Global Audiology/Americas/Guatemala

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General Information

Guatemala,officially the Republic of Guatemala,[b] is a country in Central America. It is bordered to the north and west by Mexico, to the northeast by Belize, to the east by Honduras, and to the southeast by El Salvador. It is bounded by the Pacific Ocean to the south and the Gulf of Honduras to the northeast. Guatemala is a highly diverse country, populated by a variety of ethnic, cultural, racial, and linguistic groups. Guatemala’s sole official language is Spanish, spoken by 93 percent of the population as either the first or second language. Twenty-one Mayan languages are spoken, especially in rural areas, as well as two non-Mayan Amerindian languages.

Incidence and Prevalence of Hearing Loss

Guatemala does not have prevalence or incidence studies for hearing loss or any other disability; however, they have one of the highest birthrates in Latin America. According to the National Institute of Statistics, it is 2.4%, which in 2016 meant that approximately 1000 babies were born every day. If conservative international rates are applied, Guatemala should expect an average of three babies born every day with some degree of hearing loss. [1]

While direct studies on the epidemiology of hearing loss in Guatemala are lacking, information on key demographic factors that can play a role can shed some light on the possible burden of hearing loss for the country. Guatemala is a multi-ethnic country with major populations including Maya, Ladino, Xinca, and Garifuna. Genetic studies have shown that specific mutations, such as in the GJB2 gene, are prevalent among the Mayan population, suggesting a genetic predisposition to hearing loss in this ethnic group. Socioeconomic status has been associated with hearing loss. A 2020 study conducted in Guatemala reported that the provision of hearing aids was shown to improve economic circumstances, quality of life, and mental health among affected individuals. The availability and quality of audiological services in Guatemala are limited (see Challenges below). There is a lack of culturally sensitive client-family counseling and community-based counseling services, which are crucial for addressing the needs of those with hearing impairment.

History of Audiology

Audiology services are present in Guatemala; however, there is only one university-trained audiologist in the country. Approximately 40 years ago, the first audiology shop started dispensing hearing aids; no diagnostic or repair services were available. Some years later, a second shop opened its doors. This one had better technology and more options for the clients.

As for pediatric services, hearing aids were being fitted without proper diagnosis; ABRs were being done by neurologists, and no behavioral observation techniques were used. Hearing aids were mainly body-worn aids and BTEs; very few people would try custom hearing aids, which were locally done. Digital technology was still years away.

In 1990, a new clinic opened its doors, led by a young professional with a Master’s degree in Education for the Deaf from Gallaudet University. This clinic offered top-of-the-line hearing aids, which were assembled in the United States. This seemed to be a trend for users who were looking for something new. This clinic, Centro de Audición, CEDAF, rapidly became the leader in hearing services and was responsible for introducing new technology through the years. Some examples are: the first completely in the canal (CIC) hearing aid line; the first digital aids; otoacoustic emissions (OAEs); Auditory Steady State Response (ASSR); cochlear implants; bone-anchored and middle ear implants; vestibular diagnosis (with equipment); real-ear measurements; and behavioral observation audiometry (with all its variants). During this time, the clinician pursued further studies and completed her Doctor of Audiology (Au.D.) at the University of Florida.

After CEDAF came a few other clinics, most of which were opened by former employees of audiologic clinics. They had some training, which they received during their prior employment. To date, there are approximately 10 hearing clinics throughout the country. Except for two, all of them offer hearing aid fitting and pure tone audiometry. One offers: hearing aid fitting, auditory brainstem response (ABR), pure tone audiometry (PT), and recently vestibular testing. CEDAF offers: neonatal and school hearing screening; diagnostics for all ages (PT, ABR, and ASSR); all types of implants; vestibular diagnosis and rehabilitation; and hearing, speech, and language therapy.

Information About Audiology

Education

No programs are available in Guatemala for audiology training. Speech and language therapy is available as an undergraduate program at a public university.

Audiology Practice: Public and Private

Public health systems, through Social Security, offer diagnostic services through contracts with private practitioners. Hearing aids are given to children who have completed their diagnostic tests before age five and whose parents are working either in the private or public sector. Adults may receive hearing aids if they are prescribed before retirement and it is not a congenital type of loss. Hearing aids are very basic, for both children and adults. All these services are free of charge. Cochlear implants are not available through public health services.

Private Sector

Most, if not all, audiological services are available through private clinics where most audiological services are available. There are differences in prices and quality among clinics.

Non-profit Organizations

• Sonrisas que Escuchan (Smiles that Listen Foundation), which started in 2009. To date, it offers all services listed in the table below, except for cochlear implants.
• Benemérito Comité Pro Ciegos y Sordos: is a non-profit that serves people who are blind and/or deaf. They offer educational, medical, and rehabilitation services. Within the medical services they offer the following audiological services: ABR, pure tone audiometry, tympanometry and hearing aid fitting (very basic technology).

Another program that does not offer services but instead collects money to support cochlear implantation is Ayúdame a Escuchar. It started in 2014; however, a drawback is that they do not have audiology professionals locally, so they bring in an ear, nose, and throat (ENT) surgeon for each surgery, and an audiologist comes twice a year to map the implants. There are no spare parts or distributor of the brand in Guatemala.

Audiologic Services

Service	Clinics A (Cost in US Dollars)	Clinics B (Cost in US Dollars)	Approximate number of centers offering the service	Service available in Public Sector
Neonatal Hearing Screening	15-60	-	3	Yes*
Pure Tone/ Speech Audiometry	20-35	10-18	14	Yes
Tympanometry	20-35	10-15	13	Yes
ABR/ASSR	200-340	-	8	Yes*
Hearing Aids	800-3,500	200-700	14	Yes*
Cochlear Implants	24,000-28,000	-	1	No
Vestibular Diagnosis	200-275	-	2	Yes*
Auditory Verbal Therapy	20-30	-	1	No
Speech/Language Therapy	18-25	10-15	50	No
• (*) Patients are sent to private practitioners who are subcontracted by the Public Health System due to lack of personnel and equipment. • Clinics A target medium high and high income population • Clinics B target medium and medium low-income population; they are less equipped and usually in peripheral areas.

Services offered by Otolaryngologists, Otologist’s and Otoneurologists

Otolaryngologists

Medical and surgical care of patients with diseases and disorders that affect the ears, the respiratory and upper alimentary systems, and related structures of the head and neck:

• Larynx and Nasal Endoscopy
• Few cochlear implants
• Ear wax removal
• Endoscopic Surgery
• Head and Neck Surgery
• Pediatric Otorhinolaryngology
• Audiometry
• Tympanometry
• Snoring Treatment
• Vestibular management
• Middle ear diagnosis and treatment

Otologists

There are no otologists per se; only four ENTs have skills in micro-ear surgery. Two of them have performed cochlear and bone anchored implants; however, one of them is now retired. Two more are in the process of developing these skills.

Otoneurologists

None at this time.

Audiological Services

Service	Approximate number of private centers offering the service	Approximate number of centers in the Capital City	Approximate number of centers in Rural Areas
Neonatal Hearing Screening	3	3	0
Pure Tone/ Speech Audiometry	14	8	6
Tympanometry	13	8	5
ABR/ASSR	8	6	2
Hearing Aids	14	8	6
Cochlear Implants	1	1	0
Vestibular Diagnosis	2	2	0
Speech/ Language Therapy	50	40	10
Auditory Verbal Therapy	1	1	0
Cerumen Management	Many	Many	Many
Intraoperative Monitoring	1	1	0
Auditory Processing Disorders	1	1	0
These services are offered by one Audiologist, audio technicians, and neurologists, ENT, psychologists and others.

Professionals

Professionals	Approximate Number	Ratio of the Population
Audiologists	1	16,000,000:1
Otolaryngologists	46	351,655:1
Micro-Ear Surgeons	3	5,400,000:1
Neurotologists	0	-
Speech-Language Pathologists	400	40,000:1
Teachers of the Deaf*	60	266,667:1
Hearing Aid Specialists	40	404,400:1
* Number of teachers with a bachelor’s degree in Education of Deaf Children. There are other teachers who do not have specialized education in the field. They are not accounted for.

Professional and Regulatory Bodies

There are no audiology professional organizations or regulatory agencies in Guatemala.

Scope of Practice and Licensing

There are no license requirements for audiology practitioners because there are no regulations for audiologists or training programs. Audiology practitioners basically do what their skills allow them to.

Research in Audiology

In 2026 the impact study among the low-income population in Guatemala (Do hearing aids improve lives?) was published by the London School of Hygiene & Tropical Medicine, World Wide Hearing Foundation, and the International Centre for Evidence in Disability.

Audiology Charities

Fundación Sonrisas que Escuchan / Smiles that Listen Foundation

The foundation started in 2009 and is basically sponsored by a private practice, Centro de Audición, CEDAF. They share infrastructure, personnel, equipment, etc., therefore offering quality services at affordable prices. They offer: neonatal hearing screening, pure-tone, speech audiometry, tympanometry, ABR, ASSR, hearing aids, ear molds, hearing aid repair, etc. Services are not given free of charge; a social worker will set the contribution fee on an individual basis.

Benemérito Comité Pro Ciegos y Sordos

This is a non-profit that serves people who are blind and deaf. They offer educational, medical, and rehabilitation services. Within the medical services, they offer the following audiological services: ABR, pure-tone audiometry, tympanometry, and hearing aid fitting (very basic technology).

Challenges, Opportunities and Notes

Challenges

• Audiology is unknown to many professionals
• Few professionals keep up to date in diagnosis, intervention and indication of HA fitting
• Little credibility and trust in audiology centers due to poor professional training
• In general, lack of information of where to seek help
• Audiological services are centralized in few cities, therefore transportation costs are involved
• Often, elderly are not brought for intervention, since their hearing loss seems to be “age appropriate”
• Hearing loss is usually not in government`s health care priorities
• Few trained people in the field of audiology
• No Audiology training programs available
• Lack of sufficient trained professionals, opens space to unethical “humanitarian missions”
• Calibration services are unavailable
• Few comprehensive audiological services
• Pediatric Audiological diagnostics are being done by professionals of other fields
• Insufficient specialized equipment
• Cost of diagnostic tests
• High cost of the hearing aids
• User´s manual usually not in mother language
• Use of refurbished or used hearing aids without post-care services

References

		Contributor to the original text
Dr. Patricia Castellanos de Muñoz

Edited in part by Joyce Rodvie Sagun