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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 22  |  Issue : 2  |  Page : 105-109

An epidemiological study on hearing loss and its demographic characteristics within Garhwal region of Uttarakhand


Departments of Ear, Nose, and Throat, VCSGGMS and RI, Srinagar, Pauri Garhwal, Uttarakhand, India

Date of Web Publication11-May-2016

Correspondence Address:
Ravindra Singh Bisht
Department of Ear, Nose, and Throat, VCSGGMS and RI Srinagar, Pauri Garhwal - 246 174, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-7749.182278

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  Abstract 

Background: Hearing impaired cases attending ear, nose, and throat (ENT) OPD were assessed for hearing loss and associated factors of Garhwal region of Uttarakhand. There has not been any such study yet in this region. Objective: Epidemiological study to investigate the hearing loss and its associated diseases in general population Garhwal region of Uttarakhand reporting in ENT OPD. Materials and Methods: This was a prospective study carried out on OPD basis and a total of 300 patients were included in the study. The study included all the patients attending ENT OPD with a complaint of hearing loss. The exclusion criteria were as follows: Patients who were unable to respond to pure tone audiometry (PTA) test. Assessment of hearing loss was done by PTA, which was done by a certified audiologist of the department. Results: Predominantly, patients were male of the late 50s. Moderate-severe sensory neural hearing loss was the most common type of hearing loss and intact tympanic membrane being most common otoscopic finding. The most common cause of hearing loss in this study group was presbycusis. Conclusion: Presbycusis is most common presentation of hearing loss in Garhwal region of Uttarakhand.

Keywords: Deafness, Epidemiology, Hearing impairment, Presbycusis


How to cite this article:
Bisht RS, Sikarwar V, Mina R, Arya A. An epidemiological study on hearing loss and its demographic characteristics within Garhwal region of Uttarakhand. Indian J Otol 2016;22:105-9

How to cite this URL:
Bisht RS, Sikarwar V, Mina R, Arya A. An epidemiological study on hearing loss and its demographic characteristics within Garhwal region of Uttarakhand. Indian J Otol [serial online] 2016 [cited 2019 Nov 18];22:105-9. Available from: http://www.indianjotol.org/text.asp?2016/22/2/105/182278


  Introduction Top


Deafness is one of the most significant disabilities noted in our country. It is the second most common cause of disability in India. According to national data, nearly 63 million people (6.3%) in our country suffer from significant auditory loss.[1] The main cause implicated for hearing loss is still due infectious diseases in India, especially chronic suppurative otitis media (CSOM). The incidence of CSOM varies from 0.5% to 2.0% in developed countries, but in developing countries this disease ranges from 3% to 57%. Like many other developing country, India is also coping with sequel and complications of CSOM, its incidence is around 30% with a prevalence rate of 16/1000 population in urban and 46/1000 in rural areas.[2],[3]

Deafness has many causes most common being pathology of sound conduction pathway.[4],[5],[6] Overall involvement of external and middle ear are most commonly encountered in comparison to the inner ear and conduction abnormalities of auditory nerve or brainstem.

Hearing loss could be a very distressing symptom and a disease. It causes developmental difficulties in children and communicational difficulties in adults. These all have a major impact on quality of life and work efficacy leading to cognitive and emotional problems.[7],[8],[9],[10],[11],[12] It also increases the burden on the health care system [13] and society both causing an adverse effect on health [14] and survival.[15]

In the legislature of India, deafness is defined as:

  • The Rehabilitation Council of India Act, 1992, has defined “hearing handicapped” as - hearing impairment of 70 decibels and above, in the better ear or total loss of hearing in both ears.[16]
  • The legal definition followed in India of “hearing disability” as per the Persons with Disability Act 3, 1995 is - “a hearing disabled person is one who has the hearing loss of 60 decibels or more in the better ear for conversational range of frequencies.”[17]
  • The term “deaf” is now days replaced to “hearing impaired.”[18] “Hearing challenged' is also an alternate and appropriate term. Though terminology for being hearing impaired since birth was “deaf and dumb” but in today's age it has being designated to “congenitally deaf.” Hearing Loss can be classified on the basis of Severity of loss [Table 1].


Indian government is aiding the hearing impaired population by various means such as special schools, training institutes, deafness prevention programs, and free hearing aids. The burden of disease is still more than 25% despite all the prevention programs.
Table 1: Classification of hearing loss

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In this study, the prevalence of hearing loss in Garhwal region of Uttarakhand, along with associated diseases and factors was evaluated. The population of this region is slightly more than 10 million out of which 69.45% resides in rural setup. The male and female ratio of this region is 1.03:1,[19] respectively. Since this is the first study to be done of this area, the statistics on hearing loss is not yet assimilated. Since this study has covered a limited and small population, so it does not represent the general population of Uttarakhand.

The aim of this epidemiological study was to assimilate data on hearing loss in patients approaching on OPD basis and its associated factors and diseases.


  Materials and Methods Top


This was a prospective study, carried out at the Department of Otorhinolaryngology, HNB Base Hospital, Srikot, Garhwal, a tertiary care center in the state of Uttarakhand, from May 1, 2015, to October 31, 2015. A total of 300 patients were included in the study.

The inclusion criteria: Patients attending ear, nose, and throat OPD with complaints of hearing loss. The exclusion criteria were as follows: Patients unable to respond to pure tone audiometry (PTA).

The selected patients were subjected to a detailed history and complete ear, nose, and throat examination. The ears were examined by otoscopy initially and subsequently by a microscope so as to aid in making diagnosis. Assessment of hearing was done by PTA test in sound processed room for both air conduction and bone conduction. Frequencies 250, 500, 1, 2, and 4 Hz were used for both air and bone conduction. Hearing loss was further divided into subdivisions according to the Goodman's classification.[20]

A certified audiologist performed PTA. Testing was conducted in isolated sound processed room. Instruments used for audiometry includes audiometer with standard headphones and insert headphones.

Air conduction thresholds were done for both ears from 0.5 to 4 KHz at an intensity ranging from −10 to 120 dB. Each audiometry was done and rechecked for the possibility of error if any. If a difference of more than 10 dB was noted on rechecking the test results were discarded as “unreliable audiometry.” For patients unable to respond to audiometries was further taken up for Brainstem Evoked Response Audiometry (BERA) and were excluded from the study.

Test subjects included in the study were the OPD patients with difficulty in hearing. A detailed record of age, gender, religion, and location was maintained. Each patient underwent a detailed ear examination and status of tympanic membrane was noted. This examination was followed by audiometry test, which further aided in diagnosis.


  Results Top


A total of 300 cases were included in the study. Patients were ranging from 5 to 79 years. Maximum number patients (64) were falling in 50–59 years of age group 21.5% and least were noted in 0–9 years of (7) 2.5% [Table 2]. The mean age was 42.65 years. Out of which, 55.6%, i.e., 167 were males and 44.4%, i.e., 123 were females [Table 3] and [Figure 1].
Table 2: Age distribution of the patients

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Table 3: Sex wise distribution of patients

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Figure 1: Sex wise distribution of patients

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Since in Uttarakhand, majority of the population is Hindu, the trend of religion in this study also depicted similar results. Hindus contributed 287 (95.6%), Muslims were 13 (4.4%), and rest other religions were not seen in this study [Table 4] and [Figure 2].
Table 4: Religion wise distribution of patients

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Figure 2: Religion wise distribution of patients

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The location of this institute is in Srinagar, which cover the overall large region of Uttarakhand. The majority of patients reported in this study were from Pauri Garhwal (157) 52.5% and least were from Rudraprayag (39) 13.1% [Table 5] and [Figure 3].
Table 5: Region wise distribution of patients

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Figure 3: Region wise distribution of patients

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The otoscopic findings noted in this study has shown intact drum as the most common finding. About, 191 patients (63.8%) had right tympanic membrane intact while 154 patients (51.3%) had left tympanic membrane intact. The least noted finding was bulging/congested drum for both ears. Only two patients were seen with left tympanic membrane bulging, i.e., 1.3% [Table 6] and [Figure 4].
Table 6: Otoscopic finding in patients

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Figure 4: Otoscopic finding in patients

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The trend of hearing loss in the right ear showed a moderately-severe sensory neural hearing loss (SNHL) to be major PTA finding of 27.5% followed by normal PTA 18.1% and least being moderately severe conductive hearing loss (CHL) 1.3%. The trend of the left ear had moderately-severe SNHL to be the major finding similar to the right ear of 28.1% followed by moderate CHL of 25.6% and least being moderately-severe CHL of 1.3% [Table 7] and [Figure 5].
Table 7: Severity of hearing loss in patients

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Figure 5: Severity of hearing loss in patients

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The study depicted that most common diagnosed cause of hearing loss in this region of Uttarakhand being presbycusis contributing (112 patients) 37.5% of all cases and least common being otosclerosis (6 patients) 1.9% [Table 8] and [Figure 6].
Table 8: Diagnosis of hearing loss in patients

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Figure 6: Diagnosis of hearing loss in patients

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  Discussion Top


In this study, we observed that most of the patients were clustered in the age group of 50–59 years which coincided with the demographic data and surveys were done in India, which have shown that 56% and 62% have onset of hearing loss at ≥60 years of age in rural and urban backgrounds, respectively.[1] In studies done in developed countries, the age of onset of hearing loss is usually on the higher side, probably because of higher life expectancy in developed countries.[21],[22],[23],[24] In our case, this finding can be explained by the fact that majority of the young population hailing from Garhwal region migrate to the plains in search of livelihood. As a result, the major population in Garhwal region belongs to higher age group. Male: female ratio in our study was 1.25:1. The male predominance in this study was expected due to male predominance in the general population of India. The majority of population in Uttarakhand are Hindu so even in this study, majority of subjects are Hindu. Though the religion census of state had shown 72.1% Hindu and 10.1% Muslims, in this study, the 95.6% was Hindu and 4.4% was Muslims, which could be area specific as this study has not covered whole Uttarakhand region.

The current study observed that majority of patients with hearing loss had an intact tympanic membrane. In otoscopic examination, 63.8% of right and 51.3% left tympanic membrane were found to be intact. Perforation of tympanic membrane was the second most common finding. About 14.4% right and 24.4% left tympanic membrane perforated. Since not many studies have been done in this field, the general trend could not be commented on.

It has also been in this study that moderately-severe SNHL is most common PTA finding 27.5% and 28.1%, respectively, in right and left ear. The study finding is consistent with the WHO census and few other studies in this field. It has been implicated in few studies that use of personal listening devices also could lead to hearing loss though it has not been proven yet.[21],[22],[23],[24] As an incidental finding hearing impairment was more in left ear in comparison to the right ear which has shown 18.1% normal PTA when left ear has only 6.3%.


  Conclusion Top


This study has shown presbycusis to be the leading cause of hearing loss of 37.5% followed by acute otitis media of 18.3%. The census of WHO has shown ear wax to be the leading cause of reversible hearing loss, 15.9% followed by noninfectious cause such as presbycusis and age-related changes 10.3%.[25] In our case, this finding can be explained by the fact that majority of the young population hailing from Garhwal region migrate to the plains in search of livelihood. As a result, the major population in Garhwal region belongs to higher age group. Justifying presbycusis to be the leading cause of hearing loss in our study, rather than ear wax or CSOM which more common in younger age group.

This study was generally limited due to small sample size, localized approach, data collection from a single center, lack of further testing, and imaging.

Future studies should target a larger population; data should be assimilated from all assessable centers of this region. In addition, the data should have detailed family history, co-morbid conditions, medication history, and drug abuse history. Impedance audiometry and imaging would also be useful, and it would aid in the diagnosis of patients.

Acknowledgment

We are highly thankful to our Principal Dr. I.S. Yog for allowing us to conduct this study and provided us necessary support for the same. We are also very thankful to our staff for necessary technical support to conduct the study.

Finally, we express deep appreciation to the patient who willing provided us information utilized in the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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