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Iranian Journal of Otorhinolaryngology
No.3, Vol.23, Serial No.64, Summer-2011
Determination of Hearing Loss Prevalence in Preschool Children of Ahwaz
*Mozafar Sarafraz
, Mahmood Hekmat-Shoar
, Sara Zaheri
Children learn to communicate by hearing sounds. If there is hearing loss, the cognitive and
speaking abilities and language learning will deteriorate. Early detection and intervention are
important factors in the successful treatment of hearing loss in children. Hearing loss (HL) is
divided into two main groups: conductive hearing loss (CHL) and sensorineural hearing loss
(SNHL), the prevalence of the former being higher in children, many whose causes are easy to
detect and treat.
Material and Methods:
In this descriptive, cross-sectional study, 785 children, aged 6-7 years, entering elementary
school Grade 1 in the school year 2010/2011, were randomly selected from 10% of Ahwaz
Hearing Loss Screening Centers, and their audiograms were studied. The collected data were
analyzed using SPSS and descriptive statistics.
Out of the 785 preschool children examined in this study, 77 children (9.8%) suffered from
HL (42.9% female and 57.1% male), 59.7% from CHL, and 40.3% from SNHL. Twenty-six
percent suffered from bilateral HL and 74% from unilateral HL. Thirty-eight point ninety-six
percent had abnormal tympanometry, 61% of whom were Type B. Most of the children (53%)
had mild HL.
Thirty-one point two percent of parents were aware of their children's HL.
Considering the high prevalence of HL, especially SNHL, in this study, which is usually
permanent but detectable at the neonatal ages, raising public awareness and early screening of
ear diseases, which can lead to the detection and treatment in most cases, seem to be vital.
Conductive Hearing Loss, Screening, Sensorineural Hearing Loss
Received date: 1 Dec 2010
Accepted date: 24 May 2011
Department of otorhinolaryngology, Ahwaz Jundishapur University of Medical Sciences, Ahwaz, Iran
Department of otorhinolaryngology, Ahwaz Jundishapur University of Medical Sciences, Ahwaz, Iran
General physician, Ahwaz Jundishapur University of Medical Sciences, Ahwaz, Iran
Corresponding Author:
Department of otorhinolaryngology, Imam Khomeini Hospital, Ahwaz Jundishapur University of Medical Sciences,
Ahwaz, Iran
Email: dr.m.sarafraz@gmail.com, Tell: +989161188785
Original Article
Determination of Hearing Loss Prevalence
76, Iranian Journal of Otorhinolaryngology No.3, Vol.23, Serial No.64, Summer-2011
Most children hear and listen from birth.
They learn to talk by imitating the sounds
around them and the voices of their parents
and caregivers. But about 2 or 3 out of
every 1,000 children (in the United States)
are born deaf or hard-of-hearing. More lose
their hearing later during childhood. (1-3).
The most important time for a child to be
exposed to and learn language is in the
first 3 years of life. Research suggests that
those who have hearing impairment and
get early intervention have better language
skills than those who do not (1). The
average age of the detection of congenital
hearing loss is reported to be between 16
and 18 months (2). The detection of
congenital hearing impairment in the first
few months of life is of vital importance in
rehabilitation and the earlier
commencement of speech therapy.
Fortunately, only a few cases of hearing
loss cannot be helped with the help of
modern technology, and the most effective
treatment is early intervention (3).
The normal hearing level is between 10
and 25 dB. Hearing loss of 25-45 dB is
considered mild, of 45-65 dB moderate, of
65-85 dB severe, and of over 85 dB
profound (3). Children with mild to
moderate hearing loss may not be detected
until school age, when they are identified
through either hearing loss screening or
their lack of response to sounds in class.
The results of research shows that
effective rehabilitation measures to
improve hearing has resulted in the
improvement of children’s cognitive
ability, language learning, speech and
behavior in the later years. Children who
are detected earlier have better cognitive,
social and language abilities, and besides
receiving better treatment, can study in
freer and less expensive environments.
Materials and Methods
This was a descriptive, cross-sectional
study, and the study population consisted
of preschool children who visited 10
screening centers in Ahwaz in accordance
with the national project. One of these
centers, the Fereshteh Center, was
randomly selected in a draw, which 785
children visited over five weeks from June
24, 2010 to July, 30, 2010. These children
were initially examined with mobile
instruments at 500, 1000, 2000, and 4000
Hz, and any impairment at these
frequencies was considered suspicious and
the cases underwent audiometry. The
results of the audiograms, tympanometry
and other data were recorded in special
questionnaires, and the collected data were
analyzed using SPSS and statistic and
descriptive methods. The chi-square test
was used to examine the possible
correlation between the categorized
This study was conducted on 785 preschool,
6-7-year-old children, consisting of 341 girls
(43.4%) and 441 boys (56.6%). In the initial
phase, 89 cases were suspected of hearing
loss, 12 of whom were found normal in the
later assessments, showing normal
audiometry and tympanometry. Finally, 77
cases (9.8%) were found to have hearing loss,
consisting of 33 girls (42.9% of the hearing
loss group) and 44 boys (57.1% of the
hearing loss group). The prevalence and the
correlation of hearing loss and its being uni/bilateral are shown in Table 1. According to
tympanometric examinations, 47 cases (61%)
had Type a tympanometry (Table 2).
The examination of birth weight in
children with hearing loss showed that 51
children (66.2%) had had a weight of over
1500 gr, 10 children had unknown birth
weights, and 16 children (20.7%) had had
a weight of under 1500 gr, which showed
no significant correlation between birth
weight and different types of hearing loss
The prevalence of hearing loss and its
correlation with parents’ awareness are
shown in Table 3. Overall, 31.2% of parents
were aware of their children’s hearing loss.
Sarafraz M, et al
Iranian Journal of Otorhinolaryngology No.3, Vol.23, Serial No.64, Summer-2011, 77
Table 1: The prevalence and the correlation of hearing loss and its being uni-/bilateral in children
with hearing loss
Type of hearing
Conductive Sensorineural Mixed Total
Unilateral 31 26 0 57 74%
Bilateral 15 5 0 20 26%
46 31 0
59.7% 40.3% 0%
Table 2: The prevalence of various types of
tympanometry in hearing-impaired children
Type of
Number Percentage
Type An 47 61%
Type As 1 1.3%
Type C1 1 1.3%
Type C2 1 1.3%
Type B 27 35.1%
Table 3: The prevalence of hearing loss
and its correlation with parents’ awareness
Level of
Mild Moderate Severe
53.2% 25 32.5% 8 10.4% 3 3.9%
19.5% 32% 62.5% 100%
The prevalence of hearing loss was
estimated at 9.8% according to this study;
according to studies in Ardabil and
Mahabad, the respective prevalence rates
were 10.44% and 8.11% (4,5). In other
counties, the prevalence of hearing loss in
this age group is relatively similar to that
found in our study (6-8).
In this study, 33 (42.9%) of the children
with hearing loss were girls, and 44
(57.1%) were boys, yet despite the larger
number of boys, there was no significant
correlation between hearing loss and sex.
However, in a study conducted in Ilam,
hearing loss was significantly more
common in boys (9). In our study, 46
children (5.9% of the whole study
population) had conductive hearing loss
(CHL), and 31 (3.9% of the whole study
population) had sensorineural hearing loss
(SNHL). SNHL rates in the entire
population are 0.6% in Zanjan, 1.86% in
Ardabil, 4% in Berlin, Germany, and 1.7%
in Nigeria (4,10,11,12).
Therefore, SNHL has a higher rate in this
study than those found in others, which
may be due to the small study population
or lack of examination of younger children
in this study. The higher prevalence of
unilateral hearing loss (74%) in this study
corresponds to that found in other studies
(9,11,13). In our study, mild hearing loss
had a higher prevalence (53.2%), which
corresponds to the findings of other studies
In view of the high prevalence of
sensorineural hearing loss in this study
compared with the findings of other
studies, and in view of the permanence of
SNHL and the higher prevalence of mild
hearing loss, which leads to parents’ lack
of awareness, preventing therapeutic or
rehabilitation measures, and hence causing
disruptions in children’s language learning,
social skills, and school performance, and
Determination of Hearing Loss Prevalence
78, Iranian Journal of Otorhinolaryngology No.3, Vol.23, Serial No.64, Summer-2011
also in view of various preventable and,
more importantly, delectable hereditary and
acquired causes in the developmental years
of children’s life, early screening seems to
be of vital importance.
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