Do we know the real need for hearing rehabilitation at the population level? Hearing impairments in the 5- to 75-year-old cross-sectional Finnish population

The cross-sectional population sample studied here was randomly selected from the population register of northern Finland. The subjects comprised 10 different age groups between 2 and 75 years of age. Pure tone averages over the frequencies of both 0.5, 1 and 2 kHz and 0.5, 1, 2 and 4 kHz - i.e. better ear hearing levels (BEHL) of BEHL0.5-2 kHz and BEHL0.5-4 kHz - were calculated. The prevalence of various grades of hearing impairment was investigated among the 3518 people who participated in audiometric measurements. Two different classifications were used to grade the hearing impairment. According to the World Health Organization (WHO) classification (1991), 94.3% of the subjects had normal hearing, whereas 3.8% had mild hearing impairment, 1.3% had moderate impairment, 0.4% severe impairment and 0.1% profound impairment. When the more recent EU definition (1996) was used, 85.3% of the subjects had normal hearing. Mild impairment was found in 11.5% of the subjects, moderate impairment in 2.8%, severe impairment in 0.3%, and profound in 0.1%. The difference between the two definitions mentioned above (resulting in different prevalence figures of hearing impairments) is clear. The WHO classification reveals the need for rehabilitation and can thus be used as a basis of resource allocation, whereas the EU proposal reveals even the mildest hearing impairments and hence better illustrates the real prevalence of impairment. The need for the current and future audiological services may be estimated from the prevalence rates of hearing impairments. The proportion of the Finnish elderly - the people most frequently using health services - is expected to increase from today's 15% to 23% within the next 20 years. The same phenomenon is to be expected in other Western societies.