Deafness: The ignored disability

Deafness can be seen as communication impairment rather than merely a loss of sound perception. Therefore it affects all personal, social, educational and business situations where information is given or received via speech or sound 

By Mustafa Mahmood

The Oxford Dictionary defines 'deaf' and 'deafness' as wholly or partially without hearing. Deafness is multifaceted. The greatest difficulties faced by deaf individuals are related to the problems of language acquisition and the development of a communication system. Helen Keller, probably the most famous deaf blind woman, perhaps best illustrates the impact of deafness.  Keller said ìI am just as deaf as I am blind. The problems of deafness are deeper and more complex than blindness. Deafness is a worse misfortune. It is the loss of the most vital stimulus sound of the voice that brings language, sets thoughts astir and keeps us in the intellectual company of man.î

Deafness can be seen as communication impairment rather than merely a loss of sound perception. Therefore it affects all personal, social, educational and business situations where information is given or received via speech or sound.

Dr Ehsan-ul-Haq, a consultant ENT surgeon, Hamdard University Hospital, while commenting on deafness said that it is considered as a social stigma. Those of us who wear spectacles for the apparent vision are not called blind, then why people who wear hearing aid are said to be deaf? Girls who wear spectacles live a very comfortable social life but a girl who uses a hearing aid for the clear hearing is unlikely to have a social life. A person wearing increased number glasses is likely to be considered as a very learned person by the people, while a person wearing a hearing aid is more likely to be ridiculed. Blind people have a white cane for identification, the society cares for them, help them crossing roads and feel free to guide them. The picture is quite different for the people who are deaf, they are helpless and are not only criticised by the society but at times get abused. A similar case happened with one of Dr Ehsan's patients, who was deaf and was hit by a car at main M.A. Jinnah road, he was injured severely, but to my utter surprise the injuries were not due to the collision with the car rather they were the gift from the driver for the patientís inability to hear and perceive the car horn.

About 53 percent of deafness in children worldwide is mainly due to unknown cause, but researchers say that it can probably linked to some kind of genetic cause. Other causes include premature babies, complicated pregnancies, cytomegalovirus infection of mother, improper breast feeding in lying position, post natal (after birth) meningitis (inflammation of coverings of brain), torch infections in mother during pregnancy, mumps, otitis media (inflammation of the middle ear and the ear drum), use of drugs that are toxic to the ear, trauma and few other.

Dr Ehsan informed that the most common and preventable form of deafness is 'Noise Induced Hearing Loss (NIHL).' It occurs in people expose to sound with high frequency. It is commonly seen in workers in the weaving section of textile mills, traffic police men, people working at airports, rail engine drivers, teenagers who listen to music in a very high volume especially using head phones. Other than NIHL, deafness is also observed in people living along the coastal belt especially divers and fishermen who dive in the water without wearing protective equipment like ear plugs. Recent research has also shown that the cell phone users who do not use a hand free are also at risk of developing deafness.

According to Dr Ehsan, approximately 18 percent of Pakistani population suffers from impaired hearing, the incidence being 4.5 percent in metropolitans and 3.5 percent in rural areas.

Deafness can be divided into three major types; conductive deafness in which the defect lies in the bones responsible responsible for the conduction of sound, sensi-neural deafness in which the defect is in the brain or the nervous system responsible for the perception of sound and a mixed variety in which deafness in both conductive and sensi-neural.

Talking about the treatment strategies Dr Ehsan told that today, in this modern era, many gadgets are available for the rectification of hearing. 'Body Worn Hearing Aid' is the cheapest one and affordable even for the poor, easy to maintain, sturdy and best suited for children. The device can kept in the pocket and a headphone connected to the device through a wire fit in the affected ear. The other device is the 'Digital Hearing Aidí that fits on the back of the ear and is usually hidden by the ear. And this device is slightly costly. Both of these devices having a disadvantage that these are easily visible and the patient is often ridiculed. The another aid is ëThe Ear Canal Hearing Aid,' which is very expensive but still not as efficient as devices mentioned before and has the disadvantage of echoing and rebounding sounds; the only advantage is that this device in not visible and the person cannot be identified as deaf. For the worse type of deafness 'BAHA' (bone anchored hearing aid) and 'Cochlear Implants' are also available. People with cochlear implants need speech therapy or learning lip reading for at least 3 years which is not yet available in our country.

Regarding prevention of deafness Dr Ehsan told that proper care of the mother during pregnancy and of the child immediately after birth is essential to the prevention of deafness. Protective equipment like ear plugs should be provided to all workers who are at a risk of coming in contact with nose and sounds of high frequency. Talking about the identity of deaf person Dr Ehsan said that a specific insignia should be created for them just like blinds have their canes. Such an insignia should be created and that must be a proper identification mark and not a social stigma. He said that there is a dire need of awareness among the masses and specifically doctors about deafness.

Society will have to change its attitude towards deaf people and organisations should be established to protect their rights as well. Every individual should look after his attitudes to bring a change in the society.

Alcoholism, a lethal addiction

Acute excess intake of alcohol can cause drunkenness (intoxication) or even death, and chronic or long term abuse leads to potentially irreversible damage to virtually any level of the nervous system but the way in which alcohol destroys muscle tissues is still not well understood 

Acute excess intake of alcohol can cause drunkenness (intoxication) or even death, and chronic or long term abuse leads to potentially irreversible damage to virtually any level of the nervous system. Any given patient with long term alcohol abuse may have no neurological complications, a single alcohol related disease, or multiple conditions, depending on the genes they have inherited, how well nourished they are, and other environmental factors, such as exposure to other drugs or toxins.

Neurological complications of alcohol abuse may also result from nutritional deficiency, because alcoholics tend to eat poorly and may become depleted of thiamine or other vitamins important for nervous system function. Persons who are intoxicated are also at higher risk for head injury or for compression injuries of the peripheral nerves. Sudden changes in blood chemistry, especially sodium, related to alcohol abuse may cause central pontine myelinolysis, a condition of the brainstem in which nerves lose their myelin coating. Liver disease complicating alcoholic cirrhosis may cause dementia, delirium, and movement disorder.

When a person drinks alcohol, it is absorbed by blood vessels in the stomach lining and flows rapidly throughout the body and brain, as ethanol freely crosses the blood-brain barrier that ordinarily keeps large molecules from escaping from the blood vessel to the brain tissue. Drunkenness, or intoxication, may occur at blood ethanol concentrations of as low as 50-150 mg per dL in people who don't drink. Sleepiness, stupor, coma, or even death from respiratory depression and low blood pressure occur at progressively higher concentrations.

Although alcohol is broken down by the liver, the toxic effects from a high dose of alcohol are most likely a direct result of alcohol itself rather than of its breakdown products. The fatal dose varies widely because people who drink heavily develop a tolerance to the effects of alcohol with repeated use. In addition, alcohol tolerance results in the need for higher levels of blood alcohol to achieve intoxicating effects, which increases the likelihood that habitual drinkers will be exposed to high and potentially toxic levels of ethanol. This is particularly true when binge drinkers fail to eat, because fasting decreases the rate of alcohol clearance and causes even higher blood alcohol levels.

When a chronic alcoholic suddenly stops drinking, withdrawal of alcohol leads to a syndrome of increased excitability of the central nervous system, called delirium tremens or DTs. Symptoms begin six to eight hours after abstinence, and are most pronounced 24-72 hours after abstinence. They include body shaking (tremulousness), insomnia, agitation, confusion, hearing voices or seeing images that are not really there (such as crawling bugs), seizures, rapid heart beat, profuse sweating, high blood pressure, and fever. Alcohol related seizures may also occur without withdrawal, such as during active heavy drinking or after more than a week without alcohol.

This syndrome is caused by deficiency of the Vitamin-B thiamine, and can also be seen in people who don't drink but have some other cause of thiamine deficiency, such as chronic vomiting that prevents the absorption of this vitamin.

The symptoms include marked confusion, delirium, disorientation, inattention, memory loss, and drowsiness.

Fetal alcohol syndrome occurs in infants born to alcoholic mothers when prenatal exposure to ethanol retards fetal growth and development. Affected infants often have a distinctive appearance with a thin upper lip, flat nose, short stature and small head size. Almost half are mentally retarded, and most others are mildly impaired intellectually or have problems with speech, learning, and behaviour. Fetal alcohol syndrome is the leading cause of mental retardation and many physicians warn that there is no safe level of alcohol for a pregnant mother to consume.

The severe form of acute alcoholic myopathy (any abnormality or disease of muscle tissue) is associated with the sudden onset of muscle pain, swelling, weakness, a breakdown product of muscle excreted in the urine and a rapid rise in muscle enzymes in the blood. Symptoms usually worsen over hours to a few days, and then improve over the next week to 10 days as the patient is withdrawn from alcohol. Muscle symptoms are usually generalised, but pain and swelling may selectively involve the calves or other muscle groups. The muscle breakdown of acute alcoholic myopathy may be worsened by crush injuries, which may occur when people drink so much that they compress a muscle group with their body weight for a long time without moving, or by withdrawal seizures with generalised muscle activity.

In patients who abuse alcohol over many years, chronic alcoholic myopathy may develop. Males and females are equally affected. Symptoms include painless weakness of the limb muscles, closest to the trunk and the girdle muscles, including the thighs, hips, shoulders, and upper arms. This weakness develops gradually, over weeks or months, without symptoms of acute muscle injury. Muscle atrophy, or decreased bulk may be striking. The nerves of the extremities may also begin to break down, a condition known as alcoholic peripheral neuropathy, which can add to the person's difficulty in moving.

Proposed mechanisms include muscle membrane changes affecting the transport of calcium, potassium, or other minerals; impaired muscle energy metabolism; and impaired protein synthesis. Alcohol is metabolised or broken down primarily by the liver, with a series of chemical reactions in which ethanol is converted to acetate. Acetate is metabolised by skeletal muscle, and alcohol-related changes in liver function may affect skeletal muscle metabolism, decreasing the amount of blood sugar available to muscles during prolonged activity. Because not enough sugar is available to supply needed energy, muscle protein may be broken down as an alternate energy source. However, toxic effects on muscle may be a direct result of alcohol itself rather than of its breakdown products.

Prevention requires abstinence from alcohol. Persons who consume small or moderate amounts of alcohol might theoretically help prevent nutritional complications of alcohol use with dietary supplements including B vitamins. However, proper nutrition cannot protect against the direct toxic effects of alcohol or of its breakdown products. Pregnant women and patients with liver or neurological disease with any alcohol-related symptoms or conditions should abstain completely. Persons with family history of alcoholism or alcohol-related conditions may also be at increased risk for neurological complications of alcohol use. Thus they should look after their selves and should show some sensibility and seriousness towards their health.

--www.alcoholism-information.com

A serious behaviour problem

An eating disorder is a compulsion to eat, or avoid eating, that negatively affects both, on one's physical and mental health

Eating disorder is an intricate compulsion to eat or not to eat, in a way which disturbs physical and mental health. The symptoms are not that a person has a problem with food or eating but they are actually only the signs of underlying problems in ones life. This problem can cause heart and kidney problems and even death.

Many types of eating disorder include anorexia nervosa, in which you become too thin, but you don't eat enough as you think you are fat. An approximated 0.5 to 3.7 percent of females suffer from anorexia nervosa in their lifetime. Anorexics regard themselves to be fat, no matter what their true weight is. Usually anorexics do not acknowledge they are underweight and can still feel fat at 80 lbs.

Anorexics usually strive for perfection. They fix very high standards for themselves and feel they always have to prove their competency. Bulimia nervosa, involving periods of overeating followed by purging, betimes through self-induced vomiting or taking laxatives. Bulimics often have binge food which is the food they customarily eat during binges (high carbohydrate, high fat foods).

Symptoms of bulimia nervosa include incongruous compensatory behaviours averagely occur at least twice a week in three months. Self evaluation is excessively affected by body shape and weight. Binge eating gets out of control. People who latterly recognise this disorder have frequent episodes of compulsive overeating, but unlike those with bulimia, they do not purge their bodies of food.

During these food binges, they normally eat alone and very frequently, despite of whether they feel hungry or full. This is known as emotional eating, which is a coping mechanism for stress, depression, anxiety, anger, and several other negative emotions. Eating disorders can be cured and a healthy weight restored.

Treatment of anorexia for a positive program which involves three main stages: First is reinstating weight loss to heavy dieting and purging; second is medicating psychological insaneness such as distortion of body image, low self-esteem, and interpersonal conflicts; and third is achieving long term remission and rehabilitation, or full recovery. Use of psychotropic treatment in people with anorexia should be deliberated only after weight gain has been established.

--www.google.com

 Health update

Yoga soothes worst symptoms of menopause

Women who do yoga have fewer night sweats and better concentration, study says. The postures, breathing and meditation included in the yoga intervention are aimed at one common effect, i.e. to develop mastery over modifications of the mind through slowing down the rate of flow of thoughts in the mind; the researchers explain. Improvement in the yoga group is significantly greater. In a test of memory and intelligence with 10 components, the yoga group has improved on eight, while the control group improved on six. Improvements were significantly greater in the yoga group than in the control group on seven of the subtests. The present study shows the superiority of yoga over physical activity in improving the cognitive functions that could be attributed to emphasise on correctness in breathing, synchronizing breathing with body movements, relaxation and mindful rest.

Major life changes may spark chronic headache

Worst cases occur in folks over 40 when stress is extreme and prolonged. 'Main life events may precipitate or co-occur with the development of chronic daily headaches,' Dr Ann I Scher said. The investigators assessed changes in work, marital status, children's status, or residence as well as deaths of family or close friends. They also inquired about self-defined extremely stressful situations, such as, financial problems, an ongoing individual illness or that of a family member, or an ongoing abusive relationship. Compared with men and women with episodic headache, men and women with chronic daily headache are more likely to have experienced major life events in the two year period prior to the onset of their headache condition. These findings are generally consistent with prior research related to other chronic pain conditions, the investigators note.

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