Otitis media in early childhood and its relationship to later phonological development

Binaural processing and phonological awareness in Australian Indigenous children from the Northern Territory: A community based study

OBJECTIVE

Research has found that otitis media (OM) is highly prevalent in Australian Indigenous children, and repeated bouts of OM is often associated with minimal-to-moderate hearing loss. However, what is not yet clear is the extent to which OM with hearing loss impacts auditory signal processing specifically, but also binaural listening, listening in noise, and the potential impact on phonological awareness (PA) - an important, emergent literacy skill. The goal of this study was to determine whether auditory abilities, especially binaural processing, were associated with PA in children from populations with a high incidence of OM, living in a remote Australian Indigenous community in the Northern Territory (NT).

METHODS

Forty-seven 5-12-year-olds from a bilingual school participated in the study. All were tested to determine hearing sensitivity (pure tone audiometry and tympanometry), with PA measured on a test specifically developed in the first language of the children. OM often results in a hearing loss that can affect binaural processing: the Dichotic Digit difference Test (DDdT) was used to evaluate the children's dichotic listening and the Listening in Spatialized Noise-sentences test (LiSN-S) was used to evaluate their abilities to listen to speech-in-noise.

RESULTS

Seventeen (36%) and 16 (34%) had compromised middle ear compliance (combined Type-B and -C) in the right and left ear respectively. Six children demonstrated a bilateral mild hearing loss, and another five children demonstrated a unilateral mild hearing loss. Thirty-one children were able to complete the DDdT listening task, whereas only 24 completed the speech in noise task (LiSN-S). Forty-four children (94%) were able to complete the letter identification subtask, comprising part of the PA task. The findings revealed that age was significantly correlated with all tasks such that the older children performed better across the board. Once hearing thresholds were controlled for, PA also correlated significantly with both binaural processing tasks of dichotic listening (r = 0.59, p < 0.001) and listening to speech in noise (r = -0.56, p = 0.005); indicating a potential association between early, emergent literacy and listening skills.

CONCLUSIONS

The significant correlations between phonological awareness and dichotic listening as well as phonological awareness with listening to speech-in-noise skills suggests auditory processing, rather than hearing thresholds per se, are associated to phonological awareness abilities of this cohort of children. This suggests that the ability to process the auditory signal is critical.

Estimates of the prevalence of motor speech disorders in children with idiopathic speech delay

The goal of this research was to obtain initial estimates of the prevalence of each of four types of motor speech disorders in children with idiopathic Speech Delay (SD) and to use findings to estimate the population-based prevalence of each disorder. Analyses were completed on audio-recorded conversational speech samples from 415 children recruited for research in idiopathic SD in six USA cities during the past three decades. The speech and motor speech status of each participant was cross-classified using standardized measures in the finalized version of the Speech Disorders Classification System described in the Supplement. Population-based prevalence estimates for the four motor speech disorders were calculated from epidemiological studies of SD conducted in Australia, England, and the USA. A total of 82.2% of the 415 participants with SD met criteria for No Motor Speech Disorder at assessment, 12% met criteria for Speech Motor Delay, 3.4% met criteria for Childhood Dysarthria, 2.4% met criteria for Childhood Apraxia of Speech, and 0% met criteria for concurrent Childhood Dysarthria and Childhood Apraxia of Speech. The estimated population-based prevalence of each of the first three motor speech disorders at 4 to 8 years of age were Speech Motor Delay: 4 children per 1,000; Childhood Dysarthria: 1 child per 1,000; and Childhood Apraxia of Speech: 1 child per 1,000. The latter finding cross-validates a prior prevalence estimate for Childhood Apraxia of Speech of 1-2 children per 1,000. Findings are interpreted to indicate a substantial prevalence of motor speech disorders in children with idiopathic SD. Abbreviations: CAS, childhood apraxia of speech; CD, childhood dysarthria; CND, complex neurodevelopmental disorders; DI, dysarthria index; DSI, dysarthria subtype indices; MSD, motor speech disorder; No MSD, no motor speech disorder; NSA, normal(ized) speech acquisition; PEPPER, programs to examine phonetic and phonologic evaluation records; PM, pause marker; PMI, pause marker index; PSD, persistent speech delay; PSE, persistent speech errors; SD, speech delay; SDCS, speech disorders classification system; SDCSS, speech disorders classification system summary; SE, speech errors; SMD, speech motor delay.

Evaluating the perceptual and pathophysiological consequences of auditory deprivation in early postnatal life: a comparison of basic and clinical studies

Decades of clinical and basic research in visual system development have shown that degraded or imbalanced visual inputs can induce a long-lasting visual impairment called amblyopia. In the auditory domain, it is well established that inducing a conductive hearing loss (CHL) in young laboratory animals is associated with a panoply of central auditory system irregularities, ranging from cellular morphology to behavior. Human auditory deprivation, in the form of otitis media (OM), is tremendously common in young children, yet the evidence linking a history of OM to long-lasting auditory processing impairments has been equivocal for decades. Here, we review the apparent discrepancies in the clinical and basic auditory literature and provide a meta-analysis to show that the evidence for human amblyaudia, the auditory analog of amblyopia, is considerably more compelling than is generally believed. We argue that a major cause for this discrepancy is the fact that most clinical studies attempt to link central auditory deficits to a history of middle ear pathology, when the primary risk factor for brain-based developmental impairments such as amblyopia and amblyaudia is whether the afferent sensory signal is degraded during critical periods of brain development. Accordingly, clinical studies that target the subset of children with a history of OM that is also accompanied by elevated hearing thresholds consistently identify perceptual and physiological deficits that can endure for years after peripheral hearing is audiometrically normal, in keeping with the animal studies on CHL. These studies suggest that infants with OM severe enough to cause degraded afferent signal transmission (e.g., CHL) are particularly at risk to develop lasting central auditory impairments. We propose some practical guidelines to identify at-risk infants and test for the positive expression of amblyaudia in older children.

Infection rates after tympanostomy tube insertion, comparing Aboriginal and non-Aboriginal children in the Northern Territory, Australia: a retrospective, comparative study

OBJECTIVE

To determine if there is a difference in infection rates between Aboriginal and non-Aboriginal children, following tympanostomy and ventilation tube placement, in the Northern Territory, Australia.

MATERIALS AND METHODS

A cohort of 213 patients aged zero to 10 years who had undergone tympanostomy and ventilation tube placement at the Royal Darwin Hospital between 1996 and 2004 were identified. Patients were divided into Aboriginal or non-Aboriginal groups, from their medical record. Factors such as age, sex, dwelling (remote or urban) and season were compared for each group, in order to ascertain if they contributed to infection rates. A retrospective analysis of cases was conducted for the two-year post-operative period.

RESULTS

There was no statistically significant difference in infection rates between the two groups (37 vs 35 per cent). There was no statistically significant difference when comparing the two groups for age, sex, season, or remote vs urban dwelling.

CONCLUSION

Aboriginal children were not prone to more infections following tympanostomy tube placement when compared with non-Aboriginal children.

IMPAIRED AUDITORY ATTENTION SKILLS FOLLOWING MIDDLE-EAR INFECTIONS

The present study investigated auditory attention skills in a sample of children with non-chronic otitis media with effusion (OME). Twenty children with repeated episodes of OME but not found in the need for myringotomy and insertion of ventilating tubes were compared to 20 control children with no known episodes of OME based on parental reports and medical records. Mean age during assessment was 9 years, and none of the children showed signs of impaired language functions and with normal general cognitive abilities. They were assessed with dichotic listening CV-syllables (DLCV-108) free recall and directed attention tasks. The control children showed the expected right ear advantage during free recall and the directed right condition, and demonstrated a shift toward a left ear advantage during the directed left. The children with a history of OME showed a predominant right ear advantage across all three tasks. Although some change in ear accuracy occurred across tasks, impaired auditory attention skills were found following a history of middle ear infections. These results replicate those reported earlier from a sample of children with persistent otitis media with effusion, and suggest that treatment with ventilating tubes does not appear to make any difference in the development of auditory attention skills, whereas occurrence of OME must be considered when testing auditory attentional skills as a part of a neuropsychological assessment.

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.

The role of early language experience in the development of speech perception and phonological processing abilities: evidence from 5-year-olds with histories of otitis media with effusion and low socioeconomic status

This study tested the hypothesis that early language experience facilitates the development of language-specific perceptual weighting strategies believed to be critical for accessing phonetic structure. In turn, that structure allows for efficient storage and retrieval of words in verbal working memory, which is necessary for sentence comprehension. Participants were forty-nine 5-year-olds, evenly distributed among four groups: those with chronic otitis media with effusion (OME), low socio-economic status (low-SES), both conditions (both), or neither condition (control). All children participated in tasks of speech perception and phonological awareness. Children in the control and OME groups participated in additional tasks examining verbal working memory, sentence comprehension, and temporal processing. The temporal-processing task tested the hypothesis that any deficits observed on the language-related tasks could be explained by temporal-processing deficits. Children in the three experimental groups demonstrated similar results to each other, but different from the control group for speech perception and phonological awareness. Children in the OME group differed from those in the control group on tasks involving verbal working memory and sentence comprehension, but not temporal processing. Overall these results supported the major hypothesis explored, but failed to support the hypothesis that language problems are explained to any extent by temporal-processing problems.

LEARNING OUTCOMES

As a result of this activity, the participant will be able to (1) Explain the relation between language experience and the development of mature speech perception strategies, phonological awareness, verbal working memory, and syntactic comprehension. (2) Name at least three populations of individuals who exhibit delays in the development of mature speech perception strategies, phonological awareness, verbal working memory, and syntactic comprehension, and explain why these delays exist for each group. (3) Point out why perceptual strategies for speech are different for different languages. (4) Describe Baddeley's model [A.D. Baddeley, The development of the concept of working memory: implications and contributions of neuropsychology, in: G. Vallar, T. Shallice (Eds.), Neuropsychological Impairments of Short-term Memory, Cambridge University Press, New York, 1990, p. 54] of verbal working memory.

Otitis media and speech and language: a meta-analysis of prospective studies

OBJECTIVE

Considerable controversy surrounds whether a history of otitis media with effusion (OME) in early childhood causes later speech and language problems. We conducted a meta-analysis of prospective studies to determine: 1) whether a history of OME in early childhood is related to receptive language, expressive language, vocabulary, syntax, or speech development in children 1 to 5 years old and 2) whether hearing loss caused by otitis media in early childhood is related to children's receptive language or expressive language through 2 years of age.

METHODS

We searched online databases and bibliographies of OME studies and reviews for prospective or randomized clinical trials published between January 1966 and October 2002 that examined the relationship of OME or OME-associated hearing loss in early childhood to children's later speech and language development. The original search identified 38 studies, of which 14 had data suitable for calculating a pooled correlation coefficient (correlational studies) or standard difference between parallel groups (group studies). Random-effects meta-analysis was used to pool data when at least 3 studies had usable data for a particular outcome.

RESULTS

We performed 11 meta-analyses. There were no significant findings for the analyses of OME during early childhood versus receptive or expressive language during the preschool years in the correlation studies. Similarly, there were no significant findings for OME versus vocabulary, syntax, or speech during the preschool years. Conversely, there was a significant negative association between OME and preschoolers' receptive and expressive language (lower language) (0.24 and 0.25 standard difference, respectively) in the group studies. Additionally, hearing was also related to receptive and expressive language in infancy (3%-9% of variance).

CONCLUSIONS

Our results indicate no to very small negative associations of OME and associated hearing loss to children's later speech and language development. These findings may overestimate the impact of OME on outcomes, because most studies did not adjust for known confounding variables (such as socioeconomic status) and excluded data not suitable for statistical pooling, especially from methodologically sound studies. Although some OME language differences were detectable by meta-analysis due to increased statistical power, the clinical relevance for otherwise healthy children is uncertain.

Early versus delayed insertion of tympanostomy tubes for persistent otitis media: developmental outcomes at the age of three years in relation to prerandomization illness patterns and hearing levels

BACKGROUND

Whether prompt insertion of tympanostomy tubes in children with persistent early life otitis media prevents or minimizes subsequent developmental impairment has been the subject of conflicting opinions and differing approaches to management.

METHODS

We randomly assigned 429 children with persistent middle ear effusion (MEE) before the age of 3 years to have tympanostomy tubes inserted either as soon as possible or up to 9 months later if MEE persisted. In 402 of these children, we found no significant differences at age 3 years between the 2 treatment groups in mean scores on any measure of speech, language and cognition and in 401 of the children no significant differences in measures of psychosocial development. We then examined outcomes within subgroups of children who might have been the most severely affected, namely those who had been randomized on the basis of bilateral, continuous MEE rather than unilateral and/or discontinuous MEE and those who had the greatest degrees of hearing loss.

RESULTS

In none of the subgroups we considered were scores on any outcome measure significantly more favorable in children in the early treatment group than in children in the late treatment group.

CONCLUSIONS

In otherwise normal children who have MEE, during the first 3 years of life within the durations we studied, prompt insertion of tympanostomy tubes does not measurably improve developmental outcomes at age 3 years, irrespective of whether MEE has been continuous or discontinuous and unilateral or bilateral and whether or not MEE has been accompanied by mild to moderate hearing loss.

Parent-reported language skills in relation to otitis media during the first 3 years of life

As part of a larger study of the potential impact of early-life otitis media (OM) on speech, language, cognition, and behavior, we studied the degree of association between parent-reported language scores at ages 1, 2, and 3 years and the cumulative duration of middle-ear effusion (MEE) during the first 3 years of life in a demographically diverse sample of 621 children. We estimated the cumulative percentage of days with MEE from prospective monthly observations of middle-ear status and interpolations for periods between visits. For each child, parents completed the appropriate inventory of the MacArthur Communicative Development Inventories (CDI; L. Fenson et al., 1993) at ages 1, 2, and 3 years. We also evaluated the contribution of maternal education, as a proxy for socioeconomic status, to scores on the parent reports. Scores on the new CDI-III (B. Oliver et al., in press) varied positively with sociodemographic variables and were significantly correlated with scores from the CDI used when the children were younger. Unadjusted correlations between scores at ages 1 and 2 years and the percentages of days with MEE in the respective antecedent periods were statistically nonsignificant or of questionable clinical importance. The correlations between parent-reported scores at age 3 years and children's cumulative percentage of days with MEE in Years 1, 2, and 3 combined ranged from -.187 to -.248 (all p values < .001). The percentage of days with MEE and maternal education each contributed independently to scores at age 3 years. In the light of other findings from the larger study, we think it likely that the negative associations between language measures and MEE reflect confounding factors that contribute, on the one hand, to the duration of OM in young children and, on the other hand, to slow development of their language skills.

Function of the eustachian tube after weekly exposure to pepsin/hydrochloric acid

OBJECTIVE

To determine the effects of repeated pepsin/hydrochloric acid (HCl) exposure on the eustachian tube (ET).

STUDY DESIGN AND SETTING

ET function was studied in 22 rats. Group I (control) rats received transtympanic phosphate buffered saline solution; groups II (0.5 mg/ml) and III (2.0 mg/ml) received transtympanic pepsin/HCl. Test solutions were applied on day 0 with ET function evaluated on days 1, 2, 3, and 7 after exposure. Each 7-day period represents 1 cycle; all groups underwent 4 cycles. ET function was evaluated using passive opening and closing pressure, and active clearance of positive and negative pressure tests.

RESULTS

Rats exposed to pepsin/HCl had elevated passive opening pressures and a decreased ability to clear positive and negative pressure. A temporal relationship exists.

CONCLUSION

The results suggest middle ear exposure to pepsin/HCl leads to ET dysfunction in rats, and that this dysfunction is enhanced with repeated exposures.

SIGNIFICANCE

Gastroesophageal reflux may induce ET dysfunction.

Effect of early or delayed insertion of tympanostomy tubes for persistent otitis media on developmental outcomes at the age of three years

BACKGROUND

A main indication for the insertion of tympanostomy tubes in infants and young children is persistent otitis media with effusion, reflecting concern that this condition may cause lasting impairments of speech, language, cognitive, and psychosocial development. However, evidence of such relations is inconclusive, and evidence is lacking that the insertion of tympanostomy tubes prevents developmental impairment.

METHODS

We enrolled 6350 healthy infants from 2 to 61 days of age and evaluated them regularly for middle-ear effusion. Before the age of three years 429 children with persistent effusion were randomly assigned to have tympanostomy tubes inserted either as soon as possible or up to nine months later if effusion persisted. In 402 of these children we assessed speech, language, cognition, and psychosocial development at the age of three years.

RESULTS

By the age of three years, 169 children in the early-treatment group (82 percent) and 66 children in the late-treatment group (34 percent) had received tympanostomy tubes. There were no significant differences between the early-treatment group and the late-treatment group at the age of three years in the mean (+/-SD) scores on the Number of Different Words test, a measure of word diversity (124+/-32 and 126+/-30, respectively); the Percentage of Consonants Correct-Revised test, a measure of speech-sound production (85+/-7 vs. 86+/-7); the General Cognitive Index of McCarthy Scales of Children's Abilities (99+/-14 vs. 101+/-13); or on measures of receptive language, sentence length, grammatical complexity, parent-child stress, and behavior.

CONCLUSIONS

In children younger than three years of age who have persistent otitis media, prompt insertion of tympanostomy tubes does not measurably improve developmental outcomes at the age of three years.

Association of early bilateral middle ear effusion with language at age 5 years

OBJECTIVE

This study tested the hypothesis that children with early persistent middle ear effusion (MEE) are at risk for later language deficit.

METHOD

We recruited 698 newborns and monitored them for MEE every 2 to 4 weeks at home until age 3 years. Language skills were assessed on 294 subjects at age 5, while controlling for 8 demographic and environmental factors. Language outcomes at age 5 years were studied as a function of duration of bilateral MEE from birth to age 3 years.

RESULTS

A significant relation was found between duration of bilateral MEE and speech sound sensitivity (Carrow Elicited Language Inventory) and articulation (Goldman-Fristoe Articulation). Children's ability to discriminate speech sounds in a quiet environment (Carrow Auditory Visual Abilities Test) was less affected by early prolonged MEE in homes that provided more cognitive stimulation.

CONCLUSIONS

These exploratory results indicate that prolonged early MEE may predispose children to language deficits at age 5 years. The language deficits are of small magnitude and may or may not be clinically significant. Language stimulation at home may protect against some of the effects of prolonged MEE.

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.

Risk for speech disorder associated with early recurrent otitis media with effusion: two retrospective studies

The goals of this two-part series on children with histories of early recurrent otitis media with effusion (OME) were to assess the risk for speech disorder with and without hearing loss and to develop a preliminary descriptive-explanatory model for the findings. Recently available speech analysis programs, lifespan reference data, and statistical techniques were implemented with three cohorts of children with OME and their controls originally assessed in the 1980s: 35 typically developing 3-year-old children followed since infancy in a university-affiliated pediatrics clinic, 50 typically developing children of Native American background followed since infancy in a tribal health clinic, and (in the second paper) 70 children followed prospectively from 2 months of age to 3 years of age and older. Dependent variables included information from a suite of 10 metrics of speech production (Shriberg, Austin, Lewis, McSweeny, & Wilson, 1997a, 1 997b). Constraints on available sociodemographic and hearing status information limit generalizations from the comparative findings for each database, particularly data from the two retrospective studies. The present paper reports findings from risk analysis of conversational speech data from the first two cohorts, each of which included retrospective study of children for whom data on hearing loss were not available. Early recurrent OME was not associated with increased risk for speech disorder in the pediatrics sample but was associated with approximately 4.6 (CI = 1.10-20.20) increased risk for subclinical or clinical speech disorder in the children of Native American background. Discussion underscores the appropriateness of multifactorial risk models for this subtype of child speech disorder.

Speech perception and verbal memory in children with and without histories of otitis media

Two groups of children, with (n = 7) and without (n = 7) first-year histories of otitis media, were participants in a longitudinal study that included periodic audiological and medical evaluations during the first year of life. At age 9, these children were tested on a series of speech perception and verbal short-term memory tasks using stimuli of varying degrees of phonetic contrast. Although the otitis-positive group performed less accurately than the otitis-free group, the pattern of errors was the same for the two groups. The performances of the children with and without positive histories of otitis media were negatively affected by an increase in phonetic similarity of the stimulus items. The two groups, however, did not differ on identification or on temporal-order recall when the speech sounds were differentiated by multiple features. These findings provide evidence of subtle, long-term effects of early episodes of otitis media on phonological representations and on working memory.

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.

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.

Treatment efficacy: functional phonological disorders in children

This report addresses the efficacy of treatment for functional phonological disorders in children. The definition of phonological disorders and their incidence and prevalence are first presented. The impact of this disorder on the lives of children and the role that speech-language pathologists play in treating this disorder are then discussed. Evidence of the positive outcome of phonological treatment is reviewed, with particular emphasis on treatment procedures that have been deemed effective, the specific effects of these treatments on improving intelligibility, and comparisons between treatments in facilitating improved sound production.

Early otitis media and phonological development at age 2 years

The effect of early otitis media on phonology and articulation in the presence of expressive language delay was investigated in 16 2-year-olds followed prospectively from birth. Eight of the children were designated otitis-positive and 8 were considered otitis-negative as determined by bilateral pneumatic otoscopy outcomes during year 1 of life. The groups differed significantly on measures of expressive, not receptive, language development. All members of the otitis-positive group were expressive language delayed. Phonological analyses were completed on spoken language samples elicited from each child at age 24 months. Results showed similar developmental tendencies in speech sound acquisition between the groups, but the otitis-positive group had established significantly fewer initial consonant phones and produced them less accurately than the otitis-negative subject group. The otitis-positive group acquired significantly fewer consonants with back place of articulation. Similar phonological error patterns of deletion and phoneme class deficiency were used by the groups, but the otitis-positive group used the error patterns more frequently. Findings here lend support to the otitis media effect as one of interaction among risk factors.

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.

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.

Oral communication skills of children who are hard of hearing

Forty children with mild to severe hearing losses were administered a battery of speech and language tasks. The children's speech was characterized by misarticulation of affricates and fricatives, mild-moderate hoarseness, mild resonance problems, and good intelligibility. Their language samples included syntactic errors, primarily involving the use of bound morphemes and complex sentence structures. The children's pragmatic errors consisted primarily of providing inadequate or ambiguous information to the listener. These results indicate a consistent pattern of oral communication behavior that reflects the reduction of acoustic input that they experience.

History of middle ear involvement and speech/language development in late talkers

Late-talking and normally speaking toddlers with and without histories of middle ear involvement were followed for 2 years to assess speech and expressive language outcomes. Results revealed no differences in expressive language outcome that could be attributed to history of middle ear involvement in either group. There did seem to be differences in outcome on measures of articulation that were associated with history of middle ear involvement. The implications of these findings for treatment of otitis media and for referral of late-talking toddlers for speech and language services are discussed.

Early phonological and lexical development and otitis media: a diary study

This diary study describes early phonological and lexical development in a child with chronic otitis media with effusion. Equipped with the tools of a referential/analytic language-learner, the child solved the problem of reduced and fluctuating auditory input with phonological selection and avoidance strategies that capitalized on prosodic cues. This 'tone-language' approach resulted in a lexical inventory that would be categorized as an extreme expressive style. Having 'boot-strapped' her lexical learning, the child continued to rely on phonological constraints and selection strategies to fuel lexical and syntactic growth, i.e. cross-domain interactions leading to a vocabulary spurt and the onset of two-word utterances. These findings illustrate the need to consider interactions among performance, input and linguistic constraints in order to explain individual variation in language learning.

Language development in children with recurrent acute otitis media during the first three years of life. Follow-up study from birth to seven years of age

From a cohort of 113 children, followed prospectively from birth during the first three years of life regarding different aspects of acute otitis media (AOM), two study groups were selected for the present investigation: 13 children with recurrent AOM (rAOM, i.e. at least six episodes of AOM during a 12-month period), and 29 children without any AOM episode. The purpose of this study was to analyse the possible effects of early onset rAOM on language development as assessed at four and seven years of age at phoniatric and linguistic examinations performed blindly. There were no differences between the two groups on any of the linguistic analyses performed, although the rAOM group manifested a somewhat better performance on auditory discrimination tests at four years of age. The results of the present study show that rAOM during the first three years of life, in otherwise healthy children, does not cause a detectable delay of language development at four and seven years of age.

Chronic otitis media and early speech development: a case study

A case study of the speech development in a male infant with chronic otitis media is reported. The phonetic behavior characterizing the child's vocalizations was sampled monthly between the ages of 11 and 21 months, as he progressed from pre-speech to early speech periods of language development. Results of monthly phonetic inventory analyses indicated age-appropriate types of consonants in his pre-word and later-word vocalizations. However, the child's repertoire of consonants was considerably reduced as he first began to produce meaningful speech. Results of phonetic diversity analyses revealed an overall lack of phonetic complexity in his vocalizations throughout the course of study. In general, the child's early sound productions were characteristic of developmental delay, closely resembling the speech patterns found among severely hearing-imparied children. Findings are discussed with respect to the probable influence of chronic otitis media with effusion on a child's eventual speech development.

Identification and management of children with minimal hearing loss

Throughout the last two decades, we have witnessed a gradual change in the audiological profile of the hearing-impaired child. The number of children with severe to profound hearing losses seems to be declining, while those with minimal losses seems to be increasing. Such losses include unilateral sensorineural, mild bilateral sensorineural, and bilateral conductive hearing loss. Historically, children with minimal hearing loss have received limited attention from physicians, audiologists, or educators. It has been assumed that minimally hearing-impaired children will exhibit few, if any, handicaps and require no special assistance in the academic setting. Recent evidence challenges that assumption, however, and suggests that, in fact, children with minimal hearing loss can demonstrate significant academic and communicative difficulties. It is recommended that children with minimal hearing impairment be considered at high risk for communication and educational difficulties and that assessments be made early in order to identify problems and implement management programs.