Research Article: Association between otitis media infection and failed hearing screenings in children

Date Published: February 22, 2019

Publisher: Public Library of Science

Author(s): Hadara L. Norowitz, Timothy Morello, Hadassah M. Kupfer, Stephan A. Kohlhoff, Tamar A. Smith-Norowitz, Elizabeth M. Fitzpatrick.


This study aims to assess prospectively whether there is an association between frequencies of upper respiratory tract infections (URTI) or asthma in early childhood and failed otoacoustic emission (OAE) screenings later in life. There are no clear recommendations for hearing testing following acute otitis media (AOM) infection. This is a retrospective, practice based chart review. Participants from a primary care setting were 517 pre-adolescent and adolescent children (49.9% female) (ages 10–21; mean, 15 y/o), who had presented with at least one specific bacterial URTI (AOM, Group A Streptococcus (GAS) tonsillitis, or Influenza) during childhood. Hearing testing was recorded incidentally at all subsequent routine health care maintenance visits (OAE hearing screen). Simple linear regression analyses were performed using R (v3.4.4). We found that number of episodes of AOM infections strongly correlated with number of failed OAE screenings later in life (F = 76.37; P = <0.001; R2 = 0.1279), while GAS (F = 1.859; P = 0.1733; R2 = 0.0016) or Influenza infection (F = 2.624; P = 0.1059; R2 = 0.0031) were not associated with failed OAE screening. Correlation between number of AOM infections and number of failed OAE screenings was not strengthened by presence of asthma. This study found evidence of an association between childhood history of AOM and failed OAE screenings in adolescence. Since this population may be at a higher risk for developing permanent or fluctuating hearing losses, further studies to clarify indications and timing of standard audiological testing among these children should be considered.

Partial Text

Upper respiratory tract infections (URTI) (acute otitis media (AOM), group A streptococcus (GAS), acute pharyngitis and tonsillitis) are common childhood conditions [1] that have been linked to complications including otological changes, and development of atopic disease [2]. Pathogens responsible for these infections include bacterial (Streptococcus pneumoniae, Haemophilus influenzae and others) or viral (respiratory syncytial virus (RSV), rhinovirus, influenza, adenovirus, and others) [3–6]. However, also of interest but less well investigated, is the effect of other respiratory infections on failed otoacoustic emission (OAE) screenings later in life. This prognosis is important for future audiological diagnoses or intervention.

In the present work, we examine URTIs in early life and sequelae later in life. This is illustrated by a significant association between numbers of AOM episodes in early-life and failed hearing screenings via OAE later in life. Interestingly, there was no independent effect of asthma status. Our study could not reveal significant differences in the numbers of GAS or Influenza infections and failed OAE screenings. The combination of these findings suggests that specifically AOM early in life may contribute to persistent abnormal hearing results in certain patients, even through adolescence. This underlines the importance of closer monitoring for relapse of temporary hearing loss or development of permanent hearing loss, in order to ensure accurate diagnosis and treatment in this at-risk population.

AOM is a public health concern with significant financial burdens on the healthcare system [32–33]. Our findings suggest that an abnormal OAE response can be predicted years after OM has resolved. Thus, this disease may have a longer lasting effect on otologic and auditory status than previously thought.




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