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Growing burden of hearing disability

May 07, 2015

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  • 1.04/23/1404/23/14 Capital Hospital IslamabadCapital Hospital Islamabad 11

2. 04/23/1404/23/14 Capital Hospital IslamabadCapital Hospital Islamabad 22 GROWING BURDEN OFGROWING BURDEN OF HEARING DISABILITY INHEARING DISABILITY IN PAKISTAN PAKISTAN ITS CAUSESITS CAUSES DR. GHULAM SAQULAINDR. GHULAM SAQULAIN M.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 Department Capital HospitalCapital Hospital ISLAMABADISLAMABAD 3. 04/23/1404/23/14 Capital Hospital IslamabadCapital Hospital Islamabad 33 Never to see the face of a loved one norNever to see the face of a loved one nor witness a summer sunset is indeed awitness a summer sunset is indeed a handicap. But I can touch a face and feel thehandicap. But I can touch a face and feel the warmth of the sun. But to be deprived ofwarmth of the sun. But to be deprived of hearing the song of the first spring robin andhearing the song of the first spring robin and the laughter of children provides me with athe laughter of children provides me with a long and dreadful sadness_long and dreadful sadness_ Helen KellerHelen Keller The Story of My Life, 1902The Story of My Life, 1902 4. ABSTRACABSTRAC TT Pakistan is an important Muslim Asian Country with anPakistan is an important Muslim Asian Country with an area of 3,10,403 sq. miles and a population of 140area of 3,10,403 sq. miles and a population of 140 million. According to census report 1998, 9 % of totalmillion. According to census report 1998, 9 % of total population is disabled and according to WHO survey,population is disabled and according to WHO survey, 10% of total population is suffering from one or other10% of total population is suffering from one or other disability. Hearing impairment accounts for 9% ofdisability. Hearing impairment accounts for 9% of disabilities.disabilities. Based on a retrospective study of data collectedBased on a retrospective study of data collected at National Institute for Handicapped, the articleat National Institute for Handicapped, the article highlights the causes of increasing burden of hearinghighlights the causes of increasing burden of hearing disability and handicap in Pakistan.disability and handicap in Pakistan. (Key Words: Hearing Disability, Handicap)(Key Words: Hearing Disability, Handicap) 5. 04/23/1404/23/14 Capital Hospital IslamabadCapital Hospital Islamabad 55 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, INTRODUCTIO N 6. 04/23/1404/23/14 Capital Hospital IslamabadCapital Hospital Islamabad 66 Normal brain development in babies and young children relies onNormal brain development in babies and young children relies on stimulation of the brain from sensory input: eyesight, hearing, taste,stimulation of the brain from sensory input: eyesight, hearing, taste, smell and touch.smell and touch. Children born with a hearing impairment face great difficulty inChildren born with a hearing impairment face great difficulty in learning to speak. During the first 4 years of life, children learn tolearning to speak. During the first 4 years of life, children learn to mimic and recognize different sounds, respond to voices andmimic and recognize different sounds, respond to voices and develop speech and language skills.develop speech and language skills. If a hearing loss remains undetected during these vital learningIf a hearing loss remains undetected during these vital learning years, emotional and personal development is delayed, speech andyears, emotional and personal development is delayed, speech and language are restrained, and learning disabilities may develop. Alanguage are restrained, and learning disabilities may develop. A prolonged hearing loss, may lead to speech delays, lowerprolonged hearing loss, may lead to speech delays, lower intelligence, and reading delays that can be permanent even afterintelligence, and reading delays that can be permanent even after the hearing loss is corrected. Thus a hearing loss in a child aged 1-the hearing loss is corrected. Thus a hearing loss in a child aged 1- 3 years will have a far greater impact on the child than the same3 years will have a far greater impact on the child than the same degree of hearing loss at a later age. These outcomes can bedegree of hearing loss at a later age. These outcomes can be prevented by early diagnosis and intervention.prevented by early diagnosis and intervention. INTRODUCTIO N 7. 04/23/1404/23/14 Capital Hospital IslamabadCapital Hospital Islamabad 77 Hearing Impairment is thus a major cause of disability andHearing Impairment is thus a major cause of disability and handicap in developing countries. One of the main deficiencies inhandicap in developing countries. One of the main deficiencies in the field is the absence of authentic epidemiological data in thethe field is the absence of authentic epidemiological data in the developing countries, so much so that no concensus has beendeveloping countries, so much so that no concensus has been reached regarding the etiology, prevention, treatment andreached regarding the etiology, prevention, treatment and rehabilitative strategies.rehabilitative strategies. The data on the global magnitude of the problem is scarce, recentThe data on the global magnitude of the problem is scarce, recent data relates that there are around 300 million people with disablingdata relates that there are around 300 million people with disabling Hearing Impairment in the world R-1, compared to previousHearing Impairment in the world R-1, compared to previous estimates of 100 to 120 million. However a matter of seriousestimates of 100 to 120 million. However a matter of serious concern is that it continues to affect a vast population of developingconcern is that it continues to affect a vast population of developing world especially children, where the problem is on the rise.world especially children, where the problem is on the rise. INTRODUCTIO N 8. 04/23/1404/23/14 Capital Hospital IslamabadCapital Hospital Islamabad 88 Detection of Hearing impairment and pathologies before they resultDetection of Hearing impairment and pathologies before they result in hearing disability and social handicap and rectify them at grassin hearing disability and social handicap and rectify them at grass root level is essential for developing countries like Pakistan, withroot level is essential for developing countries like Pakistan, with limited resources.limited resources. The processes by which Hearing impairment and pathologiesThe processes by which Hearing impairment and pathologies ultimately result in development of Hearing Disability and Handicapultimately result in development of Hearing Disability and Handicap11 .. Relates to wide range of pathologiesRelates to wide range of pathologies 22 .The processes may be.The processes may be influenced by a number of factors :influenced by a number of factors : Late DetectionLate Detection Poor Service IntegrationPoor Service Integration InfectionsInfections Genetic predispositionGenetic predisposition Pre maturityPre maturity TraumaTrauma Birth HypoxiaBirth Hypoxia ToxicityToxicity ConvulsionsConvulsions 9. 04/23/1404/23/14 Capital Hospital IslamabadCapital Hospital Islamabad 99 METHODSMETHODS A Retrospective analysis of data collected at the E.N.TA Retrospective analysis of data collected at the E.N.T Department, National Institute for Handicapped wasDepartment, National Institute for Handicapped was performed.performed. The study included all cases of Hearing Impairment/ Disability/The study included all cases of Hearing Impairment/ Disability/ Handicap who visited the department from 1Handicap who visited the department from 1stst .January 1998 to.January 1998 to 1212thth Dec. 2000.Dec. 2000. Cases of senile deafness (Presbycusis were excluded fromCases of senile deafness (Presbycusis were excluded from the study).the study). Total number of cases included in the study was five hundredTotal number of cases included in the study was five hundred thirty seven (n = 537). These were cases who presented atthirty seven (n = 537). These were cases who presented at NIHd with Hearing or other impairment or disability and wereNIHd with Hearing or other impairment or disability and were subjected to E.N.T examination and audiological testing.subjected to E.N.T examination and audiological testing. 10. 04/23/1404/23/14 Capital Hospital IslamabadCapital Hospital Islamabad 1010 Audiological testing was performed by a qualifiedAudiological testing was performed by a qualified audiologist, using Siemens Diagnostic Audiometer withaudiologist, using Siemens Diagnostic Audiometer with facility of Free Field testing as well.facility of Free Field testing as well. In few cases BERA was obtained.In few cases BERA was obtained. Tympanometry was essentially performed in cases withTympanometry was essentially performed in cases with suspected middle ear problems like OME.suspected middle ear problems like OME. METHODMETHOD SS 11. 04/23/1404/23/14 Capital Hospital IslamabadCapital Hospital Islamabad 1111 RESULTRESULT SS Retrospective analysis of data of 537 hearing impairedRetrospective 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 12. 04/23/1404/23/14 Capital Hospital IslamabadCapital Hospital Islamabad 1212 First presentation of patients includedFirst presentation of patients included in the studyin the study 0 50 100 150 200 250 300 350 Speech Impaired/Handicap Multiple Impairments/Handicap Hearing Impaired alone No. of Cases No.