Primary Ear and Hearing Care Training Resource

Basic Level - Trainer's Manual - Student's Workbook - Advance Level

December 2006
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The electronic version of WHO Training Resource on Primary Ear and Hearing Care on CD-ROM is a new set of four training manuals aimed at equipping primary health care workers in developing countries with simple and cost-effective methods to reduce the burden of ear and hearing disorders.

Although half of all deafness and hearing impairment is avoidable, an estimated 278 million people worldwide are living with disabling hearing impairment (moderate or worse level of hearing loss in the better hearing ear). Many more have mild hearing loss and/or ear diseases. One quarter of hearing impairment begins during childhood and 80% of all deaf and hearing-impaired people live in low and middle-income countries. These problems can be life-long and sometimes life threatening; they may have profound effects on: inter-personal communication, education, employment prospects, social relationships and through stigmatization. They produce substantial economic burdens on countries.

Some of the most effective and cost-effective interventions against ear and hearing problems can be implemented at the primary level by trained primary ear and hearing care (PEHC) workers or primary health care (PHC) workers or their equivalents. Used on a large scale, these interventions will have a major impact on the burden of ear disease and hearing loss. However most developing countries do not have PEHC workers and the topic is hardly addressed in the training of PHC workers. Workers in Community-based rehabilitation (CBR) programs rarely deal with this field.

The Primary Ear and Hearing Care Training Resource addresses the urgent need for action to prevent and manage ear diseases and hearing impairment. The manuals provide practical information and guidance and can be used as part of a training course, stand-alone training module or in a self-taught manner. They are designed to be useful to a wide range of primary health care personnel. The manuals can also be used to help communities understand common causes of deafness and hearing impairment and ways to prevent and/or treat the conditions.

The WHO Primary Ear and Hearing Care Training Resource consists of user-friendly manuals at basic, intermediate, and advanced levels. Teaching aids such as posters are included.

They are culturally appropriate for training of village health workers, PEHC, PHC, and CBR workers, and also more experienced personnel working at primary level. The resource focuses on community involvement and raising awareness, and covers basic measures for prevention and management. A section on hearing aids is included for communities where there are no other trained personnel to help people use them effectively. It should help deaf and hard of hearing people to become accepted and productive at home, at school, in the workplace and in society in general.


This level contains clear information, diagrams and drawings to enable PHC and CBR workers, village health workers, and some teachers and parents to help people in the community prevent and recognize common ear diseases and hearing impairment and when to refer. It also enables health workers to raise awareness and encourage the community to develop communication skills in order to relate to hard of hearing people. It is printed in black and white to enable easy photocopying.


This level of the training resource consists of a trainer's manual, a student's workbook and teaching aids.

The trainer's manual covers the knowledge and skills needed by the PEHC trainer for interactive training. Through interactive exercises the student's workbook teaches the essential knowledge, skills and attitudes the student needs to develop and how to apply them. Simple, accessible methods and materials are described to enable students to practice essential techniques safely e.g. syringing ears.

Diagrams and photographs clarify the structure, function and common disorders of the ear and hearing and describe the equipment needed for prevention, treatment and management of hearing loss. Posters have been developed to reinforce understanding.

The manual and workbook comprise the following modules:

1) Structure and function of the ear; 2) Hearing impairment and deafness) Causes and prevention; 3) The outer ear: examine, treat, refer; 4) The ear canal: examine, diagnose and clean; 5) The middle ear: examine, diagnose, treat; 6) Assessing hearing and counseling; 7) Hearing aids


The advanced level reinforces training received at Basic and Intermediate levels and then provides a higher level of content with more advanced medical procedures. It is intended for training experienced PHC/PEHC workers, especially where no Doctor is available. Once trained these PHC/PEHC workers should be able to recognize and manage more complex ear disease and hearing impairment. Rehabilitation for deaf and hard of hearing people, their families education and training institutions and employers is covered as well as the benefits, care, and maintenance of hearing aids.

Students are asked to discuss case studies and recommend appropriate management of hearing impairment.

Modules comprise:

1) Prevalence, causes and prevention of deafness and hearing impairment; 2) Examination of the ear; 3) Detection, screening and testing of hearing impairment; 4) Ear conditions - diagnosis and treatment; 5) Ear operations; 6) Noise-induced hearing impairment; 7) Aural habilitation, rehabilitation and education; 8) Hearing aids; Annex: Development of a National Programme for Prevention of Deafness and Hearing Impairment

World Health Organization

World Health Organization is a Specialized Agency of the United Nations, charged to act as the world's directing and coordinating authority on questions of human health. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries, and monitoring and assessing health trends.