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Original Investigation
September 2017

Prevalence of Hearing Loss Among Children 9 to 11 Years OldThe Generation R Study

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
  • 2The Generation R Study Group, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
JAMA Otolaryngol Head Neck Surg. 2017;143(9):928-934. doi:10.1001/jamaoto.2017.1068
Key Points

Question  What is the prevalence of hearing loss among 9- to 11-year-old children in the Netherlands?

Findings  Using audiometry data from the prospective Generation R cohort study of 5368 children, the estimated prevalence of sensorineural hearing loss was 7.8%. Associations were found with maternal educational level and a history of recurrent otitis media.

Meaning  These results show that progressive sensorineural hearing loss might have an unexpectedly early onset, prior to known risk factors, such as noise exposure, and that early childhood risk factors, such as recurrent otitis media, already influence hearing acuity.


Importance  Hearing loss (HL), a major cause of disability globally, negatively affects both personal and professional life.

Objective  To describe the prevalence of sensorineural hearing loss (SNHL) among a population-based cohort of 9- to 11-year-old children, and to examine potential associations between purported risk factors and SNHL in early childhood.

Design, Setting, and Participants  The study was among the general, nonclinical, pediatric community within the city of Rotterdam, the Netherlands, and was conducted between 2012 and 2015 as a cross-sectional assessment within the Generation R Study, a population-based longitudinal cohort study from fetal life until adulthood. Participants are children of included pregnant women in the Generation R Study with an expected delivery date between April 2002 and January 2006. They form a prenatally recruited birth cohort.

Main Outcomes and Measures  Pure-tone air-conduction hearing thresholds were obtained at 0.5, 1, 2, 3, 4, 6, and 8 kHz, and tympanometry was performed in both ears. Demographic factors and parent-reported questionnaire data, including history of otitis media, were also measured.

Results  A total of 5368 participants with a mean age of 9 years 9 months (interquartile range, 9 years 7 months–9 years 11 months) completed audiometry and were included in the analyses. A total of 2720 were girls (50.7%), and 3627 (67.6%) were white. Most of the participants (4426 children [82.5%]) showed normal hearing thresholds 15 dB HL or less in both ears. Within the cohort, 418 children (7.8%) were estimated to have SNHL (≥16 dB HL at low-frequency pure-tone average; average at 0.5, 1, and 2 kHz or high-frequency pure-tone average; average at 3, 4, and 6 kHz in combination with a type A tympanogram) in at least 1 ear, most often at higher frequencies. In multivariable analyses, a history of recurrent acute otitis media and lower maternal education were associated with the estimated SNHL at ages 9 to 11 years (odds ratio, 2.0 [95% CI. 1.5-2.8] and 1.4 [95% CI, 1.1-1.7], respectively).

Conclusions and Relevance  Within this cohort study in the Netherlands, 7.8% of the children ages 9 to 11 years had low-frequency or high-frequency HL of at least 16 dB HL in 1 or both ears. A history of recurrent acute otitis media and lower maternal education seem to be independent risk factors for presumed SNHL in early childhood.