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Muffled messages

Glue ear is a common problem that can look like poor attention. Faye Pring explains

An unreported epidemic of childhood hearing loss means many children in early primary school are being penalised for a medical condition.

Glue-ear, a middle ear condition otherwise known as Otitis Media with Effusion (OME) is staggeringly common among infants and children in early primary school.

Hearing loss can turn a sweet-natured child grumpy or withdrawn as they become tired and frustrated with the effort of trying to listen. This can be misinterpreted as stubbornness, rudeness or "backwardness". OME remains a condition largely unrecognised by teachers, parents, policy-makers and the educational community.

A normal middle-ear cavity is full of air that enters via the eustachian tube. In children the eustachian tube is not as straight as in adults, and can easily be blocked by inflammation or infection. When this happens negative air pressure builds in the middle ear cavity and sucks fluid out of the tissues of the walls. This fluid, or effusion - the "glue" - prevents sound from moving through the ear in the normal way. The result is a mild hearing impairment. It tends to come and go in recurrent infection. Having glue ear is a bit like listening with your fingers stuck in your ears: sound is muffled and listening to conversation is difficult and tiring.

More children go to their GPs with OME than with any other complaint, and many receive repeated doses of antibiotics. Approximately 120,000 children a year undergo surgery to insert "C grommets" or ventilation tubes temporarily into the eardrum.

OME is most common in children under five but may continue to eight years of age, and frequently goes unnoticed. More than 90 per cent of all children have at least one bout of OME. A recent study led by Professor David Moore at Oxford University found that about 20 per cent of children had fluid in their ears for more than half the first five years of their lives. This translates to nearly one in five children in school reception classes who have not been able to hear clearly at least half the conversations they have had with their parents, siblings, teachers and friends. Numbers of children with OME in Europe and the United States appear to be rising.

Hearing impairment in the early years of life affects language and literacy development. It can also be detrimental to the development of listening skills. Studies of children with a history of OME show that, even when they have recovered from the hearing impairment, their language, listening and reading abilities are lower than children without a history of OME.

As an experienced primary school teacher who has a significant hearing impairment, I am concerned that young children with glue ear, or any hearing loss, have an additional problem in that they do not develop adequate basic social listening skills. This affects their behaviour and their ability to learn in all areas of the curriculum. Few teachers are aware of this.

I know from experience that if you cannot hear properly the effort required to listen is almost paiful. It requires tremendous concentration, guess work, sometimes lip reading, and other coping strategies. The background hum of a noisy classroom makes listening particularly difficult. Children with hearing loss withdraw from such listening situations. They do not learn to listen. Therefore, even when such children's hearing has improved, they have not developed the listening habit. Teachers' comments, such as "can't concentrate" or "fidgets", may have a more complicated explanation and more difficult solution than is normally assumed.

These children need to be taught how to listen. If a large proportion of an infant class is affected by hearing loss and related poor listening skills, we have to look at the suitability of our teaching strategies and to question how realistic our expectations of these children are. Long class sessions, as required, for example, by the national literacy and numeracy strategies, will be difficult for them. The emphasis on phonics in the literacy strategy may not be appropriate. These children will make slower progress in reading and writing, and this must be recognised.

There is a need to diagnose and treat glue ear as soon as possible but also to raise teachers' awareness of the condition and its associated problems, particularly listening problems. We need to implement compensatory strategies and to look at the suitability of teaching methods. Awareness also needs to be raised among parents and health service visitors. The screening tests for hearing may not pick up a problem, because they do not test for mild hearing losses and, as OME comes and goes, they may not pick up a child who has a recurring problem.

What can teachers and education authorities do?

* Question parents about children's hearing problems and history when they begin nursery school.

* Adopt compensatory strategies, such as placing children appropriately in the group during class discussion sessions, and purposely develop listening skills.

* Have realistic expectations for progress in reading and writing. Inappropriate expectations of the child may reinforce a sense of failure.

* Review learning to read and write strategies for these children, recognising that phonics may be of limited value in the whole class setting of the literacy hour.

* Reconsider your expectations of these children's concentration span, especially in noisy classrooms.

* Look at classroom acoustics and design. Noisy classrooms make interaction and learning more difficult for everyone, especially for those with hearing impairment.

* Consider using classroom amplification systems in reception and Year 1 classes where OME is most common. These systems require the teacher to wear a lapel microphone and their voice is amplified through speakers around the class.

* Review school hearing screening services and the provision of information for awareness of OME.

* A leaflet for parents, Glue Ear, can be obtained from the Hearing Research Trust, tel: 020 7833 1733.


Faye Pring is key stage 1 teacher in Oxfordshire

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