Prevalence of Hearing Loss and Associated Factors in School-Age Individuals in an Urban Area of Northeast Brazil

Original Researches Prevalence of Hearing Loss and Associated Factors in School-Age Individuals in an Urban Area of Northeast Brazil Aryelly Dayane Silva Nunes1  http://orcid.org/0000-0002-3814-2675 Sheila Andreoli Balen2  3  http://orcid.org/0000-0003-1353-4362 Dyego Leandro Bezerra Souza4  http://orcid.org/0000-0001-8426-3120 Isabelle Ribeiro Barbosa5  http://orcid.org/0000-0002-1385-2849 1Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil 2Department of Speech, Language and Audiology, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil 3Laboratory of Technological Innovation in Health, Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil 4Department of Collective Health, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil 5Graduate Program in Collective Health, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil Abstract Introduction Hearing loss interferes in the development of language and verbal capacities, which causes learning difficulties and deleterious effects. Objective To analyze the prevalence and associated factors for hearing loss in school-age individuals of the municipality of Natal, state of Rio Grande do Norte, Northeast Brazil. Methods Cross-sectional study that evaluated 238 school-age individuals (6–17 years old) in municipal public schools. Meatoscopy was performed and school-age individuals answered the questions “Do you think that you hear well?” and “Do you have earaches?”. Auditory evaluation was performed with a Telessaúde audiometer. The responsible adults answered socioeconomic, speech and audiology aspects and risk factors for hearing loss questionnaire. Results The prevalence of hearing loss was 16% (11.7–21.4%); 16% reported not to hear well, 18.9% reported earaches, and 26.1% presented altered meatoscopy. The prevalence of hearing loss was higher in school-age individuals who reported hearing difficulties, in children between the ages of 6 and 12, and with altered meatoscopy results (p< 0.05). Airway infection (PR = 3.37; 95% confidence interval [CI]: 1.48–7.68) was found as a risk factor associated with hearing loss, remaining significant in the multivariate model (PR = 6.79; 95%CI: 1.98–23.26; p= 0.002). Conclusions Hearing loss in this sample is above the values reported in other studies performed in Brazil for this age group. This highlights the necessity of better structure of speech and audiology attention, so that auditory health promotion actions can be systematized for this population. Keywords hearing loss; child; adolescent; prevalence; epidemiological factors Introduction Hearing is fundamental for the development of speech, language and learning,1 as it favors social interaction, acquisition of knowledge and enables the individual to transmit thoughts and feelings, being the basis of the human communication system.2 Hearing loss during infancy causes significant impacts,3 with repercussions on the economic aspect due to the costs associated with detection and treatment. There are also repercussions on the psychosocial aspect: for the child, the family and the community in general. Hearing loss interferes in the development of language and verbal capacities, which causes learning difficulties and deleterious effects on the emotional, cognitive, academic and social evolution. Compromises in the development of language and school performance depend on when the impairment was acquired, its type, degree and etiology.4 Hearing losses can result from several causes,5 and risk factors for school-age individuals can be otological or non-otological,6 such as genetic factors, birth complications, superior airway infections,7 middle ear infections,8,9 use of specific drugs and exposure to excessive noise.10 Studies indicate an effect of social and economic conditions on the prevalence of hearing loss in school-age individuals, such as low socioeconomic levels,11,12 income,6,8 education levels,13 and low maternal education level.14 More than 5% of the world population – 466 million people – present incapacitating hearing loss (432 million adults and 34 million children). It is estimated that, until 2050, more than 900 million people – equivalent to 1 out of 10 people – will suffer incapacitating hearing loss. It is known that 60% of hearing losses in infancy are due to avoidable causes.10 Most people with incapacitating hearing loss live in low- and intermediate- income countries. According to the most recent census performed in Brazil, the presence of self-reported hearing loss in the Brazilian population was 5.1%, being the 3rd most prevalent loss in the population. The Northeast region of the country, considered one of the poorest regions of Brazil, presents hearing loss prevalence levels above the national average (5.8%).15 Auditory assessment is an attempt to minimize the adverse influence of auditory disorders, and enable the early detection of hearing pathologies, which generally present few symptoms, and are often not noticed or underestimated.7 The attention of speech and audiology professionals must be present since birth, in the case of profound sensorineural hearing loss predominance, until the school years, with slight or moderate determined deficits, often due to middle ear infections.5 In Brazil, in the year of 2004, the National Policy of Hearing Health Attention16 was instituted, with programmed actions directed to the actuation of audiologists in the promotion of health and specific prevention, and to the development of programs promoting hearing health in schools through practices directed to collective and early interventions. However, there are great difficulties to consolidate the policy in Brazil, due to several and diverse questions. The territorial dimension of the country is a hindering factor, along with the cost of equipment, lack of human resources,17 and flexibility of the health policy in considering optional hearing screenings in school-age individuals (children and adolescents) but not indicating the instruments to be utilized in the evaluation of auditory acuity in this population.18 In the light of the above, there is a clear necessity of developing studies focused on this theme in the Northeast region of Brazil. The objective of the present study was to analyze the prevalence and associated factors for hearing loss in school-age individuals in the municipality of Natal, capital of the state of Rio Grande do Norte, in the epidemiologic study. Methods A cross-sectional study is presented herein, on the evaluation of the prevalence and associated factors for hearing loss in school-age individuals of an elementary municipal public school in Natal. The municipality of Natal is located in the Northeast extreme of Brazil, latitude 5° 47′ 40″ South and longitude 35° 12′ 40″ West. The terri (...truncated)