Otitis Media with Effusion (‘OME’) is the medical term for glue ear; a build-up of fluid in the middle ear and a common cause of impaired hearing in children. The NHS currently estimates that 1 in 5 children around the age of 2 years old will be affected by glue ear at any given time. Moreover, 8 in 10 children will have had OME at least once by the time they reach 10 years of age, with the main symptom being an element of hearing loss in one or both ears. Furthermore, research suggests that OME is the most common cause of hearing loss in young children between 6 to 12 months, caused by a build-up of fluid behind the eardrum! Consequently, this can result in some hearing loss. So does OME have the potential to impede literacy development?
What I have found interesting about OME is that it is a ﬂuctuating condition that can occur spontaneously or following a respiratory / ear infection. Sufferers can experience a number of episodes over the period of a year, which may last up to three months at a time, often without the symptoms and signs of an infection. This therefore indicates that, even though a child may not be showing any obvious signs of infection, they can be experiencing episodes of OME (with associated hearing loss) on an intermittent and ongoing basis. Significantly, it is reported that whilst most cases do not require treatment, about 50% of affected 2 to 4-year-old children will still have OME after 3 months!
The potential risk of mild to moderate conductive hearing loss varies for each affected child but, for some, it may be significant enough to interrupt the consistency and strength of their auditory signal. One potential consequence of such hearing loss is that some children experience an interruption in the way in which they hear and process the various units of sound they are exposed to. These auditory disturbances can therefore contribute to a difficulty in phonological awareness (the ability to hear sounds in spoken words) and phonological processing (the aptitude to associate sounds with letters and the ability to segment words according to their sounds). As these skills are required in the reading and spelling process, any deficit could impede the acquisition and development of literacy and language skills thereby potentially causing dyslexic tendencies to arise.
Phonological awareness and language acquisition begin at an early age. Research has found that babies of 6-8 months can discriminate between all the phonetic units (sounds) used in all languages across the world! Moreover, the 2 months that follow (age 10-12 months) is a critical period for sound development. During this time, babies are listening intently to the language going on around them and absorbing the sounds that they hear regularly in preparation to learn that particular language. This school of thought suggests that babies’ brains are taking in statistics for the phonemes (sounds) of their home language, even before they have the ability to speak! Fascinating stuff isn’t it? Take a look at the interesting Ted Talk by Kuhl entitled ‘The Linguistic Genius of Babies’ for more information on this by clicking here!
Considering the research put forward above, it is not surprising that there is a suggestion that delayed phonological processing and language acquisition can be attributed to OME. Let us consider babies ‘babbling’ for a moment. When a baby is around 3-4 months old, they ‘babble’. This is actually a stage of language development, which gives babies the opportunity to imitate the sound patterns of their home language. During the next few months, a child’s language acquisition continues to develop to include a range of sounds that begin to sound word-like and with which they begin to attach meaning. From 15 months onwards, children begin, with increasing accuracy, to imitate the sounds that they hear others use and it is between the age of 2 and 3 years of age that most children can speak using increasingly complex sentences. By the time they start school, studies of the vocabulary development of young children have shown that the average five year old knows at least 2,000 words and may know over 10,000! Under normal circumstances, children hear, and are exposed to, the full range of language used in their environment and, as a result, they become increasingly proficient in their language use. However, some researchers have observed that many children who suffer with glue ear will be way behind these stages for their age, especially those who suffer hearing loss during their first 2 years of life. Mild to moderate fluctuating hearing loss at this critical stage may well impede development in this area, which can in turn lead to suggestions of dyslexic tendencies. This could affect not only their acquisition of literacy, but also their social and emotional development, academic achievement and attention and behavioural difficulties.
Impaired hearing can also have a significant effect on the development of speech, language and communication in young children. However, it is likely that the amount of loss, type of loss and other factors will influence the severity of the impact therefore varying from child to child. Mild hearing loss does not usually affect a child’s speech, but it is thought that they will find it difficult to hear others talking at a distance of 12 feet or when there is background noise – unavoidable in a classroom environment. This is said to be because much of the meaning in the English language is contained in the voiceless consonants i.e. s / sh / t / p / k / f / ch / th which are high pitched and soft. This makes children vulnerable to experiencing difficulties when working in groups, a school setting or from a distance. Furthermore, children that find it difficult to hear those low intensity sounds mentioned above will not be able to write them if they cannot hear them. Low intensity morphological markers such as plurals, the present progressive “ing”, and past tense markers also have a tendency to go unheard and are therefore not used in spelling.
It is worth remembering that speech, language and communication skills include not just the spoken language but also eye contact, facial expression and body language. However, findings indicate that when hearing loss is experienced by the very young, they will not be able to employ a knowledge of contextual clues or other forms of communication in the way that an adult does. Interestingly some suggest that children with chronic OM use less non-verbal strategies to communicate with their parents than their peers, which suggests perhaps that their early communication patterns differ from those of healthy peers. Furthermore, a child’s understanding of the pragmatics of language (the social roles that govern what we say and how we say it in different social situations) could also be diminished as result.
In terms of how, or if, OME affects progress in reading, opinions differ. Some researchers feel that it has an unavoidable impact upon reading development whilst others argue that reading performance is not affected. Most acknowledge and agree that those who continue to suffer with middle ear infections and hearing loss do perform at a lower level than their peers which suggests that prompt treatment is key (e.g. with the insertion of grommets). However, contrasting opinions suggest that, even after surgery when hearing has improved, continuing weaknesses and sound discrimination issues can remain.
Aside from literacy difficulties, attention and listening in the classroom could be affected by OME. One such theory suggests that when children experience regular changes in the strength of sound signals they may learn to tune out. As a result, difficulties in maintaining attention can develop especially when expected to listen for long periods at a time. Discriminating language and processing speech may become so difficult that they understand verbal information inaccurately. Consequently, some children will prefer to tune out of verbal interactions rather than engage in something that they are finding difficult. This could affect not only their participation and involvement in lessons, but also their social relationships with their peers. Children could be labelled as easily distracted and accused of not paying attention / listening.
It is worth noting that if a child experiences one episode of OME that clears up on its own, there is unlikely to be any literary repercussions long term. However, the very nature of the condition that leads some children to experience intermittent, recurring episodes (with or without any obvious symptoms) leaves many vulnerable to missing early language and phonological skills that could ultimately influence their ability to read, write and spell. That said however, we must consider each child individually and bear in mind that there could be other contributing factors in the literacy difficulties experienced by OME sufferers. In attempting to discover the context for any learning difficulty it is important to ensure we take into consideration a full case history and to remember that there is no one model that can be followed. Therefore, each case study must be considered individually and with an open mind.
British Psychological Society (1999) Dyslexia, Literacy and Psychological Assessment, Section 4, Report of the Working Party of the Division of Educational and Child Psychology. Leicester: BPS.
Browne, A (2011) Developing Language and Literacy 3-8. London: Sage
Cain, K. (2013) Reading Development & Difficulties. West Sussex: BPS Blackwell.
Charlesworth, A. (no date) Teaching Children with Hearing Loss in Reading Recovery. Literacy Teaching and Learning. Vol. 11, no. 1, pp. 21-50.
Crystal, D. (1987) Child Language, Learning and Linguistics: 2nd Edition. London: Arnold.
DeMarco, S. & Givens, G. (1989) Speech Sound Discrimination Pre and Post-Tympanostomy: A Clinical Case Report. Ear and Hearing. No. 10, pp. 64-7.
Dombey, H. (2009) ‘The simple view of reading’. [online]. Available from: http://www.ite.org.uk/ite_readings/simple_view_reading.pdf
(Accessed: 5 January 2016)
EPIC Hearing Healthcare (2016) Hearing Loss in Children. [online]. Available from: http://www.epichearing.com/about/children-hearing-loss/ (Accessed: 10 January 2016).
Frith, U. Can we have a Shared Theoretical Framework? [online]. Available from: http://www.icn.ucl.ac.uk/dev_group/ufrith/documents/Frith,%20Dyslexia%20-%20can%20we%20have%20a%20shared%20theoretical%20framework%20copy.pdf
(Accessed: 10 January 2016)
Golz, A., et al. (2005) Reading performance in children with otitis media. Otolaryngology – Head and Neck Surgery. Sage: pp. 495-499 .
Golz, A. et al. (2006) Does Otitis Media in Early Childhood Affect Reading Performance in Later School Years? Otolaryngology – Head and Neck Surgery. Sage: pp 936-939.
Higson, J. & Haggard, M. (2005) Parent versus professional views of the developmental impact of a multi-faceted condition at school age: Otitis media with effusion (‘glue ear’). British Journal of Educational Psychology. Vol. 75, pp. 623-643.
Kindig, J. S. & Richards, H. C. (2000) ‘Otitis Media: Precursor of Delayed Reading’, Journal of Pediatric Psychology. Vol. 25, no. 1, pp 15-18.
Kuhl, P. (2010) Ted Talk: The Linguistic Genius of Babies. [online]. Available from: patricia_kuhl_the_linguistic_genius_of_babies (Accessed: 10 January 2016).
Lawrence, D. (2009) Understanding Dyslexia: A Guide for Teachers and Parents. Berks: Open University Press.
Lundberg, I. (2002) The Child’s Route into Reading and What Can Go Wrong. Dyslexia. No. 10, pp. 1-13.
National Deaf Children’s Society. [online]. Available from: http://www.ndcs.org.uk/family_support/glue_ear/
(Accessed: 10 January 2016)
National Health Service NHS Choices (2015) Glue Ear. [online]. Available from: http://www.nhs.uk/Conditions/Glue-ear/Pages/Introduction.aspx (Accessed: 29 December 2015)
Nicolson, R. & Fawcett, A. (1999) Automaticity: A New Framework for Dyslexia Research? Cognition. No. 30, pp. 159-82.
Minter et al (2001) Early Childhood Otitis Media in Relation to Children’s Attention-Related Behavior in the First Six Years of Life. Paediatrics. Vol. 107, no. 5, pp 1037-1042.
Olson, A. D. & Campbell, S. E. (2013) Degree of Hearing Loss and Working Memory in Adults. University of Kentucky.
Peer, L. (2002) Dyslexia, Multilingual Speakers and Otitis Media. PhD thesis, University of Sheffield.
Peer, L. (2012) Glue Ear: An Essential Guide for Teachers, Parents & Health Professionals. Oxon: Routledge.
Schriberg et al (2003) A diagnostic marker for speech delay associated with otitis media with effusion: the intelligibility-speech gap. Clinical Linguistic & Phonetics. Vol. 17, no. 7, pp. 507–528.
Snowling, M. J. & Stackhouse, J. (2006) A Practitioner’s Handbook: Dyslexia Speech & Language 2nd Edition. West Sussex: Whurr Publishers.
The American Academy of Pediatrics (2004): Otitis Media with Effusion. Pediatrics. Vol. 113 no. 5.
Yont, K.M, Snow, C.E. & Vernon-Feagons, L. (2001) Early communicative intents expressed by 12-monthold children with and without chronic otitis media, First Language. Vol. 21, pp 265-287.
Zielhuis, G. A., Rach, G. H., & Van den Broek, P. (1990). The natural course of otitis media with effusion in preschool children. European Archives of Otorhinlaryngology. No. 247, pp. 215–221.
Zumach, A. et al (2010) Long-Term Effects of Early-Life Otitis Media on Language Development. Journal of Speech, Language, and Hearing Research. Vol. 53, pp. 34–43.