Removing Barriers to Hearing Care in Australia

Elaine Saunders, Ph.D.

Editor’s Note:  Often, hearing professionals’ views of hearing rehabilitation is influenced by their exposure to those issues within a given locale, district, region, or those presented by a hearing professional organization.  As such, the belief is that what is taking place, is unique to them.  But, is it?  Are barriers to hearing care the same or different around the world?

HHTM is pleased to present a “down under” view of hearing care in Australia – from the other side of the world.  Are issues/concerns/potential solutions different than what HHTM readers are generally exposed to on this Internet site?  Or, are their similarities?  You be the judge.  Dr. Saunders* is co-founder and CEO of Blamey Saunders hears, a hearing aid and telehealth company that supplies and supports self-fit hearing aids.

Part I of a Four-part Series 

From “Down Under” 

Innovation happens when a process is improved or a problem is solved. Australia has a rich history of innovation in hearing solutions including the development of the multichannel cochlear implant, implementation of a free hearing aid scheme for children and pensioners, and research leading to the widespread use of the NAL-RP and NAL-NL prescriptions for hearing aid fitting.{{1}}[[1]]Saunders,E. (2015) Sound of Silence, New Holland[[1]].  Despite these advances, approximately three quarters of Australians with significant hearing loss remain without hearing aids.

Hearing Loss Unmet Needs

In order to reduce this unmet need, future approaches to adult hearing care have to overcome a combination of challenges, and recognize an era of more personalized medicine. Today, the consumer drives medicine and is Internet enabled. Patient-Centred medicine is a contemporary buzz word in medicine having strong underlying science support{{2}}[[2]]Bardes, C. (2012) Defining “Patient Centred Medicine”; N Eng J Med; 366; 782-783[[2]].  However, current hearing care costs, including the audiology infrastructure, are not sustainable.  The current model of care is too expensive in both time and money, and is failing to deliver hearing aids to the majority of people who would benefit.

Australia is currently in the higher rankings for well-being among OECD (Organisation for Economic Co-operation and Development) countries, but the health spending trajectory using “Stay as they are” models is unsustainable{{3}}[[3]]Commonwealth of Australia, Department of Treasury. Australia to 2050: future challenges (Intergenerational Report). January 2010[[3]].  This is a reflection of the high cost of health-care overall, which in the wealthy countries of the world, is spinning out of control. In audiology, the cost of soundproof rooms, audiology equipment and post tertiary clinicians for primary care clients, is out of proportion with the billing capacity of audiology practices, and a high burden on public health-care.  Reducing hearing aid provision costs have been shown to give better access to hearing aid care{{4}}[[4]]Van Vliet,D (2005)The current status of hearing care: Can we change the status quo? J Am. Academy of Audiology 16(7)410-418[[4]], but it is important that this does not result in poorer hearing aids or service support.

An Emphasis on Personalized Fitting Approach

People with hearing loss are individuals with as wide a range of characteristics as any demographic, and because of this, a more personalised approach is essential. The key points that have been incorporated into the most recent innovations in hearing aids are:

• Everyone is different.
• Hearing aids need to keep sound audible and comfortable: Adaptive dynamic range optimisation of hearing aids {{5}}[[5]]Martin, LFA; Blamey, PJ; James, CJ; Glavin, KL & Macfarlane, D (2001) Adaptive Dynamic Range Optimisation for Hearing Aids; Acoustics Australia  Vol. 29 No. 1-21[[5]]{{6}}[[6]]Higgins,P. and  Searchfield, G., Coad,G. (2012) A comparison Between the First-Fit Settings of Two Multichannel Digital Signal-Processing Strategies: Music Quality Ratings and Speech-in-Noise Scores; American Journal of Audiology; 21(1), 13-21[[6]].
• Some people require a lot of help with hearing aids and need what is generally referred to as auditory rehabilitation, but many people either don’t need or don’t want much help.
• People still put off getting hearing aids till long after the time when aids would be most beneficial to them.
• There are barriers to access, including distance and physical accessibility.

My colleague, Professor Peter Blamey, and I have been seeking to address these challenges in Australia and we have become known as “innovators and disruptors” in the area of hearing care because of this.  These changes should be described, more positively, as progressive, rather than disruptive.

Part II, next week, will take readers through the decisions made during the product development stage.

*Dr Elaine Saunders, B.Sc., M.Sc. (Clinical Audiology), PhD, GAICD, Grad Dip Mgt. (Technology) has worked in hearing research and technology for forty years.  Her life in the field started with the experience of her own father’s early hearing loss and continued through to audiology studies at Manchester University, a Churchill Fellowship and then a PhD in Biomedical Engineering at Southampton University.  She is currently Adjunct Professor in the Faculty of Science, Engineering and Technology, Swinburne University (Australia), and a member of its Biodevices Advisory Board.  Elaine co-led the “Recycled Sound” project for Rotary, to collect and refurbish used hearing aids for those in need, and is co-producer of a theatrical play, “The Sound of Waves”, based on the real life experience of a deaf girl learning to hear with a cochlear implant.  Her publications include “Sound of Silence”, a book of personal experiences in the field of hearing loss. Elaine is a member of the Rotary International Action Group on Hearing and was named a Paul Harris Fellow for her work in hearing in 2015.