Hearing problems are among the most common problems encountered in the community. When unaddressed, hearing loss impacts many aspects of life at individual level including communication, speech, cognition, education, employment, social isolation, loneliness and stigma [1,2].

As per World health Organization estimates, by 2050 nearly 2.5 billion people are projected to have some degree of hearing loss and at least 700 million will require hearing rehabilitation. Over 1 billion young adults are at risk of permanent, avoidable hearing loss due to unsafe listening practices. Over 5% of the world’s population or 430 million people require rehabilitation to address their disabling hearing loss (432 million adults and 34 million children). It is estimated that by 2050 over 700 million people or 1 in every 10 people will have disabling hearing loss [1,2].

Many of the causes that lead to hearing loss can be avoided through public health strategies and clinical interventions implemented across the life course. Effective strategies for reducing hearing loss include identification and management of common ear conditions, occupational hearing conservation programmes for noise exposure, safe listening strategies for the reduction of exposure to loud sounds in recreational settings and rational use of medicines to prevent ototoxic hearing loss [2-4].

Early identification of hearing loss and ear diseases is the key to effective management. This requires systematic screening for detection of hearing loss and related ear diseases in those who are most at risk. Once hearing loss is identified, it is essential that it is addressed as early as possible and in an appropriate manner, to mitigate any adverse impact [1-3].

With this background, this study aimed to assess the risk factors for Hearing impairment among MBBS students Indira Gandhi Medical College, Shimla, Himachal Pradesh

Objectives of The Study

To assess the risk factors for Hearing impairment among MBBS students Indira Gandhi Medical College, Shimla, Himachal Pradesh

Research Approach

Descriptive

Research Design

Cross-sectional survey design

Study Area 

Indira Gandhi Medical College, Shimla, Himachal Pradesh

Study Duration

During March 2023

Study Population: All MBBS students from First year to Final year studying in Indira Gandhi Medical College, Shimla, Himachal Pradesh

Sampling

Convenience Sampling

Sample Size

We tried to include all MBBS students studying in Indira Gandhi Medical College, Shimla, Himachal Pradesh

Study Tool

A google form questionnaire consisting of questions regarding socio-demography and risk factors for Hearing impairment was created. The questionnaire was initially pre-tested on a small number of MBBS students to identify any difficulty in understanding by the respondents. 

Description of Tool

• Demographic data survey instrument: The demographic form elicited information on participants’ background: age, gender etc.

• Questionnaire: The questionnaire contains 15 structured questions regarding risk factors for Hearing impairment. One mark was given if they had that risk factor and zero mark was given if they didn’t have that risk factor.

Validity of Tool 

By the experts in this field

Data Collection

Data was collected under the guidance of supervisors. The google form questionnaire was circulated via online modes like e-mail and social media platforms like WhatsApp groups, Facebook, Instagram etc. to all batches of MBBS through their class representatives. 

Data Analysis

Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

Ethical Considerations

Participants confidentiality and anonymity were maintained. 

Through a non-experimental descriptive survey, the current study sought to assess the risk factors for Hearing impairment among MBBS students Indira Gandhi Medical College, Shimla, Himachal Pradesh. 

A total of 285 MBBS students were participated in the present survey. Among them 135 (47.4%) were male while 150 (52.6%) were females, 141 (49.5%) were ≤20 Years while 144 (50.5%) were more than 20 years old. Mean age of the participants was 20.84±2.741 years. (Figure 1). 

Figure 1: Age and Gender Distribution of the Study Participants

In this survey, the mean time spent on mobile/laptop/TV/computer for calling purposes/ watching Movies or serials/ listening music etc among the study participants was 4.82 ± 2.490 hours per day. There was no significant difference according to gender but the mean time spent was significantly more in age group of ≤20 years. On an average, participants were using earphone 2.29±1.913 hours per day. In our survey, usage of earphone was significantly more among female and in the age group above 20 years. (Table 1)

Table 1: Time Spent on Gadgets and Usage of Earphone Among Participants

In our survey, 250(87.7%) participants spent > 2 hours per day on mobile, laptop, TV, computer for calling purposes, watching Movies or serials, listening music etc, 107(37.5%) participants use of earphone > 2 hours per day, 32(11.2%) participants were using earphones that were not properly fitted to their ears,116(58.2%) had set the volume of their earphone above 60%,53(18.6%) had habit of sharing earphone with others,23(8.1%) had ever discharge of pus or fluid from their ears, 60(21.1%) had ever pain in their ears, 35(12.3%) had habit of going to noisy places like Disco, pubs, factories, concerts etc. normally, 249      (87.4%) didn’t use ear plugs in noisy places to protect hearing normally, 16(5.6%) had habit of putting hot or cold oil, home remedies into the ear normally,128(44.9%) had habit of putting Q-tips, cotton buds, Hopi candles Sticks or similar things into the inner ear to clean it normally,44(15.4%) didn’t had habit of cleaning their ear normally,244(85.6%) didn’t ever screen their ears for hearing, 262(91.9%) didn’t know about any mobile application for hearing screening and 263(92.3%) didn’t know about any mobile application for monitoring sound exposure for safe listening.(Table-2)

Table 2: Various Risk Factors for Hearing Impairment Among Study Participants

In our survey, usage of earphone was significantly more (>2 hours/day) among females as compared to males (46.0% vs 28.1%). On the other hand, significantly more number of males had habit of going to noisy places like Disco, pubs, factories, concerts etc. as compared to females (17.0% vs 8.0%). Beside these, there was no significant difference between male and female participants among other risk factors for hearing impairment. (Table 3)

Table 3: Gender Wise Distribution of Various Risk Factors for Hearing Impairment among Study Participants 

In the present survey, time spent on mobile, laptop, TV, computer per day for calling purposes, watching Movies or serials/ listening music etc was significantly more (>2 hours/day) in age group of ≤20 years as compared to age group >20 years (93.6% vs 81.9%). Beside these, there was no significant difference between participants among other risk factors for hearing impairment according to age group (Table 4).

Table 4: Gender wise Distribution of Various Risk Factors for Hearing Impairment Among Study Participants

In the present survey, 87(30.5%) participants had more than seven risk factors for hearing impairment but there was no significant difference between participants in risk scoring for hearing impairment according to gender and age group. (Table 5)

Table 5: Age group and Gender wise Distribution of Risk Scoring for Hearing Impairment Among Study Participants

Hearing is the key for communication, particularly spoken language, which is essential to strong relationships and to our mental well-being. Hearing loss, when unaddressed, affects many aspects of life including language development, cognition, education, livelihood, and social engagements. According to the World Health Organization, more than 360 million people live with disabling hearing loss. More than 1 billion people aged 12-35 years are at risk of hearing loss due to recreational noise exposure [1-3].

In the present survey, 87(30.5%) participants had more than seven risk factors for hearing impairment which highlights the need for awareness and scientific education. The importance of understanding the disease begins with the fact that hearing impairment are either preventable and or reversible [4,5].

Duration of exposure to noise is also a major factor when examining headphones and hearing loss. In our survey, 250(87.7%) participants spent > 2 hours per day on mobile/laptop/TV/computer for calling purposes/ watching Movies or serials/ listening music etc. 107(37.5%) participants use of earphone > 2 hours per day and 116(58.2%) had set the volume of their earphone above 60%. As a rule of thumb, you should only use MP3 devices at levels up to 60% of maximum volume for a total of 60 minutes a day. The louder the volume, the shorter the duration should be. At maximum volume, a person should listen for only about five minutes a day [6,7].

In our survey, 53(18.6%) participants had habit of sharing earphone with others, 23(8.1%) had ever discharge of pus or fluid from their ears and 60(21.1%) had ever pain in their ears. Many studies showed that hearing aids change the ear canal flora and increase the risk of infections [1,7].

In the present survey, 35(12.3%) had habit of going to noisy places like Disco/pubs/ factories/ concerts etc. normally and249 (87.4%) didn’t use ear plugs in noisy places to protect hearing normally. This is the perfect opportunity to highlight our shared responsibility to educate young MBBS students about noise-induced hearing loss in order to help prevent it [1,7].

Early diagnosis of ear diseases and hearing loss is crucial. In the current survey, 16(5.6%) had habit of putting hot or cold oil/ home remedies into the ear normally,128(44.9%) had habit of putting Q-tips/cotton buds /Hopi candles Sticks or similar things into the inner ear to clean it normally and 44(15.4%) didn’t had habit of cleaning their ear normally. All these habits put the person prone to ear infections. In all these cases, every person who has ear disease or hearing loss would benefit from timely and appropriate actions. Integration of ear and hearing care into primary care services is possible through training and capacity building at this level. Such integration will benefit people and help countries move towards the goal of universal health coverage [1-4].

In the present survey, 244(85.6%) didn’t ever screen their ears for hearing, 262(91.9%) didn’t know about any mobile application for hearing screening and 263(92.3%) didn’t know about any mobile application for monitoring sound exposure for safe listening.Hearing assessment and ear examination can be conducted in clinical and community settings. Tools such as the WHO “hearWHO” app and other technology-based solutions make it possible to screen for ear diseases and hearing loss with limited training and resources [1-3].

The most important aspect of any screening protocol in a developing country with huge population like India is meticulous follow-up. Thorough evaluation and addressing the needs of the person who did not pass the screening shall be conducted by an ENT specialist to identify their requirement and support accordingly. It is worthy to incorporate an annual regular hearing screening programme for students in all settings of the nation to promote health care, especially in these hilly areas where awareness might be lacking [1,8].

Limitations of The Study 

Due to the limited sample size from only one medical college of the state and cross-sectional character, it was challenging to generalize the results. In addition, because the questionnaire was delivered online, it was impossible they give erroneous information. Future studies should concentrate on qualitative investigations with a larger sample size, such as focus groups, to uncover obstacles to promoting appropriate knowledge and practices around hearing impairment.

The findings of this study conclude that majority of MBBS students had one or more risk factors for hearing impairment and had average level of personal awareness regarding Hearing Impairment as most of them had use earphone for long duration, had exposure to loud noises, poor ear hygiene practices and didn’t know about screening methods for hearing impairment. This study may also put more importance on Hearing Impairment and raise its awareness among MBBS students. As they become more aware of this, they are more likely to seek treatment for it, reducing the chances of secondary complications caused by untreated Hearing Impairment.

1. World Health Organization. “Deafness and hearing loss: Safe listening.” World Health Organization, www.who.int/news-room/questions-and-answers/item /deafness-and-hearing-loss-safe-listening. Accessed 5 Mar. 2023.

2. World Health Organization. “Deafness and hearing loss.” World Health Organization, www.who.int/news-room /fact-sheets/detail/deafness-and-hearing-loss. Accessed 5 Mar. 2023.

3. World Health Organization. “World hearing day.” World Health Organization, www.who.int/campaigns/world-hearing -day. Accessed 6 Mar. 2023.

4. Centers for Disease Control and Prevention. “World hearing day.” CDC, www.cdc.gov/nceh/hearing_loss/toolkit/pa-world-hearing-day.html. Accessed 6 Mar. 2023.

5. MSD Manuals. “Hearing impairment in children.” MSD Manuals, www.msdmanuals.com/home/children-s health -issues/ear-nose-and-throat-disorders-in-children/hearing-impairment-in-children. Accessed 5 Mar. 2023.

6. American Osteopathic Association. “Headphones and hearing loss.” Osteopathic.org, osteopathic.org/what-is osteopathic-medicine/headphones-hearing-loss. Accessed 5 Mar. 2023.

7. SoundGuys. “Headphone safety: Are earbuds a health risk?” SoundGuys, www.soundguys.com/headphone-safety-earbuds-health-risk-63011. Accessed 5 Mar. 2023.

8. KidsHealth. “Hearing factsheet.” KidsHealth, kidshealth .org/en/parents/hearing-factsheet.html. Accessed 6 Mar. 2023.