Global Audiology/Americas/Mexico

Mexico has an area of ​​1 964 375 km², making it the 14th largest country in the world and the third largest in Latin America (“Mexico”, 2017).

Mexico is the eleventh most populous country in the world, with an estimated population of 119 million people in 2015.3 Most of them have Spanish as their mother tongue, which the state recognizes as the national language along with 67 indigenous languages of the nation (“Mexico,” 2017). About 287 languages ​​are spoken in the country. Due to the characteristics of its population, it is the most populous Spanish-speaking country as well as the seventh most linguistically diverse country in the world.

The human presence in Mexico goes back 14,000 years to the present. After thousands of years of cultural development, Mesoamerican, Aridoamerican, and Oasisamerican cultures emerged in the Mexican territory. After nearly 300 years of Spanish domination, Mexico began the struggle for political independence in 1810. Subsequently, for nearly a century, the country was involved in a series of internal wars and foreign invasions that had repercussions in all areas of Mexican life. During much of the twentieth century (mainly the first half), a period of great economic growth took place within a policy dominated by a single political party.

According to the World Tourism Organization, Mexico is the main tourist destination in Latin America and the ninth most visited country in the world (INEGI, 2015). This is due in large measure to the 32 cultural or natural sites that are considered by UNESCO to be World Heritage Sites, making them in this sense the first on the continent and the sixth in the world.

The National Institute of Statistics and Geography (INEGI) and the National Population Council (CONAPO) announce the 2014 National Demographic Dynamics Survey (ENADID).

The survey was carried out between August and September 2014 and collected information from a national sample of 101,389 dwellings distributed throughout the national territory. The main results are presented below.

According to the results of ENADID 2014, of the 119.9 million people living in the country, 6% (7.2 million) have a disability, of which 33.5% (2.4 million) have a hearing problem. On figure 1, the image shows the percentage with respect to the total population with disability, a person may have more than one disability, so that the sum of the types of disability exceeds 100% (INEGI. National Meeting of the Demographic Dynamics of 2014. Database)

In 15 of the country’s 32 federative entities, the prevalence of disability among the population residing in each of them is greater than that observed at the national level (which is 6.0%).

Nayarit and Durango are the states with the highest prevalence in the country, with 8.2 and 7.5%, respectively. The states of Mexico (6.2%) and the Federal District (4.7%). Seven out of 10 people with disabilities (69.6%) have two or more disabilities simultaneously, while a third of the population with a limitation (32.8%) states that they have two or more limitations.

The causes of deafness in the country are: 28.9% by disease, 49.6% by advanced age, 9.3% by birth, 6.3% by accident, 0.8% by violence, and 5.1% by other causes. Of the total number of people with hearing impairment, 13.4% (320,000) are between 0 and 14 years of age, that is, they are of school age. However, only 14% of the hearing impaired, between 3 and 29 years of age, go to school, a percentage well below 42.4% of the blind and 23.9% of people who cannot walk in the same age range of who do attend school.

History
Mexico has been one of the countries that has been concerned about the problems of the pathology of hearing, voice, and language for more than fifty years. As an antecedent to this, in 1866, Lic. Benito Juarez, as president of the Republic, decreed the formation of the School of Deafness. During the rule of Porfirio Diaz, it was ruled that the deaf-mutes received, along with primary instruction, the teaching of a trade.

The first physicians who specialized in the field of problems of hearing, balance, voice, and language were students of doctors Pedro Barruecos at the Mexican Institute of Hearing and Language (IMAL), founded in 1951, and Andres Bustamante Gurria at the National Institute of Audiology and Fonatria in 1953. Since 1966, at the Mexican Institute of Social Security, the Otorhinolaryngology Service has established the medical residency in Audiology and Otoneurology. In 1963, the General Hospital of Mexico created the audiology and phoniatrics service and the residency in human communication.

In Mexico, the first courses were given at the General Hospital of Mexico (GHM) and the Mexican Society of Audiology and Phoniatrics (now the Mexican Association of Communication, Audiology, Otoneurology and Phoniatrics) with Arroyo, García Palmer, and Valdes, and shortly after the classification of tympanometric curves by Jerger and the publication of the “Handbook of Clinical Impedance Audiometry” (1975), protocols were adopted that are still in force (Berruecos, 1998). The objective of this technique is to know the state and functions of the external ear, the membrane and the tympanic box, the eustachian tube, the intratympanic muscles, and a portion of the auditory pathway and associated areas in the brain stem, with the search of ipsilateral and contralateral stapedial reflexes.

In 1971, Jewett clearly described the points of origin of the different potentials of the brain stem. In 1974, Hecox and Galambos demonstrated that auditory brain stem evoked potentials allowed for estimating thresholds in children and adults, and in 1975 Starr reported the effects of neurological pathology on these potentials. The first auditory brain stem evoked potentials team arrived in Mexico in the second half of that decade, thus opening a new path for audiological diagnosis, now solidly established in the country (AMCAOF, 1998).

In 1978, Kemp discovered spontaneous sounds, or sounds generated by stimulation in the ciliated cells, in one of the most important audiology milestones. Otoacoustic emissions (OAEs), discovered between 1980 and 1990, quickly became a clinical method of great importance because it was non-invasive and because of its precision, simplicity, efficiency, speed, and low cost, which consolidated the programs of neonatal hearing screening (NHS) to identify early deafness. The first NHS program in Mexico, based on the guidelines of the NHS pioneer, Marion Downs, was established at the GHM in 1999. It served as a model for structuring the National NHS Program in 2007 and for training staff in the hospitals throughout 2008, with a view to putting it into action at the national level in 2009.

Education
In Mexico, the degree in medicine receives different names according to the university at which it is studied. Some call this program the Bachelor of Medicine or Medical Surgeon program. The duration of the medical course is generally 6 years in total; however, especially in the north of the country, you can also find universities that teach it for 7 years. It is important to mention that all universities must be certified by the Ministry of Health to offer this career. This certification is based on the academic plan, the teachers, and the infrastructure of the institutions.

It is important to note that the last year in every school or medical school in Mexico consists of performing a compulsory social service that is independent of the university in which the career is being pursued and its curriculum. All the doctors in formation must render under the same conditions the year of social service, according to the type of place that they obtain.

In the case of Audiology, each university makes its own academic program where each of the thematic contents is divided into subjects, modules, or sections of the syllabus of the Audiology specialty. All programs must include four parts: basic training, clinical cycles, undergraduate education, and social service, which usually extends two years for this specialty.

Degree Options

 * Thesis and professional examination
 * Elaboration of the thesis and professional examination
 * Elaboration of a thesis report on the practice performed in the social service, if this is related to the career and professional examination
 * Elaboration of a study thesis on some aspect of the student’s work (in case he is working), if this is related to the career and professional examination

Audiology Practice: Public and Private
There is little assistance in the public sector for hearing problems. There is a small amount of information about the field of ​​audiology currently practiced in the country. This is due to the small budget that the country gives to related disabilities due to a lack of hearing, since the income is diverted to other necessities in the country. On the other hand, the public sector only deals with problems classified as level 3. Level 3 refers to all those auditory deficits that cannot be treated by a general practitioner or require specialized care related to the ear.

In most cases, access to audiological services is done privately. Individuals who suffer from an ear-related problem must attend with a general practitioner or otolaryngologist, who will provide them with a direct pass to a specific audiological service. In this case, the patient pays for the audiological services. In most cases, private clinics that sell hearing aids provide the first free diagnostic test. The reason for this is that a patient with a diagnosis is more likely to qualify for an audiological service, where the purchase of appliances is indispensable in most cases.

In Mexico, an audiometry exam costs about $40 to $70, depending on the institution. Hearing aids vary in price depending on brands and providers. Regrettably, access to hearing aids is limited to the few specialists in the country. In addition, the level of the devices is linked to the “affordable costs” that society can acquire. In other words, they do not commonly offer the newest models.

Services offered by Otolaryngologists, Otologists & Otoneurologists
Otolaryngologists in Mexico provide a diverse selection of ear-related services. Services may include the diagnosis and management of acute and chronic pathologies and congenital malformations; surgical management of pathologies and tumors; and implantable devices. The most common surgical implants available are cochlear implants and middle ear implants. It is becoming more common for small procedures, such as the placement of PE tubes for adults, to be completed in the otolaryngologist’s office. Depending on comfort level, many will also provide, in the office, inter-tympanic steroid injections for the treatment of sudden sensorineural hearing loss.

The otologist examines the patient and evaluates and diagnoses ear disease. Once the patient has been evaluated and diagnosed, the otologist will establish, through a clinical report, possible surgical or drug treatments, perform the procedures for psychological care in the event that the patient cannot benefit from the treatments, and advise on the audiophthesis adaptation (INR, 2017).

Otoneurologists evaluate integrally (diagnose, treat, and rehabilitate) patients with symptoms such as instability, vertigo and / or dizziness; Applying specialized studies such as: videonystagmography-electronystagmography, rotating tests, dynamic posturography, computerized, audiometry, neuroaudiometry, impedanciometry, and vestibular rehabilitation (INR, 2017).

Audiological Services
Below is a list of links to agencies, organizations, and other websites that offer a wide variety of information, services, and resources of interest to the deaf, hard of hearing, and their families. Also, some of the institutions mentioned below provide financial help and resources for people with communicative disorders.


 * National Institute of Rehabilitation INR
 * General Hospital of Mexico
 * Pedagogical Institute for language problems IPLIAP
 * Oira Clinic Mexico City, UDLA
 * IMAL, Mexican Institue Of Hearing And Language
 * General Directorate of Special Education (SEP – Secretaria de Educacion Publica)
 * National Medical Center November 20 ISSTE
 * Nacional Medical Center XXI IMSS
 * INER, National Institute of Respiratory Illness.
 * Gea Gonzalez Hospital
 * Federico Gomez Hospital
 * National Institute of Pediatrics INAP
 * Cruz Roja Mexicana

Professionals
In Mexico, the specialty of audiology is relatively young, so the country lacks specialists. A physician and his or her team can diagnose conditions for a limited number of deaf people. However, to reach the final diagnosis and rehabilitation work, associate professionals are required to carry out, under their supervision, specific tasks: management of electro-acoustic diagnostic and treatment equipment, clinical testing practices, ear molding, and counseling of patients in the use of prosthetics, in learning to read lips, and in the prevention of problems in speech articulation (Baloh & Honrubia, 2010).

The graduate in Audiometry and Auditory Rehabilitation can establish contacts with professionals from other areas of medicine: neurologists, pediatricians, geneticists, otolaryngologists, and general surgeons, as well as pedagogues and psychologists. It will be able to analyze and assimilate the content of books, magazines, and specialized documents and will be able to collaborate on the accomplishment of basic works of clinical or documentary research (Baloh & Honrubia, 2010). In Mexico, the levels of education related to audiology can be divided into: otolaryngologist; degree in Hearing, Voice and Oral and Written Language Therapy, Professional Associate in Audiometry and Hearing Rehabilitation, and Superior Rehabilitation Technician. In the country, there are about 500 to 600 specialists, a small figure for what is in the country, plus the fact that almost 300 are in the urban area of Mexico City.

It should be noted that the additional education required to practice audiology is only available at the National Autonomous University of Mexico (UNAM). An average of 24 doctors graduate from this program annually. Therefore, the growth of the profession occurs very slowly.” (UNAM, 2015).

In Mexico, the agencies responsible for hearing care are working in conjunction with other communication problems, such as speech problems and language disorders. Within the governmental organizations in charge of treating this type of disorder are the Instituto Mexicano de la Audición y el Lenguaje, A. C. (IMAL).

Also, the Instituto Nacional de Rehabilitation (Speech and Hearing Disorders Department), part of the UNAM (Universidad Nacional Autonoma de Mexico) is the one who helps evaluate, diagnose, and propose solutions to hearing and balance problems in the country. In general, this center oversees connecting other clinical centers for patients from the north and south of the country. This governmental body is in the center of the country, so most patients with hearing problems are forced to be treated in this area, since the deficiency of professionals in other sectors of the country is present.

Scope of Practice and Licensing
The culmination of a university career is obtaining a title and its corresponding professional certificate. In many companies, when offering a job, it is emphasized that the applicant is qualified in the field. Failure to complete the titling process can close doors or, if you get the job, imply that you will get a lower salary. In the same way, to practice some professions, it is necessary to have a professional certificate, as the different laws and regulations make it applicable.

Requirements to obtain the right to the title:


 * To have surpassed all the subjects that compose the curriculum of each race,
 * To accredit the level of knowledge of English language,
 * Submit proof of compliance with social service and
 * Pass satisfactorily through the process of titling the institution.
 * There is no compulsory degree format, so it can vary from institution to institution. Let’s list the most common options. As other alternatives are opened, we will incorporate them so that this guide is as complete as possible.

Research in audiology is poor in quality but active in Mexico. Most research is conducted through educational facilities and large research-driven institutions. Current works span the entire scope of audiological practice. Though there is a plethora of research being conducted, there is still much to be learned about the auditory system, (re)habilitative devices, the (re)habilitation process, and many other topics. The ever-increasing literature collection improves the ability of audiologists to conduct evidence-based practice. Currently, Mexican audiology research is headlined by studies of the correlation between hearing loss and cognition, noise-induced hearing loss, tinnitus, and the long-term outcomes of cochlear implantation. There are several peer-reviewed audiology-related journals published in Mexico, like: Medigraphic, Latindex, Otorrinoweb, and Imbioned. Also, Elsevier has a journal syndicated in Spain and the United Kingdom.

The following are a few of the many highly active audiology-related charities:


 * Adiós a la sordera
 * Asociación Civil Oír Mejor
 * Centro Dar
 * Fundaciã“N Escúchame
 * Fundación F.A.N.D.A.: Fundación de Ayuda al Niño con Discapacidad Auditiva
 * GIEH: Grupos Integrados Específicos para Hipoacúsicos
 * Mutualidad Argentina de Hipoacúsicos
 * Sitio de Sordos
 * Voces en el Silencio

=== Challenges === Unfortunately, in Mexico, there is a disconnect between the types of services available and the uptake of hearing healthcare. Therefore, early identification and hearing loss prevention programs are not effectively reaching those who could benefit most. Potentially treatable conditions, such as otitis media, continue to be a frequent cause of deafness. Epidemiological studies are scarce, and, on the other hand, there are no established programs for the early detection of hearing loss. All professionals dedicated to the field of audition have a serious commitment to try to advance in these aspects to continue writing a worthy history of audiology in the new millennium. The new millennium demands specialists with great concern and dedication who follow the example and commitment of those who have paved the way so that we can now practice a specialty with its own characteristics. This requires professionals with a solid basis of preparation and a commitment to continuous updating.


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 * Asociación Mexicana de Comunicación, Audiología, Otoneurología y Foniatría, A.C. Estatutos. 1998.
 * Autores Varios. Audiologia clinica. Mexico: Interamericana (Clinicas Otorrinolaringologicas de Norteamerica. Vol. 2. 1991)
 * Baloh RW. Honrubia V. Clinical neurophysiology of the vestibular system. 3rd Oxford University Press; 2001. (Contemporary Neurology Series. No. 63)
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 * Instituto Nacional De Rehabilitación (2017)
 * La discapacidad en México. Datos al 2014
 * Plan único de especialidades médicas. Comunicación, Audiología y Foniatría. Facultad de Medicina, UNAM. División de Estudios de Posgrado e Investigación. México. 2015
 * Secretaria de Salud. Instituto Nacional de la Comunicacion Humana. Registros electrofisiologicos para el diagnostico de la patologia de la comunicacion humana. Mexico SSA-INCH; 1997.
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