FIELD OF THE INVENTION
[001] The present invention relates to the field of medical science, and more particularly, the present invention relates to the prevalence and etiological factor of hearing impairment among school going children in rural area.

BACKGROUND FOR THE INVENTION:
[002] The following discussion of the background to the invention is intended to facilitate an understanding of the present invention. However, it should be appreciated that the discussion is not an acknowledgment or admission that any of the material referred to is published, known, or part of the common general knowledge in any jurisdiction as of the priority date of the application. The details provided herein the background if belongs to any publication is taken only as a reference for describing the problems, in general terminologies or principles or both of science and technology in the associated prior art.
[003] Hearing impairment is defined as condition in which a person has difficulty in hearing conversational speech, difficulty in hearing loud sounds, can only hear some words if they are shouted into ear or cannot even hear shouted words. A person who cannot even hear shouted words has deafness or is said to be deaf.Hearing impairment in children is a major public health problem in developing countries.
[004] It is unfortunate that hearing impairment obstructs their overall development. The World Health Organization (WHO) suggests that, in developing countries, children should be screened at school entry using a simple audiometer and that the external ear be inspected for the presence of discharge, to study the extent of the problem in the community. 2 360 million people in the world suffer from disabling hearing loss. This constitutes a substantial 5.3% of the world’s population.
[005] The prevalence and incidence of hearing impairment in India also are substantially high. The high burden of deafness globally and in India is largely preventable and avoidable. The prevalence of deafness in South-East Asia ranges from 4.6% to 8.8%. In India, 63 million people (6.3%) suffer from significant hearing loss. Four in every 1000 children suffer from severe to profound hearing loss, with over 100,000 babies born with hearing deficiency every year. The estimated prevalence of adult-onset deafness in India is found to be 7.6% and childhood onset deafness to be 2%. 60% of childhood hearing loss is due to preventable causes.
[006] Limited literature is available on prevalence and severity of hearing impairments among school children in Uttarakhand. Hence this study is being planned to find out the prevalence of hearing impairment in school going children (6 to 17 years) of rural area of district Dehradun as well as to know the pattern of hearing loss and causative factors of hearing impairment in children.
[007] In light of the foregoing, there is a need for the Prevalence and etiological factor of hearing impairment among school going children in rural areathat overcomes problems prevalent in the prior art.

OBJECTS OF THE INVENTION:
[008] Some of the objects of the present disclosure, which at least one embodiment herein satisfies, are as follows.
[009] The principal object of the present invention is to overcome the disadvantages of the prior art by providing the Prevalence and etiological factor of hearing impairment among school going children in rural area.
[010] An object of the present invention is to provide the Prevalence and etiological factor of hearing impairment among school going children in rural area that determines the prevalence and etiological factor related to hearing impairment among school going children in rural area district Dehradun.
[011] Other objects and advantages of the present disclosure will be more apparent from the following description, which is not intended to limit the scope of the present disclosure.

SUMMARY OF THE INVENTION:
[012] The present invention provides Prevalence and etiological factor of hearing impairment among school going children in rural area.
[013] In one aspect of the present invention, the study comprises 1003 children, aged 6 to 17 years, from the schools in the Doiwala block district Dehradun are randomly for examination.
[014] In another aspect of the present invention, clinical otologic assessment and Pure tone audiometry screening is conducted on all participants.
[015] In another aspect of the present invention, the prevalence of hearing impairment is 19.6%. The hearing impairment in majority of cases is of a mild degree i.e., 26 to 40 dB (93.9%) of which majority of children (99.0%) had conductive loss.
[016] In another aspect of the present invention, wax is the commonest cause of hearing loss (79.2%). CSOM is found in 19.0% children.
[017] In another aspect of the present invention, the prevalence of hearing impairment in school going children in rural area district Dehradun is high.
[018] In another aspect of the present invention, majority of the etiological factor of hearing impairment identified are preventable. Proper assessment and diagnosis of hearing loss in children at early age is important for better development and psychosocial development.

BRIEF DESCRIPTION OF DRAWINGS:
[019] Reference will be made to embodiments of the invention, examples of which may be illustrated in accompanying figures. These figures are intended to be illustrative, not limiting. Although the invention is generally described in the context of these embodiments, it should be understood that it is not intended to limit the scope of the invention to these particular embodiments.
[020] Figure 1shows sex-wise distribution.
[021] Figure 2shows hearing impairment.
[022] Figure 3shows prevalence of hearing impairment.
[023] Figure 4shows type of hearing loss.
[024] Figure 5shows degree of hearing loss.

DETAILED DESCRIPTION OF DRAWINGS:
[025] While the present invention is described herein by way of example using embodiments and illustrative drawings, those skilled in the art will recognize that the invention is not limited to the embodiments of drawing or drawings described and are not intended to represent the scale of the various components. Further, some components that may form a part of the invention may not be illustrated in certain figures, for ease of illustration, and such omissions do not limit the embodiments outlined in any way. It should be understood that the drawings and the detailed description thereto are not intended to limit the invention to the particular form disclosed, but on the contrary, the invention is to cover all modifications, equivalents, and alternatives falling within the scope of the present invention as defined by the appended claim.
[026] As used throughout this description, the word "may" is used in a permissive sense (i.e. meaning having the potential to), rather than the mandatory sense, (i.e. meaning must). Further, the words "a" or "an" mean "at least one” and the word “plurality” means “one or more” unless otherwise mentioned. Furthermore, the terminology and phraseology used herein are solely used for descriptive purposes and should not be construed as limiting in scope. Language such as "including," "comprising," "having," "containing," or "involving," and variations thereof, is intended to be broad and encompass the subject matter listed thereafter, equivalents, and additional subject matter not recited, and is not intended to exclude other additives, components, integers, or steps. Likewise, the term "comprising" is considered synonymous with the terms "including" or "containing" for applicable legal purposes. Any discussion of documents, acts, materials, devices, articles, and the like are included in the specification solely for the purpose of providing a context for the present invention. It is not suggested or represented that any or all these matters form part of the prior art base or are common general knowledge in the field relevant to the present invention.
[027] In this disclosure, whenever a composition or an element or a group of elements is preceded with the transitional phrase “comprising”, it is understood that we also contemplate the same composition, element, or group of elements with transitional phrases “consisting of”, “consisting”, “selected from the group of consisting of, “including”, or “is” preceding the recitation of the composition, element or group of elements and vice versa.
[028] The present invention is described hereinafter by various embodiments with reference to the accompanying drawing, wherein reference numerals used in the accompanying drawing correspond to the like elements throughout the description. This invention may, however, be embodied in many different forms and should not be construed as limited to the embodiment set forth herein. Rather, the embodiment is provided so that this disclosure will be thorough and complete and will fully convey the scope of the invention to those skilled in the art. In the following detailed description, numeric values and ranges are provided for various aspects of the implementations described. These values and ranges are to be treated as examples only and are not intended to limit the scope of the claims. In addition, several materials are identified as suitable for various facets of the implementations. These materials are to be treated as exemplary and are not intended to limit the scope of the invention.
[029] The present invention provides Prevalence and etiological factor of hearing impairment among school going children in rural area.
[030] This is an observational, cross-sectional study conducted under the Department of Otorhinolaryngology, of Himalayan Institute of Medical Sciences (HIMS), Swami Ram Nagar, Dehradun, over a period of 12 months from 2016- 2017. The protocol for the study is submitted to institutional ethical committee and clearance is obtained from the concerned authority
Inclusion criteria:
[031] Children between the age 6 to 17 years, who attend the school on the day of the screening program.
Exclusion criteria:
[032] Children below 6 year and above 17 years. Children who did not cooperate throughout the evaluating process.
Sampling type:
[033] Multistage random sampling. Sample size Sample size is calculated by the formula 4pq/d2, where p=available local prevalence rate in the target population (from comparable studies 1, 2), i.e., 12. q=100-p d=relative precision (20% of previous prevalence) keeping in view the 10% non-response rate, final sample size comes out to be 516. Tools of instruments used case reporting form (pre-structured and pre-tested) is used. Otoscope (Welch Allyn 3.5v) is used. Pure tone audiometer (ALPS advanced digital audiometer AD 2000) is used.
[034] Rural area of district Dehradun comprises of 6 blocks. Out of this one block is selected randomly. Then a list of all government and private schools (1 to 12 class) is made and four schools (2 private and 2 government) is selected randomly. Total enumeration of children is done. At first, children are screened by pure tone audiometry test. Then the children found to be having impairment are further assessed. Bio data of each participant is recorded with the help of the class teacher prior to starting the examination. The examination commenced with pure tone audiometry test followed by otoscopic examination of both the right and left ear. In this study a swollen and tender pinna/EAC is considered to be otitis externa whilst fungal infection (otomycosis) is diagnosed based on fungal debris in the EAC. Chronic suppurative otitis media (CSOM) is diagnosed based on the presence of perforated tympanic membrane. The ambient sound levels ranged from 45 to 55dB. Airconduction hearing threshold levels of greater than 25dB at any of these frequencies are taken to indicate possible hearing loss.
[035] Data is analyzed using freely available software solutions (SPSS Version 22) and electronic spreadsheets (MS Excel) to store and manage the collected data. Descriptive analysis is done to determine means, frequencies and proportions of the various variables and findings are presented by means of graphs, tables and charts where appropriate. Chi-square test is used to assess any associations/relationships between outcomes and other variables. Confidence level is taken as 95% (p<0.05) where applicable.
[036] A total of 1003 school children are included in the study. The age-gender distribution of the study subjects is shown in Table 1.

[037] Out of the 1003 children, 525 (52.3%) are boys and 478 (47.7%) are girls (Figure 1). The male to female ratio of 1:1.09. Out of 1003 students who participated in this study, 806 (80.4%) of the students had normal hearing and 197 (19.6%) had hearing impairment (Figure 2).
[038] Among the children who had hearing impairment, the female population had a significantly higher prevalence rate of 21.3% as compared to males who had a prevalence rate of 18.0% whereas overall prevalence is 19.6% (Figure 3).
[039] In present study, the most prevalent ear disease is found to be impacted wax (37.41%). The second most common cause is found chronic otitis media 9.6% and the least common cause of hearing impairment is auricular malformation in 1.0% (Table 2).

[040] Amongst the affected children majority had conductive hearing loss (99.0%), (1.0%) had mixed hearing loss and no children had found sensorineural loss (Figure 4).
[041] In the present study it is observed that out of 197, children 185 (93.9%) children had mild degree of hearing loss. 10 (5%) children are having moderate hearing loss and only 2 (1%) children had severe hearing loss. No children are found to have profound hearing loss (Figure 5).
[042] In our study we observed slight male preponderance with 525 (52.3%) cases being males and 478 (47.7%) cases being females. These finding are similar with the studies of Norman et al who also reported a male 52% and female is 48% respectively. While Ahmed et al reported male 41.8% and female is 58.2%. 3,4 In our study a prevalence rate of as much as 11% is found in otherwise apparently normal school children. These results are similar to those of Mishra et al and Sapra et al who found a prevalence rate of 21% and 16.60% respectively. 7,8 The prevalence of hearing impairment in present study is slightly higher in female (21.3%) children than in males (18.0%). Other studies have reported similar findings, Nduka et al, females are 34.0% and males are 24.9%, Rao et al, females are 12.1% and males are 11.8% but in study of Kalpana et al showed that there is a male predominance 6.8% as compared to females 4.2%.
[043] The probable reason for higher prevalence of hearing impairment is poor family attention to female child. 2,9,10 Wax impaction (79.2%) in this study could have been the most common ear disease because in the majority of cases it is asymptomatic and a coincidental finding. In the series of Rao R et al, Chishty et al, wax as the most common cause of hearing impairment, which accounted for 63% and 41.94% respectively. 2,11 Children with conductive hearing impairment are much more common (99.0%) than with mixed type (1.0%), sensorineural type (0.0%).
[044] Whereas Kalpana et al, in their study found that CHL (96.2%), (0.75%) had mixed hearing loss and (3.03%) had sensorineural loss. Sapra et al, found that CHL (96.7%) while (2.41%) are sensorineural hearing loss and (0.80%) are mixed hearing loss. 9 We are very fortunate that the conductive hearing loss is so common which in most of the cases can be treated either medically or by surgery. In our series most of the children had mild (93.9%) degree of hearing impairment followed by moderate degree (5.1%) and severe degree (1.0%) hearing impairment.
[045] No case of profound degree of hearing impairment is found in our study. Nduka et al reported, 58.9% had slight or mild hearing impairment, 5.5% moderate to severe, and none is found to have profound hearing loss. 10 Children with profound hearing impairment are not found because they do not go to mainstream school but instead attend special schools and majority of children in our study is suffering from mild degree of hearing impairment the probable reason may be less or slightly degree of hearing loss is asymptomatic for which they unnoticed by parents and teachers and had no consult to the doctor.
[046] This study has revealed the magnitude of hearing impairment of rural area of district Dehradun. Conductive hearing impairment due to wax appear to be the most common single treatable factor likely to be managed with conservative means. As also in fungal infection which is treated with local clearance with restoration of the serviceable or normal hearing. Early detection and treatment of the treatable cause of hearing impairment prevent the poor scholastic attainment, speech and behavior. Knowledge of rehabilitation in the form of hearing aids and administrative means like allotting front seats to the hearing-impaired children in the classroom be stressed. Wide publicity is desirable to make the parent, teachers and educationalists aware of serious problems, which can occur due to hearing impairment. Audiology is needed in all screening programs to cut down number of children developing hearing loss.
[047] The disclosure has been described withreference to the accompanying embodiments herein and the various features and advantageous details thereof are explained with reference to the non-limiting embodiments in the following description. Descriptions of well-known components and processing techniques are omitted so as to not unnecessarily obscure the embodiments herein.
[048] The foregoing description of the specific embodiments so fully revealed the general nature of the embodiments herein that others can, by applying current knowledge, readily modify and/or adapt for various applications such specific embodiments without departing from the generic concept, and, therefore, such adaptations and modifications should and are intended to be comprehended within the meaning and range of equivalents of the disclosed embodiments. It is to be understood that the phraseology or terminology employed herein is for the purpose of description and not of limitation. Therefore, while the embodiments herein have been described in terms of preferred embodiments, those skilled in the art will recognize that the embodiments herein can be practiced with modification within the scope of the embodiments as described herein.

We Claim:

1) A Prevalence and etiological factor of hearing impairment among school going children in rural area, the study comprises1003 children, aged 6 to 17 years, from the schools in the Doiwala block district Dehradun are randomly for examination;
wherein clinical otologic assessment and Pure tone audiometry screening is conducted on all participants.
2) The study as claimed in claim 1, wherein the prevalence of hearing impairment is 19.6%. The hearing impairment in majority of cases is of a mild degree i.e., 26 to 40 dB (93.9%) of which majority of children (99.0%) had conductive loss.
3) The study as claimed in claim 1, wherein wax is the commonest cause of hearing loss (79.2%). CSOM is found in 19.0% children.
4) The study as claimed in claim 1, wherein the prevalence of hearing impairment in school going children in rural area district Dehradun is high.
5) The study as claimed in claim 1, wherein majority of the etiological factor of hearing impairment identified are preventable. Proper assessment and diagnosis of hearing loss in children at early age is important for better development and psychosocial development.