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When my son (not apraxic, this is Ben's dad) was a toddler his speech

was unintelligible. He was having frequent ear infections, and serous

otitis between the ear infections. When the ear infections cleared we

found that he was actually already speaking whole sentences but we

didn't know it! Of course children will speak the way they hear, and

if everything sounds muffled and indistinct, that is how they talk too.

That's not a technical answer, just my experience and common sense.

Peace,

Kathy E.

On Nov 19, 2003, at 6:23 PM, thdoy2 wrote:

> My 2yr old ds has a mild-moderate hearing loss and a severe speech

> delay that has not been officialy diagnosed yet. Does anyone know if

> it is possible for him to speak like a typical child?

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Yes Sange it's possible for a child with a hearing loss...even a child

born deaf (with cochlear implants)...even a child with cochlear implants

and a speech disorder (!) -to speak like a regular child. It also is

not uncommon. I happen to know based on my son's awesome preschool! (that my

nephew attended listed below)

Below is an archive (Tammy you still out there?!)

From: " kiddietalk " <kiddietalk@...>

Date: Wed Sep 24, 2003 5:33 pm

Subject: Re: apraxia and hearing concerns at 20 (for 2.5yo) ??

Hi Tammy!

Was he only let into the program due to this? That doesn't really

doesn't make sense if his speech was that delayed. How much language

did he

have and how

old was he at the time he was first evaluated. Whether it's apraxia

or not -EI

services in the US goes by the percentage of the delay -even if it's

not a

disorder.

My one nephew attended the Summit Speech School for hearing impaired

and deaf

children in New Providence, NJ. http://www.summitspeech.com/

wasn't

severe enough for the

cochlear implants -but has hearing aids in both ears. He has a

speech impairment and a mild hearing loss in both ears due to

frequent ear infections (in spite of the repeated surgeries for

tubes, etc. My brother and sister in law are very thorough parents)

(He's one of the 5 http://www.cherab.org/news/Save.html )

I know at the Summit Speech School there was a number of children

there with hearing impairments/loss and apraxia. Lori Deforest is

one of the members of this group who's son attended the SSS who was

hearing impaired and apraxic and a member of this online group.

(she is one of the old timers however -so you'll have to go back a

bit) Most of the members who's children are doing well -again are

no longer active. That's both the good and bad news.

I always recommend private evaluations -with second opinions for

issues such as this. I'm sure your insurance would cover such an

exam. Hearing impairments is one of the other types of conditions

taken seriously by all unlike speech impairments. Hope Lori or

someone else who has answers in this area can add more. (BTW -

Lori's son was yet another that did amazing on the ProEFA)

=====

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What a coincidence. I just took my son (2.4) to an audiology

appt today, just to rule out a hearing issue. His speech issues

have not been officially diagnosed (In the process of " convincing "

EI that he deserves services for possible oral & verbal appraxia,

sigh...) He has never shown any signs of hearing problems, so it

threw me for a loop when the audiologist said fluid behind both ear

drums is causing mild hearing loss! I am so glad to know this. I

do not believe it is causing his speech " delay " but I am happy to

know that we can get this taken care of. He will need all of the

help he can get, including being able to hear properly!

I wish you all the best in getting your son diagnosed and helped too!

Also, I just wanted to thank so much and everyone on this board

this board. Cherub and this group IS making a difference! You have

gotten me on the road to getting my son the help he needs. It is

nothing short of a miracle that I found the Cherab website. When I

first searched the web I found a site that said, oh don't worry,

about your late talking child, just give it time. I went to bed

feeling more at ease, but by morning I had a nagging feeling to

search again. And I'm so happy I did.

Thanks,

--- In , " thdoy2 " <Thdoy2@a...>

wrote:

> I was wondering if anyone has a child with hearing loss &

apraxia.

> My 2yr old ds has a mild-moderate hearing loss and a severe speech

> delay that has not been officialy diagnosed yet. Does anyone know

if

> it is possible for him to speak like a typical child? His

therapists

> said the hearing loss doesn't completely explain his lack of

speech

> (although he can't hear the sounds 's','f','th' & maybe 'k'). He

is

> starting to pick up sign language after a month which is helping

him

> communcate without grunting. Unfortunately what he is trying to

say

> comes out unintelligible to others.

> Thanx, Sange

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Thank you to everyone who has responded to my question about

hearing loss & apraxia. Unfortunately my ds was born with cochlear

hearing loss and will never improve. The 'speech delay' is just

coincidental and can't be accounted for completely because of the

hearing loss. At least there is hope!

---Sange

I wish you all the best in getting your son diagnosed and helped too!

>

> Also, I just wanted to thank so much and everyone on this board

> this board. Cherub and this group IS making a difference! You have

> gotten me on the road to getting my son the help he needs. It is

> nothing short of a miracle that I found the Cherab website. When I

> first searched the web I found a site that said, oh don't worry,

> about your late talking child, just give it time. I went to bed

> feeling more at ease, but by morning I had a nagging feeling to

> search again. And I'm so happy I did.

> Thanks,

>

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Sange

My 3 and 1/2 y/o daughter has profound global apraxia (sadly, our

speech therapist says Sierra is nearly the most dyspraxic child she

has ever seen) and a moderate bilateral sensorineural hearing loss,

50 db, and auditory neuropathy. She has only a few words and a few

signs but is receptively nearly at age level. We know that her

speech difficulties are not from her hearing impairment because she

can make the " F " and " S " sounds but can't produce any vowels besides

an open/neutral vowel sound.

We have taken the Pro EFA and EPA for almost 2 years now. I think it

helped a little and I have no doubt it is good for her over-all

health but nothing dramatic happened with it.

I wish I could help you by being able to say that we had over-come

this obstacle and she is able to speak but we are not there yet. I

have alot of hope, though, and we will not give up.

If I can help is some way, please let me know.

Kim

--- In , " thdoy2 " <Thdoy2@a...>

wrote:

> I was wondering if anyone has a child with hearing loss & apraxia.

> My 2yr old ds has a mild-moderate hearing loss and a severe speech

> delay that has not been officialy diagnosed yet. Does anyone know

if

> it is possible for him to speak like a typical child? His

therapists

> said the hearing loss doesn't completely explain his lack of speech

> (although he can't hear the sounds 's','f','th' & maybe 'k'). He

is

> starting to pick up sign language after a month which is helping

him

> communcate without grunting. Unfortunately what he is trying to

say

> comes out unintelligible to others.

> Thanx, Sange

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I have a 55 db hearing loss in my left ear. It is also sensorineural,

and my audiogram is U-shaped, with the worst loss in the normal speech

range. However, because the loss is not in the high frequencies, I can

hear a watch ticking with that ear sometimes. I am not totally

convinced that your daughter's speech difficulties are not from her

hearing impairment, because the consonant sounds may be at a higher

frequency or she may be able to see (lip read) how you do the

consonants but not the vowels. What do the SLPs say? I didn't have the

hearing loss until I was 35, so of course it doesn't affect my speech.

Peace,

Kathy E.

On Nov 20, 2003, at 9:41 PM, dksierra wrote:

> a moderate bilateral sensorineural hearing loss,

> 50 db, and auditory neuropathy. She has only a few words and a few

> signs but is receptively nearly at age level. We know that her

> speech difficulties are not from her hearing impairment because she

> can make the " F " and " S " sounds but can't produce any vowels besides

> an open/neutral vowel sound.

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I just wanted to respond to you and say don't give up hope. My son who

is now 5 has a moderate to severe speech delay still but is steadily

improving. We have every hope he will be completely understandable in

the future. He had a short palatte that has been corrected, and a degree

of apraxia. He just has now been diagnosed with a mild to moderate

hearing loss. He had surgery to reconstruct his ear, and his eardrum

healed in a lateral position. The options are few for correction and

right now not advisable. Despite this, I and the speech therapist have

every hope he will attain understandable speech. We saw surges in his

speech at 3 1/2 and 4. Inbetween there was little progress. The EFA's

definitely helped, but so did therapy and time. Good luck!

Co-founder CHERAB of OHIO

[ ] Re: Anyone have child with apraxia &

hearing loss?

Thank you to everyone who has responded to my question about

hearing loss & apraxia. Unfortunately my ds was born with cochlear

hearing loss and will never improve. The 'speech delay' is just

coincidental and can't be accounted for completely because of the

hearing loss. At least there is hope!

---Sange

I wish you all the best in getting your son diagnosed and helped too!

>

> Also, I just wanted to thank so much and everyone on this board

> this board. Cherub and this group IS making a difference! You have

> gotten me on the road to getting my son the help he needs. It is

> nothing short of a miracle that I found the Cherab website. When I

> first searched the web I found a site that said, oh don't worry,

> about your late talking child, just give it time. I went to bed

> feeling more at ease, but by morning I had a nagging feeling to

> search again. And I'm so happy I did.

> Thanks,

>

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I don't know that we will ever be entirely sure what is causing what

with my daughter because of her multiple disabilities. But as she

gets older I feel more certain that her speech difficulties are from

her CP and apraxia and less from hearing difficulties. Her

audiograms are completely flat and symetrical; she does not hear

better or worse depending on frequency, only threshold of detection

is an issue and with use of an FM system for speech detection we feel

more and more that apraxia is the culprit. In addition to that, she

has never learned any motor skill by trial and error on her own.

I think the speech therapists agree but we all still wonder about

additional auditory processing difficulties that may be confusing the

picture.

Kim

>

> > a moderate bilateral sensorineural hearing loss,

> > 50 db, and auditory neuropathy. She has only a few words and a

few

> > signs but is receptively nearly at age level. We know that her

> > speech difficulties are not from her hearing impairment because

she

> > can make the " F " and " S " sounds but can't produce any vowels

besides

> > an open/neutral vowel sound.

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Most of the literature supports that frequent enough ear infections

even without hearing loss can interfere with speech and language development,

however some

argue that. I can tell you that I have a nephew who solely due to

frequent ear infections has a mild hearing loss in both ears, and a

speech impairment -and he is 7 years old. My sister in law is a

chemist for J & J and my brother is a maritime attorney -both are

very intelligent and aggressive parents in pursuing care for my

nephew with more than one surgery for tubes and in spite of their

efforts my nephew's hearing/speech was still affected.

Without his hearing aids, his hearing can range from almost fine (mild hearing

loss) when he

has no ear infections, to deaf when he has a hearing infection -so

for those of you that said that you had your child's hearing tested

and are suspecting any speech or hearing deficits -test your child's

hearing during an ear infection. How do they know if it's apraxia

or another speech impairment, vs a simple delay from hearing loss? They may

not. If you do

multisensory approaches to treatment however and watch how the child

progresses, you may then have a better idea.

I again highly support the schooling of apraxic children at schools

for the hearing impaired and deaf anyway...so does it matter? Yes -

but more likely there will be less chance your child will be

inappropriately tested and/or labeled as MR due to his hearing

loss. There is much more advocacy, compassion and awareness to

hearing loss then to those children that are verbal disabled alone.

(I even had this funny idea that if when Tanner grows up and still

doesn't speak 100%, he can wear hearing aids when interviewing for

colleges!...just kidding...I think)

Here are a few professional views on this topic:

Chronic Otitis Media - Speech/Language Disorders

Learning Disabilities: Is There A Link?

Marvin I. Gottlieb, M.D., Ph.D.

" Controversy was generated in the late 1970s regarding a possible

link between chronic otitis media and learning disabilities. After

several decades, the controversy has not been unequivocally

resolved.There remains an interesting hypothesis that " chronic

otitis media and its associated transient conductive hearing loss

adversely impact on speech/language development, with subsequent

impairment in learning skills? " The question is not an issue of

pediatricians recommending immediate surgical interventions or to

following a particular medical regimen for chronic otitis media ---

it is, however, a significant neurodevelopmental challenge which

initiates new responsibilities for primary healthcare providers. Can

we postulate that chronic otitis media, an organic problem, is in

part responsible for a pediatric developmental disorder? If so

perceived, the focus is on the need for generating an " awareness; "

initiating an early interdisciplinary diagnosis, and designing

appropriate management strategies.

The link between chronic otitis media (with associated transient

conductive hearing loss and possible central auditory processing

deficits) and speech-language delays and disorders has been fairly

well documented. However, the cause and effect relationship between

recurrent otitis media and subsequent learning impairments, with

intermediate pathologies in speech-language and auditory perceptual

development, has not been clearly defined.... " read entire article at

http://www.demauro.com/marv7.html

Ear Infections and Language Development

How ear infections and middle ear fluid might affect your child's

language development. What you can do to help.

What is Otitis Media?

Otitis media, an inflammation of the middle ear (behind the

eardrum), is one of the most common illnesses of childhood. There

are two different types of otitis media. Either can occur in one or

both ears.

Acute otitis media, which is also called an ear infection, is an

infection of the middle ear. Fluid in the middle ear may remain even

after an infection is gone.

Otitis media with effusion, also called middle ear fluid, is fluid

that is not infected. When a child has a cold, a small tube between

the ear and the throat can become blocked, causing fluid to build up

in the middle ear.

Most children will have at least one episode of otitis media by one

year of age. And 10-20 percent of children will have otitis media

three or more times, with fluid lasting an average of one month each

time. Persistent ear fluid is more common in children under two

years, but it can be seen in children older than two.

The middle ear space behind the eardrum usually contains air. When

there is fluid in this space, it can cause the bones in the middle

ear not to vibrate properly. This may cause a mild, temporary

hearing loss. The mild hearing loss lasts until the fluid is gone.

Because this can happen when your child is learning to speak,

families and health care providers may have concerns. If there are

concerns, a hearing evaluation and/or speech and language evaluation

may be appropriate.

What are sign of Otitis Media?

Child pulls on ear

Child says ear hurts

Drainage from ear fever (acute otitis media) irritability

Poor sleep

A child may have all, some, or none of these symptoms and still have

otitis media. Otitis media frequently occurs when a child has a

cold. When a child has otitis media with effusion, most of the time

there are no symptoms. Ear infections are best detected by your

child's health care provider. Contact your health care provider if

you think your child may be sick.

How Is Otitis Media treated?

Acute otitis media (ear infections) can be treated by:

Antibiotics prescribed by your health care provider. Medicine should

be given until it is gone. Fever and pain should decrease within two

days.

Surgery to put a tube in a child's ear if your child has a lot of

ear infections. This surgery is done by an ear, nose, and throat

doctor. This tube allows air to enter the middle ear space. This, in

turn, helps the lining of the middle ear return to normal and helps

prevent new infections. The tube generally stays in place for six to

twelve months and falls out by itself.

Otitis media with effusion (fluid) can be treated by:

Waiting for the fluid to go away. For 60-80 percent of children,

middle ear fluid will go away by itself in three months. For 85

percent of children, fluid will go away by itself in six months. A

health care provider should check a child's ears regularly during

this period.

Antibiotics may help reduce middle ear fluid in a small number of

cases.

Surgery to put a tube in the child's ear if fluid continues for four

to six months in both ears.

Talk with your child's health care provider about these treatments.

It is important to keep follow-up appointments.

How can Otits Media affect hearing?

When a child has fluid in the middle ear, the fluid reduces sound

traveling through the middle ear. Sound may be muffled or not heard.

Children with middle ear fluid will generally have a mild or

moderate temporary hearing loss. (It's as if you plugged your ears

with your fingers.) However, some children have no change in their

hearing.

Mild Hearing Loss-A child may not hear or may hear very faintly the

soft sounds at the beginnings and ends of words, such as the " s "

in " sun " and the " t " in " cat; and words spoken quickly such

as " and: "

Moderate Hearing Loss-A child may have trouble hearing most speech

sounds, and may have trouble with short, softly spoken words and

word endings. It's important to know that some children with otitis

media have no loss of hearing. A hearing loss due to middle ear

fluid should go away once the fluid is gone

How can I recognize if my child has a hearing loss?

Having difficulty paying attention

Showing a decayed response or no response when spoken to

Saying " huh?' often

Not following directions well

Turning up sound on radios, TV, CDs

Withdrawing from other children

Being over-active or uncooperative

Children with temporary hearing loss may show all, some, or none of

these behaviors. These behaviors may be different at each age. It is

often hard to tell whether a child has a hearing problem or whether

the child is just acting a certain way because of age or

temperament. If you are not sure, ask your health care provider for

help. The milestone chart on the following pages may also be helpful.

What can I do if I am concerned about my child's hearing?

If your child's response to sound seems different or inconsistent,

you should request a hearing evaluation to check your child's

hearing. Children as young as newborns can have their hearing

tested. Health care providers can screen hearing. When a child fails

a hearing screening, you should take the child to an audiologist for

a hearing evaluation. The audiologist specializes in diagnosis and

treatment of hearing loss.

How may language learning be affected by Otitis Media?

During the first three years when children have the most problems

with otitis media, they are learning to speak and understand words.

Children learn to do this by interacting with people around them. It

may be harder to hear and understand speech if sound is muffled by

fluid in the middle ear. Some researchers report that frequent

hearing loss in children with middle ear fluid may lead to speech

and language difficulties. However, other researchers have not found

this to be true. Researchers are still studying this. In the

meantime, it's best to pay special attention to the language

development of children who have middle ear fluid.

What can I do it I'm concerned about my child's speech and/or

language development?

When you have concerns about your child's language development, talk

to your child's healthcare provider. A speech-language pathologist

specializes in diagnosis and treatment of speech and language

problems.

Is my child achieving milestones of language development?

INSTRUCTIONS-Read each question through your child's age group and

check yes or no. Add the total and see below. All Yes: Your child is

developing hearing, speech, & language in the typical way. 1-2 No:

Your child may have delayed hearing, speech & language development.

Seek professional advice if you are unsure. 3 or more No: Ask for a

referral to an audiologist or speech-language pathologist.

yes no Hearing &

Understanding Child's Age Talking

Birth to 3 Mos

Startles to loud sounds. Makes pleasure sounds (cooing, Booing).

Smiles when spoken to. Cries differently for different needs.

Seems to recognize your voice and quiets if crying. Smiles when she

sees you.

Increases or decreases sucking behavior in response to sound.

4-6 Mos

Moves eyes in direction of sounds.

Babbling sounds more speech-like with many different sounds,

including p, b, and m.

Responds to changes in tone of your voice. Vocalizes excitement and

displeasure.

Notices toys that make sounds. Makes gurgling sounds when left alone

and when playing with you.

Pays attention to music.

4-6 Mos to 1 Yr

Enjoys games like peekaboo and pat-a-cake.

Babbling has both long and short groups of sounds such as " tata upup

bibibibi. " Turns and looks in direction of sounds. Uses speech or

non-crying sounds to get and keep attention.

Listens when spoken to. Imitates different speech sounds.

Recognizes words for common items like " cup, " " shoe, " " juice. " Has 1

or 2 words ( " bye-bye, " " dada, " " mama, " " no " ) although they may not

be clear.

Begins to respond to requests.

1-2 Yrs

Points to pictures in a book when named.

Says more words every month.

Points to a few body parts when asked. Uses some 1-2-word questions

( " Where kitty? " " Go bye-bye? " " What's that? " ).

Follows simple commands and understands simple questions ( " Roll the

ball, " " Kiss the baby, " " Where's your shoe? " ). Puts 2 words together

( " more cookie, " " no juice, " " mommy book " ).

Listens to simple stories, songs, and rhymes. Uses many different

consonant sounds at the beginning of words.

2-3 Yrs

Understands differences in meaning ( " go-stop, " " in -on, " " big-

little, " " up-down " ).

Has a word for almost everything.

Follows two requests ( " Get the book and put it on the table " ). Uses

2-3-word " sentences " to talk about and ask for things.

Speech is understood by familiar listeners most of the time.

Often asks for or directs attention to objects by naming them.

3-4 Yrs

Hears you when you call from another room.

Talks about activities at school or at friends' homes.

Hears television or radio at the same loudness level as other family

members. Usually talks easily without repeating syllables or words.

Understands simple " who?, " " what?, " " where? " questions. People

outside family usually understand child's speech.

Uses a lot of sentences that have 4 or more words.

4-5 Yrs Pays attention to a short story and answers simple questions

about it.

Voice sounds clear like other children's.

Hears and understands most of what is said at home and in school.

Uses sentences that give lots of details (e.g., " I like to read my

books " ).

Tells stories that stick to topic.

Communicates easily with other children and adults.

Says most sounds correctly except a few, like I, s, r, z, j, ch, sh,

th.

Uses adult-like grammer.

(Adapted with permission from the brochure How Does Your Child Hear

and Talk? © American Speech-Language-Hearing Association.)

How can I help my child who has persistent middle ear fluid?

Promote a Healthy Setting

These suggestions will help all children stay healthy. They may be

especially important for children who tend to get ear infections and

ear fluid. Wash child and adult hands after blowing noses or going

to the bathroom. This will fight the spread of germs. Clean toys

that have been in a child's mouth before another child plays with

them. Follow directions for giving medicine so that it is given on

time and for the entire time that is recommended. If possible,

breastfeed for at least the first four to six months of life to

reduce the chance of otitis media. Bottle-feed in an upright or

slightly leaning position. Cuddle the child in your lap with his

head raised up. A child should not be put to bed with a bottle. A

bottle should not be propped in bed. Those practices may cause the

liquid from the bottle to go up a small tube leading to the middle

ear, causing middle ear fluid. Keep children away from smoke.

Cigarette smoke increases a child's chance of middle ear disease. If

possible, put children in small rather than large groups of

children. Colds pass more easily in large groups, and colds in young

children can lead to middle ear fluid.

Promote Listening

It can be difficult to hear and concentrate in a noisy area such as

a classroom (with lots of children talking) or home (with TV on),

even with only a small amount of hearing loss. These suggestions

will help all children listen better.

Help children hear and understand your speech-

Get within three feet of a child before speaking.

Get your child's attention before speaking.

Face your child and speak clearly with a normal tone and normal

loudness.

Use visual cues such as moving your hands and showing pictures in

addition to using speech.

Seat your child near adults and children who are speaking.

Speak clearly and repeat important words, but use natural speaking

tones and pattern.

Check often to make sure your child understands what is said.

Stand still when talking to your child to decrease distractions.

Decrease background noise, especially for children with hearing loss-

Turn off unnecessary music and TV in the background.

Fix noisy appliances such as heaters or air conditioners.

Limit play with noisy toys.

Encourage teachers to create quiet areas. For example, use dividers

for small group play and reading.

Close windows and doors when it is noisy outside.

Promote Language Learning

Take advantage of opportunities every day to help children develop

their language.

All children can benefit from responsive language interactions,

especially children with hearing loss due to otitis media

Get down on your child's eye level when talking.

Listen to your child when your child is talking.

Talk about familiar things-snacks, pets, rain-anything your child

knows about and is interested in.

Talk with your child during mealtimes, baths, and throughout the

day.

Play interactive games with your child to encourage talking, such as

pat-a-cake.

Ask simple questions and pause for your child to respond.

When your child says something, respond to what the child is talking

about immediately and with interest.

Add to what your child has said by using more words.

Praise your child for talking, even if the speech is unclear.

Take your child lots of places (library, supermarket, the park) and

talk about what you see there.

Say the names of things your child sees or plays with and describe

things that happen.

Talk with preschoolers about what they did, what they will do, why

things happen, and their feelings.

Encourage children to talk to one another.

Repeat language activities so children learn what to expect.

Promote Early Literacy Learning

Activities such as reading to your child help develop early literacy

skills.

Read often to children, describing and explaining pictures and

referring to child's own experiences ( " Spot is like your dog:').

Read slowly to children, pausing at times to ask questions ( " What do

you think will happen next? " ).

Give children books and magazines to look at.

Read out loud traffic and store signs, labels of packages, and words

on a menu.

Let children draw and write using crayons, markers, and pencils.

Sing simple songs with repeated words and phrases.

Talk about sounds and names of letters.

Play sound, alphabet and word games that focus on beginning and

ending sounds of words.

Play word and listening games to encourage children to listen to

familiar patterns and fill in words.

For older preschoolers, play rhyming games such as hat, cat, bat.

---------------------------------------------------------------------

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Additional Information & Resources

Agency for Health Care Policy and Research. (1994). Middle Ear Fluid

in Young Children, Consumer Version, Clinical Practice Guide Number

12. (English and Spanish versions are available). The booklet is

available online at

http://www.kidsource.com/kidsource/content/mef.html

Green, A.R. (1997). The Parent's complete guide to ear infections.

town, PA: People's Medical Society.

, J.E., Wallace, I. F., & , F. W. (Eds). (1997).

Otitis Media in Young Children. Baltimore, MD: s Publishing

Co. .

Stool & the Otitis Media Panel. Otitis Media with Effusion in Young

Children. Clinical Practice Guideline Number 12. AHCPR Publication

No. 94-0622. Rockville, MD: Agency for Health Care Policy and

Research, Public Health Service, U.S. Department of Health and Human

Services. July, 11994. (Medical Version, Professional Guidelines).

This booklet is available online at www.aap.org/policy/otitis.htm

Watt, Mr. R., , J.E., & Zeisel, S. (1993). Ear infections in

young children: The role of the early childhood educator. Young

Children, 49(1), 65-71.

Questions & Answers about Otitis Media, Hearing and Language

Development www.asha.org/consumers/brochures/otitis_media.htm

Infections & Immunizations, Ear Infections

www.ama.assn.org/insight/h_focus/nemours/infectio/childhd/ear.htm

[NPIN Editor's note (01-30-03): this url is no longer active]

For more information about speech, language, and/or hearing , call

American Speech-Language-Hearing Association (ASHA at 1-800-638-TALK.

This text is reproduced with the permission of National Parent

Information Network.

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, thank you so much for your e-mail. It is so informative and

helpful. We have been dealing with severe ear infections with Colin

since he was born. Due to his short palatte, he was especially prone to

them. Then he developed what is called mucosa in his middle ear. The

moisture cells that normally grow in the inside of the eardrum, now

started growing on the outside of the eardrum. It caused many and

constant ear infections and buildup of scar tissue. He had to have his

eardrum rebuilt last July. Thankfully we kept up on all his follow up

visits, and while his eardrum finally healed, it healed in a lateral

position. He had a hearing test and it showed mild hearing loss for

conversational speech but below 1000 hz it drops to moderate hearing

loss, at the lowest hz reading, it is almost at the severe loss. What

effect on speech should I expect? He is 5 now and talking, but not many

people outside of the ones who know him, can understand him.

Do you know of any information on this condition with the mucosa? While

it isn't rare it is unusual. I also have it and our ENT says he has

never heard about it happening with the same family members before. One

key might be that I had a short palatte also. You are so good at finding

information I thought maybe you can help me find out more. I have tried

looking on the internent, but with no luck.

Thank you .

Co-founder CHERAB of OHIO

kmartin@...

For more information visit our web site

www.cherabofohio.org

or e-mail info@...

[ ] Re: Anyone have child with apraxia &

hearing loss?

Most of the literature supports that frequent enough ear infections

even without hearing loss can interfere with speech and language

development, however some

argue that. I can tell you that I have a nephew who solely due to

frequent ear infections has a mild hearing loss in both ears, and a

speech impairment -and he is 7 years old. My sister in law is a

chemist for J & J and my brother is a maritime attorney -both are

very intelligent and aggressive parents in pursuing care for my

nephew with more than one surgery for tubes and in spite of their

efforts my nephew's hearing/speech was still affected.

Without his hearing aids, his hearing can range from almost fine (mild

hearing loss) when he

has no ear infections, to deaf when he has a hearing infection -so

for those of you that said that you had your child's hearing tested

and are suspecting any speech or hearing deficits -test your child's

hearing during an ear infection. How do they know if it's apraxia

or another speech impairment, vs a simple delay from hearing loss? They

may not. If you do

multisensory approaches to treatment however and watch how the child

progresses, you may then have a better idea.

I again highly support the schooling of apraxic children at schools

for the hearing impaired and deaf anyway...so does it matter? Yes -

but more likely there will be less chance your child will be

inappropriately tested and/or labeled as MR due to his hearing

loss. There is much more advocacy, compassion and awareness to

hearing loss then to those children that are verbal disabled alone.

(I even had this funny idea that if when Tanner grows up and still

doesn't speak 100%, he can wear hearing aids when interviewing for

colleges!...just kidding...I think)

Here are a few professional views on this topic:

Chronic Otitis Media - Speech/Language Disorders

Learning Disabilities: Is There A Link?

Marvin I. Gottlieb, M.D., Ph.D.

" Controversy was generated in the late 1970s regarding a possible

link between chronic otitis media and learning disabilities. After

several decades, the controversy has not been unequivocally

resolved.There remains an interesting hypothesis that " chronic

otitis media and its associated transient conductive hearing loss

adversely impact on speech/language development, with subsequent

impairment in learning skills? " The question is not an issue of

pediatricians recommending immediate surgical interventions or to

following a particular medical regimen for chronic otitis media ---

it is, however, a significant neurodevelopmental challenge which

initiates new responsibilities for primary healthcare providers. Can

we postulate that chronic otitis media, an organic problem, is in

part responsible for a pediatric developmental disorder? If so

perceived, the focus is on the need for generating an " awareness; "

initiating an early interdisciplinary diagnosis, and designing

appropriate management strategies.

The link between chronic otitis media (with associated transient

conductive hearing loss and possible central auditory processing

deficits) and speech-language delays and disorders has been fairly

well documented. However, the cause and effect relationship between

recurrent otitis media and subsequent learning impairments, with

intermediate pathologies in speech-language and auditory perceptual

development, has not been clearly defined.... " read entire article at

http://www.demauro.com/marv7.html

Ear Infections and Language Development

How ear infections and middle ear fluid might affect your child's

language development. What you can do to help.

What is Otitis Media?

Otitis media, an inflammation of the middle ear (behind the

eardrum), is one of the most common illnesses of childhood. There

are two different types of otitis media. Either can occur in one or

both ears.

Acute otitis media, which is also called an ear infection, is an

infection of the middle ear. Fluid in the middle ear may remain even

after an infection is gone.

Otitis media with effusion, also called middle ear fluid, is fluid

that is not infected. When a child has a cold, a small tube between

the ear and the throat can become blocked, causing fluid to build up

in the middle ear.

Most children will have at least one episode of otitis media by one

year of age. And 10-20 percent of children will have otitis media

three or more times, with fluid lasting an average of one month each

time. Persistent ear fluid is more common in children under two

years, but it can be seen in children older than two.

The middle ear space behind the eardrum usually contains air. When

there is fluid in this space, it can cause the bones in the middle

ear not to vibrate properly. This may cause a mild, temporary

hearing loss. The mild hearing loss lasts until the fluid is gone.

Because this can happen when your child is learning to speak,

families and health care providers may have concerns. If there are

concerns, a hearing evaluation and/or speech and language evaluation

may be appropriate.

What are sign of Otitis Media?

Child pulls on ear

Child says ear hurts

Drainage from ear fever (acute otitis media) irritability

Poor sleep

A child may have all, some, or none of these symptoms and still have

otitis media. Otitis media frequently occurs when a child has a

cold. When a child has otitis media with effusion, most of the time

there are no symptoms. Ear infections are best detected by your

child's health care provider. Contact your health care provider if

you think your child may be sick.

How Is Otitis Media treated?

Acute otitis media (ear infections) can be treated by:

Antibiotics prescribed by your health care provider. Medicine should

be given until it is gone. Fever and pain should decrease within two

days.

Surgery to put a tube in a child's ear if your child has a lot of

ear infections. This surgery is done by an ear, nose, and throat

doctor. This tube allows air to enter the middle ear space. This, in

turn, helps the lining of the middle ear return to normal and helps

prevent new infections. The tube generally stays in place for six to

twelve months and falls out by itself.

Otitis media with effusion (fluid) can be treated by:

Waiting for the fluid to go away. For 60-80 percent of children,

middle ear fluid will go away by itself in three months. For 85

percent of children, fluid will go away by itself in six months. A

health care provider should check a child's ears regularly during

this period.

Antibiotics may help reduce middle ear fluid in a small number of

cases.

Surgery to put a tube in the child's ear if fluid continues for four

to six months in both ears.

Talk with your child's health care provider about these treatments.

It is important to keep follow-up appointments.

How can Otits Media affect hearing?

When a child has fluid in the middle ear, the fluid reduces sound

traveling through the middle ear. Sound may be muffled or not heard.

Children with middle ear fluid will generally have a mild or

moderate temporary hearing loss. (It's as if you plugged your ears

with your fingers.) However, some children have no change in their

hearing.

Mild Hearing Loss-A child may not hear or may hear very faintly the

soft sounds at the beginnings and ends of words, such as the " s "

in " sun " and the " t " in " cat; and words spoken quickly such

as " and: "

Moderate Hearing Loss-A child may have trouble hearing most speech

sounds, and may have trouble with short, softly spoken words and

word endings. It's important to know that some children with otitis

media have no loss of hearing. A hearing loss due to middle ear

fluid should go away once the fluid is gone

How can I recognize if my child has a hearing loss?

Having difficulty paying attention

Showing a decayed response or no response when spoken to

Saying " huh?' often

Not following directions well

Turning up sound on radios, TV, CDs

Withdrawing from other children

Being over-active or uncooperative

Children with temporary hearing loss may show all, some, or none of

these behaviors. These behaviors may be different at each age. It is

often hard to tell whether a child has a hearing problem or whether

the child is just acting a certain way because of age or

temperament. If you are not sure, ask your health care provider for

help. The milestone chart on the following pages may also be helpful.

What can I do if I am concerned about my child's hearing?

If your child's response to sound seems different or inconsistent,

you should request a hearing evaluation to check your child's

hearing. Children as young as newborns can have their hearing

tested. Health care providers can screen hearing. When a child fails

a hearing screening, you should take the child to an audiologist for

a hearing evaluation. The audiologist specializes in diagnosis and

treatment of hearing loss.

How may language learning be affected by Otitis Media?

During the first three years when children have the most problems

with otitis media, they are learning to speak and understand words.

Children learn to do this by interacting with people around them. It

may be harder to hear and understand speech if sound is muffled by

fluid in the middle ear. Some researchers report that frequent

hearing loss in children with middle ear fluid may lead to speech

and language difficulties. However, other researchers have not found

this to be true. Researchers are still studying this. In the

meantime, it's best to pay special attention to the language

development of children who have middle ear fluid.

What can I do it I'm concerned about my child's speech and/or

language development?

When you have concerns about your child's language development, talk

to your child's healthcare provider. A speech-language pathologist

specializes in diagnosis and treatment of speech and language

problems.

Is my child achieving milestones of language development?

INSTRUCTIONS-Read each question through your child's age group and

check yes or no. Add the total and see below. All Yes: Your child is

developing hearing, speech, & language in the typical way. 1-2 No:

Your child may have delayed hearing, speech & language development.

Seek professional advice if you are unsure. 3 or more No: Ask for a

referral to an audiologist or speech-language pathologist.

yes no Hearing &

Understanding Child's Age Talking

Birth to 3 Mos

Startles to loud sounds. Makes pleasure sounds (cooing, Booing).

Smiles when spoken to. Cries differently for different needs.

Seems to recognize your voice and quiets if crying. Smiles when she

sees you.

Increases or decreases sucking behavior in response to sound.

4-6 Mos

Moves eyes in direction of sounds.

Babbling sounds more speech-like with many different sounds,

including p, b, and m.

Responds to changes in tone of your voice. Vocalizes excitement and

displeasure.

Notices toys that make sounds. Makes gurgling sounds when left alone

and when playing with you.

Pays attention to music.

4-6 Mos to 1 Yr

Enjoys games like peekaboo and pat-a-cake.

Babbling has both long and short groups of sounds such as " tata upup

bibibibi. " Turns and looks in direction of sounds. Uses speech or

non-crying sounds to get and keep attention.

Listens when spoken to. Imitates different speech sounds.

Recognizes words for common items like " cup, " " shoe, " " juice. " Has 1

or 2 words ( " bye-bye, " " dada, " " mama, " " no " ) although they may not

be clear.

Begins to respond to requests.

1-2 Yrs

Points to pictures in a book when named.

Says more words every month.

Points to a few body parts when asked. Uses some 1-2-word questions

( " Where kitty? " " Go bye-bye? " " What's that? " ).

Follows simple commands and understands simple questions ( " Roll the

ball, " " Kiss the baby, " " Where's your shoe? " ). Puts 2 words together

( " more cookie, " " no juice, " " mommy book " ).

Listens to simple stories, songs, and rhymes. Uses many different

consonant sounds at the beginning of words.

2-3 Yrs

Understands differences in meaning ( " go-stop, " " in -on, " " big-

little, " " up-down " ).

Has a word for almost everything.

Follows two requests ( " Get the book and put it on the table " ). Uses

2-3-word " sentences " to talk about and ask for things.

Speech is understood by familiar listeners most of the time.

Often asks for or directs attention to objects by naming them.

3-4 Yrs

Hears you when you call from another room.

Talks about activities at school or at friends' homes.

Hears television or radio at the same loudness level as other family

members. Usually talks easily without repeating syllables or words.

Understands simple " who?, " " what?, " " where? " questions. People

outside family usually understand child's speech.

Uses a lot of sentences that have 4 or more words.

4-5 Yrs Pays attention to a short story and answers simple questions

about it.

Voice sounds clear like other children's.

Hears and understands most of what is said at home and in school.

Uses sentences that give lots of details (e.g., " I like to read my

books " ).

Tells stories that stick to topic.

Communicates easily with other children and adults.

Says most sounds correctly except a few, like I, s, r, z, j, ch, sh,

th.

Uses adult-like grammer.

(Adapted with permission from the brochure How Does Your Child Hear

and Talk? C American Speech-Language-Hearing Association.)

How can I help my child who has persistent middle ear fluid?

Promote a Healthy Setting

These suggestions will help all children stay healthy. They may be

especially important for children who tend to get ear infections and

ear fluid. Wash child and adult hands after blowing noses or going

to the bathroom. This will fight the spread of germs. Clean toys

that have been in a child's mouth before another child plays with

them. Follow directions for giving medicine so that it is given on

time and for the entire time that is recommended. If possible,

breastfeed for at least the first four to six months of life to

reduce the chance of otitis media. Bottle-feed in an upright or

slightly leaning position. Cuddle the child in your lap with his

head raised up. A child should not be put to bed with a bottle. A

bottle should not be propped in bed. Those practices may cause the

liquid from the bottle to go up a small tube leading to the middle

ear, causing middle ear fluid. Keep children away from smoke.

Cigarette smoke increases a child's chance of middle ear disease. If

possible, put children in small rather than large groups of

children. Colds pass more easily in large groups, and colds in young

children can lead to middle ear fluid.

Promote Listening

It can be difficult to hear and concentrate in a noisy area such as

a classroom (with lots of children talking) or home (with TV on),

even with only a small amount of hearing loss. These suggestions

will help all children listen better.

Help children hear and understand your speech-

Get within three feet of a child before speaking.

Get your child's attention before speaking.

Face your child and speak clearly with a normal tone and normal

loudness.

Use visual cues such as moving your hands and showing pictures in

addition to using speech.

Seat your child near adults and children who are speaking.

Speak clearly and repeat important words, but use natural speaking

tones and pattern.

Check often to make sure your child understands what is said.

Stand still when talking to your child to decrease distractions.

Decrease background noise, especially for children with hearing loss-

Turn off unnecessary music and TV in the background.

Fix noisy appliances such as heaters or air conditioners.

Limit play with noisy toys.

Encourage teachers to create quiet areas. For example, use dividers

for small group play and reading.

Close windows and doors when it is noisy outside.

Promote Language Learning

Take advantage of opportunities every day to help children develop

their language.

All children can benefit from responsive language interactions,

especially children with hearing loss due to otitis media

Get down on your child's eye level when talking.

Listen to your child when your child is talking.

Talk about familiar things-snacks, pets, rain-anything your child

knows about and is interested in.

Talk with your child during mealtimes, baths, and throughout the

day.

Play interactive games with your child to encourage talking, such as

pat-a-cake.

Ask simple questions and pause for your child to respond.

When your child says something, respond to what the child is talking

about immediately and with interest.

Add to what your child has said by using more words.

Praise your child for talking, even if the speech is unclear.

Take your child lots of places (library, supermarket, the park) and

talk about what you see there.

Say the names of things your child sees or plays with and describe

things that happen.

Talk with preschoolers about what they did, what they will do, why

things happen, and their feelings.

Encourage children to talk to one another.

Repeat language activities so children learn what to expect.

Promote Early Literacy Learning

Activities such as reading to your child help develop early literacy

skills.

Read often to children, describing and explaining pictures and

referring to child's own experiences ( " Spot is like your dog:').

Read slowly to children, pausing at times to ask questions ( " What do

you think will happen next? " ).

Give children books and magazines to look at.

Read out loud traffic and store signs, labels of packages, and words

on a menu.

Let children draw and write using crayons, markers, and pencils.

Sing simple songs with repeated words and phrases.

Talk about sounds and names of letters.

Play sound, alphabet and word games that focus on beginning and

ending sounds of words.

Play word and listening games to encourage children to listen to

familiar patterns and fill in words.

For older preschoolers, play rhyming games such as hat, cat, bat.

---------------------------------------------------------------------

-----------

Additional Information & Resources

Agency for Health Care Policy and Research. (1994). Middle Ear Fluid

in Young Children, Consumer Version, Clinical Practice Guide Number

12. (English and Spanish versions are available). The booklet is

available online at

http://www.kidsource.com/kidsource/content/mef.html

Green, A.R. (1997). The Parent's complete guide to ear infections.

town, PA: People's Medical Society.

, J.E., Wallace, I. F., & , F. W. (Eds). (1997).

Otitis Media in Young Children. Baltimore, MD: s Publishing

Co. .

Stool & the Otitis Media Panel. Otitis Media with Effusion in Young

Children. Clinical Practice Guideline Number 12. AHCPR Publication

No. 94-0622. Rockville, MD: Agency for Health Care Policy and

Research, Public Health Service, U.S. Department of Health and Human

Services. July, 11994. (Medical Version, Professional Guidelines).

This booklet is available online at www.aap.org/policy/otitis.htm

Watt, Mr. R., , J.E., & Zeisel, S. (1993). Ear infections in

young children: The role of the early childhood educator. Young

Children, 49(1), 65-71.

Questions & Answers about Otitis Media, Hearing and Language

Development www.asha.org/consumers/brochures/otitis_media.htm

Infections & Immunizations, Ear Infections

www.ama.assn.org/insight/h_focus/nemours/infectio/childhd/ear.htm

[NPIN Editor's note (01-30-03): this url is no longer active]

For more information about speech, language, and/or hearing , call

American Speech-Language-Hearing Association (ASHA at 1-800-638-TALK.

This text is reproduced with the permission of National Parent

Information Network.

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Hi !

My brother and sister and law went for multiple evaluations (did I

say multiple? I meant MULTIPLE!) and testing with every " top "

medical doctor in this area. Secondary to them was the opinions of

the speech pathologists -but that too is very important to my

nephew's treatment. (On the other hand...Most don't know to seek

neurodevelopmental medical evaluations for communication impairments

outside of hearing impairments as well, if their child is " just " a late talker)

In my nephew's case the experts decided that his hearing loss was

not severe enough for cochlear implants, however it was advised he

begin wearing hearing aids full time even though his hearing loss is

mild when there are no ear infections. He now wears hearing aids

all the time -and it's no big deal. He's just a cute normal playful

little boy who happens to wear hearing aids.

I was told that as an adult if he was to have a mild hearing loss he

could choose not have to wear hearing aids. There are many adults with mild

hearing loss (perhaps many my age who went to one to many rock

concerts!)

Mild hearing loss in a child however is different. Ability to hear

is critically important while speech is still developing. My nephew

also attended the Summit Speech School in New Providence, NJ

http://www.oraldeafed.org/schools/summit/ where my son Tanner went.

Even though Tanner and many of the other apraxic children in the

school had normal hearing -all of our children were schooled with

professionals who were fully aware of the proper way to educate and

provide therapy to a child with the duel diagnosis (which is not

uncommon) of speech problem/hearing loss. Lots of multisensory

approaches. Hence the base for The Association Method School.

http://www.usm.edu/dubard/associat.html

As I posted here when I posted one of my first emails -I first thought of this

type of schooling for

Tanner within days of his diagnosis (and at the time was shot down

by this one parent who at the time ran the only grouplist for

apraxia who also tried to shoot me down on EFAs and the importance of

neuromedical MDs) As it ended up a few years after Tanner and many others in

our group in NJ started to succeed in the Summit Speech School -and

the Lakedrive School http://www.mtlakes.org/ld/ , Dr. Joan Sheppard

from Columbia http://www.cherab.org/news/meetings/eventsmay2001.html did a

presentation at the ASHA conference on " Teaching

hearing apraxic children at schools for the hearing impaired and

deaf " to talk about how successful this is. (ASHA -is that the

organization that is now calling it childhood apraxia of speech and

that blocks out all the information to the public so only CCC SLPs

can read the information....I guess it's a wash then. Who wants

anyone to start using that stupid name childhood apraxia of speech

for a condition one does not outgrow?!! Can we send them a link to

276 month old (or if we want to talk about it in years -23 year

old) 's talking page update to put on their childhood apraxia

of speech page?)

There are two types of schools for the deaf -I like the oral based

model due to the wonderful speech models Tanner had. I would have

liked a bit more sign -but in the end it didn't matter.

Summit Speech School is an oral based school that does not encourage

sign -even though they will acknowledge it if used. As

Kanter who we all loved and now miss once told me -the theory is

that a deaf child that does not speak verbally by the age of 5 most

likely will never speak, while one can learn sign at any age.

As we've gone into in the past -there is a huge amount of

controversy in the deaf world on cochlear implants. Those that are

just into sign " deaf culture " say it's " mutating " the child. I like the

response

from one of the MD dads in Tanner's class to this comment when a

deaf man " told him off in sign " due to his son's cochlear implants " So if my

child had a heart defect you are saying I

should just allow him to die? Is that also a mutation to try to

fix that? "

I know apraxic children that were schooled at both types of hearing

impaired schools and did well. However again I prefer the oral

based model based on personal observations of my own son and the

many others in this group who attended the Summit Speech School with

him.

Here is a list of websites for schools for the deaf

http://clerccenter.gallaudet.edu/InfoToGo/schools-usa.html

This one is just one I found in Ohio that you could check out?...

Mission

St. Rita School for the Deaf is a Catholic day/residential

school whose primary mission is to provide social, spiritual, and

academic education to those who are deaf or who need special methods

of communication from the age of six months through adulthood.

These methods include: sign language, lip reading, speech and

language therapy, and assistive listening devices. Together they

make up our philosophy of Comprehensive Communication, allowing our

students and other members of the community every available

incentive for human interaction.

http://www.srsdeaf.org/ http://www.srsdeaf.org/main.htm

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