Expanding the Capacity of Otolaryngologists in Kenya through Mobile Technology

Abstract

ObjectiveTo determine if reliable, objective audiologic data can be obtained by nonotolaryngology and nonaudiology practitioners using novel mobile technology in an effort to expand the capacity for early identification and treatment of disabling hearing loss in the developing world.Study DesignCross-sectional, proof-of-concept pilot study.SettingScreenings took place during an annual 2-week otolaryngology surgical mission in October 2016 in semirural Malindi, Kenya.Subject and MethodsEighty-seven patients (174 total ears) were included from 2 deaf schools (n = 12 and 9), a nondeaf school (n = 9), a tuberculosis ward (n = 8), and a walk-in otology clinic at a local hospital (n = 49). An automated, tablet-based, language-independent, clinically validated, play audiometry system and wireless otoscopic endoscopy via an iPhone or laptop platform was administered by Kenyan community health workers (CHWs) and nursing staff.ResultsVarious degrees of hearing loss and otologic pathology were identified, including 1 child presumed to be deaf who was found to have unilaterally normal hearing. Other pathology included 2 active perforations, 2 healed perforations, 2 middle ear effusions, and 1 cholesteatoma. CHWs and nursing staff demonstrated proficiency performing audiograms and endoscopy. Patients screened in a deaf school were more likely to complete an unreliable audiogram than patients screened in other settings (P < .01).ConclusionThis study demonstrates the feasibility of a non–otolaryngology-based hearing screening program. This may become an important tool in reducing the impact of hearing loss and otologic pathology in areas bereft of otolaryngologists and audiologists by allowing CHWs to gather important patient data prior to otolaryngologic evaluation.

Community health worker‐based hearing screening on a mobile platform: A scalable protocol piloted in Haiti

“…Recently, mobile technologies have been utilized to extend the reach of existing hearing health services in LMICs . Programs using calibrated headphones, tablet computers, and smartphones have been clinically validated in collecting accurate audiometric thresholds in pediatric populations .…”

“…Programs using calibrated headphones, tablet computers, and smartphones have been clinically validated in collecting accurate audiometric thresholds in pediatric populations . Specialized cameras have also been developed for smartphone applications to provide reliable otoscopic imaging as a proxy for physical examination, which is used for diagnostics and medical decision‐making for hearing loss …”

A review of smartphone point‐of‐care adapter design

“…Surgical diagnosis applications of smartphone adapter. (A) iPhone‐based otoscopy and laptop‐based wireless endoscopic otoscopy, by Jayawardena et al, adopted with permission from SAGE publishing; (B) A polarized dermoscope mounted on a cellular telephone enables accurate comedone manipulation, by Naimer, adopted with permission from Wiley; (C) Smartphone‐endoscope adapter to capture video, by Brant et al, under the Creative Commons Attribution License; (D) Smartphone attached to a microscope through a 3D printed adapter, by Fontelo et al, under the Creative Commons Attribution License; (E) Smartphone microscope adapter, by Hartman et al, under the Creative Commons Attribution License; (F) Smartphone attached to a microscope through an adapter, by Ekong et al, under the Creative Commons Attribution License…”

“…In the case of in vivo operation requiring a video of an internal organ for the purpose of medical education or surgical assistance, the video can be stored and shared via Wi‐Fi or the Internet, as shown in Figure . Smartphone otoscopy emerges as a solution for audiologists and otolaryngologists in making simple, practical, and cost‐effective diagnoses for patients suffering from hearing problems, as in Figure A, see also the work of Jayawardena et al, where patients underwent a surgical diagnostic operation. The results were fascinating, as 59 patients out of 66 were able to achieve reliable audiogrametric measures.…”

Teacher Prescreening for Hearing Loss in the Developing World

“…[2][3][4] Recently, tablet and cell-phone audiometry has made it possible to screen children for HL in resource-poor environments. [5][6][7] There remain, however, an extraordinary number of individuals at risk of hearing impairment, and there still have been limited attempts to increase the efficiency of screening in these settings.…”