PEDIATRICS Vol. 77 No. 1 January 1986, pp. 88-92
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On Otitis Media, Child Development, and Tympanostomy Tubes: New Answers or Old Questions?

Jack L. Paradise MD1 and Kenneth D. Rogers MD1

1 From the Departments of Pediatrics and Community Medicine, University of Pittsburgh School of Medicine, and the Ambulatory Care Center, Children's Hospital of Pittsburgh, Pittsburgh

Few, if any, treatment decisions in pediatric practice are made more often, and entail more uncertainties, than decisions about tympanostomy tube placement for otitis media with effusion ("secretory," "serous," or "nonsuppurative" otitis media).1 The main concerns are usually not about symptoms, which are generally subtle or inapparent, but rather about postulated long-term effects, namely, middle ear damage2,3 or impaired speech, language, or intellectual development.4-7 These concerns must, on the other hand, be weighed against the lability of secretory otitis media and its tendency to eventually resolve spontaneously8-11; the cost, risks, and sequelae of tube placement4,5,7,12; and the absence, after all, of convincing evidence linking otitis media early in life to either otologic or developmental difficulties later in life.5,7,13-15

The August 1984 issue of Pediatrics contains two new offerings on the subject,16,17 different vantage points and with opposite thrusts. Teele et al,16 on the basis of a study of speech and language development in relation to prior middle ear disease, suggested that "intervention to rid the ears of effusion may need to be considered earlier than is being practiced." Stickler,17 on the other hand, citing earlier studies of tube placement results, proposed declaring "a moratorium on tube placements until solid data supporting the procedure have been reported."

It seems important to review each of these articles critically, not only because of the importance of the child health issues involved, but also because of the potential of both articles for influencing—one way or the other—clinicians' decisions about tube placement.

TEELE ET AL STUDY

Submitted on February 15, 1985
Accepted on May 2, 1985


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