The Hearing Report Fndngs and initial recommeridations of the Board of Health Committee on Hearing \ 1984 LIBRARY DEPARTMENT OF HEAlTH!r1J" WELlJNGTON ':)" COPYRIGHT With due acknowledgment, this report may be freely copied or quoted; but no.t for a commercial .ageI1cy or for commercial purposes.· 11 FOREWORD Hearing impairment is one of the most prevalent, preventable, yet ignored disabilities. Such an invisible handicap evokes little sympathy, yet thousands of New Zealanders and their families are affected by its complex personal and social ramifications. One of the main outcomes of deafness and hearing impairment is difficulty with interpersonal communication, leading to learn­ ing difficulties and failure to develop skills necessary for self advocacy. Social growth. may be compromised sometimes to a severe degree. While deaf and hearing impaired people were consulted in the course of producing this report, it is essential that further working parties involve the 'consumer' much more extensively. We, the hearing, often choose to 'turn a deaf ear' to the needs of the hearing impaired. This report draws together information from a wide range of sources. In the course of gathering data on deafness and hearing impairment in New Zealand, large gaps in our knowledge became apparent. A mismatch between needs and available services was also found, despite recommendations in earlier reports such as Deafness the invisible handicap. It is hoped that the. recom­ mendations set out in Part 4 of the Hearing Report will be followed by multidisciplinary cooperation and action, at national, regional, and local level. The work of the committee has culminated in a result which is required reading for those with responsibilities for the wellbeing of hearing impaired people. A /J (J1 ' ~rI d.U~ D Short Chairman Board of Health November 1984 III BOARD OF HEALTH Dr Douglas SHORT (Chairman) Mrs Betty BIDDLES Professor Michael COOPER Dr Mason DURIE Dr Bruce FOGGO Mrs Myra GRAHAM Mrs Jean McCORKINDALE Mrs Val O'SULLIVAN Mr Clive ROSS Professor Fred SHANNON Mr Nelson SPIERS Dr Ron BARKER-Director General of Health (ex officio) Ms Val TAYLOR (Secretary) . COMMITTEE ON HEARING Chairman Kenneth W NEWELL MD MB ChB MFCM MCCM DPH -Professor of Community Health, Wellington Clinical School of Medicine (until December 1983) . John W ROSE (from December 1983) - Parent of two profoundly deaf boys. Twenty years with parent and deaf organisations. Worked on the report, Deafness the invisible handicap Members Joy BAIRD BA(Hons) -Senior Advisory Officer, Department of Social Welfare Sefton BARTLETT TIC -Principal, van Asch College, Christchurch (until May 1984) Richard Campbell BEGG MB BCh D Obst RCOG DPH DIH MCCM -Director, Division of Health Promotion, Department of Health Michael (Mike) CODDINGTON BSc (Psychol) Dip Aud -Senior Audiologist, Middlemore Hospital Patrick W Eisdell MOORE OBE MB ChB FRCS FRACS·DLO RCP -Surgeon, Consultant in Otolaryngology to the Department of Health Edward (Ted) C GALLEN -Chief Executive Officer (Development), Department of Social Welfare v .1. Hazra ISMAIL MSc (Soc Med) MB BCh DCH. MFCM MCCM -Principal Medical Officer, Division of Health Promotion, Department of Health (Co-opted to the committee) William (Bill) J KEITH BA MA (Hons) PhD - Principal Audiologist, Audiology Centre, Division of Health Promotion, Department of Health (Technical Secretary to the committee) Janet LAUDER RGON RM DipN . -Principal Public Health Nurse, Timaru District Office Murray LAUGESEN MB ChB Dip Obst FRCS MCCM ' -Principal Medical Officer (Research), Management Services and Research Unit; Department of Health (Co-opted to the committee) John MILLS MB ChB DComH' -Principal Medical Officer, Hospitals Division, Department of Health (until November 1982) . Keith W RIDINGS MB ChB DA RCP RCS MCCM (from November 1982) Mary ROBERTS BA Dip Tchg TTC endorsed -Education Officer (Special Education), Department of Education (from May 1984) Ian A STEWART MB ChB FRCS -ENT Surgeon, Senior Lecturer in Otolaryngology and Head and Neck Surgery, University of Otago S Rae WEST MB ChB Dip Obst FRCGP FRNZCGP MCCM -Associate Professor of General Practice, Helj,d of Department of Com­ munity Health and General Practice, University of Auckland , Rex E WRIGHT-ST CLAIR MD MB ChB MRNZCGP MCCM , -Medical Superintendent, Extramural Hospital Waikato Hospital Board Secretaries Antonia COCHRANE 'BSc -Advisory Officer, Department of Health (until February 1983) Florence CAUGHEY BA(Hons) -Advisory Officer, Department of Health (until February 1984) Paula McIVOR MA (Hons) -Assistant Advisory Officer, Department of Health (from February 1984) Hearing Research Project Kenneth W NEWELL MD DPH MCCM MFCM -Principal Investigator, Professor of Community Heaith, Wellington Clin­ ical School of Medicine Kathleen C BOSWELL MA Dip Ed - Research Investigator, Department of Community Health, Wellington Clinical School of Medicine Vi ACKNOWLEDGMENTS Parts 1, 2 and 3 of this report were written by Kathleen Boswell and Kenneth Newell. Part 4, the recommendations, was written by Kenneth Newell as part of an interim report to the Minister of Health, and revised by Bill Keith. Funding for the Hearing Research Project was provided by the Health Services Research Committee of the Medical Research Council for one year from February 1983. Since February 1984, Kath Boswell's salary has been paid by the Management Services and Research Unit of the Department of Health. The authors would like to thank Lucy Carpenter, MRC Statistician, Wel­ lington Clinical School, and a1l members of the Committee on Hearing. Specific help from individuals is acknowledged at the end of the appropriate section. Many other organisations and individuals provided information for this report. Help from staff within the following organisations is gratefully acknowledged: • Audiology Centre (formerly National Acoustics Centre), Department of Health, Auckland • Dunedin Multidisciplinary Health and Development Research Unit • Christchurch Child Development Study • Management Services and Research Unit, Department of Health • Division of Health Promotion, Department of Health • Bureau of Public Health and Environmental Protection, Department of Health • District Offices of Health throughout New Zealand • Kelston School for the Deaf, Auckland • van Asch College, Christchurch • Speech therapy clinics throughout New Zealand • Wellington Field Office for the Deaf • Wellington Hospital Board ENT and audiology clinics We would also like to thank: • the necessarily anonymous persons who are the 'case histories' • the industries and institutions which have provided data but whose request for anonymity we have respected vii • Winifred Lamb for her help with collecting data • Colin Boswell for the computer graphics • Pat Stanton, Mary Tuipulotu (Wellington Clinical School), Elaine McKenna and Niargaret Brown (MSRU) for typing assistance • Emma Mihaere for her patience and word processing skills • Paula McIvor for editorial assistance • Karen Smyth for editorial and production assistance • Erina Chapman and Marjorie VandenBerg for help with proofreading. TERMS OF REFERENCE OF THE COMMITTEE ON HEARING To make recommendations to the Minister of Health in respect of: 1 The identification of the extent and nature of problems relating to defective hearing and ear disease'in New Zealand. 2 The measures necessary to ensure prevention, early detection and adequate management, including rehabilitation. 3 The effective coordination and expansion of services which will be required to meet present and future needs. viii PREFACE The initial tasks of the Committee on Hearing were to examine the extent and implications of hearing impairment in the community in New Zealand, and to review hearing services. Both tasks were daunting, the first because so little quantitative information on the extent of hearing impairment in New Zealand has been recorded and the second because of the difficulty of con­ sidering all types of hearing impairment as a single entity. A further problem that faced the committee was that of trying to quantify the often tragic effects of hearing loss on individual lives. The far-reaching consequences of hearing impairment on education, personal development, the realisation of potential and the quality of life are less apparent than the effects of most other hand­ icaps or health problems. In the course of their deliberations committee members have become aware of, and felt frustrated by, the limitations of statistics in conveying the implications of deafness. The lack of basic quantitative information meant that the committee had first to address itself to remedying this deficiency. In this regard the com­ mittee gratefully acknowledges the assistance of the Health Services Research Committee of the Medical Research Council of New Zealand which pro­ vided funds for a research officer to assist the committee in the tasks of gathering and reporting data on the incidence and prevalence of hearing . impairment, and describing hearing services in New Zealand. These studies, known as the Hearing Research Project, have been reported in Parts 1-3: • Part 1 presents a series of case histories to illustrate some of the effects of hearing impairment on everyday life • Part 2 brings together existing data on the incidence and prevalence of hearing loss and ear disease in New Zealand • Part 3 describes the provision of services for the hearing impaired. The Committee on Hearing has presented its recommendations in Part 4, based on information collected