Amplitude Modulation Detection in Children with a History of Temporary Conductive Hearing Loss Remains Impaired for Years After Restoration of Normal Hearing

  • Margo McKenna BenoitEmail author
  • Mark Orlando
  • Kenneth Henry
  • Paul Allen
Research Article


Otitis media with effusion (OME) is considered a form of relative sensory deprivation that often occurs during a critical period of language acquisition in children. Animal studies have demonstrated that hearing loss during early development can impair behavioral sensitivity to amplitude modulation (AM), critical for speech understanding, even after restoration of normal hearing thresholds. AM detection in humans with a history of OME-associated conductive hearing loss (CHL) has not been previously investigated. Our objective was to determine whether OME-associated CHL in children ages 6 months to 3 years results in deficits in AM detection in later childhood, after restoration of normal audiometric thresholds. Children ages 4 to 7 years with and without a history of OME-associated CHL participated in an AM detection two-alternative forced-choice task at 8 and 64 Hz modulation frequencies using a noise carrier signal and an interactive touch screen interface. Thirty-four subjects were studied (17 with a history of OME-related CHL and 17 without). Modulation detection thresholds improved with age and were slightly lower (more sensitive) for the 64 Hz modulation frequency for both groups. Modulation detection thresholds of children with a history of OME-associated CHL were higher than control thresholds at 5 years, but corrected to expected levels between ages 6–7. OME-associated CHL results in impaired AM detection, even when measured years after restoration of normal audiometric thresholds. Future studies may shed light on implications for speech and language development and academic success for children affected by OME and associated conductive hearing loss.


amplitude modulation pediatric hearing loss otitis media with effusion neurodevelopmental pediatrics 


Compliance with Ethical Standards

This study was approved by the Research Subjects Review Board at the University of Rochester. Informed consent from the parent and verbal assent from the children were both obtained for every subject.

Conflict of Interest

The authors declare that they have no conflict of interest. The project described in this publication was supported by the University of Rochester CTSA award number UL1TR002001 from the National Center for Advancing Translational Sciences of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


  1. Banai K, Sabin A, Wright BA (2011) Separable developmental trajectories for the abilities to detect auditory amplitude and frequency modulation. Hear Res 280:219–227CrossRefPubMedCentralGoogle Scholar
  2. Bates D, Mächler M, Bolker B, Walker S (2015) Fitting Linear Mixed-Effects Models Using. J Stat Softw.
  3. Bennett K, Haggard M, Silva P, Stewart I (2001) Behaviour and developmental effects of otitis media with effusion into the teens. Arch Dis Child 85(2):91–95CrossRefPubMedCentralGoogle Scholar
  4. Black LI, Vahratian A, Hoffman HJ (2015) Communication disorders and use of intervention services among children aged 3–17 years: United States, 2012. NCHS data brief, no 205. National Center for Health Statistics, HyattsvilleGoogle Scholar
  5. Bluestone CD, Beery QC, Paradise JL (1973) Audiometry and tympanometry in relation to middle ear effusions in children. Laryngoscope 83:594–604CrossRefGoogle Scholar
  6. Cabrera L, Werner L (2017) Infants’ and adults’ use of temporal cues in consonant discrimination. Ear Hear 38(4):497–506CrossRefPubMedCentralGoogle Scholar
  7. Caras ML, Sanes DH (2015) Sustained perceptual deficits from transient sensory deprivation. J Neurosci 35(30):10831–10842CrossRefPubMedCentralGoogle Scholar
  8. Casby MW (2001) Otitis media and language development: a meta-analysis. Am J Speech-Lang Pat 10:65–80CrossRefGoogle Scholar
  9. Connor C, Hieber S, Arts H, Zwolan T (2000) Speech, vocabulary, and the education of children using cochlear implants: oral or total communication? J Speech Lang Hear Res 43:1185–1204CrossRefGoogle Scholar
  10. Dawes P, Bishop DV (2008) Maturation of visual and auditory temporal processing in school-aged children. J Speech Lang Hear Res 51:1002–1015CrossRefGoogle Scholar
  11. Gravel JS, Wallace IF (2000) Effects of otitis media with effusion on hearing in the first 3 years of life. J Speech Lang Hear Res 43(3):631–644CrossRefGoogle Scholar
  12. Gravel JA, Wallace IF, Ruben RJ (1996) Auditory consequences of early mild hearing loss associated with otitis media. Acta Otolaryngol 116(2):219–221CrossRefGoogle Scholar
  13. Gravel JS, Roberts JE, Roush J, Grose J, Besing J, Burchinal M, Neebe E, Wallace IF, Zeisel S (2006) Early otitis media with effusion, hearing loss, and auditory processes at school age. Ear Hear 27:353–368CrossRefGoogle Scholar
  14. Graydon K, Rance G, Dowell R, Van Dun B (2017) Consequences of early conductive hearing loss on long-term binaural processing. Ear Hear 38(5):621–627CrossRefGoogle Scholar
  15. Hall JW, Grose JH (1994) Effect of otitis media with effusion on comodulation masking release in children. J Speech Hear Res 37(6):1441–1449CrossRefGoogle Scholar
  16. Henry KS, Neilans EG, Abrams KS, Idrobo F, Carney LH (2016) Neural correlates of behavioral amplitude modulation sensitivity in the budgerigar midbrain. J Neurophysiol 115:1905–1916CrossRefPubMedCentralGoogle Scholar
  17. Hogan SC, Moore DR (2003) Impaired binaural hearing in children produced by a threshold level of middle ear disease. J Assoc Res Otolaryngol 4:123–129CrossRefGoogle Scholar
  18. Huyck JJ, Wright BA (2018) Transient sex differences during adolescence on auditory perceptual tasks. Dev Sci 21(3):e12574CrossRefGoogle Scholar
  19. Joris PX, Schreiner CE, Rees A (2004) Neural processing of amplitude-modulated sounds. Physiol Rev 84:541–577CrossRefGoogle Scholar
  20. Jung TTK, Alper CM, Roberts JE, Casselbrant ML, Eriksson PO, Gravel JS, Hellström SO, Hunter LL, Paradise JL, Park SK, Spratley J, Tos M, Wallace I (2005) Recent advances in otitis media: 9. Complications and sequelae. Ann Otol Rhinol Laryngol Suppl 114:140–160CrossRefGoogle Scholar
  21. Kaplan AB, Kozin ED, Remenschneider A, Eftekhari K, Jung DH, Polley DB, Lee DJ (2016) Amblyaudia: review of pathophysiology, clinical presentation, and treatment of a new diagnosis. Otolaryngol Head Neck Surg 154(2):247–255CrossRefGoogle Scholar
  22. Kirk K, Miyamoto R, Lento C, Ying E, O’Neill T, Fears B (2002) Effects of age at implantation in young children. Ann Otol Rhinol Laryngol 111:69–73CrossRefGoogle Scholar
  23. Levitt H (1971) Transformed up-down methods in psychoacoustics. J Acoust Soc Am 49:467–477CrossRefGoogle Scholar
  24. Lorenzi C, Dumont A, Fullgrabe C (2000) Use of temporal envelope cues by children with developmenta dyslexia. J Speech Lang Hear Res 43(6):1367–1379CrossRefGoogle Scholar
  25. Lous J, Burton MJ, Felding JU, Ovesen T, Rovers MM, Williamson I (2005) Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev:2005 Jan 25;(1):CD001801.
  26. Moeller MP (2000) Early intervention and language development in children who are deaf and hard of hearing. Pediatrics 106(3):E43CrossRefGoogle Scholar
  27. Moore DR, Hutchings ME, King AJ, Kowalchuk NE (1989) Auditory brainstem of the ferret: some effects of rearing with a unilateral ear plug on the cochlea, cochlear nucleus, and projections to the inferior colliculus. J Neurosci 9:1213–1222CrossRefGoogle Scholar
  28. Moore DR, Hutchings ME, Meyer SE (1991) Binaural masking level differences in children with a history of otitis media. Audiology 30:91–101CrossRefGoogle Scholar
  29. Moore DR, Hine JE, Jiang ZD, Matsuda H, Parsons CH, King AJ (1999) Conductive hearing loss produces a reversible binaural hearing impairment. J Neurosci 19(19):8704–8711CrossRefGoogle Scholar
  30. Nelson PC, Carney LH (2004) A phenomenological model of peripheral and central neural responses to amplitude-modulated tones. J Acoust Soc Am 116:2173–2186CrossRefPubMedCentralGoogle Scholar
  31. Paradis JL, Dollaghan CA, Campbell TF et al (2000) Language, speech sound production, and cognition in three-year-old children in relation to otitis media in their first three years of life. Pediatrics 105(5):1119–1130CrossRefGoogle Scholar
  32. Pillsbury HC, Grose JH, Hall JW (1991) Otitis media with effusion in children: binaural hearing before and after corrective surgery. Arch Otolaryngol 117:718–723CrossRefGoogle Scholar
  33. Polley DB, Thompson J, Guo W (2013) Brief hearing loss disrupts binaural integration during two early critical periods of auditory cortex development. Nat Commun 4:2547CrossRefPubMedCentralGoogle Scholar
  34. Qi S, Mu YF, Cui LB, Li R, Shi M, Liu Y, Xu JQ, Zhang J, Yang J, Yin H (2016) Association of optic radiation integrity with cortical thickness in children with anisometropic amblyopia. Neurosci Bull 32(1):51–60CrossRefPubMedCentralGoogle Scholar
  35. Robbins AM, Bollard PM, Green J (1999) Language development in children implanted with the Clarion cochlear implant. Ann Oto Rhinol Laryn 108:113–118CrossRefGoogle Scholar
  36. Roberts JE, Rosenfeld RM, Zeisel SA (2004) Otitis media and speech and language: a meta-analysis of prospective studies. Pediatrics 113(3):e238–e248CrossRefGoogle Scholar
  37. Rosen MJ, Sarro EC, Kelly JB, Sanes DH (2012) Diminished behavioral and neural sensitivity to sound modulation is associated with moderate developmental hearing loss. PLoS One 7(7):e41514CrossRefPubMedCentralGoogle Scholar
  38. Shannon RV, Zeng FG, Kamath V, Wygonski J, Ekelid M (1995) Speech recognition with primarily temporal cues. Science 270(5234):303–304CrossRefGoogle Scholar
  39. Shekelle P, Takata G, Chan L, et al. (2003) Diagnosis, natural history, and late effects of otitis media with effusion. Evidence report/technology assessment no. 55 (prepared by Southern California Evidence-based Practice Center under Contract No 290-97-0001, Task Order No. 4). AHRQ Publication No. 03-E023. Agency for Healthcare Research and Quality, RockvilleGoogle Scholar
  40. Shriberg LD, Friel-Patti S, Flipsen P Jr, Brown RL (2000) Otitis media, fluctuating hearing loss, and speech-language outcomes: a preliminary structural equation model. J Speech Lang Hear Res 43(1):100–120CrossRefGoogle Scholar
  41. Silva PA, Kirkland C, Simpson A, Stewart IA, Williams SM (1982) Some developmental and behavioral problems associated with bilateral otitis media with effusion. J Learn Disabil 15(7):417–421CrossRefGoogle Scholar
  42. Simpson SA, Thomas CL, Van Der Linden MK, MacMillan H, Van Der Wouden JC, Butler C (2007) Identification of children in the first four years of life for early treatment for otitis media with effusion. Cochrane Database Syst Rev 24(1):1–24Google Scholar
  43. Sutcliffe P, Bishop D (2005) Psychophysical design influences frequency discrimination performance in young children. J Exp Child Psychol 91:249–270CrossRefGoogle Scholar
  44. Tailor VK, Schwarzkopf DS, Dahlmann-Noor AH (2017) Neuroplasticity and amblyopia: vision at the balance point. Curr Opin Neurol 30(1):74–83CrossRefGoogle Scholar
  45. Tomblin JB, Oleson JJ, Ambrose SE, Walker E, Moeller MP (2014) The influence of hearing aids on the speech and language development of children with hearing loss. JAMA Otolaryngol Head Neck Surg 140(5):403–409CrossRefPubMedCentralGoogle Scholar
  46. Viemeister NF (1979) Temporal modulation transfer functions based upon modulation thresholds. J Acoust Soc Am 66:1364–1380CrossRefGoogle Scholar
  47. Wallace DK, Lazar EL, Melia M, Birch EE, Holmes JM, Hopkins KB, Kraker RT, Kulp MT, Pang Y, Repka MX, Tamkins SM, Weise KK (2011) Stereoacuity in children with anisometropic amblyopia. J AAPOS 15(5):455–461CrossRefPubMedCentralGoogle Scholar
  48. Whitton JP, Polley DB (2011) Evaluating the perceptual and pathophysiological consequences of auditory deprivation in early post-natal life: a comparison of basic and clinical studies. J Assoc Res Otolaryngol 12:535–546CrossRefPubMedCentralGoogle Scholar
  49. Wiesel TN, Hubel DH (1963) Single-cell responses in striate cortex of kittens deprived of vision in one eye. J Neurophysiol 26:1003–1017CrossRefGoogle Scholar
  50. Yoshinaga-Itano C, Apuzzo ML (1998) Identification of hearing loss after age 18 months is not early enough. Am Ann Deaf 143(5):380–387CrossRefGoogle Scholar
  51. Yoshinaga-Itano C, Coulter D, Thomson V (2001) Developmental outcomes of children with hearing loss born in Colorado hospitals with and without universal newborn hearing screening programs. Semin Neonatol 6(6):521–529CrossRefGoogle Scholar
  52. Zielhuis GA, Rach GH, Van Den Bosch A, Van Den Broek P (1990) The prevalence of otitis media with effusion: a critical review of the literature. Clin Otolaryngol 15(3):283–288CrossRefGoogle Scholar

Copyright information

© Association for Research in Otolaryngology 2018

Authors and Affiliations

  1. 1.Department of OtolaryngologyUniversity of Rochester Medical CenterRochesterUSA

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