Prevalence of Mild Hearing Loss in Schoolchildren and its Association with their School Performance

THIEME Original Research Prevalence of Mild Hearing Loss in Schoolchildren and its Association with their School Performance Reem Elbeltagy1,2 1 Audio Vestibular Unit, Ear, Nose and Throat Department, Faculty of Human Medicine Ringgold Standard Institution, Zagazig University, Zagazig, Egypt 2 Health Communication Science Department, College of Health and Rehabilitation Science, Princess Noura Bint Abdulrahman University Ringgold Standard Institution, Riyadh, Saudi Arabia Address for correspondence Reem Elbeltagy, Audio Vestibular Unit, Ear, Nose and Throat Department, Faculty of Human Medicine Ringgold Standard Institution, Zagazig University, Zagazig, Egypt (e-mail: ). Int Arch Otorhinolaryngol 2020;24(1):e93–e98. Abstract Keywords ► prevalence ► hearing loss ► academic performance Introduction Hearing is important for the proper development of every child, especially for those younger than 5 years of age, because it helps in the development of language and speech. Emotional and social problems, as well as issues with academic performance, can result from hearing loss even of mild degree. Early diagnosis and management can overcome those negative impacts. Objective To determine the prevalence of mild hearing loss in primary-school children and its association with their school performance. Methods A comparative cross-sectional study was conducted at a regular school. The study included the random selection of 120 apparently normal students (aged 6-9 years) who were considered as having normal hearing by their parents. A total of 20 students were excluded from the study due to the presence of wax in their ears. Finally, the study was conducted with 100 students. All participants were subjected to a basic audiological evaluation, and the Screening Instrument for Targeting Educational Risk (SIFTER) questionnaire was given to their teachers to evaluate their school performance. Results From a total of 100 students, we confirmed that 23 (23%) had mild hearing loss, 17 (17%) had bilateral conductive hearing loss, and 6 (6%) had bilateral sensorineural hearing loss. The students who had low attention and communication performance were significantly associated with mild hearing loss. Conclusion The prevalence of mild hearing loss was of 23% (23 cases). This problem had an effect on the communication and attention in school; and it might affect academic performance later in life. A hearing assessment is highly recommended for every child, especially those who have a low rate of academic performance. Introduction Hearing is important for the proper development of every child, especially those younger than 5 years of age, because it helps in the development of language and speech.1 Hearing loss is considered one of the most prevalent disabling disorders worldwide;2 it affects between 1 to 6 children per received April 20, 2018 accepted June 16, 2019 DOI https://doi.org/ 10.1055/s-0039-1695024. ISSN 1809-9777. 1,000 live births.3,4 About 466 million people complain of disabling hearing loss, and 34 million of these people are children.5 Mild hearing loss is a hidden problem in most children in the age group between 1 and 9. The prevalence of a mild hearing loss in school-age children is estimated to be between 2.4% and 14.9%, according to the area of the Copyright © 2020 by Thieme Revinter Publicações Ltda, Rio de Janeiro, Brazil e93 e94 Prevalence of Mild Hearing Loss in Schoolchildren Elbeltagy study.6–10 When a speaker is located at a distance of more than 3 feet, this may result in missing up to 10% of the speech. This percentage is susceptible to increase if there is background noise.6 Hearing loss in children, whether congenital or acquired, may be due to several causes. Congenital hearing loss may be due to genetic or non-genetic etiologies; the non-genetic factors include premature birth, birth complications, an infection in the mother during pregnancy, and maternal diabetes. More than 50% of all cases of hearing loss that occur in children are due to genetic factors, be them present at birth or developed later in life11. A total of 60% of the hearing loss that occurs in children under the age of 15 is due to preventable causes, such as exposure to loud noise and secondhand smoke, and use of audio devices. Other causes are untreated or frequent otitis media, infections like meningitis, measles, the mumps or whooping cough, in addition to taking ototoxic medications.12 Emotional and social problems can result from hearing loss even of mild degree. It also has a negative impact on the learning of verbal language, reading, writing and academic performance. Hearing loss of any type or degree can act as a barrier to incidental learning.13 Academic losses may begin when the children are in kindergarten and first grade, but those children begin to show significant learning difficulties when they reach the third grade. This difficulty may be attributed to the complexity of the language, less visual clues, more verbalizations, more need to sequence and recall, and lack of development of pre-skills in the previous grades. Mostly, these symptoms of hearing loss are mistaken for an attention deficit problem.14 Some children do not have any physical complaints. Their parents complain only of behavioral problems, like frequent requests, improper responses to instruction, carelessness, talking too loud and confusion with similar-sounding words. However, these behavioral complaints are subjective, and are usually missed and ignored by teachers and parents, who consider that these children have normal hearing. So, identifying mild hearing loss in schoolchildren without a school hearing screening program is very difficult.15 Some countries, like Canada, have studied the importance of a hearing screening program for newborns.16 In Egypt, The prevalence of hearing loss among children is difficult to be estimated accurately because the national hearing screening program has not yet been applied, and there are only hospital-based academic studies that give just an idea about the extent of the problem. Many children with hearing loss may be missed.17 A study by Skarzyński et al18 revealed 70% of the schoolchildren screened had peripheral hearing loss; this was the first hearing screening test in those children’s lives and the families were unaware of the hearing loss in 60% of the cases.18 The Screening Instrument for Targeting Educational Risk (SIFTER) is considered a reliable method to determine the effect of hearing loss in academic performance. Bess et al19 and Most20 used the SIFTER questionnaire for the same purpose, and they concluded that children suffering from International Archives of Otorhinolaryngology Vol. 24 No. 1/2020 minimal hearing loss have a poor score in the communication domain when compared with normal-hearing children. In developing countries like Egypt, there is no established hearing screening program for the early detection of hearing impairments. There (...truncated)