Co-occurring Hearing and Visual Problems Impact Educational Outcomes : The Hearing Journal

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Pediatric Audiology

Co-occurring Hearing and Visual Problems Impact Educational Outcomes

Hill, Matilda BA, BM, BCh (Oxon)

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doi: 10.1097/01.HJ.0000602916.76319.40
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Hearing and visual difficulties are extremely common among children. The majority of affected children have mild, temporary problems that may not be formally diagnosed. An increasing stream of evidence suggests that even mild deficits in hearing or vision may have implications for learning and development.1-3 However, it is not known how often hearing and visual problems co-occur in childhood and how this co-occurence affect children's educational outcomes.

Shutterstock/GUNDAM_Ai, Hearing loss, vision loss, child health.

We recently investigated the prevalence and impact of co-occurring, common, mild hearing and visual difficulties on the academic attainment of children attending mainstream schools. The study sample was drawn from the Avon Longitudinal Study of Parents and Children (ALSPAC), a large population-based birth cohort in England.4,5 We identified children with hearing and visual difficulties at age 7, and used data on their achievement in standardized national exams at age 10 to assess educational outcomes. Potential confounding factors were adjusted for.

We found that co-occurring hearing and visual difficulties in childhood have an enduring negative impact on educational outcomes—greater than the effect of hearing or visual difficulties alone. This study provides a clear rationale for the early identification of affected children and early intervention.


The most common cause of hearing problems in childhood is persistent otitis media with effusion (OME, glue ear). There is no clear consensus regarding the impact of childhood OME on academic attainment. However, there appears to be an association between persistent OME-related hearing loss, reading ability, and cognition.2,3,6

In a cohort of 2,909 children, we identified 261 (9%) children with mild to moderate conductive hearing loss and/or OME. We demonstrated a weak association between mild hearing difficulties at age 7 and poorer academic achievement in standardized national exams at age 10 and age 16, which may have been partly mediated by IQ.


Decreased visual acuity in childhood has been associated with reduced literacy,1 but the impact of more common visual difficulties on academic attainment is not well characterized. Amblyopia and strabismus are two of the most common visual problems encountered in childhood;7 both often occur in the context of other conditions, which may in themselves impact development and educational achievement, such as prematurity and low birth weight.8,9 Rigorous adjustment for confounding factors is therefore required to establish the impact of the visual problems in and of themselves.

We identified 189 (6.5%) children with mild visual problems, which were defined as clinically significant strabismus, amblyopia, or mild-to-moderate reduced acuity. We found no negative association between mild visual problems and academic achievement at ages 10 or 16 after adjusting for possible confounding factors.


To our knowledge, the impact of common, mild hearing and visual difficulties on children's educational outcomes has not previously been studied. However, it is well established that the integration of auditory and visual information underpins many cognitive processes, including speech perception, and is essential to the development of language and communication skills.10,11 A hearing or visual problem may therefore adversely affect a child's development of literary and render him or her vulnerable to the cumulative effect of an additional sensory difficulty.

We identified 14 (0.5%) children with both hearing and visual problems and demonstrated a strong negative association between co-occurring hearing and visual problems and academic attainment at age 10, which persisted after adjustment for confounding factors and was greater than the impact of hearing problems alone. We also found a weak association between co-occurring hearing and visual problems and academic performance at age 16, which was partly explained by poorer educational performance at age 10.


Children with known visual or hearing difficulties should be routinely screened for additional sensory impairments to facilitate early identification and appropriate intervention. This study is the first to investigate the impact of co-occurring common and mild hearing and visual difficulties upon academic attainment. The study's limitations are largely related to missing data, and include underrepresentation of children from ethnic minorities and lower socio-economic backgrounds. Replication of these results using larger and more representative datasets is therefore required. Future research should also seek to elucidate the factors mediating the apparent negative association between co-occurring common hearing and visual difficulties and educational outcomes.


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