Johnny is a two and a half year old boy with Down syndrome. Since infancy, he has had almost continuous ear infections and fluid in his ears. The set of tubes put in his ears when he was one have fallen out, and during the winter he remains very congested. His language is delayed—he only says single words—and he is working with a speech-language pathologist at his childcare center. He has a mild hearing loss associated with his ear infections and the remaining fluid. In a family meeting with the early intervention team, Johnny's family is very concerned about his slow progress in language development and want to know if his chronic ear infections are contributing to the delay and if so, what they can do about it.
Johnny has multiple factors that may affect his language development—his developmental disability and chronic otitis media with effusion (OME) with an accompanying hearing loss. OME may place an additional burden on children as it increases their difficulties in hearing and thus in language learning.
Otitis media (OM) is one of the most common illnesses of early childhood. In 1990, OM accounted for 1 out of every 10 office visits in the United States and was the most frequent reason for visits in children under 15 years of age (Schappert, 1992). Diagnosis and treatment of OM presents a financial impact on the health care system with the estimated cost of treatment for children 13 years of age and younger estimated to be $5.3 billion annually (Bondy, Berman, Glazner, & Lexotte, 2000). OME is typically accompanied by a fluctuating hearing loss, which resolves with resolution of the disease. A large number of studies using prospective design have documented the incidence and course of OME in typically developing children (Casselbrandt, Brostoff, & Flaherty, 1985; Paradise et al., 1997; Midgley, Dewey, Pryce, Maw & ALSPAC Study Team, 2000; Zeisel et al., 1995; Zeisel, Roberts, Neebe, Riggins, & Henderson, 1999). OME has been documented as occurring frequently in children with Down syndrome Syndrome (Dahle & McCollister, 1986; Schwartz & Schwartz, 1978), Williams syndrome (Klein, Armstrong, Greer, & Brown, 1990), Apert syndrome (McGill, 1991), fragile X syndrome (Hagerman, Altshul-Stark, & McBogg, 1987), Turner syndrome (Sculerati, Ledesma-Medina, Finegold, & Stool, 1990; Stenberg, Nylen, Windh, & Hultcrantz, 1998), cleft palate (Paradise & Bluestone, 1974; Paradise, Bluestone, & Felder, 1969) and autism (Rosenhall, Nordin, Sandstrom, Ahlsen, & Gillberg, 1999); however, these reports in special populations are largely based on case report and retrospective studies. Problems with case report and retrospective studies are the dependence on parent memory of the illness, inconsistency in diagnostic methods because of a number of different examiners using differing methods and diagnostic criteria for OM, or reports based on a single case or small number of cases. While it is unclear whether persistent OME-related hearing loss leads to later language sequelae, this issue is of concern for both typically developing children and children with disabilities, particularly for children who may already be at risk for speech, language, and learning problems related to their disability. The purpose of this article is to discuss OM and its possible impact on language development, to present a pilot study of the prevalence of OM in children with disabilities attending childcare, to discuss implications for children with developmental disabilities, and to discuss strategies that early interventionists can use with children and families to promote listening and language learning.
WHAT IS OTITIS MEDIA AND WHY IS IT A CONCERN?
Otitis media is an inflammation of the middle ear typically accompanied by fluid. The middle ear space behind the eardrum is normally filled with air. The middle ear is connected to the throat by the Eustachian tube, which maintains middle ear ventilation and protects it from secretions. When a child has an upper respiratory tract infection, the upper respiratory tract (including the nose, throat, Eustachian tube, and middle ear) is likely to be congested with mucous, leading to obstruction of the Eustachian tube. When the Eustachian tube is inflamed or is not functioning properly, the child is more likely to have middle ear fluid. If the middle ear is filled with fluid, the eardrum cannot vibrate and thus hearing may be decreased. When the fluid is infected, the condition is called acute otitis media (AOM) or an ear infection. Children with AOM have sudden acute symptoms including fever, irritability, and ear pain. Frequently, the fluid remains in the middle ear space after the infection has resolved, or the fluid may be present without a previous infection. This condition is called otitis media with effusion (OME). The fluid may persist for several weeks or months. Children with fluid that persists more than 3 months are considered to have chronic OME.
Otoscopy and tympanometry are the most common methods used to examine ears. Otoscopy is looking into the ear with a lighted instrument. Tympanometry, or acoustic immittance, helps determine middle ear status by measuring the flow of acoustic energy in the middle ear as air pressure is varied. The instrument probe creates an airtight seal of the ear canal and introduces air under pressure into the canal through the probe tip. The changes in air pressure are measured including a tympanometric peak, shape, static admittance, and estimate of ear canal volume. Typically, an ear containing fluid will not have a peak as the eardrum cannot move with the introduction of air pressure changes from the instrument. (Refer to Bluestone and Klein, 2001, for more details on tympanometry).
AOM is frequently treated with antibiotics. Children with OME are typically observed with no medical intervention unless the condition becomes chronic and a hearing loss is present. If the fluid lasts longer than 4 to 6 months, pressure equalization (ventilation) tubes may be inserted surgically to help the middle ear heal and to restore hearing to normal.
A mild to moderate conductive hearing loss generally accompanies OME. This hearing loss resolves once the fluid is gone. A conductive hearing loss is one in which the hearing loss is due to a reduction in the transmission of sound in the middle ear. The cochlear/auditory nerve function is normal. A sensorineural hearing loss is one in which there is nerve involvement. A child with OM may have a sensorineural loss but this is not due to the OM.
The role of the Eustachian tube
Eustachian tube dysfunction is most likely to play a role in OM. Upon autopsy examination, children have been found to experience Eustachian tube dysfunction related to cleft palate, Down syndrome, and other congenital anomalies. Deformity of the Eustachian tube cartilage was associated with more severe OM and was a cause of tubal dysfunction (Sando & Takahashi, 1990) (see Table 1).
WHO IS AT RISK FOR DEVELOPING OM?
A number of factors increase children's risk for OM including the occurrence of both developmental disorders and other inherited and environmental factors. Children who have specific disabilities such as Down syndrome, Williams syndrome, Apert syndrome, fragile X syndrome, Turner syndrome, cleft lip/palate, and autism are at higher risk for developing OM. Other factors including children's age, previous experience with OM, attendance in group childcare, exposure to second hand smoke, infant feeding practices, and socioeconomic status also may increase the risk for OM. A description of studies of OM in special populations follows.
Children with Down syndrome have been reported to have high incidences of recurrent OM (Dahle & McCollister, 1986; Schwartz & Schwartz, 1978). In a study of 30 school-aged children with Down syndrome and 30 controls with retardation but without Down syndrome, Dahle and McCollister (1986) found that 83% of children with Down syndrome had ear examinations with abnormal results (impacted wax, OM, or other anomalies such as scarring of the eardrum), while 59% of the other children had abnormal results in one or both ears. Hearing thresholds were found to be elevated (greater than 15 dB HL, indicative of a hearing loss) in one or both ears for 76.9% of children with Down syndrome and 14.8% of the other children. Most hearing losses were conductive. These children were also found to have a significant amount of impacted cerumen (ear wax), which was a frequent cause of their hearing loss. Even in children with normal ears at the time of examination, hearing levels were higher than in the comparison group of children with developmental disabilities other than Down syndrome. Schwartz and Schwartz (1978) examined 38 children (mean age 3.1 years) with otoscopy and acoustic immittance measures (tympanometry) and found that 59% of children exhibited OME in at least one ear. They suggest that one reason for the high incidence of OME may be stenotic (narrow) external auditory canals as 80% (n = 12) of the children with this finding had OME while the children with normal ear canals were equally distributed with fluid and no fluid. Roizen, Wolters, Nichol, and Blondis (1993) examined the hearing of 47 children (aged 2–42 months) with Down syndrome. Because the children were unable to have their hearing tested using conventional methods, these children were examined using auditory brain stem response (ABR), which does not require active participation by the child. ABR measures how the neural pathway responds to sound, from the ear to the brainstem. They found that 34% of children had normal hearing, 28% had a unilateral loss, and 38% had a bilateral loss. Sixty-eight percent of the hearing loss was a mild conductive loss, the type usually associated with OME.
Children with Williams syndrome, a congenital anomaly with craniofacial involvement, are also linked to increased risk for OME (Klein et al., 1990). One of the conditions found in Williams syndrome is abnormal facial features with “elfin-like” appearance and characteristics such as a broad forehead, flat nasal bridge, upturned nares, and wide mouth with prominent lips. Common auditory conditions associated with Williams syndrome include hyperacusis (hypersensitivity to sound) and OM. In a questionnaire study of 65 children (aged 2–17, median age 7 years) with Williams syndrome, parents indicated that 95% of children had hyperacusis. When asked about OM, 61% of parents reported many episodes of OM and/or pressure equalizing tubes, which was found to be highly significant. No relationship was found between hyperacusis and OM.
Apert syndrome is a congenital syndrome that includes craniosynostosis (premature closure of the cranial sutures) as well as hand, foot, and other possible cranial anomalies. Upper airway obstruction is common during the first few years of life as the maxilla fails to grow while the mandible grows at a normal rate. A conductive hearing loss is almost universal in these children, most commonly caused by chronic OM. This is believed to be related to abnormal Eustachian tube functioning. McGill (1991) reported that of 35 children seen over a 10-year period, all had conductive hearing loss, at some time. Thirteen of these children had a permanent conductive loss, which was not resolved by ventilation tubes.
Fragile X syndrome
Children with fragile X syndrome have also been reported to have a high incidence of OM. In a retrospective study, McGill (1991) found that the boys with fragile X syndrome had significantly more AOM than did their typically developing siblings and controls. Thirty boys (mean age 7 years) were matched with typically developing siblings and with other unrelated children (controls) referred for developmental evaluation but without fragile X syndrome. Sixty-three percent of boys with fragile X syndrome had 6 or more episodes of AOM as compared to 15% of normal male siblings and 38% of the unrelated boys. Hagerman et al. (1987) suggest that this high incidence of AOM may be due to connective tissue dysplasia and hypotonia causing floppier Eustachian tubes as well as the presence of high-arched palates.
Turner syndrome is also a genetic disorder associated with high rates of recurrent AOM, with a prevalence rate of 61% to 82% (Sculerati et al., 1990; Stenberg et al., 1998). In a study of 22 females (aged 1–40 years, most were 11–15 years of age) with Turner syndrome, Sculeri et al. (1990) found that 45% had OME at examination. Only 27% (6) had normal hearing, while 36% (8) had conductive hearing losses, 14% (3) had sensorineural hearing losses, and 23% (5) had mixed conductive and sensorineural losses. Over half of the girls had received ventilation tubes at least once; many had multiple sets of tubes. Eight-two percent of families reported repeated ear infections. In a study of 56 girls aged 1–15 years, Stenberg et al. (1998) found a history of recurrent OM during at least one year of life in 61% of girls, with 32% having had ventilation tubes. Fifty-seven percent showed middle ear pathology. Conductive hearing losses were found in 44% of girls at time of examination and sensorineural losses in 58%. It is hypothesized that Eustachian tube dysfunction is the cause of the recurrent OM though other reasons including micrognathia have been suggested.
Numerous studies of children with cleft palate have found OM to be a nearly universal problem (Paradise et al., 1969; Paradise & Bluestone, 1974), affecting 92% to 97% of children with cleft palate in the first year of life and persisting in 70% at age 44 (Dhillon, 1988; Robinson et al., 1992). In a study of 138 infants (ages 0–20 months) with cleft palate, all infants were found to have OM in the first 3 months of life, either on initial examination or within the following 2 months (Paradise et al., 1969; Paradise & Bluestone, 1974). Broen et al. (1996) studied the ear status and hearing function of 28 children with cleft palate and 29 children without cleft palate every 3 months from 9 to 30 months of age. They found that while all children had more OM at younger ages, children with cleft palates continued to have OM at older ages. Children with cleft palate also had ventilation tubes inserted more frequently, even after repair of the cleft palate. At every age, more children with cleft palate failed hearing screenings. Prior to cleft palate repair, no child with a cleft palate had normal middle ear function and all had related conductive hearing losses.
Children with autism were also found to have increased OM. Rosenhall et al. (1999) studied 199 children and adolescents with a diagnosis of autism (mean age 7.9 years for boys, 8.4 years for girls) over a 12-year period and estimated the prevalence of OME to be 23.5% (38 children), with 24 children having a conductive hearing loss. Nineteen additional children had permanent hearing losses, with 3.5% having profound hearing loss or deafness. An estimated 18% of children with normal hearing had hyperacusis. The rate of OME was higher than expected and could not be related to a cause in this study; however, it has been hypothesized that this was due to Eustachian tube dysfunction.
Other factors have been found to play a role in OM. These factors include age of the child, attendance in group childcare, passive smoke exposure, and infant feeding practices. Among those especially important for children with developmental disabilities are age and attendance in group childcare.
Age is one on the greatest risk factors for OME. Younger children are at increased risk for developing OME because their Eustachian tubes are more horizontal than those of older children, which allows less opportunity for fluid to drain from the middle ear space. In a study of 689 children, Teele, Klein, and Rosner (1989) found that by age 3, more than 80% of children had experienced an episode of AOM and more than 40% had experienced 3 episodes. Paradise et al. (1997) found that the proportion of children developing at least one episode of OME between age 2 months and 6, 12, and 24 months was 48%, 79%, and 91% respectively. Children are likely to experience their first episode of OM by age 6 months (Casselbrandt, Mandel, Rockette, & Bluestone, 1993; Teele et al., 1989). Children who have their first episode at an early age are at greater risk for developing repeated and/or chronic episodes (Harsten, Prellner, Heldrup, & Kalm, 1989; Teele et al., 1989).
Group childcare is another risk factor for OME. Children in group childcare are more likely to have frequent upper respiratory tract infections, which are a factor in leading to Eustachian tube dysfunction. Hardy and Fowler (1993) concluded from the 1988 National Health Survey of Child Health data that children in childcare were at higher risk for repeated ear infections than were children at home. Strangert (1977) compared home, family childcare, and center-based childcare and found OM to be more common among children attending center-based care. The rate of occurrence was the same for children attending family childcare and children at home. Paradise et al. (1997) found a strong relationship between OME and exposure to other children whether that was in childcare or other children in the home. They reported that the number of children that the child is exposed to is the significant factor.
Other factors that increase risk for OM include exposure to passive smoke, infant feeding practices (bottle feeding and positioning during feeding), and socioeconomic status. See Daly (1997) for a further discussion of these risk factors for OM.
WHY IS OM A CONCERN FOR SPEECH AND LANGUAGE DEVELOPMENT?
It has been hypothesized that the link between OME and speech and language development is related to the fluctuating hearing loss that accompanies OME. Children with OME typically have a mild to moderate conductive hearing loss. The hearing loss averages about 25 db HL (like putting your hands over your ears). Some children, however, have no hearing loss while others may have a hearing loss of 50 db HL. The hearing loss is related to the amount and viscosity of the fluid in the middle ear space. When the fluid resolves, hearing returns to normal. It has been hypothesized that the hearing loss may impair the ability to hear speech and then process it. A child may encode information ineffectively, incompletely, or inaccurately into the database from which language develops. Speech at a typical conversational level in the child's environment may be more difficult to hear when there is background noise such as other children talking during free play in a classroom. A child who does not hear well may be less interactive and responsive and this could possibly affect the child's interactions with caregivers, decreasing opportunities to learn language language (Roberts et al., 1995; Roberts & Wallace, 1997).
However, the possible link between OME and language development is a controversial one, with some studies finding a relationship between OME and language development and other studies not finding this link in typically developing children. A large body of research using well-controlled prospective studies has examined the link between OM and later language development in typically developing children. Some studies found that children with OM in early childhood had poorer speech and language skills (Friel-Patti & Finitzo, 1990; Gravel & Wallace, 1992; Roberts, Burchinal, Koch, Footo, & Henderson, 1988; Teele, Klein, Rosner, & the Greater Boston Otitis Media Group, 1984), while other studies did not find a linkage between OM and later language and achievement (Fischler, Todd, & Feldman, 1985; Peters, Grievink, van Bon, & Schilder, 1994; Roberts et al., 1986, 1989; Teele et al., 1990). Several recent studies (Feldman et al., 1999; Paradise et al., 2000; Roberts et al., 2000) lend increasing support to the lack of a linkage between OM and development.
A few studies examining the linkage of OM and language development in children with developmental disabilities including Down syndrome (Whiteman, Simpson, & Compton, 1986), cerebral palsy (Van der Vyver, van der Merwe, & Tesner, 1988) and cleft palate (Jocelyn, Enko, & Rode, 1997) have shown a relationship between OME and speech and language. In a study of 30 adolescents with Down syndrome and a history of early OM, Whiteman et al. (1986) found that participants with an early OM history (without ventilation tubes) scored lower on tests of receptive and expressive language than did children with Down syndrome with ventilation tube placement and a group with no OM history. In a study of OM and speech in 20 children with cerebral palsy, Van der Vyver et al. (1988) found that the children with a history of more than 3 episodes of OM before the age of 6 years made more articulation errors than did children with cerebral palsy without a history of OM. A study of the lasting effects of chronic OM in children with cleft palates was conducted to examine the effects of the placement of ventilation tubes at different ages on speech skills (Hubbard, Paradise, McWilliams, Elster, & Taylor, 1985). The authors found that children who had tubes placed at an earlier age (mean age 3 months) had better articulation at a mean age of 106 months than did children with cleft palates who had tubes placed at a later age (mean age 30.8 months) or not at all. The children who had tubes placed earlier, and thus experienced less OM, had less impairment in hearing and speech. In a prospective study of 16 children with cleft lip and palate and 16 control children without cleft lip and palate, Jocelyn et al. (1996) found that children with cleft lip and palate had significantly more OME and ventilation tubes between the ages of 12 and 24 months. The cleft lip and palate children had lower language comprehension scores on both receptive and expressive language tests, as well as lower scores on tests of cognition, than did the control children.
A PILOT STUDY OF OME AND CHILDREN WITH DISABILITIES
Prospective studies of typically developing children have examined the prevalence of OM (Casselbrandt et al., 1985; Midgley et al., 2000; Paradise et al., 1997; Zeisel et al., 1995, 1999). While there have been case studies and retrospective studies of OM in children with disabilities, there have been no prospective studies examining the frequency of OME in children with disabilities attending childcare.
A pilot study of 14 children with special needs attending a university-based inclusive childcare program was conducted to examine the incidence of OME over a 7-month period.
The parents of children with disabilities attending a university-based inclusive childcare program were invited to participate in the study. Children ranged in age from 8 to 54 months at study entry and were followed for 7 months. There were 3 children with Down syndrome, 2 children with congenital and acquired encephalopathy, 2 children with autism, 2 children with cerebral palsy, 1 child with congenital blindness, 2 children with speech/articulation deficits, and 1 child with pervasive developmental disorder.
Children's ears were examined every other week by tympanometry (mean number of exams 13, mean interval between exams 17 days). A total of 184 examinations were conducted. Tympanometry, or acoustic immittance measurement, provides objective measurement of eardrum mobility (refer to Bluestone and Klein, 2001, for details on tympanometry). An ear that contains fluid typically will not have a peak as the eardrum cannot move with the introduction of air from the instrument.
Results for these 14 children indicated that children had bilateral OME during 15% of observations, unilateral OME during 28% of observations, and no effusion (normal ears) during 57% of observations. While children with pressure equalizing tubes have a history of chronic OM, the ventilation tubes allow the middle ear to be free of fluid and thus are considered normal at the time of examination for this study. Because of the small number of children in each diagnostic category, no statistical analysis was performed by diagnosis. However, observations can be made of children within each diagnostic category. Children with Down syndrome had the most bilateral OME regardless of age. This is consistent with the literature (Dahle & McCollister, 1986; Schwartz & Schwartz, 1978). Children with disabilities that are not typically related to OME (blindness, cerebral infection, cerebral palsy) displayed the least OME. One child with congenital brain encephalopathy had persistent unilateral OME. OME is not unusual in a child of this age (12–18 months). Two of the children with autism or pervasive developmental delay had little OME and the third child with autism had unilateral OME. One child with a speech delay had ventilation tubes and so her ears were presumed to be normal. The other child with a speech delay had normal ears about a third of the time and a unilateral OME for more than half of the time (refer to Table 2). Children demonstrated more OME when they were younger than when they were older (Table 3), which is consistent with the OME experience of typically developing children (Zeisel et al., 1995, 1999).
These results provide important information about OME and potential OM-related hearing loss. The pilot data indicate that children with disabilities have patterns of OME distribution similar to those of typically developing children, with an increased burden at younger ages and resolution at about 24–30 months of age.
The increased incidence of OM in children with a variety of developmental disabilities and its possible impact on language and learning makes OM an important issue in planning early intervention for young children with disabilities. The results of this pilot study support earlier studies of OME in children with disabilities (Broen et al., 1996; Dahle & McCollister, 1986; Hagerman et al., 1987; Klein et al., 1990; McGill, 1991; Schwartz & Schwartz, 1978; Sculerati et al., 1990). It is important to be cautious in generalizing these findings because of the small sample in this study. The results regarding the incidence of OM should be considered, given the existing literature on OM in children with disabilities, studies of OM in typically developing children in childcare settings (Hardy and Fowler, 1993; Paradise et al., 1997; Strangert, 1977; Zeisel et al., 1995, 1999) and the increased risk for language learning difficulties in children with disabilities. The data in this study and the existing literature support the importance of early interventionists having knowledge regarding OME and its possible effects on children for early interventionists.
IMPLICATIONS FOR EARLY INTERVENTIONISTS
There are a number of areas in which the early interventionist may have knowledge in order to plan for children with disabilities and provide information to parents. These include knowledge of medical interventions, signs of OME and hearing loss, and creating environments that promote active listening, language learning, and early literacy experiences. In a survey of early childhood special educators, Medley and colleagues (Medley, Roberts, & Zeisel, 1995) found that these educators expressed a need for more information, particularly in the areas of detecting hearing loss, language difficulties, and in managing children with a hearing loss.
An assessment of the child is the critical first step in planning individualized goals and services for the child and family, with reassessment a continuing part of the plan. In planning treatment goals, early interventionists will want to have up-to-date knowledge of OME and its possible impact on speech and language development in order to provide information to parents and to consider in planning services. A crucial part of the assessment plan for children must be to monitor the speech and language of children and to obtain a hearing assessment if hearing loss is suspected. An audiologic examination is an integral part of the assessment for OME. The American Academy of Pediatrics50 considers examination for signs of recurrent OM an essential part of developmental screening. They specifically recommend checking for OME at each visit for children with Down syndrome, Turner syndrome, and Williams syndrome beginning at 1 month of age. Often, OME does not present specific signs or symptoms. The early interventionist or the parent may notice that the child does not seem to be paying attention as well, may not respond when spoken to, or may sit closer to the TV or music. These may all be signs of the temporary fluctuating hearing loss associated with OME. If a child has an ear infection, the signs will be more acute. Frequently, the child will have a fever, be irritable, pull on his ear, or say that his ear hurts. If a child has an ear infection, the health care provider will probably prescribe a course of antibiotics. It is extremely important that the child take the medication on time and complete the entire course of medication. Once the acute infection has resolved, the child probably will have fluid remaining in his ear. Watchful waiting is the most common course of treatment. If the fluid persists, a hearing assessment is recommended. The guidelines for management of OME from the Agency for Health Care Policy and Research recommend hearing assessments for children after 3 months of fluid (Stool et al., 1994). Placement of ventilation tubes may or may not be recommended. This surgical procedure places a small tube in the child's eardrum to allow fluid to drain and the middle ear to heal. The tube generally stays in place 6–12 months before falling out. The tubes will help the child's hearing return to normal because they will prevent fluid in the middle ear. Speech-language pathologists and audiologists are frequently part of the early intervention team. They too can provide information to parents and other team members on OME.
Creating an environment rich in language is important for all children's development and is especially critical for children with OME. These experiences should include promoting active listening, promoting language learning, and promoting early literacy experiences. The strategies suggested are appropriate for use in the classroom and at home. Early interventionists should make it an important part of the plan in working with parents and teachers.
Promoting a healthy environment
It is important to promote a healthy environment for all children. While ear infections themselves are not contagious unless the ear is draining, the cold that frequently precedes or accompanies AOM is easily passed from child to child. An important strategy in preventing OM in bottle-fed children is to be sure they are upright or in a slightly reclined position when using a bottle. For more intervention strategies for promoting a healthy environment refer to Table 4.
Strategies for promoting listening both at home and in the classroom are important for the child who may have a hearing loss related to OME and will help all children become better listeners. These strategies have 2 main features: helping children hear and understand speech and decreasing background noise. Promoting a good listening environment will help children hear and understand speech. Specific strategies for promoting listening are suggested in Table 5.
Promoting language learning
Opportunities for promoting language are abundant in everyday activities. Asking the child simple questions, listening to what she has to say, and talking about things in which she is interested will help the child use language. Table 6 has suggestions for promoting language.
Promoting early literacy learning
Activities promoting early literacy are also important. Children can learn to listen and learn language through interaction with books, songs, and games. It is never too early to read to children, describing and explaining pictures and referring to the child's own experiences. Refer to Table 7 for specific suggestions for promoting early literacy.
Early interventionists should work collaboratively with families on a plan to create healthy environments that promote listening, language learning, and early literacy in both the classroom and home settings. This collaboration will encourage both the child's development and the parents' active participation. Discussion should also include information to assist parents in understanding OME and its possible impact on children's speech and language development.
OME is a common illness of early childhood. While it is unclear whether chronic OME leads to language sequelae, OME may present an increased risk to speech and language development for children with developmental disabilities. This is particularly important in light of the increased risk that a hearing loss may present to children who are already at high risk of language and learning delays. Berman (2001) suggests that because of the lack of studies of OM and language in children with disabilities, aggressive treatment with the placement of ventilation tubes may be prudent. Further prospective studies are needed to examine this issue. However, early interventionists can assist in creating an environment that promotes good listening and creates opportunities for language learning.
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