Download Chinese (ENT) Health in NZ

Hear and now:
Chinese Health in NZ
Michelle Wong
ENT Surgeon, ADHB
Population statistics
• 2013 Census:
– 4.24 Million Kiwis
– 170,667 Chinese
• Life Expectancy born today (non-Maori):
– Males 80 years
– Females 84 years
• Life Expectancy of 65 year-old (non-Maori):
– Males 84 years
– Females 86.5 years
Population by Age 2013
350000
300000
250000
200000
150000
Total NZ
Chinese
100000
50000
0
0-4
5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85
Years Years Years Years Years Years Years Years Years Years Years Years Years Years Years Years Years Years
And
Over
Chinese Population by age 2013
20000
18000
16000
14000
12000
10000
8000
6000
4000
2000
0
0-4
5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85
Years Years Years Years Years Years Years Years Years Years Years Years Years Years Years Years Years Years
And
Over
Chinese
Chinese HEARING Health in NZ
• Population of baby boomers and elderly on
the increase
• Newborn Hearing Screen
• Increasing Migrant population from China
• Bilingual: hearing and tonal languages
UNHS around the World
United States
United Kingdom
Screening > 3.5 million
babies per year.
Screening 600,000/yr by
March 2005
Australia
Screening >100,000
babies per year
In New Zealand
• 135- 170 children / year ( 3/1000 births) with
PCHI
• Identification ( 2003):
– Average age 3-4 years
– Maori 80% by 80 months age ( 6.7 years)
– Others 80% by 60 months age ( 5 years)
• Evidence for the importance of early
identification of hearing loss
• Critical period= first 6 months of life
Vocabulary Range at 3 years of age:
Normal hearing
Vocabulary Range (Marion Downs, 1997)
1000
No. words
800
600
75th percentile
Median
25th percentile
700+
words
400
200
0
Normal
At birth
6mths
Age of Identification
2 years
Vocabulary Range at 3 years of age:
Identified at birth
Vocabulary Range (Marion Downs, 1997)
1000
No. words
800
75th percentile
Median
25th percentile
600
400
350 words
200
0
Normal
At birth
6mths
Age of Identification
2 years
Vocabulary Range at 3 years of age:
Identified at 6 months
Vocabulary Range (Marion Downs, 1997)
1000
No. words
800
75th percentile
Median
25th percentile
600
400
200 words
200
0
Normal
At birth
6mths
Age of Identification
2 years
Vocabulary Range at 3 years of age:
Identified at 2 years
Vocabulary Range (Marion Downs, 1997)
1000
No. words
800
75th percentile
Median
25th percentile
600
400
200
0
Normal
At birth
6mths
Age of Identification
2 years
Begin pre-school with
less than 50 words in
their vocabulary.
Adjusted Mean Total
Language Quotient
Even when picked up in the
first 12mths they don’t do
significantly better.
100
80
60
40
20
0
0-6
7-12.
13-18. 19-24.
25-34
It is not until intervention
begins in the first 6mths there Age of Identification (Months)
is a significant improvement.
Mean language quotient by age of identification
From:Yoshinago-Itano et al (1998)
HIEDI
• 2001 Hearing Impairment, Early Detection and
Intervention formed in NZ
• 2006 government announces national funding
for Newborn
Screening program
• NZ 1 July 2007 rolled out over 3 years
– 20 DHBs
– Self governance
UNHSEIP- aims:
• 1. Babies to be screened by 1 month age
• 2. Audiology assessment completed by 3
months age
• 3. Initiation of appropriate medical and
audiological services and Early Intervention
education services, by 6 months of age
How do you screen for a baby’s
hearing?
Infant diagnostic test battery
Tympanometry
Otoacoustic Emissions
(OAE’s)
Auditory Brainstem
Response ( ABR)
(Distortion Product) Otoacoustic
emissions ( DPOAE)
Otoacoustic
Emissions (OAE’s)
Debris in the ear
canal.
Fluid behind
the eardrum.
Click stimulus
Pass Result
OAE testing
probe placed
in the ear
canal
Within the
cochlear
The “emission” from the
Outer Hair Cell travels out
the ear & is picked up by the
probe.
Fluid & debris can block the stimulus
getting in AND block the response coming
out = Higher Refer rates.
Outer Hair
Cells
Outer hair cells
contract in
response to the
sound.
DPOAE’s
The most prominent emission is “2F1- F2”
If F1=1000Hz.and F2=1200Hz., then
2F1-F2=2(1000)-1200=800Hz.)
(Automated) Auditory Brainstem
Response, AABR
Automated
Auditory Brainstem Response (AABR)
If built up enough fluid & debris can still
increase the refer rate because it blocks the
sound getting into the ear.
BUT
This doesn’t occur as much as with OAE
because the recording is not being made back
through the ear canal.
Auditory Brainstem Response
(ABR)
AABR screening tests the response of the hearing nerve & brainstem.
AABR tests beyond both the Inner & Outer hair cells.
Automated Auditory Brainstem Response
(AABR)
PASS result
AABR Template built into the
screener (statistical rather than
an actual waveform)
35dB
AABR – What happens with a restless baby?
Refer result
The sensors pick up the muscle
movement, which are much larger than
the ABR response. This distorts the
waveform & it can’t match up to the
template/black box algorithm.
35dB
1. Exclusion criteria – Age range:
• <34 weeks or greater than 6mths old.
6 months old:
< 34 weeks gestation
A baby > 6mths old has a more
mature brain & faster response,
which the template is NOT designed
for.
A baby <34 weeks has a less mature
Brain and more delayed response which the
sample is not designed for.
Normal AABR template
for 34 weeks to 6mths of
age.
New Zealand’s testing protocol
The incident
• July 2012 – ADHB
lead screener told
by parents of a
baby she was
about to screen
that the baby had
already been
screened, but was
not recorded.
• One report from
ADHB
• Audit of screener:
– 1 July 2011- 11 July 2012
– 1044 babies screened by screener
– 145 babies had screening in one ear twice
– 183 babies had screening in one ear with one ear
of screener
– 103 babies who had results recorded from the
screener recording her own ear results
Cochlear implants Chinese Kid
Some facts about China
• Universal Newborn Hearing Screening (UNHS) has
been implemented in China since 1999.
• By 2010 UNHS was implemented in 20 of the 32
Chinese provinces.
• In large cities 95% of babies are screened in
hospital-based programs.
• In more remote areas babies with high-risk
factors for hearing loss are referred to screening
centres within 1 month of birth and leaflets
about identifying deafness are distributed.
Some facts about China and CI
• Since 1995 more than 10 000 people in China
have received cochlear implants (CIs)
• 85% of these implant recipients have been
children under the age of 7 years
• CI penetration in China is currently less than 5%
of potential pediatric candidates,
• Cochlear implantation is continuing to expand at
great speed, and it is hoped that the
infrastructure and capacity will continue to grow
and develop.
Some numbers of interest
• 1990: 6 million ‘totally deaf people’1
• 2008: 21 million people with hearing loss 2
• 2000: WHO estimated prevalence of hearing loss3
– Childhood onset: 0.12% (hearing
threshold in better ear is 61-80 dB HL)
– Childhood onset: 0.1%
(hearing
threshold in better ear Is >81 dB HL)
– Adult onset: 1.3%
(hearing
threshold in better ear is 61-80 dB HL)
– Adult onset: 0.3%
(hearing
threshold in better ear is >81 dB HL)
– ~24.5 million people with a
severe to profound hearing
loss in China
Tonal languages
~ 88 languages in the world have ‘complex’ tone system
(more than 3 tones) – shown in red dots
Fundamental Frequency (F0)
Six lexical-tones of / wɐi /, Cantonese
Tone 1
威 (smart)
Tone 4
圍 (surround)
Tone 2
委 (appoint)
Tone 5
偉 (huge)
Time
Tone 3
餵 (feed)
Tone 6
胃 (stomach)
Fundamental Frequency (F0)
Six lexical-tones of / wɐi /, Cantonese
Tone 1
威 (smart)
Tone 4
圍 (surround)
Tone 2
委 (appoint)
Tone 5
偉 (huge)
Time
Tone 3
餵 (feed)
Tone 6
胃 (stomach)
4 lexicial tones /ma/, Mandarin
/ma/
160
F
140
F0 (Hz)
H
H
R
120
R
L
100
F
mother
hemp
horse
to scold
[Tone 1]
L
80
0
25
50
Time (%)
[Tone 2]
75
100
[Tone 3]
[Tone 4]
Outcomes with CI
• Two large scale outcomes studies in China – still
ongoing
• The preliminary data from the studies indicate
that the performance of Mandarin-speaking CI
children is comparable to that of US children with
CIs.
• Although the results of studies on CI outcomes of
Mandarin-speaking children showed variable
outcomes, it is evident that the majority of
children benefited from CI intervention.
Investigation of cortical and subcortical plasticity
following short-term unilateral auditory deprivation in
normal hearing adults
• 11 adults ( 21-50 years), normal hearing
• Left custom-fitted silicone plug for 7 days (
equivalent to a mild high freq hearing loss)
• fMRI 3.0T was performed just after plug
inserted and 7 days later; stimulus was a noise
burst to evoke cortical activity
Hearing loss in the elderly