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ORIGINAL ARTICLE
Year : 2020  |  Volume : 23  |  Issue : 2  |  Page : 116-120

Hearing loss in the pediatric age group


Department of ENT Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Date of Submission29-Jun-2019
Date of Acceptance05-Dec-2019
Date of Web Publication10-Jul-2020

Correspondence Address:
Dr. Ediriverere Nosa Oghenekaro
Department of ENT Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State
Nigeria
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DOI: 10.4103/smj.smj_30_19

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  Abstract 


Background: Hearing loss is one of the preventable diseases listed by the WHO, even though the prevalence is decreasing in the developed countries. The pediatric age is very important in terms of hearing and therefore speech development. The prevalence and pattern of hearing loss in this age group in this environment is not known. Objective: The aim of the study was to determine the etiology and pattern of hearing loss in the pediatric age group in Port Harcourt. Materials and Methods: The study involved the pediatric age group (0-18 years) presenting with hearing loss, seen in the ENT Surgery Department of UPTH from January 2010 to December 2016. The clinic registers and patients' folders were the sources from which the biodata, clinical presentations, audiological assessments, possible etiologies, and treatment were extracted. These were analyzed using IBM SPSS Statistics, version 20.0. Results: A total of 752 patients with hearing impairment were seen: males – 502 and females – 250 with a ratio of 2.01:1. Patients with the age group of 0–3 years (28.6%) were more affected, whereas 16–18 years (11.2%) were the least affected. Sensorineural hearing loss (SNHL) was 37.6%; among this, birth asphyxia made up 38.5%, syndromic 6.0%, postmeningitis (2.7%, and neonatal jaundice 21.9%. However, conductive hearing loss (62.4%); was made up of cerumen auris (31.8%), otomycosis (19.4%), chronic suppurative otitis media (13.6%), Otitis media with effusion (11.7%). Most children with SNHL had severe-to-profound degree. The most common clinical presentation was hearing impairment and speech impairment followed by discharging ears. Conclusion: Hearing loss secondary to preventable causes such as birth asphyxia and neonatal infections still ranks high among the pediatric age group in this environment.

Keywords: Children, conductive hearing loss, hearing loss, sensorineural hearing loss


How to cite this article:
Ibekwe UM, Oghenekaro EN. Hearing loss in the pediatric age group. Sahel Med J 2020;23:116-20

How to cite this URL:
Ibekwe UM, Oghenekaro EN. Hearing loss in the pediatric age group. Sahel Med J [serial online] 2020 [cited 2020 Aug 13];23:116-20. Available from: http://www.smjonline.org/text.asp?2020/23/2/116/289350




  Introduction Top


Hearing impairment is the most frequent sensory deficit in human populations, affecting more than 450 million people in the world.[1] Significant hearing loss occurs in 1–2/1000 newborns and in 2/1000 young children.[2] Even though the prevalence is decreasing in the developed countries, the prevalence in developing countries is still high. The incidence of severe-to-profound sensorineural hearing loss (SNHL) in children is approximately 1:2000 at birth and 6:1000 by 18 years of age.[3] Although these numbers indicate that SNHL is relatively common, it remains underappreciated and underdiagnosed in children.[3]

Hearing loss could be conductive, sensorineural, or mixed.[4],[5] Conductive hearing loss usually affects the low frequencies, whereas most SNHL involves high frequencies.[6],[7] Possible causes of conductive hearing loss are impacted cerumen, a foreign body, edema of the auditory canal, and otitis media among children,[7],[8] whereas meningitis, congenital syphilis, birth asphyxia, medications, and noise are among the many possible causes of SNHL in children.[6],[7]

However, the severe-to-profound unilateral losses are often not recognized until kindergarten, when the child undergoes the first audiometric evaluation.[3] The ability of a child to hear affects the child development in terms of speech development and communication. It also affects learning and academic performance; furthermore, it has an effect on the social and psychological aspect of the child's life and relationships with other people.[6] Childhood hearing loss poses huge burden on the parents and society. The quality of life is adversely disturbed as it affects all facets of the child's development. This includes inability to interpret speech, thus resulting in failure of proficiency in verbal communication; delayed language acquisition; delayed cognitive development; educational problems; stigmatization; and social seclusion.[2] These children usually require special education and often face a lot of challenge in the job market leading to unemployment with further economic burden to the nation.[2]

Public health screening and intervention play an important role in improving the health (including hearing status) and well-being of children.[6] Children are most often administered audiometric evaluations at speech frequencies as part of routine physical examinations in school settings.[6] Therefore, mandatory hearing assessment of children to discover those with hearing impairment is not negotiable because delayed speech and language development ensuing from hearing loss can often be prevented. Timely identification of hearing loss, whether sensorineural or conductive, is vital to a child's attainment of communication.[2] However, nearly all children develop some transient hearing loss related to middle ear infections during the period from birth to 3–11 years of age.[2],[9],[10]

In children under 15 years of age, 60% of hearing loss is attributable to preventable causes.[1] Primary prevention through immunization, genetic counseling, and improved antenatal and perinatal care may help to address some environmental causes, such as birth asphyxia, low birth weight, sepsis, meningitis, and neonatal jaundice requiring exchange blood transfusion.[11],[12] Others include screening of children for otitis media, avoiding the use of ototoxic drugs, and reducing exposure (both occupational and recreational) to loud noise.[1] Therefore, neonatal screening and early assessment of hearing, especially for high-risk infants (infants with birth asphyxia, neonatal jaundice, and neonatal sepsis), to ensure prompt diagnosis and appropriate management are very important.[1]


  Patients and Methods Top


Study design

This is a retrospective study involving all the pediatric age groups (0–18 years) from January 2010 to December 2016

Inclusion criteria

Paediatric patients with hearing loss seen in the ENT surgery department of the University of Port Harcourt Teaching Hospital (UPTH).

Exclusion criteria

Patients with incomplete records and those diagnosed with hearing impairment but did not undergo audiologic assessment or screenings were excluded from the study.

Data collection

The clinic registers and patients' folders were the sources from which the biodata, clinical presentations, possible etiologies, and treatment and outcome were extracted. Audiologic assessment includes pure tone audiometry (for children more the 6 years), tympanometry otoacoustic emission, and brainstem evoked response audiometry.

Data analysis

The data were analyzed by simple descriptive methods, and results were presented as tables of frequency and percentages for illustration.

Ethical consideration

Ethical approval (UPTH/ADM/90/S II/VOL XI/933) was obtained from the ethics and research committee of the University of Port-Harcourt Teaching Hospitals. The study complied with 2013 Geneva declaration.


  Results Top


A total of 752 patients were seen over this period, of a total of 9894 patients attending the ENT clinic, giving a prevalence of 7.6%. There were 502 male and 250 female with a male-to-female ratio of 2.01:1. The age distribution was as represented in [Figure 1].
Figure 1: Age distribution

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Bilateral hearing loss was seen in 337 (42.2%) patients and unilateral hearing loss in 415 (57.9%) patients – right ear accounting for 188 (45.3%) and left 227 (54.7%). SNHL was noted in 289 (37.6%) patients, whereas 469 patients (62.4%) had conductive hearing loss as shown in [Figure 2]. The cause of sensorineural and conductive hearing loss is shown in [Table 1] and [Table 2], respectively. Most of our patients with SNHL were not fitted with hearing aid. Very few patients (14) could afford a hearing aid because most parents could not afford hearing aid for their children; therefore, very few children were fitted with hearing aid, whereas most of the patients with conductive hearing loss had improved hearing with treatment of the underlying problem. The most common presentation in the patients seen was hearing impairment, followed by ear discharge as shown in [Table 3].
Figure 2: Type of hearing loss

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Table 1: Etiology of sensorineural hearing loss

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Table 2: Etiology of conductive hearing loss

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Table 3: Common clinical presentations

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  Discussion Top


From this study, slight male-to-female preponderance was observed which is similar to the studies by other authors.[3],[5],[13],[14] A study by Cremers et al. on male predominance in childhood hearing did not find any explanation, but it does not appear to arise from genetic factors.[15] The prevalence of hearing loss among children from this study was 7.6%, which is lower than 29.4% reported by Obukowho et al., among primary school children.[5] The variation is probably because this work was hospital based, whereas the latter was school-based study. Niskar et al. reported 4.9% among children aged 6–19 years.[6] However, Baille et al. had a prevalence of 0.54/1000 children under the age of 9 years.[14] Watkins noticed higher prevalence of 1.1/1000 for children between 1 and 16 years with low socioeconomic status.[16] The most common age range affected were those of 0–3 years accounting for 28.6%. Billings and Kenna reported a mean age of diagnosis as 3.52 years among children between 1 month and 13 years. The high prevalence rate in the study is probably because this is a hospital-based study with more ill children when compared to other studies that are community based with less ill children.

This study shows that more children (62.5%) presented with conductive hearing loss similar to the report by Pape et al. that noticed more conductive hearing loss (81.4%) (mainly from middle ear problems) among immigrant children in the United States.[17] Yousuf Hussein et al. also had similar report among preschool children where conductive hearing loss (65.2%) was the most common type of hearing loss found. However, this work was only on preschool child, whereas the present study covered all pediatric age groups.[18]

The most common cause of SNHL was birth asphyxia (38.5%) followed by neonatal jaundice (21.9%), whereas meningitis accounted for 12.7%, in contrast to the report by Baille et al. who noted hereditary origin (20.8%), infectious origin (11.5%), and perinatal risk factors (11.5%). However, Billings and Kenna observed that hereditary factor, prematurity, and complicated perinatal causes were seen in 28.6%, whereas syndromes, congenital anomalies, meningitis, and maternal factors accounted for 38.5% of the cause of SNHL in their study.[3] A high perinatal cause was noticed in this study probably as a result of the poor maternal and child health care that is commonly found in our environment and generally in most developing countries.[14] Fageeh's report also had a very high hereditary cause (78%) of SNHL which was attributed to consanguineous marriage among the people.[19]

In this study, the most common cause of conductive hearing loss was cerumen auris – 31.8%, followed by otomycosis – 19.4%, chronic suppurative otitis media –13.8%, otomycosis – 19.4%, and otitis media with effusion – 11.7%. This slightly differs from the study by Yousuf Hussein et al., that was among school children, where it was observed that impacted ear wax, followed by otitis media were the most common cause of conductive hearing loss.[18] Monasta et al. reported that the incidence rate of otitis media was the highest in sub-Saharan Africa and South Asia during the first 5 years of life.[20] The most common presenting complaint was hearing impairment in all the patients, followed by ear discharge and ear pain.

It has been observed that there is a marked learning difficulty in children with hearing impairments. Baille et al. found that as much as 36% of the children were 2 years behind their age group and 28% were more than 2 years behind as a result of having severe-to-profound hearing loss mostly from sensorineural origin.[12] Considering the high level of SNHL seen among children in the study, most of these children would like to have a setback.

In developed countries, the focus is toward prevention, early detection and intervention, and also, studies have shown that early diagnosis and treatment give better outcome and proper rehabilitation.[2],[21] However, the reverse is the case in the sub-Saharan Africa, where most of the patients present late and often cannot afford hearing aid and other rehabilitation devices. This is because they do not have health insurance; therefore, they settle their medical bills out of pocket.

Presentations and diagnosis at late ages, often later than 4–5 years, have a profoundly negative effect on communication and cognitive abilities as well as educational and vocational acquisition in these children.[21] Tye-Murray et al. noted that children fitted with hearing aid before the age of 5 years had more accurate production of consonant and vowel sounds.[22] In this study, most of the patients presented before the age of 5 years but could not be fitted with hearing aid due to financial constraints, with these children were likely to have these setbacks. Poor record keeping was a limitation in the study and resulted in missing data; however, the data obtained were useful and could be used for a base for future prospective studies.

Poor record and incomplete or missing data were the major limitations of this study, being retrospective in design.


  Conclusion and Recommendation Top


Hearing loss among children was noticed to have a high prevalence among patients attending the ENT clinic of UPTH, with majority of these children having conductive hearing loss. Most of the causes were also observed to be preventable.

There is an urgent need for government and cooperative organizations to assist in the rehabilitation of the children and hearing aid can be included as part of the services available at the national health insurance scheme to reduce the financial burden.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Deafness and Hearing Loss. Key Facts. Available from: https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss. [Last retrieved on 2019 Mar 23].  Back to cited text no. 1
    
2.
Frank-Briggs AI. Childhood hearing impairment: How do parents feel about it? Niger Health J 2012;12:102-5.  Back to cited text no. 2
    
3.
Billings KR, Kenna MA. Causes of pediatric sensorineural hearing loss: Yesterday and today. Arch Otolaryngol Head Neck Surg 1999;125:517-21.  Back to cited text no. 3
    
4.
Dhingra P. Diseases of the Ear. Diseases of Ear, Nose and Throat Diseases. 4th ed. 2007;3:31.  Back to cited text no. 4
    
5.
Obukowho OL, Enekole OJ, Ifeoma A. Risk factors of hearing impairment among lower primary school children in Port Harcourt. Glob J Otolaryngol 2017;6:1-12.  Back to cited text no. 5
    
6.
Niskar AS, Kieszak SM, Holmes A, Esteban E, Rubin C, Brody DJ. Prevalence of hearing loss among children 6 to 19 years of age: The Third National Health and Nutrition Examination Survey. JAMA 1998;279:1071-5.  Back to cited text no. 6
    
7.
Stein L, Clark S, Kraus N. The hearing-impaired infant: patterns of identification and habilitation. Ear Hear 1983;4:232-6.  Back to cited text no. 7
    
8.
Parving A. Epidemiology of hearing loss and aetiological diagnosis of hearing impairment in childhood. Int J Pediatr Otorhinolaryngol 1983;5:151-65.  Back to cited text no. 8
    
9.
Robson CD. Congenital hearing impairment. Pediatr Radiol 2006;36:309-24.  Back to cited text no. 9
    
10.
Smith RJ, Bale JF Jr., White KR. Sensorineural hearing loss in children. Lancet 2005;365:879-90.  Back to cited text no. 10
    
11.
Olusanya BO, Wirz SL, Luxon LM. Community-based infant hearing screening for early detection of permanent hearing loss in Lagos, Nigeria: A cross-sectional study. Bull World Health Organ 2008;86:956-63.  Back to cited text no. 11
    
12.
Smith A. Preventing deafness – An achievable challenge The who perspective. International Congress Series 2003;1240:183-91.  Back to cited text no. 12
    
13.
Bamiou DE, Phelps P, Sirimanna T. Temporal bone computed tomography findings in bilateral sensorineural hearing loss. Arch Dis Child 2000;82:257-60.  Back to cited text no. 13
    
14.
Baille MF, Arnaud C, Cans C, Grandjean H, du Mazaubrun C, Rumeau-Rouquette C. Prevalence, aetiology, and care of severe and profound hearing loss. Arch Dis Child 1996;75:129-32.  Back to cited text no. 14
    
15.
Cremers CW, van Rijn PM, Huygen PL. The sex-ratio in childhood deafness, an analysis of the male predominance. Int J Pediatr Otorhinolaryngol 1994;30:105-10.  Back to cited text no. 15
    
16.
Watkin PM. The age of identification of childhood deafness--improvements since the 1970s. Public Health 1991;105:303-12.  Back to cited text no. 16
    
17.
Pape L, Kennedy K, Kaf W, Zahirsha Z. Immigration within the United States: prevalence of childhood hearing loss revisited. Am J Audiol 2014;23:238-41.  Back to cited text no. 17
    
18.
Yousuf Hussein S, Swanepoel W, Mahomed-Asmail F, de Jager LB. Hearing loss in preschool children from a low income South African community. Int J Pediatr Otorhinolaryngol 2018;115:145-8.  Back to cited text no. 18
    
19.
Fageeh NA. Prospective study of hearing loss in schools for deaf children in Assir region, Saudi Arabia. West Afr J Med 2003;22:321-3.  Back to cited text no. 19
    
20.
Monasta L, Ronfani L, Marchetti F, Montico M, Vecchi Brumatti L, Bavcar A, et al. Burden of disease caused by otitis media: systematic review and global estimates. PLoS One 2012;7:e36226.  Back to cited text no. 20
    
21.
Butler IR, Basson S, Britz E, de Wet R, Korsten GB, Joubert G. Age of diagnosis of congenital hearing loss at Universitas hospital, Bloemfontein. S Afr Med J 2013;103:474-5.  Back to cited text no. 21
    
22.
Tye-Murray N, Spencer L, Woodworth GG. Acquisition of speech by children who have prolonged cochlear implant experience. J Speech Hear Res 1995;38:327-37.  Back to cited text no. 22
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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