Fighting deafness everyday – life and struggles of an audiologist

In India, hearing disability is the second most common disability, locomotor disability being the most common. According to 2011 census data, more than 50 lakh Indian citizens have hearing disability, and over 27,000 children are born deaf every year.

Despite the disturbing statistics, hearing disability is grossly neglected in India. Since social, intellectual, scholastic, and communicatory development of infants and children is heavily dependent upon good hearing; the lack of attention can led to dire consequences, including slow mental growth and social isolation.

Thankfully, there are ways to aid and even cure a child suffering from hearing disability. On a case-by-case basis, a doctor may either decide to equip a child with a hearing aid, or suggest a cochlear implant, which bypasses the ears and directly stimulates the auditory nerve that sends the sound signals straight to the brain.

Starting at Rs 6 lakh per implant, although an expensive option, cochlear implants are highly recommended by audiologists and ENT specialists for children whose development and future are at stake.

However, exposing a child to sound for the first time is not an easy affair. It involves great team work from audiologists, physicians, ENT specialists, teachers, early interventionists, psychologists, and most critically – parents. We interviewed Rashmi Deshpande, Chief Audiologist and Speech & Language Pathologist, Medikeri’s Super Speciality ENT Center, Bengaluru, and asked her about the nitty-gritty of hearing disability and the role an audiologist plays in rehabilitating a child who has received cochlear implants.

YS: What are the different types of hearing loss?

Deshpande: Hearing loss is categorised by the part of the auditory system that is damaged. There are three basic types of hearing loss – conductive hearing loss, sensorineural hearing loss, and mixed hearing loss.

Conductive hearing loss occurs when sound is not conducted efficiently through the outer ear canal to the eardrum and the tiny bones (ossicles) of the middle ear. Conductive hearing loss usually involves a reduction in sound level. This type of hearing loss can often be corrected medically or surgically.

Sensorineural hearing loss (SNHL) occurs when there is damage to the inner ear (cochlea), or to the nerve pathways from the inner ear to the brain. Most of the time, SNHL cannot be medically or surgically corrected. This is the most common type of hearing loss.

The third type of hearing loss, i.e., mixed hearing loss, occurs when a conductive hearing loss is coupled with SNHL. In other words, there may be damage in the outer or middle ear and in the inner ear (cochlea) or auditory nerve.

YS: What are the most common causes of hearing loss?

Deshpande: Some possible causes of conductive hearing loss can be fluid in the middle ear from colds, ear infection, poor eustachian tube function, perforated eardrum, impacted earwax, infection in the ear canal, and absence or malformation of the outer ear, ear canal, or middle ear.

Some possible causes of sensorineural hearing loss are illnesses, drugs that are toxic to hearing, hearing loss that runs in the family (genetic or hereditary), ageing, head trauma, malformation of the inner ear, and exposure to loud noise.

YS: Why should someone with hearing loss be evaluated by an audiologist?

Deshpande: An audiologist can diagnose and identify the type and severity of hearing loss. Further, an audiologist can recommend the treatment options. Other procedures that are within an audiologist’s scope of practice include fitting of hearing aid and programming and monitoring of the device; intraop testing, switch on, mapping, and troubleshooting during the cochlear implant process, and rehabilitation of the patient in getting accustomed with sounds after the implant has been conducted.

YS: What is the role of an audiologist in diagnosis and rehabilitation of hearing loss?

Deshpande: An audiologist administers the tests which help assess the hearing ability of the patient. He/she also diagnoses the type and severity of hearing loss in the patient. After the diagnosis is done, the audiologist provides information regarding candidacy for amplification, and also recommends sensory devices and assistive technology needed to help the patient. These devices need to be fitted appropriately as per the individual’s hearing loss to ensure optimal benefit. The primary intervention for hearing impairment is hearing aids, unless there is clear contraindication, meaning the device can be harmful to the patient.

Decisions about cochlear implantation – a surgical cure for deafness – are best made early, especially for children. It becomes important that usage of appropriate hearing aid should be achieved without delay. The role of the audiologist here is to regularly monitor the implant and modify the hearing aid or adjust the cochlear implant mappings as required.

The audiologist also typically provides the patient’s family with information about psychosocial aspects of hearing loss and other auditory dysfunctions, and processes to enhance communication competence so they can make informed decisions.

The audiologist, along with the speech and language pathologist, develops and implements a rehabilitation management plan for the patient. The audiologist plays an important role in providing care for a child and closely works with the rest of the team.

We at SocialStory are running a month-long campaign on deafness, with the objective to push the government to bring in policy for compulsory screening for deafness at childbirth in India. Please sign this petition and help spread the word.