Author(s)
Alexander Fahmy, BS
Kavita Dedhia, MD, MSHP
Doreen Lam, BA
Alisa Timashpolsky, MD
Melanie Cedrone, MS
Affiliation(s)
CHOP; DUCOM, UPenn
Abstract:
Objective:
Systematically review existing literature characterizing developmental outcomes for children undergoing surgical otitis media (OM) management.
Methods:
A search of Pubmed, EMBASE, Cochrane Library, Scopus databases was performed from inception to 2022. Studies assessing developmental outcomes in surgical pediatric OM management using validated instruments were included.
Results:
The search yielded 1273 studies, 81 underwent full text review and 13 studies met inclusion criteria. Three randomized controlled trials (RCT), 9 prospective cohort studies, and one retrospective cohort study were included. Developmental outcomes were assessed using 9 different outcome measure instruments (OMI), which measured patient’s verbal ability, reading comprehension and social behavior. Studies reported that OM negatively affected a child’s learning, decreased language, and speech development, and negatively impacted social behavior. There was limited consistency among developmental OMIs, with two being used in multiple studies: 5 studies used the McCarthy Scales of Children’s Abilities test, and 2 used the SDQ- Danish test. Median follow-up was 12.5 months (IQR:3.75-36). Race and socioeconomic factors were inconsistently reported. Developmental or behavioral outcome improvement after tympanostomy tubes (TT) was reported in 3 studies (2RCTs, N=383 and 1 prospective, N=96) but equivocal in 9 studies (1 RCT, N=187 and 8 prospective, N=61501). Outcomes worsened in 1 study (1 retrospective, N=7599).
Conclusion: s
Limitations in current studies assessing developmental outcomes after pediatric OM surgery exist due to heterogeneity of OMI, variation in follow-up, and few RCTs which do not allow for a meta-analysis. Lack of consistent demographic reporting also limits generalizability of findings. Higher level RCTs showed TT improved outcomes, yet prospective studies with a larger total number of patients showed equivocal findings. To adequately measure developmental outcomes, a validated tool focused on measuring speech/language acquisition, social behavior, and other aspects of both cognitive and motor developmental is necessary. This is essential to measure the impact of surgical OM management on developmental outcomes.