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Thursday, June 16, 2016

Hearing loss

This is the Editor's choice article in the latest Issue of Lancet. In view of the widespread prevalence of hearing loss, I reproduce that article below,
as I believe in sharing verified information.

Hearing loss: an important global health concern

“Deafness separates people from people”, said the deaf-blind American author Helen Keller. Hearing loss can have profound effects not only on interpersonal communication, but also on health, independence, wellbeing, quality of life, and daily function. In 2012, WHO estimated that 360 million people (5·3% of the world's population) were living with disabling hearing loss, while around 15% of the world's adult population had some degree of hearing loss. Disabling hearing loss is unequally distributed across the world, with the greatest burden in the Asia-Pacific area, southern Asia, and sub-Saharan Africa. Despite the fact that hearing loss can be prevented and treated, many people with hearing loss in both resource-poor and high-income settings do not seek or receive hearing health care, and the current production of hearing aids meets less than 10% of the global need.
Recognising the high unmet need of hearing health care in the USA, on June 2, the American National Academies of Sciences, Engineering, and Medicine issued a new report—Hearing Health Care for Adults: Priorities for Improving Access and Affordability. Establishing hearing loss as an important public health and societal concern is one of the key messages of the report, whereby hearing loss should no longer be regarded as an individual problem, but must be addressed by actions at multiple levels engaging individuals and families, the health-care community, non-profit organisations, industries, and government. The report identifies the major barriers to widespread use of hearing health care, including the high costs of hearing health care, lack of insurance coverage, the stigma associated with hearing difficulties and wearing hearing aids, and limited awareness of hearing health and the range of available options. Notably, nearly all of the costs of hearing health care are covered by the individual in the USA. Navigating the hearing health-care system can be confusing and frustrating for people living with hearing loss, as they can be left with no clear guidance on what will best fit their financial, health, social, and hearing needs, as pointed out by Dan G Blazer, chair of the Committee on Accessible and Affordable Hearing Health Care for Adults.
Accordingly, 12 recommendations to guide and mobilise the efforts of all the relevant stakeholders in the hearing health-care system are highlighted in the report. For instance, all the relevant agencies of hearing health care need to collaborate to improve population-based information on hearing loss and hearing health care, to develop and promote measures to assess and improve quality of hearing health-care services, and to empower consumers and patients in their use of hearing health care. Furthermore, the report acknowledges that evidence on the effectiveness of interventions and outcome evaluation are strikingly absent, and proposes a series of research needs and priorities such as randomised controlled clinical trials evaluating the efficacy of hearing aids and well-designed longitudinal population-based studies that adequately control for confounders to determine the effect of hearing loss on individuals, families, and society.
Although initially developed to inform hearing health care in the context of the USA, the report has global implications in terms of prevention and treatment, particularly when addressing hearing loss as an important global health challenge. However, one extremely important area the report fails to address is the serious health concern of children living with hearing loss. Worldwide, 9% of people living with hearing loss are children younger than 15 years, and the prevalence of disabling hearing loss in children in some low-income and middle-income regions can be several times that of high-income regions. The effect of hearing loss on a developing child is quite different from the effects of hearing loss that occurs in adulthood, with substantial negative influences on children's development and educational achievement. However, hearing loss in children can be mitigated through public health measures such as immunisation, avoiding the use of ototoxic drugs, and early identification and intervention for both acute and chronic ear conditions.
Hearing loss has been ranked as the fifth leading cause of years lived with disability in the Global Burden of Disease Study 2013, higher than many other chronic diseases such as diabetes, dementia, and chronic obstructive pulmonary disease. However, hearing loss receives limited research funding and public awareness. Global multidisciplinary and collaborative efforts are urgently needed to address the health needs of the child and adult with hearing loss. Hearing loss cannot and must not continue to be a silent epidemic.
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Foot Note. In UK, National Health Service lends hearing aids on long term basis - practically for life time and renders free servicing also.இன்னம்பூரான்