Abuse of antibiotics can impair hearing — Olusesi, president, ENT surgeons

As Nigeria joined the world in celebrating World Hearing Day on Saturday, president of the association of Ear, Nose and Throat surgeons, Dr Abiodun Olusesi, in this interview by SADE OGUNTOLA, speaks on why Nigerians must address hearing loss and ear disease, just as he warns against abuse of antibiotics which can result into hearing impairment.

G LOBALLY, World Hearing Day is celebrated to promote the care of the ear and hearing and also raises the awareness on how to prevent hearing loss. So, what is the population of Nigerians with unaddressed hearing loss and ear disease?

Hearing loss, also known as hearing impairment, refers to partial or total inability to hear. A deaf person has little to no hearing. Hearing loss may occur in one or both ears. In children, hearing problems can affect the ability to learn a language; in adults, it can cause work-related difficulties.

Based on the last study conducted in three states in Nigeria that was funded by the World Health Organisation (WHO), the prevalence of hearing loss was put at 4.5 per cent.

We do not have real data to show the number of people with hearing loss or ear diseases in Nigeria. But studies in different population and from different hospitals have reported different figures.

For instance, at the hearing loss clinic of the National Hospital, Abuja, of every 10 individuals that have a hearing impairment, three have severe to profound hearing nerve damage and will likely require a cochlear implant. Another three out of these 10 have an ear infection and are likely to require ear surgery while another four of the 10 have mixed partial hearing loss and as such will require a hearing aid.


What causes hearing loss?

There are three basic types of hearing loss, each caused by different underlying factors. The three most common causes of decreased hearing are conductive hearing loss, sensorineural hearing loss (SNHL), and mixed hearing loss.

Conductive hearing loss occurs when sounds are not able to travel from the outer ear to the eardrum and the bones of the middle ear. It can be as a result of allergies, ear infections, a buildup of wax in the ear or a foreign object that has become stuck in the ear. This type of hearing loss isn’t always permanent. Medical interventions can treat it.

Treatment may include antibiotics or surgical interventions, such as a Tympanoplasty and a middle ear implant.

Sensorineural hearing loss happens when there’s damage to the inner ear structures or in the nerve pathways to the brain. This type of hearing loss is usually permanent. SNHL makes even distinct, normal, or loud sounds seem muffled or unclear. It can result from a birth defect, ageing, working around loud noises or injury to the head.

Infections such as measles, meningitis and mumps as well as ototoxic medications can also damage the nerves of the ear and lead to sensorineural hearing loss. Some studies also found that over 30 per cent of childhood hearing loss is caused by diseases such as measles, mumps, rubella meningitis and ear infections. Treatment of sensorineural hearing loss includes the use of hearing aids and cochlear implants.

A cochlear implant is a small electrical machine placed under the skin behind the ear. It translates sound vibrations into electrical signals that the brain can then interpret as meaningful sound.


What do Nigerians need to know about hearing loss and ear diseases to ensure they can retain the ability to hear?

Good hearing is necessary for good communication at all stages of life. Hearing loss and related ear diseases can be avoided through preventive actions such as protection against loud sounds, good ear care practices, and immunisation. It is also important to turn down the volume on personal listening devices such as headphones and ear buds.

Hearing loss and related ear diseases can be addressed when early, and appropriate care is sought. People at risk of hearing loss should check their hearing regularly. People with hearing loss or related ear diseases should seek care from a health care provider.

Secondly is the avoidance of medications that are toxic to the ear. For instance, Gentamicin and Chloramphenicol injections that some medical practitioners give to treat typhoid fever are ototoxic medications; they can damage the nerves of the ear, leading in most cases to irreversible hearing loss.

Good ear care also involves avoiding injury to the ear and other practices like inserting cotton bud and other objects into the ear. These objects can cause damage to the middle ear, causing hearing loss.

Hearing screening, especially in newborns is important. The early the hearing loss in a child is detected, the better the results of hearing rehabilitation and hearing loss treatment.

Some types of hearing loss run in some families, It is expected that in the not too distant future, individuals will be able to undergo screening for hearing loss and then people that want to get married may be advised to go and do genetic testing to know whether any of the partners have a genetic disposition to hearing loss.


Where does the government come into prevention and care for people with hearing loss?

The government needs to support the establishment of the newborn hearing screening programme. The aim of newborn hearing screening is to enable early detection of hearing impairment and so that treatment can be instituted early. This requires that every child that is born must have his or her hearing screened, as opposed to non-universal newborn hearing screening that is solely targeting children with a high risk of hearing loss.  High-risk babies for hearing loss include babies born with jaundice and babies that convulse in their first month of life and babies with syndromes.

In addition, the government also needs to subsidise the cost of hearing aids and cochlear implants for individuals that need them. A large percentage of Nigerians are poor. Currently, of every three individuals that need a hearing aid, only one can afford to buy one. A hearing aid costs between N200,000 and N450,000. So, we have a large number of Nigerians who have hearing impairment that hearing aid would have helped  but cannot afford one.

Cochlear implementation started at the National Hospital in 2009. A cochlear implant is very effective for correcting total hearing loss but it is very expensive. A cochlear implant per ear costs about N6 million; so most people that need it cannot afford it.

In Abuja, although three out of 10 will require a cochlear implant, hardly can anyone afford it.   We had done more than 15 cochlear implantations since the programme started in 2009 but they were all sponsored by rich relatives, government officials and politicians.

Implants are expensive all over the world, so what other governments like Germany did was to provide them free to those that need them. Even the South African government provides a 25 per cent subsidy for cochlear implants for its citizenry.

The cost of treating hearing loss is what makes it very imperative that Nigeria must continue to emphasise hearing loss prevention and early detection.


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