Attention-deficit/hyperactivity disorder in children with hearing loss

Diya Ramanathan; Pavel Kipnis; Patricia Klaas; Ksenia A Aaron; Samantha Anne

doi:10.1016/j.ijporl.2023.111612

Attention-deficit/hyperactivity disorder in children with hearing loss

Int J Pediatr Otorhinolaryngol. 2023 Aug:171:111612. doi: 10.1016/j.ijporl.2023.111612. Epub 2023 Jun 9.

Authors

Diya Ramanathan¹, Pavel Kipnis¹, Patricia Klaas², Ksenia A Aaron³, Samantha Anne⁴

Affiliations

¹ Case Western Reserve University School of Medicine, Cleveland, OH, USA.
² Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
³ Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA.
⁴ Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: ANNES@ccf.org.

PMID: 37329702
DOI: 10.1016/j.ijporl.2023.111612

Abstract

Objective: To evaluate rates of Attention-Deficit/Hyperactivity Disorder (AD/HD) diagnosis among pediatric patients with normal hearing (NH) and hearing loss (HL) with and without comorbidities.

Study design: Retrospective cohort study of NH and HL patients following chart review of all pediatric patients with a history of tympanostomy tube placement treated at the Cleveland Clinic Foundation between 2019 and 2022.

Methods: Patient demographic information, hearing status (type of HL, laterality, severity), and comorbidities including prematurity, genetic syndromes, disorders with neurological impairment, and autism spectrum disorder (ASD) were collected. Rate of AD/HD amongst HL and NH cohorts with and without comorbidities were compared using Fisher's exact test. Covariate-adjusted analysis was also completed (sex, current age, age at tube placement, and OSA). The primary outcome of interest was rates of AD/HD among children with NH and HL, and the secondary outcome of interest was the impact of comorbidities on rates of AD/HD diagnosis in these cohorts.

Results: Of the 919 screened patients between 2019 and 2022, there were 778 NH patients and 141 HL patients (80 bilateral, 61 unilateral). HL ranged from mild (n = 110) to moderate (n = 21) to severe/profound (n = 9). Overall, the rate of AD/HD was significantly higher in HL children (12.1% HL vs 3.6% NH, p < 0.001). Of the 919 patients, 157 had comorbidities. In children without comorbidities, HL children still had significantly higher rates of AD/HD compared to NH children (8.0% vs 1.9%, p = 0.02), but there was loss of significance after covariate adjustment (p = 0.72).

Conclusion: The rate of AD/HD among children with HL (12.1%) is higher than the rate of AD/HD in NH children (3.6%), consistent with previous findings. After excluding patients with comorbidities and adjusting for covariates, there are similar rates of AD/HD between HL and NH patients. Given high rates of comorbidities and AD/HD in HL patients and potential for augmented developmental challenges, clinicians should have a low threshold to refer children with HL for neurocognitive testing, particularly those with any of the comorbidities or covariates described in this study.

Keywords: ADHD; Hearing loss.

MeSH terms

Attention Deficit Disorder with Hyperactivity* / psychology
Autism Spectrum Disorder*
Child
Deafness*
Hearing
Hearing Loss*
Humans
Retrospective Studies