Comprehensive Community Screening of Otological Patients by Trained Technicians Using a Telemedicine Device: An Efficient and Cost-Effective Way to Triage Patients With Ear Diseases

Abstract

Objective: To emphasize the benefits of tele-otology in community screening of patients with ear diseases. Methods: A retrospective study of all patients screened and treated under the Shruti tele-otology program between 2013 and 2019 was conducted. It involved screening, diagnosis, medical management, surgical intervention, and rehabilitation using hearing aid. The study focused on underprivileged and underserved community of rural and urban slums across 12 states of India. The study was conducted using a telemedicine device called ENTraview, that is, a camera-enabled android phone integrated with an otoscope and audiometry screening. Result: A total of 810 746 people were screened, and incidence of various ear diseases was recorded. Ear problems were found in 265 615 (33%) patients, of which 151 067 (57%) had impacted wax, 46 792(18%) had chronic suppurative otitis media, 27 875 (10%) had diminished hearing, 12 729 (5%) had acute otitis media and acute suppurative otitis media (ASOM), and 27 152 (10%) had problems of foreign body, otomycosis, and so on. Of the total 265 615 referred patients, 20 986 (8%) reported for treatment and received treatment at a significantly reduced cost through Shruti program partners. The conversion rate of nonsurgical and surgical procedure was also compared, and it was found that, while 9% of the patients opted for nonsurgical treatment, only 3% opted for surgery in the intervention group giving a significant P value of .00001. Conclusion: The potential for telemedicine to reduce inequalities in health care is immense but remains underutilized. Shruti has largely been able to bridge this gap as it is an innovative, fast, and effective programs that address the ear ailment in the community.

Community‐based assessment and rehabilitation of hearing loss: A scoping review

“…Graduate students and nurses facilitated screenings in homes or senior activity/community‐based centres (Dodds & Harford, 1982; Haanes et al, 2021). The other four studies recruited CHWs to facilitate the screenings (Gupta et al, 2021; Jayawardena et al, 2018; O'Donovan et al, 2021; Yousuf Hussein et al, 2016).…”

“…The technology used to screen adult's hearing consisted of portable audiometers (Haanes et al, 2021), Shoebox Professional Audiometer on an iPad Mini 2 (Jayawardena et al, 2018), ENTraview device for air conduction threshold screening (Gupta et al, 2021), the hearScreen application (Yousuf Hussein et al, 2016) and as mentioned earlier, O'Donovan et al (2021) used whisper testing to screen hearing. Overall, community‐based adult hearing screening in less‐than‐ideal settings can assist in overcoming the barrier of lack of services.…”

“…Seven studies fell within the rehabilitation theme and addressed hearing aids and aural rehabilitation (see Table S6). Three studies were focused on hearing aids (Borg et al, 2018;Emerson et al, 2013;Gupta et al, 2021), and the remaining four studies were focused on aural rehabilitation programs (Choi et al, 2019;Coco et al, 2019;Marrone et al, 2017;Nieman et al, 2017). This program took place in the federally qualified health centre (Marrone et al, 2017).…”

Tele Otology in India: Last 10 Years—A Scopic Review

“…Shruti has largely been able to bridge this gap as it is an innovative, fast, and effective programs that address the ear ailment in the community 14 Pavithra Ravi [ 28 ] Tele-Audiological Surveillance of MED among Individuals with CLP in Rural South India To compare in-person audiological and tele-audiological surveillance, for better screening and management of MEDs in patients of CLP in rural community Tele audiology surveillance reported greater coverage, greater follow-up compliance (61%) and cost efficiency compared to in-person audiological surveillance 15 Vijayasundaram [ 30 ] Proficiency of virtual follow-up amongst tinnitus patients who underwent Intratympanic steroid therapy amidst COVID 19 pandemic To access feasibility and efficacy of virtual follow-up in tinnitus patient undergoing intratympanic steroid 80% patients showed improvement and were satisfied with virtual mode of follow-up. Virtual follow-up is a cost effective, efficacious, patient-friendly, safer and secure method of follow up specially in covid 19 pandemic 16 Medtronic shruti programme [ 32 ] Impact Measurement Case Study Studied the effect of shruti programme on low-income rural population with the use of technology Shruti is a cost-effective equipment for community-based health care services ABR, Auditory Brainstem Response; MED, Middle Ear Disorders; CLP, Cleft Lip and/or Palate; PTA: pure tone audiometry …”

“…Shruti has been a fast, innovative and cost-effective programme to address ear diseases in the community [ 32 ].…”