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10/25/2016 | 9:45 AM - 11:00 AM | Outcomes from a Novel In-country Training Program for Surgical Treatment of Chronic Suppurative Otitis Media | BGPOP Building 402/403/404

Outcomes from a Novel In-country Training Program for Surgical Treatment of Chronic Suppurative Otitis Media

BBackground: Chronic suppurative otitis media is an under-resourced disease affecting 65 million to 330 million individuals worldwide, with over 90% of disease borne by low-income and middle-income countries. Many cases of chronic suppurative otitis media can be cured only by surgical intervention, but few low-income and middle-income countries have the resources or expertise to offer this intervention. In some locations, ENT surgeons from high-income countries undertake short-term visits to provide treatment, but this model fails to develop local capacity and expertise. We devised and evaluated a novel and sustainable in-country training program for surgical therapy of chronic suppurative otitis media in Cambodia. Method: Between 2014 and 2016, we instigated a training programme in surgery at the Children’s Surgical Centre in Phnom Penh. This programme utilised two recently qualified ENT surgeons from the United Kingdom to train local surgeons, with each trainer in residence for 4 to 6 months. Training was provided in both tympanoplasty and tympanomastoidectomy. We evaluated outcomes through qualitative data on self-reported confidence of trainee surgeons, and through quantitative data on success rates and audiological outcomes of tympanoplasty performed by these surgeons in the first year after completion of training. Results: Both of the Cambodian-trained surgeons reported high confidence in performing tympanoplasty. A total of 124 patients underwent tympanoplasty in the study period. Surgical success (closure of the tympanic membrane) at six weeks post-operation was 88.50%, and pure-tone audiometry at three months showed that 80.85% of patients had improved hearing, with a mean gain of 17.13dB. Conclusion: Our training programme has demonstrated success, as measured by surgeon confidence and by objective measures of operative outcomes, with operative outcomes as good as or better than those reported in the world literature. The local surgeons have now begun to train other Cambodian surgeons, evidencing that this is a high quality and sustainable model for developing in-country expertise in the surgical therapy of chronic suppurative otitis media.

Training of local surgeons in the surgical management of chronic suppurative otitis media within a developing country
Surgical management of chronic suppurative otitis media
Sustainable design of a permanent otolaryngology surgical service in a developing country

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Presenters/Authors

Aaron Smith (), Children's Surgical Centre, Phnom Penh, aaronkksmith@gmail.com;
Trained at Griffith University, School of Medicine, Australia. Currently working as a junior doctor at Cairns Base Hospital, Cairns, Australia. Volunteered at the Children’s Surgical Centre, Kien Khleang National Rehabilitation Centre, Phnom Penh, Cambodia in 2015 with continued correspondence regarding the development of the newly developed ENT surgical service.