title: Ear diseases among secondary school students in Xi'an, China: the role of portable audio device use, insomnia and academic stress.
abstract: BACKGROUND
  Hearing impairment negatively impacts students' development of academic, language and social skills. Even minimal unilateral hearing loss can hinder educational performance. We investigated the prevalence of ear diseases among secondary school students in the city of Xi'an, China in order to provide a foundation for evidence-based hearing healthcare.
  
  
  METHODS
  A stratified random sampling survey was conducted in 29 secondary schools. Demographics and medical histories were collected, and otologic examinations were performed. Questionnaires were administered to assess insomnia, academic stress and use of portable audio devices. Logistic regression analysis was used to identify factors associated with hearing impairment, and the association of sensorineural hearing loss with insomnia, academic stress and the use of portable audio devices was analyzed with the chi-square test.
  
  
  RESULTS
  The percentage of students with some form of ear disease was 3.32%. External ear disease, middle ear disease and sensorineural hearing loss occurred in 1.21%, 0.64% and 1.47% of the students, respectively. Boys had a relatively higher prevalence of ear disease than girls. According to our survey, the prevalence of sensorineural hearing loss increased significantly among the students with insomnia and extended use of portable audio devices, but not among those with elevated levels of academic stress. Hearing aids and surgical treatment were needed in 1.47% and 0.89% of the students, respectively.
  
  
  CONCLUSIONS
  There is a high prevalence of ear disease among secondary school students, and this should be given more attention. Insomnia and the excessive use of portable audio devices may be related to adolescent sensorineural hearing loss. It is important to establish and comply with an evidence-based preventive strategy.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an-710032, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Chen
authors.forename: Xu
authors.initials: X
authors.lastname: Li
authors.forename: Zhan
authors.initials: Z
authors.lastname: Xu
authors.forename: Zonghua
authors.initials: Z
authors.lastname: Li
authors.forename: Pengzhi
authors.initials: P
authors.lastname: Zhang
authors.forename: Ya
authors.initials: Y
authors.lastname: He
authors.forename: Fangyuan
authors.initials: F
authors.lastname: Wang
authors.forename: Jianhua
authors.initials: J
authors.lastname: Qiu
mesh_terms: D000293:Adolescent; D001299:Audiometry; D002648:Child; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004427:Ear Diseases / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D009622:Noise / Q000009:adverse effects*; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications*; D013315:Stress, Psychological / Q000150:complications*; D055815:Young Adult