Abstract
ObjectiveLarge-scale otoscopic and audiometric assessment of populations is difficult due to logistic impracticalities, particularly in low- and middle-income countries (LMIC). We report a novel assessment methodology based on training local field workers, advances in audiometric testing equipment and cloud-based technology. MethodsProspective observational study in Bohol, Philippines. A U.S. otolaryngologist/audiologist team trained 5 local nurses on all procedures in a didactic and hands-on process. An operating otoscope (Welch-AllynR) was used to clear cerumen and view the tympanic membrane, images of which were recorded using a video otoscope (JedMedR). Subjects underwent tympanometry and distortion product otoacoustic emission (DPOAE) (Path SentieroR), and underwent screening audiometry using noise cancelling headphones and a handheld Android device (HearScreenR). Sound-booth audiometry was reserved for failed subjects. Data were uploaded to a REDCap database. Teenage children previously enrolled in a 2000–2004 Phase 3 pneumococcal conjugate vaccine trial, were the subjects of the trainees. ResultsDuring 4 days of training, 47 Filipino children (M/F = 28/19; mean/median age = 14.6/14.6 years) were the subjects of the trainee nurses. After the training, all nurses could perform all procedures independently. Otoscopic findings by ears included: normal (N = 77), otitis media with effusion (N = 2), myringosclerosis (N = 5), healed perforation (N = 6), perforation (N = 2) and retraction pocket/cholesteatoma (N = 2). Abnormal audiometric findings included: tympanogram (N = 4), DPOAE (N = 4) and screening audiometry (N = 0). ConclusionTraining of local nurses has been shown to be robust and this methodology overcomes challenges of distant large-scale population otologic/audiometric assessment.
Highlights
Otitis media (OM) and its most consequential complication, chronic suppurative otitis media (CSOM), are disproportionally overrepresented in developing countries, in Asia and subSaharan Africa [1]
The overarching goal was to collect both objective and subjective data by trained local nurses as discussed below in Bohol, Philippines and be able to analyze them in the U.S It was to establish a mechanism to provide continued support for the local field workers and maintain data quality
In the otolaryngology clinic setting, standard methods were used for otoscopy and diagnostic audiometry [15,16,17,18]
Summary
Otitis media (OM) and its most consequential complication, chronic suppurative otitis media (CSOM), are disproportionally overrepresented in developing countries, in Asia and subSaharan Africa [1]. The burden of disease from CSOM includes hearing loss, tympanic membrane perforation, otorrhea, cholesteatoma and intratemporal and intracranial complications which in turn have important downstream social, educational and vocational impact. OM global health initiatives and clinical research in these populations mandate accurate epidemiologic assessments in LMIC. Large-scale otoscopic and audiometric assessment of ear. ☆ This project was presented at the American Academy of Otolaryngology-Head and Neck Surgery 2017 Annual Meeting, Chicago, IL. 16th Ave., Box 455, Aurora, CO, United States
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