On the sequelae of recurrent otitis media (ROM): a review and a proposed model

Abstract

Listen

Translate article

The literature on the effects of recurrent otitis media (ROM) on speech perception and production, language development and educational attainment is reviewed. Although these effects may be severe in some cases, they appear relatively moderate in the aggregate. Generally, the effects are most marked up to three years of age and are weaker thereafter. It appears that much of the earlier work on the effects of ROM was mainly concerned with establishing a statistical association between ROM and its apparent consequences. It is argued that such statistical links are not enough, because they do not present a causal model. Detail of the linguistic and cognitive steps by which ROM produces its effects is needed. A model for such a progression is presented, and considered in discussion of the published evidence. It is argued that the intermittent mild conductive hearing loss produced by ROM results in inconsistent perception of both phonemes and morpho-phonemes, which are thus weakly imprinted on neural reception areas. The likely consequences are central auditory processing problems and impaired development of the lexicon, producing difficulties in receptive and expressive language, and in cognition. There may ensue problems in metalanguage and metacognition, leading to impoverished academic attainment through poor reading, writing and spelling abilities, poor speech production, and problems with pragmatics and social behaviour. It is concluded that, in managing ROM, a priority is to detect and remediate the condition in infancy, though cost-effectiveness considerations may argue otherwise.