Hearing key for speech, language

Hearing is critical for the development of speech, language, communication skills and learning. Hearing loss has an enormous impact on the social, economic, and productive life of an individual.

As per the 58th round of National Sample Survey Organisation in 2002, currently there are 291 persons per 1 lakh population who are suffering from severe to profound hearing loss. Of these, a large percentage is children in the age group of 0-14. It’s noteworthy that 7% of people have a congenital sensori-neural hearing loss.

Recent research indicates that children identified with hearing loss at birth and started treatment before they are six months old, develop language (spoken) on par with normal hearing children. With early identification and appropriate intervention, children with hearing loss can get integrated into normal schools, instead of specialised programmes/deaf schools.

In practice, we see parents seeking medical help for delayed speech at age of 2-3 yrs and then getting to know the hearing problems. Why this delay? Is it because: 1) very few people realise that normal hearing is required for development of speech; and, b) presence of ear in a new-born, does it mean its functioning normally and can be taken for granted?

Basic test OAE (otoacoustic emissions) which has a probe to be inserted into the ear canal; this detects the basic hearing function in few minutes in a newborn. It’s done during sleep and is painless. BERA (brainstem evoked response audiometry) – another confirmatory test too is painless and done when baby is sleeping. With technology and specialist in place, yet delayed identification has become the routine.

Why this neglect when our incidence of hearing loss in India are high due to consanguineous marriage, genetic causes, birth hypoxia, low birth weight, jaundice, meningitis etc. Can the parents and family not take this little effort towards identifying early?

New born hearing screening is highly crucial and it’s a mandatory protocol followed after birth in all developed nations. The Government of India has programs like the National Programme on Prevention and Control of Deafness, implemented in 2006 in place to prevent and control deafness. Only identification of hearing loss and giving hearing aids would be a failure of this programme.

Hearing aids have to be regularly programmed to individual child’s hearing loss pattern and every three monthly follow up to assess the continuous benefit in terms of hearing and speech language development must be in place. If no progress seen child has to evaluated for Cochlear Implant candidacy Screening.

Timely intervention can help this child to develop age appropriate speech and language. This will allow the child to get into mainstream schooling by the age of six. Hence, the government should work towards making facilities available to screen every child at birth and maintain a single data base across every state which could help professionals in intervening in these children with the age-appropriate treatment modality. Such data obtained can help us in knowing causative factors and work towards reducing the incidence of hearing loss.

Technology does not "cure" hearing loss. Latest technological advances may help a child with sensori-neural hearing loss to attain near normal listening skills. There are many options, including: hearing aids, Cochlear implants, bone-anchored hearing aids and other assistive listening devices.

For a child to develop good language and literacy skills later, it is essential that a child has good understanding of speech. Hearing aids may not be beneficial for all children with severe to profound degree of hearing loss. Hence, audiological and speech language assessments to be made at regular intervals to identify if there is progress. With no progress, the child has to be intervened with Cochlear implants. It is an auditory device consisting of a surgically implanted device that is placed on the skull bone and an external device that looks like a hearing aid.

In India, at present we only have a central government programme and few effective state government programmes in place to allow a child with severe to profound hearing loss to get cochlear implantation with some financial assistance.Universal new born hearing screening can be a crucial and effective tool as it can ensure children with hearing loss to access cochlear implants sooner. Sooner the child gets access to hearing, higher the chances of child developing age appropriate speech and language and can get integrated in to mainstream society.

(The writer is Director, Manasa Cochlear Implant and ENT Centre)
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