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Updated: Aug 18, 2026
Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses
Published on: January 23, 2017
Randomised controlled trial of early surgery versus watchful waiting for glue ear: the effect on behavioural problems
1Department of Otolaryngology, University of Bristol, UK.
Insights
Early surgery for persistent otitis media with effusion (OME) in children significantly reduced behavioral issues. However, differences in hearing loss and behavior resolved by 18 months, though most children eventually needed surgery.
Area of Science:
- Pediatric Otolaryngology
- Child Psychology
- Evidence-Based Medicine
Background:
- Persistent bilateral otitis media with effusion (OME) affects pre-school children, potentially causing hearing loss and behavioral problems.
- The optimal management strategy, early surgery versus watchful waiting, remains a key clinical question.
Purpose of the Study:
- To compare the efficacy of early surgical intervention with watchful waiting for persistent bilateral OME in pre-school children.
- To assess the impact on hearing loss and behavioral problems over an 18-month period.
Main Methods:
- Randomized controlled trial involving 182 pre-school children with bilateral OME and hearing loss >25 dB.
- Intervention groups: early ventilation tube insertion versus 9 months of watchful waiting followed by potential surgery.
- Outcome measures: behavioral problems (Richman Behaviour Checklist) and hearing loss at 4000 Hz.
Main Results:
- Early surgical intervention led to a significant 17% reduction in behavioral problems (95% CI, 2%-33%), primarily mediated by hearing improvement.
- No significant difference in behavioral problems or hearing loss was observed between groups at the 18-month final assessment.
- The majority (85%) of the watchful waiting group eventually required surgery, and 22% of all children still exhibited behavioral problems.
Conclusions:
- While early surgery offers short-term benefits for behavioral issues in children with OME, these advantages diminish by 18 months.
- Watchful waiting for persistent OME is a viable strategy, as most children eventually undergo surgery without long-term adverse effects.
- The findings support individualized treatment decisions based on symptom severity and parental preference.
Abstract:
This trial was designed to compare early surgery with watchful waiting for persistent bilateral otitis media with effusion (OME) in terms of hearing loss and behavioural problems in pre-school children. A randomised controlled trial compared the effects of early treatment with ventilation tubes versus watchful waiting for 9 months. Results were analysed by intention-to-treat. One hundred and eighty-two pre-school children (date of birth between 1 April 1991 and 31 December 1992), mean age of 2.9 years (SD 0.85) with at least a 3-month history of bilateral OME and hearing loss of greater than 25 dB were treated in Bristol Children's Hospital between November 1993 and January 1996. Bilateral ventilation tubes were inserted within 6 weeks of randomisation or within 6 weeks of reassessment after 9 months of watchful waiting, with a final assessment at 18 months. The main outcome measures were behavioural problems, measured by the Richman Behaviour Checklist, and hearing loss at 4000 Hz in the better hearing ear. Early surgical intervention significantly reduced behavioural problems by 17% (95% CI, 2% - 33%). This difference was largely mediated by concurrent hearing loss. After 18 months, there was no longer a significant difference (95% Cl, -19% to +10%). However, the majority (85%) of the Watchful Waiting group had required surgery and 22% of all children still had behavioural problems.
