The global burden of disease due to ear and hearing disorders is growing. In 2015, hearing loss became the fourth most common prevalent chronic disease, affecting 1.2 billion people globally (20 per cent more than a decade earlier) and accounting for 5.1 per cent of all years lived with disability.Reference Saunders, Rankin and Noonan1 The greatest burden of disease is in low-income settings and in remote populations (particularly indigenous communities).
The importance and prevalence of ear and hearing disorders has not been matched by the human or capital resources needed to address them.2 Globally, there are still very few community health workers, audiologists, ENT surgeons or other health professionals to meet population needs, and the equipment for testing hearing, providing hearing aids or performing otological surgery in many countries is rudimentary or non-existent. But we should take heart; in 2016, the World Health Assembly passed a resolution recognising the importance and burden of hearing loss, and calling for greater support and action to tackle it.3 A World Report on Hearing, published by the World Health Organization, is scheduled for 2019.
When we were starting out in this field, we found a scarcity of practical literature to guide those wishing to develop programmes to tackle ear and hearing disorders in remote or resource-constrained settings. The primary purpose of this publication is to be a practical guide, based upon the experience and expertise of our authors. However, we have also done our best to ensure that our approach is academically robust, so that relevant literature in the field is included, both that specific to the field and the broader literature on global health.
We start with articles summarising the global burden of ear and hearing disordersReference Graydon, Waterworth, Miller and Gunasekera4 and discussing models of service delivery to evaluate and treat them.Reference Bhutta5 We then have three articles describing the principles of medicalReference Brophy-Williams, Jarosz, Sommer, Leach and Morris6 and surgicalReference Smith, Huins and Bhutta7 treatment, and of anaesthesia to aid the latter.Reference Kaur, Clark and Lea8 Two subsequent articles provide a perspective on the provision of audiology services, aiding and rehabilitation.Reference Swanepoel and Clark9, Reference Rutherford and Petersen10 Finally, we have an article on education,Reference Clark, Westerberg, Nakku and Carling11 which is central to delivering a sustainable service.
We are grateful to our international panel of authors, and to the editorial board of The Journal of Laryngology & Otology, for the opportunity to compile this special edition of the journal. Robin Youngs, who recently retired as the editor of the journal, supported this endeavour from its outset. Robin is no stranger to global ENT, having worked for many years developing services in Myanmar, and having chaired the Global Health Committee of ENT-UK. The Journal has also supported this topic previously, publishing both review articlesReference Fagan12 and original researchReference Smith, Sokdavy, Sothea, Pastrana, Ali and Huins13 in the field.
We are still very much in the infancy of global ENT. We hope the articles in this edition will be inspiring and useful to people at all levels working with ear and hearing disease in remote or resource-constrained environments.
