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document
Language , speech sound production , and cognition in three-year-old children in relation to otitis media in their first three years of life . OBJECTIVE As part of a prospective study of possible effects of early-life otitis media on speech , language , cognitive , and psychosocial development , we tested relationships between children 's cumulative duration of middle ear effusion ( MEE ) in their first 3 years of life and their scores on measures of language , speech sound production , and cognition at 3 years of age . METHODS We enrolled 6350 healthy infants by 2 months of age who presented for primary care at 1 of 2 urban hospitals or 1 of 2 small town/rural and 4 suburban private pediatric practices . We intensively monitored the children 's middle ear status by pneumatic otoscopy , supplemented by tympanometry , throughout their first 3 years of life ; we monitored the validity of the otoscopic observations on an ongoing basis ; and we treated children for otitis media according to specified guidelines . Children who met specified minimum criteria regarding the persistence of MEE became eligible for a clinical trial in which they were assigned randomly to undergo tympanostomy tube placement either promptly or after a defined extended period if MEE remained present . From among those remaining , we selected randomly , within sociodemographic strata , a sample of 241 children who represented a spectrum of MEE experience from having no MEE to having MEE whose cumulative duration fell just short of meeting randomization criteria . In subjects so selected , the estimated duration of MEE ranged from none to 65.6 % of the first year of life and 44.8 % of the first 3 years of life . In these 241 children we assessed language development , speech sound production , and cognition at 3 years of age , using both formal tests and conversational samples . RESULTS We found weak to moderate , statistically significant negative correlations between children 's cumulative durations of MEE in their first year of life or in age periods that included their first year of life , and their scores on formal tests of receptive vocabulary and verbal aspects of cognition at 3 years of age . However , the percent of variance in these scores explained by time with MEE in the first year of life beyond that explained by sociodemographic variables ranged only from 1.2 % to 2.9 % , and the negative correlations were concentrated in the subgroup of children whose families had private health insurance ( rather than Medicaid ) . We found no significant correlations in the study population as a whole or in any subgroup between time with MEE during antecedent periods and children 's scores on measures of spontaneous expressive language , speech sound production , or other measured aspects of cognition . In contrast , by wide margins , scores on all measures were consistently highest among the most socioeconomically advantaged children and lowest among the most socioeconomically disadvantaged children . CONCLUSIONS Our findings suggest either that persistent early-life MEE actually causes later small , circumscribed impairments of receptive language and verbal aspects of cognition in certain groups of children or that unidentified , confounding factors predispose children both to early-life otitis media and to certain types of developmental impairment . Findings in the randomized clinical trial component of the larger study should help distinguish between causality and confounding as explanations for our findings.language , speech , cognition , development , otitis media , middle ear effusion .
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Intervention_Physical
pneumatic otoscopy
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Intervention_Physical
supplemented by tympanometry
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Intervention_Physical
otitis media
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Intervention_Surgical
tympanostomy tube placement
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Outcome_Mental
measures of language , speech sound production , and cognition
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Outcome_Mental
language development , speech sound production , and cognition
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Outcome_Mental
scores on formal tests of receptive vocabulary and verbal aspects of cognition
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Outcome_Mental
spontaneous expressive language , speech sound production , or other measured aspects of cognition
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Outcome_Other
scores on all measures
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Outcome_Mental
developmental impairment
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Outcome_Mental
findings.language , speech , cognition
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Participant_Condition
three-year-old children in relation to otitis media in their first three years of life .