Newswise — The National Center for Education Statistics reported that reading levels for fourth graders showed no significant improvement over grades recorded in 1992. Many debate whether the quality of education offered in America's classrooms is the direct cause for stagnation in reading levels for young children. But according to a new research study conducted in Israel, the incidence of acute otitis media (AOM) and middle ear effusion (MEE), more commonly known as middle ear infection, may have a direct impact on a child's ability to read at a level comparable to peers without this common childhood disorder.
Ear infections occur in almost every child at some time during the first six years of life. Many infants and young children suffer from multiple episodes of AOM and some spend weeks and even months with effusion in one or both ears. The relationship between AOM and MEE is very close in infants and children: AOM is often followed by a period of MEE, and effusion sometimes precedes a period with an acute infection of the middle ear. The incidence of AOM and MEE has proven to be particularly high among children aged 1-3 years.
Children starting school have also shown a high prevalence and incidence of middle ear diseases. MEE and AOM are usually associated with a mild-to-moderate conductive hearing loss. Hearing loss is usually temporary, but periods of hearing impairment often persist even for six to 12 months. During episodes of infection or effusion, normal auditory input is attenuated and distorted. Fluctuating conductive hearing loss, frequently associated with middle ear diseases, creates a condition of temporary partial auditory deprivation.
This hearing impairment, occurring in a sensitive and critical period during which the child learns to understand and produce language, is suggested to be responsible for adverse effects on speech and language development. Fluctuation in hearing, which is typical of recurrent middle ear diseases, may cause even more problems than a stable mild hearing loss. As learning to read and spell is dependent on language development, educational problems could also be expected to arise.
It has been proposed that any difficulties in speech and language attributed to otitis media-associated hearing loss may become particularly evident when a child reaches school age. Academic skills, particularly language-based subjects like learning to read and spell, may then be affected. Several studies have demonstrated that middle ear disease is associated with significantly lower reading scores and academic achievement in school. Other studies have found no such correlations or only minor effects of middle ear disease in early childhood on later learning and academic achievements without any significant importance.
A new study has set out to assess the effects of early recurrent or persistent middle ear problems with their associated hearing loss on reading performance among first and second graders. The researchers studied the time the children spent with MEE, the degree of the hearing impairment, and the number of episodes of AOM, and estimated their contribution to the scores of the reading tests.
The authors of "Reading Performance in Children with Otitis Media," are Avishay Golz MD, Aviram Netzer MD; Henry Z. Joachims MD; David Goldenberg MD S., from the Departments of Otolaryngology - Head and Neck Surgery and Communicative Disorders, Rambam Medical Center and Bruce Rappaport Faculty of Medicine - The Technion, Haifa, Israel; and Thomas Westerman, MD; Liane M. Westerman, and David A. Gilbert, from the Westerman Research Associates Inc., Shrewsbury, NJ. Their findings will be presented at the American Academy of Otolaryngology—Head and Neck Surgery Foundation http://www.entnet.org Annual Meeting & OTO EXPO, Orlando, FL, being held September 21-24, 2003.
Methodology: Eighty children were included in the study group ranging in age from 6.5 to 8 years. They were selected from a large group of over 2,000 children who were consistently followed at the Department of Otolaryngology-Head and Neck Surgery at the Rambam Medical Center due to recurrent episodes of AOM or prolonged periods of MEE. Middle ear diseases were the only medical problems of these children who were otherwise completely healthy and normal.
Data was collected from the medical records of these children regarding the number of episodes of middle ear infection, the duration of effusions in the middle ear, the results of the hearing tests and tympanometry, and the various treatments given to these children. Only children with medical records in which middle ear diseases were systematically documented were enrolled in the study. These children had at least 10 episodes of AOM during their first 5 years of life and/or prolonged periods of MEE with an average hearing loss for the speech frequencies range (500-2000 Hz) of 25 dB or more, or SRT of at least 25 dB. In all of the children middle ear pathology was most of the time bilateral. These children were carefully matched with 80 healthy children with no previous middle ear diseases, from the same schools and classes, based on age, gender, socio-economic status (based on information about parental occupation and level of education) and cultural background. Subjects with previous diagnosis of learning disabilities were excluded. Informed consent was obtained from the parents of the children in both groups.
Each child underwent five special reading tests performed twice during the period of the study in an interval of four to six months, at the end of the first year and during the second year in school. The tests were presented to the children by a qualified special education teacher and a speech pathologist. Both were unaware of the children's history of middle ear diseases or the results of the previous and the recent audiological findings. The total number of possible reading mistakes in all of these tests was 160. Achievement in reading was determined as the ratio between the child's reading score (number of mistakes made) and a predicted reading score based on the child's age and school grade (number of possible mistakes) expressed in percentages. Analysis of the results obtained from the reading tests in both groups was done by the Student t test.
Results: In both the study and the control groups there were 40 boys and 40 girls. The average age of the children in the study group was 7.3+0.33 years, and the average age of the controls was 7.4+0.28 years (not statistically significant). The children were from Ashkenazi families of upper-middle socioeconomic status. All were born in Israel and the mother tongue of their parents was Hebrew. Key findings included:
"¢ Most of the children (72.5%) in the study group had an average hearing loss in the range of 26 to 35 decibels. No significant difference was found between the average hearing level of the right and the left ear. "¢ The average percentage of mistakes in the reading tests was 15.2 percent for the children in the study group, as compared with only 5.8 percent for the controls (seven percent of mistakes are considered an acceptable percentage for children of the first and second school grades). The difference between these two groups is statistically significant. The reading tests showed a significant trend toward impaired performance with increasing number of AOM episodes and with more severe hearing loss. Those children who had more than four episodes of otitis media per year, and the children who had average hearing losses of more than 31 dB, scored worse than those with less AOM episodes and those with an average hearing impairment of less than 30 dB."¢ The 24 children from the study group that still had conductive hearing loss at the time of their reading assessment, did not perform less well than the other children from this group that had restored normal hearing. Girls performed slightly better than boys in all reading tests and in both groups, but the differences were not statistically significant.
Conclusions: The researchers conclude that previous middle ear pathology, with the associated various degrees of hearing losses, was actually responsible for the impaired performance in reading found in the study group children. They found a clear-cut correlation between the number of AOM episodes, the duration of MEE, and the degree of hearing losses associated with these diseases, and the reading scores of the children.
Recurrent middle ear disease in young children should be regarded therefore not only as a medical problem, but also as having a potential education risk for young reading beginners.
Parents of children with middle ear disease should be encouraged to provide a language-rich environment with intensive auditory stimulation to their children. This approach together with appropriate medical treatment can minimize the possibility of auditory deficits and reading problems in early school years.
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