Why you should screen your baby for hearing problems at birth

In 2010, Carol Walubengo realised she had a problem with her hearing. Whenever her friends or family talked, she would ask them to repeat what they were saying.

"At that point, I realised something was wrong with me. I was lost," Walubengo said.

She started shunning social gatherings because she could not hear what the rest of the group was talking about.

"I would say something irrelevant to what they were talking about, so I started avoiding such events and would prefer being indoors by myself," she said.

Walubengo later presented herself to Dr Richard Mwangi, an audiologist at IncusEar Hearing and ENT Centre.

After diagnostics tests, she was fitted with a digital completely-in-canal hearing aid and later bought a spare pair of digital behind-the-ear hearing aids.

To Dr Mwangi, hearing health is one of the forgotten areas. He often hears parents who visit his clinic saying:

“Na huyu mtoto, sijui kama anasikianga ama haskiangi (I don’t know whether this child hears or not).” 

Mwangi says unlike other disabilities, you cannot point out an individual among the crowd and say they have a hearing impairment, reason being it is not visible.

This has made information on the prevalence of hearing impairment and related ear pathologies in sub-Saharan Africa scarce.

INVISIBLE PROBLEM

Mwangi is a consultant audiologist at IncusEar Hearing and ENT Centre, located on Ngong Road. He is among the only six audiologists in the country.

He receives around four patients a day. His focus is on quality and not the number of people he attends to, he says.

He takes around two to three hours per patient, depending on the complexity of the problem.

The facility is among four standalone hearing centres registered by the Kenya Medical and Dentist Council. It is classified by the council as a Level 3A medical centre.

Mwangi started his career in the pharmaceutical industry but later changed after realising the hearing healthcare shortage.

 “Other disabilities like blindness can be pointed out, but hearing is so hidden to identify. It is the reason you find many people take long to seek help and end up stigmatised about their hearing health,” the medic told the Star in his office.

Besides paediatric and adult hearing testing, the medic also offers services such as home visits for hearing loss assessments, screening, tinnitus counselling and hearing aids.

He also reaches out to the vulnerable in the society every year to reach out to those in elderly homes, police stations, churches and slums.

The activities involve testing, cleaning ears and giving hearing aids to those with hearing defects.

It is such acts of humanitarianism that got him nominated for Top 40 Under 40 awards in 2015.

Mwangi advises parents to test their children immediately after birth; this is the norm in developed countries and some developing countries where Kenya is.

“This is because if hearing problems are detected at an early age through a screening program called “Newborn hearing Screening”, they can be easily rectified,” he says.

Mwangi adds that chronic ear infections are a common cause of deafness in children especially in developing countries.

Hearing loss may then leads to other difficulties, including delayed learning and behavioural problems.

“When a child is born with congenital issues like congenital hearing impairment, there is no way we could avoid that, but it could have been rehabilitated,” the medic told the Star in his office.

One of the main impacts of hearing loss is on the individual’s ability to communicate with others. Spoken language development is often delayed in children with unaddressed hearing loss.

Unaddressed hearing loss and ear diseases such as otitis media can have significantly adverse effects on the academic performance of children.

PARENTS IN DENIAL 

The medic says in Kenya, the average age at which parents look for help is about four years.

“When a child is born, they have to be assessed. If the child fails a newborn hearing screening, it is repeated after three months," he says.

"If the child fails again, it is repeated at six months, and should the child fail at six months, the diagnostic test is done and the process of rehab starts.”

Infection may also spread with further complications. One per cent of children in Kenya may suffer from these ear infections.

“When a parent is told their child is having a problem, the denial phase starts. Some opt for herbal medicine and meanwhile, the child continues to grow. By the time you are thinking of help, it is too late,” Mwangi said.

“We should encourage newborn screening so by the time the child is turning one year, we can tell whether the child can hear or not.”

Mwangi says after four years is when parents start looking for a solution for their children, adding that when the child is found to be having a problem, denial starts.

The parents move to several other facilities for what they term as more comprehensive tests, and this takes almost a year.

By the time they come to the reality that the child has a hearing impairment, the child is already six to seven years, an age at which the medic says it will require ‘the work of God’ for the child to develop speech.

He says some parents opt for herbal medicine, while some start associating it with witchcraft.

As they continue wasting more time, the child outgrows their speech development age, and by the time they finally decide to look for help, it is too late.

“It is denial that has been making them not seek help, but it is so unfortunate. It is better they know the problem early enough because the problem can be sorted early.”

He advises teenagers and young adults to avoid self-induced hearing impairment by avoiding the use of earbuds at all times and listening to loud music that could have an effect on the ears.

OTHER CAUSES

While congenital hearing problems can be arrested with early intervention, other causes cannot be prevented. These include age and traumatic experiences. However, sometimes it is inflicted from the environment, such as exposure to loud noise.

Mwangi warns that while age-induced hearing impairment kicks in at around 55 years, it might reduce to just 50 in the next 10 years if the youth do not employ simple remedies as outlined.

He advises that the 60/60 rule, especially for people working in call centres, should be followed at all times.

This means that even though they are supposed to have their headphones on, they should not be worn for more than 60 minutes continuously.

You can do 60 minutes, remove them and have a break and more than 60 per cent of the volume.

The hearing problem can also be hereditary, he says, adding that if there is a family who had a hearing problem, it can be passed on to another person.

“At a certain age, people start developing hearing problems. Other causes you can’t avoid are traumatic experiences like bomb blast and accidents. These are very unfortunate and we can’t help much,” Mwangi says.

Some drugs taken during pregnancy may cause hearing problems in the child, as well as illnesses such as severe jaundice, meningitis and complications or injuries during and after birth.

Inbreeding between blood-related individuals, such as second cousins or closer ones, as well as genetics, can also impair hearing.

WELL-EQUIPPED

At his clinic, there is a state-of-the-art hearing and balance centre, which opened its doors six years ago.

There are also all models of advanced hearing aids, including the invisible hearing aid (commonly called Invisible In Canal IIC), which can hardly be noticed from outside. Such hearing aids are customised as per the patient’s ear canal.

The centre boasts of having the latest diagnostic audiological equipment for assessing newborn hearing levels, paediatric audiology, as well as adult hearing healthcare, balance testing and rehabilitation.

Through IncusEar, patients get to be tested using the latest technology in hearing and balance assessment. The facility is assessing the complex balance issues and offering treatment and rehabilitation.

Mwangi says enlisting all hearing and balance services in one roof has been deliberate to offer a one-stop hearing centre for his patients. 

This includes tele-audiology (utilisation of telemedicine to provide audiological services) through a US-based scholar, Prof GianPaolo Mazzoni.

Mazzoni is a Professor of Electrophysiology and Auditory Evoked Potentials at the Colombia School of Rehabilitation.

IncusEar has been working with hearing aid manufacturers from Germany, Denmark and Swiss.

Asked why the three countries, Mwangi was categorical that they have the best in technological know-how and are the oldest in hearing aid production. He also said their prices are not as prohibitive as hearing aids from other countries.

Edited by T Jalio