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Early Insertion of Tympanostomy Tubes Does Not Improve Developmental Outcomes


  • Does delayed placement of tympanostomy tubes in toddlers with chronic otitis media in children with severe disease and hearing loss put their language skills at risk of delayed development at age three?

Clinical Bottom Lines

  1. No significant difference in development was found between children with tympanostomy tubes placed early vs. "watchful waiting" before placement of tympanostomy tubes.
  2. In otherwise healthy children with persistent middle ear effusion, early insertion of tympanostomy tubes does not improve developmental outcome, regardless of duration, location or accompanying mild to moderate hearing loss.

Summary of Key Evidence

  1. 6360 healthy infants were followed prospectively. 429 children with persistent middle ear effusion agreed to participate in the study and were randomized to receive tympanostomy tubes as soon as possible or to be reassessed 9 months later if the effusion persisted.1
  2. These children received audiologic exams, and developmental exams
  3. Subgroup analysis of groups that might be the most severely affected such as bilateral effusions, continuous effusions and the greatest degree of hearing loss were performed and did not show an increased risk to these children.
  4. 82% of the early placement group and 34% of the late placement group ultimately had tympanostomy tubes placed.

Additional Comments

  • This study does not address treatment for recurrent otitis media infections.
  • Acute otitis media (AOM) costs approximately $5 billion annually in the United States, 40 % in patients between the ages of one and three years old.


  1. Paradise JL, et al. Early versus delayed insertion of tympanostomy tubes for persistent otitis media: developmental outcomes at the age of three years in relation to prerandomization illness patterns and hearing levels. Pediatric Infectious Disease Journal. 2003;22:309-14.
  2. Paradise JL, et al. Effect on Early of Delayed Insertion of Typanostomy Tubes for Persistent Otits Media on Developmental Outcomes at the age of Three Years. New England Journal of Medicine. 2001;344:1179-87.

CAT Author: Nicole Perdue, MD

CAT Appraisers: Ken Pituch, MD

Date appraised: September 17, 2003

Last updated April 26, 2004
Department of Pediatrics and Communicable Diseases
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