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«THE ECONOMIC IMPACT AND COST OF HEARING LOSS IN AUSTRALIA A report by Access Economics Pty Ltd February 2006 Listen Hear! The economic impact and ...»

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However, exposures to chemicals may directly impact on hearing loss and possibly exacerbate the damaging effects of noise when the two exposures occur either together or in sequence. Toluene is a case in point (Johnson, 1993). More common still, simple and commonly used medications such as aspirin also appear to damage the hearing mechanism (McFadden and Champlin, 1990). It is feasible that ototoxicity is the under-recognised major and preventable cause of hearing loss. Effective research into the biomolecular processes of presbyacusic hearing loss, coupled with studies of hair cell regrowth, may identify avenues for delaying or mitigating hearing loss associated with the ageing process.

7.3 ACCESSING AND USING HEARING AIDS

In Section 6.2, the extent of hearing aid use in the community was discussed, based on Australian epidemiological data. There it was noted that the number of people owning a hearing aid was low (15%) and that of those who owned an aid, only some 38% regularly used their aids. Data available on the website of the Commonwealth Department of Health for the Office of Hearing Services suggests that rates of hearing aid use in Australia have risen to over 20% among older people since the last studies were published. Nonetheless, this remains a low take-up rate. The research reported in this paper also reported that people delayed seeking assistance for hearing loss, on

average for six years. Barriers exist to:

accepting hearing loss seeking help getting a hearing aid continuing to use a hearing aid Research is required for the development of strategies that can enable people to access services earlier. Research is also required to address cosmetic and technical problems that inhibit people from using hearing aids. In particular, research needs to address making hearing aids more effective in background noise, as this is the most common technical limitation reported by users.

7.4 HEALTH EFFECTS OF HEARING LOSS

In Section 2.5.1 health effects associated with hearing loss were noted. Recalling this material it was observed that “(T)here is a need for well-controlled research studies that enable us to better identify and quantify all the effects of hearing loss on general wellbeing” (Dillon, 2001:368-369). Specifically, research is required that can examine possible connections between hearing loss and its health and personal consequences (where they exist) and in turn, to link this information back into the prevention cycle.

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There are a variety of possible causal mechanisms that were identified from the literature such as stigma and poor health outcomes (ie, the stress effects of hearing loss), lower socio-economic factors, pessimism, severity of perceived disability, social isolation, and negative emotion just to name a few. A significant barrier to progress in this area has been the absence of prospective studies that can examine causal relationships.

Specific research questions pertaining to longer term health outcomes and hearing loss

were also identified:

Does a cascade of benefits result from effective hearing interventions, so people not receiving assistance fare worse?

Do differences in attitudes and behaviours associated with health service utilisation including willingness to seek treatment for medical conditions result in differing health outcomes? and Do health professionals or patients trade off the need to treat hearing loss in the context of managing seemingly more serious conditions? If so, what are the consequences of such trade offs for people with hearing loss.

In addition, research is required to examine the extent to which current interventions such as hearing aids remediate any health and social effects arising from hearing loss.

7.5 BIOMOLECULAR AND GENETIC APPROACHES TO

HEARING LOSS

Given recent advances in the identification of specific genes and their biomolecular activities, the possibility now arises both to create diagnostics to identify those individuals with particular susceptibility to presbyacusic hearing loss, and potentially to create pharmacological approaches to reverse or mitigate the biomolecular processes that result in hearing loss. In addition, advances in this field may in the future identify pharmacological approaches to preventing or mitigating the damage to hearing sensory cells resulting from noise.

7.6 CARING Current public data sources do not document the nature or extent of informal caring provided by parents, partners and friends of people with hearing loss. Consideration should be given to questions that capture the nature and extent of such caring in surveys such as the Survey of Disability, Ageing and Carers (ABS).

7.7 PRODUCTIVITY OF PEOPLE WITH HEARING LOSS

Australia has a well developed public hearing services infra-structure for children and retired people. However, no such infra-structure exists for people of working age.

Interestingly, this group is associated with the largest socio-economic impact of hearing loss - lost productivity. Notably the productivity impact in terms of unemployment is on adults aged over 45 years – younger people with hearing loss had employment rates comparative to the rest of the community. Under-employment appeared to be more of an issue to younger people with hearing loss. By contrast, people with hearing loss are largely silent in official welfare and employment statistics. The numbers of people identified in official statistics with hearing loss were disproportionately low given the epidemiological data that also captured unemployment rates. Preliminary research in this area suggests that people with hearing loss are on the margins of the workplace

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and struggle to maintain their employment. Key problems include equally participating in meetings, coping with background noise and discrimination, keeping up to date with informal conversations, negotiating reasonable communication accommodations and being able to participate in spontaneous but critical workplace conversations (Hogan, Stewart and Giles, 2002). Research is required that more systematically articulates the impact of hearing loss on employment opportunities, particularly in the middle working years and in turn identifies strategies that address this impact.

7.8 HEARING LOSS IN THE ABORIGINAL POPULATION

An epidemiology of hearing loss and associated risk factors in Australian Aboriginal communities is required. Included within this study is a need to identify the nature and extend of intermittent as well as permanent conductive hearing loss and its effects on learning. This is particularly required given that many Aboriginal children experience chronic suppurative otitis media.

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