Large-Scale Otoscopic and Audiometric Population Assessment: A Pilot Study

Publication date: Available online 30 November 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Kenny H. Chan, Susan Dreith, Kristin M. Uhler, Veronica Tallo, Marilla Lucero, Joanne De Jesus, Eric AF. Simões

ABSTRACT

Objective

Large-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.

Methods

Prospective 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-Allyn^R) was used to clear cerumen and view the tympanic membrane, images of which were recorded using a video otoscope (JedMed^R). Subjects underwent tympanometry and distortion product otoacoustic emission (DPOAE) (Path Sentiero^R), and underwent screening audiometry using noise cancelling headphones and a handheld Android device (HearScreen^R). 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.

Results

During 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).

Conclusion

Training of local nurses has been shown to be robust and this methodology overcomes challenges of distant large-scale population otologic/audiometric assessment.

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