Hearing loss: An invisible impairment and a preventable disability
Mike Davies OBE is Head of Programme Development, CBM UK
Many years ago, I lost nearly all my upper frequency hearing as a result of military action. What prompted me to get my hearing tested was Beethoven’s Pastorale Symphony. One evening, I started playing the record, and remarked to my wife that the LP was dirty, or the needle needed to be changed, because I couldn’t hear the strings or woodwinds. My wife said that the sound quality was fine, and I realised that the recent explosions were to blame.
I gradually learned to live with my hearing impairment. I realised how much I had learned to lip-read during a lecture I gave to students in Peshawar, North West Frontier Province, Pakistan. One of the students was wearing strict Islamic dress, with her face covered, apart from her eyes, and I realised that I couldn’t see what she was saying. I explained my hearing problem, and asked if she could show me her face so I could understand what she was saying. She refused politely, so I said, “Well that being the case, please come and sit next to me, and if you have something to say, then you jolly well shout!”
It is said that there are around 10 million people with disabling hearing loss in the UK – globally around 360 million people – yet 50 per cent of all cases of deafness and hearing impairment are avoidable.
The most common causes of hearing impairment worldwide are hereditary factors, noise exposure, congenital impairment, ageing, misuse of medications and infectious diseases (Meningitis, Rubella, Cerebral Malaria etc.). Middle ear pathology, specifically chronic Otitis Media (infection of the middle ear) is common in middle and low income countries. I’ve lost count of the number of village children I have seen with pus running from their ears.
Excessive noise is recognised as an important cause of hearing loss in young people and adults. Noise-induced hearing loss and tinnitus may be temporary, but can become permanent if the noise exposure continues, or if the single event (as in my case) is very loud. Researchers are working on ways to protect ears from noise-induced hearing loss, and ways to reverse damage to hearing.
Deafness in infants and young children in low income countries is particularly concerning because it leads to communication difficulties, delayed progress in education, social isolation and stigmatization. This is made worse by late diagnosis which is often the case in rural communities. However, early intervention provides the biggest opportunity to reduce the lifetime impact of deafness and hearing impairment.
Deafness and hearing impairment are ‘the invisible disabilities’. While congenital deafness can be recognised quite soon in a child’s life, partial deafness is much more difficult to identify, especially where there are no screening or diagnostic services.
Although my own hearing impairment is not what motivates me to work for CBM, it certainly encourages me to promote greater support for prevention of deafness programmes, and to advocate for the rights of deaf and hearing impaired people in low income countries.
Sadly, many children who cannot hear in low income countries are often thought to be intellectually impaired and unable to learn. In some communities, deaf or hearing impaired children are kept behind closed doors in a world of silence, without support and without an education.
Training deaf people to use sign language and providing affordable hearing aids for hearing impaired people on a world-wide scale are the most effective ways of reducing the impact of hearing loss. It is estimated that 35 million hearing aids are needed annually in low income countries – only about one million are actually available. When I first started wearing hearing aids it felt strange, and my voice sounded distorted, but then I thought that someone with profound hearing loss in Chad or South Sudan would love to have my problems.
There is a strong case for lobbying Ministries of Education across the world to establish or strengthen school health and screening services, so that children with invisible disabilities are identified and helped to realise their full potential. Health care in developing countries can be scarce and inaccessible to the majority of the population. Eighty per cent of deaf people live in low and middle-income countries. Many of these countries do not have national programmes for the prevention of deafness and hearing impairment. Many also lack primary ear and hearing care, adequate screening programmes, referral and rehabilitation services, and enough trained health workers in rural areas.
The burden of hearing impairment and deafness falls disproportionately on the poor, because they are unable to afford the prevention and routine care necessary to avoid hearing loss. Hearing impairment can also make it more difficult to escape poverty by slowing progress in school and the workplace, and placing people in social isolation.
We focus on the prevention and early detection of hearing impairment. Prevention is relatively simple for some types of deafness, but this is still not a priority in most countries.
Today, I wear hearing aids in both ears, especially for plays and concerts, but also for meetings where the acoustics of the room are poor. Although my hearing loss is problematic at times, I count my blessings, because there are millions of deaf and hearing-impaired people in low income countries who have no access to diagnosis or help.
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