***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE One current practice guideline recommends myringotomy with tympanostomy tube insertion ( M&T ) for young children in whom middle-ear effusion ( MEE ) has persisted for 3 months , and another recommends the procedure after MEE has persisted for 4 to 6 months provided that a bilateral hearing loss of > or=20 dB is present . Sequelae of M&T are not uncommon , but the extent to which these sequelae are attributable to M&T itself or to the middle-ear disease that prompted the procedure or to both has not been clear . Our objective in the present study was to examine the prevalence of various tympanic membrane ( TM ) abnormalities in otherwise healthy children at the age of 5 years and hearing levels at the age of 6 years in relation to persistent MEE and M&T in the children 's first 3 years of life . METHODS In a prospect i ve study of child development in relation to early-life otitis media , we r and omly assigned 429 children who met specified criteria regarding the persistence of MEE in their first 3 years of life to undergo M&T either promptly ( the " early-treatment " group ) or after a defined extended period if MEE remained present ( the " late-treatment " group ) . We also followed a representative sample of 241 children who ranged from having no MEE to having MEE whose cumulative duration fell just short of meeting r and omization criteria for the clinical trial ( the " nontrial " group ) . Most of the children in each group underwent both  otomicroscopic examination  at the age of 5 years and  audiometric testing  at the age of 6 years , at times when they were free of MEE . Among these children , M&T had been performed in 82.3 % of those in the early-treatment group , 38.1 % of those in the late-treatment group , and 3.0 % of those in the nontrial group . RESULTS At the age of 5 years , we found 1 or more types of TM abnormality in 1 or both ears in 70.7 % , 42.5 % , and 9.5 % of the children in the early-treatment , late-treatment , and nontrial groups , respectively . Within the 3 groups , however , among children who received tubes , the proportions who had an abnormality of some type were similar , namely , 82.6 % , 80.4 % , and 83.3 % , respectively . The corresponding proportions among children who had not received tubes were 15.4 % , 19.3 % , and 7.2 % , respectively . Segmental atrophy and tympanosclerosis were the most common abnormalities found . At the age of 6 years , mean pure-tone average audiometric thresholds in the early-treatment , late-treatment , and nontrial groups , respectively , were 6.18 dB , 5.49 dB , and 4.63 dB in left ears and 6.17 dB , 6.02 dB , and 4.32 dB in right ears . The thresholds in the early- and late-treatment groups did not differ significantly , but the thresholds in the early- and late-treatment groups were each significantly higher than in the nontrial group . Within the early- and late-treatment groups , we found no significant relation between hearing levels and the presence or type of TM abnormalities . CONCLUSION In otherwise healthy children who have persistent MEE during their first 3 years of life , ready resort to M&T results in far more TM abnormalities at age 5 than does selective management in which most children do not receive the procedure . With these differing approaches , however , hearing levels at age 6 do not differ . Regardless of whether children with persistent early-life MEE receive M&T , they have more TM abnormalities at age 5 and negligibly poorer hearing at age 6 than do children who had less or no otitis media . Longer term otologic and audiologic outcomes of persistent early-life MEE and of M&T remain to be determined . In view of 1 ) the present findings and the remaining uncertainties concerning sequelae , 2 ) the fact that M&T involves certain immediate risks -- albeit minimal-- and substantial cost , and 3 ) previously reported findings in the study 's r and omized clinical trial that show no developmental advantage at ages 3 and 4 years accruing from children 's having received prompt M&T , a prolonged period of watchful waiting seems desirable in otherwise healthy children who are younger than 3 years and have persistent , asymptomatic MEE that is not complicated by sensorineural or severe conductive hearing loss , balance dysfunction , or severe TM retraction OBJECTIVE To study the effectiveness of ventilation tubes on the language development in infants with persistent otitis media with effusion ( OME ) . All existing studies addressed children 3 years of age or older . Currently , OME is detected and treated with ventilation tubes at a younger age . Because of the critical relationship between age , hearing , and language development , we conducted a study of the effects of ventilation tubes on language development in infants 1 to 2 years old with persistent OME . DESIGN A multicenter , r and omized , controlled trial ( embedded in a cohort ) with 2 treatment arms : 1 ) treatment with ventilation tubes  ( VT group ; n = 93 ) ; or 2 ) with a period of watchful waiting ( WW group ; n = 94 ) . Hearing loss and expressive and comprehensive language were assessed every 6 months , while tympanometry and otoscopy were performed every 3 months . Other factors with potential influence on language development were also included : adenoidectomy , hospital , attending day care , sex , age at r and omization , educational level of the mother , upper respiratory infections , and the native country of the parents and older siblings . The trial was design ed to allow for the detection of a mean difference in language development of 3 months or more between children allocated to the VT and WW groups . RESULTS No relevant differences were found in expressive or comprehensive language between the 2 groups after adjustment for educational level of the mother , IQ of the child , and differences at baseline . A principal component analysis showed that in the VT group , the children with frequent complaints improved 1.6 months more in comprehensive language than those with no or some complaints . The children with favorable language stimulation , however , did not improve more than the children with less favorable stimulation . No differences were found for expressive language among the various clusters . The probability to improve > 3 months in comprehensive language was.48 ( 95 % confidence interval [CI]:.29-.68 ) for children with highly educated mothers versus.09 ( 95 % CI:.02-.30 ) for children whose mothers had a low educational level . In the WW group , these changes were.30 ( 95 % CI:.14-.53 ) and .14 ( 95 % CI:.04-.35 ) , respectively . The probability to improve > 4 months in expressive language was.52 ( 95 % CI:.32-.71 ) for children with highly educated mothers versus.06 ( 95 % CI:.01-.31 ) for children whose mothers had a low educational level . In the WW group these changes were.42 ( 95 % CI:.23-.64 ) and .11 ( 95 % CI:.03-.35 ) , respectively . In addition , there were delays in expressive language in both groups compared with their age expected values . The comprehensive language of the children who were effusion-free during the follow-up ( n = 54 ) improved 1.5 months ( 95 % CI : -.2 - 3.2 ) more than that of the children who had persistent effusion during the entire follow-up ( n = 28 ) . No differences were found for expressive language development . Disregarding the intervention contrast , improvements in hearing seemed to be related to improvements in language development , especially in verbal comprehension . DISCUSSION In this study , we used the  Reynell , Schlichting , and Lexi tests  to study the relation between early persistent OME and language development . These tests are directly related to normal language , widely accepted , and vali date d. It can not be ruled out that more specific measures such as auditory perception tests would have produced more differences between groups , but the focus was on general language development . A total of 10 children in the WW group received treatment with ventilation tubes during follow-up . A further 11 children dropped out during the trial . A sensitivity analysis with the 10 children who received ventilation tubes did not change the results , and baseline differences were not found between the 11 children who dropped out and those who completed the trial . CONCLUSIONS In the total group of infants with persistent OME , ventilation tubes did not BACKGROUND Developmental impairments in children have been attributed to persistent middle-ear effusion in their early years of life . Previously , we reported that among children younger than 3 years of age with persistent middle-ear effusion , prompt as compared with delayed insertion of tympanostomy tubes did not result in improved cognitive , language , speech , or psychosocial development at 3 , 4 , or 6 years of age . However , other important components of development could not be assessed until the children were older . METHODS We enrolled 6350 infants soon after birth and evaluated them regularly for middle-ear effusion . Before 3 years of age , 429 children with persistent effusion were r and omly assigned to undergo the insertion of tympanostomy tubes either promptly or up to 9 months later if effusion persisted . We assessed literacy , attention , social skills , and academic achievement in 391 of these children at 9 to 11 years of age . RESULTS Mean ( + /-SD ) scores on 48 developmental measures in the group of children who were assigned to undergo early insertion of tympanostomy tubes did not differ significantly from the scores in the group that was assigned to undergo delayed insertion . These measures included the Passage Comprehension subtest of the Woodcock Reading Mastery Tests ( mean score , 98+/-12 in the early-treatment group and 99+/-12 in the delayed-treatment group ) ; the Spelling , Writing Sample s , and Calculation subtests of the Woodcock-Johnson III Tests of Achievement ( 96+/-13 and 97+/-16 ; 104+/-14 and 105+/-15 ; and 99+/-13 and 99+/-13 , respectively ) ; and inattention ratings on visual and auditory continuous performance tests . CONCLUSIONS In otherwise healthy young children who have persistent middle-ear effusion , as defined in our study , prompt insertion of tympanostomy tubes does not improve developmental outcomes up to 9 to 11 years of age . ( Clinical Trials.gov number , NCT00365092 [ Clinical Trials.gov ] . ) The  treatment of deafness secondary to glue ear by grommet insertion  is compared to Fifty-four children with established chronic secretory otitis media , who had failed to respond to medical measures were treated with adenoidectomy and insertion of 1 grommet on a side chosen at r and om . Both sides improved and remained significantly improved at 12 months ( P less than 0.001 ) . At 3 months , the side with the grommet improved significantly more than the other side ( P less than 0.05 ) but at 12 months there was no significant difference between the 2 sides ( P greater than 0.1 ) Objective To determine the clinical effectiveness of topical intranasal corticosteroids in children with bilateral otitis media with effusion . Design Double blind r and omised placebo controlled trial . Setting 76 Medical Research Council General Practice Research Framework practice s throughout the United Kingdom , between 2004 and 2007 . Participants 217 children aged 4 - 11 years who had at least one practice recorded episode of otitis media or a related ear problem in the previous 12 months , and with bilateral otitis media with effusion confirmed by a research nurse using otoscopy plus micro-tympanometry ( B/B or B/C2 , modified Jerger types ) . Intervention Mometasone furoate 50 µg or placebo spray given once daily into each nostril for three months . Main outcome measures Proportions of children cured of bilateral otitis media with effusion assessed with tympanometry ( C1 or A type ) at one month ( primary end point ) , three months , and nine months ; adverse events ; three month diary symptoms . Results 41 % ( 39/96 ) of the topical steroid group and 45 % ( 44/98 ) of the placebo group were cured in one or both ears at one month ( difference favouring placebo 4.3 % ( 95 % confidence interval −9.3 % to 18.1 % ) . Poisson regression was done with adjustment for four pre-specified covariates ( clinical severity , P=0.003 ; atopy , P=0.67 ; age , P=0.92 ; season , P=0.71 ) . The adjusted relative risk at one month was 0.97 ( 95 % confidence interval 0.74 to 1.26 ) . At three months , 58 % of the topical steroid group and 52 % of the placebo group were cured ( relative risk 1.23 , 0.84 to 1.80 ) . Diary symptoms did not differ between the two groups , and no significant harms were reported . Conclusions Topical steroids are unlikely to be an effective treatment for otitis media with effusion in general practice . High rates of natural resolution occurred by 1 - 3 months . Trial registration Current Controlled Trials IS RCT N38988331 ; National Research Register NO575123823 ; MREC 03/11/073 BACKGROUND To prevent later developmental impairments , myringotomy with the insertion of tympanostomy tubes has often been undertaken in young children who have persistent otitis media with effusion . We previously reported that prompt as compared with delayed insertion of tympanostomy tubes in children with persistent effusion who were younger than three years of age did not result in improved developmental outcomes at three or four years of age . However , the effect on the outcomes of school-age children 
    Output:
    
In children with OME the effect of grommets on hearing , as measured by st and ard tests , appears small and diminishes after six to nine months by which time natural resolution also leads to improved hearing in the non-surgically treated children .
No effect was found on other child outcomes but data on these were sparse .
No study has been performed in children with established speech , language , learning or developmental problems so no conclusions can be made regarding treatment of such children