ADEQUACY OF HEARING HEALTH RESEARCH PROGRAMS
We need to have evidence based practice. We only work on
evidence based practice.
Ms Dimity Dornan, Hear and Say Centre, Committee Hansard, 7
December 2009, p. 71.
This chapter examines the adequacy of current hearing health research
programs and explores the need to overcome identified research gaps.
Major Hearing Health Research Programs and Organisations
The Australian Government provides financial support for hearing health
research through a number of funding
- the Hearing Loss Prevention Program (HLPP), announced in May
2007. This ongoing program ($3.5 million in 2007-08) provides funding for
research and prevention activities to help reduce the burden and incidence of
avoidable hearing loss in young people, Indigenous Australians, and those in
the workplace. As this is a designated 'ongoing program', there will be
opportunities to respond to identified gaps and emerging needs after the initial
establishment phase of the program. Six research projects have been
commissioned through this program. The research programs funded to date
address issues for all three target groups;
- research by the National Acoustic Laboratory (NAL) which is funded
under the Australian Government Hearing Services Program, Community Service
Obligation (CSO) arrangements;
funding for the National Health and Medical Research Council (NHMRC)
grants, which currently includes funding for research into deafness, ear
physiology, hearing aids, otitis media and tinnitus;
the Cooperative Research Centre (CRC) program administered by the
Department of Innovation, Industry, Science and Research (DIISR) which in 2007
provided funding of $32.55 million over seven years to the HEARing CRC;
- the Department of Veterans Affairs (DVA) which is undertaking a
study of the Neuromonics tinnitus program, which has been available in private
practices in Australia for several years. Approximately 60 veterans are taking
part in the study, with results to be finalised in 2011.
The committee received many submissions that noted Australia's position
as a world leader in hearing health research, and which encouraged Australian
governments to maintain adequate funding for hearing health research, particularly
for the NAL.
The NAL focuses on research into three major areas: better ways of
assessing hearing loss; hearing rehabilitation once hearing loss has been
diagnosed including advancement of hearing aid devices; and prevention,
including the effects of noise on people.
NAL is recognised internationally for its work. Signal processing software used
in hearing aids that has been developed by NAL is used widely throughout the
In the words of Professor Dillon, Director of NAL: '...any little place or shop
around the world that sells hearing aids will know about NAL because they use
our methods on a daily basis.'
NAL is currently undertaking the Longitudinal Outcomes of Children with a
Hearing Impairment (LOCHI) study, which is the most comprehensive study of its
type in the world. NAL has recruited 475 children with a hearing loss at the
time, or not long after, they received their first hearing aids.
LOCHI will examine the development of speech, language function and
psychosocial skills, and the educational attainment of the children. The study
- importance of early detection of hearing loss, intervention and
- effects on outcomes of a range of factors including age at time
of intervention, cause of hearing loss, type of hearing aid prescription and
type of intervention;
- rate of development and relative impact of different factors at
When all data is available, the study will assist in the understanding
- whether normal speech and language development among hearing
impaired children who have received early intervention will continue through
- the impact of many factors on long-term speech, language,
functional, psychosocial; and
- the impact of hearing loss on educational attainment.
The HEARing CRC is a consortium of research, clinical and industry
organisations that facilitates communication between academic, clinical and
industry members with the aim to ensure coordinated research. The HEARing CRC
focuses on the development of targeted remediation of lost productivity that results
from hearing loss in adults and children, and research into technical and
behavioural means of preventing hearing loss. The HEARing CRC has four research
biomolecular, genetic, physiological solutions;
- intelligent sound processing;
- integrated bioengineering; and
- clinical tools and techniques.
Other key Australian hearing health research organisations include:
- Macquarie University (audiology and cognitive research);
- The Bionic Ear Institute;
University of Melbourne (audiology and cochlear implant
- Cochlear Ltd (cochlear implant development);
Menzies School of Health Research; and
- The Ear Science Institute.
Prior to the 2006 publication of Listen Hear! by Access
Economics, there had been no definitive research on the economic impact of
hearing loss and impairment in Australia. Most studies have focused on clinical,
prevalence and social issues connected to hearing loss.
A study into the epidemiology of hearing loss conducted by the then
Centre for Population Studies in Epidemiology within the South Australian (SA)
Department of Human Services has been the only epidemiological study of hearing
loss in Australia. As noted by Access Economics, in order to monitor progress
in the management and prevention of hearing loss there is a need to maintain an
accurate and current epidemiology.
Submissions received by the committee also outlined the need for further
research into the feasibility of a national hearing and tracking database for
newborns, the impact of recreational noise and personal media players on
hearing health, overcoming occupational noise induced hearing loss, acoustic shock,
the incidence of comorbidity of hearing loss and other disabilities, mental
health issues associated with hearing impairment, addressing employment issues
for people with hearing impairment, caring arrangements, ototoxicity, and
A National Tracking Database for
The committee received many submissions expressing frustration at the
lack of nationally consistent data about newborns and children diagnosed with
In particular, Professor Dillon and NAL have discovered through the
LOCHI study that a significant number of children who are diagnosed with
hearing impairments are not recorded to have received treatment:
A gap that we just discovered actually only in the last month
or two, [is that] 25 per cent of the children diagnosed [with hearing loss] have
not ended up with rehabilitation, so they have fallen through the cracks
somewhere along the way.
The committee heard from Professor Dillon that this research was
undertaken only in New South Wales (NSW), however it is likely that the same is
occurring in other parts on Australia.
Further investigation by NAL into this matter has found 15 of the 25 per cent
stated above made it to Australian Hearing, but were not issued with hearing
aid devices. The reasons for the 'missing' 10 per cent remain unknown.
Professor Dillon noted that many individual states had their own records and
databases, however given this 10 per cent gap:
There is a real need for a national database associated with newborn
screening so that we do not have to catch this up on a special-occasion basis,
but it just becomes part of the system...The way I envisage it working is...that
information would be [regularly] downloaded from the state databases to a
national one, and there we could compare the children who have been shown to
have a hearing loss with who has been picked up by Australian Hearing and
received rehabilitation. Immediately then we would spot the gap in every state
and those children could be followed up.
The discovery by NAL of children who are diagnosed with hearing
impairments, but who are not known to have received intervention, is a concern
in relation to their development outcomes. As was discussed in chapter four, research
has shown the benefits of identifying hearing impairments in children at a
young age, provided that diagnosis is followed by early intervention.
As noted in chapter two, children with hearing loss represent only a
small proportion of all people with a hearing loss. However the impact on this
group is particularly significant as they require a high level of support in
developing communication skills and accessing education.
Due to the lack of research that tracks patient outcomes nationally, it
can be difficult for parents to determine the most appropriate intervention for
their child, and which communication strategies and hearing technologies to
Submissions received by the committee referred to new trends in therapy
services for the deaf, including a move away from hands-on therapy services and
an increasing number of cochlear implants in children. Submissions outline the
need to research the educational, cognitive, linguistic, social and emotional
development outcomes, and future life situations of children who engage in
different forms of treatment for hearing loss, in order to help parents to make
informed decisions about treatment and intervention options.
The Department of Health and Ageing (DOHA) submitted to the committee
A national data set for state and territory neonatal hearing
screening and post screening services is in the process of being developed, and
- Allow for the monitoring and
evaluation of neonatal hearing screening programs
- Underpin the development of
a nationally consistent quality and standards framework
- Permit for national and
international benchmarking and collaboration
- Enable research into risk
factors and health conditions associated with permanent childhood hearing
A national register will be established as part of
the national approach to neonatal hearing screening and will be a central point
for the collection and management of all data. The data parameters of a
national register are yet to be finalised and consultation with key
stakeholders will be undertaken to determine the most appropriate national
register for neonatal hearing screening data. Consideration will also be given
to the ethics of allowing academic and other researchers accessing data held on
a national register for appropriate research projects.
Recreational noise and personal
Access Economics reported that 37 per cent of all hearing loss in
Australia is preventable and is caused by exposure to excessive recreational or
Many submissions received by the committee expressed concern with the
lack of definitive research that exists regarding the impact of excessive
recreational noise, particularly personal music players, but also including
shooting, motor sport and the use of power tools. 
Concern regarding exposure to excessive noise from personal music players was
particularly in relation to use by young people.
As was noted in chapter two, despite research evidence that exposure to
noise through personal music players can be loud enough to pose a danger for
hearing loss, it has not been well-established whether, or how much, this
recreational exposure is contributing to significant, long-term hearing loss in
Some research into the effects of recreational noise is currently being
undertaken. NAL has been funded under the HLPP to undertake a research project
to establish the prevalence of hearing loss in adolescents, and the
relationship to recreational noise.
This report is due to be released in December 2012. A complementary study by
NAL will further provide a comprehensive picture of the noise exposure of young
people, and an assessment of the contribution that different activities and
environments pose on the hearing of young people over a lifetime. Edith Cowan
University is also undertaking a similar research project into the effect of personal
music players at high volumes among young people.
Submissions received by the committee suggest that current research into
the impacts of recreational noise should be extended into longitudinal
population studies that establish the long-term effects of recreational noise
exposure, including from personal music players. 
Occupational noise induced hearing
Safe Work Australia estimate that a third of workers in Australia are
exposed to noise levels that could lead to noise-induced hearing loss.
This hearing loss, which is entirely preventable, makes a substantial
contribution toward the high cost of hearing loss to Australia, as discussed in
Submissions received by the committee note that legislation already
exists in Australia to limit noise exposure, and to protect employees from
exposure to excessive noise in the workplace. However, submissions have argued
that there are significant obstacles to the effective implementation and
acceptance of occupational noise management which contribute to the failure of
efforts to reduce personal noise exposure, and that understanding these
barriers is a key research challenge.
Safe Work Australia is undertaking research into ONIHL, including:
- analysis of the National Hazard Exposure Worker Surveillance (NHEWHS)
Survey 2008, which gathered national data on the exposure of workers in
Australia to various hazards, including loud noise. It also gathered data on
the provision of control measures in Australian workplaces, including controls
for noise exposure.
This information will enable identification of workers at risk of ONIHL, with
the aim of reducing the incidence of ONIHL through better targeted occupational
health and safety policy, enforcement and information/education campaigns; and
- the Getting Heard project, as mentioned in chapter two.
This project will determine the personal and institutional factors that
influence the control of hazardous noise exposure and the prevention of ONIHL.
Outcomes from this project will provide the Office of Hearing Services (OHS)
and stakeholders with a greater understanding of why ONIHL still occurs among
workers in Australia. The findings will also assist stakeholders in the design,
implementation and evaluation of strategic initiatives to control hazardous
Submissions received by the committee indicate that further research
into the opportunity, ability, willingness and intent of workplaces to prevent
hearing loss, the design of workplace equipment, and more appropriate forms of
hearing protection, such as pharmacological protection, could have a large
impact in improving workplace practices to prevent ONIHL.
Under-use of hearing aid devices
As was discussed in chapter five, evidence suggests that between 20 and
40 per cent of all hearing aids provided with public funding may be under-used,
or not used at all. The committee also received submissions from health
practitioners and researchers that indicate a low take-up rate of hearing aid
devices. This includes the suggestion that less than 20 per cent of adults who
could benefit from hearing devices pursue those services, and less than 10 per
cent of people who could benefit from cochlear implants seek this form of
Submissions to the inquiry note that the low usage rates of hearing aids
represents a waste of public funding, and that research into the reasons for
under use of hearing aids is required, including cosmetic and technical
Health outcomes and mental
well-being of the hearing impaired
As noted in chapter three, hearing loss has been linked to a range of increased
risks for other health conditions including diabetes, stroke, elevated blood
pressure and heart attack.
DOHA reports a growing body of Australian and international research regarding
the prevalence of mental illness among the hearing impaired. DOHA note,
however, that research findings are inconsistent and even conflicting, which
has resulted in '...the mental health industry in Australia being ill-equipped to
adequately meet the need of people with a hearing difficulty'.
Submissions further identify the need to clarify potential links between
hearing impairment, social isolation and mental health issues in order to develop
methods for early intervention and treatment.
Access economics notes that long-term research is necessary in this area.
DOHA has provided evidence to the committee that there is no research on
the relationship between mental health and hearing impairment currently funded
by the NHMRC, nor funded in previous years. Since 2005, the Australian Research
Council has provided funding to support four child-specific research projects
examining the relationship between hearing loss and mental health issues such
as development of social skills, social participation and wellbeing and
The effects of ototoxicity
Ototoxic substances are chemical substances that may damage the hair
cells of the cochlear or the auditory pathway, and which can also increase the
risk of preventable hearing loss.
Ototoxic substances may be present in medicines, including antibiotics
and chemotherapy treatments, or inhaled through the fumes of fuels, metals,
fertilisers, herbicides or pharmaceuticals.
The nature of ototoxic substances is that they are often present in the
workplace, which makes the issue of awareness and safety around these
substances a workplace issue.
Evidence received by the committee suggests that little is known about
the complete effect of ototoxic chemicals on long-term hearing loss, or how many
people are exposed to these substances in the workplace. The findings from such
research may help reduce the incidence of preventable hearing loss, and
identify a need for different audiological tests to properly assess impacts of
Meniere's disease affects around 40,000 people in Australia who
consequently experience hearing impairment including fluctuating hearing loss,
tinnitus, spinning and vertigo, and other symptoms.
Meniere's Australia noted that few other submissions received in this
inquiry mention Meniere's disease. Meniere's Australia has advised the
committee that there is not research available that determines the cause of the
disease, and that little funding is available from the Australian Government to
advance this. Further, Meniere's disease is often misdiagnosed or undiagnosed.
Meniere's Australia submit that more extensive research into the prevalence of
the disease, rates of diagnosis, treatment and personal management options, and
the impact on the employment and lifestyles of those with the disease is
The committee would like to note that it has heard from many sources
during the course of this inquiry that Australian research into hearing health
is highly regarded internationally. Whilst there are many organisations in
Australia conducting world class research in this field, the committee would
particularly like to acknowledge the leadership and vision of National Acoustic
Laboratories under the direction of Professor Harvey Dillon.
Having acknowledged that Australia is at the forefront of hearing health
research, the committee did learn about gaps in the collective knowledge and
understanding that will benefit from further attention. The committee
understands that funding is finite, and has directed its recommendations toward
two areas. Firstly, toward research that will have greatest benefit for the
quality of life of people with hearing loss. Secondly, the committee's
recommendations are directed toward research that is likely to benefit Australian
In particular the committee is concerned by the potential for 'missing'
children who are registered to have been diagnosed with a hearing impairment
but are not recorded as having received intervention. Given the unambiguous evidence
before the committee about the many benefits of a greater understanding about
the clinical and developmental pathways of children diagnosed with hearing
loss, development of a national data base should be a high priority for
research and development.
The committee heard a widespread note of concern from many sectors of
the community, including concerned individuals, research bodies and government
agencies, about the possible effects of personal music players on hearing
health. The committee believes that the high visibility of these devices in the
community, particularly among young people, has driven this general concern.
The committee understands that the research on this issue is not conclusive,
and that a long term study will be of great benefit to future safety practices.
The committee notes that there is a knowledge gap around detailed
understanding of the extent of hearing loss caused by ONIHL. To some extent
this gap may be attributable to the nature of hearing loss, whereby it is often
difficult to attribute a hearing loss to one workplace or event. What seems
certain to the committee, however, is that despite good knowledge about safe
workplace practices, many workers and employers do not comply with hearing
safety regulations, especially in smaller workplaces. The committee has
included workplace safety awareness raising in its recommendations at chapter
seven. A deeper understanding of the reasons for non-compliance and other risk
behaviours will contribute to national policy and workplace practices.
A greater understanding of the nature of ototoxins, particularly in the
workplace, may also contribute to reducing preventable hearing loss.
The committee noted in chapter four the association between hearing
health and some negative health outcomes, including mental health outcomes.
This is an area that needs greater understanding if practitioners and policy
makers are to respond effectively to improve the quality of life for people
with a hearing loss. The committee believes there would be great benefit from
further research into the link between hearing loss and mental and physical
The issue of publicly funded hearing aids sitting unused in the top
drawer was discussed in chapter five. Improved understanding of the reasons for
low take-up and use of hearing aids could have benefits for both people with
hearing impairment (who may be more inclined to use hearing aids), and public
funding currently going toward between 60,000 and 80,000 unused hearing aids
each year could be targeted more effectively.
The committee heard that Meniere's disease may affect around 40,000
Australians. The disease is little understood, and is consequently often
misdiagnosed or undiagnosed. The committee believes that improved understanding
of this disease could benefit a large number of Australians.
The committee recommends that the national data set and register for
neonatal hearing screening, currently under development by the Neonatal Hearing
Screening Working Group on behalf of the Australian Health Minister's Advisory
Council, be expanded to include a national database which can:
track children through neonatal hearing screening, diagnosis and
record and report cognitive, linguistic, social and emotional
development outcomes of children diagnosed at birth with a hearing loss; and
be expanded in future years to track all children diagnosed with
a hearing impairment later in life.
The committee recommends that the Australian Government fund the
National Acoustic Laboratory to undertake longitudinal research into the long-term
impacts of recreational noise, particularly exposure to personal music players.
The committee recommends that Australian Governments continue to prioritise
and fund research into occupational noise exposure. The focus of research
should be informed by the results of the ‘Getting heard: effective
prevention of hazardous occupational noise’ project, currently being
undertaken by Safe Work Australia, and include investigation into the
effectiveness of current legislation in limiting occupational noise exposure.
Research should continue to develop understanding about the design of workplace
equipment, hearing protection, and the long-term effects of acoustic shock and
The committee recommends that Australian Governments prioritise and fund
research into the reasons for the under use of hearing aids, and develop
practicable strategies for hearing health practitioners to help overcome the under
use in the community.
The committee recommends that the Department of Health and Ageing work
closely with Safe Work Australia to investigate the relationships between ototoxic
substances and hearing impairment, and the possible implications for workplace
The committee recommends that the Department of Health and Ageing works
with Meniere's Australia to identify opportunities for research into the
prevalence of the Meniere's disease in Australia, rates of diagnosis, options
for treatment and personal management, and the socio-economic impact of the
disease, including on the employment and lifestyles of those affected.
Navigation: Previous Page | Contents | Next Page