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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 15  |  Issue : 1  |  Page : 13-16

Hearing thresholds of junior secondary school students in kaduna metropolis


1 National Ear Care Centre, Kaduna, Nigeria
2 Department of ENT, University of Maiduguri, Maiduguri, Nigeria
3 Department of ENT, University of Ibadan, Ibadan, Nigeria

Date of Web Publication23-Mar-2018

Correspondence Address:
S B Nasir
National Ear Care Centre, Kaduna
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njbcs.njbcs_28_17

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  Abstract 

Background: Communication is key to learning. Hearing is an essential part of communication without which acquisition of knowledge is, at best, very difficult. School children require a functioning auditory system for optimal educational development. In hearing impaired children educational development can be stalled should diagnosis not be done in a timely manner. Aim: The aim of the study was to evaluate the hearing threshold and determine the prevalence of hearing loss of a cohort of junior secondary school students attending schools in Kaduna North Local Government Area of Kaduna State, Nigeria. Patients and Methods: This was a cross-sectional prospective study of junior school students aged 10 years to 15 years attending selected secondary schools in Kaduna North Local Government area of Kaduna state, Nigeria. Structured questionnaire was administered to obtain relevant biodata, school type, and auditory health. Otoscopy and Pure tone audiometry were done to determine any associated ear pathology and hearing threshold levels respectively. Data obtained were recorded and analyzed using the Statistical Package for Social Sciences version 16 (SPSS Inc., Chicago, Illinois, USA). The frequency tables were generated showing the distribution of study characteristics. Results: The prevalence rate of hearing loss among junior secondary school students in Kaduna metropolis is 14.7%. Conductive hearing loss was seen in 10.3% of students and sensorineural loss in 4%. Conclusion: There is a high prevalence of hearing loss among students of junior secondary school in Kaduna especially in public schools. Other otologic pathologies like wax and foreign bodies were also noted.

Keywords: Hearing loss, hearing threshold, Kaduna, students


How to cite this article:
Nasir S B, Labaran A S, Kodiya A M, Nwaorgu O G. Hearing thresholds of junior secondary school students in kaduna metropolis. Niger J Basic Clin Sci 2018;15:13-6

How to cite this URL:
Nasir S B, Labaran A S, Kodiya A M, Nwaorgu O G. Hearing thresholds of junior secondary school students in kaduna metropolis. Niger J Basic Clin Sci [serial online] 2018 [cited 2018 Oct 22];15:13-6. Available from: http://www.njbcs.net/text.asp?2018/15/1/13/228363




  Introduction Top


Communication is key to learning. Hearing is an essential part of communication without which learning is, at best, difficult. It has been found that hearing loss negatively affects a child's global development‒cognitive, linguistic, and emotional.[1] Public health policies have often advocated neonatal hearing screening programmes; however, in developing countries where this is often poorly implemented, hearing screening for school children has also been recommended.[2] Hearing screening at school entry has been proposed for early detection and rehabilitation of hearing impaired school children but unfortunately this is rarely done during routine clinical examination for school entrants, and health authorities pay little attention to audiometric evaluation. This is usually attributed to inadequate knowledge of parents, school authorities, and healthcare providers on the outcomes of hearing loss especially mild cases.[3]

Many of these children with mild hearing (at times moderate) and unilateral hearing loss that are not noticed are poorly understood and are underappreciated by family, friends, and teachers. They are often considered hyperactive, poor performers, or non-adapted to school.[2] Many are then sent to vocational training, apprenticeship, or even juvenile homes.

Although, the World Health Organization recognizes any hearing threshold above 25 dB in any ear as abnormal; however, hearing is not considered a “disability” except for a case of “permanent unaided hearing threshold level in the better ear of 31dB or greater.”[4],[5] However, this criterion fail to consider the disability faced by children with conductive hearing loss, a common occurrence in this age group as a result of recurrent or chronic otitis media. These children face difficulties in learning in adverse listening conditions like a noisy classroom. Such conditions will have a negative effect on their education.[6],[7] Those with conditions that are not “disabling” but may face similar difficulties in learning include those with unilateral hearing loss and those with bilateral sensorineural hearing loss less than 31 dB.

There is therefore, a need to address the needs of this group of children, for example, granting them a more favorable sitting position in front of the class; fitting of hearing aids where it would be helpful and treatment of middle ear diseases causing hearing loss.[8],[9] To be helped, this group must first be identified. While children with severe-profound bilateral hearing loss may be detected through primary parental suspicion, those with mild hearing loss are unlikely to be so detected because the handicap is associated more with receptive rather than expressive linguistic skills.[10],[11]

This study set out to determine the hearing thresholds of a group of junior secondary school students in Kaduna, Southwestern Nigeria; to determine the prevalence of hearing loss among them and the pattern, and types of hearing loss, if any.


  Participants and Methods Top


This is a descriptive cross-sectional study conducted in selected junior secondary schools in Kaduna metropolis. The study was done over a 6 month period from September 2013 to March 2014. Ethical approval was obtained from the Ethical Review Committees of the Kaduna State Ministry of Health and the National Ear Care Centre, Kaduna. The permission was also obtained from the Kaduna North Zonal Education Authority.

The students involved in the study were selected via a multistage sampling method. Six schools were randomly selected from the 40 schools in Kaduna metropolis. From these six schools a total of 750 students (125 from each school) were selected by simple ballot method, using the school register. Inclusion criteria include selected students of participating schools who are aged 10–15 years and whose parents gave their consent via a signed consent form. The exclusion criteria include those who fell outside the age bracket of 10–15 years and those who declined to participate. Five hundred and eighteen (518) students completed the study. Those who did not complete the study were those who did not meet the inclusion criteria.

The selected students were then administered a structured questionnaire on biodata and relevant information. Next, otoscopy was carried out, those with wax or foreign bodies had them removed. Each participant then had audiometry. The pure tone audiometry was done in a sound proof room using a MAICO audiometer (MA42 model, Germany) precaliberated to ISO standards. Hearing threshold for each ear was determined using circumaural headphones at frequencies 250, 500, 1000, 2000, 4000, and 8000 Hz.

The pure tone average for each ear was calculated. This is the average of thresholds for air conduction at 500, 1000, and 2000 Hz, i.e., the sum of the thresholds at these frequencies divided by 3. The pure tone average for each ear was used to determine the level of hearing for that ear. Hearing was classified into one of six categories using the WHO classification.[12]

Normal Hearing: <25dBHL

Mild Hearing Loss: 26-40dBHL

Moderate Hearing Loss: 41-55dBHL

Moderately-severe Hearing Loss: 56-70dBHL

Severe Hearing Loss: 71-90dBHL

Profound Hearing Loss: >90dBHL.

Hearing loss was also classified as conductive if the air-bone gap was greater than 15 dB and sensorineural hearing loss if air-bone gap was less than 15 dB. It was mixed hearing loss if air bone gap is greater than 15 dB and the bone conduction level is impaired.


  Results Top


A total of 518 students participated in the study. The age range was 10–15 years with a mean age of 13.1 years (±1.3). There were 266 boys (51.4%) and 252 girls (48.6%).

The commonest pathology found at otoscopy was cerumen auris. It was present in 117 (11.3%) of the 1036 ears examined. There was an almost equal distribution between right and left ears with 58 and 59 respectively. Six of the ears had perforation. The foreign bodies were found in two ears.

Taking 25 dB as normal hearing threshold,[5],[12] this study reveals that 76 (14.7%) students had hearing loss, i.e., hearing thresholds above 25 dB; while 442 students (85.3%) had normal hearing, i.e., threshold <25 dB. This is demonstrated in [Table 1] which also shows the pattern of hearing loss according to affected ears. Unilateral conductive hearing loss was the commonest type of hearing loss‒35 (6.8%), followed by 18 (3.5%) with bilateral conductive hearing loss. Twenty-one students (4%) had sensorineural hearing loss while two students exhibited mixed hearing loss.
Table 1: Type of hearing loss according to affected ears

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[Table 2] shows pattern of hearing when classified according to degree of hearing loss. Forty-seven of the 518 right ears had mild hearing loss while nine were moderate and two severe. On the left, there was mild hearing loss in 34 ears, nine moderate and four moderately severe.
Table 2: Pattern of hearing according to degree of hearing loss

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When hearing loss was analyzed according to gender, 16.5% of boys had some form of hearing loss while only 6.8% of girls had any hearing loss.


  Discussion Top


This study finds that the prevalence rate of hearing loss among junior secondary school students in Kaduna to be 14.7%. This prevalence rate is similar to rates found in studies done in other developing countries like Malaysia,[13] Egypt,[14] and India,[15] with a range from 11.9% to 19%. However, considerably lower rates were reported in Zimbabwe (2.4%),[16] Kenya (5.6%),[17] and Finland (2.4%).[18] Much higher rates were noted by Taha et al. (24.5%) in Egypt.[19]

It appears the data concerning prevalence of hearing loss in children varies widely in different studies across regions and even within the same country. In Iran, prevalent rate for the district of Tehran was 14.3%[20] while in Zahedan district it was found to be 8.8%.[21] Gierek et al. quoted a divergent range between studies of 1% and 32%.[22] Also, in the United States while Boss et al. found 2.6%,[23] Bess et al. discovered a prevalent rate of 11.3%.[24] The reasons for this divergent rates may be multifactorial such as economic and cultural differences between regions as well as different methods applied and varying working conditions of authors. Many of the of the studies showing low prevalence rates, for example, the Zimbabwean study, used the conservative definition of disabling hearing loss as 30 dB or worse in the better ear. In this study, the authors preferred to use 25 dB or worse in anyear because studies have reliably shown that even mild and unilateral hearing loss can have a deleterious effect on the educational and cognitive development of children.[1],[13],[25],[26],[27]

In Nigeria, Olusanya et al. found a prevalence rate of 13.9%.[28] She used an even lower cut-off point of 15 dB which makes the difference between that rate and this study's even more significant. However, the population she studied was younger and her study took place in Lagos, a cosmopolitan city like Kaduna but with a different cultural background. Time difference may also suggest that there is a gradual increase in prevalence rate of hearing loss in the country. An American study which examined prevalence of hearing loss in adolescents found that it had increased over time. From a prevalent rate of 14.9% in 1988, it increased to 19.5% in 2006.[29]

This study found conductive hearing loss to be more common than sensorineural in students with hearing loss. This is consistent with findings of studies done in Egypt,[19] Malaysia,[13] and Zimbabwe.[16] However, Bess et al. found sensorineural HL more prevalent (5.4%) as against 3.4% for conductive loss.[24] The study was done among primary school children in the US, a country with an advanced health system and hearing screening program for school children, so ear diseases likely to cause conductive hearing loss would be detected and treated early.


  Conclusion Top


There is a high prevalence of hearing loss among students in junior secondary schools in Kaduna and this may be on the rise. This and the presence of otologic pathologies like wax and foreign bodies in the ears of some of these students make it imperative to inculcate ear care into the school health program.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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