Table 28Functional and health-related quality-of-life outcomes: Tympanostomy tubes versus watchful waiting or myringotomy

StudyArm (N)Study Duration Until Outcome MeasurementSpeech/Language
Cognitive Development
Academic AchievementPhonological Processing/Auditory ProcessingBehaviorQuality of Life
Browning et al., 201022MA:3 RCTs
(N=394)
Maw et al., 199993
Rach et al., 1991100
Rovers et al., 200094
6–9 months
Language Comprehension, Bilateral TT vs. WW: Mean Difference 0.09 (95% CI, −0.21, 0.39)NRNRNRNR
MA: 3 RCT
(N=393)
Maw et al., 199993
Rach et al., 1991100
Rovers et al., 200094
6–9 monthsLanguage Expression
TT vs. WW: Mean Difference 0.03 (95% CI, −0.42, 0.49)
NRNRNRNR
1 RCT by child
Maw et al., 199993
(N=160)

Companions:
Wilks et al., 2000142

Hall et al., 2009141
9 monthsGriffiths Mental Development Mean Cognitive Index
TT vs. WW
106.5 vs. 104.2 (95% CI, −2·58 to 7·04) (p=ns)
NRNRRichman Behavioral Scale, % with Problems
(N=152)
TT vs. WW
30% vs. 47% (95% CI, −33% to –2%) p=0.031 (favors tx)
NR
18 months
(N=152)
Mean age 4.5 years
NRNRNR24% vs. 20% (95% CI, −10% to 19%) p=0.66NR
7 years of age
(N=108)
NRNRNRSDQ, Teacher Reporta
Total Score
OR: 2.05 (95% CI, 0.62 to 6.70)
p=0.237
NR
8 years of age
(N=108)
Language Comprehensiona
Total Score
TT vs. WW
OR: 1.58 (95% CI, 0.59 to 4.25)
p=0.366

Oral Expressiona
Total Score
TT vs. WW
OR: 2.10 (95% CI, 0.78 to 5.65
p=0.143

WISC-IIIa
Total Score
TT vs. WW
OR: 2.39 (95% CI, 0.85 to 6.76)
p=0.100
Reading
TT vs. WW
OR: 1.57 (95% CI, 0.72 to 3.43)

Writing
OR: 0.597 (95% CI, 2.05 to 0.92)

Mathematics
OR: 0.618 (95% CI, 1.71 to 0.77)
NRNRNR
1 RCT (by child) Paradise et al., 200168
(N=393)
3 years of agePPVT-R
Early Tubes vs. Late Tubes
92 vs. 92 (95% CI, −2.8 to 2.8)

McCarthy Mental Development
Mean General Cognitive Index
Early Tubes vs. Late Tubes
99 vs. 101 (95% CI, −4.1 to 1.1)
NRNRCBCL (Parent) Mean Total Problem Score
Early Tubes vs. Late Tubes
50 vs. 49
(95% CI, −0.6 to 3.4)
NR
Paradise et al., 200569
(N=395)
6 years of agePPVT-R
Early Tubes vs. Late Tubes
94 vs. 94 (95% CI, −3.6 to 3.2)

WISC-R
Early Tubes vs. Late Tubes
98 v. 98 (95% CI, −3.0 to 2.5)
NRSCAN Test
Early Tubes vs. Late Tubes
95 vs. 94 (95% CI, −4.6 to 1.5)
CBCL (Parent)
Early Tubes vs. Late Tubes
49 vs. 48 95% CI, −1.5 to 2.7)
NR
Paradise et al., 200767
(N=391)
9–11 years of ageNRWJRMT Word Identification
Early Tubes vs. Late Tubes
98 vs. 99 (95% CI, −3.2 to 1.3)

WJRMT Passage Comprehension
Early Tubes vs. Late Tubes
98 vs. 99 (95% CI, −3.2 to 1.2)

W-J III Spelling
Early Tubes vs. Late Tubes
96 vs. 97 (95% CI, −3.9 to 2.0)

WJ III Writing
Early Tubes vs. Late Tubes
104 vs. 105 (95% CI, −4.1 to 1.7)
CTPP Elision Subtest
Early Tubes vs. Late Tubes
8.6 vs. 8.7 (95% CI, −0.9 to 0.7)

Children’s HNT (noise tested from the front
Early Tubes vs. Late Tubes
−0.4 vs. −0.6 (95% CI, −0.06 vs. 0.58)
CBCL (Parent)
Early Tubes vs. Late Tubes
51 vs. 49 (95% CI, 0.2 to 4.8)
NR
1 RCT (by child)
Rovers et al., 2001140
(N=176)
6 monthsNRNRNRThe Erickson child
Mean scores
TT vs. WW
Affection
4.4 vs. 4.6
Avoidance
6.3 vs. 6.5
Compliance
5.1 vs. 5.2
Negativism
6.6 vs. 6.7
Reliance
6.5 vs. 6.7

MANOVA Hotelling Trace p=0.19
The TAIQOL
Mean scores
TT vs. WW
Vitality
3.3 vs. 3.3
Appetite
5.0 vs. 4.7
Communication
G1: 6.7 vs. 5.8
Motoric
4.4 vs. 4.4
Social
3.5 vs. 3.5
Anxiety
4.3 vs. 4.1
Aggression
11.9 vs. 11.1
Eating
3.3 vs. 3.5
Sleeping
6.8 vs. 6.6

MANOVA Hotelling Trace p=0.22
12 months
(N=165)
NRNRNRAffection
4.5 vs. 4.9
Avoidance
6.5 vs. 6.9
Compliance
5.2 vs. 5.6
Negativism
6.6 vs. 6.9
Reliance
6.6 vs. 6.8

MANOVA Hotelling Trace p=0.38
Vitality
3.1 vs.3.2
Appetite
5.3 vs.4.9
Communication
5.9 vs.5.6
Motoric
4.2 vs.4.2
Social
3.5 vs. 3.5
Anxiety
4.6 vs. 4.3
Aggression
11.8 vs.11.5
Eating
3.3 vs. 3.4
Sleeping
6.4 vs. 6.4

MANOVA Hotelling Trace p=0.94

CBCL = Child Behavior Checklist; CI = confidence interval; CTPP = Comprehensive Test of Phonological Processing; HNT = Hearing in Noise Test; MA = meta-analysis; MANOVA = Multivariate analysis of variance; N = number; NR = not reported; ns = not sufficient; OR = odds ratio; PPVT-R = Peabody Picture Vocabulary Test, Revised; RCT = randomized controlled trial; SDQ = Strengths and Difficulties Questionnaire; TAIQOL = TNO-AZL Infant Quality of Life; TT = tympanostomy tubes; tx = treatment; vs. = versus; W-J III = Woodcock-Johnson III Tests of Achievement; WISC-III = Wechsler Intelligence Scale for Children, Third edition; WISC-R = Wechsler Intelligence Scale for Children, Revised; WJRMT = Woodcock-Johnson Reading Mastery Test –Revised; WW = watchful waiting

a

Analyses adjusted for age, gender, maternal education, housing and mother’s parity.

From: Results

Cover of Otitis Media With Effusion: Comparative Effectiveness of Treatments
Otitis Media With Effusion: Comparative Effectiveness of Treatments [Internet].
Comparative Effectiveness Reviews, No. 101.
Berkman ND, Wallace IF, Steiner MJ, et al.

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