Lecture 4

Question 1

What causes conductive hearing loss in children?

Answer 1

1. Congenital deformities e.g. Down syndrome have a narrower middle ear canal
2. Head injury – could damage/fracture the ossicles
3. Benign tumors – could block the flow of movement from the outer → middle→ inner ear
4. Infection of the external auditory meatus → acute external otitis. Results in a narrowing of the canal, which affects the funnelling of the sound waves.
5. Foreign bodies – e.g. beads, sultanas etc.

Question 2

What is atresia?

Answer 2

Absence or partially formed external auditory meatus (i.e. ear canal)

Question 3

What is microtia?

Answer 3

Absence or partially formed pinna

Question 4

What is otosclerosis? Is it more common in adults or children?

Answer 4

More common in adults

Disrupts the movements of the bones in them middle ear

Fixation of the foot plate of the stapes by the development of unorganised bone (calcification) – bone becomes thicker, and thus fixates the stapes to prevent adequate movement for transfer of sounds.

Progressive – gets worse over time and doesn’t improve spontaneously. Can result in severe hearing loss.

Question 5

What are two treatment options for otosclerosis?

Answer 5

• Stapedectomy. Surgery to remove the whole stapes, or remove the calcified bone.
• Hearing aids – useful if there is only a partial fixation of the stapes.

Question 6

What is otitis media? Is it more common in children or adults?

Answer 6

• Infection of the middle ear
• More common in children
• Can have very severe symptoms – pain, discharge.
o Can also be asymptomatic (thus hard to diagnose)

Question 7

How is otitis media diagnosed?

Answer 7

1. Visual: Have a look in the ear for bulging/redness

2. Tympanogram: measure the pressure of the middle/outer ear.

Question 8

What type of tympanogram represents otitis media?

Answer 8

Type B - lack of peak shows a decrease in mobility of the tympanic membrane.

A Type C tympanogram represents Eustachian tube dysfunction

Question 9

What are the four forms of otitis media?

Answer 9

1. Acute otitis media without perforation
2. Otitis media with effusion
3. Acute otitis media with perforation
4. Chronic suppuratives otitis media

Question 10

Describe acute otitis media WITHOUT perforation. What are some causes and symptoms?

Answer 10

• Mucus membrane of the middle ear cavity is inflamed
• Increase in mucus, inflammation

CAUSES:
• Could be caused by allergy (nasal cavity is connected to Eustachian tube), drinking while laying down (infants), cold & flu, cigarette smoke

SYMPTOMS:
• Ear pain, irritable, fever, vomiting, diarrhoea
• Diagnosis: bulging red drum, decreased mobility of the drum, Type B tympanogram.

Question 11

Describe acute otitis media with effusion. What are some symptoms?

Answer 11

Otitis media with effusion
• Also known as “glue ear”
• The middle ear irriation persists and there is a build up of fluid

SYMPTOMS:
• Retracted ear drum, presence of fluid, decreased mobility of drum, different colours: white/red/yellow, usually no pain or fever
• Type B or C Tympanogram
• Mild-moderate hearing loss

Question 12

Describe acute otitis media with perforation

Answer 12

• Fluid has built up so much that the tympanic membrane bursts – discharge will come out from the ear

(YUM)

Question 13

Describe chronic suppuratives otitis media

Answer 13

• Discharge persists over a long period of time.

EVEN MORE YUM

Question 14

Name and describe four complications that may occur with otitis media.

Answer 14

• Mastoiditis: infection spreads to mastoid bone
• Cholesteatoma: build up of epithelial cells in the middle ear (thick layer of skin)
• Polyps: growth in middle ear canal. Can grow on the scar line of the tympanic membrane
• Facial palsy arising from cholesteatoma – facial paralysis

Question 15

Does otitis media require treatment in all cases? What are two treatment options?

Answer 15

• OM will generally heal on its own
• Could be treated with antibiotics – must finish the whole course
• Grommets – allows for ongoing drainage of fluid if OM occurs frequently

Question 16

What are some endogenous risk factors for otitis media? (i.e. factors WITHIN the person)

Answer 16

• Age – rarely seen in children over the age of 6, 7
• Anatomical features (e.g. narrow external auditory meatus).
• Ethnic group – associated with SES (risk factor)
• Gender – boys are much more likely (4:1) than girls to contract om
• Prematurity
• Allergy

Question 17

What are some exogenous risk factors for otitis media? (i.e. factors EXTERNAL to the person)

Answer 17

• Crowded conditions – e.g. very full houses in Aboriginal communities
• Smoke exposure
• Seasons – more common in winter (presence of infections is higer)
• Higher number of siblings
• Socio-economic factors
• Dummies

Question 18

What are four protective factors for otitis media?

Answer 18

• Breast feed for 12 months
• Avoid passive smoking
• Avoid dummies after 12 months
• Avoid prop feeding

Question 19

How is phonology affected in children with otitis media?

Answer 19

• Poor phonological repertoire - both at input level (discrimination) and output (articulation), e.g. children may have no voiceless sounds. Restricted or distorted vowels.
• Reduction of blends, deletion of the weak syllable, deletion of final sounds, underspecified syllables in multi syllable words. This pattern is stable.

Question 20

How is vocabulary affected in children with otitis media?

Answer 20

• Poor speech processing impacts on vocabulary size and organisation, thus retrieval is slow

Question 21

How is syntax affected in children with otitis media?

Answer 21

• As syntactic complexity of the message heard or formulated increases, both comprehension (input) and intelligibility (output) are compromised.

Question 22

How is PA affected by the hearing loss associated with otitis media?

Answer 22

CHL children have poor phonological awareness because their speech processing system is immature or disrupted. They lack the basic lack the basic foundations which make the relationships between sounds and letters accessible

“Through developing the speech processing system for the purpose of spoken communication, children develop awareness of the sounds and structure of their language. These phonological skills allow children to match letters to the spoken word.” Stackhouse and Wells

Question 23

Describe the chain between the onset of otitis media and its outcomes.

Answer 23

Otitis media onset 
→ mild to moderate hearing loss 
→ periodic degraded language input 
→ poorer attention to language 
→ basic language delays 
→ failure to develop well specified phonological representations 
→ fewer verbal interactions and more solitary play
→ poorer narrative and discourse skills 
→ poor PA 
→ literacy difficulties

Question 24

WHO states that if a disease is present in more than 4% of a population, it is a very serious public health issue that requires immediate attention.

What % of indigenous children will suffer from OM during a given year?

Answer 24

30% (this is extremely high!)

Question 25

Compare the rates of hearing loss (caused by OM) between Indigenous and non-Indigenous Australians

Answer 25

• Between the age of 2 and 20 years, the average Indigenous Australian will experience 32 weeks of HL because of OM compared to the 2 weeks experienced by the average non-Indigenous Australian (Coates, 2002)

Question 26

Discuss the literacy and educational outcomes of OM on the Indigenous population.

Answer 26

• Indigenous children are 3 times more likely to have literacy problems than their peers in early school years (Hewer & Whyatt, 2006)
• In year 3, only 40% of Indigenous Australian children achieved the national reading benchmark (figure needs to be considered in context), whereas 85% of non-Indigenous children reached the benchmark (Northern Territory Department of Employment Education and Training, 2006/2007).
• OM is said to be one of the greatest contributors to educational problems in Indigenous Australian populations (Thorne, 2003/4)
• Up to 90% of Indigenous prison inmates had a hearing loss resulting from a history of OM.

Question 27

Name 6 ways in which the burden of OM can be reduced in Australia.

(PIT-PIC)

Answer 27

• Prevention – known risk factors for OM must be addressed
• Intervention defined and evaluable interventions to prevent and treat OM
• Treatment- children at high risk should be identified early and treatment options should be enhanced
• Participation-involvement of Indigenous people in prioritisation, implementation and transfer of research is critical to sustainable improvements
• Investigation- ongoing laboratory research
• Communication- research findings should be conveyed to the broader community particularly health care providers and policy leaders

Question 28

List the determinants of health that may be contributing to the prevalence of OM in the Indigenous population, and its subsequent outcomes.

Answer 28

Indigenous Australians are:
• 5 times more likely to live in OVERCROWDED houses
• 40% of indigenous adults in bottom 20% of INCOMES.
• 15 times more likely to be IMPRISONED.
• EDUCATION: 71% of Indigenous people had no school qualification compared to 49% non indigenous
• UNEMPLOYMENT rate double the rate of non indigenous
• Child protection notifications around 5 times higher

Question 29

List four exclusionary practices carried out by the Australian health system

Answer 29

“Three strikes and you are off the list”

Using letters to set up and confirm appointments often a month or so in advance
• People are moving frequently

Requiring attendance at a lecture on “the speech pathologists role” prior to being put on the waiting list.

Assuming the family is not interested if your home program is not done or the book not brought back.
• Did you check if the family member could read?
• Did you ask what the family situation was?

Question 30

How does a child’s dialect influence their language? What about the combination of dialect and hearing loss?

Answer 30

Phonology and phonetics influenced by varying degrees - some Aboriginal dialects drop the sound /h/.

In combination with hearing loss, the child is likely to have difficulty with:
• Discriminating voiced from voiceless sounds,
• Long and short vowels
• Segmenting the speech stream

Question 31

How will children who speak an Aboriginal dialect differ (in terms of educational outcomes) to those children who speak an Aboriginal dialect AND have a hearing loss?

Answer 31

1. Children with dialect and NO hearing loss will begin to show discrimination and acknowledgment of voiceless sounds in contexts that require Standard Australian English (SAE) use and in tasks where they are explicitly exposed. They will start to formulate sentences in SAE in contexts that require it (e.g. at school).
2. Children with dialect AND conductive hearing loss will demonstrate no change even after multiple exposures and explicit teaching. These children will require intensive assessment and programming.