Primary ear care in low-income settings : hearing loss characteristics and cerumen management efficacy

Abstract

Hearing loss is estimated to affect 1.5 billion people globally, with higher rates in low- and middle-income countries (LMICs). Older adults frequently experience hearing and ear-related issues, such as age-related hearing loss and cerumen impaction. Access to ear and hearing services in LMICs, including sub-Saharan Africa, is challenged by limited resources, a scarcity of hearing care professionals, and underdeveloped economic infrastructures. Mobile technologies and task-shifting strategies are potential solutions to mitigate these challenges. This study implemented a community-based approach, utilising task-shifting to CHWs, to improve hearing care in these regions.

This study aimed to describe the prevalence and characteristics of hearing loss in a self-referred adult cohort in low-income South African communities and to evaluate the effectiveness of a community-based cerumen management protocol implemented in a community-based setting. This study employed a cross-sectional, predominantly quantitative design. A total of 227 participants, aged between 43 and 102 years, were recruited through self-referral from two community centres located in low-income communities (Khayelitsha and Mbekweni) in the Western Cape, South Africa. All participants underwent a hearing evaluation, and those identified with cerumen impaction received cerumen management.

Of the 448 ears evaluated, 57.9% had normal video otoscopy results, 29.1% had cerumen impaction, and 1.3% had other abnormalities. A high prevalence (97.8%) of confirmed hearing loss was observed, with mild hearing loss being the most common (45.8%). Sensorineural hearing loss was the predominant type (55.3%), followed by conductive hearing loss due to cerumen impaction (28.4%) and other conductive/mixed hearing loss (1.3%). Our cerumen management program successfully improved some participants’ hearing thresholds and restored outer ear canal integrity. After cerumen removal, 50.9% of participants with cerumen impaction had normal video otoscopy results, with mean hearing improvements of 16.2 dB (±17.9 SD) in the left ears and 15.8 dB (±17.2 SD) in the right ears. However, the overall improvement in hearing thresholds was limited in significance.

The rising rates of hearing loss in LMICs, particularly among older adults, underscore the importance of incorporating hearing care into primary healthcare (PHC) settings. Our community-based cerumen management plan effectively restored outer ear canal integrity and improved hearing thresholds for some individuals. Integrating community resources and task-shifting strategies holds significant potential in addressing ear-related issues through a cost-effective service model in resource-constrained settings.