Ear and hearing care in primary care (WHO)
- Topic
The WHO wants ear and hearing care delivered close to people, in primary care, with screening, management of common ear disease and timely referral.
What it is
More than 1.5 billion people live with some degree of hearing loss, and nearly 80 % of those with disabling hearing loss live in low- and middle-income countries. The WHO World report on hearing (2021) proposes integrated, people-centred ear and hearing care and a package of interventions summarised by the acronym H.E.A.R.I.N.G. In 2023 the WHO published a primary ear and hearing care training manual for primary care workers and doctors. This page summarises what the general practitioner can do and when to refer.
Key facts
- Among low-income countries, about 78 % have fewer than one ENT specialist per million people and 93 % fewer than one audiologist per million.
- The WHO estimates that scaling up ear and hearing care returns nearly 16 dollars for every dollar invested.
- The primary ear and hearing care manual (2023) covers how hearing works, ear examination, hearing assessment, prevention, management and referral of common ear diseases, and rehabilitation.
- WHO advice for the public: the ear cleans itself, earwax protects it, and no cotton buds, oils or objects should be put in the ear.
- Tools such as the hearWHO app allow hearing screening with little training and few resources.
- World Hearing Day is held every 3 March.
Step by step
- Ask about hearing at check-ups for children, exposed adults and older adults.
- Examine the ear with an otoscope and do a simple hearing test or one with a validated app.
- Treat what is common at first level: wax causing hearing loss, acute otitis media, otitis externa.
- Educate: no objects or oils in the ear, do not ignore ear discharge, protect against noise.
- Refer what is beyond first level with the right urgency.
- Follow up rehabilitation: actual hearing aid use, communication at home and at work.
The WHO H.E.A.R.I.N.G. package and its primary care version
| Letter | Intervention | Primary care example |
|---|---|---|
| H | Hearing screening and intervention | Newborn, school, exposed-worker and older-adult screening |
| E | Ear disease prevention and management | Treat otitis and refer ear discharge that does not settle |
| A | Access to technologies | Refer for hearing aids or implants when indicated |
| R | Rehabilitation services | Speech and language therapy and family support |
| I | Improved communication | Captioning, sign language interpretation, FM and loop systems |
| N | Noise reduction | Hearing conservation at work and safe listening |
| G | Greater community engagement | Campaigns against stigma and education on ear care |
In clinical practice
- The WHO advises against treating earache with home remedies such as hot or cold oil or with medicines not prescribed by a health worker.
- Earwax removal is justified only if it causes hearing loss or prevents examination, and it is done by trained staff.
- Water in the ear usually drains by itself; if it persists or recurs, wax may be trapping it.
- Integrating hearing care into primary care brings the service closer and eases the load on the few specialists.
Next step / Initial management
- Initial workup at first level: otoscopy and hearing screening; audiometry where available.
- First-level management: earwax removal by trained staff, treatment of acute otitis media and otitis externa, education on ear care and safe listening.
- Same-day referral: sudden hearing loss, otitis with complications (swelling behind the ear, facial palsy, headache with fever).
- Urgent referral: ear discharge that does not settle, abnormal newborn screen, or a child with suspected hearing loss and language delay.
- Routine referral to audiology: hearing loss that affects communication, to assess hearing aids and rehabilitation.
Test yourself
Think of the answer, then tap the question to see it.
What proportion of childhood hearing loss does the WHO consider preventable, and through which measures?
Almost 60 %. Through immunisation, better maternal and neonatal care, and screening for and early management of otitis media.
What are the three WHO targets for 2030 in ear and hearing care?
A 20 % relative increase in coverage of newborn hearing screening and of hearing technology use in adults, and a 20 % reduction in chronic ear disease and unaddressed hearing loss in children aged 5 to 9.
A mother asks whether she should clean her son's ears with cotton buds to remove the wax. What is the WHO answer?
No: the ear cleans itself and wax protects it. Cotton buds push wax deeper and can injure the eardrum; only the outer ear is cleaned with a cloth.
Which threshold does the WHO use to define disabling hearing loss?
A hearing loss greater than 35 dB in the better ear.
Connections
Educational content; it does not replace a medical assessment and is not a clinical instruction. For a real case, follow current guidelines and specialist advice.
Sources: World report on hearing: executive summary (World Health Organization, 2021); Deafness and hearing loss (fact sheet) (World Health Organization, 2026); Primary ear and hearing care: training manual (World Health Organization, 2023); Deafness and hearing loss: ear care (questions and answers) (World Health Organization, 2026); WHO promotes access to ear and hearing care in communities (World Health Organization, 2023).
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Representative model, for educational purposes only.