‘Luga,’ infections: Causes of hearing loss and their preventions

You're probably getting ready for the chaos of fireworks this Christmas and New Year. But even if the rest of the year is relatively free of the boom of pyrotechnics and you happen to live in quiet neighborhoods, there's still a chance you can one day lost your hearing.

Hearing loss, if it is not congenital or caused by too much exposure to noise, can be brought on by ear infections. According to local studies, ear infections affect 18 percent of the population, and about 8.8 percent of Filipinos are hearing-disabled—defined as when hearing impairment affects your education or employment.

“Unfortunately, hearing disability is invisible,” said Metro Manila Federation of Agencies for the Deaf president Dr. Norberto Martinez. “We don't have too much compassion for the hearing-impaired, unlike for the blind or the physically disabled. In this age of communication, this serves as a very big barrier for people who are hearing-impaired.”

Hearing loss is actually preventable in about 50 percent of cases, according to the World Health Organization.

“But if we cannot prevent it, then we should do something about it and start to do some rehabilitation,” said Martinez. He said this at a media event for Deaf Awareness Week, which is held every November to teach the public how to take better care of their ears—and the ears of their children.

“They say it takes a village [to raise a child],” he added. “Once you have hearing loss, it does not just affect the individual but also the people around that person.”

Ear infections

The most prevalent of ear infections is otitis media—the inflammation of the middle ear behind the eardrum. It can happen to anyone, but among the young, said St. Luke's Hospital pediatric otorhinolaryngologist Dr. Gretchen Navarro Locsin, “they're really very common.”

The reasons for this, she added, are “anatomy and immunity.”

The Eustachian tube, which connects the ear to the sinuses, runs horizontally in infants (it only starts to incline as the person grows older). “It's a lot easier for secretions to enter from the nose to the ears in young children and babies,” and so it is much easier for babies to develop ear problems as a result of sinus infections, said Locsin.

“The problem if you have frequent nasal congestions or obstructions is it's never going to be open enough for you to be able to clear your secretions,” she said. “As secretions build up, any stagnant secretion is going to get infected. Also, the immune system of young children is still developing, so they are really the ones most vulnerable to infections, including acute otitis media.”

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According to a projection from the National Statistics Office in 2010, 43 percent of the Philippine population belongs to the pediatric age group of 0 to 15 years of age. And in this large group of young and very young people, 83 percent will have at least one episode of acute otitis media (AOM) in the first three years of life.

And any of these infections, if it becomes chronic, could lead to hearing loss.

This is why education of the public is important, said Locsin—to catch AOM before it becomes a chronic condition.

The 'luga' problem

Sometimes complications occur, and if the eardrum is damaged due to AOM, a substance will drain from the ear. In the Philippines, this is called “luga”.

“Yung may luga, that's already chronic [otitis media]—it means they've had a chronically draining ear for more than three months and the disease is more extensive.

“Pag may luga, may butas na ang tenga,” said Locsin.

And it’s a huge problem. The Western Pacific region—which includes the Philippines—has the highest incidence of the discharge: it is present in an estimated 165 million people. The World Health Organization incudes the Philippines among countries with a high prevalence of chronic otitis media.

Education is one way to prevent chronic ear infections that could lead to deafness, said Locsin. “Common ang acute otitis media na wala pang complication,” she said.

Even more tragic than the prevalence of hearing loss is another statistic from Locsin: 51,000 deaths per year of children less than 5 years old in developing countries due to chronic otitis media. “Malaki talaga ang problema ng ear infection, hindi lamang doon sa magkakaroon ng hearing loss pero yung other complications na pwedeng magkaroon ka, and you're talking about meningitis and abscesses na pumupunta sa brain,” she said. “Unfortunately [the situation] hasn't changed that much, lalo na kung pupunta ka sa probinsya, marami kang nakikita na luga. Sana mabawasan 'yon.”

There's a hitch, though: “Yung problema is kung hindi nila alam na may problema,” she said.
“In the provinces pag tinanung mo sila kung may problema ba sila sa tenga, they'll tell you wala, but if you ask may tumutulo ba they'll say, 'Ah meron po! Sinisipon lang naman',” said Locsin.

“Their idea is kung sinisipon, OK lang kung may discharge sa tenga, which is wrong. Whether you have sipon or not, you shouldn't have discharge from the ear. So the level of awareness of what is normal and what is abnormal is really not there. Hindi lang kasi kailangan doctor, pati rin sa rural health centers yung mga midwives [yung may alam] kasi they're the ones who have contact. People need to realize that it's not normal to have something draining in your ear.”

Through this information campaign, the doctors hope to teach people to seek professional medical attention for luga—that while it is a sadly common occurrence, it is not a normal one that can just be ignored.

Immunization

Apart from improving sanitary conditions in these areas, the doctors also stress the importance of immunization against ear infections. “Meron sa bata at meron din sa adult,” said Locsin. “Importante ito sa amin because we'd rather go through prevention than treatment.”

“Nowadays we have vaccines to prevent infection of the ear that may prevent otitis media among children,” said Martinez. “These are the things we have to really highlight. If we are able to prevent it, a child will not have to go through an operation.”

Typhoon Yolanda

Typhoon Yolanda has in all likelihood made the situation worse, said Locsin. “In any disaster, you're going to have artificial conditions of crowding, poor sanitation, poor nutrition, exposure to the elements, and therein lies your problem,” she said. The most common infectious diseases acquired in these conditions are diseases of the upper respiratory tract—in other words, ubo't sipon, which could lead to AOM and then chronic otitis media if left unattended.

“Maraming magkakaroon ng ubo't sipon, at high risk ka na kaagad na magkaroon ng problema sa tenga,” said Locsin. Due to Yolanda, she adds, “I think we're really going to see a rise in the problems of ear infections.”

Hearing loss in newborns

In the Philippines, an estimated 15 babies are born every day with some hearing loss, whether in one ear or both—or 450 a month and 5,400 a year. Seven babies are born with profound, bilateral hearing loss every day, or 210 a month and 2,500 a year.

The leading causes are infections and illnesses that affect the mother during her pregnancy, including cytomegalovirus, measles, mumps and rubella, said the doctors.

Infant screening for hearing impairment in one or both ears has been required by law in the Philippines since 2009.

“Hearing loss is the most common disorder among newborns for which testing is available,” said Locsin. “We are familiar with metabolic screening to diagnose metabolic diseases, but those diseases are 10 to 100 times less common than hearing impairment. So if we can do screening for metabolic diseases, we have no excuse for not doing newborn hearing screening.”

The process, said Locsin, entails getting a few drops of blood from the baby's heel to screen for five conditions in the blood. “Kailangan ang early intervention,” she said. The test is free if the parents have PhilHealth, which covers the costs. Parents without PhilHealth, she adds, can still get the test done for as low as P200. “Important siya at affordable,” she said. — VC, GMA News


You can have your hearing checked for free at the UST Center for Audiological Sciences, Room 413, Medicine Bldg., University of Santo Tomas, España, Manila. Prior appointment is required. Make an appointment by calling (02) 406-1611 local 8230 or 0917-5010987 or email the center at betterhearing@hotmail.com.