Table 1: Country information [Source: Wikipedia]
|Country Name||Russian Federation|
|GDP (PPP)||$ 4.519 trillion|
The Russian Federation is the largest country in the world by area, covering more than one-eighth of the Earth’s inhabited land area (17,125,200 km2/ 6,612,100 sq miles), and the ninth most populous, with over 146 million people. The European western part of the country is much more populated and urbanized than the eastern part; about 77% of the population live in European Russia.
Russia is a transcontinental country which extends across the entirety of Northern Asia (eastern part) and much of Eastern Europe (western part). Russia spans eleven time zones and incorporates a wide range of environments and landforms. From northwest to southeast, Russia shares land borders with Norway, Finland, Estonia, Latvia, Lithuania and Poland (both with Kaliningrad Oblast), Belarus, Ukraine, Georgia, Azerbaijan, Kazakhstan, China, Mongolia and North Korea. It shares maritime borders with Japan by the Sea of Okhotsk and the U.S. State of Alaska across the Bering Strait. According to the Constitution, the country comprises eighty-five federal subjects. Federal subjects are grouped into eight federal districts.
The Russian Federation is a nation of many diverse cultures, languages, and religions. Russian is considered to be the primary language but many other languages from around the world are actively spoken throughout the nation. Christianity is the most commonly practiced religion in the Russian Federation however Islam, Judaism, Buddhism and other faiths are also participated (Russian Federation, 2020)
The system of audiological services was set up in the Soviet Union in 1952 with the issue of the legislative act by the Ministry of Public Health Care. At that time audiological units were organized within the municipal and regional hospitals.
Up to 1979, the audiological and hearing aid fitting services were separate and supervised correspondingly by the Ministry of Public Health Care and the Ministry of Social Defense. It made rendering of proper assistance to the patients with hearing problems difficult. In 1979, according to the legislative act of the Ministry of Public Health Care both services were united. This fact promoted development of a well-functioning audiological system in the country.
In November of 1988, the All-Union Research Center for Audiology and Hearing Rehabilitation was founded according to the decision of the Soviet government. It was appointed the top national institution responsible for the fundamental and applied research in audiology as well as for supervision of the activities of all regional audiological centers. After the well-known geopolitical changes in 1991 the words “All-Union” were changed to “National” (History, 2020).
One of the most efficient approaches to the solution of the problem of early detection of hearing loss is the development and wide introduction of audiological screening programs on the national level. This system, considering all the peculiarities of the country health care conditions has been developed in Russia and is being now realized all over the country. In March 1996, the Russian Ministry of Health issued the regulations on hearing screening of newborns and first-year-of-life children. It aimed TEOAE registration of babies both high-risk and had not passed behavioral testing with confirmation of referrals with ABR registration. This document had the status of legislative act and determined all steps and time of screening stages and follow-up.
In 2008, the universal newborn hearing screening program based on TEOAE registration was implemented nationally. The coverage of newborns has achieved 97% by the year of 2015. About 5,000 newborns and first-year-of-life babies with hearing loss are identified yearly (Tavartkiladze et al, 2016).
The prevalence of congenital and prelingual hearing loss among newborns and first-year-of-life babies is about 2.5-3.0 per 1000 live births (Tavartkiladze et al., 2016; Chibisova et al., 2018). The early identification of congenital hearing loss has dramatically improved with implementation of the program of universal newborn hearing screening at a national level.
According to statistical data from the Ministry of Health of Russian Federation, the prevalence of hearing loss >25 dB (average PTA thresholds 0,5, 1, 2, 4 kHz) is about 4 per 1,000 in children 0-18 years old, 6.5 per 1,000 in adult population and 14 per 1,000 in people aged 60 years and older. It is estimated that 75% is bilateral sensorineural hearing loss (Prevalence, 2020)
According to Global Burden of Disease 2017 study, prevalence of socially significant hearing loss (i.e., >35 dB in the better hearing ear with average PTA thresholds 0,5, 1, 2, 4 kHz) in Russian Federation is about 5.7 per 1,000 (Global Burden of Disease, 2020).
Traditionally, otorhinolaryngologists were responsible for hearing evaluation in Russia. Since 1996, audiology has been included into the list of medical specialties in Russia.
Primary audiological training for specialists in general medicine lasts 2 years and professional retraining for ENT specialists lasts 4 months. There is a requirement for continuous training of certified audiology specialists which includes 1-month courses with accreditation every 5 years, 3-14 days thematical courses, 1-2 hours distant educational modules and participation in audiological conferences. Hearing aid dispensers currently do not need any special education.
The Audiology Department of Russian Medical Academy of Continuous Professional Training offers all forms of audiology education. There are a total of 9 educational facilities in Russia which perform 4-months of professional retraining:
The Audiology Department of Russian Medical Academy of Continuous Professional Training also offers courses on audiometry for nurses and professional training for educational specialists in audiology.
In Russia, the state guarantees audiological services through its program of free medical care for all citizens. These services include neonatal hearing screenings, audiological diagnostics and medical treatment of hearing disorders. These services are paid by the fund of mandatory medical insurance.
Currently there are 267 state regional specialized audiological centers: 84 serve only adults, 108 only serve children, and 75 serve both adults and children. Audiological centers could be included into otorhinolaryngological departments or could be separate departments of regional inpatient or outpatient hospitals.
The number of the private audiological facilities is estimated at 400. They are mainly managed by chain clinics. The audiological services could be paid by patients themselves or by voluntary medical insurance programs. Recently, the model of private-state partnership has been established meaning the private audiological services could be paid from local mandatory medical insurance funds.
Hearing aids are distributed in Russia through state and private audiological units and centers as well as by individual representatives of various foreign hearing aid manufacturers. Once every 4 years the cost of hearing aids of Russian manufacturers is covered from the fund of social insurance for disabled children under 18 and adults with bilateral severe or profound hearing loss. The costs of more expensive hearing aids could be partly reimbursed. The annual demand for hearing aid is 500,000 units. People with hearing loss could also be provided with individual earmolds, other hearing-assistive devices such as, mobile phones, TVs with capture technology, and services of sing-language interpreter by the fund of social insurance if these needs are fixed in the individual program of rehabilitation/habilitation.
Qualifying with a hearing disability is very complicated. For this reason, many individuals with hearing impairments purchase hearing aids from their own funds. Some charities help people in need to obtain hearing aids.
The cochlear implant program was established in the Soviet Union in 1991, and the National Research Centre for Audiology and Hearing Rehabilitation was the first institution where all pre-operative testing, surgery and postoperative rehabilitation were carried out. Currently about 1,000 cochlear implants per year are performed in four federal centers and financed from the federal budget. Since 2016, the speech processors upgrade program is financed by the mandatory medical insurance (once every 5 years).
There is exact data on specialists employed in public health sector (Resources, 2020); the ratios are estimates calculated based on the population of 146,745,098 (Russian Federation, 2020).
Table 2: Ear and Hearing Care Professionals in Russian Federation
|Professionals||Approximate number||Ratio to the population|
Non-medical specialists like physicists, physiologists, specialists in acoustics, microelectronics etc. are involved in the audiological research and services. It is suggested about 500 speech-language pathologists throughout the country. The number of audiologists employed in private sector could be estimated as 700.
Audiological services include:
Otorhinolaryngologists are responsible for primary diagnostics and treatment of acute or chronic ear diseases, congenital ear malformations, injuries, balance impairments. It is responsibility of otorhinolaryngologist to refer patients with hearing impairment to audiologist. Patients with sudden sensorineural hearing loss are hospitalized for medical treatment in otorhinolaryngological departments.
Otologists or micro-ear surgeons are otorhinolaryngologists experienced in any type of ear surgery. Several specialists in Russia are trained to perform cochlear implantation and middle ear hearing devices implantation.
Otoneurologists are responsible for assessment of vestibular system and management of patients with peripheral vestibular disorders.
Neurosurgeons are invited to perform brainstem implantation, brain interventions in case of brain and intracranial nerves tumors affecting hearing and vestibular functions.
General practitioners, physicians and pediatricians could provide otoscopy and primary management of acute otitis media.
Currently, audiology research in Russia is held in different fields. Fundamental studies are dedicated to the primary auditory perception, micromechanics of the organ of Corti, mechanisms of coding and processing of speech information in the auditory system, objective electrophysiology methods including cortex auditory evoked responses.
Special interest is paid to auditory neuropathy spectrum disorders and central auditory processing disorders. Long-lasting research has been held on genetic and clinical heterogeneity of hereditary hearing loss as well as noise-induced hearing loss, ototoxicity and epidemiological issues. After implementation of the newborn hearing screening program the need for pre-school and adult hearing screening has been realized.
The results of Russian audiological research are published in peer-reviewed international scientific journals and presented at scientific conferences and meetings yearly.
In 2001, Russian Society of Audiology was officially registered by the Ministry of Justice of Russian Federation as a juridical body. Russian Society of Audiology was established for the cooperation of activities of all specialists involved in the field of audiology, hearing and speech rehabilitation, development of diagnostic equipment, hearing aids and assistive devices.
In 2017, the authority was transferred to the National Medical Association of Audiologists (https://www.нмас.рф/). The regulatory bodies of audiological service are the Ministry of Health of Russian Federation (https://minzdrav.gov.ru/) and regional public health departments
Recently several charities were founded to assist families and individuals with hearing loss. Some of them are:
Chibisova, S.S., Markova, T.G., Alekseeva, N.N., Yasinskaya, A.A., Tsygankova, E.R., Bliznetz, E.A., Polyakov, A.V., & Tavartkiladze G.A. (2018). [Epidemiology of hearing loss in children of the first year of life]. Vestnik Otorinolaringologii, 83(4), 37-42. https://doi.org/10.17116/otorino201883437
Global Burden of Disease 2017 study. (2020). Retrieved October 8, 2020, from http://ghdx.healthdata.org/gbd-results-tool
History of the National Centre for Audiology and Hearing Rehabilitation. (2020). Retrieved October 8, 2020, from https://audiology.ru/en/history-of-the-center/
Prevalence of disorders in Russian population. (2020). Ministry of Health of the Russian Federation. Retrieved October 8, 2020, from https://minzdrav.gov.ru/ministry/61/22/stranitsa-979/statisticheskie-i-informatsionnye-materialy/statisticheskie-materialy
Resources and activities of medical healthcare organizations. Medical staff. (2020). Ministry of Health of the Russian Federation. Retrieved October 8, 2020, from https://minzdrav.gov.ru/ministry/61/22/stranitsa-979/statisticheskie-i-informatsionnye-materialy/statisticheskie-materialy
Russian Federation. (2020). Retrieved October 8, 2020, from https://en.wikipedia.org/wiki/Russia
Tavartkiladze, G.A., Markova, T.G., Chibisova, S.S., Al-Sharjabi, E., & Tsygankova, E.R. (2016). [The Russian and international experience with the implementation of the programs of universal audiological screening of the newborn infants]. Vestnik Otorinolaringologii, 81(2), 7-12. https://doi.org/10.17116/otorino20168127-12
Professor George Tavartkiladze, MD, PhD, is director and founder of the National Research Center for Audiology and Hearing Rehabilitation; Head of the Clinical Audiology department of the Russian Medical Academy for Continuing Professional Education.
G.A. Tavartkiladze is President of the Russian Society of Audiology, President of the International Academy for Otorhinolaryngology – Head and Neck Surgery and Secretary General of the International Society of Audiology. He is member of WHO Expert Advisory Board and member of the Steering Committee of the World Hearing Forum (WHO)
Prof. Tavartkiladze is author of more than 450 publications in the field of audiology. He is honorary chief editor of Folia Otorhinolaryngologiae et Pathologiae Respiratoriae; editorial board member for the Acta Otolaryngologica, International Journal of Pediatric Otorhinolaryngology, Journal of Hearing Science, Audiology Research and others. The bulk of Prof. Tavartkiladze’s research is devoted to issues in experimental and clinical audiology.
Svetlana Chibisova, MD, PhD, a Senior researcher at the Department of Epidemiology and Genetics of Hearing loss of National Research Center for Audiology and Hearing Rehabilitation, helped to prepare this information.