Otitis media and speech and language: a meta-analysis of prospective studies

Article Outline

• Copyright

Roberts JE, Rosenfeld RM, Zeisel SA. Pediatrics 2004;113:e238-48

Context Considerable controversy surrounds whether a history of otitis media with effusion (OME) in early childhood causes later speech and language problems.

Objectives To determine (1) whether a history of OME in early childhood is related to receptive language, expressive language, vocabulary, syntax, or speech development in children 1 to 5 years of age; and (2) whether hearing loss caused by otitis media in early childhood is related to children's receptive language or expressive language through 2 years of age.

Design Systematic review of prospective studies examining how OME in early childhood relates to later speech and language skills.

Main outcome measures Speech and language outcomes in children tested between 1 and 5 years of age.

Study identification The authors searched online databases and bibliographies of OME studies and reviews for prospective or randomized clinical trials published between January 1966 and October 2002 that examined the relationship of OME or OME-associated hearing loss in early childhood to children's later speech and language development.

Studies reviewed Of the 38 studies identified, 14 had data suitable for calculating a pooled correlation coefficient (correlational studies) or standard difference between parallel groups (group studies).

Results There were no significant findings for the analyses of OME during early childhood versus receptive or expressive language during the preschool years in the correlation studies. Similarly, there were no significant findings for OME versus vocabulary, syntax, or speech during the preschool years. Conversely, there was a significant negative association between OME and preschoolers' receptive and expressive language (lower language, 0.24 and 0.25 standard difference, respectively) in the group studies. In addition, hearing was also related to receptive and expressive language in infancy (3%–9% of variance).

Conclusions The results indicate no to very small negative associations of OME and associated hearing loss to children's later speech and language development. These findings may overestimate the impact of OME on outcomes because most studies did not adjust for known confounding variables (such as socioeconomic status) and excluded data not suitable for statistical pooling, especially from methodologically sound studies. Although some OME language differences were detectable by meta-analysis due to increased statistical power, the clinical relevance for otherwise healthy children is uncertain.

Comment Otitis media is one of the most common problems addressed by general pediatricians. Yet questions still exist regarding the potential impact of OME on a child's speech and language development. Prior systematic reviews have been limited by a number of factors: the inclusion of retrospective studies, the combination of multiple age groups, and the grouping of multiple outcomes together. The present study is a well-planned analysis designed to overcome many of these limitations. Although the authors found that OME (and the transient hearing loss that accompanies OME) in early childhood has small to no impact on speech and language development up to age 5, these results should be interpreted with a modicum of caution. First, whereas meta-analyses are used to pool small studies together to achieve a higher power to detect differences, these analyses may have still been underpowered due to the fact that the studies reviewed used a variety of outcome measures. However, the results were consistent across analyses, lending some support to the conclusions. Second, there were not enough children older than 5 years, so we cannot say anything about longer-term effects based on this study. Third, it is likely the hearing loss, not the mere presence of OME, affects the speech and language development, and few studies actually measured the degree or duration of hearing loss. Finally, as the authors point out, the children included in these analyses are in general healthy, and their outcomes may not represent those of children at higher risk (those with Down syndrome or with baseline hearing loss). I view these results as somewhat reassuring, but parents and pediatricians may also desire larger, more definitive studies.