Hearing loss is a prevalent cause of poor language development and educational achievements in children. Neurotologist Dr Howard Francis of the Johns Hopkins University School of Medicine says one in every 500 children is born with a "significant" hearing loss. Francis said if this was not properly addressed, then children can be left in a precarious situation in society. He said, in addition, there were children who developed ear infections which were also quite prevalent. Ear infections have a significant impact on children's behaviour. Francis is an associate professor, deputy department director and residency programme director in the department of otolaryngology–head and neck surgery at the university. He has special expertise and interests in the diagnosis and treatment of disorders of the ear and skull base. Francis is also the medical director of the T&T Health Sciences Initiative (TTHSI). He spoke with the Sunday Guardian last week while on a brief visit to Trinidad.
Ear infections in children
"Children who have fluid behind their eardrums where they've lost a certain percentage of inflammation, we find that their behaviour in classrooms, their ability to focus and to attend seems to be impaired by this," he said. He said their language impact was not as severe as a deafness that was found in children with hearing loss. These issues have implications on the lives of individual children but they have additive and cumulative implications to the society at large as they are related to human capital and development, Francis said. Trinidadian otorhinolaryngologist (ear, nose and throat) Dr Solaiman Juman is working in collaboration with Francis to develop a new-born screening programme for hearing loss in T&T. Francis said it will allow doctors to determine hearing loss in the very early stages of babies' lives. Francis said parents were the primary source of knowledge for their children and the ones to pay attention to odd behavioural patterns. He said 90 per cent of children born deaf were born to deaf parents. This is what he said when asked about the impact of hearing loss/ear infections in children. "The impact is that you have a child who has no system no way of communication. "It is not something that we think about, it is not something that we fathom until we meet these children and what we encounter then are beautiful children who, when you lay out a problem for them they can solve it. "They are smart children but the concept of putting an idea together and presenting it to them is just not something they can do." He said they were not readers and that was an immediate roadblock to hindering their opportunities for education and employment. He said they cannot advance in a regular school environment which is the entry way to jobs and opportunities," Francis said. He said there are tiny hair cells inside the ear which are supposed to convert mechanical vibration to electrical signals. However, hearing loss occurs when either those microscopic cells fail to develop because the genetics aren't right, have been destroyed in delivery, pregnancy, viral infection or a particular drug that was administered.
What are the signs?
Parents need to recognise whether a child is having frequent ear infections or seems not to be hearing as well as he/she should be most of the time. He said children should be taken to a doctor if hearing loss or ear infections are suspected. He said if a baby's babbling is not progressing then there is a problem. "If a child is not following instructions by a year to 18 months then there is something wrong," Francis said. Francis said the lack of babbling should raise red flags that a child is not hearing. He said an acute infection would be associated with fever and pain but even after that has passed, there is fluid left in the ear which hadn't been drained. Children who have mild to moderate hearing loss usually use a hearing aid, while those who suffer with more severe to profound hearing loss can start with hearing aids but grow up with a language deficit.
A cochlear implant is a surgically implanted electronic device that provides a sense of sound to a person who is profoundly deaf or severely hard of hearing. Cochlear implants may help provide hearing in patients that are deaf due to damage to sensory hair cells in their cochlea. In those patients, they can often enable sufficient hearing to allow better understanding of speech. The quality of sound is different from natural hearing, with less sound information being received and processed by the brain. As of December 2010, approximately 219,000 people world-wide have received Cochlear implants. (Wikipedia) Francis said one of the more recent developments is the Cochlear implant. He said cost depended on where a patient was having it done. Three have been done in T&T–one on a child who was deaf by meningitis and one who was born deaf. Francis said there have been dramatic differences in children in the United States who have been implanted by age one. Francis said the TTHSI was focusing on three key areas to advance the delivery of healthcare, namely cardiovascular disease, diabetes and a system based on best practices and management skills. He said cardiovascular disease and diabetes accounted for close to 50 per cent of T&T's mortality rate.
Francis said, "That does not account for the many people who are disabled by those diseases. "The amount of cost in lives and productivity is also significant and we have been asked to help out colleagues here in advancing a system. "The building blocks are here but we are trying to build more blocks and we are trying to put them together in a way that allows Trinidad and Tobago to advance to a first rate kind of delivery system for those kinds of problems." He said it required a three-pronged approach–educational programme, develop infrastructure that promotes teamwork and research team to keep advancing healthcare. "Just because we know how to treat these problems in Baltimore doesn't mean that it is right for Trinidad and so we are trying to come up with a system that is really carefully thought through and strategic." He said it should first be transparent, based on data and fact, not hope and expectation.
What has TTHSI been doing?
Francis said so far there has been 115,000 hours of instruction across the spectrum of healthcare, which brought on "a new breed" of local speciality cardiologists after two years of concentrated training. He said the TTHSI was "charged" with the responsibility of advancing cardiological and diabetic healthcare in T&T. He said there was a lot of consultations and partnership-building that had to be done to understand the system as it related to cardiology and diabetes. He said three were practising after the training and others were in the pipeline. The doctors who were in the local health system were trained by professionals from Johns Hopkins. "We have had our people coming out here, constantly training them and they have the same level of training that we give our folks back home. "We feel very strongly that they would provide quality healthcare." Technicians, nurses, primary care physicians in different fields are also being trained. He said diabetic care was based on educating patients and providers for successful care because there were major problems associated with it such as blindness, renal failure and amputation.
About the TTHSI
It is an umbrella programme implemented by the previous administration in 2006 and represents a collaboration among the Ministry of Health, the Ministry of Science, Technology and Tertiary Education, the University of Trinidad and Tobago and Johns Hopkins Medicine International, aimed at advancing medicine and health sciences in T&T and the wider Caribbean.