|Year : 2021 | Volume
| Issue : 1 | Page : 151-155
Journey of hearing health care in India: Historical perspectives
S Hemaraja Nayaka1, Vijayalakshmi Subramaniam2
1 Department of Audiology and Speech Language Pathology, Yenepoya Faculty of Allied Health Professions, Yenepoya Deemed to be University, Mangalore, Karnataka, India
2 Department of Otorhinolaryngology, Yenepoya Medical College, Yenepoya Deemed to be University, Mangalore, Karnataka, India
|Date of Submission||12-May-2021|
|Date of Decision||21-May-2021|
|Date of Acceptance||24-May-2021|
|Date of Web Publication||26-Jun-2021|
Dr. Vijayalakshmi Subramaniam
Department of Otorhinolaryngology, Yenepoya Medical College, Yenepoya Deemed to be University, Mangalore, Karnataka
Source of Support: None, Conflict of Interest: None
The article presents a brief history on the evolution of Hearing Health Care in India. March 3rd, 2021 witnessed the launch of the world report on hearing by the World Health Organization as part of the observation of world hearing day with a special theme for 2021- “Hearing Care for all.” With the estimated prevalence rates of 5.67%–16.5% among all disabilities in India, hearing impairment impacts the country's overall development with a significant economic burden. Hearing health care received more attention during the 1960s with the establishment of specialized nodal centers in 1964 in India. India witnessed a spurt in the growth of hearing health care sector during the 1980s with the development and application of technology. There was an official launch of the trial of indigenous Cochlear Implants designed by the Defence Research and Development Organization of India in 2020. Currently, in India, there are both private and public domains in hearing care services with more than 6000 registered professionals in Audiology and Speech-Language Pathology. With the vast diversity of population and culture, limitation of centers to the urban area, and lack of trained professionals in hearing health care in rural areas, there is a need to reach to the unreached population with hearing problems.
Keywords: Epidemiology of hearing impairment, hearing health care, scope and practice of audiology
|How to cite this article:|
Nayaka S H, Subramaniam V. Journey of hearing health care in India: Historical perspectives. Arch Med Health Sci 2021;9:151-5
| Introduction|| |
Each year, “World Hearing Day” is held on 3rd of March, to reach to the public with the aim of prevention of hearing loss and to promote ear and hearing care. The World Health Organization had a special theme for 2021- “Hearing Care for all” and launched a first of its kind “World Report on Hearing.” The launch of the report was intended to create awareness and mobilize resources and actions among governments, stakeholders, and nongovernmental organizations globally. The WHO intends to provide evidence based practice guidance to address hearing loss and ear diseases and integrate quality Environmental Health Criteria in the National Health Policies.
Being emphasized on all fronts, hearing health care has gained momentum in India too. The National Sample Survey Organization of India in its recent (2011) report stated that around 2.68 crores of Indian population amounting to 2.21% of the total population has disabilities. Hearing impairment being the invisible disability has an estimated prevalence rate ranging from 5.67% to 16.5% among all the disabilities. According to the 2001–02 census, 0.2% and 0.1% of the total population is reported to have speech and hearing disabilities respectively.
| Historical Aspects|| |
The Otorhinolaryngological evaluations date back to the 4th century B.C., with Ayurvedic Medicine, Unani, and Siddha mentioning treatment for hearing and ear-related conditions based on diet and herbs model. Earlier to this Sanskrit literature by Charaka, Susruta, Madhavacarya, and Vaghbhata (“parilehi” and “kucikarnaka”) had mentioned of 28 types of ear diseases and the treatment. However, the recent Hearing Health Care has evolved with the adoption of the American model of medicine and rehabilitation. The recent diagnosis and treatment follow the Western medicine model.
Otorhinolaryngologists and Audiologists are specialized in the evaluation of hearing, selection of appropriate surgical and medical interventions, selection and fitting of hearing aids, cochlear implants, auditory-verbal therapies, and vestibular assessment and rehabilitation services to name a few.
Hearing Health Care in spite of the advances has remained a medical-surgical specialty. The advances in immunotherapy, gene therapy, tissue engineering, and robotic surgery may lessen the hands-on experience with added benefits to patient care and reduce the hospital stay. Hearing Health Care professionals have shown flexibility and adaptability with the modern trends.
| Indian Scenario|| |
The Hearing Health Care sector gained ground in India after 1950. The probable first ENT Department in India was commenced in 1874 at Cuttack. The formal practicing began around 1920 at centers such as Mumbai, Calcutta, Trivandrum, Madras, Lahore, Lucknow, and Vishakhapatnam. The Association of Otolaryngologists of India was formed in 1947 at Mumbai. Dr. P.B. Cherian of Madras, Dr. Homi. D. Gandhi, and Dr. C.A. Amesur from Mumbai were the founding members.
The audiological assessments have a history of less than seventy years in India. The profession of Audiology has shown exponential growth since then with integrated developments in the field of technology, electronics, and digital signal processing. In our country, Ear and Hearing care services are provided at both private and public domains. There are specialists dedicated for the same.
Initially, services started in the form of postgraduation centers at Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai in 1964. The Government of India started the All India Institute of Speech and Hearing in the year 1964–65. Being a premier institute in the country, it has played a catalyst role in the exponential growth of the profession of Audiology and Speech-Language Pathology. The above institutes have designed instruments of their own and procured many from abroad.
| Role of Government Program and Polices|| |
The subject of Health and Disability is in the States List of the Constitution and the Indian government is pro-active in addressing the issue.
Department of Empowerment of Persons with Disabilities (Divyangjan), under the Ministry of Social Justice and Empowerment, has enacted three acts in specific to hearing health care sector. 'The' with namely and remove full stop after sector. Rights of Persons with Disabilities (RPwD) Act (2016), The National Trust for the Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities Act, 1999 (NTA) and Rehabilitation Council of India (RCI) Act (1992).
The RPwD Act, 2016 which was enacted on December 28, 2016, came into force on April 19, 2017. A clear emphasis is made about the responsibility to be handled by the appropriate governments to take effective measures to ensure that persons with disabilities enjoy their rights equally with others. In this act, disability has been defined based on an evolving and dynamic concept, and list of disabilities included in the current guideline is exhaustive. India in 2007 ratified the United Nations Convention on the RPwD (UNCRPD). The new RPwD Act, 2016 is in compliance with the UNCRPD conventions.
A promising program for the prevention of Hearing problems the National Program for Prevention and Control of Deafness has been initiated by the Government of India since 2006. It intends to integrate health professionals working in the field of ear and hearing to bring services to the community level by involving both government and private sectors by providing systematic training in ENT care services to primary healthcare professionals. The interventions of ear diseases are further guided and strengthened by new revised updated Indian Public Health Standards since 2012.
RCI and the Indian Speech and Hearing Association are the professional bodies concerned with the regulation of education and audiological practice in India. As of May 2021, there are more than 59 institutes offering Bachelors in Audiology and Speech-Language Pathology course and 19 institutes offering postgraduation studies in Audiology and Speech-Language Pathology. There are diploma level and postgraduate diploma level programs and certificate courses on Audiological Rehabilitation, Vestibular Assessment and Rehabilitation, and Tinnitus specialties. There are more than 6000 registered professionals in India offering audiological services in various setups like institutions, Medical College Hospitals, independent clinics, and franchised clinics from different hearing aid companies. The proportion of available specialty centers for hearing care in rural areas is lesser compared to the urban areas as most of the professionals prefer to work in full-fledged facilities available in urban localities. The ratio of Hearing Health Care professionals to People with Hearing Disabilities is larger.
| Technology and Hearing Health Care|| |
In late 1980s with the advancement of Technology, the Audiometer and Tympanometer instrumentation got added with salient features. Technology has significantly contributed to the growth of Hearing care in terms of computerized methods, Bluetooth technology based audiometers and hearing aid programming devices.
Based on a simple nonelectric Technology, the first hearing aid was created in the 17th century. The initial electric hearing aid was created in 1898.
In the year 1995, Oticon brought the first digital hearing aid to the worldhearing aid. The dedicated audiological centers worldwide used the platform to develop digital solutions depending upon the requirements of the patients. It was a behind the ear device and received support from the software which allowed reprogramming, and attempted to utilize different signal-processing systems over extended periods, to allow for normal daily use.
The year 1996 witnessed the first digital hearing aid which was fully commercialized by the Widex Company. Widex Senso was the fully automatic digitally adjusted hearing aid. The device had its own built-in audiometer. Voice targeting technology was used by Oticon among the hearing aids for speech recognition and processing the speech in noise and quiet situations in 2001.
| Artificial Intelligence|| |
In 2004, the Oticon Syncro was designed with the introduction of artificial intelligence (AI) in hearing aid technology. The voice priority processing system and multi-band adaptive directionality and voice aligned compression technologies were advanced with the application of AI in the digital hearing aids. The features such as directional microphones, noise reduction, and feedback cancellation were utilized in the best way with the application of AI in Oticon Syncro technology.
Starkey launched Livio an AI hearing aid in the year 2019. The user's health was monitored by the AI with the integrated sensors through the accompanying Thrive app. Livio AI hearing aids use accelerometers and gyroscopes to track the wearer's physical and mental health for an overall daily wellness score. The device along with amplification helps in caring for the elders during a fall.
| Bluetooth Technology, Android and Ios Systems|| |
Bluetooth Technology was introduced to hearing aids by Starkey Laboratories in 2005. Empowered learners initiative device by the Starkey enabled hearing aids to be compatible with Bluetooth enabled mobile phones. In 2014, GN ReSound launched a first made for iPhone hearing aids. The ReSound LiNX and corresponding Beltone First were the first Made – for – iPhone hearing aids. These allow direct of streaming of sounds from iPhone, iPad and iPod products, allowing users to treat their wireless headphones. The ReSound Smart app enables volume adjustments and treble/bass settings for audio streaming. The provision of geotagging to adjust the hearing aids setting to the acoustics of frequently visited places with the added option of tracing the misplaced hearing aids was made possible.
In 2016, the Internet of things was introduced in Oticion Opn which could be programmed directly to connected devices such as doorbells, smoke detector, and baby alarms. The TwinLink combines binaural processing with the streamer. Google included the Android Streaming for Hearing Aids low-power Bluetooth protocol in its Android 10 operating system.
In broader perspectives, innovations in the integrated chip (like Sonova SWORD chip, Apple's H1 chip) and Digital Signal Processing (e.g., Qualcomm QC5100) allows for lower power consumption, active noise cancellation strategies. Miniaturization of the hearing aids like In- The -Canal, Completely- In the -Canal, was made possible through the innovations in these integrated chips. Modern Hearing Aids are at the forefront of hearable technology and cutting-edge wearable technology. In addressing the requirements of the patients, hearable devices are transforming to wearable devices making future of Hearing aid Technology as an exciting and promising arena.
| Cochlear Implantation Technology|| |
With the knowledge of electrical stimulation of cochlea producing the hearing, Italian scientist, Alessandro Volta, who invented the electrical battery carried out experiments placing metal plates in ears and connecting them to electricity in 1800 and reported listening sounds similar to that of boiling water. Djurno and Eyries, from France, propagated the idea of cochlear implantation in 1957. The popularization of the implant program and performance of the first implantation in 1961 was carried out by William House, an otologist from Los Angeles [Figure 1].
The Food and Drug Administration approved cochlear implant manufacturers are Cochlear Limited (Australia), MedEl Corporation (Austria), Advanced Bionics (USA, a division of Sonova). Neurelec (France, a division of William Demant is used in Asia, Europe, Africa and South America, and Canada. In India, the first three are used widely. The milestones of the development of the cochlear implant were the evolution of coding strategies, the miniaturization of electronic components, and the constant development of computing systems in sound processing. Binaural implantation is gaining momentum since 2020 [Figure 2] and [Figure 3].
|Figure 3: Nucleus 7 -the first cochlear implant sound processor to offer direct streaming, control and connectivity with compatible Apple and Android™ devices and Kanso 2 Sound Processor having features of direct streaming and use of the Nucleus Smart App from compatible smart phones, a built-in rechargeable battery and improved dust and water resistance (PC- www.cochlear.com)|
Click here to view
February 2020 marked the beginning of trials for indigenous Cochlear Implants developed by the Defense Research and Development Organization of India at Post Graduate Institute of Medical Education and Research, Chandigarh. The vision of the former president of India Dr. APJ Abdul Kalam in 2005 to have indigenous Cochlear Implant designed by the Defense Research and Development Organization came true. With the advent of Atmanirbhar Bharath and call for Digital India, Make in India, and vocal for local campaigns, the Hearing Care industry foresees a plethora of opportunities.
| Covid-19 and Tele – Hearing Health Services|| |
Hearing health care is considered as an essential service during pandemic situations like Covid-19 by the American Speech and Hearing Association. 'The bigger challenges in the covid-19 like pandemic situations are lack of appropriate personal protective equipment, sterilization of equipment and transducers, safety of the hearing health care professionals.
Advanced technology and internet connectivity and the use of smartphones among Indians have made telehealth and teleaudiological consultation a possibility. Teleaudiology encompasses many forms that are currently available today, from remote hearing aid programming through an app on a smartphone to comprehensive remote evaluations with patient and providers at distant sites [Figure 4].
A research study was conducted 'in south India' to o implement and evaluate a rural community-based pediatric hearing screening program integrating in-person and telediagnostic auditory brainstem response (ABR) in 2019. Village Health Workers were trained to carry out newborn hearing screening and assisting for tele-ABR. Integration of tele-ABR resulted in 11% improvement in follow-up compared to in-person ABR at a tertiary care hospital.
The challenges related to the teleaudiological consultations includes lack of infrastructure and technology for the practitioner as well as the patient, lack of trained professionals, reimbursement issues, licensure laws, and confidentiality of patient information, cost, lack of standards, need for additional training/knowledge, reduction in quality as compared to face-to-face interaction, and concern about malpractices.
| Future Directions|| |
We are currently facing challenges related to the services delivery which includes the lack of resources at rural areas, availability of professionals, time taken to travel, expenses for hearing evaluations, cost and maintenance of hearing aid devices, lack of support from health insurance agencies for hearing care, and not to forget the increasing unethical practices and dispensing issues of hearing aids.
With the over-the-counter hearing aids getting rolled out into various online consumer platforms, there is a need for specific guidelines and regulations to counter malpractices and misuse by the business platforms.
Only a planned program for the growth of the profession with appropriate regulation of education and policies by the Government and decentralized health-care facilities and facility centers with Public-Private Partnership Model and competent Institutions offering knowledge is the solution to the challenges faced. There is a call for reaching to the unreached in India for Hearing Health Care.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]