Julie Wei, MD, asscociate professor of otolaryngology-head and neck surgery at the University of Kansas Medical Center in Kansas City, said that when she gets cases of suspected speech delay, she ascertains the nature of the problem and assesses risk factors. When it comes to assessing the hearing, especially in toddlers, she likes using distortion product otoacoustic emission and tympanometry, she said. “That gives you very frequency-specific information in this age group, when generally cooperation is not there or just the speech awareness threshold is not as informative,” she said. “We’ve been utilizing that with success.”
Explore This IssueMarch 2013
Peter Weisskopf, MD, head of the neurotology section at the Barrow Neurological Institute in Phoenix, said that unilateral hearing impairment usually isn’t a barrier to speech, as long as the adults caring for the child know about it. Simple steps, such as making sure the child’s good ear is situated toward the storyteller at story time, can work well. There are other, more involved measures available, such as hearing aids and bone conduction, but he said those steps should not be considered automatic. “I think it’s very important to think a little about the social consequences…versus what we already know, which is that a lot of these kids do really, really well,” he said.
Genetics can have a hand in speech delay as well, said Scott Manning, MD, chief of otolaryngology at Seattle Children’s Hospital. Chromosome 22q11 deletion is the most common deletion syndrome. It’s marked by expressive speech delay by about one year of age, in addition to chronic middle ear effusions; anxiety, depression, ADHD or autism; and sometimes velo-cardio-facial syndome, a genetic condition involving heart defects, facial appearance effects and a lack of or underdevelopment of the thymus and parathyroid glands. Fluorescence in situ hybridization (FISH), which, in Dr. Manning’s state of Washington, doesn’t require insurance pre-authorization, can be used to test for the deletion. “We need to have a low threshold for doing that test for chromosome 22q11 deletion,” Dr. Manning said.
Mosaic Trisomy 21, present in 1 to 2 percent of trisomy 21 patients, is another genetic defect to watch out for. Its phenotype varies but is often present with speech delay. “It’s our job to make these diagnoses early,” he said, “when, developmentally, we can benefit better from speech therapy.”