Otitis media, fluctuant hearing loss, and speech-language outcomes: a preliminary structural equation model.

The goals of this study were to estimate the risk for lowered speech-language outcomes associated with early recurrent otitis media with effusion (OME) with and without hearing loss and to develop a preliminary descriptive-explanatory model for the findings. Three statistical approaches were used to assess associations among OME, hearing loss, and speech-language outcomes. Participants were a subsample of 70 children followed prospectively in the Dallas Cooperative Project on Early Hearing and Language Development (Friel-Patti & Finitzo, 1990). Findings indicated that hearing levels at 12-18 months were significantly associated with speech delay and low language outcomes at 3 years of age. The risk for subclinical or clinical speech delay at 3 years of age was 2% for children with less than 20 dB average hearing levels at 12-18 months and 33% for children with greater than 20 dB average hearing levels at 12-18 months. A structural equation model (Jöreskog & Sörbom, 1993) indicated that the significant and substantial effects of hearing levels at 12-18 months on speech status at 3 years were significantly mediated by language status at 3 years. Discussion includes implications of these findings for alternative speech perception models linking early OME and hearing loss to later speech-language disorder.

Tympanometry and otoscopy prior to myringotomy: issues in diagnosis of otitis media.

Tympanometry and pneumatic otoscopy were compared to findings at myringotomy in 86 children (163 ears). Seventy percent of the ears (115) had effusion, as revealed by myringotomy. Sensitivity and specificity for tympanometry were 90% and 86%, respectively. Sensitivity and specificity for pneumatic otoscopy were 93% and 58%, respectively. A chi-square was performed to compare the sensitivity and specificity to tympanometry to otoscopy, revealing tympanometry significantly better at determining non-effusion states. Additionally, a combined otoscopy and tympanometry sensitivity and specificity were calculated for those otoscopy and tympanometry determinations in agreement, revealing both sensitivity and specificity above 90%. A Fisher's exact probability test revealed no significant differences for the accuracy of tympanometry over otoscopy when the determinations of each were not in agreement. Implications of these results are discussed.

Research in child language disorders: what do we know and where are we going?

Advances in understanding the nature of language impairment in children over the past decade have been abundant. In this paper, several recurring hypotheses about the nature of the clinical disorder of language impairment in children and underlying etiologies are explored and the ways in which we are moving forward in our understanding of them are considered. Specifically, in the first part, the recent thinking on the nature of specific language impairment as a clinical concept is examined. Characteristics of the population are reviewed and the search for causation is considered. Literature on the relations between language and cognition and between language and social cognition is probed for contributions to our understanding of developmental disorders of language. Two areas in which we have seen marked progress and which hold promise for development in the coming decade are the focus of the second part of the paper. The focal areas are: computer-assisted language sample analyses and neurophysiological contribution to understanding language impairment in children. Thoughts about future directions for work in the area of developmental disorders of language are offered in conclusion.

Language learning in a prospective study of otitis media with effusion in the first two years of life.

We report cross-sectional findings on children's early experience with otitis media with effusion (OME) related to hearing over time and emerging receptive and expressive language skills on the Sequenced Inventory of Communication Development Scale (SICD). Tympanometry and otoscopy on the same day are combined to diagnose OME. Hearing from 6 to 12 months is significantly related to scores on the SICD beginning with receptive language at 12 months. At 18 and 24 months, both receptive and expressive language are significantly related to average hearing from 6 to 18 months. Better language is associated with better average hearing levels. These findings suggest that the relationship between OME and language is mediated by hearing. It remains to be seen whether these relationships persist as the children continue to develop language.

Otitis media. Incidence, duration, and hearing status.

The middle ear status and hearing sensitivity in 483 normal infants have been closely monitored as part of the Dallas Cooperative Project, University of Texas at Dallas, effort to assess the effect of early otitis media with effusion on speech and language development. At least one episode of otitis media with effusion occurred in 73.5% of the children between the ages of 6 and 18 months. Almost a quarter of these were discovered at "well-baby" checkups and were appropriately classified as "silent." The hearing levels, the methods of hearing assessment, and the implications of these data are described.

Mother-child dialogues: a comparison of normal and language impaired children.

This study explored similarities and differences in the dialogue of mother-child dyads with normal and language impaired children. The dialogue code used in this study assessed the child's ability to participate and sustain dialogue, and the mothers' ability to adjust to their children's level of functioning in discourse. It was found that: Language impaired children are not as skilled as younger normal language learning children of the same language stage in their ability to participate and maintain conversation; and that mothers of both normal and language impaired children adjust their language to meet the needs of their conversational partners. Implications for the language impaired mother-child dyad are discussed.

Mothers' discourse adjustments to language-impaired and non-language-impaired children.

Mother's discourse adjustments addressed to language-impaired children and non-language-impaired children were studied. Mother-child dyads with 14 language-impaired children and 14 MLU-matched non-language-impaired children served as subjects. The mothers' discourse was compared on the following measures: meaning illocutions, cohesion ilocutions, and dialogue participation. The children's participation in dialogue was also analyzed. Results indicated that the mothers' speech addressed to the two groups of children was highly similar, but the discourse performance of the language-impaired children was not like that of the non-language-impaired children. The clinical implications of these findings for the language-impaired population are discussed.

Evaluating changes in the communication skills of deaf children using vibrotactile stimulation.

Results of a 9-mo longitudinal study designed to evaluate the efficacy of a vibrotactile aid, the SRA-10, with four profoundly deaf preschool children are reported. During the study the subjects were enrolled in 30-min triweekly language therapy sessions, and changes in communication skills in connected discourse (vocalization only, sign language only, and vocalization plus sign language) were measured using a computer-based observation system. Changes in structural and semantic aspects of language were also measured. The four subjects were evaluated during one 16-week phase in which the aid was used (aid-on condition) and another 8 weeks in duration in which the aid was not used (aid-off condition). Communication skills improved in the aid-on condition and decreased in the aid-off condition. The changes were found to be significant for the communication involving the vocalization plus sign language (Total Communication) measure, indicating that the vibrotactile stimulation was positively associated with the communicative act.

Language delay in infants associated with middle ear disease and mild, fluctuating hearing impairment.

We report on a study of the relationship between early persistent middle ear disease and early language learning for 35 infants. Three independent measurements were used to evaluate hearing sensitivity and the status of the middle ear. Language development was assessed using two standardized measurements for both comprehension and expression. The otitis-prone group had a 71.5% incidence of language delay with 42.9% delayed greater than 6 months. For the normal group 21.4% had language delay, with one child having delay greater than 6 months. The feasibility of including language screening for at-risk infants is discussed.

Aspects of mother-child interaction as related to the remediation process.

Selected aspects of mother-child interaction are discussed with initial consideration given to the evidence regarding the emergence of conversational exchanges between normally developing language-learning children and their mothers. The results of a preliminary investigation in the area of mother-child interaction involving the clinical population of language-disordered children are presented. The research results are discussed in terms of the remediation process.