|Year : 2012 | Volume
| Issue : 3 | Page : 119-121
Role of ENT surgeons in the national program for prevention and control of deafness
Mahendra K Taneja, Vivek Taneja
Chief, Indian Institute of Ear Diseases, Resident, Department of E.N.T., Subharti Medical College and University, Meerut, Uttar Pradesh, India
|Date of Web Publication||12-Nov-2012|
Mahendra K Taneja
Chief, Indian Institute of Ear Diseases, Resident, Department of E.N.T., Subharti Medical College and University, Meerut, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Taneja MK, Taneja V. Role of ENT surgeons in the national program for prevention and control of deafness. Indian J Otol 2012;18:119-21
The National Deafness Program, which was launched by the Government of India, is based on the work done by the Association of Otolaryngologists of India (AOI). AOI is India's largest and only Association of Ear Nose Throat (ENT) surgeons with more than 4250 national and 8000 state members.
AOI's members are morally duty-bound to make every effort in preventing, curing, and eradicating deafness from India through their support for the National Deafness Program. The ENT surgeons of India have the knowledge, expertise, and resources required for achieving the goal, aims, and objectives of the Program. The AOI is the most potent and comprehensive group in the country that can achieve success in the pursuit of the Program's goals. Through our understanding of the objectives, and the short, as well as, the long-term benefits of this program, we will be able to do full justice to the goal of eradicating deafness in India, or at least conductive deafness.
Over the last 2 years, the AOI has organized and conducted over 450 free camps for the Prevention and Control of Deafness in India. These free camps have benefitted more than 25,000 people who have been able to join the work force. The objectives of these camps include screening for early detection, diagnosis, prevention, treatment, and rehabilitation.
To join hands with the Program of Prevention and Control of Deafness, we have to understand its objectives and benefits. 
| Objectives of the Program|| |
- To prevent the avoidable hearing loss on account of disease or injury.
- Early identification, diagnosis, and treatment of ear problems responsible for hearing loss and deafness.
- To rehabilitate persons of all age groups suffering with deafness.
- To strengthen the existing inter-sectoral linkages for continuity of the rehabilitation program for persons with deafness.
- To develop institutional capacity for ear care services by providing support for equipment and material and training personnel.
To prevent and control major causes of hearing impairment and deafness, so as to reduce the total disease burden by 25% of the existing burden.
Expected Benefits of the Program
With the involvement of ENT surgeons, this program is expected to generate the following short- and long-term objectives.
- Large-scale direct benefit of various services, such as prevention, early identification, treatment, referral, rehabilitation, etc., for hearing impairment and deafness at the primary health centers/community health centers/district hospitals.
- Decrease in the magnitude of hearing impaired persons.
- Decrease in the severity/extent of ear morbidity or hearing impairment in large number of cases.
- Improved service network for the persons with ear morbidity/hearing impairment in the states and districts covered under the project.
- Awareness creation among the health workers/grass-root level workers through the primary health center medical officers and district officers which will percolate to the lowest level as the lower level health workers function within the community.
- Larger community participation to prevent hearing loss through Panchayati Raj Institutions, Mahila Mandals, and village bodies and also creation of a collective responsibility framework in the broad spectrum of the society.
- Leadership building in the primary health center medical officers to help create better sensitization in the grass-root level workers which will ultimately ensure better implementation of the program.
- Capacity building at the district hospitals to ensure better care.
- State-of-the-art department of ENT at the medical colleges in the state/union territory under the project.
- Display of suitable logo and posters in local language at all the hospitals for education and awareness to the patients, their family and the hospital handling staff would do wonders in the success of this program.
Hearing loss is the most common sensory deficit in humans today. As per WHO estimates for India, approximately 63 million people are suffering from significant auditory impairment, which places the estimated prevalence at 6.3% of the Indian population. As per the national sample survey organzsation (NSSO) survey, currently there are 291 persons per one lakh population who are suffering from severe to profound hearing loss (NSSO, 2001). Of these, a large percentage is from children aged between 0 and 14 years. Such a large number of hearing impaired young Indians accounts for a severe loss in productivity, both physically and economically. An even larger percentage of the Indian population suffers from milder degrees of unilateral (one-sided) hearing loss.
Although deafness is a global phenomenon, available data indicate that on an average, 6.3% of the Indian population suffers from hearing loss,  which ranges from 4.0% in urban to 11.0% in rural and slum areas. The screening, prevention, counseling, and curing of deafness can be divided into two groups: Conductive and sensorineural deafness. Conductive hearing loss is a mechanical defect in conduction from pinna to the external auditory canal, tympanic membrane, middle ear up to annular ligament at stapedial footplate (otosclerosis). Sensorineural hearing loss is most commonly due to the involvement of sensory hair cells of the cochlea or sometimes of the auditory nerve or processing center in the brain. About 50% of the patients with sensorineural deafness are congenitally deaf, and 30% of these congenitally deaf patients have syndromic deafness. More than 400 different syndromes are enlisted, while 70% of congenital or hereditary deafness is non-syndromic. In sudden sensorineural deafness cases, if early prompt measures are taken up we may get recovery in some cases. 
The genetic deafness depends on the location of the faulty gene that is located on a chromosome, in the nucleus of the cell, or on the mitochondrial DNA, and also on whether one or both the copies of the gene are faulty (mutation). Genetic counseling can help the family by clarifying whether the origin of deafness is caused by genetic or environmental factors. In the USA, 1% of the babies is born through in vitro fertilization (IVF) and IVF centers worldwide can provide pre-implantation genetic diagnosis (PGD), which is the genetic testing of the embryos procured through IVF by cell biopsy and genetic analysis. 
PGD was first reported in 1990. The test may also include chromosomal analysis or DNA analysis to detect specific gene mutations. PGD was initially developed to have a baby free of genetic disease.  In this procedure, only one cell is removed. The procedure is almost safe, harmless, non-invasive, and an ethically acceptable procedure.
Though data are incomplete, the long-term health effect of IVF babies on the incidence of abnormalities is equivalent to that of the general population. , The numerous causes of deafness or hearing loss have been well researched, documented, universally accepted, and very well practiced with the preventable/curable techniques and their results. However, there are some indirect causes which may have a significant role to play in hearing loss. These are not either universally accepted or not so well documented/researched. Some of these include the deficiency of vitamin D, use of tobacco, bottle feeding of infants in lying down position, etc. 
The most common cause of deafness in Indian children is ear discharge as a result of recurrent otitis media from common cold or upper respiratory tract infection (URTI). The URTI causes (1) swelling and blockage of Eustachian tube opening leading to acute otitis media which in turn lead to negative pressure which may cause retraction pocket and cholesteatoma or (2) secretory otitis media in which there is glue formation, or (3) acute suppurative otitis media that could lead to perforation and chronic suppurative otitis media. Singly or combined, these symptoms can lead to permanent hearing loss. Fortunately, all these are curable.
The deficiency of vitamin D predisposes infants to infection and lowers the immunity. Vitamin D deficiency is also known to be associated with increased risk of certain cancers, autoimmune, and infectious diseases. Vitamin D regulates more than 200 genes including genes for cellular proliferation, differentiation, and apoptosis. Vitamin D regulates gene expression through binding with vitamin D receptor which modulates the expression of genes. In cases of recurrent URTI or otitis media, vitamin D estimation and supplementation should be performed as a part of preliminary management.
Deficiency of vitamin D has been attributed to cochlear demineralization and cochlear deafness. Deficiency of vitamin D may exert its effect by disturbed calcium metabolism as calcium ions play an important role in membrane permeability. Ionized calcium is necessary for normal function of the nerve and its deficiency may affect the action potential generation in cochlea. Low level of vitamin D and calcium may lead to demineralization of otic capsule, degenerative changes in the spiral ligament, stria vascularis, and cochlear hair cells. Brooks et al. have reported improvement in the degree of hearing after restoration of serum vitamin D level. ,
| Conclusion|| |
Some of us, as ENT surgeons, may try to avoid doing audiometry ourselves. Why this inhibition or reluctance since the ENT surgeon is ultimately going to analyze and interpret the audiogram and decide the line of treatment? Every ENT surgeon should come forward and do the audiometry or get it done under the supervision by a trained staff especially in sub-urban or far off areas in the interest of nation and service to hearing impairment.
From another perspective, let us imagine the satisfaction and confidence level of a patient if a surgeon, in addition to doing the surgery, does the dressing as well. Also imagine a patient's satisfaction if a doctor were to give an injection, instead of a nursing assistant.
Behavioral enforcement audiometry does not require any specific training or instrument, may be worth trying for preliminary searching in neonates. 
At the time of joining the medical profession, we take a pledge to serve the society our sole concern and priority to alleviate the suffering of human beings. Let us all, as ENT surgeons, remember this pledge by joining this great Army of fighters against Deafness and eradicate, or at least reduce, the sufferings of the people with auditory problems or deafness. There cannot be any bigger reward or remuneration than to see the glow or smile of thankfulness on the face of person and his family by knowing that there is a hope of fighting this deafness, a tragic life. By helping the persons with this disability, we will not only be doing a great service to the Nation but also earn satisfaction, self-respect, and an honorable status in society.
For a completely shattered hearing impaired or deaf patient and his family, reasonable recovery/treatment is worth ENT doctor's weight in gold. Service before self should be our motto. Remember that we are just taking a few steps forward and which will translate into miles of travel to reach the destination.
| References|| |
|1.||National Programme for Prevention and Control of Deafness (NPPCD). Available from: http://mohfw.nic.in/index1.php?lang=1&level=2&sublinkid=343&lid=343. |
|2.||Taneja MK. National deafness program and behavioral enforcement audiometry. Indian J Otol 2012;18:1-2. |
|3.||Taneja MK. Sudden Sensorineural deafness. Indian J Otol 2010;16:3-7. |
|4.||Taneja MK. Preimplantation genetic diagnosis and deafness. Indian J Otolaryngol Head Neck Surg 2012;64:103-5. |
|5.||Kakourou G, Dhanjal S, Daphnis D, Doshi A, Nuttall S, Gotts S, et al. Preimplantation genetic diagnosis for myotonic dystrophy type 1: Detection of crossover between the gene and the linked marker APOC2. Prenat Diagn 2007;27:111-6. |
|6.||Nayot D (2009). Severe ovarian hyperstimulation syndrome. In: The textbook of assisted reproductive techniques, supra note. 23 at.pp. 645-54: Orvieto R, Ben-Rafael Z, editors. Bleeding, severe pelvic infection, and ectopic pregnancy. In:The Textbook of assisted reproductive techniques pp 655-62. |
|7.||President's Council on Bioethics. Reproduction and Responsibility. The regulation of new biotechnologies. 2004. p. 945. Available from: http://www.bioethics.gov/reports/reproductionandresponsibility/chapte3.html. |
|8.||Weir N. Sensorineural deafness associated with recessive hypophosphataemic rickets. J Laryngol Otol 1977;91:717-22. |
|9.||Brookes EB, Morrison AW. Vitamin D deficiency and deafness. Br Med J (Clin Res Ed) 1981;283:273-4. |
|10.||Taneja MK, Taneja V. Role of Vitamin D in prevention of deafness. Indian J Otol 2012;18:55-7. |
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