1 Objectives: To estimate the prevalence of hearing impairment (HI) in Mahbubnagar district, 2 Telengana State, India. 3 Methods: A population-based prevalence survey of hearing impairment was undertaken in 4 2014. Fifty-one clusters of 80 people aged 6 months and older were selected using 5 probability-proportionate-to-size sampling. A two-stage hearing screening was conducted 6 using otoacoustic emissions (OAE) on all participants followed by pure-tone audiometry on 7 those aged 4 years and

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... der who failed OAE. Cases of HI were defined using the World 8 Health Organization (WHO) definition of disabling hearing impairment: a pure tone average 9 of thresholds at 500, 1000, 2000, and 4000Hz of ≥41dBHL for adults and ≥31dBHL for 10 children based on the better ear. Possible causes of hearing impairment were ascertained by a 11 certified audiologist. Self-reported hearing difficulties were also measured in this survey and 12 compared with audiometry results. 13 Results: 3,573 people were examined (response rate 87%), of whom 52% were female. The 14 prevalence of disabling HI was 4.5% (95% Confidence Interval (CI)=3.8,5.3). Disabling HI 15 prevalence increased with age from 0.4% in those aged 4-17 years (95%CI=0.2, 1.1), to 16 34.7% (95%CI=28.7, 41.1) in those aged >65 years. No difference in prevalence was seen by 17 sex. Ear examination suggested the possible cause of disabling hearing impairment was 18 chronic suppurative otitis media for 6.9% of cases, and dry perforation for 5.6% cases. For 19 the vast majority of people with disabling hearing impairment, a possible cause could not be 20 established. The overall prevalence of self-reported or proxy reported hearing impairment 21 was 2.6% (95%CI=2.0, 3.4) and this ranged from 0.6% (95%CI=0.08, 4.4) in those aged 0-3 22 years to 14.4% (95%CI=9.8, 20.7) in those aged 65+. 23 2 Bright, T: Hearing Impairment in India Conclusions: Disabling HI in Telengana State is common, affecting approximately one in 1 twenty-three people overall, and a third of people aged over 65 years. This substantial level 2 of hearing loss could benefit from improved access to low cost interventions. 3