Journal of Otology & RhinologyISSN: 2324-8785

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Research Article, J Otol Rhinol Vol: 5 Issue: 2

Hearing Loss in Children Attending Assiut University Hospital in Upper Egypt During 2014; It is a Problem that Deserves our Concern

Hossam Mostafa* and Maha Abd Ellah
Audiology Unit, ENT Department, Faculty of Medicine, Assiut University, Egypt
Corresponding author : Dr. Hossam Mostafa
Audiology Unit, Assiut University Hospital, Assiut, 71526, Egypt,
Tel: +201002753798
E-mail: [email protected]
Received: September 10, 2015 Accepted: February 02, 2016 Published: February 07, 2016
Citation: Mostafa H, Ellah MA (2016) Hearing Loss in Children Attending Assiut University Hospital in Upper Egypt During 2014; It Is a Problem that Deserves Our Concern. J Otol Rhinol 5:2. doi:10.4172/2324-8785.1000270

Abstract

The aim of the study was to assess the number of children diagnosed with hearing loss at Assiut university Hospital, which give an idea about the magnitude of the problem, and a step for establishing neonatal hearing screening program in Upper Egypt. The total number of diagnosed children with hearing loss was 1150 children in the year 2014. About 81 % of cases aged above 5 years. It is obvious that flow from urban area (87%) is higher than rural area, and most of cases were from Assiut governrate. The total number of children suffering from SNHL was 641 which represent 55.74% of all diagnosed subjects, of which 79% had symmetrical hearing loss. Most of SNHL (about 75%) cases had severe, profound, or severe to profound degrees of hearing loss. Regarding the etiology, 77% of cases had genetic etiology of hearing loss. Most of cases (41%) aged from 5-10 years which mean that detection of hearing loss is more later than expected, so we need to overcome this problem by implementation of screening program, that should be established for early detection, intervention and improving quality of life for children.

Keywords: Hearing loss; Upper Egypt; Screening

Keywords

Hearing loss; Upper Egypt; Screening

Introduction

Hearing plays a vital role in the acquisition of speech and language and the achievement of other developmental milestones in young children. The early detection of hearing loss is important for development of language and other cognitive abilities. It also improves the outcome of rehabilitation programs [1]. Hearing loss has become a common problem in industrialized societies due to the combined effects of noise, ageing and heredity, and infection is an added factor contributing to hearing loss in developing countries, so in other words, the problem is global [2].
Hearing loss can be a disabling condition. Mild hearing loss can impair verbal language processing, thereby limiting meaningful communication and social connectivity. Such communication difficulties negatively affect work productivity, health-related quality of life, and cognitive and emotional status [3]. These disabilities impede health care access and use, with possible adverse consequences to health and survival [4]. Hearing loss is a societal problem. It is known to be highly prevalent, and the costs of increased needs and diminished autonomy associated with hearing loss are shared by society [5].
The age of identification was the most significant variable identified to affect the development of language skill. In comparison with hearing peers, children with congenital hearing loss also have low educational attainment with poorer academic outcomes, particularly reading attainment. A delay in the diagnosis of 2 years or more being the rule rather than the exception with an irreversible delay of speech and language development [6].
Hearing loss is the most common birth defect and the most prevalent disorder in developed countries [7]. There are 360 million persons in the world with hearing loss (5.3% of the world’s population). 328 millions (91%)of these are adults (183 million males, 145 million females) 32 millions (9%) of these are children. The prevalence of hearing loss in children is greatest in South Asia, Asia Pacific and Sub-Saharan Africa. For individuals in the United States, nearly 1 in 8 has bilateral hearing loss, and it ranges from 21 to 29 million [8].
Significant hearing loss, with bilateral permanent sensorineural hearing loss ≥40 dB , is present in 1 per 500 newborn in the well baby nursery, 2 to 4 per 100 in the NICU. Prevalence of newborns with congenital hearing loss ranged from 1 to 6 children per thousand; by adolescence, prevalence increases to 3.5 per 1000 [9].
In Egypt, a few academic studies confined to specific age groups or certain geographical areas have been conducted. Prevalence of hearing loss in schoolchildren was found to be 5.3% in Alexandria [10] and 4.5% in rural areas [11]. Another study found hearing loss among 13.7% of schoolchildren in Ismailia governorate [12]. Studies done at Ain Shams University during 1980s and 1990s found the prevalence of hearing loss ranged around 10-15%. In audiology unit at Ain Shams University neonatal screening program, by otoacoustic emission, found that 5 % of neonates had hearing loss [13]. Another study done by Abdel- Hamid et al. [14] found that prevalence of hearing loss in 0-14 years old children was 13.8% of the 1600 surveyed population.
In this work, the aim of the study was to assess the number of children diagnosed with hearing loss in Assiut governerate, which give an idea about the magnitude of the problem, and a step for establishing neonatal hearing screening program in Audiology unit, Assiut university Hospital.

Patients and Methods

This study was hospital based retrospective study, targeted children (birth-18 years old) attending the Audiology Unit of Assiut University Hospital during period between 01-01-2014 up to 31-12- 2014 and were diagnosed to had hearing loss.
Equipments
• Dual-Channel Clinical Audiometer (Orbiter 922).
• Double-roomed sound treated booth: IAC 1602-A-CT.
• Interacoustic audiometer AD25.
• Impedence bridge (clinical audiometer S2).
Every subject was subjected to
• Full medical history, including pedigree chart
ENT examination
Pure tone audiometry with speech audiometry, and tympanometry with measurement of the stapedial reflex. Air conduction thresholds were measured at 250, 500, 1000, 2000, 3000, 4000 and 8000 Hz and bone conduction thresholds at 500, 1000, 2000 and 4000 Hz, according to clinical standards (ISO 8253-1, 1989).
In children less than 3 years old (194 cases), visual reinforcement audiometry is done with warble tones at 500,1000,2000, and 4000 Hz was done followed by ABR threshold determination using Nicolet Spirit;2. ABR audiometry refers to an evoked potential generated by a brief click transmitted from an acoustic transducer in the form of headphone. The elicited waveform response is measured by surface electrodes placed at the vertex of the scalp and ipsilateral earlobe (inverting input), and at the forehead (ground). These waveforms occur within a 10 millisecond time period after a click. Stimuli were rarefaction clicks and 1000 Hz tone pips. Clicks were produced from 100-psec rectangular pulses through matched TDH-39 earphones in MX-41/AR cushions. Physiologic activity was filtered (Nicolet, Model 501-A) between 150 and 3000 Hz (3 dB down points, 12 dB/ octave rejection rates). Responses were averaged (Nicolet, Model 812) over 3000 trials in a time window of 10 millisecond. Latencies were measured from stimulus onset to the positive peak of the wave. Averaged latencies from the two replications were used in the data analysis.
In children aged from 3 to 6 years (40 cases), conditioned play audiometry was done. Conditioned play audiometry uses an audiometer to assess a child’s hearing threshold levels and rely on using games such as blocks. Using positive reinforcement, the audiologist trains the child to place blocks or balls in a basket whenever he hears a tone.
If auditory neuropathy spectrum disorder (ANSD)is expected from audiogram and ABR recording, TEOAEs was done to diagnose ANSD.
All audiograms were categorized according to severity of hearing loss into six categories: mild, moderate, moderately severe, severe, profound, and severe to profound hearing loss; according to the mean of thresholds at 500, 1000, 2000, and 4000 Hz [15].
Data of this study was collected from records of those patients and include the following items: Sociodemographic data including:
• Age of children at time of audiological evalutaion
• Sex
• Residence; either from rural or urban areas, and name of governrate
• Type of hearing loss; whether SNHL, conductive, or mixed
Degree and symmetrality of hearing loss: (interaural difference of ≤15 dB in 2 consecutive frequencies or interaural difference of ≤10 dB in 3 consecutive frequencies) [16].
Etiology of hearing loss; whether genetic or environmental causes. Genetic causes were presumbed when there were positive consanguinity and other affected member in the family, and with absence of any environmental causes, but none of the children had any genetic test. Environmental etiology was presumed when there were environmental causes such as maternal infection during pregnancy (TORCH infections), neonatal hypoxia, hyperbilirubineamia, bacterial meningitis, low birth weight, or other congenital anomalies.

Results

The total number of diagnosed children with hearing loss at Audiology unit, Assiut university Hospital was 1150 children in the year 2014, from 4158 children who underwent audiological evaluation. Speech recetion threshold ranged from 28 dB to 106 dB, and speech discrimination scores ranged from 0% to 96%.
Only 19.2% of cases aged below 5 years, while 81.2% of cases aged above 5 years (Table 1) 53% of cases were males, while 46% were females.
Table 1: Distribution of the patients according to age.
It is obvious that flow from urban area (87%) is higher than rural area . Most of cases (92%) were from Assiut governrate (Table 2).
Table 2: Distribution of the patients according to governrates.
The total number of children suffering from SNHL was 641 which represent 55.74% of all diagnosed subjects with hearing loss (Figure 1), of which 79% had symmetrical hearing lossn (Table 3).
Figure 1: Distribution of children patients according to Type of hearing loss.
Table 3: Distibution of subjects according to symmetrality of hearing loss.
Most of them (41%) aged from 5-10 years which mean that detection of hearing loss is more later than expected (Figure 2). Males and females were equally affected
Figure 2: Distribution of SNHL children patients according to age.
Most of SNHL (about 75%) cases had severe, profound, or severe to profound degrees of hearing loss (Figure 3). Regarding the etiology, 77% of cases had genetic etiology of hearing loss, and only 22% of cases had environmental etiology of hearing loss (Table 4).
Figure 3: Degree of hearing loss in SNHL children patients.
Table 4: Environmental causes of hearing loss.
ABR was done to diagnose hearing loss in children less than 3 years old (194 cases), foolowing visual reinforcement audiometry with warble tones at 500, 1000, 2000, and 4000 Hz .
Only 17 cases with auditory neuropathy spectrum disorder (ANSD) are diagnoses from audiogram, acoustic immitance measurements, ABR recording, and TEOAEs.

Discussion

Assiut university Hospital is one of seven major hospitals in Upper Egypt. The total number of diagnosed children with hearing loss in Assiut university Hospital was 1150 children, which gives us idea about magnitude of this problem in Upper Egypt.
Most of diagnosed chidren aged above 5 years. Good hearing is necessary for speech learning, and for physical and mental development [17]. Age of onset has significant implications for hearing disability. Children will have a greater disability for hearing loss, particularly if the loss is acquired pre-lingually, because of the dependency of speech and language development on hearing. In children, untreated hearing loss may result in delayed development of speech, as well as language and cognitive skills, which can relate to learning, behavioural and social problems [18]. The WHO suggests that, with appropriate interventions, up to 50% of hearing loss is thought to be preventable. Congenital or other non-preventable hearing loss is managed effectively through early intervention (e.g. hearing aids, cochlear implants) to reduce the negative impact of the impairment [19].
It is obvious that flow from urban area is higher than rural area and this may be due to lack of public awarness in rural area , also it may be due to other factors like socioecnomic or lack mean of transportation. Although the flow from urban area was higher than rural area, we found that the percentage of children suffering from SNHL is 59% in children from rural area, and only 41% in children from urban area. This may be due to lack of medical care program at rural areas, and also, consanguinous marriage is very common in rural areas, which could increase genetic causes of hearing loss.
Most cases of SNHL aged above 5 years of both genders, had symmetrical severe, profound, or severe to profound degrees, and of genetic etiology. Children with severe or profound hearing loss who used conventional amplification had speech that was significantly different from children with mild through moderately severe hearing loss. Thus, degree of hearing loss differences were reduced to two categories, mild through moderately severe, versus severe to profound [20]. So, as children age, even with earlier identification, degree of hearing loss may have a greater influence on language development. Because children with severe through profound hearing loss have a huge variance in speech production and they represent the largest proportion of the population, degree of hearing loss accounts for as much variance in speech production as language ability.
Hearing loss effects are compounded in developing economies, where access to early detection and rehabilitation services is limited, and the stigma associated with hearing loss may be greater. Broad systematic audiological examinations of population single out persons with hearing impairment. It would be best to examine the newborn child immediately upon birth, during infantry, and subsequently before entering the elementary school. Population health outcomes are one of the core equity distinctions between high- and low/middleincome countries; hearing health is one such indicator [21].
Reliable epidemiological data for hearing loss in Egypt is currently lacking; existing national datasets likely underestimate the country-specific burden of hearing loss. In the study of Abdel-Hamid [14], the prevalence of hearing loss was 16.0% with no significant sex differences. There were significant differences between the age groups and governorates: Marsa Matrouh had the highest prevalence of hearing loss (25.7%) and North Sinai the lowest (13.5%).
In Shebin El-Kom city, Egypt, hearing loss of minimal to mild severity was the most common type [22]. In another study in Cairo, 18.9% of children diagnosed with hearing loss had SNHL. More than 80% of these children had mild or moderate degree of hearing loss [23]. On the other hand, Kamal et al. [13] reported that hereditary factors represented the highest percentage of hearing loss and constituted 36% of the overall cases. However, direct comparison of data regarding hearing loss from different studies may be inappropriate, in view of the different methods and criteria applied for each study.
Epidemiological data on population health and disability is vital for planning and policy responses. The results of our data should be included in policy decisions to the availability and accessibility of hearing services offered to individuals.

Conclusion and Recommendations

There is high percentage of SNHL (55.74%) among children patients with hearing loss who attend audiology unit of Assiut University.
A collaboration between different universities in Upper Egypt is needed to conduct a large scale community based study on prevalence of hearing loss among children in Upper Egypt
Neonatal screening program should be established for early detection, intervention and improving quality of life for children.
Awareness of this problem among parents and school teachers is of importance to detect this disability at an early age and hence that we can provide the child the benefit of early intervention.
Role of Pediatricians is also important for early diagnosis and intervention of hearing loss, as most of the children first attend to pediatrician.

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