Rolex Young Laureate 2014

Neeti
Kailas

Screening India’s
newborns for hearing loss

Neeti Kailas Neeti Kailas

Untreated hearing loss at a very young age severely affects a child’s speech development and sets off a chain reaction of underachievement. Neeti Kailas is determined to change the future for India’s deaf babies with a screening test designed to work in resource-poor settings.

As fellow students in India’s prestigious National Institute of Design in Ahmedabad were creating stylish lemon squeezers and other household products, 17 year-old Neeti Kailas was busy rethinking how to improve the design of the humble bedpan for use in India’s overcrowded public hospitals. Kailas has since worked in institutions in five countries on a cell phone, an electric-hybrid scooter, and more. But she longed to “have the maximum impact on society”.

Her chance came when she and her partner Nitin Sisodia cofounded Sohum Innovation Lab to develop innovative health-care products and decided to design a cheap, portable device to screen infants for hearing loss.

“India has come a long way. However, there is little awareness of how timely screening can give a child equal opportunity and access to a normal life.”

Neeti Kailas

How the device works

Screening for hearing loss

  • During the normal hearing process, sound waves pass through the ear canal and cause the eardrum to vibrate. This sets off the movement of tiny cells in the ear – hair cells – and subsequent electrical discharges through the cochlear nerve, which are transferred to the brainstem and to the higher centres of the brain.

  • One of the device’s major advantages over other testing systems is Kailas’s in-built algorithm that filters out ambient noise. “This was really important. If you’ve ever been to health clinics in India, you’ll know how incredibly crowded and noisy they are,” she says.

The device

  • 01
  • 02
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Key components

  • 01 Headband

    Kailas’s device works by measuring the response of the brainstem to sounds. A simple, adjustable headband containing three electrodes is placed on the baby’s head to detect electrical responses generated by the brain’s auditory system when stimulated. If the brain does not respond, the child cannot hear. The device is non-invasive, which means babies do not need to be sedated during screening.

  • 02 Screening application

    The device employs two separate methods to monitor activity in the ‘listening’ part of the brain, visible by means of a mobile application. “We use a novel way to read brain signals and screen them to tell if the baby can hear or not,” says Kailas. “This is to make it more sensitive and specific.”

  • 03 The technology

    The device uses ‘the cloud’ to send information back to Sohum, where Kailas and her team can gather valuable data. For example, jaundice seems to be a factor in nerve damage but as Kailas explains “we do not have statistically significant numbers to prove this, because of the dearth of research in this area in developing countries. This is something we are trying to change.” The device is battery-operated and can be used anywhere.

Watch the short film

2014 Rolex Young Laureate Neeti Kailas describes her project to change the future of hearing-impaired children by designing a low-cost, portable screening test.

An ear for inequality

Neeti Kailas knows only too well what happens when hearing loss is not detected early. A childhood friend was born deaf, her speech suffered, so did her education, and her opportunities dwindled. “She’s had a totally different life to the rest of us,” says Kailas.

When a baby spends its first few years cut off from the stimulus of sound, from a mother’s baby talk to the noise of traffic, the speech and communication areas of the brain may not ever develop. Usually it is only by the age of four or five, when it becomes evident that a child is unable to speak, that they are sent to a paediatrician for investigation, which itself takes time. They end up being enrolled in schools for the deaf after years of frustration. “By the time they are 18, their reading and comprehension skills are half those of a normal child,” says Kailas.

This is why, Kailas stresses, it is imperative to detect hearing loss in the first six months of a child’s life and provide the right intervention, in the form of amplification and habilitation, to prevent speech loss. In developed nations, universal screening is a fundamental part of primary health care. A baby born in the United States, for example, is likely to be tested using equipment that costs a few thousand dollars, which studies how a healthy ear emits soft sounds in response to those that travel into the ear.

Detectable with sensitive microphones, these ‘otoacoustic emissions’ are absent from a deaf ear and provide an early indication of problems. But this is too expensive for use in rural India, and background noise renders the method unreliable in camps and clinics. Moreover, just over half of all India’s children are born at home and outside the reach of hospitals or clinics.

Kailas and her team at Sohum Innovation Lab are devising a cheaper, simpler and less cumbersome version of an existing screening method that is able to detect hearing deficiencies caused by problems in the auditory nerve or deeper in the brain. Kailas’s device has the advantage that it can work in resource-poor settings with noisy environments and it is safe; babies do not have to be sedated to perform the test. The device is still a prototype and Rolex Award funds will allow Kailas to prepare the hardware and electrodes for clinical evaluation by the end of this year. If all goes well, she hopes to launch the device at the end of 2016, initially focusing on hospital births, paediatricians, maternity homes and health-care workers, with the aim of screening around two per cent of such births in the first year.

Kailas hopes to screen all babies

Kailas’s low-cost device will be particularly useful in resource-poor areas in rural India as it does not require a skilled operator or a quiet environment, and it is non-invasive.

High rate of deafness in India

Of the 26 million babies born in India each year, some 100,000 are hearing-impaired, and around four million people in India under the age of 15 are hard of hearing and face severe challenges. Developing countries have a much higher incidence of congenital deafness as a result of low birth weight and birth trauma, along with many infections including rubella.

Neeti Kailas

Rolex Young Laureate 2014

A simple headband is slipped on the baby to conduct the hearing test. Neeti Kailas’s device can be used anywhere, and is particularly useful in rural health clinics, which can be especially crowded and noisy, as it screens out ambient noise.

Neeti Kailas

Rolex Young Laureate 2014

Kailas’s design for a hearing test started with a simple sketch of a baby’s head. “Good design is the ability to understand what people need,” she says.

Neeti Kailas

Rolex Young Laureate 2014

Kailas and Nitin Sisodia set up Sohum Innovation Lab to develop innovative health-care products. Their technology is adaptable and can be used to screen other brain signals, for instance, those linked with sight.

Neeti Kailas

Rolex Young Laureate 2014

Children who have hearing loss attend a training centre at the Dr S.R. Chandrasekhar Institute of Speech and Hearing in Bangalore with their mothers, who will support them to learn sign language. Early intervention is key to ensuring that these children reach their full potential.

Anyone can change everything

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Follow Neeti Kailas as she rolls out her device to screen babies in India for hearing impairment. Join other people, all over the world, who are helping Kailas to achieve her goal.