Introduction: Digital technologies are increasingly used to support task-sharing to community healthcare workers (CHWs) for accessible hearing healthcare in low- and middle-income settings (LMIs). This study evaluates the feasibility of CHW-facilitated hearing care, enabled by digital technologies, for ear assessment, hearing testing, and telehealth support in LMI settings. 

Method: CHWs in three South African LMIs were trained to facilitate hearing care using smartphone- and tablet-based digital tools. For ear assessment, CHWs conducted video-otoscopy with artificial intelligence (AI) image classification support. The accuracy of AI classification was assessed by comparing results to blinded ENT evaluations (August 2022 and April 2023). For hearing testing, automated pure-tone audiometry established hearing thresholds at key frequencies. For telehealth support, CHWs engaged in WhatsApp-based consultations with audiologists and an ENT specialist for guidance in complex cases. A subsequent feasibility study (October 2023 to July 2024) assessed the real-world implementation of this CHW-facilitated hearing care model.

Results: CHWs conducted video-otoscopy on 212 adults, with AI and ENT classifications corresponding in 89.2% of cases. During the feasibility phase, 166 participants were recruited, with otoscopy completed for 163. The most common AI classifications were ‘normal’ (65.6%; n=215 ears) and ‘wax obstruction’ (24.2%; n=79). For hearing testing, CHWs facilitated audiometry for 161 participants, with 77.6% presenting with mild (45.3%; n=73) or moderate (32.3%; n=52) hearing loss. Quality control flagged concerns in 36 participants due to test-retest reliability (19.3%; n=31) and environmental noise (3.1%; n=5). CHWs used telehealth support 22 times, primarily for ‘abnormal’ (n=19) and infection/asymmetry cases (n=3).

Conclusions: Innovative digital technologies, including smartphone- and tablet-based devices, enabled CHWs to expand hearing care access in LMIs through AI-supported video-otoscopy, automated audiometry, and telehealth support, demonstrating real-world feasibility.