LISTEN UP! OTITIS MEDIA

Excerpted from the Briggs and Associates Newsletter, Fall 2003

Otitis Media: What is it?

“Otitis media” (OM) is a generic term that refers to an inflammation within the middle ear cavity which is normally air filled. It is the most frequent illness of early childhood after the common cold. OM occurs most often during the first three years of life because the young child’s Eustachian tubes are more horizontal. This makes fluid drainage from the middle ear space more difficult especially during periods of mucous congestion. If the middle ear is filled with fluid, the eardrum cannot vibrate and thus hearing may be decreased.

There are several types of OM. Acute Otitis Media (AOM) involves fluid behind the eardrum that is infected and is usually accompanied by rapid onset of symptoms such as fever and pain. Otitis Media with Effusion (OME) is the presence of fluid behind the eardrum that is not infected. OME typically causes a mild to moderate conductive hearing loss that lasts as long as the fluid persists. The fluid may persist for several weeks or months. Children with fluid that persists more than 3 months are considered to have chronic OME.

Why do speech-language pathologists care so much about OM in your child?

Because speech and language development depend on good hearing, we will want to know if your child has had or is currently experiencing OME. It has been hypothesized that the mild to moderate hearing loss caused by OME disrupts the ability to…

HEAR – OME results in hearing loss about half of the time. Generally, this loss is conductive and is related to the amount and thickness of the fluid in the middle ear space. Hearing returns to normal when the OME resolves. Repeated bouts of OME, however, can cause a hearing loss in the high frequencies (those frequencies important for the perception of speech sounds such as “s, f, th”).
ATTEND to auditory based information especially in noisy situations
PROCESS language at a rapid rate thus affecting both comprehension and production of language. For example, the disruption and variability of auditory input may cause children to encode information incompletely or inaccurately. Children with OME may not hear or may inaccurately hear grammatical units such as third person /s/. For example, they may not notice the “s” on the end of a word that distinguishes “cat” from “cats.”

What does the research show us?

The research is still controversial. Despite a considerable number of studies conducted during the past three decades on whether children with frequent OME in early childhood score lower on measures of speech, language, and academic achievement than children without such a history, there is still a lack of consensus. There seems to be increasing support that, on average, for typically developing children, OME may not in general be a substantial risk factor for speech and language development in the long term. However, OME may present an increased risk to the later speech and language development for children with developmental disabilities such as Down Syndrome, Williams Syndrome, Apert syndrome, Fragile X syndrome, Turner syndrome, cleft palate, and Autism (Zeisel and Roberts, 2003).

Several ongoing prospective studies are providing new and important information about other factors that influence the presence and affects of OME in typically developing children. Roberts and Colleagues at University of North Carolina found that the responsiveness of a child’s home and childcare environments played an important role in the relationship of OME, associated hearing loss and children’s language development during infancy. They found a mild association between a history of OME and later development of expressive language, but they found that children caught up by second grade. A child’s home environment was a much stronger prediction of language than was a history of OME.

Until further research can definitively establish whether a relationship between a history of OME and later developmental skills exists, each child’s hearing status, language development and unique developmental profile must be considered in the management of young children with histories of OME.

What to do:

Parents

Wash child and adult hands after blowing noses or going to the bathroom.
If possible, breast feed for the first 4 to 6 months of life.
Bottle feed in an upright position or slightly leaning position.
Keep children away from cigarette smoke.
Provide a highly responsive language and literacy enriched environment.
Promote optimal listening by decreasing background noise.

Pediatricians

Give special consideration to children at high risk for developmental difficulties when hearing loss is present with persistent OME.
Screen a child’s speech, language, and hearing after 3 months of bilateral OME, after 4-6 episodes of OM in a 6 month period, and/or when families or caregivers express concerns regarding a child’s development.
Screen for OME and hearing loss twice yearly in children with Down Syndrome, cleft plate or other populations who are at high risk of OME.
Routinely screen children already receiving speech therapy who have chronic OME as part or an ongoing intervention program.
Provide families, caregivers and health care professionals with current, clear and accurate information.