title: School entry level tele-hearing screening in a town in South India - Lessons learnt.
abstract: BACKGROUND
  School screening is warranted in developing countries that do not have newborn hearing screening as schools provide access to a large number of young children between 3 and 5 years of age. Due to scarcity of technical manpower and equipment, hearing screening programs are not often conducted in developing countries. In these circumstances, telehealth services appear to be a reasonable solution. Consequently, the purpose of this study was to assess the feasibility of school hearing screening using telehealth technology operated by a practitioner located 400 kms away at a distant hospital.
  
  
  METHODS
  Thirty one children received hearing screening procedures in their school. Each child was screened for both in-person and telehealth conditions to assess screening results. Remote computing software was employed for the telehealth condition in order for the practitioner to remotely operate an audiometer, DPOAE system and a video otoscope interfaced to a personal computer at the school site.Teamviewer version 10 was used to provide encrypted videoconferencing and synchronous hearing screening services between the hospital and school sites. All screening was conducted using a mobile phone hotspot or dongle device based internet connection to insure reliable connectivity.
  
  
  RESULTS
  The outcome revealed no significant difference between PTA and DPOAE performed in-person and tele-hearing screening methods. Concurrence of greater than 87% was achieved between in-person and tele-video-otoscopy. Strengths and challenges were documented for tele-hearing screening in three different dimensions: technical issues, child related and school related. Understanding these challenges may provide more effective tele-audiology services.
  
  
  CONCLUSIONS
  The results of the study indicate synchronous hearing screening services can be provided in a school setting using mobile hotspot or dongle connectivity in locations where Internet bandwidth is otherwise restricted.
authors.affiliation: Department of Speech, Language & Hearing Sciences, Sri Ramachandra University, India.
authors.forename: Saleth D
authors.initials: SD
authors.lastname: Monica
authors.affiliation: Department of Speech, Language & Hearing Sciences, Sri Ramachandra University, India. Electronic address: vidya.ramkumar@sriramachandra.edu.in.
authors.forename: Vidya
authors.initials: V
authors.lastname: Ramkumar
authors.affiliation: Music & Speech, Kent State University, Ohio, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Krumm
authors.affiliation: Department of Speech, Language & Hearing Sciences, Sri Ramachandra University, India.
authors.forename: Nitya
authors.initials: N
authors.lastname: Raman
authors.affiliation: Department of Speech, Language & Hearing Sciences, Sri Ramachandra University, India.
authors.forename: Roopa
authors.initials: R
authors.lastname: Nagarajan
authors.affiliation: Department of Speech, Language & Hearing Sciences, Sri Ramachandra University, India.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Venkatesh
mesh_terms: D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D005240:Feasibility Studies; D005260:Female; D006320:Hearing Tests / Q000379:methods*; D006801:Humans; D007194:India; D007231:Infant, Newborn; D020407:Internet; D008297:Male; D008403:Mass Screening / Q000379:methods*; D012574:Schools; D017216:Telemedicine / Q000379:methods*
keywords: Hearing; India; School screening; Telehealth