Ear Hygiene Practices, Ear Morbidity Amidst Environmental Noise in Urban Slums: Evidence to Recommend Comprehensive Ear Care Under Ayushman Arogya Mandirs in Eastern India.

BackgroundEnvironmental noise is an under-recognised public health hazard in rapidly urbanising low- and middle-income countries. Urban slum residents are disproportionately exposed to chronic transportation and occupational noise, yet community-level evidence linking noise exposure with ear morbidity remains limited in India.ObjectivesTo assess the association between environmental noise exposure and ear morbidity in urban slums of Bhubaneswar, Odisha. To examine behavioural and socio-environmental determinants of ear health among the sample for associations to offer recommendations.MethodsThe study design is a community-based, stratified, cross-sectional study conducted in the urban slums of Bhubaneswar, Odisha, India, stratified into low-, medium-, and high-noise zones. The study population were 384 residents aged 10-50 years selected through stratified random sampling with proportional allocation. The noise stratification is generalised, on the basis of city administrative definitions.Data were collected using a semi-structured questionnaire that assessed socio-demographics, occupational exposure, ear hygiene, and health-seeking behaviour. Clinical ear examination, otoscopy and tuning fork tests were conducted. Logistic limitations did not permit performing pure tone audiometry. Ear health outcomes included normal, ear infection, at risk hearing loss or both. Associations were analysed using the chi-square test and multivariable logistic regression, with statistical significance at p<0.05.ResultsAmong 384 participants, the overall prevalence of ear morbidity was 21.1% (95% CI: 17.2-25.4), including ear infections at 11.2% (95% CI: 8.3-14.8), at-risk hearing loss at 2.6% (95% CI: 1.3-4.8), and combined infection with hearing loss at 7.3% (95% CI: 5.0-10.3). A graded increase in hearing loss risk was observed across noise exposure zones-2.4% in low, 10.9% in medium, and 15.6% in high noise areas (χ2=13.21, p=0.001). External ear canal abnormalities were also significantly linked to higher regional noise exposure (χ2=19.78, p<0.001). Behavioural factors, including unsafe ear-cleaning practices (χ2=24.57, p=0.017), a history of ear infection (χ2=39.59, p<0.001), and ear piercing (χ2=15.38, p=0.002), showed significant associations with morbidity. Multivariable analysis revealed greater odds of ear morbidity among residents of high-noise zones (AOR≈8.5; 95% CI: 2.9-25.1), emphasising the combined environmental and behavioural risk factors.ConclusionEnvironmental noise exposure is a significant yet under-recognised determinant of ear morbidity among urban slum residents, exacerbated by unsafe hygiene behaviours and limited preventive care. Integrating ear and hearing services within primary health care and strengthening urban environmental regulation are essential. The study supports progress toward SDG 3 (Good Health and Well-Being), SDG 11 (Sustainable Cities and Communities), and SDG 6 (Clean Water and Sanitation) through multisectoral strategies that address environmental and social determinants of ear health. The community-based stratification provides a pragmatic assessment of environmental noise exposure; however, the cross-sectional design and the absence of individual noise exposure measurements and gold-standard hearing assessments (pure-tone audiometry) limit causal inference.