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IJCRR - 11(17), September, 2019

Pages: 06-11

Date of Publication: 09-Sep-2019


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Study of Incidence and Type of Deafness in Children Withdelayed and Non Development of Speech in Apediatric Tertiary Health Care Centre Among 5500 Childrenover 5 Years

Author: Poulomi Saha, Kapildev Mondaland, Pallab Kumar Majumder

Category: Healthcare

Abstract:Introduction: Childhood deafness is a multifaceted disability which affects a child's ability to hear and delays the speech development and language learning skill. Thus results in cognitive impairments in these children including lower IQ scores, slower information processing skills and poorer literacy skills.
Aim of the Study: To find the incidence and pattern of deafness in children with non and delayed development of speech and to look for the risk factors associated with this.
Study Type: Retrospective, observational and analytical.
Methods and Discussion: 5504 deaf children of 0 \? 12 years attended OPD of Department of ENT Dr. B.C. ROY from June, 2014 \? June, 2019 .We have examined,taken detailed history, done audiological tests and assessed after dividing the children in three age groups. Children were subdivided according to the severity of deafness and relation of each kind of deafness with non and delayed development of speech were assessed. Associated risk factors were also looked for at each stage of study.
Results: Highest number (3328) of deaf children were found in 0-3 years of age. 1502 deaf children were found in 3-7 years age group and 674 deaf children were found in 7-12 years age group. Speech and language development was significantly not developed in patients with profound and severe deaf children.
Conclusion: Highest number of deaf children were found in 0-3 years of age group. Among the major risk factors that were identified during the study in this group were prematurity, LBW, HIE, neonatal jaundice and consanguineous marriage . While in 3-7 years and 7-12 years age groups , otitis media was seen to cause hearing loss more than the other etiologies.

Keywords: Leading, Around, Congenital

Full Text:

Introduction

According to WHO (2016) around 360 million people (5% of the world’s population ) live with hearing loss, out of these nearly 32 million are children. In India, 63 million people (6.3%) suffer from significant hearing loss. Four in every 1000 children suffer from severe to profound hearing loss. Yearly more than 100,000 babies are actually born with hearing deficiency. Out of every 1000 children born in India, there may be 5–6 such children who cannot hear properly. Because of lack of visual indicator, most hearing impaired children who are not screened at birth are not identified until between 1½ and 3 years of age, which is  actually well beyond the critical period for healthy speech and language development. The prevalence of speech and language delay was found to be 27% under 3 years of age. Exact figures of delayed or non development  of speech  under 12 years  were not studied because it was difficult to determine . Overall 3% to 10% of children are affected by speech delay. Boys are 3 to 4 times affected  more than girls.  Hearing, Speech and language disorders needs early intervention. Hearing disability along with  delay in speech and language skills results in cognitive impairments including lower IQ score, slower information processing skills and poorer literacy skills like reading and spelling .Thus leading  to  psychosocial deficits in these children which is  persisting till  adulthood . However, with the help of newborn hearing screening, early detection of hearing loss and speech delay, a hearing-impaired child can be identified and treated early.

As per WHO(2016), while the most obvious impact of childhood hearing loss is on language acquisition, it also adversely affects  literacy of the child along with  the development of social skills and attitudes mainly self-esteem. Untreated hearing loss is often associated with academic underachievement which can lead to lower job performance and fewer employment opportunities later in life. For a child, difficulties in communication may result in feelings of anger, stress, loneliness and emotional or psychological consequences which may have a profound effect on the family as a whole. In low-resource settings in which a child would already be at higher risk of injury, hearing loss can place a child in unsafe situations due to decreased alertness.

Indian Census 2011(http://censusindia.gov.in) shown that, India has 19 % population with hearing disability. This census revealed number of disabled persons is highest in the age group 10-19 years (46.2 lakhs). In this group  20%  are having hearing disability followed by 18% having visual disability and rest 9% with multiple disabilities. The estimated prevalence of adult  deafness in India is 7.6% and while childhood onset deafness is  2% . Out of total 48.6 % disable population of west Bengal, 9.2%   have speech disability.

Speech and language development is a useful indicator of a child's development and cognitive ability. Identification of children at a risk for developmental delay or related problems may lead to intervention and assistance at a young age, when the chances for improvement are the best.

OBJECTIVE

Primary Objective:

To assess

(a) the incidence of  deafness and type of deafness of children from day 0 to 12 years of age and

(b)the prevalence of speech and language delay in children less than three years of age using the Language Evaluation Scale Trivandrum (LEST 0-3)

Secondary Objective:
 To study the risk factors for deafness and speech delay in children less than 12 years of age.

MATERIALS AND METHOD

Place of study: Department of  ENT, at Dr. B.C. ROY, PGIPS , Department of  ENT at a Tertiary Pediatric health care center in Kolkata (W.B.).

Study period: June, 2014 – June, 2019.

Study sample: Five thousand five hundred and four (5504) children (age group 0 – 12 years) attending the out-patient department . Children are subdivided in three age groups -

    ( a)Group A – 0 to 3 years(3,328 Patients),

      (b)Group B-  3years 1 month to 7 years (1502 Patients)and

      (c)Group C – 7years 1 month to 12 years(674 Patients).

INCLUSION CRITERIA

A)Neonates with routine neonatal hearing screening-

a)Low birth weight baby, b) babies with neonatal asphyxia, c) neonates with respiratory distress syndrome and d)   neonates with prolonged(more than 3 weeks) SNCU and NICU admission,

B) Children with  complaints deafness or of  decreased hearing or no response to sound stimuli and c)children with non and delayed development of speech are included in this study.

EXCLUSION CRITERIA

a)Children with congenital anomaly   b)children with syndromes and c)children with mental retardation and cerebral Palsy.

Study type: Retrospective, observational, analytical study.

Ethical clearance: Institutional ethics committee clearance was taken prior to the commencement of the study.

STUDY METHOD

After a thorough clinical history was obtained from each patient consisting of  10  questionnaire  of prenatal, perinatal and post natal period.  History  obtained from mother regarding gestational drug intake ,diabetes, hypertension or any other illness. Then all risk factors of  infant hearing loss and progressive or late onset hearing loss are screened. The following tests were advocated :

(A)Group A(0-3 years) :

  1)BERA  2)OAE(transient evoked)  3)language evaluation scale Trivandrum (LEST 0-3) and 4)home screening questionnaire (HSQ) by NIDCD(National Institute of  Deafness and Communication Disorder).

(B)Group B(3-7 years):

 (1)BERA,(2)behavioral conditioned play audiometry(CPA)and(3) home screening questionnaire (HSQ) by NIDCD(National institute of deafness and communication disorder).

Group C(7-12 years):

1)BERA, 2) PTA and Impedance and 3)Home Screening Questionnaire (HSQ) by NIDCD(National Institute of Deafness and Communication Disorder).

RESULT AND ANALYSES

AGE DISTRIBUTION:

It is seen that the highest number of patients screened are of 0-3 years of age. Total 3328 children were evaluated in 0-3 years of age, while in 3.1years-7 years of age total 1502 and in 7.1 years to 12 years of age 674 children were examined.

 

From our study, it was seen that in 0-3 years of age group, 1467   kids were having  profound SNHL,879 children had severe SNHL,667 had moderate SNHL   while only 315 children had mild SNHL.

It is the age when hearing screening of all infants and children is most important as screening at this critical developmental stage can prevent or reduce many of these adverse consequences.

      Speech was not developed in any child 0-3 years with profound deafness and severe deafness. Normal speech was noted to develop only in 9% children with moderate deafness and 27% children with mild deafness.

 

As the result shows, hearing loss was both congenital (present at birth) or acquired (present after birth). 50% of all congenital hearing loss is due to genetic factors . Out of  these hereditary cases, approximately 30% are classified as syndromic. About 400 named syndromes are associated with hearing loss, the associated auditory features being quite variable – sensory neural or conductive, unilateral or bilateral, and progressive and stable .1

 Causes that are not hereditary in nature include illnesses, prenatal infections and conditions occurring at the time of birth. Hearing loss can also occur after birth, perhaps as a result of a disease, a condition or an injury or  environmental factors, like  congenital hyper bilirubinemia, ototoxic medication exposure, neonatal hypoxia, viral infections, and meningitis.

In our experience, 55 % of patients suffered from hearing loss due to otitis media while by the age of 4 years 87% of children had experienced at least one episode of otitis media, while 45% of them had three or more such incidents .

11% kids had with hearing loss in one ear, lags behind in language skills, study finds Washington University school of medicine. By the time they reach school age, one in 20 children have hearing loss in one ear. That can raise significant hurdles for these children, say the results of a new study, because loss of hearing in one ear hurts their ability to comprehend and use language.     

One of the main impact of hearing loss in this developing age is the child’s  inability to converse with others. Children with hearing loss often suffered in spoken language development .Hearing loss and ear diseases such as  otitis media can have a significant  adverse effect on the education and learing  of children. However, if people suffering from hearing loss are provided a chance to communicate they can participate on an equal footing with others.

DISCUSSION

 Until recently, the problem of hearing loss was not a priority for the Indian Government. However, with the advent of National program for the prevention and control of deafness (NPPCD) there is a renewed interest in this mammoth public health problem. Half of all the cases of deafness and hearing impairment are avoidable through proper  prevention, early diagnoses and management. Hearing sense is crucial for the mental and overall development of a child. Identifying the hearing loss early will prevent the problem to magnify. This will also decrease the burden of hearing loss and thus many presumptively productive years lost will not happen. Screening of the newborns and infants is the cost-effective way to reduce the burden of hearing loss. “Catch them young” should be the central theme of any program for the control of deafness. The objective of this paediatric tertiary health care study is to find the status of the childhood deafness in present time  and may  suggest  ways  of prevention  of childhood deafness and speech delay in the national program. Screening is a very useful and important tool as by only simple screening  hearing loss in neonates and infants , can be  identified earlier than its usual time of diagnosis. Neonates and infants are not routinely screened for any specific disease in India because of the pressing need to control the infectious causes and deaths due to it. Though, India as a country has been successful in lowering mortality rates, the burden of disability has not come down, in fact, it has risen down the years. Many disabilities can be avoided if we have a proper screening programs as every individual has a right to lead a healthy life. Communication disorder like hearing impairment affects very early part   of   life. Only through systematic early detection program, infants with hearing loss can be assured of a chance to develop their full potential  to have their well deserving active, contributing, and integrated social life. For their sake and ours, we cannot afford to waste any more precious human resources. Regardless of the age of onset, all children with hearing loss require prompt identification and intervention by appropriate professionals.

WHO estimates that about 60% of hearing loss in children under 15 years of age is preventable. In developing countries like ours, children with impaired hearing or deafness rarely receive any schooling. Such children when reach adulthood, because of their hearing loss  and speech disorder ,they are  subjected to higher unemployment rate. Among those who are employed, a higher percentage of people with hearing loss are in the lower grades of employment compared with the general workforce. Whatever may be  reason of  speech delay in school going children, whether  it is SHNL or  Mental retardation ,or hyperactivity or attention deficit or poor language and language stimulation or brain damage, we should have enough resources to screen them to identify and treat them accordingly.

CONCLUSION

 The current study where 5504 deaf children were screened in tertiary pediatric health care setup,   only represented a tip of the iceberg of present pediatric deafness scenario. Highest number of   deaf children  (3328) were found in 0-3 years of age group. They suffered from profound and severe deafness. Among the major risk factors that were identified during the study in this group , the common were  prematurity, LBW, HIE, neonatal jaundice and consanguineous marriage . While in 3-7 years and 7-12 years age groups, otitis  media was seen to cause hearing loss more than the other etiologies. It was surprising to note from this study that  congenital deafness  was not detected  in  significant number of children in first 3 years or even worse  in first 7 years of life. Because of non availability of proper screening measures at grass root health care delivery system and lack of concern of family members of young children, diagnosis was often delayed leading into non and delayed speech  in these children. In all age groups, children with profound and severe deafness were devoid of normal speech and language development.  Children with moderate hearing loss showed a promising speech development but that again was not up to the mark in comparison to normal hearing children. Even the children mild hearing loss showed speech defect and underperformance.

ACKNOWLEDGEMENT: We acknowledge  medical superintendent cum vice principal of Dr B.C. Roy Hospital for providing all the amenities to conduct this study. We also thank editors of different journal and text book from where we have taken references.

SOURCES OF FUNDING:

We expend from our personal account.

CONFLICT OF INTEREST:There is no conflict of interest from our side for this study.

ABBREVIATIONS:

  1. WHO=World health organisation

  2. NIDCD=National institute of deafness and communication disorder

  3. SNHL=Sensorineural hearing loss (Snhl)

  4. PTA= Pure tone audiometry

  5. OAE=Oto acoustic emission

  6. BERA =  Brainstem evoked response audiometry

  7. HIE= Hypoxic ischemic encephalopathy

  8. LBW=Low birth weight

  9. MADI=Maternal entenatal drug intake.

10. HSQ=Home screening questionnaire

    11. NPPCD=National program for prevention and control of deafness

12.IQ=intelligent quotient.

13.NICU=Neonatal intensive care unit.

14.PICU=Pediatrcintensive care unit.

15.LBW=Low birth weight.

16.HIE=Hypoxic ischemic encephalopathy.

17.CMV=Cytomegalo virus.

 

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Deafness in India. Versaley Sourav http://www.indianjotol.org on Wednesday, July 3, 2019, IP: 110.225.13.163] 2016,  Indian Journal of Otology | Published by Wolters Kluwer – Medknow

Disabled Persons in India: A statistical profile 2016.National Statistical Commission. Government of India.

World Health Organization. Deafness and Hearing Impairment – Fact Sheet; April, 2010. Available from:  https://www.who.int/en/news-room/fact-sheets/detail/deafness-and-hearing-loss [Last accessed on 2016 Feb].  

Prevalence and Risk Factors of Speech and Language Delay in Children Less Than Three Years of Age. Nivedita Mondal, B.Vishnu Bhat, Nishad Plakkal, Mahalakshmy Thulasingam,  Payyadakkath Ajayan, and D. Rachel Poorna. Published online 2016 April 26. ComprPed. 2016 May; 7(2):e33173.

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Infant Hearing Screening in India: Current Status and Way Forward. Suneela Garg et al. Int J Prev Med.  2015; 6: 113. Published online 2015 Nov 19. doi: 10.4103/2008-7802.170027.PMCID: PMC4689099. PMID: 26730343

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Deafness: Burden, prevention and control in India

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 The Rehabilitation Council of India Act,1992, Ministry of Law, Justice and Company Affairs(1992) : (No 34 of 1992), New Delhi;1992. Available from http://www.rehabcouncil.nic.in/engweb/rciact.pdf, Last accessed on 2016 Feb.

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A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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