Deafness in highlanders.

Hearing impairment is a common health problem throughout the world. Over two million human beings on the earth are either deaf or hearing impaired, most of them in the developing countries. Pakistan is a land of multiethnic, multiracial, multilingual and varied anthropological cultures and populations. A substantial number of children and adults are suffering from hearing impairment, mostly provoked by poverty and lack of health facilities. This non-interventional descriptive study was carried out while providing primary ear care and conducting an epidemiological survey in the Northern territories of Baltistan, that covers a large terrain of Himalayan mountains of the Hindukush and Korakoram Range. A total of 1964 patients were examined during 7 camps conducted by IMPACT Pakistan in 1998, out of which 1160 were females and 804 were males. Short history was recorded and meticulous ear examination was performed, which includes otoscopy withpneumatic attachment and tuning fork testing. Tympanometry was performed in selected cases of glue ears having clinical evidence of effusion behind the drum. Common causes of deafness and hearing impairment were drawn from this study. Glue ear was found in 503 patients [25.61%] out of which 353 patients-were selected for tympanometry Impacted hard wax was found in 402 patients [20.46%]. Chronic suppurative otitis media [C.S.O.M] was found in 307 patients [15.61%] with discharging perforations in 178 patients [57.98%], dry perforations in 111 patients [36.15%] and cholesteatoma in 18 patients [5.86%]. Tympanosclerotic patches were found in 231 patients [11.76%]. Sensorineural hearing loss [SNHL] was found in 225 patients [11.43%], majority of them were due to aging process [presbaycusis] in 97 cases [43.11%]. Post-infectious neural loss was found in 55 cases [24.44%]. 39 cases [17.33%] of SNHL were associated with goitre and 7 cases [3.11%] of syndrome associated hearing loss were identified. The final message is that all the causes seen in mountainous areas of Northern territories, as indeed elsewhere in Pakistan are preventable. All we need is public awareness, which can be achieved through the help of the international agencies, particularly the W.H.O.