Effects of early middle ear effusion on child intelligence at three, five,and seven years of age

Objective: This study tested the hypothesis that children with prolonged mi ddle ear effusion (MEE) during the first 3 years of life are at risk for co gnitive delays or deficits. Method: A prospective study enrolled 698 children from diverse backgrounds and controlled for eight demographic and environmental factors. Participant s were recruited at birth and monitored for ear status frequently in the ho me; 379 children were assessed for cognition with the Stanford-Binet, 4th e d., at 3 years of age, 294 at 5 years, and 198 at 7 years. Results: Using the SAS General Linear Models (GLM) procedure, we found a si gnificant direct relation between duration of bilateral MEE and Stanford-Bi net Composite and Nonverbal Reasoning/Visualization Factor scores at age 3, but not at age 5 or age 7. Statistical clustering analysis revealed four g roups with different temporal patterns of MEE: Low MEE, Early MEE (peaking at 0-6 months), Later MEE (peaking at 6-12 months), and High MEE. GLM analy ses revealed no direct effects, but several moderated effects, of MEE clust er on cognitive development at 3 years, but none at 5 or 7 years. In genera l, children in the Later MEE and High MEE groups appeared to be more advers ely affected by bilateral MEE at 3 years, but effects were moderated in com plex ways by socioeconomic status or home stimulation. Growth curve modelin g across the three assessment periods showed no effects of total duration o f MEE but did indicate that children in the Later MEE cluster had low score s at age 3 but caught up at ages 5 and 7. Conclusions: Prolonged MEE, especially between 6 and 12 months, may put chi ldren at risk for cognitive delays at 3 years, but the risk effect is not s trong and effects are no longer detectable at 5 or 7 years.