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Diagnostic accuracy of non‐specialist versus specialist health workers in diagnosing hearing loss and ear disease in Malawi
Author(s) -
Bright Tess,
Mulwafu Wakisa,
Phiri Mwanaisha,
Ensink Robbert J. H.,
Smith Andrew,
Yip Jennifer,
Mactaggart Islay,
Polack Sarah
Publication year - 2019
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13238
Subject(s) - audiometer , audiologist , medicine , gold standard (test) , hearing loss , audiometry , audiology , officer , ear disease , medical diagnosis , family medicine , pathology , political science , law
Objective To determine whether a non‐specialist health worker can accurately undertake audiometry and otoscopy, the essential clinical examinations in a survey of hearing loss, instead of a highly skilled specialist (i.e. ENT or audiologist). Methods A clinic‐based diagnostic accuracy study was conducted in Malawi. Consecutively sampled participants ≥ 18 years had their hearing tested using a validated tablet‐based audiometer (hearTest) by an audiologist (gold standard), an audiology officer, a nurse and a community health worker ( CHW ). Otoscopy for diagnosis of ear pathologies was conducted by an ENT specialist (gold standard), an ENT clinical officer, a CHW , an ENT nurse and a general nurse. Sensitivity, specificity and kappa ( κ ) were calculated. 80% sensitivity, 70% specificity and kappa of 0.6 were considered adequate. Results Six hundred and seventeen participants were included. High sensitivity (>90%) and specificity (>85%) in detecting bilateral hearing loss was obtained by all non‐specialists. For otoscopy, sensitivity and specificity were >80% for all non‐specialists in diagnosing any pathology except for the ENT nurse. Agreement in diagnoses for the ENT clinical officer was good ( κ = 0.7) in both ears. For other assessors, moderate agreement was found ( κ = 0.5). Conclusion A non‐specialist can be trained to accurately assess hearing using mobile‐based audiometry. However, accurate diagnosis of ear conditions requires at least an ENT clinical officer (or equivalent). Conducting surveys of hearing loss with non‐specialists could lower costs and increase data collection, particularly in low‐ and middle‐income countries, where ENT specialists are scarce.