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So Many Ears and So Few Audiologists

Hall, James W. III PhD

doi: 10.1097/01.HJ.0000445220.22112.f2

Dr. Hall is a member of The Hearing Journal’s Editorial Advisory Board, as well as adjunct professor in the Department of Audiology at Nova Southeastern University in Fort Lauderdale, FL, and in the George S. Osborne College of Audiology at Salus University in Elkins Park, PA, and extraordinary professor in the Department of Communication Pathology at the University of Pretoria in South Africa.



I'm writing this editorial from India, where I'm lecturing at the 46th National Convention of the Indian Speech and Hearing Association. India is a good example of the global hearing healthcare challenge.

About 62 million people in India have serious bilateral hearing loss, and the number of people with any degree of hearing loss affecting communication is much higher. Each of the 1,500 registered audiologists/speech pathologists would need to see about 20,000 patients per day to even begin to provide hearing care services to those who need them the most.

In a rather long list of countries, many in Africa, no audiologists are available to identify, diagnose, and manage children and adults with hearing loss and related conditions.

What steps can we take to address this unacceptable situation? Four possible options come to mind immediately.

One long-term approach is the systematic development of an audiology presence in all developing countries. It would begin with the identification of a handful of bright young people who are highly motivated to enter a healthcare profession.

These individuals would be funded to complete formal audiology education where it exists before returning to their home country to become the “mothers and fathers of audiology” there. They would also need to acquire knowledge and skills in social entrepreneurship to enhance the chance of success against rather difficult odds.

Three other options are in the early stages of implementation. One is tele-audiology. Research confirms that providing specific diagnostic tests or treatment strategies remotely through tele-audiology yields equivalent findings and outcomes as traditional face-to-face service (Int J Audiol 2010;49[3]:195-202

Another option is the use of automated technology to identify hearing loss and facilitate its diagnosis in children and adults. Clinical devices now are available for automated objective test procedures, such as otoacoustic emissions and auditory brainstem response, as well as pure-tone audiometry.

Automation permits reliable hearing testing by non-audiologists with statistical analysis of findings outside the confines of a sound-treated room (Int J Audiol 2013;52[2]:66-73

A final option is growth of a global workforce of systematically educated and trained hearing care technicians who work with audiologists and physicians. Technicians will contribute importantly to efficient and cost-effective expansion of needed services in countries lacking adequate professional person-power.

Recently, I joined forces with my colleagues Drs. Jackie Clark, Richard Gans, James Saunders, and De Wet Swanepoel to develop a 20-course sequence for an entirely online educational program called the International Hearing Care Technician (IHCT) Certificate (

Course materials include narrated lectures with video clips and other teaching aids. Technician students measure learning progress with posttests for each course.

Yes, the numbers are almost unbelievable, and the task is daunting, but we now have the tools and resources to greatly expand quality hearing healthcare in all areas of the world, and especially in developing countries where potential patients need it the most.

© 2014 by Lippincott Williams & Wilkins, Inc.