Objective: To study the epidemiological, clinical and therapeutic aspects of hearing loss in 15-year-olds and over at the CHU GT of Bamako. Materials and Method: This is a longitudinal prospective study carried out in the ENT department of the University hospital Gabriel Toure in Bamako over 13 months (from September 2018 to September 2019). We carried out an exhaustive sampling of all the patients who consulted in the department for hearing loss and whose deafness was confirmed at pure tone audiometry with age greater than or equal to 15 years. The exclusion criteria were all patients under the age of 15 as well as a hearing loss related to earwax or foreign bodies and refusals to participate in the study. Results: Two hundred and thirty (230) patients were collected during the study. Dominated by the male sex with a sex ratio of 1.5 or 3 men for 2 women, with an average age of 38.16 ± 19 years with extremes ranging from 15 to 86 years. Among our patients , 37.40% had unilateral deafness, progressive installation evolving more than 12 weeks with a rate of cases had headaches 41% and had a history of chronic otitis media (CMO) 27%. There were a few cases of mixed type deafness, 30% had mild deafness, 22% moderate deafness and 40% severe deafness , according to the BIAP classification. Among our patients , 22.16% had conductive hearing loss, and those with sensorineural hearing loss accounted for 15.24%. Conclusion: Pure tone audiometry remains essential in the diagnosis of deafness. It not only makes it possible to confirm or invalidate the deafness, but also to define the type of deafness and especially to classify the deafness according to the degree of the average hearing loss established by the BIAP.
Hearing plays a fundamental role in social and professional communication [
In Mali, while certain aspects of deafness have been the subject of studies [
This is a longitudinal prospective study carried out in the ENT department of the University hospital Gabriel Toure in Bamako over 13 months (from September 2018 to September 2019). We made an exhaustive sampling of all patients who consulted for hearing loss. Thus we have collected two hundred and thirty (230) cases of all forms of hearing loss confirmed by pure tone audiometry.
Minimum age patient 15 years and older.
Hypoacusis confirmed by pure tone audiometry.
Patients under 15 years and older.
Hearing loss related to earwax plugs or foreign bodies.
Refusal to participate in the study.
The information was obtained using our questionnaire established for this purpose, either by the patient himself or his parents in the event of severe hearing loss or speech impairment. The recording of the data was done on our survey sheet. The enrollment of patients went through a procedure, which consisted of:
- Selection for consultation according to the reason for consultation: hypoacusis, tinnitus, vertigo, blast, employment report, medical expertise, among others.
- Enrollment according to the inclusion criteria.
- The otorrhea was previously aspirated.
- Reference to the audiometric unit: receive the patient, install him and explain to him the procedure and the expected results.
- Implementation of the examination, which begins with the air conduction of the better ear, then the other and ends with the bone conduction of the better ear.
- Analysis and interpretation of results.
This is a purely scientific work that aims to improve the management of hearing loss. Anonymity is strictly respected. The results will be used to improve the quality of care for patients with hearing loss. The consent of the patients or their relatives (accompanying) was obtained beforehand.
- Socio-demographic data (age, sex, profession, residence),
- Clinical data (reason for consultation, mode of onset, medical and surgical history, associated otological signs),
- Paraclinical data (threshold tonal audiometry),
- Therapeutic data.
Data were analyzed using Epi info-version 3.5.3 software. The graphs were made on EXCEL office 2019.
Two hundred and thirty (230) patients were collected during the study period. The age group between 26 and 35 years was the most represented with a rate of 23% (
Clinically, 70% of our patients had hypoacusis associated with tinnitus; it was bilateral in 56.1% with a duration of evolution greater than 12 weeks in 43%.
Age group | Effective | Percentage (%) |
---|---|---|
15 - 25 | 46 | 20.0 |
26 - 35 | 53 | 23.0 |
36 - 45 | 32 | 13.9 |
46 - 55 | 29 | 12.6 |
56 - 65 | 29 | 12.2 |
66 - 75 | 20 | 8.7 |
76 et plus | 21 | 9.1 |
Total | 230 | 100.0 |
Chronic otitis media was the most found ATCD in 27%. The examination of the external auditory canal was normal in 77.4%; on the other hand, the otoscopy of the eardrum found a unilateral or bilateral tympanic perforation in 62.16%, a unilateral or bilateral retraction pocket 6.08% and 3.04%. In 66.08%, the deafness was transmission type on audiometry and it was average in 51.30% (
During this study, we were limited by a number of issues such as:
- Calibration of the audiometer.
- The educational level of patients to differentiate sound from vibration.
- The change of address of certain patients or contact persons in Bamako.
- Failure to keep appointments for post-operative check-ups by some patients.
According to new WHO estimates, 466 million people worldwide have disabling hearing loss, 34 million of them children. It is estimated that by 2050, more than 900 million people, or one in 10 people, will suffer from disabling hearing loss [
Hearing loss | Effective | Percentage (%) |
---|---|---|
Lightweight | 67 | 20.13 |
Mean | 118 | 51.30 |
Severe | 34 | 14.78 |
deep | 9 | 3.91 |
Cophosis | 2 | 0.86 |
Total | 230 | 100 |
Causal pathology | Effective | Percentage (%) |
---|---|---|
Simple CMO with open tympanum | 120 | 52.17 |
atelectatic otitis | 35 | 15.21 |
cholesteatomatous CMO | 26 | 11.30 |
Tympanosclerosis | 11 | 4.78 |
Presbycusis | 10 | 4.34 |
Otosclerosis | 9 | 3.91 |
Chronic sound trauma | 8 | 3.47 |
Acute sound trauma | 6 | 2.60 |
External auditory meatus stenosis | 3 | 1.30 |
rock fracture | 2 | 0.86 |
Total | 230 | 100 |
Pathologies | PAM (en dB) | Total | ||||
---|---|---|---|---|---|---|
21 - 40 | 41 - 70 | 71 - 90 | 91 - 119 | 120 et plus | ||
Simple CMO with open tympanum | 33 | 76 | 11 | 0 | 0 | 120 |
Tympanosclerosis | 9 | 2 | 0 | 0 | 0 | 11 |
atelectatic otitis | 20 | 13 | 2 | 0 | 0 | 35 |
cholesteatomatous CMO | 4 | 11 | 9 | 2 | 0 | 26 |
Presbycusis | 0 | 6 | 4 | 0 | 0 | 10 |
Otosclerosis | 0 | 5 | 3 | 1 | 9 | |
External auditory meatus stenosis | 1 | 2 | 0 | 0 | 0 | 3 |
Acute sound trauma | 0 | 0 | 1 | 3 | 2 | 6 |
Chronic sound trauma | 0 | 3 | 4 | 1 | 0 | 8 |
rock fracture | 0 | 0 | 0 | 2 | 0 | 2 |
Total | 67 | 118 | 34 | 9 | 2 | 230 |
Treatment | Effective | Percentage (%) |
---|---|---|
Tympanoplasty type I | 87 | 37.82 |
hearing aid | 12 | 5.21 |
cochlear implant | 1 | 0.43 |
Meatoplasty | 3 | 1.30 |
Tympanoplasty type II | 18 | 7.82 |
Antrotomy plus type 1 tympanoplasty | 23 | 10.00 |
Mastoatticotomy | 8 | 3.47 |
Petrostoid recess | 9 | 3.91 |
Medical treatment | 65 | 28.26 |
Stapedectomy | 4 | 1.73 |
Total | 230 | 100 |
or 3.26% met our criteria. This study corroborates that previously carried out in the department [
In our study, the male sex was the most affected at 54.35% against 45.65% of the female sex, i.e., a sex ratio of 1.19. This observation was shared by several authors in the sub-region who found similar results during their various works with respectively 57.6%; 62.55%; 50.51% [
The age group between 25 and 35 years old was the most represented with a rate of 23%, the average age was 37.62 years old with extremes of 15 and 80 years old in our study. This age group corresponds to that of the young population. Recall that according to the National Institute of Statistics in Mali, the population aged 15 to 65 constitutes 81.7% of the Malian population [
Our patients consulted for bilateral hypoacusis in 56.1%. This situation is attributable to the fact that the discomfort becomes more and more perceptible, so the patient is forced to seek a solution. This is superimposed on the severity and the type of deafness. Our results were corroborated by the results of certain studies in the literature [
Bilateral deafness was the most represented with a rate of 56.1%. We also recorded 66.08% conductive deafness, 17.81% sensorineural deafness and 16.08% mixed deafness. We were able to distinguish five (5) different degrees of deafness in accordance with the BIAP classification. Moderate deafness was the most common with a rate of 51.30%, it was mild in 20.13% and severe in 14.78%. Most of the patients only consulted when the deafness became socially embarrassing, when they had difficulty communicating. At this degree of hearing loss, speech is only perceived when the voice is raised. We recorded four (4) cases of Cophosis, i.e., 0.86%. Our results are close to those of the literature [
In our study, otological damage of infectious origin was mainly found in approximately 83.47% and among its causes 52.17% was linked to simple chronic otitis media with an open eardrum, 11.30% to otitis cholesteatomatosis against 14.34% of deafness etiologies with the normal eardrum. In general, the impact of a painful ear with otorrhoea panics the patient and his entourage, which may explain their motivation to be consulted. Computed tomography of the rocks and magnetic resonance imaging are necessary to support the etiological assessment. CT was our radiological examination of choice. We asked for it in 116 cases or 50.43% and it was in favor of chronic cholesteatomatous otomastoiditis in 26 cases or 11.30%, in 9 cases or 3.91%, it was in favor of otosclerosis. We have only used MRI because it has only recently become available in our country and its cost remains extremely high for our population.
In our study, multiple treatments were proposed ranging from hearing aids to surgery as well as medical treatments. Of the 230 patients in our series, 65 patients received medical treatment, 12 patients received hearing aids and 153 or 66.52% of patients received ear surgery. Thus we performed a tympanoplasty alone or associated with an antrotomy in 110 patients, Type II tympanoplasty in 18 patients, a petromastoid recess in 9 cases, and a mastoatticotomy in 8 cases, a stapedectomy in 4 cases, a meatoplasty in 3 cases and a cochlear implant case. In general, surgery remains the main indication in the management of chronic otitis media and some of its sequelae [
Pure tone audiometry remains essential in the diagnosis of deafness. It not only makes it possible to confirm or invalidate the deafness, but also to define the type of deafness and especially to classify the deafness according to the degree of the average hearing loss established by the BIAP. Keywords: pure tone audiometry, deafness, BIAP.
The authors declare no conflict of interest regarding the publication of this article.
Diarra, K., Konaté, N., Dembele, Y., Berthé, I., Bagayoko, D.K., Guindo, B., Koné, F.I., Soumaoro, S., Singare, D.K. and Keita, M.A. (2022) Deafness: Epidemiological, Clinical and Therapeutic Aspects in 15 Year Olds and over at the University Hospital Center Gabriel Toure of Bamako. International Journal of Otolaryngology and Head & Neck Surgery, 11, 202-210. https://doi.org/10.4236/ijohns.2022.114021