Deficits in working memory, reading comprehension and arithmetic skills in children with mouth breathing syndrome: analytical cross-sectional study

Abstract

CONTEXT AND OBJECTIVE: Mouth breathing syndrome is very common among school-age children, and it is possibly related to learning difficulties and low academic achievement. In this study, we investigated working memory, reading comprehension and arithmetic skills in children with nasal and mouth breathing. DESIGN AND SETTING: Analytical cross-sectional study with control group conducted in a public university hospital. METHODS: 42 children (mean age = 8.7 years) who had been identified as mouth breathers were compared with a control group (mean age = 8.4 years) matched for age and schooling. All the participants underwent a clinical interview, tone audiometry, otorhinolaryngological evaluation and cognitive assessment of phonological working memory (numbers and pseudowords), reading comprehension and arithmetic skills. RESULTS: Children with mouth breathing had poorer performance than controls, regarding reading comprehension (P = 0.006), arithmetic (P = 0.025) and working memory for pseudowords (P = 0.002), but not for numbers (P = 0.76). CONCLUSION: Children with mouth breathing have low academic achievement and poorer phonological working memory than controls. Teachers and healthcare professionals should be aware of the association of mouth breathing with children's physical and cognitive health. RESUMO CONTEXTO E OBJETIVO:A síndrome da respiração oral é muito comum em crianças em idade escolar, e está possivelmente relacionada a dificuldades de aprendizagem e baixo rendimento escolar. Neste estudo, investigamos memória operacional, compreensão de leitura e habilidades aritméticas em crianças com respiração nasal e oral. TIPO DE ESTUDO E LOCAL: Estudo transversal analítico com grupo controle realizado em hospital universitário público. MÉTODOS: 42 crianças (média = 8,7 anos) identificadas com respiração oral foram comparadas a um grupo controle (média = 8,4 anos) e pareadas por idade e escolaridade. Todos os participantes foram submetidos a entrevista clínica, audiometria tonal, avaliação otorrinolaringológica e avaliação cognitiva da memória operacional fonológica (números e pseudopalavras), compreensão de leitura e aritmética. RESULTADOS: Crianças com respiração oral tiveram desempenho significativamente inferior ao de respiradores nasais em compreensão de leitura (P = 0,006), aritmética (P = 0,025) e memória operacional para pseudopalavras (P = 0,002), mas não para números (P = 0,76). CONCLUSÕES: Crianças com respiração oral apresentam baixo rendimento escolar e menor memória operacional fonológica em comparação ao grupo controle. Professores e profissionais da saúde devem atentar para a associação da respiração oral com a saúde física e cognitiva das crianças.

Factors associated with mouth breathing in children with ­developmental ­disabilities

“…Mouth breathing is a multifactorial syndromeand is a health concern as it can lead to many problems such as: malocclusion, negative impact on oral health, affected speech, and hearing and quality of life . Its prevalence ranges from 50% to 60% in Brazil, and 71% globally, decreasing with age . Among individuals with cerebral palsy, the prevalence can range from 60% to 86% for mixed (mouth and nose) ­breathing .…”

“…Among individuals with cerebral palsy, the prevalence can range from 60% to 86% for mixed (mouth and nose) ­breathing . The causes of mouth breathing are diverse and include allergic rhinitis, palatine hypertrophy and/or pharynx and nasal septum deviation …”

Nasal obstruction during adolescence induces memory/learning impairments associated with BDNF/TrkB signaling pathway hypofunction and high corticosterone levels

“…Nasal congestion may lead to craniofacial changes, including mouth breathing, maximum protrusion, and adenoid facies (Harari et al, ; Pirilä‐Parkkinen et al, ). Indeed, children with adenoid hypertrophy, allergic rhinitis, and oral respiration caused by nasal congestion exhibit deficits in their comprehensive, mathematical, and academic abilities and working memory compared with healthy children (Fensterseifer et al, ; Kuroishi et al, ; Walker et al, ). However, few studies have examined changes in memory and learning ability related to nasal obstruction.…”

“…During preadolescence and adolescence, mouth breathing causes a range of craniofacial and occlusal problems, including an open bite, maxillary protrusion, and lateral cross‐bite (Harai, Redlich, Miri, Hamud, & Gross, ; Pirilä‐Parkkinen et al, ), and masticatory stimulation via the periodontal ligament and temporomandibular joint are known to affect the structure and function of the central nervous system (CNS) (Okihara et al, ). A recent study found that children who do not use mouth breathing exhibit better reading comprehension, arithmetic skills, and working memory function when compared with children who use mouth breathing (Kuroishi et al, ). Moreover, adenoidal hypertrophy and allergic rhinitis were found to lead to poor academic ability (Fensterseifer, Carpes, Weckx, & Martha, ; Walker et al, ) and high stress levels (Kim, Kim, Park, Kim, & Choi, ) during adolescence.…”

Estimulação das habilidades do processamento fonológico e estudo do P300 em escolares com distúrbio de leitura e escrita

“…Os diferentes tipos de testes podem apresentar maior ou menor sensibilidade nos resultados: o teste de memória de dígitos apresenta relação mais direta com os conhecimentos prévios do indivíduo e seu acesso ao léxico ao passo que os testes de repetição de pseudopalavras medem com mais precisão a memória fonológica, devido ao fato, de o input ser desconhecido e não sujeito às influências lexicais, assim, a criança terá de valer-se exatamente de representações de palavras sem significado na memória para suportar a sua repetição (BADDELEY, 2000;CÁRNIO et al, 2015). Estudos anteriores conduzidos pelo mesmo grupo de pesquisa desse presente trabalho sugerem que a tarefa de repetição de dígitos parece não ser suficiente para evidenciar alterações na memória de trabalho, necessitando de outras tarefas para esta investigação (ZUANETTI;FUKUDA;KUROISHI et al, 2015).…”