Abstract:

Objective To compare six representative Chinese standards related to hearing disability in terms of conceptual frameworks, definitions, classification, grading and assessment.

Methods Using the framework of International Classification of Functioning, Disability and Health (ICF), World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), International Classification of Diseases, Eleventh revision (ICD-11), and World Report on Hearing (WRH), six national standards, such as Disability Assessment and Code for Life Insurance(Insurance Standard), Specification for Ability Assessment of Older Adults (Elderly Standard), Grading of Disability due to Human Body Injury(Judicial Standard), Standard for Identify Work Ability—Gradation of Disability Caused by Work-related Injuries and Occupational Diseases (Work Injury Standard), Standard for Assessment of Disability Grades of Military Personnel (Military Standard), and Classification and Grading Criteria of Disability (Disability Classification Standard), were analyzed in dimensions of definitions, coding systems, classification and grading methods, and assessment approaches.

Results In terms of definitions, Insurance Standard was relatively comprehensive, covering the dimensions of body function, activities and participation in ICF, which was consistent with the definition of functional hearing in the WRH. Elderly Standard focused on body function. Judicial, Work Injury and Military Standards were more inclined to physiological damage, emphasizing auditory structure and sensory functions. Although Disability Classification Standard covering dimensions of activities and participation, it did not elaborate on functional outcomes. In terms of classification and grading, different from the WRH's recommendation of 20 dB HL as the standard for hearing impairment, most of the six standards still used 40 dB HL or above as the threshold. For grading levels, Insurance Standard had nine grades, while Judicial, Work Injury and Military Standards had seven grades, Elderly Standard had three grades, and Disability Classification Standard had four grades. The basis for grading relied more on physiological measurements rather than functional performance. In terms of coding systems, only Insurance Standard referred to ICF codes, while the others mostly used self-defined numerical sequences or grade codes. In terms of assessment methods, the WRH advocated a comprehensive assessment integrating auditory ability, self-reports and participation restrictions. However, currently, only Elderly Standard involved subjective sensory scoring, and the others still mainly relied on objective methods, such as pure-tone audiometers, lacking assessment dimensions for social participation and environmental factors.

Conclusion Hearing disability should be defined from three levels: hearing structure and function, activity and participation, and environmental factors. However, China's six standards adopt different definitions, classifications, grading systems and assessment methods due to their varying purposes and application scenarios. The majority of these standards are primarily based on body function, specifically hearing loss. Future standards for hearing disability need to consider the introduction of the concept of functional hearing, to determine hearing loss and its impact on activity and participation.

Key words: hearing disability, disability standard, International Classification of Functioning, Disability and Health, World Report on Hearing