Download Patterns of Hearing Loss in Maitama District Hospitals Nigeria

Patterns of Hearing Loss Presentations in Maitama
District Hospitals Abuja-Nigeria
Challenges in Management.
By: Dr M Ahmed-Danfullani (Consultant ENT surgeon)
& Mr Audu Eneche (Audiologist)
Introduction
Burden of hearing loss on individuals and society at large is enormous, the impact of these
on any economy is therefore significant. The role of adequate hearing in day to day life can
not be overemphasized, attainment of millennium development goals viz; education and
eradication of poverty are strictly tied to adequate hearing and therefore not achievable
unless issues of hearing impairment are addressed especially in children[1].
The cost of treating hearing impairment is still very high even in developed society[1], in
resource limited environment such as ours, access to qualitative health, identification of
hearing problems and availability of treatment are still a mirage even in the big cities[2].
Therefore primary prevention of deafness through awareness campaign at the primary care
level is still the best options [1, 2].
Methodology
All patients who attend our clinic over a period of one year (Between Jan –Dec 2006) with
history of hearing loss were recruited.
Physical examinations and basic hearing assessment (PTA,Tympanometry, and,
occasionally oto acoustic emissions and ABR were done when patient can afford.
Results were analyzed and presented in both data and graphical forms.
(see tables and Figures).
Results
A total of 1065 patients were seen over the period under consideration.(table 1).
M/F ratio is 1:1 mix hearing loss accounted for about (38%) of all the cases seen followed
by conductive deafness alone mostly due to wax impaction and chronic supurative otitis
media (27.7%).
Pure Sensorineural Hearing loss were seen in about(23% )of the patients(table 2), mostly
due to congenital malformations, birth asphyxia, familial and idiopathic causes.(11%) of
these have severe to profound deafness (8% ) prelingual (3%) post lingual.
The commonest type of deafness amongst children in our experience is mixed hearing loss
mostly due to OME ,congenital malformations, CSOM, and idiopathic causes.(13%) of
these were pre lingual and had severe to profound Deafness[1,2,6 ].
Amongst post lingual children and adults, previously healed CSOM., ototoxicity were the
leading causes[2].
Meningitis as a cause of deafness in our environment is on the decrease.
Sudden hearing loss was seen in (3%) of the cases[3,4,5].
Myringotomy with or without ventilation tube was excellent for many of the patients
especially the pre lingual children [6,7,9]. Hearing aids fitting have been useful in carefully
selected patients.
Tables/Figures
Table 1
OME
Wax impaction
CSOM
Cong Malformation
Ototoxicity
Meningitis
NIHL
Others
Total
Female
112
102
191
60
20
11
18
40
554
Male
88
123
103
63
18
2
90
24
511
%
18.8
21.1
22.7
11.5
3.6
1.2
10.1
6
100
Table 2
Types of Hearing Loss
SNHL
CHL
MIXED
TOTAL
no
245
415
405
1065
%
23
39
38
100
Total
200
225
294
123
38
13
108
64
1065
Table 3
TYPES OF TREATMENT
Aural Syringing
315
Myringotomy with Hearing aid
Ventilation tube
110EARS
33 EARS
Referred
68
Figure 1
AGE DISTRIBUTION
34.5
35
30
24.5
25
18.5
20
15
AGE DISTRIBUTION %
15
7.5
10
5
0
<2Yrs
≥2yrs<5Yrs
5Yrs ≤18Yrs
AGE RANGE
18Yrs ≥ 65Yrs
>65Yrs Above
Figure 2
CAUSES OF HEARING LOSS %
6
18.8
10.1
1.2
3.6
21.1
OME
Wax Impaction
Congenital Malfunction
CSOM
Ototoxicity
Meningitis
NIHL
Others
27.7
11.5
Discussions
The burden of hearing impairment in ORL practice is significant [1], awareness on the
importance of hearing conservation is increasing, more and more people now seek for help
unlike in the past. In our study the total of 1065 patients represent all types of hearing loss
in all age groups and from all causes (table 1). There is no significant sex differences,
children less than 18yrs constituted about 65% of the study population (figure 1).
Generally mode of presentations are usually late except in cases of sudden hearing loss in
adults[3], this is because a lot of people in our environment belief nothing could be done
for hearing loss and will rather try traditional medication and if it fails they then come to
the hospital, this is a big challenge in the management of these cases. majority of our
patients had mix hearing loss from combination of causes, those with pure conductive
deafness are usually sudden, mild to moderate hearing loss and due largely to wax
impaction( table 1), OME in children and in HIV positive adults .a case of sudden
sensorineural hearing loss was seen in 16yr old sickler.
Chronic supurative otitis media is still a problem in our society, the presentation is still
usually late and hardly do they come back for follow up. Although the incidence of acute
mastoiditis is decreasing, the sequel of CSOM is responsible for about (27.7%) of the
patients seen[2,3,4].
Sensorineural deafness is the most difficult to manage of the presentations, partly because
of the aetiology and to the fact that SNHL requires more than just hearing Aid to manage
[5]. notable among the causes in our study is the progressive increase in the incidence of
noise induced hearing loss and ototoxicity, mostly due to anti-malaria and The
aminoglycosides antibiotics. other causes are congenital malformations birth asphyxia with
cerebral palsy, familial and idiopathic causes these groups come with a more severe forms
of hearing losses and are usually difficult to manage especially when they present post
lingual [5,7,9].
Meningitis as a cause of deafness in our study is decreasing this is because meningitis itself
is decreasing in incidence because of improved lifestyle and availability of meningitis
vaccine [2, 5]; however this has been a great challenge in the past. Idiopathic and bizarre
presentations are not uncommon (9%) while more and more cases of familial/genetic cases
are coming to the fore(5%), this makes the need for introduction of genetic counseling
more imperative in our society.
Investigations of hearing loss in our study is a very difficult one, apart from basic bedside
clinical examination and tuning fork tests, others like Pure Tone Audiometry, ABR
Tympanometry are all luxury. firstly there are less than two centers for a population of over
a million where this facility are available, less than five well trained audiologists in the
country, therefore only about 8 patients could afford a complete hearing assessment as this
entail traveling several kilometers before this tests can be done, however special
arrangements was made for PTA and Tympanometry for all our patients.
If investigating our patients was difficult then certainly managing them was more difficult,
except for simple cases of wax impaction for which aural syringing were done, other
treatments are a bit challenging. Most cases of severe sensorineural deafness are assessed
for hearing aid fitting (33 ears), affordability and maintenance of the AID is a major issue
here(see table 3).
Managing OME is a bit tasking, having to use a loop, and most time under LA, however
the outcome has been rewarding,(80%) immediate improvement, less than (10%) extrusion
rate in 3months, (5.7%) persistent perforation after 6 months and restoration of normal
hearing in about (89% )of cases, the procedure was abandoned in (3.2%) of the patients[9].
The authors experience In middle/mastoid ear surgeries is limited and as such much
progress was not made especially in the management of CSOM.
Conclusion /Challenges
Man hour loss costs on patient, severe emotional and social deprivation are major issues to
the patients. Inadequate facilities, and lack of well trained manpower are some of the
challenges faced. Middle ear reconstructions and cochlear implants are expensive and not
available to our patients, acquisition of hearing aids and its maintenance is still a challenge.
However effective utilization of the meager resources and careful selection of patients has
been rewarding
References
1.Interntional Federation of Otolaryngological society(IFOS) website(www.ifos.org)
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Int J Paediatrics Otolaryngology. 10(1985)115-135.
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and above in Lagos Nigeria Nig Med J. 44(200 3)35-38
4. B O Olusanya,L. M. Luxon, S L Wirz, Childhood deafness posses problems in developing countries. B M J
330(2005)480-481.
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J .Speech Lang.Hear.Res.41(1998)S61-S84.
6. T W. Ramkalwan, A. C, Davis, The effect of hearing loss and the age of intervention on some language
metrics in young hearing impaired children..Br.J .Audiology. 26 (1992) 97-107
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Baltimore 1991. pp 1-29.
8. Joint committee on infant hearing year 2000 position statement :principles and guideline for early hearing
detection and intervention programs, int J of paediatrics 106 (2000)798-817.
9.Somefun A. O, Adefuye S A, Danfulani M A, Afolabi S . Adult Onset Otitis Media with effusion Lagos.
Nig postgraduate med j 2005 June; 12(2)73-6