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Even though 60 per cent of hearing loss in children is preventable, more than 30 million children worldwide are reportedly living with disabling hearing loss. According to WHO estimates, up to 5 in every 1000 infants have severe-to-profound hearing impairment. In India, over 27,000 children are born deaf every year. As hearing impairment or loss cannot be seen, diagnosis is delayed in most cases, and often neglected. Hearing screening for newborns can help diagnose hearing impairment early and allow timely interventions. This is the reason why experts have been calling for Universal Newborn Hearing Screening (UNHS) programme in India. Earlier identification of hearing impairment and intervention, including cochlear implants, have enabled many children with severe to profound hearing loss lead normal lives. On World Hearing Day, some recipients of cochlear implants have shared their experiences.
Cochlear implantation may be recommended if hearing aid does not help. Experts say the sooner children with hearing loss receive cochlear implants, the better the results. A 2010 study published in the Journal of the American Medical Association found that children with profound hearing loss who received cochlear implants before 18 months of age were better able to hear, comprehend sound and music, and speak than their counterparts who receive the implants at a later age. They also nearly caught up with their normal-hearing counterparts over the subsequent three years, said the study led by Johns Hopkins University that included the University of North Carolina at Chapel Hill. Research has shown that cochlear implant surgery is safe in children aged 7 to 12 months with appropriate aesthetic and postoperative support.
The ideal age of cochlear implantation for a child is below 1 year of age. But in India, majority cases are diagnosed late hence making the treatment late, said Dr. Hetal Marfatia - ENT Head of Department at KEM Hospital, Mumbai.
"Early diagnosis is possible by testing every newborn for their hearing. Just like BCG is made compulsory for every newborn, even hearing testing for infants should be mandatory," he added.
A cochlear implant is a small, but complex electronic device that can partially restores hearing in some people who are profoundly deaf or severely hard-of-hearing. Cochlear implant consists a microphone, a speech processor, a transmitter and receiver/stimulator, and an electrode array. The microphone picks up sound from the environment and the speech processor selects and arranges the sounds. Then the transmitter and receiver/stimulator convert the signals received from the speech processor into electric impulses. A group of electrodes collects these impulses and sends them to different regions of the auditory nerve. This way, the implant provides a representation of sounds in the environment to a deaf person and help him/her to understand speech. A cochlear implant has two main parts: one sits behind the ear and the other is surgically placed under the skin.
A cochlear implant won't cure deafness or hearing impairment, but it stimulates the cochlea, a portion of the inner ear receives sound (vibrations) and converts them into nerve impulses which are then send to the brain to be interpreted. The quality of sound processed by this prosthetic substitute is comparatively low and therefore it doesn't help restore hearing to normal levels.
Kerala is the only state in India that has included screening for hearing in the list of mandatory health screening procedures for newborns. Newborn screening for hearing is done in all 61 government hospitals in Kerala and in most private hospitals.
Around 1200 children have been operated under the Cochlear Implant Scheme in Kerala in the last 8 years and received the gift of hearing, according to Dr Mohammed Asheel, Executive Director, Kerala Social Security Mission and Dr. Muhammed Noushad, Director, Dr. Noushad's ENT Hospital and Research Centre, Kochi.
"It is amazing to see how the lives of so many children in our state are being transformed. This World Hearing Day, I urge everyone to work together to spread awareness on all platforms so we can tackle hearing loss effectively," Dr Asheel added.
"Seeing these kids bounce back to life and have promising futures is extremely fulfilling," added Dr. Noushad.
Rizwana, a cochlear implant recipient and MBBS student of Kottayam Medical College, said her life changed completely after being able to hear with cochlear implants. The 22-year-old received her cochlear implant at a young age.
"Having come a long way in my hearing journey, I can testify the importance of screening and early intervention. I decided to become a doctor and specialise in ENT to make a positive impact in the lives of those with hearing loss. On this occasion of World Hearing Day, I want to ask everyone to please be aware of available options so that no one misses out on a life with hearing," asserted Rizwana.
Tatva, a 10 year-old-boy, was able to hear the exciting world of sound after receiving a cochlear implant. His parents, Ritesh and Sonia Mehta, realized that Tatva had hearing loss when he was 8 months old, and consulted specialists.
"We never realized that our child had any hearing difficulties. But we noticed that he would not look in the direction of sounds, respond to name calling or react to the ring of a doorbell. Finding out that our child has complete hearing loss in both his ears was shocking," they recalled their son's struggles of living with hearing differences before getting a cochlear implant.
Tatva got his first cochlear implant at the age of 2 years and a second cochlear implant when he was 6 years. Today, Tatva is 10 years old and he's doing well in academics and extra-curricular activities. He can comfortably speak in English and Gujarati.
"Hearing loss is an emergency which needs to be treated," noted his parents, Ritesh and Sonia Mehta.
Like Tatva, 6-year-old Aniruddha who diagnosed with bilateral profound hearing loss is now enjoying life like any other typically hearing peer after cochlear implantation.
Aniruddha Bhide's mother Manasi said initially they thought that he was busy playing and hence did not react to name calling or other ambient sound. It was only when he was 9 months old, that they found out that Aniruddha had hearing loss after they consulted a doctor.
"Finding out that your child has bilateral profound hearing loss is one of the most devastating things that can ever happen to a parent. Aniruddha got his first Cochlear implant at the age of 16 months - which was a life-changing moment for our family," Manasi shared.
Dr. Kalyani Mandke, Audiologist, from Pune said, "Like Anirrudha, there are many children who can benefit through advanced hearing technology but get missed because of low awareness around hearing issues in babies. One major reason is the unavailability of newborn screening program at birth and low awareness amongst parents."
Early screening program can help in early diagnosis which in turn will lead to early treatment, she added.
Hearing screening for newborn babies is mandatory in many developed countries. In India, except in the state of Kerala, this test is not included in the list of mandatory health screening procedures for newborn. Should India introduce Universal Newborn Hearing Screening programme? Share your views with us.