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Management of an "Ear Camp" for children in Namibia
Goetz Lehnerdt1, Anneke van Delden, Juergen Lautermann
1Department of Otorhinolaryngology, University of Duisburg-Essen, Germany. goetz.lehnerdt@uni-essen.de
Insights
This study reports on an "Ear Camp" in Namibia, improving hearing for 38 children with tympanic membrane defects. Surgical interventions led to an average 15 dB air conduction improvement, with ongoing training for local doctors.
Area of Science:
- Otolaryngology
- Global Health
- Surgical Missions
Background:
- Limited medical coverage for ear problems in northern Namibia.
- High prevalence of (sub)total tympanic membrane defects in children.
Purpose of the Study:
- To describe experiences managing an
- Ear Camp
- in a low-resource setting.
- To evaluate surgical outcomes for pediatric ear conditions.
Main Methods:
- Conducted 38 surgeries over 10 days, primarily tympanoplasty types I and III.
- Utilized various ossicular chain reconstruction techniques, including titanium prostheses (PORP/TORP) and cartilage.
- Performed antrotomy and mastoidectomy in select cases for cholesteatoma management.
Main Results:
- Follow-up on 31 children showed a 15 dB average improvement in air conduction thresholds.
- Five cases experienced tympanic membrane defects post-surgery due to discharge.
- Successful tympanic membrane reconstruction using tragal cartilage.
Conclusions:
- Surgical techniques and perioperative care must be adapted to resource limitations.
- Initiated training for local doctors in pre- and postoperative ear surgery care.
- Commitment to continued training and future
- Ear Camp
- initiatives.
Objective:
In this publication, we present our experiences with managing an "Ear Camp" in northern Namibia, where the population is predominantly black. Medical coverage for ear problems is poor in this part of the country.
Methods:
Within 10 days, 38 children (median age 12 years) were operated mainly for (sub) total defects of the tympanic membrane. In two cases, an open cavity had to be created because of a cholesteatoma. We performed a tympanoplasty type I in 18 cases and a tympanoplasty type III in 20 cases. Additionally, in 8 cases an antrotomy and in another 8 cases a mastoidectomy was performed. The ossicular chain was reconstructed with a titanium-PORP (14 cases), a titanium-TORP, interposition of the head of the malleus or a cartilage columella (one case each) or by placing the reconstructed tympanic membrane directly onto the head of the stapes (three cases). The tympanic membrane was reconstructed by the use of tragal cartilage with overlapping perichondrium in underlay-technique.
Results:
Thirty-one children could be followed up. A defect of the tympanic membrane was found in five cases because of continuous purulent discharge. The average improvement of air conduction thresholds in the frequencies between 250 and 4000 Hz was 15 dB.
Conclusions:
Surgical techniques, antibiotic treatment and perioperative management have to be adapted to limited possibilities of pre-treatment and aftercare. As development aid should support people to look after themselves, we started to instruct local doctors with regard to pre- and postoperative care in ear surgery. Training of the local doctors will be continued in our next "Ear Camp" in 2004.
