Ramkumar Vidya, Rajendran Akilan, Nagarajan Roopa, Balasubramaniyan Subramaniyan, Suresh Dhulase Krithega
Department of Speech, Language & Hearing Science, Sri Ramachandra Medical College and Research Institute (Deemed to be University), Chennai, India.
Am J Audiol. 2018 Nov 19;27(3S):455-461. doi: 10.1044/2018_AJA-IMIA3-18-0015.
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.
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.
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.
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.
本研究旨在制定一项基层策略，用于在印度南部泰米尔纳德邦两个农村地区针对唇腭裂患者的社区项目中识别和管理中耳疾病。
社区工作者接受了使用ENTraview设备进行视频耳镜检查的培训。社区工作者对社区中160名年龄在3至35岁之间的唇腭裂患者进行了视频耳镜检查。使用存储转发远程医疗实践来识别中耳状况。对于那些被诊断为鼓膜（TM）和/或中耳疾病（MED）的患者，使用同步纯音听力测定和鼓室图进行诊断性远程听力评估。对13个月期间收集的数据进行了回顾，以评估覆盖率和后续干预率。
该项目在实施13个月内成功实现了80%的鼓膜和中耳疾病识别覆盖率。在接受视频耳镜检查的患者中，26%（82/320耳）被诊断为鼓膜和/或中耳疾病。对42名患有鼓膜和/或中耳疾病患者的耳朵进行了远程听力评估；其中52%（22/42耳）的患者有轻度、中度或重度听力损失。关于干预的后续跟进，78%的患者符合手术干预条件，31%的患者符合药物治疗条件。
这种基层远程医疗方法成功实现了更高的覆盖率，存储转发远程医疗实践有助于耳鼻喉科医生为农村社区所有患有鼓膜/中耳疾病的患者提供远程诊断和建议。耳科干预的后续跟进情况比前几年有了显著改善。
