Resolution of middle ear effusion in newborns
D. G. Roberts, C. E. Johnson, S. A. Carlin, V. Turczyk, M. A. Karnuta and K. Yaffee
Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
OBJECTIVES: To determine the natural history of middle ear effusion (MEE)
in newborns and compare the results of pneumatic otoscopy with tympanometry
and acoustic reflex measurements in the evaluation of the middle ear of
neonates. DESIGN: A descriptive natural history study with comparison of
three evaluation methods for MEE. SETTING: County hospital nursery and
pediatric clinic. PARTICIPANTS: Sixty-eight full-term, healthy neonates
were studied on day 1 of life; 65 on day 2; and 24 on day 3. Thirty-eight
infants returned at 2 weeks of age, and from this group, 23 returned at 2
months of age. INTERVENTIONS: Two independent observers performed otoscopy.
An audiologist performed tympanometry and ipsilateral acoustic reflex
measurements. Infants were evaluated daily from birth by all three methods
for up to 3 days. MAIN OUTCOME MEASURE: The time to resolution of MEE as
determined by three methods. RESULTS: In the first 3 hours of life, all
babies examined had MEE diagnosed in both ears. By the third day, MEE
apparently had resolved in 73% of ears by otoscopy, 88% by acoustic reflex
measurements, and 92% by tympanometry. At 2 weeks, MEE was present by
otoscopy in 13% (10/75 of ears). These were primarily newly acquired MEEs.
Interobserver agreement by otoscopy as determined by kappa scores was
moderate on days 1 and 3, poor on day 2, and excellent at 2 weeks and 2
months. CONCLUSIONS: Middle ear effusion diagnosed by otoscopy apparently
resolves in 72 hours in most neonates. Interobserver agreement of
otoscopists was excellent after babies were discharged from the nursery,
suggesting that pneumatic otoscopy can be used to diagnose MEE in neonates
this age. Most MEEs that are diagnosed 2 weeks and 2 months after birth are
new and asymptomatic.
