Med. J. Cairo Univ., Vol. 79, No. 2, March: 157-161, 2011 www.medicaljournalofcairouniversity.com

Quality of Life among Adult Yemeni Patients with Hearing Loss MOHAMED Y. AL-MAHBASHI, Ph.D.* and YAHIA A. RAJA’A, Ph.D.** The Departments of Otorhinolaryngology* and Community Medicine**, Faculty of Medicine and Health Sciences, Sana'a University, Yemen

Abstract

world are affected by moderate bilateral hearing loss. Two third of these people are in developing countries [2] . Severity of hearing loss is associated with reduced quality of life (QoL), usually causes difficulty in understanding speech, affects cognitive, emotional status; lower income and increased morbidity and mortality [3-6] .

Objective: To associate the hearing loss with quality of life and to describe the pattern of hearing loss among adult patients presenting at Al-Thawra and Al-Kuwait Teaching Hospitals, Yemen. Methods: There were 345 patients (aged 18 years and above) and another 345 healthy controls of comparable age. Patients presented to the ENT outpatient clinics during the period from November 2008 to May 2009. All patients were investigated for pure tone audiometry. Questionnaire was done by the team to evaluate the effect of hearing loss on QoL.

The prevalence of hearing loss may be growing because of increasing exposure to excessive noise, increased life expectancy, smoking, cardiovascular risks and infection [7-10] . Hearing loss in industrialized countries affects elderly and female more than younger age and male sex [3,11,12] . Causes of hearing loss in Oman and Egypt were mainly inflammatory [13,14] . Health QoL of patients with hearing loss is affected negatively [12] , and the severity of hearing loss is associated with reduced QoL in older adults [3] . Hearing aids improve adults hearing related QoL by reducing psychological, social, and emotional effects of hearing loss [15] . Industrialized societies have strategies for prevention and early detection for hearing impairment, while these programs are little and progress slowly in developing countries where more than 30 million hearing aids are needed [2] . Studies tackling this health problem in Yemen could not be traced.

Results: The mean age of patients is 37.5 ± 17.8 years. The malepatients were 213 (61.7%) and the female were 132 (38.3%). Urban were (65.2%) patients, rural (34.85%) patients. Educated were 211 (61.2%), housewife were 89 (25.8%), workers were 53 (15.4%). The common causes for hearing loss were inflammations 132 (38.3%), congenital 57 (16.5%), senile 56 (16.2%), 123 (35.7%) had mild hearing loss, 91 (26.4%) had moderate, 73 (21.2%) had severe and 58 (16.8%) had Profound. Patients using hearing aids are 28 (8.1%). There were 97 patients (28.1%) with problematic to very problematic QoL. Whereas only 33 of control individuals (9.6%) with problematic to very problematic QoL. Conclusions: The common causes of hearing loss in adults were inflammations followed by congenital then senile hearing loss. Bilateral hearing loss is more than unilateral hearing loss. The majority of patients had mild hearing loss followed by moderate to the severe then profound hearing loss. There is association between hearing loss and decreased QoL. Nonhearing aid users were more than hearing aid users.

The objective of this study was to describe the pattern of hearing loss and its effect on quality of life among patients attending at Al-Thawra and Al-Kuwait Teaching Hospitals. Specifically: To identify the causes, and severity of hearing loss. We also attempted to associate the grade of severity of hearing loss with QoL.

Key Words: Hearing loss – Quality of life – Yemen.

Introduction HEARING loss in adult is one of the most common chronic illnesses throughout the world; it is the third chronic disability after arthritis and hypertension [1] . According to World Health Organization (WHO) 2004 around 278 million people in the

Patients and Methods We adopted a case-control design in order to associate the hearing loss with QoL. Some 345 adult patients with hearing loss were enrolled in the study as the cases and another 345 healthy

Correspondence to: Dr. Yahia A. Raja'a, E-mail: [email protected]

157

158

volunteers were assigned as controls. The controls were included to perform as a baseline for QoL for similar individuals. All cases and controls were subjected to complete ENT physical examination and pure tone audiometry. Pattern of hearing loss among cases was also described. The cases and controls were matched for age, gender, level of education and place of residence. Patients recruited in the study were those who presented to the Otorhinolaryngology outpatient clinics of Al-Thawra and Al-Kuwait Hospitals in Sana'a city. The study was carried out between 5 th November 2008 and 5 th May 2009. Al-Thawra Teaching Hospital is the largest hospital in the country which received around 520 thousand patients from all parts of Yemen during the year 2009 [16] . It has an ENT outpatient clinic that is equipped with proper technology and employs highly qualified consultants. Al-Kuwait Hospital is a University Hospital and one of the best places for medical researches. Inclusion criteria for the patients group were; age of 18 and above. Audiogram should match patient’s complaint of hearing loss and clinical picture. Exclusion criteria included hearing loss due to wax, foreign bodies, acute otitis media, and patients with multiple disabilities. Quality of life was investigated for both patients and controls following the format of Hearing Handicap Inventory for the Adult (HHIA) [17] and modified to match with the habits of Yemeni people. Questionnaires were filled by a team of 10 medical graduates to evaluate the effect of hearing loss on QoL by interviewing the patients after informed verbal consent was obtained to comply with the medical ethics requirement. A Quality of Life Score is calculated based on total points accumulated from answers to the 46 questions on the QoL Questionnaire. A YES answer is counted as 2 points, SOMETIMES as 2 points, and NO as 0 (zero) points. The range of possible total scores is 0-184. A score of >95% (175 degree) is considered very problematic. A score of 80%95% (148-175 degree) indicates a problematic situation. A score of 65%-80% (120-180 degree) indicate an acceptable situation. A score of 50%65% (92-120 degree) is very acceptable. A score of