About 430 million people worldwide need hearing care, and more than 25% of those over 60 live with disabling hearing loss. Reduced hearing, tinnitus or difficulty following speech in noise all deserve to be measured objectively.
If you are hearing less well, have tinnitus or are unsure about your hearing, the first step is an objective measurement. Noria Health Hub can arrange a full check-up or a second medical opinion in Brussels, with a report within 24 h, coordinate your care where needed across more than 40 medical pathways in 48 h, then, if your medical condition allows, arrange surgery within 7 days.
How many people are affected
| What is measured | The figure | Source |
|---|---|---|
| People needing hearing care worldwide | 430 million today, over 700 million expected by 2050 | World Health Organization |
| Share of those over 60 affected | more than 25% | World Health Organization |
| Share of those who would benefit from a hearing aid and use one | 17%, an 83% service gap | World Report on Hearing, 2021 |
| Low-income countries without a single ENT specialist per million people | 78% | World Report on Hearing, 2021 |
Hearing and cognition, what the reference trial actually showed
This is the most repeated and most distorted argument in the field. The reference trial, published in the Lancet in 2023, randomised 977 adults aged 70 to 84 between hearing aids and health education, over 3 years.
| What was found | The result |
|---|---|
| Across the whole cohort, primary endpoint | No difference. 0.002 standard deviation units, confidence interval minus 0.077 to 0.081, p equals 0.96 |
| In the high-risk subgroup, 238 older participants at high cardiovascular risk | Cognitive decline slowed by 48% over 3 years |
| Association in the 2024 Lancet commission meta-analysis | Dementia risk raised by 37%, but the confidence interval touches 1.00 and heterogeneity between studies reaches 80% |
| Share of dementia cases theoretically attributable to hearing | 7%, out of 45% for all 14 modifiable factors. This is a modelling estimate, not a measure of benefit |
What this trial allows us to conclude fits in a single sentence. Hearing aids may help people already at risk, it is not demonstrated that they prevent dementia in the general population.
Hearing loss and falls, an association, not proof of causation
Older people with hearing loss have a 2.39-fold risk of falling. But when only the studies that measured hearing by audiometry rather than by self-report are retained, the excess risk drops to 1.69, nearly half as much. The authors of the meta-analysis themselves flag publication bias and heterogeneity of 98.1%. And no randomised trial shows that hearing aids reduce falls.
Sleep apnoea, a common problem and often an unrecognised one
| What is measured | The figure | What must be said about it |
|---|---|---|
| Adults aged 30 to 69 with obstructive sleep apnoea worldwide | 936 million, of whom 425 million moderate to severe | Extrapolated from 17 studies in 16 countries, industry funded |
| Share of moderate to severe cases never diagnosed | 93% of women and 82% of men | A 1997 cohort, before ambulatory sleep recording. To be presented as a historical order of magnitude |
| Road accident risk in affected drivers | Multiplied by 2.43, and reduced by about 72% after nocturnal ventilation | The excess risk is solid, the reduction rests on before-and-after comparisons |
| Effect of treatment on cardiovascular events | No reduction in the reference randomised trial, 2,687 patients, 17.0% against 15.4% | Mean adherence was only 3.3 h a night, which weakens the conclusion without cancelling it |
Treating sleep apnoea therefore has effects that are proven, and others that are not. It robustly improves sleepiness, quality of life and risk at the wheel. Its effect on survival is not demonstrated by randomised trials, and the meta-analyses that claim it rest mostly on non-randomised data.
How reliable the measurements are, what is reproducible and what is less so
In ENT, measurement is reliable, more so than in most other specialties. Tablet-based audiometry differs on average by only 1.36 decibels from thresholds measured by conventional audiometry, well below the 10-decibel threshold of clinical relevance. Across 9 international sleep centres, the apnoea index computed on the same recordings shows near-perfect agreement.
The divergence is elsewhere, on the fine parameters. Scoring of light sleep remains highly discordant between readers, with an agreement coefficient of 0.31. That is precisely where re-reading and computer assistance have value, and nowhere else.
Three waiting-time figures circulate, they do not measure the same thing
| Country | What is measured | The wait |
|---|---|---|
| England | ENT pathways waiting, May 2026 | 595,204 pathways. 58.9% wait less than 18 weeks, against a national standard of 92%. Median wait of 14 to 15 weeks |
| Canada | From family doctor referral to ENT treatment, 2025 | 43.8 weeks median, against 28.6 weeks across all specialties |
| France | Reported wait for an ENT appointment, 2026 | 2 months and 1 week, against 1 month and 1 week in 2019. It has risen 1.8-fold in 7 years |
The English figure, the Canadian one and the French one do not measure the same thing. The first comes from an exhaustive administrative file, the second from a declarative survey of physicians, the third from a patient poll. Aligning them without saying so would be a methodological error.
ENT surgery, measured benefits and measured complications
Two recent British randomised trials give clear figures, and publish their complications too.
| The procedure | The benefit | The cost |
|---|---|---|
| Adult tonsillectomy for recurrent tonsillitis | Sore throat days reduced by 47% over 24 months, median 23 days against 30. The adjusted rate ratio corresponds to 47% fewer episodes. | 19% postoperative bleeding episodes |
| Septoplasty for nasal obstruction | Symptom score improved by 20 points more than medical management at 6 months, against a clinical relevance threshold of 9 points | 4% readmission for bleeding, 12% antibiotics for infection |
What the studies do not allow anyone to claim
We will not write that a hearing aid prevents dementia, because the trial that tested that question is negative on its primary endpoint. We will not claim that treating sleep apnoea extends life, because the reference randomised trial does not show it. And we found no study demonstrating that computer assistance improves the clinical ENT examination beyond audiometry and sleep scoring.
Two facts, on the other hand, are not disputed. Hearing that is never measured is never corrected, apnoea that is never recorded is never treated, and both are measured in a single morning.
In practice, if this concerns you
You set out your problem, your symptoms or your question. Reports, test results and images that are already available can be studied before you arrive, so the pathway is prepared in advance. The aim is not to run every test as a matter of course, but to select those that can genuinely help confirm a hypothesis, rule out a risk or guide a decision. The findings are then summarised and the next steps organised. Follow-up is coordinated afterwards.
Need a medical opinion quickly? For a concern that does not call for the emergency services, you can ask to speak to a doctor at any time through Noria Health Hub. This on-demand medical consultation is billed separately from the work-up pathway.
Further reading
The companion articles.
Waiting” rel=”noopener” target=”_blank”>https://noriahealth.com/blog/what-delay-really-costs-what-the-studies-say/”>Waiting for a diagnosis or a treatment, what the studies actually measure
Who” rel=”noopener” target=”_blank”>https://noriahealth.com/blog/who-performs-your-examination-changes-what-it-finds/”>Who performs your examination changes what it finds
Sources
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Livingston G et al., Dementia prevention, intervention, and care, 2024 report of the Lancet standing Commission, The Lancet, 2024. https://doi.org/10.1016/S0140-6736(24)01296-0
Organisation mondiale de la santé, World Report on Hearing, 2021. https://www.who.int/publications/i/item/9789240020481
Organisation mondiale de la santé, fiche d’information Deafness and hearing loss. https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss
Jiam NTL, Li C, Agrawal Y, Hearing loss and falls, systematic review and meta-analysis, The Laryngoscope, 2016. https://doi.org/10.1002/lary.25927
Benjafield AV et al., Estimation of the global prevalence and burden of obstructive sleep apnoea, The Lancet Respiratory Medicine, 2019. https://doi.org/10.1016/S2213-2600(19)30198-5
Young T et al., Estimation of the clinically diagnosed proportion of sleep apnea syndrome, Sleep, 1997. https://doi.org/10.1093/sleep/20.9.705
Tregear S et al., Obstructive sleep apnea and risk of motor vehicle crash, Journal of Clinical Sleep Medicine, 2009. https://doi.org/10.5664/jcsm.27662
McEvoy RD et al., SAVE, CPAP for prevention of cardiovascular events in obstructive sleep apnea, New England Journal of Medicine, 2016. https://doi.org/10.1056/NEJMoa1606599
Oremule B et al., Mobile audiometry for hearing threshold assessment, Clinical Otolaryngology, 2024. https://doi.org/10.1111/coa.14107
Magalang UJ et al., Agreement in the scoring of respiratory events and sleep among international sleep centers, Sleep, 2013. https://doi.org/10.5665/sleep.2552
NHS England, Consultant-led Referral to Treatment Waiting Times, données de mai 2026. https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/
Fraser Institute, Waiting Your Turn, Wait Times for Health Care in Canada, 2025. https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2025
Ipsos BVA pour la Fédération hospitalière de France, Observatoire de l’accès aux soins, vague 3, mars 2026.
Wilson JA et al., NATTINA, Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis, The Lancet, 2023. https://doi.org/10.1016/S0140-6736(23)00519-6
Carrie S et al., NAIROS, Clinical effectiveness of septoplasty versus medical management, BMJ, 2023. https://doi.org/10.1136/bmj-2023-075445