Ear Infections Take Toll Later : Health: A recurrent problem in childhood could lead to learning problems in school. Early detection and treatment is recommended.
With speedy detection and antibiotic treatment, ear infections are blessedly brief ordeals for most children. But for those whose early years are blighted by an endless string of ear problems, the legacy may be more than a painful memory.
Several recent studies suggest that severe, recurrent ear infections may impair infants’ and toddlers’ hearing at critical points in development of language, possibly leading to learning problems later at school.
The more ear infections kids have before age 3, the lower their scores on later tests of speech, language and even intellectual ability, according to a study of more than 200 children by the Greater Boston Otitis Media Study Group. Reading and math skills lag at least through second grade.
Middle-ear infection (otitis media) is the most common cause of hearing loss in youngsters. Half of all U.S. kids have at least one such infection by their first birthday, which then predisposes them to repeated bouts until about age 6, according to the American Speech-Language-Hearing Association (ASHA). Only colds outrank ear infections as preschoolers’ most widespread health problem.
With better detection and more young children in day care, infection rates are rising. Colds, the main trigger of ear infections, spread easily whenever tots mingle in close quarters.
Parents with children in day care, however, may be reassured by a study of nearly 500 normal children in Dallas, which found that playing with other kids promotes language development. Toddlers who stay home with their mothers get fewer ear infections, but they tend to learn language more slowly, reports Dr. Sandy Friel-Patti, a speech and language pathologist at the University of Texas at Dallas.
Middle-ear infections inflame the lining of the middle ear, which includes the eardrum. Younger ears are particularly vulnerable because children’s Eustachian tubes, which drain fluid from the middle ear to the cavity at the back of the nose, are short, almost horizontal (adults’ are nearly vertical) and easily blocked.
Blockage allows fluid to build up in the middle ear, where it hinders vibrations from the eardrum to the trio of tiny bones crucial to hearing. This may temporarily impair hearing, and without treatment the eardrum may burst, scarring as it heals.
It’s also possible--though rare--for the middle-ear bones eventually to deteriorate or for the auditory nerve to be permanently damaged.
But even with no lasting hearing loss, some researchers maintain that repeated ear infections in the first year or two of life can blunt the listening skills needed later in the classroom.
Listening requires paying attention, and children who have had recurrent ear infections may start to “tune out,” says Dr. Joanne Roberts, a clinical assistant professor of speech and hearing sciences at the University of North Carolina in Chapel Hill. Temporary hearing loss muffles sound, she explains.
But the best way to prevent language delays is to treat infections promptly.
In most cases, a 10-day course of an antibiotic--usually Amoxicillin--does the trick. If the infection recurs, as it does in about a third of cases, or if it clears up but fluid persists, long-term, prophylactic antibiotic therapy is usually effective. If that doesn’t work, the pediatrician may recommend lancing the eardrum to drain the fluid. Children with chronic ear fluid and/or chronic or acute infections may require the surgical placement of a tiny plastic tube through an incision in the eardrum to help drain the fluid. For six months to a year, until the tube falls out, the child may be advised to wear custom-made ear plugs when bathing or swimming and to avoid diving or going beneath the surface of the water.
Tube insertion remains controversial, however. On the one hand, results of Friel-Patti’s recent study support early tube placement (on average, at 16 months of age). Language scores of children given tubes exceeded those of kids with chronic ear infections who didn’t have them and were equivalent to those of a group virtually free of ear infections.
But at the University of Pittsburgh, Dr. Jack Paradise, a professor of pediatrics, sees similarities between the popularity of tubes and that of tonsillectomies 30 years ago.
“Some children given tubes,” he says, “clearly could get by without them.”
At other centers, doctors are experimenting with steroid treatment and even “elimination” diets, as some stubborn cases stem from allergies to substances, including certain foods.
In the meantime, what’s a puzzled parent to do?
Tubes, which do not cure, should be a last resort for severe, recurrent cases.
“Because of the risks of surgery,” says Dr. Steven Shelov, a professor of pediatrics at Albert Einstein College of Medicine in the Bronx, N.Y., “tubes should be considered only if fluid persists in both ears for more than three months, impairing hearing and resisting prophylactic antibiotics.”
If a child’s doctor recommends inserting a tube, the pediatrician should refer the parents to a pediatric ear, nose and throat specialist for a second opinion.
“After an infection,” Shelov says, “it often takes three months for fluid to drain. Tubes do help certain children whose fluid lingers longer despite treatment.
“Nonstop ear infections,” he adds, “usually resolve themselves as the child gets older, so the decision to place tubes should be made on an individual basis.”
