Prevalence of Hearing Loss in US Children and Adolescents: Findings From NHANES 1988-2010

Abstract

Importance: There have been concerns about increasing levels of hearing impairment in children and adolescents, especially in relation to noise exposure, because even mild levels of hearing loss can affect educational outcomes.

Objective: To further characterize changes in prevalence of hearing loss and noise exposures in the US pediatric population over time.

Design, setting, and participants: This is a retrospective analysis of demographic and audiometric data from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994), NHANES 2005-2006, NHANES 2007-2008, and NHANES 2009-2010. The NHANES are nationally representative survey data sets collected and managed by the US National Center for Health Statistics, and this study includes a total of 7036 survey participants ages 12 to 19 years with available audiometric measurements.

Exposures: Hearing-related behaviors and risk factors such as history of ear infections, noise exposures, firearm use, and hearing protection use.

Main outcomes and measures: Level of hearing loss measured by pure-tone audiometry, as well as high-frequency and low-frequency hearing loss and noise-induced threshold shifts.

Results: Overall, data from 7036 survey participants ages 12 to 19 years with available audiometric measurements were analyzed. The prevalence of hearing loss increased from NHANES III to NHANES 2007-2008 (17.0% to 22.5% for >15 dB hearing loss; absolute difference, 5.5%; 95% CI, 6.1%-10.3%) but decreased in the NHANES 2009-2010 to 15.2% (absolute difference, 7.2%; 95% CI, 2.0%-12.4%) with no significant overall secular trend identified. There was an overall rise in exposure to loud noise or music through headphones 24 hours prior to audiometric testing from NHANES III to NHANES 2009-2010. However, noise exposure, either prolonged or recent, was not consistently associated with an increased risk of hearing loss across all surveys. The most recent survey cycle showed that nonwhite race/ethnicity and low socioeconomic status are independent risk factors for hearing loss.

Conclusions and relevance: This analysis did not identify significant changes in prevalence of hearing loss in US youth ages 12 to 19 years over this time period despite increases in reported noise exposures. No consistent associations were shown between noise exposure and hearing loss, though there was an association between racial/ethnic minority status and low socioeconomic status and increased risk of hearing loss. Ongoing monitoring of hearing loss in this population is necessary to elucidate long-term trends and identify targets for intervention.

Figure 1.. Prevalence Estimates of Hearing Loss and Noise Exposures

A, Prevalence estimates and 95% confidence intervals (error bars) for several common definitions of hearing loss, and (B) exposure to loud noise or music through headphones in the 24 hours prior to audiometry, compared with prevalence of hearing loss at or greater than 15 dBs. dB indicates decibels; HFHL, high-frequency hearing loss; HL, hearing loss; LFHL, low-frequency hearing loss; NHANES, National Health and Nutrition Examination Survey; NITS, noise-induced threshold shifts.

Figure 2.. Odds Ratios From Multivariate Logistic Regression for Hearing Loss at 15 dB or More for NHANES 2009 to 2010

Reference groups are: age 12 to 13 years, female sex, all other racial/ethnic groups, PIR 1.3 or less, answers of “no” for noise exposure/firearm/hearing protection use. Tan bars represent statistically significant odds ratios. White, non-Hispanic category is modeled as vs all other groups due to small sample size, and hearing aid use was not included in models due to small sample size. NHANES indicates National Health and Nutrition Examination Survey; PIR, poverty income ratio.

Figure 3.. Prevalence Estimates for Hearing Loss of 15 dB or More Among Different Demographic Groups

A, Overall prevalence and 95% CIs for hearing loss of 15 dB or greater; B, prevalence and 95% for hearing loss by white non-Hispanic and nonwhite status; C, hearing loss by history of 3 or more vs fewer than 3 ear infections; and D, hearing loss by high or low PIR. Error bars represent 95% CIs. AOM indicates acute otitis media; HL, hearing loss; NHANES, National Health and Nutrition Examination Survey; PIR, poverty income ratio.

Figure 4.. Odds Ratios From Multivariate Logistic Regression for Hearing Loss of 15 or More dB for Aggregated NHANES, 2005 to 2010

Reference groups are: age 12 to 13 years, female sex, all other racial/ethnic groups, PIR 1.3 or less, answers of “no” for noise exposure/firearm/hearing protection use. Red bars represent statistically significant odds ratios. White, non-Hispanic category is modeled as vs all other groups due to small sample size, and hearing aid use was not included in models due to small sample size. NHANES indicates National Health and Nutrition Examination Survey; PIR, poverty income ratio.