Hearing loss in children: the need for early diagnosis and treatment & the miracle of Cochlear Implant technology
Birth related hearing loss is a very common problem affecting about 6 out of every 1000 children born. Unless parents are extremely observant and astute, diagnosis is often missed until the child is much older and hearing and speech issues become practically irreversible. Delay in treatment of hearing loss will lead to delay and problems with speech and language development. Thus, early diagnosis and intervention are key to successfully treating hearing impairment. The team of the “I Can Hear Foundation (ICHF)” works actively to increase awareness in this regard, and help families get access to treatment at subsidised costs.
Current guidelines recommend that all new borns should undergo a screening test to determine hearing potential within 48 hours after birth. The OAE is a quick, easy to administer test that does not require highly trained personnel. Should the child not pass the test, a second screening test at the age of 1 month is necessary. Should the child not pass this test too, a comprehensive, complete hearing test is performed by a pediatric audiologist, ideally between the age of 3 to 6 months. A complete assessment involves different tests including a diagnostic otoacoustic emissions,tympanometry, auditory brainstem response orbrainstem evoked response audiometry, auditory steady-state response, and behavioral observation audiometry tests. These different tests assess different parts of the hearing pathway with the aim of determining three main features: the presence or absence of hearing loss, the type of hearing loss, and the severity of the hearing loss.
The course of the treatment is decided based on the type and severity of the hearing loss. Some children may have minor hearing impairment due to fluid in the ear which can be treated medically. However, moderately severe to profound hearing loss is often due to sensorineural hearing loss which is irreversible by medication or surgery and requires hearing devices. For many, noninvasive technology such as hearing aids are enough, and hearing can be restored merely by wearing the hearing aid devices. For others with more severe hearing impairment, the latest technology of cochlear implants maybe required.
A cochlear implant is an electronic device that can restore useful hearing and provide improved communication abilities for persons who have severe to profound sensorineural hearing loss (nerve deafness) and who cannot benefit from hearing aids. Hearing aids simply amplify sounds. A cochlear implant, on the other hand, transforms speech and other sounds into electrical energy that is used to stimulate the hearing nerve in the inner ear.
For people who are cochlear implant candidates, the outer ear and the middle ear function normally. However, in the inner ear (cochlea), the tiny hair cells are damaged or missing and do not generate electrical pulses to be sent to the hearing centres of the brain. Therefore, the brain does not perceive the sound.
The cochlear implant attempts to replace the function of the hair cells with electrical stimulation. Sounds are picked up by the microphone of the speech processor. The speech processor analyses and codes sounds into electrical pulses. These pulses are sent to the surgically implanted receiver/stimulator package and through to the electrode array, which stimulates the residual nerve fibres in the cochlea. The hearing nerve then sends these electrical pulses to the brain and which are finally interpreted as sound.
Seema (name changed) is one such child who was diagnosed with severe hearing loss and recommended cochlear implants in both ears. Initially, she did not pass the newborn screening twice andwas therefore referred to the Cochlear Implant Team of the ICHF. Ms. Neevita Narayan, Pediatric Audiologist, Audiology Director & Cochlear Implant Specialist at SpHear Speech and Hearing Clinic, Delhi. conducted a complete hearing assessment at the SpHear Clinic when Seema was of 3 months age. The results indicated that Seema had severe hearing loss in both ears which could not be treated with medication.
Seema’s parents then met with Ms. Narayan and Dr. (Prof) Ameet Kishore, Sr Consultant Surgeon, ENT & Hearing Implant. Director of, Adventis (Advanced ENT Service) and ENT – Cochlear Implant Surgeon at , Indraprastha Apollo Hospital, Delhi, for a counselling session to decide on next options. As a team, they agreed to first try hearing aids. Along with hearing aids, Seema underwent speech and language therapy programme twice a week under the guidance of the pediatric audiologist. Seema’s parents were taught how to provide hearing stimulation, and Seema was taught how to listen to sound. Parents were also taught how to continue these exercises at home. These exercises are developed such that the hearing-impaired child is exposed to all types of sound.The therapist monitored hearing milestones for assessing progress. After about 4-4 months, at the age of 7 months Seema underwent some of the hearing tests again to re-assess and determine the benefits of the hearing aids.
While Seema was responding to louder levels of sound and was babbling, she was not achieving the requisite hearing milestones and would not develop normal speech with the hearing aids alone. After another counselling session with the entire cochlear implant team, the parents agreed to provide Seema with cochlear implants. Two main decisions needed to be made – when to do the cochlear implant surgery and whether to implant one ear or both.
Early diagnosis and intervention are key to restoring hearing impairment. At younger age, the brain of a child is more plastic and can easily learn from new auditory input. Research has shown that children acquire faster speech perception when implanted prior to age two rather than after age two.The earlier the implants, the better the outcomes. Having already performed over a 1000 cochlear implants, and being experienced in pediatric ENT surgery, Dr.(Prof) Kishore was completely confident that his surgical team at Apollo Hospitals are able toundertake the surgery safely in very young kids. He recalls, ‘The parents opted for implanting the By hearing with two ears, the child has the best chances of completely integrating into normal school and society without any hearing or speech disabilities.’
Cochlear implant technology is life changing, but as it is a sophisticated electronic device, there is a substantial cost of the device itself. The trustees of the ICHF continually raise funds through various means for the benefit of such families. Through this endeavor, Dr Kishore and Ms Neevita (the primary managing trustees of ICHF) have been able to help over a 100 children obtain cochlear implants and hearing aids at highly subsidised costs.
Seema’s family could not afford the complete cost of treatment. The team managed to raise funds through philanthropy and good will of donors, and thus the ICHF was again able to help this family met the cost of a life changing treatment.
Seema was 12 months of age when she underwent the procedure safely, which took about three hours to implant both ears and Seema was discharged within a day after the surgery. Two weeks later, the device was switched on in the audiology clinic and Seema continued to go through the same habilitation program as before in speech and language therapy sessions. Regular monitoring and programing of the device continue, wherein the audiologist gradually increases sound levels in the processor of the device over a period of months. Dr. Kishore and Ms Narayan are very happy to see Seema’s progress Seema is now one and half year old and currently doing extremely well. In another 6 months to a 1 year, she willhear and speak like a normal child and attend normal school. If we did not restore her hearing, she would have remained deaf and mute.’
Seema is one of the younger children to have bilateral simultaneous cochlear implant in the country. With early diagnosis and better team management, we hope to see many other babies that will receive appropriate interventions to address hearing impairment in a timely manner using the wonderful technology of cochlear implants.
The “I Can Hear Foundation” is a registered (80G) charitable Trust and its dedicated team of workers work tirelessly to:
Create awareness among parents, care givers, policy makers, community leaders about deafness and early intervention of hearing loss
Providing early diagnostic support to “at risk” children
Identifying children for intervention, develop action plan including, referrals, resources and fund for intervention
Providing ongoing hearing and auditory verbal health care, technology support and socialization to children and adults
Provide access to affordable surgery for ear disease and hearing loss in children and adults
Enable access to technology such as hearing aids, bone conduction aids and cochlear implants
Our key professionals have partnered with other philanthropic organizations for providing financial support for the provision of hearing aids, hearing and speech therapy / habilitation and to fund cochlear implantation to children and adults at very highly subsidised costs to the patients and their families
