Hearing loss and mathematical skills in school-aged children: Evidence based on the BDE-2 test assessment

Abstract Context: Children with sensorineural hearing loss (HL) are at risk for difficulties in language, cognition, and academic learning, particularly in mathematics. Early diagnosis and rehabilitation have improved auditory and verbal outcomes, but less is known about their effects on mathematical skills. Aims: This study aims to assess the mathematical skills in children with and without HL through the standardized BDE-2 test and to explore the potential correlations between audiological parameters and cognitive-mathematical performance. Settings and Design: A case–control study was performed on 37 children aged between 9 and 15 years, enrolled at the Audiology and Phoniatrics Unit of the University of Naples Federico II. Subjects and Methods: The sample included 25 children with bilateral sensorineural HL (study group) and 12 normal-hearing peers (control group). Each participant underwent a full audiological assessment – comprising unaided and aided pure-tone and speech audiometry – and completed the BDE-2 test. The two groups were compared in terms of mathematical skills, and correlations were analyzed between the degree of HL and BDE-2 assessment. Statistical Analysis Used: Chi-square, Fisher’s exact, t -test, Mann–Whitney, Wilcoxon, and Spearman correlation coefficients were applied. Significance was set at P < 0.05. Results: Children with HL scored significantly lower in calculation (75.4 ± 22.9 vs. 95.0 ± 12.7; P = 0.0021) and in total BDE-2 (82.2 ± 21.9 vs. 95.2 ± 6.9; P = 0.0113) indices than controls, while differences in number recognition and sense were not statistically significant. No correlations emerged between HL severity and BDE-2 outcomes. All children with HL showed a statistically significant improvement in pure-tone thresholds and speech recognition when tested with hearing aids or cochlear implants. Conclusions: Despite modern rehabilitative technologies, children with HL exhibit persistent weaknesses in complex calculation and global mathematical performance. Early screening and interventions targeting linguistic, mnemonic, and symbolic reasoning abilities should be integrated into standard follow-up programs to enhance academic outcomes.