title: Diagnostic otoscopy skills of community ear assistants in Western Nepal.
abstract: BACKGROUND
  Deafness is a major problem in developing countries. Rural communities tend to be affected more than urban ones, and chronic otitis media is common. The World Health Organization has proposed primary ear care as a method of providing otological services in developing countries. This study aimed to assess the diagnostic otoscopy skills of community ear assistants in rural Western Nepal.
  
  
  METHODS
  Community ear assistants undertook the pre-operative evaluation of 92 patients selected for middle-ear surgery in an 'ear camp' setting. The otoscopy skills of community ear assistants were also assessed by means of an otoscopy quiz. Consultant otologists and trainee otolaryngologists underwent an identical assessment.
  
  
  RESULTS
  The community ear assistants' selection of patients for middle-ear surgery concurred with the consultant otologists' opinion in 87 of 92 patients (94.5 per cent). The level of community ear assistants' otoscopy skills was between that of junior and senior otolaryngology trainees.
  
  
  CONCLUSIONS
  With intensive training, medically unqualified community ear assistants can develop otoscopy skills comparable to those of medically qualified otolaryngology trainees. These results support the development of primary ear care in poorer countries where access to specialist otological services is difficult or impossible.
authors.affiliation: Britain Nepal Otology Service, Guildford, UK. robin.youngs@glos.nhs.uk
authors.forename: R
authors.initials: R
authors.lastname: Youngs
authors.forename: N
authors.initials: N
authors.lastname: Weir
authors.forename: P
authors.initials: P
authors.lastname: Tharu
authors.forename: R B
authors.initials: RB
authors.lastname: Bohara
authors.forename: D
authors.initials: D
authors.lastname: Bahadur
mesh_terms: D000328:Adult; D002648:Child; D002983:Clinical Competence; D003153:Community Health Services / Q000458:organization & administration*; D003150:Community Health Workers / Q000193:education*; D003906:Developing Countries; D004427:Ear Diseases / Q000175:diagnosis*; D004521:Educational Measurement; D006297:Health Services Accessibility; D006801:Humans; D009390:Nepal; D010036:Otolaryngology / Q000193:education; D038781:Otoscopy; D018579:Patient Selection; D012423:Rural Health; D014944:World Health Organization