Frustrated by the static nature and high cost of hearing screening tests, Prof De Wet Swanepoel from the Speech Language Pathology and Audiology Department of the University of Pretoria, came up with the idea of developing a test that uses smartphone technology.
“Clinical and traditional solutions are not meeting the requirements of the SA market as they are prohibitively expensive and stationary, unable to support decentralised screening projects,” Swanepoel says. “On top of that, traditional hearing test equipment has to be operated by trained healthcare professionals. I was looking for a solution that would make hearing screening more accessible to people who traditionally do not have access to healthcare.”
Swanepoel estimates that over 3m people in SA have permanent disabling hearing loss. Many of them, however, are unaware that they or their child are suffering from a hearing problem, which is why it is also referred to as an invisible epidemic.
The reason for an expected upward trend in hearing-loss is two-fold, says Swanepoel. The world’s aging population means more people suffer from age-related problems; one in three people over 60 suffer from significant hearing loss, he says.
Exposure to noise is the second cause, with workers in industries and people with noisy hobbies, such as woodwork or hunting, being especially vulnerable, says Swanepoel.
Noise is also resulting in younger people increasingly suffering from early onset hearing loss, primarily because they are listening to loud music, especially over earphones. The World Health Organisation estimates that 1.1bn people between the ages of 12 and 35 are at risk of developing hearing loss due to unsafe listening practices.
To address this challenge, Swanepoel asked Dr Herman Myburgh of the engineering department at the University of Pretoria, to help build the initial version of hearScreen, which became the first clinical smartphone hearing test solution in the world.
The test, used to screen hearing at predetermined frequencies, met all their targets. “It reduced screening costs by more than 80%, was mobile on a smartphone carried in your pocket and the user-friendly test was automated so that it can be conducted in resource constrained environments by untrained, non-specialist personnel,” Swanepoel says.
Swanepoel and Myburgh sought avenues to ensure the solution could reach its full impact globally as a sustainable social enterprise. With no business or marketing experience, they tasked Nic Klopper, an experienced entrepreneur, with the commercialisation of intellectual property and the building and running of the business.
The company was officially launched in June 2015 as hearScreen, but was renamed hearX Group in 2017 as their product range grew.
Their business-to-business technologies include hearTest, which is more extensive than the hearScreen test; hearScope, a world-first smartphone otoscope using artificial intelligence to diagnose ear diseases; hearDigits, a screening tool that can be embedded onto websites; and hearKiosk, which tests people’s ability to identify and perceive sound in noise. All these tools are linked to a cloud-based data management service for surveillance, referrals and reporting purposes.
The company has also developed hearZA, the National Hearing Test of SA, and hearScreen USA, applications that allow the public to test their hearing for free.
“The vision with these apps is to eliminate avoidable hearing impairment through early detection. Geolocation is used to link people with their closest hearing health providers when a problem is detected,” Swanepoel says.
By incorporating supporting partner smartphone solutions in their platform, the company also provides ancillary services, such as vision screening in combination with their hearing solutions.
The company was started with the help of angel investment with over $2.8m raised from international investors and funding grants during their first 16 months of operation.
The greatest challenge in starting the company, according to Swanepoel, was finding and nurturing the right team to develop and support the value proposition, while solidifying external partnerships. They also had to navigate the resource intensive exercise of adhering to regulatory frameworks.
“All our solutions are clinically validated and results have been published in leading peer-reviewed journals,” he says. “This means all the tools are evidence-based, adhering to best practice guidelines. The impact of age, gender and proficiency in English on test outcomes, especially the digits-in-noise tests, are also taken into account.”
So far, they’ve provided access to hearing and vision services to more than 150 000 people in low- and middle-income countries across the globe and particularly in sub-Saharan Africa: “At least half of these have been young preschool- and school-aged children for whom hearing and vision loss are leading contributors to academic failure,” Swanepoel says.
Other vulnerable groups benefiting directly from the technology are patients with multidrug resistant TB, who are on medications that cause hearing loss. “The technology in this case is used to monitor hearing to inform preventative treatment,” Swanepoel says.
“Other areas of impact include preventative occupational health testing in the industry sector and primary healthcare sectors. Furthermore, our consumer hearZA App has had more than 35 000 downloads and over 65 000 end users.”
They plan to expand their global reach substantially over the next three to five years. Markets that they are eyeing include Australia, Kenya, Brazil, India, Malaysia, Indonesia and France, “with the launch of products that we are currently developing, including hearBrazil and hear hearFrance”.