Paediatric ear disease and hearing loss in the Solomon Islands

According to the World Health Organisation (WHO), around 90% of the global burden of hearing loss is found in Low- and Middle-Income Countries (LMICs).  It is estimated that 75% of childhood hearing loss in LMICs is preventable.  Otitis media (OM) and infectious diseases that may be avoided through immunisations are the leading causes of preventable hearing loss in children.  Given the well-known adverse effects of hearing loss in childhood development, the WHO is leading global efforts to address the burden of hearing loss in children through public health measures.  Newborn and Infant Hearing Screening (NIHS) and school-based hearing screening programmes are key strategies that should facilitate early identification and intervention for children with hearing disorders.There is very little in the audiology literature on childhood hearing loss in the Pacific Islands.  Yet, this region is estimated to have among the highest global burden of OM and disabling hearing loss.  The limited literature indicates that OM begins early in life, and may quickly progress to advanced/chronic stages of disease and potentially fatal complications.  Ear, Nose and Throat (ENT) and audiology services are virtually non-existent throughout the Pacific Islands, and public health measures such as community ear/hearing screening programmes may be a feasible option until more sophisticated ENT/audiology services become available.The Solomon Islands are a Pacific Island nation that is currently developing the outreach service of the ENT Clinic at the National Referral Hospital in the capital city, Honiara.  The present study was developed to assess community engagement and readiness for ear/hearing screening programmes for children, as well as to assess the prevalence of OM and hearing loss among children in Honiara.  Should the results of the study indicate that OM and hearing loss are a significant public health issue among children, and that caregivers are supportive of ear/hearing services, the recommendation for routine community-based ear/hearing screening programmes in Honiara will be justified.Parental knowledge and attitudes to childhood hearing loss and hearing services was assessed through semi-structured interviews with 150 parents attending community clinics in Honiara.  The highest level of  parental knowledge found regarding causes of hearing loss was for OM (94%).  Knowledge of routine childhood immunisations (84%) and breast-feeding (76%) as public health measures to reduce/prevent OM were also high.  The knowledge of fathers was generally the same or better than that of mothers.  Approximately half of participants (56%) agreed that curses may cause childhood hearing loss.  There was high parental support for infant hearing screening programmes (96%) and school-based ear and hearing health examinations (99.3%).  Overall, the results of the study showed excellent community support and readiness for community-based ear/hearing services.The WHO recommends that NIHS should be the goal of all member states.  In the Solomon Islands context, an interim infant hearing screening programme was assessed through ear examination and administration of the JCIH Risk-Factor Questionnaire (Developing Countries) to 288 infants attending Child Welfare Clinics in Honiara.  Overall, 150 infants (52.1%) presented with bilateral normal ear examinations and no risk-factors for sensorineural hearing loss.  There were 73 infants (25.4%) with ear pathology in at least one ear, 13 (4.5%) of whom required referral to the ENT Clinic for medical management.  The most common pathology was Otitis Media with Effusion (OME) (21.9%).  There were 71 infants (24.7%) with at least one risk-factor for sensorineural hearing loss.  The most common risk-factors were ototoxicity (8.3%), non-elective caesarean delivery (6.6%), and possible in-utero syphilis infection (5.6%).  The results of the study indicated that implementation of an interim Infant Ear and Hearing Programme is warranted.The WHO recommends school hearing screening programmes to address the burden of OM and hearing loss among primary school students.  A total of 604 government and non-government primary school students in Honiara were seen for school-based ear examinations.  Students who did not pass their screening assessment were referred to the hospital ENT/Audiology Clinic for further assessment and intervention.  A total of 342 students (56.6%) did not pass their school-based ear examination.  The most common pathologies were OME (34.2%), impacted cerumen (22.8%), and Chronic Suppurative Otitis Media (CSOM) (3.1%).  The follow-up attendance rate at the ENT/Audiology Clinic was 81.1%.  Among students with OME in at least one ear, 50% failed audiometry in the affected ear.  The results of the study indicated that the implementation of School Ear and Hearing Programmes is warranted.Overall, the present research project found that there is high caregiver support for community-based ear/hearing services for children.  The prevalence studies of OM and hearing loss among infants and primary school students in Honiara indicated that OM is a significant public health problem in the Solomon Islands.  The implementation of Ear and Hearing Programmes for infants and students is recommended to address the burden of ear disease and hearing loss in the country.  The results of the present study may be translational to other Pacific Island nations, where the prevalence of OM is high and formal audiology services are limited or non-existent.