Assessment of sensorineural hearing loss in children in the kingdom of Saudi Arabia

Abstract

Sensorineural hearing loss (SNHL) in children could have serious long-term effects if not identified early after onset. To identify SNHL in children early, childhood hearing screening programmes at birth and later ages have been recommended. In the Kingdom of Saudi Arabia (KSA), until recently, there was no nationwide commitment to the universal neonatal hearing screening programme (UNHS). Even if full coverage was achieved, UNHS might be inadequate to identify a high percentage of cases of SNHL, so more options for hearing screening later in childhood are needed.To better understand the situation of children with SNHL in the KSA, the first two studies of this research estimated the age of identification (AOI) of SNHL in children in the KSA prior to the UNHS, which has not been investigated before, and investigated the characteristics of the affected children. The two cross-sectional studies were either a review of children’s medical records (n=1226) or surveys of parents (n=174). The main findings included: (1) a high AOI of SNHL in children (around 3 years old, range from around 0.1-10 years); (2) a strong association between consanguinity, which is known to cause late-onset SNHL, and SNHL was found (in >70% of the children with SNHL); (3) parental concern about child’s hearing identified for the first time as a predictor of SNHL in Saudi children; and (4) parents finding it difficult to access audiology clinics. These findings indicate that late-onset SNHL is expected to be prevalent among children in the KSA, and the difficulty of accessing audiology clinics may play a role in delaying the identification of those children. This motivated the development of a hearing screening tool that is suitable to young children, is easily accessible, can be used by non-audiologists, and is sensitive to SNHL. The developed test, called the Paediatric Arabic Auditory Speech Test (PAAST), which is a speechin-noise (SIN) test, was inspired by the McCormick Toy Discrimination Test, which suits children from the age of 2 years onwards. It was implemented in a downloadable iPad application that ran the test automatically to widen the possibilities of implementing a hearing screening test. The development of the PAAST included the conducting of five studies to determine the following: (1) pre-recorded speech material equalised for intelligibility; (2) the test-retest reliability of the PAAST with normal-hearing Arabic-speaking adults (n=30); (3) the normal-range and test-retest reliability of the PAAST with normal-hearing Arabic-speaking children (n=40, 3-12 years old); (4) typical results in children with mild to severe SNHL (n=16, 6-14 years old) in the KSA; and (5) the usability and feasibility of the tablet application at home and school by parents (n=26) and teachers (n=24) in the KSA. The studies also sought to explore the normal developmental trajectory of speech intelligibility and the supra-threshold effects of SNHL in Arabic-speaking children. The PAAST showed good test-retest reliability when tested with adults, older children (>6-12 years), and young children (3-6 years) (e.g. intra-class correlation coefficient= 0.7, 0.8, 0.7 respectively). It could differentiate between normal-hearing children and hearing-impaired children. A high system usability score (>80/100) was found for parents and teachers. It seems feasible to use the PAAST as a hearing test in schools in the KSA. It was also found that there was probably a developmental ageeffect on the performance of Arabic-speaking normal-hearing children on SIN tests and that there were substantial difficulties in performing SIN tests for Arabic-speaking children who have SNHL, which has not been documented previously. In general, it could be concluded that the PAAST provides a useable platform for speech intelligibility testing in noise, and the SIN test seems to provide a useful assessment of speech intelligibility in Arabic-speaking children with SNHL.

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