This study reveals that balloon dilatation is a very promising method offering a new approach to the problem of Eustachian tube dysfunction. – even in children. From Germany, which has a very high rate of balloon dilation of the Eustachian tube, this report cautions that there is a lack of evidence-base medicine for a precise definition of indications, lack of control groups, and consensus about criteria for defining success. This procedure should be considered experimental until there is proof of safety and efficacy. Read more of this article edited and annotated by Dr. Charles Bluestone.
The role of acetic acid irrigation in medical management of chronic suppurative otitis media is the subject of a comparative study. The study also reviews medical management of chronic suppurative otitis media (CSOM), essential for dry ear surgical treatment. Chronic otitis media treatments are also reviewed. In India, which has a high rate of chronic suppurative otitis media and associated with serious complications, aural toilet (cleaning) of the ear and administration of acetic acid irrigation was found to be superior to oral and topical antibiotics, which is very cost-effective in a developing nation. Read more of this article edited and annotated by Dr. Charles Bluestone.
Patients who receive olfactory training (OT) improve discrimination and identification of smells, according to a recent study published in Laryngoscope magazine.
“This paper describes the first significantly effective treatment of olfactory loss ever,” according to SMED advisor Dr. Karl Bernd Huttenbrink. The professor is one of the specialists who conducted the study from the Department of Otolaryngology, University of Cologne, Cologne, Germany.
OT is based on the theory that olfactory function appears to be influenced by repeated odor stimulation. OT was used to treat post-infectious olfactory dysfunction (PIOD) in this study, which is commonly due to infections in the upper respiratory tract.
Participants were tested using the “Sniffin’ Sticks” method – odor threshold, odor discrimination, and odor identification. They were placed into groups and asked to smell rose, eucalyptol, citronellal, lemon, cloves and other primary odorous substances over two periods of 16 weeks.
The groups also sniffed four felt-tip pens for 15 seconds, twice in the morning and twice in the evening. They were asked to keep a diary to rate overall olfactory abilities. Participants received high and low odor concentrations during this period for comparison. The investigator did not know group member identities.
Read more: of this article.
Antihistamine use for otitis media with effusion(OME) has ongoing opportunities for quality improvement. This treatment method continues to be a subject for articles even after almost 35 years of clinical trials that failed to show efficacy and were associated with an unacceptable rate of side effects. Oral antihistamines are significantly more likely to be administered when OME is diagnosed. Read more of this article edited and annotated by Dr. Charles Bluestone.
Originally from Zimbabwe, “I spent most of my working life – after a somewhat extensive and varied training – as a Paediatric ENT surgeon in the Red Cross War Memorial Children’s Hospital in Cape Town, South Africa,” he says.
“Towards the end of my working life there, I developed a vision for trying to do something to improve ENT services in the Central African region of Zambia, Zimbabwe and Malawi where such services were desperately needed,” he said.
In Zimbabwe, Dr. Prescott has been involved in setting up a training program for ENT surgeons. “Three ENT surgeons have returned after training outside the country to strengthen to pool of expertise,” he explains. “To date, eight doctors are enrolled in the program with the first two graduates emerging next year.”
“There is a desperate shortage of audiologists, and funding has been found to start a training program for audiologists and speech therapists at the medical school which hopefully will begin next year,” he says.
Called “Centre of Excellence,” a mission hospital is also being established in Lusaka in Zambia with an ENT surgeon and an audiologist.
Another “Centre of Excellence” is being established at a mission hospital in Madagascar with an ENT surgeon and a Physician Audiologist.
The third “Centre of Excellence” is an audiology clinic being established in the Central Hospital attached to the Medical School. This is near completion and will soon be open. This clinic will be headed by a new graduate who is returning to his country as a Malawian ENT surgeon. A second Malawian clinic is being started in this region.
“A medical-school-based program to train ENT surgeons has just been approved by the university and first recruits will start training next year. Another program is about to start to train village health workers to identify and refer people with ear disease and hearing problems,” says Prescott.
These centres are sponsored by Christian Blind Mission (CBM). “They historically had been concerned with blindness but are now developing an interest in ENT – particularly with respect to deafness,” he explains.
The Malawi project is exciting because the Centre is slated to be the base for expansion of ENT services throughout the country as part of a National Plan for the Ear Disease and Deafness.
“In Malawi, the backbone health care personnel are the medical assistants – the equivalent of the Asian ‘Barefoot Doctors’,” Prescott explains. A training program was established to train these medical assistants to become ENT Clinical Officers.
“To date, there have been 30 graduates from the program who have been deployed to various hospitals throughout the country to provide ENT services,” he says.
“Wherever you find poverty, you find middle ear disease, pretty much,” says Paul Higginbotham, CEO of the Earbus foundation of Western Australia.
The bus is funded by government grants and carries a team, consisting of an audiologist, ENT specialist, nurse practitioner and general practitioner, to children in remote communities of Western Australia who suffer from middle ear disease.
The team provides education and training, medication, surgery lifts, postoperative follow-up, hearing screenings, ear irrigation and wax removal, Betadine treatment for infected ears, as well as general medical care.
“Otitis media is a nasty disease, but in and of itself just a disease, except for its impact on development,” he says. “If we can restore children to their full potential to learn and succeed at school, then we’ve beat the disease.”
“People in aboriginal communities suffer from middle ear disease at ten times the rate of non-aboriginal Australians,” adds Lara Shur, the team’s audiologist and speech pathologist.
“We’re raising the profile of ear disease in aboriginal communities,” by educating families, teachers and childcare workers, says Higginbotham. “We’ve seen something of a tolerance as ear disease being a natural part of childhood, and something you can’t really do much about.”
“Most of the reasons are related to the social determinant of health,” says Shur. “So, poverty is the primary reason. Issues like breastfeeding, access to clean water. There are maybe 16 children in one home, excluding a number of adults.”
Genetic factors also influence the prevalence of otitis media in communities, for both aboriginal and non-aboriginal residents, explains Shur.
“From North to South is a couple of thousand miles, and from East to West it’s about 1500 miles. It’s a huge area – the heart of Western Europe, so getting services into these regions is a real challenge,” explains Higginbotham.
The team visits small towns and communities in the region of Goldfields-Esperance, 370 miles East of Perth, on a monthly basis.
Another region served by the team is in Pilbara, 1000 miles north of Perth. “This is a remote community with aboriginal settlements. They don’t get much by way of health services,” says Higginbotham.
“Most of the children had discharge in the ears – green pus,” Shur explains. “For example, 40 children had green pus in the ear, and now we have two ears that are discharging. That’s an example of a performance indicator of the changes we’ve seen.”
The World Health Organization (WHO) benchmark for otitis media is 4 percent of the population. “There was one remote community where 86 percent of the children could not pass the hearing screening due to otitis media,” says Higginbotham.
“I would be confident to say that in 12 months, we’ve reduced the number of discharging ears in otitis media to about 90 percent,” he says.
The Earbus program was started in February 2014, by Dr. Harvey Coates, ENT specialist, and SMED advisor. It was modeled after a similar service operating in New Zealand during the 1980s.
The current Earbus partners with Aboriginal Medical Services in Kalgoorlie, Port Hedland, Maya and Bega Gambirringu to provide mobile clinics and medication.
“We’re trying to be a catalyst for change,” Higginbotham explains. “To build capacity in aboriginal health services and communities to take over – so educating elders, teachers and children to understand the disease, and to play a proactive role in managing it.”
The Earbus is in the process of receiving a state-funded, hospital-based contract to screen infants in remote areas of Western Australia. The first program of this kind originated in Colorado.
“Every neonate is now screened at birth depending on whether they have permanent hearing loss. This is done in the UK, Europe, New Zealand, Canada, and the US – all babies in the Western World,” explains Higginbotham.
The Earbus website is: http://www.earbus.org. The full Earbus article will appear in the upcoming SMED online newsletter.