ORLI 2020 Volume 50 No.

1: 16-20 Hearing status of children under five years

Research

Hearing status of children under five years old in Jatinangor district

Wijana, Frino Abrianto, Shinta Fitri Boesoirie, Arif Dermawan

Department of Otorhinolaryngology Head and Neck Surgery.
Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin Hospital,
Bandung

ABSTRACT
Background: Hearing is one of the most influential factors in children developmental process.
The critical period of hearing and speech development begins in the first 6 months of life and continues
until the age of 3 years. World Health Organization estimates that one to three in a thousand births have
sensorineural hearing loss (SNHL). Early detection of hearing loss is substantial so that the diagnosis
can be established and appropriate intervention can be done earlier. Purpose: To determine the hearing
status in children under five years of age in Jatinangor. Method: A cross-sectional observational study
with 240 subjects under the age of five in 12 Integrated Healthcare Center (Posyandu) in Jatinangor.
Examinations included parental interviews, Behavioral Observation Audiometry (BOA), Otoacoustic
Emissions (OAE), and tympanometry tests. Result: One child (0.4%) had moderate conductive hearing
loss in the left ear, 1 child (0.4%) had bilateral severe SNHL, and 7 children (2.9%) had profound bilateral
SNHL. Conclusion: The incidence of hearing loss in children under five in Jatinangor was 3.8%, with
bilateral profound SNHL as the highest number, and the most common cause were prenatal Toxoplasma,
Rubella, Cytomegalovirus (CMV) dan Herpes simplex virus (TORCH) infections.

Keywords: children under-five, early detection, hearing status

ABSTRAK
Latar belakang: Pendengaran merupakan salah satu faktor yang sangat berpengaruh dalam proses
perkembangan anak. Periode kritis perkembangan pendengaran dan berbicara dimulai dalam 6 bulan
pertama kehidupan dan terus berlanjut sampai usia 3 tahun. Badan kesehatan dunia memperkirakan
satu sampai tiga dalam seribu kelahiran terdapat kejadian gangguan dengar jenis sensorineural.
Deteksi dini gangguan dengar penting untuk dilakukan sehingga diagnosis dapat ditegakkan dan
intervensi yang tepat dapat dilakukan sedini mungkin. Tujuan: Untuk mengetahui status pendengaran
pada anak usia bawah lima tahun di kecamatan Jatinangor. Metode: Penelitian observasional potong
lintang dengan subjek penelitian 240 anak usia bawah lima tahun di 12 Pos Pelayanan Terpadu
(Posyandu) Kecamatan Jatinangor. Dilakukan pemeriksaan meliputi wawancara orangtua anak, tes
Behavioral Observation Audiometry (BOA), tes Otoacoustic Emissions (OAE) dan tes timpanometri.
Hasil: Didapatkan 1 anak (0,4%) mengalami gangguan dengar konduktif derajat sedang pada telinga
kiri, 1 anak (0,4%) mengalami gangguan dengar sensorineural derajat berat bilateral, dan 7 anak
(2,9%) mengalami gangguan dengar sensorineural derajat sangat berat bilateral. Kesimpulan: Angka
kejadian gangguan dengar pada balita di kecamatan Jatinangor sebesar 3,8% dengan gangguan dengar
terbanyak berupa sensorineural derajat sangat berat bilateral, dan latar belakang penyebab terbanyak
adalah infeksi prenatal Toxoplasma, Rubella, Cytomegalovirus dan Herpes simplex virus (TORCH).

Kata kunci: anak bawah lima tahun, deteksi dini, status pendengaran

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ORLI 2020 Volume 50 No.1 Hearing status of children under five years

Correspondence address: DR. dr. Wijana, SpTHT-KL(K), FICS, Department of Otorhinolaryngology

Head and Neck Surgery, Faculty of Medicine Padjadjaran University / Dr. Hasan Sadikin Hospital,
Bandung, Indonesia. Email: wijana@unpad.ac.id.

INTRODUCTION appropriate intervention should begin before

6 months of age.4
Hearing is one of the most important
senses in children developmental process Public Health Center (Puskesmas) as the
particularly in speech development.The front line in promotion and implementation
critical period of hearing and speech of public health programs has an important
development begins in the first 6 months of role in surveillance of children growth and
life and continues until the age of 3 years. development, including the development of
In general, hearing impairment is caused by hearing function and the presence of hearing
genetic (hereditary) and nongenetic (acquired) loss by implementing an Integrated Healthcare
factors. Hearing impairment can be present at Center (Posyandu). One of Posyandu tasks
birth (prelingual) or occur after the age of 3 as its base function is to monitor children’s
years (postlingual) which will affect patient’s development. Based on data from Sumedang
communication ability. Globally, hearing County Health Office, out of 32 Puskesmas
impairment has become the 4th leading cause in Sumedang county, the highest number of
of the world main disability.1.2 children under-five was found in Jatinangor
District Public Health Centers.5 Based on this
The prevalence of hearing disturbance in
data, the researcher wanted to find out the
newborn and babies is estimated between 1
hearing status of children under five years old
to 3.47 cases per 1000 live births.2 According
in Jatinangor district.
to World Health Organization (WHO) one to
three in a thousand births have sensorineural
hearing loss (SNHL). WHO estimates that
METHOD
the prevalence of disabling hearing loss
in the world from 42 millions in 1985 had This was a cross-sectional observational
increased to 360 millions in 2010. Seven and study with 240 subjects under the age of
half millions of these children were under the five in 12 Integrated Healthcare Center
age of 5 years. Thirty four millions (7.3%) (Posyandu) in 6 villages of Jatinangor district.
from 466 million people with hearing loss are The study was conducted from July 2018
children, with the highest prevalence in South until September 2018. Research subjects were
Asia, Asia Pacific, and Sub-Sahara Africa.3 babies and under-five children registered in
Posyandu at Jatinangor District. Posyandu
Due to that fact, European, American
was selected with multistage cluster sampling
and international groups of experts have
method, and subjects were chosen by total
recommended the organization of universal
sampling method. The inclusion criteria were
newborn hearing screening (UNHS) for years.
babies and children under five years of age,
The main purpose of a UNHS is to lower
registered at Posyandu Jatinangor district, and
the age of hearing-impaired children at the
the parents gave consent to let their children
time of diagnosis,17 so that allowing earlier
joined in this study. The exclusion criteria was
intervention. According to Joint Committee
babies and under-five with cerumen impaction
on Infant Hearing (JCIH), a comprehensive
in one or both ears.
audiological assessment should be performed
using Auditory Brainstem Response Examinations included parental
(ABR), Otoacoustic Emissions (OAE), and interviews on the risk of hearing loss
tympanometry before 3 months of age, and according to American Joint Committee on

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ORLI 2020 Volume 50 No.1 Hearing status of children under five years

Infant Hearing (JCIH) 2007, ENT physical instrument was designed to be automatically
examination, Behavioral Observation detecting the presence of emission (pass) or
Audiometry (BOA), Oto-acoustic Emissions whenever emission was none/decreased the
(OAE) and tympanometry tests. instrument will show (refer).4
Tympanometry was needed to evaluate
the condition of middle ear through a probe RESULT
tone installed in auditory canal to measure
the reflected voice energy by tympanic In this research, from 275 subjects (135
membrane. boys and 140 girls) there was 35 children
with cerumen impacted, so that only 240
OAE is an electrophysiology test to subjects fulfilled inclusion criteria, revealing
evaluate the cochlear outer hair cell. It is the highest subject of group age under-five as
an non invasive, objective, automatic test, many as 83 children (34.6%).
which is easy, quick, and practical, making it
very efficient for universal newborn hearing Hearing loss was found in 9 children
screening (UNHS). (3.8%) consisted of 1 subject (0.4%)
suffered unilateral intermediate conductive
In healthy ears, the OAE could be simply hearing loss on left ear, 1 subject (0.4%)
noted down by installing a probe made of suffered severe sensorineural hearing loss,
sponge to the auditory canal, to give an and 7 subjects (2.9%) suffered profound
acoustic stimulus and to receive emission sensorineural hearing loss. This prevalence
produced by cochlea. Whenever a disturbance rate of hearing loss was less than the data
of voice happened during voice conduction report from WHO multicenter study in the
from external ear, such as debris or cerumen, year 1998, stating Indonesia, a country in
middle ear disturbances such as otitis media South East Asia as the 4th leading country in
and tympanic stiffness, membrane timpani, the world with hearing loss disability (4.6%).
then the acoustic stimulus reaching cochlea Distribution of gender and age is shown in
will be disturbed and the result of emission Table 2.
produced from cochlea will be reduced. OAE

Tabel 1. Distribution of gender and age of research subject

Gender and age Total Percentage

(n) (%)
Gender
Male 120 50
Female 120 50

Age
< 3 months 2 0,8
3 - < 6 months 4 1,2
6 - < 12 months 15 6,3
12 - < 18 months 16 6,7
18 - < 24 months 10 4,2
2 - < 3 years 33 13,8
3 - < 4 years 77 32,1
4 - < 5 years 83 34,6
Total 240 100

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ORLI 2020 Volume 50 No.1 Hearing status of children under five years

Tabel 2. Distribution of risk factor based on type and hearing loss degree

Conductive Hearing Loss (CHL) Sensorineural Hearing Loss Total

(SNHL)
Risk factor Normal Moderate Severe Profound Moderate Severe Profound

Hereditary 0 0 0 0 0 0 0 0

Prenatal infection 1(0,4%) 0 0 0 0 0 5 (2,1%) 6 (2,5%)

(TORCH)
Congenital deafness 0 0 0 0 0 0 0 0
syndrome
Craniofacial 0 0 0 0 0 0 0 0
malformation
History of asphyxia 2 (0,8%) 0 0 0 0 0 0 2 (0,8%)

Very low birth weight 5 (2,1%) 0 0 0 0 1 (0,4%) 0 6 (2,5%)

Hyperbilirubinemia 1 (0,4%) 0 0 0 0 0 0 1 (0,4%)

Mechanical ventilator 0 0 0 0 0 0 0 0
for at least 5 days
History of ototoxic 2 (0,8%) 0 0 0 0 0 0 2 (0,8%)
medicine
Bacterial meningitis 0 0 0 0 0 0 0 0

No risk factor 220 (85%) 1 (0.4%) 0 0 0 0 2 (0,8%) 223(92,9%)

Total 231 1 (0,4%) 0 0 0 1 (0,4%) 7 (2,9%) 240 (100%)

(96,25%)

Tabel 3. Result of OAE and Tympanometry tests In this research, 2 children (0.8%)
of 2 months old with bilateral profound
OAE Normal Not Total sensorineural hearing loss were found
Tympanometry normal
without any risk factor. Bielecki I et al.7 found
Normal 231 8 239 43.47% normal babies with sensorineural
Abnormal 0 1 1 hearing loss without the presence of risk
Total 231 9 240 factor. Evidence Non hereditary hearing loss
(acquired) in children was majority caused by
prenatal TORCH infection. This non genetic
hearing disturbance was acquired during
DISCUSSION mother’s pregnancy in the first trimester
and at birth.8 It was detected in 5 children
Early diagnosis and rehabilitation of
(2.1%) with profound sensorineural hearing
congenital hearing loss was needed to
loss, and 1 child (0. 4%) without any hearing
achieve an optimal linguistic and cognitive
loss although he had a history of mother’s
development. Without the right opportunity
prenatal TORCH infection. This infection
to learn language, children with hearing
could cause intrauterine growth restriction,
loss would be left behind from their age
microcephaly, seizures, mental retardation,
counterparts with normal hearing in areas
visual organ defect, cerebral palsy, and
of cognition, reading, and socio-emotional
sensory neural hearing loss (SNHL) as a
development.3,6
direct effect of Toxoplasma gondii parasites,

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ORLI 2020 Volume 50 No.1 Hearing status of children under five years

and of other virus infection such as Rubella, 5. Agustin A, Rakhmawati W, Nurlita L.

Cytomegalovirus (CMV), Herpes simplex Gambaran Pengetahuan Kader di Posyandu
virus (HSV), Varicella zoster virus (VZV) Desa Cipacing Tentang Perkembangan Pada
Balita. JKP. 2013; 5(3): 59–64.
and syphillis which could cause cochlear
damage and cell death in Corti organ and 6. Paludetti G, Conti G, Di Nardo W, De Corso
E, Rolesi R, Picciotti PM, et al. Infant hearing
stria vascularis. Rubella is the highest risk loss: from diagnosis to therapy. Official
factor. SNHL is the most common sequelae Report of XXI Conference of Italian Society
of congenital rubella infection (58%) and of Pediatric Otorhinolaryngology. Acta Oto-
is mostly seen when maternal rubella Laryngol Italica. 2012; 32: 347 – 70.
infection occurs within the first 16 weeks of 7. Bielecki I, Horbulewicz A, Wolan T.
pregnancy.8,9 Risk factors associated with hearing loss
in infants: An analysis of 5282 referred
Profound bilateral SHNL was found neonates. Int J Pediatr Otorhinolaryngol.
in 1 child (0.4%) who had a history of very 2011;75: 925 – 30.
low birth weight. A delayed process of 8. Korver AMH, Smith RJH, Van Camp G,
myelination in very low birth weight baby is Schleiss MR, Bitner-Glindzicz MAK, Lustig
also a factor contributing an immaturity and LR, et al. Congenital hearing loss. Nat Rev
body physiological dysfunction, including Dis Primers. 2017 (3): 1 – 37.
hearing function.8,10 9. Cohen BE, Durstenfeld A, Roehm PC.
Viral Causes of Hearing Loss: A Review
The prevalence of hearing loss in children for Hearing Health Professionals. Sagepub.
under five years of age in Jatinangor district Trends in Hearing. 2014;18:1-7.
was 3.8%, the highest is bilateral profound 10. Wroblewska-Seniuk K, Greczka G ,
sensorineural hearing loss with a history of Dabrowski P, Harris Szyfter J, Mazela J.
origin prenatal TORCH infection. Hearing impairment in premature newborns-
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