Hearing Loss

Hearing loss is an often-overlooked disability that requires formal assessment for detection. Its prevalence increases with age, affecting one-third of individuals over the age of 65. It has a significant impact not only on the quality of life, but also a modifiable risk factor in the progression of cognitive decline in seniors.

In Singapore, four out of every thousand newborns have significant hearing impairment¹. Typically, these children have parents with normal hearing. Timely intervention allows children with hearing loss to integrate into mainstream education, and perform on par with hearing peers in speech, language, intellectual, social and emotional development.

Hearing loss can be conductive in nature (involving problems with sounds getting into the inner ear), sensorineural (involving the inner ear and hearing nerve) or mixed. Causes include:

• External ear problems (e.g., earwax and infections)
• Middle ear conditions (e.g., effusions, ossicular problems and tumours)
• Inner ear conditions (e.g., age related hearing loss, noise induced hearing loss, treatment related hearing loss, or tumours in the brain and hearing nerve)
  

Hearing loss should be screened in all newborns as part of the Universal Newborn Hearing Screening (UNHS) programme.

In adults and older children, hearing evaluation is recommended when there is a speech impediment or if there is a suspicion of hearing loss.

Hearing loss can be diagnosed with the audiological tests below. These help your doctor to determine the type of hearing loss and diagnose the cause of the hearing complaint.

• Acoustic Reflex Threshold
• Acoustic Reflex Decay
• Auditory Brainstem Response (ABR)
• Central Auditory Processing Disorder (CAPD)
• Cochlear Implant Evaluation
• Eustachian Tube Function Test
• Hearing Aid Fitting
• Hearing Screening
• Otoacoustic Emissions (OAE's)
• Play Audiometry
• Pure Tone Audiometry
• Speech Audiometry
• Speech Test
• Steady State Evoked Potential (SSEP)
• Tone Decay
• Tympanometry
• Visual Reinforcement Audiometry (VRA)

Hearing loss is the most common congenital disorder. The Department of Neonatology, NUH, initiated the screening programme in 1999. Initially, the tests targeted only high-risk infants, but this approach identified only about 50% of affected children. The failure to identify all cases led to late diagnosis and delayed interventions. As a result, the Universal Newborn Hearing Screening (UNHS) programme has become an important component of standard medical care. This programme is run in collaboration with the ENT department. With a national UNHS programme in place since April 2002, more hearing-impaired children in Singapore are now expected to successfully integrate into mainstream education.

The aim of the UNHS programme is to diagnose and intervene early, allowing children to develop normal speech and language, thereby reducing communication disabilities. This early intervention also aims to foster positive academic outcomes and normal social development, enhancing the opportunities for hearing-impaired children to integrate into the hearing world from infancy and receive formal education alongside their hearing peers.

For most children with significant hearing loss, the preferred method of intervention may be amplification, accompanied by appropriate counselling and rehabilitative therapy.

Treatment of hearing loss depends on the underlying cause. Your ENT doctor will do a detailed evaluation of your hearing complaint and advise the most appropriate option based on the diagnosis and your needs.

The treatment offered may range from medications, simple clinic procedures, to surgery to remove tumours and treat infections, and implants to help with hearing. Treatments include but are not limited to:

• Aural clearance and ear wax removal
• Bone conduction device implantation
• Cochlear Implantation
• Eustachian tube dilation
• Intratympanic steroid injections
• Mastoidectomy (endoscopic / microscopic)
• Middle Ear Implant Surgery
• Myringotomy and tube insertion
• Myringoplasty / Tympanoplasty (ear drum repair)
• Ossicular reconstruction / Ossiculoplasty surgery
• Removal of ear foreign bodies
• Stapedotomy / Stapedectomy

In patients with hearing loss not reversible by, or not amenable to surgery, hearing rehabilitation in the form of hearing devices may be offered.

Digital, programmable and multi-channel behind-the-ear (BTE) hearing aids cater to a range of hearing losses from mild to profound. Various custom models, such as Completely-In-The-Canal (CIC), In-The-Canal (ITC) and In-The-Ear (ITE), utilise the natural ear shape to enhance hearing. These devices are designed to be unobtrusive and aesthetically pleasing.

Our audiologists provide a wide range of hearing aids and services. We offer tailored fitting for every individual of all ages and degrees of hearing loss.

Services

• Custom-Made Ear Mould
• Custom-Made Swimming Mould
• Family Guidance Counselling
• FM System
• Hearing Aid Evaluation and Fitting
• Test/Repair Hearing Aid
• Tinnitus Masker

In patients with conductive hearing loss, bone conduction hearing devices (BCHDs) provide an option for hearing rehabilitation. These devices bypass the external and middle ear to stimulate the inner ear directly via the skull bone. The hearing device is worn off the ear, keeping the ear canal open, making it suitable for patients with chronic ear discharge or wetness. These devices may be surgically implanted, improving the ease of use for patients.

Cochlear implants are advanced electronic devices that restore hearing for individuals who experience severe to profound hearing loss. Unlike traditional hearing aids, they work by directly stimulating the auditory nerve. The system comprises an external processor and an internal surgically implanted component. Though the perceived sound differs from natural hearing, the brain learns to interpret these signals effectively. The implantation procedure is generally safe, and many recipients report significant improvements in their daily lives post-surgery.

For more information, refer here.

Aural rehabilitation focuses on maximising the auditory function of individuals with hearing impairments to facilitate listening and spoken language acquisition. This is highly recommended for all, especially for children diagnosed with hearing loss, as the development of listening and speaking skills is not automatic following the fitting of hearing aids or cochlear implantation.

Therapy sessions are conducted weekly, or as recommended by our therapists. The caregiver attends each session with the child and learns various techniques to encourage the child to listen, react, respond and subsequently comprehend. The goal of each session is to equip caregivers with the skills necessary for daily interaction with the child. Sessions are tailored to the child's needs and typically involve play activities, including singing and reading. These activities aim to develop listening, language comprehension, language expression, speech, cognition and social, in accordance with the child's needs. These strategies are then shared with parents for continued application during play at home. The ultimate goal is to integrate each child, as fully as possible, into our listening society.

We work closely with caregivers and family members to ensure that the child's home environment supports an auditory-verbal lifestyle. Our aim is to provide families with the necessary education, guidance, advocacy and support. Regular home and school visits are conducted to monitor the child's integration into the listening world. We also maintain close contact with teachers, principals and other school staff. This therapy is also suitable for adults who have experienced hearing loss since childhood wish to improve their listening and speaking skills after being fitted with current amplification devices (hearing aids or cochlear implants) as recommended by doctors and audiologists.