Contents lists available at ScienceDirect International Journal of Pediatric Otorhinolaryngology journal homepage: www.elsevier.com/locate/ijporl Community health workers obtain similar results using cell-phone based hearing screening tools compared to otolaryngologists in low resourced settings Justin R. Shinn a,∗ , M. Geraldine Zuniga a , Ian Macharia b , Jim Reppart c , James L. Netterville a,c , Asitha D.L. Jayawardena a a Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA b Department of Otolaryngology, University of Nairobi, Nairobi, Kenya c Caris Foundation, Malindi, Kenya ARTICLE INFO “Technology-Driven Community Health Care Worker-Based Hearing Screening in Rural Kenya.” American Academy of Otolaryngology Annual Meeting. Podium presentation. Atlanta, Georgia. 2018. Keywords: Global health Public health Low-resourced settings Low- and middle-income countries Hearing loss Hearing tests Audiometry Mobile health Community health workers Physician-extenders ABSTRACT Objective: To establish community health workers as reliable hearing screening operators in a technology-based pre-surgical hearing screening program in a low and middle-income country (LMIC). Methods: This is a cross sectional study that evaluated community health worker driven hearing screening that took place in semi-rural Malindi, Kenya during an annual two-week otolaryngology surgical training mission in October 2017. At five separate locations (four schools) near Malindi, Kenya, children between the ages of 2–16 underwent hearing screening using screening audiometry (Android-based HearX Group). Children were screened by a community health worker who underwent a short training course, a senior otolaryngology resident, or both. Hearing screening results were compared to determine the reliability and concordance between independent, blinded community health worker and otolaryngology resident testing. Results: One hundred and four participants (53% males) underwent hearing screening. Hearing screening pass rate was 93%. Community health workers obtained a similar result to otolaryngology residents 96% of the time (McNemar test: p = 0.16, OR 0.96, 95% CI 0.9–1.0). Conclusion: Community health workers can obtain reliable results using a technology-based, pre-surgical hearing screening platform when compared to otolaryngology residents. This finding has profound implications in low- resourced settings where hearing healthcare specialists (audiologists and otolaryngologists) are limited and can ultimately improve the surgical yield of patients presenting to local otolaryngologists in these settings. 1. Introduction Disabling hearing loss (HL) is one of the most prevalent health conditions in the world, estimated to affect 6.1% of the world's popu- lation with nearly 90% of these individuals living in the developing world [1,2]. This is especially important as the countries with the greatest functional, social, and economic burden are the same countries that are the least able to provide basic care and early intervention for this disability. In 2017, due to the projected global rates of HL, the World Health Organization has advocated for member states to imple- ment strategies for hearing and ear protection under universal health- care [3]. Unfortunately, in low- and middle-income countries (LMICs), there are not an adequate number of healthcare providers available to screen children for hearing loss and there are a vast number of at-risk children who require early identification and treatment [4–6]. Recent technologic developments make possible the use of a vali- dated portable audiologic examination to facilitate basic hearing- screening that can provide audiologic data in the hands of local vo- lunteers who have no audiology or otolaryngology training [2,7–10]. To date, however, specialty-trained otolaryngologists supervised and guided these evaluations. Furthermore, the reliability of these results has not been compared between individuals with various levels of training. In order to efficiently scale this screening technology, the ef- ficacy of community health workers (CHWs) and other non-specialty trained providers needs to be established. Due to the automated nature of many of these portable audiometry platforms, non-audiology and https://doi.org/10.1016/j.ijporl.2019.109670 Received 9 June 2019; Received in revised form 1 September 2019; Accepted 3 September 2019 ∗ Corresponding author. Vanderbilt University Medical Center Department of Otolaryngology, 7209 Medical Center East – South Tower, 1215 21st Avenue South, Nashville, TN, 37232-8605, USA. E-mail address: justin.r.shinn@vumc.org (J.R. Shinn). International Journal of Pediatric Otorhinolaryngology 127 (2019) 109670 Available online 05 September 2019 0165-5876/ © 2019 Elsevier B.V. All rights reserved. T