research

1. Impact of secretory otitis
media on education and
learning
Under supervisionof
ENT Department
Damietta Faculty of Medicine,
AL Azhar University, Egypt
BY
AHMED FUAD IBRAHIM

2. CONTENT
1-Otitis media with effusion (Introduction)
2- Presentation in children
3- When does secretory otitis media affect language
development
4- How can I recognize if my child has a hearing loss?
5- Does early detection of otitis media with effusion prevent
delayed language development?
6- How may language learning be affected by Otitis Media?
7- Is my child achieving milestones of language
development?
8- The Effects of Early Bilateral Otitis Media with Effusion
on Educational Attainment
9- The impact of otitis media on cognitive outcomes
10- Why and how should serous otitis media be treated?
11- Serous and recurrent otitis media. Pharmacological or
surgical management?
12- Refrences

3. Otitis media with effusion(Introduction)
Synonym: glue ear
Otitis media with effusion (OME), also called glue ear, is characterised by a
collection of fluid in the middle-ear cleft. there is chronic inflammation but
without signs of acute inflammation. OME is the most common cause of
hearing impairment (and the most common reason for elective surgery) in
childhood, where it usually follows an episode of acute otitis media (AOM). It
is uncommon in adults, in whom Eustachian tube dysfunction is the
predominant cause and suspicious aetiologies should be considered(NICE CKS,
March 2011)
Presentation in children
 Hearing loss is the usual presenting symptom, although this is easily missed in
very young children.
 Hearing loss is not invariably present. Hearing loss in children may present as:
 Mishearing, difficulty with communication in a group, listening to the TV at
excessively high
 volumes or needing things to be repeated.
 Lack of concentration, withdrawal.
 Impaired speech and language development.
 Impaired school progress.
 Mild intermittent ear pain with fullness or popping.
 There may be a history of recurrent ear infection, upper respiratory tract
infections or nasal obstruction.
 Occasionally balance problems may be a feature. (NICE CKS, March 2011)
When does secretory otitis media affect language development
During the period in which these patients were seen, a much larger number of
children who attended for audiological examination was found tg have secretory otitis
media without any abnormality of language development, and conversely there were
many with language problems without evidence of this disorder. Since secretory otitis
media is so common, it is difficult in the individual child to determine how much the
disorder is affecting development. Parents often report an improvement in the child's
hearing immediately after surgery, but it is much more difficult to document
subsequent acceleration in language development. Furthermore, the diagnosis of
secretory otitis media with language delay is often followed by several simultaneous
interventions in addition to surgery-for example, advice to parents, nursery placement,
and beginning speech therapy. In spite of all these difficulties, the patients described
above lead us to suspect that secretory otitis media can indeed have a devastating
effect on some children, yet be of trivial importance to others. We postulate that at
least five variables must be considered to explain these differences. These are
.(1) The age at which the disorder occurs
2)The duration of the episodes;)
(3) The severity of the hearing loss
(4) Intrinsic qualities in the child
(5) The child's environment
D M B HALL AND P HILL APRIL 2008))

4. How can I recognize if my child has a hearing loss?
■Having difficulty paying attention ■ Showing a delayed response or no response
when spoken to ■ Saying “huh?” often ■ Not following directions well ■ Turning up
sound on radios, TV, CDs ■ Withdrawing from other children ■ Being over-active or
uncooperative
Children with temporary hearing loss may show all, some, or none of these behaviors.
These behaviors may be different at each age. It is often hard to tell whether a child
has a hearing problem or whether the child is just acting a certain way because of age
or temperament ( Roberts, J. E., Wallace, I. F., & Henderson, F. W. (Eds). (1997).
Does early detection of otitis media with effusion prevent
delayed language development?
There is insufficient evidence to support attempts at early detection of OME in the
first 4 years of life in the asymptomatic child to prevent delayed language
development
ButlerCC1, MacMillanH))
How may languagelearning be affected by Otitis Media?
During the first three years when children have the most problems with otitis media,
they are learning to speak and understand words. Children learn to do this by
interacting with people around them. It may be harder to hear and understand speech
if sound is muffled by fluid in the middle ear. Some researchers report that frequent
hearing loss in children with middle ear fluid may lead to speech and language
difficulties. However, other researchers have not found this to be true. Researchers are
still studying this. In the meantime, it’s best to pay special attention to the language
development of children who have middle ear fluid( Watt, M.R.,Roberts, J.E., &
Zeisel, S. (1993).
Is my child achieving milestones of language development?
INSTRUCTIONS—Read each question through your child’s age group and checkyes or no.
Add the total and see below .
All Yes:Your child is developing hearing, speech, & language in the typicalw ay.
1–2 No: Your child may have delayed hearing, speech & language development. Seek
professionaladvice if you are unsure.
3 or more No:Askfor a referralto an audiologist or speech-language pathologist

5. Green, A. R. (1997).
The Effects of Early Bilateral Otitis Media with Effusion on
Educational Attainment
The relationship between long-lasting, bilateral otitis media with effusion (OME)
between the ages of 2 and 4 and educational attainment, in particular, reading and
spelling ability at 7 years of age, was studied in a prospective cohort study of 946
children. After selection, three groups were distinguished: 151 children with long-
lasting, bilateral OME at preschool age, 37 preschool children treated with ventilation
tubes, and 82 children with no history of OME at that age. Early bilateral OME was
found to affect spelling ability, but not reading ability, at 7 years. The effects of OME
did not appear to increase with the number of observations of OME. Also, recurrent
hearing loss did not have more detrimental effects than continuous hearing loss.
Effects of treatment with ventilation tubes were not found. Only the teachers' ratings
of writing ability indicated a slight advantage of treatment with ventilation tubes. In
conclusion, the educational consequences of early OME appear to be very small(
Sylvia A. F. Peters Eefje H. Grievink Wim H.J. van Bon Anne G. M. Schilder May 2005)

6. The impact of otitis media on cognitive outcomes
• Otitis media is a common disease in childhood that can adversely affect cognitive
and educational outcomes. The literature in this area is equivocal, and findings may
be influenced by research design.
• The impact of otitis media on individual children’s development appears to depend
on the inter-relationship between several factors. Children who have early-onset otitis
media (under 12 months) are at high risk of developing longterm
speech and language problems.
• Otitis media has been found to interact negatively with preexisting cognitive or
language problems.
• For biological or environmental reasons, some populations have a pattern of early
onset, higher prevalence and episodes of longer duration; this pattern leads to a higher
risk of longterm speech and language problems.
• These factors suggest that Indigenous children may be at higher risk of cognitive
and educational sequelae than non- indigenous children ( Corinne J Williams and Ann
M Jacobs2009)
Why and how should serous otitis media be treated?
Serous otitis media is an extremely commonplace condition in pediatric patients and
tends to resolve spontaneously. Only some forms warrant treatment. Indications for
treatment include(1) frequent superinfections(,2) lasting hearing impairment with
adverse consequences on socialization, or debilitation of the tympanic membrane
carrying a risk for the ear. Tympanostomy tubes are a palliative treatment for serous
otitis which restores hearing within a few hours and eliminates unfixated retractions
of the tympanic membrane within a few weeks. Tympanostomy tubes may lead to
complications including otorrhea and perforation of the tympanic membrane and
should therefore be used only in patients with severe otitis media. Etiologic treatment
of serous otitis rests on restoration of satisfactory nasal ventilation (education to
improve nose-blowing, adenoidectomy), improvement of eustachian tube patency
(corticosteroids), and modification of the characteristics of middle ear secretions
(mucolytic agents and mucomodifying agents( François M1, Bonfils P,Van Haver K,
Narcy P)
Serous and recurrent otitis media. Pharmacological or surgical
management?
The management of recurrent acute otitis media and serous otitis media is both
challenging and controversial. The efficacy of antimicrobial prophylaxis of children at
high risk for recurrent acute otitis media is established, but the indications for such
therapy are controversial. Tympanostomy tube insertion also decreases the frequency
of recurrent otitis media. High-risk children can be successfully managed with
chemoprophylaxis from autumn through to spring. If this fails, then tympanostomy
tube insertion should be considered. Serous otitis media that follows acute otitis
media resolves spontaneously in more than 90% of cases. Serous otitis media of
unknown onset also has a strong tendency to resolve without treatment.
Antihistamines and decongestants, although popular, have no significant effect on the
course of serous otitis media. Antimicrobial therapy has a modest effect on the
resolution of serous otitis media. Tympanostomy tubes usually improve the
conductive hearing loss associated with serous otitis media and should be used when
bilateral serous otitis media fails to resolve spontaneously. If repeated tympanostomy

7. tube insertion fails, then adenoidectomy should be considered. With the course of
management outlined, most children will have a successful outcome with
conservative therapy and the need for surgery will be minimized
Marchant CD1, CollisonLM2006))
Refrences
1 -Otitis media with effusion; NICE CKS, March 2011 (UK access only)
2- D M B HALL AND P HILL
Departmentsof ChildHealthand Psychiatry,StGeorge'sHospital Medical School,London
3- Roberts, J. E., Wallace, I. F., & Henderson, F. W. (Eds). (1997). Otiitis Media in
Young Children. Baltimore, MD: Brookes Publishing Co.
Stool & the Otitis Media Panel. Otitis Media with Effusion in Young Children.
Clinical Practice Guideline Number 12. AHCPR Publication No. 94-0622.
Rockville, MD: Agency for Health Care Policy and Research, Public Health
Service, U.S. Department of Health and Human Services. July, 1994.
(Medical Version, Professional Guidelines). This booklet is available online
at www.aap.org/policy/otitis.htm
4- Butler CC1, MacMillan H
https://www.ncbi.nlm.nih.gov/pubmed/11466181
5- Watt, M.R., Roberts, J.E., & Zeisel, S. (1993). Ear infections in young children:
The role of the early childhood educator. Young Children, 49(1), 65–71.
Questions & Answers about Otitis Media, Hearing and Language Development—
www.asha.org/consumers/brochures/otitis_media.htm
Infections & Immunizations, Ear Infections— www.ama-assn.org/insight/
h_focus/nemours/infectio/childhd/ear.htm
6- Green, A. R. (1997). The parent’s completeguide to ear infections. Allentown,
PA: People’s Medical Society
7- Sylvia A. F. Peters Eefje H. Grievink Wim H.J. van Bon Anne G. M. Schilder
http://journals.sagepub.com/doi/abs/10.1177/002221949402700206
8-Marchant CD1, Collison LM
https://www.ncbi.nlm.nih.gov/pubmed/3322783
9- François M1, Bonfils P, Van Haver K, Narcy P.
https://www.ncbi.nlm.nih.gov/pubmed/1456683