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General Information

Spain,(officially the Kingdom of Spain) is a sovereign state and member of the European Union, located on the Iberian Peninsula in southwestern Europe. With a population of approximately 47 million, it is the fourth most populous country in the EU. Spain is a parliamentary constitutional monarchy divided into 17 autonomous communities, each with significant responsibility for public services including health. The national language is Spanish (Castilian), with several co-official regional languages including Catalan, Galician, and Basque. [1] Spain has one of the largest ageing populations in Europe, with more than 20% of citizens aged 65 or over, a demographic factor that significantly increases the burden of age-related hearing loss on the healthcare system. [2][3]

History of Audiology

Audiology in Spain has a long clinical history, though the formal recognition of audiology as a standalone university-level health profession has been slow compared with many other European and non-European nations. For decades, hearing care in Spain has been provided primarily by otorhinolaryngologists (ENT specialists), hearing aid technicians (audioprotesistas), and speech-language pathologists (logopedas), without a unified, independently licensed general audiologist profession as currently defined by the European Federation of Audiology (EFAS). [4][5][6] In 2001, the Spanish government formally regulated the qualification of Technicians in Hearing Aid Dispensing (Técnico Superior en Audioprótesis), establishing it as the mandatory credential for hearing aid fitting and dispensing. Since then, hearing aid services have been provided primarily by professionals trained through this vocational education program rather than university-level programs. Thus, audiology as a comprehensive, independent clinical discipline—including diagnostic audiology, vestibular assessment, tinnitus management, and pediatric audiology—remains structurally underrepresented in Spanish higher education well into the 21st century[4] . A landmark development came in 2023 and 2024, when the Universitat de Vic–Universitat Central de Catalunya (UVic-UCC) and the University of Salamanca, respectively, launched Spain's first bachelor's degree programs in General Audiology. [7] [8] . These programs represent a transformative milestone in the development of audiology education in Spain. Nevertheless, despite these important advances, the profession of general audiologist has not yet been formally recognized as an independent regulated health profession within the Spanish healthcare system.

Incidence and Prevalence of Hearing Loss

According to the EuroTrak Spain 2023 survey — the largest population-based survey of hearing loss and hearing aid use in Spain — approximately 10.6% of the total Spanish population report living with hearing loss. Among adults aged 18 and over, the prevalence rises to 12.3%, representing an estimated five million people and placing Spain fifth in Europe for hearing loss prevalence. [2][3] Hearing loss prevalence in Spain increases substantially with age, consistent with global trends in presbycusis (age-related hearing loss). Earlier population-based audiometric data also provide normative hearing threshold levels for screened Spanish adults, confirming the progressive nature of hearing loss across age groups. [9] Despite the high prevalence, hearing aid uptake remains modest: in 2023, only 39% of individuals with self-reported hearing loss in Spain were using hearing aids, a slight increase from 37% in 2020. Binaural fitting rates have improved, with 55% of users now fitted with two hearing aids, up from 47% in the previous survey. Among hearing aid users, 96% report that their devices improve their quality of life at least sometimes. [2] The EuroTrak 2023 data also highlight the broader health and social benefits of hearing aid use. Users are less likely to experience depression, mental and physical fatigue, or poor sleep quality compared to those with untreated hearing loss — 51% of hearing aid users show depressive symptoms, compared to 60% of non-users with hearing loss. In the workplace, 96% of employed hearing aid users found their devices useful, with 70% rating them as significantly beneficial for their job performance. Additionally, 73% of users report a better social life since receiving their devices, and 87% feel safer navigating their urban environment due to improved detection of traffic and environmental sounds. A strong 67% of hearing aid users stated they should have started using their devices sooner, citing missed social opportunities and emotional wellbeing as their primary regrets. [2]

Information About Audiology

Education of Professionals Working in Hearing Care Services

The primary educational route to working in hearing care in Spain has traditionally been the Grado Superior en Audiología Protésica (Technical Degree in Hearing Aid Dispensing), a two-year vocational program. This qualification trains students to carry out audiological evaluations, select and fit hearing aids, maintain prosthetic devices, and advise patients and families on device use. It is available through numerous public and private institutions across the country, including distance learning options. [10][5] Until very recently, no university-level undergraduate degree in audiology existed in Spain, a significant anomaly by international standards. Very recently, UVic-UCC and University of Salamanca became the first universities in Spain to offer a bachelor's degree in General Audiology. This degree covers the full scope of audiological practice, including clinical audiology, vestibular assessment, pediatric audiology, hearing rehabilitation, and research. [7][8] Prior to this, some Spanish universities had offered postgraduate specialization diplomas in audiology, such as the University of Salamanca's 36-ECTS specialization program, but these did not constitute a full undergraduate degree. However, they provided high-quality training to many hearing care professionals providing services not only in Spain, but also in Latin American countries [11]

Scope of Practice and Licensing

Professionals Providing Hearing Care Services Spain currently recognizes three professional categories involved in hearing care. First, the otorhinolaryngologist (ENT specialist), a medical doctor who diagnoses and treats diseases of the ear but whose scope does not fully encompass the management of auditory function. Second, the Técnico Superior en Audiología Protésica (Technical Degree in Hearing Aid Dispensing), a vocational healthcare professional focused primarily on the selection, fitting, and maintenance of hearing aids, but not covering areas such as balance disorders, tinnitus, or pediatric audiology in depth. Third, the speech therapist (logopeda), who addresses communication and language disorders that may be associated with hearing loss. [4][5] The absence of a regulated, university-trained general audiologist, a professional with comprehensive competencies across the full scope of audiological practice (see EFAS [6]) , is widely identified as a structural gap in Spain's hearing care system. [12][7]

Audiological Services

Audiological services in Spain are provided across public and private settings. In the public sector, hearing assessments and ENT consultations are accessible through the Sistema Nacional de Salud (SNS), with referrals typically initiated by primary care physicians. In the private sector, a network of hearing care centers, including major chains such as GAES, provides hearing testing, hearing aid fitting, and follow-up care. [1][4] The Spanish hearing aids market was valued at approximately USD 348 million in 2024 and is projected to reach USD 791 million by 2035, reflecting a compound annual growth rate (CAGR) of 7.74% over the forecast period. This growth is driven primarily by demographic pressures from an ageing population, rising health consciousness, and rapid technological advancement in device design. Behind-the-Ear (BTE) devices currently represent the largest product segment, while In-the-Ear (ITE) models are the fastest-growing, reflecting consumer demand for more discreet solutions. Digital hearing aids dominate the technology landscape. Key players active in the Spanish market include Sonova Holding AG, Amplifon S.p.A., Demant A/S, and WS Audiology. [13]

Services Offered by Otolaryngologists, Otologists, and Otoneurologists

ENT specialists form the medical backbone of hearing care in Spain. Services provided include diagnostic audiological assessments, surgical intervention for otological conditions, and cochlear implant programs. The Clínica Universidad de Navarra, in Pamplona (Navarra), for example, operates a well-established cochlear implant program within its Department of Otolaryngology, providing multidisciplinary assessment, surgery, and rehabilitation for candidates with severe to profound hearing loss. [14][15]

Role of Primary Health Care Providers and Community Health Workers

Primary care physicians (médicos de cabecera) play a central gatekeeping role in accessing hearing care services in Spain. According to the EuroTrak Spain 2023 data, 79% of hearing aid users first discussed their hearing loss with their family doctor; however, only 58% received a hearing aid recommendation from that consultation, and just 39% ultimately acquired hearing aids. These gaps highlight the importance of awareness and training at the primary care level. Access to financial support is also limited: only 26% of hearing aid owners in Spain reported receiving any third-party funding for their devices, and awareness of available coverage is low, with just 11% of non-users believing they would qualify for any subsidy. These barriers in both clinical referral and funding awareness contribute to the low overall uptake rate and point to the need for stronger integration of hearing care into primary care pathways [3]. Additionally, recognizing the profession of general audiologist would allow integrating these professionals into the healthcare systems which would also reduce these barriers [11].

Laws Related to Hearing Care Services

The legal framework for hearing care in Spain is primarily governed by the Ley General de Sanidad (General Health Law) of 1986, which established the Sistema Nacional de Salud (SNS) and enshrined the right of all citizens to comprehensive healthcare, including prevention, treatment, and rehabilitation. [1] Regarding hearing aid provision, the SNS provides partial subsidies primarily for children and young people up to age 26 with a hearing loss of at least 40 dB in the better ear, subject to ENT prescription. Adult reimbursement is notably limited. The European Federation of Hard of Hearing People's 2022 report identifies Spain as one of seven European countries with worryingly low levels of hearing aid reimbursement, noting that Spain does not support hard-of-hearing adults with hearing aid reimbursement. [7]

Professional and Regulatory Bodies

The principal professional body for audiology in Spain is the Asociación Española de Audiología (AEDA), which represents audiologists and promotes the development of the profession. In 2023, AEDA published a formal position statement in AUDITIO, the Spanish Journal of Audiology calling for the establishment of a university degree in audiology in Spain, reflecting the profession's advocacy for higher-level training standards, and the recognition of the general audiologist profession. [11] Hearing aid dispensers are represented by the Asociación Nacional de Audioprotesistas (ANA), which co-commissioned the EuroTrak Spain surveys in partnership with EHIMA (European Hearing Instrument Manufacturers Association). [2] Otorhinolaryngologists are represented by the Sociedad Española de Otorrinolaringología y Cirugía de Cabezay Cuello (SEORL-CCC), which includes otologists and other ENT specialists involved in the medical and surgical diagnosis and management of hearing and balance disorders.

Scope of Practice and Licensing

The scope of practice for hearing care professionals in Spain is currently fragmented. The hearing aid dispenser is licensed to fit and dispense hearing aids but is not recognized as having the full clinical competencies of a general audiologist. ENT specialists hold the broadest medical authority over ear-related conditions. Speech therapists hold a university degree and are regulated health professionals, but their scope is primarily linguistic and communicative rather than audiological. [4][5] It is expected that, in the coming years, the recently established undergraduate degrees in audiology, together with the work of professional audiology societies, will support the formal recognition of general audiologist as a new regulated profession in Spain. This development would broaden the scope of audiological practice, enabling general audiologists to provide high-quality services across both the public and private hearing healthcare systems. [12][11]

Ongoing audiology research

Spain has a long and distinguished history of hearing research dating back to the pioneering neuroscientific work of Dr. Santiago Ramón y Cajal in the early twentieth century. His studies on the structure of the nervous system laid important foundations for understanding the neural basis of hearing [16][17]. This tradition has continued through an important lineage of auditory neuroscience researchers, many of whom have been affiliated with the Instituto de Neurociencias de Castilla y León (INCYL) at the University of Salamanca and have made internationally recognized contributions to the field [16][17]. More recently, Spanish researchers have made internationally recognized contributions to psychoacoustics, cochlear implants, auditory perception, and hidden hearing loss. Among the most influential is Dr. Enrique López-Poveda (INCYL, University of Salamanca), whose work on computational auditory modeling, speech perception, cochlear implants, and hidden hearing loss has had a substantial international impact [18][19]. Significant contributions have also been made by clinician-scientists, including Drs. Manuel Manrique and Alicia Huarte at Clínica Universidad de Navarra (Pamplona, Spain), whose work has advanced cochlear implantation and hearing rehabilitation [20], as well as Dr. José Juan Barajas del Prat (Clínica Barajas, Tenerife, Spain), who has made important contributions to auditory evoked potentials and to the development of clinical audiology and hearing healthcare internationally [21][22]. Finally, also in the Canary Islands, the research group led by Dr. Ángel Ramos pioneered the development of a vestibular implant [23]. In recent years, a new generation of Spanish hearing scientists has emerged following advanced training at leading international institutions. Researchers such as Drs. Waldo Nogueira (Universitat Autònoma de Barcelona/Hannover Medical School) and Joaquín Valderrama (University of Granada) exemplify this trend, contributing to the expansion of audiology research and strengthening Spain's academic capacity in hearing science. As a result, research in both basic and clinical audiology continues to grow, positioning Spain as an increasingly active contributor to international hearing research. The relaunch of AUDITIO – The Spanish Journal of Audiology by the Asociación Española de Audiología (AEDA) in 2021 represents another important milestone (https://journal.auditio.com/auditio). The journal provides an international platform for research in clinical audiology, hearing technology, professional practice, and public health audiology, reflecting Spain’s growing contribution to the global audiology community. Importantly, AUDITIO publishes all articles in both English and Spanish, underscoring its international, inclusive, and multilingual mission.

Challenges, Opportunities and Notes

Spain's hearing care landscape faces several significant challenges. First, the absence of full reimbursement for hearing aids for adults under the SNS creates financial barriers for a large portion of the population with hearing loss. Spain is identified among European nations with the lowest levels of adult hearing aid coverage. [24] Second, with only 39% of those with hearing loss using hearing aids, and with stigma reported as a major barrier, particularly among younger adults, awareness and destigmatisation campaigns remain a critical need. [2][3] Third, the historical absence of a university-level audiology degree has meant that Spain has lacked a cadre of comprehensively trained general audiologists capable of addressing the full scope of hearing healthcare, including vestibular disorders, tinnitus, and complex pediatric cases. [12][11] However, there are important opportunities. The launch of the first audiology degrees at UVic-UCC and University of Salamanca marks a turning point for the profession. The growing evidence base, including population-level EuroTrak data, normative audiometric studies, and validated assessment tools, provides a stronger foundation for policy advocacy. The Spanish hearing aid market is projected to grow from USD 348 million in 2024 to USD 791 million by 2035 (CAGR 7.74%), driven by an ageing population, rising health consciousness, and the integration of technologies such as Bluetooth connectivity, artificial intelligence, and personalized fitting algorithms into hearing devices. Emerging telehealth platforms for remote audiology services represent a further opportunity to extend access beyond major urban centers. [2][13]

Audiology Charities

Spain has several organizations working to support people with hearing loss and advocate for improved hearing healthcare. The Confederación Española de Familias de Personas Sordas (FIAPAS) is a leading national organization representing families and individuals affected by hearing impairment. At the European level, the European Federation of Hard of Hearing People (EFHOH) includes Spain among its member organisations and has drawn attention to Spain's limited hearing aid reimbursement

policies.[24]

References

  1. ↑ 1.0 1.1 1.2 Wikipedia (2024), Spanish National Health System (Sistema Nacional de Salud)
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 EHIMA / Spanish Association of Audiologists (2023), EuroTrak Spain 2023 Survey, HearingYou.org Research Library
  3. ↑ 3.0 3.1 3.2 3.3 HearingYou.org (2023), 10% of people in Spain have hearing loss according to latest EuroTrak survey, HearingYou.org
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Audiology Worldnews (n.d.), Audiology in Spain
  5. ↑ 5.0 5.1 5.2 5.3 European Union of Hearing Aid Acousticians (EUHA) (n.d.), Audiology in Spain
  6. ↑ 6.0 6.1 European Federation of Audiology Societies (EFAS) (2001). Audiology in Europe (Report).
  7. ↑ 7.0 7.1 7.2 7.3 Universitat de Vic – Universitat Central de Catalunya (UVic-UCC) (2024), The Bachelor's Degree in General Audiology at the UVic-UCC Faculty of Medicine Becomes the First Audiology Degree in Spain
  8. ↑ 8.0 8.1 Universidad de Salamanca (2024), Grado en Audiologia General
  9. ↑ Valiente, A. R. (2015). "Hearing Threshold Levels for an Otologically Screened Population in Spain". International Journal of Audiology 54 (8): 499–506. 
  10. ↑ Educations.com (2025), Audiology Degree and FP Grado Superior in Prosthetic Audiology in Spain
  11. ↑ 11.0 11.1 11.2 11.3 11.4 Benítez-Barrera, C. R.; de Diego-Lázaro, B. (2021). "Servicios y formación de los técnicos superiores en audiología protésica en España: una comparación con el modelo de audiólogo general". Auditio 5 (3): e78-e78. 
  12. ↑ 12.0 12.1 12.2 AEDA (Asamblea de la Asociación Española de Audiología) (2023). "Posicionamiento de la AEDA acerca del grado universitario en audiología en España". Auditio 7. 
  13. ↑ 13.0 13.1 Market Research Future (MRFR) (2024), Spain Hearing Aids Market Size, Growth Report 2035
  14. ↑ Clínica Universidad de Navarra (2024), Department of Otolaryngology – Cochlear Implant Program
  15. ↑ Clínica Universidad de Navarra (2024), Department of Otolaryngology
  16. ↑ 16.0 16.1 Saldaña, E.; de Castro, F.; López, D. E.; Malmierca, M. S. (2025). "Miguel A. Merchán and the Cajalian influence: Pioneering auditory neuroscience in Spain". Hearing Research 464: 109323. 
  17. ↑ 17.0 17.1 Benítez-Barrera, C. (2025). "Ciencia en Español desde Salamanca: De la Neurobiología Auditiva de Cajal a la Audiología Contemporánea: Comentario al artículo de Saldaña y colaboradores (2025) publicado en Hearing Research". Auditio 9: e119-e119. 
  18. ↑ Lopez-Poveda, E. A. (2014). "Why do I hear but not understand? Stochastic undersampling as a model of degraded neural encoding of speech". Frontiers in Neuroscience 8: 348. 
  19. ↑ Lopez-Poveda, E. A.; Marrufo-Pérez, M. I. (2025). "¿ Audífono o implante coclear? Una propuesta razonada para decidir cuál es el momento de indicar un implante coclear". Auditio 9: e120-e120. 
  20. ↑ Manrique-Huarte, R.; Calavia, D.; Huarte Irujo, A.; Girón, L.; Manrique-Rodríguez, M. (2016). "Treatment for hearing loss among the elderly: auditory outcomes and impact on quality of life". Audiology and Neurotology 21 (Suppl. 1): 29–35. 
  21. ↑ Barajas de Prat, J.; Zenker Castro, F.; Fernández Belda, R. (2007). "Potenciales evocados auditivos". In Suárez, C.. Tratado de otorrinolaringología y patología de cabeza y cuello. 6. Editorial Médica Panamericana. pp. 1133–1155. 
  22. ↑ Barajas del Prat, J. J.; Zenker, F. (2002). "Steady-state auditory evoked potentials: Review". Auditio 1 (2). doi:10.51445/sja.auditio.vol1.2002.0010. 
  23. ↑ Ramos de Miguel, Á.; Falcon Gonzalez, J. C.; Ramos Macias, A. (2017). "Vestibular response to electrical stimulation of the otolith organs. Implications in the development of a vestibular implant for the improvement of the sensation of gravitoinertial accelerations". Journal of International Advanced Otology 13: 154–161. 
  24. ↑ 24.0 24.1 European Federation of Hard of Hearing People (EFHOH) (2022). State of Provision of Hearing Aids in Europe 2022 Report (Report).

Contributor to the original text
Carlos Benitez Barrera

Edited by Nausheen Dawood and Sajana Aryal

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