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Updated: Apr 28, 2026

Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses
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Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses

Published on: January 23, 2017

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Bilateral hearing loss is associated with decreased nonverbal intelligence in US children aged 6 to 16 years

Susan D Emmett1, Howard W Francis

  • 1Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A.

The Laryngoscope
|June 11, 2014
PubMed

Insights

Bilateral hearing loss in children is linked to lower nonverbal intelligence. Unilateral hearing loss showed no significant association, highlighting the importance of early detection and intervention for bilateral cases.

Area of Science:

  • Pediatric audiology
  • Developmental psychology
  • Public health

Background:

  • Hearing loss is a common sensory impairment in children.
  • Nonverbal intelligence is crucial for cognitive development and academic success.
  • Understanding the relationship between hearing and cognition is vital for early intervention.

Purpose of the Study:

  • To investigate the association between different types of hearing loss (unilateral vs. bilateral) and nonverbal intelligence in a representative sample of US children.
  • To identify demographic factors associated with lower nonverbal intelligence.

Main Methods:

  • Utilized data from the Third National Health and Nutrition Examination Survey (NHANES III), a cross-sectional study (1988-1994).
  • Included 4,823 children aged 6-16 years with audiometric evaluation and cognitive testing.
  • Defined hearing loss based on pure-tone averages and nonverbal intelligence using the Wechsler Intelligence Scale for Children-Revised block design subtest.

Main Results:

  • Children with bilateral hearing loss had significantly lower mean nonverbal intelligence scores compared to those with normal hearing (P = .02).
  • Bilateral hearing loss was independently associated with a 5.77-fold increased odds of low nonverbal intelligence (OR: 5.77; P = .02).
  • Unilateral hearing loss and non-Hispanic black race/ethnicity and family income <$20,000 were not significantly associated with low nonverbal intelligence.

Conclusions:

  • Bilateral hearing loss, but not unilateral, is significantly associated with reduced nonverbal intelligence in US children.
  • Findings underscore the need for longitudinal studies to explore causal links and long-term impacts.
  • Early identification and management of bilateral hearing loss are critical for supporting cognitive development.
Abstract

Keywords:
Hearing lossNational Health and Nutrition Examination Survey IIInonverbal intelligencepediatric

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