Reading performance is not affected once otitis media has been cured

A follow-up study from Israel regarding pediatric hearing loss caused by otitis media and poor reading performance has determined that first and second graders with obvious reading impairments have escaped the deleterious effect of otitis media during later school years, once they were completely cured, and restored normal hearing. These children have caught up their reading skills nearly to the level of a control group.

One year ago, study results were presented addressing the reading performance in children with otitis media in early childhood. The findings revealed that middle ear diseases during early years and the attendant hearing losses adversely affect reading performance in first and second graders. Now a follow-up study using the same children from the study group three to four years later sought to determine whether the differences in reading performance between these children and the healthy children persist, or whether the ‘otitis children’ would catch up in their reading skills once they will recover from their middle ear diseases and grow older.

This research effort reevaluated the reading performance in those children who had reading impairment when they were in the first and second grades. Now the same children are in the fifth and the sixth grades; researchers inquired whether reading performance was still affected beyond the first years in school, once middle ear diseases are cured and hearing returns to normal; whether that performance is still affected among those children who still suffer from middle ear problems and hearing losses in later school years; and if reading is impaired among the unhealed children, what is the extent of such impairment?

The authors of “Does Otitis Media in Early Childhood Affect Reading Performance in Later School Years?” are Avishay Golz MD, Aviram Netzer MD, Arie Gordin MD, and David Goldenberg MD, all from the Department of Otolaryngology and Head & Neck Surgery, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; and Liane M Westerman, S Thomas Westerman, MD and David Gilbert, from Shrewsbury, NJ. Their findings are being presented at the American Academy of Otolaryngology-Head and Neck Surgery Foundation Annual Meeting & OTO EXPO, being held September 19-22, 2004, at the Jacob K. Javits Convention Center, New York City, NY.

Methodology:

Seventy-five children of the original otitis media study group were included in this study. The children ranged now in age from 10.2 to 11.6 years (mean age 11.1 years). A history of middle ear diseases was the only significant medical problem of these children who were otherwise completely healthy and normal.

The children were followed consistently and systematically every three to four months since the original study, or whenever someone had any ear problem. Follow-up visits included a complete ear nose and throat examination, including pneumatic and microscopic otoscopy, and a complete audiological assessment including pure tone audiometry for air and bone conduction, speech reception thresholds and tympanometry. Sixty children from the original control group of the first study, who never had any middle ear disease, either during early childhood or during the time between the two studies, were also examined. These children underwent the same ear nose and throat examination and the audiological evaluation.

The children of both groups were from the same classes and schools, and were carefully matched based on age, gender, socio-economic status (based on information about parental level of education and occupation) and cultural background. Reading tests were presented to the children of both groups approximately four years following the original study, at the end of the fifth year and during the sixth year in school. Each child underwent five special reading tests for Hebrew speaking children. The tests were adapted to the age and grade of the child, and were performed twice during the period of the study, in an interval of four to six months.

Results:

Out of the 75 children from the original otitis media study group, 64 completely recovered from their middle ear problems and had restored normal hearing as was determined during the follow-up visits. Otologic examination of the 64 healed children revealed normal or slightly sclerotic eardrums with aerated middle ear cavity. Eleven children still had recurrent or persistent middle ear diseases, and suffered from various degrees of hearing impairment. All the controls had normal tympanic membrane and normal hearing thresholds.

The findings revealed that the children, who have had obvious reading impairments while they were in first and second grades in school, have escaped the deleterious effect of otitis media during later school years, once they were completely cured, and restored normal hearing. These children have caught up their reading skills nearly to the level of the control children.

Since the unhealed group was too small, it was not possible to derive any significant statistical conclusions from the difference in reading performance between the cured children and these children. Nevertheless, the magnitude of this difference should be considered functionally significant.

Conclusions:

The relatively high percentage of mistakes among the unhealed children should come to the attention of teachers and physicians who treat these children, since chronic middle ear disease may affect not only reading, but other fields of learning as well. From these findings, the authors conclude:

1. Reading performance is not affected once otitis media has been cured and hearing restored.
2. Children who still suffer from middle ear problems and hearing losses performed less well than healed children in all reading tests.
3. Although reading among the unhealed children was not as impaired as it was when tested during the first and second grades, and although the unhealed group was too small, the difference in reading performance between the healed and the unhealed children should be considered functionally significant.