Providing a listening ear

SINGAPORE - Dr Low Wong Kein, an Ear, Nose and Throat (ENT) specialist at Mt Elizabeth Novena Hospital, was only 12 when he first came into close contact with a doctor.

And seeing the doctor's love for his patients, his professionalism, and the amazing gift he had for making his patients feel better was what birthed Dr Low's dream of going into medicine.

All about ENT

Dr Low has made it his mission to improve the hearing of his patients for over 15 years. One of his biggest achievements is being the first surgeon in Singapore to do a paediatric cochlear implant.

"During my advanced ENT training in Sydney, I was under the mentorship of the world-renowned paediatric cochlear implant surgeon Professor Bill Gibson, and I was impressed with the post-implant results of his paediatric patients," he shared.

That inspired him to introduce this procedure to Singapore upon his return to the country.

"I first started doing the procedure on older children, but found that the results were not as ideal as if the implants were done on very young children," Dr Low said.

"In a previous study of deaf children in Singapore, I found that the diagnosis and intervention of congenital hearing loss was too late, at the ages of two and four years respectively."

From this study, Dr Low felt that more needed to be done to ensure early detection for hearing loss, and was appointed by the Ministry of Health as the director of a pilot programme to implement Universal Newborn Hearing Screening (UNHS), and also to create a national cochlear implant programme.

"The two programmes proved to be a resounding success and I am pleased to say that UNHS is now generally accepted as standard medical practice in Singapore, and government funding for cochlear implants is available for needy patients."

A holistic balance

In a bid to understand how traditional Chinese medicine could play a part in the treatment for hearing loss, Dr Low has also earned a diploma in acupuncture.

"I once saw a patient who developed sudden hearing loss. Despite comprehensive Western treatment, he did not improve," Dr Low remembered.

The question confounded him because he did not have a deep understanding of acupuncture, but also inspired him to learn more about the topic, resulting in his diploma.

"There is a lot of hearsay about the effectiveness of acupuncture - many Western-trained doctors would brush it off as a waste of time, but acupuncture has been practiced for over 2,000 years. I was curious to find out if it was truly effective, or if it was just continued acceptance."

Through his study of acupuncture and other traditional Chinese treatments, Dr Low has been able to better sieve out information that could be relevant to a Western doctor, and find out how it could be used to effectively treat patients.

"Along with my PhD training in research, I am able to apply past and future medical perspectives to current day medicine, putting me in a truly unique position to holistically advise and treat patients," he said.

Opening the ears

According to Dr Low, hearing loss affects up to 10 per cent of the population in most countries, and conditions can range from mild, moderate, to severe or profound.

Childhood hearing loss, specifically, can either be congenital, where it can be genetic or non-genetic; or acquired, from conditions such as middle-ear effusion, the most common cause which can develop later in childhood until the age of eight or so.

In congenital hearing loss, it is often too late if you act when warning signs such as delayed speech or a lack of reaction to sounds become obvious. "It is recommended that congenital hearing loss is diagnosed by three months, and that intervention occurs by six months of age for optimal results," he said.

"The brain's ability to adapt and learn from sensory stimulus received decreases with age. In complete auditory deprivation, the ability to understand speech and learn speech or language is totally lost by six to eight years of age… this is why UNHS is very important for early diagnosis," he added.

"It is also important that parents take the results of a child failing a screening test seriously. Many parents just do not believe that their child could have hearing loss, and prefer to observe instead of opting for further tests to confirm the condition.

"While parents often have feelings of guilt and denial when they find out that their child cannot hear, full parental support is essential to achieve post-treatment outcomes in children."

A journey to hearing

There are a number of treatment options available for children with hearing loss, depending on what the cause is."

Although hearing loss usually remains permanent, a child's hearing can be rehabilitated by the use of hearing aids and implantable hearing devices such as cochlear implants," Dr Low explained.

One such patient is 3-year-old Shakira, or Shasi, who came to Singapore from Indonesia last November with her parents Susanto and Yenny, to seek treatment for profound hearing loss.

The first clue Shasi's parents had of her hearing loss was the fact that she was not speaking, even at the age of two.

"We talked to some of our relatives, who said that a delay in speech development was not uncommon. But we decided that if there was no improvement by the time she turned three, we would seek treatment," Susanto said.

They brought Shasi to three doctors in Jakarta, who all had the same diagnosis - profound hearing loss.

"Shasi has two older siblings who have no problems with their hearing, so it was shocking to hear the same diagnosis from all three doctors," Susanto recalled. "I was in a state of shock for over a week - I couldn't concentrate on my work, or at home."

The doctors in Jakarta recommended a cochlear implant for Shasi, and the parents decided to get Dr Low to do the surgery at Mount Elizabeth Novena Hospital.

 

"We did our research to find out which implant to choose and placed an order for the implant the moment we decided. A speech therapist that we knew in Jakarta recommended Dr Low for the surgery, so we also got into contact with him.

"The moment we found out that the implant had been delivered, we made our first trip to Singapore to meet Dr Low."

"Our first impression of Dr Low was that he was very kind and very professional. We were also very well taken care of by the staff at the hospital, who made the whole process very smooth," Susanto said smiling.

They were also surprised to find out that the cost of having the surgery at the brand new Mount Elizabeth Novena Hospital was comparable to other public hospitals in Singapore, but with much better service.

"And three weeks after their first appointment, they returned to Singapore for the surgery, which Shasi sailed through without any problems.

"The surgery was very smooth, with no unexpected issues. We also tested the implant immediately after the surgery and no problems were detected," Dr Low shared. "From my assessment of Shasi, she is very keen to learn and interact, so I expect her to do well."

Surgery does not mark the end of the road to Shasi's recovery - she will have to undergo auditory verbal therapy, where toys and other tools will be used to help her learn to speak and catch up with her hearing peers.

"Her family will also play a big part in her learning process, because the contact time with them is much longer than the therapists... ultimately, the goal is to get the child interested in listening and to relate the sounds to words or actions," Dr Low explained.

Opportunity to lead a normal life

But even though there is still much for Shasi to learn, it is a relief for her parents to know that Shasi has an opportunity to lead a normal life.

"All we want is for her to catch up on what she has missed out over the past three years, to be able to go to a normal school, and to live a normal life like her older siblings," Susanto said.

Out of the Office Dr Low's passion for helping others with hearing loss does not just exist in the hospital. He champions the cause as an educator, a volunteer, and even as the President of the Singapore Association of the Deaf.

"As President of the Singapore Association of the Deaf, I am in a more effective position to help individuals with hearing loss to successfully integrate into mainstream society," he said. Most recently, the Association submitted a plan to the government, which included suggestions to improve education, employment, communication and accessibility for the deaf community in Singapore.

As an active volunteer, Dr Low also makes visits to less-developed countries to help develop their cochlear implant programmes and conduct surgeries. "I believe that every child should be given the opportunity to hear, including needy children in rural areas," Dr Low shared. And he finds every trip very memorable and rewarding.

"I remember one trip when we went to visit a patient we had operated on the year before. We were driven some 200km on muddy tracks to a remote region of Yunnan [China] to be greeted by firecrackers that the family had set off to welcome us. They served us a huge feast - something that we were told was only served to very important guests.

"When I met the child, she was hearing well with the cochlear implant and was even learning how to speak!" he added. "It was heart-warming to see the difference medical intervention had made to the life of a child, even in such a remote corner of the world."

Dr Low Wong Kein

Dr Low Wong Kein
Ear, Nose and Throat (ENT) specialist at Mt Elizabeth Novena Hospital

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