Hearing aid uptake low in Singapore
Singapore has low bilateral hearing aid adoption and average daily use rates compared with other developed countries, as reported in a recent study. In general, patients with hearing impairment wait until they have developed disabling hearing loss (HL) before seeking help.
Such delayed presentation may be attributed to the patients’ perception and, possibly, ignorance, according to the authors, noting that in the 2010 Singapore National Health Survey report, majority of residents (73.2 percent) with disabling HL indicated that they “did not feel they had hearing loss.’’
In the present study cohort of 1,068 patients (50.8 percent male; 87.0 percent Chinese) issued with hearing aids, the authors found that the mean age at fist fitting was 70 years. Initial mean HL, as evaluated using Pure-Tone Audiometry (PTA), was 63.1 dB, and 69.5 percent had at least moderate-to-severe HL. Sensorineural and symmetrical HL was present in 66.4 and 69.8 percent of patients, respectively. [Int J Audiol 2018;doi:10.1080/14992027.2017.1420921]
Majority of patients (85.6 percent) used HA ≥4 days/week, whereas the remaining 35.7 percent used HA >7 hours/day. Furthermore, only 18 percent received bilateral first HA fitting.
In multivariate logistic regression models, bilateral first HA fitting uptake was independently associated with younger age (adjusted odds ratio [aOR], 0.99; 95 percent CI, 0.98–1.00; p=0.05) and presentation with symmetrical HL (aOR, 2.34; 1.49–3.81; p<0.001). On the other hand, predictors of successive HA fitting included better PTA of aided ear at first fitting (aOR, 0.93; 0.88–0.98, p=0.014) and >7 hours of daily HA usage (aOR, 3.75; 1.16–12.19; p=0.028).
In terms of HA types and cost, the behind-the-ear type was significantly cheaper than the in-ear type (mean, 1,785.90 SGD vs 2,270.30 SGD; p<0.001). The standard behind-the-ear also costed much lower compared with the receiver-in-canal type (mean, 1730.63 SGD vs 2870.50 SGD; p<0.001).
Among in-ear HAs, in-the-canal and completely-in-canal subtypes were more popular than in-the-ear subtype despite being more expensive. This pattern of preference may indicate that “visibility outranks cost as a factor in the decision making for types of HA by the patients,” the authors noted.
“Quoting the maxim ‘better late than never,’ this study provides valuable insight into the 3.3 percent of the adult Singapore population with at least moderate HL who are using HAs (Ministry of Health Singapore 2011). The larger challenge at hand is the remaining 96.7 percent who are not rehabilitating their hearing impairment with HAs,” the authors said.
They pointed out that the cost of HA is likely to be a factor for the observed suboptimal HA uptake rate in Singapore, given that two-thirds of patients opted for standard BTE, which was the cheapest type of HA, and more than four-fifth opted for only unilateral HA fitting. There was no subsidy or funding scheme available for HAs before 2014, and users had to pay out of their own pockets.
Based on available evidence, HA usage rate may be influenced by four audiological factors (severity of hearing loss, type of HA, acceptance of background noise, and insertion gain relative to target gain) and seven nonaudiological factors (self-perception of hearing problems, expectation, demographics, group consultation, support from significant others, self-perceived benefit and satisfaction). These factors are said to overlap with the reasons why patients fitted with HAs may not actually use the devices. [Int J Audiol 2015;54:291-300; Int J Audiol 2013;52:360-368]
“It will be useful to evaluate which of [the said] factors are relevant for the hearing-impaired patients in Singapore. This will help with healthcare resource planning and allocation to help meet the hearing needs of our ageing population,” the authors said.