New Delhi: Disabilities related to hearing have become a big concern as the WHO has also said that nearly 2.5 billion people worldwide or one in every 4 individuals will have some degree of hearing loss by 2050. Top experts Dr Alok Thakar, HoD of ENT at AIIMS, Dr Sumit Mrig, senior consultant and HoD of ENT at Max Hospital, and Dr Prachi Jain, ENT specialist at Alchemist Hospital, suggest that early detection and awareness can protect people from many hearing-related problems.
Q: Why is hearing loss usually neglected?
Dr Thakar: Hearing loss is often a silent disability because people who have hearing loss generally withdraw from social interaction slowly. The simple reason for that is that they can’t participate fully. The problem with hearing loss is also that leads to significant slow effects which are not easily recognised. It can lead to decreased language development in younger children and academic performance in school-going children. It does lead to cognitive or mental decline and dementia for elderly people who can’t hear well too.
Q: Does it affect people psychologically?
Dr Thakar: Yes, they are probably affected psychologically but we have not proven it scientifically. Unfortunately, hearing loss or hearing damage is very minimal and cumulative, which means it adds up over the years. It happens primarily because of noise as we live in very noisy environments, which are not safe for us. We also use earphones all the time for using the phone or listening to music, but the effects of that will show as age increases.
Q: Do you think working from home is a reason for hearing issues now?
Dr Thakar: Certainly. Earphones, especially poor-quality ones, if used at loud volumes, are an issue. Otherwise, for conversation, there is no issue. Using earphones for music can be a problem because music has highs and lows and a sudden increase in volume and amplitude can lead to ear damage.
Q: What are other reasons for hearing issues among the general public?
Dr Mrig: I would say that the most common reasons for hearing loss are draining ears, discharging ears, age-related problems and congenital problems. I see a lot of patients who have hearing loss from their first year but don’t get to know about it till they focus on the fact that they are not able to perceive sounds. In fact, people realised they have hearing loss when they were sitting at home during Covid. They were not able to focus on it otherwise in their busy schedules. The incidence of unilateral hearing loss is also very high. A wide spectrum of hearing loss affects all age groups, starting from newborns who are born congenitally deaf to children of lower socio-economic status who go to school with draining or discharging ears and never get it checked. Less than 1% of people go deaf suddenly. Most of them have acquired deafness which keeps on accumulating with discharging ears, causing the erosion of the ear bone, ear ossicles and, finally, the main organ.
As Dr Alok said, hearing loss is a silent killer. When a child is born, if you don’t have a program in practice like a universal newborn hearing screening program, the child will never be able to tell that they can’t hear. Then there are adolescents who might be using lots of headphones or who live in a noisy environment. Then we have the geriatric age group who ignore slow and progressive hearing loss and adapt to it without any interventions. If we have to address the problem of hearing loss in our country, we have to think of the most basic things. Every child in India should be screened for hearing loss. Four in every thousand children born in India may suffer some kind of hearing loss and every year about a lakh kids are born with some kind of hearing loss or deficiency. It might be shocking to hear what the WHO has said today but even now one in five people in the world have some kind of a hearing disability.
Dr Jain: As Dr Sumit said, a universal screening program is very important. At least, a high-risk pregnancy screening programme should be thoroughly followed. Any child who had antenatal events or who was born to a mother who was deaf, or had a high-risk pregnancy, or was a patient who was on fentin or any drugs, or has any kind of infection like rubella needs to be screened thoroughly. Same for any patient who had a prenatal history, did not cry at birth, had high bilirubin or was later given drugs which affect hearing like aminoglycoside, cisplatin or chloroquine. People should get audiometry or evaluation before starting such drugs, and afterwards, periodic assessment should be done.
Q: What are age-related hearing problems?
Dr Thakar: It is when people slowly develop hearing loss when they are over the age of 60. Unfortunately, many people are developing hearing loss before that age too. The prime reason is noise exposure during adulthood or mid-life, which slowly accumulates. There is a very interesting study which shows that tribal populations from Africa who were not exposed to loud music or drums never developed age-related hearing loss. It is only with people who live in civilized society because we are exposed to such noise.
Q: How harmful is using earbuds when the ears itch?
Dr Mrig: When you use an earbud, you actually push the wax deep inside which cannot be taken out. I, as an ENT surgeon who knows the length of my ear canal, have not been able to take out my wax using an earbud. I have seen people use the back of a pencil or pen, car keys, earbuds and toothpicks which can cause damage to the very delicate epithelium inside the ear canal and the skin, causing infection. I see close to three or four cases every month where there is a traumatic perforation or a hole in the ear drum, where a person was trying to clean their ear and a child came running from behind and caused trauma. So, earbuds should be discouraged.
Q: For timely cleaning, should people visit a doctor?
Dr Mrig: When I was at Maulana Azad, we did a lot of programmes where we covered close to 15-20 schools and where the National Program for Deafness started. You would be surprised to know how accumulation of earwax may be a reason for hearing loss in a child. A child may accumulate a lot of impacted wax that can cause about 25% to 30% of hearing loss, but since he is a child, he is not aware about it. So, awareness and annual checkups by an ENT surgeon will help.
Q: What are the latest technologies to treat hearing issues?
Dr Mrig: The most important technology to treat such issues depends upon the cause of hearing loss. Like I said, with a universal screening program, you can have a basic test which can detect whether a child will hear or not. Once a child fails on the SCOI and on the BERA, you diagnose the child with profound bilateral hearing loss, where hearing loss is more than 90%. So, this lets you detect deafness by one month, establish a diagnosis by three months and intervention should be possible by six months. These newborn cases diagnosed with severe or profound loss should then be counselled for cochlear implant surgery. It is an ear surgery where you place an electronic device which has certain electrodes. There is an external processor too. So, the device serves as a bionic sense organ or artificial ear and carries the sound from the external and internal environment and converts it into signals which go to the brain, which you perceive as sound.
Q: Cochlear implant is very costly. Are there any affordable substitutes?
Dr Mrig: Let me take away the myth that it is a costly surgery. The Government of India helps through different schemes, state program funding and central program funding. More than 300 institutions in the country offer this implant. Dr Alok is part of AIMS, which offers this surgery free of cost. The problem is not the cost of the surgery. In fact, every year, more than 3,000 implants are sanctioned by the government for free implantation to be used by surgeons for deaf kids. The problem is awareness and not detecting it early. By the time these kids reach any surgeon, they are already 3 or 4 years. So, if we are able to identify these children as early as six months and get them implants by eleven months, which is approved by the US FDA and which we follow in India, then these children will have a normal life. The problem is that we don’t have the standardized universal hearing screening program in our country. Last year, on 3 March, I, along with representatives from AOI, met Dr Harsh Vardhan and gave him a proposal. Unfortunately, we all got stuck due to Covid. My sincere request to policymakers and the health ministry is to implement the universal newborn hearing program. Kerala is the only state which has been doing this for the last 2-3 years. Rajasthan, Gujarat and Andhra Pradesh have this program rolled out on paper not in practice.
Q: How can we spread awareness about hearing impairment among parents and children?
Dr Thakar: I think we first need to realize that this is a problem that has a significant impact on how people develop and interact with society and on their economic potential. Three major causes of hearing loss today are presbycusis, discharging ears and early onset presbycusis. Hearing is the only sense which we can replace using technology in a fairly accessible and cost-effective way. And there is funding available. But we are at a stage where screening is necessary. For schoolchildren who cannot perform in school because of hearing and speaking impairment, operation can be done, but they need to be referred to one of us. So, a school healthcare program would help there. Lastly, when you tell us that 700 million will have this problem 30 years from now, it is going to be people of your and my age. So, we need to be careful and take care of our ears by not using earphones, not going to noisy events and places and not using big speakers.