title: Prevalence and etiology of hearing loss in rural Nicaraguan children.
abstract: OBJECTIVE
  The prevalence and causes of pediatric hearing loss (HL) in the developing world are largely unknown. Infectious sequelae, ototoxic medications, and genetic causes may play a larger role in developing countries. In addition, the significance of GJB2 mutation gene in poorly developed areas remains unclear. The intent of this study is to investigate the prevalence and etiology of HL in children living in a remote, impoverished region of northern Nicaragua.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Clinical data from two sources were analyzed: data from screening examinations performed in rural schools in the Department of Jinotega, Nicaragua (group A) and pediatric HL patients seen at the Otolaryngology and Audiology Clinic in Jinotega, Nicaragua (group B). Patients with congenital HL were offered a genetic test for GJB2 mutations. Comparisons were made using parametric (analysis of variance) and nonparametric (Kruskal-Wallis) tests.
  
  
  RESULTS
  School-based screening examinations (group A) revealed a high prevalence of significant HL (>30 dB) of 18%. The majority of these children had normal otoscopic examinations (58%). A family history of HL was seen in 24% of children who failed screening exams. Positive family history was more common in patients with HL (P < .01) and in specific schools (P < .05). Clinic-based evaluations (group B) reveal a population with predominantly severe-profound HL. Physical dysmorphism was common, yet identifiable syndromic HL was rare. Although familial HL was common (33%), there were no pathologic GJB2 mutations. Other common risk factors in this population were maternal infection during pregnancy, neonatal distress, low birth weight or prematurity, and gentamicin exposure.
  
  
  CONCLUSIONS
  HL in this rural, third world environment is more prevalent, and the etiologies responsible in this study group are different from those encountered in industrialized nations. Poor perinatal health care, infectious causes, gentamicin exposure, and hereditary HL are potentially preventable causes that play a major role in this population.
authors.affiliation: Department of ORL, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma 73190, USA. james-saunders@ouhsc.edu
authors.forename: James E
authors.initials: JE
authors.lastname: Saunders
authors.forename: Sharon
authors.initials: S
authors.lastname: Vaz
authors.forename: John H
authors.initials: JH
authors.lastname: Greinwald
authors.forename: James
authors.initials: J
authors.lastname: Lai
authors.forename: Leonor
authors.initials: L
authors.lastname: Morin
authors.forename: Karen
authors.initials: K
authors.lastname: Mojica
mesh_terms: D002648:Child; D000072259:Connexin 26; D017630:Connexins; D005260:Female; D020022:Genetic Predisposition to Disease; D005839:Gentamicins / Q000009:adverse effects; D034381:Hearing Loss / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D018811:Maternal Exposure / Q000009:adverse effects; D009527:Nicaragua / Q000453:epidemiology; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population
chemical_list: D017630:Connexins; C000607042:GJB2 protein, human; D005839:Gentamicins; D000072259:Connexin 26