Background and the Need

It is well established that hearing loss is one of most frequent chronic conditions in older adults and a major health issue, particularly for the low- and middle-income nations. As an example, the World Health Organization (WHO) estimates that there are more than 360 million people with disabling hearing loss (WHO, 2012). Data indicate that more than 80 percent of this population are from low- and middle-income countries with little to no access to any audiological services. Estimates from WHO suggest that in developing nations only about 3 percent of those in need of hearing care have access to and avail themselves of appropriate services (WHO, 2004). Hearing care services are impeded mainly by the two following major barriers: 

  1. Service clustering—Most of the services are confined to urban/suburban areas. For example, a survey of audiologists in private practice reported that only 13 percent are working in rural settings (ASHA, 2015). Even in advanced developing countries like India, greater numbers of hearing–care services are in urban areas with limited access to residents in rural areas (Manchaiah, 2016). 
  2. Cost—High purchase and maintenance expenses are related to hearing aid use. Therefore, there is a clear need for services that are capable of reaching individuals underserved due to limited resources, and those who are deprived financially.

Audiology education and practice vary considerably across countries. In North America and some parts of Europe audiology is well defined, and audiology services and delivery models are quite developed and sophisticated; in some countries audiology is considered an “autonomous” profession. In most parts of the world, however, the profession of audiology is still in its infancy and is viewed as a support profession under the umbrella of another profession (e.g., otolaryngology, acoustics, etc.). Hence, there is much work to be done in audiology to bridge this inequality in education and access to services. Moreover, much can be learned, even within the developed world, by comparing audiology practices across countries and taking inspirations from established and functional working practices to enhance the standard of audiological care.

We believe the first step in bridging the gap in the access to audiology care is to better understand audiology education and practice; and to form a network to connect audiologists and other stakeholders around the world. Based on this premise, our work began on the Global Audiology Initiative. 


Global Audiology, known as the Global Resource for Audiology Information Networking (GRAIN), is a nonprofit initiative that is focused on promoting networking among all stakeholders in hearing health care and helping to develop accurate and current knowledge about audiological practices worldwide. We believe that promoting networking and collaboration and also developing the knowledge about current practice trends is the first step in helping to standardize audiology practice and ultimately improve audiological care, facilitate the standardization of audiology practice and help with providing better access to audiology services. The Global Audiology ePlatform is available to all without charge.

FIGURE 1. To populate the Global Audiology website with information, teams were created based on the United Nations world regions and subregions.

Activities and Method

GRAIN uses three methods to accomplish its goals. These include the following: 

  1. Building an infrastructure—Develop a website that provides information about audiology education and practice around the world.
  2. Building a team—Recruit key individuals who will volunteer to serve as resource editors and key contact people for the region/country. 
  3. Creating an opportunity for networking activities—Organize ongoing networking activities to promote communication and interactions between all hearing health-care professionals around the world. 

Each of these activities has been implemented and is in various stages of development.

Building an Infrastructure

The website for Global Audiology provides up-to-date information about audiology education and practice in the regions across the world. The content of the website is managed by a web developer and the editors. This will ensure that the information presented in the website is peer-reviewed by those who have knowledge of audiology and audiology practice within a region.

Building a Team

To make the work manageable, the world has been divided into five regions and subregions based on the United Nations classification (see FIGURE 1). The five regions include Africa, Americas, Asia, Europe, and Oceania. The project will work with the following editorial structure: 

  • Co-founders and senior editors (SEs)
  • Regional resourse editors (RREs)
  • Subregional resource editors (SRREs)
  • Subregional contributors (SRCs)

The overall responsibility of SEs is to ensure that GRAIN meets the stated goals and objectives, which involve providing the following: 

  1. A description of audiology practice around the world.
  2. Opportunity for information exchange and networking for stakeholders in ear and hearing health care. 

RREs will be invited to represent the five regions referred to earlier. They will be chosen based on their familiarity with audiology activities and resources that are available within their regions. Each RRE will invite the SRREs to represent defined world subregions based on the United Nations classification. 

There will be 22 SRREs, who will be chosen based on their familiarity with audiology activities and resources that are available within the subregions. The SRREs will then find and invite suitable SRCs to represent a particular country and provide necessary information about the country. 

There will be one SRC for each country, who will be chosen based on familiarity with audiology activities and resources that are available within the country. 

Creating an Opportunity for Networking Activities

The Global Audiology team will organize activities to promote networking among various stakeholders of hearing health care around the world. These activities can be either face-to-face meetings during professional conferences and/or virtual meetings. These meetings will help foster discussion, make specific action plans to develop audiology knowledge across the globe, and help develop audiology services for underserved populations.  

Potential Implications

The hope is that Global Audiology will be of interest to various stakeholders including audiologists, hearing scientists, otologists/otolaryngologists, people with hearing loss, related health-care professionals, and hearing instrument manufacturers/specialists, and various governmental and nongovernmental organizations. While the potential impacts of such an initiative can be hard to anticipate, we believe and hope that this initiative will have the following implications:

  • Generate accurate and reliable information about the audiology profession from each country to help redefine audiology education and practice around the world. 
  • Promote a network of stakeholders within and across the countries to help the exchange of ideas, particularly in promoting good practice. 
  • Promote a network of stakeholders to help stimulate humanitarian activities and further help promote access to hearing care for underserved populations. 

The professional network that is created through this initiative can be used for conducting multicenter cooperative studies that will help to better understand the crosscultural differences and similarities in various aspects of ear and hearing health care. 

The professional network that is developing through this initiative can be helpful when mobilizing and coordinating advocacy activities related to deafness and hearing loss prevention program, as initiated by the World Health Organization.

The Future

GRAIN is a new initiative that is attempting to have an impact on audiology around the world by providing an opportunity for audiologists and all those interested in hearing, hearing health and hearing loss prevention to network through an active website. The website is now available; several of the key editors have volunteered to represent geographic regions, and more are being recruited. There are completed webpages available for 11 countries. We hope that the future of GRAIN will be a positive impact on all aspects of audiology and audiology health care worldwide. We believe that this unique model can inspire health professionals in other health fields to build global network to promote access to care and good practice around the world.   


American Speech-Language-Hearing Association. (2015) 2014 Audiology Survey Report: Private Practice. (accessed on September 23, 2016).

Manchaiah V. (2016) Hearing healthcare in India. ENT Audiol News 25(1):73–74. 

World Health Organization. (2004) Guidelines for Hearing Aids and Services for Developing Countries (2nd ed.). Geneva, Switzerland: World Health Organization.

World Health Organization. (2012) Global Estimates on Prevalence of Hearing Loss. (accessed on September 23, 2016). 

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