Hearing impairment is a condition estimated to affect one in seven Australians including as many as three out of four people over 70 years of age. Hearing impairment may impact a person’s self-esteem and mental health as well as their ability to fully participate in social and employment activities.
The effects of hearing impairment among children can include delays in the development of language skills and can have a long term impact on educational achievement. Among older people hearing loss can increase social isolation and the risk of cognitive decline and dementia. This chapter discusses these costs and impacts as well as the ongoing effects of the social stigma related to hearing loss.
The impact of hearing impairment is also significant for the Australian economy and includes the direct costs of providing hearing services, productivity losses due to reduced workforce participation, and the impact of reduced wellbeing for individuals.
In addition to issues around hearing health, the Inquiry received evidence on balance disorders. Balance disorders can result in attacks of acute dizziness that can increase the risk of falls and have a detrimental impact on a person’s work and social life. In addition, this chapter outlines the prevalence and impact of balance disorders, while acknowledging there is some uncertainty regarding whether balance disorders are common in Australia. This chapter also discusses programs serving Australians with hearing impairment or balance disorders.
Hearing Impairment in Australia
Types and Causes of Hearing Impairment
Experiences of hearing loss can vary depending on: what part of the ear is affected, whether it impacts one ear (unilateral) or both ears (bilateral), the severity of the hearing loss, and whether it was present at birth or acquired at a later stage. There are three types of hearing impairment:
Conductive hearing loss is caused by a blockage or damage to the outer or middle ear which stops sound reaching the hearing nerve. It is often seen with ear infections, but can also have genetic causes. Conductive Hearing Loss can be temporary but can also cause long term hearing impairment. Conductive Hearing Loss can be corrected medically, surgically, or remediated with the use of hearing devices.
Sensorineural hearing loss is due to problems in the cochlea or auditory nerve which disturbs the sound signals being sent to the brain, and is usually permanent. This form of hearing loss can be caused by genetics, ageing, noise damage or disease. Sensorineural hearing loss is most commonly addressed through the use of hearing devices, such as hearing aids or cochlear implants.
Mixed hearing loss involves a combination of hearing problems in the middle and inner ear.
The severity of hearing loss is classified as mild, moderate, severe or profound, with prevalence rates decreasing as the severity increases. The Department of Health advised the following grades are used in Australia to classify hearing impairment:
0-20 decibels (dB) — normal hearing — no effects in good listening environment;
21-45 dB — mild — understanding speech can be difficult especially in a noisy environment;
46-65 dB — moderate — has trouble hearing and understanding in ideal conditions;
66-90 dB — severe — unable to hear normal speech, depends on visual clues such as speech reading or sign language;
Over 91 dB — profound — may hear some loud sounds but does not rely on hearing as the primary channel for communication.
Hearing loss can be present at birth (congenital) or occur later in life (acquired). Causes of congenital hearing loss include genetic factors; physical development issues; pre-natal rubella and cytomegalovirus; and birth trauma and prematurity. The Human Genetics Society of Australasia stated that approximately 50 per cent of cases of congenital hearing loss are genetic, 25 per cent are not genetic with cytomegalovirus a ‘major cause’ of hearing impairment in this group, and 25 per cent have no established cause.
Acquired hearing loss in adults is commonly caused by ageing and/or excessive exposure to noise. The Human Genetics Society of Australasia advised that while these forms of acquired hearing loss are based in part on environmental factors, ‘increasingly we are understanding that there are susceptibility genes which predispose a person to developing age-related hearing loss or susceptibility to noise induced hearing loss.’
Otitis media, or middle ear disease, refers to inflammation and infection of the middle ear, and causes conductive hearing loss. Mild otitis media is common among children, the majority of whom will recover with no long term damage. If the otitis media is recurrent or becomes chronic, however, it can cause permanent hearing loss. Aboriginal and Torres Strait Islander children experience severe and persistent otitis media at much higher rates than non‑Indigenous Australians. This is discussed in further detail in Chapter 3.
As well as ageing, noise exposure and chronic middle ear disorders, Australian Hearing advised that other causes of acquired hearing loss or later onset hearing loss include: genetic factors or malformations in the inner ear; disease including meningitis; Meniere’s disease; injury; consequences of cancer treatment including use of ototoxic medication; and Otosclerosis (a hereditary thickening of the bones in the ear).
Central Auditory Processing Disorder (CAPD) is a dysfunction of the brain rather than the ear that can make it harder ‘to understand speech when there is background noise present.’ Sound Scouts Australia advised that the causes of CAPD are ‘largely unknown but include protracted conductive hearing loss during the first five years of life.’ Australian Hearing stated that children with recurrent middle ear disease are more likely to have Spatial Processing Disorder, a type of CAPD which ‘interrupts a person’s ability to learn in a noisy environment, such as the classroom’. The HEARing Cooperative Research Centre (CRC) stated that children with CAPD are often misidentified as having reading disorders. The HEARing CRC further stated that if CAPD is ‘properly detected, remediation can be effective in improving communication and educational outcomes.’
Prevalence of Hearing Impairment
Australian Hearing stated that approximately one (1.1) in every thousand babies is born each year with a moderate or greater bilateral hearing impairment, and almost one (0.6) in every thousand babies is born with a moderate or greater unilateral hearing impairment. First Voice advised that by the age of school entry, the rate of hearing loss increases to approximately three in every thousand children, due to a number of factors including: a failure to detect a hearing loss at birth, progressive hearing loss, or trauma, infections and childhood diseases.
The prevalence of hearing loss continues to increase with age. The Department of Health advised that ‘less than one per cent of people under the age of 15 are affected by hearing loss compared to three out of every four people over the age of 70 years’.
A 2017 Deloitte Access Economics report commissioned by the Hearing Care Industry Association estimated that there were 3.6 million people in Australia with hearing loss in the better ear, which equated to 14.5 per cent of the total Australian population. Hearing loss was found to be more common among males than females, with 2.2 million males and 1.4 million females with hearing loss in 2017. The Deloitte Access Economics report stated that the prevalence of hearing loss is ‘expected to more than double to 7.8 million by 2060.’
Current and Future Cost of Hearing Impairment
The 2006 Access Economics Listen Hear! report found that, in 2005, the real financial cost of hearing impairment was $11.75 billion. In the 2017 update of the Listen Hear! report, the financial cost of hearing loss was revised up to $15.9 billion. The largest component of this cost was lost productivity ($12.8 billion), most of which was due to the reduced employment of people with hearing loss. Health system costs accounted for $881.5 million, 76 per cent of which was attributed to the Australian Government, largely through the Hearing Services Program. The remaining financial costs included informal care costs ($141.6 million), deadweight losses ($1.6 billion), and other financial costs ($480.3 million).
The 2017 report also stated there was a further $17.4 billion cost associated with lost wellbeing. Loss of wellbeing includes the ‘pain, suffering and premature mortality’ associated with hearing loss. Combined with the financial costs, Deloitte Access Economics found that the total cost of hearing loss in 2017 was $33.3 billion.
Impact on the Development of Communication Skills in Children
The Department of Health found that hearing loss in children can lead to ‘delays in language and psychosocial development’ and ‘also impact on educational achievements and employment opportunities.’ The South Australian Department for Education and Child Development stated that ‘hearing begins operation in the last trimester of pregnancy … so, if you are born without hearing, you have already missed some period of development.’
Cochlear Limited outlined four ways hearing loss can affect a child’s development:
It causes delay in the development of receptive and expressive communication skills (speech and language).
The language deficit causes learning problems that result in reduced academic achievement.
Communication difficulties often lead to social isolation and poor self‑concept.
It may have an impact on vocational choices.
The Shepherd Centre highlighted that while children with bilateral hearing loss have ‘the most profound deficits in speech, language, literacy and social inclusion’, children with unilateral hearing loss ‘also suffer significant impacts.’ Hear for You expressed similar sentiments, stating that ’30 [to] 40 per cent of students with mild or unilateral hearing losses experience difficulty with one or more of: speech production, speech and language proficiency, [and] psychosocial outcomes.’
Australian Hearing also advised that ‘approximately one quarter of children with permanent hearing loss have at least one other disability,’ which can have a ‘significant impact’ on the progress of a child with hearing loss.
The Shepherd Centre stated that risks to language, speech and academic development can be minimised if a child with hearing loss is:
effectively fitted with appropriate assistive hearing devices (hearing aids, cochlear implants, etc; depending if spoken language communication is selected by the parents); and
enrolled in a specialist early intervention service.
The Shepherd Centre added that these steps must be ‘rapidly completed, without loss to follow up between them, to ensure each child has a reasonable opportunity to achieve successful outcomes.’
Links to Other Health Conditions
Hearing loss was identified as being related to a range of cognitive and physical health conditions, particularly in older Australians. Australian Hearing stated that ‘untreated age‑related hearing loss can not only link to brain shrinkage but also increase the likelihood of cognitive decline, dementia, falls and social isolation.’
The Hearing Care Industry Association added that hearing loss is associated with an ‘increased risk of heart disease, other cardiovascular diseases including peripheral arterial disease … depression, other psychiatric disorders, poorer social relations, higher sickness impact profiles and reduced quality of life’.
The Australian Society of Rehabilitation Counsellors stated that people with impaired hearing:
use [general practitioners] up to three times more often than other members of the community;
are three times more likely to consume prescription medicines;
are 1.5 times more likely to [have been] hospitalised in the last 12 months; and
are four times more likely to require home support services.
Dr Elaine Saunders advised that there is ‘strong evidence that hearing loss decreases [the] ability to self-manage chronic conditions, seek effective treatment, or be reached by public health campaigns.’
As well as being related to other health conditions, high rates of hearing loss in older Australians can make interactions with the medical system difficult. Better Hearing Australia advised that due to older Australians making up the majority of hospital admissions:
… almost four in every ten hospital admissions will have some form of hearing loss — more than double the prevalence in the general population. This all too often causes communication difficulties between a patient and the hospital medical and nursing staff, to the patient’s disadvantage.
Stigma and Social Impact of Hearing Impairment
The Department of Health outlined the social and psychological effects of hearing loss as including ‘isolation, depression, anxiety, paranoia, stress, loss of concentration, frustration, irritation, perceived inferiority, and anger.’ The department added that ‘hearing impairment will affect a person differently depending on when the hearing loss occurred and the severity of the hearing loss.’
The Telethon Kids Institute outlined social difficulties faced by children and young people with hearing loss and stated:
Peer stigmatisation is common among children and adolescents with hearing loss, particularly children who use assistive devices such as hearing aids and cochlear implants.
Hear for You stated that there is evidence that over 40 per cent of deaf adolescents experience mental health problems. In addition, deaf adolescents may experience isolation and social stigma due to their hearing impairment. In a survey of its deaf and hearing impaired teenage membership base, Hear for You found that prior to seeking support, many of the teenagers felt ‘embarrassed, angry, frustrated, sad, lonely, shy, withdrawn and weird.’
A Year 10 student, Olivia Barnes, described her experience of starting high school as a deaf teenager before she sought support from Hear for You:
I struggled with the pace, rushing from class to class, and trying to hear was exhausting. Trying to keep up with conversations at recess and lunchtime was almost impossible. I fell behind socially. I was not being included. I was not getting any invitations to social events. It was very hard.
William Demant Holding stated that ‘unlike spectacles or dental devices, hearing devices are still judged negatively by many in the community.’
Australian Hearing stated that as well as having an impact on the affected individual, hearing loss can impact on the individual’s family. This is known as a ‘third party disability’.
A report by Better Hearing Australia and the Institute of Governance and Policy Analysis at the University of Canberra outlined that impacts on partners and carers of people with hearing loss can include ‘reduced self‑esteem, a loss of intimacy, stress and tiredness due to
communication-based conflicts and a reduced social life because their partner does not wish to socialise.’
Box 2.1: Experiences of Hearing Impairment
A number of submissions from people with hearing impairment described the impact of their hearing loss on their everyday lives:
‘I’ve stopped going to public spoken-word occasions such as drama and talks and many community events because I too often can’t hear the speakers. I often can’t hear when I try to listen to podcasts or YouTube videos online. I want to be able to participate in and contribute to community organisations. I do not feel confident that I would any longer be able to take on voluntary or paid work.’
‘I find it distressing that I am often treated as being ‘daft’ when I am just deaf.’
‘I am at a point where my hearing loss is affecting my work life and my personal relationships so I plan to purchase a hearing aid for my affected ear. There is still a social stigma associated with hearing aids, however, so I plan to purchase one that will be largely invisible to others. This, of course, is a more expensive option but important to my self-confidence.’
‘I had lots of instances when I was in meetings and I gave the wrong answer to a question because I misheard, and I sometimes felt that people thought I was a little bit mentally deficient because of that.’
‘In my experience, hearing loss still cannot be openly discussed amongst the corporate and social communities and many people still refuse to wear hearing aids because of the stigma attached.’
‘As a young teenager in secondary school, he [my son] began to feel conscious of wearing the hearing aids in term of his appearance. He wanted to feel what he perceived as being “normal” and he subsequently refused to continue to wear the hearing aids. I observed that without the hearing aids, he could not hear conversations properly.’
‘I know of many older men who have worked in the building industry (my husband is a plumber) who by 60 years old are not yet able to retire but have such poor hearing and often other associated mental health issues that they cannot effectively work.’
Balance Disorders and Other Ear Health Issues in Australia
Types and Causes
The Australian Society of Otolaryngology Head and Neck Surgery (ASOHNS) described most balance disorders as being:
… chronic medical conditions that derive from dysfunction of the balance (“vestibular”) organs within the inner ear, central (brain) vestibular processing or the integration of information across the senses of vision, balance and body position.
The Whirled Foundation stated that ‘chronic ear and balance disorders are common, however, the causes often remain unexplained.’ The ASOHNS listed conditions that cause balance disorders as including ‘benign paroxysmal positional vertigo (BPPV), Meniere’s disease, vestibular migraine, drug injury to the inner ear (ototoxicity) or infection, or sudden loss of function of the inner ear (labyrinthitis or vestibular neuronitis)’. The ASOHNS added that imbalance could also be a symptom of a stroke or heart problems.
Meniere’s disease is a condition of the inner ear with symptoms including fluctuating hearing loss, a ringing and/or feeling of fullness in the ears, dizziness and balance problems. While the cause of Meniere’s disease is unknown, the Deafness Forum of Australia (Deafness Forum) advised that the build-up of excess fluid in the inner ear plays an important part in creating the symptoms.
Tinnitus is a ‘hearing condition where people hear noises that have no external source’, and is often described as a ‘ringing in the ears’. The Deafness Forum stated tinnitus could be caused by sudden or prolonged exposure to loud sounds, as well as underlying hearing conditions such as Meniere’s disease, hyperacusis or hearing injuries. Further, the Deafness Forum stated tinnitus has been linked to certain medications and medical conditions including high blood pressure and diabetes.
Prevalence of Balance Disorders and Other Ear Health Issues
Dr Daniel Brown stated that:
… as our population is ageing both hearing and balance disorders and the social and financial costs of those disorders is increasing. Particularly with balance disorders, the incidence increases quite significantly with age.
The ASOHNS similarly stated that ‘self-reported prevalence of dizziness and vertigo exceeds 36 per cent in Australians over the age of 50 years.’ The Whirled Foundation advised that Meniere’s disease affects one in 600 Australians.
The Bionics Institute of Australia stated that tinnitus affects ‘approximately 18 per cent of Australians at some point in life’, and that ‘one to three per cent of people suffer from debilitating and chronic tinnitus.’ The Bionics Institute also advised that:
The prevalence of tinnitus is particularly high in people returning from military service, and is much higher in people with severe to profound hearing loss. Of growing concern is the overexposure of young people to recreational sounds, considered a key driver of hearing loss and tinnitus.
The Whirled Foundation stated that ‘the exact number of Australians affected by vestibular disorders is not known as the conditions are under‑diagnosed and under-reported’ and that there is a lack of research into the prevalence of these disorders in Australia. The Whirled Foundation recommended the Government fund research into the prevalence and incidence of these disorders in Australia.
Economic Cost of Balance Disorders and Other Ear Health Issues
Neurosensory advised that there has been ‘very little research and analysis of the economic impact of balance disorders in Australia’. Despite this, Neurosensory stated that ‘the most likely outcome for untreated dizziness is a fall, and preventing falls could potentially have a very positive outcome on Australia's economy.’ Dr Daniel Brown estimated that the national cost of emergency department patients presenting with dizziness exceeds $148 million annually.
Impact of Balance Disorders and Other Ear Health Issues
Neurosensory outlined the impact that dizziness and balance disorders could have on the lives of working aged people and stated:
… 27 per cent of patients with dizziness or balance disorders had to change jobs because of their balance problems, and a further 21 per cent gave up work entirely. 57 per cent of these patients also reported disruptions to their social lives, due to an inability to take part in outdoor activities and travel.
Mr Stephen Spring described the impact Meniere’s disease can have on a person’s life, which can range from being a ‘minor nuisance’ to ‘completely devastating’ depending on the severity and stated:
Not only do you lose all your sense of who you are because you cannot communicate with the world; you lose your orientation because you cannot stand up. Having chronic imbalance means that you cannot walk on sand or drive a car. It means that you are too frightened to go down the street to pick up your groceries because, if you have a Meniere's attack whilst you are there, you are going to be on the ground, prostrate and throwing up. That is the kind of thing that people end up living with.
Current Provision of Hearing Services and Treatment
Universal Newborn Hearing Screening
All states and territories provide newborn hearing screening programs, under which all babies are screened for hearing loss at birth, at no cost to families. Babies identified as being hearing impaired are referred to a diagnostic service within the hospital. If a permanent hearing loss is diagnosed, a newborn is referred to Australian Hearing and/or the cochlear implant service.
According to the Australasian Newborn Hearing Screening Committee (ANHSC) this early screening and referral pathway to services makes Australia a ‘world leader in delivery of services for children with hearing loss.’ Australian Hearing stated that due to this ‘very fast’ process, ‘a baby can be fitted with hearing aids within the first six weeks of life if diagnostic results are confirmed and the family agrees to proceed.’
The ANHSC also advised that despite the universality of the screening programs, ‘a lack of available data’ means it can only state with certainty that ‘more than 95 per cent of all children born in Australia are now screened for hearing loss at birth.’ The ANHSC suggested that babies who are missing out on screening are likely to: be from remote locations; be born outside the hospital system; have families which decline to participate in screening; or have families with a first language other than English.
Australian Hearing advised that Aboriginal and Torres Strait Islander babies are screened and referred at the same rate as non-Aboriginal and Torres Strait Islander babies. The proportion of Aboriginal and Torres Strait Islander babies who go on to be fitted with hearing aids within the first year of life, however, is ‘significantly lower’. As a consequence, Australian Hearing stated that ‘there is a need to develop an understanding of where and why families depart from the pathway and implementation strategies to address this.’
Early Intervention Programs
After referral to Australian Hearing, children with hearing loss receive audiological assessment and, if necessary, are fitted with a hearing device. If a child is found to have profound hearing loss, they may be referred to an Ear, Nose and Throat (ENT) surgeon for a cochlear implant. Families are then directed to an online resource outlining options including early intervention services.
Using this online resource, families may choose to engage a specialist provider of early intervention services for their child. According to the Shepherd Centre, the percentage of children with hearing loss accessing these services ranges from ‘less than 50 per cent up to 90 per cent depending on the state or territory.’
Early intervention hearing services are provided by a range of groups, including charities, non-government organisations and governments. For example, the Shepherd Centre provides early intervention services in New South Wales, the Australian Capital Territory and Tasmania, and receives a third of its funding from government grants, with the remaining two thirds sourced through fundraising and donations. Government provided services include an early intervention service for children from birth to school entry offered by the South Australian Department for Education and Child Development.
Early intervention services are usually provided by multidisciplinary teams of specialists including:
… certified auditory-verbal therapists, teachers of the deaf, speech pathologists, paediatric audiologists, psychologists, child and family counsellors, social workers, occupational therapists, specialist kindergarten professionals, and youth workers.
For children with cochlear implants, a ‘cochlear implant program’ may be used in conjunction with the early intervention services. First Voice advised that this would include input from ‘cochlear implant surgeons, paediatricians, and other medical and health personnel.’
The Australian Hearing Hub at Macquarie University commented that:
… Australia’s capacity for early intervention and sustained follow-up to ameliorate the effects of hearing loss in infancy is outstanding, both in terms of attrition (i.e. loss to follow up…) and in terms of easily accessible and identifiable pathways to secure hearing technology and assistive devices for children (e.g. through Australian Hearing Services, or providers of cochlear implant technologies and education services such as the Royal Institute for Deaf and Blind Children).
Hearing Services Program
The Office of Hearing Services administered Australian Government Hearing Services Program ‘provides access to subsidised hearing services and devices for eligible people, and supports research that assists with reducing the incidence and consequences of hearing loss in the community.’
Hearing Services Program components include: the Community Service Obligations (CSO), a Voucher Scheme, and the funding of research. The Department of Health advised that for 2016-17, it expects Australian Government expenditure in the Hearing Services Program to be $564.5 million.
Community Service Obligations Program
Hearing services are provided to at-risk groups through the CSO component of the Australian Government’s Hearing Services Program. These groups include:
hearing impaired children and young adults aged 0 to 26;
adults who are eligible for the Voucher Scheme and have ‘complex hearing or communication needs or live in remote areas’; and
Aboriginal and Torres Strait Islanders with hearing impairment over the age of 50 or who are participating in an eligible government program.
Australian Hearing is the sole provider of CSO services. Australian Hearing stated that:
The block funding of service provision, via the CSO, to children and adults with complex communication needs allows for the benefits of economies of scale for the purchase of devices as well as improved outcomes from maximising the training of staff, and the creation and maintenance of the expertise gained from servicing a high volume of clients with specialised needs.
In 2015-16, Australian Government expenditure on the CSO program was $65.3 million. The Department of Health advised that in this year:
29 850 children or young adults under 21 received 67 864 services;
3628 young adults aged between 21-26 received 7736 services;
23 344 adults with specialised needs received 53 771 services;
4300 Indigenous people received 8256 services; and
578 cochlear implant speech processors were funded through the speech processor upgrade program.
The Australian Government’s Hearing Services Program includes a Voucher Scheme, which provides eligible adults with access to hearing services and devices from Australian Hearing and private providers. Pensioner Concession Card holders make up 85.7 per cent of Voucher Scheme clients.
The Voucher Scheme subsidises services including hearing assessments and the fitting and ongoing maintenance of hearing devices. Fully subsidised hearing aids are available under the Voucher Scheme, and all hearing service providers must discuss the fully subsidised option with their clients. A client can also choose to purchase a more expensive device with additional features (a ‘top-up’) and will pay the differential between this model and the voucher value from their own pocket.
In 2015-16, Australian Government expenditure on the Voucher Scheme was $406.3 million. The Department of Health advised that in this year, 1.2 million services were delivered to nearly 700 000 Voucher Scheme clients.
Programs for Aboriginal and Torres Strait Islanders and Other
From 2013-14 to 2018-19 the Australia Government’s Indigenous Australians’ Health Program includes $39.5 million for ‘targeted ear health activities.’ These activities comprise:
$31.3 million over five years for clinical ear health services through the Healthy Ears – Better Hearing, Better Listing Program. This Program ‘improves access to ear and hearing health services [for Aboriginal and Torres Strait Islander children and youth aged up to 21] on an outreach basis, with a focus on rural and remote locations nationally.’ In 2015‑16, 42 357 patients accessed care under this program.
$1.9 million over three years to expedite access to ear surgery for Aboriginal and Torres Strait Islander children, particularly in rural and remote locations, through the Eye and Ear Surgical Support initiative.
$2.6 million over five years for workforce training in ear and hearing assessment for Aboriginal health workers, general practitioners and nurses, including those in remote locations.
$2.1 million over three years for ear health coordinators around Australia, who assist in streamlining referrals to services.
$1.4 million over two years for the provision of ear and hearing health equipment at Australian Government funded Aboriginal and Community Controlled Health Services and health clinics.
Clinical guidelines to assist practitioners in the management of otitis media, which were ‘comprehensively revised’ in 2010.
$150 000 over two years for promotional ear health resources for children, women’s groups, teachers and other carers as part of the ‘Care for Kids’ Ears’ campaign.
From 2012-13 to 2021-22 the Australian Government is providing $33.4 million for ear health services in the Northern Territory, under the National Partnership on Northern Territory Remote Aboriginal Investment.
The Northern Territory Department of Health advised that its ‘Healthy Under Five Kids’ program is an ‘integral component’ of the Northern Territory Hearing Health System.’ The program includes: ear examinations, developmental milestone checks for hearing and communication, and key prevention and health promotion messages. According to the Northern Territory Department of Health, the program serves as a ‘universal entry point for care planning … and supports early identification and intervention’.
Teleotology has been implemented in the Northern Territory to ensure remote communities have access to ENT services. Teleotology involves nurses taking video or images of ear concerns and forwarding them to an ENT surgeon to review, diagnose and provide management recommendations.
The Queensland Government has implemented the ‘Deadly Kids, Deadly Futures’ framework to address middle-ear disease and associated hearing loss in Aboriginal and Torres Strait Islander children across Queensland. The framework provides a ‘coordinated and effective response across the health, early childhood and education sectors.’ Implementation and development of the framework is led by the Deadly Ears Program, which also delivers ‘outreach services and local capacity building to eleven locations around the state’.
In Western Australia, the ‘Earbus’ service travels to remote communities to deliver ear screening and primary health care to Aboriginal and Torres Strait Islander children in schools, day care, kindergartens and playgroups. The team that travels to the communities includes audiologists and primary health practitioners. Periodically, an ENT surgeon also attends visits.
Veterans are entitled to hearing support services through the Hearing Services Program and, in addition, a number of additional support services. The Department of Veterans’ Affairs advised that eligible veterans receive the following services at no cost:
Hearing aids through the Hearing Services Program;
An Assistive Listening Device from the [Rehabilitation Appliances Program];
Maintenance of these devices;
Access to medical and allied health specialists;
Education and training; and
The Rehabilitation Appliances Program (RAP) provides eligible veterans with devices to manage their hearing loss such as devices to assist with using the telephone or television, specialised alarms and response systems, microphone/FM listening systems, and tinnitus maskers and inhibitors.
In 2015-16 approximately $70 million was ‘spent addressing the hearing needs of veterans and their dependents, including $17.95 million on aids and appliances through the RAP and a further $50 million through the [Hearing Services Program].
Auslan Interpretation and Other Communication Support
Deaf Australia advised that the Australian Government funds three Auslan services:
the National Auslan Interpreter Booking and Payment Service (NABS), which provides interpreters for medical appointments at no charge.
the National Relay Service, which is a telephone service for deaf and hearing impaired people using typing and reading, or video relay for Auslan users. The Conexu Foundation described this service as ‘a wonderful thing’ that is ‘used significantly’. The Conexu Foundation, however, stated that while the typing and reading version of the phone service is available 24 hours a day, seven days a week, the video relay service for Auslan users is only ‘open from 7am to 6pm Monday to Friday’.
Job Access, which offers financial assistance through the Employment Assistance Fund for Auslan interpreting in the workplace and in job interviews, deafness awareness training and workplace adjustments and equipment.
Deaf Australia stated that these services all require prior knowledge of Auslan, and there is no government assistance for families to learn Auslan. The National Disability Insurance Agency advised that ‘Auslan lessons may be considered “reasonable and necessary” in a [National Disability Insurance Scheme] plan’ and Auslan lessons for parents may also be included in the associated reference packages.
Support for Balance Disorders and Other Ear Health Issues
William Demant Holding stated that due to the multiple causes of balance disorders, ‘difficulty lies with determining who looks after the patient within the health care system, whether it be audiologists, ENT [surgeons], neurologists, physiotherapists or psychologists.’ The ASOHNS added that ‘there are few centres that bring together the multidisciplinary teams required to provide best-practice management plans.’
The Whirled Foundation advised that ‘due to the lack of awareness and information on vestibular disorders in Australia, many Australians diagnosed with a vestibular disorder find that a correct diagnosis can take years, even decades, to achieve.’ The Whirled Foundation also stated that while there are a number of tests that can diagnose vestibular disorders, many ‘are expensive with minimal or no coverage by Medicare.’
The Whirled Foundation stated that vestibular rehabilitation therapy is effective in treating vestibular dysfunction, while cognitive behavioural therapy has been ‘helpful to sufferers in coping with anxiety related symptoms (such as panic attacks and agoraphobia) and chronic disease management.’
Some balance disorders respond to medication. Some of these medications, however, do not attract a Pharmaceutical Benefits Scheme (PBS) subsidy and the cost can ‘be a burden on those with balance disorders.’ The Whirled Foundation recommended certain medications be added to the PBS to treat symptoms of Meniere’s disease.
The ASOHNS stated that ‘emotional and social support for balance disorder sufferers is often difficult to access’ and that ‘peer support groups are well placed to provide this.’
Better Hearing Australia advised that ‘more than two million Australians currently suffer from tinnitus yet there is no strategy or support system in place to deliver effective intervention or even provide information and advice.’ Better Hearing Australia recommended the creation of a national community awareness campaign on tinnitus.
Prevalence and Cost of Hearing Impairment
Deafness and hearing impairment are significant public health issues, affecting 3.6 million Australians in 2017. As Australia’s population ages, the prevalence of hearing impairment is expected to increase considerably. It has been estimated that by 2060, approximately 7.8 million Australians will have a hearing impairment.
The Committee acknowledges and is concerned by the significant cost of hearing impairment to the Australian economy. In 2017, the estimated financial cost of hearing impairment was $15.9 billion. The largest contributor to this cost is productivity loss ($12.8 billion), as people with hearing impairment tend to have lower levels of employment. The cost of lost wellbeing due to hearing impairment was estimated to be $17.4 billion. It is expected these costs will increase as the prevalence of hearing impairment rises over time.
Impacts of Hearing Impairment
While the costs of hearing impairment to the economy and health system are significant, the impacts of hearing impairment are felt most profoundly at the individual level. Hearing loss can impact on personal relationships, mental health and educational and employment opportunities. The Committee is grateful to the individuals who provided submissions and personally described the impact their hearing loss has had on their everyday lives. The Committee also notes the important role of advocacy groups who support people with hearing loss. These groups provide hearing impaired individuals with advice and assistance to improve their quality of life and, perhaps most importantly, connect them with other individuals facing similar challenges.
Hearing Services for Children
The Committee was pleased to receive evidence that the timely and universal provision of hearing services to newborns in Australia is among the best in the world. Universal newborn hearing screening programs and rapid referral to Australian Hearing ensures newborns diagnosed with a hearing impairment are provided with treatment within their first year of life, and are given the best opportunity to develop communication skills at the same rate as their hearing peers.
The Committee also acknowledges the importance of early intervention services in supporting the development of children with hearing impairments, and the need to ensure all children with hearing impairments have access to these services. While the early detection of hearing impairment and provision of hearing devices is paramount, communication and developmental support is needed to ensure children are getting the most out of their hearing devices. Early intervention services also help children develop their speech, language, literacy and social skills, and if successful can have a positive lifelong impact on their educational and employment opportunities.
Hearing Impairment and Cognitive Decline
Hearing loss disproportionately affects older Australians, with three out of four Australians aged over 70 years being affected by hearing loss. The Committee was concerned to receive evidence of an association between hearing loss and other serious health issues such as cognitive decline, dementia and depression. Earlier detection and treatment of hearing loss in older Australians may slow the progression of cognitive decline and associated health impacts, and help prevent social isolation by enabling older Australians to better communicate and participate in social situations.
Balance Disorders and Other Ear Health Issues
As well as deafness and hearing impairment, the Committee acknowledges that balance disorders are a related and significant health issue. Balance disorders and other ear health issues can have a debilitating impact on a person’s life, and support and understanding can be difficult to come by. Further adding to this burden, the causes of some balance disorders such as Meniere’s disease are complex and not well understood, meaning a person with this disease may have to see numerous health professionals before they receive the help they need.
Programs for At-Risk Groups
The Committee acknowledges the range of programs and supports targeting hearing loss in Aboriginal and Torres Strait Islander communities and other at risk populations. The Committee further discusses hearing issues that impact these groups in Chapter 3.