According to the World Health Organization it is the most common chronic disability in the world. In South Africa estimates suggest that 3.3 million people suffer from permanent disabling hearing loss constituting one in four adults over 45 years of age and 1 in 3 of adults over 65 years of age.

Hearing loss is also a common childhood disability. According to current evidence provided by Prof De Wet Swanepoel from the University of Pretoria, close to 6 000 babies are born with permanent hearing loss every year in South Africa. This means 17 babies are born with hearing loss across the country every single day. Because it cannot be detected in young babies without using objective physiologic screening methods, offered by audiologists, hearing losses are mostly identified late after critical developmental periods for language development have been lost. Late identified hearing loss is associated with significant delays in language, speech and subsequent long-term effects on academic and vocational outcomes.

Unfortunately national surveys of newborn hearing screening in South Africa, undertaken by Prof Swanepoel’s team, has revealed that less than 10% of newborns will have the opportunity to get their hearing screened in the first year of life. In contrast other countries like the USA, Australia, and the UK screen virtually every newborn before they leave the hospital.

Parents of newborns must therefore be informed to request for hearing screening by an audiologist if it was not offered. Family members and even health care providers often give poorly informed advice to parents to wait and see how the child develops and responds to sound. As children grow older important risk factors that should prompt action to assess a child’s hearing include inconsistent responses to sound and delayed speech and language development. It is never too early to have a child’s hearing assessed.

Another important time to watch for hearing in children is during school-entry. All formal learning activities in typical school environments are mediated through the sense of hearing and any loss in hearing sensitivity therefore constitutes a major, and if unidentified an often insurmountable, barrier to effective learning. Even minimal and unilateral hearing losses have been associated with poorer educational test performance, higher incidence of failed grades and greater dysfunction in areas such as behaviour, energy, stress, social support, self-esteem and socio-emotional aspects. Despite the recently launched Integrated School Health Policy requiring hearing screening of all 1.2 million grade 1 learners in South Africa, the vast majority of these are not being screened at present. The Departments of Health and Basic Education are however working hard towards rolling out widespread screening starting at the most underserved school districts.

As children progress into adolescence recent evidence suggests that the risk of acquired hearing loss is becoming greater than in previous generations. Noise induced hearing loss is a major cause of hearing loss. Although it has previously been ascribed mostly to occupational causes such as working in factories or mines where loud noise is generated in adolescents and young adults it is ascribed mostly due to recreational noise. The typical sound intensity (loudness) of personal music players used by teenagers is at potentially hazardous levels that can result in permanent hearing damage. An increasing body of research evidence is demonstrating the risk of noise induced hearing loss in teenagers using personal music players at excessively loud volume levels. Furthermore, many of the recreational activities which young adults and adolescents are typically exposed to like movies, parties, nightclubs and even sporting events pose a risk of hearing damage.

During the soccer world cup in 2010, Prof Swanepoel did measurements of the Vuvuzela’s noise levels and found that one direct blow to someone’s ear is likely to cause permanent hearing damage. In his research, Prof Swanepoel also measured the hearing levels at a typical premier league soccer match in South Africa and the effect of the stadium noise on spectators’ hearing. Results confirmed noise levels above those allowed in occupational environments without personal noise protection (e.g. earmuffs) and showed significantly decreased hearing ability after a single soccer match.

Apart from noise exposure the most important reason for hearing loss is aging. With average life expectancy increasing, hearing loss is a rapidly growing and major global health care concern. As in the case of children early detection of hearing loss is essential to ensure best outcomes with interventions currently available for hearing loss. Because age and noise related hearing loss is usually gradual those who have it slowly become accustomed to the reduced ability to hear and therefore are often unaware that they have a hearing problem. Only once they are in difficult listening environments like a restaurant does this become clearer to them and those around them.

Despite the fact that there is no cure for permanent hearing loss current treatments are very effective. Audiologists are able to counsel patients on these available treatment options that may include assistive listening devices, hearing aids and cochlear implants along with a variety of rehabilitation and counseling strategies.

The best advice with hearing loss is that it’s never too soon to test, whether you’re 1 day or 100 years old, help is available and proven to be effective.

By Prof De Wet Swanepoel: Associate Professor in Audiology at the Department of Communication Pathology – University of Pretoria