KUALA LUMPUR, March 6 — Identifying and treating a hearing impairment early will prevent the early onset of dementia in patients, said Prince Court Medical Centre (PCMC) medical director Dr Kuljit Singh.
Dr Kuljit, speaking at a World Hearing Day 2023 event launched by the Auditory Unit of PCMC here last Friday, held that it is important for patients with poor hearing to get electronic devices that will enable them to maintain communications with the rest of society as sensory input stimulates the brain, thus delaying the onset of dementia.
“Now, evidence has shown that identifying hearing impairment early will help patients in having better lifestyles and better quality of life in a daily activity,” said Dr Kuljit, who is also a consultant ear, nose and throat (ENT) surgeon.
“There are also studies today that have shown that it also prevents early dementia. Dementia is something that we all get worried about, but if you don’t have enough input into our system, then dementia is possible to set in.
“So we always tell this to our patients as ENT surgeons – get yourself some sort of appliance so that you can still communicate. Poor communication and less communication at an older age – there is evidence to show that dementia was set in earlier. So communication is important. Vision, hearing, tactile feeling give stimulation to the brain, and we can delay dementia,” said Dr Kuljit.
Based on the statistics shared by PCMC, about 44,500 people with hearing impairment were registered with the Welfare Department in Malaysia in 2018.
According to Dr Kuljit, though hearing loss is commonly seen as something that afflicts the elderly members of society, with the advancement of modern technology, the younger generation too are at risk of developing hearing loss as they “are constantly having something in their ear and listening to music to keep their sanity, I presume.”
To destigmatize hearing loss and to educate the members present at the event, a forum of three medical experts on the causes and treatments of hearing loss was brought together to address the causes, signs, and treatments for hearing loss.
When it comes to hearing loss and the impact it has on communication, Dr Anura Michelle Manuel, a consultant ENT surgeon who sub-specialises in paediatric otorhinolaryngology, held that hearing loss can greatly impact one’s ability to communicate with the surrounding world.
Complete hearing loss at birth eliminates the person’s ability to speak completely, which in turn, gives birth to the stigma that characterises people with hearing loss as being slow learners.
In a population of approximately 33 million where 5 per cent of its people are afflicted by “disabling hearing loss”, Dr Anura states that facilities are woefully inadequate.
“If you just look at the available facilities for people with hearing loss, it’s really inadequate. If you go to schools, for example, and we talk to teachers and their awareness of hearing loss and how it may impact their students, it’s also inadequate,” she said.
“So in general, I would say the answer to that would be we need to increase awareness. There is a lot of work to be done in this: the impact of hearing loss from a very young age.
“If you take a child who’s not developed hearing or for a congenital reason, for example, with reduced hearing or no hearing. Reduced hearing – the speech is unclear with no hearing – so a complete hearing loss or a severe hearing loss at birth. If they cannot hear, they cannot learn to speak, so they cannot develop speech.
“Then you have problems with communication. If a child cannot express themselves, they become frustrated. They become emotionally upset. Then we go to the next level. Child goes to school. Even with a mild hearing loss, it will affect the studies; the child’s potential in school; the child’s ability to communicate with their peers, their friends, their teachers. And they’re very often labelled as being slow learners.
“But the solution is very simple. Just get the child’s hearing back to normal and it can be done very easily in the majority of cases,” said Dr Anura.
The impact of hearing loss at a very young age can have far-reaching consequences that stretches into their adult life. The lack of redress when they are young could cause a person to poorly perform at their job, causing “a lot of segregation” that would ultimately isolate the individual.
There are three main types of hearing loss:
- Conductive – caused by a problem in the outer or middle ear and usually affects all frequencies, though not severely;
- Sensorineural – caused by a problem in the inner ear or auditory nerve, and distorts sounds even with the use of a hearing aid;
- A person can suffer from a combination of conductive and sensorineural loss.
As it is crucial to catch hearing loss as early as possible, Dr Anura states that the newborn hearing screen is a form of early detection that should, “by right”, be carried out on all babies, preferably within three days after conception.
“So every child by right who’s born, within the first three days, should have a hearing screen done. And this will rule out congenital hearing loss from birth, but it is a hearing screen, and it’s not definitive. So if there is a problem with the newborn hearing screen, then they (the family) are asked to come back again for a second test to confirm this.
“And it’s a more detailed test, which will tell us the degree of the hearing loss. The first step would be to stress to them the importance of coming back if the child does fail that initial hearing screen, because it is important to detect early and to put them on rehabilitation or hearing aids, for example, early, to overcome this,” said Dr Anura.
As hearing loss could be mild and it could develop later on in life, it is important for teachers, parents, and paediatricians to look out for the signs of hearing loss. While in international schools, teachers are more perceptive when it comes to hearing loss, the same can’t be said for local schools, according to Dr Anura.
According to the statistics provided by the forum, Malaysia has a newborn hearing screening coverage of 50 to 60 per cent and is currently lagging behind Thailand. However, Health Minister Dr Zaliha Mustafa has sought to achieve a 90 per cent coverage by the year 2025 and has made it a part of the Ministry of Health’s key performance index (KPI).
Family And Friends Recognise Hearing Loss Faster
In adults, families and friends tend to recognise hearing loss faster than the person suffering the condition, especially sensorineural hearing loss, as the brain adapts and compensates for the loss of hearing, which is progressive in nature, said audiologist Dr Saravanan Selanduray.
“In terms of symptoms of hearing loss, what we usually see is that other people actually realise that you have a hearing loss much earlier than you yourself would realise it. A lot of times, especially with sensory neural hearing loss, it’s progressive, so you kind of adapt towards it and your brain kind of like adapts towards it.
“You have some adaptation techniques that you take. You move closer to a person, you look at the lips to understand context. It takes quite a long time before it progresses to a degree that you would say, ‘Yes, I do have a hearing loss.’” said Dr Saravanan in a forum at the PCMC event.
With sudden hearing loss, the individual would experience an immediate reduction in loudness and would go seek treatment immediately. However, with damage caused by exposure to noise or age related hearing loss, the individual would not realise it till there has been substantial degradation of hearing.
The World Health Organization’s World Report On Hearing 2021 found that 80 per cent of people with hearing loss live in low or middle-income countries and do not have access to interventions.
In addition to this, the report also held that “people with hearing loss, particularly those who do not use hearing aids, show elevated levels of loneliness. This lack of engagement with their surroundings, due to their hearing loss, may mediate the pathway linking hearing loss and cognitive decline and can contribute to worsened mental health, leading to experience of depression and distress”.
Additionally, the WHO report found that 83 per cent of people with hearing difficulties do not wear hearing aids because of regulations, pricing and stigmatisation. Many people choose not to wear hearing aids due to prejudice and ageist stereotypes.
With that being said, Dr Saravanan held that such concerns about wearing hearing aids are slowly on the decline, as it is more common to see people wearing personal audio devices that look “huge in your ear”.
“So one good thing that has happened recently is the advent of usage of personal audio devices like Airpods and things like that. And those are huge in your ear, and that is something that the youngsters are using. So it’s something that they don’t feel ashamed or they don’t feel it’s that odd for them to have a device in their ear.
“That has made it slightly easier with the younger population. Acceptance has grown a little bit more, so people are willing to use the hearing aid.”
Additionally, hearing aid companies themselves are creating smaller and multifunctional devices to encourage usage.
“Definitely the hearing aid industry itself is trying to make a device that could actually give so much functionality that it becomes something like a handphone. Something that you carry around with you all the time. You even feel that when you are not having a handphone with you, something’s missing, right?
“So that’s the thing that they would want to inculcate or try to make people get used to the idea. So hearing aids have become something that is not just a device that amplifies sounds, but a monitoring device.
“And it’s positioned pretty much in an effective way because it’s right there in your ears. So if there’s falls or there’s increase of temperature, increase of pulse, and things like that, it’s ideally positioned to monitor those things.
“So, yes, the industry is trying to incorporate all of these features inside the smallest device possible just to make sure that those people who really need it actually don’t feel shy or don’t feel ashamed. That’s something that we want to try to improve further,” said Dr Saravanan.
1,000 Occupational Health Doctors Not Enough To Meet Industry Needs
Dr Shawaludin Husin, president of Malaysian Society for Occupational Safety and Health, stated that the 1,000 currently available occupational health doctors (OHDs) are insufficient for workers employed by 22,000 employers covered under the occupational safety and health administration law in Malaysia.
Dr Shawaludin pointed out that large government-linked companies like Petronas and Khazanah employ 16,000 or 30,000 workers.
“So it is not enough. Basically, that’s why we need audiologists,” he said at the forum at the PCMC event.
He highlighted that under the Occupational Safety and Health Act 1994, OHDs are registered medical practitioners whose role is to manage occupational noise-related hearing disorders.
According to OSHA, it is the duty of every employer and self-employed person to ensure, so far as it is practicable, the safety, health, and welfare at work of all employees.
Dr Shawaludin held that if companies were found to be non-compliant, they could be penalised under OSHA, citing as example the requirement for employers to survey noise levels for each work unit every year.
Employers must fill up a questionnaire annually as a declaration that the company is complying with OSHA noise management standards; this is applicable across industries.
“For example, the hospital, each department sharing the same processing. For example, usually in hospital, maybe in CSSD (central sterile services department) department, or the ambulance driver, where is the noisy area we identify, but even in the office or OT (operation theatre), you need to declare,” said Dr Shawaludin.
Currently, noise occupational hearing loss is the leading category of occupational hazards experienced by workers, as seen in statistics by the Department of Occupational Safety and Health (DOSH) and the Social Security Organisation (Socso), according to Dr Shawaludin.
However, OSHA only covers three categories of excessive noise exposure that must be proven for a claim against an employer to be made.
“But in OSH, you need evidence. So you need to get the noise risk assessment. In OSH, we must establish 85 decibels for eight hours, or 115 decibels for maximum, or 140 for peak sound.”
Based on the Management of Occupational Noise-Related Hearing Disorders 2021 guideline, excessive noise is characterised as daily noise that exceeds 82 dB(A), or daily personal noise exceeding 50 per cent or maximum sound pressure level exceeding 115 dB(A) at any time, or peak sound pressure level exceeding 140 dB(C).
Under the Industry Code of Practice for Management of Occupational Noise Exposure and Hearing Conservation 2019, Noise Risk Assessment shall be conducted when excessive noise is identified in the workplace.
