Hearing problems: how to help the most vulnerable.
I’m a great believer in living and enjoying a healthy lifestyle. It has two major benefits in that it reduces risks of diseases such as heart disease, cancer and diabetes, and if you do succumb to some dreaded problem, then at least you’re in the best shape to face it and get through it as quickly as possible.
But some people aren’t as lucky as others and as the expression goes – they do it tough! Thankfully, in our communities there are some amazing people who stand up and champion the underdog and refuse to believe that “nothing can be done to help”. Fred Hollows was one of those people, and thousands of people both within Australia and around the world owe the fact that they can see to Fred’s blunt approach to getting things done. The Fred Hollows Foundation continues with his mission to restore sight to the less fortunate, decades after its founder died, too young, from cancer.
There’s another visionary here in WA who has been doing something similar for our indigenous people in the North West for many, many years. Prof Harvey Coates has been restoring hearing to the deaf and preventing thousands of others from the despair of deafness and associated speech and educational difficulties, by screening the kids in remote communities.
Every parent knows that in the winter months our toddlers get colds and runny noses, and some of them will progress to getting what is termed otitis media, or middle ear infections due to blocked noses and blocked eustachian tubes. If the otitis media becomes a recurrent problem, then ear drums can perforate and discharge pus which if left untreated, can lead to permanent holes in the ear drums, chronic ear discharge and permanent damage to the hearing mechanisms that are located within the middle ear.
One of the mainstays of the management of otitis media is good nasal “toilet” – cleaning the nose so that it stays clear and allowing the eustachian tube to do it’s job properly. If an ear discharge should occur, then it is important to watch it carefully until the perforation has closed and there is no danger of germs getting into the ear from the outside. If a perforation doesn’t close of its own accord, then simple corrective surgery may be necessary to put a graft over the hole in order to seal it off.
Down here in the city, such follow up is routine, but in remote areas where the level of hygiene and medical care is at a different level, then kids don’t get the attention they merit, and it is then not surprising to learn that in 2008 10% of indigenous children aged between 4 – 14 had experienced, or had an ear problem. And the rate of otitis media in indigenous children is nearly three times that of that in non-indigenous children: 20% of them in the 0 – 17 year age bracket suffering from recurrent ear infections.
Enter Harvey! He has promoted remote ear nose and throat clinics for decades now with teams of volunteers travelling north each year to check out these remote communities and to find those who need most help. He has pioneered the use of modern hi tech equipment that allows a trained technician to place a fibre-optic instrument into the ear to visualise the ear drum, so that the expert in Perth can see it on a computer and assess the severity of the problem.
But prevention is much better than cure so Harvey championed the idea of clean swimming pools! Naturally the kids love jumping in and out of water and playing: what they don’t realise is that every time they jump into the water, they flush out their nasal passages and allow the important eustachian tube to be freed of debris and return to its normal function of ventilating the middle ear and allowing normal hearing. Naturally, the water the kids play in is strictly monitored and sanitised and the result is happy, healthy kids who will have a better chance of growing up with normal hearing.
The Middle Ear
As you can see from this diagram (from the Children’s Hospital at Westmead, Sydney) the Eustachian Tube – ET - is a passage between the back of the nose near the Adenoids, which leads to a space inside the eardrum. This allows the eardrum to vibrate freely when sound hits it: if you block the ET, then you will reduce the ability to hear. If the nose is full of infected material there is a real possibility that it can ascend the ET and enter the middle ear behind the ear drum, thus causing an abscess there. If the ET remains blocked and the abscess expands, then the only way out is to burst through the eardrum itself: in other words a perforation and consequent ear discharge. That’s why we talk of “nasal toilet” to clean the nose and allow the ET to operate normally.
To reduce the risks of recurrent ear problems in your child, talk to your GP about how best to keep the nose clear. In the vast majority of cases antibiotics are of little help for “one off” ear infections and the best management is to use simple pain relief and lots of cuddles! If you are concerned about your child’s hearing, then a referral to a specialist would be the next step to consider.