Global Audiology/Asia/Pakistan
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Brief Country Information
Pakistan, officially the Islamic Republic of Pakistan,is a country in South Asia. It is bounded by the Arabian Sea on the south, the Gulf of Oman on the southwest, and the Sir Creek on the southeast, it shares land borders with India to the east; Afghanistan to the west; Iran to the southwest; and China to the northeast. It shares a maritime border with Oman in the Gulf of Oman, and is separated from Tajikistan in the northwest by Afghanistan's narrow Wakhan Corridor. Pakistan is a diverse society with estimates suggesting it has between 75 and 85 languages. Urdu and English serve as the official languages, with Urdu being the country's lingua franca among over 75% of Pakistanis.
Incidence and Prevalence of Hearing Loss
Hearing loss affects a substantial portion of the Pakistani population. About 14.5 million individuals in Pakistan are estimated to suffer from some type of hearing loss.[1] This includes both genetic and environmental causes, with a prevalence of genetic mutations such as GJB2, which accounts for 6.1% to 9.2% of cases.[2][3] The prevalence of childhood hearing loss in Pakistan is reported to be over double the global average.[4]
Hearing loss following acute episodes of meningitis in children is reported at 22% among patients being treated in the Children's Hospital in Lahore.[5] The incidence of hearing impairment associated with otitis media is estimated at 40 per 10,000 population.[6] Hearing loss is estimated to be more prevalent in males and those aged 15-35 years.[7] Additionally, a significant portion of children with profound bilateral hearing loss have a positive family history of the condition, with 76.9% of their parents being first-degree relatives.[8]
The estimate of 14.5 million Pakistanis suffer from some form of hearing loss highlights a pervasive burden that national health planning has not adequately addressed. When applied to the 2023 national census count of 241 million people, complementary data from official government sources, such as the Pakistan Bureau of Statistics and Ministry of Health briefings, place the prevalence rate at approximately 4.8% of the total population, or roughly 11.6 million people (Pakistan Bureau of Statistics, 2023). These estimates show a significant and expanding need for comprehensive audiological services, early detection programs, and fair access to rehabilitative care nationwide, even though they differ slightly amongst reporting bodies.
History of Audiology and Aural Care
Hearing Care Services
Professionals providing hearing care services
Clinicians and public health researchers continue to pay attention to childhood and early-onset hearing loss, which is significantly higher than many global averages, according to recent studies and reviews from Pakistan. The prevalence of congenital/early-onset hearing loss varies between community and school studies (~1.9% in a recent school-based sample and higher estimates up to ~7-8% reported in other regional work), and some estimates suggest higher rates than generally believed. These findings highlight a significant, partially avoidable disease burden that requires primary care intervention (Bhatti et al., 2024; Shaikh, 2024; Mazlan et al., 2024).
Unlike higher-income nations, Pakistan does not have a national newborn hearing screening program that is both universal and well-resourced. Screening programs are dispersed; some hospitals, NGOs, and specialty centers conduct focused screening or pilot programs, but coverage is restricted and not yet integrated into regular primary-care interactions across the country (WHO/World Hearing Day activities in Pakistan have promoted primary EHC, but large-scale adoption remains early). This indicates that many newborns and kids with hearing loss are discovered after the fact (World Hearing Day report from WHO; PIRS activities).
One of the biggest Community Health Workers platforms in the world, Pakistan's Lady Health Worker program has been effective in promoting maternal and child health. The potential of Lady Health Workers to expand their skill set to include referral tasks, basic screening questions, and hearing promotion has been highlighted in a number of reports, pilot projects, and international actors; however, formal, scaled training and supervisory integration for ear/hearing tasks are scarce. Results from seminars and small pilot trainings are encouraging but limited in the areas where hearing work has been attempted (World Hearing Day/PIRS seminar reports; Hafeez et al., 2011).
Major cities (Karachi, Lahore, Islamabad/Rawalpindi, etc.) are the main locations for audiology and ENT services, including cochlear implantation, diagnostic testing, and hearing aids. Audiology services are offered by a number of academic hospitals and private clinics; gaps are also filled by charitable organizations and visiting surgical missions (for instance, charity ENT/implant projects have supported children with middle-ear disease and cochlear implants). However, low-income and rural patients continue to face significant barriers to access due to geography and cost.
Education and Professional Practice
Education of professionals working in hearing care services
Professional and Regulatory Bodies
Scope of Practice and Licensing
Audiology Research
Most of research related to hearing is focused on describing the epidemiology of hearing conditions and its causes, as described above under incidence and prevalence of heraing loss.
Audiology Charities
Challenges and Opportunities
Challenges are associated with the needed expansion of health care services and education of professionals with needed expertise. Initiatives for hearing and aural care are increasing with training, awareness events, and referral pathway developments with some examples being educational seminars (World Hearing Day events), brief training pilots introducing WHO Primary Ear & Hearing Care concepts (through organizations like PIRS), and recent work on clinical practice guidelines and primary-care referral pathways for ENT conditions (a 2025 primary care/ENT guideline development effort). Some facilities, like the Indus Hospital, have tested telepractice and tele-audiology during COVID-era service adjustments. Scalability is still the main obstacle, but these initiatives indicate growing awareness and preliminary efforts to incorporate ear care into public health care.
References
- ↑ Naz, Sadaf (2022-04). "Molecular genetic landscape of hereditary hearing loss in Pakistan". Human Genetics 141 (3-4): 633–648. doi:10.1007/s00439-021-02320-0. ISSN 0340-6717. https://link.springer.com/10.1007/s00439-021-02320-0.
- ↑ Ali, Ejaz; Hussain, Nageen (2022). "Analysis of the GJB2 Gene and its Mutated Protein in Non-Syndromic Hearing Loss Patients of Gilgit-Baltistan". Pakistan Journal of Zoology 54 (4). doi:10.17582/journal.pjz/20200527140529. http://researcherslinks.com/current-issues/Analysis-the-GJB-Gene-Mutated-Protein-Non-Syndromic-Hearing-Loss/20/1/4872/html.
- ↑ Ahmed, Ashfaque; Wang, Meng; Khan, Rizwan; Shah, Abid Ali; Guo, Hui; Malik, Sajid; Xia, Kun; Hu, Zhengmao (2021-12). "A splice-site variant (c.3289-1G>T) in OTOF underlies profound hearing loss in a Pakistani kindred". BMC Medical Genomics 14 (1). doi:10.1186/s12920-020-00859-x. ISSN 1755-8794. PMID 33397372. PMC 7784026. https://bmcmedgenomics.biomedcentral.com/articles/10.1186/s12920-020-00859-x.
- ↑ Mazlan, Rafidah; Dar, Hamza Mushtaq (2024-11-15). "Evaluating parental knowledge and attitudes toward childhood hearing loss: a cross-sectional study in Rawalpindi, Pakistan". BMC Pediatrics 24 (1). doi:10.1186/s12887-024-05230-y. ISSN 1471-2431. https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-024-05230-y.
- ↑ Zeeshan, Fatima; Bari, Attia; Dugal, Mubeen Nazar; Saeed, Fauzia (2018-05-24). "Hearing impairment after acute bacterial meningitis in children". Pakistan Journal of Medical Sciences 34 (3). doi:10.12669/pjms.343.14373. ISSN 1681-715X. http://pjms.com.pk/index.php/pjms/article/view/14373.
- ↑ Shakoor, Sadia; Malik, Faisal Riaz; Khan, Erum (2016-01-02). "Bacterial aetiology of otitis media in children in Pakistan aged 0–59 months; laboratory surveillance data from 2004 to 2013: comparison between before and after the introduction of Hib vaccination". Paediatrics and International Child Health 36 (1): 34–38. doi:10.1179/2046905514Y.0000000170. ISSN 2046-9047. https://www.tandfonline.com/doi/full/10.1179/2046905514Y.0000000170.
- ↑ Naz, Erum; Saqulain, Ghulam; Mumtaz, Nazia; Babur, Muhammad Naveed (2021-05-07). "A Hospital based study on sudden sensorineural Hearing Loss: It’s audiological characteristics and prevalence". Pakistan Journal of Medical Sciences 37 (4). doi:10.12669/pjms.37.4.3851. ISSN 1681-715X. PMID 34290796. PMC 8281165. http://pjms.org.pk/index.php/pjms/article/view/3851.
- ↑ Raza, Syed Hashim; Waris, Rehmana; Akhtar, Samina; Riaz, Ramish (2020-10). "Precochlear Implant Assessment: Clinical Profile and Family History of Children with Severe Bilateral Prelingual Hearing Loss". International Archives of Otorhinolaryngology 24 (04): e457–e461. doi:10.1055/s-0039-3402442. ISSN 1809-9777. PMID 33101511. PMC 7575360. http://www.thieme-connect.de/DOI/DOI?10.1055/s-0039-3402442.
Other sources
Bhatti, M. A., Khan, M. N., Ali, S., & Ahmed, S. (2024). Prevalence and early detection challenges of childhood hearing loss in Pakistan. Journal of Pakistan Medical Association, 74(3), 215–221.
Dawn. (2015, November 22). Only two audiologists in Punjab’s public hospitals. Dawn News.
Indus Hospital & Health Network. (2023). Cochlear Implant Treatment Program Report 2022–2023. Lahore, Pakistan: TIH.
Irfan, M. (2024). Outcomes of newborn hearing screening in a tertiary care hospital in Lahore. Pakistan Journal of Otolaryngology, 40(1), 17–22.
International Medical Relief Agency. (2021). IMRA Medical Society has completed 100 cochlear implants in Pakistan. Medical News PK. https://www.medicalnews.pk
Mashhadi, S. F., Khan, N., Malik, I. A., Anwaar, R., Sultan, H., & Shahbaz, R. (2024). Post-cochlear implant rehabilitation outcomes in children: A cross-sectional analysis. Pakistan Armed Forces Medical Journal, 74(Suppl-4), 854–858. https://doi.org/10.51253/pafmj.v72iSUPPL-4.9679
Mumtaz, Z., Levay, A., Bhatti, A., & Salway, S. (1995). Exploring health-seeking behaviour in Pakistan. Health Policy and Planning, 10(3), 242–248.
Pakistan Bait-ul-Mal. (2024). Cochlear Implant Sponsorship and Assistive Devices Program. Government of Pakistan.
Pakistan Bureau of Statistics. (2023). Population and housing census 2023: National results. Government of Pakistan. https://www.pbs.gov.pk Pakistan Institute of Rehabilitation Sciences. (2012). BS Audiology program overview. Islamabad: PIRS.
Pyarali, M., Akhtar, S., Adeel, M., Mallick, S. A., Uneeb, S. N., & Aslam, A. (2023). Universal newborn hearing screening: A tertiary-care pilot study in Karachi. Journal of the Pakistan Medical Association, 73(9), 1788–1793. https://doi.org/10.47391/JPMA.6264
Rentech Digital. (2024). Count of registered audiologists in Pakistan. Pakistan Business Directory Dataset.
Saqulain, G., Pervaiz, A., Qazafi, L., Zahid, K., & Sami, M. (2024). Awareness and practices related to hearing healthcare in Pakistan: A cross-sectional study. Pakistan BioMedical Journal, 7(5), 8–13. https://doi.org/10.54393/pbmj.v7i05.1087
Shaikh, R. (2024). Prevalence and risk factors of congenital hearing loss in school-aged children in Sindh. Sindh Journal of Public Health, 12(2), 45–52.
Shah, S. I., Rehman, A., Siddiqui, A., & Yasmeen, S. (2024). Speech and auditory outcomes after cochlear implantation in Pakistani children. Journal of Ear, Nose & Throat Disorders, 9(1), 12–19.
World Health Organization. (2021). World report on hearing[1]. WHO.
Ziauddin College of Speech Language & Hearing Sciences. (2013). Bachelor of Audiology and Speech-Language Therapy program outline. Karachi: Ziauddin University.
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 Contributors to the original text | |
| Mamoon Ali | Amina Siddiqui | |
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Edited by Nausheen Dawood