Preschoolers, clear speech and middle ear infections

What do these three things have to do with each other? In the preschool age range, there is a massive development in the clarity of clear speech that occurs from age two to five years. There is also a huge potential for middle ear fluid or infections to occur, sometimes with no outward symptoms. The presence of fluid or infection in the middle ear can have a mild to profound effect on the child’s clear speech development. This might mean that grommets are a consideration.

But how do you know if your child has a middle ear infection or fluid? How do you know if your child’s speech is being affected? What are grommets and how can they help?

Middle ear fluid or infections generally are caused by a blockage building up inside the back of the nose/throat area. There is a small curled tube that goes from the back of your nose to your middle ear, one for each ear. The purpose of this little tube – called the Eustachian tube – is to allow air to pass through it from the nose into the middle ear. This helps equalise air pressure in the middle ear and this then helps your eardrum work properly. If you have ever held your nostrils tight and “popped” your ears, you are pushing air into your middle ear. Scuba divers do this all the time to avoid sharp pain when scuba diving. People flying in planes also use this as a trick to stop their ears hurting when they increase or decrease altitude.

In young children, there is a tendency for the tubes to become blocked. This can be for a number of reasons, but the main one is because the tubes in younger kids are almost horizontal, and thus if mucus or fluid gets into the tube from the back of the nose/throat area, then it doesn’t drain easily. Adults tend to have less of a problem with this because their faces have already elongated and this makes the tubes sit more vertically so they drain much better. Another reason is that kids (especially preschool age) find blowing their nose to clear accumulated mucus difficult, whereas adults can give their nose a good blow anytime they feel the need. This means, in kids, there is more mucus just hanging around the area, waiting to slide into the Eustachian tube at any time.

So, how do you know if your child has a middle ear infection? Sometimes you don’t. However if your child has a prolonged “snotty nose”, persistent allergies with runny nose, or has a persistent cough, don’t think only of their nose and lungs when you are at the doctors. Think of their ears and ask your GP to check in the ear canals to see if they can see any evidence of fluid or infection. The GP will get a good look at the ear drums which can tell them a lot about the middle ear condition. Of course kids with regular colds and flu can also have a middle ear infection. Serious or more intense ear infections are often accompanied by pain, redness and higher temperatures.

If you know, or suspect, your child’s speech is being affected by ongoing middle ear infections, do something about it whilst they are still in preschool.

1. Seek a GP’s opinion
2. Book in for a hearing test
3. See a Speech Pathologist

There will be a different outcome from each of these avenues, but in the end you will have a clearer picture from three different avenues. Discuss your child’s speech with your Preschool Director or teacher too.

If your child has ongoing issues with middle ear infections, then insertion of grommets might be needed. An Ear, Nose and Throat specialist can advise you. Grommets are mini tubes that fit in the ear drum that ventilate the middle ear with air from the ear canal. They do require surgery to be inserted, however Ear, Nose and Throat Specialists will tell you it is a fairly straight forward procedure. They will also explain the risks associated, as with any surgical procedure. The benefits, in my opinion, significantly outweigh the fact that surgery is required. Once the grommets are in place, they allow air to flow into the middle ear. This helps to equalise the air pressure in the middle ear and should reduce any pain present. They also allow any infection or fluid to drain from the middle ear harmlessly into the outer ear canal. Once air pressure is equalised, the ear drum can do its job properly once more. This makes for steadier hearing levels. If a child is suffering from middle ear fluid and/or infection, their hearing levels can fluctuate day to day, morning to afternoon and this makes learning speech sounds difficult. It also is thought to contribute to children finding it hard to attend to words, and to pay attention to conversations. Not a good set up for sound and language learning, nor for development of attention skills.

Insertion of grommets also helps reduce the pressure feeling in the ears, and when accompanied by less pain, this makes for a happier child too. Most of us know how a head cold feels when our ears feel blocked and there is ear pain. As a child experiencing the same symptoms, it must be very frustrating. Any wonder they feel and show us how miserable they are.

Once your child has a stable level of hearing, they are able to use their hearing skills to assist their speech development. They will develop knowledge of the sameness and difference of speech sounds. Their discrimination of the different sounds and the positions the sounds occur in the words will be learned more consistently than when the hearing levels fluctuate with middle ear fluid or infections.

When your child starts preschool, there is a lot of sharing of germs. They are exposed to coughing, sneezing, colds, runny noses and general every day germs. Keep an eye on your child and monitor their level of wellness. Watch for mood changes, watch to check if they attend to your words, or if you have to call their name several times before they will pay attention to you. If you are worried, seek your GP’s advice, or book in to a Speech Pathologist for a review of your child’s skills. Preschoolers, clear speech and middle ear infections are tightly linked and if you keep an eye out for any changes in your child’s abilities, or if they have been sick on an ongoing basis for a while, double check with your GP about your child’s middle ear status.

Bottom line, if you are concerned about your child, seek help.