Hostname: page-component-6766d58669-vgfm9 Total loading time: 0 Render date: 2026-05-21T19:11:00.276Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  12 July 2018

A K K Smith ,
T Sokdavy ,
C Sothea ,
M K R Pastrana ,
R F Ali ,
C T Huins ,
M P A Clark ,
J G Gollogly  and
M F Bhutta
A K K Smith*
Affiliation:
ENT Department, Gold Coast University Hospital, Southport, Queensland, Australia School of Medicine, Griffith University, Gold Coast, Australia
T Sokdavy
Affiliation:
Children's Surgical Centre, Kien Khleang Rehabilitation Centre, Phnom Penh, Cambodia
C Sothea
Affiliation:
Children's Surgical Centre, Kien Khleang Rehabilitation Centre, Phnom Penh, Cambodia
M K R Pastrana
Affiliation:
St Luke's College of Medicine, Quezon City, Philippines
R F Ali
Affiliation:
School of Medicine, Imperial College London, UK
C T Huins
Affiliation:
ENT Department, University Hospitals, Birmingham NHS Foundation Trust, UK
M P A Clark
Affiliation:
ENT Department, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
J G Gollogly
Affiliation:
Children's Surgical Centre, Kien Khleang Rehabilitation Centre, Phnom Penh, Cambodia
M F Bhutta
Affiliation:
Children's Surgical Centre, Kien Khleang Rehabilitation Centre, Phnom Penh, Cambodia ENT Department, Brighton and Sussex University Hospitals Trust, Brighton, UK
*
Author for correspondence: Dr Aaron K K Smith, ENT Department, Gold Coast University Hospital, 1 Hospital Blvd, Southport, QLD 4215, Australia E-mail: aaronkksmith@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

EducationGlobal HealthOtologic Surgical Procedures

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 8 , August 2018 , pp. 711 - 717
Copyright
Copyright © JLO (1984) Limited, 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

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.

References

1Acuin, J. Chronic Suppurative Otitis Media: Burden of Illness and Management Options. Geneva: World Health Organization, 2004Google Scholar
2Monasta, L, Ronfani, L, Marchetti, F, Montico, M, Brumatti, LV, Bavcar, A et al. Burden of disease caused by otitis media: systematic review and global estimates. PLoS One 2012;7:e36226Google Scholar
3World Health Organization. Prevention of Hearing Impairment from Chronic Otitis Media. Geneva: World Health Organization, 1996Google Scholar
4Jung, KH, Cho, YS, Hong, SH, Chung, WH, Lee, GJ, Hong, SD. Quality-of-life assessment after primary and revision ear surgery using the chronic ear survey. Arch Otolaryngol Head Neck Surg 2010;136:358–65Google Scholar
5Bhutta, MF, Williamson, IG, Sudhoff, HH. Cholesteatoma. BMJ 2011;342:d1088Google Scholar
6Unit for Prevention of Blindness and Deafness. Multi-country Assessment of National Capacity to Provide Hearing Care. Geneva: World Health Organization, 2013Google Scholar
7Palva, T, Ramsay, H. Myringoplasty and tympanoplasty--results related to training and experience. Clin Otolaryngol Allied Sci 1995;20:329–35Google Scholar
8Barrs, DM, Muller, SP, Worrndell, DB, Weidmann, EW. Results of a humanitarian otologic and audiologic project performed outside of the United States: lessons learned from the ″Oye, Amigos!” project. Otolaryngol Head Neck Surg 2000;123:722–7Google Scholar
9Horlbeck, D, Boston, M, Balough, B, Sierra, B, Saenz, G, Heinichen, J et al. Humanitarian otologic missions: long-term surgical results. Otolaryngol Head Neck Surg 2009;140:559–65Google Scholar
10Isaacson, G, Melaku, A. Results of pediatric tympanoplasty on short-term surgical missions. Laryngoscope 2015;126:1464–9Google Scholar
11Lehnerdt, G, van Delden, A, Lautermann, J. Management of an “Ear Camp” for children in Namibia. Int J Pediatr Otorhinolaryngol 2005;69:663–8Google Scholar
12Riviello, R, Ozgediz, D, Hsia, RY, Azzie, G, Newton, M, Tarpley, J. Role of collaborative academic partnerships in surgical training, education, and provision. World J Surg 2010;34:459–65Google Scholar
13Aliu, O, Pannucci, CJ, Chung, KC. Qualitative analysis of the perspectives of volunteer reconstructive surgeons on participation in task-shifting programs for surgical-capacity building in low-resource countries. World J Surg 2013;37:481–7Google Scholar
14Waller, B, Larsen-Reindorf, R, Duah, M, Opoku-Buabeng, J, Edwards, BM, Brown, D et al. Otolaryngology outreach to Komfo Anokye Teaching Hospital: a medical and educational partnership. J Laryngol Otol 2017;131:608–13Google Scholar
15Farmer, PE, Kim, JY. Surgery and global health: a view from beyond the OR. World J Surg 2008;32:533–6Google Scholar
16UNDP in Cambodia. In: http://www.kh.undp.org/content/cambodia/en/home.html [1 June 2018]Google Scholar
17The World Bank. World Development Indicators. In: https://data.worldbank.org/products/wdi [1 June 2018]Google Scholar
18Children's Surgical Centre. In: http://www.csc.org/ [6 November 2016]Google Scholar
19Clark, MP, Westerberg, BD, Mitchell, JE. Development and validation of a low-cost microsurgery Ear Trainer for low-resource settings. J Laryngol Otol 2016;130:954–61Google Scholar
20Bhutta, MF. A review of simulation platforms in surgery of the temporal bone. Clin Otolaryngol 2016;41:539–45Google Scholar
21Isaacson, G. Framework for advancing otolaryngology: head and neck surgery in Ethiopia. Otolaryngol Head Neck Surg 2014;151:634–7Google Scholar
22Redleaf, HH, Mihretu, DY, Tulu, T. Ethiopian surgical camps a win for surgeons and patients. Hear J 2016;69:24–6Google Scholar
23Isaacson, G, Drum, ET, Cohen, MS. Surgical missions to developing countries: ethical conflicts. Otolaryngol Head Neck Surg 2010;143:476–9Google Scholar
24Hardman, J, Muzaffar, J, Nankivell, P, Coulson, C. Tympanoplasty for chronic tympanic membrane perforation in children: systematic review and meta-analysis. Otol Neurotol 2015;36:796–804Google Scholar
25Kamath, MP, Sreedharan, S, Rao, AR, Raj, V, Raju, K. Success of myringoplasty: our experience. Indian J Otolaryngol Head Neck Surg 2013;65:358–62Google Scholar
26Mishra, P, Sonkhya, N, Mathur, N. Prospective study of 100 cases of underlay tympanoplasty with superiorly based circumferential flap for subtotal perforations. Indian J Otolaryngol Head Neck Surg 2007;59:225–8Google Scholar
27Ibrahim, GM, Cadotte, DW, Bernstein, M. A framework for the monitoring and evaluation of international surgical initiatives in low- and middle-income countries. PLoS One 2015;10:e0120368Google Scholar