Orienting ourselves towards prevention & early identification of deafness

Scanning through the huge lot of unpublished papers of our journal- particularly those on otology, it was surpris- ing to find that there are practically no papers (except one on noise induced heating loss) on prevention of deafness. There are numerous papers on therapeutic otology, but when it comes to preventive otology or research on the basic sciences regarding hearing, we have not lived upto expectations. Our research is focussed on clinical / thera- peutic otology only. Preventive otology, which is much more important and relevant in a country like ours has not caught our fascination. This is unfortunate. Preventive otology, on a broader perspective, encompasses ways and means of not only preventing the occurrence of deafness but also minimising the ravages of deafness by early iden- tification.

A culture shift is of paramount importance. Otolaryngo- logists must take upon themselves the responsibility of changing the attitude and perception (of not only fellow otologists but also that of the general population) towards deafness and creating an awareness on the necessity of maintenance of heating health. We, as a professional body have been unable to instill in the public mind the concep- tion that --(1)hearing is as important as vision, (2) hear- ing too needs to be protected like our teeth and eyes. (3) most, if not all cases of hearing loss can be prevented, (4) hearing loss can be ameliorated in most cases (5) very early identification of deafness is essential especially in young children (6) identification and quanti- fication of deafness is possible even in newborns. Early identification of deafness and prevention of deafness is a burning social necessity. We cannot turn a blind eye to this.

Our research priuritie~ at least in otology arc perverted and insensitive to our social needs. We need more of ba- sic research on hearing. Requis i te funding for such projects is the need of the hour. Research on the physiol- ogy of hearing, the genetics of hearing loss and clinically refining the technological break-through in artificial hear- ing made by our colleagues from the electronic industry is now needed. Genetic engineering, transplantation and / or regeneration of the inner ear hair-cells, functional im- aging of the auditory system, cochlear and brain-stem implantation are just some of the areas of research where our academicians should now focus their attention to. We have had enough of research on the virtues and vices of the d i f f e r en t b io -mate r i a l s fo~ tympanop las ty , the

stapedotomy and stapedectomy controversy, the canal- up and canal-down dilemma. Now we need to focus our attention to (1) Prevention of deafness and (2) Early iden- tification of deafness.

I do not have ready figures at hand to quote Indian staffs- tics but from published reports from USA, I find that 10- 20% of the entire US population has hearing impairment that is severe enough to hinder learning and detrimental to the quality of life. It is estimated that 2-4 out of every 1000 babies born in USA have a very significant hearing loss which remains undetected till the child has crossed the age of normal language development. When it is de- tected it is already too late. If this is the scene in a medi- cally advanced country like U, SA what the situation could be in our country (where me~dical facilities is not some- thing we can boast of) is just anybody's guess. So the requirement of research on prevention of deafness and early identification of deafness is all the more important in a poor country like ours because patients of hearing im- pairment are a very heavy burden to our society. Rehabili- tating them costs our already burdened exchequer heavily. It would be much more cost-effective if we could pool our resources for funding of research on prevention of deafness, early identification of deafness and also on in- creasing awareness on the maintenance of hearing health. It is the task of our professional bodies like the Associa- tion of Otolaryngologists of India to put the above fea- tures on the national agenda. If our legislators have been able to introduce punitive measures for non-compliance of rules for safe-driving, there is no reason why the same cannot be implemented for violation of rules for hearing preservation. Parents teach children the ways and means of protecting their teeth and eyes but the same does not hold true for hearing. Hearing is taken for granted. We have a responsibility towards the society and moulding public mind towards preservation of hearing health is our prerogative. Let 's not fight shy of this responsibility.

Even if research on genetic engineering for prevention of deafness or bio-electronic research on artificial hearing seem to be a far cry in our country (though there is no valid reason for it), we can at least prioritise early identi- fication of deafness on the national agenda and focus Our research programs towards it. Our natural capacity to learn language develops mainly in the first 2 years of life. Any impairment of hearing in these first 2 years will im- pede (if not abolish) the development of linguistic skills.

210 Editorial

The results of this is disastrous. A deaf child is bound to fall behind in the development of linguistic / social skills. To prevent this, the deafness has to be detected soon af- ter birth. Detecting it after the child has crossed 2 years of age will not be of much help. A subject devoid of communicative skills (i.e. taking and hearing) is an unfor- tunate (but preventable) burden to the society. Rehabili- tating such as subject later on in life when the damage has already been done is much more difficult than identi- fying the deafness in the first 2 years of life and institut- ing suitable remedial measures such that the subject does not grow up as a deaf-mute. This message has to be reg- istered in the powerful ears of those who allocate health care budgets and formulate medical research. Hearing screening programs in all newborns have to made man- datory- (it is criminal to miss out on a complete hearing assessment on all babies born out of at-risk pregnancies). Campaigns on developing public awareness on preserva- tion of hearing and the importance of hearing checkups especially in new borns and requisite legislature for pre- vention of noise trauma both in industry as well as out- side it are the need of the hour. We can no longer afford to ignore preservation of hearing health and deafness pre- vention as mere topics for organising seminars and meet- ings only.

Otoacoustic emission machines and Brain-stem Evoked Potential machines, which are essential for identifying deafness in a child in the first 2 years of life, are just not available in most of our clinics and govt. hospitals. The otoacoust ic emission machines which are now readily available in our country should be a boon to the otolaryn- gologist. It is a screening machine that helps detection of any deafness above 35dB within a minute or so. The test is very easy to perform, non-invasive and objective. BERA machines are now being manufacture in our country and be cost has also comedown drastically making it afford- able for most clinics. It is not that we are not spending any money on medical equipment and research, but our priorities are perverted and urgently need a change. Our medical research and expenditure on medical equipment should be attuned to our social needs.

The importance of hearing screening in newborns has now been recognised by our peers in developed countries but we are yet to orient ourselves to realising its impor-

tance. The Times magazine of 1/1/2000 reports that hear- ing screening for all new-borns has now been made man- datory in 22 states in USA. Though one cannot deny that hearing tests by otoacoustic emissions are not foolproof, yet they do act as a very good screening test and help us to identify nearly all cases of deafness. Due to its propen- sity for false positive cases, a repetition of all the cases where otoacoustic emission test suggests deafness, fol- lowed by BERA test is the standard protocol. By follow- ing this protocol the otologist can identify nearly all cases of deafness in new borns. I f the deafness in children is identified very early and suitable remedial measures un- dertaken, the communicative skills of the child develop normally. The significance of this has to be realised by all of us and early identification of deafness by otoacoustic emission test and BERA prioratised immediately. Side by side research on genetic engineering and such advanced technologies like hair-cell regeneration and bio-electron- ics should go on so that our profession can be instrumen- tal in putting an end to all types of hearing loss and the effects associated with non-development of communica- tion skills.

John Wheeler who is a very big name in health adminis- tration in the USA and the director of the Deafness Re- search Foundation had written an editorial in the Ameri- can Journal of Otology in Jan 1998 where he had pre- dicted that the "end of all hearing loss is in reach". I f otologists can motivate themselves into prioritising pre- ventive otology in their practise as well as in research, if we can create awareness in the public mind regarding the necessity of testing all children at birth for deafness and inculcate into them the importance of conserving hearing health during the entire lifetime, John Wheeler ' s predic-

tion is bound to be true.

Re fe rences - 1. www.hearinghealth.net 2. www.i fhoh.org

3. www.dea fnes s . com

Dr. Anirban Biswas

(Editor)

C O R R I G E N D U M

The ed i to r ' s off ice regrets omi t ing the name of Dr. A. K. Mehta of AFMC Pune as a Co-au the r along with Dr. V. K. Singh of the same instititute in the article titled " Nasal Dysfunction Amongst Divers During Bounce and Saturation Diving" published in the last issue of our journal.

Indian Journal o f Otolaryngology and Head and Neck Surgery VoL 52 No. 3, July - September 2000