Hearing impairments among Saudi preschool children Mohammed A. Al-Rowaily a, *, Abdulrhman I. AlFayez b , Mohammed S. AlJomiey b , Adil M. AlBadr c , Mostafa A. Abolfotouh d a Family and Community Medicine Department, King Saud bin Abdul-Aziz University for Health Sciences (KSAU-HS), Riyadh NGHA, Saudi Arabia b ENT Division, Department of Surgery, King Saud bin Abdul-Aziz University for Health Sciences (KSAU-HS), Riyadh NGHA, Saudi Arabia c School Health Center, Iskan Clinic, King Abdulaziz Medical City, Riyadh, Saudi Arabia d King Abdullah International Medical Research Center, King Saud bin Abdul-Aziz University for Health Sciences (KSAU-HS), Riyadh NGHA, Saudi Arabia 1. Introduction Hearing loss among school-entrant children in the developing world has been widely reported as a significant health problem [1– 6]. Because mainstream schools are auditory–verbal environ- ments, the failure to detect hearing loss, either congenital or acquired, in children may result in lifelong deficits in speech and language acquisition, poor academic performance, personal social maladjustments, and emotional difficulties [7]. Studies from different parts of the world have reported hearing impairments among school children with different rates. Theses figures ranged from 1.4% in China [8], 1.49% in UK [9], 2% in Sweden [10], 4.4% in Southwestern Saudi Arabia [11], 9.8% in Iran [12], 11.9% in India [13] and 20.9% in Egypt [14]. There is a consensus that the early detection of hearing impairment is desirable and can lead to improved communication skills, educational attainment and quality of life. Therefore, hearing screening at the time of school entry has been proposed for the early detection and rehabilitation of hearing impairments in school children in the developing world [15,16]. In the UK, for example, there is a long-established history of screening children for hearing impairment [17–19]. Some congenital hearing loss may not become evident until later in childhood. Hearing impairments can be acquired during infancy and/or childhood for various reasons. Infectious diseases (i.e., otitis media and meningitis) are a leading cause of acquired hearing loss. Traumatic injuries to the nervous system, damaging noise levels, and ototoxic drugs can all place a child at risk of developing acquired hearing loss. Otitis media is a common cause of typically reversible hearing loss. International Journal of Pediatric Otorhinolaryngology 76 (2012) 1674–1677 A R T I C L E I N F O Article history: Received 11 June 2012 Received in revised form 29 July 2012 Accepted 2 August 2012 Available online 24 August 2012 Keywords: Screening Hearing loss Hearing impairment Preschool A B S T R A C T Background: Hearing loss among school-entrant children in the developing world has been widely reported as a significant health problem. Failure to detect hearing loss, either congenital or acquired, in children may result in lifelong deficits in speech and language acquisition. The aims of this study were: (1) to estimate the prevalence of hearing loss and (2) to identify its different types. Methods: This is a cross-sectional study that included all children (n = 2574) aged 4–8 years who attended the obligatory health examination for kindergarten (=370) and primary school (n = 2204) entry at the school health center of King Abdulaziz Medical City, Riyadh, Saudi Arabia, from March 2009 to December 2010. Pure-tone air conduction audiometry was conducted for each child in a sound-treated room followed by a diagnostic test. Tympanometry was performed as a complement to the overall objectives of a hearing screening program. Results: A total of 45 children were diagnosed with hearing impairment (84.4% conductive and 15.6% sensori-neural), with an overall prevalence of 1.75% (95% C.I.: 1.25, 2.25). The majority of cases were females (71.1%), of school age (80.0%), with conductive deafness (84.4%). More than one-half of cases had bilateral deafness (55.6%) of mild degree (57.8%). As for conductive deafness, otitis media with effusion ranked first as a cause of deafness (34.9%), followed by wax and chronic otitis media (23.3% each), while traumatic perforated drum came last (2.3%). Sensorineural deafness constituted 16.2% of all cases. Conclusion: Conductive hearing loss is the primary type of hearing loss among children and is easy to correct. The urgent development of audiological services in other school health centers in the country, particularly those with good referral systems to Ministry of Health hospitals, is needed. Evidence-based guidelines to identify, monitor, and manage otitis media with effusion (OME) in children in the primary healthcare setting and a strategy to prevent hearing loss are recommended. ß 2012 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: PO Box 69404, Post code 11547, Riyadh, Saudi Arabia. Tel.: +966 505490787. E-mail addresses: binwaeel@yahoo.com, rowailym1@ngha.med.sa (M.A. Al-Rowaily). Contents lists available at SciVerse ScienceDirect International Journal of Pediatric Otorhinolaryngology jo ur n al ho m ep ag e: ww w.els evier .c om /lo cat e/ijp o r l 0165-5876/$ – see front matter ß 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijporl.2012.08.004