Demographic and Audiometric Profiles of Adults Accessing Audiological Services in Public Hospitals and Private Hearing Aid Centres in Malaysia
Article information
Abstract
Background and Objectives
We aimed to describe the demographic and audiometric profiles of adults accessing audiological services in Malaysia, including comparisons between public hospitals and private hearing aid centers and between the west and east coasts of Peninsular Malaysia.
Subjects and Methods
We retrospectively reviewed 1,828 patient records, including 1,720 from public hospitals and 108 from private hearing aid centers.
Results
Patients in private centers were older (mean age, 65.99 years; standard deviation [SD], 16.97) and had more severe hearing loss (mean four-frequency average hearing loss [4FAHL], 50.56 dB HL; SD, 21.47) than those in public hospitals (mean, 53.83 years; SD, 16.91; mean 4FAHL, 39.37 dB HL; SD, 22.55). Patients on the west coast of Malaysia were slightly older (mean, 55.10 years; SD, 16.87) than those residing on Malaysia’s east coast (mean, 53.18 years; SD, 17.76). Gender distribution differed according to region, with more males on the east coast (57.3%) than on the west coast (50.9%) but was similar across public and private settings.
Conclusions
Distinct demographic and audiometric trends were observed between service settings. Older age and more severe HL were associated with private care, whereas regional differences suggest the need for services that accommodate geographic variations.
Introduction
Hearing loss is a prevalent health issue that impacts communication, social interactions, and mental well-being [1-3]. Hearing loss also imposes a significant economic burden, including healthcare costs and lost productivity, particularly in low- and middle-income countries (LMICs) where access to hearing care services remains limited [4,5]. Audiological interventions, including hearing aids, are effective in managing hearing loss, improving well-being, and other outcomes for people with hearing loss [6,7]. In Malaysia, the prevalence of hearing loss (hearing thresholds >20 dB HL) was estimated at 21.5% among those aged over 18 years [8], but access to audiology services is limited [9].
Malaysia is geographically divided into two main regions: Peninsular Malaysia (West Malaysia) and East Malaysia, located on the island of Borneo. Peninsular Malaysia consists of eleven states and two federal territories, while East Malaysia comprises two states and one federal territory. Peninsular Malaysia is further subdivided into several states, with Selangor being one of the most affluent and urbanized states on the west coast. In contrast, the east coast of Peninsular Malaysia, which includes the states of Pahang, Terengganu, and Kelantan, is characterized by a predominance of rural and semi-urban areas with varying levels of economic development. The three predominant ethnic groups in Peninsular Malaysia are the Malay, Chinese, and Indian.
Malaysia is an upper-middle-income country with an estimated population of 34.1 million in 2024 [10]. The country operates a two-tier healthcare system, consisting of both public and private sectors. Public healthcare facilities, primarily under the Ministry of Health (MOH), provide a full range of medical services, including primary, secondary, and tertiary care. In contrast, the private healthcare sector mainly offers curative and diagnostic services in an outpatient setting [11].
Public hospitals are the main providers of outpatient healthcare services in Malaysia due to government subsidies, making them highly accessible and affordable. Treatment costs in public hospitals are either nominal or fully subsidized, whereas individuals seeking care in the private sector must pay out-of-pocket or rely on insurance coverage. Consequently, more Malaysians seek care in public hospitals than in private facilities, leading to a higher patient volume in public settings. The National Health and Morbidity Survey (NHMS) reports from 2011, 2015, and 2019 showed a declining trend in private outpatient service utilisation, further increasing demand on public healthcare facilities [12-14].
Audiology services in Malaysia are available in both public and private settings. In the public sector, these services are typically offered in government and university hospitals in facilities that have specialized clinics such as ENT clinics. However, the availability of audiology services in government hospitals is limited. As of 2024, there are 48 public hospitals in Malaysia that offer audiology services. Private audiology services are available in private hospitals and hearing aid centers, predominantly located in urban areas. Distribution of audiology services remains uneven across the country.
Existing research on the demographic and audiometric profiles of adults accessing audiology services is limited, particularly in the Malaysian context. A scoping review by Romli, et al. [9] revealed gaps in the current understanding of audiology service uptake in Malaysia. The review suggested that the uptake of hearing services was low; rates of hearing aid use were around 6.5%–7.3% for those with at least moderate hearing loss. But these estimates were derived from studies conducted in the central zone (Selangor)—a region that is more affluent and urbanized compared to other areas of Malaysia. The estimates of uptake of hearing services derived from these Selangor-based studies may not, therefore, be representative of Malaysia in general, and likely are over-estimates of true levels of hearing aid uptake.
Understanding the demographic and audiometric characteristics of adults accessing audiology services is crucial for identifying patterns in service utilisation across different healthcare settings and regions. Examining the severity of hearing loss at first access provides insight into whether individuals seek care at earlier or more advanced stages of hearing loss. Similarly, differences in service utilization across ethnic groups may highlight disparities in access.
Public hospitals, which offer government-subsidized care, may attract different patient demographics than private hearing aid centers, where patients pay out-of-pocket. Regional disparities may also exist, with urban areas generally having greater service availability than rural regions. Identifying these variations is essential for addressing gaps in service accessibility and informing targeted strategies to improve hearing care provision.
Therefore, this study aimed to 1) identify and describe the demographics and audiometric profiles of adults accessing audiological services for the first time in public hospitals and private hearing aid centers in Malaysia; 2) compare the demographic characteristics and audiometric patient profiles between public hospitals and private hearing aid centers; and 3) compare the demographic characteristics and audiometric patient profiles between the west coast and east coast of Peninsular Malaysia.
Subjects and Methods
Study design
This retrospective study was conducted across five public hospitals and four private hearing aid centers covering the west and east coasts of Malaysia. Data were extracted from the databases of each hospital and private hearing aid center from January 2023 to June 2023. Ethics approval was obtained from the University of Queensland Human Research Ethics Committee (Project number: 2023/HE001429) and the Medical Research Ethics Committee, Ministry of Health Malaysia (NMRR ID-23-02077-RBX).
Participants
The study employed a purposive sampling approach. The data that were extracted pertained to Malaysian adults who 1) were aged 18 years and above and 2) attended audiology services for the first time. Adults with nationalities other than Malaysian were excluded.
Data collection procedures
Hospitals were selected to ensure representation from both the west coast (predominantly urban) and east coast (rural or semi-urban) regions, as prior studies primarily focused on Selangor. The selection process was informed by discussions with the Head and Deputy Head of Audiology at the Ministry of Health Malaysia, considering hospital capacity, patient volume, referral patterns, and geographical coverage.
Based on these criteria, eight public hospitals were initially identified as potential data collection sites. However, participation required approval from multiple levels, including the on-site audiologist, head of department, and hospital director. Due to workforce constraints and administrative challenges, some hospitals declined participation. Consequently, five hospitals were included—two in Selangor (out of six with audiology services), two in Pahang (out of three), and one in Terengganu (out of two).
These five hospitals capture key variations in public audiology service provision, reflecting differences in patient demographics, referral pathways, and service accessibility. The two hospitals in Selangor are among the busiest referral hospitals in the state, managing high inpatient admissions and outpatient visits, and serving as key referral centers for district hospitals and health clinics. In Pahang, the largest state in Peninsular Malaysia, the two selected hospitals are two of only three public hospitals offering audiology services, covering a wide geographical area and serving rural populations with limited access to hearing care. Similarly, the selected hospital in Terengganu serves both semi-urban and rural populations, ensuring representation of diverse patient demographics and accessibility challenges.
Together, these hospitals serve populations from Selangor, Pahang, and Terengganu—states that collectively account for approximately 27.4% of Malaysia’s total population. This geographic distribution strengthens the study’s representativeness, ensuring that the sample captures key variations in hearing care accessibility across urban, semi-urban, and rural settings within the public healthcare system.
To capture adults seeking audiology services outside the public healthcare system, well-established private hearing aid centers with nationwide presence, particularly in the west coast and east coast regions, were identified and invited to participate. Few major providers were approached, but due to corporate policies and confidentiality concerns, only one commercial hearing aid center agreed to participate.
The selected provider is one of the largest independent hearing care service providers in Malaysia, with over 25 years of experience, a network of 23 branches, and a team of 48 audiologists. It offers a range of hearing aid products, hearing tests, and rehabilitative services, making it a representative choice for private-sector hearing care.
Within the three states covered in this study, this provider has eight branches, out of which four were selected. These centers were chosen as they are well-equipped and among the highest-volume private centers for adult hearing care in their respective states. This selection ensures that the data reflects private-sector hearing aid users in Malaysia. The private provider’s role in this study was limited to providing anonymized demographic and audiometric data, with no involvement in subsequent analysis, interpretation, or reporting.
Demographic and audiometric data were extracted from the medical records and databases of each participating hospital and hearing aid center. The data pertained to new cases of adult patients accessing these facilities between January 2023 and June 2023. Demographic data encompaszed age, gender, and ethnicity, while audiometric data comprised pure tone audiometry results (air conduction and bone conduction thresholds in dB HL) for both ears.
Data collection was facilitated by audiologists at each hospital and hearing aid center. The extracted data were compiled and organized in Microsoft Excel spreadsheets.
Hearing loss severity (based on four frequency average over 500 Hz, 1 kHz, 2 kHz, and 4 kHz) was classified according to the seven grades of hearing loss used by the World Health Organization (2019) (Supplementary Table 1 in the online-only Data Supplement) [15]. Hearing loss was classified as bilateral if thresholds in both ears were 20 dB HL or greater and classified as unilateral if thresholds were 20 dB HL or greater in one ear but less than 20 dB HL in the other.
Data analysis
Data analysis was conducted using Statistical Package for the Social Sciences (SPSS) version 29 (IBM Corp.). Descriptive statistics were computed for demographic variables and audiologic measures. ANOVA and chi-square tests were employed to compare demographic (age, gender, ethnicity) and audiologic (type and severity of hearing loss) variables between public and private healthcare settings and across different geographic regions (west coast, east coast). Regression analysis was used to model demographic correlates of hearing loss severity.
Results
From January to June 2023, a total of 1,720 new adult patients were assessed in participating public hospitals, with 108 patients in the participating private hearing aid centers. Table 1 provides the detailed patient numbers at each site. Fig. 1 illustrates the geographical distribution of the participating public hospitals and private hearing aid centers.
Geographical distribution of sites and number of new adult patients assessed
Geographical distribution of participating public hospitals and private hearing aid centers in Peninsular Malaysia. Public hospitals are represented by red pins, while private hearing aid centers are represented by blue pins.
Patient demographics
The age of patients ranged from 18 to 93 years, with a mean age of 54.55 years (standard deviation [SD]=17.15). The mean age of patients in the public setting (n=1,720) was 53.83 years (SD=16.91), while in the private setting (n=108), it was higher at 65.99 years (SD=16.97) (F(1, 1,826)=52.55, p<0.001). The mean age of west coast patients (n=1,308; mean=55.10, SD=16.87) was higher than the east coast patients (n=520; mean=53.18, SD=17.76) (F(1, 1,826)=4.68, p=0.03). Full distributions of the number and percentage for demographic and audiometric profiles by setting and region are provided in Supplementary Table 2 (in the online-only Data Supplement).
Overall, the gender distribution of the patients was 52.7% male and 47.3% female. In public hospitals, 52.3% of the patients were male and 47.7% were female, whereas in private centers, 59.3% were male and 40.7% were female. There was no difference in gender distribution across public and private settings (χ2(1)=1.96, p=0.162). However, there was a difference in gender distribution among patients from the west coast and east coast regions (χ2(1)=6.10, p=0.014). On the west coast, 50.9% of the patients were male and 49.1% were female, whereas on the east coast, a higher proportion of patients were male (57.3%) compared to female (42.7%). Fig. 2 illustrates this gender distribution patterns across healthcare settings and regions.
Gender distribution across healthcare settings. The central pie chart shows the overall gender distribution, while the smaller donut charts break down the distribution by public hospitals, private centers, west coast, and east coast.
Most patients accessing public hospitals and private centers were Malay (Public=63.0%, Private=54.6%). The ethnicity distribution was different between public hospitals and private centers (χ2(3)=16.71, p<0.001). Public hospitals had a higher proportion of Malay patients (63.0%) compared to private centers (54.6%), while private centers had a higher proportion of Chinese patients (30.6%) compared to public hospitals (19.5%). Indian patients were more likely to access public hospitals (17.0%) than private centers (12.0%). There was a difference in ethnicity distribution between patients from the west coast and east coast regions (χ2(3)=161.62, p<0.001). The east coast had a higher proportion of Malay patients (84.2%) compared to the west coast (53.7%), while the west coast had higher proportions of Chinese (23.9%) and Indian patients (21.9%) compared to the east coast (Chinese=10.8%, Indian=3.8%). Fig. 3 illustrates the ethnic distribution patterns across healthcare settings and regions.
Ethnic distribution across healthcare settings. The central pie chart shows the overall ethnic distribution, while the smaller donut charts break down the distribution by public hospitals, private centers, west coast, and east coast.
Audiometric profiles
The mean hearing loss in the better ear, measured by the four-frequency average hearing loss (4FAHL), was 40.03 dB HL (SD=22.64). The mean hearing loss in the public setting was 39.37 dB HL (SD=22.55), lower than that among private settings; 50.56 dB HL (SD=21.47) (F(1, 1,826)=25.14, p<0.001).
Multiple regression analysis revealed that the difference in 4FAHL between public and private settings can be attributed to differences in age and ethnicity; patients in private settings were generally older, and a higher proportion of Indian and Chinese patients were seen in these settings (Supplementary Table 3 in the online-only Data Supplement).
However, there was no difference in severity of hearing loss in the better ear between patients from the west coast (mean=40.36 dB HL, SD=21.80) and east coast regions (mean=39.20 dB HL, SD=24.63) (F(1, 1,826)=0.98, p=0.322).
Degree of hearing loss
Public hospitals had a higher proportion of patients with normal hearing and mild hearing loss, whereas private centers had a higher proportion of patients with moderately severe to profound hearing loss (χ2(6)=31.01, p<0.001). There was a difference in the distribution of hearing loss severity between patients from the west coast and east coast regions (χ2(6)=37.99, p<0.001). Patients from the west coast were more likely to have mild to moderate hearing loss, while those from the east coast had a higher prevalence of moderately severe to profound hearing loss. Fig. 4 illustrates the distribution patterns of hearing loss severity across healthcare settings and regions.
Degree of hearing loss across healthcare settings and regions. The central pie chart shows the overall distribution, while the smaller charts break it down by public hospitals, private centers, west coast, and east coast regions. Categories include normal hearing, mild, moderate, moderately severe, severe, profound, and total hearing loss.
Type of hearing loss
The proportion of patients with normal hearing was higher in public hospitals compared to private centers (31.3% vs. 12.9%; χ2(3)=45.33, p<0.001). However, private centers had a higher proportion of patients with mixed hearing loss (30.6%). The proportion of patients with sensorineural hearing loss was higher in the west coast region (59.2% vs. 47.7%; χ2(3)=22.62, p<0.001). Fig. 5 illustrates the distribution patterns of hearing loss types across healthcare settings and regions.
Type of hearing loss across healthcare settings and regions. The central chart shows the overall distribution, with smaller charts displaying the breakdown by public hospitals, private centers, west coast, and east coast regions. Categories include normal hearing, sensorineural, conductive, and mixed hearing loss.
Laterality of hearing loss
The proportion of patients with unilateral hearing loss was similar in public hospitals and private centers (13.0% vs. 12.0%; χ2(1)=0.09, p=0.767). Similarly, the proportion of patients with bilateral hearing loss was comparable in public hospitals and private centers (87% vs. 88.0%; χ2(1)=1.75, p=0.185).
Sources and reasons for referral
The analysis of sources and reasons for referral was more comprehensive for public hospitals compared to private centers, where data was incomplete, and the number of cases was smaller. This limitation may affect the comparability of referral patterns between the two settings. The more complete data for public hospitals could be due to stricter documentation practices and more consistent record-keeping requirements in the public healthcare system. As such, sources and reasons for referral are reported separately for public hospitals and private centers to acknowledge potential bias in the data.
In public hospitals, the top three sources of referral were: 1) ENT specialists, 2) health clinics, and 3) other (e.g., other clinic departments in the hospital, private clinics or hospitals). In private centers, the top three sources of referral were: 1) websites, 2) signboards, and 3) self-referral. The most common reasons for referral across both public and private settings were: 1) hearing impairment, 2) vestibular problems, and 3) tinnitus.
Discussion
This study explored the demographic and audiometric profiles of new adult patients accessing audiological services in both public hospitals and private hearing aid centers in Malaysia.
The higher number of patients in public hospitals compared to private hearing aid centers in this study reflects real-world healthcare utilisation patterns in Malaysia, where public hospitals cater to a larger population and have more available audiologist. As data were extracted from real-time patient records rather than predetermined quotas, the sample sizes were naturally influenced by patient flow at each site.
This study revealed that hearing loss severity among patients accessing public hospitals and private hearing aid centers corresponded to moderate and moderately severe levels, respectively, based on WHO classifications. The average hearing level at which individuals are reported to seek professional help varies across studies internationally. For instance, one study found that people with hearing loss exceeding 30 dB HL in the Netherlands were likely to consult their doctor for help [16]. Prior research in Australia indicated that adults may only seek assistance when their hearing loss reaches moderate to severe levels and begins to interfere with daily activities or restrict participation [17]. With respect to LMICs, a recent report suggested that patients in LMIC hearing clinics generally present with more severe levels of hearing loss compared to patients in high-income countries [18]. A similar trend was identified in a study on hearing loss configurations in LMICs, which showed a higher proportion of more severe levels of hearing loss [19]. This trend may indicate that people in LMICs, such as Malaysia, might delay seeking help until their hearing loss becomes more severe compared to those seeking help in high income countries. The more severe levels of hearing loss among patients in LMIC clinics may be attributed to several factors. Barriers to accessing hearing care services in LMICs include a shortage of trained personnel, the high costs of hearing devices, and limited public awareness of hearing health benefits [20,21]. These challenges are compounded by competing health priorities and lack of public funding for hearing healthcare in LMICs [22].
In the current study, patients in private hearing aid centers presented with more severe levels of hearing loss compared to those in public hospitals. The primary reason for the milder average level of hearing loss among public hospital patients is possibly because public patients are a more diverse group accessing care for diagnostic and non-interventional purposes, such as monitoring conditions unrelated to hearing aid provision (e.g., balance problem or tinnitus management). Private hearing aid centers, with their specialist focus on hearing assessment and hearing aid dispensing can facilitate faster access to hearing aids for those able to afford private hearing care. This difference between public and private settings suggests there may be an issue with equitable access to hearing aids and audiological services. Unfortunately, in the current study, there were no data concerning hearing aid provision, or provision of other hearing interventions.
Private hearing aid centers had a higher proportion of older adults seeking services compared to public hospitals, which served a broader age range. This difference in age between public hospitals and private hearing aid centers could also be attributed to the differing reasons for seeking audiological services in these two settings. Public hospitals cater to a broader spectrum of auditory-related conditions, including vestibular issues, external and middle ear problems, tinnitus, and occupational hearing assessments, which are not exclusively associated with older adults. These hospitals are equipped with full audiology facilities and house ENT specialists and multidisciplinary teams, enabling them to manage auditory conditions that may not be addressed in private hearing aid centers. In contrast, private hearing aid centers primarily focus on age-related hearing loss and hearing aid fittings, which predominantly attract older adults seeking hearing aids [23,24]. The absence of specialized diagnostic and rehabilitative services in private hearing aid centers may further contribute to the lower representation of younger individuals in these centers.
Regional differences in age of patients were also observed, with patients on the west coast being slightly older, on average, than those on the east coast. This may be due to demographic differences between the regions, as the west coast is more urbanized and economically developed, potentially leading to a higher demand for audiological care, particularly among older adults who may have more financial resources or health awareness.
Overall, there was a slightly higher proportion of males, but the gender distribution of patients accessing audiological services did not differ significantly between public and private settings. However, a higher proportion of male patients was observed in east coast centers. This regional disparity in gender may be influenced by cultural or socioeconomic factors affecting healthcare-seeking behaviours. Previous studies indicate that gender differences in healthcare access are often shaped by traditional gender roles, with men more likely to seek care for occupational hearing issues [25]. In contrast, women often face barriers such as the cost of medications and specialist services and are more likely to delay seeking care due to various responsibilities [25]. Similarly, Azad, et al. [26] found that sociocultural norms can restrict women’s access to healthcare, as both men and women often adhere to traditional gender roles. Understanding these regional and gender-specific differences may be useful for tailoring hearing care services to meet the needs of diverse populations across Malaysia.
In terms of ethnicity, most patients were Malay. Public hospitals had a higher proportion of Malay patients compared to private centers, which could be attributed to the greater accessibility and affordability of public healthcare [27]. In contrast, private centers had a higher proportion of Chinese patients, likely reflecting relative affluence of the Chinese population in Malaysia, which may enable access to private healthcare services, or a greater propensity to seek intervention for hearing-related conditions. While no studies specifically examined ethnic differences in the use of hearing care services, evidence from other healthcare settings supports this pattern. For example, a study in Sarawak found that private dental clinics had a higher percentage of Chinese attendees (85.0%) compared to public clinics (64.5%) [28]. Similarly, in the Klang Valley, Chinese patients were significantly more likely to use private healthcare facilities for dengue treatment [29]. These findings suggest that economic and cultural factors may influence healthcare utilization patterns across health services.
Regional differences were also found, with the east coast being predominantly Malay, while the west coast had higher proportions of Chinese and Indian patients. Although Malays are the majority ethnicity across Malaysia, their dominance is particularly pronounced on the east coast, where other ethnic groups are less represented. In contrast, the west coast, with its greater urbanization and economic opportunities, has historically attracted a more varied population. This urban-rural dynamic has led to a concentration of Chinese and Indian communities in urban centers on the west coast, while Malays remain more prevalent in rural and less urbanized regions. These regional disparities in ethnic distribution may influence healthcare access and utilization patterns, underscoring the need for culturally sensitive and geographically equitable audiological services throughout Malaysia.
Although this study focuses on Malaysian citizens, it is important to consider the approximately 3 million migrants in Malaysia, which made up 8.9% of the country’s population of 33.4 million. Migrants in Malaysia primarily come from countries such as Indonesia, Bangladesh, Myanmar, and Nepal, with smaller groups from India, Cambodia, and Lao PDR [30]. They are often employed in sectors like manufacturing, agriculture, plantation work, hospitality, and domestic services, many of which have high exposure to noise, increasing their risk for noise-induced hearing loss. Research showed that migrants in Malaysia face significant barriers in accessing healthcare, including affordability and financial constraints, language barriers, and discrimination and xenophobia [31]. Despite their contributions to the Malaysian economy, migrants are not represented in this study, raising questions about their access to hearing healthcare services. The exclusion of this group highlights a gap in understanding hearing healthcare needs in Malaysia. Future research should consider including migrant populations to provide a more comprehensive picture of hearing healthcare access and outcomes across all groups contributing to the workforce.
This study has several strengths, particularly the inclusion of data from both public hospitals and private hearing aid centers, providing a comprehensive view of the demographic and audiometric profiles of adults accessing audiological services in Malaysia. Additionally, the comparison between the west and east coast regions offers insights into geographic disparities in service utilization, which is an area that has been underexplored in previous research.
The main limitations are, first, that this study only included a subset of public hospitals and private hearing aid centers from the west and east coasts of Peninsular Malaysia, which may limit the generalizability of findings to the entire country. However, the selected hospitals serve a diverse patient population, covering both urban and rural regions, and together, they account for approximately 27.4% of Malaysia’s total population. This suggests that while the findings may not fully capture all public hospitals and private providers, they reflect key service access trends across different geographic and healthcare settings. Private centers did not supply information regarding referral sources, which limited the ability to compare referral pathways across settings. The study also included data from only one commercial hearing aid provider, despite initial efforts to recruit two major providers. The selected provider, however, is one of the largest independent hearing care service providers in Malaysia, with 23 branches and 48 audiologists nationwide, making it a key player in private hearing healthcare. While this enhances the relevance of the findings to private hearing aid service delivery in Malaysia, the results may not fully generalize to smaller or less-established private providers.
The study lacked information on treatment and hearing aid provision, which constrains the evaluation of outcomes and the effectiveness of audiological care. Future studies should also focus on evaluating hearing aid adoption rates and patient outcomes following audiological interventions, which would provide insights into the effectiveness of current service delivery models. The cross-sectional nature of the study also limits the ability to assess causality or longitudinal changes in patient profiles and hearing loss progression over time.
The study did not include information on the socioeconomic status of patients or detailed geographical data about patient residence, such as rural versus urban classification. Future research should collect these demographics to understand how socioeconomic and geographical location influence uptake of audiological services. This information could provide insights for developing strategies to improve service uptake and address disparities in hearing care access.
In conclusion, older adults and those with more severe hearing loss were more likely to seek care in private centers, while public hospitals served a more demographically diverse population, including a broader range of ethnic backgrounds and hearing-related conditions. Regional variations in age and ethnicity underscore a need for context-specific approaches to hearing care. Migrant workers, who face higher risks of noise-induced hearing loss, have limited access to hearing care, underscoring the need for workplace screenings and improved service accessibility.
Future research should examine hearing aid adoption rates and patient outcomes, alongside qualitative studies to explore barriers and facilitators in accessing audiological services.
Supplementary Materials
The online-only Data Supplement is available with this article at https://doi.org/10.7874/jao.2024.00710.
Supplementary Table 1.
WHO classification of hearing loss severity based on pure-tone average in the better ear
Supplementary Table 2.
Demographic and audiometric profiles of new case adult patients accessing public hospitals and private hearing aid centers in the west and east regions
Supplementary Table 3.
Multiple regression model predicting 4FAHL from demographic variables, site, and region
Notes
Conflicts of Interest
The authors have no financial conflicts of interest.
Author Contributions
Conceptualization: all authors. Data curation: Maziah Romli. Formal analysis: Maziah Romli, Piers Dawes. Funding acquisition: Maziah Romli. Methodology: Maziah Romli, Barbra H. B. Timmer. Investigation: Maziah Romli. Project administration: Maziah Romli. Software: Maziah Romli. Supervision: Barbra H. B. Timmer, Piers Dawes. Validation: all authors. Visualization: Maziah Romli. Writing—original draft: Maziah Romli. Writing—review & editing: all authors. Approval of final manuscript: all authors.
Funding Statement
Maziah Romli is funded by a Ministry of Higher Education (MOHE) Malaysia scholarship.
Acknowledgments
The authors would like to thank the audiologists from the participating public hospitals and private hearing aid centers for their valuable assistance with data collection at each respective setting included in this study.