Hearing screening outcomes and otoscopic findings among primary school children in Southwest Ethiopia: A cross-sectional study.
Gugsa N Germossa, Linn S Mork, Ebissa B Kebede and 6 others
In 396 Ethiopian second-graders, 31.6% failed a basic hearing check.
Among those who failed, 59% had normal-looking ears, so the cause is unclear. Before attributing a child's communication difficulty to a language disorder, rule out a hearing problem — many are simple and treatable.
Key findings
131.6% of children (95% CI 27.0–36.1%) failed pure-tone audiometry at a threshold of 25 dB HL or worse in at least one ear at 500 Hz, 1 kHz, 2 kHz or 4 kHz.
2Among the 124 children who failed screening, 59% had a normal otoscopic examination; impacted earwax was the most common abnormality at 34%, followed by four foreign bodies, three middle-ear infections and two tympanic membrane perforations.
3Screening failure varied sharply by school: 68.9% in one school (which serves a highly vulnerable population) versus 13.3% to 22.2% in the other four.
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What it does not show
This was a screening, not a diagnostic, study: no bone-conduction audiometry, tympanometry or speech-in-noise testing was done, so the 31.6% figure is an upper bound on true hearing loss and may include false positives. No inferential statistics were performed, so the differences between schools, sexes and age groups cannot be interpreted as statistically significant. No power calculation was conducted; the sample size was whatever was feasible in five schools. The fifth school was added at the principal's request rather than through the systematic selection process, introducing selection bias. Testing took place in ordinary classrooms with ambient noise up to 40 dB(A), which is above the ideal 30 dB(A) for audiometry and may have inflated low-threshold failures. 59% of children who failed had a normal otoscopic view, meaning the cause of their elevated thresholds is unknown — it could be sensorineural loss, a transient shift, or a measurement artefact. Findings come from one town in one region of Ethiopia and may not generalise to other settings. Genetic, cultural and socio-economic contributors to hearing loss were not measured.
Declared interests
Funded by the Research Council of Norway. The funder declared no role in the design, analysis or interpretation of the study. No other conflicts of interest were reported.
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