Otitis media and linguistic incompetence

Otoacoustic Emissions in Children with Long-Term Middle Ear Disease

Introduction: Otoacoustic emissions (OAEs) evaluate the functional status of the cochlea. Repeated otitis media (OM) can cause changes in the peripheral structures of the auditory system, and, in this way, middle ear infection may irreversibly damage the middle ear, or even the cochlea. Objectives: To analyze the results of transiently evoked otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs) in individuals with a history of OM. Method: Participants with 8 to 16 years of schooling were split into two groups: a control group (CG) of 50 subjects who had no history of otological disease and an experimental group (EG) of 50 subjects who had a history of recurrent otitis in childhood and had consequently undergone myringotomy to insert bilateral ventilation tubes. All children underwent basic audiological assessment (tonal audiometry, speech audiometry, and immittance testing) and otoacoustic emission testing (TEOAEs and DPOAEs). Results: There were no significant differences between the groups when audiometrically tested via air and bone conduction. OAEs were found in all CG subjects. For the EG, there were no TEOAE responses in 17 ears and no DPOAEs in nine ears; response amplitudes were lower at all frequencies. The emission level and the signal-to-noise ratio were statistically different between the two groups, and OAEs in the EG were statistically smaller compared to the GC. Conclusion: In the EG, responses were more likely to be absent and were of statistically smaller amplitude compared to the CG. A history of repeated OM apparently interferes with the generation and transmission of TEOAEs and DPOAEs.

Sevoflurane anesthesia during pregnancy in mice induces hearing impairment in the offspring

Introduction

Exposure to gamma-aminobutyric acid-mimetics and N-methyl-D-aspartate-receptor antagonists during pregnancy may lead to hearing loss and long-term behavioral abnormalities in the offspring. The purpose of this study was to explore the association between prenatal exposure to sevoflurane (SEV) anesthesia and hearing impairment in mice.

Materials and methods

On gestational day 15, pregnant Kunming mice were exposed for 2 hours to 2.5% SEV plus 100% oxygen (anesthesia group) or 100% oxygen alone (control group).

Results

During auditory brainstem response testing on P30, offspring of the anesthesia group mice exhibited higher hearing thresholds at 8, 16, 24, and 32 kHz; longer peak latency of wave II at all four frequencies; and longer interpeak latencies from waves II to V at 16, 24, and 32 kHz, compared to the control offspring. Caspase-3, iNOS, and COX-2 activation occurred in the fetal cochlea of the anesthesia group. Mitochondrial swelling was observed in the anesthesia group offspring at P1 and P15.

Conclusion

Our results suggest that SEV exposure during pregnancy may cause detrimental effects on the developing auditory system.

Impedance Screening

Rationale is presented for including tympanometry as an integral part of all hearing screening programs. Impedance screening will yield more accurate screening results in the identification of middle ear disease than traditional hearing testing or otoscopic examination. Medical complications often result from unidentified otitis media which also contributes to speech, language, and educational delays in children. Although additional research information is needed on the significance of early identification of children with otitis media, it is argued that tympanometry will foster such research efforts, while providing improved identification and potential management of middle ear disease in screening programs.

The role of audiological diagnostics in children with cleft lip & palate (CLP)

OBJECTIVE

To assess the otologic and audiologic status of patients with cleft lip and palate (CLP) operated in the Department of Pediatric Surgery attached to the Advanced Pediatric Centre, Post Graduate Institute of Medical Education & Research (PGIMER), India. The main idea of carrying out this study was to know the incidence of middle ear pathologies in a group where no complaints have been noticed.

SETTING

Research study was carried in Post Graduate Institute of Medical Education & Research (PGIMER) which is one of the tertiary care institutions in India.

PARTICIPANTS

55 children (Mch: 28; Fch: 27) in the age range of 4-13 years constituted the study group. These children were operated upon by the same surgeon (JKM) during the period 1996-1998 and were attending the speech clinics at PGIMER. None of these children/parents had complained of any ear problem and were taken up for the study to find out the middle ear pathology. The ontological and audiological evaluation was done for all the children.

RESULTS

53 of 110 ears had normal hearing status. None of the ears had severe or profound hearing loss. The air conduction thresholds ranged from 20.2 to 29.63 dB across the frequencies whereas the bone conduction thresholds varied from 7.13 to 12.41 dB. Only 42% of the right (R) ears and 47% of the left (L) ears had a normal tympanic membrane.

CONCLUSION

On the basis of this finding, investigation of the benefits of early and routine follow-up for otologic and audiologic status is warranted. Patients with cleft lip and palate should have an intense and detailed otologic and audiologic follow-up to identify any ME pathology/hearing loss so that timely intervention can be taken.

Early Middle Ear Effusion and School Achievement at Age Seven Years

OBJECTIVE

This study tested the hypothesis that children with early persistent middle ear effusion (MEE) are at risk for later deficits in academic performance.

METHODS

We recruited 698 newborns and monitored them for MEE every 2 to 4 weeks at home until age 3 years. At age 7 years, it was possible to obtain school data for 226 children. Tests included the Iowa Tests of Basic Skills or the Stanford Achievement tests, the Woodcock Reading Mastery Tests, and the Woodcock-Johnson Tests of Achievement.

RESULTS

There was no significant relationship between early MEE and measures of school achievement as shown by correlations or multiple regression. Differences between extreme MEE groups were not significant. School achievement was strongly associated with ethnicity, home environment, and socioeconomic status.

CONCLUSIONS

Early persistent MEE does not appear to affect achievement in school at age 7 years.

Secretory otitis media: A school health survey

The present study was carried out to find out prevalence of secretory otitis media in 200 school going children between the age group of 5-7 years by impedance audiometry besides clinical evaluation. 100 children were taken from two different schools catering to higher and lower socioeconomic strata of society. The overall prevalence of secretory otitis media came out to be 20.75%. It was 28.5% in lower socioeconomic group and, 13% in the other group. This high prevalence warrants routine screening for secretory otitis media. Further impedance audiometry was found to be very good method of screening secretory otitis media.

Effectiveness of ototopical antibiotics for chronic suppurative otitis media in Aboriginal children: a community-based, multicentre, double-blind randomised controlled trial

OBJECTIVES

To compare the effectiveness of ototopical ciprofloxacin (0.3%; CIP) with framycetin (0.5%), gramicidin, dexamethasone (FGD) eardrops (5 drops twice daily for 9 days) together with povidone-iodine (0.5%) ear cleaning as treatments for chronic suppurative otitis media (CSOM) in Aboriginal children.

DESIGN AND PARTICIPANTS

Aboriginal community-controlled, community-based, multicentre, double-blind, randomised controlled trial in eight Aboriginal Community Controlled Health Services across northern Australia, involving 147 Aboriginal children with CSOM.

MAIN OUTCOME MEASURES

Resolution of otorrhoea (clinical cure), proportion of children with healed perforated tympanic membrane (TM) and improved hearing, 10-21 days after starting treatment.

RESULTS

111 children aged 1-14 years (CIP, 55; FGD, 56) completed treatment. CSOM cures occurred in 64% (CIP, 76.4%; FGD, 51.8%), with a significantly higher rate in the ciprofloxacin group (P = 0.009, absolute difference of 24.6% [95% CI, 15.8%-33.4%]). TM perforation size and the level of hearing impairment did not change. Pseudomonas aeruginosa was the most common bacterial pathogen (in 47.6%), while respiratory pathogens were rare (in 5.7%).

CONCLUSIONS

Twice-daily ear cleaning and topical ciprofloxacin is effective at community-level in achieving cure for CSOM. Healthcare providers to Aboriginal children with CSOM should be given special access to provide ototopical ciprofloxacin as first-line treatment.

Audiologic and tympanometric findings in children with cleft lip and palate

OBJECTIVE

To evaluate the otologic and audiologic status of 50 children with repaired cleft lip, cleft palate, or both in Hacettepe University, Ankara, Turkey.

DESIGN

Audiometric and tympanometric evaluation of 100 ears in 50 children were performed. Hearing levels < or = 15 dB and middle ear pressures between -50 to +50 decaPascals were considered to be normal. Results were examined according to cleft type and laterality. The least and most affected frequencies were calculated. A simple evaluation of speech characteristics including nasal resonance, nasal air escape, and errors of articulation was also performed.

RESULTS

Sixty-three of the 100 ears had normal hearing status, whereas 40 had normal middle ear pressures. No evidence was found to suggest that individual cleft type and laterality of the ear had any effect on hearing loss or middle ear disease. Two-thirds of the patients had normal or acceptable degree of language skills.

CONCLUSION

The final hearing status of patients with cleft palate is a result of a combination of surgical correction, developmental factors, and treatment of middle ear disease. Early and aggressive ventilation tube placement is the standard of cleft care in many countries. Our long-term hearing outcome is relatively good in a population not treated with routine insertion of ventilation tubes. The majority of patients also have satisfactory speech. Patients with cleft palate should have close follow-up for middle ear disease, but further research is warranted to determine the aggressive usage of ventilation tubes.

The Landau-Kleffner Syndrome

Landau-Kleffner syndrome (LKS), or acquired epileptiform aphasia, is an epilepsy syndrome involving progressive neuropsychological impairment related to the appearance of paroxysmal electroencephalograph (EEG) activity. LKS appears to share a common pathophysiologic mechanism with continuous spike-wave of sleep (CSWS), acquired epileptic opercular syndrome (AEOS), and even benign childhood epilepsy with centrotemporal spikes (BECTS), with differentiating factors including age of onset, area of primary epileptogenicity, and severity of clinical presentation. This article covers the clinical, diagnostic, therapeutic, and prognostic features of LKS. In a child with autistic spectrum disorder, the presence of a fluctuating clinical course or regression should raise suspicion for the presence of associated epilepsy.

Optimal timing of cleft palate closure

Treatment objectives for the cleft palate patient--normal speech, normal maxillofacial growth, and normal hearing--are closely related. Controversy about the timing of cleft palate surgery is directed at the need for early palatoplasty for improved speech and hearing versus delayed hard palate repair for undisturbed facial growth. This controversy as to the value of early versus delayed closure continues into the present. The authors present an updated argument regarding this controversy along with a comprehensive literature review. They also present a logical algorithm based on the literature and their personal experience.

A systematic review of clinical research addressing the prevalence, aetiology, diagnosis, prognosis and therapy of otitis media in Australian Aboriginal children

The objective of this review was to systemically identify and summarize all the clinically relevant evidence available from studies addressing the prevalence, aetiology, diagnosis, prognosis and therapy of otitis media in Australian Aboriginal children. Electronic searching of Medline, the Australian Medical Index and the Aboriginal and Torres Strait Islander Health Bibliographic Index was performed. This was supplemented by hand searching the Menzies School of Health Research otitis media collection, the Aboriginal and Torres Strait Islander Health Information Bulletin and Aboriginal Health: an annotated bibliography. Data were extracted and placed in a series of evidence tables relevant to clinical practice. There were 59 studies that met the inclusion criteria. The majority were surveys, and only 19 addressed diagnosis, prognosis or therapy. Severe otitis media in rural Aboriginal children does not occur in isolation but as part of a spectrum of chronic bacterial infections of the respiratory tract. Although the aspects of poverty that result in this condition remain to be clarified, exposure to other young children with chronic nasal discharge is likely to be important. Whilst there is a considerable amount of literature on otitis media in Australian Aboriginal children, the number of studies most relevant to improving health outcomes is small. A systematic approach to disease surveillance, diagnosis, and application of medical interventions is required urgently. Future medical research should be concerned with the evaluation of interventions and the generalisabilty of studies from different populations.

Otitis media and child development: should we worry?

Persistent middle ear effusion in infancy and early childhood has been blamed for impairments of speech, language, cognition and psychosocial development later in life. Whether that blame is justified remains unresolved and a matter of controversy, because studies of the relationships involved have been limited and often contradictory and because none was designed so as to address the issue of causality. At issue in particular is the common practice of subjecting infants and young children with persistent otitis media with effusion (OME) to tympanostomy tube placement specifically to reduce the risk of developmental impairment. Currently children younger than age 3 years undergo an estimated 313000 tympanostomy tube placement operations per year, at a cost of about $750 million. If a causal association between early life OME and later developmental impairment were to be established, answers would also be needed to the questions whether the adverse effects of OME are linear or threshold, whether they are permanent or transient and whether they are preventable by timely tube placement. A prospective study designed to address all of these questions is currently under way at Children's Hospital of Pittsburgh. The study involves enrolling a large, demographically diverse sample of normal infants before 2 months of age; monitoring them for the presence or absence of otitis media throughout the first 3 years of life; identifying those in whom OME has persisted for specified minimum periods; randomly assigning those subjects either to prompt tube placement or to delayed tube placement if OME persists; and administering a battery of standardized developmental tests to those subjects and to a sample of the others at ages 3, 4 and 6 years. Details of the study design and procedures are described in this report.

Otologic and audiologic status of Russian children with cleft lip and palate

OBJECTIVE

In this study, researchers evaluated the otologic and audiologic status of 112 children with repaired cleft lip and palate who had received primary palatal repair by means of Frolova palatoplasty, a surgical technique developed by Dr. Larisa Y. Frolova, founder and director of the National Pediatric Center for Congenital Maxillofacial Pathology, Moscow, Russia.

DESIGN

Results of hearing thresholds and tympanograms for these Russian children were compared with data previously reported from a group of 48 children and adults with repaired cleft lip and palate at the University of Florida Craniofacial Center, Gainesville, Florida.

RESULTS

There were no substantial differences in hearing thresholds between the two groups, which was surprising in view of the vast differences between middle ear management techniques used in Russia and the United States.

CONCLUSIONS

Considering these findings and the growing body of literature favoring a more conservative approach to the management of middle ear effusion in infants with cleft lip and palate, a reexamination of otologic strategies in the United States seems advisable.

Fetal alcohol syndrome. Hearing, speech, language, and vestibular disorders

Fetal alcohol syndrome (FAS) refers to a pattern of anomalies that include craniofacial, CNS, growth, and various sensory anomalies. We have observed that FAS is associated with four kinds of hearing disorders: (1) developmentally delayed auditory function, (2) sensorineural hearing loss, (3) intermittent conductive hearing loss owing to recurrent serous otitis media, and (4) central hearing loss. As is the case with other syndromes associated with craniofacial anomalies and hearing impairments, speech and language pathologies also are common in FAS patients. Although auditory and vestibular systems arise from similar embryological tissue, vestibular dysfunction is variable in FAS. Early identification and intervention to treat hearing, language, and speech problems should improve the functional level of FAS in children.

Treatment efficacy: hearing loss in children

This article provides a review of the topic of treatment efficacy for children with hearing loss. Efficacy is related to a wide range of treatment goals in the areas of sensory and perceptual skill development, language development (regardless of communication modality), speech-production skill development, academic performance, and social-emotional growth. Topics addressed in this article include (a) the definition of hearing loss in children; (b) incidence and prevalence data; (c) the effects of childhood hearing loss on daily life, including language and literacy, speech perception and production, socialization and family dynamics; (d) the role of audiologists and speech-language pathologists in managing children with hearing loss; and (e) a summary of pertinent efficacy research for children with hearing loss. The analysis of the available research suggests that (a) early intervention for children who are deaf or hard of hearing has long-term positive effects on overall development; (b) a variety of communication modalities exist for this population, and research to date has been more descriptive than prognostic on the choice of modality; (c) sensory aids (hearing aids, tactile aids, and cochlear implants) provide different degrees of benefit for children in the areas of speech perception, production, and language development, depending upon the extent of their hearing loss; (d) few studies have addressed rates of learning and long-term outcomes, but existing data suggest that enriched programs provide some children with hearing loss with the ability to overcome developmental lags in language and academic skills.

Hearing, speech, language, and vestibular disorders in the fetal alcohol syndrome: a literature review

Fetal alcohol syndrome (FAS) is characterized in part by mental impairment, as well as craniofacial and ocular anomalies. These conditions are traditionally associated with childhood hearing disorders, because they all have a common embryonic origin in malformations of the first and second branchial arches, and have similar critical periods of vulnerability to toxic insult. A review of human and animal research indicates that there are four types of hearing disorders associated with FAS. These are: (1) a developmental delay in auditory maturation, (2) sensorineural hearing loss, (3) intermittent conductive hearing loss due to recurrent serous otitis media, and (4) central hearing loss. The auditory and vestibular systems share the same peripheral apparatuses (the inner ear and eighth cranial nerve) and are embryologically and structurally similar. Consequently, vestibular disorders in FAS children might be expected. The evidence for vestibular dysfunction in FAS is ambiguous, however. Like other syndromes associated with craniofacial anomalies, hearing disorders, and mental impairment, FAS is also characterized by a high prevalence of speech and language pathology. Hearing disorders are a form of sensory deprivation. If present during early childhood, they can result in permanent hearing, language, and mental impairment. Early identification and intervention to treat hearing, language, and speech disorders could therefore result in improved outcome for the FAS child. Specific recommendations are made for intervention and future research.

Observations on the Use of SCAN to Identify Children at Risk for Central Auditory Processing Disorder

The SCAN: A Screening Test for Auditory Processing Disorders was designed for administration in a quiet school test setting, although it is also administered by audiologists in the audiometric booth in a study seeking to screen for the presence of central auditory processing disorder (CAPD) in children with a history of otitis media (OM), 14 children with a history of OM and an equal number without this risk factor for CAPD (non-OM) were tested in a school setting using the SCAN and the Peabody Picture Vocabulary Test-Revised (PPVT-R). Forty-three percent of the OM group failed the SCAN, as did 29% of the non-OM group; hence, the groups were not differentiated using the SCAN. To prove the effects of environment on test results, a second experiment was conducted in which six additional children were administered the SCAN in both a school setting and an audiometric test booth. Individual data revealed that subjects performed more poorly on the SCAN administered in the school setting than in audiometric test booth. The marked difference in SCAN scores between the two environments raises methodological concerns regarding the use of this instrument for indentification of children at risk for central auditory processing disorders.

Randomised controlled trial of treatment of chronic suppurative otitis media in Kenyan schoolchildren

BACKGROUND

The outcomes of treatment of chronic suppurative otitis media (CSOM) are disappointing and uncertain, especially in developing countries. Because CSOM is the commonest cause of hearing impairment in children in these countries, an effective method of management that can be implemented on a wide scale is needed. We report a randomised, controlled trial of treatment of CSOM among children in Kenya; unaffected schoolchildren were taught to administer the interventions.

METHODS

We enrolled 524 children with CSOM, aged 5-15 years, from 145 primary schools in Kiambu district of Kenya. The schools were randomly assigned treatments in clusters of five in a ratio of two to dry mopping alone (201 children), two to dry mopping with topical and systemic antibiotics and topical steroids (221 children), and one to no specific treatment (102 children). Schools were matched on factors thought to be related to their socioeconomic status. The primary outcome measures were resolution of otorrhoea and healing of tympanic membranes on otoscopy by 8, 12, and 16 weeks after induction. Absence of perforation was confirmed by tympanometry, and hearing levels were assessed by audiometry. 29 children were withdrawn from the trial because they took non-trial antibiotics. There was no evidence of differences in timing of withdrawals between the groups.

FINDINGS

By the 16-week follow-up visit, otorrhoea had resolved in a weighted mean proportion of 51% (95% CI 42-59) of children who received dry mopping with antibiotics, compared with 22% (14-31) of those who received dry mopping alone and 22% (9-35) of controls. Similar differences were recorded by the 8-week and 12-week visits. The weighted mean proportions of children with healing of the tympanic membranes by 16 weeks were 15% (10-21) in the dry-mopping plus antibiotics group, 13% (5-20) in the dry-mopping alone group, and 13% (3-23) in the control group. The proportion with resolution in the dry-mopping alone group did not differ significantly from that in the control group at any time. Hearing thresholds were significantly better for children with no otorrhoea at 16 weeks than for those who had otorrhoea, and were also significantly better for those whose ears had healed than for those with otorrhoea at all times.

INTERPRETATION

Our finding that dry mopping plus topical and systemic antibiotics is superior to dry mopping alone contrasts with that of the only previous community-based trial in a developing country, though it accords with findings of most other trials in developed countries. The potential role of antibiotics needs further investigation. Further, similar trials are needed to identify the most cost-effective and appropriate treatment regimen for CSOM in children in developing countries.

Middle Ear Disorders and Hearing Loss in Native Hawaiian Preschoolers

This study reported on the prevalence of middle ear disorders and hearing loss among native Hawaiian preschoolers. The subjects included children enrolled in the Kamehameha Schools on the islands of Kauai, Maui, and Oahu. At the beginning of the school year, each child received a battery of tests that included pure-tone audiometry, tympanometry, acoustic reflectometry, and pneumatic otoscopy. Approximately 15% of the children failed a majority of these tests. Serial testing, involving pure-tone audiometry and tympanometry, was administered at regular intervals throughout the school year. Approximately 9–15% of the children failed both audiometric and tympanometric tests at each of the serial screenings. The results are discussed in comparison to other indigenous groups at risk for middle ear disorders and hearing loss and as evidence of the need to develop systematic screenings for Hawaii’s preschool children.

Communicative development in twins with discordant histories of recurrent otitis media

The communicative abilities of six sets of same-sex, dizygotic twins (CAs 2;1-4;1) were examined. In each dyad, one sibling had a strong positive history of recurrent otitis media (ROM), while the other twin had a negative or minimal history of ROM. Standardized test performance and spontaneous speech and language abilities were examined. Results suggest that although a history of ROM is associated with lowered receptive vocabulary scores in these dyads, no consistent effects of ROM could be detected in expressive speech and language tasks. In two dyads, the ROM-positive twin did score lower on articulation and language measures; however, in two dyads, children with equivalent histories of ROM outscored their ROM-negative siblings. In the remaining dyads, little difference was observed between the siblings on the measures we used. We suggest that the effects of ROM on communicative development are complex and subtle, and that control of home and day care environment may minimize some of the previously documented associations between ROM and speech-language development.

Effects of recurrent otitis media in infancy on auditory perception and speech

INTRODUCTION

Recurrent otitis media is commonly encountered in children before 3 years of age. Conductive hearing loss up to 40 dB is frequently associated with suppurative otitis media. Good hearing is believed to be critical to the development of normal language. This study was undertaken to evaluate the effect of recurrent otitis media on auditory perception and speech.

PATIENTS AND METHODS

The experimental group consisted of 33 children with a history of at least three episodes of acute otitis media before 2 years of age. A control group of 29 children experienced one or fewer episodes of otitis media in the first 2 years of age. At the time of investigation, all children were 8 to 10 years of age and had attended similar pre-school, kindergarten, and elementary school programs. None showed evidence of mental retardation nor behavioral or emotional disorders. Speech ability was assessed by a battery of tests specific for Slovene language. Subtests of the Wechsler Intelligence Scale for Children were used as well as the Reading and Writing Test.

RESULTS

Auditory perception disorders were evident in 88% of children investigated who had a history of at least three episodes of otitis media by 2 years of age. Decreased auditory stimulation during the time of auditory maturation could prevent the development of these functions completely. No statistically significant differences were observed in the development of articulation. These observations underscore the importance of early management of recurrent otitis media during the first 2 years of age.

Reading skills and auditory processing ability in children with chronic otitis media in early childhood

The effect of recurrent middle ear disease during the first 2 years of life on auditory perceptual skills and reading ability was examined in two groups of 6- and 7-year-old children who were pair-matched by age, gender, socioeconomic status, and receptive vocabulary. Group 1 consisted of children with documented chronic otitis media at an early age, and group 2 had no history of middle ear problems. Tests of auditory perceptual skills and reading ability were administered. Significant differences in performance on all tests of auditory processing ability and reading ability were noted.

Quality of life issues in chronic otitis media with effusion: parameters for future study

This pilot project studied 61 children with chronic otitis media with effusion. The 12-month period prior to ventilation tube surgery was compared with the 12 months after surgery with respect to numbers of health care visits, the use of antibiotics, parental perceptions of hearing and speech problems, and other selected parameters. Significant decreases were found in total health care visits (mean decrease: 6.18 visits, P less than 0.001). Ear-related health care visits also decreased significantly (mean decrease = 10.93, P less than 0.001). Total health care visits correlated strongly with visits for ear problems both before and after surgery (r = 0.4474, P less than 0.001). Usage of antibiotics significantly decreased. Parental reports concerning the issues of secondary speech and hearing problems raised questions for additional study. In addition, the qualitative comments offered by parents suggest the breadth of impact of chronic otitis media with effusion in this patient population, and point the direction for future research.

The Staggered Spondaic Word Test. A ten-minute look at the central nervous system through the ears

We have described three major groupings that encompass most auditory processing difficulties. While the problems may be superimposed upon one another in any individual client, each diagnostic sign is closely associated with particular communication and learning disorders. In addition, these behaviors may be related back to the functional anatomy of the regions that are implicated by the SSW test. The auditory-decoding group is deficient in rapid analysis of speech. The vagueness of speech sound knowledge is thought to lead to auditory misunderstanding and confusion. In early life, this may be reflected in the child's articulation. Poor phonic skills that result from this deficit are thought to contribute to their limited reading and spelling abilities. The auditory tolerance-fading memory group is often thought to have severe auditory-processing problems because those in it are highly distracted by background sounds and have poor auditory memories. However, school performance is not far from grade level, and the resulting reading disabilities stem more from limited comprehension than from an inability to sound out the words. Distractibility and poor auditory memory could contribute to the apparent weakness in reading comprehension. Many of the characteristics of the auditory tolerance-fading memory group are similar to those of attention deficit disorder cases. Both groups are associated anatomically with the AC region. The auditory integration cases can be divided into two subgroups. In the first, the subjects exhibit the most severe reading and spelling problems of the three major categories. These individuals closely resemble the classical dyslexics. We presume that this disorder represents a major disruption in auditory-visual integration. The second subgroup has much less severe learning difficulties, which closely follow the pattern of dysfunction of the auditory tolerance-fading memory group. The excellent physiological procedures to which we have been exposed during this Windows on the Brain conference provide a glimpse of the exciting possibilities for studying brain function. However, in working with individuals who have cognitive impairments, the new technology should be validated by standard behavioral tests. In turn, the new techniques will provide those who use behavioral measures with new parameters and concepts to broaden our understanding. For the past quarter of a century, the SSW test has been compared with other behavioral, physiological, and anatomical procedures. Based on the information that has been assembled, we have been able to classify auditory processing disorders into three major categories.(ABSTRACT TRUNCATED AT 400 WORDS)

The psychological, educational and auditory sequelae of early, persistent secretory otitis media

Previous studies have suggested an association between chronic middle ear disorders due to secretory otitis media and adverse effects on auditory, educational and psychological development in children. Experimental design of such studies has often been poor. In this study, attempts were made to control extraneous variables more rigorously, using matched pairs. A group of children (n = 10) without current hearing problems but with a history of recurrent early secretory otitis media, aged 7-11 yrs, were compared on auditory, educational and psychological measures with a matched group of children with no history of otitis media. The results indicated weak but distinct differences between the two groups on the educational and psychological measures in favour of the control group. The implications for medical and educational services are outlined.

Otitis media and well-being in a male population in Gothenburg. The study of men born in 1913

In a sample of 767 60-year-old men and 220 50-year-old men from the general population of Gothenburg, Sweden, the possible influence of otitis media, suffered in the past, on various measures of well-being was studied. Men with a history of otitis media required more medical care, measured as number of appointments with a doctor during the last 10 years, number of drugs taken during the last 14 days, and early retirement due to illness, than men with no such history. They also had lower grade of self-estimated perceived health, hearing, memory, physical fitness, appetite, mental energy and patience. There was no correlation between a history of otitis and a number of socio-economic factors. In addition, otitis infections in the past were measured as a hearing loss in the low-frequency range (greater than 20 dB loss in the 250 Hz and 500 Hz register). Such a hearing loss was related to the same variables as the otitis history. In addition, men with a low-frequency hearing loss were less well educated, were heavier, had more days and more periods of sickness benefit than other men. They also had spent more time as an in-patient in hospital and were less active during their leisure time. These results indicate that otitis infections affect the health and the well-being of the patients even long after the actual incident.

An association between recurrent otitis media in infancy and later hyperactivity

An association between the frequency of otitis media in early childhood and later hyperactivity is reported in this study. The subjects were 67 children referred to a child development clinic for evaluation of school failure. Ranging from 6 to 13 years old, all the children demonstrated specific school learning problems, and 27 were also considered hyperactive by two or more raters. Sixteen of the hyperactive children were treated with central nervous system stimulant medication. In retrospect, there was positive correlation between an increasing number of otitis media infections in early childhood and the presence and severity of hyperactive behavior. Ninety-four percent of children medicated for hyperactivity had three or more otitis infections, and 69 percent had greater than 10 infections. In comparison, 50 percent of non-hyperactive school-failure patients had three or more infections and 20 percent had greater than 10 infections. Twenty-two of 28 children (79%) known to have more than 10 infections experienced recurrent otitis before 1 year of age.

Age of onset and outcome in 'acquired aphasia with convulsive disorder' (Landau-Kleffner syndrome)

The relationship between age at onset of language disorder and eventual outcome was examined in 45 cases of Landau-Kleffner syndrome reported in the literature, all of whom had been followed up to at least 12 years of age. A strong relationship was found, which is opposite to that for childhood aphasia after structural lesions of the left hemisphere; i.e. in Landau-Kleffner syndrome, the older the child at onset the better the prognosis for language.

A 5-year prospective case-control study of the influence of early otitis media with effusion on reading achievement

In a still ongoing prospective longitudinal study, more than 500 children--a total birth-cohort in a Danish municipality--were followed from their 3rd to their 9th year of life by multiple impedance tests in order to investigate a number of factors concerning epidemiology and long-term impacts of otitis media with effusion. This is a report on the influence of otitis media with effusion early in life on reading achievement. The study revealed no difference in school-class level between the 9% of the children (n = 46) who constantly had abnormal tympanometry during a 6-month period at the age of 3, and the other pupils in the municipality. At the Silent Reading Test (OS-400), done on 40 of the 46 case-pupils the results did not differ from (1) the other pupils in the municipality, (2) from other pupils of the same sex in the same classroom, or (3) from individual control-pupils matched by sex, social group and classroom.

A critical period during postnatal auditory development of mice

CBA/J mice were given a 50 dB unilateral conductive hearing loss by removal of the left cartilaginous external auditory meatus. When the conductive loss extended from 12 to 24 days after birth, the left globular cells and left large spherical cells of the ventral cochlear nucleus were significantly smaller (P less than 0.01) than comparable cells on the right side. Right medial nucleus of the trapezoid body cells and right inferior colliculus cells were significantly smaller (P less than 0.01) than comparable left side cells. These same effects were found with conductive losses of 4-24, 4-45, and 4-90 days after birth. There were no significant differences (P greater than 0.05) between right and left cell sizes with conductive losses of 4-12 or 24-45 days after birth. There were significant right/left cell size differences (P less than 0.01) when the conductive loss was 4-18, 12-18, or 18-24 days, but these differences were of lesser magnitude than when the conductive loss included the full 12-24 day period. Since normally all these neurons have adult soma size by postnatal day 12, it is evident that adequate acoustic stimulation is necessary between 12 and 24 days postnatally in order to maintain normal brainstem auditory neuronal size in CBA/J mice.

The assessment of middle ear function and hearing by tympanometry in children before and after early cleft palate repair

Tympanometry has been carried out to assess middle ear function in cleft lip and cleft palate children from birth. All these children had normal aeration of the middle ear at birth, and remained normal until complications began to appear at 17 weeks. Closure of the palatal defect is known to reduce middle ear complications and its seems that closure at, or before, 4 months of age significantly reduces these complications.

Learning disabilities and conductive hearing loss involving otitis media

This article examines the relationship between mild conductive hearing loss associated with otitis media and auditory, language, and academic performance of children. The nature of conductive hearing loss in children is explained. A review or research studies focuses on the following topics: (1) prevalence of otitis media among learning disabled children, (2) effects of early-onset, persistent otitis media on auditory, language, and academic skills of children, and (3) effects of early onset, resolved otitis media on auditory, language, and academic skills of children. Suggestions are made for identifying children who may be at risk for developing psychoeducational sequelae. In addition, approaches to intervention with at-risk children and directions for future research are presented.

Ventilation tubes in secretory otitis media. A randomized, controlled study of the course, the complications, and the sequelae of ventilation tubes

The purpose of this study has been to evaluate the use of ventilation tubes in the treatment of cases of primary secretory otitis media. Bilateral cases were selected and a tube inserted in one ear while the other ear was left intact. Adenoidectomy was performed on all children, tonsillectomy in 34% of the cases. A total of 150 children (mean age = 3.9 years) were included during the years 1976-1979 and check-ups performed every 3-6 months. The follow-up rate was 89.3%. The condition of each individual was assessed after a 5-year period, the mean period of observation was 3.2 years. The results of tympanometry and audiometry from the two types of ears were, on average, similar. Repeat operation was carried out in 17% of the cases and later otomicroscopy revealed a higher incidence of atrophy in these eardrums (p less than 0.01). A period of suppuration was noted in 25% of the ears with a ventilation tube, 2 months or more after operation; a higher incidence of tympanosclerosis was later found (p = 0.02). Twentythree per cent of the treated eardrums were characterized at the final check-up as "normal" by means of otomicroscopy, in contrast to 83% of the intact ears. The "end-result" of each ear was estimated using tympanometry, audiometry as well as otomicroscopy, and a difference in favour of the intact ears was found (p less than 0.01). A similar estimate for each child gave the result that 31% had one ear categorized as "pathological" while this was the case in both ears of 9% of the children. The children subjected to initial tonsillectomy showed a worse "end-result" (p less than 0.05). It is concluded that the use of ventilation tubes in children with primary secretory otitis media is not justified. Observation has shown that only a small proportion will require surgical treatment of the middle ear. A ventilation tube may be indicated in order to combat hearing loss, but it should be borne in mind that its use involves a high risk of complications and sequelae which may result in chronic middle ear disease.

Occurrence and recurrence of acute otitis media among children

The occurrence and recurrence of acute otitis media among 37 570 Finnish children at risk who were under 15 years of age were studied. During a one-year period, 4 337 of the children experienced a total of 6 249 attacks of acute otitis media, giving an annual incidence rate of 16.6%. The highest incidence, 75.5%, was found among infants 6--11 months old. 50% of Finnish children had experienced at least one ear infection before their third birthday and 75% before the age of 10, and among this latter group the total number of otitis attacks per child-year during a lifetime was 0.71. Among children under 10, half of the index attacks were recurrences, and among children under 16, 28% of the index attacks were followed by recurrences during the study year. The highest relative recurrence rate was found during the second year of life. Before the second birthday both incidence and recurrence rates were significantly (p less than 0.001) higher among boys. Acute otitis media was most common in the higher social class families and the lowest incidence and recurrence rates were found among children of farmers.