Samoa Launches Outreach Program to Address Occupational Hearing Loss

INTRODUCTION The ENT Clinic of Samoa marked World Hearing Day (WHD) 2025 by launching an initiative aimed at addressing occupational hearing loss. This initiative aligned with the WHD 2025 theme of empowering individuals with the knowledge of wearing hearing protection for the prevention and management of avoidable hearing disorders. Occupational hearing loss represents a significant proportion of the caseload seen at the ENT Clinic of Samoa, and we felt the time was right for a formal outreach program aimed at promoting hearing conservation among workers at risk of occupational noise exposure.The outreach was initiated under the leadership of our Head of Department Dr Sione Pifeleti and ENT Registrar Dr Maria Ah Kuoi Lauano. The Head of Human Resources for the largest company in Samoa attended the ENT Clinic in 2024 and was so impressed with the service that she approached Dr Maria about the possibility of an outreach visit to provide on-site ear and hearing assessments for all their employees. Based on this keen interest from a prominent community member, the ENT Clinic worked towards providing this outreach service to coincide with our WHD 2025 celebrations. Contextualising a Hearing Conservation Program for Samoa In my Australian audiology life, I (AK) performed workplace hearing assessments and was formally trained in the extensive testing required to comply with Australian national standards and occupational health and safety regulations (i.e., strict criteria for testing environment, all octave and inter-octave frequencies, baseline audiometry for all new workers then repeat at three months to assess who may be at increased risk of noise-induced hearing loss, review hearing protection availability/compliance, etc). In my Samoan audiology life, however, I need to be practical and contextually relevant. I am the only audiologist in Samoa and, given the extent of ear disease which is further exacerbated by the heat and humidity of our tropical climate, a hearing conservation program in our context cannot be limited to otoscopy and hearing tests by an audiologist alone. Under the leadership of Dr Maria, a hearing conservation program protocol was developed that not only addressed ear and hearing health but was also extended to provided screening for noncommunicable diseases (NCDs). The Occupational Hearing Screening Form of the American Audiology Association was adapted as follows: (1) minimal modifications were made to the case history and hearing screening sections, (2) otoscopy was expanded to include possible ear pathologies and interventions (i.e.., cerumen removal, antibiotic prescription), and (3) a section was added to screen for NCDs (i.e., vital signs, blood pressure, blood sugar levels, height/weight). This initial outreach service was our opportunity to trial the proposed protocol. Outreach Visit – World Hearing Day Celebrations Arrangements were made for an ENT outreach service to the corporate staff and factory workers of the largest company in Samoa from February 26-28, 2025. ENT nursing staff would perform initial general health screening tests, as well as any ear health interventions that may be required. Dr Maria would perform all ear health examinations and manage any ear pathologies as required. Annette Kaspar would perform hearing screening with immediate full diagnostic audiometry should the participant not pass the screening assessment. Overall, a total of 124 staff members were seen by the ENT Team (67 male, 57 female). There were 72 corporate staff members (35 male, 37 female), and 52 factory workers (32 male, 20 female). Hearing tests were performed for 90 staff members, with the remaining 34 declining a hearing test. Overall, 61 staff members passed hearing screening, 11 staff member results were suggestive of noise-related hearing loss, 8 staff member results were confounded by concurrent upper respiratory tracts infection at the time of testing, 7 staff members were referred for ENT review (i.e.., to assess candidacy for myringoplasty), and 3 staff members were suitable candidates for amplification devices. Initial Reflections and Future Directions Overall, the ENT outreach service was well-received, and the ENT team was encouraged to further develop and implement a hearing conservation program as a routine feature of our clinical service. An unexpected issue was that one of our outreach participants shared their respiratory infection with me (AK) and I was unavailable for one of the days of our planned outreach visit. From my development practitioner perspective, this highlights the limitations of a program that is dependent on the availability of one person/audiologist. I would therefore offer the controversial suggestion that, in a low-resourced setting like Samoa, you do not NEED to include hearing tests in order to begin a hearing conservation program – the rationale being that the primary goal of such programs is for workers to be provided with and wearing suitable hearing protection when exposed to excessive noise while performing routine work duties. This is a goal that can be achieved without hearing tests, or indeed, without audiologists. From this perspective, it further becomes clear that our hearing conservation program will best achieve its desired outcomes when we involve nonclinical colleagues such as health promotion officers and Occupational Health and Safety policymakers. Despite the competing demands for our ENT clinical services, preparations are underway to conduct further outreach visits to promote hearing conservation among construction workers and airport ground staff employees before the end of the year. We aim to include health promotion officers in our future endeavours, with the view that they may then include hearing conservation within their own existing occupational health and safety efforts. An opportunity has also arisen to review Occupational Health and Safety regulations in Samoa regarding hearing protection in the workplace. Given our tropical climate, the ENT clinic would strongly advocate for hearing protection options that minimise/manage the risk of outer ear infections. Formal policies regarding employer obligations towards employees exposed to excessive workplace noise levels should raise awareness about ear health and hearing conservation in Samoa. We write this article to encourage other low-resourced colleagues, and especially our Pacific Island neighbours, that workplace hearing conservation programs may be initiated within Occupational Health and Safety frameworks, with formal clinical services to follow as resources allow.