians, American Academy of
Otolarynogology-Head and Neck Surgery, American Academy of
Pediatrics Subcommittee on Otitis Media with Effusion. (2004).
Clinical Practice Guideline: Otitis Media with Effusion.
Pediatrics, 113(5), 1412-1429.
Paradise, J. L., Dollaghan, C. A., Campbell, T. F., Feldman,
M., Bernard, B. S., Colborn, D. K., Rockette, H. E., Janosky, J.
E., Pitcairn, D. L., Kurs-Lasky, M., Sabo, D. L., and Smith, C.
G. (2003). Otitis Media and tympanpostomy tube insertion during
the first three years of life: Developmental outcomes at age four
years. Pediatrics, 112, 265-277.
Paradise, J. L., Feldman, H., M., Campbell, T. F., Dollaghan,
C. A., Colborn, D. K., Bernard, B. S., Rockette, H. E., Janosky,
J. E., Pitcairn, D. L., Sabo, D. L., Kurs-Lasky, M., & Smith,
C. G. (2001). Effect of early or delayed insertion of
tympanostomy tubes for persistent otitis media on developmental
outcomes at the age of three years. New England Journal of
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Roberts, J., Hunter, L., Gravel, J., Rosenfeld, R., Berman,
S., Haggard, M., Hall, J., Lannon, C., Moore, D., Vernon-Feagans,
L., & Wallace, I. (2004). Otitis media, hearing loss, and
language learning: Controversies and current research.
Developmental and Behavioral Pediatrics, 25(2), 1-13.
Roberts, J. E., Burchinal, M. R., & Zeisel, S. A. (2002).
Otitis Media in early childhood in relation to children's
school-age language and academic skills. Pediatrics(110),4,
Roberts, J. E., Rosenfeld, R. M., & Zeisel, S. A. (2004).
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- Does a history of OME causes later speech, language,
leaning, auditory processing, and learning difficulties?
- How do you manage a child with persistent OME?
- When should a child with persistent OME be referred to an
This article first appeared in the Vol. 3, No. 6,
November/December 2004 issue of