2 March 2021 │ Geneva │
Nearly 2.5 billion people worldwide ─ or 1 in 4 people ─ will be living with some degree of hearing loss by 2050, warns the World Health Organization’s (WHO) first World Report on Hearing, released today. At least 700 million of these people will require access to ear and hearing care and other rehabilitation services unless action is taken.
“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.”
The report, launched ahead of World Hearing Day on 3 March, underlines the need to rapidly step up efforts to prevent and address hearing loss by investing and expanding access to ear and hearing care services. Investment in ear and hearing care has been shown to be cost-effective: WHO calculates that governments can expect a return of nearly US$ 16 for every US$ 1 invested.
Main findings of the report
Lack of accurate information and stigmatizing attitudes to ear diseases and hearing loss often limit people from accessing care for these conditions. Even among health-care providers, there’s often a shortage of knowledge about prevention, early identification and management of hearing loss and ear diseases, hampering their ability to provide the care required.
In most countries, ear and hearing care is still not integrated into national health systems and accessing care services is challenging for those with ear diseases and hearing loss. Moreover, access to ear and hearing care is poorly measured and documented, and relevant indicators are lacking in the health information system.
But the most glaring gap in health system capacity is in human resources. Among low-income countries, about 78% have fewer than one ear, nose and throat (ENT) specialist per million population; 93% have fewer than one audiologist per million; only 17% have one or more speech therapist per million; and 50% have one or more teacher for the deaf per million. This gap can be closed through integration of ear and hearing care into primary health care through strategies such as task sharing and training, outlined in the report.
Even in countries with relatively high proportions of ear and hearing care professionals, there is unequal distribution of specialists. This not only poses challenges for people in need of care, but also places unreasonable demands on the cadres providing these services.
Main causes of hearing loss
In children, almost 60% of hearing loss can be prevented through measures such as immunization for prevention of rubella and meningitis, improved maternal and neonatal care, and screening for, and early management of, otitis media – inflammatory diseases of the middle ear. In adults, noise control, safe listening and surveillance of ototoxic medicines together with good ear hygiene can help maintain good hearing and reduce the potential for hearing loss.
Identification is the first step in addressing hearing loss and related ear diseases. Clinical screening at strategic points in life ensure that any loss of hearing and ear diseases can be identified as early as possible.
Recent technological advances, including accurate and easy-to-use tools, can identify ear disease and hearing loss at any age, in clinical or community settings, and with limited training and resources. Screening can even take place in challenging situations such as those encountered during the COVID-19 pandemic and those living in underserved and remote areas of the world.
Access to timely and appropriate care
Once diagnosed, early intervention is key. Medical and surgical treatment can cure most ear diseases, potentially reversing the associated hearing loss. However, where hearing loss is irreversible, rehabilitation can ensure that those affected avoid the adverse consequences of hearing loss. A range of effective options are available.
Hearing technology, such as hearing aids and cochlear implants, when accompanied by appropriate support services and rehabilitative therapy are effective and cost-effective and can benefit children and adults alike.
The report notes that the use of sign language and other means of sensory substitution such as speech reading are important options for many deaf people; hearing assistive technology and services such as captioning and sign language interpretation can further improve access to communication and education for those with hearing loss.
“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.”
Deafness and hearing loss
Key facts
- Globally, 1.5 billion people live with some degrees of hearing loss out of which around 430 million people require rehabilitation services for their hearing loss.
- By 2050 nearly 2.5 billion people are projected to have some degree of hearing loss and at least 700 will require hearing rehabilitation.
- Hearing loss may result from genetic causes, complications at birth, certain infectious diseases, chronic ear infections, exposure to loud sounds, use of ototoxic medicines, and ageing.
- In children, almost 60% of hearing loss is due to causes such as ear infections and birth complications that can be prevented through public health measures.
- Over 1 billion young adults are at risk of permanent, avoidable hearing loss due to unsafe listening practices.
- Unaddressed hearing loss is expensive to communities worldwide and costs governments US$ 980 billion annually. Interventions to prevent, identify and address hearing loss are cost-effective and can bring great benefit to individuals.
- Of those who could benefit with the use of a hearing aid, only 17% actually use one. The gap is consistently high in all parts of the world, ranging from 77% to 83% across WHO regions, and from 74% to 90% across income levels.
- An annual additional investment of less than US$ 1.40 per person is needed to scale up ear and hearing care services globally.
- Over a 10-year period, this promises a return of nearly US$ 16 for every US dollar invested.
Over 5% of the world’s population – or 430 million people – require rehabilitation to address their ‘disabling’ hearing loss (432 million adults and 34 million children). It is estimated that by 2050 over 700 million people – or one in every ten people – will have disabling hearing loss.
‘Disabling’ hearing loss refers to hearing loss greater than 35 decibels (dB) in the better hearing ear. Nearly 80% of people with disabling hearing loss live in low- and middle-income countries. The prevalence of hearing loss increases with age, among those older than 60 years, over 25% are affected by disabling hearing loss.
Hearing loss and deafness
A person who is not able to hear as well as someone with normal hearing – hearing thresholds of 20 dB or better in both ears – is said to have hearing loss. Hearing loss may be mild, moderate, severe, or profound. It can affect one ear or both ears, and leads to difficulty in hearing conversational speech or loud sounds.
‘Hard of hearing’ refers to people with hearing loss ranging from mild to severe. People who are hard of hearing usually communicate through spoken language and can benefit from hearing aids, cochlear implants, and other assistive devices as well as captioning.
‘Deaf’ people mostly have profound hearing loss, which implies very little or no hearing. They often use sign language for communication.
Causes of hearing loss and deafness
Although these factors can be encountered at different periods across the life span, individuals are most susceptible to their effects during critical periods in life.
Prenatal Period
- Genetic factors – Include hereditary and non-hereditary hearing loss
- Intrauterine infections – such as rubella and cytomegalovirus infection
Perinatal period
- Birth asphyxia (a lack of oxygen at the time of birth
- Hyperbilirubinemia (severe jaundice in the neonatal period)
- Low-birth weight
- Other perinatal morbidities and their management
Childhood and adolescence
- Chronic ear infections (chronic suppurative otitis media)
- Collection of fluid in the ear (chronic nonsuppurative otitis media)
- Meningitis and other infections
Adulthood and older age
- Chronic diseases
- Smoking
- Otosclerosis
- Age-related sensorineural degeneration
- Sudden sensorineural hearing loss
Factors across the life span
- Cerumen impaction (impacted ear wax)
- Trauma to the ear or head
- Loud noise/loud sounds
- Ototoxic medicines
- Work related ototoxic chemicals
- Nutritional deficiencies
- Viral infections and other ear conditions
- Delayed onset or progressive genetic hearing loss
The impact of unaddressed hearing loss
When unaddressed, hearing loss impacts many aspects of life at individual level:
Communication and speech
Cognition
Education and Employment: In developing countries, children with hearing loss and deafness often do not receive schooling. Adults with hearing loss also have a much higher unemployment rate. Among those who are employed, a higher percentage of people with hearing loss are in the lower grades of employment compared with the general workforce.
Social isolation, loneliness and stigma
Impact on society and economy
Years Lived with Disability (YDLs) and Disability Adjusted Life Years (DALYs)
WHO estimates that unaddressed hearing loss poses an annual global cost of US$ 980 billion. This includes health sector costs (excluding the cost of hearing devices), costs of educational support, loss of productivity, and societal costs. 57% of these costs are attributed to low- and middle-income countries.
Prevention
Many of the causes that lead to hearing loss can be avoided through public health strategies and clinical interventions implemented across the life course.
Prevention of hearing loss is essential throughout the life course – from prenatal and perinatal periods to older age. In children, nearly 60% of hearing loss is due to avoidable causes that can be prevented through implementation of public health measures. Likewise, in adults, most common causes of hearing loss, such as exposure to loud sounds and ototoxic medicines, are preventable.
Effective strategies for reducing hearing loss at different stages of the life course include:
- immunization;
- good maternal and childcare practices;
- genetic counselling;
- identification and management of common ear conditions;
- occupational hearing conservation programmes for noise and chemical exposure;
- safe listening strategies for the reduction of exposure to loud sounds in recreational settings; and
- rational use of medicines to prevent ototoxic hearing loss.
Identification and management
- Early identification of hearing loss and ear diseases is key to effective management.
- This requires systematic screening for detection of hearing loss and related ear diseases in those who are most at risk. This includes:
- Newborn babies and infants
- Pre-school and school-age children
- People exposed to noise or chemicals at work
- People receiving ototoxic medicines
- Older adults
- Hearing assessment and ear examination can be conducted in clinical and community settings. Tools such as the WHO “hearWHO” app and other technology-based solutions make it possible to screenfor ear diseases and hearing loss with limited training and resources.
- Once hearing loss is identified, it is essential that it is addressed as early as possible and in an appropriate manner, to mitigate any adverse impact.
- Measures available to rehabilitate people with hearing loss include:
- the use of hearing technologies, such as hearing aids, cochlear implants and middle ear implants;
- the use of sign language and other means of sensory substitution, such as speech reading, use of print on palm or Tadoma, signed communication; and
- rehabilitative therapy to enhance perceptive skills and develop communication and linguistic abilities.
- The use of hearing assistive technology, and services such as frequency modulation and loop systems, alerting devices, telecommunication devices, captioning services and sign language interpretation, can further improve access to communication and education for people with hearing loss.
WHO response
WHO’s work on ear and hearing care is to promote integrated people-centred ear and hearing care (IPC-EHHC).
WHO’s work is guided by the recommendations of the WHO World report on hearing (2021) and the World Health Assembly resolution on prevention of deafness and hearing loss.
WHO’s work includes:
- guide, assist and support Member States to increase awareness on EHC issues;
- facilitate data generation and dissemination of ear and hearing care related data and information (link);
- providing technical resources and guidance to facilitate planning and health systems capacity building for ear and hearing care (link);
- supporting heath workforce training in ear and hearing care (link);
- promoting safe listening to reduce the risk of recreational noise-induced hearing loss through the WHO Make Listening Safe initiative;
- observing and promoting World Hearing Day as an annual advocacy event;
- building partnerships to develop strong hearing care programmes, including initiatives for affordable hearing aids, cochlear implants and services;
- Advocating for ear and hearing care through the World Hearing Forum.
