Cerumen Research Articles

Ear disorders

Ear disorders affect pediatric and geriatric patients with greater frequency than other patients. Self-treatment with nonprescription medications should be restricted to external ear disorders, which include disorders of the auricle and the external auditory canal (EAC). Excessive cerumen (ear wax) and water-clogged ears are self-treatable EAC disorders for which FDA has approved nonprescription otic medications.

Prevalence of cerumen impaction and associated factors among primary school children in Mwanza city, Tanzania

Background: Cerumen impaction is a worldwide problem constituting a significant proportion of health problems in many settings and its prevalence varies. There is a paucity of published data regarding this condition in Tanzania with none from Mwanza region. The aim of this study was to determine the prevalence of cerumen impaction and associated factors among primary school children in Mwanza City and to assess the effect of cerumen impaction and its removal on hearing ability
 Methods and Patients: This was a cross-sectional, community-based study of primary school children with cerumen impaction that was carried out in randomly selected primary schools in Mwanza City between December 2016 and May 2017. Multistage cluster sampling technique was employed to obtain a required number of the study population.
 Results: Out of the 406 participants, ninety-five (23.4%) had cerumen impacted in their ears. Of these, 56 (58.9%) were males and 39(41.1%) were females. The mean age at presentation was 11.24±8.86 years. Ear bud abuse (83.7%) was the most common predisposing factor for cerumen impaction. Cerumen impaction was found in the right ear of 9 (9.5%) patients and in the left ear in 31 (32.6%) patients and bilateral in 55 (57.9%) of patients. The major presenting symptoms were ear itching, otalgia, hearing loss and tinnitus. Ear syringing was used to remove cerumen impaction and caused significant improvement in hearing thresholds. There were no recorded complications.
 Conclusion: Cerumen impaction is a common otologic presentation in our sub-region. Ignorance with the profound abuse of cotton buds is the major predisposing factor. Health education is of the essence as treatment is simple and effective.

Prevalence of Hearing Loss in Primary School Children in Lusaka, Zambia

Background: Disabling hearing loss has serious implications in a child's development as it reduces the intelligibility of speech thereby interfering with the learning process. This will negatively impact on their vocational choices.
 Study objective: To determine the prevalence of hearing loss in primary school children in the central zone of Lusaka district, Zambia.
 Methodology: 1277 children, aged 6 to 13 years, from public primary schools in the central zone of Lusaka district were randomly selected and examined. Clinical otologic assessment, tympanometry and audiometry screening were conducted on all participants. Children who failed the audiometry-screening test underwent a pure tone audiometry to determine the extent and nature of their hearing impairment.
 Results: The prevalence of hearing impairment was 11.5% consisting of conductive hearing loss (87.8%), sensorineural hearing loss (6.8%) and mixed hearing loss (5.4%). Hearing impairment was more common in male children (13.8%) compared to female children (9.3%) (P value= < 0.05). Thirty six point eight percent children had ear disease. The commonest ear disease was wax impaction (66%)found in children followed by otitis media with effusion (20%), foreign body ear (4%) and chronic suppurative otitis media (2%). The odds of developing hearing impairment in children with chronic suppurative otitis media was nine times greater than that of children without chronic suppurative otitis media OR = 9.9(95% CI, 2.33- 47.43).
 Conclusions: The prevalence of hearing impairment in school children in central zone of Lusaka district is high. This study shows that chronic suppurative otitis media has a statistical significant association with hearing loss and that the male children are at a higher risk of developing hearing impairment. There is urgent need for ear and hearing care awareness, and screening programs at the community level in the central zone of Lusaka district.

Comparison growth of Candida albicans in alternative media and semi-synthetic on fisheries cerumen in bastiong karance Ternate City

Otomycosis is an inflammatory process in the ear canal caused by a fungal infection. The activity of fishermen on the high seas at night or during the day is often at risk of contracting fungal diseases, because their workplaces are in the open air and in wet and humid areas favored by fungi. Work as a fisherman also makes them often exposed to direct sunlight so that the body's temperature rises, the body will produce sweat and cause the ear wax to be disturbed. Semi-synthetic media such as PDAs have sufficient carbohydrate content so that they are good for fungal growth. This media is pretty much needed in fungal breeding both in the laboratory and in agriculture. But the price of this media is quite expensive besides that not all chemical shops provide it, while the needs of PDA media are increasing so that another alternative is needed to replace the fungal culture media. This research is instrumental with a cross sectional approach and aims to find out the level of significance of the differences in the growth of Candida albicans against alternative media for agar dextrose agar and semi-synthetic Potato Dextrose agar (PDA). The sampling technique was non-random with a purposive sampling design of 46 people. The sample was then isolated on a semi-synthetic PDA media and alternative media to see differences in the growth of Candida albicans. Based on the research that has been carried out, it is concluded that there are 38 samples of respondents detected positively Candida albicans on semi-synthetic media (PDA) and alternative media, and based on the results of data processing obtained p value 0,000 <0.05 which indicates that there are very significant differences in growth Candida albicans between semi-synthetic media (PDA) and alternative media.Keyword : Candida albicans, Alternative Media, Potato Dextrose Agar.

Diagnostic Images of the Ocular Fundus Using a Low-Cost Portable Endoscope in Premature Patients at Risk of Developing Retinopathy of Prematurity.

The purpose of this article is to describe how fundus images are obtained using a low-cost device: the “Visual Ear Wax Cleaner Tool” portable endoscope (Soonhua Inc., China) connected to a smartphone, after installation of free applications (“Inskam” and “CameraFI”) using the smartphone screen as a monitor and after medication mydriasis, local anesthesia, and blepharostat placement. With this endoscope, video recording and fundus imaging are easily performed, for the case of patients at the risk of developing retinopathy of prematurity (ROP), facilitating timely screening in order to start treatment in patients who require it. This fundus imaging technique shares certain similarities with the RetCam® (Clarity, Pleasaton California) system, which performs real-time fundus imaging providing the ability to record and document findings and capture images from the video footage, with high quality and definition, although with a smaller angle of vision. The capture of images using a smartphone allows storing and sharing the images. These are devices which are generally accessible and portable and which use simplified energy sources, requiring very simple training. The low-cost, easy-to-learn technique and quick sharing of images through communication networks make this a tool to be considered for the practice of telemedicine.

Troubleshoot It: Accuracy of Various Thermometer Types Is Important to Consider During the COVID-19 Pandemic.

Troubleshoot It: Accuracy of Various Thermometer Types Is Important to Consider During the COVID-19 Pandemic.

The hearing function of sound engineers: A hearing conservation perspective.

BackgroundOccupational activities performed by sound engineers are associated with hearing loss. However, there is a dearth of research on the hearing functions and the related hearing loss for sound engineers.ObjectivesTo determine the hearing function and early effects of noise on the hearing ability of sound engineers, and to establish whether there are hearing conservation programmes (HCPs) available for sound engineer participants in Johannesburg.MethodsA quantitative cross-sectional design was used. Eight sound engineers from the Academy of Sound Engineering (ASE) participated in the study. The following data were collected from the participants: case history data, ear-related symptoms and hearing conservation data. Hearing screening followed by full diagnostic audiological assessments was conducted for each participant. Descriptive statistics and one-sample t-test were used to analyse the data (confidence interval [CI] = 95%).ResultsParticipants reported tinnitus and aural fullness as common complaints. Only one participant had a unilateral impacted cerumen. All the participants presented with hearing within normal limits bilaterally, with a percentage loss of hearing (PLH) of 1.1% for all the participants. However, five participants presented with a notched configuration that was ≥ 10 decibel (dB), in the high frequency region at 3000 Hz and 6000 Hz bilaterally. One-sample t-test (p = 0.001) inferred that at a mean age of 27.6 years (standard deviation [SD] = 3.85), a notch at 3000 Hz and 6000 Hz was associated with an early sign of a hearing loss for the study participants. An HCP was not in place at the study site.ConclusionThe study indicated a younger age as an associated early sign of noise-induced hearing loss (NIHL) for the study participants, and that audiologists’ clinical practice needs to explore HCP strategies specific for the sound engineers in order to prevent hearing loss.

Cerumenolytic Efficacy of 2.5% Sodium Bicarbonate Versus Docusate Sodium: A Randomized, Controlled Trial.

To evaluate the efficacy of 2.5% sodium bicarbonate and docusate sodium in patients with complete occlusion of the ear canal from impacted cerumen. Randomized controlled trial. We enrolled patients with unilateral complete cerumen occlusion of the ear canal that was unable to be removed using suction. Either 2.5% sodium bicarbonate or docusate sodium was applied and allowed to sit for 15 minutes. The ear canal was then cleaned under a microscope for up to 3 minutes until the tympanic membrane was completely visible. A second attempt with the same agent was performed in subjects in whom the first application was unsuccessful. The outcomes were compared between the two groups in terms of cleaning, the success rate, time taken to clean the canal, and adverse events. There were 91 participants enrolled in this study. The mean age of the participants was 48.0 years. The patients' demographic did not differ between the two groups. At the end of the treatment, the tympanic membrane was completely visible in 41 (91.11%) subjects treated with 2.5% sodium bicarbonate and 38 (82.61%) subjects treated with docusate sodium, with a 1.10 success ratio between the two groups (95% CI: 0.94-1.29, p = 0.23). The mean successful suctioning time was 103.61 seconds using 2.5% sodium bicarbonate and 124.13 using docusate sodium. The mean difference was 20.52 seconds (95% CI: -10.55-51.59). 2.5% sodium bicarbonate demonstrated non-inferior efficacy and safety compared with docusate sodium. We recommend using this agent in clinical practice. Clinicaltrials.in.th/TCTR20160803001.

Temporary threshold shift following ear canal microsuction

Objectives: To investigate a temporary threshold shift (TTS) of hearing and pain/discomfort caused by the microsuction procedure. Hearing loss induced by impacted cerumen was also investigated.Design: Impacted cerumen was removed from patients using microsuction. Hearing assessments were carried out before the procedure, immediately after and 1-week later. Hearing thresholds measured in different sessions were compared to determine the TTS caused by the microsuction procedure and hearing loss induced by impacted cerumen. A questionnaire was used to evaluate the pain/discomfort experienced by patients.Study Sample: 30 patients (50 ears) were recruited from a cerumen removal clinic.Results: Significant hearing loss caused by impacted earwax was found across individual frequencies (mean 11.4 dB, maximum 38.1 dB). A TTS appeared in 43/50 (86%) ears, ranging from 0 to 16.2 dB averaged across frequencies between 0.25 and 8 kHz, with the highest TTS at 6 kHz. Pain and discomfort levels were both rated low, the mean levels were 1.2 (SD = 0.5) and 1.6 (SD = 0.5) respectively on a scale from 1 to 10.Conclusions: Microsuction appears to be a well-tolerated and preferred procedure for removing impacted cerumen. Because of the significant TTS induced by the microsuction procedure, safety concerns from a hearing perspective should be raised with the patient.

The Efficacy and Safety of Cinnarizine in the Treatment of Vertigo in a Sample of Iraqi Patients in Al-Diwaniyah Province

Background: Vertigo is acoomon vestibular disorder in daily clinical practice that is frequently described as rotational sensation by patients and caused by a variety of causes that can be central or peripheral in origin. Treatment should be directed toward underlying etiology, but symptomatic relief is required to improve patients’ quality of life. Cinnarizine is frequently prescribed to relieve symptoms associated with vertigo; however little is known about its efficacy in daily clinical practice in Al-Diwaniyah province.Aim of the study: To evaluate the safety and efficacy of cinnarizne in the treatment of vertigo in patients visiting ENT unit at Al-Diwaniayh teaching hospital.Patients and method: The present cohort study included 66 patients of vertigo who were treated medically by cinarrizine (stugeron) and followed up for treatment response evaluation. The study was carried out in Ear Nose and Throat (ENT) unit in Al-Diwaniyah Teaching Hospital, Mid-Euphrates region, Iraq. The study started on June 2018 and ended on July 2019. The main variables included in the study were age, residency, level of education, occupation, other associated ENT manifestations and chronic illnesses. The primary outcome was response to treatment classified into satisfactory and unsatisfactory.Results: Mean age of patients with satisfactory response was significantly less than that of patients with unsatisfactory response, 45.73 ±13.31 years versus 54.95 ±15.67 years, respectively (P = 0.016). Response to treatment was not significantly associated to gender, residency, occupation and education (P > 0.05). Response to treatment was not significantly associated to bilateral ear wax, acute otitis media, chronic suppurative otitis media, Meniere’s disease and common cold (P > 0.05); however, it was significantly in the absence of hearing impairment and tinnitus (P 0.05), but significantly better in the absence of diabetes mellitus and hypertension (P < 0.05).

Treatment of impacted ear wax: a case for increased community-based microsuction.

Excess earwax is a very common problem, with figures estimating a prevalence of between 700 000 and 2 million adults in England and Wales. Although wax build up can occur in any individual, risk factors include anatomical deformity, hairs in the external canal, physical barriers to wax excretion, dermatological conditions affecting the ear, use of cotton buds, and increasing age (Box 1).1 Requests for the removal of ear wax are a very common reason for presentation in primary care. In the US, approximately 150 000 wax removals are performed each week.2 A survey of GPs in Edinburgh by Sharp et al put estimates at nine patients per month per doctor, equating to two patients per week.3 A more recent study suggested that 2.3 million ear irrigations are performed in England and Wales every year.4 Box 1 ### Risk factors for cerumen impaction View this table: Funding for treatment of impacted earwax is variable across clinical commissioning groups (CCGs). National Institute for Health and Care Excellence(NICE) guidance recommends ear wax removal should be performed in primary care,5 although without a commissioned service, GPs are under no obligation to do so. The funding for these additional services is variable by CCG area, with many practices now opting out of providing irrigation due to cost, high service demand, and safety implications. High set up cost and training requirements make provision of microsuction at individual practice level unfeasible, however many CCGs have funded community-based microsuction services. Access is usually restricted based on NICE criteria for …

Video laryngoscopic oral intubation in rats: a simple and effective method

Endotracheal intubation is a vital component of many rat in vivo experiments to secure the airway and allow controlled ventilation. Even in the hands of experienced researchers, however, the procedure remains technically challenging. The safest and most reliable way for human intubation is by video laryngoscopy. Previous attempts to apply this technique in rodents have been complicated and expensive. We, hereby, describe a novel, noninvasive method to safely intubate rats orally by video laryngoscopy, thus avoiding the need for a surgical tracheostomy. By repurposing a commercially available ear wax removal device, visualization of the rat larynx can be significantly enhanced. Because of its small diameter, integrated illumination, and a powerful camera with adequate focal length, the device has all of the necessary properties for exploring the upper airway of a rat. After identifying the vocal cords by video laryngoscopy, the insertion of an endotracheal tube (a 14G intravenous catheter) into the trachea under constant visual control is facilitated by using PE50 polyethylene tubing as a stylet (Seldinger technique). The procedure has been performed more than 60 times in our laboratory; all intubations were successful on the first attempt, and no adverse events were observed. We conclude that the described procedure is a simple and effective way to intubate a rat noninvasively, using inexpensive and commercially available equipment.

HEMODİYALİZ HASTALARINDA ÜREMİK KULAK KAŞINTISI: PREVELANS VE ŞİDDET ANALİZİ

AMAÇ: Kulak kaşıntısı, dış kulak yolunda hissedilen ve çok yaygın görülen bir rahatsızlık hissidir. Bu çalışmada, hemodiyaliz replasman tedavisi alan hastalarda kulak kaşıntısı prevelansını ve şiddetini normal popülasyon ile karşılaştırmak amaçlanmıştır.GEREÇ VE YÖNTEM: Bu çalışmada toplam 123 hasta değerlendirildi (grup I; (hemodiyaliz hastaları) 71 hasta, grup II; (kontrol) 52 hasta). Hastalara otoskopik muayene yapıldıktan sonra, kulak kaşıntısının varlığı ve şiddeti sözel değerlendirme ölçeğine göre sorgulandı, dış kulak yolunda ksreozis varlığına bakıldı, hastaların mevcut klinik ve laboratuvar tetkikleri incelendi.BULGULAR: Kulak kaşıntısı; grup I’de 13 hastada (%18,3) hafif şiddette, grup II’de 10 hastada (%19,2) hafif şiddette, 2 hastada (%3,8) orta şiddette tespit edildi. Kserozis varlığı sadece grup I’de 2 hastada (%2,8) saptandı. Kulak kaşıntısı prevelansı, şiddeti, ve kserozis varlığı açısından her iki grupta istatiksel anlamlı bir fark tespit edilmedi (p&amp;lt;0,529, p&amp;lt;0,491, p&amp;lt;0,304). Laboratuvar tetkiklerinden Grup I’de glikoz, kan üre nitrojen , kreatin değerlerinin Grup II’ye göre anlamlı derecede yüksek olduğu (p&amp;lt;0,001), Ca (p&amp;lt;0,001), hemoglobin (p&amp;lt;0,048) değerlerinin anlamlı derecede düşük olduğu saptandı.SONUÇ: Hemodiyaliz replasman tedavisi alan hastalarda, üremik kaşıntı vücutta çok yaygın olarak gözlenebilmesine rağmen kulakta tespit edilmemiştir. Üremik kaşıntının kulakta gözlenmemesi, dış kulak yolunun kendini temizleyebilmesi ve serumen sekresyonunun dış kulak yolunda koruma ve yağlama yapmasından kaynaklanabilir.

Removal of impacted cerumen by irrigation of the external auditory canal - Step-by-step

Cerumen impaction is a common consultation issue at general medical practices and causes symptoms like hearing loss, itching, pain or tinnitus. Without any indication of eardrum perforation, ear irrigation with warm water is a safe, effective and fast aid.

Hearing Impairment Overview in Africa: the Case of Cameroon.

The incidence of hearing impairment (HI) is higher in low- and middle-income countries when compared to high-income countries. There is therefore a necessity to estimate the burden of this condition in developing world. The aim of our study was to use a systematic approach to provide summarized data on the prevalence, etiologies, clinical patterns and genetics of HI in Cameroon. We searched PubMed, Scopus, African Journals Online, AFROLIB and African Index Medicus to identify relevant studies on HI in Cameroon, published from inception to 31 October, 2019, with no language restrictions. Reference lists of included studies were also scrutinized, and data were summarized narratively. This study is registered with PROSPERO, number CRD42019142788. We screened 333 records, of which 17 studies were finally included in the review. The prevalence of HI in Cameroon ranges from 0.9% to 3.6% in population-based studies and increases with age. Environmental factors contribute to 52.6% to 62.2% of HI cases, with meningitis, impacted wax and age-related disorder being the most common ones. Hereditary HI comprises 0.8% to 14.8% of all cases. In 32.6% to 37% of HI cases, the origin remains unknown. Non-syndromic hearing impairment (NSHI) is the most frequent clinical entity and accounts for 86.1% to 92.5% of cases of HI of genetic origin. Waardenburg and Usher syndromes account for 50% to 57.14% and 8.9% to 42.9% of genetic syndromic cases, respectively. No pathogenic mutation was described in GJB6 gene, and the prevalence of pathogenic mutations in GJB2 gene ranged from 0% to 0.5%. The prevalence of pathogenic mutations in other known NSHI genes was <10% in Cameroonian probands. Environmental factors are the leading etiology of HI in Cameroon, and mutations in most important HI genes are infrequent in Cameroon. Whole genome sequencing therefore appears as the most effective way to identify variants associated with HI in Cameroon and sub-Saharan Africa in general.

Community health worker-based hearing screening on a mobile platform: A scalable protocol piloted in Haiti.

ObjectiveTo establish the feasibility of a systematic, community health worker (CHW)‐based hearing screening program that gathers Health Insurance Portability and Accountability Act‐compliant electronic data (otoscopic images of tympanic membrane and audiometric evaluation) on a smartphone in an effort to streamline treatment options in resource‐limited communities.MethodsThis is a cross‐sectional study in which four schools were screened in Port‐au‐Prince, Haiti, during in April 2018. A total of 122 subjects (61% female) aged 5‐17 years underwent an initial brief audiometric screen followed by a more comprehensive air conduction audiometric evaluation if they failed their initial screen. Participants with more than 35‐dB loss in any frequency on their comprehensive audiometric evaluation received endoscopic otoscopy.ResultsSeventy‐five percent of subjects (91/122) passed their initial screen. Of those who failed, 9% (4/44 ears) had a severe or profound hearing loss on comprehensive evaluation. Abnormal otoscopic findings (11/36 ears, 31%) included are cerumen impaction (n = 6), myringosclerosis (n = 3), tympanic membrane perforation (n = 1), and tympanic membrane retraction (n = 1). The average duration of the initial testing was 100 seconds (SD = 74 seconds), whereas the duration of comprehensive testing was 394 seconds (SD = 175 seconds). Extrapolating from these data, we estimate that a group of seven trained CHWs could gather formal audiologic and otologic data points for 100 children per hour using this protocol.ConclusionsA systematic approach that utilizes local resources (CHWs) and existing infrastructure (cell phones and the Internet) can significantly reduce the burden of hearing healthcare specialists while simultaneously facilitating early diagnosis and management of disabling hearing loss in low‐resourced settings.Level of evidenceLevel 4.

Australian surfers’ awareness of ‘surfer’s ear’

ObjectivesTo assess awareness of external auditory exostosis (EAE) among Australian surfers.MethodsThis is a cross-sectional observational study, assessing professional and recreational Australian surfers. Currently, active surfers over 18 years of age,...

Revisiting pachyonychia congenita: a case-cohort study of 815 patients.

Pachyonychia congenita (PC) is a group of autosomal dominant disorders caused by mutations in one of five keratin genes (KRT6A, KRT6B, KRT6C, KRT16, KRT17). The establishment of an international registry containing clinical and molecular data led to the development of a disease classification based on the mutant gene and associated features. To harness the same resource to clarify the prevalence of PC-associated clinical features, delineate phenotype-genotype correlations and identify prognostic features for disease severity. In total, 815 individuals with confirmed keratin mutations registered in the International Pachyonychia Congenita Research Registry were surveyed for clinical findings associated with PC. Data were analysed using various statistical methods, including the Student's t-test, χ2 -test and anova tests for differences in means/proportions. Spearman correlation and logistic regression were used for phenotype-genotype correlations. KRT6A mutations were associated with oral leucokeratosis, hoarseness, youngest age or highest number of fingernails/toenails involved, and use of walking aids. KRT17 mutations were most commonly associated with cysts and natal teeth. Using logistic regression, we found that oral leucokeratosis was correlated with earlier toenail involvement, walking aids, nursing difficulties and hoarseness. Cysts were correlated with oral leucokeratosis, natal teeth and ear wax. Natal teeth predicted earlier toenail involvement, walking difficulties and cyst formation. Hoarseness was correlated with an increased number of involved fingernails. Here, we establish phenotype-genotype correlations in the largest cohort of patients with PC described to date and reveal novel and clinically useful predictors of disease course and manifestations. What's already known about this topic? Pachyonychia congenita (PC) is a group of autosomal dominant disorders caused by mutations in one of five keratin genes (KRT6A, KRT6B, KRT6C, KRT16, KRT17). The main clinical features are nail dystrophy, palmoplantar keratoderma, oral leucokeratosis and cysts. The establishment of an international registry containing the clinical and molecular data of patients with PC led to the development of a disease classification based on the mutant gene and associated features. What does this study add? Data were collected via an international registry to clarify the prevalence of PC-associated clinical features, delineate phenotype-genotype correlations and identify prognostic features for disease severity. This is the largest cohort of patients with PC described to date. The earliest clinical manifestations of PC are nail dystrophy and palmoplantar keratoderma. Diagnosis can be suspected and confirmed in preschool years. Painful plantar keratoderma has the most profound and debilitating effect on quality of life and daily function. Linked Editorial: Steele and O'Toole. Br J Dermatol 2020; 182:521-522. Linked Comment: Mordaunt. Br J Dermatol 2020; 182:537.

Cerumen Management: An Updated Clinical Review and Evidence-Based Approach for Primary Care Physicians.

Objective: To provide family physicians with a practical, evidence-based approach to managing patients with cerumen impaction. Methods: MEDLINE, The Cochrane Library, and the Turning Research Into Practice (TRIP) database were searched for English-language cerumen impaction guidelines and reviews. All such articles published between 1992 and 2018 were reviewed, with most providing level II and III evidence. Results: Cerumen impaction is a common presentation seen in primary care and cerumen removal is one of the most common otolaryngologic procedures performed in general practice. Cerumen impaction is often harmless but can be accompanied by more serious symptoms. Cerumenolytics and irrigation of the ear canal are reasonable first-line therapies and can be used in conjunction or isolation. If irrigation and cerumenolytics are contraindicated, manual removal is appropriate, but the tools necessary are not commonplace in primary care clinics and specialized training may be required to prevent adverse outcomes. Conclusion: Family physicians play a key role in the assessment and management of cerumen impaction and are well equipped to do so. Knowledge of the available techniques for cerumen removal as well as their contraindications ensures that cerumen is removed safely and effectively. When cerumen removal cannot be removed safely in a primary care setting, referral to Otolaryngology-Head and Neck Surgery is appropriate.

Childhood hearing impairment and its associated factors in sub-Saharan Africa in the 21st century: A systematic review and meta-analysis.

Background:Childhood hearing impairment is still a significant cause of disability in the 21st century in developing countries. Particularly, the burden is more severe in sub-Saharan Africa, where the majority of children with hearing problems is living. Thre are great variations and inconsistencies of available findings conducted in sub-Saharan Africa. Hence, the aim of this review was to determine the pooled prevalence of childhood hearing impairment and its associated factors in sub-Saharan Africa.Methods:Studies were searched from main databases (PubMed, CINAHL, and African Journals Online), Google Scholar, and other relevant sources using electronic and manual techniques. All observational studies, written in English and conducted among participants (aged less than 18 years) from 2000 to 2018, were eligible. Heterogeneity between included studies was assessed using I2, and publication bias was explored using visual inspection of the funnel plot. Statistical analysis was carried out to determine pooled prevalence using Stata version 14. In addition, subgroup analysis was carried out for the normality criteria of hearing thresholds and characteristics of the study populations.Results:The pooled prevalence of hearing impairment was 10% (95% confidence interval (CI): 9%–11%). The magnitude of hearing impairment varies with the normality criterion used. The most commonly used threshold was 25 and 30 dB hearing level. The prevalence of hearing impairment based on normality criterion (>20 dB, >25 dB, >30 dB, and >35 dB) were 17%, 19%, 2%, and 1%, respectively. While in the questionnaire-based evaluation, the prevalence was 6% (95% CI: 3%–9%). In addition, based on population characteristics, the prevalence of hearing impairment for school or community-based children was 6% (95% CI: 5%–7%) while the prevalence for children with comorbidities was 23% (95% CI: 15%–31%). Chronic suppurative otitis media, impacted cerumen, advanced stage of human immunodeficiency virus, tuberculosis infection, and age of the children were associated with hearing impairment in sub-Saharan Africa.Conclusion:Hearing impairment in children and adolescents in sub-Saharan Africa was high, and associated with preventable and treatable risk factors.