by Dr Lindsay Peer CBE
My research with a sample group of one thousand young people shows that the number of dyslexic people with a history of ear infections and Otitis Media (OM) is significantly higher than in other groups of the population. I believe that this link is highly significant when considering functioning within a learning situation for a sub-group of dyslexic people. It would appear that the existence of OM in early childhood has a major impact upon the development of language and literacy as well as on the emotional stability of the individual. These effects may have an impact well into adolescence and beyond, even when tests at a later stage show that levels of hearing have returned to within normal limits.
Indicators of Glue Ear (Otitis Media)
A major research finding is the extraordinarily high incidence of severe OM (70%) in dyslexic multilingual children. This has strong implications for theory and practice. From a theoretical perspective, one intriguing possibility is that, rather than reflecting some underlying brain abnormality from birth, the difficulties in phonological processing, in auditory magnocellular performance and in vestibular function are actually acquired later in life. If a child suffers from OM in the early years, normal development of all of these functions just will not take place.
Key findings in this study show that the OM sub group have dyslexic tendencies that are more severe than those found in the dyslexia group that does not suffer from OM. It should also be noted that whilst the majority of children world-wide experience a single bout of OM in their first year (Daly cites between 14% - 18% in Sweden; 49% - 97% in the USA among non-native populations, depending on the criteria used) the majority do not go on to develop severe and continuing bouts of the condition.
Not surprisingly, due to the impact a loss of hearing has on the children, their families and their reactions in school, these children tend to be identified earlier than other dyslexic children. Often they are considered to be more severe cases than non-OM group dyslexic children.
This group of learners also presented with more significant problems than
other dyslexic learners when language performance was measured. In areas of
both spoken (‘academic’ as opposed to ‘chat’ language) and written English,
they were performing at a greater deficit than the non-OM dyslexic group.
Reading skills were also significantly poorer in that group. As a result of
this, their general success across the curriculum was depressed and there were
often particular difficulties in the areas of language learning, short-term
memory and behaviour. Significant weaknesses among the OM group in the speed of
processing is also, I suggest, a result of intermittent and significant hearing
loss for weeks or months at a time.
In the following conceptualisation, I consider the strongest possible causal involvement of OM with dyslexia and postulate a new theory for this sub-group of dyslexic learners. The causal chain for these children may look like the figure below:
Figure: Otitis Media and Dyslexia, an ontogenetic causal
Cumulative risk factors
It may be the case that in fact some genetic abnormality predisposes ‘dyslexic’ children to OM. It is almost certainly the case that the risk factors are cumulative, so that a dyslexic child who has for example, to learn two or more languages and who has OM is particularly likely to develop literacy difficulties.
Those young children, who are exposed to bouts of OM so severe that it has led to the insertion of grommets, have been deprived of the input that is so needed for normal development in areas of language and literacy. This loss has the effect of causing a chain of difficulties in the development of phonological awareness, ultimately leading to difficulties with reading and spelling. As bouts of OM occur at a very young age, the early loss of consistent hearing, together with bouts of ear infections is equally likely to impact upon the vestibular system, which will affect balance and may cause oculomotor abnormalities.
The research presented here opens up the possibility that a minor childhood
complaint (OM), occurring at a time when auditory and vestibular skills are
developing rapidly, may be sufficient in itself to lead to the symptoms of
Whilst not a part of the causal chain, the issue of behaviour is an
important part of the story. It is quite common for dyslexic children to
evidence signs of anxiety and often, poor behaviour. This is often a reaction
to the frustration felt by the learner when demotivation and low self-esteem
set in. The results of this study show enhanced levels of these behaviours in
the OM group. I would expect this when children cannot hear too well and
language is spoken too fast for them to comprehend. Life perhaps seems to be
passing them by and may often appear frightening. They are frequently in
trouble, both at home and at school for ‘not listening’ and ‘not
concentrating’. Identification of the problem at an early age together with
appropriate support and intervention may well help overcome some of these
Dr Lindsay Peer CBE
International Dyslexia Consultant
This article was received on 8th November, 2004 and was first published in the SENCo Journal of June, 2004.
A book by Dr Lindsay Peer CBE, is due out in the late spring 2005 through David Fulton Publishers and will be entitled: Glue Ear: A Sticky Educational Issue.
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