Listen up!

Star:
Helen Keller once said: ‘Blindness separates us from things but deafness separates us from people.’ The impact of hearing loss can be quite devastating. Hence, it’s important that we educate ourselves about the conditions associated with hearing loss, and how we can take measures to detect it early in order to minimise its effects.
CAN a deaf person hear? If your answer is “no”, then you are among the majority of the population who has the wrong idea about hearing impairment. Being deaf or hard of hearing does not mean that a person can’t hear any sound, but merely that he/she does not hear all levels of sounds or all types of sounds, depending on the severity of the individual’s hearing loss.

What is hearing loss
Hearing loss takes many forms and has varying degrees of severity. In fact, it would not be a big stretch of the imagination to say that every one of us has faced hearing loss at least once in our lifetime.
Do you laugh at this claim and think it is ridiculous? Well, if you have felt a blocked feeling when you were driving up a hill or had some water that went inside your ear canals when swimming, then you have experienced temporary loss of hearing at those moments.
Fortunately, most of these incidents are rare and temporary, and you quickly put it out of your mind once it has passed. However, for a number of individuals, hearing loss is permanent or lasts much longer than a few minutes, and this causes difficulties with communication and has a significant impact on their lives.
A family member or a close friend could have hearing problems and you might not have realised it. Hearing loss is an invisible problem and because of that, it has often been neglected or not taken seriously.
However, the impact of hearing loss affects academic performance, social life and career. Helen Keller, a deaf and blind writer and lecturer, once said: “Blindness separates us from things but deafness separates us from people”.

Types of hearing loss
To describe every type of hearing loss and their causes would be impossible within the context of this article. Instead, we will focus on the more common types of hearing loss and some common causes.
Normally, hearing loss is divided into conductive loss, sensorineural loss and mixed loss. These descriptions are based on the cause of the hearing loss. A conductive loss means that the cause of the hearing loss is present in the outer ear canal or the middle ear, which are considered the conductive pathway for sound into the ears. Some common causes would be wax blockage in the outer ear, middle ear infections and hole in the eardrum.
Sensorineural hearing loss indicates that the cause of the hearing loss is in the cochlear or the auditory nerve that connects the cochlear to the auditory centres of the brain. Some common causes include damage to the cochlear hair cells due to noise, ageing or infection; Meniere’s disease (increase of fluid levels in the cochlear); and acoustic neuroma (cancer on the auditory nerve).
A mixed loss is a combination of a conductive loss and sensorineural loss existing together. Some of these causes can be cured, especially conductive loss, either by medication or surgery. However, some are permanent and need other management options.
When an individual has hearing loss, the person would most often be referred to an audiologist for a diagnosis of the type of hearing loss, severity of hearing loss, site of problem and non-medical management.
An audiologist is an allied health professional specialising in hearing and non-medical management of the auditory and balance systems. An audiologist is trained in the prevention, identification and assessment of hearing loss and other related disabilities (like balance disorders) as well treatment and rehabilitative services.

Impact on communication
Take a few minutes and think of your family members and close friends. Have any of them seemed to have not been paying attention or very quiet lately? Have any of them seemed lost in a conversation, especially in noisy places? Have they asked you to repeat a sentence more than once, frequently?
If it’s a “yes”, there is a strong possibility that the person might be having some form of hearing impairment. I am very sure that you do not have to think for long before you could think of someone with these signs.
The incidence of hearing loss is not rare. Worldwide statistics show that one to five babies in every 1,000 babies born have permanent hearing loss, which makes it one of the highest incidences of birth defects. Other research estimate that more than 40 % of those aged above 65 years old have hearing loss.
To properly understand hearing loss, we have to accept the fact that hearing loss can occur at different levels of severity which is described by the softest intensity of sound we can detect. The accompanying table (right) shows the different levels of hearing loss and the associated difficulties with communication.

How is hearing loss detected
Identification of hearing loss is most often done by screening for hearing loss. This is usually done for population groups with a high incidence of hearing loss, such as newborns, school-going children and the aged, due to the simple reason that sometimes hearing loss cannot be detected and early identification would lead to better intervention and outcome.
Studies show that hearing loss in children, if identified and diagnosed early so that intervention can begin before six months of age, results in speech and language development that is on par with normal hearing children.
The management of hearing loss most often involves a team that includes the individual or parents of a child with hearing loss, an audiologist, a paediatrician, ear, nose & throat (ENT) surgeon, speech language pathologist and other specialists based on the needs of the individual.
For example, after diagnosing the hearing loss, the patient might be referred to an ENT surgeon for problems that can be treated with medications or surgery. In other cases, a referral to the speech language pathologist would be made to address speech and language or communication difficulties.
However, in a lot of cases, the hearing loss might be permanent and cannot be cured. In these cases, the audiologist would recommend and fit amplification devices such as hearing aids or suggest cochlear implants for more severe cases.
What follows would be the rehabilitation process whereby the individual with hearing impairment is trained to listen with their amplification devices. This might be a long and trying process as the sounds from the hearing aid might be different than what the individual is used to or the processing of sound by the cochlea is abnormal, requiring a lot of fine-tuning to be done before the hearing aid or cochlear implant is accepted by the individual.
The notion that a deaf individual cannot hear and a deaf child is destined to be mute is outdated. Technological advancements and knowledge has given these individuals the key to overcome the effects of hearing loss. However, the only way that this can be achieved is if each and every one of us is educated on what hearing loss is and what we have to do in order to help someone address the problem.

With regards to public awareness and education, the first National Better Hearing and Speech Campaign 2006 begins in the month of May. The campaign, with the support and participation of related government ministries, services and organisations, is meant to disperse information, to inform and to raise general awareness of hearing difficulties/problems and services available in the country.
During the month, there will be various speech-language and hearing related activities going on in various places around the country. Kindly refer to the table to find out about it.
For further information, please contact the Secretary, Malaysian Association of Speech-Language and Hearing (MASH), at PO Box 610, Pejabat Pos Jalan Sultan, 46770 Petaling Jaya, Selangor, Malaysia or email: mash1995@yahoo.com. Website: www.mash.org.my

Note: Saravanan Selanduray is an audiologist and member of MASH.