MM105 - Spatial Hearing and Tinnitus in Children with Chronic Otitis Media

Abstract:
Chronic otitis media with effusion (COME) is a common condition that causes hearing loss and is associated with recurrent middle ear infection, impaired school performance, behavioral problems, and reduced quality of life (QoL). Treatment guidelines differ for bilateral and unilateral COME, with stronger recommendations for bilateral COME. In addition to reviewing the current knowledge base and clinical recommendations for COME, we will describe a pilot study investigating consequences of COME on auditory performance, subjective reports of auditory and psychosocial function and tinnitus reported by children with no COME and children with unilateral COME or bilateral COME.

Summary:
Chronic otitis media with effusion (COME) is defined as the presence of fluid in the middle ear ≥ 3 months without signs or symptoms of acute ear infection. While approximately 90% of children develop middle ear effusions with at least 25% persisting to become COME. Treatment guidelines by the American Academy of Otolaryngology differ for bilateral vs. unilateral COME – hearing restoration by surgical evacuation of middle ear fluid and tympanostomy tube placement for bilateral COME, but only intervention consideration for unilateral COME.

In unilateral COME, which often results in asymmetric hearing loss, the dominant view is that the better ear alone is sufficient for communicative function. There is little information on how well children with unilateral COME understand speech under real-world listening conditions, where noise may be embedded in signal or spatially separated from signal. Reduced sound sensitivity in one ear has been shown to correlate with tinnitus laterality in adults, but there is virtually nothing known about how the poorer ear with fluid may or may not trigger tinnitus in children.

We will describe a pilot study investigating consequences of COME on central auditory performance, subjective reports of auditory function and tinnitus profile across three cohorts: children with no COME, children with unilateral COME and children with bilateral COME.

Children between the ages of 5 and 16 years, with and without COME participated in a preliminary study Parents or guardians and the child completed the questionnaires together. Audiometry and speech perception were assessed and spatial release from masking (SRM) was measured using a game-based protocol on an ipad (PART, Brain Game Center).

Statistically significantly better performance on SRM was observed for children without COME. Additionally, children without COME performed significantly better on the spatial hearing task than the unilateral COME cohort. Children with a greater degree of asymmetry demonstrated less spatial release from masking, as denoted by more positive values, regardless of their COME status or degree of hearing loss.

With regard to tinnitus, 40% of the control group, 55% of children with bilateral COME and 71% of children with unilateral COME reported tinnitus. There existed no significant association between loudness of daytime or nighttime tinnitus and degree of hearing loss. Tinnitus loudness was not associated with COME status or greater asymmetric hearing loss. However, there existed a statistically significant association between loudness of tinnitus and parent-reported symptoms on measures of depression/anxiety and hearing-related quality of life, respectively. The association between tinnitus and anxiety or depression in adults is established science in the adult population, but much less is known about the impact on children. This study provides evidence that the presence of tinnitus, irrespective of hearing loss, is associated with lower hearing quality of life and measures of risk for depression and anxiety.

These results provide evidence that even unilateral COME with mild conductive hearing loss can impact a child’s ability to meaningfully interpret sound in their environment.

Brief Summary of Clinical Takeaways:
The clinical takeaway for this session is evidence to support and counsel patients with COME and their families.