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Primary ear & hearing care

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These activities will be covered in the WHO skill's session. This page provides an outline of expectations for both students and facilitators.

For Facilitators

The facilitators’ role in this course is essential. The facilitators need to provide context for students and need to provide them with the practical skills that every healthcare worker should have to provide high quality primary ear care.

The activities have been well described and provide a basic outline of what is expected from both facilitators and students.

Being a health professional is about more than diagnosing and treating conditions. Excellent health professionals should display the following attributes: professionalism, good communication skills, the ability to form collaborations with others, leadership, and health advocacy.

Much of health education focusses on knowledge. We would like to include professionalism, communication skills, collaborative ideas and health advocacy in this course.

We aim to improve professionalism by contextualizing the importance ear and hearing care and thereby discussing empathy and an approach to patients. And by facilitating their interaction with patients through the skills that they are required to learn, including history taking and counselling.

The students will be required to interview a patient with hearing loss. This is to determine the challenges and difficulties that the patients face and to engage with the patient and learn from the patient about various coping strategies. They will write an essay which will be peer reviewed.

Please read through the activity sheet. In addition to teaching students the following skills:

  • Otoscopy
  • Tuning fork tests
  • Ear irrigation
  • Dry mopping and ear wicking
  • Ear drop installation
  • The whisper test (adults and older children)
  • Other hearing tests without equipment, depending on the age of the patient

Students need to participate in a group discussion (linked to Module 1) about how they felt watching the videos on hearing loss. Ask whether any family members or friends have hearing loss and discuss how this impacts the individuals’ life and that of their family.

Activity 1 – defer

Activity 2 – Examining the ear

Divide the participants into groups. Number of groups will depend on the number of equipment sets available. So, if you have 5 otoscopes, you can divide into 5 groups.

  • Ask each group to start by examining the different parts of the ear on each other. Focus on one part at a time and introduce them to the corresponding section of the Patient health record (appendix II):
    • Pinna
    • Mastoid
    • Ear canal
    • Ear drum
  • Participants should fill in the forms below
  • Did you examine both sides or only one?

Activity 3 – examining the ear (outer ear, ear canal)

Activity 5: Discuss

  • How would you immobilize a small child to put drops in their ear?
  • Why would a child move?

Activity 6:

​Choose a partner. One is the ‘Health Care worker’ and one is the ‘Patient’. The patient chooses one of the problems from the list below and uses their imagination to make it sound like a typical patient from their clinic. The health care worker asks more questions about the problem and then uses their knowledge to describe what they might see if they were to examine the patient.
 Some suggested patient problems:

  • Mother thinks child has put something into the ear.
  • Patient has been swimming in dirty water. Ear now discharging.
  • Mother brings a child who has severe pain in the ear, especially while touching.

Discuss this and then present your problem to the group.

Complete the patient’s health card. Fill in the patient details. Write in details of the problem. Circle each finding of the examination.

WHO COULD THE PATIENT BE REFERRED TO?
Patients who cannot be treated or patients who have a problem but you do not know what it is should be referred to someone with more experience – a more highly trained nurse, a clinical assistant, a nurse or clinical practitioner or a doctor. If someone with more experience is not available or if the case is urgent then refer the patient to your local hospital.

Activity 7:

  • What does the eardrum do?
  • What can damage the eardrum?
  • Discuss your answers with your group and with your trainer.

Before learning more about ear infections and their treatment, please revise Practical B on otoscopic examination and practical D on dry mopping

Activity 8: Examining the eardrum

 Use an otoscope to examine the ears of the other participants in your group.
Hold the otoscope like a pencil in your hand. Some otoscopes are difficult to hold like this; if that is the case, hold the otoscope in a fist.
Then, do the following to properly examine the eardrum:

  • Pull the pinna back and up to straighten the ear canal.
  • Move the tip of the speculum around gently until you can see the whole of the eardrum.
  • Answer these questions while you are looking at the eardrum.


Important tips: Use a speculum that is large enough to see through and is comfortable for the size of the ear canal.
If you cannot see the eardrum or are not sure, then discuss it with your trainer.

Can you see the eardrum? Yes/no/unsure

Does it look normal and healthy?​ Yes/no/unsure

Activity 9: Examining the eardrum [when otoscopes are not available]

Discuss the following with your trainer:

  • What would you do if you could not see the eardrum?

Try look in the ear canal with the help of a torch or strong light.

  • What would you do if you were not sure if you see the eardrum?

If you are certain that what you are looking at is the eardrum, and you are not certain what the problem is, refer the patient to a doctor or medical centre for assessment.

  • What would you do if the eardrum was not normal and healthy?

Examine carefully to understand what you are seeing and decide the possible diagnosis and management.

What would you do if you were not sure if the eardrum is normal and healthy?

Activity 10:

Discuss the following points about your dry mop/wick with your group and teacher 

  • Will the cotton wool come off the stick easily? 

 

Ensure that the cotton is firmly attached to the stick and that it doesn’t slide out before inserting it into the ear. If it is not tightly attached, it could come off in the patients ear. 

What would happen if it did? 

It needs to be immediately removed, if not it could cause an infection. 

  • What would you do if the cotton wool or a piece of the paper/cloth got stuck in the ear canal?

You can remove it. Do so gently if you are able to get a grip on the cotton. In case it is too deep, then you need to send the person to a doctor for removal. 

  • What would happen if the tip of the stick pushed through the cotton wool? 

The tip can injure the skin of the ear canal, or (if pushed in deep) injure the eardrum (which may perforate the eardrum). 

  • Why should you use clean cotton wool or a clean piece of paper/cloth in each ear? 

Inserting anything into the ear could cause infection, including cloth, unclean cotton, tissue paper etc. 

  • Why should you wash your hands with soap and water and air dry both before and after? 

To avoid any chance of passing germs from your hand to the patient, causing infection.

Activity 11:

Divide the participants into groups of two. One can be the health worker and the other is the parent of a child with discharging ear or have a discharging ear herself. The health worker to give proper instructions to the patient or parent using the community resource.
10 min then switch roles.

Activity 12:

Divide the participants into two groups. Ask each group to list out simple steps for preventing hearing loss in the community. Each group should make a list.  [ [Then have a common discussion with both groups presenting their points of view.] ]

Activity 13:

Divide participants into groups of four or five and ask them to discuss how hearing loss and ear diseases can be prevented in the community. Then large group discussion (10min and 10 min)

Activity 14: Discussion

  1. You have to behave as though a very small child (age 1 year) has been brought to you. Please ask relevant questions to assess the hearing and also test the hearing with distraction testing.
  2. You have to behave as though a child of 5 years has been brought to you. Please ask relevant questions to assess the hearing and also test the hearing by voice tests.
  3. You have to behave as though a child of 10 years has been brought to you. Please ask relevant questions to assess the hearing and also test the hearing by Whispered voice test.
  4. You have to behave as though a 60-year old woman has come to you. Please ask relevant questions to assess the hearing and also test the hearing by using the hearWHO app.

Activity 15:

  • Divide the group in pairs.
  • One person should explain to the other how to care for a hearing aid
  • Then ask them to switch roles
  • Tell them to also pose questions to each other as if they were users of hearing aids

Activity 16:

  • Divide the batch in to 4 groups and allocate each group with its activity. Each activity is to be in the form of role play (wherein they have to act out the given scenario).
  • Give them half an hour to discuss and prepare the role play. Encourage them to ask you for clarifications.
  • After half an hour, ask them to present their role play. They must involve as many persons in the group as possible. One can be the child, the mother, the father, the doctor, the attendant etc.
  • Each group’s role play must last no more than 10 minutes.
  • After each presentation, discuss the good points of their role play with the entire batch. Also point out whatever points they may have missed.
  • Ideas for role play:
  1. A 1 year old child has been diagnosed to be deaf. Counsel the parents regarding the need and possible methods of rehabilitation of this child.
  2. A hard of hearing child has started going to school, advise parents on what the school can do to ensure the child can hear and learn.
  3. An older adult is reluctant to use hearing aids, tell him why it is important to do so.
  4. A person has just started using hearing aids, explain how to take care of their hearing aids.

Activity 17: Divide participants into groups of four or five and ask them to discuss what they could possibly do to improve ear and hearing care within their community.

Divide the participants into two groups. Ask each group to list simple steps for preventing hearing loss in the community. Each group should make a list. Then have a common discussion with both groups presenting their points of view. Students should later, also engage in a discussion on the role of healthcare workers in ear and hearing care.

After this session they will be required to participate in an online forum discussion about easy, practical and innovative ways that primary level healthcare workers can improve patient education, improve healthcare and access to healthcare. The forum discussion will be where students attempt to provide ideas/solutions to this problem. Participation is compulsory and students will be given a mark out of 3 (depending on the quality of their suggestions). [note: this is Module 9 discussions].

Activity 2: Examining the ear

​​​​​​​Participants should fill in the forms below

Did you examine both sides or only one? Describe findings on one side below

 

Activity 3

What can you see when you examine the pinna? Choose a partner and look at both ears of your partner and examine the pinna Mark off each your findings on the examination chart.
Choose a partner and look at both ears of your partner and examin the pinna. Mark off each of your findings on the examination chart.

[Discuss with your trainer what you have seen and any difficulties that you have had.]

Activity 4

Choose a partner. Use an otoscope to examine both ear canals of your partner.

[Discuss what you have seen and any difficulties that you have had with your trainer.]

Activity 6

Choose a partner. One is the ‘Health Care worker’ and one is the ‘Patient’. The patient chooses one of the problems from the list below and uses their imagination to make it sound like a typical patient from their clinic. The health care worker asks more questions about the problem and then uses their knowledge to describe what they might see if they were to examine the patient.
 

Some suggested patient problems:

  • Mother thinks child has put something into the ear.
  • Patient has been swimming in dirty water. Ear now discharging.
  • Mother brings a child who has severe pain in the ear, especially while touching.

Discuss this and then present your problem to the group.

Complete the patient’s health card. Fill in the patient details. Write in details of the problem. Circle each finding of the examination.

WHO COULD THE PATIENT BE REFERRED TO?
Patients who cannot be treated or patients who have a problem but you do not know what it is should be referred to someone with more experience – a more highly trained nurse, a clinical assistant, a nurse or clinical practitioner or a doctor. If someone with more experience is not available or if the case is urgent then refer the patient to your local hospital.

ALWAYS CHECK BOTH EARS!

Activity 8: Examining the eardrum

Use an otoscope to examine the ears of the other participants in your group.
Hold the otoscope like a pencil in your hand. Some otoscopes are difficult to hold like this; if that is the case, hold the otoscope in a fist.


Then, do the following to properly examine the eardrum:

  • Pull the pinna back and up to straighten the ear canal.
  • Move the tip of the speculum around gently until you can see the whole of the eardrum.
  • Answer these questions while you are looking at the eardrum.


Important tips: Use a speculum that is large enough to see through and is comfortable for the size of the ear canal.
If you cannot see the eardrum or are not sure, then discuss it with your trainer.

 

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