Diagnostic otoscopy skills of community ear assistants in Western Nepal

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.

The role of community health workers in addressing the global burden of ear disease and hearing loss: a systematic scoping review of the literature

“…The initial search yielded 674 articles, which reduced to 420 after removal of duplicates (see online supplementary table 3). After screening of abstracts, 356 studies were excluded and after full-text review a further 30, leaving 38 studies that met the inclusion criteria 21 22 30–65. Further details are in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart (figure 1).…”

“…The majority of studies have been published in the past decade (since 2008, n=30), with no relevant studies published before 1980. Studies took place in South Asia (n=13),30 36 43–45 48 55–59 61 65 Oceania (n=7),21 38 39 41 42 62 63 North America (n=7),22 35 37 47 49 50 60 South America (n=6)31–34 40 64 or Africa (n=5) 46 51–54…”

“…In eight studies, the primary focus was in evaluating the delivery of CHW training programmes 32–34 40 41 52 60 65. There was a great deal of heterogeneity between studies regarding content, duration and method of delivery, making direct comparison difficult.…”

“…Some training programmes, such as that by Eikelboom et al 41, provided indepth coverage of topics including a theoretical background on the anatomy and physiology of the ear, and an outline of the causes, prevention and treatment of common ear diseases. Other training programmes were focused on one key area, such as diagnostic otoscopy skills 65. Five studies referred to the use of the WHO Primary Ear Care Training Manuals as the educational resource,32–34 40 52 whereas the remainder did not detail the training content or how it was developed.…”

Optimising the pre-treatment process before mobile ear surgery for chronic suppurative otitis media in Wolisso and Attat, Ethiopia

“…In western Nepal, a programme for community ear assistants is very successful. 6 Workers receive intensive training in the diagnosis of ear diseases, and they are qualified to select patients for ear surgery. The present study showed that similar skills can also be obtained by specially trained nurses.…”