South Africa, officially the Republic of South Africa (RSA), is the southernmost country in Africa. RSA shares borders with Botswana, Zimbabwe, Namibia, Lesotho, Eswatini, and Mozambique. It has 12 official languages: Afrikaans, English, Ndebele, Pedi, Sotho, South African Sign Language, Swati, Tsonga, Tswana, Venda, Xhosa, and Zulu.

Incidence and Prevalence of Hearing Loss

Hearing loss is a widespread public health concern, with Sub-Saharan Africa contributing significantly to global estimates (WHO, 2021). The World Health Organization (WHO) reports that approximately 15.7% of adults aged 15 and older in this region experience hearing loss (WHO, 2021). In South Africa, an estimated 12 million people are affected by some degree of hearing loss, including about 4 million individuals with hearing disabilities, of whom fewer than 600,000 use South African Sign Language (SASL) (World Hearing Report, 2022).

There are notable regional disparities in hearing loss prevalence across South Africa. Less developed provinces generally report higher rates compared to more developed areas. In Cape Town, located in the developed Western Cape province, the overall prevalence of hearing loss in the population was reported to be 12.35% (95% CI: 11.06%- 13.64%), and the prevalence of disabling hearing loss was 4.57% (95% CI: 3.75%- 5.39%) amongst individuals ≥ 4 years old (Ramma & Sebothoma, 2016). In primary health care settings within urban and peri-urban facilities in Tshwane, the prevalence of hearing loss has been reported at 17.5%, with the majority of cases being bilateral (70.0%) and sensorineural in nature (84.2%) (Louw et al. 2018). Conversely, the overall prevalence of hearing loss in the Elias Motsoaledi Local Municipal (EMLM) area in rural Limpopo province, was reported to be 19.88% (95% confidence interval [CI]: 0.15–0.2) and 8.94 (95% CI: 0.08–0.12) for disabling hearing loss. The prevalence of ear disease was 13.19% (95% CI: 0.10–0.15), with impacted cerumen and otitis media reported as the most prevalent cause (Joubert & Botha, 2019).

Similar patterns of disparities are observed across age groups, as illustrated in table 1 below.

Table 1. Prevalence rates across age groups for Limpopo and Gauteng Province
Limpopo Province (Joubert & Botha, 2019)	Gauteng Province (Louw et al, 2018)
0-14.11 years = 14.01%	3-14 years = 4.8%
15-64.11 years = 20.22%	15-39 years=5.7%
65 years and older = 64.65%	40 years and above = 15%
Overall prevalence = 19.88%	Overall prevalence = 17.5%

These findings underscore the critical need for comprehensive hearing care services, including prevention, early detection, and intervention, to address the rising prevalence of hearing loss across South Africa.

Information About Audiology

Landscape of Audiological Care

Hearing healthcare services in South Africa began with limited availability, primarily emerging in the mid-20th century. The development of audiology was closely linked to the establishment of university training programs, which began at the University of the Witwatersrand (Wits) in the late 1930s and early 1940s. In those early years, hearing healthcare services were often provided through hearing aid fitting and assessment programs, and much of the clinical work was associated with hospitals, schools for the deaf, and other special education facilities. Throughout the 1970s and 1980s, more formalized audiology clinics began to emerge in hospitals across South Africa, often as part of larger healthcare systems. During the 1990’s the government started to recognize the need for comprehensive hearing care services, and more initiatives to improve accessibility in both urban and rural settings were developed.

Today, audiology services in South Africa are more widespread, however they remain concentrated in urban areas. In 2024, 947 audiologists were registered with the Health Professions Council of South Africa (HPCSA), with the majority practicing in private settings rather than public healthcare facilities. This distribution underscores the ongoing gap in access to services. To meet the diverse needs of individuals with hearing and balance issues, South Africa relies on a network of hearing healthcare professionals who work collaboratively to provide comprehensive care. These include:

Audiologists who are central to hearing healthcare, offering services such as hearing assessments, cerumen management, hearing intervention (invasive and non-invasive hearing devices), aural rehabilitation, vestibular evaluations and interventions. These professionals are trained through accredited university programs and work in a variety of settings, including public and private hospitals, private practices, and community health centers.
Hearing aid acousticians specialize in the assessment, fitting and maintenance of hearing aids and other assistive listening devices for adults. They typically work in private practices or audiology clinics.
Ear-, Nose-, Throat, Specialists (otolaryngologists/otologists/otoneurologists) focus on complex ear and balance disorders, managing advanced cases of hearing loss or vestibular conditions in urban hospitals and private clinics. ENT specialists often collaborate with audiologists, particularly for patients requiring surgical interventions such as cochlear implants or treatments for chronic otitis media. These specialists provide services in both public and private healthcare settings, with their training conducted through accredited medical schools and specialized ENT programs within the country.
Community healthcare workers (CHWs) and early childhood development (ECD) practitioners, where available, support audiologists and hearing healthcare professionals in underserved areas. They may serve as the first point of contact, conducting basic hearing screenings and referring individuals for further evaluation when necessary. Their community-based position also enables them to monitor at-risk populations, provide early intervention, and raise awareness through health education campaigns on hearing loss prevention, hearing protection, and the importance of early screening.

Education and Training

The field of speech therapy in South Africa began in 1937, when Professor Pierre de Villiers Pienaar introduced the first diploma in Logopaedics at the University of the Witwatersrand (Wits). This program focused primarily on speech and language disorders, and he also established the Speech, Voice, and Hearing Clinic at Wits, laying the groundwork for the profession. Audiology was later incorporated as a distinct discipline, and in 1959, Professor Pienaar further advanced these fields by heading the newly established Department of Speech Science, Logopedics, and Audiology at the University of Pretoria. These developments were instrumental in formalizing education and clinical training in both speech therapy and audiology in South Africa.

Today, six (6) universities in South Africa offer degree programs in audiology, including the University of Pretoria, the University of the Witwatersrand, the University of KwaZulu-Natal, Stellenbosch University, University of Cape Town, and Sefako Makgatho Health Sciences University. Since 2006, all these institutions have transitioned to training audiologists and speech-language therapists separately, moving away from the previous dual qualification model (Swanepoel, 2006). The programs now consist of a four-year undergraduate degree, followed by a mandatory year of community service in public healthcare facilities. This system ensures graduates gain practical experience as community-service audiologists or speech-language therapists, addressing the needs of underserved populations. Despite the progress in education, there is still a shortage of audiologists to meet the country’s healthcare needs (Pillay et al., 2020; Swanepoel, 2006).

Table 2. Institutions offering training in Audiology
Institution	Degree Name	Estimated Number of Annual Graduates
University of Pretoria	B: Audiology	35-40
University of Witwatersrand	B: Audiology	25
University of Cape Town	BSc: Audiology	20-30
University of Kwazulu Natal	B: Audiology	35
Sefako Makgatho Health Sciences University	B: Audiology	25-30

Scope of Practice

In South Africa, the scope of practice for audiologists is clearly defined and regulated by the Health Professions Council of South Africa (HPCSA). Audiologists are authorized to provide or be involved in the following:

Hearing Assessment and Diagnosis
Hearing Rehabilitation and Management
Vestibular Assessment and Rehabilitation
Neonatal and Paediatric Audiology
Public Health and Education
Interdisciplinary collaboration

Audiological Services

Audiology services in South Africa encompass both core and advanced diagnostic and rehabilitative options to address a range of hearing and balance disorders. These services play a crucial role in improving the quality of life for individuals affected by hearing loss and balance disorders.

Core Audiology Services

Pure-tone audiometry (PTA): A standard test to determine hearing thresholds.
Tympanometry: Evaluation of middle-ear function, including eardrum movement and pressure within the middle ear. Impedance audiometry: Assessment of middle-ear reflexes and compliance.
Otoacoustic emissions (OAE): Screening for cochlear (inner ear) function, particularly for newborn hearing programs, and used for differential diagnostic purposes in older populations.
Screening auditory brainstem response (ABR): Early detection of auditory pathway integrity, especially for infants and individuals unable to perform standard audiometric tests.
Hearing aid assessment and dispensing: Comprehensive evaluation and fitting of hearing aids tailored to individual hearing needs.
Aural rehabilitation: Therapy and counselling to maximize the use of residual hearing and optimize communication skills.

Advanced Audiology Services

Advanced audiology services are available at selected practices and hospitals, these services expand diagnostic and rehabilitative options:

Diagnostic auditory brainstem response (ABR): A detailed evaluation of the auditory pathway, aiding in the diagnosis of neurological and cochlear disorders.
Auditory steady-state response (ASSR): Assessment of hearing thresholds, particularly in difficult-to-test populations, including infants.
Implantable devices: Evaluation, programming, and management of cochlear implants, bone-anchored hearing aids (BAHA), and other implantable hearing solutions.
Vestibular audiology: Comprehensive assessment and management of balance disorders, including:
- Computerized Dynamic Visual Acuity (cDVA): Evaluation of visual stability during head movements.
- Video head impulse testing (vHIT): Assessment of semicircular canal function.
- Vestibular evoked myogenic potentials (VEMPs): Measurement of vestibular function through muscle responses.
- Electrocochleography (EcoG): Diagnosis of endolymphatic hydrops and other inner ear conditions.
- Videonystagmography (VNG): Analysis of eye movements to assess vestibular function.
- Posturography: Evaluation of balance and postural control.
- Fall Risk Assessment: Identification of individuals at risk of falling using standardized tools, including gait and balance evaluations, timed up-and-go (TUG) test, Berg Balance Scale (BBS), and functional reach tests. Audiologists assess the impact of vestibular dysfunction on postural stability and recommend appropriate interventions to mitigate fall risk.

Vestibular rehabilitation: Customized therapy programs to address balance dysfunction and dizziness, incorporating exercises for gaze stabilization, balance improvement, and compensation strategies.
Central auditory processing disorder (CAPD) testing and management: Identification and treatment of difficulties in the brain’s ability to process auditory information.
Tinnitus management: Multi-faceted approach to alleviate tinnitus symptoms, including sound therapy, counselling, and habituation strategies.

This comprehensive list reflects the range of audiology services available in South Africa, showcasing the country's capacity to provide both foundational and advanced care across diverse populations. These services are critical for addressing the needs of individuals with hearing and balance disorders, contributing to improved quality of life.

The public sector provides audiology services primarily in hospitals and community clinics, but access can be inconsistent, especially in rural areas. While government hospitals offer these services, they are often limited due to resource constraints, including equipment shortages and understaffing. This disparity is accentuated in rural and underserved areas, where audiology services may be entirely unavailable.

In contrast, private audiology practices are more equipped and accessible in urban and peri-urban areas, offering a broader range of diagnostic and rehabilitative services. Private practitioners often include tinnitus management, vestibular assessments, auditory processing evaluations, and hearing aid fittings as part of their comprehensive care. However, these services are typically funded out-of-pocket or through medical aid schemes, limiting access for economically disadvantaged individuals.

Newborn hearing screening in the Public Sector

In South Africa, newborn hearing screening remains unevenly implemented, with access varying across public and private healthcare sectors. Although universal newborn hearing screening is not yet standard practice, some hospitals, particularly well resourced urban facilities, offer targeted screening for infants considered at high risk. This is most commonly provided in specialised settings such as neonatal intensive care units and high risk clinics, including for infants born prematurely, exposed to ototoxic medications, or with medical complications associated with hearing loss. Once infants are discharged from hospital, opportunities for early identification shift to community based services, including early development centres and primary schools, where hearing screening can support early intervention before hearing difficulties negatively affect language development and academic performance. In response to gaps in service provision, non governmental organisations and universities have implemented outreach screening initiatives in under resourced communities; however, these efforts remain limited in scale and coverage. Broader public health initiatives, such as the Road to Health booklet, aim to support early detection by guiding caregivers to monitor developmental milestones and seek healthcare support when concerns arise. Despite these measures, a coordinated, large scale hearing screening programme is needed to improve early identification and reduce inequities in hearing health outcomes nationwide.

Newborn hearing screening in the Private Sector

In the South African private healthcare sector, newborn hearing screening is more routinely available and is often offered as part of standard postnatal care in maternity hospitals. Private facilities are more likely to have access to appropriate screening equipment and trained personnel, enabling the use of objective measures such as otoacoustic emissions and automated auditory brainstem response testing. Screening in this sector is commonly conducted on a universal basis or, at minimum, for infants identified as high risk. Despite greater availability, access remains limited to families with medical insurance or the financial means to pay out of pocket, contributing to disparities in early identification between private and public healthcare users. Follow up diagnostic assessment and early intervention services are also more readily accessible in the private sector, further widening inequities in hearing healthcare outcomes across socioeconomic groups.

Regulatory Body

The Health Professions Council of South Africa (HPCSA) is the primary regulatory authority for healthcare professionals, including audiologists. The HPCSA oversees the registration, scope of practice, accreditation of higher education programmes, continuing professional development (CPD), and disciplinary processes for practitioners. Based on the regulatory framework an audiologist must:

Complete Accredited Education: Obtain a degree in audiology from a recognized South African university.
Community service: Fulfil a compulsory community service year, providing audiological services in public healthcare facilities after completing a degree in Audiology.
Register with the HPCSA: Registration is mandatory to practice legally. Audiologists are listed under the Professional Board for Speech, Language, and Hearing Professions.
Engage in Continuing Professional Development (CPD): Practitioners must participate in ongoing education to maintain their registration and stay updated on advancements in the field.
Ethical guidelines: Audiologists must adhere to the ethical guidelines set out by the HPCSA which emphasizes patient confidentiality and informed consent, non-discriminatory practices and evidence-based decision making.

The HPCSA may register persons holding qualifications that are not prescribed, that is, qualifications obtained from outside of South Africa. In this regard, Section 25 of the Health Professions Act No. 56 of 1974 (as amended) states, “the Minister may, after consultation with the council by regulation provide that any person who holds a qualification which the council may accept by virtue of the fact that such qualification, in the opinion of the council, indicates a satisfactory standard of professional education and training”. This allows registration of such a person, at the discretion of a relevant professional board, but subject to any regulations and national health policy and international protocols. A professional board may require such a person to pass an evaluation before persons appointed by the professional board, to determine whether such person possesses adequate professional knowledge, skill, and competence to practice in South Africa. Holding a foreign qualification does not guarantee registration with the HPCSA unless the above requirements are met.

Professional Associations

South Africa has several professional bodies that support and regulate the practice of audiology and speech-language therapy. These organizations play a crucial role in professional development, advocacy, and ensure that high standards of practice are maintained within the industry. They provide resources, networking opportunities, and continuing education to audiologists, speech-language therapists, and related professionals.

South African Speech-Language-Hearing Association (SASLHA): A professional organization representing speech-language therapists and audiologists. SASLHA supports its members through advocacy, education, and collaboration, promoting excellence in the professions.
South African Association of Audiologists (SAAA): A dedicated body for audiologists, providing support, networking opportunities, and resources for members. SAAA also advocates for the audiology profession and promotes evidence-based practice.

Audiology Research

Much of the audiology research in South Africa is conducted at universities, with independent clinical audiologists and hearing aid companies also actively contributing. This research spans the full range of audiological practice, often through student projects at the undergraduate, master’s, and doctoral levels. Notable innovations in particular in the field of TeleAudiology and mHealth have resulted from research pioneered by South African Audiologists (https://www.hearxgroup.com/about-us).

South African Audiology researchers publish widely in several peer-reviewed international audiology-related journals, as well as in the South African Journal of Communication Disorders (SAJCD). SAJCD is an open-access double-blinded peer-reviewed local South African journal with an impact factor of 1.0. The journal has a dual focus and includes “reports and papers concerned with research, and critically evaluative theoretical, philosophical and conceptual issues dealing with aspects of human communication and its disorders, dysphagia, service provision, training and policy.” (https://sajcd.org.za/index.php/sajcd).

Some of the themes published in SAJCD in recent years have focused on the following topics:

Early Hearing Detection and Intervention (EHDI). Topics covered include: Newborn hearing screening (NHS) programs, targeted vs. universal NHS, follow-up challenges (Khan & Joseph 2024; Kgare & Joubert 2024; Kanji 2022; Petrocchi-Bartel & Khoza Shangase, 2014).
Public Awareness and Knowledge of Hearing Health. Key topics reported were: Awareness of audiology professions, community education on hearing loss (Ehlert 2017).
Hearing Conservation and Occupational Hearing Health. Topics covered: Noise-induced hearing loss, hearing conservation in workplaces (A Special Edition on this topic was published in 2020 https://sajcd.org.za/index.php/sajcd/issue/view/71; Mahomed & Panday 2024).
Barriers to Accessing Audiological Services: Topics include: Socioeconomic, cultural, and systemic barriers to care (Mtimkulu & Khoza-Shangase 2024; Joubert et al 2017).
Pediatric Hearing Loss. Including topics of: Parental knowledge, intervention in early childhood (Ehlert & Coetzer 2024; Van Zyl et al 2024)
Rural and Underserved Populations. Topics included: Hearing impairment prevalence, community-based approaches (Joubert 2023; Petrocchi 2023).
Technological and Methodological Advances. Key Topics: Tele-audiology, improved diagnostics (Moll et al 2024,Naude et al 2024, Kuschke et al 2023; Khoza-Shangase & Moroe 2020).

Audiology Charities

There are several organizations in South Africa that are dedicated to supporting audiology and enhancing hearing healthcare services. Below are some notable organizations and their contributions:

HiHopes offers early intervention programs that provide free, home-based support to families with infants or toddlers diagnosed with hearing loss. Their mission is to optimize the development of children with hearing loss by offering care, support, and partnership.
hearX Foundation is focused on creating access to hearing care services in underserved communities. They provide community-based hearing screenings, referrals, and awareness programs to address educational barriers related to hearing impairments.
Hearing Africa is dedicated to improving the lives of individuals with hearing loss by providing affordable hearing aids and support services.
DeafSA acts as the national research, information, and community action organization facilitating services to the South African Deaf and hard-of-hearing communities. The organization's mission is to preserve, protect, and promote the civil, human, and linguistic rights of Deaf, Deafblind, Hard of hearing and deafened people in South Africa.
DEAFinition Organization is a non-profit organization that empowers the Deaf community through education, advocacy, and support services. Their work aims to create an inclusive society where Deaf individuals have equal opportunities and access to resources.
DEAFability works to promote the rights and well-being of Deaf individuals through various programs and services. Their initiatives focus on enhancing the lives of people with hearing loss by providing educational support and advocacy.
South African National Deaf Association (SANDA) provides quality services, ensuring public accessibility and increasing awareness of issues affecting Deaf people at all levels in South Africa. As an advocacy organisation, SANDA is at the forefront in promoting and advancing the rights of Deaf people at all levels of society.
‘Give an Ear Foundation’ is dedicated to improving the lives of African children with Microtia/Atresia and related conditions. They aim to raise awareness about Microtia/Atresia and provide access to life-changing corrective surgeries and hearing aids.
Hear Us is a non-profit organisation based in the Western Cape, established in 2001 by parents of deaf children who received cochlear implants. Hear Us is committed to financially supporting disadvantaged individuals with severe-to-profound hearing loss to afford a Cochlear Implant and maintain them lifelong in order to realise their full potential in the hearing world. They also give support to those with hearing loss and their families.
Dischem Foundation: The gift of hearing, as part of their commitment to “Better Health Starts Here”, the Dis-Chem Foundation is proud to partner with Miss South Africa (2024), Mia le Roux, and the Miss South Africa Organisation to provide cochlear implants to hearing-impaired individuals who cannot afford this life-changing device. The Gift of Hearing forms part of Le Roux’s campaign, the Mia Le Roux Movement, which advocates for deaf individuals in South Africa and raises awareness about exclusion.
The National Institute for the Deaf (NID) is a registered Non-Profit Company (NPC) – established in 1881, they have been dedicated to the wellbeing of the Deaf community for well over a century.

These organizations play a crucial role in addressing the challenges faced by individuals with hearing loss in South Africa, providing essential services, resources, and advocacy to improve their quality of life.

Challenges and Opportunities

Rural South Africa faces a significant gap in audiology services. Limited infrastructure and healthcare resources result in minimal to no access to audiology care in these areas. Additionally, the healthcare workforce ratios remain insufficient to meet the growing demand for audiology services, especially in underserved regions. The National Health Insurance (NHI) bill highlights the need for an additional 608 audiologists by 2030 to address these gaps (Pillay et al., 2020), yet a significant portion of recent graduates face unemployment, partially due to the lack of available positions and other systemic barriers (Hlayisi, 2020). This shortage has been compounded further due to limited resources in public healthcare settings, where hospitals and clinics often struggle with equipment shortages and understaffing, making it difficult to provide comprehensive care (Bhamjee et al., 2022).

Regardless of these challenges, opportunities exist to improve access to hearing healthcare. South Africa has the potential to improve the accessibility and quality of hearing care across the country. Efforts to address the challenges require collaboration between the government, private sector, and NGOs. These could include:

Enhancing training programs to produce more audiologists
Targeted policies and incentives to attract specialists to rural and underserved areas
Expanding mobile audiology services to underserved areas
The formalization and integration of CHWs into hearing healthcare to improve service accessibility

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					Contributors to the original text
Faheema Mahomed-Asmail	Alida Naude	Anita Edwards	Katerina Ehlert	Khomotjo Kgare