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Academic, behavioural and quality of life outcomes of slight to mild hearing loss in late childhood: a population-based study
  1. Jing Wang1,2,
  2. Jon Quach1,3,
  3. Valerie Sung1,4,
  4. Peter Carew5,6,
  5. Ben Edwards7,
  6. Anneke Grobler1,2,
  7. Lisa Gold1,8,
  8. Melissa Wake1,2
  1. 1 Murdoch Childrens Research Institute, The University of Melbourne, Parkville, Victoria, Australia
  2. 2 Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
  3. 3 Melbourne Graduate School of Education, The University of Melbourne, Carlton, Victoria, Australia
  4. 4 Centre for Community Child Health, Royal Childrens Hospital, Parkville, Victoria, Australia
  5. 5 Centre for Community Child Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  6. 6 Department of Audiology and Speech Pathology, The University of Melbourne, Parkville, Victoria, Australia
  7. 7 ANU Centre for Social Research and Methods, The Australian National University, Canberra, Australia
  8. 8 School of Health and Social Development, Deakin University, Geelong, Melbourne, Australia
  1. Correspondence to Professor Melissa Wake, Murdoch Childrens Research Institute, Parkville, VIC 3052, Australia; melissa.wake{at}


Objective To investigate the associations of hearing thresholds and slight to mild hearing loss with academic, behavioural and quality of life outcomes in children at a population level.

Methods Design and participants:children aged 11–12 years in the population-based cross-sectional Child Health CheckPoint study within the Longitudinal Study of Australian Children. Audiometry:mean hearing threshold across 1, 2 and 4 kHz (better and worse ear); slight/mild hearing loss (threshold of 16–40 decibels hearing loss (dB HL)). Outcomes: National Assessment Program – Literacy and Numeracy, language, teacher-reported learning, parent and teacher reported behaviour and self-reported quality of life. Analysis:linear regression quantified associations of hearing threshold/loss with outcomes.

Results Of 1483 children (mean age 11.5 years), 9.2% and 13.1% had slight/mild bilateral and unilateral hearing loss, respectively. Per SD increment in better ear threshold (5.7 dB HL), scores were worse on several academic outcomes (eg, reading 0.11 SD, 95% CI 0.05 to 0.16), parent-reported behaviour (0.06 SD, 95% CI 0.01 to 0.11) and physical (0.09 SD, 95% CI 0.04 to 0.14) and psychosocial (0.06 SD, 95% CI 0.01 to 0.11) Pediatric Quality of Life Inventory (PedsQL). Compared with normally hearing children, children with bilateral slight/mild losses scored 0.2–0.3 SDs lower in sentence repetition, teacher-reported learning and physical PedsQL but not other outcomes. Similar but attenuated patterns were seen in unilateral slight/mild losses.

Conclusions Hearing thresholds and slight/mild hearing loss showed small but important associations with some child outcomes at 11–12 years. Justifying hearing screening or intervention at this age would require better understanding of its longitudinal and indirect effects, alongside effective management and appropriate early identification programmes.

  • deafness
  • outcomes research
  • adolescent health

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  • Contributors MW conceived and led the CheckPoint study with the CheckPoint team and was LSAC’s health design leader. MW was the primary student supervisor, along with VS, and oversaw all aspects of the study and the manuscript preparation. PC designed the hearing protocols. JW performed data analysis and wrote the main paper. JQ, VS, PC, BE, AG, LG and MW provided expert advice and critical review of this manuscript. All authors critically reviewed the manuscripts and had final approval of the submitted and published version of this paper.

  • Funding This work was supported by the Australian National Health and Medical Research Council (NHMRC) Project Grants 1041352 and 1109355, The Royal Children’s Hospital Foundation (2014-241), the Murdoch Children’s Research Institute, The University of Melbourne, the National Heart Foundation of Australia (100660), Financial Markets Foundation for Children (2014-055, 2016-310), the Victorian Deaf Education Institute and the Victorian Government’s Operational Infrastructure Support Program. JW was supported by the University of Melbourne Postgraduate Scholarship and the Murdoch Children’s Research Institute PhD Top Up Scholarship. The following authors were supported by the NHMRC: VS (Early Career Fellowship 1125687), PC (Centre of Research Excellence in Child Language 1023493), LG (Early Career Fellowship 1035100) and MW (Research Fellowships 1046518 and 1160906) in this work. VS was additionally supported by a Cottrell Research Fellowship from the Royal Australasian College of Physicians.

  • Disclaimer The funding bodies did not play any role in the study.

  • Competing interests None declared.

  • Ethics approval The Australian Institute of Family Studies Ethics Committee approved each wave of LSAC and CheckPoint (AIFS14-26), and the Royal Children’s Hospital Human Research Ethics Committee (HREC33225) approved CheckPoint.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement MW and JW had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Patient consent for publication Not required.

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