Tympanostomy tube outcomes in children at-risk and not at-risk for developmental delays.

OBJECTIVES: To assess outcomes after tympanostomy tubes in children at-risk or not-at-risk for developmental delays based on criteria from the American Academies of Pediatrics, Family Physicians, and Otolaryngology - Head and Neck Surgeons. METHODS: Historical cohort study in a pediatric otolaryngology practice at an urban, not-for-profit hospital. All children had baseline audiometry followed by bilateral tube insertion with a Likert-type outcome questionnaire administered to the caregiver by telephone (86%) or mail (14%). RESULTS: We identified 229 eligible children aged .5-13 years, of which caregivers of 168 children (73%) were available for follow-up at a median time of 2.0 years (range .7-3.1 years). Most children (55%) had at least one condition placing them at-risk for developmental delays. The mean pure-tone average at baseline for the better-hearing ear was 32dB HL (10.4 SD). After tube insertion most caregivers (89%) stated that their child's life "much better," and that expectations were met (60%) or exceeded (38%). Speech and language was "much better" for 55%, more often in at-risk children (odds ratio 4.6, 95% CI 2.4-8.8). Similarly, learning or school performance was "much better" after tubes for 55%, more often in at-risk children (odds ratio 3.1, 95% CI 1.6-5.9). Improved hearing was reported by 84% with no relationship to at-risk status. CONCLUSIONS: Caregivers reported favorable outcomes regardless of their child's at-risk status, but children at-risk for delays had better reported outcomes for speech, language, learning, and school performance. Results are limited by lack of a control group and reliance on caregiver-report, but add to the very limited data currently available about predictors of benefit from tubes.

Duke Scholars

Author David W Jang Rhinology and Skull Base Surgery