SINGAPORE: Around 430 million people worldwide live with disabling hearing loss, a figure expected to rise to 700 million by 2050.

One in six Australians lives with it (this is higher for Indigenous people), projected to rise to one in four by 2050, in large part due to our ageing population.

But despite the condition’s relative prevalence, only one in five people who would benefit from a hearing aid uses one. Even fewer eligible adults (one in 10) receive a cochlear implant.

Professor Bamini Gopinath, Cochlear Chair in Hearing and Health at Macquarie University, says the reasons for the slow uptake of hearing tests and technology (relative to, say, spectacles for eyesight loss) is multifactorial, but includes stigma and lack of awareness.

“Many people don’t realise, for example, that midlife hearing loss is one of the top modifiable risk factors for a dementia diagnosis in later life,” she says.

Unaddressed hearing loss is also associated with social isolation, mental fatigue, reduced workplace productivity and early retirement.

Cost is another barrier, says Gopinath, with most costing in the thousands before subsidies.

The Australian government offers subsidised hearing services and devices to eligible Australians, including those under the age of 26 and over 67. But this excludes many in the middle – 15.6 per cent of non-Indigenous and 31.7 per cent of Indigenous Australians aged 50 to 59 years, for example.

In September, Gopinath was part of a team that helped develop the first Australia New Zealand Adult Cochlear Implant Living Guidelines, adapted from international guidelines.

Until now, she says there have been “no evidence-based guidelines for healthcare professionals, including GPs, audiologists and ear, nose and throat specialists and patients”.

The new guidelines include that screening starts at 50 to increase hearing loss identification in adults, and to “increase referral for cochlear implant evaluation”, says Gopinath.

So what is it about hearing loss that carries such a stigma?

“That’s the million-dollar question,” says Gopinath. “We’re trying to understand what it is about glasses that people think it’s cool to wear them [but not hearing aids].”

Gopinath suspects some stigma may lie with the “cultural conception that hearing loss and wearing a hearing device is associated with ageing. And in some cultures, there’s a false conception that hearing loss is associated with lower IQ.”

Nicky Chong-White, principal engineer at the National Acoustic Laboratories, says: “There’s been huge technological advances that have happened in the last five to 10 years, making devices more accessible, smarter and personalised.

“The look has totally changed. If you think of people wearing hearing aids 20 years ago, they were these ugly beige things. Now, they’re pretty stylish.”

Many, like Audika’s Oticon Zeal, use “advanced signal processing that can detect speech in a noisy environment”, she says.

Change is afoot for those with mild to moderate hearing loss too. Last year, Apple announced its AirPods Pro earbuds could be used to conduct hearing tests and as aids.

Chong-White sees AirPods as a potential low-cost “stepping stone” for those who don’t need hearing support all day, with the hearing test allowing users to conduct one from the comfort of their own home.

“You don’t have to let anyone know you’re doing it. And if you’ve got AirPods already, there’s no cost involved. Generally hearing aids are in the thousands, so that’s a big financial decision,” she says.

Audika audiologist Amanda Brown has been working in the field for almost 30 years. Anecdotally, she finds men in particular can be reticent to come in for a test.

“Many men are conscious of what their devices look like, whereas what we’re hoping is, ‘look, here’s a solution, it doesn’t matter if you have no hair, you can put it in and it’s going to be virtually invisible’.”

Still, Chong-White urges users to be aware that adjusting to a new device can take time.

“No device is perfect in every situation. You want it to at least improve things in the situations that matter most to you. But if you go in with an expectation that it’s going to restore feeling to normal, then you’ll probably be disappointed,” she says.

While the risk and incidence of hearing loss increases with age, it can affect young people, too. Matildas goalkeeper Mackenzie Arnold, 32, for example, has spoken about her hearing loss.

Forty-year-old hearing aid wearer Aleks Czerwinski, a Melbourne-based wedding celebrant and DJ, unexpectedly lost most of the hearing in her right ear in 2019 following an infection that caused severe vertigo.

“I didn’t actually realise I’d lost my hearing until I put a pair of headphones in on the tram one day and couldn’t hear the music in one side,” she says, explaining it took a while for her to receive a specialist diagnosis.

“There was a bit of frustration there. I gave up for a little bit, and avoided noisy environments, apart from obviously my job. I just adjusted by always turning my good side to a person when they’re speaking,” she says.

Exercise classes – which tend to blast loud music – can be particularly difficult. She often foregoes her hearing aids while working out as they tend to fall out, and can be reluctant to ask the instructor to adjust the volume.

“When I make these requests, I feel perceived as difficult, or I have to explain that I’m hard of hearing. Because I don’t have my aids in, and I’m youngish, I feel like it’s seen as a strange request,” she says.