Degree of Hearing Loss and Students' Quality of Life at a State-Owned Extraordinary School in Jember Indonesia

Hearing loss is one of the health problems that can be caused by genetic factors, anatomical abnormalities, trauma to the ears and head, ototoxic drugs, and bacterial meningitis. People with hearing loss may have physical, intellectual, and mental limitations that can hinder daily activities and affect quality of life. Extraordinary School (Sekolah Luar Biasa/SLB) is the school that serves school-age children with special needs or those having a physical or/ mental disorder. This study aimed to determine the relationship between the degree of hearing loss and the quality of life of students with hearing disabilities at SLB Negeri Jember, Indonesia. This study used an analytic observational research design. The total number of samples in this study was 23 students who met the inclusion and exclusion criteria, then an audiometer examination and a questionnaire survey were carried out. This study used the Pediatric Quality of Life Inventory (PEDS-QL^TM) questionnaire. The statistical test used was the Spearman correlation test. Interpretation of the results was considered to have a significant correlation if the p-value <0.05. The result of statistical analysis using Spearman's rank shows the relationship between the degree of hearing loss and the physical function of students with hearing loss at the SLB Negeri Jember shows a significance value of 0.184. The relationship between the degree of hearing loss and emotional function obtained a result of 0.005. The relationship between the degree of hearing loss and social functioning shows a significance value of 0.561. The relationship between the degree of hearing loss and school functioning showed a significance value of 0.016. The results were considered to have a significant correlation if the p-value <0.05. In conclusion, hearing loss was found not to have significant relationship with physical and social functioning in students with hearing disabilities at SLB Negeri Jember, Indonesia

INTRODUCTION

There were an estimated 466 million people with hearing loss in 2019 according to the World Health Organization (WHO), of which 34 million were children. Deaf people in Southeast Asia account for about 180 million people. One in ten people in the world by 2050 or more than 900 million people are expected to suffer from hearing loss¹¹. Based on data collected by the Basic Health Research (Riskesdas) in 2018, people with hearing disabilities from birth in children aged 24-59 months in Indonesia were 0.11%²². According to data from the Ministry of Social Affairs' Management Information System (SIMPD) published in 2019, 7.03% suffered from hearing disability among all people with disabilities in Indonesia³³. Extraordinary School (Sekolah Luar Biasa/SLB) is a school that serves school-age children with special needs or those who have a physical or/ mental disorder, one of them being deaf, whether it is acquired or congenital^4,545.

The etiology of hearing loss in children can be congenital genetic (80%) and non-genetic (20%). Genetic hearing loss can be further classified as syndromic and non-syndromic. Syndromic hearing loss can be caused by diseases such as Waardenburg syndrome, Usher syndrome, and Pendred syndrome. Non-syndromic genetic hearing loss can result from autosomal dominant, recessive, or sex-linked mutations.Syndromic genetic hearing loss accounts for about 20% and non-syndromic genetic hearing loss is the most common cause of congenital hearing loss at about 80%. Non-genetic hearing loss can be caused by TORCH (toxoplasma, rubella, cytomegalovirus, and herpes) which are infectious agents acquired in the prenatalphase, and bacteria such asNeisseria meningitidisandStreptococcus pneumoniaacquired in the postnatalphase. Abnormalities in the inner ear will affect the function of the transduction organ in the cochlea, resulting in damage to hair cells which is then called sensorineural deafness^6-8.⁶⁷⁸

More severe degree of hearing loss is known to worsen the quality of life of individuals. As compared to normal hearing children, children with hearing loss were found to have lower scores in global general health, including emotional, physical, behavioral, and mental health, as well as family activity and cohesion, parental time, self-care, mobility, and social function^9-1191011.

Hearing-impaired children who do not receive early intervention and rehabilitation will fall behind their normal-hearing peers in reading skills, cognition, and socio-emotional development. This gap might in turn result in modest educational achievements and employment levels in adulthood^12-14121314.

MATERIALS AND METHODS

This study used an observational analytic design with a cross-sectionalapproach. The data obtained in this study were taken from January 4^thto February 4^th, 2023. The research was conducted at SLB Negeri Jember, Indonesia. The sample in this study was 23 students with hearing disabilities of SLB Negeri Jember who met the inclusion and exclusion criteria. The inclusion criteria included an active student at SLB Negeri Jember, aged 10-18 years old, the children and their parents/guardians were willing to be included in the study by filling out informed consentand willing to become respondents, and the students are suffering from hearing loss as evidenced by audiometry results. The exclusion criteria in this study were as follows: Students who use hearing aids and students with other disabilities. This study was approved by the Ethical Review Board of the Medical Faculty of Jember University with registration number 1667/H25.1.11/KE/2022. This study adhered to STROBE guidelines for reporting observational studies (https://www.strobe-statement.org/)¹⁵¹⁵.

RESULTS

The description of the sample characteristics in this study is classified based on gender, age, type of hearing loss, and the location of the ear that experiences hearing loss which can be seen in table 1.

Table 1.Characteristics of the research sample

Sample characteristics	Number (n)	Percentage (%)
Gender
Male	10	43
Female	13	57
Age
10 - 12 years	6	26
13 - 15 years	3	13
16 - 18 years	14	61
Hearing Impairment
Right	0	0
Left	0	0
Bilateral	23	100

Table 1, most of the students who are suffering from hearing loss are female, consisting of 13 students (54%) compared to male (46%). Based on age, most samples were found in the age range of 16-18 years, consisting of a total of 14 students (58%). All samples were diagnosed with bilateral hearing loss. Table 2 shows the distribution of hearing loss characteristics according to the types and the degree of hearing loss.

Table 2.Distribution of hearing loss characteristics

Sample characteristics	Number (n)	Percentage (%)
Types of Hearing Loss
Sensorineural	13	54
Conductive	6	25
Mix	4	17
Degree of Hearing Loss
Light	1	4
Medium	4	17
Medium Severe	1	4
Severe	1	4
Very Severe	16	67

Table 2 shows that 13 students (54%) under study presented with sensorineural hearing loss, whereas only 4 (17%) were those with mixed type hearing loss. Based on the degree of hearing loss most of the students had a very severe degree, which was found in 16 students (67%).

This research conducted at SLB Negeri Jember also measured the average value of four functions as the criteria to measure the quality of life of the students with hearing loss (Table 3). The four functions are physical, social, emotional, and school function. The physical and social functions were highly qualified, while the emotional and school functions were moderate.

Quality