World Rural Health Conference
Home Print this page Email this page Small font size Default font size Increase font size
Users Online: 1029
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents 
ORIGINAL ARTICLE
Year : 2019  |  Volume : 8  |  Issue : 3  |  Page : 1196-1201  

Validation of a questionnaire to identify noise-induced hearing loss among drivers


1 Department of Community Medicine and Public Health, KG Medical University, Lucknow, Uttar Pradesh, India
2 Department of Civil Engineering, Rajkiya Engineering College, Banda, Uttar Pradesh, India
3 Department of Otorhinolaryngology & Head Neck Surgery, KG Medical University, Lucknow, Uttar Pradesh, India

Date of Web Publication27-Mar-2019

Correspondence Address:
Dr. Manish K Manar
Department of Community Medicine and Public Health, KG Medical University, Lucknow, Uttar Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_108_19

Rights and Permissions
  Abstract 


Objective: To assess the validity of a questionnaire (consisting of 10 items/questions) to identify hearing loss (HL) among three-wheeler tempo and noncommercial car drivers. Materials and Methods: This was a cross-sectional study conducted in an urban area of Lucknow city. Three-wheeler tempo drivers and noncommercial car drivers were assessed for HL by audiometry. A total of 300 subjects, who fulfilled the study criteria, were selected for the interview and health assessment. The pure tone audiometry was conducted after >12 hours of the last noise exposure to avoid temporary threshold shift. Results: The percentage of respondents aged between 31 and 40 years was 36%. The highest affirmative response item was “Do you have trouble hearing in noisy background?” constituting 68% and the lowest affirmative response item was “Do you have trouble understanding the speech of women and children?” constituting 33.7%. Kappa values showed that there was significantly (<0.05) mild agreement between most of the items and the gold standard for mid and high-frequency HL. The area under the curve for low, mid, and high frequency HL was 0.76% (95% CI = 0.68–0.84), 0.69 (95% CI = 0.73–0.75), and 0.67 (95% CI = 0.62–0.73), respectively. The sensitivity and specificity were reasonable for all the definition of HL at different cutoff scores. Conclusion: A self-reported questionnaire-based approach may be used for the assessment of HL especially when audiometry is not feasible.

Keywords: Hearing loss, tempo car drivers, validity


How to cite this article:
Manar MK, Shukla SP, Mohan U, Singh SK, Verma V. Validation of a questionnaire to identify noise-induced hearing loss among drivers. J Family Med Prim Care 2019;8:1196-201

How to cite this URL:
Manar MK, Shukla SP, Mohan U, Singh SK, Verma V. Validation of a questionnaire to identify noise-induced hearing loss among drivers. J Family Med Prim Care [serial online] 2019 [cited 2019 Aug 23];8:1196-201. Available from: http://www.jfmpc.com/text.asp?2019/8/3/1196/254841




  Introduction Top


Noise-induced hearing loss (HL) is one of the most common disability, affecting millions of people around the world.[1]

HL is a universal public health problem affecting people of all ages. The epidemiological data on HL severity and magnitude can be helpful in designing preventive policies. The epidemiological studies usually cover large population; however, the use of pure tone audiometry (PTA) for epidemiological studies is inadequate especially in developing countries as it requires trained professionals, technical equipment, and soundproof space for the accurate assessment of hearing. Because of operational constraints as well as costs involved in using the audiometry, many authors use the self-reported approach for the assessment of HL.[2],[3],[4]

Audiometry is a gold-standard test to evaluate the ability of hearing. However, its conduction sometimes get hindered because of the problems of access, reference, and reimbursement. Therefore, many researchers adapt the self-administered questionnaires.[5] The identification of prevalence and trends of HL in large geographical areas as well as in subgroups of risk populations, large-scale trials on hearing impairment investigations may be useful. The self-administered questionnaire-based investigations may be a quick and cheap way of providing estimates to large populations.[6] National Institute for Deafness and Communication Disorders (NIDCD) has developed a questionnaire (consisting of 10 items/questions) to assess a person's hearing ability.[7] However, the validity of NIDCD questionnaire is not validated for taxi and car drivers, especially in the Indian context. The self-reported questionnaire-based assessment of hearing could be a reliable indicator of hearing impairment. It is also quick, cheap, and easy to administer.[8]

This study was conducted to assess the validity of an NIDCD questionnaire (consisting of 10 items/questions) to identify HL among three-wheeler tempo and noncommercial car drivers.


  Materials and Methods Top


Study design

This was a cross-sectional study.

Study area

Urban area of old Lucknow.

Study participants

Light motor vehicle drivers.

Ethical approval and consent

The study was approved by the ethical committee of the institute and consent was taken from each participant before including in the study.


  Materials and Methods Top


The subjects, tempo drivers, and noncommercial car drivers, who were previously exposed to nontraffic occupational noise, had a history of diabetes mellitus illness, head injury, chronic suppurative otitis media, and who had ever been suffered from ear infection were excluded from the study. The exclusion criteria for selection of tempo drives and non-commercial car drivers were kept same except one more exclusion criterion included in the selection of non-commercial car drives, that is, those car drivers who had ever worked as commercial vehicle drivers were also excluded. The tempo drives were selected from three tempo routes (1) Chowk – Charbagh, (2) Chowk – Dubagga, and (3) Madiyaon – Kaisarbagh, and nonprofessional car drivers were selected from academic and research institutions, who were working as personal car drivers of academicians and scientists. A total of 300 subjects, 150 tempo drivers, and 150 noncommercial car drivers, who fulfilled the study criteria, were selected by using simple random sampling for the interview and health assessment.

The PTA of both the ears of the subjects was conducted minimum 12 hours after the last noise exposure to exclude the effect of temporary threshold shift.

Audiometric testing was performed using a Medical Grade MAICO (Model: MA42) Audiometer.

This was carried out by doing air conduction test at frequencies of 250, 500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz, taken for each ear in a soundproof closed room, had an ambient noise level <25 dBA.

PTA was further classified into mean threshold tonal value in the sound frequencies of 250, 500, and 1000 Hz as low-frequency HL (PTA-1), mean threshold tonal value in the sound frequencies of 2000, 3000, and 4000 Hz as mid-frequency HL (PTA-2), and mean threshold tonal value in the sound frequencies of 6000 and 8000 Hz as high-frequency HL (PTA-3). Mean threshold tonal value of PTA-1, PTA-2, and PTA-3 ≤25 dB classified as normal hearing and >25 dB classified as altered hearing. Self-reported hearing problems (SRHPs) of NIDCD questionnaires were used for assessment of HL.

Statistical analysis

Statistical analysis was done using SPSS version 23.0 for Windows (SPSS Inc., Chicago, IL, USA). The Kappa statistic was calculated to find the agreement between questions and audiometry as a gold standard. The receiving operating curve analysis was carried out. The area under the curve (AUC) with its 95% confidence interval (CI) was calculated. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Multiple logistic regression analysis was done to analyze these variables.


  Results Top


More than one-third of respondents were between 31 and 40 years of age (36%). Majority belonged to the Hindu community (42.7%) and 57% were from a backward caste. A majority of respondents were married (75.7%) and 63% belonged to the joint family. More than one-third of respondents had secondary level education [Table 1].
Table 1: Demographic profile of respondents

Click here to view


[Table 2] depicts the distribution of questionnaire item responses with audiogram results for the three definitions of HL. The highest affirmative response item was “Do you have trouble hearing in a noisy background?” constituting 68% and the lowest affirmative response item was “Do you have trouble understanding the speech of women and children?” constituting 33.7%. Kappa values showed that there was significantly (<0.05) mild agreement between most of the items and the gold standard for mid-frequency (PTA-2) and high-frequency (PTA-3) HL.
Table 2: Distribution of questionnaire item responses with audiogram results for the three definitions of hearing loss

Click here to view


The predictive values of each definition of HL were calculated. SRHP cutoff >11 for low frequency correctly detected HL among 8.3% with sensitivity and specificity of 73.5% (95% CI = 58.7–88.4) and 71.8% (95% CI = 66.4–77.2), respectively. However, SRHP cutoff >9 for middle frequency correctly detected HL among 21.3% with sensitivity and specificity of 60.4% (95% CI = 51.1–69.7) and 67.5% (95% CI = 60.9–74.1), respectively. SRHP cutoff >9 for high frequency correctly detected HL among 21% with sensitivity and specificity of 59.4% (95% CI = 50.1–68.8) and 63.9% (95% CI = 57.2–70.7), respectively [Table 3], [Table 4], [Table 5].
Table 3: Predictive value of SRHP for low-frequency HL

Click here to view
Table 4: Predictive value of SRHP for middle-frequency HL

Click here to view
Table 5: Predictive value of SRHP for high-frequency HL

Click here to view


The AUC for low-, mid-, and high-frequency HL was 0.76 (95% CI = 0.67–0.86), 0.69 (95% CI = 0.62–0.76), and 0.67 (95% CI = 0.61–0.74), respectively [Figure 1], [Figure 2], [Figure 3].
Figure 1: ROC curve showing predictive value of SRHP for low-frequency HL. HL: hearing loss, ROC: receiving operating curve, SRHP: self-reported hearing problem

Click here to view
Figure 2: Predictive value of SRHP for middle-frequency HL. HL: hearing loss, SRHP: self-reported hearing problem

Click here to view
Figure 3: Predictive value of SRHP for high-frequency HL, HL: hearing loss, SRHP: self-reported hearing problem

Click here to view



  Discussion Top


The findings of this study revealed that the use of NIDCD questionnaire to assess HL has good sensitivity; however, fair specificity as with audiometry test used, being the gold standard. These findings are adequate to support a self-administered approach in identifying hearing impairment.

The comparison of the results of this study with other studies is limited because of age range and type of study subjects. This study found low agreement between most of the question and audiogram results. The highest affirmative response item was “Do you have trouble hearing in a noisy background?” constituting 68% but had a poor agreement at all the frequencies. McCullagh reported that the 10-item questionnaire did not perform with fewer items reported in separate studies.[9]

The Epidemiology of Hearing Loss Study evaluated the validity of four questions in addition to the Hearing Handicap Inventory for the Elderly-Screening (HHIE-S) to identify hearing impairment in an older community. These questions were: “Do you feel you have a hearing loss?”; “In general, would you say your hearing is excellent, very good, good, fair, poor?”; “Have you ever worn a hearing aid or amplifying device?”; “Do your friends and relatives think you have a hearing problem?” The most sensitive (sensitivity, specificity 71%) question was, “Do you feel you have a hearing loss?” with overall prevalence estimates within 3.2% of the audiometric.[6]

Some studies have reported poor sensitivity for single questions to assess mild HL. A study conducted on 2278 people aged 40–64 years in South-East of England showed the sensitivity and specificity of a single question “Do you have difficulty in hearing and understanding most things people say, without seeing their face and lips?” to be 58.3% and 91.8%, respectively.[10]

Louw et al. evaluated self-reported HL by a single question, PTA screening by mobile phone using hearScreen Android application, and pure tone diagnostic testing by a clinical audiometer. They showed that the sensitivity and specificity of self-reported HL were 71.9 and 72.2, respectively. However, when self-reported HL and audiometry screening were combined, it showed high test accuracy (81.0%) for HL and being most accurate (86.1%) at a high-frequency HL, when compared with clinical audiometry test.[11]

We calculated the predictive values of the SRHP questionnaire in predicting HL at different HL frequency levels, that is, at low, middle, and high frequency. The findings showed that there were reasonable sensitivity and specificity for a different cutoff of SRHP score at low, middle, and high frequency. A study by Rosdina et al. found the sensitivity of the single question to be at 41.4% and 55% for the identification of at least mild and moderate HL, respectively.[12] In Singapore, Wu et al. reported the sensitivity of the question as 58%.[13] Nondahl et al. reported the sensitivity and specificity of the single question in identifying older adults with HL in the USA as 71%.[6] The performance of a set of questions or a questionnaire such as HHIE-S was found to yield better sensitivity and specificity.[14] These differences in results could reflect the difference in term of the definition used to describe HL, questions for HL identification, and population under studies.

WHO estimated that 466 million persons of the world live with disabling HL in 2018, disabling HL is unequally distributed all around the world, and South Asia is the highest contributor (27%), and also, projected that number of persons with disabling HL grows with the years, 630 million by 2030 and 900 million by 2050.[15]

The management of ear diseases of rural population is guided and strengthened by revised updated Indian Public Health Standards (IPHS) since 2012 for National Programme for Prevention and Control of Deafness (NPPCD) for rural health facilities such as subcenter, primary health center, and community health center.[16] However, even despite the existence of IPHS, the coverage and quality impact of IPHS on ear care from the primary care level are still questionable.[17]

NPPCD emphasizes on early identification of cases of hearing impairment and their management in collaboration with NRHM at the primary health care level, the detailed guidelines, and facilities essentially required have also been mentioned for all levels of health care but facility of audiometry is being not provided at the primary health care level.[18]

One of the basic challenges with the primary care physicians for hearing care of their patients is finding a suitable HL screening tool that is user-friendly, simple, affordable, and efficient. The findings of this study showed that HL could be assessed by using self-reported questionnaire protocol. Therefore, the NIDCD questionnaire may be used as a tool for screening of HL by the primary care physicians in the absence of audiometry facility.


  Conclusion Top


When audiometry is not feasible, a self-reported, questionnaire-based approach can be used as an easy, cheap, and simple tool for HL assessment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lazzarotto S, Baumstarck K, Auquier P. Age-related hearing impairment and impact on quality of life: A review of available questionnaires. Ann Otolaryngol Rhinol 2016;3:1107.  Back to cited text no. 1
    
2.
Agrawal Y, Platz EA, Niparko JK. Prevalence of hearing loss and differences by demographic characteristics among US adults: Data from the National Health and Nutrition Examination Survey, 1999-2004. Arch Intern Med 2008;168:1522-30.  Back to cited text no. 2
    
3.
Burr H, Lund SP, Sperling BB, Kristensen TS, Poulsen OM. Smoking and height as risk factors for prevalence and 5-year incidence of hearing loss. A questionnaire-based follow-up study of employees in Denmark aged 18-59 years exposed and unexposed to noise. Int J Audiol 2005;44:531-9.  Back to cited text no. 3
    
4.
Cruz MS, Oliveira LR, Carandina L, Lima MC, César CL, Barros MB, et al. Prevalence of self-reported hearing loss and attributed causes: A populationbased study. Cad Saude Publica 2009;25:1123-31.  Back to cited text no. 4
    
5.
Gates GA, Murphy M, Rees TS, Fraher A. Screening for handicapping hearing loss in the elderly. J Fam Pract 2003;52:56-62.  Back to cited text no. 5
    
6.
Nondahl DM, Karen JC, Wiley TL, Tweed TS, Klein R, Klein BEK. Accuracy of self-reported hearing loss. Audiology 1998;37:295-301.  Back to cited text no. 6
    
7.
NIDCD. Ten ways to recognize hearing loss. Available from: http://www.nidcd.nih.gov/health/hearing/10ways.htm. [Last accessed on 2019 Jan 24].  Back to cited text no. 7
    
8.
Sindhusake D, Mitchell P, Smith W, Golding M, Newall P, Hartley D, et al. Validation of self-reported hearing loss. The blue mountains hearing study. Int J Epidemiol 2001;30:1371-8.  Back to cited text no. 8
    
9.
McCullagh MC. Validation of a questionnaire to identify hearing loss among farm operators. Noise Health 2012;14:32-8.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
D'Souza MF, Irwig LM, Trevelyan HT, Swan AV, Shannon D, Tuckman E, et al. Deafness in middle age—how big is the problem? J Roy Coll Gen Pract 1975;25:472-8.  Back to cited text no. 10
    
11.
Louw C, Swanepoel DW, Eikelboom RH. Self-reported hearing loss and pure tone audiometry for screening in primary health care clinics. J Prim Care Community Health 2018;9:1-8.  Back to cited text no. 11
    
12.
Rosdina A, Leelavathi M, Zaitun A, Lee V, Azimah M, Majmin S, et al. Self-reported hearing loss among elderly Malaysians. Malays Fam Physician 2010;5:91-4.  Back to cited text no. 12
    
13.
Wu HY, Chin JJ, Tong HM. Screening for hearing impairment in a cohort of elderly patients attending a hospital geriatric medicine service. Singapore Med J 2004;45:79-84.  Back to cited text no. 13
    
14.
Tomioka K, Ikeda H, Hanaie K, Morikawa M, Iwamoto J, Okamoto N, et al. The hearing handicap inventory for elderly-screening (hhie-s) versus a single question: Reliability, validity, and relations with quality of life measures in the elderly community, Japan. Qual Life Res 2013;22:1151-59.  Back to cited text no. 14
    
15.
World Health Organization. Addressing the rising prevalence of hearing. Available from: 2018.https://www.who.int/pbd/deafness/estimates/en. [Last accessed on 2019 Feb 13].  Back to cited text no. 15
    
16.
Government of India, Ministry of Health and Family Welfare. National Programme for Prevention and Control of Deafness; 2016. Available from: http://www.dghs.gov.in/content/1362_3_NationalProgrammePreventionControl.aspx. [Last accessed on 2019 Feb 08].  Back to cited text no. 16
    
17.
Indian Public Health Standards for Sub-centres, Primary Health Centres, Community Health Centres, Government of India, Ministry of Health and Family Welfare. Available from: http://www.nhm.gov.in/nhm/nrhm/guidelines/indian-public-health-standards.html. [Last accessed on 2019 Feb 13].  Back to cited text no. 17
    
18.
Davey S, Maheshwari C, Raghav SK, Singh N, Muzammil K, Pandey P. Impact of Indian public health standards for rural health care facilities on national programme for control of deafness in India: The results of a cohort study. J Family Med Prim Care 2018;7:780-6.  Back to cited text no. 18
[PUBMED]  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

Top
   
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
   Abstract
  Introduction
   Materials and Me...
   Materials and Me...
  Results
  Discussion
  Conclusion
   References
   Article Figures
   Article Tables

 Article Access Statistics
    Viewed311    
    Printed4    
    Emailed0    
    PDF Downloaded45    
    Comments [Add]    

Recommend this journal