HEARING IMPAIRMENT AND EAR PATHOLOGY IN NEPAL

A stratified random cluster sample of 15,845 subjects was performed in two regions of Nepal to determine the prevalence and main causes of h earing impairment (the most common disability) and the prevalence of e ar disease. Subjects reporting current ear pain, or ear discharge, or hearing impairment on direct questioning by a Nepali health worker (pr imary screening failed), had otoscopy and audiometry (using the Liverp ool Field Audiometer) performed, and a questionnaire administered rela ting to past history. In every fifth house subjects who passed the pri mary screening (1,716 subjects) were examined to assess the false nega tive rate of screening. An estimated 16.6 per cent of the study popula tion have hearing impairment (either ear worse than 30 dB hearing thre shold level (HTL) 1.0-4.0 kHz, or 50 dB HTL 0.5 kHz), and 7.4 per cent ear drum pathology, equivalent to respectively 2.71 and 1.48 million people extrapolated to the whole of Nepal. Most hearing impairment in the school age group (55.2 per cent) is associated with otitis media o r its sequelae. Probably at least 14 per cent of sensorineural deafnes s is preventable (7 per cent infectious disease, 3.9 per cent trauma, 0.8 per cent noise exposure, 1 per cent cretinism, and 1 per cent abno rmal pregnancy or labour). Most individuals reporting current ear path ology (61 per cent) had never attended a health post, and of those rec eiving ear drop treatment, 84 per cent still had serious pathology. Of subjects who reported ear drop treatment at any time, 31 per cent sti ll had serious pathology. The use of traditional remedies was prevalen t. In conclusion this study shows high prevalences of hearing impairme nt and ear drum pathology. To reduce hearing impairment in Nepal, part icularly in the school age group, a priority should be the effective t reatment of otitis media.