Global Audiology/Asia/Thailand

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Brief Country Information

Thailand, known officially as the Kingdom of Thailand, is a country in Southeast Asia. It is bordered by Myanmar, Laos, Cambodia, Malaysia, the Andaman Sea, and the Gulf of Thailand. Home to an estimated population of 70 million people, 80% are of Thai ethnicity, followed by 12% who are Thai-Chinese. Thai is the national language. The main religions are Buddhism, Islam, and Christianity. Bangkok is the capital and the largest city in Thailand.

Incidence and Prevalence of Hearing Loss

According to the nation-wide statistics from the Department of Empowerment of Persons with Disabilities, the National Disability Registry (collected from 1 November 1994 to 30 June 2023) reported that Thailand has a total of 2,204,207 people living with disability (3). Hearing or communication disability accounts for 410,126 people (18.61%), which is the second most common disability (3). The cause of hearing or communication disability can be divided into acquired 37,998 people (male 19,674 people, female 18,324 people), inherited 1,227 people (male 607 people, female 620 people), congenital 89 (male 45 people, female 44 people), trauma 2,268 people (male 1,448 people, female 820 people), idiopathic 206,262 people (male 102,609, female 103,653), and not specified 162,282 people (male 79262 people, female 83,020). The proportion of people with hearing or communication disabilities who do not work is 3,668 people (male 1,897 people, female 1,711 people) (3).

Information About Audiology and Aural Care

History

The first audiology care in Thailand could be traced back to around the year 1914, when the first otolaryngologist treated patients in King Chulalongkorn Memorial Hospital. Otolaryngology was a part of the Department of Surgery until 1934, when the Department of Otolaryngology and Ophthalmology was founded. The two specialties worked independently despite being in the same department. In 1962, they were divided into the Department of Otolaryngology and the Department of Ophthalmology.

Technological advancements allowed for more complex surgeries. The audiometer was introduced to Thailand in 1951. 1961 marked the first use of a microscope in ear surgery, which was followed by Thailand’s first stapedectomy in 1962, treatment of acoustic neuroma by a combined translabyrinth and transoccipital approach in 1971, and cochlear implant surgery in 1986.

Regarding education of the health workforce providing hearing services, the first generations of Thai otolaryngologists were mostly returning American boarded doctors. In 1968, the study of Audiology and Speech and Language Pathology was founded at Ramathibodi Hospital, which later provided audiologist and speech and language pathologist trainings. The Royal College of Otolaryngologists-Head and Neck Surgeons of Thailand was established in 1989 and granted residency training. Fellowship training in Otology and Neurotology began in 2008.

Hearing Care Services

Services offered by Otolaryngologists, Otologists, and Otoneurologists General otolaryngologists are available in high secondary care hospitals, which are regional hospitals and certain general hospitals (4). University hospitals, which are super tertiary care hospitals, offer the most subspecialties, which may include the rhinology, allergy, sleep clinic, swallowing, voice, facial plastic, otology, and vestibular clinics (5) (6).

Role of primary health care providers and community health workers in hearing care Primary healthcare providers such as internists and general practitioners are expected to be able to detect hearing impairments and refer patients to otolaryngologists (7).

Laws related to hearing care services

• Newborn hearing screening is available to all infants aged 0-6 months free of charge. The service is applicable at every Universal Healthcare Coverage affiliated healthcare center (8).
• Cochlear implant reimbursement is included in the Universal Coverage Scheme for prelingual children younger than 3 years and 6 months old who had undergone hearing treatment for at least 6 months or for postlingual children younger than 5 years old, with hearing impairment of at least 90 dB for both ears (9).
• Hearing conservation program under the Department of Labour Protection and Welfare (10). In workplaces where employees are exposed to noise louder than 85 dB for longer than 8 hours, employers must provide a hearing conservation program. The program must include noise monitoring, hearing monitoring, audiometric sting at least once a year, noise contour map, education for employees on hearing conservation and the importance of hearing screening.
• Hearing aids reimbursement is available for all Universal Healthcare Coverage Schemes. Patients who are evaluated as disabled are offered approximately 10,000 THB for hearing aid on each side (11).

Education and Professional Practice

Otolaryngologist

Education: Residency Training in Otolaryngology-Head and Neck Surgery (Diploma, Thai Board of Otolaryngology-Head and Neck Surgery) (12)

Professional and Regulatory Bodies:

• Royal College of Otolaryngologists-Head and Neck Surgeons of Thailand
• Thai Medical Council

Scope of practice: Diagnosis, medical and surgical treatment of disorders and diseases of the ear, nose, and throat, including the head and neck region.

Neurotologist

Education: Clinical fellowship program in Otology and Neurotology (Certificate of Medical Proficiency in Otology and Neurotology) (13)

Professional and Regulatory Bodies:

• Royal College of Otolaryngologists-Head and Neck Surgeons of Thailand
• Thai Medical Council

Scope of practice: Diagnosis, medical and surgical treatment of disorders and diseases in auditory system, vestibular system, temporal bone, and its related structures. Interpretation of special audio-vestibular investigations. Neurotological skills including tympanoplasty, mastoidectomy, intratympanic injection, vestibular rehabilitation, and hearing aids fitting. Able to perform ossiculoplasty, stapes surgery, facial nerve decompression, and labyrinthectomy under supervision. (14)

Audiologist or Speech and Language Pathologist (15)

Education: Bachelor of Science Program in Communication Disorders, Master of Science Program in Communication Disorders License: Regulated by Department of Health Service Support, Ministry of Public Health

Scope of practice:

• Audiologist: Evaluation of the audiovestibular system for hearing and balance disorders, including newborn hearing screening. Provision of hearing aids selection and fitting.
• Speech and Language Pathologist: Evaluation of language and speaking abilities and swallowing. Treatment and rehabilitation of disorders, such as mutism, unclear speech, abnormal pronunciation, cleft lip and cleft palate, deafness, mental retardation, difficulty swallowing, swallowing incorrectly, and post-laryngeal surgery patients.

Research in Audiology

Research in audiology is active in Thailand, especially in university hospitals which often have joint projects with overseas countries. The ASIA Fellows Program in Aging, Hearing, & Public Health is a partnership between Chulalongkorn University and Johns Hopkins Cochlear Center for Hearing and Public Health, with the objective of curating leaders in the management and implementation of public health strategies and solutions for hearing loss in older adults (16, 17). The TeleRehabilitation of Balance clinical and economic Decision Support System, under the EU Horizon Europe Grant, seeks to adopt artificial intelligence for balance rehabilitation training (18, 19). The Transforming Systems through Partnership program, supported by the International Science Partnership Fund, is an innovation and research collaboration between the UK, Thailand, India, Jordan, and South Africa, aiming to address sustainable development goals (20). Updates in the otolaryngology field are shared at a domestic level in annual conferences held by The Royal College of Otolaryngologists-Head and Neck Surgeons of Thailand (21).

Audiology Charities

The Foundation for the Deaf under the Royal Patronage of Her Majesty the Queen was founded in 1952. (22)

Objectives:

1. Support and promote the education of the deaf, regardless of gender, nationality, and religion.
2. Collaborate with training institutes for teachers of the deaf.
3. Promote audiology research and rehabilitation of the deaf
4. Raise awareness about deafness
5. Encourage deaf people to have career
6. Collaborate with other agencies that support the deaf

Services:

1. Education: educational fund, hearing aids and cochlear implants, stationery fund, lunch fund
2. Training: training teacher for the deaf, sign language training, sign language interpreter training
3. Academic: Audiology research, research in language teaching for deaf children
4. Human rights: raise awareness and protection of the rights of the deaf
5. Quality of life: hearing rehabilitation services, general quality of life support, sign language interpreter on certain television channels, career development support
6. Networking: training with network, collaborating with international agencies for human development, collaborating with other governmental agencies

Challenges, Opportunities and Notes

• Newborn hearing screening program is remains inadequate. A retrospective study in a university hospital (23) reported that coverage and referral rate was satisfactory, but the diagnosis and hearing aid fitting rate failed to meet the criteria. Another study conducted in a university hospital and secondary care hospitals reported the screening to be lower than the standards of the American Academy of Pediatrics standards but were still able to provide early intervention in infants diagnosed with hearing loss. (24)
• Hearing aid and cochlear implant reimbursement may increase accessibility to hearing devices. However, some older adults are still hesitant to seek treatment and wear hearing devices due to stigma. Family support may be the key in acceptance of hearing aids (25)
• Thai citizens with disabilities can apply for a disability identification card, providing them with the Disability Grant of 800 THB per month (26). There are plans to increase the disability grant from 800 THB to 1000 THB per month (27).

References

1. National Statistical Office [Internet]. National Statistical Office. [cited 2/4/2024]. Available from: http://statbbi.nso.go.th/staticreport/page/sector/en/index.aspx.
2. ประวัติศาสตร์โสต ศอ นาสิกแพทย์ และประวัติราชวิทยาลัยโสต ศอ นาสิกแพทย์แห่งประเทศไทย. Bangkok: The Royal College of Otolaryngologists-Head and Neck Surgeons of Thailand 2023.
3. สถานการณ์คนพิการ 30 มิถุนายน 2566 (รายไตรมาส). Bangkok; 2023.
4. เกณฑ์การแบ่งระดับสถานบริการในสงั กัดสํานักงานปลัดกระทรวงสาธารณสุขตามระบบ ภูมิศาสตร์สารสนเทศ (Geographic Information System : GIS). Bangkok: Thai Health Coding Center.
5. Department of Otolaryngology, Faculty of Medicine Ramathibodi Hospital Bangkok: Faculty of Medicine Ramathibodi Hospital; [Available from: https://www.rama.mahidol.ac.th/ent/th/serviceth.
6. Department of Otolaryngology, King Chulalongkorn Memorial Hospital Bangkok: King Chulalongkorn Memorial Hospital; [Available from: https://chulalongkornhospital.go.th/kcmh/en/dept/department-of-otolaryngology/.
7. Bunnag C, Prasansuk S, Nakorn AN, Jareoncharsri P, Atipas S, Angsuwarangsee T, et al. Ear diseases and hearing in the Thai elderly population. Part I. A comparative study of the accuracy of diagnosis and treatment by general practitioners vs ENT specialists. J Med Assoc Thai. 2002;85(5):521-31.
8. สงสัยเด็กแรกเกิด ‘ได้ยินบกพร่อง’ คัดกรองได้ด้วยสิทธิประโยชน์จาก สปสช. หาก ‘ประสาทหูเสื่อม’ ต้องผ่าตัด ‘บัตรทอง’ ก็ครอบคลุม2023. Available from: https://www.nhso.go.th/news/4175.
9. การจ่ายค่าใช้จ่ายเพื่อบริการสาธารณสุข กรณีการใช้อุปกรณ์ชุดประสาทหูเทียมในการผ่าตัดฝังประสาทหูเทียม พ.ศ. ๒๕๖๕. Bangkok: สำนักงานหลักประกันสุขภาพแห่งชาติ; 2022.
10. หลักเกณฑ์และวิธีการจัดทํามาตรการอนุรักษ์การได้ยินในสถานประกอบกิจการ. Bangkok: กรมสวัสดิการและคุ้มครองแรงงาน; 2018.
11. การจ่ายค่าใช้จ่ายเพื่อบริการสาธารณสุข กรณีการให้บริการอุปกรณ์และอวัยวะเทียมในการบําบัดรักษาโรค พ.ศ. ๒๕๖๖. Bangkok: สํานักงานหลักประกันสุขภาพแห่งชาติ; 2023.
12. หลักสตูรและเกณฑ์การฝกึอบรมแพทย์ประจําบ้าน เพื่อวุฒิบัตรแสดงความรู้ความชํานาญในการประกอบวิชาชีพเวชกรรม สาขาโสต ศอ นาสิกวิทยา. Bangkok: Royal College of Otolaryngologists-Head and Neck Surgeons of Thailand; 2022.
13. เกณฑ์หลักสูตรการฝึกอบรมเพื่อประกาศนียบัตรในวิชาชีพเวชกรรม ด้านโสตวิทยาโสตประสาทวิทยา. Bangkok: Royal College of Otolaryngologists-Head and Neck Surgeons of Thailand. Available from: https://docs.google.com/viewerng/viewer?url=https://www.rcot.org/2021/download/education/rcot-education-12102564.pdf.
14. Clinical Fellowship program in Otology and Neurotology. Bangkok: Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University. Available from: https://www2.si.mahidol.ac.th/en/wp-content/uploads/2020/10/Clinical-Fellowship-program-in-Otology-and-Neurotology-หลักสูตรใหม่-อาจารย์ศ.pdf.
15. ประวัติความเป็นมา วิชาชีพโสตสัมผัสวิทยาและการแก้ไขการพูดและสมาคมโสตสัมผัสวิทยาและการแก้ไขการพูดแห่งประเทศไทย Bangkok: Thai Speech-Language and Hearing Association; [Available from: https://www.thaisha.or.th/aboutus.
16. Fellows Program in Aging, Hearing and Public Health for Health care professionals: Chulalongkorn University; 2022 [Available from: https://mooc.chula.ac.th/course-detail/177.
17. August 15-17, 2022 The ASIA Fellows Program in Aging, Hearing, & Public Health: Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University; 2022 [Available from: https://ent.md.chula.ac.th/en/กิจกรรมของภาควิชา/august-15-17-2022-the-asia-fellows-program-in-aging-hearing-public-health/.
18. คณะพันธมิตรนักวิจัยไทย จากคณะแพทยศาสตร์ จุฬาลงกรณ์มหาวิทยาลัย ร่วมมือกับคณะพันธมิตรนักวิจัยจากทวีปยุโรป เปิดตัว และสาธิตเปิดตัวแว่นเสมือนจริง ตัวช่วยฝึกการทรงตัวผ่านการกระตุ้นหูชั้นใน AR for Vestibular Rehabilitation2023 2/4/2024. Available from: https://chulalongkornhospital.go.th/kcmh/ar-for-vestibular-rehabilitation/.
19. TeleRehabilitation of Balance clinical and economic Decision Support System Uninova; 2023 [Available from: https://www.uninova.pt/project/telerehabilitation-balance-clinical-and-economic-decision-support-system-telerehab-dss.
20. Transforming Systems through Partnership: Engineering X; [Available from: https://engineeringx.raeng.org.uk/tsp.
21. การประชุมวิชาการประจำปี Bangkok: The Royal College of Otolaryngologists-Head and Neck Surgeons of Thailand; 2024 [Available from: https://www.rcot.org/2021/Conference/Annual/meeting-1-2567.
22. The Foundation for the Deaf under the Royal Patronage of Her Majesty the Queen Bangkok: The Foundation for the Deaf under the Royal Patronage of Her Majesty the Queen; [cited 2024 2 April]. Available from: https://www.deafthai.org/en/home/.
23. Thanakij Chouyboonchum, Panita Chamchoi, Tanutcha Chaikhamrongkul, Sittiprapa Isarangura, Rattinan Tiravanitchakul. Universal Newborn Hearing Screening and Incidence of Hearing Loss in Ramathibodi Hospital: A 5 Years Experience (2014 to 2018). Ramathibodi Medical Journal. 2022;45(4).
24. Pitathawatchai P, Khaimook W, Kirtsreesakul V. Pilot implementation of newborn hearing screening programme at four hospitals in southern Thailand. Bull World Health Organ. 2019;97(10):663-71.
25. Pornprasit P, Utoomprurkporn N, Areekit P, Manum P, Thanutammakul S, Parmar B, et al. Attitudes towards hearing difficulties, health-seeking behaviour, and hearing aid use among older adults in Thailand. Front Digit Health. 2023;5:1075502.
26. การจ่ายเบี้ยความพิการ. Bangkok: Department of Empowerment of Persons with Disabilities; 2015.
27. ลุ้น "เบี้ยยังชีพผู้สูงอายุ -เบี้ยคนพิการ 2567 "จ่ายเดือนละ 1000 บาท2024 2/4/2024. Available from: https://www.thansettakij.com/news/general-news/589223#google_vignette.

		Contributors to the original text
Pornnapat Manum	Nattawan Utoomprurkporn