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10/13/2017  |   5:30 PM - 7:15 PM   |  East Ballroom at Shalala Student Services Building

Evaluation of a pre-surgical otologic screening tool: a pilot study in rural Kenya

INTRODUCTION: The vast majority (80%) of disabling hearing loss is found in the developing world. Sub-Saharan Africa, where otolaryngology and audiology services are limited, is no exception. In Kenya specifically, there are 1.2 otolaryngologists per 1,000,000 people and 0.12 audiologists per 1,000,000 people. When compared to similar ratios in the United Kingdom, Kenya has 12.1% the capacity of otolaryngologists and 0.3% the capacity of audiologists as the UK per 1,000,000 people. In an effort to expand the capacity for otolaryngologists and audiologists to identify preventable hearing loss, we created a novel, pre-surgical screening tool designed to be conducted by nurses and non-medical staff with minimal training. Screening consists of an iPad audiometry application and endoscopic otoscopy to provide two objective measures otolaryngologists can review to determine a patient’s is a candidate for otologic intervention. This study tests the feasibility of the aforementioned screening program in multiple healthcare settings. MATERIAL AND METHODS: This is a pilot study characterizing the results of a pre-surgical screening tool. Screening included endoscopic otoscopy with either the Firefly wireless endoscopes or the Cellscope Oto iPhone attachment. Audiometry was conducted using the SHOEBOX iPad Audiometer Professional version. RESULTS: 174 total ears (n=87 patients) were screened in 6 different settings. Settings included 2 separate deaf schools (n=12,9), a regular primary school (n=9), a TB ward (n=8), and a walk-in otology clinic at a local hospital (n=49). Unfortunately, deaf children exhibited great difficulty understanding iPad audiometry and therefore did not return reliable test data. However, 1 ‘deaf’ child was found to have unilaterally normal hearing. 33% (3/9) of children in the non-deaf primary schools had mild hearing loss and the remainder had normal hearing bilaterally. 37.5% (3/8) of patients on the TB ward exhibited moderate bilateral sensorineural hearing loss (SNHL). The walk-in clinic identified 40% (20/49) of patients with SNHL and 14% (7/49) of patients with conducting hearing loss (CHL). Otoscopic evaluation revealed 2 perforations, 2 middle ear effusions, and 1 cholesteatoma. Local nursing staff and non-medical personnel exhibited proficiency at both the audiometry and otoscopic endoscopy. CONCLUSION: This study highlights the utility of this pre-surgical screening tool in identifying and documenting both hearing loss and an otologic examination. These two objective measures can help identify candidates for otologic surgery, an important tool in reducing preventable hearing loss in areas bereft of audiologists and otolaryngologists. The use of iPad audiometry in profoundly deaf children, however, remains a challenge.

• iPad audiometry and smartphone otoscopy can both be utilized by a community health worker to gather reliable, objective otologic data points on patients in the developing world.
• Children who are bilaterally severe to profoundly deaf have difficulty reliably completing iPad play audiometry due to difficulty understanding play audiometry.
• TBD

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Asitha Jayawardena (POC,Primary Presenter), asitha.d.jayawardena@vanderbilt.edu;
TBD

ASHA DISCLOSURE: Financial - Nonfinancial -

AAA DISCLOSURE: Financial - No relevant financial relationship exists.

Charissa Kahue (Co-Author), tbd33@tbd.tbd;

ASHA DISCLOSURE: Financial - Nonfinancial -

AAA DISCLOSURE: Financial - No relevant financial relationship exists.

James Netterville (Co-Author), tbd44@tbd.tbd;

ASHA DISCLOSURE: Financial - Nonfinancial -

AAA DISCLOSURE: Financial - No relevant financial relationship exists.