‘Screening of hearing loss should be prioritised at primary health care centres’

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‘In this interview by SADE OGUNTOLA, Dr Adebolajo Adeyemo, a consultant Ear, Nose and Throat expert, says ear complaint is one of the major complaints received in an average health facility and calls for a boost in the primary ear and hearing care, even as Nigeria joins the global world to celebrate the World Hearing Day.

What exactly does hearing loss or damage signify?

Hearing loss is a state where an individual has impaired ability to hear properly the sounds generated around him or her. Hearing is a key human sense that facilitates social connections, allowing human beings to function in communities.

Many circumstances and conditions can lead to loss of hearing such as noise pollution, especially when it is frequent and prolonged; impacted ear wax, injury to the head or ear and habits such as poking things like keys, pen covers and matchsticks into the ear. Hearing loss also can occur from side effects of medications. Loud blasts of sounds, sudden changes in pressure, poking the eardrum with an object and middle-ear infection can cause the eardrum to rupture and affect the hearing.

Noise pollution can result from indiscriminate use of earphones and personal music devices, occupations like construction or factory work, unprotected exposure to noise from machinery such as pepper grinders, milling and printing machines as well as living close to a busy airport or road.

Multiple diseases can also predispose to hearing loss, such as meningitis, diabetes, or hypertension. The mechanisms by which these diseases cause hearing loss are varied. For example, the side effects of some hypertension medications cause hearing loss.

Moreover, hypertension is common in the elderly and the elderly are prone to developing age-related hearing loss due to the effect of wear-and-tear of ageing on the inner ear. Diabetes can damage small blood vessels and nerves in the inner ear leading to hearing loss.

Are all hearing loss the same?

Hearing loss may be mild, moderate, severe, or profound. It can affect one ear or both ears and lead to difficulty in hearing conversational speech or loud sounds. According to WHO, hearing loss occurs when the hearing threshold is greater than 25dB. Unfortunately, some children are born with hearing loss, what is called congenital hearing loss, due to genetic defects and infections that occur to women in pregnancy such as rubella and cytomegalovirus infection.

Babies with neonatal sepsis or severe jaundice after birth are also predisposed to hearing loss. Many countries have instituted newborn hearing screening policies for early identification of children with hearing loss.

What are the common signs of hearing loss or damage?

Multiple things can alert an individual of the state of his hearing. These include ringing noise in the ear, what is called tinnitus; difficulty in understanding words, especially against background noise or in a crowd; needing to turn up the volume of the television or radio and frequently asking others to speak more slowly, clearly and loudly.

What is the implication of ignoring hearing loss or hearing damage?

Hearing loss can have a significant effect on the quality of life because it is associated with cognitive impairment and decline. When unaddressed, children with hearing loss often do not receive sufficient schooling and so could be denied the ability to maximize their potential. Adults with hearing loss also find it difficult getting jobs; miss out on some job opportunities and their choice of life partners. They experience social isolation, loneliness, and stigma because hearing loss can make conversation difficult. Older adults with hearing loss also stand a higher risk of depression.

So, how best can individuals protect their hearing?

Basic steps to prevent noise-induced hearing loss and avoid worsening of age-related hearing loss should include limiting the duration and intensity of noise exposure. In the workplace, protective devices should be worn to protect the ear from damaging noise. Individuals that work in a noisy environment need to have regular hearing tests. Recreational activities such as listening to loud music that can damage hearing over time are better avoided.

Can treatment for hearing loss be accessed at the primary health care facilities across the country?

The causes of hearing loss are varied and so its treatment is also an entire spectrum. Cases like earwax blocking the canal can be handled at the primary health centre where there are appropriately trained health workers. PHC workers could do ear syringing and restore hearing to the affected individual. Also, procedures like ear dressing in cases where there is ear discharge following perforation of the eardrum can also be managed at the PHC. Of course, there are many other conditions because of the entire spectrum of what could cause hearing loss that will need to be referred to the teaching hospital where a specialist will be required to manage them.

However, studies that we have done showed that the capability of PHCs to offer ear and hearing care currently is limited even though the training guide for primary health care workers covers some aspects of ear and hearing care. But currently, WHO is relaunching what they call the primary ear care manual. It is a teaching guide to train PHC workers in doing basic things that could help in ear and hearing care like syringing the ear and removing foreign body from the ear as well as indicating the kind of instruments to use and how it is done in a safe manner.

This is what we need to incorporate into the training curriculum for primary health care workers while offering the same as on-the-job training for current workers within our primary care system.

Are there other strategies that Nigeria needs to take up to ensure high quality ear and hearing services at the PHC given its importance to good quality of life?

First, it is to offer training of trainers to supervisors and coordinators of PHCs on primary ear and hearing care based on WHO’s training guidelines. These people can step down the training to the existing primary healthcare workers. The PHCs are the first point of contact with the healthcare system for most of Nigeria’s population. Incidentally, ear complaint is one of the major presentations in an average general medical practice.

Provision of basic instruments for ear and hearing care such as the kidney bowls, ear syringes, and head lights is also important. These are not expensive items; so, managers of primary care centres can easily acquire and make them available for provision of care.

Primary ear and hearing care training needs to be incorporated into the current curriculum for training community health officers and community health extension workers as well so that the new batches of PHC workers that we are churning out are already fully and properly trained while in school.

Monitoring practices in the PHC is imperative to ensure good record keeping. The review of records of patients who present with ear and hearing complaints to the health facility and the kind of treatment offered to them is also necessary. This feedback mechanism will help to ensure that the right management is offered to the patients who present to the PHCs.

Currently, people pay for health care expenses out of their pockets. This is not a very effective way of sustaining the healthcare system. As such, the managers of health insurance schemes in Nigeria need to be brought on board to ensure that primary ear and hearing care is incorporated into even the most basic of the health plans that we have. This way, without having to think of paying out of pocket, patients can be assured of improved access to ear and hearing health care.

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