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World Wide Hearing Takes Fast Track to High-Volume Hearing Aid Fittings

de Carpentier, Brother Andrew A.L.

doi: 10.1097/01.HJ.0000429450.62362.a1

Brother de Carpentier is chairman of World Wide Hearing and executive director of the Holy Land Institute for Deaf and Deafblind Children in Salt, Jordan.

Figure. B

Figure. B

World Wide Hearing was created to fill an enormous gap in the provision of services for the millions of children and adults with hearing loss in developing countries. These individuals can be helped fairly simply with a relatively low-cost intervention, but somehow they tend to fall through the cracks of the global disability safety net.

It is estimated that only 1 of 40 people in developing countries has access to a needed hearing aid. Certain communities in more affluent societies are just as in need, such as the Inuit population of Canada, the elderly populations of affluent Asian countries, the children of the desert in some of the richest countries in the world, and the multihandicapped children and young people in any society.

We face numerous challenges in providing better hearing. The first problem is the staggering number of people with disabling hearing loss—an estimated 300 million worldwide. In addition, hearing aid fitting and delivery systems are complicated, time-consuming, and not very consumer oriented. There is an enormous dearth of audiology clinics and providers; recuperation of cost is an almost impossible objective in a low-income market. Although the manufacturing costs of hearing aids are relatively low—a top-of-the-line digital hearing aid can be had for less than $100—the cost of fitting easily doubles or otherwise multiplies that amount. On top of that, repair and maintenance services are sparse, batteries expensive, and earmold laboratories few and far between.



After six years of deliberations with the World Health Organization and CBM, World Wide Hearing was established in 2006 for the purpose of creating change and “making hearing matter.” In order to do that, the organization has developed ways to increase the number of hearing aids fitted in developing countries. Through preparatory and exploratory activities, World Wide Hearing eventually broke the mold of conventional thinking, which tends to blame expensive hearing aids and stigma for the problems in hearing healthcare access while seeking solutions in even more complicated and expensive devices.



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Looking at ear and hearing health as a health issue and better hearing as a functional hearing issue represents two different approaches. Hearing health belongs in the realm of otolaryngology and related professions. Better hearing is the fief of audiologists or hearing specialists. We have learned much about this distinction from our colleagues in ophthalmology and optometry, who divorced eye and vision health from better vision through standard refraction and over-the-counter eyeglasses.



Traditional medical/audiological and hearing aid services focus on both ear health and better hearing, which is fine, but it's a slow process and difficult to accelerate. Separate and distinct services for better hearing can now be provided much more simply and rapidly, and can be scaled up exponentially.

Recognizing these considerations, World Wide Hearing promotes a multi-track model of hearing aid fitting and delivery. Taking the traditional approach, the first track is concerned with ear and hearing health. It is suited to difficult cases needing special audiology services and is needed for training programs and research. The second track is traditional as well but tailored to infants and children, whose treatment requires more experience and investigations of a sensitive nature.

Quick fit—the third approach—uses computers and software-based instruments and applications to speed up medical and audiological services. It should bring down costs dramatically through the use of cheaper digital equipment.

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A fourth track is being designed specifically for services that pertain only to better hearing, applying innovative processes that speed up and facilitate the fitting of large volumes of hearing aids in developing countries, leaving the troubleshooting to scientists and the medical issues to the medical community (tracks 1, 2, and 3).

The latest hearing aid technology is bringing intelligent and self-fitting hearing aids to market, helping us reach those objectives. High-quality, self-fitting ear molds will soon be available as well.

Services can be provided by trained technician-level staff. The training of such technicians by audiological scientists specifically notes what they can and cannot do, as well as when they should refer medical conditions. This approach does not in any way affect the current standard audiological procedures, instead providing a new and parallel stream of services within and beside conventional delivery systems.

The key to the rapid fitting of high volumes of hearing aids is affordability and a smooth, reliable, viable, and sustainable distribution system. MicroConsignment Models of service delivery are being developed.

World Wide Hearing is currently working on field tests and experimental fitting programs. With such practical experience behind us, we hope to make the process available to interested parties and put the approach to further use in developing countries.

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The World Wide Hearing International Conference 2013 is planned for May 14 and15 in Jordan. The organization will showcase Hearing Express products and the models being developed for good business practices. More details are available at:

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Audiology Without Borders

Our Audiology Without Borders column, featured each month in the HJ eNewsletter, highlights humanitarian hearing healthcare programs.

The column is edited by active humanitarians Jackie Clark, PhD, and King Chung, PhD. Dr. Clark is a clinical associate professor at the University of Texas at Dallas and a research scholar at University of the Witwatersrand in Johannesburg; and Dr. Chung is an associate professor of audiology at Northern Illinois University in DeKalb.

Let us know about your humanitarian program! Send the details to—manuscripts should be about 1,000 words, and photographs are also welcome (300 dpi in jpg, tif, or gif format).

Read past Audiology Without Borders columns in a special collection at

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