On 3 March, the WHO’s ‘International ear care day’ focuses on the theme ‘Ear care can avoid hearing loss’. On this day, as a partner organisation, CBM aims to raise awareness about hearing loss and outline the possibilities for prevention through appropriate ear care.
Ear care can avoid hearing loss
Globally, hearing loss is the most prevalent sensory disability and is increasing rapidly, especially among ageing people. For this reason, CBM wishes to actively support and promote this awareness raising initiative, by inviting all CBM workers, partners and friends, to find out about and share practical ways to avoid hearing loss through basic ear care. To effectively contribute to this effort, we first need to provide some background about the main causes of hearing loss and explain CBM’s understanding of “ear care”, in its widest sense.
The causes leading to deafness and hearing loss are many, including hereditary factors, congenital infections (especially maternal Rubella, Syphilis and Cytomegalovirus), birth problems (such as low birth weight, prematurity and Hypoxia), ageing (Presbyacusis), excessive noise exposure, effects of ototoxic medications and chemicals, and infectious diseases (Meningitis, Malaria, Measles, Mumps, Toxoplasmosis, Typhoid, Varicella (Chicken pox), etc). Impacted wax can affect any population age group and is probably the most common cause of mild to moderate hearing loss. Chronic Otitis Media (long-lasting infections of the middle ear) is a cause of primary concern in low and middle income countries and the most common cause of mild to moderate hearing loss in children in these countries. Otitis Media with effusion and head trauma are also common, especially in children and may lead to permanent hearing impairment. Nutritional deficiencies such as lack of iodine in the diet cause hearing loss in some poorer parts of the world.
CBM is committed to improving the quality of life of people living with, or at risk of, hearing loss and ear diseases, by acting at all levels of intervention: prevention, early identification, early intervention, rehabilitation (or habilitation for persons with congenital hearing disability) and inclusion. CBM works through its partners in the field, through international alliances and through careful planning, fundraising and direction at its headquarters, regional offices and member associations.
Despite the diversity amongst the actors involved and the sheer magnitude of the challenge faced, CBM recognises two different but effective routes to “avoid” hearing loss through “ear care”. The first route is directly linked to health care, either by developing comprehensive public health programmes or by the individual direct intervention of one person over his/her health. The second route takes into consideration a mid to long-term approach to help changing attitudes and perceptions amongst professionals, policy makers and the general population. For the purpose of this article, we will concentrate on the first route, which aligns with the focus for this year’s theme.
There are several key components of an EHC programme which directly address the main causes responsible for hearing loss, as described above.
Key interventions could be summarised as follows:
1. Genetic counselling
In genetic counselling the families of parents of a deaf child are studied to advise them if there is a risk of inherited deafness being passed on if they have children. It does not need to be a complex or expensive service, a thorough interview with a basic family tree identifying the history of deafness should be available at primary health care level.
2. Prevention of ear infections
Avoiding: overcrowding, smoking at home where there are children, poor hygiene, children having contact with people with runny noses, coughs and colds.
Promoting: Breast-feeding (which helps a baby resist infections), balanced and nutritious diet, seeking help early for ear infections. This is best addressed by Mother & Child Health programmes and by professional Ear & Hearing Care services.
3. Ear Hygiene
Ear hygiene is not the same as “ear cleaning”. The term ear hygiene means to take good care of one’s ears, sometimes by doing nothing, for example: not trying to clean the ear canal (it will clean itself out), not putting things in the ear canal (which may harm it) or if you feel something in the ear canal, by getting it checked at a clinic. It is essential that a good programme for EHC has a community education component.
There are many conditions that may lead to hearing loss, caused by micro-organisms, which can be avoided through immunisation (vaccination), for example: bacteria (Haemophilus, Pneumococcus, Meningococcus) or viruses (Measles, Mumps & Rubella), amongst others. Adherence to the national Extended Plan of Immunisation is advisable.
5. Avoidance or rational use of ototoxic drugs
Ototoxic drugs are medications that can damage hearing. These medications should only be prescribed by doctors, under strict control and monitoring, and only when it’s essential to restore the health of a patient in the absence of an alternative. Health ethics committees are key to influence policy on pharmaceutical legislation.
6. Protection of ears from noise, solvents and head trauma.
There are external factors which, by themselves, may already cause permanent hearing loss, however, when combined, their effects are much worse than the sum of them separately. This is the case of simultaneous exposure to noise and solvents. A clear and strong legislation in regards to Occupational Health policies is essential to ensure a safe work environment (ear protection, masks, helmets, etc.).
7. Early provision of EHC services.
If all the above components are in place, but there is no early provision of ear and hearing care services, both at primary health care level and at hospital specialised services level, avoiding hearing loss through basic ear care alone may not be sufficient. This is the reason why a complementary “indirect route” is also necessary.
This second route aims at developing national and international networks for EHC, to be able to achieve a long-lasting impact in reducing the prevalence of ear disease and hearing loss, both at a national and global level.
The details of this route fall beyond the scope of this article, however, to share a glimpse of this strategic aspect of CBM’s work in EHC, we list the three main activities which CBM considers a priority when embarking in the pursuit of a sustainable EHC programme in a low or middle income country.
a. Capacity building of professionals at all levels.
b. Primary prevention, early detection and early intervention.
c. Raising awareness about ear and hearing care in the community.
Whether you work for a programme in the community or within the health service, you collaborate with a national or international organisation, you are involved in planning or policy development, or you are simply interested in ear and hearing, there is plenty to be done to help improve the quality of life of persons living with ear disease and/or hearing loss in the world. Together we can do more!
Why March 3rd?
The choice of the date 3 March is due to the shape of the numbers in 3.3, being representative of the two ears.
In April 2007, the China Rehabilitation Research Center for Deaf Children (CRRCDC), China Disabled Persons’ Federation (CDPF) and WHO jointly hosted the First International Conference on Prevention and Rehabilitation of Hearing Impairment in Beijing. A key outcome of this conference was the “Beijing Declaration”, among its key recommendations was the establishment of “International Ear Care Day”. International Ear Care Day aimed to further promote global actions on hearing care and minimise the occurrence of hearing impairment.
Every year, “International Ear Care Day” addresses a specific theme and carries out an extensive range of activities with a wide multi-sector participation in order to raise awareness of hearing care and the prevention of hearing loss. This day has been observed and supported by partner organisations all over the world.