Objective-To compare the efficacy of three surgical treatment combinations -myringotomy and tympanostomy tube insertion (M&T), adenoidectomy with M&T (A-M&T), and adenoidectomy with myringotomy (A-M) -in reducing middle ear disease in young children with chronic OME.Methods-Children 24-47 months of age, with a history of bilateral middle-ear effusion (MEE) for at least 3 months, unilateral for 6 months or longer or unilateral for 3 months after extrusion of a tympanostomy tube, unresponsive to recent antibiotic, were randomly assigned to either M&T, A-M&T, or A-M. Treatment assignment was stratified by age (24-35 months, 36-47 months), nasal obstruction (no, yes) and previous history of M&T (no, yes). Subjects were followed monthly and with any signs or symptoms of ear disease for up to 36 months.Results-Ninety-eight subjects were randomly assigned to the 3 treatment groups. Fifty-six subjects (57%) were 24-35 months of age; 63% had nasal obstruction, and 36% had previously undergone M&T. During the 36 months after entry, subjects were noted to have MEE for the following percentages of time: 18.6% in the M&T group, 20.6% in the A-M&T group, and 31.1% in the A-M group (M&T vs A-M&T, p=.87; M&T vs A-M, p=.01). By 36 months, there were no differences in the number of further surgical procedures for ear disease needed among the groups.Conclusions-Adenoidectomy with or without tube insertion provided no advantage to young children with chronic OME in regard to time with effusion compared to tube insertion alone. Fewer tympanostomy tubes were placed in children undergoing A-M as their initial procedure, but this should be balanced by the performance of the more invasive surgical procedure and their increased time with effusion.

Objective-To obtain normative longitudinal vestibulo-ocular and balance test data in children from ages 3 to 9 with normal middle-ear status. Study Design-Prospective, longitudinal cohort Setting-Tertiary care pediatric hospitalSubjects and Methods-Three-year-old children were entered and tested yearly. Subjects underwent earth vertical axis rotation testing using sinusoidal and constant velocity stimuli and performed the Sensory Organization Test.Results-One hundred forty-eight children were entered and usable data were collected on 127 children. A linear increase in the vestibulo-ocular reflex gain as children aged was found, without a change in the phase of the response. An age-related linear increase in Equilibrium Scores, indicating reduced postural sway, was also observed.Conclusion-These normative data can be used in the evaluation of dizziness and balance disorders in children.

Children with otitis media with effusion (OME) have been shown to have a significantly higher velocity of sway than normal children. To further evaluate the effect of OME on balance, we studied visual dependency for balance by investigating the influence of optic flow on postural sway. The results of this preliminary study suggest that children with OME may be more visually dependent for balance than healthy age-matched controls. This was particularly evident for higher-frequency stimulus conditions (0.25 Hz) as opposed to lower-frequency stimulus conditions (0.10 Hz). These findings indicate that OME may affect vestibular function in children, thereby causing excessive reliance on other, nonvestibular sensory cues to maintain balance. Further studies are needed to define the role of vestibular function in the management of children with OME.

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