.-l/j/n* < í M S r h it t h rA cohort of 946 children who were screened for otitis media with effusion (OME) from the ages of S to 4 were studied for language» reading, and spelling at 7 years of age. The effects of OME in combination with single risk factors and with ♦ An interaction with an additional risk factor was found only for gender and OME, with boys' spelling influenced negatively by a history of OME, OME in combination with preterm birth and low birthweight also appears to put children at risk for later langauage and educational problems* Although a negative linear relation between the number of risk factors and later functioning was found, it is suggested that OME, t produces only minor effects on later language, reading, and spelling.O titis media with effusion (OM R) is one of th e most com m on iseases in earlv childhood. it is also considered a-risk factor ior latersp eech , language, an d associated learning problems, because it is accom panied by a loss of conductive hearing (Silva et al. 19tt(5 OMR to later language an d educational problem s art1 nevertheless conflicting. In recent prospective studies, the associa tion ol OM R with taler language and educational problem s has been found to be fairly weak ( H u b b a rd et al. 1985( H u b b a rd et al. : Lous et al. 1988 Fried Patti 1990; H u b erts et ai. 1991. 1994 Oravel and Wallace 1992: O rievuik et al. 1993: Schildcr et al. 19911a: Peters et al. 1994. W henever there are detrim en tal effects o f early OM R a t school age. they ap p ear to be of little practical im p o rta n c e (R o b e rts et al, 1991, 1994 (írievink et al. 1993: Pesters et al. 1994, Most ehil-( dren with OMR a p p e a r to overcom e th e sh o rt-term effects of OMR as soon as th e disease disap]»ears, even when the OM R has been 1 o u tla s tin g . T hese results also do not change when tin* frequency of th e ( )M E a n d the p a tte rn of its recurrence arc taken into account ((írievink et ai. Í993, Peters el: al. 1994((írievink et ai. Í993, Peters el: al. , R oberts el al. 1994. In o th e r studies, however, a m ajor effect of OM R on later language* and learn in g has been found (Silva et al. l9S(i,Teele et al. 1990). In search of an explanation for these differences, it lias been suggested th at th e effect o f ( )MR m later language an d learn in g may be the cum ulative effect of a n u m b er of risk faetors {Rapin 1979. M enyuk 1980, Bishop and Rdm undson 198H, Lous et al, 1988, 1 Varee et al. 1988, R oberts and Schuele 1990. R o b e rts cl al. 1991). Some a u th o rs ( R oberts and Schuele 1990, R o b erts ct al. 1991) suggest th a t it is im p o rtan t to consider those variables that may potential* lv co n trib u te to th e effects o f OM R as we'll. In this study, it is 1 * assumed that most children can cope w ith OM R and th a t diffi culties may most often arise in tin* presence of o th er risk fac tors. If th e negative effects o f ( )M R arise from its coincidence with o th e r risk factors, one can expect to find only small effects of OMK in a...