Prevalence of hearing loss and ear morbidity among adolescents and young adults in rural southern Nepal

Abstract

Abstract

A cross-sectional survey was conducted among 3646 persons, 15 to 23 years of age, in the southern plains District of Sarlahi, Nepal, to assess the prevalence and severity of hearing loss and middle-ear dysfunction, and adverse effects of hearing loss on social integration. Between 2006 and 2008, subjects were enumerated and underwent otoscopic, tympanometric, and audiometric evaluations at central sites in villages. Hearing loss was diagnosed in subjects who failed a hearing screening and exhibited an average air conduction threshold value greater than or equal to 30 dBHL in the worse ear. Clinically, 32.8% of subjects exhibited a dull or retracted tympanic membrane, and 18% had abnormal tympanometry. Nearly 12% failed the hearing screening test, among whom more than half, or 6.1% overall, had hearing loss. Hearing-impaired subjects were six- to eight-fold (ORs, with 95% CIs excluding 1.0) more likely to report problems in hearing usual sounds or communicating with other people. Among young adults living in southern Nepal, hearing loss is common, and associated with social disability.

Sumario

Se realizó una investigación transversal en 3646 personas de 15 a 23 años de edad en las llanuras del Distrito de Sarlahi, en el Sur del Nepal, para evaluar la prevalencia y severidad de la hipoacusia y de la disfunción del oído medio y los efectos adversos de la pérdida auditiva en la integración social. Entre 2006 y 2008 se incluyeron los sujetos y se evaluaron otoscópica, timpanométrica y audiométricamente en zonas centrales de los poblados. Se diagnosticó hipoacusia a quienes fallaron el tamiz auditivo y mostraron una vía aérea con promedio de umbrales mayor a 30 dBHL en el oído peor. Clínicamente, el 32.8% tenían membrana timpánica opaca o retraída y 18%, timpanometría anormal. Cerca del 12% fallaron en el tamiz auditivo y de ellos, más de la mitad, globalmente el 6.1%, tenían hipoacusia. Estos sujetos fueron 6 a 8 veces (ORs 95% excluyendo 1.0 CIs) mayor probabilidad de reportar problemas para escuchar sonidos comunes o para comunicarse con otras personas. Entre los adultos jóvenes que viven en el sur de Nepal, la hipoacusia es común y se asocia a discapacidad social.

Key Words:

• Hearing impairment
• Hearing loss
• Ear morbidity
• Children
• Young adults
• Nepal

Acknowledgements

We thank our fellow Johns Hopkins investigators, including Christine Stewart, Parul Christian, Joanne Katz, Jim Tielsch, and Luke Mullany, and our audiometric technicians, Matrika Dhungel and the late Jaisi Lal Ran Yadav. We are grateful for the helpful comments offered by Andrew Smith of the World Health Organization, and Ian Mackenzie of the Liverpool School of Tropical Medicine. We extend our gratitude to all of the young adult participants in the study.

This follow-up study was funded by the Bill and Melinda Gates Foundation, Seattle, USA under Grant # 614, with the Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA. The original preschool vitamin A supplementation trial was funded under the Micronutrients for Health Cooperative Agreement No. DAN0045-A-5094 between the Johns Hopkins University and the Office of Health, Infectious Diseases, and Nutrition, United States Agency for International Development, Washington, USA. The Sight and Life Research Institute, Baltimore, USA provided additional support for the study. This research was conducted independently of funding agencies and none had any input in the collection, analysis, and interpretation of data, in the writing of the report, or in the decision to submit the article for publication.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.