Glue ear and SL delay

[cjn27b]

We seem to be going around in circles with healthcare professionals and our 2.5 year old DS. He has S & L delay, and after a lot of speech therapy we're now up to about 100 words, but little linking. His pronouciation is also pretty bad, and he gets similar sounding words very muddled. He is however learning sign language really well.

After suggestions of all kind of causes, we've just had a second hearing test which he didn't perform at all well in and the tympanogram suggests glue ear (the first hearing test was perfect, but we didn't have a tympanogram).

Is it possible for glue ear to cause quite serious S&L delay? I was under the impression that children had a lot of ear infections with glue ear, and while he's had a couple of ear infections over a year ago, there's been none this winter. Also, the information I've found suggests it often clears up by itself, but even without any ear infections he is still struggling to learn to speak.

I'm getting a bit baffled and was wanting to hear of others experiences, and also of what we might be able to expect next. Thank you.

DD (3) also has s&l delay and we had problems with glue ear in the past. she had, however, v v frequent ear infections. we also had bad hearing tests. DD has had grommets twice. grommets really helped with the ear infections but her language didn't really come one.
however, have read very often that some children with glue ear catch up very quickly after getting the glue ear sorted. but I suppose this is only the case if the hearing is the only thing standing in the way of s&l.

will they do a repeat tympanogram? as you said, often glue ear will sort itself. also, a child doesn't have to have ear infection to develop glue ear.

how is his understanding? have quite often heard that children with glue ear related speech delay have nevertheless a good understanding (my DDs receptive language was always behind).

cjn27b

Otitis Media with Effusion (Glue Ear) can cause Auditory Processing Disorder (APD), and APD can cause Speech Delay.

APD is a listening disability, which can have a genetic origin of can be acquired as a result of having had a severe ear infection such as Glue Ear. Some like my eldest son had both.

APD is about not being able to process the sound information that you hear, which includes speech.

We learn to speak by processing what others, usually parents and family, say and then reprocess our own speech.

Those who have APD tend to only to be able to process and reproduce the whole sound of a word, as we have problems processing the gaps between the sounds which can make up a word, and if people speak too fast we are not able to process what they say.

At 2.5 years he could still grow out of these issues any time until the age of maturation (7 - 8 years of age)

It's entirely possible for a child with glue ear to have real s&l issues, dd3 has had glue ear (as well as permanent deafness) for years and only had about 2 ear infections. I'd recommend you have a good read through the ndcs website, they have info on glue ear and apd and all sorts that's really parent friendly.

this page if you scroll down has an audiogram (you may need to enlarge it!) that shows where all the speech sounds are, if you know what your ds' levels/loss is it may help you understand why he struggles with certain things.

it's also possible that there's something else going on but until you can deal with the glue ear it's going to be hard to isolate any other cause, unless of course you have any specific worries about other areas of development?

have they suggested any treatment for the glue ear? If his hearing loss is significant and as you say his s&l needs a lot of work you can look into/request treatment sooner rather than later if that's the route you want to take. You could look at grommets or hearing aids as the obvious treatment but there are all sorts of other things you could try too.

We have been prescribed a otovent (nose balloon) and another hearing test in 2 - 3 months. Meanwhile, we continue with speech therapy. APD sounds entirely plausable, but until we've got the glue ear treated will we know if that's a problem? He is progressing really well with his speech therapy in the meantime which has reduced my worries about other possible developmental issues.

my DS has had 3 sets of grommets, he started having problems at 2 and is now 7.
he only had mild S&L issues, with just pronunciation problems, it more affected his behaviour, with not being able to hear in crowded environments, or just not hearing insructions/questions etc.

his last lot of gromts, seem to have worked since he is at the age now where they tend to grow or at least start to grow out of it. he is still under ENT but for reveiw only.

DS didnt have many ear infections, but he does suffer with quite bad wax, which i suppose actually stopped the infection.

grommets although they seem scary and are by no meens a light decision, are a VERY common procedure, and can only help the child.

good luck with the baloon, and i hope that you get sorted soon. it is very commonly used as an overall "excuse" for S&L/behaviour etc issues, so if you feel that once something has been done to help the glue ear, the issues he is facing have not improved, just keep shouting to get heard (which im sure you would huni).

take care and good luck xxx

My DD has glue ear although apart from one test it has not affected her hearing enough to cause the s and l delay she has. Now it seems she has problems processing language and a language disorder/disorders so I am not sure whether glue ear was a red herring or a cause, there are learning difficulties in the family so it could be a few things. Signing is really good at least that will help avoid frustration,we use pictures too which has been good.

Glue ear can potentially significantly contribute to speech and language issues. Children learn speech and language through interacting and listening. When they have glue ear, auditory information can become significantly 'muffled'.

Glue ear can range from mild to severe in its impact on hearing.

It's possible your DS has underlying speech and language issues, which may have been present to some extent even without glue ear. It's possible he has underlying language difficulties which have been compounded and made worse by glue ear. Thirdly, it's possible his glue ear has been significant enough to impact on speech and language development. Unfortunately, it is difficult to know the extent that the glue ear has impacted on speech and language development without knowing how severe the impact on hearing has been.

You could ask the audiologist who tested his hearing whether he has a mild, moderate or severe hearing loss associated with the glue ear. You can also ask whether the hearing loss is likely to impact on the 'speech banana'. The 'speech banana' basically refers to the shape that's created when one plots on a graph the hearing level needed to access the sounds of conversational speech. The audiologist may be able to tell you what sounds your child is having trouble hearing. This can give you an idea of the impact on speech and language difficulties.

Of course, glue ear is known to fluctuate (and this sounds likely in your son's case given his hearing results have varied). So, potentially your son's hearing can be at different levels at different times. It can clear up by itself but sometimes requires intervention (e.g. grommets).

His hearing needs to be monitored and it would be useful for the SALT to be informed of the status of his hearing. I'm glad you are seeing results with SALT. Your DS is too young to be diagnosed with APD at the moment although it may still be a possibility.

Wow, what a lot of helpful advice - this is brilliant.

I have mapped his hearing test results on the audiogram and it would imply he is actually not hearing a lot of conversational sounds (he is only hearing about half). And, while he's had a few colds this winter he's had no ear infections. Given during his first year he had a few ear infections and a lot of colds / flu, I'm guessing he wasn't hearing for much of it. I wonder if the glue ear has just meant he's been not hearing much for a large proportion of his life. Meanwhile, combined with a family history of quite severe dyslexia and deafness I'm starting to wonder if he might have a combination of the two. I guess time will tell and we might discover it's actually something totally different like APD. Either way, now he can say about 100 words and do some signing he's so much happier and easier to manage it's brilliant. He's stopped biting and hitting and we're altogether a happier family!

@cjn27b Hello, I know this is a very old post & you may not even be here anymore but wondering how your DS' progress is/was& if the glue ear caused him s&l delays? My DS (22 months old)has glue ear in both ears& troubbles with speech and understanding. Many thanks

Hi, going through the same here. Wondered if you might have an update too, please?
21 months dd

Hi, my son is now 2.7. His glue ear had cleared out in late Spring. Overall he had around 7 months of conductive hearing loss which clearly impacted his s&l. Since then his speech has improved a lot, especially in the last couple of months.He is just starting to put two words together. You can't have two ways conversation with him yet & he is way behind his peers but overall he is making a great progres. I must say that we still don't know how well he can hear as at the moment he does struggle with pronanciation. Luckily he is due another hearing test soon. His understanding is a lot better too( I was worrying about it more than about his speech). Does your DD talk at all? How is her understanding?

@Springmama
Thank you for replying, I didn't get an email notification. (I've also happened to tag you in another post, asking for an update, and saw your reply here.)

My daughter had a lot of words, which happened to stop once she had a bad ear infection. She seemed to completely withdraw and was a different child altogether. Ear infection was in August, and early Sept is when everything stopped.
Over the last few weeks, we saw a huge amount of difference with eye contact, responding to name, following instructions etc. We've now been hit with another cold, and she's tugging on her ears again now, and isn't responding to her name as much.
She has been saying 'bye' and waving (sounds more like bah) which is a new word for her, so I'm guessing this is some progress albeit slow.
The only thing I noticed was that she has also been repeating words that she knew before, but only the words starting with B. She will babble with other phonics, like D, bay bee, L sounds etc.

When you noticed an improvement, what sort of things did you start noticing first? Language, or other skills?

She's also stopped pointing, but I'm sure that will come next as she has also started waving again.

@Popping13 Hi, sorry I did not tag you in the last post. Hope your daughter is feeling much better now, poor her, heavy colds are so unconfortable, my son gets them once a month& I feel like I am constantly wiping his nose( he gets annoyed about it now😬.He also touches his ears a lot. It is a good sign your daughter is repeating words she knows( as it means no permament/ long term regression). I am not an expert but apparently words starring with 'b' are the easiest to say so maybe that is why she is saying these? Hope the other words she knows will come back soon along new ones& she will start to respond better to her name as her ears get better. Maybe she is also beginning the toddler phase' I respond when I want?'. Do you have another appointment for her at the audiology? They usually restest after 3 months. My son's progress was v slow: from 6-8 words at 20-21 months (when we first found out that he has glue ear in both ears) to around 20ty at 2 ( one of his ears did clear itself by then but he still failled the hearing test) & now he can say around 150 but as I mentionned his speech is very unclear( hence we think he still have some hearing loss). We started noticing the improvement only a couple of months ago when he suddently started to point at pictures in a picture book when we asked him to show us things. From that point he is getting words much quicker, he is also repeating words which he did not for months& months before. I remember walking him in his buggy& saying ' a car' for a milion time & he would only watch cars passing saying nothing, he can now name most vehicules. I am doing speech& language therapy with him daily since January. Tried to get a private salt but everyone in our area had long waiting lists after the last lockdown.Does your DD have salt? He still does not point to show somethimg interesting but he will come & tell me if he sees something interesting & then he will pick my hand & walk me to a object of his interest or he will say with excitement e.g ' mama a tractor' if he sees one🙂