Effects of early middle ear effusion on child intelligence at three, five, and seven years of age.

Abstract

This study tested the hypothesis that children with prolonged middle ear effusion (MEE) during the first 3 years of life are at risk for cognitive delays or deficits. A prospective study enrolled 698 children from diverse backgrounds and controlled for eight demographic and environmental factors. Participants were recruited at birth and monitored for ear status frequently in the home; 379 children were assessed for cognition with the Stanford-Binet, 4th ed., at 3 years of age, 294 at 5 years, and 198 at 7 years. Using the SAS General Linear Models (GLM) procedure, we found a significant direct relation between duration of bilateral MEE and Stanford-Binet Composite and Nonverbal Reasoning/Visualization Factor scores at age 3, but not at age 5 or age 7. Statistical clustering analysis revealed four groups with different temporal patterns of MEE: Low MEE, Early MEE (peaking at 0-6 months), Later MEE (peaking at 6-12 months), and High MEE. GLM analyses revealed no direct effects, but several moderated effects, of MEE cluster on cognitive development at 3 years, but none at 5 or 7 years. In general, children in the Later MEE and High MEE groups appeared to be more adversely affected by bilateral MEE at 3 years, but effects were moderated in complex ways by socioeconomic status or home stimulation. Growth curve modeling across the three assessment periods showed no effects of total duration of MEE but did indicate that children in the Later MEE cluster had low scores at age 3 but caught up at ages 5 and 7. Prolonged MEE, especially between 6 and 12 months, may put children at risk for cognitive delays at 3 years, but the risk effect is not strong and effects are no longer detectable at 5 or 7 years.