A diagnostic marker for speech delay associated with otitis media with effusion: the intelligibility-speech gap.

The goal of this study was to determine if notably reduced intelligibility is a potential diagnostic marker for children with speech delay and histories of early recurrent otitis media with effusion (SD-OME). Intelligibility was assessed in one 5-10 minute conversational speech sample from each of 281 speakers. The OME histories of 148 of these children with normal speech acquisition were described in two prior reports. OME histories of 85 additional children with speech delay were obtained from case history reports. For both groups, the children with positive OME (OME+) histories had significantly lower intelligibility scores but significantly higher speech production scores than children with negative OME (OME-) histories. Findings for a diagnostic marker to discriminate speech delayed children with OME+ versus OME- histories were promising, considering that the data were obtained retrospectively and did not include audiological information characterizing children's concurrent fluctuant hearing loss. The formula for the diagnostic marker, termed the Intelligibility-Speech Gap, was identified by a machine learning routine. Diagnostic accuracy findings for the marker were as follows: positive predictive value = 74%, negative predictive value = 86%, sensitivity = 79%, specificity = 83%, positive likelihood ratio = 4.6 and negative likelihood ratio = 0.25. Discussion considers speech processing perspectives on the source of the intelligibility-speech gap in children with suspected SD-OME, and methodological perspectives on its development as a diagnostic marker of one etiological subtype of speech delay.