Eardrum Perfs and Language Spurts An audiologist is flummoxed when a toddler—her own—stops talking. First Person/Last Page
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First Person/Last Page  |   September 01, 2015
Eardrum Perfs and Language Spurts
Author Notes
  • Jessica J. Messersmith, PhD, CCC-A, is an associate professor and clinical supervisor at the University of South Dakota. She is an affiliate of ASHA Special Interest Group 8, Public Health Issues Related to Hearing and Balance. jessica.messersmith@usd.edu
    Jessica J. Messersmith, PhD, CCC-A, is an associate professor and clinical supervisor at the University of South Dakota. She is an affiliate of ASHA Special Interest Group 8, Public Health Issues Related to Hearing and Balance. jessica.messersmith@usd.edu×
Article Information
Hearing Disorders / Language Disorders / First Person/Last Page
First Person/Last Page   |   September 01, 2015
Eardrum Perfs and Language Spurts
The ASHA Leader, September 2015, Vol. 20, 72. doi:10.1044/leader.FPLP.20092015.72
The ASHA Leader, September 2015, Vol. 20, 72. doi:10.1044/leader.FPLP.20092015.72
My little girl fell silent. At 12 months she had four words, by 16 months she wasn’t vocalizing. My mommy instincts were sounding.
My pediatrician assured me that “all children develop differently.” I’m a pediatric cochlear implant audiologist, so I know that children develop at different rates—I remind the parents of my patients of this every day. Children don’t stop talking, though. My mind raced through possibilities … Autism? Rett’s? What was happening to my baby?
A speech-language pathologist friend and colleague recommended an immediate speech and language evaluation. But we needed an audiologic evaluation first. Previous evaluations were fine, but my daughter’s hearing hadn’t been checked since she stopped talking. Results showed a flat tympanogram and a mild conductive hearing loss, bilaterally. She had middle ear fluid.
A few days later, her eardrum ruptured and drained. Afterward, she started using a few words again. I thought little of it; she was enrolled in speech and language treatment so perhaps the language spurt was due to that. I requested tympanograms every two weeks, which would provide support for the placement of ear tubes if the fluid persisted for three months (American Academy of Pediatrics recommendation). One flat tymp, two flat tymps, three flat tymps, another eardrum perforation and another language spurt! Did middle ear fluid cause her to stop talking? Three months after the initial flat tympanogram she received ear tubes, and within a week my daughter was using two-word utterances.
Now 2, my daughter has graduated from speech-language treatment and uses three- and four-word phrases, and the tubes are in place. A year ago, I would not have predicted that she stopped talking because of middle ear fluid, which is often viewed as a minor transient event with no impact on language development. No published data show a connection between recurrent/persistent otitis media and language delays.
My experience indicates there is a connection. A child’s ability to accurately extract information from an auditory signal is directly related to language and reading development (see sources below). Middle ear fluid impedes the auditory system’s ability to access the auditory signal. The long-term implications of this early setback may be insignificant, but I was a proactive parent. Many parents follow the pediatrician’s recommendation that “all children develop differently,” and their child may experience this language setback for a longer period.
Consider this, however: Infants with higher levels of vowel discrimination at 6 months have larger vocabularies at 18 and 24 months, and early vocabulary is a predictor of overall language ability at school age. What if a child has middle ear fluid during this critical stage of development? Perhaps recurrent/persistent middle ear fluid is not getting the credit (or discredit) it deserves. Perhaps we haven’t figured out how to best assess its implications.
Sources
Kuhl, P. K., Conboy, B. T., Padden, D., Nelson, T., & Pruitt, J. (2005). Early speech perception and later language development: Implications for the critical period. Language Learning and Development, 1(3–4), 237–264.
Kuhl, P. K., Conboy, B. T., Padden, D., Nelson, T., & Pruitt, J. (2005). Early speech perception and later language development: Implications for the critical period. Language Learning and Development, 1(3–4), 237–264.×
Marchman, V., & Fernald, A. (2008). Speed of word recognition and vocabulary knowledge in infancy predict cognitive and language outcomes in later childhood. Developmental Science, 11(3), F9–F16. [Article] [PubMed]
Marchman, V., & Fernald, A. (2008). Speed of word recognition and vocabulary knowledge in infancy predict cognitive and language outcomes in later childhood. Developmental Science, 11(3), F9–F16. [Article] [PubMed]×
Reed, M. A. (1989). Speech perception and the discrimination of brief auditory cues in reading disabled children. Journal of Experimental Child Psychology, 48, 270–292. [Article] [PubMed]
Reed, M. A. (1989). Speech perception and the discrimination of brief auditory cues in reading disabled children. Journal of Experimental Child Psychology, 48, 270–292. [Article] [PubMed]×
3 Comments
September 3, 2015
Patricia Mayro
Thanks for validating clinical experience
I am so happy to see Dr. Messersmith point out the connection between recurrent/persistent otitis media and language delays that she has seen clinically. Although current research does not show a connection, it may be true that we have not yet figured out how best to assess iit.
September 17, 2015
Danielle Cepero
Great observation!
Yes! After working with children for years, sometimes a pattern emerges. Language bursts with the placement of tubes when the child could barely orient to mom's face before us but one example. We cannot expect kids to give us consistent speech and language if their auditory perception is inconsistent. They are new to language learning and if sounds are " moving targets", it's no wonder our little ones are sometimes slow to develop or regress in communication (associated with middle ear issues or childhood illness). Thank you sharing your experience.
September 20, 2015
Carol Maynard
Love It!
As a pediatric audiologist dealing with mild fluctuant hearing loss on a daily basis, I LOVE your article. Thank you for stating so succinctly and clearly this incredibly valuable information.
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September 2015
Volume 20, Issue 9