4. Research and Prevention of Hearing Loss

Overview

4.1
Exposure to noise is a major, and predominantly preventable, cause of adult onset hearing loss. Exposure to noise in the workplace has, in the past, been the primary source of noise induced hearing loss. While this remains a serious issue, in recent times recreational sources of noise have emerged as posing an additional significant risk to hearing health. This chapter will discuss occupational and recreational noise induced hearing loss, as well as education and awareness programs that aim to encourage people to protect their hearing and, if necessary, seek treatment for hearing loss.
4.2
In addition to considering how hearing loss can be prevented, this chapter discusses research into treatments for hearing loss and balance disorders including in emerging areas such as gene therapy. This chapter will also focus on how developments in communication technology are creating opportunities for new methods of delivering hearing treatment and support.

Noise Induced Hearing Loss

4.3
Safe Work Australia stated that hearing can be damaged through exposure to a loud noise for a short period of time, or lower noise levels over a longer period.1 In outlining how noise can affect hearing, the HEARing Cooperative Research Centre (CRC) stated that:
… the impact is a result of the degree of insult (i.e. the loudness of the sound/noise), the length of the exposure, and the frequency of exposure, in addition to the factor of individual susceptibility.2
4.4
Noise induced hearing loss was described by the HEARing CRC as ‘the most significant contributor to the prevalence and degree of acquired hearing loss in adults’3. Deloitte Access Economics observed that it ‘can be difficult to distinguish between the effects of [noise induced hearing loss and age-related hearing loss], as they frequently co-exist.’4 In 2006 Access Economics estimated that 37 per cent of hearing loss in adults was due to preventable causes.5
4.5
Deloitte Access Economics stated that while traditionally most cases of noise induced hearing loss have occurred through workplace activity (known as occupational noise induced hearing loss), there is an ‘increasing risk’ of recreational noise induced hearing loss. Activities associated with recreational noise induced hearing loss include: listening to personal music players at a high volume, and attending loud music concerts and nightclubs.6

Occupational Noise Induced Hearing Loss

4.6
Safe Work Australia indicated that noise induced hearing loss is a ‘priority disorder for national action under the Australian Work Health and Safety Strategy 2012-2022 because of the severity of the consequences and the estimated number of workers affected.’7
4.7
In 2011 Safe Work Australia developed model Work Health and Safety (WHS) Regulations, which:
… set out the requirements for noise control in the workplace … The model WHS Regulations for noise have been implemented in all jurisdictions except Victoria and Western Australia, where the regulations for noise control are dealt with in their occupational health and safety regulations.8
4.8
The model WHS Regulations include two standards for limiting noise exposure; a maximum of 85 dB for eight hours, and a maximum peak of
140 dB for short, loud noises.9
4.9
Safe Work Australia explained that noise in the workplace should be managed using a ‘hierarchy of control’ where the most effective control measures should be chosen wherever practicable. Safe Work Australia stated that the ‘most effective control measure for noise is to eliminate the source of noise completely, for example by ceasing to use a noisy machine’.10
4.10
Where elimination of a noise source is not possible ‘risks may be minimised by choosing one or more of the following measures:
substitute the hazard with plant or processes that are quieter;
modify plant and processes to reduce the noise using engineering controls;
isolate the source of noise from people by using distance, barriers, enclosures or sound-absorbing surfaces.’11
4.11
Where a risk remains it should be minimised using administrative controls and if a ‘risk still remains, then suitable hearing protection must be provided and used.’12
4.12
Safe Work Australia stated that 69 481 workers’ compensation claims for noise induced hearing loss were accepted between 2000-01 and 2014-15.13 The majority of these cases (67 084 or 4472 per year) arose due to long term exposure to sounds, while the remainder (2048 or 136 per year) were due to exposure to a single, sudden sound.14
4.13
The rate of workers’ compensation claims for noise induced hearing loss has not significantly reduced in the past 15 years. Safe Work Australia stated that analysis of trends in workers compensation figures was complicated by the potentially long period between noise exposure and the appearance of hearing loss. Safe Work Australia further stated it is difficult to determine ‘whether hearing loss is work-related or due to age or non-occupational noise exposure’.15
4.14
Safe Work Australia advised that it had undertaken research indicating that noise was primarily controlled in workplaces through ‘the use of personal protective equipment like ear plugs and ear muffs … rather than putting controls in place to eliminate or minimise the noise at the source’.16 The research also found that:
In addition to an over-reliance on personal hearing protectors … barriers to effective noise control and [workplace noise induced hearing loss] prevention include infrequent and improper use of personal hearing protectors, lack of prominence of noise as a serious WHS issue, and lack of consideration of potential benefits of effective noise control.17
4.15
The Australian Institute of Occupational Hygienists (AIOH) recommended greater use of audiometric testing for people exposed to high levels of workplace noise. The AIOH suggested that providing personalised information for employees, rather than group presentations, would be more engaging. The AIOH explained that someone:
… saying: 'Those are your results. You are personally in danger here. This is not a theory; this is you.' It gives them an opportunity to take the preventative methods that are at work a bit more seriously.18
4.16
The Australian Society of Rehabilitation Counsellors advised that workers with noise induced hearing loss ‘are not routinely offered either hearing rehabilitation or injury prevention services’, and recommended the Government investigate the most appropriate and cost effective mechanisms for providing hearing services to this cohort.19

Ototoxins

4.17
Ototoxins are chemicals that ‘may interact with noise’ to increase the risk of hearing loss.20 They are found in some workplace chemicals including some painting, cleaning and degreasing agents.21
4.18
The AIOH commented that exposure standards have not been altered to indicate the increased risk to hearing health caused by the interaction of ototoxins and noise.22 The AIOH advised that until standards are established Safe Work Australia recommended that workers exposed to ototoxins are not exposed to daily noise levels above 80 dB(A).23

Hearing Loss in Specific Industries

4.19
Safe Work Australia stated that the manufacturing and construction industry sectors have the highest number of workers’ compensation claims for noise induced hearing loss. The highest incidence rate, which is the number of claims per million employees, was in the mining sector.24
4.20
Safe Work Australia also identified a ‘sustained year-on-year reduction in [the] incidence rate’ for the Electricity, Gas, Water and Waste Services sector for the fifteen year period 2000-01 to 2014-15.25 No other industry sectors displayed any clear trends regarding occupational noise induced hearing loss.26

Box 4.1:   Noise Induced Hearing Loss and Farmers

Noise induced hearing loss has been estimated to affect over 60 per cent of farmers.27 The National Centre for Farmer Health stated that there is evidence that farmers develop hearing loss fifteen years earlier than the general population.28 Farmers also have higher rates of social isolation, which can be exacerbated by hearing loss.29
Higher rates of hearing loss in farmers is largely due to occupational noise exposure, such as through the use of tractors and agricultural machinery.30 Sound Scouts Australia stated that, in addition, ‘people living in rural areas often make use of noisy recreational equipment such as power tools, firearms, motorcycles or quadbikes.’31
According to the National Centre for Farmer Health, hearing loss among the farming and agricultural population has become normalised and accepted.32 This acceptance of hearing loss, as well as a culture of being ‘strong and stoic’, has meant that farmers do not always seek treatment for hearing issues.33

Shhh Hearing in a Farming Environment Program

From 2012 to 2015, the ‘Shhh hearing in a farming environment’ program was conducted by the National Centre for Farmer Health at Deakin University, in partnership with the National Acoustic Laboratories and the University of Canberra, and funded by the National Health and Medical Research Council.34
The program tested whether early intervention services tailored to farming families and agricultural workers would reduce the social impact of hearing loss on farmers, and successfully educate and empower farmers to reduce their exposure to noise.35
As part of this program the National Centre for Farmer Health: screened farmers for hearing loss, conducted on-farm noise audits, and introduced methods to reduce the social impact of hearing loss.36 The on-farm noise audit tested farmers’ exposure to noise over a 24 hour period. The results of the audits were characterised by Associate Professor Susan Brumby as ‘alarming’, with 51 per cent of participants being over their safe daily noise exposure limit.37
The research program found that as a result of the screening, farm audit and education about noise hazards and risks, ‘most participants took action in reducing their noise and improving their psychosocial interactions—[becoming] more empowered to tell people they had a hearing loss and to be direct with how people communicated with them.‘38
The research also identified that farmers preferred to learn techniques to manage their hearing loss instead of getting hearing devices. Techniques included meeting in quiet areas and being confident in asking people to use eye contact when speaking.39

Recreational Noise Exposure

4.21
According to HEARsmart and the HEARing CRC, ‘excessive noise exposures from recreational sources, such as music venues, nightclubs, bars, sporting events and personal music players … pose a risk to hearing.’40 The HEARing CRC further stated that young adults in particular ‘are at significant risk from leisure noise.’41
4.22
Personal music devices such as iPods may present a risk to hearing if the device is used for long periods of time and at a high volume.42 The HEARing CRC presented the common scenario of people listening to music devices on public transport on their way to and from work. As public transport can be noisy, some people may listen to their devices at unsafe volumes, in order to hear over the background noise.43 Can:Do Group also stated that up to 93 per cent of Australian children own personal music players, which may expose them to a risk of noise induced hearing loss at a young age.44
4.23
In contrast, Dr Timothy Makeham suggested that ‘the intensity of the sound’ from earphones is often ‘not sufficient to cause long-term permanent damage’. As such, ‘most people’ are not at a high risk of permanent damage, as they are not listening at dangerously high volumes.45
4.24
The Hearing Care Industry Association (HCIA) stated that, in Australia, there is no required volume restriction on personal music players.46 While the HEARing CRC agreed, it stated that it is not only the volume of sound but also length of time it is listened to that is important. As such, preventing noise induced hearing loss is ‘not quite as simple as just legislating’ a maximum volume level.47
4.25
The HEARing CRC stated that young people who attend nightclubs are a ‘real at-risk population’48 for hearing loss, and that ‘of those people who go to clubs, some 30 per cent end up with temporary threshold shifts, and, importantly, tinnitus as an outcome.’49 Dr Makeham expressed similar concerns:
When you are at a nightclub or in a loud environment where you cannot hear conversation, the noise level is often at 100 decibels. At that point, the amount of time you can spend there without expecting to see irreversible damage is actually quite short—often less than an hour.50
4.26
Aboriginal and Torres Strait Islander communities may also experience high rates of noise induced hearing loss. The article Dangerous Listening: The Exposure of Indigenous People to Excessive Noise outlined recreational noise exposure risks in Aboriginal and Torres Strait Islander households, stating that:
Crowded housing, the high proportion of Indigenous people with conductive hearing loss and easier access to noise-generating entertainment equipment appear to result in an extreme noise exposure profile in many Indigenous households.51
4.27
The Dangerous Listening article also stated that there was ‘excessive noise exposure among quite young Indigenous children’, which can have lifelong consequences.52 The article advocated that ‘urgent action’ was needed to prevent noise induced hearing loss in Indigenous communities, primarily through the provision of information on the dangers of excessive noise exposure, with a focus on ‘family based solutions’ and the engagement of Indigenous health workers.53

Box 4.2:   Preventing Recreational Noise Induced Hearing Loss: The HEARsmart Campaign

The HEARing CRC, observing that preventing hearing loss is ‘much more effective than remediation’,54 partnered with the National Acoustic Laboratories (NAL) to launch HEARsmart. HEARsmart aims to ‘engage, inform and educate the public regarding the risk of developing hearing loss and tinnitus from excessive noise exposure’.55
HEARsmart identified young adults as being at ‘significant risk’ of experiencing hearing loss due to ‘noise levels in the music industry’.56 To address this risk HEARsmart has been collaborating with the music industry to ‘promote healthy management of sound in live music venues’.57
HEARsmart installed sound management technology in a venue known to play particularly loud music. The results of the trial suggest that while the ‘musical integrity’ of performances at the venue were maintained the system produced safer levels of noise exposure for staff and patrons. Surveys suggest that the lower sound levels have also been appreciated by the venue’s patrons.58
Another HEARsmart project, the Know Your Noise campaign, aims to promote good hearing health among young people aged between 18 and 35. Know Your Noise is ‘focused on promoting simple actions to help keep sound doses safe (and importantly, not to be the ‘fun’ police)’.59
The Know Your Noise website features an online hearing test and a noise risk calculator. The noise risk calculator (developed using NAL research data) asks users to enter information about their lifestyle and listening habits and provides them with a personalised assessment of their risk of exposure to dangerous levels of noise.60
Results from a survey of Know Your Noise users found that ‘following exposure to Know Your Noise, 43 per cent of young adults increased their motivation to take active steps to protect their hearing’.61

Public Awareness of Hearing Health Issues

Hearing Health Awareness in Australia

4.28
Despite the large number of Australians affected by hearing loss, many organisations suggested that the general public had a low level of knowledge surrounding hearing health issues. Reflecting this, Australian Hearing referred to hearing loss as the ‘hidden disability’.62 Self Help for Hard of Hearing People Australia (SHHH Australia) further stated that there is ‘a general lack of awareness in the community of the many signs of deafness and ear and balance disorders as well as what to do about it and how it can be managed.’63
4.29
The Australian College of Audiology stated that in its view:
… the community is poorly informed about hearing health care choices. Many pensioners are not aware that they can obtain free hearing services from the Office of Hearing Services … education around hearing loss is most often left to support groups instead of government agencies. Much of the promotion regarding hearing loss is more focussed on the fitting of hearing devices rather than general information about hearing loss and hearing conservation.64

Effects of Limited Awareness of Hearing Health Issues

4.30
The Royal Institute for Deaf and Blind Children (RIDBC) stated that despite efforts to ‘educate Australians about hearing loss, it is estimated that around two thirds of all Australians with hearing loss still go untreated.’65 In addition, the Deafness Forum of Australia (Deafness Forum) stated that on average there is a delay of seven years between ‘the time the person becomes aware of a hearing problem to the time when they do something about it.’66
4.31
SHHH Australia suggested that a greater focus on hearing health issues would encourage people to seek treatment for hearing loss earlier, stating:
… by raising awareness of hearing loss and its consequences, the community will better understand that by addressing hearing loss earlier people can enjoy a better quality of life, avoid significant downstream health costs and help prevent cognitive decline particularly in the elderly.’67
4.32
Australia’s hearing population also may not know how to assist hearing impaired people in their interactions. The Deafness Forum explained that:
People generally do not know the strategies that can be applied to improve the communication with a hearing impaired person or how to change the environment to make it easier for a person with hearing loss to follow conversation.68
4.33
The HEARing CRC highlighted that even among general practitioners (GPs) awareness of hearing health issues may be low and this could, potentially, result in misdiagnoses.69 The RIDBC suggested GPs needed greater knowledge of ‘the implications of hearing loss and the services and strategies available to their patients and family members’.70Australian Hearing also highlighted that hearing technology is ‘advancing at a rapid rate’ and that medical practitioners need access to accurate information and education so that their patients are provided with ‘the most appropriate intervention for their needs’.71
4.34
Deafblind Australia stated that deafblindness was a ‘unique and isolating sensory disability resulting from the combination of both a hearing and vision loss’72 and that representatives of the health system were lacking in awareness of the needs of deafblind Australians. Deafblind Australia stated that there is an:
… extremely limited understanding among service providers of the complex needs of people with combined vision and hearing loss … two key areas which require addressing urgently are awareness of National Disability Insurance Scheme planners and aged care services.73

Education and Awareness Programs

4.35
There are currently two national awareness campaigns related to hearing health: the National Week for Deaf People, led by Deaf Australia, and Hearing Awareness Week, led by the Deafness Forum.74 Both Deaf Australia and the Deafness Forum called for government funding to undertake further awareness raising and communications work.75
4.36
CICADA Australia suggested that Hearing Awareness Week ‘is not widely advertised but could achieve much more with a national approach, better funding and professional marketing involvement.’76 Goulburn Valley Hearing Clinic added that apart from the Hearing Awareness Week, ‘most of the information and promotion about hearing loss and health care is coming from the retail sector in the form of advertising and direct marketing’.77
4.37
Deaf Services Queensland (DSQ) provides Deafness Awareness Training, which it described as ‘crucial in workplaces to help co-workers understand how to work with someone who is deaf’ and also beneficial to staff who may interact with deaf Australians in ‘mainstream services’ such as health and education. The DSQ stated that funding for the training was being phased out with the introduction of the National Disability Insurance Scheme.78
4.38
Mr David Brady commented that there has been no government led national awareness campaign focussing on hearing health since at least the early 1990s.79 Many organisations stated there is a need for the creation of a major nationally coordinated campaign. Organisations calling for such a campaign included: the Australian Hearing Hub80, Cochlear81, the Deafness Forum82, the HCIA83, the RIDBC84, and SHHH Australia85.
4.39
The HCIA stated that raising awareness about hearing health issues was ‘part of its mandate’. The HCIA highlighted the impact of awareness campaigns in other areas of public health, stating:
We know from Australia’s experience with previous public health campaigns such as the National Skin Cancer Campaign and the National Tobacco Campaign that awareness campaigns can and do lead to changes in knowledge, attitudes and ultimately in changed behaviour. In the area of hearing health, there is a glaring need for education and awareness programs.86
4.40
The RIDBC suggested that an awareness and education campaign should focus on encouraging Australians to:
Become aware of hearing health;
Understand the implications of high risk hearing behaviours;
Implement preventative strategies to minimise behaviours that are damaging to hearing;
Attend assessments at key life stages; and
Understand the range of options available to assist in returning to optimal hearing health, and the pathways to seeking help.87
4.41
Life Unlimited, a New Zealand charitable trust which is funded by the New Zealand Ministry of Health to provide aural rehabilitation services, explained that the provision of a national education strategy on hearing health is part of its contract with the Ministry of Health. Life Unlimited stated that 10 to 15 per cent of its therapists’ time was expected to be spent on community education and training. Life Unlimited recommended that the Australian Government investigate contracting a ‘non-clinical, community-based’ organisation to ‘raise awareness and understanding of hearing loss … and to educate people in the community on hearing loss prevention and management.’88

Research into Hearing Impairment

Cochlear Implant Technology

4.42
In the late 1970s the cochlear implant (also known as the bionic ear) was created by a team of researchers at the University of Melbourne led by Professor Graeme Clark.89 The cochlear implant was then commercialised by Cochlear Ltd and has since been used to treat hearing loss in over 450 000 people worldwide.90 Professor Clark also established the Bionic Ear Institute (now the Bionics Institute of Australia) to conduct further research in this area.91
4.43
The Bionics Institute of Australia (Bionics Institute) stated that significant technological advances were made to cochlear implant technology during the 1980s and 1990s but that ‘relatively little progress has been made in the last 15 years’.92 The Bionics Institute stated that this was due to ‘a number of serious challenges’ limiting technological developments in cochlear implants and that it was engaged in research programs aimed at overcoming these challenges.93 These research programs include:94
Using new brain imaging techniques to study the role of brain reorganisation (neuroplasticity) in the variability in speech understanding among cochlear implant users.
Development of a new automatic system for programming cochlear implants (this would be particularly valuable for children who are too young to provide verbal feedback during implant programming).
Manipulation of the way electrical stimulation is presented to the cochlea to assist the understanding of speech in noisy environments.
Brain imaging studies focussed on people who have difficulty understanding speech but do not have decreased hearing thresholds.

Genetics and Stem-Cell Research

4.44
Genetic factors are responsible for approximately 50 per cent of the cases of children born with hearing impairment.95 Diagnosis of the causes of genetic hearing impairment has recently been improved by advances in
next-generation gene sequencing. The Human Genetics Society of Australasia linked these advances in gene sequencing to improved treatment outcomes stating:
… we are also starting to learn that some specific types of hearing loss, whose genetic basis one does need to identify, can be treated or have specific management recommendations. So while we may not be able to cure them we can actually prevent deterioration.96
4.45
Research into genetic and stem-cell based therapies could also, potentially, lead to new methods of treating and preventing noise induced or age related hearing impairment. The Human Genetics Society of Australasia stated that:
… recent advances in the molecular understanding of specific genes and conditions mean that new medications which are coming through and currently being tested in animals are able to restore hearing in the context of noise-induced or age-related types of hearing loss after hearing has already been lost.97
4.46
The Australian Society of Otolaryngology Head and Neck Surgery (ASOHNS) stated that we are ‘moving into a time of pharmalogical and regenerative medicine in hearing loss’.98 The ASOHNS added that a drug which aimed to regenerate inner ear hair cells was about to begin clinical trials in Melbourne, but cautioned:
… we would be lucky if it works with the first iteration, but we are starting to move into a field where there may be more than devices and there may be medical treatments for hearing loss evolve over the next 10 to 20 years.99
4.47
Other research organisations undertaking research in similar fields include:
The HEARing CRC, in conjunction with the Walter and Eliza Hall Institute, is researching ways to stop the apoptotic chain which results in the death of hair cells in the inner ear.100
The Bionics Institute has undertaken stem-cell transplantation to rehabilitate the auditory nerve after deafness; and gene therapy to
‘re-program’ cells to function like inner ear hair cells.101
4.48
Several witnesses suggested that while new gene and stem-cell research had shown it was potentially possible to restore damaged hair cells, this research was still at a very early stage.102 These techniques had been tested in animal studies but considerable further safety studies would be required before human trials could begin.103
4.49
Even if hair cells in the inner ear are able to be regenerated there may be additional challenges. The HEARing CRC explained that hair cells connect to nerves to convey particular sound frequencies and if lost hair cells are regenerated ‘we do not know if they are going to be connected in the same way’.104

Longitudinal Studies

4.50
The NAL and the HEARing CRC have undertaken longitudinal research into the long term impacts of the early diagnosis and treatment of children with hearing impairment in the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study. This study is considering ‘whether universal newborn hearing screening and early intervention improve outcomes at a population level’.105
4.51
From 2002 to 2007 the LOCHI study recruited 453 hearing impaired newborn children in New South Wales, Victoria and Queensland and is following their development to the age of 12 to 15 years.106 The LOCHI study found that ‘early device fitting and early intervention do make a significant difference in terms of getting to peer-equivalent language … by age five.’107 Early intervention improved language outcomes for children fitted with hearing aids and those fitted with cochlear implants.108
4.52
The HEARing CRC stated that the results of the LOCHI study are:
… unequivocal in supporting the need for early identification through screening and early intervention. By far, the most significant factor in influencing outcomes is earlier age at hearing aid fitting or cochlear implantation. This is not feasible without universal newborn screening and comprehensive early intervention programs.109
4.53
Australian Hearing stated that an additional finding of the LOCHI study was that, in Australia, there was almost no loss of children between a referral from a newborn hearing screening to treatment from Australian Hearing. In contrast, in ‘every country overseas’ there was a problem with children failing a hearing screening but not going on to receive treatment.110
4.54
Better Hearing Australia recommended longitudinal research be undertaken on hearing impaired adults following intervention from a hearing services provider.111 This recommendation was supported by the Bionics Institute, which was of the view that longitudinal research would help clinicians predict how clients would respond to rehabilitation and enable them to try to ‘tailor the rehabilitation more precisely to the exact problem that the person is having’.112

Research into Balance Disorders and Other Ear Health Issues

4.55
Dr Daniel Brown stated that Australian researchers had been successful in developing ‘innovative tools and techniques for the diagnosis of hearing and balance disorders.’ For example, Australian researchers developed ‘head impulse goggles’ that provided a ‘very effective and much more accurate measure of the vestibule-ocular reflex’ and allowed nurses to perform tests that previously required specialised neurologists.113
4.56
Dr Brown suggested that within the field of hearing impairment research there has been a move towards clinical research undertaken on human subjects, but that the same trend has not occurred for research into balance disorders. Dr Brown called for a commitment to increasing the amount of clinical research into balance disorders.114
4.57
Mr Stephen Spring agreed that there was a lack of funding for clinical research and that this was preventing promising outcomes of basic research being translated into marketable outcomes. Mr Spring stated that:
… it should not really be up to private individuals to scratch around [for funding], when the benefit for the community, if there is successful translational medicine, is going to far outweigh the initial investment.115
4.58
The Whirled Foundation stated that there was a need to fund research into balance disorders focussing on the causes of balance disorders and potential treatments.116 Neurosensory advocated for research to be undertaken on the economic impact of balance disorders.117

Innovation in Hearing Service Delivery

4.59
The growth in the use of the internet has enabled the development of new methods of accessing hearing health services and delivering real-time communication supports for deaf or hearing impaired people.
4.60
Telehealth118 services enable metropolitan based medical practitioners to provide specialised health services to clients in remote locations via the internet. A telehealth model can be used to provide hearing health services including:
Early intervention treatment and services for children;119
Speech pathology services; and120
Cochlear implant mapping.121
4.61
Speech Pathology Australia stated that there was ‘a strong evidence base’ for the efficacy of telehealth speech pathology services.122 Hear and Say similarly drew attention to evidence for the value of early intervention telehealth services stating it had ‘published a journal paper that looks at comparing the outcomes of our children who have therapy through [telehealth] versus face to face [consultations], and [it was found that] there is no significant difference.’123
4.62
The HEARing CRC advised that its research found that ‘95 per cent of cochlear implant recipients could have their speech processor appropriately mapped using remote connections’.124
4.63
Several organisations125 observed that telehealth services are not eligible for Medicare rebates. The Telethon Kids Institute suggested that telehealth services will:
… considerably increase efficiency and access to diagnostic audiology in underserved areas in Australia. However, the primary barrier to these developments is the inability of audiologists to directly claim [Medicare benefits] for telehealth procedures.126
4.64
Vicdeaf advised that it provides a Video Remote Interpreting service which ‘enables interpreting access to those who are in settings in which Auslan interpreters are not readily available’.127 In addition, hearing impaired Australians who use English can follow spoken content at live events using live captioning.128
4.65
The National Relay Service (NRS) has used technology to expand the range of services it supplies to deaf and hearing impaired Australians. The NRS now provides five types of services: the teletypewriter, which is a fixed keyboard device attached to a phone; SMS relay which can be used with braille for deafblind users; video relay for Auslan users to make calls; a captioned phone service; and a relay service for people with a speech impediment.129
4.66
Deafblind Australia stated that deafblind Australians have ‘significant difficulty accessing telecommunication devices’.130 Barriers to using telecommunications devices for deafblind people include: insufficient funds to purchase specialised equipment; a lack of training in using the equipment; and a lack of support staff trained in working with deafblind people.131
4.67
One communication service designed specifically for deafblind people is Able Link which aims to develop ‘digital literacy, including digital financial literacy skills of people with deafblindness’.132 Able Link helps deafblind people access social media and engage in shopping, banking, and community based activities.133
4.68
Dr Elaine Saunders stated that her company, Blamey Saunders hears, was also using technology to provide hearing tests, in this case aimed at adults. Dr Saunders stated that this test can be undertaken at home or at a GP clinic and does not require a soundproof room or specialised equipment.134

Concluding Comment

Noise Induced Hearing Loss

4.69
Approximately one-third of all hearing loss in adults may be due to noise exposure. This represents a serious, and predominantly preventable, burden on the Australian community. The Committee was disappointed to discover that the rates of occupational noise induced hearing loss have not significantly reduced in the past 15 years. Workplaces appear to be relying on the use of personal hearing protection (such as ear plugs) rather than investing in methods of reducing noise levels at the source. Given the serious costs of hearing loss, both to the individual and to the economy, the Committee believes that efforts to prevent hearing loss in the workplace need to be re-invigorated.
4.70
Agriculture is an industry of particular concern. Farmers are developing hearing loss on average fifteen years earlier than the general population and as many as 60 per cent of farmers are experiencing hearing loss. The Committee welcomes the work of the National Centre for Farmer Health in addressing hearing health issues in farming communities. A greater focus on providing education on preventing hearing damage among workers in agricultural industries is needed.
4.71
An emerging concern is the impact of recreational noise induced hearing loss on young people. In recent years there has been a rapid growth in the use of personal music players. The degree to which this is a danger to the hearing health of young people appears to still be a matter of debate. What is more certain is that some young people are being exposed to dangerously loud levels of noise at live music venues and nightclubs.
4.72
Live music venues need to do more to protect the hearing of their patrons and staff. The work of HEARsmart, a project formed by the HEARing Cooperative Research Centre and the National Acoustic Laboratories, offers a promising example of the benefits of collaboration between music venues and researchers. Whether focussed on changing practices in the music industry or on educating young people about hearing health, projects that can promote safe listening practices without compromising on the opportunities to enjoy music are likely to be the most effective.
4.73
The Committee was concerned to hear about the risk posed by high levels of noise within some Aboriginal and Torres Strait Islander homes. As discussed in Chapter 3, hearing loss is far too common in Aboriginal and Torres Strait Islander communities. Dangerous levels of noise caused by many hearing impaired people living together represents yet another risk to the hearing health of Aboriginal and Torres Strait Islander children and is a further reason why hearing loss in these communities needs to be addressed.

Hearing Health Awareness

4.74
With 3.6 million Australians experiencing some form of hearing impairment it is surprising that public knowledge of hearing health issues remains relatively low. Addressing hearing loss early helps people maintain their quality of life, as well as prevent social isolation and cognitive decline. Despite this, on average people take seven years between realising they are losing their hearing and doing something to address it. As many as
two-thirds of Australians with hearing loss may be going untreated.
4.75
Many of the organisations that contributed to the Inquiry called for a government led awareness campaign focussed on hearing health. A hearing health awareness and education campaign was also recommended by the 2010 Senate Inquiry into Hearing Health and in the intervening years the need has not diminished. Despite the prevalence of hearing impairment it has never been the focus of a broad scale public health campaign like those that have targeted the prevention of skin cancer and quitting smoking.
4.76
The Committee believes that an education and awareness campaign focussed on promoting practices to prevent hearing damage, destigmatising hearing loss, and encouraging people experiencing hearing loss to seek treatment could have significant public health benefits.

Hearing Health Research

4.77
The cochlear implant, one of the most important advances in the treatment of hearing loss and deafness, is a product of Australian hearing health research. The Committee was pleased to see that Australian researchers are continuing to make significant advances in understanding the causes of hearing impairment and developing successful treatment options. The Longitudinal Outcomes of Children with Hearing Impairment study is providing valuable long-term data on the effects of early intervention on children’s development of communication skills. The Committee is also interested in the potential value of similar longitudinal studies focussing on hearing impaired adults.
4.78
The fields of genetics and stem-cell therapies appear to have the potential to offer a step-change in how hearing impairment is treated. While the research in these fields is at an early stage, it is possible that, one day, they will lead to new techniques that could prevent, or even reverse, hearing loss.
4.79
Balance disorders can have a devastating impact on those that suffer from them, and yet there appears to be significant uncertainty about their cause or how they might be treated. The Committee believes further research into the causes and possible treatment options for balance disorders is needed.

Innovation in Hearing Service Delivery

4.80
Rapid development in telecommunications technology has been of great benefit for deaf and hearing impaired Australians. Services such as live captions and video Auslan translation assist deaf and hearing impaired people to participate in work, community, and social events. In addition, internet based telehealth services provide an opportunity to deliver hearing health services effectively to rural and remote regions. Changes to the Medicare Benefits Schedule should be made to allow providers to claim for the provision of telehealth services.

Recommendation 6

4.81
The Committee recommends that the Department of Health, in consultation with state and territory counterparts and key stakeholder groups, develop and implement an education and awareness raising campaign focussed on national hearing health. The campaign should:
Promote safe noise exposure practices in the workplace. (The department, in partnership with Safe Work Australia, should focus on encouraging businesses to enact measures to eliminate or isolate sources of noise rather than relying on personal hearing protection.)
Build on existing projects such as HEARsmart and Know Your Noise to promote safe listening practices in the music industry and among young people.
Encourage people who may be experiencing hearing loss to seek assistance and encourage general practitioners and other relevant medical practitioners to actively enquire about the hearing health of their patients, particularly those aged 50 years and over.
Include messaging aimed at destigmatising hearing loss and educating the public on the challenges faced by deaf and hearing impaired Australians.

Recommendation 7

4.82
The Committee recommends the Department of Health develop a national hearing loss prevention and treatment program for agricultural communities. Effective interventions piloted in the National Centre for Farmer Health’s Shhh Hearing in a Farming Environment project should serve as the basis for the development of the program. Specifically, the program should include:
The provision of education on farm-based sources of noise exposure and how the risks to hearing health from these noise sources can be minimised.
Hearing screening services targeted at workers in agricultural industries and referrals to treatment services for people found to have a hearing loss.
The promotion of communication techniques to assist people with hearing loss regardless of whether they choose to use hearing devices.

Recommendation 8

4.83
The Committee recommends that the Hearing Services Program and the National Acoustic Laboratories prioritise funding for research which focuses on:
The causes of balance disorders and potential treatment options;
Genetic and stem-cell based treatments for hearing impairment; and
Longitudinal research on the experiences of adults undergoing treatment for hearing impairment.

Recommendation 9

4.84
The Committee recommends that the Australian Government add hearing health services delivered via the internet to the Medicare Benefits Schedule. These services should include: audiology; ear, nose, and throat consultations; early intervention listening and spoken language therapy; and speech pathology.

  • 1
    Safe Work Australia, Submission 35, p. 1.
  • 2
    The HEARing Cooperative Research Centre (CRC), Submission 59, p. 7.
  • 3
    The HEARing CRC, Submission 59, p. 6.
  • 4
    Deloitte Access Economics, Exhibit 18: An Update of the Social and Economic Cost of Hearing Loss and Hearing Health Conditions in Australia, p. 31.
  • 5
    Access Economics, 2006, Listen Hear! The Economic Impact and Cost of Hearing Loss in Australia, p. 7.
  • 6
    Deloitte Access Economics, Exhibit 18, p. 31.
  • 7
    Safe Work Australia, Submission 35, p. 1.
  • 8
    Safe Work Australia, Submission 35, p. 3.
  • 9
    Safe Work Australia, Submission 35, p. 3.
  • 10
    Safe Work Australia, Submission 35, p. 4.
  • 11
    Safe Work Australia, Submission 35, p. 4.
  • 12
    Safe Work Australia, Submission 35, p. 4.
  • 13
    Safe Work Australia, Submission 35, p. 1.
  • 14
    Safe Work Australia, Submission 35, p. 2.
  • 15
    Safe Work Australia, Submission 35, pp 1-2.
  • 16
    Safe Work Australia, Submission 35, pp 2-3.
  • 17
    Safe Work Australia, Submission 35, pp 2-3.
  • 18
    Mr Jeremy Trotman, Councillor and Executive Officer, Australian Institute of Occupational Hygienists (AIOH), Official Committee Hansard, Melbourne, 1 May 2017, p. 43.
  • 19
    Australian Society of Rehabilitation Counsellors, Submission 23, p. 9.
  • 20
    Safe Work Australia, Submission 35, p. 1.
  • 21
    Mr Jeremy Trotman, AIOH, Official Committee Hansard, Melbourne, 1 May 2017, p. 43.
  • 22
    AIOH, Submission 54.1, p. 1.
  • 23
    AIOH, Submission 54.1, p. 1.
  • 24
    Safe Work Australia, Submission 35, p. 2.
  • 25
    Safe Work Australia, Submission 35, pp 2, 7.
  • 26
    Safe Work Australia, Submission 35, p. 2.
  • 27
    National Centre for Farmer Health (NCFH), Exhibit 9: Shhh Hearing in a Farming Environment: Parliamentary Inquiry Hearing Health and Wellbeing, May 2017, p. 1.
  • 28
    Associate Professor Susan Brumby, Director, NCFH, Official Committee Hansard, Shepparton, 2 May 2017, p. 20.
  • 29
    Associate Professor Susan Brumby, NCFH, Official Committee Hansard, Shepparton, 2 May 2017,
    p. 18.
  • 30
    Sound Scouts Australia, Submission 41, p. 8.
  • 31
    Sound Scouts Australia, Submission 41, p. 8.
  • 32
    Associate Professor Susan Brumby, NCFH, Official Committee Hansard, Shepparton, 2 May 2017, p. 18.
  • 33
    Associate Professor Susan Brumby, NCFH, Official Committee Hansard, Shepparton, 2 May 2017, p. 20; NCFH, Exhibit 9, p. 1.
  • 34
    NCFH, Exhibit 9, p. 1.
  • 35
    NCFH, Exhibit 9, p. 1.
  • 36
    Associate Professor Susan Brumby, NCFH, Official Committee Hansard, Shepparton, 2 May 2017,
    p. 18.
  • 37
    Associate Professor Susan Brumby, NCFH, Official Committee Hansard, Shepparton, 2 May 2017,
    p. 19.
  • 38
    Associate Professor Susan Brumby, NCFH, Official Committee Hansard, Shepparton, 2 May 2017,
    p. 19.
  • 39
    Associate Professor Susan Brumby, NCFH, Official Committee Hansard, Shepparton, 2 May 2017,
    p. 22.
  • 40
    HEARsmart and the HEARing CRC, Submission 32, p. 1.
  • 41
    HEARsmart and the HEARing CRC, Submission 32, p. 1.
  • 42
    Professor Robert Cowan, Chief Executive Officer, the HEARing CRC and HEARsmart, Official Committee Hansard, Melbourne, 1 May 2017, p. 14.
  • 43
    Professor Robert Cowan, The HEARing CRC and HEARsmart, Official Committee Hansard, Melbourne, 1 May 2017, p. 14.
  • 44
    Can:Do Group, Submission 50, p. 2.
  • 45
    Dr Timothy Makeham, Private Capacity, Official Committee Hansard, Canberra, 14 February 2017, p. 2.
  • 46
    Ms Donna Staunton, Chief Executive Officer, Hearing Care Industry Association (HCIA), Official Committee Hansard, Adelaide, 3 May 2017, p. 18.
  • 47
    Professor Robert Cowan, The HEARing CRC and HEARsmart, Official Committee Hansard, Melbourne, 1 May 2017, p. 15.
  • 48
    Professor Robert Cowan, The HEARing CRC and HEARsmart, Official Committee Hansard, Melbourne, 1 May 2017, p. 14.
  • 49
    Professor Robert Cowan, The HEARing CRC and HEARsmart, Official Committee Hansard, Melbourne, 1 May 2017, p. 12.
  • 50
    Dr Timothy Makeham, Private Capacity, Official Committee Hansard, Canberra, 14 February 2017, p. 2.
  • 51
    Dr Damien Howard and Jody Barney, Submission 98, Attachment A, p. 7.
  • 52
    Dr Damien Howard and Jody Barney, Submission 98, Attachment A, p. 7.
  • 53
    Dr Damien Howard and Jody Barney, Submission 98, Attachment A, p. 8.
  • 54
    Professor Robert Cowan, The HEARing CRC and HEARsmart, Official Committee Hansard, Melbourne, 1 May 2017, p. 12.
  • 55
    HEARsmart and the HEARing CRC, Submission 32, p. 1.
  • 56
    HEARsmart and the HEARing CRC, Submission 32, p. 1.
  • 57
    HEARing CRC, Submission 59.1, p. 1.
  • 58
    HEARing CRC, Submission 59.1, p. 1.
  • 59
    HEARing CRC, Submission 59, p. 8.
  • 60
    HEARsmart and the HEARing CRC, Submission 32, p. 2.
  • 61
    HEARing CRC, Submission 59, p. 8.
  • 62
    Australian Hearing, Submission 58, p. 4.
  • 63
    Self Help for Hard of Hearing Australia (SHHH Australia), Submission 42, p. 14.
  • 64
    Australian College of Audiology, Submission 94, p. 2.
  • 65
    Royal Institute for Deaf and Blind Children (RIDBC), Submission 48, p. 7.
  • 66
    Deafness Forum of Australia, Submission 16, p. 13
  • 67
    SHHH Australia, Submission 42, p. 14.
  • 68
    Deafness Forum of Australia, Submission 16, p. 13.
  • 69
    Professor Robert Cowan, The HEARing CRC and HEARsmart, Official Committee Hansard, Melbourne, 1 May 2017, p. 12.
  • 70
    RIDBC, Submission 48, p. 7.
  • 71
    Australian Hearing, Submission 58, p. 5.
  • 72
    Deafblind Australia, Submission 69, p. 1.
  • 73
    Deafblind Australia, Submission 69, p. 2.
  • 74
    Mr David Brady, Submission 65, p. 3.
  • 75
    Deaf Australia, Submission 82, p. 7; Deafness Forum of Australia, Submission 17, p. 14.
  • 76
    CICADA Australia, Submission 73, p. 5.
  • 77
    Goulburn Valley Hearing Clinic, Submission 104, p. 2.
  • 78
    Deaf Services Queensland, Submission 113, p. 3.
  • 79
    Mr David Brady, Submission 65, p. 1.
  • 80
    Australian Hearing Hub, Submission 60, p. 3.
  • 81
    Cochlear, Submission 91, p. 5.
  • 82
    Deafness Forum of Australia, Submission 17, p. 14.
  • 83
    HCIA, Submission 30, p. 6.
  • 84
    RIDBC, Submission 48, p. 7.
  • 85
    SHHH Australia, Submission 42, p. 5.
  • 86
    HCIA, Submission 30, p. 6.
  • 87
    RIDBC, Submission 48, p. 8.
  • 88
    Life Unlimited, Submission 70, pp 2-4.
  • 89
    The Bionics Institute of Australia (Bionics Institute), Submission 27, p. 1.
  • 90
    Mr Dig Howitt, Chief Operating Officer, Cochlear Ltd, Official Committee Hansard, Sydney, 15 November 2016, p. 9.
  • 91
    Bionics Institute, Submission 27, p. 1.
  • 92
    Bionics Institute, Submission 27, p. 5.
  • 93
    Bionics Institute, Submission 27, p. 5.
  • 94
    Bionics Institute, Submission 27, p. 5.
  • 95
    Dr Matthew Hunter, Member, Human Genetics Society of Australasia (HGSA), Official Committee Hansard, Canberra, 14 February 2017, p. 8.
  • 96
    Dr Matthew Hunter, HGSA, Official Committee Hansard, Canberra, 14 February 2017, p. 9.
  • 97
    Dr Matthew Hunter, HGSA, Official Committee Hansard, Canberra, 14 February 2017, pp 7-8.
  • 98
    Professor Stephen O’Leary, Member, Australian Society of Otolaryngology Head and Neck Surgery (ASOHNS), Official Committee Hansard, Sydney, 6 April 2017, p. 45.
  • 99
    Professor Stephen O’Leary, ASOHNS, Official Committee Hansard, Sydney, 6 April 2017, p. 47.
  • 100
    Professor Robert Cowan, The HEARing CRC and HEARsmart, Official Committee Hansard, Melbourne, 1 May 2017, pp 13-14.
  • 101
    Bionics Institute, Submission 27, p. 6.
  • 102
    Including: the Bionics Institute, the HGSA, The HEARing CRC.
  • 103
    Professor Colette McKay, Leader in Translational Hearing Research, Bionics Institute, Official Committee Hansard, Melbourne, 1 May 2017, p. 7.
  • 104
    Professor Robert Cowan, The HEARing CRC and HEARsmart, Official Committee Hansard, Melbourne, 1 May 2017, p. 14.
  • 105
    The HEARing CRC, Submission 59, p. 10.
  • 106
    The HEARing CRC, Submission 59, p. 10.
  • 107
    Professor Robert Cowan, The HEARing CRC and HEARsmart, Official Committee Hansard, Melbourne, 1 May 2017, p. 12.
  • 108
    The HEARing CRC, Submission 59, p. 10.
  • 109
    The HEARing CRC, Submission 59, p. 10.
  • 110
    Dr Harvey Dillon, Director, National Acoustic Laboratories, Australian Hearing, Official Committee Hansard, Canberra, 3 March 2017, p. 20.
  • 111
    Mr Andrew Bush, National Secretary, Better Hearing Australia, Official Committee Hansard, Melbourne, 1 May 2017, p. 3.
  • 112
    Dr Hamish Innes-Brown, Research Fellow, Bionics Institute, Official Committee Hansard, Melbourne, 1 May 2017, p. 8.
  • 113
    Dr Daniel Brown, Senior Research Fellow, Sydney Medical School, The University of Sydney (University of Sydney), Official Committee Hansard, Sydney, 6 April 2017, p. 3.
  • 114
    Dr Daniel Brown, University of Sydney, Official Committee Hansard, Sydney, 6 April 2017, p. 2.
  • 115
    Mr Stephen Spring, Private Capacity, Official Committee Hansard, Sydney, 6 April 2017, p. 56.
  • 116
    Whirled Foundation, Submission 77, p. 23.
  • 117
    Ms Shaunine (Nina) Quinn, Chief Executive Officer, Neurosensory, Official Committee Hansard, Brisbane, 21 April 2017, p. 8.
  • 118
    Other names used to refer to particular health services provided remotely via the internet include: ehealth, telepractice, teleaudiology, and teleotology.
  • 119
    Ms Emma Rushbrooke, Clinical Director, Hear and Say, Official Committee Hansard, Brisbane, 21 April 2017, p. 3.
  • 120
    Speech Pathology Australia, Submission 51, p. 19.
  • 121
    Audiology Australia, Submission 49, p. 12.
  • 122
    Speech Pathology Australia, Submission 51, p. 19.
  • 123
    Ms Emma Rushbrooke, Hear and Say, Official Committee Hansard, Brisbane, 21 April 2017, p. 3.
  • 124
    The HEARing CRC, Submission 59, p. 13.
  • 125
    For example: Speech Pathology Australia, Submission 51, p. 9, Royal Institute for Deaf and Blind Children, Submission 48, p. 19, Cochlear, Submission 91, p. 6.
  • 126
    Telethon Kids Institute, Submission 44, pp 7-8.
  • 127
    Vicdeaf, Submission 86, p. 3.
  • 128
    Mr Andrew Lyall, Chief Operations Officer, Vicdeaf, Official Committee Hansard, Shepparton,
    2 May 2017, p. 8.
  • 129
    Dr Phil Harper, Community Liaison Manager, Conexu Foundation, Official Committee Hansard, Brisbane, Friday 21 April 2017, p. 43.
  • 130
    Deafblind Australia, Submission 69, p. 7.
  • 131
    Deafblind Australia, Submission 69, p. 5.
  • 132
    Deafblind Australia, Submission 69, p. 5.
  • 133
    Deafblind Australia, Submission 69, p. 5.
  • 134
    Dr Elaine Saunders, Submission 53, pp 2-3; Dr Elaine Saunders, Official Committee Hansard, Melbourne, 1 May 2017, p. 50.

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