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# 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.

Updated Nov 5, 2026

## Key points

- Almost 60 % of childhood hearing loss is due to preventable causes: immunisation, good maternal and neonatal care, and screening for and early management of otitis media.
- H.E.A.R.I.N.G.: Hearing screening and intervention, Ear disease prevention and management, Access to technologies, Rehabilitation services, Improved communication, Noise reduction, Greater community engagement.
- WHO 2030 targets: a 20 % relative increase in effective coverage of newborn hearing screening and of hearing technology use in adults.
- Third 2030 target: a 20 % relative reduction in chronic ear disease and unaddressed hearing loss in children aged 5 to 9.
- Systematic screening for the highest-risk groups: newborns, preschool and school children, workers exposed to noise or chemicals, people on ototoxic medicines and older adults.
- WHO definition of disabling hearing loss: a loss greater than 35 dB in the better ear.

## 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.

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## Connections

## Related 1

- [Hearing aids and cochlear implants](https://durgical.com/en/ent/hearing-aids-and-cochlear-implants/)

[← All of ENT](https://durgical.com/en/ent/)

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](https://cdn.who.int/media/docs/default-source/documents/health-topics/deafness-and-hearing-loss/world-report-on-hearing/wrh-executive-summary.en.pdf) (World Health Organization, 2021); [Deafness and hearing loss (fact sheet)](https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss) (World Health Organization, 2026); [Primary ear and hearing care: training manual](https://www.who.int/publications/i/item/9789240069152) (World Health Organization, 2023); [Deafness and hearing loss: ear care (questions and answers)](https://who.int/news-room/q-a-detail/deafness-and-hearing-loss-ear-care) (World Health Organization, 2026); [WHO promotes access to ear and hearing care in communities](https://www.who.int/news/item/03-03-2023-who-promotes-access-to-ear-and-hearing-care-in-communities) (World Health Organization, 2023).

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Representative model, for educational purposes only.

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