Background: Hearing impairment negatively impacts students� development of academic, language and social\r\nskills. Even minimal unilateral hearing loss can hinder educational performance. We investigated the prevalence of\r\near diseases among secondary school students in the city of Xi�an, China in order to provide a foundation for\r\nevidence-based hearing healthcare.\r\nMethods: A stratified random sampling survey was conducted in 29 secondary schools. Demographics and\r\nmedical histories were collected, and otologic examinations were performed. Questionnaires were administered to\r\nassess insomnia, academic stress and use of portable audio devices. Logistic regression analysis was used to\r\nidentify factors associated with hearing impairment, and the association of sensorineural hearing loss with\r\ninsomnia, academic stress and the use of portable audio devices was analyzed with the chi-square test.\r\nResults: The percentage of students with some form of ear disease was 3.32%. External ear disease, middle ear\r\ndisease and sensorineural hearing loss occurred in 1.21%, 0.64% and 1.47% of the students, respectively. Boys had a\r\nrelatively higher prevalence of ear disease than girls. According to our survey, the prevalence of sensorineural\r\nhearing loss increased significantly among the students with insomnia and extended use of portable audio devices,\r\nbut not among those with elevated levels of academic stress. Hearing aids and surgical treatment were needed in\r\n1.47% and 0.89% of the students, respectively.\r\nConclusions: There is a high prevalence of ear disease among secondary school students, and this should be\r\ngiven more attention. Insomnia and the excessive use of portable audio devices may be related to adolescent\r\nsensorineural hearing loss. It is important to establish and comply with an evidence-based preventive strategy
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