Although these estimates must be viewed with great caution due to heterogeneity that arose from study design and documentation issues for which we could not adjust in our analysis, about 22.5 to 42.7 percent cumulatively resolved over a period of three months, depending on the definition of OME resolution. Our findings on the possible effects of early life otitis media on speech and language development are in general agreement with the 1994 Agency for Healthcare Research and Quality OME guideline conclusion that rigorous, methodologically sound research does not adequately support or refute the possible effect of otitis media on speech and language. We found that children with early life otitis media have a greater risk of conductive hearing loss at age 6 to10 years. In addition, we found that pneumatic otoscopy had the best operating characteristics among the nine alternatives examined, for diagnosing the presence of middle-ear effusion in OME at single points in time.
Considering the abundance of literature addressing otitis media, these findings concerning natural history, speech and language development, and hearing are very limited. Future research on the natural history of otitis media with effusion must focus on improving study quality. In particular, control of therapeutic intervention during the study and the distinction between OME persistence and recurrence needs to be addressed. For evaluation of long-term effects of early life otitis media on speech, language, or hearing, a coordinated approach that uses uniform definitions and considers the interactions of multiple risk factors, interventions, and outcome measures is recommended. Such an integrated approach is also important for the evaluation of diagnostic methods. Further, a systematic review of diagnostic studies that employ algorithms or aggregated scores may be useful.