December 16, 2008 Features

Universal Hearing Health Care: China

About one-fifth of the world's population lives in China, and according to the National Bureau of Statistics (NBS) survey, approximately 21 million have hearing loss, although the actual number is probably higher. The primary causes of hearing loss are presbycusis, otitis media, congenital factors, ototoxic drugs, and noise exposure.

Although the overall prevalence of hearing loss in the aging population is reportedly similar to Western societies, the prevalence of presbycusis is particularly significant in China, where an estimated 14 million people over age 60 have hearing loss. In 2005, more than 100 million people (7.7% of the population) were over age 65, a number that is expected to grow at a rate of 3%–4% annually, making China potentially one of the largest hearing aid markets in the world. Yet only 1%–8% of the population with hearing loss uses hearing aids, compared to 20%–30% in Western societies.

Despite the low hearing-aid penetration rate, almost all major hearing aid manufacturers began marketing their products in mainland China in the late 1970s. In addition, locally made hearing aids, some priced as low as $25 (US), constitute 20%–30% of China's hearing aid sales. Most people in China obtain hearing aids in retail electrical appliance or medical supply shops, and some obtain aids from hospital clinics. The quality of hearing care they receive depends on availability of resources, trained personnel and other factors. Most users are fitted monaurally, regardless of the hearing loss.

In mainland China, most hearing aids are dispensed to children. Universal newborn hearing screening is advancing, and children living in major cities are often fitted with amplification at age 2. In economically developed cities like Beijing, children are provided with free hearing aids, but rural children may not be diagnosed and fitted with hearing aids until they reach age 4 or 5. Cochlear implants (CI) are gaining in popularity, and more than 3,000 people use a CI. The Formosa Foundation recently donated 15,000 CIs for children on the mainland, which should give many more children access to this technology.

Although Hong Kong is part of China, hearing aid provision is very different from the mainland. More than 100 audiologists serve a population of about 7 million. Widespread newborn hearing screening is now in place; failed cases receive follow-up diagnostic ABR and otolaryngology assessment, resulting in diagnosis by 3–6 months of age and amplification shortly afterwards. Children receive free hearing aids through the Hong Kong Education Bureau. Because of a higher per capita income, senior citizens in Hong Kong find hearing aids affordable and obtain them from private hearing aid clinics. Previously, many audiologists in Hong Kong received training in the United Kingdom, but now many train locally at the University of Hong Kong, which offers a two-year master's program in audiology.

China is probably one of the largest hearing-aid markets in the world, yet overall use of hearing aids remains low. The greatest challenge in China is the lack of trained personnel to provide rehabilitative services and the absence of culturally and linguistically appropriate outcome measurement materials. 

Lena L. N. Wong , PhD, CCC-A, is an associate professor at the Centre for Communication Disorders, Faculty of Education, University of Hong Kong.

Bradley McPherson , MEd, PhD, is associate professor at the Centre for Communication Disorders, Faculty of Education, University of Hong Kong.

cite as: Wong , L. L.  & McPherson , B. (2008, December 16). Universal Hearing Health Care: China. The ASHA Leader.

Hearing Aid Use in China

Overall, only 1%–8% of people with hearing loss in China use hearing aids, and most of them are children. The following reasons may contribute to the low prevalence of hearing aid use:

  • Tonal language differences. Chinese speakers do not seem to note a significant communication challenge until the hearing loss in the better ear reaches 40 dB HL or worse, and many first-time hearing aid users have a mean threshold of 54 dB HL. Perhaps Chinese speakers experience fewer handicaps from hearing loss, compared to nontonal language speakers, because their residual hearing at the low frequencies that carry much of the important information for tonal language perception.
  • Perception of aging. Many Chinese elderly persons regard hearing loss as part of the aging process and expect their children and others to adapt to their needs, rather than seek help for difficulties. They often do not seek help until their doctors or family members urge them to do so.
  • Concerns about cost and cosmetics. Many older people in China believe that hearing aids are expensive and unaffordable. In comparison to reports in the Western literature, elderly Chinese are often more concerned about affordability issues and consider hearing aids an option only for severe hearing loss. However, they may be less concerned with the quality of dispenser service and have fewer cosmetic concerns about hearing aids.
  • Limited access to hearing health services. The majority of the Chinese population lives in rural areas, with limited access to hearing health care. There are often high costs for transportation and accommodation when seeking services in cities.
  • Over-the-counter amplification. Many elderly people in China with hearing loss purchase over-the-counter hearing aids or similar amplification devices. These devices are more affordable, costing 50 USD or less, are widely available, and do not require a custom earmold. Unfortunately, their electroacoustic characteristics are generally not appropriate for the typical audiometric configurations associated with presbycusis.
  • Lack of professional recognition. Audiology is not a profession recognized by the mainland government. Most "audiology professionals" were trained as teachers, otolaryngologists, or nurses and became involved in audiology after graduation. This limits community identification of a single professional group that can provide specialized help with hearing loss.

Lena L. N. Wongand Bradley McPherson


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