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

OBJECTIVE: To establish the feasibility of a systematic, community health worker (CHW)-based hearing screening program that gathers Health Insurance Portability and Accountability Act-compliant electronic data (otoscopic images of tympanic membrane and audiometric evaluation) on a smartphone in an effort to streamline treatment options in resource-limited communities. METHODS: This is a cross-sectional study in which four schools were screened in Port-au-Prince, Haiti, during in April 2018. A total of 122 subjects (61% female) aged 5-17 years underwent an initial brief audiometric screen followed by a more comprehensive air conduction audiometric evaluation if they failed their initial screen. Participants with more than 35-dB loss in any frequency on their comprehensive audiometric evaluation received endoscopic otoscopy. RESULTS: Seventy-five percent of subjects (91/122) passed their initial screen. Of those who failed, 9% (4/44 ears) had a severe or profound hearing loss on comprehensive evaluation. Abnormal otoscopic findings (11/36 ears, 31%) included are cerumen impaction (n = 6), myringosclerosis (n = 3), tympanic membrane perforation (n = 1), and tympanic membrane retraction (n = 1). The average duration of the initial testing was 100 seconds (SD = 74 seconds), whereas the duration of comprehensive testing was 394 seconds (SD = 175 seconds). Extrapolating from these data, we estimate that a group of seven trained CHWs could gather formal audiologic and otologic data points for 100 children per hour using this protocol. CONCLUSIONS: A systematic approach that utilizes local resources (CHWs) and existing infrastructure (cell phones and the Internet) can significantly reduce the burden of hearing healthcare specialists while simultaneously facilitating early diagnosis and management of disabling hearing loss in low-resourced settings. LEVEL OF EVIDENCE: Level 4.

Monitoring neonates for ototoxicity.

OBJECTIVES: Neonates admitted to the neonatal intensive care unit (NICU) are at greater risk of permanent hearing loss compared to infants in well mother and baby units. Several factors have been associated with this increased prevalence of hearing loss, including congenital infections (e.g. cytomegalovirus or syphilis), ototoxic drugs (such as aminoglycoside or glycopeptide antibiotics), low birth weight, hypoxia and length of stay. The aetiology of this increased prevalence of hearing loss remains poorly understood. DESIGN: Here we review current practice and discuss the feasibility of designing improved ototoxicity screening and monitoring protocols to better identify acquired, drug-induced hearing loss in NICU neonates. STUDY SAMPLE: A review of published literature. CONCLUSIONS: We conclude that current audiological screening or monitoring protocols for neonates are not designed to adequately detect early onset of ototoxicity. This paper offers a detailed review of evidence-based research, and offers recommendations for developing and implementing an ototoxicity monitoring protocol for young infants, before and after discharge from the hospital.

The development of the vanderbilt pediatric dizziness handicap inventory for patient caregivers (DHI-PC).

PURPOSE: The purpose of the present investigation was to develop a psychometrically sound dizziness disability/handicap outcome measure for use with a pediatric population between 5 and 12 years of age. METHODS: Items comprising Phase 1 of the DHI-PC were created based on reports from parents, providers and patients. This version was administered to the caregivers (mean age 31.6 years, sd 5 years, 74 female) of 86 pediatric patients (mean age 9 years, sd=2.83 years, 45 female). The caregiver's responses to each item were limited to "yes" (scored as 4 points), "sometimes" (scored as 2 points) or "no" (scored as zero points). RESULTS: A factor analysis for Phase 1 of the scale showed there to be a single factor (eigenvalue of 11.51) that explained 29% of the total variance. The results of Cronbach's alpha analysis enabled us to eliminate 15 items reducing the scale to 25 items (i.e. Phase 2 of the DHI-PC). Following elimination of the items with low item-total coefficients, the second phase of the DHI-PC was administered to 56 legal guardians (mean patient age 8 years, sd 4.65 years, 37 female). The analysis of this data again showed there to be a single factor (eigenvalue of 8.30) that explained 33% of the variance. Four items demonstrated item-total correlations less than 0.40. The final version of the DHI-PC has 21 items and a maximum score of 84%. Short-term test-retest reliability (i.e. three week interval between test and retest) of this DHI-PC was assessed for a subset of 10 patients (caregivers, mean age 38 years, sd=7 years, 10 female). The results indicated the short-term, test-retest reliability to be strong (r=0.98, p≤0.001). CONCLUSION: The DHI-PC represents a new tool for assessing the impact of pediatric dizziness on the patient (as viewed through the perspective of the caregiver). This tool may be incorporated into the comprehensive evaluation of children suffering from dizziness.