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Professor Greg Leigh and Professor Catherine McMahon

Spreading the word: how Australia’s experience can influence newborn hearing health in the Asia Pacific

By Professor Greg Leigh and Professor Catherine McMahon

Australia punches above its weight in many fields. We have an international reputation as an incubator for new technology: Google Maps, WiFi, and of course the cochlear implant are standouts. And we’re known around the world for our wine and our sporting prowess. We also happen to be very good indeed at screening newborns for hearing loss.

Australia’s approach to newborn hearing screening gives us the means to intervene early so that babies born with hearing loss are afforded immeasurable benefits in terms of their communication, language, and social development. We are, quite literally, changing lives every day.

But there’s a broader contribution we can make. We have two decades of experience and a pool of deeply talented and committed experts whose combined knowledge could be a boon for hearing health in the Asia Pacific region.

The WHO estimates in its 2021 World Report on Hearing that in the South-East Asia Region, 401 million people have some degree of hearing loss. Of this, 109.4 million (5.5%) have a moderate or higher grade of hearing loss.

Working better together

So, earlier this year, we began a conversation about how we might harness this expertise, and work better together to share what we know.

We and our colleagues formed the Universal Newborn Hearing Screening Expert Working Group – a joint initiative of the Australian Hearing Hub based at Macquarie University, and the Australasian Newborn Hearing Screening Committee.

This exciting collaboration will help us maximise our value and impact beyond our own borders. And it’s powered by the very same collegiate spirit that saw all of Australia’s jurisdictions come together more than two decades ago to do better for babies with hearing loss.

This week, we will host a delegation of 25 leaders from Thailand, including representatives from Mahidol University, Ramathibodi Hospital, the National Health Security Office, Ministry of Health and The Royal College of Otolaryngologists. We have a packed program to share and are hoping the conversations we have will be the beginning of an ongoing partnership.

And in November an Australian delegation will travel to China as part of a collaboration with Chinese researchers funded through a grant from the National Foundation of Australia China Relations. The focus will be on improving early detection of hearing loss and managing it effectively post diagnosis.

The relationship with China is a longstanding one. Australia and China formed a hearing care partnership back in 1995 when AusAID funded a delegation of surgeons and health providers to learn about Audiology in Australia. Since then, Macquarie University supported the establishment of the first Masters’ program in Audiology at Capital Medical University.

We know we will learn in return. These relationships will give us insights we can feed back into our own work and approaches. We’ve been on a long journey of learning since the Australasian Newborn hearing Screening Committee issued the first Consensus Statement on Universal Neonatal Hearing Screening back in 2001. And we know we’re far from done.

What we’ve learned so far about what works

More than 97% of Australian babies are now screened for hearing loss after birth. Two decades ago, this figure was 6%. While the almost universal population coverage we have achieved is a major success story, there are other important features of our program that work particularly well.

We have developed something of a well-oiled machine when it comes to helping families navigate the system after their newborn is diagnosed with hearing loss. The steps from screening to diagnosis, and from diagnosis to early intervention, are well controlled. This means we have very low levels of ‘loss to follow up’. In other words, we’re great at stopping families from falling through the cracks.

Here, we do better than some other developed countries with universal screening programs. In the United States for example, there are some states where as many as a quarter of all children diagnosed with hearing loss as newborns are lost to follow up.

We know that universal newborn screening is effective. Patterns of hearing aid fitting and cochlear implantation have changed dramatically over time in jurisdictions with universal screening. For example, the average age for cochlear implantation in children with severe to profound hearing loss in Australia has fallen to around nine months of age. And the average age of diagnosis for children with permanent bilateral hearing loss has fallen in NSW from 18 months to under two months. This has resulted in improved language, literacy and educational outcomes.

The innovative way we’ve accommodated jurisdictional differences is a key to our success in Australia. Rather than imposing one, rigid, national program, we have built a gold-standard network of programs – a national system of approaches if you will. This all sits within one framework that guides our individual activities. For example, we have consistent guidelines and practice standards, we rely on building collaborative partnerships with key stakeholders, we have a national strategy to evaluate success and a national approach to collecting managing and sharing data.

This works incredibly well. It allows each jurisdiction to adapt to its environment and population needs and build its own unique strengths – while still operating under a nationally-consistent screening protocol.

Queensland, for example, has developed leading techniques in screening rural and regional populations, and Victoria has developed specialist expertise in data management.

This ‘hybrid vigour’ means we can continually learn from each other. And it’s a role model for new partnerships that we really must build if we’re to tackle the many other issues faced by people with hearing loss – both in Australia and across the region.

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