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Implementation and results of a surgical training programme for chronic suppurative otitis media in Cambodia

  • A K K Smith (a1) (a2), T Sokdavy (a3), C Sothea (a3), M K R Pastrana (a4), R F Ali (a5), C T Huins (a6), M P A Clark (a7), J G Gollogly (a3) and M F Bhutta (a3) (a8)...

Chronic suppurative otitis media is a massive public health problem in numerous low- and middle-income countries. Unfortunately, few low- and middle-income countries can offer surgical therapy.


A six-month long programme in Cambodia focused on training local surgeons in type I tympanoplasty was instigated. Qualitative educational and quantitative surgical outcomes were evaluated in the 12 months following programme completion. A four-month long training programme in mastoidectomy and homograft ossiculoplasty was subsequently implemented, and the preliminary surgical and educational outcomes were reported.


A total of 124 patients underwent tympanoplasty by the locally trained surgeons. Tympanic membrane closure at six weeks post-operation was 88.5 per cent. Pure tone audiometry at three months showed that 80.9 per cent of patients had improved hearing, with a mean gain of 17.1 dB. The trained surgeons reported high confidence in performing tympanoplasty. Early outcomes suggest the local surgeons can perform mastoidectomy and ossiculoplasty as safely as overseas-trained surgeons, with reported surgeon confidence reflecting these positive outcomes.


The training programme has demonstrated success, as measured by surgeon confidence and operative outcomes. This approach can be emulated in other settings to help combat the global burden of chronic suppurative otitis media.

Corresponding author
Author for correspondence: Dr Aaron K K Smith, ENT Department, Gold Coast University Hospital, 1 Hospital Blvd, Southport, QLD 4215, Australia E-mail:
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Dr A K K Smith takes responsibility for the integrity of the content of the paper

Presented at the Coalition for Global Hearing Health Conference, 23–25 October 2016, Manila, Philippines, and at the 19th International Symposium on Recent Advances in Otitis Media, 4–8 June 2017, Gold Coast, Australia.

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