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Origi na l A r tic le
Prevalence and Etiological Factors Causing
Hearing Loss in School Going Children of
Vizianagaram District
Ramachandra Rao Vengala1, Visweswara Rao Suraneni2, Sadhana Osuri3, Pruthviraju Uppalapati4,
Ayyappa Amara5
Associate Professor, Department of Otorhinolaryngology, Maharajah Institute of Medical Sciences, Nellimarla, Vizianagaram,
Andhra Pradesh, India, 2Associate Professor, Department of Otorhinolaryngology, Maharajah Institute of Medical Sciences, Nellimarla,
Vizianagaram, Andhra Pradesh, India, 3Post-graduate Student, Department of Otorhinolaryngology, Maharajah Institute of Medical Sciences,
Nellimarla, Vizianagaram District, Andhra Pradesh, India, 4Post-graduate Student, Department of Otorhinolaryngology, Maharajah Institute
of Medical Sciences, Nellimarla, Vizianagaram District, Andhra Pradesh, India, 5Post-graduate Student, Department of Otorhinolaryngology,
Maharajah Institute of Medical Sciences, Nellimarla, Vizianagaram District, Andhra Pradesh, India
1
Abstract
Introduction: Normal hearing in children provides the primary source for acquisition of speech, language and cognitive skills. Hence,
hearing loss in children will cause poor academic and cognitive performance and is a major public health concern in developing countries.
Aim: The aim of this study is to know the prevalence and etiological factors causing hearing loss among primary school children
in Vizianagaram district.
Materials and Methods: In this cross-sectional, observational study 2735 students from 30 schools in Vizianagaram district
were screened for hearing loss from April 2014 to September 2014 for a period of 6 months. Primary information was obtained
by history, free field conversational voice test, clinical ENT examination, Otoscopy and pure tone audiometry. Statistical analysis
was performed using MS excel 2007 and Epi Info software.
Results: Of the 2735 children screened 342 school children (12.5%) had hearing loss. Impacted ear cerumen (wax) was the
most common cause for hearing loss seen in 184 children (53.8%), followed by Otitis media with effusion in 70 cases (20.46%),
chronic suppurative otitis media (CSOM) in 60 cases (17.54%). Among 342 children, 329 (96.19%) showed conductive type
of hearing loss. Maximum number, i.e., 151 (44.15%) of children were in the age group of 9-12 years. School children having
hearing loss showed bad academic performance than normal hearing children (P < 0.001).
Conclusion: This study emphasizes the fact that most of the etiological factors in causing hearing loss in school going children
are temporary and treatable. Hence, deafness can be prevented to a large extent if remedial measures are taken in time.
Keywords: Cerumen, Cross-sectional studies, Hearing loss, Otitis media with effusion
INTRODUCTION
In the process of global epidemiological transition, the
economic burden associated with chronic diseases is on
the rise, especially in low- and middle-income countries.1
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Hearing loss has a significant effect on both individual and
society. Hearing impairments in children can create various
disabilities in children like speech and language problems,
cognitive impairment and poor academic performance.2,3
Population-based surveys in 2003 in India using the
World Health Organization (WHO) protocol estimated
the prevalence of hearing impairment to be 6.3% or
approximately 63 million people suffering from significant
auditory loss.4 The estimated prevalence of adult-onset
deafness in India was found to be 7.6% and childhood
onset deafness to be 2%.
Corresponding Author:
Dr. Ramachandra Rao Vengala, Associate Professor, Department of Otorhinolaryngology, Maharajah Institute of Medical Sciences, Nellimarla,
Vizianagaram - 535 217, Andhra Pradesh, India. Phone: +91-9246667726/9959131817. E-mail: [email protected]
International Journal of Scientific Study | December 2014 | Vol 2 | Issue 9
36
Vengala, et al.: Prevalence and Etiological Factors Causing Hearing Loss in School Going Children
As per National sample survey office (NSSO) Survey
in India, currently there are 291 persons per one lakh
population who are suffering from severe to profound
hearing loss (NSSO, 2001). Of these, a large percentage
is children between the ages of 0-14 years. With such
a large number of hearing impaired young Indians, it
amounts to a severe loss of productivity, both physical
and economic.
It has been noted by WHO that half the causes of
deafness are preventable and about 30%, though not
preventable, are treatable or can be managed with assistive
devices. Thus, about 80% of all deafness can be said to
be avoidable.4
Since no previous similar studies were conducted in this
region, the present study was undertaken to know the
prevalence and etiological factors of hearing loss among
school going children. By this study we, to some extent
can prevent, detect hearing loss and interventions can be
made early.
MATERIALS AND METHODS
For this cross-sectional observational study informed
consent from school children and their teachers were taken
and also clearance from Ethical Committee.
assessment, which included pure tone audiometry, speech
audiometry and impedance audiometry. Results were
analyzed using standard statistical methods MS excel 2007
and Epi Info software. Frequencies, percentages and tests
of significance were applied where necessary.
RESULTS
A total of 2735 school children were examined in the
present study 0.342 (12.5%) students were found to have
hearing impairment (Table 1). Of the total 342 children
who had hearing loss, 101 (29.53%) children were in the
age group 5-8 years, 151 children (44.15%) were between
9 and 12 years and 90 (26.31%) children were between 13
and 16 years (Table 1). 139 (40.65%) were male children and
203 (59.35%) were female children with a male to female
ratio of 1:1.46 (Table 2).
Among the causes for hearing loss, impacted ear wax
was found to be the commonest cause seen in 184 cases
(53.8%), followed by secretory otitis media (SOM) or
otitis media with effusion in 70 cases (20.46%), chronic
supportive otitis media in 60 cases (17.54%), acute
suppurative otitis media in 7 (2.04%), otitis externa in
4 (1.17%) and otomycosis in 4 (1.17%). Sensory neural
hearing loss was seen in 13 children (3.8%) of which
2 cases are congenital (Table 3).
Screening was done for 2735 school children ranging
between 5 and 16 years of age from 30 co-educational
urban and semi-urban schools in Vizianagaram district
which is in southern part of India from April 2014 to
September 2014 for a period of 6 months. Screening
was conducted according to the guidelines of National
program for prevention and control of Deafness (NPPCD)
12th 5-year plan, ministry of health and family welfare,
Government of India.
Conductive type of hearing loss is present in 329 school
children (96.19%) and sensory neural hearing loss (SNHL)
in 13 children (3.8%) (Table 4). Degree of hearing loss
mostly fall in mild degree in 283 cases (82.74%) followed
by moderate degree hearing loss in 50 cases (14.62%),
severe hearing loss in 7 cases (2.04%) and profound in
Special attention for clinical examination was given to all
students with a history of any ear problem or complaint,
found to have impaired hearing in free field conversational
voice test and students with poor academic performance.
Their academic performance in the prior 1year was assessed
with the help of the marks lists supplied by the school
teacher.
Total number of students Students with hearing loss Prevalence
Complete medical and personal history was taken including
age, socioeconomic status which was graded according to
modified Kuppuswamy scale.
All the school children underwent clinical ENT examination,
Otoscopy examination and tuning fork tests. Children who
showed some abnormality in the audiometric screening
were referred to our hospital for complete hearing
37
Table 1: Prevalence of hearing loss among school
children
2735
342
12.5%
Table 2: Socio demographic variables of study
subjects with hearing impairment (n=342)
Variable
Age
5-8 years
9-12 years
13-16 years
Sex
Male
Female
Area
Urban
Semi urban
Number
%
101
151
90
29.53
44.15
26.31
139
203
40.65
59.35
96
246
28.07
71.92
International Journal of Scientific Study | December 2014 | Vol 2 | Issue 9
Vengala, et al.: Prevalence and Etiological Factors Causing Hearing Loss in School Going Children
2 cases (Figure 1). Hearing loss was unilateral in 146 cases
(42.69%) and bilateral in 196 (57.31%).
Semi-urban school children are affected more (13.87%)
than urban schools (9.97%). Children belonging to poor
socio-economic statuses were more affected. Of the 13
school children with SNHL 8 school children (61.5%) had
bad school performance while in 329 students with CHL
only 119 students (36.17%) have bad school performance
(Table 5). This difference was found to be statistically
significant (P < 0.001).
Table 3: Causes of hearing loss and their
prevalence (n=342)
Cause
Congenital
SNHL
Impacted wax
Otitis externa
Otomycosis
SOM
CSOM
Acute suppurative otitis media
Number
Prevalence %
02
11
184
04
04
70
60
07
0.05
3.21
53.8
1.17
1.17
20.46
17.54
2.04
SOM: Secretory otitis media, CSOM: Chronic suppurative otitis media,
SNHL: Sensory neural hearing loss
Table 4: Type of hearing loss and their prevalence
Type of hearing loss
Total number
Percentage
329
13
96.19
3.80
Conductive
Sensori neural
Table 5: Hearing loss versus academic
performance among school children (n=2735)
SNHL
CHL
Normal
Total
Good academic
performance (%)
Poor academic
performance (%)
Total
5 (38.5)
210 (63.8)
2034 (85)
8 (61.5)
119 (36.2)
359 (15)
13
329
2393
2735
Chi square: 105.71; P<0.001, CHL: Conductive hearing loss, SNHL: Sensory neural
hearing loss
n=342
Frequency
283 (82.74%)
300
200
100
0
50 (14.6%)
7 (2.04%)
Mild (25Moderate Severe (5540db H.L) (40-55db H.L) 70 db H.L)
2 (0.5%)
Profound
(70-90 db
H.L)
Degree of hearing loss
Figure 1: Degree of hearing loss in students with impaired
hearing (n = 342)
DISCUSSION
Ear disease in children is a major public health concern
in developing countries. Preventable ear diseases have
been found to be important health problems among
children.5 The WHO suggests that, in developing countries,
children should be screened at school entry using a simple
audiometer and the external ear be inspected for the
presence of discharge to study the extent of the problem
in the community.6
In our study, prevalence rate of hearing loss was found
as much as 12.5%. These results were similar to studies
conducted by Mishra et al.,7 Pand Tuli et al.8 who found
a prevalence rate of 11.7% and 12.5%, respectively.
This high prevalence can be attributed to poverty,
lack of health awareness and lack of medical facilities.
Maximum prevalence of hearing handicap was in the age
group 9-12 years as found in our study and also in the
study in north India by kalpana et al.9 Female children
are more affected than males in our study. Children are
belonging to low socio-economic statuses were more
affected in our study and also in the study conducted in
Nepal by nepali.10
In our study, conductive type of hearing loss (CHL)
is more common compared to SNHL. The overall
prevalence of conductive deafness in the affected children
was 93.86% unlike Sukhthankar and Chamyal11 who
in their study of conductive deafness found an overall
incidence of 24%. As CHL is correctable by proper
management, early detection of this disability can reduce
the incidence of this handicap. Mild degree hearing loss
is most common in our study and also in the study by
Chishty.12 Impacted wax was the most common etiological
factor in our study (53.8%). Similar results were found
in the study in northern India conducted by Sharma
et al.13, Chadha14 and also in the study in Tanzania by
Minja15 who reported wax as the most common cause of
hearing impairment, which accounted for 50%, 47.28%
and 56.7% of cases respectively. In other studies carried
out by Hatcher et al.,16 Mann et al.,17 Elango et al.18 and
Jacob et al.19 reported prevalence rates of impacted ear
wax ranging only from 8.6% to 29.8%.
SOM which is caused mainly due to combination of
infection and eustachian tube dysfunction20 falls in the
second commonest cause for hearing loss in our study and
also in other studies by Haddad and Snashall.21,22 This could
be explained by frequent upper respiratory tract infections
in children in our region.
CSOM is a major health problem throughout the world
in developing countries, including Nepal.23 About 17.54%
International Journal of Scientific Study | December 2014 | Vol 2 | Issue 9
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Vengala, et al.: Prevalence and Etiological Factors Causing Hearing Loss in School Going Children
prevalence of this disease in our study was explained
by poor hygiene and low socio-economic status.
Similar results were obtained in the study conducted
by Olatoke in Nigeria.24 It is the most common cause
of persistent mild to moderate hearing impairment in
children and young adults in the study by Biswas in
Bangladesh.25
SNHL is found in 13% of cases. Providing rehabilitation
in the form of hearing aids for SNHL children can reduce
the handicap. The present study shows that 82.7% (283)
of the children with impaired hearing suffer from a mild
degree only.
Poor academic performance was observed in children with
hearing impaired (significant P < 0.001), which causes
a significant effect on productivity and put burden in
individual, family and society as well.
Awareness of this problem among parents and school
teachers is of utmost importance to detect this disability
at an early age and hence that we can provide the child the
benefit of proper medical attention before the disability
reaches serious proportions. Role of Pediatricians is also
crucial as most of the children first attend to pediatrician.
Conducting regular screening camps in schools as directed
by NPPCD that includes free field voice testing and
tympanometry for SOM26 are highly essential. Our study
can be improved further by visiting more number of
schools, screening more number of children and involving
parents as well.
CONCLUSION
Public relations department. And we should thank all the
children and their teachers.
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Hearing impairment is a major problem in early life
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communication ability. There was a high prevalence
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study. Children with hearing loss showed bad academic
performance in school. Impacted wax was the most
common cause of hearing loss in our study. Most of
the causes for hearing loss in our study were treatable
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detection of hearing loss in school children, effective,
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ACKNOWLEDGMENT
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We acknowledge the constant support from other members
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How to cite this article: Vengala RR, Suraneni VR, Osuri S, Uppalapati P, Amara A. Prevalence and Etiological Factors Causing Hearing
Loss in School Going Children of Vizianagaram District. Int J Sci Stud 2014;2(9):36-40.
Source of Support: Nil, Conflict of Interest: None declared.
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