Hearing loss often unnoticed, untreated in Singapore

Most of the otological conditions diagnosed at a community mobile hearing clinic (MHC) in Singapore are chronic, with hearing loss being the predominant auditory condition, according to a study. These conditions are often unnoticed or untreated by patients at the time of their MHC visit.

“Being situated in the community puts the MHC in the right place to capture these patients who are either knowingly or unknowingly suffering in silence,” the researchers said. “They can then be directed to the appropriate channels for the needed audiological solutions or medical attention.”

This retrospective, cross-sectional pilot study obtained clinical records of 375 patients who were seen by audiologists at a community-based MHC and required ear, nose, and throat (ENT) specialist referrals. The researchers used these records for the descriptive analysis.

Of the patients, 314 (83.73 percent) attended their ENT appointments as advised by audiologists. More than half of the patients (n=234, 57.07 percent) had one condition diagnosed by the specialist, while one had four ENT conditions: myringitis, otitis externa, allergic rhinitis, and Eustachian tube dysfunction. [Proc Singap Healthc 2021;30:286-293]

Overall, 22 types of otological conditions were detected. The four most common conditions diagnosed in this subgroup were chronic suppurative otitis media (16.36 percent), otitis externa (10.90 percent), impacted cerumen (10.90 percent), and otitis media with effusion (10.00 percent).

Twelve types of auditory conditions were identified, with asymmetrical hearing loss being the most predominant. For other ENT conditions, 16 types were found. Finally, four incidental findings of vestibular schwannoma were documented.

“Chronic discharging ears can lead to moderate conductive hearing loss, which may or may not be reversible after treatment,” the researchers said. “Impacted cerumen and otitis media were also identified as acquired causes of hearing loss by the World Health Organization.” [Ann Trop Med Parasitol 2009;103:565-571; https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss]

Of note, chronic otitis media can lead to hearing loss and intracranial complications if left untreated. [Int Med J 2012;19:84-85]

A retrospective analysis of otological diagnoses from the US nationwide emergency department (ED) system from 2009 to 2011 revealed that suppurative and unspecified otitis media were the most frequently diagnosed condition in adults (32.4 percent of 3,126,562 adults), followed by external ear disorder (28.8 percent). [Laryngoscope 2015;125:1926-1933]

In another study of 1,067 patients in the ED of a hospital in Brazil over a 1-year period, the most frequently diagnosed conditions were upper respiratory tract infection (24.55 percent), acute rhinosinusitis (16.21 percent), and tonsillitis (16.25 percent).

“The nature of the emergency setting accounts for the higher acuity of the conditions seen compared to this study which is reflective of the community-specific ENT burden,” the researchers said. “It underpins the prevalence of untreated chronic ENT conditions in the larger community.”

The current study was limited by its small sample size that came from only one hospital and the absence of statistical significance in t-test or chi-square test of significance. In addition, only descriptive analysis was presented.