Diagnosis and management of otitis media with effusion in a tertiary hospital in Kano: a best practice implementation project

Abstract

Objective: To implement the best available practice to improve the diagnosis and management of OME according to best available evidence at the Aminu Kano Teaching Hospital, Kano, Nigeria. Introduction: Otitis media with effusion (OME) is characterized by the presence of fluid in the middle ear, without signs and symptoms of an acute infection. It has high rates of physician visits and is a common cause of hearing impairment in affected children. In Nigeria, the prevalence is estimated to range from 8% to 25.2%. Methods: The current quality improvement project was conducted using the Joanna Briggs Institute approach for clinical audits, involving a baseline audit, an implementation of change phase and a follow-up audit, using Practical Application of Clinical Evidence System software. Eleven evidence-based audit criteria were used for this project. The same audit criteria were used for the baseline and follow-up audit. The sample size was 20 for both the baseline and follow-up. Implemented change involved the introduction of pneumatic otoscope use in the department and educational sessions with clinicians and caregivers. The project was conducted from July to November 2017. Results: Implementation of strategies to improve practice led to large increases in compliance with audit criteria, particularly Criteria 1, 6, 9 and 10 (from 0–25% to 70–100%). Paradoxically, a decrease in compliance was observed for two criteria. Conclusion: The current project succeeded in increasing clinician compliance with best available evidence. The most significant evidence-based change seen was in the use of pneumatic otoscope, whereas the most difficult barrier to overcome was resistance to change.

Impact of adenoidectomy alone or with ventilation tube for treatment of secretory otitis media in children

“…Drainage of effusion through myringotomy with ventilation tube insertion represents rapid effective treatment. Adenoidectomy is another option for treatment especially for those with enlarged adenoid 7 . However, surgical intervention did not always provide satisfactory results.…”

Otitis media with effusion in Africa‐prevalence and associated factors: A systematic review and meta‐analysis

“…3 The main symptom of OME is conductive hearing loss caused by impaired transduction of sound waves in the middle ear due to the presence of middle ear effusion. 4 When this hearing loss persists or recurs frequently, it may have a negative impact on language, behavior and progress at school. 5 Moreover, children with a longer duration of OME are more likely to have problems with behavior and cognitive sequelae later in life.…”

“…In addition, health care professionals in LMICs have suboptimal access to information regarding evidence-based clinical care, and where information is available, it is poorly disseminated. 4 Furthermore, the absence of setting-specific guidelines could also explain disparities in management approaches. Guidelines based on setting-specific prevalence rates and risk factors are important in diseases that are influenced by climatic conditions and can consequently vary depending on the geographical area considered.…”

“…Furthermore, 80% of children have had one or more episodes of OME by 10 years of age 3 . The main symptom of OME is conductive hearing loss caused by impaired transduction of sound waves in the middle ear due to the presence of middle ear effusion 4 . When this hearing loss persists or recurs frequently, it may have a negative impact on language, behavior and progress at school 5 .…”

“…The paucity of otolaryngologists in these settings 7,8 could explain this tendency. In addition, health care professionals in LMICs have suboptimal access to information regarding evidence‐based clinical care, and where information is available, it is poorly disseminated 4 . Furthermore, the absence of setting‐specific guidelines could also explain disparities in management approaches.…”