Don’t take hearing loss for granted

Hearing loss is not a “benign condition”. As it stands, approximately 1.5 billion people in the world are living with some level of hearing loss, and about 450 million of those people need an urgent audiological intervention, or risk losing their hearing completely.

So, don’t take it for granted and when loss of hearing creeps in, do something about it, Professor Lebogang Ramma urged guests who attended his inaugural lecture on Thursday, 1 February. Ramma is a professor in audiology in the Department of Health and Rehabilitation Sciences at the University of Cape Town (UCT).

He delivered the first inaugural lecture of 2024 in the Neuroscience Institute Auditorium at Groote Schuur Hospital, while his family, friends, colleagues and students listened attentively as he summarised years of research into an hour-long talk. UCT’s inaugural lecture series is a central part of the academic project and provides a platform for professors who were appointed in the preceding five years to present their body of research. It also serves as an opportunity for UCT to showcase academics’ work and share their research with members of the wider university community and the general public in an accessible way.

A survey of the Cape

As he took the audience through his work, Ramma highlighted a research project he embarked on with colleague Dr Ben Sebothoma in Cape Town a few years ago. Eager to establish Capetonians’ level of hearing, the pair went door to door from Cape Town to Khayelitsha and recruited participants who were open to have their hearing tested.

“Ben and I decided that we would take our audiometers and literally go around Cape Town, going door to door in the Klipfontein Corridor.”

“Ben and I decided that we would take our audiometers and literally go around Cape Town, going door to door in the Klipfontein Corridor – testing [participants’ hearing] and not just screening, but diagnosing hearing loss,” he said.

Hundreds of participants joined the six-month-long research study. Ramma said roughly 12.35% tested positive for some degree of hearing loss, and 4.57% recorded disabling levels of hearing loss, which indicated they needed an audiological intervention. At the time, the risk factors among participants varied and included age, a family history of hearing loss, a self-reported history of hypertension, and a prior history of head and neck trauma.

“It was a very tedious [process] and, in some cases, a risky operation because while we were testing, sometimes we had to be pulled into the house, be stuck under the bed, because there was someone shooting in the street. But I’m happy to say that we managed to test over 2 000 people [during this programme],” he said.

Hearing loss as a comorbidity

In addition to acquired hearing loss as a result of an injury or old age, Ramma said it could also be a tell-tale sign of an underlying health impediment. These conditions, he said, include diabetes, cardiovascular disease, depression and in some cases even dementia.

Through several studies over the years researchers have conclusively determined that hearing loss and diabetes go hand in hand. And when one of his master’s students (currently a PhD candidate) studied the prevalence of hearing loss among patients with diabetes at a diabetes clinic in Limpopo, she reached the same conclusion. Her research found that more than half of patients surveyed at the clinic experienced some level of hearing loss. And a high proportion of participants presented with disabling hearing loss that required an urgent audiological intervention.

“The moral of the story here is if you are a general practitioner somewhere or a medical doctor who works with patients who happen to have diabetes, and in your management plan you don’t include screening for hearing loss, know that you are doing them [patients] a disservice,” Ramma said.

Not a favourite

Surprisingly, even though hearing aids provide vital assistance for people with hearing loss, Ramma said many consider them an unattractive prosthetic device and therefore choose not to use them. Some, he added jokingly, also strangely associate hearing aids with end-of-life care.

“Hearing aids are not a favourite … The story goes like this: first you [need to] get glasses and this is [part of] the process of aging, then you get a hearing aid and after [getting] a hearing aid, you die. So, people tend to avoid hearing aids,” he said, as his audience chuckled.

“Hearing aids have [come] a long way, just like phones, and there is no reason for not getting [one].”

To date Ramma has encountered countless patients who don’t “want that ugly thing in my ear”. And today, they don’t have to. Thanks to modern technology, even the look, feel and functionality of hearing aids have completely changed. Today, modern hearing aids are much smaller and sleeker and its processing power has skyrocketed. They’re artificial-intelligence-enabled and can accommodate about 80 million adjustments in an hour, which, he added, translates to about 1.3 million adjustments in a second.

“Hearing aids are bluetooth-enabled. When the phone rings, you don’t even have to touch anything, you just answer the phone, and it transfers directly to the hearing aid. You can even set reminders. So, hearing aids have [come] a long way, just like phones, and there is no reason for not getting [one],” he said.

Screening babies at birth

As he concluded his lecture and touched on his research plans for the future, Ramma, who’s currently pursuing a PhD in health economics, told his audience that about 1 million children are born in South Africa every year and roughly 100 000 of them are born in the Western Cape. Yet, an overwhelming number of those newborns don’t get their hearing screened and tested at birth to identify any hearing defects – one of the most common congenital disabilities at birth.

To change this and ensure newborns are screened and tested, Ramma said, a universal hearing monitoring and screening programme designed with newborn babies in mind is currently being set up at Mowbray Maternity Hospital – an exciting project that’s guaranteed to change the lives of thousands of babies, as well as their parents and caregivers.

“This is a project where I can see my role as an audiologist with health economics training [and] reaping the [benefits] of that training to make this a credible project that we are all going to be proud of. Hopefully this will be a project that is now going to enable South Africa to enact policy or legislation to make sure that all babies born in our hospitals are screened at birth,” he said.