Public Health Impact of Hearing Impairment

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Public Health Impact of Hearing Impairment
DisabilityExperiences from Thailand
Developing Countries

• Suchitra Prasansuk M..D.
• President Hearing International
• Director Bangkok Otological Center
• WHO-HI-IFOS-ISA Center

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Hearing is Importantfor

• Communication
• Participation
• Education
• Social Activity
• Earn Living
• Quality of Life

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What is Public Health?

• Public People
• Heath Physically Mentally Healthy
• To be Healthy
• not only Free from diseases
• but also Socially Participation
• Quality of Life

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Hearing Impairment / Hearing Disability

• Limitation in
• Leading a normal life
• Social Participation
• Education
• Earning the living

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GLOBAL ESTIMATES

• 10 of World Population suffers from
• Disabling Hearing Impairment
• AT LEAST 250 M.
• ( Better Hearing Ear gt40 dB. Av. At
  .5,1,2,4 Hz )
• (Data are vary in different
  countries)

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Impact on Hearing Loss

• Majority are children in Rural Area in
  Developing World
• School age Children
• Adult with Occupational Noise Induced Hearing
  Loss
• Elderly Population by Ageing

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2000 ESTIMATES OF WORLD BURDEN OF DISABLING
HEARING IMPAIRMENT in ADULTS
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Common Ear Hearing problems

• Congenital Hearing Impairment
• Genetic / Acquired
• Otitis Media
• Noise Induced Hearing Loss
• Ototoxic Drugs Hearing loss
• Aging Hearing Impairment
• All Preventable

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Healthy Ear Better HearingConcepts

• Cure existing Diseases / Disorders
• Prevent Complications
• Prevent Disability
• Habilitation / Rehabilitation
• Lower the Incidence
• Self- Help / Community Back up
• Awareness Individual / Public

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Points for Consideration

• Existing ..the Needs
• 1. Problems ?
• 2. Resources Facilities
• - Manpower
• - Equipments
• - Diagnostic
• - Rehabilitation
• 3. Back up Services
• 4. National Policies
• 5. Commitment individual !

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CAUSES OF HEARING LOSS AND OR EAR DISEASE
Country INA IND MMR
SRL Place Vellore Bandung Yangoon
Kandy Causes () Ear wax 15.9 13.2 9.0 2.9 Chr
onic supp. otitis media 5.2 3.6 6.0 2.0 Serous
otitis media 3.0 0.3 2.1 2.1 Dry perforation of
tympanic m. 0.5 2.6 1.8 0.5 Bilateral genetic
(cong. deafness) 0.2 0.1 0.5 0.2 Non-infectious
(mostly aging) 10.3 4.1 5.0 9.2 Other causes
unknown 26.6 3.2 24.0 7.6
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DiseasesCountry all age Bangkok Students
Rural Students (7499)
(10242)
(2153)OME 14.9 19.56 9.94 AOM 0.58
0.69 0.14 COM 4.1 1.38 1.23 Healed
OM 3.8 1.16 1.05 Ext.Ear 5.8
2.55 1.97 Wax 2 1.16
0.7SN.HL 8.3 3.5 3.6 Mixed 3.59
1.27 5.32
(
Prasansuk el al 1991 )
Ear Diseases and Hearing Loss in
Thailand (Hearing Loss gt30dB)
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Whole Country Bangkok Students Rural Students
13.6 3.94
6.08 Moderate 41-60 11.4 3.87
5.88 Severe 61-80 1.7 0.072
0.2 Deaf gt 80 0.5 0
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Hearing Disability in Thailand 1991 (Better
Hearing Ear av. At .5,1.2.Kz. gt 40dB)
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Born Deaf Babies (SEAR)

• 2 - 4 per 1000
• ( 38 M. New born / year in SEAR
• 38,000 Born-Deaf Babies/ year)

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PREVENTABLE HEARING IMPAIRMENT
..in Children
50 ACQ
50 GEN
PREVENTABLE

• GENETIC- Familial
• DISEASES - in mother
• Bilateral SNHL
• profound
• - progressive

ACQUIRED Peri-, post-natal - problem in
Delivery - Hyper-bilirulinemia -
Diseases in infants
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WHO SEA INFRA- STRUCTURE SURVEY of Existing
Personnel FOR THE PREVENTION OF DEAFNESS AND
HEARING IMPAIRMENT(2002)

• Mixed method Questionnaire,
• Checklist,
• Mapping,
• Panel Discussions
• Conducted in Bangladesh, India, Indonesia, Nepal,
  Sri Lanka, Thailand

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AVAILABLE - HUMAN RESOURCES (WHO SEAR 2002)

• Lacking and Unequally distribution
• Ratio of professionals to the population vary
  greatly among countries
• - ENT specialists 1 100,000 1,000,000
• Otologists 1 400,000 7,000,000
• Scarce of paramedical personnel
• (Audiologists, Audiometricians, Hearing Aid
  technicians
• Speech therapists and Special teachers)

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Thailand Infra structure (2002)

• Population 60 M. Ratio/Population
• M.D. 20,000 1 3000
• ENT 500
  1120,000
• Audiologist/ 50 1
  1,200,000
• Speech

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PROVIDERS OF PRIMARY EAR HEARING HEALTH CARE
SERVICES
PHC Doctor, Trained Nurses Volunteers NEPAL,
THAILAND
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RURAL OUT REACH PROGRAMS- GO NGOs (1996 2001)
Jakarta WHO CC for Ear Care and Communicative
Disorders
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SECONDARY LEVEL for EAR AND HEARING CARE

• Many countries have no ENT at this level
• Very limited services at this level in most
  countries, except in Thailand
• No clear understanding of the criteria for
  services and/or to refer.
• ? the Inter-country Consultation proposed at
  least one ENT specialist and an Audiometer
  available

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TERTIARY LEVEL - EAR AND HEARING CARE

• Most countries not able to provide early
  screening, diagnosis and management - (except
  Thailand ).
• Insufficient Hearing aids Provision and Services
• ( 4 to 6 of the population is in need - High
  Price no Back up Services ( 50-1500 US)
• No reliable service for maintenance and
  calibration of equipment hearing aids.
• Large variations of cost of ear surgery in most
  countries
• ( range 40 - 700 USD) (except Thailand )

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REHABILITATION OF THE DEAF

• All 6 countries have Laws, Bills or Acts that
  encourage education and rehabilitation of all
  disabilities including hearing impairment
  deafness.
• All 6 countries have National Sign Language for
  the Deaf. Thailand has a pilot model on NECTEC
  WEB for free use (Crown Princess Project)
• Subsidy for Hearing Aids only in Thailand
  (free) India (free or 50 depending on income)
• 70 90 of the deaf children were reported NOT
  to get formal education (except Thailand)

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School for the Deaf in Thailand (year
2003)Common Education Ministry of Education

• Number of Schools 20 ( 3 privates)
• Number of Student 6228
• 1 school 311 students
• Number of Teachers 880
• 1 teacher 7 Students

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Integrated Schools76 Provinces (13,000 schools)

• Number of Students
• Preschool 508
• Primary Level 3867
• Secondary Level 462
• Total 4837
• lt 50 of students possess hearing aids

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Hearing Aids Freefor Hearing disability Adult
better hearing ear gt 56 dB.Children better
hearing ear gt 40 dB.

• Hearing Test Certificate of Hearing Disability
  by ENT specialist.
• Registration at Social Welfare Dept.
• Free Hearing Aids from Provincial Centers
• lt 50 of hearing impaired possess hearing aids

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Hearing Aids

• Not known to people
• Expensive
• Never reach the needed rural people
• Do not know how to use
• No Maintenance no after fitting service
• No Battery no repairing
• Service Centers if available are far away
• 50 were put in drawers or on shelves

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Hearing Impairment Registration in Thailand(
National Statistic 1999)

• Only 29,868 are registered
• Estimated Deaf or severe hearing loss
• 177,200
• Access for Registration Difficult
• 30 Centers with Facilities
• Not enough personnel
• Work under volunteer bases

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TYPES OF HEARING AIDS SOLD IN SEA IN 2001
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RESULT OF THE WHO SEAR SURVEY

• The main obstacle to the prevention of deafness
  in the region is .lack of policy, facilities
  and human resources
• National programs for the Prevention of Hearing
  Impairment Deafness should be encouraged and
  Developed.

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Possibility?

• Hearing for All.
• Multi-disciplinary Approach
• .All for Hearing

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Primary Ear Hearing Care

• An Example from Thailand
• Bangkok Otological Center

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Community Out-reach Program

• To be encourage in all countries
• Same Standard Strategy Methods
• Minimum Standard Requirement be set up
• Practice Guideline for Community Primary Ear
  Hearing Care set up.
• Good System of Referral

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Multi-disciplinary Approach
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Linkages 4 Levels - Thailand

• Level I Community Primary Care
  Personnel
• Level II Local Hospitals - Medical
  Personnel, Nurses G.P.
• Level III Provincial Hospitals - G.P. ENT
• Level IV Specialized Hospitals - Otologists
• 
  (Audiologists)

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Rural Training
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Result of Early Identification -
Thailand1. Free Hearing Aids2. Mainstream
-Integrated Education3. Special
Education4. MMR Vaccination5. Noise legislation
Control
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Hearing Aids

• Not known to people
• Expensive
• Never reach the needed rural people
• Do not know how to use
• No Maintenance no after fitting service
• No Battery no repairing
• Service Centers if available are far away
• 50 were put in drawers or on shelves

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International CooperationIFOS-ISA since 1985, HI
1992

• Awareness of professional groups
• Support from professional groups
• Net work of professional groups
• Commitment of professional groups
• Need Leadership personality

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Hearing International Bangkok CenterProgram
for Developing Countries

• Transfer of Technical Know-how
• Help Training of personnel of all levels
• Initiate recommend Survey with Service
• Help Establishment of Resources i.e.
  Manpower-Equipments
• Development of Practice Guide Line
• Development of Minimum Standard Requirement
• Screening Diagnostic Rehabilitation.
• Low Cost Hearing Aids with appropriate services

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Training of Fellowship -International
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Hearing International Low cost HAs Projectfor
Urban poor or Rural People

• Available Hearing Aids with good standard
• Low cost by mass production
• Good Service Delivery maintenance by local
  people with good training
• Using standard ear mould

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Low cost Hearing Aidsfor Urban Poor and Rural
People

• Hearing International Centers - Working Group

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HAs Trial Study Multi-centers study7 HI Centers

• China - Beijing, Nanjing
• Indonesia -Jakarta, Bund dung
• India - New Delhi
• Philippines - Manila
• Thailand - Bangkok
• Vietnam - Danang

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Survey ServiceRecommended by Bangkok Center

• 1. Population Based - Survey with Service
• 2. Rapid Screening Whole Village screening
• 3. School survey
• 4. Neonatal Hearing Screening High risk only
• 5. Medical Service at Primary Health Care Level
• 6. Hearing Aids Services at community level
• 7. Schooling Deaf school Mainstream ?
• WHO Protocol (need time trained personnel)

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WHO Hearing ScreeningMethodological
StudyExpert Informal consultation

• Geneva February 2003

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Survey Methodology ?

• Expert Panel
• Seriously Discussion
• Method / Tools

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Happy - Cooperation

• Professional Organization IFOS-ISA-IAPA
• INGOs Hearing International others
• Manufacturers
• Consumers Organization - IFHOH-AG Bell
• Public Health Personnel
• Community / Individuals

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Role of Professional Organization IFOS-ISA

• Good Strong Professional Support is needed
• Recognition of Preventive Measures
• Ear and Hearing Health Care Approach
• Not only Medical Care Approach
• Create Awareness of Hearing Loss and its
  Consequences among specialists as well as General
  Physicians and Public
• Active Participation in Program and Activity

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Asia-Oceania ORL Congress

• Hearing International - Plenary Discussion

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10th ASEAN ORL Meeting - Brunei
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Success ? Sustainable ?

• Public Awareness
• Political commitment
• Social acceptance of the Program
• Primary Ear and Hearing Care Approach
• Manpower Development Training at all Levels
• Net-working of all levels of service Providers
• Net-working of all supporters NGOs- INGOs
• Encouragement should come from Professional
  Organizations.
• WHO should be more active and act as facilitators
  to the Government of countries around the world

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Worldwide Strategy

• Noise Awareness Day
• Better Hearing Day
• Healthy Ear - Hear Better

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Slogan

• Better Hearing for All..
• .....TODAY !!

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Final Remarks !

• HEARING FOR ALL.
• ..ALL FOR HEARING

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JoinHearing International

• .So All can Hear
• www.hearinginter.com

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THANK YOU