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PHONEMIC AWARENESS AND MIDDLE-EAR DISEASEAMONG BEDOUIN ARABS IN ISRAELSALIM ABU-RABIA aa University of Haifa, Mt. Carmel, Haifa, IsraelPublished online: 21 Jun 2010.

To cite this article: SALIM ABU-RABIA (2002) PHONEMIC AWARENESS AND MIDDLE-EAR DISEASE AMONG BEDOUIN ARABS INISRAEL, Reading Psychology, 23:4, 289-296, DOI: 10.1080/713775285

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Reading Psychology, 23:289–296, 2002Copyright © 2002 Taylor & Francis0270-2711/02 $12.00 + .00DOI: 10.1080/02702710290061364

Address correspondence to Salim Abu-Rabia, University of Haifa, Faculty of Education,Mt. Carmel, Haifa 31905, Israel. E-mail: salimar@construct.haifa.ac.il

PHONEMIC AWARENESS AND MIDDLE-EAR DISEASEAMONG BEDOUIN ARABS IN ISRAEL

SALIM ABU-RABIA

University of Haifa, Mt. Carmel, Haifa, Israel

This study investigated the effect of middle-ear infections on phonemic awarenessof first-grade elementary school children. Forty-nine children were screenedaccording to their infant medical records, and divided into two groups: onewith repeated middle-ear infection and one without. They had to read aloudseven different phonemic awareness measures. The results indicated anonsignificant effect of middle-ear infections on phonemic awareness ability.The limitations of this study and other studies in this field concerning thisspecific phenomenon are discussed.

Phonemic awareness is known to be essential for reading acquisi-tion (Stanovich, 1988a, 1988b) in Bedouin Arab children in north-ern Israel. This study investigated the influence of middle-earinfection on their phonemic awareness. The Arab sector in Israelin general is equipped with poor healthcare centers and poor edu-cational systems (Abu-Rabia, 1996). Not all Bedouin Arabs live inpermanent settlements and they must travel for hours to obtaintheir healthcare services.

Review of the Literature

Scholars are almost universally in agreement that reading disabili-ties cause dysfunction in three major cognitive processes: phone-mic decoding, syntactic awareness, and working memory (Siegel,1993). Phonemic awareness is the ability to identify the smallestspeech sounds in the spoken words and to control them by meansof phonetic manipulations. Phonemic awareness is the most im-

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portant faculty that influences reading ability in children(Stanovich, 1998a, 1988b).

Siegel (1993) states that three major cognitive processes are in-volved in reading: phonological processes, syntactic processes, andworking memory. The phonological decoding process is the mostessential for reading development. Siegel explains these threemajor processes by the Dual-Route theories, where readers mayaccess texts through phonological codes and/or through visual-orthographic routes. To access the lexicon through phonologicalrepresentations, readers have to acquire the Grapheme-PhonemeCorrespondence rules (GPC rules). Siegel (1993) argues thatreaders with severe phonological deficits may access the lexiconvia visual-orthographic routes, namely bypass the phonologicalroute. Many researchers contend that phonemic awareness is animportant variable affecting the early development of reading ac-quisition. Further, phonemic intervention programs for reading-disabled children may help them acquire reading efficiently.

Here infants’ middle-ear infection becomes one more variablethat may disrupt the natural development of hearing: discriminat-ing between many similar speech sounds, and the ability to con-trol and tackle phonological codes.

Nittrouer (1996) developed the Developmental Weighting Shift(DWS), where she argues that the phonemic structure stems fromthe orientation of multi-face acoustical speech. Children in factlearn how to pay attention to the acoustic information in order toacquire the phonemic structure. The more practice the child re-ceives in the language, the more attention the child will give tovast language parameters. Namely, phonemic awareness by defini-tion demands language exposure, and without hearing, or clearhearing, it is almost impossible to acquire the phonemic rules ofspeech and written language. This ultimately will result in prob-lems with reading acquisition.

The assumption that middle-ear infections may cause tempo-rary hearing loss is based on medical reports of it, especially whenthe infection is located in the middle ear causing pressure on thethree small bones (U.S. Department of Health and Human Ser-vices, 1994).

In her study Nittrouer (1996) attempted to prove that variancein linguistic experience may cause variance in phonemic aware-ness. Four groups of grade 2 children participated in her study.

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One group, the control, was from the middle class, and had noear infection; the second group, also from the middle class, had ahistory of ear infection history; the third group, of low socioeco-nomic status, had no history of ear infection, and the fourth, alsoof low socioeconomic status, was the same except for linguisticexperience due to a history of ear infection. The rationale of thestudy was that middle ear infection causes temporary hearing loss,which affects the amount of exposure to the language. Differenceswere found in phonemic awareness measures between the twogroups of the middle class. However, the two groups of low socio-economic status evinced no significant differences. Their resultswere all low. This study certainly indicates the importance of so-cial status in tests on middle-ear infection issues and their effecton phonemic awareness and/or reading.

Other studies focused on the relationship of middle-ear infec-tions and other reading skills, such as attention. Lynne (1994)tested the relationship between middle-ear infection and atten-tion of infants to the language. Subjects were 46 children agedfour months to four years. Lynne based his study on the attentionthat these infants paid to the tester while he or she was readingnumbers from a book with pictures. Another tester observed andrecorded the infants’ behavior.

The results indicated that there was a relationship betweenmiddle-ear infection and attention level. However, other studiesindicate a different pattern of results: a non-relationship patternbetween middle-ear infection and attention and/or phonemicawareness.

Peters (1994) conducted a longitudinal study testing the influ-ence of middle-ear infection on reading and spelling. Participantswere tested at ages two and four, and again when they were sevenyears old. They were divided into two groups based on their middle-ear infection history between ages two and four: one group whichsuffered from double-side ear infection and the second group with-out any ear infection. The participants had to perform pseudowordreadings, word recognition, reading comprehension, and sentenceidentification. The results indicated that ear infections had a sig-nificant effect on spelling, but not on reading. Further, both groupsused similar phonological reading strategies.

Likewise, Donahue (1993) conducted a qualitative longitudinalstudy using his young daughter as the main case study. His daugh-

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ter suffered from ear infections, and she developed her own strat-egy to cope with phonology and reading. She preferred long con-sonants—a pattern that characterizes children with hearing lossor weak hearing. Donahue argued that his daughter succeeded indeveloping compensating strategies to overcome her hearing prob-lems. He added that his daughter developed different coping strat-egies from those developed by other children with ear infection.Donahue’s (1993) results differed from those of Peters (1994),who concluded that in both groups of children, ear-infected andnon-ear infected, used similar phonological and lexical strategies.

Share and Chalmers (1986) conducted a longitudinal study onthe relationship between ear infection and reading disabilities.Participants ranged from three to 11 years of age. The results indi-cated a nonsignificant effect for middle-ear infection on readingdisability. Likewise, Hemmer and Ratner (1994) tested the com-munication development of twins with a history of repeated middleear infections. Six pairs of twins were tested: one of each pair hada repeated middle-ear infection and one did not. They were ad-ministered a standard achievement test, speech and spontaneoustalk, which is an essential factor for reading acquisition. A historyof repeated middle-ear infections proved to be correlated to a lowlevel of vocabulary knowledge. However, these infections had nolasting effect on speech and other linguistic skills, nor ultimatelyon reading acquisition.

As seen from the literature, the effects of ear infection on pho-nemic awareness and reading are still not determined. Some stud-ies indicate a significant effect and some indicate a nonsignificanteffect on phonemic awareness. The present study was thought likelyto shed more light on the relation of ear infection to phonemicawareness. It was hypothesized that ear infection through earlyinfancy significantly affects phonemic awareness and ultimatelyreading acquisition.

Method

Participants

Forty-nine children were randomly sampled from three first-gradeclasses in two elementary Bedouin Arab schools in northern Is-

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rael; all were from low socioeconomic status families. The chil-dren were tested at the end of grade 1; they were divided into twogroups: a group with a record of infant middle-ear inflection anda group without. The division was made according to their familydoctors’ files. The files were checked from birth to age six forrecords of the number of middle-ear infections in this period. Achild who had suffered from middle-ear infection at least once inhis/her first six years was considered suitable for the first group.Eleven such children were found. The rest, 38 children, formedthe control group.

Tools

Seven phonological awareness tests were administered to the twogroups, all in fully vowellized Arabic:

PHONOLOGICAL AWARENESS TESTSPhoneme deletion. Ten words. Children had to read the target

words without the first phoneme.Phoneme deletion. Ten words. Children had to read the target

words without the last phoneme.Odd word out. Ten series of words, four words in each. Three

words rhymed and one did not rhyme. Children had to repeat theword that did not rhyme.

Odd word out. Ten series of words, three words in each. Two wordsrhymed and one did not. Children had to repeat the word that didnot rhyme.

Blending. Ten target words, each of two syllables. The tester pro-nounces the two syllables of the word and the children had toconnect the two syllables to make one word.

Syllable counting. Ten target words. Children had to count thenumber of syllables in each word.

Pseudowords. Ten target pseudowords. The children had to readthem aloud. They were devised from words in their grade 1 basalreader and consisted of two and three readable syllables. Eachcorrect answer scored 1 point and a wrong answer scored zero.Maximum score was 70 points.

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Procedure

Each child in the two groups described above was tested individu-ally on the seven phonological awareness tasks. They had to an-swer out loud. Then each child had to read the pseudowords outloud. All children’s readings were recorded to reduce and over-come human error.

Results

The t-tests procedure for dependent variables was employed toanalyze the data of this study. The goal was to test the differencesbetween the two groups, that with middle-ear infection and thatwithout it. The mean score of the non-infected middle ear groupwas x̄ = 33.34, SD = 11.56, and of the infected middle ear group itwas x̄ = –32.27, SD = 13.52. The t-test procedure revealed a non-significant difference between the two groups on the phonologi-cal awareness tasks t = 2.87, p < 0.097, and a non-significantdifference on the pseudoword reading task t = .07, p < .079.

Discussion

The results of this study indicated that middle-ear infections hadno significant effect on phonemic awareness, which ultimately didnot hinder the reading acquisition process. These results accordwith previous results obtained by Share and Chalmers (1986).These authors argued they did not find a significant effect ofmiddle-ear infection on the development of reading disability inthe children they tested. The reason was that these children hadprobably been successfully remediated. The results of the presentstudy also partially support the results of Nittrouer (1996) whofound no significant differences in phonemic awareness betweenmiddle-ear infected children and non-middle-ear infected childrenof low socioeconomic status. However, she found significant dif-ferences in phonemic awareness between the two groups (infectedand non-infected) of children from the middle class.

Nittrouer (1996) argued that low socioeconomic status was avery important factor that affected the phonemic awareness, asattested by the generally poor performance of children of low socio-

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economic-status, whether ear-infected or not. The slight exposureto print of these children in their homes and schools influencedthe results.

The present results differ from those of Donahue (1993), thatthe middle-ear infected children developed different phonemicstrategies that help to cope with language acquisition and/or prob-lems of phonemic awareness. The Donahue (1993) study is a casestudy where the ability to generalize their results is very limited.They followed up the case, a girl, but stopped at the age of five,before she acquired reading skills. A longitudinal study is thusnecessary to observe and learn more about some important be-havioral patterns of phonemic awareness and reading developmentin children with and without infected middle-ear.

Limitations of the present study were small sample size, namelyonly 11 middle-ear infected children. The small sample size of theear infected children versus the 38 non-infected children may beadded to the present results of this study. The study, as mentioned,was conducted in the Bedouin sector in northern Israel, wherethe level of healthcare at medical health centers is not very high.Children’s ear infections at early ages may not always be recordedin the children’s medical files, a possibility confirmed by nurses atthe clinics. Further, some people move from one clinic to another,which may hinder regular registration of children’s diseases. Thehaphazard registration of these ear infections makes the opera-tional definition of middle-ear infected children problematic.

In addition, the nature of the Arabic language is an additionalvariable that may affect this situation. These children started school,where they began learning literary Arabic to which they had neverbefore been exposed (Abu-Rabia, 2000), more particularly becausethey were of low socio-economic status. Their lack of exposure toliterary Arabic may also have caused the very poor phonemic aware-ness in both ear-infected and non-ear infected children. It may beworth testing older children, whose exposure at school to literaryArabic may have improved their phonemic awareness (Stanovich,1988a, 1988b). A further recommendation is to investigate thisphenomenon among other populations, such as Bedouins of theNegev in southern Israel, where the level of health services is verypoor. There Bedouins are scattered over hundreds of square milesin the desert and must travel far to reach health centers.

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In sum, it is recommended to take a larger sample, to considerthe socioeconomic status of the children, and to design longitudi-nal studies in order to shed more light on this very important issue.

References

Abu-Rabia, S. (1996). The Israeli Arab educational system in southern Israel (Techni-cal report). Tel-Aviv: The Adva Center for Community Research (in Hebrew).

Abu-Rabia, S. (2000). The effect of exposure to literary Arabic on reading com-prehension in a diglossic situation. Reading and Writing: An InterdisciplinaryJournal, 13, 147–157.

Donahue, M. (1993). Early phonological and lexical development and otitismedia: A diary study. Journal of Child Language, 20, 489–501.

Hemmer, V., & Ratner, B. (1994). Communicative development in twins withdiscordant histories of recurrent otitis media. Journal of Communication Disor-ders, 27, 91–106.

Lynne, F. (1994). The effects of otitis media on the attention skills of day careattending toddlers. Development Psychology, 30, 701–708.

Nittrouer, S. (1996). The relation between speech perception and phonemicawareness: evidence from low-SES children with chronic OM. Journal of Speechand Hearing Research, 39, 1059–1070.

Peters, S. (1994). The effects of early otitis media with effusion on educationalattainment a prospective cohort study. Journal of Learning Disabilities, 27, 111–121.

Share, D. L., & Chalmers, P. (1986). Reading disability and middle ear disease.Archives of Disease in Childhood, 61, 400–401.

Siegel, L. (1993). The development of reading. In H. W. Reese, Advances in childbehavior and development. New York: Academic Press.

Stanovich, K. E. (1988a). Explaining the differences between the dyslexic andgarden-variety poor readers: The phonological core variable difference model.Journal of Learning Disabilities, 21, 590–612.

Stanovich, K. E. (1988b). The right and wrong places to look for cognitive locusof reading disability. Annals of Dyslexia, 38, 154–177.

U.S. Department of Health and Human Services (1994). Otitis media with effu-sion in young children. AHCPR Publication No. 94-0622, Rockville, MD: Agencyfor Health, Policy and Research.D

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