Does early detection of otitis media with effusion prevent delayed language development?

Objective-To consider whether earlier detection of otitis media with effusi on (OME) in asymptomatic children in the first 4 years of life prevents del ayed language development. Methods-MEDLINE and other databases were searched and relevant references f rom articles reviewed. Critical appraisal and consensus development were in accordance with the methods of the Canadian Task Force on Preventive Healt h Care. Results-No randomised controlled trials assessing the overall screening for OME and early intervention to prevent delay in acquiring language were ide ntified, although one trial evaluated treatment in a screened population an d found no benefit. The "analytic pathway" approach was therefore used, whe re evidence is evaluated for individual steps in a screening process. The e vidence supporting the use of tools for early detection such as tympanometr y, microtympanometry, acoustic reflectometry, and pneumatic otoscopy in the first 4 years of life is unclear. Some treatments (mucolytics, antibiotics , steroids) resulted in the short term resolution of effusions as measured by tympanometry. Ventilation tubes resolved effusions and improved hearing. Ventilation tubes in children with hearing loss associated with OME benefi ted children in the short term, but after IS months there was no difference in comparison with those assigned to watchful waiting. Most prospective co hort studies that evaluated the association between OME and language develo pment lacked adequate measurement of exposure or outcome, or suffered from attrition bias. Findings with regard to the association were inconsistent. Conclusions-There is insufficient evidence to support attempts at early det ection of OME in the first 4 years of life in the asymptomatic child to pre vent delayed language development.