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Randomized Controlled Trial
. 2012 Jan 10:344:d7962.
doi: 10.1136/bmj.d7962.

Vitamin A supplementation in preschool children and risk of hearing loss as adolescents and young adults in rural Nepal: randomised trial cohort follow-up study

Jane Schmitz  1 , Keith P West Jr, Subarna K Khatry, Lee Wu, Steven C Leclerq, Sureswor L Karna, Joanne Katz, Alfred Sommer, Joseph Pillion
Affiliations
Randomized Controlled Trial

Vitamin A supplementation in preschool children and risk of hearing loss as adolescents and young adults in rural Nepal: randomised trial cohort follow-up study

Jane Schmitz et al. BMJ. .

Abstract

Objective: To determine whether vitamin A supplementation administered in the preschool years can lower the risk of hearing loss in adolescence and adulthood.

Design: Follow-up study of adolescents and young adults who, as preschool aged children in 1989, were enrolled into a cluster randomised, double blinded, placebo controlled trial of vitamin A supplementation.

Setting: South central, rural Nepal.

Participants: 2378 adolescents and young adults aged 14 to 23, representing 51% of those who finished the original trial and 71% of those living in the study area in 2006.

Interventions: Every four months for 16 months preschool children were visited at home, given an oral 200,000 IU dose of vitamin A (half dose at age 1-11 months, quarter dose at <1 month) or placebo and the parents were queried about any childhood illnesses in the previous week, including purulent discharge from the ears.

Main outcome measures: Prevalence of mild or worse hearing loss (≥ 30 dB) in the most affected ear and tympanometric measures of middle ear function (peak height, ear canal volume, and gradient).

Results: During the original trial, the prevalence of middle ear infection during the preschool years did not differ between the supplement groups. By adolescence and early adulthood, a non-significant 17% reduction in hearing loss occurred among those who had periodically received vitamin A compared with placebo as preschool aged children (odds ratio 0.83, 95% confidence interval 0.62 to 1.12). Among participants with any ear discharge in early childhood, vitamin A supplementation was associated with a reduced risk of hearing loss, by 42% (0.58, 0.37 to 0.92) compared with controls, after adjusting the confidence interval for the design effect of the original trial. Abnormal tympanometric peak height of the middle ear system was less likely among participants supplemented with vitamin A in childhood.

Conclusion: In undernourished settings, periodic, high dose vitamin A supplementation may reduce the risk of hearing loss associated with purulent ear infections in early childhood.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships that could appear to have influenced the submitted work.

Figures

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Fig 1 Flow of participants through trials
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Fig 2 Relative odds of hearing loss in adolescents and young adults by reported frequency of ear discharge in preschool years, Sarlahi, Nepal 2006-8. Odds ratios (95% CI) expressed on natural log scale. Hearing loss defined as mean of air conduction threshold values at 0.5, 1, 2, and 4 kHz ≥30 dB in worst affected ear
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References

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