Volume 25 Number 1
October 1985

Wm. A. Scaldwell and Janet E. Frame
Educational Clinic, The University of Western Ontario

OTITIS MEDIA, or middle ear infection, is recognized as one of the most common childhood illnesses. It is generally thought, at present, that occlusion of the eustachian tube, which inhibits middle ear ventilation and prevents drainage, is a precipitating condition, causing inflammation and a buildup of mucous secretions in the middle ear cavity. Infection in the area may be caused by a number of organisms, streptococcus pneumoniae and hemophilus influenzae being the most common (Howie, 1972). These usually enter through the eustachian tube. Incidence of otitis media is most extreme in infancy and early childhood, when the eustachian tube is shorter, wider and in a more horizontal position, and the small muscles which control the opening of the tube are less efficient in function, leaving the eustachian tubes and the middle ears open to the invasion of infection-producing organisms. The susceptibility of young children and infants to middle ear infection, and the concomitant interference with the processing of sound, presents a barrier to normal hearing and language development.

Effects of the disease on hearing range from fluctuating hearing levels with mild infrequent attacks to damage to the ear drum and bones of the middle ear or even sensorineural loss, in severe and chronic cases. [Since hearing is vital to language learning, particularly in the critical years of language and speech development (birth to 31/2 years), the early onset of otitis media presents a major threat to normal language development (Dale, 1972).] Other effects, such as impaired verbal intellectual development (Howie, 1975; Zinkus & Gottlieb, 1980) and educational difficulties (Zinkus, Gottlieb, and Shapiro, 1978) have been noted.

At the Educational Clinic, the University of Western Ontario, the authors noted a high incidence (about 38%) of severe and early ear infections, upper respiratory problems, and allergies among children referred as having moderate and severe school learning problems in language areas, particularly word recognition and spelling. When the authors began a developmental project in a federal school for Indian children, a similar pattern was noted with over 52% of the children referred for difficulty in word recognition and spelling having a history of chronic middle ear infection and respiratory ailments. Indian children, especially those living on reserve lands, have been noted as scoring lower on reading tests than children of the majority population (Tomusiak, 1983). A set of reasons for this, often strongly adhered to by teachers and authors, is that lower reading and spelling performance is the result of living in isolated areas, having a first language other than English, and having a different cultural and experiential background. However, a high incidence of middle ear disease among Indian children has also been noted: for a comprehensive discussion of otitis media and its educational sequelae in Indian children, see McShane (1982).

The authors were interested in examining the incidence of otitis media in Indian schools, because it was believed that it might be a significant factor affecting language development, and one susceptible to early intervention and/ or modified teaching techniques.

School children attending Federal reserve schools in 2 southern Ontario and 4 northern Ontario communities were tested by a registered audiologist who was widely experienced in working with children. Testing was carried out during June in 3 schools, October in 2, and April in 1. The children were in grades Kindergarten to eight with a small group of day-care children, where such a facility existed. The age range was 3 to 16 years. A total of 739, or all children at school, were tested using an electroacoustic tympanometer (impedance bridge) with a printer attached so that record cards could be examined at a later date. The audiologist sorted the record cards into 3 categories--those with present serious or purulent otitis media, those for whom compliance readings showed evidence of past infections, and those whose ears and hearing were normal.

The results of the survey are given in Table 1.

In order to see trends by age, the cards were sorted into three categories by grade. This is shown in Table 2.

The children in group one, those having middle ear infections at the time of examination, were referred to the public health nurse for treatment or further referral.

As was mentioned earlier, young children are more prone to middle ear infections, Table 2, column one suggests that this was so in the group studied. This is presented in graph form in Figure 1, and is consistent with data reported by Howie, 1975.

TABLE 1
Impedance Bridge Screening Results in Six Schools

It is important to note that if columns one and two in Table 2 are combined, the percentage of children with present and past otitis media rises to 40.7%. In other words, only 60% of the group tested were free of signs of otitis media in active or passive forms. The reasons for this high incidence in Indian children are unclear. McShane (1982) presents a digest of studies in which genetic, cultural, socio-economic, climatic, and child-rearing practices are cited. It should also be noted that the time of year in which screening was carried out does not seem to be a factor in the incidence rate.

From the educator's point of view it is important to note that if the rate of otitis media infections is higher in infants and remains high in the early school years, language development, and acquisition and use, will be limited to some degree in a large percentage of Indian children, especially if an auditory or phonetic method of teaching is used. Teaching methods and programmes which put less emphasis on auditory skills must be developed.

TABLE 2
Percentage by Grade - Combined Groups

While otitis media may be regarded as a largely medical problem, it is being recognized that long term effects of an educational and social nature are concomitant. The teachers in reserve schools are in a good position to observe and refer children having ear infections, and also to have an influence on community awareness and understanding of this serious problem.

Dale, P. S. (1972). Language development: Structure and function. Hinsdale, Illinois: Dryden Press.

Howie, V. M. (1975). The otitis prone condition. American Journal of the Diseases of Children, 129, 676-678.

Howie, V. M. (1977). Acute and recurrent otitis media. In J. Burton (Ed.), Hearing loss in children (pp. 421-430). Baltimore, MD: University Park Press.

Howie, V. M., & Ploussard, V. H. (1972). Efficacy of fixed combination antibiotics versus separate components on otitis media. Clinical Pediatrics, 11, 205-214.

McShane, D. (1982). Otitis media and American Indians: Prevalence, etiology, psychoeducational consequences, prevention and intervention. In S. Manson (Ed.), New directions in prevention among American Indian children and Alaska native communities. Portland, Oregon: Oregon Health Sciences University.

Tomusiak, R. F. (1983). Summary report of the northern Saskatchewan norms project: Obtaining northern lights school division norms on group tests of scholastic achievement and ability (Report No. 96). Regina, Sask.: Saskatchewan School Trustees Association.

Zinkus, P. W., & Gottlieb, M. I. (1980). Patterns of perceptual and academic deficits related to early chronic otitis media. Pediatrics, 66(2), 246-253.

Zinkus, P. W., Gottlieb, M. I., & Schapiro, M. (1978). Developmental and psychoeducational sequelae of chronic otitis media. American Journal of the Diseases of Children, 132, 1100-1104.

Wm. A. Scaldwell, Ed.D., is an associate professor, division of educational psychology, and director of the educational clinic, the University of Western Ontario, London, Canada.

Janet E. Frame, M.Ed., is the associate director of the educational clinic, U.W.O., and the WESDIAND project in the federal Indian schools of the Ontario region.

NOTE: This project was funded by the Ontario Public School Teachers Federation and the Department of Indian Affairs and Northern Development (Ontario Region).