Scaling community-based care for conductive hearing loss in low- and middle-income settings

This review examines recent advances in community-based care for conductive hearing loss in low- and middle-income countries (LMICs), focusing on developments that have materially shifted the feasibility of decentralized service delivery across prevencommution, screening and diagnosis, medical management, and rehabilitation.

World Health Organization guidance now explicitly endorses task-sharing for primary ear and hearing care, including community health worker-facilitated hearing aid provision. Long-term follow-up from pneumococcal vaccination trials demonstrates sustained otitis media prevention and improved hearing outcomes 16-20 years postvaccination. Smartphone-based screening and diagnostic tools, including AI-assisted otoscopy and mobile tympanometry, are enabling accurate community-level identification without specialist infrastructure. Medical management of common conductive hearing loss (CHL) causes, including cerumen impaction and uncomplicated chronic suppurative otitis media, can be safely delivered by trained community health workers and primary care nurses. Community-based hearing aid provision achieves sustained rehabilitation outcomes comparable to specialist-led models across diverse LMIC settings.

Recent evidence demonstrates that community-based CHL care is feasible, safe, and effective when supported by appropriate training, technology, and task-sharing frameworks. The primary constraint to scale is no longer technological feasibility but prioritisation within health planning and financing frameworks.