LONG TERM LANGUAGE DEFICIENCIES IN CHILDREN WITH. OTITIS MEDIA DURING THEIR FIRST YEAR OF THE LIFE. Ruben RJ,. Wallace IF,. Gravel J,.
GUEST EDITORIAL
LONG TERM LANGUAGE DEFICIENCIES IN CHILDREN WITH OTITIS MEDIA DURING THEIR FIRST YEAR OF THE LIFE Ruben RJ, Wallace IF, Gravel J, Department of Otolaryngology Rose F. Kennedy Center for Human Growth and Development Albert Einstein College of Medicine, Montefiore Medical Center 111 Eat 210 ht Street, Bronx NY 10467-2490 USA ruben @aecom.yu.edu. Ruben RJ, Wallace /F, Grave/ JS. Long term language deficiencies in children with otitis media during their first year of fife. Acta Otolaryngo/ (Stockh) 1997 : 117 : 033033 A cohort of lower socio-economic children who experienced multiple and prolonged episodes of otitis media (OM) during their first year of life were compared to an equivalent group of children who were largely free of OM during their first year. Both groups were followed until 9 years of age. The data indicate that children with positive histories of OM performed poorer on a variety of/inguisitc tasks across the nine year age span than the children with the positive histories of OM. The results suggest that the effect of the otitis media and its accompanying hearing loss on communication skills may extend throughout childhood. Keywords : Otitis media, language
During the past decade we have published a number of reports concerning the outcomes of a group of children from lower socioeconomic backgrounds who had experienced multiple episodes of otitis media (OM) during their first year of life as compared with a grouP of children who had one or no episode of OM during the same period 1,2.3,4,s,6,~.Both groups were seen at regular intervals over a nine year period for cognitive and language assessments. Results of data collected at the different age periods indicate that the otitis positve (OM+) group had lower scores than the otitis free (OM-) group on many of the outcome measures. The effect of otitis media and its accompanying hearing loss on communicative outcomes at individual ages was noted in these reports. The current paper presents the data longitudinally : specifically, what happened to the OM+ group over the nine years, how it compared with the OM- group, and what the results were for the individual OM+ children. This approach was MO & HNS/Vol. 49, No. 2, April-June, 1997
chosen in order to explore the question of the persistence of the relationship of OM to communicative skills over time.
Method The data were compiled and analyzed for 30 children who were enrolled at term in the Longitudinal Infant Follow-up and Evaluation (LIFE) Program of the R.F. Kennedy Center, Bronx, NY (1). All protocols were approved by the Committee on Clinical Investigations, the institutional Review Board for Albert Einstein College of Medicine. High-risk infants (i.e., low birth weight, perinatally asphyxiated, or mechanicaUy ventilated) who were cared for in the Neonatal intensive care unit, as well as healthy full-term infants from the same socioeconomically disadvantaged backgrounds, were followed prospectively beginning at term (ages of premature infants were corrected for prematurity). The children were scheduled for 11 well-baby visits during the first year of life. 94
Long Term Language Deficiencies in Children with Otitis Media During Their First Year of the Life--Ruben RJ et al.
Pneumatic otoscopy was completed at every scheduled visit and at sick visits by a trained and validated pediatric nurse practitioner. Visits were counted only when separated by a month. At the end of the first year, two groups of infants were identified. The OM- group were those who were bilaterally free of otitis media at 80% or more of their first year visits and had no more than one episode of OM during the first year. The OM+ group had bilateral OM at 30% or more of their first year visits, and had from two to six episodes during the first year. Children in both groups had a similar number of visits; details of the procedure have been published 2. This report concerns the 18 OM- and 12 OM+ children who were followed for nine or more years, although some children were missing data at one or more visits. Data were obtained on 18 measures administered at ages 1,2,3,4,5,6 and 9 years of age. Data were summarized by calculating the average score for the OM- group and then comparing the score of each child in the OM+ group with that of the average for the OMgroup. Each OM+ score that was equal to or higher than the average of the OM- group was counted and the percentage of children in the OM+ group who had higher scores that the OMwas catcu~ated for each measure (Tabte l). The percentage of the OM+ group with higher scores than the O M group ranged from 0 to 89%. Differences between the groups were considered significant when less than 40% of the OM+ group ;xceeded the score of the O M group. Table I List of Evaluations and the percentage that the OM+ were better than the OM-children
% OM+ better than the mean OMExpressive Language 1 year (SiCD-R) 0% Receptive Language 1 year (SICD-R) 72% Expressive Language 2 years (SICD-R) 8% Receptive Language 2 years (SICD-R) 58% Expressive Language 3 years (SICD-R) 54% Receptive Language 3 years (SICD-R) 67% Expressive Language 4 years (SICD-R) 25% Receptive Language 4 years (SiCD-R) 38% AUD 4 years (6) Pediatric Speech 30% Intelligibility Test) LIST 5 years (Listening, TOLD-P) 89% SPEAK 5 years (Speaking. TOLD-P) 67% PPVT 6 years (Peabody Picture 76%
Vocabulary Test) GC 6 years (Grammatical Closure, ITPA) TOKEN 6 years (Token Test) GU 6 years (Grammatical understanding) SIFTOT 7-8 years (Total Scores (SIFTER) SMRECAL 9 years (Story Memory recall) CELF 9 years
67% 50% 11% 0% 14% 43%
Results
Eight of the 18 measures of the OM+ children obtained over the nine years, compared with the average of the OM- group were found to be significant. Stated differently, on eight of the measures, the OM+ children performed worse than the OM- group average. These eight measures were : the expressive language scores a~ measured by the Sequenced Inventory of Communication Development-Revised (SICD-R), at 1 year (0%), 2 years (8%), and 4 years (25%); receptive language scores as measured by the SICD-R, at 4 years (38%); speech in noise as measured by the Pediatric Speech Intelligibility Test, at 4 years (30%); comprehension of grammatical structures as measured by the Test of Language Development-Primary Grammatical Understanding subtest, at 6 years (11%); school readiness as measured by the overall score on the SIFTER, at s to 7 years of age (0%); and reca~t of a narrative as measured by the Story Memory recall subtest of the Wide Range Assessment of Memory and Learning, at 9 years (14%). The percentage of tests on which each of the children in the OM+ group was significantly lower than the average score of the OM- group is presented in Table 11. Table II Percentage of testes that each OM+ child was poorer than the OM- group
Evaluation
IJO & HNS/Vol. 49, No. 2, April-June, 1997
OM+ Child JH WE MC JO LA FE HE ME DO TU MU MS
% poorer than OM-group 86% (6/7) 88% (7/8) 50% (3/6) 100% (3/3) 86% (6/7) 100% (7/7) 100% (2/2) 100% (8/8) 63% (5/8) 75% (3/4) 88% (718) 100% (3/3) 95
Long Term Language Deficiencies in Children with Otitis Media During Their First Year of the Life--Ruben RJ et aL
Discussion
The data show that many of the measures of linguistic function were found to be less well developed in the OM+ children as compared with the mean of the OM- group : in fact, eight of the 18 measures of communication distinguished the groups. On these eight measures, OM+children tended to show impairments on most (87%) of the tests. Although the OM+ group tended to display more deficits during the preschool years, many of the children had poorer communication scores throughout the age range : 10 of the 12 QM+ children had lower scores on over 75% of the evaluations in which differences were observed. Inspection of the scores reveals that the individual OM+ children followed the same pattern as was shown in the pooled data (Tables I and II). These observations suggest that the effect of the otitis
media and its concomitant hearing loss during the first year of life had a persistent deleterious effect on the OM+ children through their ninth year of life. Conclusion
A cohort of children from lower socioeconomic backgrounds who experienced recurrent episodes of otitis media during their first year of life and were followed for nine years were found to display poorer performances on measures of linguistic skills than did a control group of children without recurrent otitis media. Differences were found between the groups at all ages, and each of the OM+ children displayed deficiencies on two or more measures. The persistent and consistent effect of the OM and its concomitant hearing loss was noted through the nine year period of observation.
References
1. 2, 3. 4. 5. 6, 7.
Gravel J.S., McCarton C.M., Ruben, R.J. (1988) : A prospective study of otitis media in infants born at very low birth weight. Acta OtolaryngoI (Stockh) 105:561-521. Wallace I.F., Gravel J.S., McCarton C, Stapells DR, Bernstein R.S., Ruben R.J. (1988) : Otitis media and language development at 1 year of age. J Speech Hear Disord; 53:245-51. Gravel J.S., Wallace I.F. (1992) : Listening and language at 4 years of age : effects of early otitis media. J Speech Hear Res 35:58-95. Wallace I.F., Gravel, J.S., Schwartz R.G., Ruben R.J. (1996) : Otitis media, communication style of primary care givers, and language skills of 2 year old : A preliminary report. Devel Behav Ped 17:27-35. Gravel J.S., Wallace I.F. (1995) : Early otitis media auditory abilities and educational risk. Am J Speech Lang Pathol 4:89-94. Gravel J.S., Wallace I.F., Ruben R.J. (1996) : Auditory consequences of early mild hearing loss associated with otitis media. Acta Otolaryngol (Stockh) 116:219-21. Abraham S.S., Wallace I.F., Gravel J.S. (1996) : Early otitis media and phonological development at age 2 years. Laryngoscope 106:727-32.
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