Middle ear disease - Uncertain whether it increases the risk of behaviour problems at 10 years
Clinical Bottom Line
Middle ear disease is associated with a small increase in behaviour problems at 10 years but the difference may not be clinically significant and may be partly explained by socio-economic factors.
Citation
Bennett, K.E. Haggard M.P.Behaviour and cognitive outcomes from middle ear disease. Arch Dis Child 1999;80:28-35 .
Clinical Question
Are children with middle ear disease at increased risk of behaviour problems?
The Study
- Large, national birth cohort of 12,000 children.
- Middle ear disease (discharge or hearing difficulty) and behaviour measured at 5 and 10 years by parental responses to questions and child assessment. Behaviour at 10 years also measured by teacher responses.
- Follow up of about 12, 000 at 5 years and about 9,000 at 10 years. Authors state that loss to follow up did not significantly affect proportions that had middle ear disease.
The Evidence
| Antisocial | Neurotic | Hyperactive | Poor Conduct | |
|---|---|---|---|---|
| Difference in Behaviour Score @ 5 years | 0.12 (0.06 to 0.18) |
0.20 (0.14 to 0.25) |
0.19 (0.12 to 0.25) |
0.07 (0.01 to 0.13) |
| Difference in Behaviour Score @ 10 years | -0.01 (-0.07 to 0.06) |
0.15 (0.08 to 0.22) |
0.25 (0.18 to 0.32) |
0.07 (0.00 to 0.14) |
Comments
- The differences in behaviour score are small. However, middle ear disease is common (10% in this cohort) and at a population level, these small differences may be clinically important.
- The slightly higher adverse behaviour scores in children with hearing difficulty could be partly explained by residual confounding due to socio-economic factors.
- Occurence of middle ear disease was based on parental reports and misclassification of exposure was likely. This may reduce the strength of true associations.
Appraised By
R. Gilbert; 4 March 1999
Expiry Date
March 2000