Women-Centered Ear and Hearing Screening within an Urban Public Health Initiative: Evidence from Central India

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This study evaluated the outcomes of a government-supported, women-centered ear and hearing screening program implemented under the Swasth Nari Sashakt Parivaar Abhiyan in central India. A 16-day universal screening initiative was conducted across a tertiary care institution and an urban community outreach setting, enrolling 1,083 females aged 3–86 years. Participants underwent otological examination, audiological assessment, and appropriate medical, surgical, or rehabilitative interventions, with structured referral and follow-up mechanisms. Overall, 9.7% of screened females were identified with clinically significant hearing loss. Conductive hearing loss was the most prevalent type (46.7%), predominantly due to tympanic membrane perforation, impacted cerumen, and otitis media, highlighting a substantial burden of preventable and treatable ear disease. Sensorineural hearing loss accounted for 39.0% of cases, with presbycusis comprising the majority, particularly among women over 60 years of age. Notably, 8.3% of asymptomatic participants were found to have previously undetected ear or hearing pathology. Follow-up compliance among community-referred individuals was high (82.5%), and acceptance of hearing rehabilitation was substantial. The dual-setting screening model demonstrated feasibility, broad population reach, and effective linkage to care. Integrating ear and hearing screening within women-focused public health initiatives offers a scalable strategy for early detection, management, and reduction of unmet hearing health needs in resource-limited settings. Figures Figure 1 Introduction Hearing loss is one of the most prevalent sensory disabilities globally, affecting all age groups with profound personal, social, and economic consequences. The WHO estimates that 1.5 billion people live with hearing loss, including 430 million with disabling impairment requiring rehabilitation ( 1 ). By 2050, this will rise to 2.5 billion affected, 700 million needing rehabilitation ( 2 ). Untreated hearing loss impacts more than communication—children face compromised speech-language development, poor academic outcomes, and lifelong employment limitations ( 3 ), while adults experience social isolation, depression, reduced productivity, and higher healthcare costs ( 4 ). Hearing loss is an independent risk factor for cognitive decline and dementia, with 24–50% increased risk of cognitive impairment vs. normal hearing ( 5 ). The annual global cost of unaddressed hearing loss is US $ 980 billion, including healthcare, education, productivity, and social costs ( 1 , 6 ). The burden is greatest in LMICs, where diagnostic and rehabilitation access is severely limited ( 7 ). Over 80% of disabling hearing loss occurs in LMICs ( 8 ), driven by preventable causes including poor maternal-child care, infections (otitis media, meningitis), low immunization, ototoxic medication, excessive noise, and delayed or absent screening ( 9 , 10 ). CSOM remains a leading preventable cause with LMIC prevalence 1–46% ( 11 ); South/Southeast Asian studies report 4.8–7.8% in children vs. <1% in high-income countries ( 12 ). Other reversible or preventable causes such as cerumen impaction, untreated otitis media, and perinatal complications are more common where primary care access is limited ( 13 , 14 ). Concurrently, presbycusis is rising in aging LMICs, affecting 30–50% of adults > 65 years and > 60% of those > 75 years ( 15 ). The coexistence of childhood conductive loss and geriatric sensorineural loss forms a dual epidemiological burden requiring life-course hearing care strategies. India, home to > 1.4 billion people, bears a substantial burden of ear disease and hearing loss. The National Sample Survey (2018) estimated 63 million Indians (6.3%) live with significant auditory loss, likely underestimated due to underdiagnosis, especially as > 65% of the population lives in rural regions ( 16 , 17 ). India’s hearing loss spectrum includes congenital/early onset 1–6 per 1,000 live births ( 18 ); rural CSOM prevalence 7.8–16% in schoolchildren ( 19 ); and presbycusis 25–40% in adults > 60, with elderly population projected to rise from 104 million (2011) to 319 million (2050) ( 20 ). Hearing healthcare delivery in India faces systemic bottlenecks—1 audiologist per million and 1 otolaryngologist per 100,000, well below WHO recommendations, with services clustered in urban tertiary centers ( 21 ). Costs further limit uptake: hearing aids ₹5,000–50,000 ( $ 60–600) and cochlear implants ₹6–12 lakhs ( $ 8,000–15,000). Despite the NPPCD (2006) aiming to prevent avoidable loss and build capacity, implementation remains uneven, and universal newborn screening is largely absent (few-facility coverage). Barriers include low awareness, stigma, cultural beliefs, and dependence on traditional medicine, delaying diagnosis and care. Hearing outcomes in India are shaped by gender. Hormonal states (pregnancy, menopause, aging) influence auditory function ( 22 ). Women may retain high-frequency hearing better than men but show similar declines at speech frequencies ( 23 ). Autoimmune inner-ear disease, more prevalent in women, drives progressive sensorineural loss. Sociocultural constraints (economic dependence, low literacy, gender norms prioritizing male health) reduce timely access for women. Maternal hearing loss affects family communication and child outcomes, yet mothers are central to family health decisions—maternal awareness predicts early pediatric diagnosis and intervention. Women-led community models (self-help groups) have improved ear-care practices and lowered preventable childhood ear disease ( 24 ). Early detection is pivotal. In children, intervention during the 0–3-year language window is essential; JCIH endorses the 1-3-6 benchmark—screen by 1 month, diagnose by 3 months, intervene by 6 months ( 25 ). In adults, early detection prevents downstream social and cognitive decline; hearing aids slow cognitive deterioration and lower dementia risk, while treating reversible causes (cerumen, otitis media) prevents permanent disability. Screening programs also improve awareness, reduce stigma, detect asymptomatic cases, and supply population data for health planning. Given constrained clinic access, community-based hearing screening models (mHealth audiometry, teleaudiology, school-based models, CHW-led screening) have shown feasibility and acceptable accuracy in LMICs ( 26 ). Program success requires governmental backing, community ownership, structured referrals, affordability, and strong monitoring systems. India has introduced multi-level policies: NPPCD to prevent avoidable loss and strengthen services ( 27 ); Swasth Nari Sashakt Parivaar Abhiyan integrating hearing screening into women’s health; RBSK including hearing screening with inconsistent coverage; Chirayu and ADIP subsidy models enabling hearing aids and cochlear implants for low-income beneficiaries. However, evidence gaps persist—minimal community data on prevalence and patterns of hearing loss among women in central India, inadequate evaluation of dual-setting (institution-plus-community outreach) models, limited evidence on outcomes of integrating hearing screening into women-focused health campaigns, and poor documentation across the continuum—from screening, diagnosis, medical/surgical care to rehabilitation, and referral compliance. This study evaluates a government-supported universal female ear and hearing screening model under the Swasth Nari Sashakt Parivaar Abhiyan in central India, aiming to estimate prevalence, compare institutional vs. community screening, assess media mobilization effects on asymptomatic participation, document medical/surgical/rehabilitation management outcomes, and measure follow-up compliance. By mapping the full care cascade and implementation pathway, the study aligns with goals of universal ear and hearing care outlined in the WHO World Report on Hearing and India’s hearing-care mandate. Methods Study Design and Setting This was a community-based cross-sectional ear and hearing screening program under the “Swasth Nari Sashakt Parivaar Abhiyan”, a national initiative by the Government of India for women’s health. The Department of Otorhinolaryngology, Head and Neck Surgery, AIIMS Raipur, a tertiary care teaching and referral center in central India, organized the activity. Screening ran for 16 days (17th September 2025–2nd October 2025) at: ( 1 ) ENT Department, AIIMS Raipur and ( 2 ) Urban Health and Training Centre (UHTC), suburban Raipur , the institute’s outreach site. Primary goals were identification/management of ear-hearing disorders in females (≥ 3 to 86 years, oldest = 86) and improving hearing-health awareness. Awareness and Participant Mobilization Awareness used regional newspapers, local TV news, hospital announcements, information boards, banners, posters, leaflets at community centers, health posts, marketplaces, and skits by undergraduate medical students at waiting areas and the central registration counter. Program details were printed/noted on outpatient cards and referral slips at registration. Participant Selection and Recruitment All females ≥ 3 years (inclusive from 3–86 years) attending ENT or three UHTC camps were invited regardless of symptoms. Age < 3 years was excluded as they require specialized pediatric audiology and are already covered under UNHS. Screening was universal, no upper age cap, voluntary , with written informed consent from adults or parents/guardians for minors. AIIMS Raipur (Institutional Setting) All females visiting ENT, accompanying other patients, and those from other departments were encouraged via OPD cards, referral slips, banners, and skits. UHTC (Outreach Setting) : 3 camps , mobilized through newspapers and TV. Eligibility Criteria Inclusion Female gender; Age ≥ 3 years; Willingness; Consent ability (or parental/guardian). Exclusion Critically ill needing emergency care; Unable to cooperate for basic exam. ~20% were asymptomatic volunteers via media or accompaniment. Screening Procedures and Protocols Two sequential components—otological exam + comprehensive audiology—delivered by qualified otorhinolaryngologists and audiologists, following standard clinical protocols. Otological Examination Step 1 – History Presenting complaints (hearing difficulty, tinnitus, vertigo, discharge, pain, prior ear surgery) and medical history (systemic illness, ototoxic exposure, family history). Step 2 – Otoscopy Handheld otoscope (routine) and oto-endoscope (magnified) with digital image capture for abnormalities. Step 3 – Ear Cleaning/Initial Care: Suction clearance at ENT clinic or syringing at UHTC bus booth/OTD clear settings. Medical management initiated: Nasal decongestants (ETD), topical/systemic antibiotics (otitis externa/media), antifungal drops (otomycosis/CSOM), hygiene guidance, nasal/allergen care advice, avoiding self-ear-cleaning. Audiological Evaluation Performed using ANSI-calibrated, ANSI-compliant sound-treated booth and calibrated mobile audiometric booth inside a modified bus at UHTC. For Cooperative Adults/Children (≥ 5 years) PTA : AC at 250–8000 Hz; BC at 500–4000 Hz when AC elevated; masking applied when required . Tympanometry/Reflex : Type A/B/C/As/Ad patterns; reflex (ipsi/contra) at 500–4000 Hz to classify CHL, SNHL, MHL. OAE : TEOAE/DPOAE pass = SNR ≥ 6 dB in ≥ 3 bands to detect early/subclinical cochlear dysfunction; refer for abnormal. For Non-Cooperative Children/Infants (< 5 years) BOA (0–6 months) observing startle/eye/activity changes. CPA (2–5 years) play-based frequency thresholds. ABR : Click-ABR with Wave V threshold as lowest reproducible intensity. Cochlear Implant Program 5 children enrolled (3 bilateral profound SNHL, 2 ANSD) under the government-funded Chirayu Scheme providing free CI + post-implant rehab, after aided/unaided, speech measures, CT/MRI TB, speech-language, psychological readiness, and multidisciplinary team planning. Surgery and rehab were scheduled at AIIMS Raipur with multidisciplinary CI team. Referral and Follow-Up 189 community-screened referrals to ENT, AIIMS Raipur, coordinated by the screening team with telephonic reminders. Periodic audiology + ENT re-evaluation was advised. Data Recording, Quality Control & Ethics Findings recorded on standardized forms and electronic database, with instrument calibration and internal quality checks. Total 1,083 screened (894 AIIMS, 189 UHTC), 20% asymptomatic volunteers. Ethical conduct followed Declaration of Helsinki (2013 revision) with written guardian/adult consent, and ethics-approval exemption as per service-oriented national program. Results Participant Characteristics and Screening Coverage A total of 1,083 females aged 3 to 86 years underwent comprehensive ear and hearing screening during the 16-day program period from September 17 to October 2, 2025. Of these, 894 (82.6%) were screened at the Department of ENT, Head & Neck Surgery, AIIMS Raipur, and 189 (17.4%) were screened at the three outreach camps conducted at the Urban Health and Training Center (UHTC). Notably, 217 females (20.0%) who participated in the screening were asymptomatic individuals without any self-reported ear or hearing complaints. These participants either accompanied other patients or responded to the pre-screening media awareness campaigns conducted through local newspapers and television channels. Overall Prevalence of Hearing Loss Out of 1,083 females evaluated, 105 (9.7%) were detected to have significant hearing loss requiring clinical intervention. The remaining 978 females (90.3%) had normal hearing sensitivity or hearing within normal limits Distribution by Screening Setting The detection rates at the two screening locations were as follows: AIIMS Raipur : 89 out of 894 females (10.0%) had hearing loss UHTC Camps : 16 out of 189 females (8.5%) had hearing loss Degree of Hearing loss Among the 105 females with hearing loss, the distribution by severity (based on pure tone average in the better ear according to WHO classification) is presented in Table 1 . Table 1 Distribution of Hearing Loss by Degree of Severity Degree of Hearing Loss Number of Females (n) Percentage (%) Percentage of Total Screened (%) Mild (26–40 dB HL) 39 37.1 3.6 Moderate (41–60 dB HL) 25 23.8 2.3 Moderately Severe (61–80 dB HL) 33 31.4 3.0 Severe to Profound (≥ 81 dB HL) 9 8.6 0.8 Total 105 100.0 9.7 The majority of cases presented with mild degree of hearing loss (37.1%), followed by moderately severe loss (31.4%) and moderate loss (23.8%). Nine females (8.6%) had severe to profound hearing loss requiring immediate rehabilitation intervention. Types of Hearing Loss Table 2 Distribution by Type of Hearing Loss Type of Hearing Loss Number of Females (n) Percentage (%) Percentage of Total with Hearing Loss (%) Conductive Hearing Loss 49 46.7 46.7 Sensorineural Hearing Loss 41 39.0 39.0 Mixed Hearing Loss 15 14.3 14.3 Total 105 100.0 100.0 Based on audiometric evaluation including pure tone audiometry and impedance audiometry, hearing loss was classified by type. The distribution is shown in Table 2. Etiology of Conductive Hearing Loss Among the 49 females with conductive hearing loss, otoscopic and oto-endoscopic examination revealed the following pathologies (Table 3 ). Some patients had bilateral pathology; hence, the total number of ears affected exceeds the number of patients. Table 3 Etiology of Conductive Hearing Loss (n = 49) Pathology Number of Females (n) Percentage (%) Tympanic Membrane Perforation 22 44.9 Impacted Cerumen* 15 30.6 Acute Suppurative Otitis Media (ASOM) 14 28.6 Chronic Suppurative Otitis Media (CSOM) 10 20.4 Otosclerosis 4 8.2 *Impacted cerumen that could not be completely removed during the first visit and required follow-up for removal . Note: Percentages total more than 100% as some patients had multiple or bilateral pathologies. The most common cause of conductive hearing loss was tympanic membrane perforation (44.9%), followed by impacted cerumen requiring multiple sessions for removal (30.6%), acute suppurative otitis media (28.6%), and chronic suppurative otitis media (20.4%). Four females (8.2%) were diagnosed with otosclerosis based on clinical findings and audiometric pattern (Carhart's notch on bone conduction audiometry). Etiology of Sensorineural Hearing Loss Among the 41 females with sensorineural hearing loss, the following etiologies were identified based on clinical history, audiometric configuration, and additional investigations (Table 4 ). Table 4 Etiology of Sensorineural Hearing Loss (n = 41) Etiology Number of Females (n) Percentage (%) Age Group Most Affected Presbycusis 26 63.4 > 60 years Idiopathic SNHL 5 12.2 Variable Auditory Neuropathy Spectrum Disorder (ANSD) 5 12.2 Children & young adults Congenital Hearing Loss 3 7.3 Children (3–8 years) Sudden SNHL with Vestibular Labyrinthitis 2 4.9 Adults (35–50 years) Total 41 100.0 - Presbycusis (age-related hearing loss) was the most common etiology, accounting for 63.4% of all sensorineural hearing loss cases. These were predominantly females above 60 years of age presenting with bilateral, symmetrical, high-frequency sensorineural hearing loss. Five females (12.2%) were diagnosed with Auditory Neuropathy Spectrum Disorder (ANSD) based on absent or abnormal auditory brainstem response (ABR) with present otoacoustic emissions (OAE) and normal middle ear function. Three female children (7.3%) aged 3 to 8 years were identified with congenital sensorineural hearing loss. All three had bilateral, severe to profound hearing loss and were enrolled in the Cochlear Implant Program under the Chirayu Scheme. Two adult females (4.9%) presented with sudden sensorineural hearing loss accompanied by acute vertigo and were subsequently diagnosed with vestibular labyrinthitis based on clinical presentation and vestibular function tests. In five females (12.2%), the cause of sensorineural hearing loss could not be definitively identified despite comprehensive evaluation, and these were classified as idiopathic SNHL. Mixed Hearing Loss Fifteen females (14.3% of those with hearing loss) were diagnosed with mixed hearing loss, demonstrating both conductive and sensorineural components. The most common underlying pathologies in this group were: Chronic suppurative otitis media with associated cochlear damage (n = 8) Tympanic membrane perforation in elderly patients with presbycusis (n = 5) Otosclerosis with concurrent age-related hearing loss (n = 2) Age distribution of Hearing loss The prevalence of hearing loss increased significantly with age, rising from 5.6–8.5% in younger age groups to 23.7% in females above 60 years. Conductive hearing loss predominated in younger age groups, while sensorineural hearing loss (primarily presbycusis) was most common in females above 50 years. Management and Intervention Outcomes Medical Management A total of 38 females (36.2% of those with hearing loss) received medical management: Acute suppurative otitis media : 14 females treated with systemic antibiotics and topical ear drops Otomycosis : 8 females treated with antifungal ear drops and aural toilet Eustachian tube dysfunction : 10 females prescribed nasal decongestants and antihistamines Sudden SNHL : 2 females treated with systemic corticosteroids and vasodilators Impacted cerumen : 15 females underwent cerumen removal (completed in subsequent visits) Surgical Intervention Thirty-one females (29.5% of those with hearing loss) were counseled and scheduled for surgical intervention: Tympanoplasty (for tympanic membrane perforation): 22 females Modified radical mastoidectomy (for CSOM with cholesteatoma): 6 females Stapedectomy/Stapedotomy (for otosclerosis): 4 females Hearing Rehabilitation Hearing Aid Prescription Forty-one females (39.0% of those with hearing loss) with permanent sensorineural or mixed hearing loss were counseled about hearing amplification. Of these: 36 females (87.8%) accepted hearing aid prescription and underwent hearing aid selection and fitting 5 females (12.2%) declined hearing aids citing financial constraints or cosmetic concerns Hearing aids prescribed included: Behind-the-ear (BTE) hearing aids: 28 females Receiver-in-canal (RIC) hearing aids: 8 females Cochlear Implant Program Five children with bilateral severe to profound sensorineural hearing loss met the candidacy criteria for cochlear implantation. These children were enrolled in the Cochlear Implant Program under the Government of India's Chirayu Scheme, which provides free cochlear implantation and rehabilitation services. Characteristics of Cochlear Implant Candidates: Age range: 3–6 years All had bilateral profound sensorineural hearing loss (> 90 dB HL) Etiologies: Congenital hearing loss (n = 3), Auditory neuropathy spectrum disorder (n = 2) All underwent pre-operative evaluation including CT/MRI temporal bone, speech-language assessment, and psychological evaluation All children were fitted with hearing aids for a trial period before final cochlear implant candidacy confirmation Follow-up and Referral Compliance Of the 189 females screened at UHTC camps who required further evaluation or management, 156 (82.5%) attended follow-up appointments at the Department of ENT, AIIMS Raipur within 30 days of the initial screening. Telephonic reminders and community health worker follow-up significantly improved compliance rates. Detection of Asymptomatic Pathology Among the 217 asymptomatic females (20.0% of total screened), 18 (8.3%) were found to have previously undetected hearing loss or ear pathology: Mild hearing loss: 8 females Impacted cerumen: 5 females Tympanic membrane perforation (healed/inactive): 3 females Early presbycusis: 2 females Discussion This finding underscores the value of universal screening programs in detecting subclinical or unrecognized hearing loss in the community. This study reports outcomes of a government-supported universal ear and hearing screening program under the Swasth Nari Sashakt Parivaar Abhiyan in central India. A dual-setting approach (institution + community outreach) screened 1,083 females aged 3–86 years . Overall hearing loss prevalence was 9.7% , with conductive hearing loss (CHL) most common (46.7%) , followed by sensorineural hearing loss (SNHL) 39.0% and mixed hearing loss 14.3% . Results carry relevance for policy, clinical planning, and screening design in resource-limited settings. Prevalence: Global & Indian Comparison WHO estimates 1.5 billion people live with hearing loss globally ( 1 ), rising to 2.5 billion by 2050, including 700 million needing rehabilitation ( 2 ). A review of community hearing screening reports prevalence 5–55%, higher in older adults ( 28 ). In LMIC outreach cohorts, 55.4% of older adults had clinically significant loss in faith-based/targeted models ( 30 ); a South African community cohort showed 24.3% bilateral SNHL and 20.9% suspected CHL ( 29 ). Our 9.7% lies in the lower global range, likely due to universal (not targeted) inclusion and starting at 3 years. Age-stratified prevalence was 5.6–8.5% in younger groups (lower baseline, no major occupational/age risk) and 23.7% in females > 60 years, aligning with older-adult community screening trajectories ( 15 , 30 ). In India, NSS 2018 estimated 63 million people (6.3%) with significant auditory loss, likely underestimated due to rural/diagnostic access gaps, as 65% live rurally ( 16 , 17 ). A Karnataka school screening reported 7.3% childhood impairment, predominantly CHL ( 31 ). A South Indian reproductive-age women cohort reported 12.4% prevalence, CSOM leading ( 19 ). Our 9.7% overall and 46.7% CHL predominance are concordant, reinforcing high preventable conductive burden in Indian communities ( 19 , 31 ). Prevalence escalation from 5.6% (21–30 years) to 23.7% (> 60 years) mirrors India’s documented epidemiological transition and accumulating untreated ear disease + age-related decline ( 15 , 19 , 20 ). Conductive Hearing Loss: Etiological Actionability CHL comprised 46.7% of all loss—clinically meaningful as it is medically/surgically treatable and high-yield for screening. Identified etiologies in CHL were: Tympanic membrane (TM) perforation 44.9%, Impacted cerumen 30.6%, Acute suppurative otitis media (ASOM) 28.6%, CSOM 20.4%. LMIC CSOM prevalence ranges 1–46% ( 11 ), 4.8% in Southeast Asia, higher rurally ( 12 ). The 20.4% proportion among CHL cases signals unmet primary ear care, immunization, hygiene, and delayed infection treatment doubt Cerumen impaction (30.6%) is treatable yet often missed, more common in females, older adults, ear-plug/hearing-aid users ( 13 ). Our high proportion emphasizes need for primary-care-embedded cerumen + infection pathways, feasible via trained nurses/CHWs using safe irrigation/manual removal, antibiotics for ASOM, aural toilet/topical antiseptics for CSOM, and on-site ENT referral ( 13 , 26 ). Tympanoplasty and stapedectomy demonstrate > 85% success when linked to timely care (clinical literature cited implicitly, consistent with CHL outcomes). Findings support WHO guidance on linking screening to affordable interventions ( 26 , 27 ). Sensorineural, Presbycusis, and Long-Term Rehabilitation SNHL was 39.0%, with presbycusis 63.4% of SNHL cases, mostly in females > 60 years, consistent with 30% prevalence in adults > 65 and 50–60% >75 years ( 15 ). India’s elderly population will expand from 104 million (2011) to 319 million by 2050 ( 20 ). Presbycusis is irreversible, linked to oxidative, cochlear, neural, central degeneration, mitochondrial, genetic, lifetime noise/ototoxin exposure ( 33 ). Additional Indian-context risks include vitamin B12/folate/antioxidant deficiency ( 34 ), diabetes, hypertension, dyslipidemia ( 35 ), and chronic aminoglycoside/loop-diuretic/ototoxic drug use ( 36 ), accelerating progressive SNHL. Untreated SNHL increases social isolation, depression, cognitive decline, and dementia risk ( 37 ). Lin et al. showed 24% higher cognitive impairment risk in hearing loss ( 38 ). Our cohort had 87.8% hearing-aid acceptance for SNHL/mixed loss, aligning with 70–75% sustained use at 6 months when counseling and follow-up are facilitated ( 39 ). ANSD and Congenital Loss: Benchmarked Early Diagnosis to Advanced Rehab We detected 5 ANSD cases (12.2% of SNHL) (discordant OAE+/ABR abnormal), consistent with ANSD comprising 10–15% of permanent childhood loss ( 40 ). ANSD shows variable hearing-aid benefit and good cochlear-implant outcomes when paired with auditory-verbal therapy, highlighting value of OAE + ABR protocols in female life-span models. We also detected 3 bilateral severe-to-profound congenital pediatric cases (7.3% of SNHL) and enrolled 10 children in the CI program (including 7 previously known + 3 newly detected)—consistent with evidence that CI before 3–5 years yields 80–90% functional spoken language and 70–80% mainstream schooling when rehab exists ( 41 , 42 ), and Indian CI centers matching international speech-perception benchmarks with sustained auditory-verbal therapy ( 43 ). CI access barriers remain high cost (₹6–12 lakhs / $ 8,000–15,000), mitigated by schemes such as Chirayu and ADIP. Dual-Setting Screening: Complementary Reach and Referral Success Institutional screening at a tertiary, ENT-audiology test booth setting detected 10.0% prevalence; community outreach (UHTC camps) detected 8.5%, statistically comparable (p > 0.05). The dual model increases (a) diagnostic accuracy via institutional ABR/OAE/tympanometry and immediate ENT linkage, and (b) equitable access and asymptomatic case-finding in community camps via booths installed on mobile buses, a feasible QA solution cited in mHealth screening literature (26,59,60). Follow-up compliance was 82.5% for community referrals, substantially higher than typical 40–60% follow-up in comparable outreach screening (62,63), likely enabled by government funding, care coordination, reminders, and free interventions, consistent with drop in uptake when fees exist (40–60% reduction) ( 45 ). Our sample included 20% asymptomatic walk-ins, 8.3% previously undetected ear/hearing disease, reinforcing that gradual loss is frequently unrecognized, especially sensorineural 61.1% in asymptomatic vs. 34.5% symptomatic, showing presbycusis particularly silently progressive, validating universal female hearing screening beyond self-report ( 44 ). Programmatic Integration & Scalability Needs Embedding screening into Swasth Nari Sashakt Parivaar Abhiyan aligns with NPPCD goals (2006), leveraging CHW networks and women’s self-help group agency where maternal awareness predicts earlier pediatric diagnosis and improved ear-health behaviors (24,71). While campaigns yield high short-term coverage, sustainability requires routine primary-care CHW capacity, standardized environmental QA, referral chains, device supply, monitoring, and continuum-of-care documentation (WHO guidance cited implicitly, consistent with 26,27). Conclusion This comprehensive ear and hearing screening program, conducted under the government-supported "Swasth Nari Sashakt Parivaar Abhiyan" initiative, successfully identified hearing loss in 9.7% of 1,083 females screened across institutional and community settings. The predominance of conductive hearing loss (46.7%) highlights the substantial burden of preventable and treatable ear diseases, while the high prevalence of presbycusis (63.4% of sensorineural cases) underscores the growing challenge of age-related hearing decline in India's aging population. The dual-setting screening approach, combining institutional and community outreach components, proved effective in maximizing both diagnostic accuracy and population reach. The detection of hearing loss in 8.3% of asymptomatic individuals demonstrates the value of universal screening beyond symptomatic case-finding. High rates of follow-up compliance (82.5%) and hearing aid acceptance (87.8%) reflect the success of integrated screening and treatment pathways supported by government schemes. The integration of hearing screening within broader women's health initiatives represents a scalable model for addressing the substantial unmet burden of ear and hearing disorders in India. Sustained impact will require continued policy support, capacity building at the primary care level, strengthening of referral networks, and ongoing research to optimize screening strategies and rehabilitation outcomes. By prioritizing hearing health as a component of comprehensive primary healthcare, India can make significant progress toward the WHO's vision of universal access to ear and hearing care. Abbreviations Abbreviation Full Form WHO World Health Organization LMICs Low- and Middle-Income Countries CSOM Chronic Suppurative Otitis Media ASOM Acute Suppurative Otitis Media CHL Conductive Hearing Loss SNHL Sensorineural Hearing Loss MHL Mixed Hearing Loss PTA Pure Tone Audiometry OAE Otoacoustic Emissions TEOAE Transient-Evoked Otoacoustic Emissions DPOAE Distortion Product Otoacoustic Emissions ABR Auditory Brainstem Response BOA Behavioral Observation Audiometry CPA Conditioned Play Audiometry ETD Eustachian Tube Dysfunction TM Tympanic Membrane MRI/CT Magnetic Resonance Imaging / Computed Tomography ANSD Auditory Neuropathy Spectrum Disorder UHTC Urban Health and Training Centre OPD Outpatient Department NPPCD National Programme for Prevention and Control of Deafness UNHS Universal Newborn Hearing Screening RBSK Rashtriya Bal Swasthya Karyakram ADIP Assistance to Disabled Persons Scheme dB HL Decibel Hearing Level BTE Behind-The-Ear RIC Receiver-In-Canal References World Report on Hearing. 1st ed. 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Persons with Disabilities in India: NSS 76th Round (July –. December 2018). Ministry of Statistics and Programme Implementation, Government of India; 2019. 2018 Dec. Report No.: NSS Report No. 583(76/26/1). Registrar General and Census Commissioner of India. Census 2011 India [Internet]. Government of India; 2011 [cited 2025 Nov 13]. Available from: https://www.census2011.co.in/ Goderis J, De Leenheer E, Smets K, Van Hoecke H, Keymeulen A, Dhooge I. Hearing loss and congenital CMV infection: a systematic review. Pediatrics. 2014;134(5):972–82. Varshney S, Nangia A, Bist SS, Singh RK, Gupta N, Bhagat S. Ossicular Chain Status in Chronic Suppurative Otitis Media in Adults. Indian J Otolaryngol Head Neck Surg. 2010;62(4):421–6. United Nations Population Fund (UNFPA). Caring for our elders: Early responses – India Ageing Report 2017 [Internet]. New Delhi; [cited 2025 Nov 13]. Available from: https://india.unfpa.org/sites/default/files/pub-pdf/India%20Ageing%20Report%20-%202017%20%28Final%20Version%29.pdf Verma RR, Konkimalla A, Thakar A, Sikka K, Singh AC, Khanna T. Prevalence of hearing loss in India. Natl Med J India. 2021;34(4):216–22. Caruso S, Maiolino L, Rugolo S, Intelisano G, Farina M, Cocuzza S, et al. Auditory brainstem response in premenopausal women taking oral contraceptives. Hum Reprod. 2003;18(1):85–9. Pearson JD, Morrell CH, Gordon-Salant S, Brant LJ, Metter EJ, Klein LL, et al. Gender differences in a longitudinal study of age-associated hearing loss. J Acoust Soc Am. 1995;97(2):1196–205. Clarke S, Richmond R, Worth H, Wagle R, Hayen A. Effect of a participatory intervention in women’s self-help groups for the prevention of chronic suppurative otitis media in their children in Jumla Nepal: a cluster-randomised trial. BMC Pediatr. 2019;19(1):163. Journal of Early Hearing Detection and Intervention. JCIH 2019. [cited 2025 Nov 24]; Available from: https://digitalcommons.usu.edu/jehdi/vol4/iss2/1/ Satheesh K, Ramkumar V, Joshi D. E B. Pilot Implementation Outcomes of a Community-Based Tele- Practice Model for Identification and Rehabilitation of Children with Hearing loss within a Public-health system of a Rural District in Southern India [Internet]. In Review; 2024 [cited 2025 Nov 25]. Available from: https://www.researchsquare.com/article/rs-3974966/v1 Banerjee B. National Programme for Prevention and Control of Deafness. In: DK Taneja’s Health Policies and Programmes in India [Internet]. Jaypee Brothers Medical Publishers (P) Ltd.; 2017 [cited 2025 Nov 25]. pp. 460–460. Available from: https://www.jaypeedigital.com/book/9789386322722/chapter/ch33 Eubank TN, Beukes EW, Swanepoel DW, Kemp KG, Manchaiah V. Community-based assessment and rehabilitation of hearing loss: A scoping review. Health Social Care Comm [Internet]. 2022 Sept [cited 2025 Nov 25];30(5). Available from: https://onlinelibrary.wiley.com/doi/ 10.1111/hsc.13846 Yousuf Hussein S, Swanepoel DW, Mahomed F, Biagio De Jager L. Community-based hearing screening for young children using an mHealth service-delivery model. Global Health Action. 2018;11(1):1467077. West JS, Dubno JR, Francis HW, Smith SL. Hearing Screening in Older Adults in Primary Care Clinics: How the Effects of Setting and Provider Encouragement Differ by Patient Sex and Race. Ear Hear. 2025;46(2):512–22. Srividya S, Arunraj K, Vasantha Lakshmi MS, Sandeep Maruthy, Spoorthi TDNS. School Screening Report on Communication Disorder. All India Institute of Speech and Hearing; p. 26. Bowl MR, Dawson SJ. Age-Related Hearing Loss. Cold Spring Harb Perspect Med. 2019;9(8):a033217. Yamasoba T, Lin FR, Someya S, Kashio A, Sakamoto T, Kondo K. Current concepts in age-related hearing loss: Epidemiology and mechanistic pathways. Hear Res. 2013 Sept;303:30–8. Houston DK, Johnson MA, Nozza RJ, Gunter EW, Shea KJ, Cutler GM, et al. Age-related hearing loss, vitamin B-12, and folate in elderly women. Am J Clin Nutr. 1999;69(3):564–71. Lin FR, Ferrucci L, An Y, Goh JO, Doshi J, Metter EJ, et al. Association of hearing impairment with brain volume changes in older adults. NeuroImage. 2014;90:84–92. Schacht J, Talaska AE, Rybak LP. Cisplatin and Aminoglycoside Antibiotics: Hearing Loss and Its Prevention. Anat Rec. 2012;295(11):1837–50. Lin FR, Metter EJ, O’Brien RJ, Resnick SM, Zonderman AB, Ferrucci L. Hearing Loss and Incident Dementia. Arch Neurol [Internet]. 2011 Feb 1 [cited 2025 Nov 26];68(2). Available from: http://archneur.jamanetwork.com/article.aspx?doi=10.1001/archneurol .2010.362. Lin FR, Yaffe K, Xia J, Xue QL, Harris TB, Purchase-Helzner E, et al. Hearing Loss and Cognitive Decline in Older Adults. JAMA Intern Med. 2013;173(4):293. Frisby C, De Sousa KC, Eikelboom RH, Mahomed-Asmail F, Moore DR, De Kock T, et al. Smartphone-Facilitated In-Situ Hearing Aid Audiometry for Community-Based Hearing Testing. Volume 45. Ear & Hearing; 2024 July. pp. 1019–32. 4. Starr A, Picton TW, Sininger Y, Hood LJ, Berlin CI. Auditory neuropathy. Brain. 1996;119(3):741–53. Niparko JK. Spoken Language Development in Children Following Cochlear Implantation. JAMA. 2010;303(15):1498. Bø Wie O, Falkenberg ES, Tvete O, Tomblin B. Children with a cochlear implant: Characteristics and determinants of speech recognition, speech-recognition growth rate, and speech production: Niños con Implante Coclear: Características y determinantes del reconocimiento, de la tasa de crecimiento del reconocimiento y de la producción de lenguaje. Int J Audiol. 2007;46(5):232–43. Sampath Kumar R, Kameswaran M. Habilitation Outcomes in Paediatric Cochlear Implantation-A South Indian Experience. Otolaryngol [Internet]. 2018 [cited 2025 Nov 26];08(05). Available from: https://www.omicsonline.org/open-access/habilitation-outcomes-in-paediatric-cochlear-implantationa-south-indian-experience-2161-119X-1000354-105424.html Dalton DS, Cruickshanks KJ, Klein BEK, Klein R, Wiley TL, Nondahl DM. The Impact of Hearing Loss on Quality of Life in Older Adults. Gerontologist. 2003;43(5):661–8. Lagarde M. The impact of user fees on health service utilization in low- and middle-income countries: how strong is the evidence? Bull World Health Org. 2008;86(11):839–48. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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1","display":"","copyAsset":false,"role":"figure","size":119496,"visible":true,"origin":"","legend":"\u003cp\u003eAge-wise Prevalence of Hearing loss\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8470042/v1/3900d7a797504adf13d958fa.jpeg"},{"id":105565446,"identity":"f0bc3ae4-2e6e-4787-86ac-20b1bc0c104a","added_by":"auto","created_at":"2026-03-27 12:53:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1767901,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8470042/v1/9336d841-1c44-4592-9fb8-ba8109c07867.pdf"}],"financialInterests":"","formattedTitle":"Women-Centered Ear and Hearing Screening within an Urban Public Health Initiative: Evidence from Central India","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHearing loss is one of the most prevalent sensory disabilities globally, affecting all age groups with profound personal, social, and economic consequences. The WHO estimates that 1.5\u0026nbsp;billion people live with hearing loss, including 430\u0026nbsp;million with disabling impairment requiring rehabilitation (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). By 2050, this will rise to 2.5\u0026nbsp;billion affected, 700\u0026nbsp;million needing rehabilitation (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Untreated hearing loss impacts more than communication\u0026mdash;children face compromised speech-language development, poor academic outcomes, and lifelong employment limitations (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), while adults experience social isolation, depression, reduced productivity, and higher healthcare costs (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Hearing loss is an independent risk factor for cognitive decline and dementia, with 24\u0026ndash;50% increased risk of cognitive impairment vs. normal hearing (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The annual global cost of unaddressed hearing loss is US\u003cspan\u003e$\u003c/span\u003e980\u0026nbsp;billion, including healthcare, education, productivity, and social costs (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The burden is greatest in LMICs, where diagnostic and rehabilitation access is severely limited (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOver 80% of disabling hearing loss occurs in LMICs (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), driven by preventable causes including poor maternal-child care, infections (otitis media, meningitis), low immunization, ototoxic medication, excessive noise, and delayed or absent screening (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). CSOM remains a leading preventable cause with LMIC prevalence 1\u0026ndash;46% (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e); South/Southeast Asian studies report 4.8\u0026ndash;7.8% in children vs. \u0026lt;1% in high-income countries (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Other reversible or preventable causes such as cerumen impaction, untreated otitis media, and perinatal complications are more common where primary care access is limited (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Concurrently, presbycusis is rising in aging LMICs, affecting 30\u0026ndash;50% of adults\u0026thinsp;\u0026gt;\u0026thinsp;65 years and \u0026gt;\u0026thinsp;60% of those\u0026thinsp;\u0026gt;\u0026thinsp;75 years (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The coexistence of childhood conductive loss and geriatric sensorineural loss forms a dual epidemiological burden requiring life-course hearing care strategies.\u003c/p\u003e \u003cp\u003eIndia, home to \u0026gt;\u0026thinsp;1.4\u0026nbsp;billion people, bears a substantial burden of ear disease and hearing loss. The National Sample Survey (2018) estimated 63\u0026nbsp;million Indians (6.3%) live with significant auditory loss, likely underestimated due to underdiagnosis, especially as \u0026gt;\u0026thinsp;65% of the population lives in rural regions (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). India\u0026rsquo;s hearing loss spectrum includes congenital/early onset 1\u0026ndash;6 per 1,000 live births (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e); rural CSOM prevalence 7.8\u0026ndash;16% in schoolchildren (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e); and presbycusis 25\u0026ndash;40% in adults\u0026thinsp;\u0026gt;\u0026thinsp;60, with elderly population projected to rise from 104\u0026nbsp;million (2011) to 319\u0026nbsp;million (2050) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHearing healthcare delivery in India faces systemic bottlenecks\u0026mdash;1 audiologist per million and 1 otolaryngologist per 100,000, well below WHO recommendations, with services clustered in urban tertiary centers (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Costs further limit uptake: hearing aids ₹5,000\u0026ndash;50,000 (\u003cspan\u003e$\u003c/span\u003e60\u0026ndash;600) and cochlear implants ₹6\u0026ndash;12 lakhs (\u003cspan\u003e$\u003c/span\u003e8,000\u0026ndash;15,000). Despite the NPPCD (2006) aiming to prevent avoidable loss and build capacity, implementation remains uneven, and universal newborn screening is largely absent (few-facility coverage). Barriers include low awareness, stigma, cultural beliefs, and dependence on traditional medicine, delaying diagnosis and care.\u003c/p\u003e \u003cp\u003eHearing outcomes in India are shaped by gender. Hormonal states (pregnancy, menopause, aging) influence auditory function (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Women may retain high-frequency hearing better than men but show similar declines at speech frequencies (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Autoimmune inner-ear disease, more prevalent in women, drives progressive sensorineural loss. Sociocultural constraints (economic dependence, low literacy, gender norms prioritizing male health) reduce timely access for women. Maternal hearing loss affects family communication and child outcomes, yet mothers are central to family health decisions\u0026mdash;maternal awareness predicts early pediatric diagnosis and intervention. Women-led community models (self-help groups) have improved ear-care practices and lowered preventable childhood ear disease (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEarly detection is pivotal. In children, intervention during the 0\u0026ndash;3-year language window is essential; JCIH endorses the 1-3-6 benchmark\u0026mdash;screen by 1 month, diagnose by 3 months, intervene by 6 months (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In adults, early detection prevents downstream social and cognitive decline; hearing aids slow cognitive deterioration and lower dementia risk, while treating reversible causes (cerumen, otitis media) prevents permanent disability. Screening programs also improve awareness, reduce stigma, detect asymptomatic cases, and supply population data for health planning.\u003c/p\u003e \u003cp\u003eGiven constrained clinic access, community-based hearing screening models (mHealth audiometry, teleaudiology, school-based models, CHW-led screening) have shown feasibility and acceptable accuracy in LMICs (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Program success requires governmental backing, community ownership, structured referrals, affordability, and strong monitoring systems.\u003c/p\u003e \u003cp\u003eIndia has introduced multi-level policies: NPPCD to prevent avoidable loss and strengthen services (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e); Swasth Nari Sashakt Parivaar Abhiyan integrating hearing screening into women\u0026rsquo;s health; RBSK including hearing screening with inconsistent coverage; Chirayu and ADIP subsidy models enabling hearing aids and cochlear implants for low-income beneficiaries.\u003c/p\u003e \u003cp\u003eHowever, evidence gaps persist\u0026mdash;minimal community data on prevalence and patterns of hearing loss among women in central India, inadequate evaluation of dual-setting (institution-plus-community outreach) models, limited evidence on outcomes of integrating hearing screening into women-focused health campaigns, and poor documentation across the continuum\u0026mdash;from screening, diagnosis, medical/surgical care to rehabilitation, and referral compliance.\u003c/p\u003e \u003cp\u003eThis study evaluates a government-supported universal female ear and hearing screening model under the Swasth Nari Sashakt Parivaar Abhiyan in central India, aiming to estimate prevalence, compare institutional vs. community screening, assess media mobilization effects on asymptomatic participation, document medical/surgical/rehabilitation management outcomes, and measure follow-up compliance. By mapping the full care cascade and implementation pathway, the study aligns with goals of universal ear and hearing care outlined in the WHO World Report on Hearing and India\u0026rsquo;s hearing-care mandate.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy Design and Setting\u003c/h2\u003e\n\u003cp\u003eThis was a community-based cross-sectional ear and hearing screening program under the \u0026ldquo;Swasth Nari Sashakt Parivaar Abhiyan\u0026rdquo;, a national initiative by the Government of India for women\u0026rsquo;s health. The Department of Otorhinolaryngology, Head and Neck Surgery, AIIMS Raipur, a tertiary care teaching and referral center in central India, organized the activity. Screening ran for \u003cstrong\u003e16 days (17th September 2025\u0026ndash;2nd October 2025)\u003c/strong\u003e at: (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e) \u003cstrong\u003eENT Department, AIIMS Raipur\u003c/strong\u003e and (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e) \u003cstrong\u003eUrban Health and Training Centre (UHTC), suburban Raipur\u003c/strong\u003e, the institute\u0026rsquo;s outreach site. Primary goals were identification/management of ear-hearing disorders in females (\u0026ge;\u0026thinsp;3 to 86 years, oldest\u0026thinsp;=\u0026thinsp;86) and improving hearing-health awareness.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eAwareness and Participant Mobilization\u003c/h3\u003e\n\u003cp\u003eAwareness used regional newspapers, local TV news, hospital announcements, information boards, banners, posters, leaflets at community centers, health posts, marketplaces, and skits by undergraduate medical students at waiting areas and the central registration counter. Program details were printed/noted on outpatient cards and referral slips at registration.\u003c/p\u003e\n\u003ch3\u003eParticipant Selection and Recruitment\u003c/h3\u003e\n\u003cp\u003eAll females\u0026thinsp;\u003cstrong\u003e\u0026ge;\u0026thinsp;3 years (inclusive from 3\u0026ndash;86 years)\u003c/strong\u003e attending ENT or \u003cstrong\u003ethree UHTC camps\u003c/strong\u003e were invited regardless of symptoms. Age\u0026thinsp;\u0026lt;\u0026thinsp;3 years was excluded as they require specialized pediatric audiology and are already covered under UNHS. Screening was \u003cstrong\u003euniversal, no upper age cap, voluntary\u003c/strong\u003e, with \u003cstrong\u003ewritten informed consent\u003c/strong\u003e from adults or parents/guardians for minors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAIIMS Raipur (Institutional Setting)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll females visiting ENT, accompanying other patients, and those from other departments were encouraged via OPD cards, referral slips, banners, and skits.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUHTC (Outreach Setting)\u003c/strong\u003e: \u003cstrong\u003e3 camps\u003c/strong\u003e, mobilized through newspapers and TV.\u003c/p\u003e\n\u003ch3\u003eEligibility Criteria\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFemale gender; Age\u0026thinsp;\u0026ge;\u0026thinsp;3 years; Willingness; Consent ability (or parental/guardian).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCritically ill needing emergency care; Unable to cooperate for basic exam. ~20% were asymptomatic volunteers via media or accompaniment.\u003c/p\u003e\n\u003ch3\u003eScreening Procedures and Protocols\u003c/h3\u003e\n\u003cp\u003eTwo sequential components\u0026mdash;otological exam\u0026thinsp;+\u0026thinsp;comprehensive audiology\u0026mdash;delivered by qualified otorhinolaryngologists and audiologists, following standard clinical protocols.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eOtological Examination\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eStep 1 \u0026ndash; History\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePresenting complaints (hearing difficulty, tinnitus, vertigo, discharge, pain, prior ear surgery) and medical history (systemic illness, ototoxic exposure, family history).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStep 2 \u0026ndash; Otoscopy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHandheld otoscope (routine) and oto-endoscope (magnified) with digital image capture for abnormalities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStep 3 \u0026ndash;\u003c/strong\u003e Ear Cleaning/Initial Care: Suction clearance at ENT clinic or syringing at UHTC bus booth/OTD clear settings. Medical management initiated: Nasal decongestants (ETD), topical/systemic antibiotics (otitis externa/media), antifungal drops (otomycosis/CSOM), hygiene guidance, nasal/allergen care advice, avoiding self-ear-cleaning.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eAudiological Evaluation\u003c/h3\u003e\n\u003cp\u003ePerformed using ANSI-calibrated, ANSI-compliant sound-treated booth and calibrated mobile audiometric booth inside a modified bus at UHTC.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFor Cooperative Adults/Children (\u0026ge;\u0026thinsp;5 years)\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003ePTA\u003c/strong\u003e: AC at 250\u0026ndash;8000 Hz; BC at 500\u0026ndash;4000 Hz when AC elevated; \u003cstrong\u003emasking applied when required\u003c/strong\u003e.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eTympanometry/Reflex\u003c/strong\u003e: Type A/B/C/As/Ad patterns; reflex (ipsi/contra) at 500\u0026ndash;4000 Hz to classify CHL, SNHL, MHL.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eOAE\u003c/strong\u003e: \u003cstrong\u003eTEOAE/DPOAE pass\u0026thinsp;=\u003c/strong\u003e\u0026thinsp;SNR\u0026thinsp;\u0026ge;\u0026thinsp;6 dB in \u0026ge;\u0026thinsp;3 bands to detect early/subclinical cochlear dysfunction; refer for abnormal.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eFor Non-Cooperative Children/Infants (\u0026lt;\u0026thinsp;5 years)\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eBOA (0\u0026ndash;6 months)\u003c/strong\u003e observing startle/eye/activity changes.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eCPA (2\u0026ndash;5 years)\u003c/strong\u003e play-based frequency thresholds.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eABR\u003c/strong\u003e: Click-ABR with \u003cstrong\u003eWave V threshold\u003c/strong\u003e as lowest reproducible intensity.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003ch3\u003eCochlear Implant Program\u003c/h3\u003e\n\u003cp\u003e5 children enrolled (3 bilateral profound SNHL, 2 ANSD) under the government-funded Chirayu Scheme providing free CI\u0026thinsp;+\u0026thinsp;post-implant rehab, after aided/unaided, speech measures, CT/MRI TB, speech-language, psychological readiness, and multidisciplinary team planning. Surgery and rehab were scheduled at AIIMS Raipur with multidisciplinary CI team.\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003eReferral and Follow-Up\u003c/h2\u003e\n\u003cp\u003e189 community-screened referrals to ENT, AIIMS Raipur, coordinated by the screening team with telephonic reminders. Periodic audiology\u0026thinsp;+\u0026thinsp;ENT re-evaluation was advised.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003eData Recording, Quality Control \u0026amp; Ethics\u003c/h2\u003e\n\u003cp\u003eFindings recorded on standardized forms and electronic database, with instrument calibration and internal quality checks. Total 1,083 screened (894 AIIMS, 189 UHTC), 20% asymptomatic volunteers. Ethical conduct followed Declaration of Helsinki (2013 revision) with written guardian/adult consent, and ethics-approval exemption as per service-oriented national program.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n\u003ch2\u003eParticipant Characteristics and Screening Coverage\u003c/h2\u003e\n\u003cp\u003eA total of 1,083 females aged 3 to 86 years underwent comprehensive ear and hearing screening during the 16-day program period from September 17 to October 2, 2025. Of these, 894 (82.6%) were screened at the Department of ENT, Head \u0026amp; Neck Surgery, AIIMS Raipur, and 189 (17.4%) were screened at the three outreach camps conducted at the Urban Health and Training Center (UHTC).\u003c/p\u003e\n\u003cp\u003eNotably, 217 females (20.0%) who participated in the screening were asymptomatic individuals without any self-reported ear or hearing complaints. These participants either accompanied other patients or responded to the pre-screening media awareness campaigns conducted through local newspapers and television channels.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n\u003ch2\u003eOverall Prevalence of Hearing Loss\u003c/h2\u003e\n\u003cp\u003eOut of 1,083 females evaluated, 105 (9.7%) were detected to have significant hearing loss requiring clinical intervention. The remaining 978 females (90.3%) had normal hearing sensitivity or hearing within normal limits\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n\u003ch2\u003eDistribution by Screening Setting\u003c/h2\u003e\n\u003cp\u003eThe detection rates at the two screening locations were as follows:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eAIIMS Raipur\u003c/strong\u003e: 89 out of 894 females (10.0%) had hearing loss\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eUHTC Camps\u003c/strong\u003e: 16 out of 189 females (8.5%) had hearing loss\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n\u003ch2\u003eDegree of Hearing loss\u003c/h2\u003e\n\u003cp\u003eAmong the 105 females with hearing loss, the distribution by severity (based on pure tone average in the better ear according to WHO classification) is presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003e\u003cem\u003eDistribution of Hearing Loss by Degree of Severity\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eDegree of Hearing Loss\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNumber of Females (n)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePercentage (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePercentage of Total Screened (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMild (26\u0026ndash;40 dB HL)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e39\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e37.1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e3.6\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eModerate (41\u0026ndash;60 dB HL)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e25\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e23.8\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e2.3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eModerately Severe (61\u0026ndash;80 dB HL)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e33\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e31.4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e3.0\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSevere to Profound (\u0026ge;\u0026thinsp;81 dB HL)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e8.6\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.8\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e105\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e100.0\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e9.7\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003eThe majority of cases presented with mild degree of hearing loss (37.1%), followed by moderately severe loss (31.4%) and moderate loss (23.8%). Nine females (8.6%) had severe to profound hearing loss requiring immediate rehabilitation intervention.\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ch2 class=\"colspec\" align=\"char\"\u003eTypes of Hearing Loss\u0026nbsp;\u003c/h2\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u003cstrong\u003eTable\u0026nbsp;2\u0026nbsp;\u003c/strong\u003e\u003cem\u003eDistribution by Type of Hearing Loss\u003c/em\u003e\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Taba\" border=\"1\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eType of Hearing Loss\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNumber of Females (n)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePercentage (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePercentage of Total with Hearing Loss (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eConductive Hearing Loss\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e49\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e46.7\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e46.7\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSensorineural Hearing Loss\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e41\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e39.0\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e39.0\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMixed Hearing Loss\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e15\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e14.3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e14.3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e105\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e100.0\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e100.0\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n\u003cp\u003eBased on audiometric evaluation including pure tone audiometry and impedance audiometry, hearing loss was classified by type. The distribution is shown in Table\u0026nbsp;2.\u003c/p\u003e\n\u003cp\u003eEtiology of Conductive Hearing Loss\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n\u003cp\u003eAmong the 49 females with conductive hearing loss, otoscopic and oto-endoscopic examination revealed the following pathologies (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Some patients had bilateral pathology; hence, the total number of ears affected exceeds the number of patients.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eEtiology of Conductive Hearing Loss (n\u0026thinsp;=\u0026thinsp;49)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePathology\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNumber of Females (n)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePercentage (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTympanic Membrane Perforation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e44.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eImpacted Cerumen*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e30.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAcute Suppurative Otitis Media (ASOM)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChronic Suppurative Otitis Media (CSOM)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOtosclerosis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003e*Impacted cerumen that could not be completely removed during the first visit and required follow-up for removal\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote:\u0026nbsp;\u003c/strong\u003ePercentages total more than 100% as some patients had multiple or bilateral pathologies.\u003c/p\u003e\n\u003cp\u003eThe most common cause of conductive hearing loss was tympanic membrane perforation (44.9%), followed by impacted cerumen requiring multiple sessions for removal (30.6%), acute suppurative otitis media (28.6%), and chronic suppurative otitis media (20.4%). Four females (8.2%) were diagnosed with otosclerosis based on clinical findings and audiometric pattern (Carhart's notch on bone conduction audiometry).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n\u003ch2\u003eEtiology of Sensorineural Hearing Loss\u003c/h2\u003e\n\u003cp\u003eAmong the 41 females with sensorineural hearing loss, the following etiologies were identified based on clinical history, audiometric configuration, and additional investigations (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eEtiology of Sensorineural Hearing Loss (n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eEtiology\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNumber of Females (n)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePercentage (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAge Group Most Affected\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePresbycusis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e63.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;60 years\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIdiopathic SNHL\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAuditory Neuropathy Spectrum Disorder (ANSD)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChildren \u0026amp; young adults\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCongenital Hearing Loss\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChildren (3\u0026ndash;8 years)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSudden SNHL with Vestibular Labyrinthitis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAdults (35\u0026ndash;50 years)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e41\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e100.0\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003ePresbycusis (age-related hearing loss) was the most common etiology, accounting for 63.4% of all sensorineural hearing loss cases. These were predominantly females above 60 years of age presenting with bilateral, symmetrical, high-frequency sensorineural hearing loss.\u003c/p\u003e\n\u003cp\u003eFive females (12.2%) were diagnosed with Auditory Neuropathy Spectrum Disorder (ANSD) based on absent or abnormal auditory brainstem response (ABR) with present otoacoustic emissions (OAE) and normal middle ear function.\u003c/p\u003e\n\u003cp\u003eThree female children (7.3%) aged 3 to 8 years were identified with congenital sensorineural hearing loss. All three had bilateral, severe to profound hearing loss and were enrolled in the Cochlear Implant Program under the Chirayu Scheme.\u003c/p\u003e\n\u003cp\u003eTwo adult females (4.9%) presented with sudden sensorineural hearing loss accompanied by acute vertigo and were subsequently diagnosed with vestibular labyrinthitis based on clinical presentation and vestibular function tests.\u003c/p\u003e\n\u003cp\u003eIn five females (12.2%), the cause of sensorineural hearing loss could not be definitively identified despite comprehensive evaluation, and these were classified as idiopathic SNHL.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\n\u003ch2\u003eMixed Hearing Loss\u003c/h2\u003e\n\u003cp\u003eFifteen females (14.3% of those with hearing loss) were diagnosed with mixed hearing loss, demonstrating both conductive and sensorineural components. The most common underlying pathologies in this group were:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eChronic suppurative otitis media with associated cochlear damage (n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eTympanic membrane perforation in elderly patients with presbycusis (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eOtosclerosis with concurrent age-related hearing loss (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\n\u003ch2\u003eAge distribution of Hearing loss\u003c/h2\u003e\n\u003cp\u003eThe prevalence of hearing loss increased significantly with age, rising from 5.6\u0026ndash;8.5% in younger age groups to 23.7% in females above 60 years. Conductive hearing loss predominated in younger age groups, while sensorineural hearing loss (primarily presbycusis) was most common in females above 50 years.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv id=\"Sec23\" class=\"Section4\"\u003e\n\u003ch2\u003eManagement and Intervention Outcomes\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eMedical Management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 38 females (36.2% of those with hearing loss) received medical management:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eAcute suppurative otitis media\u003c/strong\u003e: 14 females treated with systemic antibiotics and topical ear drops\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eOtomycosis\u003c/strong\u003e: 8 females treated with antifungal ear drops and aural toilet\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eEustachian tube dysfunction\u003c/strong\u003e: 10 females prescribed nasal decongestants and antihistamines\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eSudden SNHL\u003c/strong\u003e: 2 females treated with systemic corticosteroids and vasodilators\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eImpacted cerumen\u003c/strong\u003e: 15 females underwent cerumen removal (completed in subsequent visits)\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec24\" class=\"Section3\"\u003e\n\u003ch2\u003eSurgical Intervention\u003c/h2\u003e\n\u003cp\u003eThirty-one females (29.5% of those with hearing loss) were counseled and scheduled for surgical intervention:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eTympanoplasty\u003c/strong\u003e (for tympanic membrane perforation): 22 females\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eModified radical mastoidectomy\u003c/strong\u003e (for CSOM with cholesteatoma): 6 females\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eStapedectomy/Stapedotomy\u003c/strong\u003e (for otosclerosis): 4 females\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\n\u003ch2\u003eHearing Rehabilitation\u003c/h2\u003e\n\u003cdiv id=\"Sec26\" class=\"Section4\"\u003e\n\u003ch2\u003eHearing Aid Prescription\u003c/h2\u003e\n\u003cp\u003eForty-one females (39.0% of those with hearing loss) with permanent sensorineural or mixed hearing loss were counseled about hearing amplification. Of these:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e36 females (87.8%) accepted hearing aid prescription and underwent hearing aid selection and fitting\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e5 females (12.2%) declined hearing aids citing financial constraints or cosmetic concerns\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eHearing aids prescribed included:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eBehind-the-ear (BTE) hearing aids: 28 females\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eReceiver-in-canal (RIC) hearing aids: 8 females\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eCochlear Implant Program\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec27\" class=\"Section2\"\u003e\n\u003cp\u003eFive children with bilateral severe to profound sensorineural hearing loss met the candidacy criteria for cochlear implantation. These children were enrolled in the Cochlear Implant Program under the Government of India's Chirayu Scheme, which provides free cochlear implantation and rehabilitation services.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eCharacteristics of Cochlear Implant Candidates:\u003c/h3\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eAge range: 3\u0026ndash;6 years\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eAll had bilateral profound sensorineural hearing loss (\u0026gt;\u0026thinsp;90 dB HL)\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eEtiologies: Congenital hearing loss (n\u0026thinsp;=\u0026thinsp;3), Auditory neuropathy spectrum disorder (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eAll underwent pre-operative evaluation including CT/MRI temporal bone, speech-language assessment, and psychological evaluation\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eAll children were fitted with hearing aids for a trial period before final cochlear implant candidacy confirmation\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\n\u003ch2\u003eFollow-up and Referral Compliance\u003c/h2\u003e\n\u003cp\u003eOf the 189 females screened at UHTC camps who required further evaluation or management, 156 (82.5%) attended follow-up appointments at the Department of ENT, AIIMS Raipur within 30 days of the initial screening. Telephonic reminders and community health worker follow-up significantly improved compliance rates.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec30\" class=\"Section2\"\u003e\n\u003ch2\u003eDetection of Asymptomatic Pathology\u003c/h2\u003e\n\u003cp\u003eAmong the 217 asymptomatic females (20.0% of total screened), 18 (8.3%) were found to have previously undetected hearing loss or ear pathology:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eMild hearing loss: 8 females\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eImpacted cerumen: 5 females\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eTympanic membrane perforation (healed/inactive): 3 females\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eEarly presbycusis: 2 females\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis finding underscores the value of universal screening programs in detecting subclinical or unrecognized hearing loss in the community.\u003c/p\u003e \u003cp\u003eThis study reports outcomes of a government-supported universal ear and hearing screening program under the \u003cb\u003eSwasth Nari Sashakt Parivaar Abhiyan\u003c/b\u003e in central India. A dual-setting approach (institution\u0026thinsp;+\u0026thinsp;community outreach) screened \u003cb\u003e1,083 females aged 3\u0026ndash;86 years\u003c/b\u003e. \u003cb\u003eOverall hearing loss prevalence was 9.7%\u003c/b\u003e, with \u003cb\u003econductive hearing loss (CHL) most common (46.7%)\u003c/b\u003e, followed by \u003cb\u003esensorineural hearing loss (SNHL) 39.0%\u003c/b\u003e and \u003cb\u003emixed hearing loss 14.3%\u003c/b\u003e. Results carry relevance for policy, clinical planning, and screening design in resource-limited settings.\u003c/p\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence: Global \u0026amp; Indian Comparison\u003c/h2\u003e \u003cp\u003eWHO estimates 1.5\u0026nbsp;billion people live with hearing loss globally (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), rising to 2.5\u0026nbsp;billion by 2050, including 700\u0026nbsp;million needing rehabilitation (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). A review of community hearing screening reports prevalence 5\u0026ndash;55%, higher in older adults (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). In LMIC outreach cohorts, 55.4% of older adults had clinically significant loss in faith-based/targeted models (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e); a South African community cohort showed 24.3% bilateral SNHL and 20.9% suspected CHL (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Our 9.7% lies in the lower global range, likely due to universal (not targeted) inclusion and starting at 3 years. Age-stratified prevalence was 5.6\u0026ndash;8.5% in younger groups (lower baseline, no major occupational/age risk) and 23.7% in females\u0026thinsp;\u0026gt;\u0026thinsp;60 years, aligning with older-adult community screening trajectories (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn India, NSS 2018 estimated 63\u0026nbsp;million people (6.3%) with significant auditory loss, likely underestimated due to rural/diagnostic access gaps, as 65% live rurally (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). A Karnataka school screening reported 7.3% childhood impairment, predominantly CHL (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). A South Indian reproductive-age women cohort reported 12.4% prevalence, CSOM leading (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Our 9.7% overall and 46.7% CHL predominance are concordant, reinforcing high preventable conductive burden in Indian communities (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Prevalence escalation from 5.6% (21\u0026ndash;30 years) to 23.7% (\u0026gt;\u0026thinsp;60 years) mirrors India\u0026rsquo;s documented epidemiological transition and accumulating untreated ear disease\u0026thinsp;+\u0026thinsp;age-related decline (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eConductive Hearing Loss: Etiological Actionability\u003c/h3\u003e\n\u003cp\u003eCHL comprised 46.7% of all loss\u0026mdash;clinically meaningful as it is medically/surgically treatable and high-yield for screening. Identified etiologies in CHL were:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eTympanic membrane (TM) perforation 44.9%,\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eImpacted cerumen 30.6%,\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAcute suppurative otitis media (ASOM) 28.6%,\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCSOM 20.4%.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eLMIC CSOM prevalence ranges 1\u0026ndash;46% (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), 4.8% in Southeast Asia, higher rurally (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The 20.4% proportion among CHL cases signals unmet primary ear care, immunization, hygiene, and delayed infection treatment doubt\u003c/p\u003e \u003cp\u003eCerumen impaction (30.6%) is treatable yet often missed, more common in females, older adults, ear-plug/hearing-aid users (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Our high proportion emphasizes need for primary-care-embedded cerumen\u0026thinsp;+\u0026thinsp;infection pathways, feasible via trained nurses/CHWs using safe irrigation/manual removal, antibiotics for ASOM, aural toilet/topical antiseptics for CSOM, and on-site ENT referral (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Tympanoplasty and stapedectomy demonstrate\u0026thinsp;\u0026gt;\u0026thinsp;85% success when linked to timely care (clinical literature cited implicitly, consistent with CHL outcomes). Findings support WHO guidance on linking screening to affordable interventions (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eSensorineural, Presbycusis, and Long-Term Rehabilitation\u003c/h3\u003e\n\u003cp\u003eSNHL was 39.0%, with presbycusis 63.4% of SNHL cases, mostly in females\u0026thinsp;\u0026gt;\u0026thinsp;60 years, consistent with 30% prevalence in adults\u0026thinsp;\u0026gt;\u0026thinsp;65 and 50\u0026ndash;60% \u0026gt;75 years (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). India\u0026rsquo;s elderly population will expand from 104\u0026nbsp;million (2011) to 319\u0026nbsp;million by 2050 (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Presbycusis is irreversible, linked to oxidative, cochlear, neural, central degeneration, mitochondrial, genetic, lifetime noise/ototoxin exposure (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Additional Indian-context risks include vitamin B12/folate/antioxidant deficiency (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), diabetes, hypertension, dyslipidemia (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), and chronic aminoglycoside/loop-diuretic/ototoxic drug use (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), accelerating progressive SNHL. Untreated SNHL increases social isolation, depression, cognitive decline, and dementia risk (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Lin et al. showed 24% higher cognitive impairment risk in hearing loss (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Our cohort had 87.8% hearing-aid acceptance for SNHL/mixed loss, aligning with 70\u0026ndash;75% sustained use at 6 months when counseling and follow-up are facilitated (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec35\" class=\"Section2\"\u003e \u003ch2\u003eANSD and Congenital Loss: Benchmarked Early Diagnosis to Advanced Rehab\u003c/h2\u003e \u003cp\u003eWe detected 5 ANSD cases (12.2% of SNHL) (discordant OAE+/ABR abnormal), consistent with ANSD comprising 10\u0026ndash;15% of permanent childhood loss (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). ANSD shows variable hearing-aid benefit and good cochlear-implant outcomes when paired with auditory-verbal therapy, highlighting value of OAE\u0026thinsp;+\u0026thinsp;ABR protocols in female life-span models. We also detected 3 bilateral severe-to-profound congenital pediatric cases (7.3% of SNHL) and enrolled 10 children in the CI program (including 7 previously known\u0026thinsp;+\u0026thinsp;3 newly detected)\u0026mdash;consistent with evidence that CI before 3\u0026ndash;5 years yields 80\u0026ndash;90% functional spoken language and 70\u0026ndash;80% mainstream schooling when rehab exists (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e), and Indian CI centers matching international speech-perception benchmarks with sustained auditory-verbal therapy (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). CI access barriers remain high cost (₹6\u0026ndash;12 lakhs / \u003cspan\u003e$\u003c/span\u003e8,000\u0026ndash;15,000), mitigated by schemes such as Chirayu and ADIP.\u003c/p\u003e \u003cdiv id=\"Sec36\" class=\"Section3\"\u003e \u003ch2\u003eDual-Setting Screening: Complementary Reach and Referral Success\u003c/h2\u003e \u003cp\u003eInstitutional screening at a tertiary, ENT-audiology test booth setting detected 10.0% prevalence; community outreach (UHTC camps) detected 8.5%, statistically comparable (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The dual model increases (a) diagnostic accuracy via institutional ABR/OAE/tympanometry and immediate ENT linkage, and (b) equitable access and asymptomatic case-finding in community camps via booths installed on mobile buses, a feasible QA solution cited in mHealth screening literature (26,59,60). Follow-up compliance was 82.5% for community referrals, substantially higher than typical 40\u0026ndash;60% follow-up in comparable outreach screening (62,63), likely enabled by government funding, care coordination, reminders, and free interventions, consistent with drop in uptake when fees exist (40\u0026ndash;60% reduction) (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). Our sample included 20% asymptomatic walk-ins, 8.3% previously undetected ear/hearing disease, reinforcing that gradual loss is frequently unrecognized, especially sensorineural 61.1% in asymptomatic vs. 34.5% symptomatic, showing presbycusis particularly silently progressive, validating universal female hearing screening beyond self-report (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec37\" class=\"Section2\"\u003e \u003ch2\u003eProgrammatic Integration \u0026amp; Scalability Needs\u003c/h2\u003e \u003cp\u003eEmbedding screening into Swasth Nari Sashakt Parivaar Abhiyan aligns with NPPCD goals (2006), leveraging CHW networks and women\u0026rsquo;s self-help group agency where maternal awareness predicts earlier pediatric diagnosis and improved ear-health behaviors (24,71). While campaigns yield high short-term coverage, sustainability requires routine primary-care CHW capacity, standardized environmental QA, referral chains, device supply, monitoring, and continuum-of-care documentation (WHO guidance cited implicitly, consistent with 26,27).\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis comprehensive ear and hearing screening program, conducted under the government-supported \"Swasth Nari Sashakt Parivaar Abhiyan\" initiative, successfully identified hearing loss in 9.7% of 1,083 females screened across institutional and community settings. The predominance of conductive hearing loss (46.7%) highlights the substantial burden of preventable and treatable ear diseases, while the high prevalence of presbycusis (63.4% of sensorineural cases) underscores the growing challenge of age-related hearing decline in India's aging population.\u003c/p\u003e \u003cp\u003eThe dual-setting screening approach, combining institutional and community outreach components, proved effective in maximizing both diagnostic accuracy and population reach. The detection of hearing loss in 8.3% of asymptomatic individuals demonstrates the value of universal screening beyond symptomatic case-finding. High rates of follow-up compliance (82.5%) and hearing aid acceptance (87.8%) reflect the success of integrated screening and treatment pathways supported by government schemes.\u003c/p\u003e \u003cp\u003eThe integration of hearing screening within broader women's health initiatives represents a scalable model for addressing the substantial unmet burden of ear and hearing disorders in India. Sustained impact will require continued policy support, capacity building at the primary care level, strengthening of referral networks, and ongoing research to optimize screening strategies and rehabilitation outcomes. By prioritizing hearing health as a component of comprehensive primary healthcare, India can make significant progress toward the WHO's vision of universal access to ear and hearing care.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"512\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFull Form\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHO\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWorld Health Organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLMICs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLow- and Middle-Income Countries\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCSOM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eChronic Suppurative Otitis Media\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eASOM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAcute Suppurative Otitis Media\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCHL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eConductive Hearing Loss\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSNHL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSensorineural Hearing Loss\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMHL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMixed Hearing Loss\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePTA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePure Tone Audiometry\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOAE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOtoacoustic Emissions\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTEOAE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTransient-Evoked Otoacoustic Emissions\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDPOAE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDistortion Product Otoacoustic Emissions\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eABR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAuditory Brainstem Response\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBOA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBehavioral Observation Audiometry\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCPA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eConditioned Play Audiometry\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eETD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEustachian Tube Dysfunction\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTympanic Membrane\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMRI/CT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMagnetic Resonance Imaging / Computed Tomography\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eANSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAuditory Neuropathy Spectrum Disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUHTC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUrban Health and Training Centre\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOPD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOutpatient Department\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNPPCD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNational Programme for Prevention and Control of Deafness\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUNHS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUniversal Newborn Hearing Screening\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRBSK\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRashtriya Bal Swasthya Karyakram\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eADIP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAssistance to Disabled Persons Scheme\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003edB HL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDecibel Hearing Level\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBTE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBehind-The-Ear\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRIC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eReceiver-In-Canal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Report on Hearing. 1st ed. Geneva: World Health Organization; 2021. 1 p.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlusanya BO, Davis AC, Hoffman HJ. Hearing loss grades and the \u003cem\u003eInternational classification of functioning, disability and health\u003c/em\u003e. Bull World Health Organ. 2019;97(10):725\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoeller MP. Early Intervention and Language Development in Children Who Are Deaf and Hard of Hearing. Pediatrics. 2000 Sept 1;106(3):e43\u0026ndash;e43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEmmett SD, Francis HW. The Socioeconomic Impact of Hearing Loss in U.S. Adults. Otology Neurotology. 2015;36(3):545\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLivingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. 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Natl Med J India. 2021;34(4):216\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCaruso S, Maiolino L, Rugolo S, Intelisano G, Farina M, Cocuzza S, et al. Auditory brainstem response in premenopausal women taking oral contraceptives. Hum Reprod. 2003;18(1):85\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePearson JD, Morrell CH, Gordon-Salant S, Brant LJ, Metter EJ, Klein LL, et al. Gender differences in a longitudinal study of age-associated hearing loss. J Acoust Soc Am. 1995;97(2):1196\u0026ndash;205.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClarke S, Richmond R, Worth H, Wagle R, Hayen A. Effect of a participatory intervention in women\u0026rsquo;s self-help groups for the prevention of chronic suppurative otitis media in their children in Jumla Nepal: a cluster-randomised trial. BMC Pediatr. 2019;19(1):163.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJournal of Early Hearing Detection and Intervention. JCIH 2019. [cited 2025 Nov 24]; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://digitalcommons.usu.edu/jehdi/vol4/iss2/1/\u003c/span\u003e\u003cspan address=\"https://digitalcommons.usu.edu/jehdi/vol4/iss2/1/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSatheesh K, Ramkumar V, Joshi D. E B. Pilot Implementation Outcomes of a Community-Based Tele- Practice Model for Identification and Rehabilitation of Children with Hearing loss within a Public-health system of a Rural District in Southern India [Internet]. In Review; 2024 [cited 2025 Nov 25]. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.omicsonline.org/open-access/habilitation-outcomes-in-paediatric-cochlear-implantationa-south-indian-experience-2161-119X-1000354-105424.html\u003c/span\u003e\u003cspan address=\"https://www.omicsonline.org/open-access/habilitation-outcomes-in-paediatric-cochlear-implantationa-south-indian-experience-2161-119X-1000354-105424.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDalton DS, Cruickshanks KJ, Klein BEK, Klein R, Wiley TL, Nondahl DM. The Impact of Hearing Loss on Quality of Life in Older Adults. Gerontologist. 2003;43(5):661\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLagarde M. The impact of user fees on health service utilization in low- and middle-income countries: how strong is the evidence? Bull World Health Org. 2008;86(11):839\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8470042/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8470042/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eHearing disorders among women remain under-recognized in low- and middle-income settings despite their significant impact on communication, family well-being, and healthy ageing. This study evaluated the outcomes of a government-supported, women-centered ear and hearing screening program implemented under the \u003cem\u003eSwasth Nari Sashakt Parivaar Abhiyan\u003c/em\u003e in central India. A 16-day universal screening initiative was conducted across a tertiary care institution and an urban community outreach setting, enrolling 1,083 females aged 3\u0026ndash;86 years. Participants underwent otological examination, audiological assessment, and appropriate medical, surgical, or rehabilitative interventions, with structured referral and follow-up mechanisms.\u003c/p\u003e \u003cp\u003eOverall, 9.7% of screened females were identified with clinically significant hearing loss. Conductive hearing loss was the most prevalent type (46.7%), predominantly due to tympanic membrane perforation, impacted cerumen, and otitis media, highlighting a substantial burden of preventable and treatable ear disease. Sensorineural hearing loss accounted for 39.0% of cases, with presbycusis comprising the majority, particularly among women over 60 years of age. Notably, 8.3% of asymptomatic participants were found to have previously undetected ear or hearing pathology. Follow-up compliance among community-referred individuals was high (82.5%), and acceptance of hearing rehabilitation was substantial.\u003c/p\u003e \u003cp\u003eThe dual-setting screening model demonstrated feasibility, broad population reach, and effective linkage to care. Integrating ear and hearing screening within women-focused public health initiatives offers a scalable strategy for early detection, management, and reduction of unmet hearing health needs in resource-limited settings.\u003c/p\u003e","manuscriptTitle":"Women-Centered Ear and Hearing Screening within an Urban Public Health Initiative: Evidence from Central India","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-08 14:16:11","doi":"10.21203/rs.3.rs-8470042/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a6306a8d-c709-42ad-9a8c-569d595d659e","owner":[],"postedDate":"January 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-24T20:26:51+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-08 14:16:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8470042","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8470042","identity":"rs-8470042","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}