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Int J Pediatr Otorhinolaryngol. 2019 Sep 5;127:109670. doi: 10.1016/j.ijporl.2019.109670. [Epub ahead of print]

Community health workers obtain similar results using cell-phone based hearing screening tools compared to otolaryngologists in low resourced settings.

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Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address:
Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Otolaryngology, University of Nairobi, Nairobi, Kenya.
Caris Foundation, Malindi, Kenya.
Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA; Caris Foundation, Malindi, Kenya.



To establish community health workers as reliable hearing screening operators in a technology-based pre-surgical hearing screening program in a low and middle-income country (LMIC).


This is a cross sectional study that evaluated community health worker driven hearing screening that took place in semi-rural Malindi, Kenya during an annual two-week otolaryngology surgical training mission in October 2017. At five separate locations (four schools) near Malindi, Kenya, children between the ages of 2-16 underwent hearing screening using screening audiometry (Android-based HearX Group). Children were screened by a community health worker who underwent a short training course, a senior otolaryngology resident, or both. Hearing screening results were compared to determine the reliability and concordance between independent, blinded community health worker and otolaryngology resident testing.


One hundred and four participants (53% males) underwent hearing screening. Hearing screening pass rate was 93%. Community health workers obtained a similar result to otolaryngology residents 96% of the time (McNemar test: p = 0.16, OR 0.96, 95% CI 0.9-1.0).


Community health workers can obtain reliable results using a technology-based, pre-surgical hearing screening platform when compared to otolaryngology residents. This finding has profound implications in low-resourced settings where hearing healthcare specialists (audiologists and otolaryngologists) are limited and can ultimately improve the surgical yield of patients presenting to local otolaryngologists in these settings.


Audiometry; Community health workers; Global health; Hearing loss; Hearing tests; Low- and middle-income countries; Low-resourced settings; Mobile health; Physician-extenders; Public health

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