I am pleased to be here this morning for the official launch ceremony of the "Listen and Talk" Programme and commemoration of the 100^th cochlear implantation.

After the U.S. Food and Drug Administration announced its approval for use of cochlear implant devices for adults in 1985 and for children in 1990, SGH did its first cochlear implant in an adult in 1989 and in a child in 1997. Over the last 13 years, I am proud to note that 81 children and 19 adults, in total a 100 of them, have received cochlear implants with good results.

In September 2001, MOH supported a Cochlear Implant Programme for children with profound hearing problems in NUH, SGH and KKH, so as to enhance collaboration and achieve the best results possible for these hearing impaired children. Children as young as 12 months of age with profound sensorineural hearing loss in both ears and found to have minimal or no useful benefit from hearing aids, with strong family support, would be eligible for cochlear implants. The cochlear implantation programme will allow these children to have their hearing restored back to almost normal, but not completely. Cochlear implants are expensive and the implant device itself already costs about $27,000 each. Therefore, the Ministry undertook to fund this programme as a pilot under the Health Service Development Programme (HSDP), where subsidies are given to 15 children per year for the next 3 years. An eligible patient can receive a subsidy of up to 80% of the cost of the implant, making the implant much more affordable. To date, 6 children had received subsidies from the Ministry to undergo cochlear implantation in this programme. At the end of the 3-year period, MOH will review the clinical outcomes and cost-effectiveness of the programme.

The cochlear implant programme does not stop with the implantation of the device. Getting the implants is only like being given the keys to a car but not knowing how to drive it. A lifetime commitment is required. Children have to return to hospitals for follow-up on programming of the implant and would also require aural habilitation. Especially in children where their learning, language and hearing skills may not be there in the first place, it has to be taught and hence the habilitative needs of these children may be extensive and could take up to 5 years before optimal results can be achieved.

Therefore, aural habilitation services for children would include training in auditory perception and sound discrimination in their environment, using visual cues, improving speech, developing age-appropriate language skills, managing communication and maintaining the cochlear implants. Parents have a critical role in aural habilitation and are the primary teachers for their child, participating actively in therapy sessions and trying to weave listening and speech learning into activities throughout the day.

There must be a very dedicated team of highly specialised staff, involving the otolaryngologist, audiologist, speech therapist, medical social worker and educationist to help the children and parents in the habilitation process. I am glad that the programme had been able to attract nurse-coordinators, audiologists and auditory verbal therapists on board to assist these children. SGH has appropriately named this programme as the "Listen and Talk" programme. This programme now extends beyond the hospital environment to even schools, where classroom teachers would be guided to integrate the children with hearing impairment into the class environment, so as to help them to listen and talk.

We are a fortunate mass of people who never knew what it was like being not able to hear. Except when sometimes in the night, when everything is so quiet that a world of silence could be imagined. Thus, deafness has been recognised by the World Health Organisation to be a global problem and in Singapore, the incidence of babies born with impaired hearing is estimated to be 1 per 1,000 newborns. If the hearing problems were left undetected in these children, speech, language and cognitive development, which provide the foundation for later schooling and success in society, would be impeded, resulting in vocational consequences and high societal costs being incurred in the long term.

Studies have endorsed the goal of early detection of hearing loss in all infants below 3 months of age, with appropriate intervention no later than 6 months of age. However, a study conducted in Singapore on children with hearing impairment confirmed that hearing loss was detected at mean age of 20.8 months and intervention at a mean age of 42.4 months, which was not ideal.

As such, a second programme, the Newborn Hearing Screening Programme, used in most states in USA, UK and Europe, was also included for funding under HSDP. This programme aims to detect profound hearing loss early in children by screening for hearing loss in all infants at birth, so that appropriate intervention can be instituted early in order for the successful integration of the children into normal society. The programme also ensures that those who did not pass the screening receive appropriate and timely follow-up care. From April 2002, KK Women’s and Children’s Hospital (KKH) which handles nearly a third of the total births in Singapore per year, will introduce this newborn hearing screening programme. This programme has already been implemented in SGH and NUH since 1999. In the middle of this year, this newborn hearing screening programme will also be extended to all polyclinics, mainly for newborns delivered in the private hospitals. These newborns will be screened when they visit the polyclinics for their immunisation, as early as 3 months of age when they come for their 1^st diphtheria, pertussis, tetanus and polio immunisation. A national data bank will be set up in SGH for newborns screened in SGH, NUH, KKH and the polyclinics, to ensure that children screened can be tracked and ensure that they have received the appropriate intervention.

However, delayed childhood hearing loss could still occur. Hence parents and doctors must be educated on the need for continued surveillance for hearing loss, despite passing the newborn hearing screening tests. This continued surveillance will be carried out in the polyclinics and therefore, the primary health physicians must remain vigilant for the possibility of hearing loss for all children, regardless of whether prior screening had been performed.

The Newborn Hearing Screening Programme, which aims to detect and diagnose deafness early in children during their infancy stage, is well-integrated and goes hand-in-hand with the Cochlear Implant Programme and aural habilitation, which aims at early intervention of children found to have profound hearing loss. These 2 programmes will then ensure that more benefits and better outcomes could be achieved in the areas of speech perception, language development, communication skills and psycho-social development. These will then result in a higher likelihood of these hearing impaired children coping well in mainstream education, in terms of academic performance, close to – or at the same rate – as their peers, and eventually better career opportunities which will enable them to contribute back to society.

In conclusion, I wish SGH success in their "Listen and Talk" programme and fruitful outcomes for all the hearing impaired children in the Newborn Screening and Cochlear Implant Programmes.

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