Doctors decries shortage of ENT experts for hearing loss patients

On Oct 13, 2024

Doctors are worried about rising cases of hearing loss among Nigerians amid an acute shortage of specialists compounded by the japa syndrome bedeviling the health sector.

The ear, nose, and throat specialists disclosed that Nigeria has less than 500 ENT experts serving a country of over 200 million people.

The physicians expressed worry that many Nigerians with hearing impairment do not have access to specialist care due to the manpower gaps.

The experts warned that poor access to specialist care could lead to more individuals going deaf, especially children born with hearing challenges.

The World Health Organisation in its Status Report on Ear and Hearing Care estimated that approximately 40 million people in the African region currently live with hearing loss, saying that this figure could rise to 54 million by 2030 if urgent measures were not taken to address the issue.

The WHO report emphasised that without immediate interventions, widespread hearing loss, disproportionately affecting poor and vulnerable populations, will continue to escalate, exacerbating existing inequalities in access to health services across Africa.

For children, the WHO said, the consequences of hearing loss could be profound, leading to delays in language development, poor educational outcomes, and limited career prospects. Adults with untreated hearing loss often experience isolation, loneliness, and an increased risk of depression and dementia.

They said that this situation had resulted in a daunting doctor-patient ratio of 1:500,000.

A Chief Consultant Otolaryngologist at the University of Maiduguri Teaching Hospital in Borno State, Prof.Mala Sandabe, highlighted the acute shortage of ENT specialists, disclosing that less than 500 experts serve over 200 million Nigerians.

He emphasised that without significant changes, Nigeria will struggle to mitigate the WHO’s projections for hearing loss by 2030 and beyond.

Sandabe stressed that having only 500 ENT specialists was insufficient to prevent the looming epidemic of hearing loss in Nigeria, lamenting that this number was dwindling as experienced professionals retire or pass away, while younger specialists often leave the country in search of better opportunities.

He said, “The ratio of ENT specialists is alarmingly low, less than one for every 500,000 people, making it difficult to meet healthcare needs. In some states, like Yobe, there are no practicing ENT surgeons at all.

“There is only one centre that trains ENT nurses, the National Healthcare Centre in Kaduna, with an intake of just 30 students. Additionally, many diagnostic centres for ENT issues are non-functional, and cochlear implants for people with hearing impairment, are unavailable due to their high costs, N20 million.

“There are also no rehabilitation centres in the country, forcing families to seek treatment abroad for speech and language therapy. To reduce this medical tourism, it’s essential to develop local ENT specialists and improve healthcare accessibility in Nigeria.”

Sandabe said that one of the major causes of hearing loss in Nigeria is upper respiratory tract infections, which are frequently linked to ear infections.

He noted that in children, especially those under five, untreated URTIs can lead to significant hearing loss.

Sandabe explained, “These infections can cause pus to drain from the middle ear, potentially rupturing the eardrum and severely affecting hearing. Furthermore, infections can destroy small bones in the ear that are essential for hearing.

“In Nigeria, many children with URTIs do not seek hospital care, exacerbating the burden of hearing loss. Low awareness and financial constraints severely impact access to treatment, leaving many low-income families unable to afford necessary healthcare.

“Even when doctors refer patients to specialists, the cost of treatment often prevents access. In some cases, teachers play a crucial role by encouraging parents to take their children for check-ups.

“Poor hygiene and living conditions, exacerbated by poverty, further complicate these issues. Trauma, such as inserting foreign objects into the ear, can damage the eardrum.”

Sandabe stressed that accessible insurance coverage for children in Nigeria could address many of these challenges. He noted that patients often face high out-of-pocket expenses, leaving hospitals struggling to survive by raising treatment costs.

“This situation makes it increasingly difficult for the poorest families to afford care,” he said, emphasising that education is vital to inform communities about necessary treatments and their availability.

Sandabe added, “The high cost of specialised treatment in the country has led to the prevalence of traditional medicine practitioners, although their methods are often unstandardised. Without intervention, we risk an increase in age-related hearing loss in the future, and drug abuse may further exacerbate this issue.”

On medications that contribute to the burden of hearing loss, Sandabe stated, “Certain groups of medications, including aminoglycosides, can cause permanent hearing loss. I have encountered cases where the legal use of such drugs has led to hearing impairment. I don’t foresee Nigeria achieving any positive changes by 2030, or even in the next 20 years.”

Corroborating his statement, an ENT specialist and Head of the Department of Ear, Nose, Throat, and Neck Surgery at the Federal Medical Centre, Jabi, Abuja, Dr. Enema Amodu, affirmed that the WHO’s projection accurately reflects the challenges Nigeria faces due to a lack of ENT specialists.

He emphasised, “Nigeria doesn’t have comprehensive data to support these points, but with a ratio of 1:500,000 patients to specialists, we still have a long way to go in meeting the country’s ENT needs. We are not even close to having 500 ENT specialists in Nigeria.”

Amodu, also the Secretary General of the Oto-Rhino Laryngological Society of Nigeria, said, “Unfortunately, many senior specialists are dying, and capable professionals are leaving the country. The best form of treatment is prevention.

“We must avoid practices that can damage the ear, and when issues arise, it’s crucial to visit specialised centres. However, in many of these centres, there are often no specialists available to assist patients.

“Many of us have drifted to urban areas, and within those areas, some have focused on super-specialised fields. Consequently, we lack sufficient specialists at primary and secondary health facilities, and this gap continues to widen every day.”

The former Chairman of the Nigeria Medical Association for the Federal Capital Territory and North-Central regions attributed the rising burden of hearing loss in the country to the use of certain devices considered fashionable by young people.

He stated, “The use of air pods, earphones, and exposure to loud sounds significantly impacts ear health. We are currently in a trend of using Bluetooth devices, air pods, and earphones, all of which pose potential harm to our hearing.

“Over time, users may begin to hear ringing or noises that seem external, often unaware that an ear problem has already begun. If left untreated, this can lead to irreversible hearing loss.”

PUNCH/Wumi