PREVENTION OF HEARING IMPAIRMENT DUE TO OTITIS MEDIA

1.1 Health education material for public (posters and pamphlets).
1.2 Copy of the latest edition of the "Guidelines for the prevention of hearing impairment due to otitis media at clinic level".
1.3 Standard Treatment Guidelines on Treatment of Acute and Chronic Otitis Media at PHC

2.1 Basic equipment: auroscope with spare batteries and bulbs.

3.1 According to EDL.

4.1 Staff have continuing education on acute respiratory infections (upper and lower) as part of integrated management of childhood illnesses
4.2 Staff are able to:

4.2.1 Elicit an adequate history from mother and child (e.g. irritable, difficulty sleeping, pulling on ear, runny nose, fever, discharge of pus, snoring, delayed language development, allergy to penicillin).
4.2.2 Use an auroscope and evaluate the eardrum; always palpate lymph nodes, examine throat and test for neck stiffness and mastoid for pain, oedema or tenderness.
4.2.3 Use two hearing tests such as the Voice test and the Swart Questionnaire for babies younger than 12 months.
4.2.4 Distinguish acute otitis media, otitis media with effusion and chronic otitis media and provide relevant management for each, according to protocol.
4.2.5 Use eardrops and dry mops a discharging ear and teach mother how to do it.

5.1 Persistent or worsening signs of acute otitis media after 5 - 7 days of treatment.
5.2 Those who on first follow up still have pain or complications.
5.3 Those with effusion who have moderate or severe hearing loss, or where effusion has persisted for more than a month.
5.4 Patients with pain associated with an ear that has been discharging for more than 2 weeks.
5.5 If there is an inflammatory swelling or tenderness over mastoid.
5.6 If there is neck stiffness or vomiting or drowsiness.
5.7 Large central perforation with significant hearing loss.
5.8 Dry perforation or perforation due to trauma.
5.9 If there is pus discharge suspected to be due to a cholesteatoma.
5.10 Patients with speech, language and/or auditory perceptual problems.

6.1 Staff provide mother with instruction and follow up.
6.2 Opportunities are taken to inform community health committee and women groups that middle ear problems are very common and if not treated early can lead to hearing loss with effects on a child’s development and language skills.

7.1 All information on cases is correctly recorded in the appropriate register.
7.2 Registers are kept up to date to ensure continuity of care and recall.

8.1 The clinic has sensitised the community and receives support from the community health committee.

9.1 The clinic staff collaborate with schools, crèches to identify children with ear infection.
9.2 Clinic staffs collaborates with the clinic health committee, the civic organisations and workplaces in the catchment area to enhance health promotion.