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J Am Acad Audiol 2020; 31(03): 185-194
DOI: 10.3766/jaaa.18085
Articles
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Authors

  • Pavithra Ravi

    *   Department of Speech, Language and Hearing Sciences, Sri Ramachandra Institute for Higher Education and Research (Deemed to be University), Chennai, India

  • Vidya Ramkumar

    *   Department of Speech, Language and Hearing Sciences, Sri Ramachandra Institute for Higher Education and Research (Deemed to be University), Chennai, India

  • Akilan Rajendran

    *   Department of Speech, Language and Hearing Sciences, Sri Ramachandra Institute for Higher Education and Research (Deemed to be University), Chennai, India

  • Prasanna Kumar Saravanam

    †   Department of ENT, Head and Neck Surgery, Sri Ramachandra Institute for Higher Education and Research (Deemed to be University), Chennai, India

  • Subramaniyan Balasubramaniyan

    *   Department of Speech, Language and Hearing Sciences, Sri Ramachandra Institute for Higher Education and Research (Deemed to be University), Chennai, India

  • Roopa Nagarajan

    *   Department of Speech, Language and Hearing Sciences, Sri Ramachandra Institute for Higher Education and Research (Deemed to be University), Chennai, India
Further Information

Publication History

29 October 2018

Publication Date:
24 May 2020 (online)

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Abstract

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.

Key Words

audiological surveillance - cleft - community-based - community-based rehabilitation worker - lip and/or palate - middle ear disease - tele-audiology - video-otoscopy

We thank Transforming Faces, Canada for their funding support and Medtronic India Pvt. Ltd for equipment support.