Let’s compare childhood development to the process of building a house. The ability to hear would form the foundation on which the bricks of speech and language development can be laid. Once the walls reach window height, literacy skills start developing which in turn form the basis for academic and ultimately vocational success. Socio-emotional development is fostered inside the house and impacts every aspect of the building process.

Just as a strong foundation is essential for a house, healthy hearing is vital for learning! Unfortunately, as with the foundation of a house, the ability to hear is not visible and hearing difficulties in children are thus often missed.

The World Health Organisation (WHO, 2021) estimates that 34 million children live with disabling hearing loss and many more with milder losses. Children can present with congenital or acquired hearing loss that may be due to several causes.

Below are some examples:

• During pregnancy: genetic factors, intrauterine infections
• During and shortly after birth: birth asphyxia, low birthweight, severe jaundice, infections, ototoxic medications
• Childhood: middle ear diseases (i.e. otitis media), infections such as measles, mumps and meningitis

Impact of childhood hearing loss Recent studies highlight the fact that hearing loss, especially milder forms, is a hidden problem in children. They often do not have any physical complaints and parents and teachers usually complain only of behavioural or attention related difficulties. Researchers investigated the hearing ability of children, aged between 6 and 9, attending a normal school who were considered to have normal hearing by their parents and teachers². The results show an almost 1 in 4 affected rate for mild hearing loss that impacted the learners’ communication as well as attention at school². Similarly, an Australian study showed that mild hearing loss, often due to middle-ear infection, was independently associated with poorer early academic achievement³. The good news is that with the appropriate interventions and support, the effects of hearing loss on these outcomes can be moderated⁴. If we think back to our house analogy, the golden key remains early identification and intervention.

Importance of early detection Identifying hearing loss in school-aged children without a school hearing screening programme is very difficult². A hearing assessment is highly recommended for every child, especially those who show any signs of behavioural, attention or scholastic difficulties. In the World Report on Hearing, the WHO calls for primary and secondary prevention strategies which include greater awareness, prevention practices and screening¹.

“School screening programmes can be a useful tool in mitigating the effect of unaddressed hearing loss and ear diseases; and for educating children regarding practices that help maintain their hearing trajectory (as part of overall health), such as safe listening.” (WHO, 2021)

A school-based hearing screening test can usually be facilitated in less than 10 minutes and is a non-invasive procedure. Typically, a pure tone screening audiometer is used and an age appropriate response is elicited from the child (i.e. such as raising their hand). An example of a modern version of this technology is a solution by hearX Group, called hearScreen^®.

What is hearScreen^® and how does it work? It is a digital hearing screening solution for schools that is easy-to-use, fast and affordable. The hearing screening test is facilitated through a mobile application on a standardised smartphone or tablet together with calibrated headphones. The automated screening protocols and result interpretation allow non-specialists to use it with confidence. Importantly, it enables programme managers to remotely monitor the quality of the hearing screening service by tracking various quality indicators via the cloud-based data management portal. Other features that are of particular value in the school-based hearing screening context include electronic referral tracking, automated reporting and the ability to integrate additional tests such as hearScope (a digital video otoscope with artificial intelligence image classification) and hearTest (a pure tone tablet-based audiometer) on the same device.

It is important to note that the result of a hearing screening is indicated as a ‘pass’ or ‘refer’ and is not a diagnosis of hearing loss. A ‘refer’ result will trigger a referral for a more comprehensive assessment. Parents and caregivers are urged to prioritise and comply with the follow-up recommendations that are made to ensure the full continuum of care. Lastly, a reminder that our hearing ability is transient and can change. Regular hearing checks are thus recommended throughout the life-course but especially during the important ‘house building’ years!