Language Testing

Language testing should be conducted for children with hearing loss (pure-tone average more than 20-dB HL on comprehensive audiometric evaluation). Testing for language delays is important, because communication is integral to all aspects of human functioning. Young children with speech and language delays during the preschool years are at risk for continued communication problems and later delays in reading and writing. In one study, 6% to 8% of children 3 years old and 2% to 13% of kindergartners had language impairment. Language intervention can improve communication and other functional outcomes for children with histories of OME.

Children who experience repeated and persistent episodes of OME and associated hearing loss during early childhood may be at a disadvantage for learning speech and language. Although Shekelle concluded that there was no evidence to support the concern that OME during the first 3 years of life was related to later receptive or expressive language, this meta-analysis should be interpreted cautiously, because it did not examine specific language domains such as vocabulary and the independent variable was OME and not hearing loss. Other meta-analyses have suggested at most a small negative association of OME and hearing loss on children's receptive and expressive language through the elementary school years. The clinical significance of these effects for language and learning is unclear for the child not at risk. For example, in one randomized trial, prompt insertion of tympanostomy tubes for OME did not improve developmental outcomes at 3 years old regardless of baseline hearing. In another randomized trial, however, prompt tube insertion achieved small benefits for children with bilateral OME and hearing loss.

Clinicians should ask the parent or caregiver about specific concerns regarding their child's language development. Children's speech and language can be tested at ages 6 to 36 months by direct engagement of a child and interviewing the parent using the Early Language Milestone Scale. Other approaches require interviewing only the child's parent or caregiver, such as the MacArthur Communicative Development Inventory and the Language Development Survey. For older children, the Denver Developmental Screening Test II can be used to screen general development including speech and language. Comprehensive speech and language evaluation is recommended for children who fail testing or whenever the child's parent or caregiver expresses concern.