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. (See sidebar for theories about the low rate of hearing aid use.)
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.