Hearing screening program for school going children in India: necessity, justification, and suggested approaches

Background
It is estimated that about 15% of students have transient hearing loss worldwide sufficient enough to interfere with communication, psychosocial relationship, and learning resulting in poor educational achievement and poverty. However, these conditions are reversible through timely detection and effective interventions. India is home to the largest number of school age children with hearing impairment, and majority of them remain undetected and untreated due to the absence of any dedicated hearing screening program. Therefore, this paper attempts to convince all stakeholders for planning and implementing early detection and intervention program for children with hearing impairment in school settings.

Methods
Recent literature estimates that children between the ages 0 and 14 years contribute 25.9% of the total Indian population. As per the global estimates of the prevalence of hearing impairment, India houses the largest number of school age children with hearing impairment. Many of them either remain out of school or perform poorly in school curriculum.

Results
The children in educational programs are readily and easily available for applying hearing screening procedures to detect hearing impairment and instituting audiological and educational remedial measures. But unfortunately, India has not yet envisaged any dedicated early detection and intervention program for school-going children consequently majority of children with hearing impairment undetected and untreated in the classroom.

Conclusion
Hearing impairment is a serious health concern among school age children which can adversely impact on communication, educational achievement, and vocational options. However, screening approaches for early identification in school age children across the world which are simple, effective, and cost-efficient can be considered for countries like India to reverse the ill effects of hearing impairment.

Potential implication
The paper may heighten the awareness among school personnel, educational administrators, and policymakers to consider planning and implementation of early detection and intervention program for children with hearing impairment in school settings.

Harnessing the power of artificial intelligence to transform hearing healthcare and research

The advances in artificial intelligence that are transforming many fields have yet to make an impact in hearing. Hearing healthcare continues to rely on a labour-intensive service model that fails to provide access to the majority of those in need, while hearing research suffers from a lack of computational tools with the capacity to match the complexities of auditory processing. This Perspective is a call for the artificial intelligence and hearing communities to come together to bring about a technological revolution in hearing. We describe opportunities for rapid clinical impact through the application of existing technologies and propose directions for the development of new technologies to create true artificial auditory systems. There is an urgent need to push hearing towards a future in which artificial intelligence provides critical support for the testing of hypotheses, the development of therapies and the effective delivery of care worldwide.

Maternal knowledge and attitudes to childhood hearing loss and hearing services in the Pacific Islands: A cross-sectional survey protocol for urban and rural/remote Samoa

Introduction
The successful implementation of ear and hearing health services for children depends on the support and engagement of primary caregivers. The World Health Organization recommends childhood hearing screening programs for all member states to enable early detection and intervention for children with hearing loss. Ear and hearing specialists are limited in the Pacific Islands, a region with one of the highest global rates of ear disease and hearing loss. Given that a significant proportion of childhood hearing loss is preventable through public health measures, collaboration with health promotion activities is recommended to improve primary caregiver knowledge of avoidable ear and hearing disorders among infants and young children. Previous work has examined the knowledge and attitudes of parents in an urban Pacific Island settings, and this study will investigate for differences between urban and rural/remote Pacific Island populations.

Study design
Cross-sectional survey.

Methods
Questionnaire administered to mothers attending immunization clinics with their infants in urban (Apia) and rural/remote (Savai’i) Samoa. A 25-item questionnaire was formally translated from the original English into Samoan by an accredited translator in collaboration with an Ear, Nose and Throat registered nurse. It will be administered in a semi-structured interview style by a Health Promotion Officer in Samoan. The participating mothers are required to respond with ‘yes,’ ‘no,’ or ‘unsure.’ The questions assess knowledge of biomedical etiology of hearing impairment (9 questions), beliefs regarding non-biomedical etiology of hearing impairment (2 questions), knowledge of otitis media and its risk factors (5 questions), knowledge of hearing loss identification and intervention (4 questions), and attitudes towards hearing services for children (6 questions).

Results
Not applicable. Data to be collected.

Conclusion
We publish these protocols to facilitate similar studies in other Low- and Middle-Income Countries, and especially among our Pacific Island neighbours.

Ethical Dilemmas in Surgical Mission Trips During the COVID-19 Pandemic

This case is hypothetical and does not involve real patients or actual entities.

A long-running otolaryngology surgical teaching mission to Haiti was postponed in 2020 due to a combination of Haitian travel restrictions and American-based university travel bans during the coronavirus disease 2019 (COVID-19) pandemic. Several months have passed since the postponement of this recurring trip, and the local Haitian ear, nose, and throat (ENT) team has reached out to the international surgical teaching team to express their desire for surgical mission trips to return. The backlog of patients that the local team feels could not be treated without assistance continues to grow.

The COVID-19 vaccine is now available in the United States, and most US-based health care practitioners have been vaccinated, including all medical volunteers involved in this trip. University-based travel bans have also been lifted. Few Haitian health care providers have been vaccinated. Local Haitian travel restrictions are no longer being enforced, and it is legally possible to travel to the island. The international team has obtained enough personal protective equipment (PPE) to run a self-sufficient trip, but local PPE resources remain scarce.

Should the international surgical team restart mission work at this time? If so, what criteria need to be met for humanitarian organizations to provide safe and ethical care in the COVID-19 era when global inequality remains regarding vaccine distribution?

Going Global: Interest in Global Health Among US Otolaryngology Residents

Background: To meet the rising interest in surgical global health, some surgical residency programs offer global health experiences. The level of interest in these programs, however, and their role in residency recruitment and career planning has not been systematically evaluated.

Objective: (1) Define interest in global health among Otolaryngology residents in the USA. (2) Assess engagement of Otolaryngology residencies in global health training. (3) Determine barriers to global health training in residency.

Methods: A survey questionnaire was developed and sent to all Otolaryngology Residency Program Directors for distribution to all current Otolaryngology residents in the US.

Results: A total of 91 complete surveys were collected. A majority of respondents felt that global health was either “very important” or “extremely important” (67%). Two-thirds of respondents had prior global health experience (68%). While 56% of respondents would definitely participate in a global health elective and 78% would likely or definitely participate, only 37% of residency programs offered a global health experience. The availability of a global health elective significantly correlated with residency match choice in respondents with previous global health experience. The three most common barriers to participation were insufficient time, insufficient funding, and lack of program.

Conclusion: Participation in bilateral and equitable international electives is a unique experience of personal and professional growth. There is an interest in these opportunities during residency training among Otolaryngology residents that is not reflected in availability within training programs. This suggests the need for development of humanitarian outreach exposure through global health experiences during surgical residency training.

Global head and neck surgery research during the COVID pandemic: A bibliometric analysis

Background
Before the COVID-19 pandemic, access to otolaryngology and head-and-neck surgery was limited in low- and middle-income countries (LMICs). The pandemic has increased the burden on LMIC health systems by causing unanticipated expenses, delayed care, and changes in research activity. We aimed to assess the landscape of global ENT research during the pandemic.

Materials and methods
The authors developed a search strategy composed of the following keywords: “otolaryngology,” “head and neck surgery,” and “low- and middle-income countries.” Then, they searched eleven citation databases via the Web of Science from January 01, 2020, to May 03, 2021. They imported the result as metadata into VosViewer and ran bibliometric analyses to identify the most influential institutions, countries, and themes.

Results
During the study period, 3077 articles were published. Two hundred eighty-nine articles (9%) mentioned COVID-19 explicitly. The second most common theme was pediatric ENT (223 articles, 7%). The United States had the most publications [1616 articles, 12,033 citations, and 2986 total link strength (TLS)], followed by China (336 articles, 10,981 citations, and 571 TLS). South Africa, the first African country, was fourth (302 articles, 699 citations, and 908 TLS), while Brazil, the first South American country, was seventh (158 articles, 582 citations, and 376 TLS). The most prolific institution was the National Institute of Allergy and Infectious Diseases (186 articles, 1110 citations, and 674 TLS).

Conclusion
COVID-19 was the most common research theme during the pandemic, surpassing pediatric ENT.

Feasibility of establishing an infant hearing screening program and measuring hearing loss among infants at a regional referral hospital in south western Uganda

Introduction
Despite the high burden of hearing loss (HL) globaly, most countries in resource limited settings lack infant hearing screening programs(IHS) for early HL detection. We examined the feasibility of establishing an IHS program in this setting, and in this pilot program measured the prevalence of infant hearing loss (IHL) and described the characteristics of the infants with HL.

Methods
We assessed feasibility of establishing an IHS program at a regional referral hospital in south-western Uganda. We recruited infants aged 1 day to 3 months and performed a three-staged screening. At stage 1, we used Transient Evoked Oto-acoustic Emissions (TEOAEs), at stage 2 we repeated TEOAEs for infants who failed TEOAEs at stage 1 and at stage 3, we conducted Automated brainstem responses(ABRs) for those who failed stage 2. IHL was present if they failed an ABR at 35dBHL.

Results
We screened 401 infants, mean age was 7.2 days (SD = 7.1). 74.6% (299 of 401) passed stage 1, the rest (25.4% or 102 of 401) were referred for stage 2. Of those referred (n = 102), only 34.3% (35 of 102) returned for stage 2 screening. About 14.3% (5/35) failed the repeat TEOAEs in at least one ear. At stage 3, 80% (4 of 5) failed the ABR screening in at least one ear, while 25% (n = 1) failed the test bilaterally. Among the 334 infants that completed the staged screening, the prevalence of IHL was 4/334 or 12 per 1000. Risk factors to IHL were Newborn Special Care Unit (NSCU) admission, gentamycin or oxygen therapy and prematurity.

Conclusions
IHS program establishment in a resource limited setting is feasible. Preliminary data indicate a high prevalence of IHL. Targeted screening of infants at high risk may be a more realistic and sustainable initial step towards establishing IHS program s in a developing country like Uganda.

Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study

Peri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery within 0–2 weeks, 3–4 weeks and 5–6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3–4.8), 3.9 (2.6–5.1) and 3.6 (2.0–5.2), respectively). Surgery performed ≥ 7 weeks after SARS‐CoV‐2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9–2.1)). After a ≥ 7 week delay in undertaking surgery following SARS‐CoV‐2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2–8.7) vs. 2.4% (95%CI 1.4–3.4) vs. 1.3% (95%CI 0.6–2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS‐CoV‐2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay

Otitis media with effusion in Africa‐prevalence and associated factors: A systematic review and meta‐analysis

Objectives
To estimate the overall and subgroup prevalence of otitis media with effusion (OME) in Africa, and identify setting‐specific predictors in children and adults.

Methods
PubMed, African Journals Online, African Index Medicus, Afrolib, SciELO, Embase, Scopus, Web of Science, The Cochrane Library, GreyLit and OpenGray were searched to identify relevant articles on OME in Africa, from inception to December 31st 2019. A random‐effects model was used to pool outcome estimates.

Results
Overall, 38 studies were included, with 27 in meta‐analysis (40 331 participants). The overall prevalence of OME in Africa was 6% (95% CI: 5%‐7%; I2 = 97.5%, P < .001). The prevalence was 8% (95% CI: 7%‐9%) in children and 2% (95% CI: 0.1%‐3%) in adolescents/adults. North Africa had the highest prevalence (10%; 95% CI: 9%‐13%), followed by West and Southern Africa (9%; 95% CI: 7%‐10% and 9%; 95% CI: 6%‐12% respectively), Central Africa (7%; 95% CI: 5%‐10%) and East Africa (2%; 95% CI: 1%‐3%). There was no major variability in prevalence over the last four decades. Cleft palate was the strongest predictor (OR: 5.2; 95% CI: 1.4‐18.6, P = .02). Other significant associated factors were age, adenoid hypertrophy, allergic rhinitis in children, and type 2 diabetes mellitus, low CD4 count in adults.

Conclusion
OME prevalence was similar to that reported in other settings, notably high‐income temperate countries. Health care providers should consider age, presence of cleft palate, adenoid hypertrophy and allergic rhinitis when assessing OME in children and deciding on a management plan. More research is required to confirm risk factors and evaluate treatment options.

A Novel and Simple Technique of Reconstructing the Central Arch Mandibular Defects-a Solution During the Resource-Constrained Setting of COVID Crisis

The current COVID 19 pandemic has a major impact on healthcare delivery globally. Oral cancer involving anterior arch of mandible is difficult to reconstruct and ideally, requires free fibular osteomyocutaneous flap. During this time of resource constraint situation, these free flaps are not a great choice, as it increases exposure of both patient and surgical team to the deadly virus. We are describing a novel method of reconstruction after resection of oral cancer involving anterior arch of mandible. In this new technique, we have reconstructed central arch defect by hanging bipaddle pectoralis major myocutaneous flap with orbicularis oris muscle using ethylene terephthalate suture. Operative time, early postoperative complications and early cosmetic and functional outcome were assessed. We have used this novel technique in eight patients of T4a oral cancer involving anterior arch of mandible and skin over chin. Mean operative time was 180 min. One patient had minor flap loss with surgical site infection (Clavien-Dindo grade I). In all patients, we were able to discharge all patients on eighth postoperative day. Cosmetic outcome and functional outcomes were mostly satisfactory. All patients were able to oppose their lips without any oral incompetence and drooling. Tongue mobility was good. There was no incidence of ‘Andy Gump deformity’. This is a feasible option for reconstructing anterior arch defect in resource- and time-limited setting of COVID 19 pandemic. This technique can also be used in comorbid conditions where it is not advisable to do very long surgery.