IMAGINE a world where deaf children, through the help of technology, can join their hearing friends in the classroom and chat with ease.

According to experts such a world is no longer a figment of the imagination.

It is something we can have today – if only we could afford it and could implement internationally proven plans.

Early detection of hearing impairment and sophisticated new technology now enable audiologists and doctors to teach deaf children to hear and talk, even if the child has only one per cent hearing.

If hearing loss can be diagnosed before a baby is six months old parents can be taught to develop their baby’s brain and teach their child to speak before the brain loses its ability to learn a new language, says ear, nose and throat (ENT) specialist Dr Derrick Wagenfeld of Somerset West.

He is involved in eff orts to help deaf children hear again and also works with the Carel du Toit Centre for speech development in Cape Town.

Tygerberg Hospital audiologist Lida Müller says early detection is critical because there is only a small window period during which a baby can be helped.

Studies have shown that children who receive cochlear implants before the age of six months and who attend habilitation progammes can chatter away like their hearing friends within fi ve years.

The earlier the brain paths can be stimulated for hearing and language development the better a child can learn to hear and talk normally.

The tests to determine whether a baby has a hearing impediment are quick and simple – which is why all American parents are obliged to have a hearing screening test done on newborn babies.

If a hearing impediment is diagnosed early the child can receive a cochlear implant or other hearing aid from day one. Th ese devices are so sophisticated nowadays that they enable children to have virtually normal hearing.

But in South Africa the majority of children have their hearing tested too late. Now a group of ENT specialists and audiologists are striving to get the simple hearing test made compulsory for newborn babies here too, but they haven’t had much success at state hospitals thus far.

Most private hospitals do conduct a simple hearing screening test on two-day-old babies if the parents consent.

Medical schemes pay for this test. In some academic hospitals the test is done free on babies with a high risk of hearing problems.

Compulsory hearing tests are the first step towards making permanent disability due to deafness, and even the need for sign language, something of the past, says Laurette du Preez, head of the Carel du Toit Centre in Tygerberg.

These centres (situated across the country) off er a comprehensive habilitation programme, so called because it does not restore hearing but enables deaf or hearingimpaired children to have the best possible hearing. The team assisting the centres includes ENT specialists, audiologists, speech therapists, teachers, social workers and psychologists.

The role of parents in this process is of utmost importance.

The hearing screening test costs R72. According to Du Preez the cost plays a role but the biggest obstacle to implementing it is the lack of good primary healthcare, particularly in rural areas.

“The government will not readily agree to making the test compulsory because primary healthcare services are not yet established,” Du Preez says.

The second major obstacle in the hearing path of deaf children is the high cost of a cochlear implant. At R185 000 it’s extremely expensive but it could mean the child could eventually speak normally and attend a mainstream school.

Many South African children who had cochlear implants as babies or toddlers can hear today.

Some of them are in mainstream schools, talk with normal infl ections, phone their friends and can hear conversations in noisy clubs where they dance to the beat of music.

Were it not for the relatively inconspicuous fl eshcoloured hearing aids behind their ears it would be diffi cult to tell that any of them had a hearing problem. It is incredible to think some of them had less than one per cent hearing.

Nearly all the children to whom YOU Pulse spoke have greater hearing loss than thousands of other South Africans who communicate with sign language and lip-reading.

How is it possible that a deaf baby can learn to hear? Th e late Professor Carel du Toit, then head of the ENT department at the University of Stellenbosch and Tygerberg Hospital, proved with pioneering work that in virtually every deaf child some trace of hearing remains intact.

He also believed if you enhance this bit of remaining hearing – even if it is only one per cent – with a hearing aid, you can teach the deaf child to “learn” to hear and talk normally. He proved this in the era before cochlear implants and hearing aids. Now the process is made much easier with cochlear implants but it’s still imperative that it be done within the critical window period.

It’s a tragic fact that only one in every fi ve South Africans needing a hearing aid can aff ord it and that the other four, for this reason, will never be able to hear.

What is a cochlear implant?

A receiver, which is implanted in the cranium (skull) behind the ear, receives impulses from outside via an aerial also implanted under the skin.

A total of 24 electrodes connect the receiver to the acoustic nerve in the innerear. The external part consists of a microphone, a speech processor that analyses and encodes the sound waves and an apparatus that transmits the information via radio waves to the receiver. Most medical funds will pay for this procedure.

The most common causes of deafness in children

• In most cases permanent deafness is hereditary. A third of people who are deaf for genetic reasons were born deaf, a third become deaf during childhood and the other third become deaf as adults. Permanent hearing loss among children is the most common congenital disability – in developing countries this is up to fi ve in every 1 000 babies.

• Inflammation of the middle ear (tympanitis) is the most common cause of a type of deafness known as conductive deafness. Regular ear infections can cause permanent hearing loss among children.

• German measles during pregnancy can cause permanent deafness. If a pregnant woman contracts German measles during the fi rst eight weeks of pregnancy there is an 86 per cent chance her baby will be deaf.

• Other problems during pregnancy that can also result in deafness in the unborn baby include infection with the cytomegalo virus, Rhesus-irreconcilable blood between mother and baby, thyroid problems and diabetes in the mother.

• Permanent deafness can result if the baby suff ers from a lack of oxygen during birth or has to be connected to a respirator for more than five days.

• Another risk factor is if the baby weighs less than 1,5 kg at birth.

• Injuries during birth (especially head injuries) and jaundice in babies can also be a cause.

• So can viral and bacterial infections such as meningitis in babies and toddlers.

• Certain medicines such as some antibiotics and TB drugs can also cause deafness.

Most recent developments in hearing technology:

1. Powerful hearing aids. Hearing aids can reinforce sound to such an extent that you can communicate eff ectively even if you have only one per cent hearing. The latests aids use digital technology which has resulted in a dramatic improvement in sound quality. Prices range from R2 500 to R40 000.
2. Cochlear implants. The technology is so good that people who are technically deaf can hear again. Implantation costs about R185 000.
3. Cordless FM systems. These systems eliminate background noise and were designed to help students who have hearing aids or cochlear implants in a classroom situation.
A small microphone attached to the teacher’s collar picks up her voice and sends the sound waves through cordless technology directly to the child’s hearing aid or speech processor. Background noise is eliminated because the child receives the teacher’s voice directly into the ear. Prices range from R7 000 to R25 000.
4. Voice recognition. Some digital hearing aids have this function which can distinguish between speech and noise. Speech is recognised and there is less disturbance caused by background sounds.
5. Direction focus. Some hearing aids and speech processors can be set to pick up sound coming from the direction in which a person is looking.

The program in the speech processor of the cochlear implant is able to distinguish between foreground and background sounds.

Prevent infection of the middle ear
Infection of the middle ear is one of the most common preventable causes of deafness

Children are particularly prone to middle-ear infection because their eustachian tubes, which ventilate the middle ear and drain off fluids that build up in the middle ear during fl u or colds, are narrow and can become blocked easily.

Bacteria and viruses move effortlessly from the nose and throat to the middle ear. Fluids that accumulate in the middle ear are an ideal breeding ground for bacteria. Earache occurs as a result of the infection and severe pressure on the eardrum.

Prevent infection of the middle ear by not putting your baby or toddler to bed with a bottle. Milk that runs into the ear may cause infection.

Also do not allow children who have grommets (see illustration) to swim or bath without wearing good plastic or silicone earplugs. If water that contains bacteria gets into their inner ear they could end up with an ear infection and possibly deafness.

This story originally appeared in the first edition of Pulse magazine. Buy the latest copy, on newsstand now, for more fascinating stories in the world of health and wellness.

Click here and listen to hearing impaired Gerhard van der Merwe's story

For more information visit the Hearing condition centre.