Ep. 55: How Can Ear Infections Lead to Sensory Processing Disorders?
I am an Ear, Nose and Throat surgeon who specializes in caring for kids. So as you might guess, I am a bit of an expert on all things ear infections. I have previously shared many (many, many) posts about ear infections and ear tube surgery that may be helpful. I have also touched on some of the dreaded ear infection complications and ear tube problems that can occur. But one topic that has not been emphasized is the relationship between ear infections and sensory processing disorders.
I have received messages and questions about this topic from many parents and decided to officially address it now. So here is my take after treating kids with ear infections for over 30 years. Nothing is 100% in terms of cause and effect because we can always point to the times that it does not occur.
Be sure to listen to the podcast (audio link above) where I add more color and details to many of the concepts shared below.
But to answer the question: is there a connection between ear infections and sensory processing disorders? The simple answer is YES. But I am not one to give simple answers, so let’s discuss.
What are sensory processing disorders?
Of course, defining this group of disorders is an excellent starting point because we need to be on the same page about what we are discussing. Please take notice of the fact that I said “disorders”. This is critical because there are many different types, so ear infections are not related to most of them.
Every day, we are all bombarded with information that our bodies have to process using our senses. This includes sight, sound, touch, smell, and taste. There can be processing problems related to one sense or to multiple senses. And some senses may be over-reactive while another is under-reactive. All at the same time.
Our bodies are built to process information and sort out what is most important. Our brains normally do a great job filtering this sensory information to prevent us from becoming overloaded with too much input. If we get excessive amounts of information at the same time, we could become paralyzed and have trouble deciding which input to deal with first.
Most people consider these sensory disorders to occur when an excessive amount of sensory information is allowed to flow through our bodies. Essentially, the filtering process fails, and kids over-react to the excess amount of sensory signals. However, children who under-react to sensory input can also be severely impacted by sensory processing disorders.
Sensory processing disorders may lead to emotional problems because kids struggle to make sense of the world. And they become isolated because they often do not have the social skills needed to make friends. Also, their behavior seems irrational which scares other kids. For example, children seeking out physical contact are considered too aggressive because they crowd the personal space of others.
Ear infections tend to be associated with specific sensory processing disorders
Clearly, since there is a large group of sensory processing disorders, the exact cause has not been identified. Kids misunderstand normal every day sensory input. It is important to remember that sensory processing disorders include kids who are sensory seekers (with constant movement and touching) and kids who are sensory avoiders.
This problem used to be called sensory integration dysfunction. But neither name has a classic set of findings to lead to a clear medical diagnosis. Kids with sensory processing disorders have a wide range in the amount and severity of symptoms. Debilitation symptoms can stop people from having meaningful social interactions. But mild ones may only cause some irritation. The symptoms can be misdiagnosed as a learning disorder or attention deficit hyperactivity disorder. Also, the symptoms can be associated with autism spectrum disorders.
The sensory areas most commonly affected by ear infections are related to sound and balance. This makes sense since the hearing and balance nerves are in the same area. The classic reasoning why sensory processing disorders are associated with ear infections is that during brain development, middle ear fluid reduces hearing; therefore, kids do not learn how to process normal sound levels.
So, recurrent hearing loss keeps the brain from getting the input needed for the natural development of auditory processing skills. The ear infections themselves are not the problem but the middle ear fluid leads to hearing loss. Even though it is a temporary loss, because it happens over time, the net result is that normal hearing has not occurred during a critical time in a child’s life.
By the time kids no longer have ear infections and normal hearing is present, ongoing sensory processing disorders may occur. This is because brain development during the early toddler years has already happened.
What are auditory processing disorders?
Auditory processing disorder, also known as central auditory processing disorder, occurs when kids have trouble processing sounds. In other words, the problem does not happen because of a hearing problem but instead is due to the brain having trouble processing sounds.
There are many types of this disorder and after 30 years as a Ped ENT, I have seen a wide range of symptoms. Problems may be suspected in toddlers who are not developing as expected. But I have seen more than my fair share of high school students who had never been diagnosed. Sometimes, the stress of high school, with the added burden of more independence, can cause kids who previously found ways to cope to now have problems.
Even after I show kids that they passed a hearing test, I have treated previous straight-A students who were struggling and repeatedly said they could not hear the teacher. They actually meant that they could not understand what the teacher was saying. Hearing and understanding are different.
It can be similar to someone speaking in a language you do not understand. You hear the sounds the words make, but your brain has no idea what to do with those sounds. Some kids guess and try to figure it out while others do nothing.
Hearing loss contributes to auditory processing disorders
During infancy and toddler years, when ear infections are most common, many kids have intermittent hearing loss. And unfortunately, this occurs during a critical developmental time.
These kids can have trouble distinguishing certain sounds which could lead to a speech problem or trouble learning phonics. Both reading and spelling can be affected, but it also can change the way kids are able to listen.
Many kids are felt to have selective hearing, meaning that they choose to listen to things other than their parents. Of course, this is a possibility! But, sometimes the amount of energy needed to listen and store the information takes too much work. And then kids become overloaded and begin to tune out.
This action of tuning out can be confused with attention deficit disorder when really their attention depends on how much auditory processing is needed. As kids mature, we may notice that they have trouble repeating a story in the correct order. They can also have trouble hearing their internal voice and prefer to read out loud. Some kids confuse one word for another because the sounds are similar but the meaning is completely different. (Example: mixing up pink with think). It could appear the child is not listening and simply guessing what was said.
Some of these symptoms are seen more often in a classroom or daycare, which can explain why many parents do not notice the problem early. Listening to complex information or listening in a noisy environment is harder and at home, the situation is usually easier to control.
Because processing disorders have such wide variations and causes, it is important to also stress that there kids with auditory processing disorder without hearing loss or ear infections.
Common auditory processing symptoms
Over time, the impact of having processing disorders can lead to chronic reactions that may continue into adulthood. There are two types of auditory processing disorders.
- Hypersensitive: when someone is too sensitive to noise it can lead to
- Distraction by sounds that others do not notice
- Fear of or sensitivity to loud noises
- Becoming startled or distracted by unexpected sounds
- Frequently asking for quiet
- Hyposensitive: when hearing seems to be muffled it can lead to
- No response to verbal cues
- Listening to music or TV at excessive volumes
- Making noise for the sake of hearing noises
- Difficulty understanding or remembering what is said
- Confusion over where sounds are coming from
- Talking through directions or instructions while performing tasks
How are auditory processing disorders diagnosed and treated?
Well, first a hearing test must be done to be sure there is no hearing loss. Then a complete medical examination must be done because there should be no signs of neurological disease. If other diagnoses are present, such as autism, learning disabilities or attention deficit, those diagnoses are managed as the primary problem.
Otherwise, the diagnosis is made based on extensive testing by professionals who determine how a child processes auditory information. Although there is no cure, therapists are able to teach coping skills and tricks to avoid problems that can greatly improve a child’s quality of life.
Despite the lack of widely accepted diagnostic criteria, occupational therapists commonly see and treat children and adults with sensory processing problems.
Treatment depends on a person’s individual needs. But in general, it involves improving the ability to do activities they have struggled with. Or helping them to get used to things that were hard to tolerate in the past.
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