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Tympanometry in three-year-old children. The 3-year follow-up of a cohort study
Insights
Middle ear conditions in children show some improvement between ages 3 and 6, but many still have abnormal tympanograms. Early intervention did not significantly improve hearing outcomes, questioning the effectiveness of treatments like adenoidectomy.
Area of Science:
- Pediatrics
- Audiology
- Otolaryngology
Background:
- Middle ear disease is common in young children.
- Longitudinal data on middle ear status and hearing from early childhood is crucial.
Purpose of the Study:
- To assess changes in middle ear status and hearing from age 3 to 6 years.
- To evaluate the impact of early middle ear pathology and interventions on later outcomes.
Main Methods:
- Tympanometry screening of 503 3-year-olds in 1976.
- Tympanometric and tone audiometric screening of 498 6-year-olds in 1979.
- Tracking 70% of children between the two screening periods.
Main Results:
- Significant improvement in middle ear status from age 3 to 6.
- Approximately one-third of tympanograms remained abnormal in both age groups.
- Children with normal middle ear pressure at age 3 had better impedance results at age 6, but similar hearing loss rates.
- A quarter of initially flat tympanograms remained flat at age 6; 1 in 6 children failed tone audiometry.
- Differences in middle ear function based on sex, schooling, and location at age 3 were not evident at age 6.
- Systematic tracing and treatment from age 3 did not show a favorable effect on hearing or impedance at age 6.
Conclusions:
- Middle ear function shows some improvement but remains a concern in early childhood.
- Early intervention and consistent tracing did not demonstrably improve hearing outcomes by age 6.
- Findings challenge the efficacy of adenoidectomy for treating or preventing middle ear pathology.
Abstract:
All 3-year-old children in a region were screened by tympanometry in January 1976 (503 children), and the 6-year-olds of the same region had tympanometric and tone audiometric screening in January 1979 (498 children), 70% being included both times. Significant improvement in middle ear status had occurred from the age of 3-6 years, but otherwise there was surprisingly little difference between the two age levels, e.g., about one-third of the tympanograms were abnormal in both age groups. Ears having a middle ear pressure of 0 to -99mm H2O at 3 years showed significantly better impedance audiology at 6 years, but as regards hearing loss they proved to be like cases who had previously had more or less negative pressure in the middle ear. Out of the flat tympanograms at 3 years a quarter were still flat at 6 years, and every sixth child did not pass tone audiometric screening. The subgroups boys/girls, nursery school/homecare children, urban/rural children that had exhibited differences in middle ear function at 3 years showed identical results at 6 years. A favourable effect of systematic tracing and active treatment of middle ear pathology from the age of 3 years could not be found at tone audiometry and impedance testing at 6 years. This must, inter alia, shake faith in adenoidectomy as a therapeutic or preventive procedure in dealing with middle ear pathology.