Overview

Last month, the World Health Organisation (WHO) developed the first World Report on Hearing in response to a World Health Assembly resolution. The resolution was adopted in 2017 to provide guidance for Member States to incorporate ear and hearing care into their national health plans.

The report outlines the need to swiftly step up efforts to address and prevent hearing loss by expanding and investing in access to ear and hearing care services. Funding ear and hearing care has been proven to be cost-effective when it comes to preventing more severe health problems. The WHO estimates that governments can expect a return of nearly $16 for every $1 invested.

The first World Report on Hearing warns that almost 2.5 billion people globally, 1 in 4 people, will be living with some form of hearing loss by 2050. Unless action is taken, at least 700 million of these people will need access to ear and hearing care.

"Our ability to hear is precious. Untreated hearing loss can have a devastating impact on people’s ability to communicate, to study and to earn a living. It can also impact on people’s mental health and their ability to sustain relationships," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. 

“This new report outlines the scale of the problem, but also offers solutions in the form of evidence-based interventions that we encourage all countries to integrate into their health systems as part of their journey towards universal health coverage.”

What did we learn from the report?

Stigmatising attitudes and a lack of information about hearing loss and ear diseases frequently limit people from accessing care for these conditions. Often, there is a shortage of knowledge about prevention, early management, and identification of hearing loss and ear diseases among health-care providers which hinders their ability to provide the care required.

Ear and hearing care has still not been integrated into national health systems in most countries which makes accessing care services challenging for those who need it. Furthermore, access to ear and hearing care is inadequately measured and documented. 

The most glaring gap in the health system capacity is human resources. 

Looking at low-income countries, about 93% have fewer than one audiologist per million population; 78% have fewer than one ear, nose, and throat specialist (ENT); 50% have one or more teacher available for people with hearing loss; and only 17% have one or more speech therapist per million.

The report outlines that this gap can be closed through integration of ear and hearing care into primary health care via strategies such as training and task sharing.

In countries with relatively high proportions of ear and hearing care professionals, there is an unequal allocation of specialists. This also places unreasonable demands on the teams providing these services along with posing challenges for people in need of care.

Causes and Prevention

In younger people, a whopping 60% of hearing loss can be prevented through initiatives such as improved maternal and neonatal care, immunisation for prevention of meningitis and rubella, and early management/screening for otitis media an inflammatory disease of the middle ear. In adults, safe listening, noise control, and monitoring of ototoxic medications along with good ear hygiene can help support good hearing and reduce the risk of hearing loss.

The first step in addressing hearing loss and related ear diseases is identification. Clinical screening at different stages in life makes certain that any loss of ear and hearing diseases can be identified as early as possible.

Current technological developments in community or clinical settings can identify hearing loss and ear disease at any age with limited training and resources. This enables screening to take place even in challenging times such as those experienced during the COVID-19 pandemic and for those living in remote and underserved areas of the world.

What can be done?

Early intervention is essential. Surgical and medical treatment can cure most ear diseases, with the potential to reverse the associated hearing loss. In the case where hearing loss is irreversible, rehabilitation can make sure that those affected avoid the adverse effects of hearing loss. There are a range of effective options available.

Technology such as cochlear implants and hearing aids when coupled with appropriate support and rehabilitation therapy are effective while also benefiting children and adults alike.

 “To ensure that the benefit of these technological advances and solutions is equitably accessible to all, countries must adopt an integrated people-centered approach,” said Dr Bente Mikkelsen, Director of the WHO Department of Noncommunicable Diseases. 

“Integrating ear and hearing care interventions within national health plans and delivering these through strengthened health systems, as part of universal health coverage, is essential to meet the needs of those at risk of or living with hearing loss.”

The report outlines that the use of sign language and other sensory substitutions such as speech reading are important options for people with hearing loss. Services such as captioning, sign language interpretation, and hearing assistive technology can further improve access to education and communication for those with hearing loss.