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Updated: Apr 22, 2026
Neuro-rehabilitation Approach for Sudden Sensorineural Hearing Loss
Published on: January 25, 2016
Hearing loss is associated with decreased nonverbal intelligence in rural Nepal
Susan D Emmett1, Jane Schmitz, Joseph Pillion
1*Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine; and †Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; ‡Department of Urban and Environmental Policy, Occidental College, Los Angeles, California; §Department of Audiology, Kennedy Krieger Institute, Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.; ║Nepal Nutrition Intervention Project-Sarlahi; and ¶Speech and Hearing Unit, Ganesh Man Singh Memorial ENT Centre, Tribhuvan University Institute of Medicine, Kathmandu, Nepal.
Objective:
To evaluate the association between adolescent and young-adult hearing loss and nonverbal intelligence in rural Nepal.
Study Design:
Cross-sectional assessment of hearing loss among a population cohort of adolescents and young adults.
Setting:
Sarlahi District, southern Nepal.
Patients:
Seven hundred sixty-four individuals aged 14 to 23 years.
Intervention:
Evaluation of hearing loss, defined by World Health Organization criteria of pure-tone average greater than 25 decibels (0.5, 1, 2, 4 kHz), unilaterally and bilaterally.
Main Outcome Measure:
Nonverbal intelligence, as measured by the Test of Nonverbal Intelligence, 3rd Edition standardized score (mean, 100; standard deviation, 15).
Results:
Nonverbal intelligence scores differed between participants with normal hearing and those with bilateral (p = 0.04) but not unilateral (p = 0.74) hearing loss. Demographic and socioeconomic factors including male sex; higher caste; literacy; education level; occupation reported as student; and ownership of a bicycle, watch, and latrine were strongly associated with higher nonverbal intelligence scores (all p < 0.001). Subjects with bilateral hearing loss scored an average of 3.16 points lower (95% confidence interval, -5.56 to -0.75; p = 0.01) than subjects with normal hearing after controlling for socioeconomic factors. There was no difference in nonverbal intelligence score based on unilateral hearing loss (0.97; 95% confidence interval, -1.67 to 3.61; p = 0.47).
Conclusion:
Nonverbal intelligence is adversely affected by bilateral hearing loss even at mild hearing loss levels. Socio economic well-being appears compromised in individuals with lower nonverbal intelligence test scores.
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