by Lori Riggs, MA, CCC/SLP
Are you tired hearing us talk about tympanograms yet? We’re not tired of talking about them or recommending that you get them yet. Obviously we’re not afraid to admit that we’re pretty opinionated on the subject of how significantly middle ear fluid can affect a child’s development.
For years there has been conflicting information by researchers regarding a correlation between speech and language delays/disorders and history of middle ear fluid. Studies that support each side are criticized by the other side for having design flaws, and nobody can seem to decide if having transient hearing loss (sometimes very frequently or else ongoing) and hearing a distorted speech signal affects how a child develops communication skills and phonology (speech sound development). A little common sense and some consideration of anecdotal data go a long way here. Because we’ve been at this business of observing and assessing lots and lots of kids for a very long time, we have some opinions on the subject. And because of these opinions, we frequently recommend to parents that they take their child for a series of tympanograms to see what the trend is over time with the status of their middle ears.
In the following article, pediatric audiologist Jessica Messersmith comes to the same conclusion when her own daughter regresses in language development during a period of ear infections. (It’s a short article and worth reading.)
As she mentions in the article, the American Academy of Pediatrics supports the recommendation of ear tubes if fluid persists for three months. To really be proactive and collect strong data, tympanograms every two weeks over a three-month period is your best course of action.
That being said, as objective as tympanograms appear to be, here are a few points of caution:
- The established “normal” range may not apply to everyone equally. Our own observations in children with Down syndrome (one of the populations for whom this whole subject is especially critical) has been that many children have a tymp reading with compliance scores at the lowest end of the established (for the typical population) “normal” range. Because of history and functional observations, there has been a high suspicion of fluid in many of these cases. Some have had fluid confirmed when they had tubes placed and fluid was found (in spite of the tymp measurement). It raises the question of whether different norms might apply in this population. Or, as will be discussed below, whether kids with Down syndrome simply need to be tested differently due to their structural differences.
- In their chapter on tympanometry in Handbook of Clinical Audiology, Shanks and Shohet suggest that what is “normal” may vary by age and also by race. So again, as above, the current normative standards may not be valid for every individual.
- Some studies discussed that typical testing with the 226 Hz probe tone may not be an accurate assessment in the Down syndrome population. There was discussion of whether the 1000 Hz probe may yield more valid results.
That is all to say that even with something as seemingly simple and straightforward as a tympanogram, sometimes and for some kids, results need to be interpreted with caution. If all signs point to fluid issues and the tympanogram doesn’t support it, don’t just assume that your observations are wrong. Find a practitioner who will work with you and who is open to discussion and critical thinking and assessment.
Messersmith, J.J. (2015). Eardrum Perfs and Language Spurts. The ASHA Leader, 20(9), 72.
Shanks, J. & Shohet, J. (2009). Tympanometry in Clinical Practice. In J. Katz, L. Medwetshy, R. Burkhard & L. Hood (Eds), Handbook of Clinical Audiology (6th ed., pp. 157-188). Baltimore: Lippincott Williams & Wilkins.