Outcomes research assesses the end results of health care from the perspective of those who receive the care, those who provide it, and those who pay for it. The article by Karin Minter and her colleagues1 at the Frank Porter Graham Child Development Center in Chapel Hill, North Carolina, provides important new information related to the functional outcomes of otitis media (OM) in early childhood. Their study documenting the relationship of otitis media with effusion (OME) and hearing loss with functional measures of attention and behavior obtained from parents, teachers, and clinicians appears in this issue ofPediatrics.1 They conducted this prospective cohort study in 85 children whose middle ear and hearing status had been closely monitored from 6 months to 4 years of age. The diagnosis of OME was based on both pneumatic otoscopy and tympanometry. Audiologists who were unaware of the middle ear findings performed hearing...
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1 May 2001
Dr. Minter's article, along with the recent follow up study by Dr. Paradise in the New England Journal, certainly suggest that tympanostomy tubes are not useful if the outcome of interest is language development or another developmental outcome that is related to it. Indeed the AHRQ guideline addresed OME and discusses it as if tympanostomy tubes were inserted primarily for persistent OME. I'm not sure this is correct or that the outcome of interest for most parents and some pediatricians is really being addressed. Parents raise the question of tubes when their child has had "too many" episodes of AOM. Their concern is with the pain and suffering, need to see the doctor, miss work, miss school, lose sleep, too many antibiotic courses, etc. I don't think I have ever had a parent ask me whether their infant who has had her 6th episode of AOM should have tubes to prevent problems with attention span when she is school age. There was a time when prophylactic antibiotics seemed to be of use for this problem (recurrent AOM), but experts no longer advise this. Is Dr. Berman no longer recommending tubes for recurrent AOM, and, if he isn't, what is he recommending? Is he aware of any randomized trials of tympanostomy tubes where the outcome of interest was the number of episodes of AOM? I suspect that it could be shown that the benefits would be minimal, and if this were the case, the final nail could be driven in the the tympanostomy tube coffin.
We want to thank Dr. Prescott for reminding the readers that infanticide is a leading cause of death. As we noted in the statement, the child death review system in the United States originated from this observation, and from the need to carefully determine the cause of unexpected infant deaths. Dr. Prescott also notes that an apparent reduction in SIDS deaths may be yet another reason for pediatricians to support breastfeeding.
Conflict of Interest:
None declared
Dear Dr. Berman
Thank-you for taking the time to comment obout the results of recent study regarding early otitis media and later learning and behavior difficulties. Good follow-up for each patient rather than immediate referal to ENT (surgery) when there is hearing loss is now valid under the right circumstances. I would like to know your opinion of "temporary hearing aids" versus "tubes" as an option for our patients with persistent effusion and hearing loss.