| Abstract|| |
Introduction: Hearing impairment indicate a full or partial decrease in ability to detect or understand sounds. Their first presentation could be with delayed speech, language and cognitive ability. The goal of universal newborn hearing screeningprograms (UNHS), which are widely used in developed countries, is early recognition and treatment of hearing impairment. All children should be managed by a multidisciplinary team. Objectives: To study the risk factors and treatment of hearing loss and impairement in children seen at Aldwha and Khartoum ENT Hospitals, Sudan. Material and Methods: This is a retrospective, descriptive and hospital-based study done at Aldwha and Khartoum ENT Hospitals, Sudan. Study period was four months. Study population were children with hearing loss and hearing impairment seen in the referal clinics of the two hospitals. Data was collected by using a questionnaire. General examination, developmental assessment and some investigations were done. Data was analyzed using Cochran's equation. Results: A total of 119 children with hearing impairment or hearing losswere selected. M to F ratio was 1.13 to 1. Sensory neural hearing loss was the commonest in 75.6% followed by conductive hearing loss in 21.0%, mixed in 2.5% and rarely central in 0.8%. Bilateral (HL) was detected in 89.1%. As a risk factors, early rubella during pregnancy account for 1.7% , birth asphyxia in 2.5% , prematurity in 5.9%, neonatal jaundice in 6.7% and otitis media in 19.3%. Quinine was the commonest drug that caused HL. Isolated hearing loss was detected in 42.0% , hearing loss and speech defect in 47.9%. Who received ear aids were 70.6%. There was a significant association between otitis media and conductive hearing loss. In conclusion the commonest age group affected were children between 1 and 4 years. Male to Female ratio was 1.13 to 1. Consanguineous marriage was reported in almost ¾ of studied families. Sensory neural hearing loss was the commonest and majority had bilateral (HL). Otitis media was a common risk factor followed by meningitis. Three quarters received ear aids. We recommend early screening of neonates and infants with risk factors by introduction of NHS program, safe administration of drugs, activation of primary health programs & establishment of audiological units.
Keywords: Children, hearing loss, Khartoum
|How to cite this article:|
Ahmed S, Hajabubker MA, Satti SA. Risk factors and management modalities for sudanese children with hearing loss or hearing impairment done in Aldwha and Khartoum ENT hospitals, Sudan. Ann Trop Med Public Health 2017;10:357-61
|How to cite this URL:|
Ahmed S, Hajabubker MA, Satti SA. Risk factors and management modalities for sudanese children with hearing loss or hearing impairment done in Aldwha and Khartoum ENT hospitals, Sudan. Ann Trop Med Public Health [serial online] 2017 [cited 2020 Jul 7];10:357-61. Available from: http://www.atmph.org/text.asp?2017/10/2/357/208721
| Introduction|| |
Hearing impairment indicates a full or partial decrease in the ability to detect or understand sounds. Hearing loss can be silent in children so they appear to be normal. Their first presentation could be with delayed speech, language and cognitive ability.
Universal newborn hearing screening programs(UNHS) are widely used in developed countries. There are two types of hearing loss: Conductive and Sensorineural hearing loss (SNHL). Degree of hearing loss is either slight, mild, moderate, moderately severe, severe or profound. In general, meningitis, measles, otitis media and different febrile illnesses such as bacterial infections are the major causes of childhood hearing loss. Otitis media (OM) is a common childhood disorder associated with conductive hearing loss. An insult to the developing cochlea, such as intrauterine infection, medications or toxins can lead to congenital hearing loss., The risk of hearing loss is increased in children with prolonged hyperbilirubinemia and adverse perinatal factors, such as acidosis and low birth weight.
Measles is a recognized cause of hearing loss in developing countries. Malaria has been implicated in the causation of deafness in several studies in West Africa. Ototoxic drugs such as aminoglycosides, cisplatinand quinine can cause significant hearing loss., Salicylates, aspirin and anti-malarial medications can cause reversible hearing loss. The most common tumor that causes SNHL is a vestibular schwannoma.
The goal of universal newborn hearing screening (UNHS) is early recognition and treatment of hearing impairment, which may maximize linguistic competence and literary development of children who are deaf or hard of hearing. Selective screening alone would delay the detection of hearing loss in a substantial number of children with congenital hearing loss.,
Because of risk of hearing loss in patients admitted to the NICU, at least one audiologic reassessment between 24 and 30 months of age is recommended. Ideally, all children with permanent hearing loss should be managed by a multidisciplinary team that includes audiologists, otolaryngologists, speech pathologists, geneticists, and educational specialists. Amplification devices are recommended for children with bilateral sensorineural hearing loss or long-term conductive hearing loss.
There is a range of hearing aid styles, types, and costs that are available. If access to hearing aid is not possible, it can be managed by the deaf training. Some cases of hearing loss are amenable to surgical intervention. An option of treating hearing loss (hearing impairment) is by using stem cells. Special school learning and speech therapist to improve their language, communication and cognitive skills is needed. Majority of causes of hearing impairment and hearing loss are preventable.
| Objectives|| |
To study the risk factors and treatment of hearing loss in children seen at Aldwha and Khartoum ENT Hospitals, Sudan. No recent similar study was done in Sudan.
| Material and Methods|| |
This is a retrospective, descriptive and hospital-based study. Aldwha is a specialized-referral ENT hospital established in 2008 and ENT Khartoum hospital was established in 1960.The study period was four months.
The study population was children with hearing loss and hearing impairment seen in the referred clinics of the two hospitals. Children whose parents refused to participate in the study were excluded. The data was collected by using a questionnaire, which containedpersonal data about the risk factors of hearing loss. General examination, growth parameters, developmental assessment and some investigations were done. Data was analyzed using Cochran's equation.
| Results|| |
A total of 119 children with hearing impairment or hearing loss were selected. The major age groups were as follows: less than 5 yrs, 53 (44.5%), between 5-11 yrs were 52 (43.7%) and between 12-18 yrs were 14 (11.8%). 63 (52.9%) were boys; while 56 (47.1%) were girls. M to F ratio was 1.13 to 1, and 66 (55.5%) of children were from Khartoum while 53 (44.5%) were from outside Khartoum. The most common tribe affected was Jalia 17 (14.3%) and 3 (2.5%) were Jwama.
Consanguineous marriage was reported in 91 (76.5%) of the studied group and non- consanguine marriage in 28 (23.5%). Sensory neural hearing loss was the most common in 90 (75.6%) followed by conductive hearing loss in 25 (21.0%), mixed in 3 (2.5%) and rarely central in 1(0.8%). 79 (66.4%) of the studied group were not educated. Bilateral (HL) was detected in 106 (89.1%) and unilateral in 13 (10.9%) 55 (46.2%) had profound HL, 32 (26.9%) moderate, 22 (18.5%) severe HL and 10 (8.4%) with mild HL [Figure 1].
|Figure 1: Distribution of studied children according to degree of hearing loss.|
Click here to view
Regarding the age of diagnosis: in (1-4) yrs age group number diagnosed was 58 (48.7%), in (5-8) yrs age group number was 37 (31.1%), in age group (9-12) yrs number was 17 (14.2%), from (13-16) yrs age group number was 6 (4.9%), and from (17-18) yrs age group number was only 1 (0.8%). 30 (32.8%) of mothers detected their child problem because of delayed language, 29 (24.4%) because of positive family history, 29 (24.4%) because of poor schooling, and 21 (17.6%) because of delayed response after calling. As a risk factor, prenatal problems account for 2 (1.7%), due to early rubella during pregnancy, birth asphyxia in 3 (2.5%); while prematurity in 7 (5.9%), neonatal jaundice in 8 (6.7%) and otitis media in 23 (19.3%). Quinine was the most common drug that caused HL in 3 (2.5%) then gentamycin in 2 (1.7%). 6 (5.0%) of our children had ICU admission.
The distribution of percentage of children who had infected diseaseswere as follows: meningitis 14 (11.8%),measles 10 (8.4%), mumps 9 (7.6%) and malaria 3 (2.5%) [Figure 2].
|Figure 2: Distribution of children who were diagnosed with hearing impairment according to Infectious diseases.|
Click here to view
91 (76.5%) of children had adequate nutrition, 24 (20.2%) had under nutrition and 2 (1.7%) had malnutrition. Isolated hearing loss was detected in 50 (42.0%), hearing loss and speech defect in 57 (47.9%) and global developmental delay in 10 (8.4%). Cerebral palsy was detected in 2 (1.7%) [Figure 3]. 8 (6.7%) of the studied children were retarded.
The children who received ear aids were 84 (70.6%), 23 (19.3%) had treatment of otitismedia, 7 (5.9%) had tympanoplasty and in 1 (1.7%) cochlear implantation was done [Figure 4]. 11 (9.2%) of studied children had learning at special school. There was a significant association between otitis media and conductive hearing loss (P value = 0.000) There was a correlation between meningitis and profound hearing loss, and also between mumps and moderate hearing loss. The two correlations showed P value of 0.036. However, there was insignificant correlation between meningitis and sensory neural hearing loss which showed P value of 0.158.
| Discussion|| |
Hearing impairment or hearing loss is a common problem that leads to disability andmodulates adult lifestyle by affecting communication and cognitive skills. The prevalence rates in many African countries of south of Sahara are higher than in most developed countries. Most of risk factors can be preventable, so identification of them is the first step.
A total of 119 children with hearing impairment and hearing loss were seen in this study. Themost common age group affected was found to be where children were less than 5 yrs old (44.5%). It can be explained by the fact that infectious diseases are known to be common in this age group. In contrast to the study done at Ibn-Sina Hospital revealed that the 7 to 9 yrs age was the most common group for hearing loss.
The prevalence of consanguinity marriage was 76.5% in our study, which was similar to Ibn Sina study ,that is 72.8%. This is a high prevalence expected as auto-somal recessive is the commonest type of hereditary hearing loss. In our study,the sensory NHL was found as the most common type with 75.6% in the group, followed by conductive HL with 21.0% and then mixed HL. This is different from the study done in Nigerian school children where conductive HL was 36% followed by SNHL in 24% then mixed HL in 40%. This difference can be explained by the fact that infectious diseases are more common in our country compared to other African countries. The incidence of bilateral hearing loss was high in this study, that is 89.1%, which is comparable to the study done previously at Khartoum ENT hospital.
Almost half of children in this study (48.7%) were diagnosed at the age group of 1 to 4 yrs. This delay in diagnosis was due to a deficiency in organized programmes, such as universal neonatal hearing screening-UNHS. Infectious diseases was the most common etiology with 30.3% in this studyfollowed by otitis media in 19.3%, explained by the fact that primary health care programs are still lagging behind in our country. This is different from the study conducted in Swaziland, which showed that the chronic otitis media,as 30% was the most common cause of hearing loss and impairment. In our study, meningitis was found to be the most infectious common cause with 11.8% after otitis media, then followed by measles with 8.4% then mumps as (7.6%), which is comparable to the study done at Khartoum ENT hospital previously in three yrs old children. Bacterial meningitis causes persistent hearing impairment in 2.5 to 18 % of survivors.,
The study done at North of Tunisia showed that genetic factor was the most common cause of HL unlike in our study where only 24.4% of our cases had a positive family history.
Otitis media was the third most common cause of HL with 19.3% in our study while being the leading cause in the study done at Swaziland as 30%. Quinine was the most common drug causing HL, that is 2.5% in this study, as it is the drug of choice for severe malaria which is endemic in Sudan. The study done in India is different from our results, where streptomycin was the most common drug causing HL. Streptomycin is commonly used as an anti-tuberculous drug in that region. In our study,the children with speech and hearing loss were 47.9%, with isolated HL loss 42%, with HL and global developmental delay 8.4% and with HL and cerebral palsy 1.7%. From this data we estimate that almost half of our children were present with isolated HL. The studied children who received hearing aids were 70.6%, unlike the study done in Ibadan, Nigeria where the access to hearing aids was rare, only in 2.5%. There was a significant association between otitis media and conductive hearing loss, between meningitis and profound hearing loss and between mumps and moderate hearing loss. In this study, cochlear implant was done for only 5.9% of children, but was widely used in the study done in china.
In our study only 9.2% attended schools with special needs , where such schools are mainly private in nature and concentrated only in Khartoum city.
The strategies concerning prevention include proper treatment of otitis media and better supply of drugs and equipment, which include otoscopes and presence of otolaryngologist. Also, by providing good antenatal care, avoidance of toxins during pregnancy, using of vaccination and early screening and detection of congenital infections they can prevent the disease. Moreover, attendance of high risk deliveries to reduce the risk of birth asphyxia, health education messages in relation to personal hygiene could be developed. Negative practices such as instilling various substances in the ear (e.g oil, milk, leaf extract, cows urine) should also be targeted and prevented.
In conclusion, from a total of 119 children with hearing impairment or hearing loss seen in this study, the most common age group who got affected were the children between 1-4 years. Male to Female ratio was 1.13 to 1. The most common tribe affected was Jalia. Consanguineous marriage was reported in almost ¾ of studied families. Sensory neural hearing loss was the most common and majority of the studied children had bilateral (HL). The main cause of why in these children Hl was discovered, was because of delayed language, of positive family history, of poor schooling and of delayed response after calling. Otitis media was a common risk factor followed by meningitis. Quinine was the most common etiological drug. Most of them, that is 70.6% received ear aids.
We recommend early screening of neonates and infants with risk factors of HL and impairment by introduction of NHS program, safe administration of drugs especially ototoxic ones, activation of primary health programs, establishment of audiological units to facilitate hearing screening with introduction of O.A.E test, early involvement of pediatricions in these screening programs and counseling of families with children having hearing loss.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Rave Travis. Family Health legal Definition of Hearing Impaired. ehow contributor. www.ehow.com
Yoshinaga-Itano C, Sedey AL, Coulter DK, Mehl AL. Language of early and later identified children with hearing loss. Pediatrics 1998;102:1161-71.
Downs MP, Yoshinaga-Itano C. The efficacy of early identification and intervention for children with hearing impairment. Pediatr Clin North Am 1999;46:79-87.
WHO Guidelines for hearing and services for developing countries. 2004. 2nd ed.
WHO tackles hearing disabilities in developing world. Lancet 2001;358:219.
Roizen NJ. Etiology of hearing loss in children: Nongenetic causes. Pediatr Clin North Am 1999;46:49-64.
Nelson K, Wasserman EE, Rose NR. Maternal thyroid autoantibodies during the third trimester and hearing deficits in children: an epidemiologic assessment. Am J Epidemiol 2008;167:701-10.
De Vries LS, Lary S, Duboitz LMS. Relationships of serum bilirubin levels to ototoxicity and deafness in high risk low birthweight infants. Pediatrics 1985;76:351-4.
Chukuezia A. Hearing loss: a possible consequence of malaria. Afr Health 1995;17:18-9.
Bendush CL. Ototoxicity: Clinical considerations and comparative information. In: The aminoglycosides: Microbiology, clinical use and toxicology. Marcel Dekke, New York. 1982;p.453.
Robertson CM, Tyebkhan JM, Peliowski A, Etches PC, Cheung PY. Ototoxic drugs and sensorineural hearing loss following severe neonatal respiratory failure. Acta Paediatr 2006;95:214-23.
Gallagher KL, Jones JK. Furosemide-induced ototoxicity. Ann Intern Med 1979;91:744-5.
Jackler RK. Acoustic neuroma. In: Neurotology, Jackler, R, Brackman, DE (Eds). Mosby, St. Louis.1994.p.729.
Outcome of A WHO Informal Consultation ELD at WHO Headquarters. Geneva, Switzerland. 2009.
Finitzo T, Albright K, O'Neal J. The newborn with hearing loss: detection in the nursery. Pediatrics 1998;102:1452-60.
Stewart DL, Mehl A, Hall JW. Universal newborn hearing screening with automated auditory brainstem response: a multisite investigation. J Perinatol 2000;20:S128.
American Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics 2007;120:898-921.
Lasisi OA, Ayodele JK, Ijaduola GT. Challenges in management of childhood sensonineural hearing loss in Sub-Saharan Africa- Nigeria. Int J Pediatr otorhinolanyngol 2006;70:625-9.
Asfaur E. The incidence and cause of SNHL in Sudanese children admitted at Ibn Sina Hospital. Thesis inclinical MD of otorhinology head and neck surgery. 2006.
The Hearing Profile of Nigerian School Children. International Journal of Pediatric Otorhinolaryngology. 2000;55:173-9.
Elamin SM, Sensonueral H. L in relation to febrile illnesses in Sudanese children in Khartoum. July 2007 -Feb 2009.
Report of a WHO/ CIBA foundation workshop. Prevention of hearing impairment from Chronic Otitis Media. London. 1996.
Fortnum HM. Hearing impairment after bacterial meningitis: a review. Arch Dis Child 1992;67:1128-33.
Fortnum H, Davis A. Epidemiology of permanent childhood hearing impairment in Trent Region, 1985-1993. Br J Audiol 1997;31:409-46.
Tomaski SM, Grundfast KM. A stepwise approach to the diagnosis and treatment of hereditary hearing loss. Pediatr Clin NorthAm 1999;46:35-48.
WHO Report of an informal consultation on strategies for prevention of hearing impairment from ototoxic drugs Geneva. 1994.
Zeng FG. Cochlear implants in China. Audiology 1995;34:61-75.
Satti Abdelrahim Satti
Pediatric Department, Sudan International University, Khartoum
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4]