Restoring the gift of sound for the hearing impaired

By Carol Aloysius

Silence means many things to many people. To those who seek it voluntarily for solitude and meditation it is like a soothing balm. But to those who are forced to endure a lifetime of silence due to hearing impairment, it means isolation and separation from the rest of society. With new advanced technology however, hearing impairment is no longer considered a lifetime sentence as it was in the past. In addition to such technology which includes sophisticated state of the art hearing aids, those with hearing impairments also have the benefit of a growing breed of professional audiologists who know how to detect their hearing defects early and initiate rehabilitation therapy irrespective of their age. "Every human being has the right to enjoy the world of sounds", says Consultant audiologist , speech and language pathologist Lasni de Alwis who explains in this interview with the Sunday Observer how that magical door to hearing can be opened.

Excerpts ...

Q. Recent research studies have shown that the number of persons with hearing impairments in Sri Lanka has risen. What is the percentage of such persons if you take our population as a whole?

A. According to our research studies around nine percent of Lankans currently suffer from some form of hearing loss.

Q. How do you define 'hearing loss'?

A. In short, it is decreased sensitivity to sounds that are normally heard

Q. Are there different types of hearing loss?

A. There are two main types of hearing loss. One is Reversible and the other Non reversible.

Q. Elaborate.

A. Reversible loss means that it is a temporary loss of hearing. Most of the conductive hearing loss are reversible.

Non reversible loss of hearing is mostly permanent loss of hearing due to the damage to the sensory cells in the inner ear or to the nerve pathways from the inner ear to the brain.

Q. What causes the first type of hearing loss (reversible hearing loss?)

A. This is caused due to gradual build up of wax, infection in the outer or middle ear, spongy growth in the middle ear, traumatic injuries caused by someone hitting the ear or with a hard blow can be damaged to ear drum. Sometimes the ossicular chain breaks due to trauma.

Q. what about ear infections and ear discharges?

A. Children are more prone than adults to get ear infections which can occur in the outer ear or the middle ear. Long-standing ear infections may lead to permanent hearing loss.

Q. How?

A. In the outer ear, it is due to foreign bodies and subsequently infections. Middle ear infections (otitis media) is more common. This occurs after common cold, mucus accumulated in the middle ear get infected due to bacteria or virus.

Q. What about nonreversible hearing loss?

A. Its also known as Sensorineural hearing loss. This reduces the ability to hear faint sounds. Even when speech is loud enough to hear, it may still be unclear or sound muffled.

It could be congenital (from birth) due to genes or hereditary or malformation of the inner ear. Sensorineural hearing loss could be due to ageing, drugs that are toxic for hearing, head trauma or exposing to loud noise prolonged period of time.

Q. Are there any other contributory factors?

A. Permanent hearing loss can also be due to infections like meningitis, mumps, scarlet fever, measles and Infections(toxoplasmosis, rubella, herpes) if the mother passes to her baby in the womb

Q. What is the treatment?

A. Some people with permanent hearing loss can benefit with properly fitted hearing aids. But that depends on the degree of loss, proper programming and usage of hearing aids. If a child or adult having severe to profound hearing loss or does not develop his speech/ language skills, or speech perception and speech understanding with a hearing aid he may need to have a Cochlear Implant. But before that the parents should first consult their ENT specialist or Audiologist.

Q. So when are the services of audiologists and speech therapists such as yourself required? What is your role?

A. Our role is to do screen tests and detect the hearing loss as early as we can, perform diagnostic tests, differentially diagnose the hearing loss to determine whether the particular individual benefit from hearing aids or cochlear implant. We are also responsible for starting up the rehabilitation program, in keeping with the child's needs.

Today, all mothers are encouraged to get screen tests for hearing on their new born babies before leaving the hospital especially if their children fall into the high risk categories I have mentioned.

Q. What are these tests for new born babies?

A. The simple test we use to identify the hearing loss is called OAE ( Oto Accoustic Emissions ) which record the function of the hair cells in a very young child(new born babies). If the child's hearing is weak, this device will flash 'Fail' on the screen.

Q. How is it done?

A. It takes only five minutes per ear and we usually do it when the child is sleeping. We recommend the test for every new born baby and advise our mothers to get their babies test before they leave the hospital after giving birth.

Q. When a child fails the test what is the next step?

A. We ask the parents to bring the child back for more tests after a period of three months. If necessary, we also request them to bring the child for tests in between that period.

Q. If the hearing has still not improved what do you do?

A. We do tests to find the hearing level of the child and thereafter, based on those tests, recommend that the child gets a hearing aid. Once a hearing aid is fixed externally (by a qualified audiologist,) an audiologist and speech therapist initiates the rehabilitation program in order to try and restore the child's listening, speech and language skills as much as possible.

Q. Tell us more about this rehabilitation program. What does it involve?

A. Our job is to first counsel the parents or carers on how they should communicate with the child and help to develop the listening skills. One of the first things we tell them is to face the child and talk directly to him and talk closer to their ears and talk at recommended level of the loudness.

Q. So how do you stimulate his hearing?

A. The speech and language therapist or auditory verbal therapist will expose the child to the sounds in his environmental and help him develop an understanding of the meaning of those sounds. We stimulate the child's vocalisation and babblings using various methods suited to its age and his understanding of speech and language according to his chronological age periodically adjusting the hearing aid to judge the child's response.

Q. And if there is no real positive response ?

A. If the child's hearing is still very weak or the child's development of listening skills ,speech - language skills are poor, we advise parents to go for other options.

Q. Like what?

A. Cochlear implant is the new technology that is now available for such children or adults who get limited benefit or does not get benefit from aids. It is an evolving technology with a wide range and enables the user to help enjoy the vibrant world of sounds as in the real world.

Q. Tell us more about these implants.

A. Well, a cochlear implant is a more complex and highly advanced electronic device. This is an advanced version of a hearing aid, provides sense of sound to a person who is severe - profound deaf, by acting like an artificial ear.

A cochlear implant has two components as internal and external. The internal component should be surgically implanted inside the head.

The external device is called the processor which capture environmental sounds as well as speech and music, which needs proper programing, so that the child will be able to hear well in all the environment (school, business environment) even in a noisy back ground, soft speech, enjoy the music, use of telephone. As audiologists we monitor the function of the implant during the surgery and program the processor i.e. connect the external device to the computer and according to the responses we adjust the processor (external device) to the child's need.

Once the surgeon fits the implant internally, we generally allow the child 3-4 weeks to recover from the surgery and the scars to heal, before we fix the external device to initiate the rehabilitation programme.

As I mentioned earlier, our job is to develop the child's skills of listening , understanding and expressive language. For this we have to be constantly alert and keep adjusting the processor from time to time in order to gauge the child's response correctly.

Q. For how long do such children need to undergo this programme?

A. All children whose hearing is being restored through our rehabilitation programme have to undergo a good speech therapy training programme for at least two years. This however depends on the child's age and the age at which he/she received the implant, as well as the time period during which he used the hearing aid..

Q. What is this training like?

A. Those who give them this training are people with special knowledge in both theory and practical training in the implant technology. I learnt most of my work on the job and have been in this field for over 12 years.

Q. Are there any problems you face?

A. For one thing we have a dearth of qualified experienced audiologists and speech pathologists. Secondly parents with hearing impaired children who have been advised to get a cochlear implant, don't often realise that this is a life time investment that will make a world of difference to their child.

So they go for cheap brands that get outdated and whose parts cannot be replaced because new brands are constantly entering the market. There are only three brands of cochlear implants in the entire world at present. Each has its advantages and disadvantages.

It is up to the physician or hearing specialist to recommend what is most suited to the patient without being misguided by salesmen trying to promote their products.

Q. What is the price range?

A. The cost is often a drawback because it is very high. In Sri Lanka it can vary from Rs. 20-35 lakhs. I have had practical training with all 3 brands of implants, and always advise patients to improve their awareness of these products, before purchasing the implant.

There are very good brands and models of implants in the market today made out of Titanium which is tough and durable as well as upgradable and give good sound quality, which will improve the child's clarity of speech.

They can I believe be purchased at a price below Rs. 26 lakhs. Purchasing a good brand that has been tested is an important consideration for any parent intending to buy an implant.

Health Wise  Is cochlear implant done in all our hospitals?

Health Wise  No, only a limited number.

Q. What is the newest technology or breakthrough in this field?

A. The swimmable sound processor with flexible wearing styles. It can be used while surfing or swimming in pools, lakes or rivers. But patients should have enough knowledge to make an informed choice.

Q. Is the swimmable sound processor available in Sri Lanka?

A. It was introduced to Sri Lanka just last year. Unfortunately we have only one brand at present.

But the fact that it is available here is a huge step forward to both hearing impaired adults and children, as they need never be cut off from the world of sound since this new implant is waterproof.

Q. What is your advice to parents of hearing impaired children?

A. My advice is: Try to improve your knowledge on these products. Don't look only at the cosmetic aspect when purchasing an implant for your child.

Anticipate a further need for the child beyond his present needs.

But a brand that cannot be upgraded is useless as new technology is constantly replacing the old one. Blue tooth technology has now invaded every field of electronics in the country. Make sure that any implant you buy will allow your child to also benefit from this technology.

Q. Lastly what is the success rate you have had so far?

A. Though no survey has been done, the feedback from my hearing impaired students may be 99 percent. However, we must be aware that the treatment includes not only the Cochlear Implant Surgery, but the subsequent speech therapy also.

"So, before purchasing an implant device, patients must also consider the availability of right speech pathology and audiology services they can obtain from a qualified "Audiologist and Speech and Language Pathologist".

WHO report: Antibiotic resistance happening all over the world

Antibiotic resistance, which can lead to minor injuries and common post-operative infections becoming fatal, is no longer a prediction for the future but is happening "right now", the World Health Organisation (WHO) has said.

In a stark report, global health officials said that antibiotic resistance, the process whereby bacteria evolve to resist the drugs we use to combat them, "threatens the achievements of modern medicine" and will have "devastating" consequences unless "every country and individual" in the world takes action to prevent its further spread. The report, the WHO's first looking at the threat on a global scale, analysed data from 114 countries and found that antibiotic resistance was happening in "every region of the world and has the potential to affect anyone, of any age, in any country".

Already, resistance to last resort treatments for life-threatening hospital infections caused by the common bacteria Klebsiella pneumoniae has spread to all parts of the world, the report said. Resistance to the most widely used drugs for treating urinary tract infections caused by E.coli is also widespread, while last resort drugs to treat gonorrhoea has been confirmed in 10 developed countries, including the UK. In Europe, 25,000 people a year already die from infections which are resistant to drugs of last resort.

Overuse of antibiotics, both in medicine and in agriculture, is driving the rise of antibiotic resistance by hastening the evolution of resistant strains of bacteria. The WHO said that in some countries there was still no strategy in place to slow the spread of resistance. Doctors should prescribe antibiotics "only when truly needed", while individuals should only use antibiotics prescribed by a doctor and should never share them with others, the report said.

"Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill," said Dr Keiji Fukuda, the WHO's assistant director general for health security.

"Effective antibiotics have been one of the pillars allowing us to live longer, live healthier, and benefit from modern medicine. Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating."

The report warns that an infection with resistant bacteria not only makes the likelihood of death from an infection up to twice as high, but would make infections "harder or impossible to control", increasing the rate at which the infection spreads, lengthening hospital stays and adding significant economic burdens to already stretched healthcare systems around the world.

In the UK, health officials have already responded to a significant rise in hospital infections caused by a strain of drug resistant bacteria called known as carbaenemase-producing enterobacteriaceae (CPE), which caused 600 infections 2013, compared to just five in 2003. Public Health England is monitoring the situation on a national level. Dame Sally Davies, the chief medical officer, has previously compared the risk of rising antibiotic resistance in the UK to the threat posed by terrorism.

Responding to the WHO's report, she said that the world had reached a "critical point". "The soaring number of antibiotic-resistant infections poses such a great threat to society that in 20 years' time we could be taken back to a 19th century environment where everyday infections kill us as a result of routine operations," she said.

"I have already issued a call to action in the UK, but we can't tackle the problem on our own and urgently need coordinated international action."

-The Independent

 'Out of sight is not out of mind for babies'

Babies begin to recognise real-life objects from photographs at just nine-months-old, according to a new study carried out by scientists from the UK and the USA.

Researchers showed 30 babies aged between eight and nine months a life-size photograph of a toy for one minute.

The real-life toy was then presented to the babies, alongside a different toy.

The babies reached for the new toy, which, the researchers said, suggested that they recognised the pictured toy and found it less interesting than the new one, "because its novelty had worn off".

In a separate part of the experiment, carried out at Royal Holloway's specialised 'baby lab', the babies' attention was drawn to both toys, which were then placed in containers and hidden from view.

In this instance, the babies went for the toy they had seen in the picture - suggesting that they had formed an image of it in their mind, the researchers said.

Dr Jeanne Shinskey, from the department of psychology at Royal Holloway, said that the findings would be of interest to any parent or care-giver who has read a picture book to their infant.

"These findings suggest that, well before their first birthdays and their first words, babies are capable of learning about the real world indirectly from picture books, at least those that have very realistic images like photographs," she said.

"One brief exposure to a picture of a toy affects infants' actions with the real toy by the time they reach nine-months-old.

It also demonstrates that experience with a picture of something can strengthen babies' ideas of an object so they can maintain it after the object disappears - so out of sight is not out of mind."

- The Independent