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link=https://en.wikipedia.org/wiki/Costa Rica

General Information

Costa Rica, officially the Republic of Costa Rica, is a country in Central America. It borders Nicaragua to the north, the Caribbean Sea to the northeast, Panama to the southeast, and the Pacific Ocean to the southwest, sharing a maritime border with Ecuador to the south of Cocos Island. The primary language spoken in Costa Rica is Spanish, but it is home to at least five living local indigenous languages spoken by the descendants of pre-Columbian peoples: Maléku, Cabécar, Bribri, Guaymí, and Buglere.

History of Audiology

From the middle of the last century ear and hearing services in Costa Rica started as basic ENT care. Since then it has developed into a structured system that includes formal audiology education and the provision of hearing loss technology (hearing aids/cochlear implants. The Costa Rican Social Security Fund (CCSS) division of the federal government provides hearing evaluation and treatment for free, however, challenges to the profession include a lack of centralized oversight on the dispensing process, the demand for hearing aids, and the influence of private hearing aid dispensers on quality of care. Key points in countries audiology history:

● Early Formalization (1980s): Costa Rica identified as one of the few countries in Latin America with a formal 2-year audiometric technician training program by the late 1980s.

● Deaf Education (1940s-1990s): First school for deaf children was established by Fernando Centeno Güell in 1940. Given the strong Deaf culture and identity in Costa Rica, Deaf education follows the "Total Communication" approach in public schools, teaching Deaf individuals both in LESCO (Costa Rican Sign Language) and Spanish. There are a few private preschools for Deaf individuals that follow the aural-oral method providing only spoken Spanish instructions well as speech therapy services. Parents who prefer this method of education for their children must pay its cost personally. These children are then usually sent to mainstream schools for subsequent education.

● Cochlear Implantation (2000s): Technological advancements in hearing care improved substationally in the early 2000s, with the start of cochlear implant surgeries at Hospital Mexico.

Incidence and Prevalence of Hearing Loss

Little data exists on overall incidence or prevalence rates of hearing loss in Costa Rica across the general population. Information is available for specific age groups, regions or hearing conditions in a subset of the population (e.g. neonates, premature infants, or Zika-affected infants). They provide related insights that may be useful for understanding specific aspects of hearing loss in Costa Rica.

Findings indicate that sensorineural hearing loss and tinnitus are common among this population (In the adult population, 52% presented some level of hearing handicap, unlike older adults, where the majority (77%) did not present any level of handicap). People with vestibular disorders perceive greater physical handicap (83%), with hearing loss often linked to metabolic diseases rather than vestibular conditions themselves.[1] 

A national study on the prevalence of hearing impairment in school-aged children was carried out across four phases in 250 elementary schools (12,500 children) from 1996 to 1997.[2] The study found that the number of hearing-impaired children in Costa Rica is between 1,174 and 1,274; a ratio of 1.50 to 1.63 hearing impaired per 1,000 live births. As the first study of its kind in Latin America, this data has been used to suggest the general regional prevalence of hearing loss is comparable to developed nations of Europe and North America. Costa Rica's universal neonatal hearing screening program evaluates nearly 98% of newborns. This program has been effective in identifying risk factors and early detection of hearing disorders.[3] In Costa Rica, approximately half of newborns annually have risk factors for hearing loss, such as anoxia, intrauterine infections, syndromes, and ICU stays longer than five days. These factors are associated with altered results in neonatal hearing screenings.[4]  

Among infants affected by Zika virus during the 2016–2018 outbreak in Costa Rica, 9% were reported to have hearing loss as part of associated birth defects.[5]

A study in Costa Rica found that premature infants had a higher prevalence of significant hair cell loss (41%) compared to full-term infants (28%), suggesting a higher risk of sensorineural hearing loss in this group.[6]

Compared to similar countries, Costa Rica has one of the lowest reported levels of hearing loss in the older (over 85) population with data indicating ~40% of adults in this age group have some degree of loss.[7]

Information About Audiology

Ninety five percent of the population's healthcare services are covered by the Costa Rican Social Security administration and/or the Ministry of Health. In 2022 the population of Costa Rica was estimated to be 5,044,197 people.

Audiology services in Costa Rica are fairly well developed, especially in cities like San José, Heredia, and Cartago. They typically cover hearing testing, diagnosis, hearing aids, and rehabilitation. Many services are available privately, while public healthcare may provide hearing aid prescriptions and referrals, which private clinics can fulfill.

Cochlear implant surgeries in Costa Rica are centralized at Hospital México under the federal health system, with a limited, government determined prioritization program performing roughly 20-30 surgeries annually. Through the federal healthcare system only unilateral implantation is provided regardless of age. Additionally, while the surgery and implant are covered expenses through the government, mapping, aural rehab, batteries and repairs are out of pocket expenses to the patient/families. Pediatric specific services are probably insufficient in Costa Rica due to lack of formalized training for evaluation of children. Pediatric testing is performed mainly in the case of infant screening and with medically complex cases.

In 2006, the Minister of Health, Dr. Maria Luisa Avila allocated resources to establish a universal newborn hearing screening program (DITS: Detection and Early Intervention on Newborn Deafness).

Scope of Practice and Licensing

Professionals are typically licensed and trained under national medical/therapy boards. Access to hearing care, hearing aids and rehabilitation services are critical areas of need. Services offered by:

  • Otolaryngologists: medical evaluation of ear health, medical and surgical treatment of ear disease
  • Audiologist: complete spectrum of advanced diagnostic testing and treatment of hearing and balance disorders
  • Technicians: audiology technicians are responsible for the general hearing testing.
  • Hearing aid dispensers: evaluate hearing sensitivity and sell hearing aids

Professional and Regulatory Bodies

Professional and Regulatory Bodies

Graduates of the 3-year Audiology Bachelor and 1-year Master's programs are associated with ACOA (Costa Rican Association of Audiology) Costa Rican ENTs are affiliated with the Association of Otorhinolaryngology-Head and Neck Surgery Scope of Practice and Licensing In Costa Rica, technicians are mandated to be supervised. There is no legislation to enforce the calibration of audiology testing and verification equipment.

Laws related to hearing care services

  • Disability Rights (1996): Law 7600 was passed, mandating the state to reduce communication barriers for deaf individuals.
  • State Provision and Disputes (2010s): The CCSS (Social Security Fund) plays a major role in free hearing aid provision, but in the 2010s, it changed the buying model, creating tension with local audiologists regarding the limitation of providers.

Education of professionals working in hearing care services

  • ENTs: Foundational medical degree (4-6 years), Major medical institutions: Universidad de Ciencias Medicas (UCIMED) and Universidad de Costa Rica (UCR), and Universidad Santa Paula. This is followed by clinical ORL specialization. There is not a strong audiology component to ORL specialty training.
  • Audiology technician: The highest level of education needed is a high school degree, supplemented by technical training/certification that can be completed locally or virtually.
  • Audiologist: The Bachelor's is the foundational entry-level, while the Master's is an advanced degree. 3 year bachelor degree in Audiology through Universidad Santa Paula to include University Community Work. A one year four month Masters in Audiology through the Universidad Santa Paula provides a deeper training in advanced diagnostics and prepares audiologists for jobs in senior or specialized roles.

Ongoing audiology research

The research in Costa Rica is limited but related to audiology spans several key areas, focusing on both clinical and public health aspects.[8]

Surveillance systems in Costa Rica, such as a national reporting system for individuals identifying as deaf and national newborn hearing screening system, should facilitate future research. .[9]

Challenges, Opportunities and Notes

Despite advancements, challenges remain in Costa Rica, including limited funding, public awareness, and availability of qualified personnel for audiological services. These barriers are consistent with broader trends in Latin America, where efforts to expand newborn hearing screening and intervention programs are ongoing [10]

Audiology Charities

  • Asembis: Organization providing eye and ear healthcare since 1991 across 11 clinics. This group often works with international partners/donors to provide free services and treatment technologies. Asembis is a non-profit entity whose clinics operate in a tiered pricing model in which higher revenues earned from wealthier patients subsidize patients who apply for treatment assistance. They treat patients who fall into the following categories:
  1. middle income individuals who cannot afford the private health but are willing to pay for services beyond what is provided through national health care service,
  2. low-income individuals who cannot afford to pay the Asembis fees but are willing to pay something for essential treatments, and 3) individuals below the poverty line who cannot afford any medical care,
  3. Costa Rican Social Security Fund: Responsible for the majority of public hearing aid funding. For ~30 year the program for providing state funded hearing aids to

Deaf and hard of hearing individuals functioned by allowing the patient to select their private practice provider and their brand/model of technology. However, under the current model of service provision, the patient must choose from 9 provider clinics. This shift changed CCSS hearing aid provider numbers from 75 to 30. CCSS changed the model to create greater quality control and reduce patient responsibility but local providers worry that the change can hurt patients by significantly increasing time to treatment.

References

  1. ↑ Chacón Rodríguez, Adriana; Jiménez Gómez, Jorge Antonio; Dávila Rojas, Mónica (2022-09). "Perfil audiológico y grados de discapacidad en las personas con alteraciones vestibulares pertenecientes a la consulta del Centro Equilibra, Vértigo y Equilibrio, San José, Costa Rica". Acta Otorrinolaringológica Española 73 (5): 271–278. doi:10.1016/j.otorri.2021.04.004. https://linkinghub.elsevier.com/retrieve/pii/S0001651921000844. 
  2. ↑ Mencher, George T.; Madriz Alfaro, Juan Jose (2000-01). "Prevalence of Sensorineural Hearing Loss in Children in Costa Rica: Prevalencia de la hipoacusia infantil en Costa Rica". International Journal of Audiology 39 (5): 278–283. doi:10.3109/00206090009073092. ISSN 1499-2027. http://www.tandfonline.com/doi/full/10.3109/00206090009073092. 
  3. ↑ González, Leiner Rodríguez; Zeledón Díaz, Ana Laura; Mora, Óscar Centeno (2021-12-10). "Eficacia del «Programa de tamizaje auditivo neonatal universal» de la Caja Costarricense del Seguro Social en la detección de sordera en niñas y niños, entre 2016 y 2018". Población y Salud en Mesoamérica. doi:10.15517/psm.v19i2.47144. ISSN 1659-0201. https://revistas.ucr.ac.cr/index.php/psm/article/view/47144. 
  4. ↑ Narváez, Amanda María; Pacheco Calderón, Mary Cruz; Centeno Mora, Óscar (2022-12-08). "Risk factors for hearing loss associated with hearing alterations in neonates admitted to the Intensive Care Unit of the Hospital Dr. Rafael Ángel Calderón Guardia, San José, Costa Rica, 2018-2019". Población y Salud en Mesoamérica. doi:10.15517/psm.v20i2.51928. ISSN 1659-0201. https://revistas.ucr.ac.cr/index.php/rpsm/article/view/6468. 
  5. ↑ Benavides-Lara, Adriana; la Paz Barboza-Arguello, María de; González-Elizondo, Mauricio; Hernández-deMezerville, Marcela; Brenes-Chacón, Helena; Ramírez-Rojas, Melissa; Ramírez-Hernández, Catalina; Arjona-Ortegón, Nereida et al. (2021-02). "Zika Virus–Associated Birth Defects, Costa Rica, 2016–2018". Emerging Infectious Diseases 27 (2). doi:10.3201/eid2702.202047. ISSN 1080-6040. PMID 33496653. PMC 7853552. https://wwwnc.cdc.gov/eid/article/27/2/20-2047_article.htm. 
  6. ↑ Amatuzzi, Monica; Liberman, M. Charles; Northrop, Clarinda (2011-10). "Selective Inner Hair Cell Loss in Prematurity: A Temporal Bone Study of Infants from a Neonatal Intensive Care Unit". Journal of the Association for Research in Otolaryngology 12 (5): 595–604. doi:10.1007/s10162-011-0273-4. ISSN 1525-3961. PMID 21674215. PMC 3173554. http://link.springer.com/10.1007/s10162-011-0273-4. 
  7. ↑ Group, BMJ (2025). "Countries with highest reported levels of hearing loss have lowest use of hearing aids".
  8. ↑ Chacón Rodríguez, Adriana; Jiménez Gómez, Jorge Antonio; Dávila Rojas, Mónica (2022-09). "Perfil audiológico y grados de discapacidad en las personas con alteraciones vestibulares pertenecientes a la consulta del Centro Equilibra, Vértigo y Equilibrio, San José, Costa Rica". Acta Otorrinolaringológica Española 73 (5): 271–278. doi:10.1016/j.otorri.2021.04.004. https://linkinghub.elsevier.com/retrieve/pii/S0001651921000844. 
  9. ↑ Madriz, Juan J (2001-01). "Audiology in Latin America: hearing impairment, resources and services". Scandinavian Audiology 30 (2): 85–92. doi:10.1080/010503901750166781. ISSN 0105-0397. http://www.tandfonline.com/doi/full/10.1080/010503901750166781. 
  10. ↑ Bhutta, M F (2019-01). "Models of service delivery for ear and hearing care in remote or resource-constrained environments". The Journal of Laryngology & Otology 133 (1): 39–48. doi:10.1017/S0022215118002116. ISSN 0022-2151. https://www.cambridge.org/core/product/identifier/S0022215118002116/type/journal_article. 

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Contributor to the original text
Madison Saunders
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