Tuesday, January 28, 2014

WHISPERS LOST IN STORMS

A WORLD of utter silence awaits one child among a thousand born—and two more loses the gift of hearing in early childhood.

Fact hits like crack of thunder: ear infections acquired at birth up to 11 years of age can also touch off deafness in nearly 100 percent of all children. At least 10-15 of every 100 school children fail the hearing screening test. Too, studies found that two of every five grade one pupils suffer from impaired hearing.

Such impairment arise from two conditions and both can be treated, avers Dr. Teresa Luisa L. Gloria-Cruz, one of three tenured research faculty of the Philippine National Ear Institute in her updates delivered before a January 16, 2014 forum on “Hearing Screening in Filipino School Children: The Accuracy of the Hearing Screener Device” held at the University of the Philippines in Manila.

The two conditions that trigger hearing impairment in Filipino school children: impacted cerumen and otitis media.

Cerumen or earwax, which an attentive mother tenderly eases out of her baby’s ears with soft cotton buds to cap every bath episode, such wax which turns up in the ear to block dirt and infective agents can also become tightly packed in the outer ear canal to the point that the canal is blocked.

Otitis media is, on the other hand, inflammation of the middle ear resulting from infection—this can be painful and often causes temporary loss of hearing.
My handwriting. I had to write the article by hand after our desktop conked out.
The inner parts of the ear, as a character in an Irwin Shaw story suggests, can be fine-tuned to its utmost functions of keeping body equilibrium, poise, even hear of roses sigh in their blooming, or pluck clear as crystal notes even whispers in bedlam—but fiction stretches the capability of human hearing to unheard-of acuity.

Downright loss or less than severe impairment affects a child’s capacity to learn.

“Third grade students even with minimal, not moderate, not severe, not profound, but just minimal or mild hearing loss had lower scores in reading vocabulary, reading total, language mechanic, basic battery, word analysis, and science.

“So because of all these concerns, for the sake of our students, because of the concern of possible hearing loss that is undetected in school children, the Philippine National Ear Institute took upon itself an advocacy in screening for such hearing loss,” she points out.

After the Institute was established in 2004, members of its faculty zeroed in on two key areas of research they needed to tackle for the next 10 years: (1) newborn hearing screening, and (2) hearing screening in grade 1 pupils.
Institute Director Dr. Generosos T. Abes explains their decade-long pursuit:
“(1) there was high prevalence of hearing loss among this population;
  (2) most of the causes of hearing loss in this population are preventable and treatable;
  (3) there is high impact on omission of learning and speech development among patients affected by hearing loss in this (age) group; and,
 (4) more than anything else, we thought that there were no existing programs for hearing screening for these two population groups.”

The Institute’s research efforts paid off in the enactment of a 2009 law which mandates “every newborn must undergo hearing screening before the age of three months.”

Hearing screening for school children, however, faced a stumbling block: “There is no official and standardized national hearing screening for school children in the Philippines, unlike in developed countries where pure tone audiometry and tympanometry are the most common standards in use.”

Such lack of standards stems from  “paucity of epidemiologic data of hearing disorder in school children to be used as basis, a lack of cohesive guidelines in reporting of results locally and internationally, a lack of collaboration with agencies and institutions for a unified effort to formulate such a program,” Dr. Gloria-Cruz cites.

Beginning 2004, PNEI faculty hopped through the country’s major islands and took to training, teaching, and research missions—school nurses were trained in ear examinations using a penlight to detect earwax and discharge, “and they were able to produce significant sound pressure level with the use of the PNEI Tuning Fork Test.”

Indeed, dire necessity can be the mother of inventions—PNEI turned up a battery-operated instrument, a “handheld gearing screener to check the hearing ability of a patient simply, quickly and easily so that its correct usage may be learned and done by nurses and teachers in the school.”

Thus far, the accuracy of the PNEI hearing screening device is 95.9 percent—and there was 73-percent coverage of the entire population under study, she reports.
“Screening is a component of preventive medicine—primary, secondary and tertiary. Primary preventive measures are used to prevent the onset of a specific disease; secondary measures are used to detect disease, and tertiary measures are used to manage an existing disease with the goal to restore a patient to highest function, minimize the negative consequence and prevent disease-related complications,” Dr. Gloria-Cruz relates.

The tasks at hand remain a work in progress but PNEI strives onward, for the sake of Filipino children, because “undetected hearing loss in children can lead to speech and language delay, social and emotional problems, and academic difficulties”—veritable whispers than can be lost in the storms of din these days.

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