Hearing Loss Is Associated With Decreased Nonverbal Intelligence in Rural Nepal

Susan D. Emmett, Jane Schmitz, Joseph Pillion, Lee Wu, Subarna K. Khatry, Sureshwar L. Karna, Steven C. LeClerq, Keith P. West

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


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 G 0.001). Subjects with bilateral hearing loss scored an average of 3.16 points lower (95% confidence interval, j5.56 to j0.75; 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, j1.67 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.

Original languageEnglish (US)
Pages (from-to)86-92
Number of pages7
JournalOtology and Neurotology
Issue number1
StatePublished - Jan 1 2015


  • Cognition
  • Hearing loss
  • Nepal
  • Nonverbal intelligence

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Sensory Systems
  • Clinical Neurology


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