Why Help 2 Hear

by Dr. Robert V. Harrison, Ph.D, D.Sc.

Dr. Harrison is Senior Scientist, Research Institute, The Hospital for Sick Children, and Professor, Department Otolaryngology and Physiology, University of Toronto.

The Challenge

To develop, within Ontario, a system which will allow the early detection of hearing loss in neonates and infants, and then to guide them to an appropriate treatment strategy. The goal is to provide hearing impaired children the earliest opportunity to develop their communication abilities, have normal educational and career prospects, and most importantly, improve their quality of life.

The early detection of hearing loss in young children is a rather neglected issue in Canada, including Ontario. Our ongoing experience with severe and profoundly deaf children (for example, the Cochlear Implant Program, which Mason's helped us to establish), has drawn our attention to the critical importance of the early detection of infants with profound hearing loss. Our own research with our cochlear implant patients, and parallel studies worldwide, has indicated that the earlier implantation is carried out, the more benefits are to be achieved. We know that if such children can be implanted at one year of age they will have maximal benefit from such a device. We have found that delaying implantation of children who are congenitally deaf (deaf from birth) by five or six years often means that they receive relatively little benefit from a cochlear implant.

Our experience parallels that of others who work in auditory verbal therapy. It is clear that the younger the child's hearing loss is detected, the better will be the outcome of any habilitation strategy. Whilst the exact numbers are difficult to ascertain, the consensus is that between one and ten and one and twenty children has some sort of hearing disorder. Swedish statistics indicate 125 children per thousand have a significant hearing loss. This represents a considerable number of children in Ontario. It is clear that whilst many of these hearing losses are eventually detected, the delay in detecting them is unacceptable. Presently, the average age of children in Ontario detected to have a hearing loss is between two and three years. This is unacceptable given that appropriate therapy is best implemented at a much earlier age.

Not only is the average age of detection of the hearing loss in children too late, but very often when the hearing loss is detected, its effect on the development of the child are often underestimated. There is still a lingering "old school of thought" amongst many health care professionals that a child with a moderate hearing loss may have a delayed speech production and language development but will eventually "catch up". This is, in fact, not the case. The child who is disadvantaged by a hearing loss for which there has been no early therapy, is often disadvantaged for life.

To meet the goals of our program, there is, in addition to the early detection of hearing loss, the need to steer a hearing impaired child into an appropriate therapy and educational stream. There has to be an increased awareness amongst health care professionals (including, for example, general practitioners, nurses, ear doctors, audiologists) that hearing loss is a problem that needs action as early as possible. Any scheme for implementing screening procedures for hearing loss in infants has to be accompanied by an appropriate educational effort for the scheme to be successful.

We have had, at times, efforts to test "high risk" neonates in specific centres at a local level, but nothing on a systematic/universal scale. Up until a few years ago, we had pre-school testing of hearing in children, but by some act of poor judgment (related to fiscal belt tightening), the Ontario government scrapped pre-school hearing tests. This essentially puts Ontario into a "third world" category with respect to this issue. So, whilst other countries, for example in the European Union and in the United States have strengthened schemes for the testing of hearing in young children, we in Ontario are regressing. This program can hopefully be the start of a more positive approach to this problem by all relevant parties.

The first step is to test those children who are at high risk of having a hearing disorder. Babies are categorized as high risk based on a number of factors. For example, there may be a history of hearing loss in the family, there may have been some problem during pregnancy, such as infection or drug toxicity, there may have been a premature birth and a period in which the baby is in Intensive Care Unit or a problem during birth itself. Approximately 10 to 15% of children who are high risk have a hearing problem.

Thus, a program which is focused on testing hearing in high risk population, can be more efficient, and hopefully a stepping stone towards universal screening.

The implementation of neonatal and infant hearing screening is not trivial. However, in recent years, some new techniques have been developed which are well suited to screening of hearing. Many of the Masons are familiar with the use of otoacoustic emissions to objectively monitor function of the inner ear. Because otoacoustic emissions testing is relatively noninvasive and rather simple to carry out, it is the ideal tool (at present) for an initial screening process. Once a hearing loss has been detected, then the other types of tests need to be carried out to further define its type and severity, but for the screening itself, the best technology is otoacoustic emission measurement.

The Masons of Ontario have already been significantly committed to issues of hearing health-care, auditory research and rehabilitation of the hearing impaired. Their long-term support for this basic research, the cochlear implant program, and "Voice" has meant that in terms of charitable causes in the area of hearing and hearing loss, the Masons are high profile. This project is a natural continuation from those programs currently supported. Indeed, the Cochlear Implant Program and "Voice" are essential parts of the plan described here.

The Masons helped out the Cochlear Implant Program before there was any government or institutional support. Similarly I see the Masons' support as "seeding" this screening program. Ultimately, a universal screening program would have to be funded at a level much higher than is reasonable from a charitable organization. The Masonic support of this initial thrust would need to be supplemented, eventually, from other sources. I see also a role for Masons in creating a greater general awareness of issues relating to hearing loss. Masonic support can influence the notion that this type of "preventative medicine" should be an important and cost effective part of our health care system. In the meantime, we will be relying on the success of the Masonic millennium campaign to get things moving.

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