Can middle ear infections affect speech development?

Print Friendly, PDF & Email

In the short-term, “yes”. In the long-term, we’re not entirely sure – but probably not for otherwise healthy kids who get appropriate treatment.

Middle ear infections: what are they?

Middle ear infections – also called otitis media – are inflammations of the middle ear. The middle ear is the part that conducts speech and other sounds from the outer ear (the bit you can see) to the inner ear.

Credit: staff, via Wikipedia

Otitis media with effusion (OME) is an inflammation of the middle ear where fluid fills the (normally air-filled) cavity (Hayves & Northern, 1996).

What are the symptoms?

Middle ear infections can cause pain, fever, irritability, sickness, lack of sleep, lack of appetite, and/or constant pulling or touching of the affected ear(s). They can also be symptom-free, and ear infections without liquid in the middle ear can be hard to see.

Middle ear infections can cause fluctuating hearing loss. This can make others’ speech harder to process. Some children with hearing problems caused by middle ear infections might:

  • appear to lip read their teachers or others;
  • turn a particular ear (the good one!) towards the speaker;
  • rely on gestures and visual clues to follow instructions;
  • look to other children to figure out what to do; and/or
  • withdraw from class discussions and playground games relying on verbal arrangements.

How long do middle ear infections last?

Bouts of middle ear infections may last between two weeks and three months, but children who have it repeatedly may have constant middle ear fluid and therefore reduced hearing levels for long periods of time.

How can middle ear infections affect speech development and language comprehension in the short-term?

In the short-term, a child with middle ear hearing loss (sometimes called conductive hearing loss) may have problems hearing speech in conversation. They may have problems hearing some speech sounds, or telling the difference between speech sounds.

Some speech sounds are harder to hear than others. For example, sounds like /f/, /s/ and “th” have high frequencies (pitches) that are hard to pick up if you have hearing loss. Children with mild or moderate hearing loss may struggle to hear plural /s/ (as in “cats”), the /s/ in third person present tense verbs like “hops”, the possessive /s/ in words like “pup’s”, and the “th” in ordinal numbers (like “first” and “sixth”). Conversely, sounds like /m/, /d/ and “oo” are lower in pitch, and easier to hear at lower volumes. You can see this in the below diagram, the so-called “speech banana”.

Credit: DiegoSLP, via Wikipedia.

Hearing difficulties can also affect a child’s ability to acquire and say speech sounds. We’ve written a summary of some of the short-term speech-related red flags for possible hearing loss here.

To understand oral language, children need:

  • auditory awareness. In other words, the child needs to hear that a sound has occurred, e.g. a knock on a door, or a word;
  • auditory discrimination. The child needs to be able to tell the difference between one speech sound and another, e.g. the difference between /b/ and /s/;
  • auditory recognition: the ability to identify the source of the sound and to attach a spoken message to the action or object it represents, e.g. that the knocking sound is coming from something called a “door”; and
  • auditory comprehension: the ability to attach meaning to the sounds or words heard, so that, e.g. on hearing a knock on a door, the child will walk over, open the door and say hello to the person who knocked.

All of these levels of response require a degree of hearing, and can be affected by middle ear infections.

What about the long-term effects of middle ear infections on speech outcomes?

The research is mixed, with the weight of higher quality evidence suggesting that the long-term effects of treated middle ear infections on speech outcomes are limited, negligible or non-existent.

Some studies show that middle ear infections increase the risk of speech sound disorders and literacy issues. But others have suggested that there is no relationship, and that short-term, treated bouts of middle ear infections do not have a long-term effect on speech outcomes. For example, there is a strong body of evidence that OME and associated hearing loss are not associated with speech problems in otherwise healthy children (e.g. Campbell et al., 2003, Roberts et al., 2004, Paradise et al., 2005; 2007).

A reasonably recent study found that a hearing impairment of more than 20 dB loss at the age of 7 years and a history of grommet insertion at any time before the age of 8 years were statistically significant predictors of persistent speech sound disorders in children aged 8 years (Wren et al., 2016). However, this study was susceptible to sample bias, with a small control group and some other methodological limitations that make it hard to compare or reconcile the results directly with the findings of earlier, larger studies.

Clinical bottom line

Middle ear infections can cause hearing fluctuations and loss. In the short-term, these can have negative knock-on effects for speech discrimination, production, and language comprehension development. If managed actively, middle ear infection-related hearing loss does not appear to affect long-term speech outcomes in otherwise healthy children.

Regular hearing checks with a qualified independent audiologist can help to detect hearing problems caused by ear infections. Children with recurrent middle ear infections should see their doctor to ensure appropriate medical management and treatment to reduce the effects of any hearing issues, including on language, speech, literacy and learning.

Related articles:

Principal source: Robinshaw, H. (2007). Acquisition of hearing, listening and speech skills by and during key stage 1. Early Child Development and Care, 177, 6&7, 661-678.

Wren, Y., Millar, L.L., Peters, T. J., Emond, A., & Roulstone, S. (2016). Prevalence and Predictors of Persistent Speech Sound Disorder at Eight Years Old: Findings from a Population Cohort Study. Journal of Speech, Language, and Hearing Research, 59, 647-673.



Man wearing glasses and a suit, standing in front of a bay

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.

David Kinnane
Speech-Language Pathologist. Lawyer. Father. Reader. Writer. Speaker.

Leave a Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Share This

Copy Link to Clipboard