Tele-Audiological Surveillance of Middle Ear Status among Individuals with Cleft Lip and/or Palate in Rural South India.

BACKGROUND: A community-based program for the comprehensive management of communication disorders among individuals with cleft lip and/or palate (CLP) was implemented in two rural districts in the state of Tamil Nadu, India. The program was successful in terms of early surgical repair, orthodontic management and speech correction; however, audiological surveillance was challenging due to poor follow-up rates. PURPOSE: The aim of the study was to compare tele-audiological and in-person audiological surveillance to identify the most beneficial approach for the identification and treatment of middle ear disease (MED) in individuals with CLP in this rural community-based program. RESEARCH DESIGN: Quasi-experimental study. STUDY SAMPLE: All beneficiaries older than 5 years actively seeking services in Cuddalore (n = 44) and Thiruvannamalai (n = 65) districts of Tamil Nadu, India, were included in the study. Individuals in Cuddalore district were assigned to the tele-audiological surveillance group, whereas individuals in Thiruvannamalai district were assigned to the in-person audiological surveillance group. METHODS: In the tele-audiological surveillance group, video-otoscopy examinations were performed by trained community-based rehabilitation workers (CBRWs). Pure-tone audiometry and tympanometry were performed by an audiologist from the tertiary care hospital through remotely accessed equipment using broadband internet at the participants' homes and monthly camps. Findings from those with suspected MED were forwarded to the otolaryngologist at the tertiary care hospital for remote diagnoses and treatment plans. Subsequently, CBRWs relayed the otolaryngologist's recommendations to the individuals receiving services at the community. In the in-person audiological surveillance group, video-otoscopy, pure-tone audiometry, and tympanometry were performed by the audiologist following standard testing procedures at monthly camps. Individuals with suspected MED and impacted cerumen were referred for in-person diagnoses and treatment plans. Follow-up audiological surveillance was conducted in both districts after implementation of the otolaryngologist's recommendations. DATA ANALYSIS: The coverage, follow-up rate for intervention and cost-outcomes from the provider's perspective were analyzed and compared between two groups. RESULTS: Tele-audiological surveillance provided superior coverage (68%) compared with in-person audiological surveillance (38%). The tele-audiological surveillance group showed greater follow-up compliance (61%) than the in-person audiological surveillance group (19%) for treatment plans such as cerumen management and hearing aid fitting provided locally. Compared with in-person audiological surveillance, tele-audiological surveillance resulted in cost saving of USD 47 per individual. CONCLUSION: Tele-audiological surveillance was beneficial for the purpose of identifying and providing treatment in patients having CLP with MEDs in rural locations.

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

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.

Planning community-based intervention for speech for children with cleft lip and palate from rural South India: A needs assessment.

BACKGROUND AND AIM: A community-based rehabilitation programme, Sri Ramachandra University-Transforming Faces project, was initiated to provide comprehensive management of communication disorders in individuals with CLP in two districts in Tamil Nadu, India. This community-based programme aims to integrate hospital-based services with the community-based initiatives and to enable long-term care. The programme was initiated in Thiruvannamalai (2005) district and extended to Cuddalore (2011). The aim of this study was to identify needs related to speech among children with CLP, enroled in the above community-based programme in two districts in Tamil Nadu, India. DESIGN: This was a cross-sectional study. PARTICIPANTS AND SETTING: Ten camps were conducted specifically for speech assessments in two districts over a 12-month period. Two hundred and seventeen individuals (116 males and 101 females) >3 years of age reported to the camps. METHODS: Investigator (SLP) collected data using the speech protocol of the cleft and craniofacial centre. Descriptive analysis and profiling of speech samples were carried out and reported using universal protocol for reporting speech outcomes. Fleiss' Kappa test was used to estimate inter-rater reliability. RESULTS: In this study, inter-rater reliability between three evaluators revealed good agreement for the parameters: resonance, articulatory errors and voice disorder. About 83.8% (n = 151/180) of the participants demonstrated errors in articulation and 69% (n = 124/180) exhibited abnormal resonance. Velopharyngeal port functioning assessment was completed for 55/124 participants. CONCLUSION: This study allows us to capture a "snapshot" of children with CLP, living in a specific geographical location, and assist in planning intervention programmes.