In conversation with Excelsior,
Dr. Sohit Paul Kanotra, Assistant Professor in Otolaryngology-Head and Neck Surgery, Louisiana State University, New Orleans, USA, was invited to conduct a continuing medical education on ‘Pediatric Deafness and implantable hearing devices’ on Children’s day, 14th Nov. 2015,at Government Medical College Jammu with the object of sensitizing the pediatricians, ENT specialists and audiologists on the topic of childhood hearing loss. On this occasion talks were presented by Dr. Kanotra on Newborn hearing screen, evaluation of hearing loss in children and Cochlear implants and other devices for restoring hearing in children
EC. What is the magnitude of the hearing loss in children?
SPK: Deafness in newborn and children is fairly common with 1-3/1000 live births having severe to profound hearing loss and another 1-2/1000 having mild and one sided hearing loss.In the developing countries its prevalence is higher due to lack of immunization, greater exposure to ototoxic agents, malnutrition, consanguinity etc..About 50% of the causes of disabling hearing loss worldwide are preventable.
EC. How does hearing loss affect child’s development?
SPK: Profound hearing loss has lifelong consequences not only for the child but also his family .A profoundly deaf child will not be able to develop any speech and eventually end up ‘Deaf and Mute’. Without any oral communication ,his learning abilities are affected compromising his educational achievements and later his employment opportunities. With lesser degrees of hearing loss the speech does develop but will be defective.In fact ,the commonest cause of delayed or defective speech in children is hearing impairement.The earlier the hearing loss occurs in a child’s life,the more serious are the effects on the child’s development.Similarly,the earlier the problem is identified and intervention begun,the less serious the ultimate impact. A profoundly deaf child will not be able to develop any speech and eventually end up ‘Deaf and mute’. The socioeconomic impact of ‘Deaf mutism’ is immense as they cannot contribute to the society in a productive way as normal hearing individuals.
EC. Does one sided deafness affect the child’s development?
SPK: One sided deafness in children is often undiagnosed and undertreated. For optimal hearing,binaural meaning hearing from both the ears is essential. Children with one sided deafness have difficulty in hearing in a noisy environment like classroom, which affects their academic performance. Also, one sided deafness leads to difficulty in localizing sounds which can be problematic for the child.
EC. What are the causes of deafness in children?
SPK: The most common cause of newborn hearing loss is genetic and this is commoner in case of consanguineous marriages.If a pregnant mother develops certain infections,is exposed to ototoxic drugs like gentamycin etc.,is suffering from diabetes,hypothyroidism or malnutrition,the child can be born with deafness.Difficulties during birth causing asphyxia i.e, prolonged lack of oxygen associated with convulsions or coma can cause the child to be born deaf. Newborns who are admitted to the intensive care unit due to immaturity and other causes or those who develop jaundice or meningitis(Brain Fever) ,measles mumps etc. after birth are very much prone to develop hearing loss. In older children, recurrent ear infections manifesting as ear pain and pus discharge if neglected can lead to hearing loss. Some children born with defects of ear,nose,throat or face have associated deafness.
EC. How do we diagnose hearing loss in children?
SPK: In older children, suspicion of hearing loss can be made by parents when the child does not respond to normal sounds or tends to increase the volume of the TV.In the class, inattentiveness or decreased performance can be an indicator of hearing loss and this can be confirmed by the hearing test called audiometry.. A high index of suspicion is required for diagnosing one-sided hearing loss in older children. . In newborns, hearing testing is done by using 2 methods namely otoacoustic emissions (OAE’s) and auditory brainstem response audiometry (ABR) testing. In the absence of these modalities, responses of the newborn to various sound stimuli like blinking,cessation of activity or head turning to locate the source of sound can tell us about the integrity of child’s hearing.In developed countries, Universal Newborn Hearing Screen is used for all live births.
EC: Tell us about this Universal Newborn Hearing Screen?
SRK: It has been shown that earlier the child is detected with hearing loss and intervention begun, the better the results of any rehabilitative measure. Most important thing is the fact that children born deaf can become near normal members of the society if their hearing loss is diagnosed before a critical period. Universal new born hearing screening programs are based on the 1-3-6 rule according to which, a new born should be screened for hearing loss by 1 month of age by OAE and if he fails this test, by 3 months , a complete evaluation should be done by a trained audiologist and by 6 months some sort of rehabilitation in the form of hearing aid should be given. The earlier the problem is identified and intervention begun, the less serious the ultimate impact
EC: Is this newborn hearing screen being used here.
SPK: No. However ,during the deliberations of the programme, there was a lot of enthusiasm among the participants and it was decided to pursue the matter with the authorities and implement the programme at the earliest.
EC. What are the rehabilitative measures?
SPK: Various rehabilitative options available for hearing loss in children include hearing aids and cochlear implants. The technology for cochlear implants has advanced a lot in recent years. Usually hearing aids are reserved for children who have moderate to severe hearing loss. Children who have profound hearing loss , don’t get much benefit from hearing aids and require cochlear implants.
EC. What is a difference between a hearing aid and a cochlear implant?
SPK: A hearing aid is a sound amplification device which can be worn in the ear or behind the ear and offers augmentation of moderate to severe hearing loss. Cochlear implants are devices which are implanted by surgery and directly stimulate the hearing nerve and are used for cases which cannot be fully rehabilitated by hearing aid. The cochlear implant can cost as much as 6-8 lac rupees while the hearing aid costs only a fraction of that.
EC: What is the ideal age of doing a cochlear implant?
SPK: The earlier the child is identified and rehabilitated for hearing loss the better the results are. If identified earlier the child can have a cochlear implant as early as 1 year of age. Deaf children who are fitted cochlear implants by 2 years of age will develop speech and hearing almost like normal children.
EC: It is not possible for most people to afford the high cost of a cochlear implant.
SPK: During my interaction with the local specialists, it was heartening to learn that the Government of India is providing free cochlear implants to all children below 5 years of age through the National Health Mission .
EC: What can be done to prevent hearing loss in children?
SPK: Avoiding marriages among close relatives, ensuring good health of the expectant mother, proper immunization of both the mother and child, making sure the deliveries are performed under the supervision of trained personnel, treating ear infections timely, avoiding exposure to loud noise are some of the measures to prevent hearing loss in children. Early diagnosis by using the Universal newborn hearing screen and early use of rehabilitative measures as outlined above will go a long way in reducing the deafness related disability.
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