Silent reading and secretory otitis media in school children

Phonological awareness and reading outcomes in children with a history of otitis media: a review

OBJECTIVE

A review was conducted to investigate the current evidence for effects of otitis media (OM) on phonological awareness and reading skills in children under 12 years old.

DESIGN

A review conducted in 2024 to identify articles between 1978 and 2024 related to OM and its impact on (pre-)reading skills.

STUDY SAMPLE

An initial search across six databases provided 6808 research outputs. After screening, 27 articles were retained. Screening of the references on the selected articles provided an additional 6, giving 33 articles in the final review.

RESULTS

The selected research papers did not all evaluate the same phonological awareness or reading skills. Of the studies, 20 identified that a history of OM impacted reading outcomes. Twelve studies found no significant impact while one study showed an impact which resolved with time.

CONCLUSION

The findings do not show a consistent association between a history of OM and phonological processing or reading skills. This is likely due to the wide range of methodologies employed and variability in the focus of the respective studies. Future research, including longitudinal studies, would be beneficial to infer the potential impacts of OM on phonological processing or reading skills.

Comparison of the Reynell Developmental Language Scale II and the Galker test of word-recognition-in-noise in Danish day-care children

OBJECTIVE

To search for predictive factors for language development measured by two receptive language tests for children, the Galker test (a word-recognition-in-noise test) testing hearing and vocabulary, and the Danish version of Reynell Developmental Language Scale (2nd revision, RDLS II) test, a language comprehension test. The study analysed if information about background variables and parents and pre-school teachers was predictive for test scores; if earlier middle ear disease, actual hearing loss and tympanometry was important for language development; and if the two receptive tests differed in terms of the degree to which variables were able to predict test scores at the age of three to five years.

METHODS

All children aged three and five years attending 20 day-care centres for children without cognitive development issues from the Municipality of Hillerød, Denmark, were invited to participate. We used questionnaires to the parents and day-care teachers and examined the children using tympanometry, hearing test and the two receptive language tests. We performed unadjusted and adjusted analyses of raw and grouped scores and background variables, as well as stepwise regression analysis with group scores as outcome.

RESULTS

The results of the two tests were surprisingly similar in relation to background variables. The same variables were predictive for scores in the two receptive language tests. The predictive variables were: age group (22-31%), having no sibling (2-3%), being a boy (1%), information from the parents about the child's vocabulary (3%), phonology (0-2%). information from the pre-school teachers on the child's vocabulary (4-6%), and hearing beyond 25 dB in best ear (mean of four frequencies) (1%).

CONCLUSION

We found that nearly the same variables were predictive for the test score and the grouped score in pre-school children in the RDLS II and the Galker test. Information from the pre-school teachers was more predictive of the test score than information from the parents. In the adjusted analysis, beside age group, information about the child's vocabulary was the most predictive information explaining 4-6% of the variation.

Reading performance in children with otitis media

OBJECTIVE:

To examine whether middle ear diseases and the associated hearing loss in early childhood affect reading performance later at school.

STUDY DESIGN AND SETTING:

One hundred and sixty children, 6.5 to 8 years of age, were enrolled in this study: 80 children with a history of recurrent infections and/or prolonged periods of effusions of the middle ear before the age of 5 years, and 80 healthy children without any history of middle ear disease. Data were collected from the medical records of the children. Every child underwent a complete otological and audiological evaluation, followed by special reading tests.

RESULTS:

The study group performed more poorly, in all reading tests, as compared to the controls ( P < 0.001).

CONCLUSION:

Children with recurrent or prolonged middle ear diseases during the first five years of life tend to be at greater risk for delayed reading than aged-matched controls with no previous middle ear diseases.

Associations between otitis media and child behavioural and learning difficulties: Results from a Danish cohort

OBJECTIVES

Findings from studies investigating early childhood episodes of otitis media (OM) and developmental outcomes are inconclusive. This may in part be because large-scale prospective studies controlling for relevant confounding factors are sparse. The present study investigates associations between OM in early childhood and later behavioural and learning difficulties controlling for relevant confounding factors.

METHODS

The study applied data from the Aarhus Birth Cohort's 10-12-year-old follow-up (N=7578). Associations between retrospective parent-reported OM (no OM; 1-3 episodes of OM with/without tympanostomy tubes; 4+ OM episodes without tympanostomy tubes and; 4+ OM episodes with tympanostomy tubes) one the one hand, and parent- and teacher-reported scores on the Strengths and Difficulties Questionnaire (SDQ) and parent-reported academic difficulties on the other hand, were investigated. The following variables were controlled for: parental educational level, maternal and paternal school problems, parental post-natal smoking, breastfeeding, and age at which the child started walking. All analyses were stratified by gender.

RESULTS

Large differences in background characteristics were observed for the group of children with 4+ OM episodes with tympanostomy tubes compared to the no OM group. After controlling for relevant confounders, negative associations were consistently observed for the group of children with 4+ episodes of OM with tympanostomy tubes compared to the group of children without OM. This was particularly so for girls.

CONCLUSION

The findings suggest an association between 4+ episodes of early OM with tympanostomy tubes and behavioural and learning difficulties later in childhood. The large inter-group differences, i.e. impact of residual and unmeasured confounding factors, may in part explain the observed associations and underline the need to include these in future studies.

A speech reception in noise test for preschool children (the Galker-test): Validity, reliability and acceptance

PURPOSE

This study evaluates initial validity and reliability of the "Galker test of speech reception in noise" developed for Danish preschool children suspected to have problems with hearing or understanding speech against strict psychometric standards and assesses acceptance by the children.

METHODS

The Galker test is an audio-visual, computerised, word discrimination test in background noise, originally comprised of 50 word pairs. Three hundred and eighty eight children attending ordinary day care centres and aged 3-5 years were included. With multiple regression and the Rasch item response model it was examined whether the total score of the Galker test validly reflected item responses across subgroups defined by sex, age, bilingualism, tympanometry, audiometry and verbal comprehension.

RESULTS

A total of 370 children (95%) accepted testing and 339 (87%) completed all 50 items. The analysis showed that 35 items fitted the Rasch model. Reliability was 0.75 before and after exclusion of the 15 non-fitting items. In the stepwise linear regression model age group of children could explain 20% of the variation in Galker-35-score, sex 1%, second language at home 4%, tympanometry in best ear 2%, and parental education another 2%. Other variable did not reach significance.

CONCLUSION

The Galker-35 was well accepted by children down to the age of 3 years and results indicate that the scale represents construct valid and reliable measurement.

Wideband acoustic transfer functions predict middle-ear effusion

OBJECTIVES/HYPOTHESIS

Compare the accuracy of wideband acoustic transfer functions (WATFs) measured in the ear canal at ambient pressure to methods currently recommended by clinical guidelines for predicting middle-ear effusion (MEE).

STUDY DESIGN

Cross-sectional validating diagnostic study among young children with and without MEE to investigate the ability of WATFs to predict MEE.

METHODS

WATF measures were obtained in an MEE group of 44 children (53 ears; median age, 1.3 years) scheduled for middle-ear ventilation tube placement and a normal age-matched control group of 44 children (59 ears; median age, 1.2 years) with normal pneumatic otoscopic findings and no history of ear disease or middle-ear surgery. An otolaryngologist judged whether MEE was present or absent and rated tympanic-membrane (TM) mobility via pneumatic otoscopy. A likelihood-ratio classifier reduced WATF data (absorbance, admittance magnitude and phase) from 0.25 to 8 kHz to a single predictor of MEE status. Absorbance was compared to pneumatic otoscopy classifications of TM mobility.

RESULTS

Absorbance was reduced in ears with MEE compared to ears from the control group. Absorbance and admittance magnitude were the best single WATF predictors of MEE, but a predictor combining absorbance, admittance magnitude, and phase was the most accurate. Absorbance varied systematically with TM mobility based on data from pneumatic otoscopy.

CONCLUSIONS

Results showed that absorbance is sensitive to middle-ear stiffness and MEE, and WATF predictions of MEE in young children are as accurate as those reported for methods recommended by the clinical guidelines.

Which children would benefit most from tympanostomy tubes (grommets)? A personal evidence-based review

Otitis media with effusion (OME) is a common condition in young children. OME causes some hearing loss, and can cause permanent changes in the tympanic membrane as well as other symptoms. In most cases OME is of short duration. As long-lasting bilateral OME for decades has been associated with delayed cognitive and language development, parents and ENT specialists have a positive attitude towards treatment with tympanostomy tubes (TT).

METHOD

This personal evidence-based review is build on own observations and research combined with newer studies and guidelines.

RESULTS

The review argues for a relatively restrictive treatment policy concerning the use of TT in children with OME without signs or symptoms of impaired social or linguistic function.

CONCLUSION

Six months with bilateral OME and significant hearing loss should be present before treatment with TT in otherwise healthy children. At the moment we have no evidence for the subgroups of children excluded from the RCTs, i.e. children with speech/language delays, behaviour and learning problems, or syndromes. Clinicians will need to make their own decisions regarding treatment of such children. The situation just now is that some children are over-treated and some are under-treated. There is an urgent need for prospective cohort studies and randomised studies on children with long-lasting OME in an attempt to characterise the children who would benefit most from TT.

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.

Prevalence of otitis media with effusion in first and second grade primary school students and its correlation with BCG vaccination

OBJECTIVE

The object of this study was to determine the prevalence of otitis media with effusion (OME) in first and second grade primary school students, to analyze the causes of the difference in the prevalence, to define the effect of OME on the academic performance of the children and to investigate a correlation between the prevalence of OME and Bacillus Calmette-Guerin (BCG) vaccination. STUDY PLAN AND METHODS: The study was conducted during the September-November, 2002 period in Elazig. A total of 3675 clinically healthy primary school children attending primary schools in the central district of Elazig, living in the same region and of a similar socioeconomic status and age group were included in the study. Of the 3675 children, 2042 were in their first and 1633 in their second grade of primary school. The routine ear-nose and throat examinations of the children were carried out at their schools by the same medical team. The tympanometric test was performed in children diagnosed with OME following otoscopic examination. A scale measuring the academic performance of the children was developed. This scale was filled in by the student's teachers prior to physical examination.

RESULTS

OME was diagnosed in 64 out of 2042 (3.1%) first grade and in 25 out of 1633 (1.5%) second grade students. The difference between the percentages of OME in first and second grade students was statistically significant (P < 0.05). The frequency of other ear-nose and throat pathologies accompanying OME was similar to those in children without OME. There was no statistically significant difference between the academic performances of children with and without OME (P > 0.05).

CONCLUSION

The analysis of risk factors for OME revealed no difference between first and second grade students. The reason for the difference in the prevalence of OME between first and second grade students may be the positive effect on the immune system of the BCG vaccine which had been administered to the second grade students 4 months previously.

Otitis media, hearing loss, and language learning: controversies and current research

This article reviews research on the possible linkage of otitis media with effusion (OME) to children's hearing and development, identifies gaps, and directions for research, and discusses implications for healthcare practices. About half of children with an episode of OME experience a mild hearing loss while about 5-10% of children have moderate hearing loss. Recent prospective and randomized clinical trials suggest none to very small negative associations of OME to children's later language development. Based on both retrospective and prospective longitudinal studies, associations between OME and perceiving speech in noise and tasks that require equal binaural hearing have been reported but have not been adequately studied with regard to functional outcomes. Thus, on average, for typically developing children, OME may not be a substantial risk factor for later speech and language development or academic achievement. However, these conclusions should be interpreted cautiously, since most of these studies used OME rather than hearing loss as the independent variable (although hearing loss rather than OME is hypothesized to affect language development) and many studies did not control for important confounding variables such as socioeconomic status (SES).

Slight and mild hearing loss in primary school children

Although slight/mild sensorineural hearing loss affects about 3% of the school-aged population, with many more children having such impairments at single frequencies or in only one ear, little is known about its impacts on language, learning, and quality of life. This annotation explores what is known about prevalence and impact of this condition and argues for large-scale research to better address these issues.

Otitis media in early childhood in relation to children's school-age language and academic skills

OBJECTIVE

To examine whether otitis media with effusion (OME) and associated hearing loss during the first 4 years of life are related to the language development and academic achievement of children between 4 years of age and second grade.

METHODS

In a prospective cohort study, 83 black children, primarily from low-income families and recruited from community-based child care programs, were examined repeatedly between the ages of 6 months and 4 years for the presence of OME and hearing loss, both when well and when ill with OME. Children's child-rearing environments at home were assessed annually from infancy through second grade, whereas children's language and academic skills were assessed repeatedly between 4 years of age and second grade.

RESULTS

We did not find in our longitudinal analyses a relationship between OME and hearing loss during the first 4 years of life and later academic skills in early reading and recognition of words heard. We did find that children with greater incidence of OME and hearing loss during the first 4 years of life scored lower in verbal math problems between kindergarten and second grade, even after partialing out important background factors. Children with more OME tended to score lower in math at the younger ages but caught up once they entered school. Follow-up analyses indicated also that children with more OME during the first 2 years of life scored lower in expressive language during the preschool and early elementary school years but caught up by second grade. In contrast, children from homes that were rated as more stimulating and responsive scored higher on every measure of language and academic skills than did children from less responsive homes. The home environment was related more strongly to all of the outcomes examined than was OME or hearing loss.

CONCLUSIONS

There was no evidence of a significant relationship between a history of OME or hearing loss and children's later academic skills in reading or word recognition during the early elementary school years. Children with greater incidence of OME and hearing loss scored lower in math and expressive language at the younger ages but caught up in math with their peers on entering school and in expressive language by second grade. Furthermore, a child's home environment was more related to early math and expressive language skills than was OME or hearing loss, and the home environment continued to be predictive of all of the language and academic outcomes through second grade. These study results should be interpreted cautiously when generalizing to other populations.

Otitis media and academic achievements

OBJECTIVE

This is a study of whether there are any long-term differences in academic achievements between children with and without observed or treated middle ear disease in a population with a stable long-standing treatment policy.

METHODS

A birth cohort of 2156 children was previously studied through a questionnaire to the parents at 4 years of age, follow-up after audiometric screening at 4, 7, 11 and 14 years of age, and study of records from all Ear, Nose and Throats departments in the area; 2095 of these still lived in the area and received academic grades on leaving the ninth year of the state school system. We have compared these grades, and the choice of high school course for children with different experiences of otitis media.

RESULTS

A history of treatment for bilateral secretory otitis media was correlated to minor group difference in the mean of grades, but not to any significant difference in the individual grades or in the choice of further studies. Having many episodes of acute otitis before the age of four was uncorrelated to lower grades and to less tendency to continue with theoretical studies.

CONCLUSIONS

No harmful effect of middle ear disease could be shown in a large sample, suggesting that Swedish children do not suffer long-term effects on learning from otitis media.

Otitis media in childhood in relation to preschool language and school readiness skills among black children

OBJECTIVE

To examine whether otitis media with effusion (OME) and associated hearing loss (HL) during the first 5 years of life were related to children's language skills during the preschool years and to school readiness skills at entry to kindergarten.

METHODS

In a prospective study, the ears of 85 black children primarily from low-income families and recruited from community-based childcare programs were repeatedly examined from 6 months to 5 years of age for the presence of OME and from 6 months to 4 years of age for HL when well and ill with OME. Assessments were made annually of the children's child-rearing environments at home and in childcare, and children's language skills between 3 and 5 years of age and readiness skills in literacy and math were evaluated at entry into kindergarten.

RESULTS

Children had either bilateral or unilateral OME approximately 30.4% and HL 19.6% of the observation time. OME and associated HL were significantly positively correlated with some measures of expressive language at 3 and 4 years of age; however, these direct relationships were no longer significant when the child's gender, socioeconomic status, maternal educational level, and the responsiveness and support of the home and childcare environments were also considered. Further, both OME and HL were moderately correlated with school readiness skills at entry to school, with children having more OME scoring lower in verbal math problems and with children with more HL scoring lower in math and recognizing incomplete words. These associations continued to remain significant even after partialing out the child and family background factors.

CONCLUSIONS

There was not a significant relationship between children's early OME history or HL and language skills during the preschool years. However, children with more frequent OME had lower scores on school readiness measures. These associations were moderate in degree, however, and the home environment was more strongly related to academic outcomes than was OME or HL. These results should be interpreted cautiously when generalizing to other 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.

Epidemiology and treatment of otitis media with effusion in children in the first year of primary school

In this multicentre study we evaluated the prevalence and risk factors of otitis media with effusion (OME) in Italian school-children and the effectiveness of medical treatment of chronic OME with a new cephalosporin, ceftibuten. During two winter periods, 3413 children, aged 5 to 7 years, were examined for the presence of OME by means of pneumotoscopy and a portable, hand-held tympanometer. The prevalence of asymptomatic OME was 14.2%, with no difference as regards sex, age, month of examination or geographic area. Younger children had significantly more bilateral than unilateral effusion. A recent episode of acute otitis media and previous tonsillectomy or adenoidectomy were associated with an increased risk of OME in multivariate logistic regression models. The presence of OME was unrelated to such factors as birthweight, prematurity, sibling or parental history of allergy, duration of daycare attendance, family history of ear infections. After 12 weeks, 26.6% of children with OME still had middle-ear fluid: 52 were randomized to ceftibuten (9 mg/kg q.d. for 14 days) and 59 to no treatment (nasal saline drops allowed). Children treated with ceftibuten had a significantly better resolution of middle-ear effusion after 4 and 8 weeks. As mass screening programmes for OME in the year of school entry are questioned, a focus only on children with known risk factors seems advisable. Ceftibuten can be useful in reducing the duration of middle-ear effusion.

The contribution of risk factors to the effect of early otitis media with effusion on later language, reading, and spelling

A cohort of 946 children who were screened for otitis media with effusion (OME) from the ages of 2 to 4 were studied for language, reading, and spelling at 7 years of age. The effects of OME in combination with single risk factors and with increasing numbers of risk factors were investigated. An interaction with an additional risk factor was found only for gender and OME, with boys' spelling influenced negatively by a history of OME. OME in combination with preterm birth and low birthweight also appears to put children at risk for later language and educational problems. Although a negative linear relation between the number of risk factors and later functioning was found, it is suggested that OME, even when combined with a number of other risk factors, produces only minor effects on later language, reading, and spelling.

Developmental implications of early-life otitis media

This symposium addressed possible relationships between early-life otitis media (OM) and various components of child development. The existence and nature of such relationships are of substantial theoretical and practical consequence. Particularly at issue are policies concerning optimal frequencies of examination and screening for middle-ear disease as well as the relative appropriateness of conservative vs. aggressive regimens of management.

Otitis media and reading achievement: a review

Nineteen studies on the relationship between otitis media (OM) or otitis media with effusion (OME) (secretory otitis media (SOM)) and reading achievement were reviewed. The result is that the children catch up in cognitive development when their ears and hearing become normal at about school age. The correlations that have been found between SOM and reading achievement are so small that they have no practical importance for the average child. At the present time we have no knowledge that justifies intervention against SOM as a general preventive task to ensure the cognitive development, or reading achievement. The absent or very small correlation between SOM and reading in the reviewed studies, 'explaining' only 2-4% of the variance, has no implications in comparison with other important factors. Reading achievement was more closely correlated with cognitive, language, and linguistic factors, and to a series of socioenvironmental and classroom related factors. The high frequency of SOM, with resulting hearing loss, and the long duration and high rate of occurrence of OM in 'otitis-prone' children, and clinical observations underlines the need for further research.