Evidence Profile: Documentation

Aggregate evidence quality: C, observational studies.

Benefits: defines severity, duration has prognostic value, facilitates future communication with other clinicians, supports appropriate timing of intervention, and, if consistently unilateral, may identify a problem with specific ear other than OME (eg, retraction pocket or cholesteatoma).

Harm: administrative burden.

Benefits-harms assessment: preponderance of benefit over harm.

Policy level: recommendation.

CHILD AT RISK: CLINICIANS SHOULD DISTINGUISH THE CHILD WITH OME WHO IS AT RISK FOR SPEECH, LANGUAGE, OR LEARNING PROBLEMS FROM OTHER CHILDREN WITH OME AND SHOULD EVALUATE HEARING, SPEECH, LANGUAGE, AND NEED FOR INTERVENTION MORE PROMPTLY

This recommendation is based on case series, the preponderance of benefit over harm, and ethical limitations in studying children with OME who are at risk.

Earlier guidelines for managing OME have applied only to young children who are healthy and exhibit no developmental delays. Studies of the relationship between OME and hearing loss or speech/language development typically exclude children with craniofacial anomalies, genetic syndromes, and other developmental disorders. Therefore, the available literature mainly applies to otherwise healthy children who meet inclusion criteria for randomized, controlled trials. Few, if any, existing studies dealing with developmental sequelae caused by hearing loss from OME can be generalized to children who are at risk.

Children who are at risk for speech or language delay would likely be affected additionally by hearing problems from OME, although definitive studies are lacking. For example, small comparative studies of children or adolescents with Down syndrome or cerebral palsy show poorer articulation and receptive language associated with a history of early otitis media. Large studies are unlikely to be forthcoming because of methodologic and ethical difficulties inherent in studying children who are delayed or at risk for further delays. Therefore, clinicians who manage children with OME should determine whether other conditions coexist that put a child at risk for developmental delay and then take these conditions into consideration when planning assessment and management.

Children with craniofacial anomalies (eg, cleft palate; Down syndrome; Robin sequence; coloboma, heart defect, choanal atresia, retarded growth and development, genital anomaly, and ear defect with deafness association) have a higher prevalence of chronic OME, hearing loss (conductive and sensorineural), and speech or language delay than do children without these anomalies. Other children may not be more prone to OME but are likely to have speech and language disorders, such as those children with permanent hearing loss independent of OME, specific language impairment, autism-spectrum disorders, or syndromes that adversely affect cognitive and linguistic development. Some retrospective studies have found that hearing loss caused by OME in children with cognitive delays, such as Down syndrome, has been associated with lower language levels. Children with language delays or disorders with OME histories perform more poorly on speech-perception tasks than do children with OME histories alone.

Children with severe visual impairments may be more susceptible to the effects of OME, because they depend on hearing more than children with normal vision. Any decrease in their most important remaining sensory input for language (hearing) may significantly compromise language development and their ability to interact and communicate with others. All children with severe visual impairments should be considered more vulnerable to OME sequelae, especially in the areas of balance, sound localization, and communication.

Management of the child with OME who is at increased risk for developmental delays should include hearing testing and speech and language evaluation and may include speech and language therapy concurrent with managing OME, hearing aids or other amplification devices for hearing loss independent of OME, tympanostomy tube insertion, and hearing testing after OME resolves to document improvement, because OME can mask a permanent underlying hearing loss and delay detection.