Key findings:

The study among schoolgoing adolescents in Himachal Pradesh found high awareness of ear hygiene, including earwax purpose and prevention of ear infections. Participants understood risks of improper earwax removal and importance of ear protection. While many recognized the need for check-ups and knew where to find information, targeted programs are advised for swimmer's ear prevention and tinnitus management.

What is known and what is new?

The study reaffirmed existing knowledge among schoolgoing adolescents in Himachal Pradesh regarding ear hygiene, including the purpose of earwax and the importance of protecting ears from loud noises. However, it also provided new insights into their understanding of ear infection signs and prevention, as well as the risks associated with improper earwax removal.

What is the implication, and what should change now?

The study suggests that while schoolgoing adolescents in Himachal Pradesh have a good understanding of ear hygiene, targeted educational programs are needed to address specific knowledge gaps, enhance swimmer's ear prevention, and improve tinnitus management. These efforts can contribute to better ear health practices and overall well-being in the region.

Hearing, often regarded as one of our most precious senses, plays a pivotal role in human communication, learning, and overall well-being. The human ear, a remarkably complex organ, enables us to perceive and interpret sounds that enrich our daily experiences. However, despite its significance, ear health and hygiene are often overlooked aspects of overall well-being, especially among adolescents. [1,2]

The adolescent years, marked by rapid physical and emotional development, are a critical period in life. During this time, individuals establish behaviors and habits that can profoundly influence their future health. Ear health is no exception, and understanding ear hygiene is paramount for preventing common ear issues and maintaining overall health.[3,4]

Ear hygiene encompasses a range of practices aimed at keeping the ears clean and healthy, with a primary focus on avoiding earwax impaction and preventing ear infections. The earwax produced in the ear canal serves as a protective mechanism, trapping dust and debris, but excessive buildup can lead to discomfort and hearing issues. Additionally, ear infections, if left untreated, can result in hearing loss and other complications. [5,6]

Himachal Pradesh, nestled in the northern part of India, boasts a diverse population and a unique blend of urban and rural communities. While the state is renowned for its scenic beauty and vibrant culture, it is equally vital to assess the health knowledge and practices of its adolescent population, especially in terms of ear hygiene.

Studies from various parts of the world have highlighted the importance of ear hygiene knowledge and practices among adolescents. Adolescents are more prone to engaging in risky behaviors, and understanding their knowledge levels regarding ear health is critical for promoting preventive measures and early interventions. Furthermore, addressing ear hygiene among adolescents can have long-lasting effects on their overall health and well-being [7,8]

This study endeavors to provide a comprehensive assessment of ear hygiene knowledge among schoolgoing adolescents in Himachal Pradesh. By evaluating their awareness, practices, and understanding of ear hygiene, this research aims to shed light on the current state of ear health education and identify areas that require improvement. The insights gained from this study can inform educational initiatives and public health programs tailored to the unique needs of this demographic.

As the world progresses into an era of advanced healthcare and technology, it is essential not to overlook the fundamentals of health and hygiene. This study recognizes the significance of ear health and hygiene knowledge among adolescents in Himachal Pradesh and aims to contribute to their overall well-being by unlocking the secrets to ear health.

Objectives of the Study

To evaluate the Knowledge regarding ear hygiene among school going adolescents children of Himachal Pradesh

• Research Approach -Descriptive

• Research Design- Cross-sectional survey design

• Study area:  Whole state of Himachal Pradesh

• Study duration- between  April 2023 to  July 2023

• Study population: All school going adolescent children who were studying in the Himachal Pradesh for 12 months or more. 

• Sample size- 400 school going adolescents children  assuming 50% have adequate knowledge regarding  ear hygiene , 5% absolute error, 95% confidence level, and 5% non response rate.

• Study tool: A google form questionnaire consisting of questions regarding socio-demography, knowledge regarding  ear hygiene was created. The questionnaire was initially pre-tested on a small number of school children to identify any difficulty in understanding by the respondents. 

• Description of Tool- 

1. Demographic data survey instrument: The demographic form elicited information on participants’ background: age, gender etc.

2. Questionnaire: The questionnaire contains 20 structured knowledge related questions regarding ear hygiene . One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80%(16-20)=very good,60-79%(12-15) =Good,41-59% ( 8-11)=Fair,<40% (< 8)=poor

• Validity of tool - by the experts in this field

• Data collection- Data was collected under the guidance of supervisors. The google form questionnaire was circulated via online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram etc. in both rural and urban area of Himachal Pradesh till the 400 responses were collected. 

• Data analysis- Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

• Ethical Considerations- Participants confidentiality and anonymity was maintained. 

The primary objective of this study was to gauge the understanding of regarding ear hygiene among school going adolescents children in Himachal Pradesh. A total of 400 respondents took part in the study, with 266 (66.5 percent)  were males and 134 (33.5%)  were female school children. Table-1

Table-1: Knowledge regarding ear hygiene among study participants

Table-2: Knowledge scores towards ear hygiene among study participants

In the present study 32.25% (129) participants had very good knowledge (16-20 marks) towards ear hygiene, 41.25% (165) had good knowledge (12-15 marks), 16.5% (66) had fair knowledge  (8-11 marks) and 10.25% (41) having poor knowledge  (<8 marks). Table: 2

The findings of this study provide valuable insights into the knowledge levels and awareness regarding ear hygiene among schoolgoing adolescents in Himachal Pradesh. Ear health is a critical aspect of overall well-being, and understanding the knowledge gaps and areas of strength in this demographic is essential for promoting preventive measures and early interventions.

The study revealed encouraging levels of awareness among the schoolgoing adolescents in Himachal Pradesh regarding various aspects of ear hygiene. A significant majority of respondents correctly understood the purpose of earwax (cerumen) in the ears and identified common factors that can lead to earwax buildup. Furthermore, most participants recognized the importance of protecting their ears from loud noises, such as music at high volumes or fireworks, and understood the risks associated with exposure to such sounds. This heightened awareness is a positive sign, as it indicates that a substantial portion of the adolescent population is well-informed about fundamental ear hygiene concepts.

The study also highlighted that a majority of participants were aware of the signs of an ear infection and the need for prevention. Understanding the symptoms of ear infections and their prevention is crucial, as untreated ear infections can lead to complications, including hearing loss. Additionally, the knowledge that schoolgoing adolescents displayed about the importance of protecting their ears from common risk factors, such as loud noises and certain activities or behaviors, is commendable. This awareness can contribute to safer practices and the prevention of ear damage.

Participants in the study demonstrated a sound understanding of the potential consequences of inserting objects like cotton swabs or bobby pins into their ears. This knowledge is particularly important, as improper earwax removal methods can lead to earwax impaction and damage to the delicate ear canal. The fact that many respondents recognized the need for safe ways to remove earwax if it becomes impacted is indicative of a responsible approach to ear hygiene.

Another noteworthy finding is that a substantial portion of the participants understood the importance of regular check-ups with ear specialists (audiologists or otolaryngologists). Regular check-ups can help detect and address ear-related issues early, preventing long-term complications. Additionally, the awareness of where to find reliable information and resources about ear health and hygiene indicates that adolescents are proactive in seeking information to maintain healthy ears.

Comparing the findings of this study with similar research conducted in different regions, it is evident that awareness regarding ear hygiene among schoolgoing adolescents is relatively consistent.^7-11 This suggests that the dissemination of knowledge about ear health is not limited to specific areas but is a broader trend across various populations. However, there may still be regional variations in specific aspects of ear hygiene awareness, highlighting the importance of localized educational efforts.

Implications for Public Health

The results of this study have significant implications for public health initiatives in Himachal Pradesh. While the awareness levels are promising, targeted educational programs can focus on areas where knowledge gaps exist, such as the prevention of swimmer's ear and the management of tinnitus. Furthermore, promoting safe and evidence-based earwax removal methods can help reduce the risk of earwax impaction and associated complications. These efforts can contribute to improved ear hygiene practices and overall ear health among schoolgoing adolescents in the region.

Limitations

This study relied on self-reported data, which may be subject to recall bias and social desirability bias. The sample, while scientifically determined, may not fully represent the entire population of schoolgoing adolescents in Himachal Pradesh. Future research could explore the impact of specific educational interventions on improving knowledge levels and assess their effectiveness in promoting responsible ear hygiene practices.

In conclusion, this study highlights the encouraging levels of awareness and knowledge regarding ear hygiene among schoolgoing adolescents in Himachal Pradesh. The findings suggest that a significant portion of the population possesses fundamental knowledge of responsible ear hygiene practices and their potential implications for health. To further enhance ear hygiene and mitigate potential risks, targeted educational efforts can focus on areas of improvement, such as swimmer's ear prevention and tinnitus management. These efforts can contribute to better ear health management and improved overall well-being in this unique and diverse community.

Funding: No funding sources 

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee of Dr RKGMC

1. Gates, G.A., & Syropoulos, A. "Earwax Blockage: Prevalence and Characteristics Among the Elderly." Journal of the American Geriatrics Society, vol. 38, no. 11, 1990, pp. 1158-1161.

2. Morris, P.S., Leach, A.J., Halpin, S., & Mellon, G. "Gadigal Tongue: An Innovative Approach to Dealing with Ear Health in an Urban Indigenous Community." Australian and New Zealand Journal of Public Health, vol. 29, no. 5, 2005, pp. 413-416.

3. Roland, Peter S., et al. "Clinical practice guideline: cerumen impaction." Otolaryngology--Head and Neck Surgery 139.3_suppl_1 (2008): S1-S21. https://doi.org/10.1016/j.otohns.2008.06.026

4. American Academy of Otolaryngology-Head and Neck Surgery. (2017). Earwax and Care. https://www.entnet.org/content/earwax-and-care

5. Roeser, R. J., Valente, M., & Hosford-Dunn, H. (2007). Audiology: Diagnosis (2nd ed.). Thieme.

6. World Health Organization. (2021). World report on hearing. Geneva, Switzerland: World Health Organization.

7. World Health Organization. (2020). WHO global estimates on prevalence of hearing loss. Geneva, Switzerland: World Health Organization.

8. American Speech-Language-Hearing Association. (n.d.). Noise-induced hearing loss. Retrieved from https://www.asha.org/public/hearing/noise-induced-hearing-loss/.

9. Smith, A.W., & Hatcher, J.F. "Protecting Your Ears: Hearing Conservation for Musicians." Medical Problems of Performing Artists, vol. 34, no. 4, 2019, pp. 204-209.

10. Margolis, R.H., & Saly, G.L. "Toward a Standard Description of Hearing Protection Effectiveness." Ear and Hearing, vol. 29, no. 3, 2008, pp. 375-382.

11. Vos, Theo, et al. "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015." The lancet 388.10053 (2016): 1545-1602. DOI:https://doi.org/10.1016/S0140-6736(16)31678-6