Resolution of middle ear effusion in newborns.
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.