Language, speech sound production, and cognition in three-year-old children in relation to otitis media in their first three years of life

Objective. As part of a prospective study of possible effects of early-life otitis media on speech, language, cognitive, and psychosocial development, we tested relationships between children's cumulative duration of middle e ar effusion (MEE) in their first 3 years of life and their scores on measur es of language, speech sound production, and cognition at 3 years of age. Methods. We enrolled 6350 healthy infants by 2 months of age who presented for primary care at 1 of 2 urban hospitals or 1 of 2 small town/rural and 4 suburban private pediatric practices. We intensively monitored the childre n's middle ear status by pneumatic otoscopy, supplemented by tympanometry, throughout their first 3 years of life; we monitored the validity of the ot oscopic observations on an ongoing basis; and we treated children for otiti s media according to specified guidelines. Children who met specified minim um criteria regarding the persistence of MEE became eligible for a clinical trial in which they were assigned randomly to undergo tympanostomy tube pl acement either promptly or after a defined extended period if MEE remained present. From among those remaining, we selected randomly, within sociodemo graphic strata, a sample of 241 children who represented a spectrum of MEE experience from having no MEE to having MEE whose cumulative duration fell just short of meeting randomization criteria. In subjects so selected, the estimated duration of MEE ranged from none to 65.6% of the first year of li fe and 44.8% of the first 3 years of life. In these 241 children we assesse d language development, speech sound production, and cognition at 3 years o f age, using both formal tests and conversational samples. Results. We found weak to moderate, statistically significant negative corr elations between children's cumulative durations of MEE in their first year of life or in age periods that included their first year of life, and thei r scores on formal tests of receptive vocabulary and verbal aspects of cogn ition at 3 years of age. However, the percent of variance in these scores e xplained by time with MEE in the first year of life beyond that explained b y sociodemographic variables ranged only from 1.2% to 2.9%, and the negativ e correlations were concentrated in the subgroup of children whose families had private health insurance (rather than Medicaid). We found no significa nt correlations in the study population as a whole or in any subgroup betwe en time with MEE during antecedent periods and children's scores on measure s of spontaneous expressive language, speech sound production, or other mea sured aspects of cognition. In contrast, by wide margins, scores on all mea sures were consistently highest among the most socioeconomically advantaged children and lowest among the most socioeconomically disadvantaged childre n. Conclusions. Our findings suggest either that persistent early-life MEE act ually causes later small, circumscribed impairments of receptive language a nd verbal aspects of cognition in certain groups of children or that uniden tified, confounding factors predispose children both to early-life otitis m edia and to certain types of developmental impairment. Findings in the rand omized clinical trial component of the larger study should help distinguish between causality and confounding as explanations for our findings.