- Specialist in paediatric auditory electrophysiology;
- Bachelor, Master and Doctor of Audiology;
- Medical Director at CENAUDI;
- Director of Audiology at Fundación FUNOR, Ecuador;
- 28 years of professional experience, 24 years dedicated to audiology;
- 14 years of experience in audiology for microtia, Down syndrome and other paediatric pathologies.
The name of this country speaks for itself. Located near the equator, it has the flattest climate on the planet. Ecuador is distinctive, mysterious and insanely beautiful. It is one of the smallest South American countries. In addition to world-famous bananas, magnificent parks that amaze with the diversity of biological species, mesmerising active volcanoes, Ecuador has a rich history and culture.
On the territory of modern Ecuador, various Indian tribes — Kara, Kitu, Tumbe and Kanyari — have lived since ancient times. They were engaged in hunting, fishing and farming. The history of Ecuador remembers the Spanish conquest, wars of independence and revolutions, territorial disputes with neighbours, economic successes and political problems… But in this article we want to tell you about something else: how Ecuador, despite all the difficulties, is developing audiology and hearing care, how the country has built a system of assistance to people with hearing impairments, and what are the specific features of the detected disorders in the local population.
Luis Andrés Serrano, doctor of Medicine and Surgery, specialist in audiology, otoneurology and phoniatrics of the Republic of Ecuador, answered questions from the SurdoInfo editorial board.
On the territory of modern Ecuador, various Indian tribes — Kara, Kitu, Tumbe and Kanyari — have lived since ancient times. They were engaged in hunting, fishing and farming. The history of Ecuador remembers the Spanish conquest, wars of independence and revolutions, territorial disputes with neighbours, economic successes and political problems… But in this article we want to tell you about something else: how Ecuador, despite all the difficulties, is developing audiology and hearing care, how the country has built a system of assistance to people with hearing impairments, and what are the specific features of the detected disorders in the local population.
Luis Andrés Serrano, doctor of Medicine and Surgery, specialist in audiology, otoneurology and phoniatrics of the Republic of Ecuador, answered questions from the SurdoInfo editorial board.
— What is the number of people with hearing loss in your country? How many are adults and how many are children?
— Unfortunately, there are no accurate statistics on hearing impairment in Ecuador. However, international official data from the Ministry of Economic and Social Inclusion (MIES) can be used. According to them, approximately 5 per cent of the Ecuadorian population has some degree of hearing impairment. Among children under 4 years of age, the prevalence of hearing impairment is 4.3 per cent, and between 5 and 9 years of age it is 5 per cent. The prevalence of hearing loss among adults is 12.29 per cent. As for hearing impairment among newborns, it is estimated that 2 to 3 children out of every thousand have some degree of hearing loss. In addition to this, another peculiarity in our region is microtia. Ecuador has one of the highest rates of congenital malformations of the outer ear, ranging from 1 to 3 cases per 1,000 newborns.
As a specialist in paediatric audiology, I can confirm that these figures reflect the reality observed in clinical practice.
As a specialist in paediatric audiology, I can confirm that these figures reflect the reality observed in clinical practice.
— What is the general situation regarding hearing care in Ecuador?
— In the last 15 years, Ecuador has made significant progress in the diagnosis and treatment of hearing impairment in both the public and private sectors. There are currently four major hearing centres: PROAUDIO, Hearing Health, GAES, AUDIO CENTRO by CENAUDI. In addition, many smaller hearing centres have emerged, driven by the growing supply of hearing aids on the market. However, many of these establishments focus solely on the sale of hearing aids without offering a comprehensive, specialised approach to hearing care.
— How many practising audiologists and hearing care professionals are there in the country? Where is this speciality trained, who can get it and how?
— The number of audiologists in Ecuador is very small, with less than five specialists in the country. However, it is possible to study at university in the speciality of ‘sound-audiology', which involves working on speech and hearing assessment. According to statistics, more than 150 people graduate from this profession every year. They play a key role in providing audiological care in Ecuador.
— Are there government programmes for hearing aids in Ecuador and which categories of citizens are covered?
— Since 2010, the Government of Ecuador has implemented a programme to provide low-income people with hearing aids, bone vibrators and cochlear implants. This initiative has been effective and has facilitated access to quality hearing devices for people with hearing loss. However, waiting times can be quite long due to high demand and administrative processes.
— How effective is universal hearing screening for newborns and children in the first year of life in your country? How long has it been conducted and are there any data on its results?
— Newborn hearing screening in Ecuador has undergone significant changes. I personally initiated neonatal hearing screening programmes in 1999, but it was only in 2010 when the government introduced the Universal Neonatal Hearing Screening programme at the national level. Thanks to this programme, there has been a significant improvement in the early detection of hearing problems. For example, in 1995, the average age of diagnosis of severe and profound hearing loss was about 5 years. Today, this diagnosis is rarely made later than 2 years of age, allowing treatment to begin much earlier.
In 2016, we also developed a private screening programme at the OMNIHOSPITAL clinic in Guayaquil, where 700 to 800 newborns are screened each year. This programme has made it possible to identify many cases of hearing loss and refer patients to specialists for timely treatment.
In 2016, we also developed a private screening programme at the OMNIHOSPITAL clinic in Guayaquil, where 700 to 800 newborns are screened each year. This programme has made it possible to identify many cases of hearing loss and refer patients to specialists for timely treatment.
— How do you assess the population’s demand for hearing aids?
— Although there are no official statistics on the demand for hearing aids in Ecuador, we have seen a steady increase in the diagnosis of hearing impairment and the use of these devices. A number of factors are contributing to this. Firstly, increased access to early detection programmes for hearing impairment. Secondly, advances in hearing aid technology that are becoming less visible and more effective. And finally, changing social perceptions of hearing loss, with more and more people recognising the need for good hearing and not being embarrassed to use hearing aids.
In general, the number of diagnosed hearing loss cases has increased in recent years, and therefore the demand for hearing aids has also increased steadily.
In general, the number of diagnosed hearing loss cases has increased in recent years, and therefore the demand for hearing aids has also increased steadily.
— What do you think are the challenges in the field of audiology and hearing care in your country and what are they related to?
— The main challenge in Ecuador is the high cost of hearing aids, which limits access for many people. Although the government provides hearing aids and other devices through social programmes, waiting times and bureaucracy can delay getting help for those who need it immediately.
Other challenges include a shortage of audiologists and speech therapists, the need to expand early diagnosis programmes across the country, and improving the coverage and effectiveness of government hearing programmes.
Other challenges include a shortage of audiologists and speech therapists, the need to expand early diagnosis programmes across the country, and improving the coverage and effectiveness of government hearing programmes.
Figures and facts:
- Approximately 5% of the Ecuadorian population has some degree of hearing impairment.
- 4,3% is the prevalence of hearing impairment among children under 4 years of age and 5% among children between 5 and 9 years of age.
- 12,29% — is the prevalence of hearing loss among adults.
- 2–3 children out of every thousand have some degree of hearing loss.
- Up to 3 children per 1000 newborns have microtia of the external ear.
— Has the business environment in audiology changed recently?
— Yes, government involvement in the diagnosis and provision of hearing aids has had a significant impact on the private market. With increased competition and the emergence of government programmes, the cost of hearing aids in the commercial segment has decreased slightly. At the same time, the variety of devices offered has increased, and more private hearing aid centres have appeared. However, many of them prioritise sales over quality of service. Therefore, those audiology business owners who focus on the quality of diagnostics and subsequent hearing care, not just on the sale of hearing aids, have an advantage.
— How do you see the future prospects for audiology in Ecuador?
— We focus on the leading associations and programmes in the field of audiology. For example, we are learning from the American Speech-Language and Hearing Association (ASHA) and the Academy of Audiology, the Spanish Association of Audiology (AEDA), which promotes regulation of the sector and early detection programmes. A strong development of audiology can be observed in Brazil thanks to the Brazilian Society of Phonoaudiology (Sociedade Brasileira de Fonoaudiologia). These models and principles for building a system of early diagnosis and care for people with hearing loss can serve as a reference for Ecuador to develop its own audiology and hearing care strategies.
Microtia in Latin America
Microtia is a congenital underdevelopment of the auricle, accompanied by a reduction in size, deformity or complete absence. The overall prevalence among members of the Caucasoid race ranges from 1 in 8,500−10,000 newborns.
Clinically manifested by dysplasia of the whorl, contra-cochlea, earlobe and ear canal orifice. The pathology is often combined with malformations of the bones of the facial skeleton. Diagnosis of the disease is based on the results of objective examination, speech hearing tests, audiometry or impandanceometry, CT and MRI. Treatment of microtia is surgical, consists in correcting the shape of the outer ear, restoring the patency of the ear canal.
- > 6000 ⤋
More than 6,000 confirmed cases of microtia have been recorded. - > 2500 ⤋
Each year, more than 2,500 children in Latin America are born with microtia - > 1300 ⤋
Since 2015, more than 1,300 bone conduction devices have been fitted to patients
For surgical treatment of atresia and microtia, complex reconstructive interventions are performed to open the ear canal to restore hearing and shape the auricle to improve the patient’s quality of life.
Among the effective methods of helping patients with conductive hearing loss caused by atresia of the ear canal and microtia of the outer ear is the use of bone conduction hearing aids. An undoubted advantage of modern bone conduction hearing aids is that there is no need for surgical intervention to start using them. This takes on special significance for the youngest patients.
Among the effective methods of helping patients with conductive hearing loss caused by atresia of the ear canal and microtia of the outer ear is the use of bone conduction hearing aids. An undoubted advantage of modern bone conduction hearing aids is that there is no need for surgical intervention to start using them. This takes on special significance for the youngest patients.