Just like poor vision or any other condition that needs medication, hearing impairment equally needs serious attention to avert bigger complications. Dr Rajab Mugabo, a senior ear neck and throat (ENT) consultant and neck surgeon at King Faisal Hospital, Kigali, says people with hearing impairment tend to shun treatment due to stigma or fear of being noticed as people with hearing problems.

Dr Mugabo says there is need for everyone, regardless of their age, to be checked for hearing problems if there is cause for worry.

Available research findings indicate that there are estimated 360 million people with disabling hearing impairment globally, majority of these in developing countries. Disabling hearing impairment happens when hearing drops to a level that an individual cannot follow normal conversations or follow lessons in class.

Mugabo also notes that 50-60 per cent of hearing impairement is preventable especially in children and this is an area where emphasis and resources should be focused.

How does hearing impairment come about?

According to Protais Munyarugamba, an ENT surgeon at Kigali Citizens Polyclinic in Kigali, hearing impairment can affect a person at any age including the fetus in the mother’s womb. The causes of hearing impairment in the newborn can be due to genetic disorders or maternal infections. Maternal infections that can cause hearing impairment in the fetus include rubella and syphilis.

He notes that during delivery, delayed or obstructed labour brings about hearing impairment, explaining that this is due to the reduced supply of oxygen to the baby asphyxia (where the oxygen is reduced) leading to brain damage. Depending on which part of the brain is damaged, it can lead to hearing loss.

Munyarugamba notes that babies born with low birth weight and premature delivery could also lead to loss of hearing. He explains that when the infant is born prematurely, they are put in incubators, which puts them at risk of developing hearing impairment due to the noisy environment they are exposed to.

Childhood diseases such as severe jaundice (yellowing of eyes and skin in babies), measles, severe malaria and meningitis can affect the whole body, and can also end up damaging the nerve responsible for hearing, Munyarugamba adds.

On the same note, he points out that diseases of the ear can result to one losing their hearing capacity.

Munyarugamba says that frequent colds are common in children due to their weak immune system, explaining that it causes fluid accumulation in their ears and results in hearing loss if not well treated.

However, Dr Mugabo says that wax in the ears is another common cause of hearing impairment in both children and adults.

"For instance, the ear is supposed to clean itself, but to some people this does not happen, they therefore, become vulnerable to hearing loss because they always accumulate wax in their ears. People who use cotton buds or other things to clean their ears tend to push wax further in the ears and this can lead to wax blocking the ear canal and cause reduced hearing,” he says.

Dr Mugabo says that according to a study they did recently in primary school children in Rwanda, 19 per cent of the children had wax in their ears.

"This is a big problem as most of them end up developing hearing impairment if they don’t get treatment to remove the wax,” he says.

Dr Gratien Tuyishime, an ear, nose and throat surgeon at University Teaching Hospital, Kigal, explains that hearing impairment can also result from injuries such as trauma to the head and some medicines such as quinine and medicines used to treat high blood pressure, tuberculosis and HIV can trigger hearing problems.

"This is because such medicines may damage the nerve responsible for hearing and such patients need to be closely monitored during treatment so that they don’t develop hearing problems or any other complications,” he says.

Aging is also another cause, and according to Tuyishime, people above 60 years of age are likely to develop a hearing problem because of their aging sense organs.

"The biggest danger today is related to exposure to loud noise that we have in our society, especially among the young generation who keep their ears plugged listening to loud music. People working in industries and processing plants are exposed to loud noise that can damage their hearing.

"The projection is that we are likely to see a sharp increase in hearing impairment in the near future due to use of earphones in the young population,” says Mugabo.

He adds that noise above 80 decibels from any source is damaging to the ears.

What can be done to avoid such problems?

According to Daniel Gahungu, a general practitioner at Polyclinic Ectoile in Kigali, the most important thing to be done is embracing prevention measures.

"First of all, mothers and children should be vaccinated against rubella infection, which is notorious for causing hearing infections,” he says.

For the mothers, Gahungu advises that they should always consume a balanced diet throughout their pregnancy so that they prevent the cases of babies being born with low birth weight, which is among the causes of hearing loss in children.

"While pregnant, mothers should also avoid use of alcohol and tobacco as they interfere with the growth of the fetus in the womb. Promoting or improving maternal health is also another measure of ensuring good hearing in babies,” he says.

Vaccination against childhood diseases such as measles and meningitis is also essential in preventing hearing loss in children, Gahungu says.

Munyarugamba notes that early identification and treatment of ear infection is also vital as it prevents further complications. Creating awareness is also important, for instance, reducing occupational hazards by providing people working in the industries with protective gears, so that they don’t fall victims of hearing impairment with time. He adds that annual hearing checkups are also vital.

Awareness in the young generation is also important to avoid over use of earphones.

When does one need hearing aids?

"People who suspect to have hearing impairment should always seek treatment. A parent who suspects that their child could be having a hearing problem should consult an ENT specialist to be checked for hearing impairment and the likely cause,” says Mugabo.

According to him, there are those with problems that can be treated and recover their normal hearing, especially those who have infections or fluid in their ears as well as holes in their eardrums.

However, there is a category where the impairment cannot be treated and those affected need to get hearing aids. According to Munyarugamba, hearing aids raise the sound that comes and amplifies it so that one can hear normal conversation sounds at a certain level.

"People with very severe or profound hearing loss may not benefit from hearing aids and therefore need to learn sign language. This category can also benefit from cochlear implants but this device is still costly and not available in Rwanda and most developing countries,” he says.