Community-based ear and hearing care

Research question: How can we best enable community-based ear and hearing care? Background: Ear disease and hearing loss are prevalent and under-recognised disorders, with 80% of the 1.6 billion worldwide with hearing loss living in Low and Middle-Income Countries (LMICs). Although hearing aids may help many, they will fail to support two of the most disadvantaged groups living with hearing loss: those with chronic suppurative otitis media (CSOM) and those congenitally deaf. These individuals suffer poor access to care and stigma, with effects to individuals, communities, and society. Aims and objectives: 1. To evaluate the lived experience of individuals living with CSOM and children who are deaf, and the attitudes knowledge and beliefs of their families, teachers and community, to ensure current and future interventions are sensitive to their needs. 2. To evaluate the effectiveness and uptake of interventions for community-based ear and hearing care: topical iodine for ear discharge in people with CSOM, low-cost bone conduction headsets for people with CSOM, and digital sign-language dictionaries for empowering Deaf culture. 3. To train four PhD researchers in our partner countries (Malawi, Cambodia, Zambia) to become the academic leaders of the future in this field. 4. To develop a global academic team that will lead future research in ear and hearing, focused on real world change, through impact on healthcare policy and practice. Methods: Our work will be in four work packages (WP), each aligned to a PhD, and working in communities in Zambia, Malawi and Cambodia. WP1 will used interviews, art and story-telling to explore the lived experience of adults and children living with CSOM to understand their knowledge beliefs and attitudes, as well as those of family members and community. WP2 will be a randomised controlled trial of self-directed topical treatment for ear discharge in 480 adults and children with CSOM, with a view to understanding (in particular) if self-administered topical iodine is an effective treatment in the short and long-term. WP3 will be a trial of a low cost bone-conducting headset in a direct-to-consumer models, as a means to rehabilitate hearing loss in 150 adults and children with hearing loss due to CSOM. WP4 will be a qualitative analysis of the lived experiences of children who are deaf in LMICs with a view to understanding enablers or barriers to empowerment and self-determination, and an exploration of the potential for a tech-based platform for sign language in this space. Timelines for delivery: In the first year, the first 3 months will be project set-up, the next 3 obtaining regulatory and ethical approval, the next 3 undertaking study design and community engagement, and the final 3 performing pilot studies. In year two we will recruit to each project. In year three we will complete recruitment and students will write up their thesis. In year four write up will complete and the project team will author an overall project report and engage with stakeholders and policy makers to instigate real world change. Impact and dissemination: The work we are proposing represents a potential step-change in enabling community-based care for ear and hearing care, and overcoming barriers to access. It also promises to build a strong and sustainable global academic partnership in this under-researched area.