Data hub
Overview
Each year the NCHA policy team analyses hearing data to help inform our policy work. In this section we share data which members might find useful when estimating local needs and hearing services.
If you would like to discuss these data or talk about other data projects we have undertaken please email us at [email protected].
Open source
The following data can help you estimate local needs:
- The NCHA hearing map helps estimate the number of people with hearing loss at different thresholds and the number of people with tinnitus
- The common causes of hearing loss and tinnitus and other conditions sections of our website include prevalence and incidence rates for common conditions.
Hearing loss in the UK - projections
The NCHA policy team has estimated the number of UK adults (aged 18) with hearing loss (better ear average over 0.5, 1, 2 and 4 Hz) at different thresholds between 2014 and 2040.
The graph below shows how the most significant rate of growth in demand is likely to be driven by those with a hearing loss of 20dB HL to 45dB HL. A separate analysis performed by the NCHA shows that this estimated growth is driven by people aged 70 and over, and in the main by people aged over 80.
Hearing loss estimates - by UK country and threshold
We have calculated the estimated prevalence of hearing loss in the UK based on local authority populations in 2014. These estimates control for level of hearing loss, sex and age.
| Hearing Loss ≥25db HL in better ear | Hearing Loss ≥45db HL in better ear | Hearing Loss ≥65db HL in better ear | Hearing Loss ≥95db HL in better ear | |
|---|---|---|---|---|
| UK | 10,573,000 | 3,634,000 | 1,115,000 | 206,000 |
| England | 8,843,000 | 3,048,000 | 937,000 | 173,000 |
| Scotland | 904,000 | 304,000 | 92,000 | 17,000 |
| Wales | 552,000 | 190,000 | 58,000 | 10,000 |
| Northern Ireland | 245,000 | 92,000 | 28,000 | 5,000 |
All estimates are rounded to the nearest thousand. The data reading from right to left represent cumulative data – e.g. ≥25dB HL data include people with more severe losses of ≥45, ≥65 and ≥95 dB HL.
Please note, the estimates in this table are based on 2014 population data. Between 2014 and 2020 the population has grown older and an additional 1 million adults are estimated to have a hearing loss of at least 25 dB HL hearing loss. We will be updating this table in 2021.
Evidence from the English Longitudinal Study of Ageing
The English Longitudinal Study of Ageing (ELSA) collects data from more than 18,000 people aged over 50 to understand all aspects of ageing in England. It started in 2002 and interviews people every two years. You can access all the study documentation here.
The following Wave studies include an estimate of hearing loss and need. To help save you time, here are some extracts from each report with quick references to the most important datasets and page references so you can quickly find what you need:
- Wave 1 (2002) – self reported hearing loss
“The percentage reporting fair or poor hearing increases with age after about age 60, from 15.6% at ages 55-59 to 39.2% at age 80 and over”
- Wave 2 (2004) – self reported hearing loss, hearing aid recommendations etc.
“The percentage of respondents aged 65 or over reporting difficulty following a conversation if there was background noise, or rating their hearing as poor or fair (as opposed to excellent, very good or good), was 45%. Half of these had told a doctor or nurse of the problem, of whom three-quarters were referred for a hearing test and two-thirds were recommended to use a hearing aid (Table 7A.5). Those aged 75 and over were more likely to be recommended a hearing aid than those aged 65-74. Of those recommended to use a hearing aid, 83% received one and were taught how to use it (Table 7A.6). No significant variation in care by wealth quintile was seen (Tables 7A.7 and 7A.8).”
- Wave 3 (2006) – self reported hearing problems
Table 3A (Page 104) Includes survey data on self-reported hearing problems in a graded format from minimal difficulty to maximal difficulty
- Wave 7 (2016) – self reported hearing acuity by age and gender, objective hearing assessment and use of hearing aid
Table H4a (page 262) includes data on hearing loss and use of aids and more. Tables on pages 262 to 264 include more hearing related data.
- Wave 8 (2018) – Data on sensory impairment including hearing loss
“Hearing impairment is highly prevalent overall (28% of men and 19% of women) and increases steadily with age from 60 onwards to reach 43% of men and 37% of women aged 80 and above”. With the data supporting this on page 271-272.
Hearing aid sales
Hearing aid sales are often used to estimate ‘market penetration’ and some organisations have relied on such data to derive estimates of ‘unmet need’.
The challenge with using unit sales to estimate market penetration include: the fact that this does not control for different treatment thresholds or the variation in binaural fitting rates in different countries, nor how long hearing aids last, or other complex variables.
For example, the 1,667,863 reported hearing aid sales in 2016, might tell us that somewhere between 828,932 (100% binaural fitting rate) and 1,667,863 (0% binaural fitting rate) people might have received hearing aids in that year, but even this does not tell us how many were new users and existing users. This is why it is currently difficult to estimate unmet hearing need.
To compare the uptake of hearing aids, the NCHA has reviewed international models of hearing care and developed in-house models to estimate unmet hearing needs in the UK.
This work showed that in countries like Australia, Denmark and the UK, the number of hearing aids sold per year was estimated to be more than 100 per 1,000 people with a hearing loss of at least 25dB HL in their worse ear. In comparison, the US and Switzerland, despite having a similar proportion of their population aged 60 and over, they sold 53-66 hearing aids per 1,000 people with a hearing loss of 25dB HL in their worse ear. Although this was only a high level overview, and did not control for important variables like the binaural fitting rate, it did support other research which suggests unmet hearing needs are greater in health systems where there is no or limited financial support with hearing health costs.
In 2017 the NCHA estimated UK hearing aid sales per year based on various thresholds of hearing loss (20, 25, 35, 40 and 45dB HL), varying binaural fitting rates (%), fitting cycles (3, 4 or 5 years) and various market penetration rates (10 to 90%). The goal was to assess how many hearing aids might be sold if a greater proportion of hearing needs were met.
Although we did not control for life expectancy in this project, we estimated that based on hearing loss threshold of 25dB HL, 90% binaural fitting rate, an estimated 40% market penetration rate and a three-year cycle, it would take an annual growth rate of 6% per annum to achieve a 40% penetration rate by 2028. In comparison when running the same assumptions for a 35dB HL threshold, a 2% growth in hearing aid sales per annum would result in a 40% penetration rate by 2026.
In all the scenarios we assessed, even without building more complex models, it was clear that much more needs to be done if we are to tackle hearing loss in the UK and finally address the growing public health challenge unaddressed hearing loss presents. The NCHA does this through its proactive policy and advocacy work, and builds on this each year to ensure hearing care is taken seriously.
Hearing loss classification
There have been multiple attempts to describe measured hearing loss (dB HL) in terms of functional impact on individuals. These classifications can be controversial, especially where third-party payers use them to set treatment thresholds, but are still useful in terms of explaining to service users and decision-makers how hearing loss impacts on quality of life. The most common used systems are set out in the tables below.
| Hearing impairment category | Better ear hearing level (dB HL) |
|---|---|
| Slight/mild | 26-40 |
| Moderate | 41-60 |
| Severe | 61-80 |
| Profound | 81+ |
| Hearing impairment category | Better ear hearing level (dB HL) | Hearing in quiet environment | Hearing in noisy environment |
|---|---|---|---|
| Unilateral | <20 in better ear / ≥35 the worse ear | Possible problems if sound near poorer ear | May have real difficulty following/taking part in conversations |
| Mild | 20-34 | Unlikely to have problems | |
| Moderate | 35-49 | May have difficulty hearing a normal voice | Difficulty following/taking part in conversations |
| Moderately Severe | 50-64 | Can hear loud speech | Great difficulty following/taking part in conversations |
| Severe | 65-79 | Can hear loud speech directly in ear | Very great difficulty following/taking part in conversations |
| Profound | 80-94 | Great difficulty hearing | Cannot hear any speech |
Diagnostic data
In England hospitals code patients based on their primary diagnosis, the table below provides a list of all the 3-character primary diagnosis codes linked to ear conditions and provides the mean age of diagnosis [3].
| Primary diagnosis (3 character code and description) | Mean age |
|---|---|
| H60 Otitis externa | 41 |
| H61 Other disorders of external ear | 47 |
| H65 Nonsuppurative otitis media | 15 |
| H66 Suppurative and unspecified otitis media | 18 |
| H68 Eustachian salpingitis and obstruction | 36 |
| H69 Other disorders of Eustachian tube | 41 |
| H70 Mastoiditis and related conditions | 25 |
| H71 Cholesteatoma of middle ear | 34 |
| H72 Perforation of tympanic membrane | 34 |
| H73 Other disorders of tympanic membrane | 30 |
| H74 Other disorders of middle ear and mastoid | 38 |
| H80 Otosclerosis | 47 |
| H81 Disorders of vestibular function | 66 |
| H83 Other diseases of inner ear | 59 |
| H90 Conductive and sensorineural hearing loss | 30 |
| H91 Other hearing loss | 27 |
| H92 Otalgia and effusion of ear | 33 |
| H93 Other disorders of ear not elsewhere classified | 49 |
| H95 Postprocedural disorders of ear and mastoid process NEC | 35 |
| Q16 Congenital malforms of ear causing impairment of hearing | 16 |
| Q17 Other congenital malformations of ear | 10 |
Workforce data
We last reviewed the UK workforce in 2016, a high-level summary of our data can be found in the table below.
| Qualified audiologists working in the NHS | Audiologist support working in the NHS | HCPC registered HADs | |
|---|---|---|---|
| England | 1,736 | 734 | 1,620 |
| Northern Ireland | 65 | No data | 30 |
| Scotland | 171 | 56 | 94 |
| Wales | 213 | 32 | 281 |
| UK | 2,185 | 822 | 2,025 |
Note, there is no official register or reliable collection of the number of hearing care assistants supporting HADs and other audiologists.
Since 2016 the number of registered HADs has increased significantly, with the HCPC reporting the following data on 1 September 2020 [4].
| HADs registered with the HCPC (Sept 2020) | |
|---|---|
| Female | 1,819 |
| Male | 1,533 |
| Total | 3,352 |
Data inventory
The NCHA worked closely with NHS England on the Action Plan on Hearing Loss, and as part of that work developed a data inventory. The goal of this project was to take stock of existing data sources and to avoid duplication. You can access the data inventory here. If you have any additions for the inventory please email [email protected].
Other data
The NCHA regularly undertakes projects to support members and to help inform its policy analysis, so if you have questions about data we hold or data you are interested in please get in touch by emailing [email protected].
Updates
Originally published: 2016
Reviewed: September 2020
Next review date: May 2022
Info: Data sources updated for new website in 2021.
Reference and notes
The next review was originally planned for January 2021. This was changed due to prioritising work during the pandemic.
Hearing loss estimates are based on the better ear average over 0.5, 1 and 4KHz. Using worst ear average would result in higher estimates of hearing loss. Using Davis, Adrian (1995), Hearing in Adults. The prevalence and distribution of hearing impairment and reported hearing disability in the MRC Institute Hearing Research’s National Study of Hearing, MRC Institute of Hearing Research, Nottingham, Whurr Publishers Limited, London. Specifically, tables: B5124-4 to B5124-9 pp. 46 to 47. This only covered people aged 18 to 80. We therefore used table 8.1 p. 822 for prevalence estimates for people aged 81 and older. Davis 1995 does not provide estimates for people aged over 80 with hearing loss of 20dB HL or 40dB HL, these cells were therefore populated with the same estimates for 25dB HL and 45dB HL respectively.
UK population projections are based on ONS data. Source: ONS. 2014-based National Population Projections. Published 29 October 2015. Coverage: United Kingdom (UK); Years: 2014-2114. We rely on the principal projections (PPP) model. We could have used high/low fertility/migration/life expectancy variants, but chose the standard PPP as the goal was to develop a simple model for members to see the general trend based on standard assumptions.
[1] WHO, Grades of hearing impairment http://www.who.int/pbd/deafness/hearing_impairment_grades/en/
[2] Stevens et al. 2011, Global and regional hearing impairment prevalence: an analysis of 42 studies in 29 countries. The European Journal of Public Health, 1-7. doi: 10.1093/eurpub/ckr176
[3] Reference. The NHS Information Centre, Hospital Episode Statistics for England. Inpatient statistics, 2010-11. Activity in English NHS Hospitals and English NHS commissioned activity in the independent sector. Please see HESonline [http://www.hesonline.nhs.uk] for more information on data quality. Data for ear problems was extracted and summarised by the NCHA policy team
[4] NCHA, 11 September 2020 member update “HCPC update – HADs data”, reporting “The HCPC has published a snapshot of registrants as of 1 September 2020. It states there are a total of 3,352 hearing aid dispensers (HADs), 1,819 female and 1,533 male.”
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