Objective To determine whether vitamin A supplementation administered in the preschool years can lower the risk of hearing loss in adolescence and adulthood.Design Follow-up study of adolescents and young adults who, as preschool aged children in 1989, were enrolled into a cluster randomised, double blinded, placebo controlled trial of vitamin A supplementation. Setting South central, rural Nepal.Participants 2378 adolescents and young adults aged 14 to 23, representing 51% of those who finished the original trial and 71% of those living in the study area in 2006.Interventions Every four months for 16 months preschool children were visited at home, given an oral 200 000 IU dose of vitamin A (half dose at age 1-11 months, quarter dose at <1 month) or placebo and the parents were queried about any childhood illnesses in the previous week, including purulent discharge from the ears.Main outcome measures Prevalence of mild or worse hearing loss (≥30 dB) in the most affected ear and tympanometric measures of middle ear function (peak height, ear canal volume, and gradient).Results During the original trial, the prevalence of middle ear infection during the preschool years did not differ between the supplement groups. By adolescence and early adulthood, a non-significant 17% reduction in hearing loss occurred among those who had periodically received vitamin A compared with placebo as preschool aged children (odds ratio 0.83, 95% confidence interval 0.62 to 1.12). Among participants with any ear discharge in early childhood, vitamin A supplementation was associated with a reduced risk of hearing loss, by 42% (0.58, 0.37 to 0.92) compared with controls, after adjusting the confidence interval for the design effect of the original trial. Abnormal tympanometric peak height of the middle ear system was less likely among participants supplemented with vitamin A in childhood. ConclusionIn undernourished settings, periodic, high dose vitamin A supplementation may reduce the risk of hearing loss associated with purulent ear infections in early childhood.
A cross-sectional survey was conducted among 3646 persons, 15 to 23 years of age, in the southern plains District of Sarlahi, Nepal, to assess the prevalence and severity of hearing loss and middle-ear dysfunction, and adverse effects of hearing loss on social integration. Between 2006 and 2008, subjects were enumerated and underwent otoscopic, tympanometric, and audiometric evaluations at central sites in villages. Hearing loss was diagnosed in subjects who failed a hearing screening and exhibited an average air conduction threshold value greater than or equal to 30 dBHL in the worse ear. Clinically, 32.8% of subjects exhibited a dull or retracted tympanic membrane, and 18% had abnormal tympanometry. Nearly 12% failed the hearing screening test, among whom more than half, or 6.1% overall, had hearing loss. Hearing-impaired subjects were six- to eight-fold (ORs, with 95% CIs excluding 1.0) more likely to report problems in hearing usual sounds or communicating with other people. Among young adults living in southern Nepal, hearing loss is common, and associated with social disability.
Early childhood undernutrition is a modifiable risk factor for early adulthood hearing loss.
ObjectiveAssess influences of early life undernutrition on young adult hearing loss in Nepal.Design: Ear health was assessed in 2378 Nepalese young adults (14‐23 y) who as preschoolers participated in a 4‐monthly placebo‐controlled, randomized vitamin A (VA, 200,000 IU) supplement trial ('89‐'92). At baseline, children were measured for WT, HT and MUAC. Parents were queried about ear discharge at each visit. Sixteen years later, audiometry and tympanometry were performed, blinded to original supplement receipt. Hearing loss was defined as pure‐tone average>30dB (0.5,1,2,4kHz) and middle ear dysfunction (MED) as abnormal tympanometric peak height (<0.3‐>1.4mmho) or width (<50‐>110daPa). Children were classified as stunted (<‐2 HAZ) or wasted (<‐2 MUAC & <‐2 BMI‐for‐age Z).Results: Hearing loss and MED affected 5.9% and 16.6% of subjects, respectively. Wasting was associated with odds ratios of 1.8‐2.2 for hearing loss and 1.4‐1.8 for MED, and stunting with ORs of 2.2‐1.7 for hearing loss, irrespective of MED (all 95% lower CL>1). For subjects with preschool ear discharge, VA receipt was protective against hearing loss, OR=0.58 (95% CI 0.37‐0.92). Further, we posit human antenatal VA deficiency may cause MED‐independent hearing loss (S Emmett, Med Hypotheses 2014;82:6), as reported in animals, similar to that associated with stunting.ConclusionPreventable early childhood and possibly fetal undernutrition, including VA deficiency, may predispose children to permanent hearing loss. Hearing loss should be considered a nutrition‐related public health burden.Funded by Gates Foundation (OPP614)
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.