Sustained middle ear infections among children from birth

Infections of the ear are a range of diseases involving the structures of the outer ear, the middle ear, the mastoid process, and the inner ear. “Otitis Media”, an inflammation of the middle ear (the area behind the eardrum), is associated with a middle-ear effusion or the collection of fluid inside the middle ear. Simply stated, otitis media is fluid in the middle ear which is caused by an ear infection. It is one of the most common illnesses in children between birth and five years of age. (World Health Organization, 1998)

During the first five years when a child has the most problems with otitis media, the child is still in the process of learning to speak and understand words. Children learn to do this by interacting with people and the world around them. It may be harder to hear and understand speech if sound is muffled by fluid in the middle ear. Some researchers report that frequent hearing loss in children with middle ear fluid may lead to speech and language difficulties. Although other researchers have not found this to be true; researchers are still studying the disease.

(World Health Organization, 1998) Otitis Media Otitis media is fluid in the middle ear which is caused by an ear infection, and is one of the most common illnesses of childhood. Fluid in the middle ear acts like a sponge and prevents the ear from conducting sound properly. It also can interfere with normal hearing. The child with otitis media loses around 40 percent of his speech. Even a temporary and mild hearing loss can delay the development of language skills. There are two types of otitis media; either can occur in one or both ears.

• Acute otitis media (ear infection), is an infection of the middle ear. Fluid in the middle ear may continue even after an infection is gone. • Otitis media with effusion (middle ear fluid), is fluid that is not infected. When a child has a cold, a small tube between the ear and the throat can become blocked, causing the build up of fluid in the middle ear. Most children will have at least one episode of Otitis Media by one year of age. And ten to twenty percent of children will have Otitis Media three or more times, with fluid lasting an average of one month each time.

Persistent ear fluid is more common in children under two years, but it can be seen in children older than two. The middle ear space behind the eardrum usually contains air. When there is fluid in this space, it can cause the bones in the middle ear not to vibrate properly. This may cause a mild, temporary hearing loss. The mild hearing loss lasts until the fluid is gone. Because this can happen when a child is first learning to speak, this can cause grave concern for the child’s family.

If there are concerns regarding Otitis Media, a hearing evaluation or speech and language evaluation may be appropriate for the child. (World Health Organization, 1998) Otitis Media and Language Development The fluid in the middle ear of a child with Otitis Media reduces sound traveling through the middle ear; thus sounds may be muffled or not heard. Children with middle ear fluid will usually have a mild or moderate temporary hearing loss; though some children experience no change in their hearing. (Roberts et al. , 2000)

• Mild Hearing Loss: a child may not hear or may hear very faintly the soft sounds at the beginnings and ends of words, such as the “s” in “sun” and the “t” in “cat,” and words spoken quickly such as “and. ” • Moderate Hearing Loss: a child may have trouble hearing most speech sounds, and may have trouble with short, softly spoken words and word endings. It’s important to know that some children with otitis media have no loss of hearing. A hearing loss due to middle ear fluid should be restored to normal once the fluid is gone.

Research studies imply that Otitis Media may negatively effect speech-language development secondary to fluctuating conductive hearing loss associated with middle ear effusion (Gravel & Wallace, 2000). On the other hand, there are inconsistent findings among studies on the potential association of Otitis Media and delayed speech-language development. There have been studies relating Otitis Media to speech-language delay that found little evidence to support impact or risk (Roberts et al. , 2004).

Thus, parents who have concerns regarding their child’s language development should best talk to their child’s health care provider. A speech-language pathologist specializes in diagnosis and treatment of speech and language problems can be of great help. When a child has Otitis Media, a mild to moderate fluctuating hearing loss usually occurs, which has been hypothesized to interfere with rapid language processing, causing a child to encode information inefficiently, completely, or inaccurately into the brain’s database from which language develops.

If Otitis Media and the associated hearing loss persist or recurs during the formative years of language and learning, it has been assumed to delay language development, possibly affecting vocabulary or grammar. However, most of the data in the research studies analyzed in this paper were not adjusted for known confounding variables such as socioeconomic status and childcare environment which have been shown to explain a significantly larger portion of children’s language development than Otitis Media.

The insignificant association of Otitis Media with developmental outcomes suggests that differences in otherwise healthy children are detectable only by larger studies to increase statistical power. Hearing, but not Otitis Media, was a major predictor of outcomes, suggesting an association between hearing and language development, which would make sense because hearing loss, not Otitis Media, is theorized to affect children’s language development. Studies also suggest that environmental factors including language stimulation may mediate the potential negative developmental impact of Otitis Media. (Roberts et al. , 2000)

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