In an interview with ETHealthworld, Prof and Dr Mohan Kameswaran, MD, Madras ENT Research Foundation (P) Ltd., Chennai, discusses the burden of deafnessin the country and more precisely in Tamil Nadu, reckoned as the deaf state of the country. Edited Excerpts:
How prevalent is deafness in the country and what are the underlying reasons?
Deafness is the most poignant of all handicaps. A person who is deaf does not elicit sympathy as you just look like any other person and nobody knows that this person is profoundly deaf. If somebody talks to him and he doesn't respond, he is usually mistaken for a fool or either a very arrogant person. In double handicap, somebody who is born profoundly deaf is also dumb, with no language so they can’t communicate or fight for their rights. Deafness is also the commonest congenital anomaly that affects children globally. All over the world one in every thousand live births is born profoundly deaf and an additional three or four of them have partial degrees of deafness. Partial deafness is correctable with a hearing aid but profound deafness is not. It often needs more integrate interventions which are more costly and expensive. As per WHO statistics, the burden of deafness is twice in India as compared to the world. Our own state Tamil Nadu is the deaf state of the country. 6 out of every 1000 children born in Tamil Nadu are born profoundly deaf and the reason is the widespread practice of consanguineous marriages. This results in genetic intermixing of recessive genes from both parents and there is a high prevalence of deafness and other congenital consequences.
What are the challenges and how would you like to address them?
The problems have to be addressed in several levels, the easiest part is to diagnose a problem and then the next question is what we do after the diagnosis? We have to intervene. Thanks to development in technology, we can actually diagnose a child at birth and it is a standard practise in most developed countries now. Before a child is discharged from a hospital, the child has to go through a mandatory hearing screening test and it either passes the test or doesn't. If the child doesn't pass the test, we closely monitor the child and do tests at periodic intervals. So intervention has to start well before the child reaches a few months of age but we don't have such a scheme in India though we are trying to diagnose them early. In our country very often the parents start suspecting that the child has a hearing problem beyond 1-2 years of age when the child is not developing a language. When a child's hearing is delayed it is the first indication that something is seriously wrong and this child needs a very comprehensive evaluation to find more about the problem. If you have 10 children who are found profoundly deaf, two of them are syndromic which means one of the systems is affected. The child could be going blind, having problems of the heart, problem of the kidney etc. So there may be other associated anomalies and you have to look for that also. The workup of a child who is profoundly deaf is very comprehensive. In a good facility you have to have a knowledgeable person looking after the child as a whole and also trying to establish the cost of deafness as a well as the extent and severity of deafness.
How has technology helped us to restore hearing?
Fortunately, a lot good developments have happened in this field in the last 20 years. If we talk about the cochlear implants it is an extremely intricate device which is surgically placed in the inner ear or cochlea. 95 percent of children who are profoundly deaf have that problem in the cochlea and only in 5 percent the problem rises beyond that. In cochlear implants we surgically place an implant into the inner ear and we are able to stimulate this cochlear by picking up sounds from outside and then sequentially stimulating the cochlear in different places. We are able to give back the essence of hearing to the child and by doing this we can restore hearing and with that comes speech and language.
Role and contribution of Madras ENT Research Foundation in fighting deafness
With cochlear implants we have been able to give hundreds and thousands of children in Tamil Nadu alone. We have been in the forefront of fighting against deafness for the last 20 years and Madras ENT Research Foundation as a pioneer in this area introduced cochlear implants in this part of the world. We have been talking to our policy makers in this state and one of our greatest achievements has been to introduce cochlear implants free of cost to every child who needs it in the state. This is one state where a child who is born profoundly deaf can have completely free evaluation, diagnosis, intervention with a cochlear implant and then a subsequent rehabilitation. This is a very far sighted scheme by the state and it is a very cost intensive and the most cost effective scheme in the state. With this we have been able to dream and create a deafness free state in the next four to five years. The state has agreed a proposal from us to start a universal neonatal hearing screening programme and this is a unique challenge in this country because a lot of children are born at home. We are now trying to have a screening program in maternity hospitals but also combine it with the vaccination programme with oral polio vaccination scheme where the children have more than 95 percent coverage. This is a pilot scheme initially being tried out in two districts in Tamil Nadu and hopefully in the next few years it will spread out over the length and breadth of the state.
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