Hearing loss is a chronic disability, with 466 million people worldwide residing with permanent disabling hearing loss and this figure estimated to double by 2050 (WHO, 2019). The steady increase in global life-expectancy means that hearing loss is increasing and, unsurprisingly, has become a leading contributor to the global burden of disease. Unfortunately, almost 90% of persons with hearing loss live in low- and middle-income countries (LMICs), where hearing healthcare services remain limited.
What are the challenges and possible solutions?
Early access to care, which is out of reach for most people with hearing loss in LMICs, is critical to ensure optimal outcomes for persons with hearing loss. Challenges for accessible hearing care include awareness, severely limited human resources, the cost of audiological equipment and the level of expertise required to operate traditional equipment (Swanepoel & Clark, 2019). Novel solutions, capitalizing on connectivity and technology, promise to increase access and quality of care whilst reducing costs. Mobile phone penetration has seen exponential growth over the past two decades with more than 90% of the world populations having access to a mobile signal. Mobile connectivity has been an important driver for progress towards reaching the sustainable development goals (GSMA, 2018). Greater access to mobile technology is clearly associated with improvements in quality of life (GSMA, 2018). In combination with exponential growth in technological advances like the smartphone, these tools can drive hearing health penetration in LMICs.
Connected technologies already making a difference
Examples of this are already forging new service delivery models that are community-based and decentralized. In South Africa, where children don’t have access to systematic screening for hearing loss, pilot programs utilizing smartphone-based hearing screening (hearScreenTM) are ensuring preschool children are screened and linked to appropriate care. Using simple user-interfaces and automated test sequences allow lay health workers to be trained to facilitate hearing screening (Yousuf-Hussein et al., 2018; Yousuf-Hussein et al., 2016). Integrated quality control measures ensure the environment and test operator compliance can be monitored remotely by program managers. Referrals based on geolocation can link children directly to their closest clinics through automated text messages to caregivers (Yousuf-Hussein et al., 2018). Including mobile phone-based visual acuity screening allows lay community members to facilitate sensory screening in preschool children.
In another example, consumer-based hearing screening can be offered as a downloadable app on iOS and Android smartphones. The South African National Hearing Screening test, hearZATM, was launched in 2016, employing a validated digits-in-noise speech recognition test (Potgieter et al., 2016; Potgieter et al., 2018). The App allows a rapid screening test, after which users can connect with their closest audiologist within the app based on their location. To date thousands of people have been identified with hearing loss using the app with hundreds of appointments made with audiologists (De Sousa et al., 2018). The success of this app has resulted in the launch of hearScreen USA in partnership with the American Academy of Audiology and the hearWHO app launching on World Hearing Day 2019 (WHO, 2019).
Supporting hearing care across the patient journey
These examples illustrate some of the ways connected technologies can support scalable ways of widespread access to hearing care. Decentralized and community-based models can improve the reach, efficiency and impact of hearing care and bridge the gap, especially in LMICs (Swanepoel & Clark, 2019). As these types of connected technologies mature, they may support the entire continuum from awareness, detection right through to interventions and long-term surveillance.
Prof De Wet Swanepoel’s recorded webinar on this same topic will be available on Phonak Learning (accessible in participating countries). Watch for its promotion on social media or search #eaudiologyphonak directly on LinkedIn, Twitter and Facebook. For more information on all eAudiology webinars, please visit https://learning.phonakpro.com/
De Sousa, K. C., Swanepoel, D., Moore, D., & Smits, C. (2018). A smartphone national hearing test – performance and characteristics of users. American Journal of Audiology, 27, 448-54.
GSMA Intelligence. (2018). 2018 Mobile industry impact report: Sustainable development goals. Retrieved from https://www.gsmaintelligence.com/research/?file=ecf0a523bfb1c9841147a335cac9f6a7&download
Potgieter, J. M, Swanepoel, D., Myburgh, H. C., Hopper, T. C., & Smits, C. (2016). Development and validation of a smartphone-based digits-in-noise hearing test in South African English. International Journal of Audiology, 55(7), 405-11.
Potgieter, J. M., Swanepoel, D., Myburgh, H. C., & Smits, C. (2018). The South African English smartphone digits-in-noise hearing test: Effect of age, hearing loss, and speaking competence. Ear and Hearing, 39(4), 656-63.
Swanepoel, D., & Clark, J. L. (2019). Hearing healthcare in remote or resource-constrained environments. The Journal of Laryngology & Otology, 133, 11-17.
World Health Organization [WHO]. (2019). Deafness prevention. Retrieved from https://www.who.int/deafness/en/
Yousuf Hussein, S., Swanepoel, D., Biagio de Jager, L., Myburgh H, Eikelboom, R. H., & Hugo, J. (2016). Smartphone hearing screening in mHealth assisted community-based primary care. Journal of Telemedicine and Telecare, 22(7), 405-12.
Yousuf Hussein, S., Swanepoel, D., Mahomed-Asmail, F., & Biagio de Jager, L. (2018). Community-based hearing screening for young children using an mHealth service-delivery model. Global Health Action, 11(1), 1467077.