Consequences of Mild to Moderate Hearing loss in Children

Few members of the pharmacology and biotechnology communities would deny that hearing is generally important. However, when considering the necessity for ototoxicity screening and prevention, many drug developers and regulatory experts assume that only severe consequences of ototoxicity (profound hearing loss and deafness) are worthy of preventative efforts in children. It is often concluded that if a drug causes mild to moderate hearing loss, this is a small and acceptable price to pay for the drug’s therapeutic benefits. In reality, though, there is significant evidence in pediatric hearing literature that even mild or delayed hearing impairment leads to high costs for children in terms of overall health, psychological well-being, and social integration (Bass et al., 2016).

One area in which children with mild or moderate hearing loss suffer is education (Bass et al., 2016; Hornsby et al., 2017). A large, education-based study showed that children with minimal hearing loss (approximately 5% of 1,200 students surveyed) exhibited significantly lower test scores on comprehensive basic skills tests in third grade, and 37% of surveyed students with minimal hearing loss had failed at least one grade (Bess et al., 1998). In another study of older children who survived cancer treatment but experienced ototoxic hearing loss, the risk of learning difficulty in reading, math, and general studies was at least twice as high as normal hearing cancer survivors (Gurney et al., 2007).

Mild to moderate hearing loss can also lead to increased fatigue and stress for students. In a study of 60 students with mild or moderate hearing loss (mean pure tone average threshold of 36 dB), self-reported classroom fatigue was significantly higher compared to normal hearing students (Hornsby et al., 2017). This was presumably due to the increased attention and concentration needed for listening in the classroom. Increased classroom fatigue is also related higher levels of stress experienced by students with hearing loss, again likely due to the higher demands on students to listen during school (Bess et al., 2016).

Given the educational consequences of mild to moderate hearing loss caused by ototoxicity, federal and state governments may be motivated to promote regulations that limit harm to the ears. Under the Individuals with Disabilities Education Act, funding for assistive hearing devices in classrooms and audiological services is required, and Individualized Educational Programs must be developed for hearing-impaired students who qualify for special education services (Bass et al., 2016). Thus, in addition to protecting the public from ototoxic drugs, governments could reduce education costs, even for students with mild or moderate acquired hearing loss, by requiring better preventative measures against ototoxicity.

Outside of the classroom, children with mild or moderate hearing loss suffer from a variety of psychosocial problems. Such children display lower observed and self-reported quality of life scores (Gurney et al., 2007), and significantly greater dysfunction than children with normal hearing in terms of behavior, energy, stress, social support, and self-esteem (Bess et al., 1998).

Hearing impairment clearly puts children with mild or moderate hearing loss at a disadvantage in terms of educational performance and psychosocial well-being. Even as adults the consequences can be significant. Children with hearing loss are up to 39% less likely to attend college, are twice as likely to experience work stress, and have lower labor participation rates than normal hearing individuals (Roland et al., 2016). This broad range of consequences suggests that ototoxicity need not result in deafness to deserve our attention. Instead, it would be logical for the pharmaceutical industry and regulatory bodies to focus on improved screening and prevention of ototoxicity to help all potential sufferers.

References Bass, J.K., Knight, K.R., Yock, Y.I., Chang, K.W., Cipkala, D., & Grewal, S.S. (2016). Evaluation and management of hearing loss in survivors of childhood and adolescent cancers: a report from the Children’s Oncology Group. Pediatr Blood Cancer 63(7), 1152-1162.

Bess, F.H., Dodd-Murphy, J., & Parker, R.A. (1998). Children with minimal sensorineural hearing loss: prevalence, educational performance, and functional status. Ear Hear 19(5), 339-354.

Bess, F.H., Gustafson, S.J., Corbett, B.A., Lambert, E.W., Camarata, S.M., & Horsnby, B.W. (2016). Salivary cortisol profiles of children with hearing loss. Ear Hear 37(3), 334-344.

Gurney, J.G., Tersak, J.M., Ness, K.K., Landier, W., Matthay, K.K., Schmidt, M.L., & Children’s Oncology Group. (2007). Hearing loss, quality of life, and academic problems in long-term neuroblastoma survivors: a report from the Children’s Oncology Group. Pediatrics 120(5), 1229- 1236.

Hornsby, B.W.Y., Gustafson, S.J., Lancaster, H., Cho, S-J., Camarata, S., & Bess, F.H. (2017). Subjective fatigue in children with hearing loss assessed using self- and parent-proxy report. Am J Audiol 26, 393-407.

Roland, L., Fischer, C., Tran, K., Rachakonda, T., Kallogjeri, D., & Lieu, J. (2016). Quality of life in children with hearing impairment: systematic review and meta-analysis. Otolaryngol Head Neck Surg 155(2), 208-219.

Authors David Hicks, M.D.: Dr. Hicks directs business development at Turner Scientific, and has significant training and experience in clinical treatment of ear disorders. Contact:

Jeremy Turner, Ph.D.: Dr. Turner is the founder and Chief Scientific Officer at Turner Scientific. He completed his Ph.D. in auditory neuroscience, and has more than 22 years’ experience in preclinical hearing loss, tinnitus, and ototoxicity research. Contact:

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