Hearing impairment and poverty: The epidemiology of ear disease in Peruvian schoolchildren

Abstract

Objectives 1.) To measure prevalence of hearing impairment (HI) in schoolchildren living in poverty in Peru. 2.) To identify risk factors for HI and assess its impact on academic performance. Study design Cross-sectional. Setting Elementary schools in an “asentimiento humano” (shantytown) near Lima, Peru, October 2008–March 2009. Subjects Schoolchildren (n=335), ages 6–19 years. Methods Audiologic health was assessed with pure-tone audiometry, tympanometry and otoscopy. The primary outcome was HI, defined as average threshold >25dB HL for 0.5, 1, 2, and 4 kHz, in one or both ears (per World Health Organization/International Organization for Standardization). A questionnaire on health history was administered to parents. Statistical analysis included univariate analysis for chi-squared values and odds ratios, and multivariate logistic regression. Results HI prevalence: 6.9% (95%CI 4.2–9.6%). Risk factors for HI (OR 95%CI, p-value): neonatal jaundice (5.59, 1.63–19.2, 0.015), seizure (7.31, 2.50–21.4, 0.0013), trauma-related hospitalization (5.80, 1.66–20.3, 0.003), recurrent otitis media(5.06, 1.98–12.9, 0.002), past otorrhea (4.70, 1.84–12.0, 0.003), family history of HI at <35 years (2.91, 1.19–7.14, 0.026), TM abnormality (13.8, 4.48–42.7, <0.001), cerumen impaction (15.8, 4.71–53.1, <0.001) and Eustachian tube dysfunction (4.87, 1.74–13.7, <0.001). HI was an independent predictor of academic failure (3.36, 1.15–9.82, 0.03). Conclusions Impoverished Peruvian schoolchildren were 4-7 times more likely to experience HI than children living in higher-income countries. Untreated middle-ear disease in the context of limited access to pediatric care was a major risk factor for HI. Furthermore, HI was associated with worse scholastic achievement. These results support prioritization of pediatric ear health as an essential component of the global health agenda, especially in resource-poor countries.

Hearing Impairment in a Semi-urban Community in North-Western Nigeria

“…Expectedly, ear diseases are the commonest causes of hearing loss and this is corroborated by several studies [26], with perhaps poverty as a contributory factor [25,27].…”

Traffic deaths: recent evolution and regional differences in Bahia State, Brazil

“…A maior frequência de hospitalização entre as pessoas com deficiência pode ter suas origens na maior frequência de doenças de ouvido e garganta 29,30 , no caso da deficiência auditiva, doenças cardiovasculares 31 , musculoesqueléti-cas 32 , além de doenças crônicas 13 , entre as pessoas com deficiência física. Esses seriam fatores que poderiam contribuir para uma maior prevalência referida de internações hospitalares.…”

Hearing impairment in otitis media with effusion: A cross-sectional study based in Pokhara, Nepal

“…Early identification and treatment of children with HI is therefore imperative. This is particularly true in low-income countries, where the overall prevalence of HI in infants is twice that of high-income countries [5].…”

“…Otitis media is the single most common cause of childhood hearing impairment in low-income countries, where middle ear disorders tend to be more prevalent than in high-income countries [5,6]. Of these, otitis media with effusion (OME) is amongst the most prevalent, as it is linked to poverty and malnutrition [7,8].…”

“…The literature on hearing loss in OME is small and fragmented, with existing papers employing various methodologies [5]. Consensus exists, however, that hearing loss in OME is typically mild.…”