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52 million Europeans experience hearing loss but many don’t find their way to professional hearing care. Lidia Best looks at strategies to improve the uptake of amplification at a national level [1].


With rising numbers of people experiencing hearing loss, the focus on affordable access to quality hearing aids is being made a high priority due to an increase in demand. Access to hearing aids and hearing care to support independent living and improve employment and education prospects for persons with hearing loss is part of the World Health Assembly Resolution on Prevention Deafness and Hearing Loss WHA 70.13 [2].

As part of this effort, the European Federation of Hard of Hearing People has conducted a review based on affordability and funding rules in relation to the provision of hearing aids in Europe. The main goal of this was to inform users of what is happening in different countries as part of concerted efforts with other advocacy organisations working in this field.

The provision of hearing aids is only the first basic step; we need to ensure the provision is following quality standards and that the users of the services are offered follow-up care, including counselling. By involving users in planning care and enabling them to make their own informed choices, we can see benefits to the health system, becoming more efficient. For this reason, understanding variations across Europe as well as examples of good practice can be a catalyst for better investment in hearing care across Europe.

“We need to ensure the provision is following quality standards and that the users of the services are offered follow-up care, including counselling”

The availability of access to hearing aids and hearing care is a cause for concern as it can present a barrier to independent living and an improved quality of life. It is positive to see some countries putting hearing care and reimbursement as a high priority of their respective national health policies.

Interestingly, a report from France by Laurence Hartmann [3] concluded that if the French Government were to offer hearing aids free of charge, the French society would save money and the millions of helped people would feel a marked increase in quality of life. According to the report, the cost of untreated hearing loss in Europe is 178 billion euros per year. For every euro that is spent in hearing care, governments get 10 euros in return (reduced overall cost of untreated hearing loss). Currently there are positive changes with access to affordable hearing aids in France thanks to such reporting and users’ advocacy.

The conclusion? The European public health policy should consider treatment of hearing loss as one of the major concerns in its action plan, as supported by Livingstone et al in 2017 [4].

But what about user satisfaction? What about rehabilitation? Essen Declaration [5] mentioned rehabilitation, so did London Declaration [6] . So far there is no comprehensive study exploring association between clinical setting and real-time experiences of hearing aid users. One of the constant issues facing hearing aids users, as well as professionals fitting hearing aids, is getting the fitting right so the user can enjoy the maximum improvement in the quality of their hearing experience.



Since we already know the connection between our brain and hearing and listening with our brain thanks to research in the area [7], it makes sense to support those who receive hearing aids or cochlear implants with additional rehabilitation, which may involve auditory training. Children in their early development stages are naturally supported with speech and listening training and therapy, but adults are often overlooked, despite the need for support to assist them in adjusting to using hearing aids or cochlear implants. After all, it is not exactly the same as wearing spectacles.

This is where the EVOTION project may well fit in, with its model based on a combination of data collection and auditory training (

The EVOTION project is being delivered in the UK, Greece and Denmark, with the largest number of participants based in the UK using state-of-the-art hearing aids collecting data on user listening behaviours, which is promising to improving hearing aids fittings and user satisfaction. A project like this is vital to understand the importance of a person-centred approach, rather than a ‘one size fits all’.

Additionally, according to the protocol [8], participants were taking part in rehabilitation using auditory training apps. For some, it was the first time being offered such training. I met some of the project participants during workshops in London. All commented on how their confidence and quality of life was boosted thanks to participating in the project. I was also pleased to hear from one participant how his newly-found confidence helped him to gain a better job.

“The European public health policy should consider treatment of hearing loss as one of the major concerns in its action plan”

The dedication of professionals and users involved cannot be underestimated. Perhaps developing auditory training apps is something to look at for adults in addition to person-centred approach in fitting hearing aids? The Swedish example may be worth following thanks to Arlinger et al in 2017; presenting how Hörselsbron actually invests in learning from the good clinics/clinicians to transfer the learning to othes [9].

EVOTION demonstrates how data collected with a person-centred approach to interventions is providing valuable insights to the health professionals, as the outcomes of several persons’ treatment allows insights and learning on how people on a day-to-day basis use and benefit from hearing aids.

The EVOTION project is also making such insights and knowledge available to the greater society, by monitoring the quality of treatment for large groups of patients. EVOTION shows how the future of hearing healthcare may be improved by use of monitoring of various clinical interventions and use of technologies in real life situations. Learnings from such projects underpins effectively how quality of hearing care supported with better understanding of users’ needs has a highly positive effect on quality of life at reasonable direct costs and will result in long-term net savings to society and the individual.



1. Laureyns M, Best L, Bisgaard N, Hougaard S. “Getting our numbers right on Hearing Loss, Hearing Care and Hearing Aid Use in Europe”.

2. Seventieth world health assembly. Prevention of deafness and hearing loss.

Last accessed May 2019.
3. de Kervasdoué J, Hartmann L. Economic Impact of Hearing Loss in France and Developed Countries.

Last accessed May 2019.
4. Livingston G, Sommerlad A, Orgeta V, et al. Dementia prevention, intervention, and care. Lancet 2017;390:2673-4.
5. Essen Declaration 2015. European Federation of Hard of Hearing People.

Last accessed May 2019.
6. London Declaration 2017. European Federation of Hard of Hearing People.

Last accessed May 2019.
7. Dawes P, Emsley R, Cruickshanks KJ. Hearing loss and cognition: the role of hearing AIDS, social isolation and depression. PLoS One 2015;10(3):e0119616.
8. Dritsakis G, Kikidis D, Koloutsou N, et al. Clinical validation of a public health policy-making platform for hearing loss (EVOTION): protocol for a big data study. BMJ Open 2018;8(2):e020978.
9. Arlinger S, Nordqvist P, Öberg M. International Outcome Inventory for Hearing Aids: Data From a Large Swedish Quality Register Database. American Journal of Audiology 2017;26(3S):443-50.


Declaration of Competing Interests: None declared.

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Lidia Best

Study group 16 - Question 28, ITU-T (International Telecommunications Union; WHO-World Hearing Forum, Make Listening Safe Workgroup; EFHOH (European Federation of Hard of Hearing People).

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