Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Nov 19;27(3S):455-461.
doi: 10.1044/2018_AJA-IMIA3-18-0015.

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

Vidya Ramkumar  1 , Akilan Rajendran  1 , Roopa Nagarajan  1 , Subramaniyan Balasubramaniyan  1 , Dhulase Krithega Suresh  1
Affiliations

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

Vidya Ramkumar et al. Am J Audiol. .

Abstract

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.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Outcome of video otoscopy. TM = tympanic membrane; ME = middle ear; MED = middle ear diseases.
Figure 2.
Figure 2.
Outcome of hearing assessment. TM = tympanic membrane; MED = middle ear diseases.
See this image and copyright information in PMC

References

    1. Biagio L., Swanepoel D. W., Adeyemo A., Hall J. W., & Vinck B. (2013). Asynchronous video-otoscopy with a telehealth facilitator. Telemedicine and E-Health, 19(4), 252–258. - PubMed
    1. Chen Y. W., Chen K. T., Chang P. H., Su J. L., Huang C. C., & Lee T.-J. (2012). Is otitis media with effusion almost always accompanying cleft palate in children?: The experience of 319 Asian patients. Laryngoscope, 122, 220–224. - PubMed
    1. Dharmar M., Simon A., Sadorra C., Friedland G., Sherwood J., Morrow H., … Marcin J. P. (2015). Reducing loss to follow-up with tele-audiology diagnostic evaluations. Telemedicine Journal and E-Health, 22(2). Epub ahead of print. https://doi.org/10.1089/tmj.2015.0001 - PubMed
    1. Dhillon R. S. (1988). The middle ear in cleft palate children pre and post palatal closure. Journal of the Royal Society of Medicine, 81(12), 710–713. - PMC - PubMed
    1. Flynn T., Möller C., Jönsson R., & Lohmander A. (2009). The high prevalence of otitis media with effusion in children with cleft lip and palate as compared to children without clefts. International Journal of Pediatric Otorhinolaryngology, 73(10), 1441–1446. - PubMed

MeSH terms