We operate a Hearing Testing and Hearing Loss Programme at schools for needy children.
Young children with undiagnosed hearing loss are often misdiagnosed as suffering from learning disabilities, attention deficit hyperactivity disorder or even autism spectrum disorder. They often present with poor school performance, poor attention, speech and language difficulties or delays and, in many instances, leads to them being regarded as rude or disobedient. In some instances, they may be neglected because the impression they leave is that they are not interested in learning.
The Integrated School Health Policy states that every school-aged child should undergo a hearing screening at each grade level throughout their school career, whilst health professionals recommend that individuals should have a hearing test annually.
The impact of a child with hearing loss is varied and might include:
● Speech and pronunciation difficulties and delays;
● Language development delays;
● Poor verbal memory and attention;
● Difficulty with spelling;
● Difficulty following instructions;
● Learning and concentration difficulties;
● Behavioural difficulties, depression and irritability; and
● Poor social development, social isolation and social rejection.
The causes of hearing loss in children may include the following:
● Illness and disease, such as middle ear infections and meningitis;
● Genetic or congenital hearing loss;
● Trauma, through such things as contact sports, an accident or injury; and
● Noise exposure, such as earphones, or music and entertainment at high volume levels.
Working in collaboration with schools, we ensure:
● Parents are sent a permission slip indicating services, dates and information; (Parents who agree are required to sign and return the permission slip);
● That no child is tested without our having received a completed and signed permission slip;
● That a quiet room, equipped with electrical plug-points and several tables and chairs is secured in which to undertake tests;
● That we are provided class lists, preferably in Excel format, two days prior to testing dates;
● That each test is completed within 5 and 15 minutes; and
● The willingness of school staff to co-ordinate the ferrying of children between classrooms and the testing station, ensuring that each child has to hand their permission slips for presentation at the testing station.
Our comprehensive Hearing Testing and Hearing Loss Programme is professionally overseen by Dr Nadir Kana (FCORL(SA), MBChB), who is an Ear, Nose and Throat Surgeon, together with Carmen Esterhuizen (BA (SP & HT) Wits, PDM WBS), who is an Audiologist and Speech Therapist. Together, they provide the necessary training, consultation and oversight with regard to the teams conducting screenings. Before any school visit is undertaken, the audiologist visits local clinics, ensuring the existence of 'partners' willing to receive referrals.
Once screenings are cleared, the audiologist inspects the ears of learners ahead of testing. In instances where infection or damage is identified, the affected learners are referred. Notably, between 25% and 30% of participating learners are found to have impacted wax, which is removed on-site ahead of any further testing. In some cases, foreign objects are found to be lodged in the ears of learners, with pencil tips and insects being amongst the most common. These, too, are removed on-site.
Upon the completion of initial testing and if any issue is detected, the audiologist undertakes further diagnostics. Based on results, affected learners are issued referral letters to the local clinic, general practitioner or ears, nose and throat specialist. Such issues are discussed with both the parents and the school Principal. The audiologist is responsible for explaining to the affected parents and learner the importance of seeking assistance, together with outlining potential scenarios.
Follow-ups are undertaken a fortnight later. During such sessions, we check:
- Whether the affected learner has seen a doctor or visited a clinic;
- If not, an effort is made to understand why not;
- If yes, an effort is made to understand whether the learner received assistance and, if not, why not;
- Whether the affected learner was treated and, if so, whether any discernible improvement had been noted; and
- If no treatment was received, an effort is made to understand whether the identified issue has settled.
This appointment is followed by a further session another fortnight later.
An emerging trend indicates that if parents understand the issues faced by their children, they do follow-up. However, it is equally important that parents are directly notified of referrals, as in many instances learners do not present the referral letters they have been given to their parents.
Depending on the location and services offered by local clinics, it has come to light that on occasion children do not receive adequate care. In such instances, we intercede - making decisions based on circumstance - as to whether to escalate the situation with the Principal or local clinic. In such instances, we give consideration as to whether a personal decision has been made in terms of not receiving treatment and whether we attempt to fast-track treatment via private clinics and doctors.
The current referral rate is extremely low, at less than 5%. To be on the safe side, we project a 7% referral rate. The majority of referrals are expected to be efficiently dealt with through public institutions, although we do have agreements with a number of general practitioners and ear, nose and throat specialists for the provision of consultations pro bono.
To date, more than 5 000 learners have been tested, with likely issues documented.