Neonatal middle ear effusion predicts chronic otitis media with effusion
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Published on: February 29, 2020
Karen Jo Doyle1, Ying Yee Kong, Karen Strobel
1University of California Davis Medical Center, Sacramento, California, USA. karen.doyle@ucdmc.ucdavis.edu
Insights
Newborns with persistent middle ear effusion are significantly more likely to develop chronic otitis media with effusion within their first year. Early detection of neonatal middle ear effusion is crucial for monitoring infant hearing health.
Area of Science:
- Pediatrics
- Otolaryngology
- Audiology
Background:
- Middle ear effusion (MEE) in newborns can impact hearing development.
- Persistent MEE in neonates may indicate a higher risk for long-term ear conditions.
- Early identification of MEE is essential for timely intervention.
Purpose of the Study:
- To determine if persistent middle ear effusion in newborns (30-48 hours old) increases the likelihood of developing chronic otitis media with effusion (COME) in the first year of life.
- To compare the incidence of COME in infants with and without neonatal MEE.
Main Methods:
- Prospective case-control study involving 14 neonates with MEE and 15 controls.
- Pneumatic otoscopy used for effusion detection at birth; follow-up included otoacoustic emissions, tympanometry, and visual reinforcement audiometry.
- COME defined as hypomobile/immobile tympanic membrane for three consecutive months; hearing loss defined as >25 dB hearing loss.
Main Results:
- Significantly higher incidence of COME in the MEE group (58%) compared to controls (20%) (p < 0.04).
- Experimental group had a higher average number of effusions and showed worse hearing thresholds at 9 months.
- Hearing loss exceeding 25 dB was observed in the MEE group at 9 months.
Conclusions:
- Persistent neonatal middle ear effusion is a strong predictor of chronic otitis media with effusion in the first year.
- COME is prevalent in infants, underscoring the importance of frequent audiological monitoring.
- Early MEE detection aids in identifying infants at risk for persistent otitis media and potential hearing impairment.
Hypothesis And Aims:
The specific aims of the research are to determine whether newborn ears with persistent middle ear effusion at age 30 to 48 hours are more likely to develop chronic otitis media with effusion over the first year of life when compared with ears without persistent middle ear effusion. The hypothesis is that neonates with middle ear effusion persisting to 30 to 48 hours are more likely to develop chronic otitis media with effusion.
Study Design:
Prospective, case-control design. Loupe-magnified pneumatic otoscopy performed at the time of newborn hearing screening determined presence or absence of effusion. Infants enrolled in the study returned for outpatient examinations.
Setting:
University medical center well-baby nursery and out-patient audiology clinic.
Subjects:
From 454 neonates, 14 experimental subjects with neonatal middle ear effusions and 15 control subjects free of neonatal effusion were recruited for the study and followed-up for 1 year.
Interventions:
Outpatient study tests included transient-evoked otoacoustic emissions, tympanometry, pneumatic otoscopy, and visual reinforcement audiometry (starting at age 6 months), at 3, 6, 9, and 12 months of age. Experimental (neonatal effusion) infants were followed-up starting at age 1 month. Infants found at any follow-up examination to have effusion on otoscopy were followed-up and tested 1 month later.
Main Outcome Measures:
Chronic otitis media with effusion defined as hypomobile or immobile tympanic membrane on pneumatic otoscopy in one or both ears for three consecutive monthly examinations. Hearing loss defined as greater than 25-dB hearing loss visual reinforcement audiometry thresholds.
Results:
Eight experimental infants (58%) and three control infants (20%) developed chronic otitis media with effusion (p < 0.04). The average number of effusions was 1.27 for control and 4.14 for experimental infants (average number of effusions for each group at 3-, 6-, 9-, and 12-month visits). Warbled tone and speech visual reinforcement audiometry thresholds averaged 3 dB worse in the experimental group, but these differences were not statistically significant. For the control group, mean visual reinforcement audiometry thresholds never exceeded 25 dB hearing loss. For the experimental group, mean visual reinforcement audiometry thresholds exceeded 25 dB hearing loss at 1,000, 2,000, and 4,000 Hz at 9 months.
Conclusions:
A majority of infants with persistent neonatal middle ear effusion found by pneumatic otoscopy at 30 to 48 hours will develop chronic otitis media with effusion during the first year of life. However, chronic otitis media with effusion is common in all infants (20% of controls), a time during which infants are examined and tested frequently.
