The results of the most recent studies on Global Burden of Disease (GBD) indicate
a growing and, now, alarming burden of hearing loss.
Researches involved in hearing loss are being targeted to provide detailed information
that decision-makers need to position hearing loss among health care priorities; to
present best practices for hearing health care; to indicate the many additional conditions
of change for hearing healthcare around the world; and to offer recommendations to
first stop the burden of hearing loss growth and then to reduce it.
One of the key drivers of economic vitality is an educated and healthy workforce.
In addition, the proportions of jobs that depend on spoken communication or on high
literacy, or on both, are high, and are growing rapidly worldwide.
The important points to consider are:
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The absence or substantial attenuation of auditory input to the brain alters the connectivity
and processing of the brain, especially before the age of 3 years old, and perhaps
again after the age of 60 years old.
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Children with severe or with a considerable degree of hearing loss have a lower literacy
level than their listening peers, and their educational achievements are severely
compromised.
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Most adults with disabling hearing loss have a feeling of deep isolation and, typically,
distance themselves from society, and even from family interactions.
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Many people with hearing loss try to hide it, because it is commonly associated with
aging and low intelligence. Stigma can prevent treatment and greatly reduce self-esteem.
Psychological illnesses are more prevalent in individuals with hearing loss than in
the general population.
Prevalence
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10% of the world population has some hearing impairment.
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Between 5 and 6% of the world population presents some degree of hearing loss.
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Approximately 2% of the world population presents severe and profound hearing loss.
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The World Health Organization (WHO) predicts that, by 2050, 500 million young people
and young people will have hearing loss due to the use of headphones.
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The number of elderly people impacted by hearing loss is increasing, and almost 100%
of the elderly population worldwide will have hearing loss.
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Hearing loss is the most common communicable disease in man.
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Severe and profound hearing loss:
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From 1 to 6 in 1,000 normal live births.
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From 1 to 4 in 100 newborns attended at a neonatal intensive care unit.
All data suggest that a high emphasis on the prevention and on the treatment of childhood
hearing loss would be more effective in reducing the burden of hearing loss in countries
at the lower levels of economic prosperity and of sociodemographic indices, while
special attention to adults would be more effective in highly developed countries.
In the last annual GBD[1], it was announced that hearing loss ranked 4th among 347 illnesses in years of life lost through disability (YLD).
According to the WHO, ∼ 50% of hearing loss cases could be avoided, and most of the
remaining ones could be treated effectively.
The WHO and the World Bank have categorized prevention at three levels: primary prevention
to avoid an adverse health condition; secondary prevention to detect a condition at
an early stage and to treat it promptly; and tertiary prevention to reduce the impact
of an established condition and to restore function to the maximum possible extent.
Prevention is usually better than treating a condition; it is usually less expensive
and can often be implemented at the community level. Among the avoidable causes are
otitis media, maternal rubella, other infectious diseases, birth problems, excessive
use of ototoxic drugs, consanguinity, and exposure to harmful sounds.
Secondary and tertiary interventions are generally more expensive than primary prevention,
but are becoming more viable in many low- and middle-income countries due to the improvement
of their economies. Thus, the scope of decision-making considerations can be expanded
to further reduce the burden of hearing loss.
The main treatments for hearing loss today are hearing aids for mild to severe loss,
and cochlear implants for severe to complete loss.
A cost-effectiveness analysis (CEA) can provide cost and cost-effectiveness inputs
that can assist with decisions. The results may indicate whether an addition to an
existing combination of interventions would be very cost-effective, cost-effective,
or not cost-effective.
Cost-effectiveness analyses have been made to evaluate interventions for hearing loss
in low- and middle-income countries: chronic otitis media with aural hearing aid plus
topical antibiotics and meningitis.
A generalized CEA that includes a broad spectrum of possible interventions for hearing
loss prevention and treatment still needs to be done for each country or region.
Hearing health professionals are lacking in most low- and middle-income countries.
Impediments to increasing or even maintaining supply include inadequate funding for
the education of these professionals, migration of trained professionals to high-income
countries, low pay, and lack of a career plan for nonmedical hearing healthcare professionals.
The high and increasing burden of hearing loss should be a compelling argument for
collaboration and international assistance. Even before the present burden, the WHO
and nongovernmental organizations (NGOs), such as the Fundação de Otorrinolaringologia
(Otorhinolaryngology Foundation), in Brazil, have been working for decades to improve
hearing health care services.
Fortunately, other factors favor the additional funding needed: the shift in emphasis
from noncommunicable diseases and injuries to prominent development agencies and NGOs;
the fact that 5 of the 17 United Nations (UN) 2030 targets for sustainable development
are “inclusive of disability” goals; and the rights of individuals with disabilities
to receive the best health care and education available, and to participate as widely
as possible in society, as repeatedly and forcefully affirmed by the UN and as required
by the laws of many countries.
The current costs are high, but could be reduced by innovations in technology, new
models, and more competition. For cochlear implants, for example, smart choices and
increased competition can also produce large reductions in costs.
In addition, the assessment of hearing loss and the adaptation of hearing aids and
of cochlear implants remotely via internet, and appropriate equipment and personnel
at each end have the potential to dramatically increase the impact of hearing health
professionals, particularly in the coverage of large geographic areas.
In middle-income, populous countries, and in large regions of the world, setting up
centers of excellence could reduce costs and improve the handling of complex cases,
as has been experienced in high-income countries and in some middle-income countries.
These centers bring together in one place the knowledge needed for complex cases and
reduce costs through scale efficiencies.
Committees were created in at least 24 countries. The groups represented on the committees
usually include professional associations, academic institutions, organizations for
persons with disabilities, NGOs, and Ministries of Health, Education, and Social Assistance.
The important point is that country-level engagement is critical to the optimal provision
of hearing healthcare, in which conditions may vary widely from country to country,
and most decisions are made at the national level.
Doctors, speech therapists, scientists, and other health professionals at universities
should be heavily involved in hearing healthcare. Health foundations can also help
to reduce the impact of hearing loss.
Global multidisciplinary and collaborative efforts are needed to address the health
needs of children and of adults with hearing loss. Hearing loss cannot and should
not continue to be a silent epidemic.
