Eloise Scholtz, experienced audiologist of Hearing Balance Cape Town (Liezel Kotze Inc.) and Cape Hearing Implants (CHi) was recently on television. She was interviewed by Dr. Darren Green presenter of the actuality program “Medies” on kykNET channel 145. Eloise discussed contemporary issues in audiology.
Eloise mentioned that 8 million people in South Africa suffer from some degree of hearing loss. However, only 10% seek help from an audiologist. The wearing of masks, since the Covid epidemic has played a major role in creating more awareness of hearing loss in patients in general. The reason for this is that the hard-of-hearing loses the important visual cue of the speaker when obscured by a mask. Lip reading is an important aid for patients with hearing loss. An interesting fact is that hard-of-hearing people suffer to follow cartoon programs on television, because of the lack of lip-reading movements from the cartoon characters.
Every person who battles to hear background noise should have their hearing assessed. Hearing loss of ageing (Presbyacusis) may often have an insidious onset and therefore difficulty communicating in background noise may be an early indicator. Patients with ear problems and those using potential ototoxic medication should have their hearing tested. Everyone exposed to loud noise should use noise protection and have regular hearing tests.
Eloise also mentioned that hearing aid technology is improving all the time. There are different styles of hearing aids and fitting a patient with a specific style depends on the type and configuration of the hearing loss as well as local factors such as the ear canal shape and size. In cases where hearing aids are not effective, implantable hearing devices such as the Vibrant Soundbridge or cochlear implantation (CI) may be helpful.
The issue of neonatal hearing screening and hearing loss in early childhood cannot be overemphasised. It is so vital that hearing loss, whatever the cause may be, is diagnosed as early as possible. Early intervention is mandatory to provide the hearing impaired child with hearing amplification and if indicated CI as early as possible. Without hearing a child cannot develop speech and language. The period to do so is time-dependant. The brain of a child in the first few years acts like a sponge, absorbing all information so that language and speech can develop. After a few years, this window period passes whereafter speech development is impaired and later even impossible.
Neonatal hearing is therefore offered in many hospitals. If not available it is strongly recommended that the mothers of newborns contact their closest audiologist to perform screening. Screening is a noninvasive test. It is not painful. The audiologist will use a device with a probe that is placed in the baby’s ear canal to perform the test. The otoacoustic emission (OAE) test objectively records the responses created by the hair cells of the cochlea when exposed to sound. If the baby passes this test it is a good sign, but the baby is not out of the woods yet! In rare cases, there may still be a hearing loss, from a nerve problem. To detect this a screening auditory brainstem (ABR) test is performed. The ideal scenario is always to perform both tests but costs may be a problem and luckily nerve-related hearing loss is rare.
When a baby fails a screening OAE a follow-up OAE should be performed within 6 weeks. If the baby fails again fluid in the middle ear may be responsible and therefore a paediatrician or ENT surgeon should see the baby. The audiologist should then perform a high-frequency tympanogram, another objective, non-invasive, non painfully test. This may indicate the presence of fluid in the middle ear that will render all tests inaccurate. The fluid in the middle ear will have to be managed by the paediatrician and if needed by the ENT who will likely drain the fluid and place grommets for ventilation. If the tympanogram is normal an automated ABR should be performed. This should be performed within 3-4 months at the latest.
If the baby fails the ABR test the baby should see an Otologist who may then order imaging of the inner ear to exclude congenital abnormalities. The ideal is that by six months hearing loss in a baby should be confirmed. At this stage hearing aids should be fitted.
In the case where hearing loss is severe to profound, and hearing aids are not of benefit CI may be the only option.
For any other questions feel free to contact Eloise Scholtz from Hearing Balance Cape Town at 021 946 3620.