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Diagnostic otoscopy skills of community ear assistants in Western Nepal

  • R Youngs (a1), N Weir (a1), P Tharu (a1), R B Bohara (a1) and D Bahadur (a1)...

Abstract

Introduction:

Deafness is a major problem in developing countries. Rural communities tend to be affected more than urban ones, and chronic otitis media is common. The World Health Organization has proposed primary ear care as a method of providing otological services in developing countries. This study aimed to assess the diagnostic otoscopy skills of community ear assistants in rural Western Nepal.

Materials and methods:

Community ear assistants undertook the pre-operative evaluation of 92 patients selected for middle-ear surgery in an ‘ear camp’ setting. The otoscopy skills of community ear assistants were also assessed by means of an otoscopy quiz. Consultant otologists and trainee otolaryngologists underwent an identical assessment.

Results:

The community ear assistants' selection of patients for middle-ear surgery concurred with the consultant otologists' opinion in 87 of 92 patients (94.5 per cent). The level of community ear assistants' otoscopy skills was between that of junior and senior otolaryngology trainees.

Conclusions:

With intensive training, medically unqualified community ear assistants can develop otoscopy skills comparable to those of medically qualified otolaryngology trainees. These results support the development of primary ear care in poorer countries where access to specialist otological services is difficult or impossible.

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Copyright

Corresponding author

Address for correspondence: Mr Robin Youngs, Consultant Otologist, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK E-mail: robin.youngs@glos.nhs.uk

References

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1 Deafness and hearing impairment. In: http://www.who.int/mediacentre/factsheets/fs300/en/ [8 February 2010]
2 World Bank. World Development Report 2004. Equity and Development. Washington DC: World Bank, 2006
3 Tucci, DL, Merson, MH, Wilson, BS. A summary of the literature on global hearing impairment: current status and priorities for action. Otol Neurotol 2009;31:3141
4 Kumar, S. Deafness and its prevention – Indian scenario. Indian J Paediatr 1997;64:801–9
5 World Health Organization. Primary Ear and Hearing Care Training Resource, Advanced Level. Geneva: WHO Press, 2006;1112
6 Shrestha, R, Baral, K, Weir, N. Community ear care delivery by community ear assistants and volunteers: a pilot programme. J Laryngol Otol 2001;115:869–73
7 Snidvongs, K, Vatanasapt, P, Thanaviratananich, S, Pothaporn, M, Sannikorn, P, Supivaphun, P. Outcome of mobile ear surgery units in Thailand. J Laryngol Otol 2009;24:382386
8 Wormald, PJ, Browning, GG, Robinson, K. Is otoscopy reliable ? A structured teaching method to improve otoscopic accuracy in trainees. Clin Otol 1995;20:63–7

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Diagnostic otoscopy skills of community ear assistants in Western Nepal

  • R Youngs (a1), N Weir (a1), P Tharu (a1), R B Bohara (a1) and D Bahadur (a1)...

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