Paediatric cochlear implantation in north-western Nigeria case report and review of our challenges

Overcoming developing-world challenges in cochlear implantation: A Nigerian perspective

The emergence of cochlear implantation (CI) in the mid-20th century was a transformation to the field of restorative otology. The advance in this field has not been felt in lower-income countries where a huge burden of profound hearing loss lies. The authors sought to review the literature on the practice of cochlea implantation in Nigeria. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews, we conducted a scoping review of the literature on CI in Nigeria. All observational studies with information on cochlear implants and/or implantation in Nigeria were included with no limitations on outcomes. The authors extracted the following data; age, sample size, sex, aetiology, outcome, type of devices, complications, challenges and the location of the surgery. The results were pooled and reported as frequencies and percentages. Three studies were utilised in this review. The study included 25 patients. The age of the identified patients ranged from 1.2 months to 63 years. There were slightly more males than females (52% males). The most common aetiology of deafness in the participants was following a febrile illness (40%), followed by deafness post-meningitis (24%). The challenges identified included high cost, lack of full rehabilitative facilities and staff, scepticism, and lack of funding. CI remains the most effective for those that are profoundly deaf. Although successful CI programmes exist in Nigeria, the number of implant programmes and the affordability are not yet commensurate to the needs of the entire Nigerian population.

A narrative review of the logistic and economic feasibility of cochlear implants in lower-income countries

Objectives: Globally, less than 1% of people who could benefit from a cochlear implant have one and the problem is particularly acute in lower-income countries. Here we give a narrative review of the economic and logistic feasibility of cochlear implant programmes in lower-income countries and discuss future developments that would enable better healthcare. We review the incidence and aetiology of hearing loss in low- and middle-income countries, screening for hearing loss, implantation criteria, issues concerning imaging and surgery, and the professional expertise required. We also review the cost of cochlear implantation and ongoing costs. Findings: The cost effectiveness of cochlear implants in lower-income countries is more limited by the cost of the device than the cost of surgery, but there are also large ongoing costs that will deter many potential users. Conclusions: We conclude that the main barriers to the future uptake of cochlear implants are likely to be logistical rather than technical and cochlear implant provision should be considered as part of a wider programme to improve the health of those with hearing loss.

Role and Scope Coverage of Speech-Related Professionals Linked to Neuro-Advancements within the Academic Literature and Canadian Newspapers

Speech-related professionals such as speech language pathologists (SLPs) and audiologists make use of neuro-advancements including neurotechnologies such as cochlear implants (CIs), brain-computer interfaces, and deep brain stimulation. Speech-related professionals could occupy many roles in relation to their interaction with neuro-advancements reflecting the roles expected of them by their professional organizations. These roles include: service provider, promoter of neuro-products such as CIs, educator of others, neuro-related knowledge producer and researcher, advocates for their fields and their clients in relation to neuro-advancements, and influencers of neuro-policy, neuroethics and neuro-governance discussions. Lifelong learning, also known as professional development, is used as a mechanism to keep professionals up to date on knowledge needed to perform their work and could be used to support the fulfillment of all the roles in relation to neuro-advancements. Using 300 English language Canadian newspapers and academic articles from SCOPUS and the 70 databases of EBSCO-Host as sources, we found that the neuro-advancement content linked to speech-related professionals centered around CIs and brain computer interfaces, with other neuro-technologies being mentioned much less. Speech-related professionals were mostly mentioned in roles linked to clinical service provision, but rarely to not at all in other roles such as advocate, researcher or influencer of neuroethics and neuro-governance discussions. Furthermore, lifelong learning was not engaged with as a topic. The findings suggest that the mentioning of and engagement with roles of speech-related professionals linked to neuro-advancements falls short given the expectations of roles of speech-related professionals for example. We submit that these findings have implications for the education of speech-related professionals, how others perceive the role and identity of speech-related professionals, and how speech-related professionals perceive their own role.

Cochlear implantation in Malawi: report of the first four cases

Objective:

This paper reports on the first four cochlear implant cases in Malawi.

Case reports:

Three patients were deafened from infectious diseases and one from an unknown cause. They all had post-lingual deafness. Six months after the last implant, they are all progressing well.

Conclusion:

Despite significant practical difficulties, it has proved possible, with the right support, to carry out cochlear implantation in one of the world's poorest countries. The project has also raised awareness of deafness in Malawi and highlighted significant public health issues relating to the aetiology of deafness in developing countries.

Management challenges of congenital & early onset childhood hearing loss in a sub-Saharan African country

BACKGROUND

Hearing impairment is a hidden human disability with potentially catastrophic and age long consequences. This study highlighted the challenges associated with the management of congenital and early onset childhood hearing loss in a sub-Saharan African country.

METHODS

A retrospective descriptive study of children seen between January 2008 and December 2013 RESULT: A total of 223 children consisting of 124 (55.6%) males with (M:F) of 1.3:1. Age ranged 1-15 years (mean±SD; 6.39±4.37 years) and age group 1-5 years constituted the largest proportion (56.5%). Congenital causes, febrile illness and hypoxia were the leading causes of HI. Over 93% had moderately severe to profound hearing loss and 64.6% had delayed speech development. Majority (99.3%) with congenital/perinatal onset of HL had significantly delayed speech development and 99.3% of HL due to ototoxicity and infective causes had peri/post lingual speech impairment. Larger percentage of patients presented late; 16.6% of patients with congenital/perinatal onset of HL presented within the first year, >41% presented after the fifth year. Less than 5% had hearing aid fitted and patients with profound hearing impairment were referred for cochlear implant

CONCLUSION

The burden of congenital and early onset hearing impairment is high and management outcomes are unsatisfactory in our locality, Challenges associated with managing such children were discussed, and suggestions/strategies for better management and outcome were made.

Common genes for non-syndromic deafness are uncommon in sub-Saharan Africa: a report from Nigeria

INTRODUCTION

Little is known about the molecular epidemiology of deafness in sub-Saharan Africa (SSA). Even in Nigeria, the most populous African nation, no genetic studies of deafness have been conducted. This pioneering work aims at investigating the frequencies of gene mutations relatively common in other parts of the world (i.e. those in GJB2, GJB6, and mitochondrial DNA) among subjects from Nigeria with hearing loss (HL) with no evidence of acquired pathology or syndromic findings. In addition, we review the literature on the genetics of deafness in SSA.

METHOD

We evaluated 81 unrelated deaf probands from the Yoruba tribe residing in Ibadan, a suburban city in Nigeria, for the aetiology of their deafness. Subjects underwent genetic testing if their history was negative for an environmental cause and physical examination did not find evidence of a syndrome. Both exons of GJB2 and mitochondrial DNA flanking the 1555A>G mutations were PCR-amplified followed by Sanger sequencing. GJB6 deletions were screened via quantitative PCR.

RESULT

We identified 44 probands who had nonsyndromic deafness with no environmental cause. The age at study time ranged between 8 months and 45 years (mean=24 years) and age at onset was congenital or prelingual (<age 2 years) in 37 (84%) probands and postlingual in 7 (16%) probands. Among these, 35 probands were the only affected members of their families (simplex cases), while there were at least two affected family members in nine cases (multiplex). Molecular analyses did not show a pathogenic variant in any one of the 44 probands studied.

CONCLUSION

GJB2, GJB6 and mitochondrial DNA 1555A>G mutations were not found among this initial cohort of the deaf in Nigeria. This makes imperative the search for other genes in the aetiology of HL in this population.