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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 24  |  Issue : 3  |  Page : 184-189

A cross-sectional study on hearing loss using world health organization protocol in Delhi


1 Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
2 Department of Community Medicine, North DMC Medical College and Hindu Rao Hospital, New Delhi, India
3 Technical Officer, Prevention of Deafness and Hearing Loss, World Health Organization, Geneva, Switzerland

Date of Web Publication11-Jan-2019

Correspondence Address:
Dr. Vipra Mangla
Department of Community Medicine, Maulana Azad Medical College, New Delhi - 110 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/indianjotol.INDIANJOTOL_57_18

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  Abstract 


Background: The World Health Organization (WHO) as per its recent estimates has predicted increasing prevalence of hearing loss globally. Data on magnitude of hearing loss in Delhi, India, are scarce, and the present study aims to highlight the extent of hearing loss problem in population using the standardized WHO protocol. Materials and Methods: A community-based cross-sectional study using the WHO protocol on “Survey for prevalence and causes of hearing loss” was conducted in selected rural and urban areas of Delhi from January to December 2017 among study participants aged 3 months and above. The sample size of 664 was taken from rural and urban areas of Delhi. Data collection instruments included the WHO structured questionnaire, hearing test, and ear examination using handheld otoacoustic emission (OAE) in children <5 years of age and pure-tone audiometry in persons >5 years. Ethical clearance was taken from the Institutional Ethical Committee. Written informed consent/assent was taken from study participants. Data were analyzed using SPSS (version 25). Qualitative data were expressed in percentage and quantitative data were shown as mean + standard deviation (SD). Results: The prevalence of hearing loss was 26.9%–15.6% in rural area (Barwala) and 84.4% in urban areas (0.62% in Balmiki Basti, 15.6% in Delhi Gate, 64.4% in Gokulpuri, and 3.8% in Vikram Nagar). Mean + SD age of study participants was 32.17 + 20.85 years. Mild hearing loss was seen in 66.7%, 54.5%, and 43.5% in 6–9, 10–19, and 20–39 years' age group of participants, respectively. Severe hearing loss was seen in 46.7% and 68.3% of study participants in 40–59 and >60 years' age group, respectively. Severe hearing loss was seen in 55.3% males and 42.8% females, respectively. In children <5 years, OAE was passed in 69.4% male and 30.6% female children. About 14.3% children with OAE referred were males and 85.7% were females. Conclusion: The prevalence of hearing loss using the WHO protocol was 26.9% in Delhi, and severity increased with increasing age and more among males than females.

Keywords: Delhi, hearing loss, World Health Organization protocol


How to cite this article:
Garg S, Mangla V, Kohli C, Singh M M, Chadha S, Dahiya N. A cross-sectional study on hearing loss using world health organization protocol in Delhi. Indian J Otol 2018;24:184-9

How to cite this URL:
Garg S, Mangla V, Kohli C, Singh M M, Chadha S, Dahiya N. A cross-sectional study on hearing loss using world health organization protocol in Delhi. Indian J Otol [serial online] 2018 [cited 2019 Jan 18];24:184-9. Available from: http://www.indianjotol.org/text.asp?2018/24/3/184/249875




  Introduction Top


Hearing loss has potentially devastating consequences on physical and mental health, education, and employment.[1] The World Health Organization (WHO) has estimated that the prevalence of hearing loss is on rise worldwide due to the several factors mainly growing global population and increasing proportion of elderly population. Unless this trend is reversed, it will mean higher direct costs for health systems, and unless action is taken by 2030, there will be nearly 630 million people with disabling hearing loss, and by 2050, the number could rise to over 900 million.[2] Globally, males are reported to be more commonly affected than females.[3]

As per the 58th round of the National Sample Survey Organization (NSSO) survey conducted in 2002, there are 291 persons/100,000 populations who are currently suffering from severe to profound hearing loss. Of these, a large percentage is children in the age group of 0–14 years. The NSSO results revealed that hearing loss accounted for 9% of all disabilities in urban and 10% in rural areas. About 7% of people had congenital hearing loss, 32% had profound hearing loss, and 39% had severe hearing disability.[4]

High burden of deafness worldwide is largely preventable and avoidable.[5] The WHO has estimated that half of the causes of deafness are preventable and 30%, though not preventable, are manageable with assistive devices. Thus, about 80% of all deafness is avoidable.[3]

There is a paucity of tools for guiding health professionals to conduct community-based studies regarding the prevalence of hearing loss in rural and urban area in Indian context. As a result, this study was planned to provide information about age and gender distribution of hearing loss among people aged >3 months in selected areas of Delhi so that it can be used in future for policy-making and planning.


  Materials and Methods Top


Study setting, sample size, and sampling

A community-based cross-sectional study was conducted in selected rural and urban areas of Delhi using the WHO protocol on “Survey for prevalence and causes of hearing loss.” Rural and urban areas that were selected were field practice areas under the Department of Community Medicine, Maulana Azad Medical College (MAMC), New Delhi, India. From rural area, a village in North West district of Delhi (Barwala), located at a distance of 30 Km from MAMC, was selected. In urban areas, a resettlement colony in North East district of Delhi (Gokulpuri), two urban colonies (Delhi Gate and Vikram Nagar), and an urban slum area in Central Delhi (Balmiki Basti) were selected. The study population included persons aged >3 months of selected areas of Delhi. The study was conducted from January 2017 to June 2017.

For sample size calculation, national figures for the prevalence of hearing loss (6.3%)[6] was used as data from Delhi were not available. Taking 95% confidence interval and 2% absolute error, sample size came out to be 585. Considering 10% nonresponse rate, the sample size was calculated to be 645. However, a total of 664 individuals were considered for the study. Considering a family size of 5, a total of 133 households were selected and all individuals aged >3 months in selected households were included in the study.

Population proportionate to size sampling method was used to select eligible study participants from study areas. Urban and rural areas of Delhi constitute 89% and 11% of total population of Delhi, respectively, and the same figures were used for sample size calculation from these areas. Further in urban areas also, the sample was taken from proportionately from all four areas. In urban areas, proportion of the selected population was 70% from Gokulpuri, 25% from Delhi Gate, 3% from Balmiki Basti, and 2% from Vikram Nagar. Of total sample size of 664, 85 study participants were selected from rural area and 579 study participants from urban area. Distribution of study participants in urban area was Gokulpuri 405, Delhi Gate 145, Balmiki Basti 17, and Vikram Nagar 12. In each study area, the required number of households was selected by systematic random sampling method.

Inclusion criteria included all residents of selected areas >3 months of age who gave written informed assent/consent for participation in the study. Exclusion criteria involved participants who were unable to follow simple commands or unable to remain alert during duration of hearing test device, any other physical or mental disability where air conduction audiometry was not possible, and if study participant was not available even after 3 visits to household.

Data were collected by door-to-door survey, and all members of selected household were included in the study. A pretested semi-structured interview schedule was prepared for data collection which consisted of personal demographic details of participants such as age and gender and findings of ear examination on inspection, otoscopy, and audiometry. Data collection from deaf persons was carried out using sign language through family members or through an interpreter.

The WHO classification for hearing disability was considered.[7] Disabling hearing loss was referred to hearing loss >40 dB in better hearing ear in adults and >30 dB in better hearing ear in children.[7] Mild hearing disability was considered when hearing disability was between 26 and 40 dB, moderate 41–60 dB, severe 61–80 dB, and profound >81 dB. All steps given in the WHO protocol were followed for study.

For data collection, the survey team comprised postgraduate trainees in the Department of Community Medicine, health worker, audiologists, and doctor from the Department of Otorhinolaryngology, MAMC. Presurvey visit by survey teams was carried out to sensitize community. Mapping of area and site identification was done to locate a suitable (quiet and central) site for conduct of ear and hearing assessment. A pilot study was carried out covering 10% of total sample size to test methodology, equipment, logistics, and timing of each part of survey and to familiarize staff with conduct of survey. Missed participants who could not be examined during the first visit due to nonavailability or any other reason were also followed up. Patients identified with hearing loss or ear diseases who required diagnostic or therapeutic interventions were referred to nearby hospitals.

All study participants were explained about survey purpose and objectives. Written informed consent/assent was taken from study participants. Confidentiality of data was maintained at all steps. Ethical clearance was taken from the Institutional Ethical Committee, MAMC.

SPSS version 25 was used for statistical analysis (IBM Corporation, Armonk, New York, United States). Qualitative data were expressed in proportions (frequency and percentage) and quantitative data were expressed as mean and standard deviation (SD). P < 0.05 was considered as statistically significant.


  Results Top


A total of 664 participants were included in the study. Mean (+SD) and median age was 32.17 + 20.85 years and 29 years, respectively. The range of age was 1–94 years. The 25th quartile of age was 15 years, 50th quartile- 29 years and 75th quartile was 48 years. Of 664 study participants, 69 were of <5 years of age. Of remaining 595 study participants, hearing loss was prevalent in 160 (26.9%). It was 25 (15.6%) in rural area (Barwala) and 135 (84.4%) in urban areas (0.62% in Balmiki Basti, 15.6% in Delhi Gate, 64.4% in Gokulpuri, and 3.8% in Vikram Nagar).

[Table 1] shows age- and area-wise distribution of hearing loss. In 6–9 years' age group, hearing loss was present in 25%, 25%, and 50% study participants from Barwala, Delhi Gate, and Gokulpuri, respectively. In 10–19 years' age group, hearing loss was present in 9%, 9%, and 82% participants from Barwala, Delhi Gate, and Gokulpuri, respectively. In 20–39 years' age group, hearing loss was present in 4.3%, 8.7%, and 87.0% participants from Barwala, Delhi Gate, and Gokulpuri, respectively. In 40–59 years' age group, hearing loss was present in 6.8%, 11.8%, 74.6%, and 6.8% participants from Barwala, Delhi Gate, Gokulpuri, and Vikram Nagar, respectively. In >60 years' age group, hearing loss was present in 28.6%, 1.6%, 22.2%, 44.4%, and 3.2% participants from Barwala, Balmiki Basti, Delhi Gate, Gokulpuri, and Vikram Nagar, respectively.
Table 1: Age- and area-wise distribution of hearing loss (n=160)

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[Table 2] shows age- and area-wise distribution of hearing loss in children <5 years. In 0–5 years' age group, 13.0%, 8.0%, and 79.0% children from Barwala, Delhi Gate, and Gokulpuri, respectively, passed otoacoustic emission (OAE) test. About 100% of children <5 years from Gokulpuri following OAE were referred.
Table 2: Age- and area-wise distribution of hearing loss in children <5 years of age (n=69)

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[Table 3] shows gender- and area-wise distribution of hearing loss in different age groups. In 6–9 years' age group, 100% study participants from Gokulpuri with hearing loss were males and 50% participants each from Barwala and Delhi Gate with hearing loss were females. In 10–19 years' age group, 14.3% participants from Barwala and 85.7% from Gokulpuri with hearing loss were males. In this age group, 25% participants from Delhi Gate and 75% from Gokulpuri with hearing loss were females. In 20–39 years' age group, 16.6% participants from Barwala and 83.4% participants from Gokulpuri with hearing loss were males. In this age group, 11.8% participants from Delhi Gate and 88.2% from Gokulpuri with hearing loss were females. In 40–59 years' age group, 9.1% participants from Barwala, 9.1% from Delhi Gate, 77.2% from Gokulpuri, and 4.6% from Vikram Nagar with hearing loss were males. In this age group, 5.4% participants from Barwala, 13.5% from Delhi Gate, 73.0% from Gokulpuri, and 8.1% from Vikram Nagar with hearing loss were females. In >60 years' age group, 35.9% participants from Barwala, 2.6% from Balmiki Basti, 18.0% from Delhi Gate, and 43.5% from Gokulpuri with hearing loss were males. In this age group, 16.6% participants from Barwala, 29.2% from Delhi Gate, 45.9% from Gokulpuri, and 8.3% from Vikram Nagar with hearing loss were females.
Table 3: Gender- and area-wise distribution of hearing loss in different age groups (n=160)

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[Table 4] shows gender- and area-wise distribution of hearing loss in children <5 years. In 0–5 years' age group, OAE was pass in 43 (69.4%) male and 19 (30.6%) female children. Almost 9.6%, 3.2%, and 56.4% male children were from Barwala, Delhi Gate, and Gokulpuri, respectively. OAE pass among female children was seen in 3.2% children from Barwala, 4.8% from Delhi Gate, and 22.6% from Gokulpuri. About 14.3% of children <5 years from Gokulpuri with OAE refer were males and 85.7% of children from Gokulpuri were females.
Table 4: Gender- and area-wise distribution of hearing loss in children <5 years of age (n=69)

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[Table 5] shows area-wise distribution of severity of hearing loss. Mild hearing loss was seen in 15.7%, 1.9%, 13.7%, 66.6%, and 1.9% study participants from Barwala, Balmiki Basti, Delhi Gate, Gokulpuri, and Vikram Nagar, respectively. Moderate hearing loss was seen in 12.5% and 87.5% participants from Delhi Gate and Gokulpuri, respectively. Severe hearing loss was seen in 18.2%, 16.9%, 58.4%, and 5.5% participants from Barwala, Delhi Gate, Gokulpuri, and Vikram Nagar, respectively. Profound hearing loss was seen in 37.5%, 25.0%, and 37.5% participants from Barwala, Delhi Gate, and Gokulpuri, respectively.
Table 5: Area-wise distribution of severity of hearing loss among participants >5 years (n=160)

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[Table 6] shows age-wise distribution of severity of hearing loss. In 6–9 years' age group, 66.7% of study participants had mild hearing loss and 33.3% had profound hearing loss. In 10–19 years' age group, mild, moderate, and severe hearing loss was seen in 54.5%, 27.3%, and 18.2%, respectively. In 20–39 years' age group, mild, moderate, severe, and profound hearing loss was seen in 43.5%, 34.8%, 17.4%, and 4.3%, respectively. In 40–59 years' age group, mild, moderate, severe, and profound hearing loss was seen in 28.3%, 21.7%, 46.7%, and 3.3%, respectively. In >60 years' age group, mild, severe, and profound hearing loss was seen in 25.4%, 68.3%, and 6.3%, respectively.
Table 6: Age-wise distribution of severity of hearing loss (n=160)

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[Table 7] shows gender-wise distribution of severity of hearing loss. In males, mild, moderate, severe, and profound hearing loss was seen in 31.6%, 7.9%, 55.3%, and 5.2% participants, respectively. In females, mild, moderate, severe, and profound hearing loss was seen in 31.0%, 21.4%, 42.8%, and 4.8%, respectively.
Table 7: Gender-wise distribution of severity of hearing loss among participants >5 years (n=160)

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  Discussion Top


The present study was conducted to find prevalence and age- and gender-wise distribution of hearing loss among study participants aged >3 months in selected areas of Delhi. Age- and gender-wise distribution of severity of hearing loss was also studied. Age-wise distribution of severity of hearing loss in 6–9 years' age group showed that 66.7% participants had mild hearing loss and 33.3% had profound hearing loss. In 10–19 years' age group, mild, moderate, and severe hearing loss was seen in 54.5%, 27.3%, and 18.2% participants, respectively. In 20–39 years' age group, mild, moderate, severe, and profound hearing loss was seen in 43.5%, 34.8%, 17.4%, and 4.3% participants, respectively. In 40–59 years' age group, mild, moderate, severe, and profound hearing loss was seen in 28.3%, 21.7%, 46.7%, and 3.3% participants, respectively. In >60 years' age group, mild, moderate, severe, and profound hearing loss was seen in 25.4%, 0.0%, 68.3%, and 6.3% participants, respectively.

Figures for moderate-to-severe hearing loss in the present study are much higher compared to another population-based study conducted by Gondim et al. in Brazil in 2012 using the WHO protocol. A study had found that the prevalence of moderate-to-severe hearing loss in the age groups of 40–<50 years, 50–<60 years, 60–<70 years, 70–<80 years, and >80 years was 2.33%, 6.67%, 7.14%, 32.43%, and 46.15%, respectively.[8]

Figures for hearing loss was higher in the present study compared to another study done by Baraky et al. in 2012 in Brazil among 349 households with 1050 individuals. In 4–9 years' age group, mild, moderate, severe, and profound hearing loss was seen in 2.12%, 1.06%, 0.0%, and 0.0% participants, respectively. In 10–19 years' age group, mild, moderate, severe, and profound hearing loss was seen in 0.57%, 1.73%, 0.57%, and 0.57% participants, respectively. In 20–39 years' age group, mild, moderate, severe, and profound hearing loss was seen in 2.25%, 1.12%, 0.75%, and 0.75% participants, respectively. In 40–59 years' age group, mild, moderate, severe, and profound hearing loss was seen in 11.8%, 2.44%, 0.69%, and 0.0% participants, respectively. However, in >60 years' age group, mild, moderate, severe, and profound hearing loss was lower than in the present study and was 36.3%, 21.7%, 4.46%, and 0.55%, respectively.[9]

In older age groups, the highest burden of hearing loss was seen in 39.3% participants. This is consistent with the fact that approximately one-third of persons >65 years are affected by disabling hearing loss. The prevalence of disabling hearing loss in adults >65 years is highest in South Asia region.[10]

In the present study, gender- and area-wise distribution of hearing loss in various age groups showed that in 6–9 years' age group, 100% participants from Gokulpuri with hearing loss were males and 50% participants each from Barwala and Delhi Gate with hearing loss were females. In 10–19 years' age group, 63.6% participants affected were males and 36.4% were females. In 20–39 years' age group, 26.0% participants affected were males and 74.0% were females. In 40–59 years' age group, 37.2% participants affected were males and 62.8% were females. In >60 years' age group, 61.9% participants affected were males and 38.1% were females. Gender-wise distribution of severity of hearing loss in males and females showed that hearing impairment was seen in 47.5% and 52.5%, respectively. Mild, moderate, severe, and profound hearing loss was seen in 31.6%, 7.9%, 55.3%, and 5.2% of males, respectively. In females, mild, moderate, severe, and profound hearing loss was seen in 31.0%, 21.4%, 42.8%, and 4.8%, respectively.

Baraky et al. did descriptive study in 2012 in Brazil among 349 households with 1050 individuals. They found that in 10–19, 20–29, 30–39, 40–49, 50–59, 60–69, 70–79, and >80 years' age group, males afflicted were 16.6%, 18.4%, 15.0%, 14.0%, 10.6%, 5.8%, 3.2%, and 1.4%, respectively, and females were 14.8%, 17.0%, 14.8%, 14.8%, 11.8%, 7.1%, 4.3%, and 2.4%, respectively.[9]

Global estimates have revealed that hearing impairment was greater for males than females. The prevalence of hearing impairment ≥35 dB for males aged ≥15 years was 12.2% whereas for females aged ≥15 years was 9.8%. The prevalence of severe hearing impairment was 0.8% for adult males and 0.6% for females. Profound and complete hearing impairment has a combined global prevalence of 0.5% for adult males and 0.3% for females.[11]

Bauer et al. interviewed 7315 elderly individuals in 59 cities in the state of Rio Grande do Sul, Brazil. Hearing loss complaint rate was 28% among the elderly. Mean + SD age of elderly with hearing complaints was 72.8 (7.75) years. About 29.8% of elderly males and 26.4% of elderly females had hearing complaints.[12]


  Conclusion Top


The prevalence of hearing loss using the WHO protocol was 26.9% in Delhi, more among males than females and severity increased with increase in age. The present study has used the WHO protocol in India to study hearing loss, and urgent interventions are required to be undertaken in these individuals to reduce burden on public health system.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Deafness, Make Listening Safe. Available from: http://www.who.int/mediacentre/news/releases/2015/ear-care/en/. [Last accessed on 2016 Oct 13].  Back to cited text no. 1
    
2.
World Health Organization. Deafness and Hearing loss – Fact Sheet; 2018. Available from: http://www.who.int/news-room/fact-sheets/ detail/deafness-and-hearing-loss. [Last accessed on 2018 Jul 10].  Back to cited text no. 2
    
3.
World Health Organization. State of Hearing and Ear Care in the South East Asia Region. Available from: http://apps.searo.who.int/pds_docs/ B1466.pdf. [Last accessed on 2018 Jul 10].  Back to cited text no. 3
    
4.
National Sample Survey Organization. Disabled Persons in India. Report No. 485. New Delhi: Ministry of Statistics and Programme Implementation, Government of India; 2003.  Back to cited text no. 4
    
5.
Garg S, Chadha S, Malhotra S, Agarwal AK. Deafness: Burden, prevention and control in India. Natl Med J India 2009;22:79-81.  Back to cited text no. 5
    
6.
State of Hearing and Ear Care in the South East Asia Region. WHO Regional Office for South East Asia. World Health Organization. Available from: http://www.searo.who.int/LinkFiles/Publications_Hearing_&_Ear_Care.pdf. [Last accessed on 2018 Jun 12].  Back to cited text no. 6
    
7.
World Health Organization. Deafness and Hearing loss – Fact Sheet; 2015. Available from: http://www.who.int/mediacentre/factsheets/fs300/en/. [Last accessed on 2016 Oct 13].  Back to cited text no. 7
    
8.
Gondim LM, Balen SA, Zimmermann KJ, Pagnossin DF, Fialho Ide M, Roggia SM. Study of the prevalence of impaired hearing and its determinants in the city of Itajaí, Santa Catarina state, Brazil. Braz J Otorhinolaryngol 2012;78:27-34.  Back to cited text no. 8
    
9.
Baraky LR, Bento RF, Raposo NR, Tibiriçá SH, Ribeiro LC, Barone MM, et al. Disabling hearing loss prevalence in Juiz de Fora, Brazil. Braz J Otorhinolaryngol 2012;78:52-8.  Back to cited text no. 9
    
10.
World Health Organization. Global Estimates on Prevalence of Hearing Loss-Mortality and Burden of Diseases and Prevention of Blindness and Deafness WHO; 2012. Available from: http://www.who.int/pbd/deafness/WHO_GE_HL.pdf. [Last accessed on 2018 Jun 12].  Back to cited text no. 10
    
11.
Stevens G, Flaxman S, Brunskill E, Mascarenhas M, Mathers CD, Finucane M, et al. Global and regional hearing impairment prevalence: An analysis of 42 studies in 29 countries. Eur J Public Health 2013;23:146-52.  Back to cited text no. 11
    
12.
Bauer MA, Zanella ÂK, Filho IG, Carli G, Teixeira AR, Bós ÂJ, et al. Profile and prevalence of hearing complaints in the elderly. Braz J Otorhinolaryngol 2017;83:523-9.  Back to cited text no. 12
    



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



 

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