Hearing development of cognitive and verbal communication. Barbra

Hearingloss is a hidden disability that hinders the ability of a person to listencompletely or partially resulting in severe consequences 1 HL depends ontype, degree and configuration of HL. Type is defined by which part of theauditory pathway is damaged, and it could be conductive, sensorineural andmixed. Degree refers to the severity of HL (Mild, moderate, severe andprofound) and configuration means shape of hearing frequencies on Audiogram 2Hearing impairment/ HL can be congenital or acquired. Congenitally it could bedue to maternal infections, hereditary factor, low birth weight, birthasphyxia, side effects of drugs and in acquired cases HL is present soon afterbirth due to any cause like foreign bodies, wax, otitis media, noise induced HLand more.3Theprevalence of hearing loss is alarmingly high, as mentioned by several studiesconducted. WHO reported that prevalence of DHL (disabling hearing loss) inSouth Asia in children is 2.

4% 4 In general population setting of Pakistan’srural areas prevalence of all hearing loss is 7.9% and the prevalence rate forsensorineural hearing loss is 3.9% 5Hearingsense forms the major component of communication and is very important in thedevelopment of cognitive and verbal communication. Barbra Dodd’s speech processingchain model suggests that contribution of language through listening is about75% and pre-linguistic infants combine visual and speech inputs6 Foracquisition of language, child’s first 5 years  from birth is considered very critical.7Amidinitial six months of baby’s life, hearing is viewed as significant fordevelopment of normal language. Hence, newborn children that diagnosed withpermanent congenital & early onset hearing loss by 6 months of age areaccounted to accomplish better language over those distinguished later than ahalf year of age. The detection of reciprocal bilateral hearing loss in babiesbefore age 3 months with complete intervention, not after 6 months of age, isconsidered as vital segment of primary healthcare delivery.

8Inmost developed countries, the public healthcare framework gives some sort ofscreening within first year of life. High risk newborns and infants admitted inneonatal ICUS are chosen for screening earlier or not long after hospitaldischarge. In last two decades, increase in technological advancement has ledto the two objective tests for screening of newborns, which are: Oto-acousticemissions (OAE) and Auditory Brainstem Response (ABR) otherwise called BERA. Thesetests has brought the rise of universal newborn hearing screening (UNHS) toenhance the yield from the currently focused newborn screening and to lessenthe age at confirmation of permanent congenital & early onset hearing loss (PCEHL). The screening procedure focuson testing all babies before or after hospital discharge and is presently beingused by number of developed countries. Evidence based practice with regards to UNHSprograms demonstrates that objective of early identification and interventionbefore 6 months of age is at time achievable for PCEHL. But newborn hearingscreening cannot identify mild to late onset progressive hearing loss in newborns.

9 Themain purposes of NHS are: 1.     Toidentify newborns that are more likely to have HL and require more evaluation 2.     Toidentify infants with medical conditions that can lead to the late-onsethearing loss and 3.     Toestablish an accurate plan for ongoing monitoring of their hearing status.10Newbornhearing screening protocol has been proved to be quite successful in developedcountries and has had massive societal, personal and economic benefit. However,in developing countries, it is still the major problem to find the properresources for standardized screening and intervention programs for thedetection and treatment of newborns.

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11Dueto number of reasons the implementation of NHS protocol in developing countries(like Pakistan) is very challenging. These include weak healthcare framework andinfrastructure, lack of experienced professionals, awareness of professionalsand caregivers regarding NHS and limited resources. Moreover, government policesfocuses on more fatal diseases like cancer, tuberculosis and HIV etc.

{12}Beforethe regular practice of NHS, infant’s age of screening was considered 2 yearsand now the average age at which hearing screening can be performed is frombirth to six months. Findings shows that when hearing is screened at birth,infants with more severe degrees of hearing loss and an unknown cause tend tobe identified and receive intervention as early as possible. 12Timelydiagnosis of HL is key to early intervention if not ,it can leads to manycomplications and it can have negative and long lasting effects on speech,language , social, emotional and cognitive development. Moreover, it can causelearning disorders, academic failures, writing and reading problems and delayin socio-cultural growth. Hereby early detection and intervention is verynecessary for the normal development of speech production.

13Factorsthat can affect the early diagnosis and intervention of hearing loss are: Unawarenessof the problem, its solution among general population and lack of knowledge onthe topic by medical professionals. Even in countries where newborn hearingscreening has been in regular practice for years, attitude, knowledge andpractice of physicians, general practitioners, pediatricians and otolaryngologistis primary concern because they are the one that guide and educate the patientsand their families about proper diagnosis and treatment procedures.14 Theirmajor role is to successfully implement the NHS and early hearing detection andintervention programs.

15 AStudy of Moeller and White (2006) from the National Center for HearingAssessment and Management investigated primary care physicians’ knowledge,attitude, and practices related to this topic in the USA, a country whereuniversal hearing screening is performed on 95% of newborns and 41 states havehearing screening legislation. Their study included 1968 primary care physicians(PCPs) from metropolitan, small town, and rural areas across 21 states and oneterritory (Puerto Rico). They found that even though only 14% of PCPs believedthat their training in medical school prepared them to meet the needs ofinfants with permanent hearing loss, most respondents were very confident(47.

9%) or somewhat confident (41.1%) in explaining the newborn hearingscreening process to parents who had questions about their infant’s results.The physicians in the study also reported a high level of support for universalhearing screening, as 81.6% judged it to be very important to screen allnewborns for hearing loss at birth.

16 Aquestionnaire basedobservational study was conducted by Department of Speech and Hearing, Schoolof Allied Health Sciences, Manipal University, India in 2016. The objectives ofthe study were to investigate and compare the knowledge and attitude amonggeneral physicians in primary health?carecenters and medical interns. Results showed that the generalphysicians and medical interns showed a positive attitude toward importance ofhearing in development of speech and language, importance of hearing as asense, need of hearing screening in newborns, consideration of suspicion ofhearing loss by parents, and need of speech therapy. 17 Across-sectional Study of the Knowledge of Pediatricians and Senior ResidentsRelating to the Importance of Hearing Impairment and Deafness Screening amongNewborns was conducted in Isfahan in 2012 among 300 pediatricians andfinal-year pediatric residents. Results indicated 83% of pediatricians agreedon the importance of hearing impairment screening for all infants. However 65%were not aware of special needs for hearing-impaired patients. 18Anotherstudy conducted by Dept.

of Speech and Hearing, School of Allied HealthSciences, Manipal University, Manipal, Karnataka, India, 2017 showed that majorityof the pediatricians (95%) were aware of the newborn hearing screening while98.3% were affirmative about the importance of screening of all infants. Veryfew pediatricians reported of a screening program in their set-up or in theirclose locality. Overall the pediatricians were confident about their knowledgeon this topic but expressed a need to know more about hearing screening. 19