Table 1 Service needs according to diagnosis

Diagnostic audiology assessment (possible hearing aid)

Sensorineural (acquired or congenital) or mixed hearing loss in both ears

Bilateral hearing loss (> 25 dB HL)

This involves air and bone conduction audiometry in sound proof room to confirm hearing levels and potential hearing aid fitting (depending on degree, and duration of loss). If a hearing aid is not suitable, other interventions such as cochlear implants, or sign language training may be suitable [32].

For mixed hearing loss, the underlying cause of the conductive component also needs to be treated.

Surgical assessment

Chronic otitis media – wet perforation

Chronic otitis media – dry perforation

Chronic otitis media – possible cholesteatoma

N/A^a

Chronic otitis media – wet or dry require tympanoplasty to mend tympanic membrane [33]

Chronic otitis media – possible cholesteatoma requires surgery to remove

Medication

Acute otitis media (AOM)

Chronic otitis media – wet perforation

Chronic otitis media – possible cholesteatoma

Otitis externa (OE)

N/A^a

AOM requires analgesics, and antibiotics [34]

Chronic otitis media – wet perforation requires aural toilet, and ear drops (medication) to allow otorrhea (discharge) to clear prior to surgery [33].

Chronic otitis media – cholesteatoma may also require medication

OE requires antifungal or antibiotic ear drops [35]

Impacted wax or foreign body removal

Impacted wax (IW)

Foreign body (FB)

Hearing loss > 25 dB HL in either ear

IW and FB are removed using suction or hooks depending on skill and equipment availability [51]

Review (“watchful waiting”)

Otitis media with effusion (OME)

Hearing loss > 25 dB HL in either ear

OME requires re-examination of ears, and repeat audiometry [37]