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

Parental views on otitis media: systematic review of qualitative studies

This study aims to describe parental experiences and perspectives of caring for a child with otitis media. We conducted a systematic review of qualitative studies on parental perspectives on caring for a child with otitis media. We searched electronic databases to July 2015. Seventeen studies involving 284 participants from six countries were included. We identified seven themes: diminishing competency (guilt over failure to identify symptoms, helpless and despairing, fear of complications, disempowered and dismissed); disrupting life schedules (disturbing sleep, interfering with work, burden on family); social isolation (stigma and judgement, sick consciousness); threatening normal development (delaying growth milestones, impairing interpersonal skills, impeding education); taking ownership (recognising symptoms, diagnostic closure, working the system, protecting against physical trauma, contingency planning); valuing support (needing respite, depending on community, clinician validation); and cherishing health (relief with treatment success, inspiring resilience).

CONCLUSION

The additional medical responsibilities and anxieties of parents caring for a child with otitis media, often discounted by clinicians, can be disempowering and disruptive. Chronicity can raise doubt about treatment efficacy and parental competency, and fears regarding their child's development. Care that fosters parental confidence and addresses their concerns about the child's development may improve treatment outcomes for children with otitis media.

WHAT IS KNOWN

• Otitis media is a leading cause of conductive hearing loss in children. • Parental perception of the treatment burden of otitis media can potentially affect their confidence and ability to care for their child. What is New: • We identified five themes to reflect parental perspectives: diminishing competency, disrupting life schedules, social isolation, threatening normal development, taking ownership, valuing support, and cherishing health. • Parents may perceive caring for a child with otitis media as disempowering and disruptive and with reoccurrence doubt treatment efficacy and their parental competency and develop fears regarding their child's development.

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.

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.

Language, speech sound production, and cognition in three-year-old children in relation to otitis media in their first three years of life

OBJECTIVE

As part of a prospective study of possible effects of early-life otitis media on speech, language, cognitive, and psychosocial development, we tested relationships between children's cumulative duration of middle ear effusion (MEE) in their first 3 years of life and their scores on measures of language, speech sound production, and cognition at 3 years of age.

METHODS

We enrolled 6350 healthy infants by 2 months of age who presented for primary care at 1 of 2 urban hospitals or 1 of 2 small town/rural and 4 suburban private pediatric practices. We intensively monitored the children's middle ear status by pneumatic otoscopy, supplemented by tympanometry, throughout their first 3 years of life; we monitored the validity of the otoscopic observations on an ongoing basis; and we treated children for otitis media according to specified guidelines. Children who met specified minimum criteria regarding the persistence of MEE became eligible for a clinical trial in which they were assigned randomly to undergo tympanostomy tube placement either promptly or after a defined extended period if MEE remained present. From among those remaining, we selected randomly, within sociodemographic strata, a sample of 241 children who represented a spectrum of MEE experience from having no MEE to having MEE whose cumulative duration fell just short of meeting randomization criteria. In subjects so selected, the estimated duration of MEE ranged from none to 65.6% of the first year of life and 44.8% of the first 3 years of life. In these 241 children we assessed language development, speech sound production, and cognition at 3 years of age, using both formal tests and conversational samples.

RESULTS

We found weak to moderate, statistically significant negative correlations between children's cumulative durations of MEE in their first year of life or in age periods that included their first year of life, and their scores on formal tests of receptive vocabulary and verbal aspects of cognition at 3 years of age. However, the percent of variance in these scores explained by time with MEE in the first year of life beyond that explained by sociodemographic variables ranged only from 1.2% to 2.9%, and the negative correlations were concentrated in the subgroup of children whose families had private health insurance (rather than Medicaid). We found no significant correlations in the study population as a whole or in any subgroup between time with MEE during antecedent periods and children's scores on measures of spontaneous expressive language, speech sound production, or other measured aspects of cognition. In contrast, by wide margins, scores on all measures were consistently highest among the most socioeconomically advantaged children and lowest among the most socioeconomically disadvantaged children.

CONCLUSIONS

Our findings suggest either that persistent early-life MEE actually causes later small, circumscribed impairments of receptive language and verbal aspects of cognition in certain groups of children or that unidentified, confounding factors predispose children both to early-life otitis media and to certain types of developmental impairment. Findings in the randomized clinical trial component of the larger study should help distinguish between causality and confounding as explanations for our findings.language, speech, cognition, development, otitis media, middle ear effusion.

The initial development of an instrument for the description of “otitis media with effusion specific behavior” in young children

The objective of this study was a preliminary evaluation of a newly developed questionnaire concerning behavior of young children with recurrent Otitis Media with Effusion (OME) and documenting behavioral change after tympanostomy tube insertion. A sample of 95 parent-child pairs were interviewed using an age specific questionnaire: after diagnosing OME and scheduling for surgery, at the day care theatre a few weeks later, and 6 weeks after the intervention. The levels of internal consistency were varying from still insufficient to fairly good for the different subscales of the construct "OME-specific behavior" and these levels were comparable for both age specific questionnaires. As expected, parental report proved to be stable during time, but behavioral changes were reported after tympanostomy tubes insertion. The questionnaires seem to assess a decline in behavior expected to be specific for OME. Implications for future research are discussed, while considering the influence of parental concerns on behavioral reports.

The impact of early onset otitis media on babbling and early language development

Numerous studies have shown that otitis media (OM) during infancy has a negative impact on language development later in life. Few studies have examined the effect of OM on linguistic and prelinguistic behavior during infancy. The purpose of this study was to investigate the impact of OM on the development of canonical babble in children who experienced at least one episode during the period birth through 6 months of age, in comparison with children who did not experience OM during this period. The results show a consistently lower rate of canonical syllable production among children with early onset OM, when compared to children with later onset OM, during the period 6 through 18 months of age. In addition, a relationship between canonical babbling ability and expressive vocabulary size was observed at 18 months of age.

Fragile X, iron, and neurodevelopmental screening in 8 year old children with mild to moderate learning difficulties

OBJECTIVE

To examine the value of neurodevelopmental examination, fragile X testing, iron studies, and other screening procedures in children with mild to moderate learning difficulties.

DESIGN

A cross sectional case-control study.

SUBJECTS

A 34% random sample (n = 130) of children with mild to moderate learning difficulties born between 01/07/83 and 30/06/84 and resident in North and West Belfast. Controls were 130 children without learning difficulties matched for age and geographical area.

RESULTS

The prevalence of mild to moderate learning difficulties in North and West Belfast was 16%; 115 (89%) of the learning difficulties group and 80 (58%) of the control group consented to participate. Children in the learning difficulties group scored significantly lower in neurodevelopmental testing and were more likely to fail their audiometry assessment than controls. Children in the learning difficulties group were also more likely to be anaemic and had lower serum iron and transferrin saturation than controls. No cases of fragile X were identified. Thyroid function tests and urinary amino acids were all within normal limits There were no significant differences in anthropometry, head circumference, or formal neurological examinations.

CONCLUSIONS

Children with learning difficulties are more likely to be neurodevelopmentally immature and iron depleted than controls. Iron depletion should be aggressively sought and treated. The role for routine assessment for fragile X, thyroid function tests, and amino acid chromatography is doubtful.

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.

Evidence for aberrant auditory anatomy in developmental dyslexia

Abnormal auditory processing in dyslexics suggests that accompanying anatomical abnormalities might be present in the auditory system. Therefore, we measured cross-sectional neuronal areas in the medial geniculate nuclei (MGNs) of five dyslexic and seven control brains. In contrast to controls, which showed no asymmetry, the left-side MGN neurons were significantly smaller than the right in the dyslexic sample. Also, as compared with controls, there were more small neurons and fewer large neurons in the left dyslexic MGN. These findings are consistent with reported behavioral findings of a left hemisphere-based phonological defect in dyslexic individuals.

The effects of early bilateral otitis media with effusion on educational attainment: a prospective cohort study

The relationship between long-lasting, bilateral otitis media with effusion (OME) between the ages of 2 and 4 and educational attainment, in particular, reading and spelling ability at 7 years of age, was studied in a prospective cohort study of 946 children. After selection, three groups were distinguished: 151 children with long-lasting, bilateral OME at preschool age, 37 preschool children treated with ventilation tubes, and 82 children with no history of OME at that age. Early bilateral OME was found to affect spelling ability, but not reading ability, at 7 years. The effects of OME did not appear to increase with the number of observations of OME. Also, recurrent hearing loss did not have more detrimental effects than continuous hearing loss. Effects of treatment with ventilation tubes were not found. Only the teachers' ratings of writing ability indicated a slight advantage of treatment with ventilation tubes. In conclusion, the educational consequences of early OME appear to be very small.

Long-term effects of otitis media with effusion on language, reading and spelling

The long-term effects of early OME on language and educational attainment were studied in 47 children of 7-8 years of age who had participated in an earlier pre-school study on otitis media with effusion (OME) and language development. At pre-school age OME was diagnosed by quarterly tympanometric screens (maximum nine) and language was assessed by a standard Reynell test. At school age the ears of the children were assessed by otomicroscopy, tympanometry and audiometry, and the development status by several language, reading and spelling tests. The association between early OME and language development found at pre-school age was no longer present at school age.

Hearing and language in preschool very low birthweight children

To get more insight into preschool language and hearing in high-risk very low birthweight (VLBW) children, we conducted a prospective study in a cohort of 79 children. The prevalence of language impairment and hearing loss at age 3-4 years, their relationship to each other as well as to perinatal conditions, neurodevelopmental outcome and the home environment are described. Mild hearing loss was found in 26%, moderate hearing loss in 13% and severe hearing loss in 3% of the children. None of the children was deaf. Abnormal tympanometry was found in 57% of the children. Hearing loss at age 4 years was related to a less optimal neonatal condition and was not related to the obstetrical condition or to neonatal cerebral ultrasound findings. Language impairment was found in 21% of the children at age 3.6 years. Receptive and expressive language was not related to perinatal conditions. There was no relation between the language assessments and the audiological assessments. Cognition and the home environment of the child were the only independent variables in the prediction of language in preschool VLBW children.

Mucocutaneous leishmaniasis

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