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Lovett B, Welschmeyer A, Johns JD, Mowry S, Hoa M. Health Disparities in Otology: A PRISMA-Based Systematic Review. Otolaryngol Head Neck Surg 2021; 166:1229-1237. [PMID: 34488507 DOI: 10.1177/01945998211039490] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Social determinants of health (SDOHs), including but not limited to sex, race, socioeconomic status, insurance status, and education level, play a significant role in health disparities and affect health outcomes. The purpose of this systematic review is to examine health disparities in otology within the United States and highlight areas warranting further research. DATA SOURCES PubMed, Ovid MEDLINE. REVIEW METHODS Our search encompassed all years through January 10, 2021. All peer-reviewed primary literature of any design and publication date regarding health disparities and otology outcomes in the United States was eligible for inclusion. Eligibility assessment was performed via 3 independent investigators. RESULTS Of the 6326 unique abstracts identified, 188 studies underwent full-text review, and 52 remained in the final review. The most frequently examined otologic condition was hearing loss (36.5%), followed by cochlear implantation (28.8%) and infection/effusion (15.4%). Vertigo/dizziness (1.9%), Ménière's disease (1.9%), and tinnitus (1.9%) were the least represented otologic conditions. Comprehensive articles on multiple disparity topics were the most common (n = 18), followed by articles on race/ethnicity (n = 11) and socioeconomic status (n = 9). Language (n = 2), education (n = 2), and gender (n = 1) were the least discussed. Over 5-fold the number of articles were published between 2011 and 2020 compared to the preceding decade (42 vs 8). CONCLUSION This study captures the existing literature regarding health disparities and outcomes in otology. The lack of robust data suggests the need for future quality studies aimed at investigating disparities in otologic care, as well as a broader push for recording and reporting SDOHs.
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Affiliation(s)
- Braeden Lovett
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - James Dixon Johns
- Department of Otolaryngology and Head and Neck Surgery, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Sarah Mowry
- Department of Otolaryngology, Case Western Reserve University School of Medicine, Ohio, USA
| | - Michael Hoa
- Department of Otolaryngology and Head and Neck Surgery, Medstar Georgetown University Hospital, Washington, DC, USA
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Khoza-Shangase K, Ramdin N. Audiological function in a group of adults following myringoplasty: an exploratory study in South Africa. Pan Afr Med J 2019; 34:57. [PMID: 31803343 PMCID: PMC6876893 DOI: 10.11604/pamj.2019.34.57.11714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 08/01/2019] [Indexed: 11/26/2022] Open
Abstract
Introduction Chronic suppurative otitis media is a global middle ear disease with quality of life as economic implications, which are worse felt in low and middle income (LAMI) countries; thus the need for myringoplasty. This study aimed to explore audiological function in a group of adults following myringoplasty in South Africa, with an exploration of the possible influence of factors such as HIV/AIDS and type of surgical technique on hearing outcomes. Methods Within a retrospective chart review research design, 41 participant files for a six-year period from two academic hospitals in Johannesburg, South Africa, were reviewed. Data were analysed using both descriptive and inferential statistics. Results Participant files comprised of 16 males and 25 females between 18-63 years. Findings revealed that clinically, overall hearing improved post-operatively, as indicated by improved tympanometry findings, pure tone air-conduction and speech reception thresholds. Descriptively, the predictors of improved hearing outcomes post-operatively appeared to be HIV negative status and butterfly cartilage inlay surgery as a surgical technique adopted. Although clinically, hearing outcomes improved post-operatively at all air-conduction frequencies tested; these clinical improvements were only statistically significant at specific frequencies. Conclusion Current findings provide useful initial evidence on the benefits of myringoplasty from the South African context; particularly because of the HIV/AIDS prevalence and its potential influence on middle ear disease and its management. Prospective efficacy studies with bigger sample sizes are recommended, with early identification strategies for middle ear disease to reduce the need for myringoplasty seriously considered bearing in mind the resource constraints.
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Affiliation(s)
- Katijah Khoza-Shangase
- Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Namita Ramdin
- Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
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Surgical treatment of chronic ear disease in remote or resource-constrained environments. The Journal of Laryngology & Otology 2018; 133:49-58. [DOI: 10.1017/s0022215118002165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackgroundSurgery for chronic suppurative otitis media performed in low- and middle-income countries creates specific challenges. This paper describes the equipment and a variety of techniques that we find best suited to these conditions. These have been used over many years in remote areas of Nepal.Results and conclusionExtensive chronic suppurative otitis media is frequently encountered, with limited pre-operative investigation or treatment possible. Techniques learnt in better-resourced settings with good follow up need to be modified. The paper describes surgical methods suitable for resource-poor conditions, with rationales. These include methods of tympanoplasty for subtotal wet perforations, hearing reconstruction in wet ears and open cavities, large aural polyps, and canal wall down mastoidectomy with cavity obliteration. Various types of autologous ossiculoplasty are described in detail for use in the absence of prostheses. The following topics are discussed: decision-making for surgery on wet or best hearing ears, children, bilateral surgery, working with local anaesthesia, and obtaining adequate consent in this environment.
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Avnstorp MB, Homøe P, Bjerregaard P, Jensen RG. Chronic suppurative otitis media, middle ear pathology and corresponding hearing loss in a cohort of Greenlandic children. Int J Pediatr Otorhinolaryngol 2016; 83:148-53. [PMID: 26968069 DOI: 10.1016/j.ijporl.2016.01.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 12/24/2015] [Accepted: 01/16/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Otitis media (OM) has been observed at elevated prevalence rates in Greenlandic children. OM associated hearing loss (HL) may compromise the children's linguistic skills, social development and educational achievements. OBJECTIVES We investigated the prevalence of chronic suppurative otitis media (CSOM), otitis media with effusion (OME) and tympanic membrane sequelae of OM, and compared the corresponding hearing thresholds. METHODS In 2010 we examined a cohort of 223 Greenlandic children aged 4-10 years by video otoscopy, tympanometry and tested hearing thresholds for the low-frequencies: 500, 1000 and 2000Hz and the high-frequencies: 4000 and 6000Hz. HL was categorized according to the worst hearing ear and was compared within the groups: CSOM, OME, tympanic membrane sequelae of OM and normal. RESULTS Of 207 children, 5.8% had CSOM, 13.9% had OME and 55.6% had tympanic membrane sequelae of OM. The median pure tone average in low-frequencies/high-frequencies were: CSOM: 34.2/31.3dB, OME: 23.3/22.5dB, Sequelae of OM: 13.3/15dB and normal ears: 11.7/12.5dB. We found a significant difference (p<0.05) between the four groups. In 56.5% of all children a HL>15dB in any frequency was found, while 6.5% suffered from a bilateral low-frequency HL>25dB. CONCLUSION The severity of OM significantly corresponded to increased HL. The burden of CSOM and HL remains high in young Greenlandic children. Aggressive treatment with antibiotics, improved hearing rehabilitation, sound field amplification in classrooms and otosurgical capacity should be further promoted in Greenland.
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Affiliation(s)
- Magnus Balslev Avnstorp
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Denmark.
| | - Preben Homøe
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Denmark; Department of Otorhinolaryngology and Maxillofacial Surgery, Køge University Hospital, University of Copenhagen, Denmark
| | - Peter Bjerregaard
- National Institute of Public Health, Centre for Health Research in Greenland, University of Southern Denmark, Odense, Denmark
| | - Ramon Gordon Jensen
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Denmark; Department of Otorhinolaryngology and Maxillofacial Surgery, Køge University Hospital, University of Copenhagen, Denmark
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Isaacson G, Melaku A. Results of pediatric tympanoplasty on short-term surgical missions. Laryngoscope 2015; 126:1464-9. [PMID: 26227177 DOI: 10.1002/lary.25486] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 05/15/2015] [Accepted: 06/08/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Glenn Isaacson
- Department of Otolaryngology-Head & Neck Surgery
- Department of Pediatrics; Temple University School of Medicine; Philadelphia Pennsylvania U.S.A
| | - Abebe Melaku
- Department of Otolaryngology; Addis Ababa University School of Medicine; Addis Ababa Ethiopia
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Shrime MG, Sleemi A, Ravilla TD. Charitable platforms in global surgery: a systematic review of their effectiveness, cost-effectiveness, sustainability, and role training. World J Surg 2015; 39:10-20. [PMID: 24682278 PMCID: PMC4179995 DOI: 10.1007/s00268-014-2516-0] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE This study was designed to propose a classification scheme for platforms of surgical delivery in low- and middle-income countries (LMICs) and to review the literature documenting their effectiveness, cost-effectiveness, sustainability, and role in training. Approximately 28 % of the global burden of disease is surgical. In LMICs, much of this burden is borne by a rapidly growing international charitable sector, in fragmented platforms ranging from short-term trips to specialized hospitals. Systematic reviews of these platforms, across regions and across disease conditions, have not been performed. METHODS A systematic review of MEDLINE and EMBASE databases was performed from 1960 to 2013. Inclusion and exclusion criteria were defined a priori. Bibliographies of retrieved studies were searched by hand. Of the 8,854 publications retrieved, 104 were included. RESULTS Surgery by international charitable organizations is delivered under two, specialized hospitals and temporary platforms. Among the latter, short-term surgical missions were the most common and appeared beneficial when no other option was available. Compared to other platforms, however, worse results and a lack of cost-effectiveness curtailed their role. Self-contained temporary platforms that did not rely on local infrastructure showed promise, based on very few studies. Specialized hospitals provided effective treatment and appeared sustainable; cost-effectiveness evidence was limited. CONCLUSIONS Because the charitable sector delivers surgery in vastly divergent ways, systematic review of these platforms has been difficult. This paper provides a framework from which to study these platforms for surgery in LMICs. Given the available evidence, self-contained temporary platforms and specialized surgical centers appear to provide more effective and cost-effective care than short-term surgical mission trips, except when no other delivery platform exists.
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Affiliation(s)
- Mark G Shrime
- Harvard Interfaculty Initiative in Health Policy, 14 Story Street, 4th Floor, Cambridge, MA, 02138, USA,
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Optimising the pre-treatment process before mobile ear surgery for chronic suppurative otitis media in Wolisso and Attat, Ethiopia. The Journal of Laryngology & Otology 2014; 128:421-4. [DOI: 10.1017/s002221511400098x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground:Chronic suppurative otitis media is a major cause of long-standing hearing impairment in many Sub-Saharan African countries.Methods:Attempts were made to optimise the pre-treatment process before mobile ear surgery for chronic suppurative otitis media in Wolisso, a semi-urban community in the Oromia region, and in Attat, a rural community in the Gurage region, both in the south-west of Ethiopia, between 2008 and 2010. This included special training for ENT nurses, and the use of a strict scheduling regime and improved topical treatment.Results and conclusion:This strategy allowed effective middle-ear surgery to be carried out using simple means and with a mobile ear surgery team, the latter of which is only transiently but regularly on site.
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Gyebre YMC, Ouedraogo RWL, Elola A, Ouedraogo BP, Sereme M, Ouattara M, Ouoba K. Epidemiological and Clinical Aspects and Therapy of Chronic Otitis Media in the "ENT" and Cervicofacial Surgery Ward in the University Hospital of Ouagadougou. ISRN OTOLARYNGOLOGY 2013; 2013:698382. [PMID: 24066241 PMCID: PMC3770051 DOI: 10.1155/2013/698382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 07/18/2013] [Indexed: 11/17/2022]
Abstract
Objectives. The aim of this study was to analyze the epidemiological and clinical aspects of chronic otitis media and its therapeutic processes in our context. Patients and Methods. In a prospective study over a period of 1 year (March 2009-February 2010), 79 patients with chronic otitis media have been cared for in the otolaryngology ward of the University Hospital of Ouagadougou. Results. Chronic otitis media (COM) commonly occurs in the age group from 0 to 15 years (40.50%). Otorrhea was the main reason for consultation in 53 cases (67.10%); the most frequently encountered clinicopathological forms were simple COM (71%) followed by otitis media with effusion (24.30%). Intra-auricular instillations of traditional products (46.09%) were the dominant favoring factor. Treatment was essentially through medication in 59 cases with a stabilization of lesions. Endotemporal complications were noticed in 6 cases. Conclusion. The fight against chronic otitis media is carried out through preventive measures of education the of people.
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Affiliation(s)
- Y. M. C. Gyebre
- Department of Otolaryngology (ENT) and Cervico-Facial Surgery (CFS), “Yalgado Ouedraogo” University Hospital (CHU-YO), 03 BP 7022, Ouagadougou 03, Burkina Faso
- Faculty of Health Sciences (FHS), 03 BP 7021, Ouagadougou 03, Burkina Faso
| | - R. W.-L. Ouedraogo
- Department of Otolaryngology (ENT) and Cervico-Facial Surgery (CFS), “Yalgado Ouedraogo” University Hospital (CHU-YO), 03 BP 7022, Ouagadougou 03, Burkina Faso
| | - A. Elola
- Department of ENT and CFS, “Souro Sanou ” Hospital (CHU-SS), Bobo-Dioulasso, Burkina Faso
| | - B. P. Ouedraogo
- Department of Otolaryngology (ENT) and Cervico-Facial Surgery (CFS), “Yalgado Ouedraogo” University Hospital (CHU-YO), 03 BP 7022, Ouagadougou 03, Burkina Faso
| | - M. Sereme
- Department of Otolaryngology (ENT) and Cervico-Facial Surgery (CFS), “Yalgado Ouedraogo” University Hospital (CHU-YO), 03 BP 7022, Ouagadougou 03, Burkina Faso
| | - M. Ouattara
- Department of Otolaryngology (ENT) and Cervico-Facial Surgery (CFS), “Yalgado Ouedraogo” University Hospital (CHU-YO), 03 BP 7022, Ouagadougou 03, Burkina Faso
| | - K. Ouoba
- Department of Otolaryngology (ENT) and Cervico-Facial Surgery (CFS), “Yalgado Ouedraogo” University Hospital (CHU-YO), 03 BP 7022, Ouagadougou 03, Burkina Faso
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Mitton C, Dionne F, Masucci L, Wong S, Law S. Innovations in health service organization and delivery in northern rural and remote regions: a review of the literature. Int J Circumpolar Health 2011; 70:460-72. [PMID: 22030009 DOI: 10.3402/ijch.v70i5.17859] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To identify and review innovations relevant to improving access, quality, efficiency and/or effectiveness in the organization and delivery of health care services in rural and remote areas. STUDY DESIGN Literature review. METHODS Key bibliographic databases that index health research were searched: MEDLINE, EMBASE and CINAHL. Other databases relevant to Arctic health were also accessed. Abstracts were assessed for relevancy and full articles were reviewed and categorized according to emergent themes. RESULTS Many innovations in delivering services to rural and remote areas were identified, particularly in the public health realm. These innovations were grouped into 4 key themes: organizational structure of health services; utilization of telehealth and ehealth; medical transportation; and public health challenges. CONCLUSIONS Despite the challenges facing rural and remote regions, there is a distinctly positive message from this broad literature review. Evidence-based initiatives exist across a range of areas - which include operational efficiency and integration, access to care, organizational structure, public health, continuing education and workforce composition - that have the potential to positively impact health care quality and health-related outcomes.
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Affiliation(s)
- Craig Mitton
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
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Niclasen B, Mulvad G. Health care and health care delivery in Greenland. Int J Circumpolar Health 2010; 69:437-47. [PMID: 21118636 DOI: 10.3402/ijch.v69i5.17691] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To describe the health care system and health care delivery in Greenland. STUDY DESIGN AND METHOD This was a literature study that included literature and articles searched in PubMed published from 1989 to 2009 about health care in Greenland. RESULTS The health care system is a publicly financed governmental responsibility. Its major challenges are limited economic resources, Greenland's demographic structure, rapid epidemiological changes, increased public demand for specialized treatment, difficulty in recruiting professionals and the economic burden imposed by around-the-clock maintenance of specialized staff in sparsely populated areas. To meet these challenges, a public health program focusing on health promotion and prevention, educational initiatives to improve recruitment and a system reorientation moving towards larger health care regions is proposed to be gradually implemented from 2010. One fundamental component of this plan is tying the system together with a telemedicine system and in the future also with a joint electronic patient file system. The importance of better surveillance and monitoring of health has been recognized, while securing best clinical practice and implementing better steering instruments on resource allocation and quality are areas needing focus in the future. CONCLUSION Many of the challenges for the Greenlandic health care system are being addressed with promising strategies, but only the future will show whether they are successful.
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Abstract
Otitis media (OM) is a common illness in young children. OM has historically been associated with frequent and severe complications. Nowadays it is usually a mild condition that often resolves without treatment. For most children, progression to tympanic membrane perforation and chronic suppurative OM is unusual (low-risk populations); this has led to reevaluation of many interventions that were used routinely in the past. Evidence from a large number of randomized controlled trials can help when discussing treatment options with families. Indigenous children in the United States, Canada, Northern Europe, Australia, and New Zealand experience more OM than other children. In some places, Indigenous children continue to suffer from the most severe forms of the disease. Communities with more than 4% of the children affected by chronic tympanic membrane perforation have a major public health problem (high-risk populations). Higher rates of invasive pneumococcal disease, pneumonia, and chronic suppurative lung disease (including bronchiectasis) are also seen. These children will often benefit from effective treatment of persistent (or recurrent) bacterial infection.
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Outcome of mobile ear surgery units in Thailand. The Journal of Laryngology & Otology 2009; 124:382-6. [PMID: 19930779 DOI: 10.1017/s0022215109991836] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To evaluate the outcome of mobile ear surgery, in terms of tympanic membrane perforation closure, absence of otorrhoea and hearing threshold improvement. STUDY DESIGN Descriptive study. METHODS The study enrolled patients with chronic ear disorders requiring surgery who presented to the mobile ear surgery unit at Sakaeo Hospital, Thailand, from 1 to 4 July 2008. The following data were recorded: pre-operative audiogram, post-operative middle-ear and mastoid infection, wound infection, graft condition, any complications, and post-operative audiogram. Patients were followed up at one week, two weeks, four weeks and 24 weeks post-operatively. RESULTS For the 31 cases of tympanic membrane perforation, the closure rate was 90.3 per cent. For the 32 patients with otorrhoea, the rate of ear dryness was 87.5 per cent. All 35 patients had impaired hearing initially; the rate of hearing improvement was 74.3 per cent (95 per cent confidence intervals = 56.7-87.5 per cent). Patients' mean hearing improvement was 22.9 dB. CONCLUSION The assessed ear surgery procedures had good results.
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Mobile, one stage, bilateral ear surgery for chronic otitis media patients in remote areas. The Journal of Laryngology & Otology 2009; 123:1108-13. [PMID: 19575840 DOI: 10.1017/s0022215109005738] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We evaluated the results of mobile, one stage, bilateral ear surgery conducted in Greenland, where chronic otitis media with and without suppuration is prevalent. The study aimed to increase the number of operations conducted and to reduce the cost of ear surgery in remote areas. MATERIALS AND METHODS The study was longitudinal and prospective, with a two-year follow up. Seventeen East Greenlandic patients with bilateral chronic suppurative otitis media or chronic otitis media were selected. Their median age was 16 years; 53 per cent were female and 47 per cent male. Hearing was assessed using median air conduction pure tone average gain, and the 'take rate' (i.e. the percentage of total ears with a closed perforation) was evaluated. RESULTS All patients attended for follow up. Eighty-two per cent had at least one perforation closed, and the overall take rate was 65 per cent of the 34 ears. The median air conduction pure tone average gain after two years was 18 dB and 13 dB for the right and left ears, respectively. Fourteen patients (82 per cent) obtained an air conduction pure tone average hearing level of < or =25 dB in at least one ear. In total, 71 per cent of the patients were satisfied. There were no hearing hazards. CONCLUSIONS The results of mobile, one stage, bilateral ear surgery conducted in Greenland for long-lasting chronic suppurative otitis media and chronic otitis media were acceptable and safe, and more ears underwent surgery at reduced cost compared with unilateral ear surgery.
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