INTRODUCTION:

Our ability to hear is precious. Untreated hearing loss can have a devastating impact on people’s ability to communicate, to study and to earn a living. It can also impact on people’s mental health and their ability to sustain relationships. maintain good hearing and reduce the potential for hearing loss.¹ Over, 1.5 billion people globally live with hearing loss and number could rise to over 2.5 billion by 2050(WHO)². According to a WHO estimate, there are approximately 63 million hearing impaired persons in India. Hearing loss is the second most common cause of "Years lived with disability" (YLD) and the sensory defect³. It affects 6.3 percent of the Indian population, and more than half of all cases are avoidable.⁴

Auditory tests are indicated for the early detection of hearing disorder. However, lack of accurate information and stigmatizing attitudes to ear diseases and hearing loss often limit people from accessing care for these conditions.⁵ Even among health-care providers, there’s often a shortage of knowledge about prevention, early identification and management of hearing loss and ear diseases, hampering their ability to provide the care required. Early detection of hearing impairment can prevent from various complications. ⁶ Thus the study was undertaken to assess the prevalence of hearing impairment by using smartphone based mobile application.

MATERIAL AND METHOD:

Descriptive cross sectional study design was used in the study. The study was conducted in Dhanas village, Chandigarh. A total of 496 individuals from 500 families were screened for hearing impairment. Sample size calculation was done using OpenEpi software and was based on the prevalence of hearing impairment in Chandigarh (10.7%)at 99% confidence interval and 80% power assuming 10% attrition. Inclusion criteria was individuals aged 18 years and above. Mentally challenged and terminally ill patients were excluded . All the families in the selected village were included. However one adult member from each family was selected by using kish method for screening. Interview schedule was used to collect socio demographic and clinical profile of participants. Factors associated with hearing impairment i.e. use of earphones, working in noisy places, family history of hearing impairment, history of head injury, history of ear infections or use of ototoxic drugs was also assessed using interview schedule. Screening for hearing impairment was done using “hearWHO pro” mobile application. However audiometry was also done for 10 % of the patients who screened positive through the app.

Hear WHO pro is a free mobile application for mobile devices produced by the World Health Organization that allows users to check their hearing on a regular basis. The app shows the user's score and its meaning, as well as storing the test results so that the user can track their hearing health over time. Investigators downloaded and used the app from their own mobiles for screening. There are 23 sets of numbers in this smartphone application. Each set contains three numerals, which are uttered against varied amounts of background sound in order to imitate everyday hearing conditions. The user is assigned a number out of 100 that represents their signal noise ratio, with the likelihood and severity of hearing loss increasing as the score decreases. A score of 75 or more indicates good hearing, while a score of 50 or lower indicates that the user already has some degree of hearing loss and should get a professional hearing. Data was collected in the month of October 2022. Written informed consent was taken from all the participants. The study was approved by the ethics committee of NINE, PGIMER, Chandigarh.

RESULT:

A total of 496 individuals were screened by using “hear WHOpro” mobile application. Sociodemographic profile revealed that mean age of participants was 35.26±12.08 years and 58.09% were females. As regard educational status 12.9 % had no formal education and nearly one fifth (22.4%) were educated upto high school. Occupational status revealed that 39.7% were housewives and nearly one fifth (19.2%) of the participants were unemployed. Majority (81.6%) of them were staying in nuclear families. Socioeconomic status as per BG Prasad scale revealed that 32.5%, 30.1%and 27.2% of the participants were from lower middle class, upper middle class and middle class respectively. (table 1)

Table 1: Socio-demographic profile of the participants n-496

Variables	f(%)
Age (in years)
18-45 years More than 45 years	380(76.6) 116(23.4)
Gender
Male Female	204(41.1) 292(58.9)
Marital Status
Married Unmarried Divorced/Widow/Separated	395(79.5) 85(17.1) 16(3.2)
Education
No formal education	64(12.9) 72(14.5) 95(19.2) 111(22.4) 71(14.3) 83(16.7)
Primary schooling
Middle schooling
High schooling
Intermediate schooling
Graduate and above
Occupation
Government employee	11(02.2)
Self employed	64(12.9)
Labor	87(17.5)
Unemployed	95(19.2)
Housewife	197(39.7)
Private job	35(7.1)
Professional	07(1.4)
Religion
Hindu	311(62.7)
Sikh	135(27.2)
Muslim	49(9.9)
Christian	1(0.2)
Type of family
Nuclear family	400(80.6)
Joint family	93(18.8)
Extended family	03(00.6)
Number of family members
1-4 members	274(55.2)
5-8 members 9-12 members	193(38.9) 22(4.4)
Above 12 members	07(1.4)
Total monthly per capita income BG Prasad scale
Upper class (Rs.7863 and above)	38(8.4)
_{Upper middle class (Rs.3931-7862)}	136(30.1)
Middle class (Rs.2359-3930)	123(27.2)
Lower middle class (Rs.1179-2358)	147(32.5)
Lower class (Rs.<1179)	08(1.8)

Score of less that 50 as per WHOpro” mobile application indicate some degree of hearing impairment. Out of the 496 individuals, 44 were screened positive by using the app. So the prevalence of hearing impairment as per scores gained from mobile application was 8.9%. Mean age of screened positive participants was 41.36±15.03 years and nearly two third (63.6%) were females.

Figure1: Prevalence of hearing impairment. N-496

Clinical profile and associated factors of patients who screened positive is shown in table 2. Results revealed that 31.8% had some significant medical history. Past medical history of hypertension (9.1%), diabetes mellitus (4.5%), tonsillitis (4.5%), ear infections (6.8%)and tuberculosis (2.3%) was reported by participants who were screened positive. One participant (2.3%) also reported the history of ear surgery. History of COVID 19 infection was reported by only 4.5% participants. (Table 2) Assessment of signs and symptoms related to hearing impairment revealed that 36.4% were frequently asking others to repeat, 34.1 % had problem in understanding in noisy places and 22.7% used to increase the TV volume frequently. Ear pain and ear discharge was reported by 20.5% and 13.6% participants respectively. One fourth (25%) of participants also reported dizziness or fear of losing balance. Majority of participants (90.91%) were not working in noisy places. Family history of hearing impairment was revealed by 11.4% of participants. History of head trauma and use of ototoxic drugs was reported by 2.3% and 6.8 % of the participants respectively

Table 2: Clinical profile of participants screened positive through the WHO hear pro app n=44

Variables	F (%)
Past medical history
Yes	14(31.8)
No	30(68.2)
Specific medical history	02(4.5) 01(2.3) 04(9.1) 02(4.5) 03(6.8) 02(4.6) 30(68.2)
Tonsillitis
Tuberculosis
Hypertension
Diabetes mellitus
Ear infection
Hypertension and diabetes mellitus
No significant history
Specific Surgical history
Ear Surgery	01(2.3)
None	43(97.7)
History of COVID-19 infection Yes No	2(4.5) 42(95.5)
Sign and symptoms related to hearing impairment
Frequently ask others to repeat Increase TV volume frequently Trouble in understanding conversation in noisy places People you talk seems to mumble Ringing sensation in ears Ear pain Ear discharge Dizziness or fear of losing your balance	16(36.4) 10(22.7) 15(34.1) 11(25.0) 14(31.8) 9(20.5) 6(13.6) 11(25.0)
Associated factors of hearing impairment
Use earphones Yes No	9(20.5) 35(79.5)
Work in noisy places Yes No	4(9.09) 40(90.91)
Family history of hearing impairment Yes No History of head trauma Yes No History of taking ototoxic medicines for a prolonged period of time Yes No	5(11.4) 39(88.6) 1(2.3) 43(97.7) 3(6.8) 41(93.2)

Audiometry was done for 10% of the participants who were screened positive through the app. All the participants(n=5) had mild to high frequency sensory neural hearing loss in both ears on audiometry test.

DISCUSSION:

Over 5% of the world's population suffers from hearing impairment, which is the most common kind of disability. Rehabilitation is necessary for 430 million people to treat their incapacitating hearing loss. A debilitating hearing loss is predicted to affect approximately 70 million people by 2050, or one in ten people. People from low- and middle-income nations make up over 80% of those with hearing loss that is incapacitating.⁷ Early identification of hearing loss, impairment and disease is key to effective management however this requires systematic screening for detection and management of hearing impairment and related hearing disease. Thus, the study was under to assess the prevalence of hearing impairment using a smart phone-based application.

Many mobile applications are available for screening hearing impairment such as Wulira app⁸, hearWHOpro⁹, hear screen¹⁰, ear trumpet¹¹. These applications are easily available accessible and pocket friendly. One of these mobile applications by World Health Organization i.e., “hearWHO pro” was used in present study. The hearWHO app is based on validated digits-in-noise technology. This app gives the general public access to a hearing screener to check their hearing status and monitor it over time. The easy-to-use app clearly display the users’ results and keeps a personalized track record of their hearing status over time.¹² Gupta A et al in their study used the similar app for assessing hearing damage¹³.

The prevalence of hearing impairment in the present study is 8.9%. Findings are almost similar to the other study done in Chandigarh where the prevalence of hearing impairment was 10.7%¹⁴ However in the study done by Asghari M et al in Iran it was 14.27%¹⁵. The difference in the results may be due to different research setting and different methodology e.g., in our study inclusion criteria was age 18 and above whereas in this study it was 5years and above. Review done by Verma et al revealed that the prevalence of hearing loss (allages) ranges between 6% and 26.9% and prevalence of disabling hearing loss between 4.5% and 18.3% in India¹⁶.

Prolonged use of ototoxic drugs was reported by 6.8 % of the participants who screened positive in our study. Study by Joo Y et al reported on the contribution of ototoxic medication to hearing loss among older adults. Most common ototoxic medication taken by older adults was NSAIDs (57%), followed by acetaminophen (35.6%) followed by loop diuretics (9.5%)¹⁷.

Other factors present among screened positive participants in the present study were using earphones, working in noisy places, having family history of hearing impairment, history of ear infections. Study done by Wallhagen H I et al also showed that men's hearing impairment was linked to potentially high-noise-exposure employment, while women's hearing impairment was linked to ototoxic substance use.¹⁸.

As per finding of current study participants who are screened positive of hearing impairment were having comorbidities such as tonsillitis (4.5%) and diabetes mellitus (4.5%) followed by hypertension (9.1%) and hypertension with diabetes mellitus (2.3%). The findings of this study are inconsistent with study conducted by Besser Jana et al on comorbidities of hearing loss implication of multimorbidity for audio logical care. Comorbid conditions in this study included visual impairment (2.4%), mobility restriction (2.5%), cognitive impairment (4.4%), diabetes mellitus (17.3%)¹⁹. The difference in the findings may be due to different research setting and research methodology.

The study concludes that the prevalence of hearing impairment in the studied population is high. Study highlights the need of regular screening programs to identify the cases at the earliest. Training of frontline workers in the community e.g. ANM, ASHA, Anganwadi workers can also be done in using the app and to create awareness in the community.S

REFERENCES:

1. Van Wieringen A, Boudewyns A, Sangen A, Wouters J, Desloovere C. Unilateral congenital hearing loss in children: Challenges and potentials. Hearing Research. 2019 Feb 1; 372:29-41.

2. WHO: 1 in 4 people projected to have hearing problems by 2050? Accessed from https://www.who.int/news/item/02-03-2021-who-1-in-4-people-projected-to-have-hearing-problems-by-2050.

3. Garg S, Chadha S, Malhotra S, Agarwal AK. Deafness: Burden, prevention and control in India. Natl Med J India. 2009 Mar 1; 22(2): 79-81.

4. Hoppe U, Hesse G. Hearing aids: indications, technology, adaptation, and quality control. GMS current topics in otorhinolaryngology, Head and Neck Surgery. 2017;16.

5. Heffernan E, Coulson NS, Henshaw H, Barry JG, Ferguson MA. Understanding the psychosocial experiences of adults with mild-moderate hearing loss: An application of Leventhal’s self-regulatory model. Int J Audiol. 2016 Jul; 55 Suppl 3:S3–12.

6. Baiduc RR, Poling GL, Hong O, Dhar S. Clinical measures of auditory function: the cochlea and beyond. Disease-a-month: DM. 2013 Apr; 59(4):147.

7. Davis AC, Hoffman HJ. Hearing loss: rising prevalence and impact. Bulletin of the World Health Organization. 2019 Oct 10; 97(10):646.

8. Batte C, Olayanju T, Mukisa J, Namusobya MS, Alenoghena I, Sulaiman L, Tazifua EA, Oladele DM, Morton B. The accuracy of a mobile phone application (Wulira app) compared to standard audiometry in assessing hearing loss among patients on treatment for multidrug-resistant tuberculosis in Uganda. Journal of the Pan African Thoracic Society. 2020 Sep 27;1(1):20-5.

9. Gupta A, Bakshi SS, Kakkar R. Epidemiology and Risk Factors for Hearing Damage Among Adults Using Headphones via Mobile Applications. Cureus. 2022 May 31;14(5).

10. Spurling GK, Askew D, Reath J. Mixed-methods evaluation of screening for hearing loss using the hearScreen™ mobile health application in Aboriginal and Torres Strait Islander children presenting to an urban primary healthcare service. Australian Journal of Primary Health. 2021 Oct 11;27(5):371-6.

11. Derin S, Cam OH, Beydilli H, Acar E, Elicora SS, Sahan M. Initial assessment of hearing loss using a mobile application for audiological evaluation. The Journal of Laryngology & Otology. 2016 Mar;130(3):248-51.

12. WHO? Hear WHO. Accessed from https://www.who.int/teams/noncommunicable-diseases/sensory-functions-disability-and-rehabilitation/hearwho.

13. Gupta A, Bakshi SS, Kakkar R. Epidemiology and Risk Factors for Hearing Damage Among Adults Using Headphones via Mobile Applications. Cureus. 2022 May 31;14(5).

14. Chavan BS, Sharma N, Singh K. Prevalence of disability in Chandigarh: Findings of large household screening. Industrial Psychiatry Journal. 2019 Jul;28(2):218.

15. Asghari A, Farhadi M, Daneshi A, Khabazkhoob M, Mohazzab-Torabi S, Jalessi M, Emamjomeh H. The prevalence of hearing impairment by age and gender in a population-based study. Iranian journal of public health. 2017 Sep;46(9):1237.

16. Verma RR, Konkimalla A, Thakar A, Sikka K, Singh CA, Khanna T. Prevalence of hearing loss in India. The National Medical journal of India. 34(4);216-222. Doi:10.25259/NMJI_66_21.

17. Joo Y, Cruickshanks KJ, Klein BE, Klein R, Hong O, Wallhagen MI. The contribution of ototoxic medications to hearing loss among older adults. The Journals of Gerontology: Series A. 2020 Feb 14;75(3):561-6.

18. Wallhagen MI, Strawbridge WJ, Cohen RD, Kaplan GA. An increasing prevalence of hearing impairment and associated risk factors over three decades of the Alameda County Study. American journal of public health. 1997 Mar;87(3):440-2.

19. Besser J, Stropahl M, Urry E, Launer S. Comorbidities of hearing loss and the implications of multimorbidity for audiological care. Hearing research. 2018 Nov 1;369:3-14.

Received on 01.11.2024 Revised on 05.12.2024

Accepted on 01.01.2025 Published on 24.02.2025

Available online from March 17, 2025

Asian J. Nursing Education and Research. 2025;15(1):53-57.

DOI: 10.52711/2349-2996.2025.00012

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.