Donglei Li ^1,2,3 Lin Ken ^1,2,3 Xinru Cen ^1,2,3 Yuwei Fan ^2,3 Liping Hong ^1,2,3 Zhao Wu ^1,2,3 Wenliang Chen ⁴ Xinqi Zhong ^2,3*

• ¹ Guangzhou Medical University, Guangzhou, Guangdong Province, China
• ² Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
• ³ Key Laboratory for Major Obstetric Diseases of Guangdong Province, Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
• ⁴ Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong Province, China

Objective: Childhood hearing impairment has potential repercussions on the mental well-being of both children and their parents. As a vulnerable population in accessing health care services, they may face specific challenges, especially during the COVID-19 pandemic. This crosssectional study aims to investigate the association between childhood hearing impairment and the mental health of children and their parents and to assess health care utilization of hearingimpaired children and its impact on mental outcomes for both during the COVID-19 pandemic.Methods: Using the National Health Interview Survey (NHIS) database, we analyzed data for 15,989 children aged 5 to 17 and their corresponding parents. The correlations between childhood hearing impairment and mental outcomes were examined using logistic regression models. The 2020 (quarter 3 and quarter 4)-2021 NHIS data was singled out and re-analysis, focusing on the utilization of medical care during the COVID-19 pandemic.Results: After accounting for covariates, hearing-impaired children exhibited a higher frequency of anxiety (OR 2.33, 95% CI 1.79-3.02) or depression (OR 2.14, 95% CI 1.59-2.88). Parents of hearing-impaired children had significantly higher odds of a higher frequency of anxiety (OR 1.55, 95% CI 1.20-2.01) or depression (OR 1.73,. Interaction effect of hearing impairment with survey year on parents' mental health outcomes was observed (P for interaction < 0.1). Children with hearing loss had higher odds of reporting delayed medical care (OR 2.00, 95% CI 1.11-3.59) or canceled medical care (OR 1.96, 95% CI 0.98-3.96, P = 0.059) due to the pandemic. Delayed medical care (OR 12.41, or canceled medical care (OR 6.26,) due to the COVID-19 pandemic significantly contributed to the increase of anxiety frequency in hearing-impaired children.Childhood hearing impairment exhibits a substantial impact on children's and parental mental health, which is further exacerbated by the COVID-19 pandemic. Families of hearing-impaired children appear to be in a vulnerable position during public health emergencies such as the COVID-19 pandemic, which can further exacerbate their mental outcomes.