Support to ATscale to develop audiological profiles for pre-programmable hearing aids and to analyse operational experience of the use of pre-programmable hearing aids in low & middle-income countries

Please note that a modest amount of flexibility is available to accommodate travel restrictions due to the coronavirus pandemic, to be discussed.

Globally, approximately 466 million people have disabling hearing loss, a number expected to double by 2050 due to ageing populations, untreated ear infections, ototoxicity, and noise exposure.

The World Health Organization (WHO) estimates that unaddressed hearing loss costs the global economy USD 750 billion annually, with a negative impact on education, social life and employability of those with hearing loss. Currently, WHO estimates that 72 million people worldwide need hearing aids; however, hearing aid coverage is only 10% globally and less than 3% in low- and middle-income countries (LMICs). This is in large part due to barriers such as limited investment from governments, the high cost of products and services, and a resource-intensive service delivery model, as well as low interest from global suppliers in LMIC markets.

Hearing aids are a uniquely tailored and personalised assistive technology.

Hearing aids must be adjusted to match the amplification and perceptive needs of each individual user and can serve some, but not all, levels of severity of hearing loss. Different hearing aids are distinguished by amplification power, amplification technology (analogue vs. digital), sound processing capabilities, style, battery types used, and special features (such as Bluetooth, artificial intelligence, etc).

The process of obtaining a hearing aid in most LMICs is lengthy, costly, and a burden on the health system. Obtaining a typical hearing aid requires a process of screening the patient, diagnosing hearing loss, selecting a device, fitting the device, and then long-term follow-up care and rehabilitation. Technologies for screening and diagnosis are typically prohibitively expensive, and the process relies on highly trained technicians and audiology specialists to select, fit, and programme the aid for the user over multiple visits. In LMICs, these requirements become barriers, which reduce access to hearing care, and hearing aids as there are fewer trained specialists and screening technologies are less affordable. However, private sector research largely focuses on higher-end products, which do not aim to overcome these barriers, and more work is needed to understand the potential impact of some innovative technologies, which could bypass these issues in service delivery for hearing aids.

Innovative hearing aid technologies can reduce barriers related to personnel, infrastructure, cost, and reach of services. Pre-programmable hearing aids are one example of an innovative product, which can simplify service delivery, empower users, and expand access. They take advantage of the fact that most people with a hearing impairment have one discreet type of audiological profile, and that any given population has a number of discreet profiles, which are common. Rather than generating a custom profile fit per user, the pre-programmed aids mimic common profiles, leaving only the volume to be adjusted by the user or a low-skilled provider. Suppliers pre-load hearing aids appropriate to different profiles, and a technician selects one to match a user’s audiogram. Pre-programmable hearing aids could dramatically expand access to support for the hearing impaired in LMICs.

Pre-programmed hearing aids could be profoundly beneficial in increasing access to hearing aids in LMICs, as they reduce the need for highly skilled technicians, reduce the cost, and do not require the user to be technically proficient. However, there has been limited research into the suitability of pre-programmable hearing aids in LMICs, the range and prevalence of audiological profiles in different populations, how the hearing aids could be introduced, and how they would be received.