title: Hearing impairment and poverty: the epidemiology of ear disease in Peruvian schoolchildren.
abstract: OBJECTIVE
  1) To measure prevalence of hearing impairment (HI) in schoolchildren living in poverty in Peru. 2) To identify risk factors for HI and assess its impact on academic performance.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Elementary schools in an asentimiento humano (shantytown) near Lima, Peru, October 2008 to March 2009.
  
  
  METHODS
  Schoolchildren (n = 335), ages six to 19 years.
  
  
  METHODS
  Audiological health was assessed with pure-tone audiometry, tympanometry, and otoscopy. The primary outcome was HI, defined as average threshold >25 dB HL for 0.5, 1, 2, and 4 kHz, in one or both ears (per World Health Organization/International Organization for Standardization). A questionnaire on health history was administered to parents. Statistical analysis included univariate analysis for chi(2) values and odds ratios (ORs), and multivariate logistic regression.
  
  
  RESULTS
  HI prevalence: 6.9 percent (95% confidence interval [CI] 4.2%-9.6%). Risk factors for HI (OR, 95% CI, P value): neonatal jaundice (5.59, 1.63-19.2, 0.015), seizure (7.31, 2.50-21.4, 0.0013), hospitalization (4.01, 1.66-9.68, 0.003), recurrent otitis media (5.06, 1.98-12.9, 0.002), past otorrhea (4.70, 1.84-12.0, 0.003), family history of HI at <35 years (2.91, 1.19-7.14, 0.026), tympanic membrane abnormality (13.8, 4.48-42.7, <0.001), cerumen impaction (15.8, 4.71-53.1, <0.001), and eustachian tube dysfunction (4.87, 1.74-13.7, <0.001). HI was an independent predictor of academic failure (3.36, 1.15-9.82, 0.03).
  
  
  CONCLUSIONS
  Impoverished Peruvian schoolchildren were four to seven times more likely to experience HI than children living in higher-income countries. Untreated middle ear disease in the context of limited access to pediatric care was a major risk factor for HI. Furthermore, HI was associated with worse scholastic achievement. These results support prioritization of pediatric ear health as an essential component of the global health agenda, especially in resource-poor countries.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA. jaczecho@stanford.edu
authors.forename: Josephine A
authors.initials: JA
authors.lastname: Czechowicz
authors.forename: Anna H
authors.initials: AH
authors.lastname: Messner
authors.forename: Edith
authors.initials: E
authors.lastname: Alarcon-Matutti
authors.forename: Jorge
authors.initials: J
authors.lastname: Alarcon
authors.forename: Gina
authors.initials: G
authors.lastname: Quinones-Calderon
authors.forename: Silvia
authors.initials: S
authors.lastname: Montano
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Zunt
mesh_terms: D000158:Acoustic Impedance Tests / Q000379:methods; D000293:Adolescent; D000328:Adult; D001301:Audiometry, Pure-Tone / Q000379:methods; D002648:Child; D003430:Cross-Sectional Studies; D004427:Ear Diseases / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D034381:Hearing Loss / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010035:Otitis Media, Suppurative / Q000453:epidemiology; D038781:Otoscopy / Q000379:methods; D010568:Peru / Q000453:epidemiology; D011203:Poverty; D015995:Prevalence; D012307:Risk Factors; D013334:Students / Q000706:statistics & numerical data*