Identification and Management of Middle Ear Disorders in a Rural Cleft Care Program: A Telemedicine Approach

Abstract

Purpose The aim of this study was to devise a grassroots-level strategy for identification and management of middle ear disorders in a community-based program for individuals with cleft lip and palate in 2 rural districts in the state of Tamil Nadu in South India. Method Community workers underwent training to conduct video otoscopy using the ENTraview device. Community workers conducted video otoscopy on 160 individuals with cleft lip and palate between 3 and 35 years old in the community. Middle ear conditions were identified using store-and-forward telepractice. Diagnostic telehearing evaluation was conducted using synchronous pure tone audiometry and tympanometry for those who were identified with tympanic membrane (TM) and/or middle ear diseases (MEDs). A review of data collected over a 13-month period was carried out to assess coverage and follow-up intervention rates. Results The program was successful in achieving 80% coverage for identification of TM and MEDs within 13 months of program implementation. TM and/or MEDs were identified in 26% (82/320 ears) of those who underwent video otoscopy. Telehearing evaluations were completed on 42 ears of individuals with TM and/or MEDs; 52% (22/42 ears) of these individuals had a minimal, mild, or moderate degree of hearing loss. Regarding follow-up for intervention, 78% qualified for surgical intervention, and 31% qualified for medication. Conclusions This grassroots-level telemedicine approach was successful in achieving better coverage, and store-and-forward telepractice helped in providing remote diagnosis and recommendation by otolaryngologists to all individuals with TM/MEDs in the rural community. The follow-up for otological intervention significantly improved from that achieved in the previous years.

Uptake of telepractice among speech-language therapists following COVID-19 pandemic in India

“…In recent years, there have been attempts in India to provide services via telepractice in Speech-language Therapy and Audiology mainly with respect to audiological services (Ramkumar, Rajendran, Nagarajan, Balasubramaniyan, & Suresh, 2018;2019) and language screening (Raman et al, 2019). However, most of these studies have been single centre studies or confined to a single geographical location of the state of Tamil Nadu in India.…”

Continuation of telemedicine in otolaryngology post-COVID-19: Applications by subspecialty

“…Another domain in which telemedicine can be utilized and integrated into clinical care is the care of cleft lip and palate patients [ 12 ]. Patients undergoing cleft lip and palate repair require comprehensive and multidisciplinary care for a prolonged period of time [ [12] , [13] , [14] ]. Costa et al demonstrate the feasibility of telemedicine for the initial evaluation and for continued postoperative management of cleft patients in the Southern United States and Mexico, with alleviated cost and travel burdens on patient families and providers, extending specialty care to otherwise underserved areas [ 12 ].…”

A systematic review of remote otological assessment using video-otoscopy over the past 10 years: reliability and applications

“…A range of devices were used to perform video-otoscopy (Table 3 ). In seven studies [ 2 , 6 , 12 – 14 , 18 , 19 ], non-medical healthcare facilitators performed the remote assessment; however, in two studies, the parents of paediatric patients were used [ 16 , 17 ]. All but two studies [ 10 , 11 ] utilised an asynchronous assessment of remote images.…”

“…In addition to this, 1 study included an analysis of 210 still images of tympanic membranes collected prospectively from an unspecified number of adult patients. Six studies included adults only [6][7][8][9][10][11], seven studies included children only [12][13][14][15][16][17][18], three studies included both adults and children [2,3,19] and one study did not specify population age [20]. A range of devices were used to perform video-otoscopy (Table 3).…”