About the Ear

Hearing is essential to communication, allowing us to receive information and to develop speech: a child that does not hear will not learn to speak.

The ear is a wonderfully sophisticated device for the transmission of sound to the brain, but unfortunately, like all complicated devices, is prone to malfunction and breakdown.

Infancy

Infants may suffer deafness from birth due to infections, genetic problems, nutritional deficiencies or birth trauma.  In some, hearing loss may get worse over time.

Chronic infection

The ear can also be subject to chronic infection that often leads to deafness:

• A perforation of the eardrum may lead to an offensive discharge that can persist for many months at a time.
• As the infection persists, the delicate mechanism of hearing is scarred and eroded causing damage reversible only by surgical intervention.
• In some cases, infection of the eardrum can cause further, life-threatening infection within the brain.

How is ear Disease Treated?

In developed countries, ear disease is common but resources allow sufferers to live healthy, productive lives. Take the United Kingdom as an example:

• Over 55% of people of retirement age suffer a degree of hearing loss,(1) and many of these people benefit from state of the art hearing aids.
• Around 0.2%(2) of children are born deaf and the majority are treated with cochlear implants. Thanks to this technology, they can go on to lead healthy, communicative lives.
• More than 4%(3) suffer with ‘glue ear’ that can be treated with a simple operation to insert a grommet.
• Perforated eardrums can be treated with an operation to rebuild the eardrum (a myringoplasty), and the devastating complications of ear infections can usually be managed with antibiotic therapy.

In contrast, ear disease is more common and its consequences more keenly felt in poorer countries such as Nepal:

• 16% of Nepalese people have hearing impairment in at least one ear.(4) There are not the resources to fund hearing aids for much of the population, let alone cochlear implants.
• Due to poor nutrition, overcrowding and exposure to smoke within the home from open wood fires, ear infections are common. This is particularly true for the poorer members of society: a recent study of relatively prosperous children found a level of chronic infection of 5%,(5) a figure rising to 13% in a rural school serving a poorer population.(6)

This burden of disease contrasts with that seen in the UK (less than 1%) and puts Nepal into the group of nations with the highest prevalence of chronic ear infection as defined by the World Health Organisation.(7)

Prevention and Treatment

Treatment of ear disease and deafness takes many forms.

Education

Education plays a vital role, informing parents of the links between chronic infection and smoking, and of poor sanitation.

Immunisation and nutrition

Immunisation programs are required to eliminate infectious causes of childhood deafness. Nutritional advice can help to build immunity.

Treatment

Simple hearing aids can be provided to relieve the elderly from isolation. Surgery can repair damaged eardrums and the delicate bones of hearing damaged by disease: to see examples of such operations see the videos in the education section of this website.

1. Gates GA, Mills JH; Presbycusis. Lancet. 2005 Sep 24-30;366(9491):1111-20.
2. Hearing impairment – cochlear implants, NICE Technology Appraisal Guidance (January 2009)
3. Surgical management of children with otitis media with effusion (OME), NICE Clinical guideline (February 2008)
4. Paul Little, Alison Bridges, Rajendra Guragain, Del Friedman, Rakesh Prasad and Neil Weir (1993). Hearing impairment and ear pathology in Nepal. The Journal of Laryngology & Otology, 107, pp 395-400
5. Prakash Adhikari, Dr. Binit Kharel, Jasmine Ma, et al. (2008) Pattern of Otological Diseases in School Going Children of Kathmandu Valley. Int Arch Otol 12(4)
6. Maharjan M, Bhandari S, Singh I, Mishra SC. Prevalence of otitis media in school going children in eastern Nepal. Kath Uni Med J. 2006, 16:479-82.
7. Acuin J (2004) Chronic suppurative otitis media: burden of illness and management options. Child and adolescent health and development prevention of blindness and deafness. World Health Organisation, Geneva