As a deaf child in India, Sneha Das Gupta struggled to make friends and to learn during classes at school. Fortunately, in her earliest years, she was able to do well because she had access to a hearing aid, as well as speech therapy and support from her teachers at school.  Today, she is a PhD student at the prestigious TATA Institute of Social Sciences.

Most people who are at risk of hearing loss, however, are less lucky than Sneha, struggling to communicate, study, and to earn a living, revealed the WHO’s first World Report on Hearing, published on Tuesday, ahead of World Hearing Day on 3 March. 

“Our ability to hear is precious,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “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.”

Over 1.5 billion People Affected – Another 1 Billion At Risk 

The number of people affected is massive, found the report, with over 1.5 billion people, from all walks of life, with some degree of hearing loss. And unless hearing care is prioritized and integrated into national health systems, that number will grow to 2.5 billion people by 2050, generating losses of over US$ 1 trillion a year to economies worldwide –  especially in low- and middle-income countries which harbor 80% of the total number of people with hearing loss. 

The report, published in collaboration with the US-based Institute of Health Metrics and Evaluation, found that most countries have failed to integrate hearing care into their national health systems, and that the bulk of people who need EHC services cannot access them – largely as a result of stigma associated with hearing loss, as well as insufficient human resources and services to deliver, fit, maintain and support use of the hearing aids.

“About 1 billion people around the world are at risk of avoidable hearing loss,” said Malala Yousafzai, Nobel laureate and UN messenger of peace. “WHO estimates that over 400 million, including 34 million children, live with disabling hearing loss, affecting their health and quality of life”, added Yousafzai, who has suffered from hearing loss herself. 

Because hearing loss severely impairs the cognitive and linguistic development of children, it can have lifelong impacts on their education and employability. People with moderate to severe hearing loss were half as likely to achieve higher education and twice as likely to be unemployed as people without hearing loss, the report notes.

The causes of hearing loss are often preventable, at least in children and young adults. In children, 60% of hearing loss can be prevented through vaccinations against preventable illnesses and treatment of common ear diseases. And 50% of young people aged 12–35 years – or one billion people – are at risk of losing their hearing due to exposure to unsafe sound levels in recreational settings. 

Workplaces & Public Venues Key To Reducing Risks  

The report also illustrates how practical solutions for workplaces and stricter legislation for public venues can reduce hearing loss risks. 

European countries such as France, Italy, the United Kingdom, and Czechia – have reported dwindling levels of noise-induced hearing loss (NIHL) in past years, largely as a result of hearing conservation programmes. In the US, for instance, a military hearing conservation programme found that workers were almost 30% less likely to develop hearing loss.

Meanwhile, strict legislation in Switzerland has ensured that audiences at public venues are offered free ear plugs. Together with other measures, this may explain why an impressive 40% of attendees in recreational venues in Switzerland wear hearing protection – a much higher percentage than in other countries. Such measures include: 

1. A limit on the average hourly sound levels to 100 A-weighted decibels.
2. Measurement and recording of sound levels.
3. Visible information and posters on safe listening.
4. Provision of “quiet areas” for events whose duration exceeds three hours. 

The report also calls on Member States to implement “HEARING”, a package of cost-effective interventions that include: screening and intervention; ear disease prevention and management; access to technologies; rehabilitation services; improved communication; noise reduction; greater community engagement.

Through HEARING, the WHO aims to boost the relative coverage of ear and healthcare services by 20%, building on the World Health Assembly’s resolution in 2017 to prevent deafness and hearing loss, and contributing to the Sustainable Development Goals – including SDG3 (good health and well-being), SDG4 (quality education), SDG8 (decent work and economic growth), and SDG10 (equality). 

Shortage Of Trained Specialists To Address Ear Health

The WHO’s report also found glaring disparities in the numbers of trained professionals equipped to help people with hearing issues. It found that 80% of LMICs have only 1 ear, nose and throat specialists (EAT) specialist per 1 million people – in contrast to 95% of high-income countries, which have ten times as many ENT specialists.

Similarly, the report found that 35% of countries in Africa had less than 1 teacher of the deaf per million people, in comparison to 15 teachers per million people in 50% of American and 42% of European countries, respectively. 

Using various case studies, the report also illustrates strategies to overcome the shortage of highly specialized professionals at a low-cost in a range of settings. 

On Kiribati’s island of South Tarawa, for instance, 25% of patients who presented at the island’s hospital suffered from ear problems – prompting authorities to train nurses to deliver ear health care to children in three primary schools. The strategy, which also included the set up of a specialized ear clinic on the island, contributed to a “dramatic decrease” in chronic ear problems faced by students.

Stigma As Key Barrier To Uptake Of Hearing Services 

The report also emphasizes that stigma is a key issue that has hampered progress in EHC care. In some communities, deaf babies are regarded as a “bad omen” that could bring misfortune. As a result, families are less likely to screen their children for hearing disabilities.

“Hearing loss has often been referred to as an “invisible disability”, not just because of the lack of visible symptoms, but because it has long been stigmatized in communities and ignored by policy-makers,” said Dr. Tedros in the report. 

Stigma could also explain why adults usually stall for ten years before seeking any hearing care, and why in high-income countries, three-quarters of the people that need hearing aids do not use them, even when they are available. 

Marketing strategies that promote hearing devices do not help either, notes the report, because they emphasize discreteness of their devices, thus reinforcing the belief that hearing devices should be hidden, and contributing to public reluctance to wear these devices – even when they are accessible. 

According to the WHO, usage of a hearing aid can reduce the years lived with disability (YLDs) due to unaddressed hearing loss by almost 60% – but only 68 million out of a total 400 million people in need actually use one.

Hearing Aids Are Expensive ; Six Manufacturers Produce 98% of Hearing Aids Worldwide

Apart from stigma, hearing devices can be expensive, and earmolds, batteries, and maintenance services are not always covered by health insurance. In countries like the US, the price of hearing aids ranges between US$ 500 and US$ 3000, although low-cost devices in India can be bought for as little as US$50.

Another issue that is likely to maintain high prices is the fact that a mere 6 manufacturers produce up to 98% of the hearing devices worldwide. And they mostly tailor their products to high-income markets, further complicating access in low-resource settings. 

Initiatives like pooled procurement, usage of solar-powered batteries and locally-sourced materials, or even innovative reimbursement schemes, can bolster access to hearing aids across a range of settings, suggests the report, noting that the UK’s pooled procurement scheme has fitted 750,000 hearing aids across all age groups in recent years.

Universal Screening Is Crucial 

Given that hearing lies at the heart of cognitive and linguistic development in children, health systems should attempt to screen children as early as possible, emphasizes the report. 

Perhaps surprisingly, many parents may be unaware of their children’s hearing difficulties, according to a Polish study of 71, 000 first-graders who were examined in over 4,000 schools. In the study, about half of parents who had children with hearing issues were unaware of their child’s condition. In total, almost 15% of all children who were screened were diagnosed with hearing loss, and referred for further care and treatment. 

Screening, however, should not be limited to children, given that 1.1 billion young people are at risk of permanent hearing loss due to exposure to unsafe sound levels in recreational settings.

Older people should also take part in screening programmes, as two thirds of people over the age of 60 experience some degree of hearing loss. 

Timely diagnosis of hearing loss in older people could also have another benefit – it could prevent up to 8% of cases of dementia in older adults, which is one of the major causes of disability in adults worldwide.

Image Credits: WHO/Otto Mejía, Eddie Linssen / WHO, Hear The World Foundation.