Burden of hearing disability in pakistan – its

04/11/2304/11/23 Capital Hospital IslamabadCapital Hospital Islamabad 11


GROWING BURDEN OF GROWING BURDEN OF HEARING DISABILITY IN HEARING DISABILITY IN

PAKISTAN – PAKISTAN – ITS CAUSESITS CAUSES

DR. GHULAM SAQULAINDR. GHULAM SAQULAINM.B.B.S., D.L.O., F.C.P.SM.B.B.S., D.L.O., F.C.P.S

Head of E.N.T DepartmentHead of E.N.T DepartmentCapital HospitalCapital Hospital

ISLAMABADISLAMABAD


Never to see the face of a loved one Never to see the face of a loved one nor witness a summer sunset is indeed nor witness a summer sunset is indeed a handicap. But I can touch a face and a handicap. But I can touch a face and feel the warmth of the sun. But to be feel the warmth of the sun. But to be deprived of hearing the song of the deprived of hearing the song of the first spring robin and the laughter of first spring robin and the laughter of children provides me with a long and children provides me with a long and dreadful sadness_dreadful sadness_

Helen KellerHelen KellerThe Story of My Life, 1902The Story of My Life, 1902

ABSTRAABSTRACTCT

Pakistan is an important Muslim Asian Country Pakistan is an important Muslim Asian Country with an area of 3,10,403 sq. miles and a with an area of 3,10,403 sq. miles and a population of 140 million. According to census population of 140 million. According to census report 1998, 9 % of total population is disabled report 1998, 9 % of total population is disabled and according to WHO survey, 10% of total and according to WHO survey, 10% of total population is suffering from one or other population is suffering from one or other disability. Hearing impairment accounts for 9% of disability. Hearing impairment accounts for 9% of disabilities.disabilities.

Based on a retrospective study of data Based on a retrospective study of data collected at National Institute for Handicapped, collected at National Institute for Handicapped, the article highlights the causes of increasing the article highlights the causes of increasing burden of hearing disability and handicap in burden of hearing disability and handicap in Pakistan.Pakistan. (Key Words: Hearing Disability, (Key Words: Hearing Disability, Handicap)Handicap)


Normal HearingNormal Hearing Outer and middle Ear:

Any abnormality or disease could result in conductive hearing loss,

Inner Ear:

Abnormality or disease would result in Sensory Hearing loss,

Cochlear nerve and auditory centres:

Abn. or disease would result in Neural hearing loss,

INTRODUCTION


• Normal brain development in babies and young children relies Normal brain development in babies and young children relies on stimulation of the brain from sensory input: eyesight, on stimulation of the brain from sensory input: eyesight, hearing, taste, smell and touch.hearing, taste, smell and touch.

• Children born with a hearing impairment face great difficulty in Children born with a hearing impairment face great difficulty in

learning to speak. During the first 4 years of life, children learn learning to speak. During the first 4 years of life, children learn to mimic and recognize different sounds, respond to voices to mimic and recognize different sounds, respond to voices and develop speech and language skills.and develop speech and language skills.

• If a hearing loss remains undetected during these vital If a hearing loss remains undetected during these vital

learning years, emotional and personal development is learning years, emotional and personal development is delayed, speech and language are restrained, and learning delayed, speech and language are restrained, and learning disabilities may develop. A prolonged hearing loss, may lead to disabilities may develop. A prolonged hearing loss, may lead to speech delays, lower intelligence, and reading delays that can speech delays, lower intelligence, and reading delays that can be permanent even after the hearing loss is corrected. Thus a be permanent even after the hearing loss is corrected. Thus a hearing loss in a child aged 1-3 years will have a far greater hearing loss in a child aged 1-3 years will have a far greater impact on the child than the same degree of hearing loss at a impact on the child than the same degree of hearing loss at a later age. These outcomes can be prevented by early later age. These outcomes can be prevented by early diagnosis and intervention. diagnosis and intervention.

INTRODUCTION


• Hearing Impairment is thus a major cause of disability and Hearing Impairment is thus a major cause of disability and handicap in developing countries. One of the main handicap in developing countries. One of the main deficiencies in the field is the absence of authentic deficiencies in the field is the absence of authentic epidemiological data in the developing countries, so much epidemiological data in the developing countries, so much so that no concensus has been reached regarding the so that no concensus has been reached regarding the etiology, prevention, treatment and rehabilitative strategies. etiology, prevention, treatment and rehabilitative strategies.

• The data on the global magnitude of the problem is scarce, The data on the global magnitude of the problem is scarce, recent data relates that there are around 300 million people recent data relates that there are around 300 million people with disabling Hearing Impairment in the world R-1, with disabling Hearing Impairment in the world R-1, compared to previous estimates of 100 to 120 million. compared to previous estimates of 100 to 120 million. However a matter of serious concern is that it continues to However a matter of serious concern is that it continues to affect a vast population of developing world especially affect a vast population of developing world especially children, where the problem is on the rise. children, where the problem is on the rise.

INTRODUCTION


• Detection of Hearing impairment and pathologies before they result in Detection of Hearing impairment and pathologies before they result in hearing disability and social handicap and rectify them at grass root level hearing disability and social handicap and rectify them at grass root level is essential for developing countries like Pakistan, with limited resources. is essential for developing countries like Pakistan, with limited resources.

• The processes by which Hearing impairment and pathologies ultimately The processes by which Hearing impairment and pathologies ultimately result in development of Hearing Disability and Handicapresult in development of Hearing Disability and Handicap11. Relates to . Relates to wide range of pathologies wide range of pathologies 22.The processes may be influenced by a .The processes may be influenced by a number of factors :number of factors :

Late DetectionLate Detection Poor Service IntegrationPoor Service Integration InfectionsInfections Genetic predispositionGenetic predisposition Pre maturityPre maturity TraumaTrauma Birth HypoxiaBirth Hypoxia ToxicityToxicity ConvulsionsConvulsions


METHODMETHODSS

• A Retrospective analysis of data collected at the E.N.T A Retrospective analysis of data collected at the E.N.T Department, National Institute for Handicapped was Department, National Institute for Handicapped was performed.performed.

• The study included all cases of Hearing Impairment/ The study included all cases of Hearing Impairment/ Disability/ Handicap who visited the department from Disability/ Handicap who visited the department from 11stst.January 1998 to 12.January 1998 to 12thth Dec. 2000. Dec. 2000.

• Cases of senile deafness (Presbycusis were excluded Cases of senile deafness (Presbycusis were excluded from the study).from the study).

• Total number of cases included in the study was five Total number of cases included in the study was five hundred thirty seven (n = 537). These were cases who hundred thirty seven (n = 537). These were cases who presented at NIHd with Hearing or other impairment or presented at NIHd with Hearing or other impairment or disability and were subjected to E.N.T examination and disability and were subjected to E.N.T examination and audiological testing. audiological testing.


• Audiological testing was performed by a qualified Audiological testing was performed by a qualified audiologist, using Siemen’s Diagnostic audiologist, using Siemen’s Diagnostic Audiometer with facility of Free Field testing as Audiometer with facility of Free Field testing as well.well.

• In few cases BERA was obtained. In few cases BERA was obtained. • Tympanometry was essentially performed in Tympanometry was essentially performed in

cases with suspected middle ear problems like cases with suspected middle ear problems like OME.OME.

METHODMETHODSS


RESULTRESULTSS

• Retrospective analysis of data of 537 hearing impaired Retrospective analysis of data of 537 hearing impaired patients including 327 males and 210 femalespatients including 327 males and 210 females

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

Percentage

Males Females

Gender

Percentage Distribution of Gender of Patients


First presentation of patients First presentation of patients included in the studyincluded in the study

0 50 100 150 200 250 300 350

SpeechImpaired/Handicap

MultipleImpairments/Handicap

Hearing Impairedalone

No. of Cases

No. of Cases

340 Patients presented with Hearing and Speech Impairment, while 29 showed multiple handicaps. Only 168 cases cases with HI alone.


Distribution of patients according to Distribution of patients according to province of originprovince of origin

NO. OF PATIENTS

N.W.F.P

A.J.K

Baluchistan

Punjab

Poor service integration was noted as services were mainly utilized by a single province because of one reason or the other,


Distribution of Patients according to Distribution of Patients according to Age of PresentationAge of Presentation

Distribution of hearing impaired children according to age of presentation is shows in fig., which shows that very few cases presented before three years of age i.e., hardly 10% which was responsible for the increasing disability.

5%24%

23%

43%

5%

Less than 1 year

1.1 to 3 Years

3.1 to 5 Years

5.1 to 18 Years

Above 18 Years


0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00%

Percentage

Late Presentation (After 3 Years)

Offsprings of First Cousins

Prenatal CMV

Prenatal Rubella

Prenatal Ototoxic Drug Exposure

Birth Hypoxia

Prematurity

Low Birth Weight

Forceps Delivery

Delivery via C/Section

Neonatal J aundice

Meningitis

Typhoid

High Grade Fever

Mumps

Measles

Trauma

Noise Trauma

OME

Discharging Ears

Ototoxic drug intake

Cau

se/ R

isk

Fac

tor

Breakdown of causes/risk factors

responsible for increasing burden

of hearing disability and

handicap.


CONCLUSICONCLUSIONON

• Identification of possible causes responsible for Identification of possible causes responsible for increasing the hearing disability and handicap is of increasing the hearing disability and handicap is of utmost importance especially for formulation of utmost importance especially for formulation of evaluation, treatment and rehabilitation strategies.evaluation, treatment and rehabilitation strategies.

• The Common Causes of Increasing Burden of The Common Causes of Increasing Burden of Hearing disability and Handicap noted in this study Hearing disability and Handicap noted in this study were:were:

Late Presentation and lack of neonatal Late Presentation and lack of neonatal screening.screening.

ConsanguinityConsanguinity OMEOME


• Most of the causes are either:Most of the causes are either: Preventable through immunization, early Preventable through immunization, early

diagnosis and treatment of OME and ear diagnosis and treatment of OME and ear infections and avoidance of ototoxic drugs so infections and avoidance of ototoxic drugs so that disease/ impairment do not occur.that disease/ impairment do not occur.

Other pathologies/ impairments may be Other pathologies/ impairments may be contained by early diagnosis esp. neonatal contained by early diagnosis esp. neonatal screening and intervention at an early age to screening and intervention at an early age to prevent development of disability or handicap. prevent development of disability or handicap.

• Lack of Neonatal Screening and Late presentation Lack of Neonatal Screening and Late presentation of cases with hearing pathologies and of cases with hearing pathologies and impairments is the root cause of increasing impairments is the root cause of increasing burden of hearing disability and handicap. Not burden of hearing disability and handicap. Not only is it resulting in delayed diagnosis and only is it resulting in delayed diagnosis and wastage of resources but also easily treatable wastage of resources but also easily treatable conditions like Otiits Media and CSOM are conditions like Otiits Media and CSOM are resulting in hearing disability and handicap. resulting in hearing disability and handicap.


THE LEEDS CASTLE THE LEEDS CASTLE DECLARATIONDECLARATION

““Avoidable disability with all its consequences Avoidable disability with all its consequences in human suffering and economic loss need no in human suffering and economic loss need no longer be an inescapable part of our human longer be an inescapable part of our human predicament. It’s prevention on an predicament. It’s prevention on an unprecedented scale and at an acceptable cost unprecedented scale and at an acceptable cost is one of the options which are now available is one of the options which are now available to the international community.”to the international community.”


In children 1-6 years of age, at any one point in In children 1-6 years of age, at any one point in time 5-10 % of children have OME in both ears and time 5-10 % of children have OME in both ears and 20% in single ear. In children with persisting OME 20% in single ear. In children with persisting OME after 7 years are at very high risk of developing after 7 years are at very high risk of developing complications of OME and becoming handicapped. complications of OME and becoming handicapped.


Several NGO’s have taken up deafness and Several NGO’s have taken up deafness and hearing impairment on their main agenda like hearing impairment on their main agenda like Hearing International, Impact Foundation, Dewa Hearing International, Impact Foundation, Dewa Academy, Lions Club and so many others.Academy, Lions Club and so many others.


REFERENCEREFERENCESS

World Health Forum: Prevention of deafness World Health Forum: Prevention of deafness and hearing impairment, 1993, 14,No 1, and hearing impairment, 1993, 14,No 1, 1:12 WHO Geneva.1:12 WHO Geneva.








Burden of hearing disability in pakistan – its

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