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Comprehensive Otolaryngology

(288) Is Screening Enough? Follow-up on a Kenyan Hearing Screening Initiative

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Kelsey E. Richard, Other

    Resident Physician
    Madigan Army Medical Center
    Nashville, Tennessee, United States

    • Co-Author(s)

  • Rory J. lubner, MD

    Physician Resident
    Vanderbilt University Medical Center
    Nashville, TN, USA

  • Julia R. Brennan, MD

    Department of Otolaryngology - Head and Neck Surgery
    Vanderbilt University Medical Center
    Nashville, Tennessee, United States

  • Kristen Yancey, MD

    Assistant Professor
    Weill Cornell Medical Center
    New York, New York, United States

  • Ankita Patro, MD

    Resident Physician
    Vanderbilt University Medical Center, USA

    • Senior Author(s)

  • James l. Netterville, MD

    Professor of Head and Neck Oncology, Director of Head and Neck Oncologic Services
    Vanderbilt University Medical Center
    Nashville, TN, USA

Disclosure(s):
Kelsey E. Richard, Other: No relevant relationships to disclose.
Kristen Yancey, MD: No relevant relationships to disclose.


Introduction: Pediatric hearing loss impacts speech and language acquisition and ultimately education and future employment. In 2018-2019, our team deployed a hearing screening program for school-aged children in Kilifi, Kenya. The COVID-19 pandemic prevented follow up until October 2022, at which time we aimed to identify whether our initial screening initiative led families to seek further care.

Methods: Hearing screenings were conducted at Kilifi County schools and churches using HearScope, a validated mobile device with audiometry and otoscopic examination. In addition, children and families were surveyed about interim follow up and continued otologic symptoms. If abnormal findings were found, appropriate referrals were made to a local ENT or audiologist.

Results: Among 155 children initially screened in 2018 and 2019, 15 had unilateral or bilateral hearing loss, 45 had abnormal findings on otologic exam, and 8 had both hearing loss and an abnormal exam. At follow up screenings in 2022, four participating schools could not be reached, and four churches were no longer in operation. Of 12 individuals identified from the initial cohort of 68 children, 7 (58%) had persistent otologic abnormalities including otosclerosis, drainage, effusions, and retractions. Four (33%), 2 (17%), and 1 (8%) reported seeing an ENT, undergoing complex otologic surgery, and tympanostomy tube placement, respectively. One child who previously underwent bilateral tympanoplasty had bilateral otitis media and externa during our repeat screening. The following ear symptoms were noted by 8 (67%) children: drainage (n=8), otalgia (n=6), aural pressure/fullness (n=6), infections (n=4), worsening hearing (n=4), and dizziness (n=5). These children were referred to a local ENT and given topical antibiotics when indicated.

Conclusions: A hearing screening program in underserved areas can successfully identify children with hearing loss and ear abnormalities, but many children needing further care did not adequately follow up. Screening should be linked with providers and facilities that can offer accessible follow up and coordinate care.