HEARING LOSS AMONG SCHOOL-AGE CHILDREN, UNRECOGNIZED DEFICITS AND LOWER READING SCORES Robert S Byrd MD, MPH ¹, Peggy Auinger MS ², Institutions: ¹Pediatrics, UC Davis Medical Center, Sacramento, CA and ²Center for Child Health Research, American Academy of Pediatrics, Rochester, NY.

BACKGROUND: Routine hearing screening at or prior to school entry should greatly reduce unrecognized hearing deficits among children. Recognition allows for intervention and accommodation.

OBJECTIVE: (1) To describe the prevalence of hearing loss among school-age children, (2) To determine the proportion of hearing loss that was previously unrecognized, and (3) To determine a threshold associated with decreased reading and increased school failure.

DESIGN/METHODS: Nationally representative data from NHANES III (1988-94) regarding 5,078 children ages 6 to 16 yrs were analyzed. The analysis included parent reports of hearing problems and school failure, cognitive and audiometry testing. Hearing loss was categorized as: unilateral or bilateral; low-frequency (LF) or high-frequency (HF); and none, slight, or mild+ for threshold levels of <16 db, 16-25 dB, and >25 db. SUDAAN software was used to account for the complex sampling design. Weighting factors were used to obtain national estimates.

RESULTS: Parent-reported hearing problems occurred in 3.1% of school-age children, with another 2.8% having a parent-reported history of hearing problems. Prior screening was reported in 89%. Audiometry testing showed that 14.3% of children have some level of hearing loss, 2.2% with only LF loss, 7.1% with only HF loss, and 5.1% with both. Among the 7.3% of children with LF loss, bilateral hearing loss of a level of >25 dB is present in only 7.4% (or 0.54% of all school-age children). Only 32.6% of bilateral LF hearing loss was recognized by their parents. Similarly, 0.69% of children have bilateral HF loss > 25 dB, of which 33.6% was noted by parents. Unilateral loss and slight loss were less likely to be recognized by parents . Slight unilateral hearing loss was not associated with increases in school failure. Standardized reading scores were lower for children with bilateral slight hearing loss, compared to children with normal hearing (LF loss: 81.0±5.4(s.e.) vs. 92.4±0.55(s.e.), p=.04; and HF loss: 84.9±3.0(s.e.) vs 92.4±0.55(s.e.), p=.02). Bilateral hearing loss that was >25 dB occurred too infrequently to allow for reliable comparisons of school failure and reading scores

CONCLUSIONS: Hearing loss affects 14.3% of children in the U.S., but is most likely to be slight (16-25dB) and unilateral. Slight hearing loss, when bilateral, is associated with lower reading scores. Hearing loss, at all levels, is often unrecognized by parents. As most school-age children have hearing screening, reexamination of screening procedures is warranted.