Otitis Media During Early Life: How Hazardous to Development? A Critical Review of the Evidence

Abstract

In a number of recent reports1-3 developmental impairments of a lasting nature have been attributed to prolonged or repeated episodes of otitis media occurring during the first one to three years of life. The impairments described include intellectural and learning difficulties,1,2,4-8,10-13 impaired speech and language,3,5,8,9,11-13 and disturbed behavior.7,8 In some of the reports1,12 the impairments have been referred to as permanent or irreversible. These reports, having appeared in publications directed respectively to physicians,2-4,6,8-13 speech-language-hearing professionals,1-3,5 educators,11 and psychologists,7,12 and in some instances having been cited in widely disseminated professional and lay news media (reference 14; Newsweek, June 14, 1976, p 47; New York Times, Dec 26, 1978, p C2) quite naturally have aroused broad anxiety and concern. The reports also have served to provide the impetus, or the justification, not only for aggressive casefinding programs, but also, in infants and children with recognized middle-ear effusions, for early recourse to aggressive modes of treatment, most often in the form of myringotomy and tympanostomy tube insertion. The purpose of the present report is to review critically the body of evidence on which the supposed relationship between early otitis media and later developmental impairments is based. DISEASE PROCESS In the typical case of acute otitis media, pus fills the middle-ear cavity. Sooner or later the infection begins to subside—with or without the help of antimicrobial drugs—and the initially purulent middle-ear liquid changes in character, coming to resemble serum, mucus, or even glue. With continued healing the Eustachian tube gradually recovers its ventilatory function, and the middle-ear liquid eventually is resorbed, or drains, and becomes replaced by air.