By Henrylito D. Tacio
Photo credit: thehearinginstitute.org
Expect more Filipinos to be hard of hearing in the coming years – thanks to the proliferation of gadgets like Ipods and MP3 Players.
“Most of the young people who have them don’t know that improper use of these gadgets can cause deafness,” laments Dr. Willie T. Ong, an internist/cardiologist and book author.
“If you are sitting next to a friend and you can hear the music through his earphones, then that is already too loud,” informs Dr. Ong, who was given the Outstanding Filipino Physician Award by the Department of Health in 2007.
“The worst damage you can inflict to your ears is to bombard it with loud sounds,” he points out. “Noise is the biggest threat to your hearing. If you tend to watch too many rock concerts, you will develop mild hearing loss and possibly tinnitus, which is ringing of the ears.”
“Noise damage is caused by both the intensity of the sound and the duration of the exposure,” explains Dr. Charles Kimmelman, professor of otolaryngology at Manhattan Eye, Ear, and Throat Hospital. “But because the effect of noise damage is cumulative, hearing loss from noise adds to the hearing loss you’ll get from aging.”
Noise – unwanted or harmful sound – is pervasive pollution in society. It enters our ears as powerful waves of mechanical energy. Scientists measure sound intensity in decibels (dB), with each doubling of energy adding three decibels.
Ordinary conversation measures about 60 dB; a child’s scream hits around 90 dB. On this logarithmic scale, the scream is potentially 1000 times more powerful. High-fidelity amplified music – be it rock or classical – from a soundbox can pound as high as 110 dB.
In the Philippines, the standard threshold of noise allowed is 85 dB for eight working hours.
But it’s not only in the Philippines that the problem is hearing loss is prevalent. In fact, the Geneva-based World Health Organization (WHO) reports that nearly 2.5 billion people worldwide ─ or 1 in 4 people ─ will be living with some degree of hearing loss by 2050.
In its first World Report on Hearing, the United Nations health agency said that at least 700 million of these people would require access to ear and hearing care and other rehabilitation services unless action is taken.
“Our ability to hear is precious. Untreated hearing loss can have a devastating impact on people’s ability to communicate, to study and to earn a living. It can also impact on people’s mental health and their ability to sustain relationships,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. “This new report outlines the scale of the problem, but also offers solutions in the form of evidence-based interventions that we encourage all countries to integrate into their health systems as part of their journey towards universal health coverage.”
The report underlines the need to rapidly step up efforts to prevent and address hearing loss by investing and expanding access to ear and hearing care services. Investment in ear and hearing care has been shown to be cost-effective: WHO calculates that governments can expect a return of nearly US$ 16 for every US$ 1 invested.
According to the report, lack of accurate information and stigmatizing attitudes to ear diseases and hearing loss often limit people from accessing care for these conditions. Even among health-care providers, there’s often a shortage of knowledge about prevention, early identification, and management of hearing loss and ear diseases, hampering their ability to provide the care required.
“In most countries, ear and hearing care is still not integrated into national health systems and accessing care services is challenging for those with ear diseases and hearing loss,” the report stated.
In addition, access to ear and hearing care is poorly measured and documented, and relevant indicators are lacking in the health information system.
But the most glaring gap in health system capacity is in human resources. Among low-income countries, about 78% have fewer than one ear, nose, and throat (ENT) specialist per million population; 93% have fewer than one audiologist per million; only 17% have one or more speech therapists per million, and 50% have one or more teachers for the deaf per million.
“This gap can be closed through integration of ear and hearing care into primary health care through strategies such as task sharing and training,” the report said.
The report said that almost 60% of hearing loss in children could be prevented through measures such as immunization to prevent rubella and meningitis, improved maternal and neonatal care, and screening for, and early management of, otitis media – inflammatory diseases of the middle ear.
In adults, noise control, safe listening, and surveillance of ototoxic medicines together with good ear hygiene can help maintain good hearing and reduce the potential for hearing loss. Identification is the first step in addressing hearing loss and related ear diseases. Clinical screening at strategic points in life ensures that any loss of hearing and ear diseases can be identified as early as possible.
Recent technological advances, including accurate and easy-to-use tools, can identify ear disease and hearing loss at any age, in clinical or community settings, and with limited training and resources. Screening can even take place in challenging situations such as those encountered during the coronavirus disease 2019 (COVID-19) pandemic and those living in underserved and remote areas of the world.
“Once diagnosed, early intervention is key,” the report said.
Medical and surgical treatment can cure most ear diseases, potentially reversing the associated hearing loss. However, where hearing loss is irreversible, rehabilitation can ensure that those affected avoid the adverse consequences of hearing loss. A range of effective options is available.
Hearing technology, such as hearing aids and cochlear implants, when accompanied by appropriate support services and rehabilitative therapy, are practical and cost-effective and can benefit children and adults alike.
The report notes that the use of sign language and other means of sensory substitution such as speech reading are important options for many deaf people; hearing assistive technology and services such as captioning and sign language interpretation can further improve access to communication and education for those with hearing loss.
“To ensure that the benefit of these technological advances and solutions is equitably accessible to all, countries must adopt an integrated people-centered approach,” said Dr. Bente Mikkelsen, Director of the WHO Department of Noncommunicable Diseases.
“Integrating ear and hearing care interventions within national health plans and delivering these through strengthened health systems, as part of universal health coverage, is essential to meet the needs of those at risk of or living with hearing loss,” the WHO official added.