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Don't Worry: Delaying Ear Tube Surgery Won't Harm Language Development

Delaying Ear Tube Surgery Doesn't Harm Language Development

Levine and Luber are typical of thousands of parents says Heidi M. Feldman, PhD, MD, who's with the Children's Hospital of Pittsburgh and a professor of pediatrics at the University of Pittsburgh. She tells WebMD that many parents worry that their children will "be robbed of some potential because of these constant ear infections. They worry about developmental problems."

But Feldman says that results of a new study she and her colleagues at the University of Pittsburgh conducted can put some of those fears to rest. They report in Thursday's New England Journal of Medicine that although insertion of tubes in infants with persistent ear infections does reduce the frequency of the infections and eliminate fluid build-up, it has no effect on development of language by the age of 3.

She says that children who waited as long as nine months to have tubes inserted did no worse on a series of language development tests than the children who had earlier insertion of tubes. The findings are exactly the opposite of other studies that suggested that a delay in tube surgery would have an adverse effect on developmental outcomes.

In the new research the scientists studied 402 children who all had a similar history of frequent ear infections during infancy (when they were 2-61 days old). One hundred and sixty-nine children had early placement of tubes and 66 waited up to nine months for the surgery. Feldman and her colleagues then used sophisticated measurements of words, sounds, and conversation to assess developmental differences. "There was no difference," she says.

The children who waited several months before surgery did have more fluid in their ears and longer sustained hearing loss, she says, but that didn't show up in the developmental tests. Feldman says there is an explanation for this: "the hearing loss that occurs with fluid buildup tends to be in the low frequency range. That means that a child might not hear a plane or a machine." The human voice, on the other hand, "tends to fall in higher frequencies." The result is that even with fluid in the ear the children can still hear spoken words, she says.

This new study means that it is time to rethink current guidelines for tube surgery, says Stephen Berman, MD, president of the American Academy of Pediatrics. Berman, a professor of pediatrics at the University of Colorado Health Sciences Center in Denver, says that current guidelines suggest that tubes should be placed if fluid persists for at least three months. "But this new evidence suggests that it may be better to wait rather than perform an unnecessary procedure," he says.

Glenn Isaacson, MD, professor and chair of otolaryngology/head and neck surgery and chief of pediatric otolaryngology at Temple University School of Medicine in Philadelphia, says the study by the Pittsburgh researchers does call into question the three-month rationale but he says that "children who have tubes placed for persistent fluid represent only one segment of children in whom tubes are inserted."

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