Practical Screening Priorities for Hearing Impairment among Children in Developing Countries

By Gell, F. M.; White, E. McC. et al. | Bulletin of the World Health Organization, September-October 1992 | Go to article overview

Practical Screening Priorities for Hearing Impairment among Children in Developing Countries


Gell, F. M., White, E. McC., Newell, K., Mackenzie, I., Smith, A., Thompson, S., Hatcher, J., Bulletin of the World Health Organization


Routine screening for hearing impairment in childhood is now widespread in industrial countries, although there is considerable controversy over the most efficient techniques and procedures. In most developing countries, however, routine screening programmes for hearing impairment do not currently exist. The problems involved in implementing screening programmes in developing and industrial countries are very different, and in selecting screening procedures for a particular population the following factors have to be taken into consideration: the environmental test conditions; the availability of resources for equipment and the training of testers; the local attitudes towards disability, the level of hearing impairment that may cause handicaps; and the major types of pathology causing hearing impairment. We suggest that in developing countries children should be screened at school entry using a simple field audiometer and that the external ear be inspected for the presence of a discharge. There is an urgent need to develop reliable and simple screening procedures for infants and young children; where possible, all children should be screened for severe or significant hearing impairment before the age of 2 years. No screening should, however, be implemented until appropriate follow-up services are available.

Introduction

Childhood hearing impairment,(a) even when mild, may have a detrimental effect upon linguistic and educational development, which can result in social and psychological problems for affected children and their families. The effects are most severe when there is a profound sensorineural hearing defect present from birth or early life, but even less severe conductive impairments that develop later in chilhood can slow down the child's linguistic and educational development[1]. Poor educational performance has been observed in children with mild and transient conductive impairments, which are frequently associated with recurrent middle ear infection[2, 3]. Since prompt appropriate therapy and supportive services can prevent many of the damaging effects of early hearing impairment, timely detection is essential to alert both parents and health care professionals to the need for appropriate action.

Routine screening of infants and preschool and school-age children is now widespread in industrial countries, and a considerable range of methods has been developed to detect hearing impairment in children and to assess its extent. If a possible hearing impairment is detected in this way, otoscopy and a full audiometric examination normally follow, and referral may then be made to an appropriate specialist.

In developing countries the demands on health resources can be such that the detection of children with hearing impairments takes low priority4], even though the prevalence of ear pathology and hearing impairment is higher than in industrial countries. Also, audiological services may be limited or nonexistent, and equipment for the routine screening of hearing impairment is rarely available. Informal enquiries suggest that where audiometers are provided, they tend to be expensive nonportable diagnostic instruments, which are rarely recalibrated. Markides has pointed out that these are often second-hand instruments donated by industrial countries which are eager to dispose of out-of-date equipment in a "useful" way5]. Breakages are common, spare parts rarely provided, and since local maintenance and repair services are seldom available the costs in the long run can be very high. In addition, the equipment may be unsuitable for use in hot, humid, and dusty conditions, where air-conditioned testing areas may not be available.

In developing countries, audiometers are usually located in urban clinics or hospitals; rural clinics and school medical services are almost never equipped to screen for hearing impairment[4]; and staff are rarely trained to use the instruments. …

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