Audiology Without Borders
Non-fatal conditions such as hearing loss are increasingly becoming dominant contributors to the burden of disease. For example, the latest Global Burden of Disease Study estimated that 1.23 billion people had some form of hearing impairment (20 dB or more), of which 414.5 million had moderate or greater hearing loss. This ranks hearing loss as the 5th most significant contributor to the global burden of disease based on years lived with disability.
The impact of hearing loss prevalence on the global burden of disease is further exacerbated by the inaccessibility of hearing health services for the majority of the world's population. In sub-Saharan Africa, for example, many countries have more than a million people per hearing health provider (bit.ly/29fyA6X http://bit.ly/29fyA6X; WHO, 2013a http://bit.ly/29fzMXC). This shortage is also evident in high-income countries with training programs that are unable to meet the rising demand for hearing loss services among the aging population (Windmill. J Am Acad Audiol 2013;24:407 http://bit.ly/29fz8JZ).
Early access to ear and hearing health care is key to ensuring optimal outcomes. In fact, up to 50 percent of hearing loss cases could be prevented through primary and secondary measures (WHO, 2013b http://bit.ly/29fzUGD). People with permanent hearing loss but have early access to appropriate care can have excellent outcomes and endure minimal impact of the disability and its associated psychosocial difficulties.
Considering the scale of the hearing loss burden and the limited access to hearing health care, alternative solutions are necessary. One of the burgeoning fields in health service provision is mHealth, broadly defined as any use of mobile technology to address health care challenges such as access, quality, affordability, matching of resources, and behavioral norms (bit.ly/29fAxA9). It demonstrates the promise to improve access and well-being of people around the world.
There has been a growing interest to employ mHealth in ear and hearing health care provision as a means of improving access to care, especially in underserved regions across the globe (Clark. Disabil Rehabil Assist Technol 2014;9:408 http://bit.ly/29fAHYj). One of these developments is an innovative smartphone application developed at the University of Pretoria in South Africa called hearScreen (Figs. 1 & 2). While there are many end-user apps available that provide some form of hearing test, none of these allow for actual calibration of headphones according to international and national standards (e.g., ISO, ANSI). hearScreen features accurate headphone calibration according to mandatory standards using a low-cost smartphone. This validated application automates screening protocols and interpretation for adults and children according to best practice guidelines. It has a simple, user-friendly interface and onscreen instructions that allow screening to be facilitated by people with minimal training. The smartphone microphone is equipped with intelligent real-time noise monitoring to evaluate if test outcomes are influenced by environmental noise. All patient details and results are captured intuitively on the smartphone and uploaded to a cloud-based server for remote data management and surveillance. Geotagged results link patients with the closest hearing health care providers.
These features make hearScreen uniquely suited to community-based hearing health care centers with minimally trained personnel (Swanepoel. Int J Audiol 2014;53:841 http://bit.ly/29fBd8u). A recent evaluation of the use of hearScreen on school children demonstrated similar sensitivity and specificity compared with existing screening audiometers (Mahomed. Ear Hear 2016;37:e11 http://bit.ly/29fBDvX). The screenings were done using a low-cost smartphone ($80) and supra-aural headphones. A follow-up study is currently investigating a model in which schools have their own hearScreen devices to allow teachers or other personnel to conduct screening at logistically convenient times. This model also allows for prompt screening of children who demonstrate academic failure or behavioural difficulties during the course of an academic year or for those whose parents or teachers have concerns.
In another community-based project, 24 community health care workers (CHWs) from an underserved community used their smartphones, which they employ for health registrations and risk assessments in homes, to conduct hearing screenings with a calibrated headphone linked to the hearScreen application. They screened close to 1,000 children and adults in their homes over a 12-week period. Patients were linked to their closest primary health care clinic for follow-up services. The consensus amongst CHWs was that the hearing tests were easy to conduct and community members valued the service (Yousuf. J Telemed Telecare 2015 http://bit.ly/29fBYi2).
Innovative mHealth solutions like hearScreen present new ways to offer health care access to people at a grassroots level. A low-cost solution can be made widely available so that laypersons can administer hearing screenings. In fact, this type of solution can change school hearing health models by providing schools with their own devices to take responsibility for the hearing health of students. Similarly, CHWs or other community members can conduct screening in homes. Screening results managed centrally allow for direct reporting to parents or patients by email or text messaging, while linking them with the closest hearing health providers. Integrated cloud-based data management and surveillance provide detailed reporting of program efficacy and patient- and service-provider linkages.
The rapid advances in technology and global connectivity are offering hearing health care providers not only new tools but also new models of service-delivery for community-based ear and hearing health care. mHealth for hearing is a young and dynamic field that will certainly benefit underserved communities.