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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Language, speech sound production, and cognition in three-year-old children in relation to otitis media in their first three years of life.
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Language, speech sound production, and cognition in three-year-old children in relation to otitis media in their first three years of life.

机译：三岁儿童在出生后的前三年与中耳炎有关的语言，语音产生和认知。

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OBJECTIVE: As part of a prospective study of possible effects of early-life otitis media on speech, language, cognitive, and psychosocial development, we tested relationships between children's cumulative duration of middle ear effusion (MEE) in their first 3 years of life and their scores on measures of language, speech sound production, and cognition at 3 years of age. METHODS: We enrolled 6350 healthy infants by 2 months of age who presented for primary care at 1 of 2 urban hospitals or 1 of 2 small town/rural and 4 suburban private pediatric practices. We intensively monitored the children's middle ear status by pneumatic otoscopy, supplemented by tympanometry, throughout their first 3 years of life; we monitored the validity of the otoscopic observations on an ongoing basis; and we treated children for otitis media according to specified guidelines. Children who met specified minimum criteria regarding the persistence of MEE became eligible for a clinical trial in which they were assigned randomly to undergo tympanostomy tube placement either promptly or after a defined extended period if MEE remained present. From among those remaining, we selected randomly, within sociodemographic strata, a sample of 241 children who represented a spectrum of MEE experience from having no MEE to having MEE whose cumulative duration fell just short of meeting randomization criteria. In subjects so selected, the estimated duration of MEE ranged from none to 65.6% of the first year of life and 44.8% of the first 3 years of life. In these 241 children we assessed language development, speech sound production, and cognition at 3 years of age, using both formal tests and conversational samples. RESULTS: We found weak to moderate, statistically significant negative correlations between children's cumulative durations of MEE in their first year of life or in age periods that included their first year of life, and their scores on formal tests of receptive vocabulary and verbal aspects of cognition at 3 years of age. However, the percent of variance in these scores explained by time with MEE in the first year of life beyond that explained by sociodemographic variables ranged only from 1.2% to 2.9%, and the negative correlations were concentrated in the subgroup of children whose families had private health insurance (rather than Medicaid). We found no significant correlations in the study population as a whole or in any subgroup between time with MEE during antecedent periods and children's scores on measures of spontaneous expressive language, speech sound production, or other measured aspects of cognition. In contrast, by wide margins, scores on all measures were consistently highest among the most socioeconomically advantaged children and lowest among the most socioeconomically disadvantaged children. CONCLUSIONS: Our findings suggest either that persistent early-life MEE actually causes later small, circumscribed impairments of receptive language and verbal aspects of cognition in certain groups of children or that unidentified, confounding factors predispose children both to early-life otitis media and to certain types of developmental impairment. Findings in the randomized clinical trial component of the larger study should help distinguish between causality and confounding as explanations for our findings.language, speech, cognition, development, otitis media, middle ear effusion.
机译：目的：作为前瞻性中耳炎对言语，语言，认知和社会心理发展可能影响的前瞻性研究的一部分，我们测试了儿童出生后头3年的中耳积液累积持续时间（MEE）与儿童之间的关系。他们在3岁以下时对语言，语音发声和认知度的得分。方法：我们招募了2350岁的6350名健康婴儿，他们在2家城市医院中的1家或2个小镇/农村中的1家和4家郊区私人儿科诊所就诊。我们在孩子出生后的头3年内，通过气动耳镜对儿童的中耳状况进行了深入监测，并辅以鼓室图。我们持续监测耳镜观察的有效性;我们按照指定的指南对儿童进行了中耳炎治疗。符合指定的关于MEE持久性的最低标准的儿童有资格参加临床试验，在该临床试验中，他们被随机分配立即进行鼓膜置管，或者如果仍存在MEE，则在规定的延长期限后进行。我们从剩余的那些人中，从社会人口统计学层次中随机选择了241名儿童样本，这些儿童代表了一系列的MEE经历，从没有MEE到累积MEE持续时间刚好不符合随机标准的MEE。在如此选择的受试者中，MEE的估计持续时间范围从无到生命的第一年的65.6％，到生命的头三年的44.8％。在这241名儿童中，我们使用正式测试和会话样本评估了3岁时的语言发展，语音产生和认知。结果：我们发现儿童在生命的第一年或包括生命的第一年的年龄段中的MEE累积持续时间与接受词汇和认知方面的形式测验得分之间存在弱到中等的统计显着负相关在3岁时。但是，这些分数的变异百分比由生命的第一年用MEE解释，超出了社会人口统计学变量所解释的变异百分比，范围仅在1.2％至2.9％之间，并且负相关集中于家庭有私人孩子的亚组中。健康保险（而不是医疗补助）。我们发现研究人群的整体或任何亚组之间在前期的MEE时间与儿童的自发表达语言，语音发音或其他认知方面的评分之间没有显着相关性。相反，从很大的角度来看，所有衡量指标的得分在社会经济最有利的儿童中始终最高，而在社会经济最弱势的儿童中最低。结论：我们的研究结果表明，持续的早期MEE实际上会在某些儿童组中引起后来的，较小的，受限制的接受语言和言语方面的认知障碍，或者是未知的混杂因素使儿童容易患早期中耳炎和某些疾病发育障碍的类型。较大研究的随机临床试验组成部分中的发现应有助于区分因果关系和混淆，以解释我们的发现。语言，言语，认知，发育，中耳炎，中耳积液。

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