Dr. Hans Centre For ENT, Hearing Care & Vertigo

Hi,

I am Dr. J M Hans, ENT Specialist. I am specialized in ENT, hearing handicap, cochlear implants, vertigo, tinnitus. Today I am going to tell you about the causes and treatment of hearing loss and deafness in our country. There is about 10% of the population of India suffers from some amount of hearing loss whether it is mild, moderate, severe or profound. 1% of this suffers from hearing handicap. We say hearing handicap when the better ear has 60 decimal or more of hearing loss. 1% of this suffers from profound deafness that means no amount of hearing age or surgery would help them. And these kinds of people would be helped only with a cochlear implant. So, that makes a huge amount of population who suffers from profound deafness in our country and about 25000 are added to this every year in India. The causes could be divided into congenital causes and quite causes.

The foremost causes in congenital are genetics and most of them are because of consanguinity. It means when you marry between close relationships and that is why the gene pool comes into the child and the child not only suffers from hearing loss but also other congenital problems including heart disease, visual problem, thyroid etc. TORCH infection again in the mother is very important causes problem in children who are born with these infections. TORCH means toxoplasmosis, rubella cytomegalovirus, herpes simplex, and HIV. Now if the mother is suffering from these problems in pregnancy can also cause the problem in the child of hearing loss and other congenital disorder. If you have any viral disorders like measles and ototoxicity. If the child is suffering from jaundice during the early stages of his neonatal life, noise trauma is one another very important cause and discharge from ear.

If the mother doesn't feed the child in the proper manner, the infection and the milk get into the ear and cause ear infection, eardrum ruptures, and hearing loss can also happen. Now we have to investigate these children. And the most important investigations are the OAE, ASSR. Now, these need to be done in children to know what is the hearing loss, how much is the hearing loss. This not only helps us to give the prognostic value when we are treating the child with hearing aids or cochlear implants. It also helps in better improvement of the child with postoperative habilitation. Hearing loss can also be because of wax in the external auditory canal, perforation of the eardrum and we have to identify these causes and treat them either surgically or if the cochlear loss is there that means loss of the hear cells but they can be benefitted with the hearing aid, that needs to be done. If the child or adult can be benefited with the hearing aid boost science, he should be given the hearing aid and speech therapy should be given so that whatever he has lost in his developmental years, that should be taken care of.

If there is no improvement with any of these cases then only a cochlear implant is needed. Now as far as it is concerned, it is a device which has 2 parts. One is the inner device which has a surgeon, has to operate and put inside the skull of the child and then there is an outer device called as speech processor which has the microphone, battery and digitalize the sound, gives it through the inner device through radio frequency. That is how we bypass all the 3 parts of the ear, outer, middle and inner ear. Thus, helps children with hearing. Now, the most important part of the cochlear implant that it needs to be done as early as possible. Today, we have a universal hearing program in which we do an OE for every child who is born which is very important. And if needs to be treated surgically or with a hearing aid or with cochlear implant then it needs to be done as early as possible.

This is because it is not ear which hears, it is the brain which hears and understands. So, the better the early stimulation of the brain, early the results are. So, if the child is seen to have a hearing loss, he should be put into treatment with hearing aids, speech therapy and as early as 7-8 months we do a cochlear implant so by the time the child is still very small and young. The brain can be stimulated and desired results can be achieved. Cochlear implants are very good devices, full proof devices. And it is put by a good surgeon. This surgery is done well. The implant is always good. The result with cochlear implant can be 100%.

Thank You.

Hi,

I am Dr. J M Hans, ENT Specialist. Tinnitus has many causes. But what I want to discuss here is tinnitus is a part of the meniere's disease. We must understand that the inner ear has 2 parts. The cochlea which is responsible for hearing and the labyrinth and vestibular which is responsible for equilibria. Now meniere's disease typically has many symptoms like fluctuating hearing loss, tinnitus, and vertigo. But this is not always presented by the patient. There is a part of meniere's disease in the early stages. It may come as either imbalance or dizziness or may be the cochlear component of the disease with tinnitus. So, we have to pick up this disease at prodromal stage. Later on, it may start with unilateral that means it may start at one side but later on it may become bilateral. Usually, it becomes a bilateral disorder.

It is very important that we pick up this disease during the prodromal stage which generally remains for the first year. It is this period when we need to understand that it may not be idiopathic tinnitus which is known like drug induce, noise induce or head injury induce. We have to make out that first attack of meniere's can or is presenting like tinnitus. There are different ways of diagnosing this. One is audiometry. We might find some hearing loss, maybe in the lower frequency, higher frequency or in the middle frequency. But there is another very important stage during this stage which we called short increment sensitivity index which needs to be done. This may indicate an onset of meniere's disease at a later time. The causes of meniere's are many and particularly in the present era, high salt intake, high-stress levels, hereditary, high estrogen levels particularly during pregnancy or in menopausal age.

It can also occur in men. It is very important to find out the causes. Apart from this, the very important thing is an autoimmune disorder. We have tests to rule out autoimmune disorder and to see another organ in the body whether they are affected or not. The treatment for meniere's is to prevent these causative agents like the salt intake has to be reduced, the stress level has to be reduced. Medicines are given to increase blood circulation. Another medicine to reduce the fluid content of endolymphatic space which actually has gone high in these cases. Last but not least, things which block the debris. It not only gives the allergic component but also inflammation in the ear. If it is the chronic case, the tinnitus may not come out but vertigo and the hearing loss may improve definitely. The hearing loss may or may not improve. The tinnitus also improves 70-80% of the time if treated and diagnosed in the early stages in a period of time. If not, then tinnitus has the way we treated the other cases, we treat tinnitus that way.

Thank You.