Global Audiology/Asia/Philippines

The Philippines is a stunning archipelagic country located in Southeast Asia, consisting of a vast expanse of more than 7,600 islands, which are divided into three primary geographical areas, namely Luzon, Visayas, and Mindanao. As of the 2020 census, the country's population has grown to 109,035,343, positioning the Philippines as the 13th most populous country globally (Philippine Statistics Authority, 2022).

Filipino and English are the most spoken languages in the country, serving as the official languages, followed by Cebuano, Ilocano, Hiligaynon, Waray, and several other regional languages and dialects (Ethnologue, 2022).

The Philippines is widely recognized for its natural beauty, featuring picturesque landscapes, coral reefs, and idyllic beaches. It's a country with a rich and diverse cultural heritage, shaped by its past as a Spanish, American, and Asian colony, with historical landmarks and heritage sites representing the influence of various cultures over the centuries.Hearing loss is a common problem across all age groups in the Philippines, and the prevalence rates are higher than global estimates (Newall et al., 2020). The national prevalence of moderate or worse hearing loss is 7.5% in children, 14.7% in working-age adults, and 49.1% in the elderly (Newall et al., 2020).

The prevalence rates are also high regionally, with a study conducted in Southern Tagalog Region IV-A: CALABARZON (Cavite, Laguna, Batangas, Rizal, and Quezon) showing that around 71% of people have at least mild hearing loss, and 26.33% have disabling hearing impairment (Pardo et al., 2022). Among children aged between 4 and 18 years, 11.87% have disabling hearing loss, while among working adults aged between 19 and 64 years, the prevalence rate is 8.97%. In older adults aged 65+, the rate is 3.17% (Pardo et al., 2022).

Local studies reveal that hereditary factors play a significant role. Research on cochlear implant patients found a frequent genetic mutation SLC26A4 c.706C>G underlying hearing impairment (Chiong et al., 2018). Another study of an indigenous Filipino community identified genetic factors like SLC26A4 variants as major contributors to otitis media and conductive hearing loss (Santos-Cortez et al., 2016).

Outer and middle ear conditions, often caused by chronic infections, can also increase the risk of hearing impairment (Newall et al., 2020). Socioeconomic status is also a factor, with higher income associated with lower odds of moderate hearing loss. Wax occlusion affects 12.2% of people, while middle ear disease is present in 14.2% (Newall et al., 2020).

The number of Filipinos with severe to profound hearing loss is higher than in developed countries. Given the higher prevalence and severity rates, hearing loss is a significant public health concern that requires urgent attention to curb the rising disability.

Challenges
The prevalence of hearing loss in the Philippines is increasing, yet access to audiological services remains limited, particularly in rural and underserved areas. This lack of access highlights the need for expanded healthcare infrastructure and improved distribution of audiologists and trained hearing care healthcare workers across regions. Unfortunately, the disparities in the existing healthcare infrastructure significantly impact the quality of life of people living in these areas. The Philippines currently needs more skilled audiologists and other healthcare professionals specializing in hearing care. This shortage is impeding the nation's ability to meet the increasing demand for hearing healthcare services, highlighting the need for investment in education and training programs to develop a competent workforce. A significant challenge confronting audiology in the Philippines is the phenomenon of brain drain, wherein most locally-trained audiologists seek better opportunities overseas. This trend of emigration of skilled professionals exacerbates the shortfall of audiologists in the country and undermines initiatives to enhance the local healthcare system. The resulting shortage of qualified audiologists in the Philippines poses a severe concern for the delivery of ear and hearing care services and the population's overall well-being. Therefore, measures must be taken to address this issue and retain local talent in audiology. One significant problem in the Philippines is the need for health insurance coverage for hearing devices. This applies to both national insurance and private health insurance. As a result, individuals requiring hearing devices often have to pay for them out of their pockets or seek assistance from various sources. This includes seeking sponsorship from local politicians, NGOs, and social welfare services or receiving donations of refurbished hearing aids from other countries. The establishment of hearing centers and the distribution of hearing aids without appropriate licensing or training pose significant challenges to audiology practice in the Philippines. The lack of regulations and oversight results in substandard care, inaccurate diagnosis, and inappropriate management of hearing disorders, ultimately jeopardizing patient safety and outcomes. Implementing stringent guidelines and qualifications for hearing center establishments and hearing aid dispensers is imperative to ensure that qualified and trained professionals provide quality audiological care. Failure to do so may lead to detrimental consequences for patients with hearing impairments and the audiological profession. In the Philippines, most of the general population lacks awareness and knowledge about hearing health issues. As a result of the stigma attached to hearing loss, people often delay seeking services, which can lead to insufficient management of auditory disorders. It is crucial to address this stigma through public education and awareness campaigns to promote early intervention, management, and (re)habilitation.
 * Limited access to services
 * Shortage of qualified professionals
 * Brain drain
 * Lack of health insurance coverage for hearing devices
 * Unregulated hearing centers and dispensing of hearing aids
 * Awareness and stigma

1. [https://psa.gov.ph/population-and-housing/node/186896Philippine Statistics Authority. (2022). 2020 Census of Population and Housing.]

2. [https://www.ethnologue.com/country/PH Ethnologue. (2022). Languages of the World - Philippines.]

3. Newall, J. P., Martinez, N., Swanepoel, W., & McMahon, C. M. (2020). A National Survey of Hearing Loss in the Philippines. Asia-Pacific journal of public health, 32(5), 235–241. https://doi.org/10.1177/1010539520937086

4. Pardo, P. M., Niñal-Vilog,. , Acuin, J. M., Calaquian, C. E., & Onofre-Telan, R. D.(2022).Hearing and clinical otologic profile of Filipinos living in Southern Tagalog Region IV-A (CALABARZON), Philippines: The Southern Tagalog ENT Hearing Specialists (STENTS) Survey 2012-2017. Philippine Journal of Otolaryngology Head and Neck Surgery, 37(2), 8-15

5. Chiong, C. M., Reyes-Quintos, M. R. T., Yarza, T. K. L., Tobias-Grasso, C. A. M., Acharya, A., Leal, S. M., Mohlke, K. L., Mayol, N. L., Cutiongco-de la Paz, E. M., & Santos-Cortez, R. L. P. (2018). The SLC26A4 c.706C>G (p.Leu236Val) Variant is a Frequent Cause of Hearing Impairment in Filipino Cochlear Implantees. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 39(8), e726–e730. https://doi.org/10.1097/MAO.0000000000001893

6. Santos-Cortez, R. L., Reyes-Quintos, M. R., Tantoco, M. L., Abbe, I., Llanes, E. G., Ajami, N. J., Hutchinson, D. S., Petrosino, J. F., Padilla, C. D., Villarta, R. L., Jr, Gloria-Cruz, T. L., Chan, A. L., Cutiongco-de la Paz, E. M., Chiong, C. M., Leal, S. M., & Abes, G. T. (2016). Genetic and Environmental Determinants of Otitis Media in an Indigenous Filipino Population. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 155(5), 856–862. https://doi.org/10.1177/0194599816661703