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Excessive exposure to noise: a life sentence? cbm joins the defence team

Ayawavi Moudon, 25, is one of four deaf workers at Credaniah Nouvelle Coupe, a high-fashion tailor shop in Lome, Togo. She dreams of eventually owning her own boutique.

Exposure to excessive noise - a life sentence? It doesn't need to be because it's avoidable. Join our defence team and see based on a hypothetical story how a preventable hearing loss affected Amanda's life.

Exposure to excessive noise is a major avoidable cause of permanent hearing loss worldwide1. What does this really mean for our lives and our daily routines? On the International Ear and Hearing Care Day 2015, cbm aims to contribute to raising awareness regarding this issue by sharing its many years of experience. In order to better understand, let’s look closer at a hypothetical journey through life and exposure to noise:

Birth
Let’s imagine that a baby girl called Amanda is born prematurely in a low or middle income country. Besides the risks of hearing damage associated to her premature birth and those related to the limitations of her country’s pre-natal and peri-natal health care services, she may also be exposed to the noise of the incubator from her first day of life until the day in which she is discharged from the baby care unit. At home Amanda may be exposed daily to the loud noise of the car mechanic workshop next to, or in, her house, until she is old enough to attend pre-school. She will be more vulnerable to hearing loss due to noise exposure if solvents are also used at the mechanic workshop or in her home. It is unlikely that her hearing loss would have been detected at this stage due to lack of universal screening services in low and middle income countries, therefore she would miss the opportunity to be enrolled in early intervention and education programmes, if available at all in her country.

Goma, a young Nepali woman is deaf and blind and is affected by bilateral cataract. Here she is seen visiting a CBM partner hospital for ear examinations.

Goma, a young Nepali woman is deaf and blind and is affected by bilateral cataract. Here she is seen visiting a cbm partner hospital for ear examinations.


Schooling

Once Amanda is old enough she would join mainstream schooling, because special

or inclusive education programmes may not be available, or her family cannot afford access to them. On her way to school, perhaps sitting on the back of her father’s loud noisy motorbike, she would be exposed to the road traffic noise at least twice a day from Monday to Friday. At school she will struggle to hear and learn due to the noise of the elevated voices of her fifty or more classmates, and be exposed to the extra noises produced in the crowded playground (from high pitched whistles to noisy firecrackers).

Youth
During her youth Amanda will experience the never ending sound of music, at progressively higher volumes, at home, at social gatherings, night life and also through personal devices which do not have noise distortion reduction or maximum volume

control; because those are the only devices her family can afford to buy. Neither she or her family or friends will notice her gradually deteriorating hearing loss because her story will be all too similar to many of her peers and therefore considered “normal” in a country where the highest personal priority is daily survival.

Employment
A group of deaf children with their teacher in a special learning center in Peru

A group of deaf children with their teacher in a special learning center in Peru.


The level of Amanda’s hearing loss may prevent her from completing the national education curriculum due to a lack of educational support programmes. When she leaves school, hopefully after completion, and if her hearing is still good enough, she may be able to find employment working at a factory producing commercial items in the midst of very loud machinery noise. In the unlikely case that she would be provided with adequate noise protection muffles for her ears, she may still decide to take them off to have a break from wearing

them. The humidity and heat of her country make them uncomfortable, and furthermore, they prevent her from any meaningful form of social interaction with her work colleagues. By doing that her hearing would deteriorate even further.

Family life
Assuming that Amanda’s self-esteem has not already been seriously damaged by stigma, misunderstanding, lack of livelihood opportunities, limited resources to access services and/or a lesser quality of life compared to her peers, she may gain access to a dignified continuous employment, a family and descendants. She may now even be driving her own loud noisy motorbike, and taking her child (or children) to school on it. She would probably also be providing her neighbors with free samples of her taste of music at maximum possible volume on the loudspeakers during her children’s birthday parties and at weekend family gatherings.

Mature age
If Amanda would be fortunate enough to reach mature age she would then add agerelated hearing loss to her already damaged hearing due to life-long noise exposure. If finances do not permit her to consult a doctor, see an audiologist and purchase an appropriate and custom-adapted hearing aid, she may decide to buy a cheap sound amplifier device for her ear at the local market, mistaking it for a hearing aid, adding insult to her already injured hearing.

Progressive damage
The concerning message of this fictional, yet very realistic, story is not only that Amanda’s hearing has been progressively damaged throughout her entire life span, but that most probably nobody in her whole life has told her about the possible causes and prevention measures available in her own country. Here is where cbm aspires to intervene.

Intervention by cbm
cbm is committed to improving the quality of life of persons living with, or at risk of, hearing loss and ear diseases, by acting at all levels of intervention: prevention, early identification, early intervention, rehabilitation (or habilitation for the persons with congenital hearing disability) and inclusion.

Whether you work for a programme in the community or within the health service, you collaborate with a national or international organisation, you are involved in planning or policy development, or you are simply interested in the ear and hearing; there is plenty to be done to help improve the quality of life of persons living with ear disease and/or hearing loss in the world. Together we can do more!

Original article by Dr Diego Santana-Hernández, cbm Senior Advisor for Ear & Hearing Care, 2015.


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