Ear and
Hearing Care

The Rohingya refugees have no access to ear and hearing care service. We have been working with national and international partners to develop this service for the refugees and the impoverished host community in Bangladesh.

Our program is led by Professor Mahmood Bhutta, Chair in ENT Surgery at Brighton and Sussex Medical School and Honorary Consultant for the WHO Program for the Prevention of Deafness & Hearing Loss, and Dr Khaleda Zaheer, CEO of Refugee Crisis Foundation.

Chronic suppurative otitis media (CSOM) is characterised by a perforated tympanic membrane (ear drum) associated with chronic inflammation and infection of the middle ear, associated with ear discharge (otorrhoea) and hearing loss. It affects 250 million globally, and disproportionately people in socioeconomic deprivation, with prevalence in low- and middle-income countries typically at 4%.

Some also experience ear pain (otalgia) or discomfort, and most (>80%) experience temporary or permanent hearing loss. Hearing loss, particularly if it is bilateral and moderate to severe, can impact a person’s ability to understand speech at conversational level. For adults, this may affect employment and psychosocial wellbeing, and for children speech and language skills, psychosocial and cognitive development and academic performance.

Bangladesh is a low-middle income country, where surveys of the rural population show that 5-6% of adults and children have CSOM. There are no published surveys of CSOM prevalence in the Rohingya population. Local teams had recognised that ear discharge was a prevalent issue, but there was no local resource to tackle the issue.  We conducted a survey of refugees in the camps in Cox’s Bazar to estimate the prevalence of CSOM which we found to be 14%, the highest recorded in any population in the world. Of those with CSOM, 60% had mild to moderate hearing loss and 20% had severe to profound hearing loss. From these data, we estimate that of the 946,000 Rohingya refugees, 136,000 have CSOM and 109,000 hearing loss due to CSOM.  This is a major public health issue.

As part of our research study, our team interviewed a cohort of Rohingya adults and children with CSOM, who told us that their hearing loss affected their socialising, employment, self-confidence, and relationships. Successful rehabilitation of hearing loss in individuals with CSOM impacts their education and employability, as well as physical and mental health, and has been modelled to be cost-effective.

Conventional air conduction hearing aids are usually unsuitable for those with hearing loss due to CSOM. They are costly, increase the risk of ear discharge, and require an audiologist to program the device.  Our group has pioneered an approach repurposing low-cost bone conduction aids for children with chronic otitis media.  Bone conduction sends sound through the skull, bypassing the diseased middle ear. The low-cost bone conduction headset, connected with a microphone, has been shown to improve speech discrimination in children with chronic glue ear (another form of chronic otitis media), with high compliance. We are currently conducting a trial using this same technology for schoolchildren with hearing loss in the camps.

We will be measuring audiological outcomes, including aided pure tone and speech hearing thresholds, and qualitative outputs using questionnaires and interviews. These outcomes will be important both to report but also to evaluate scalability of this emerging technology.

We also deliver training on primary care management of ear disease for doctors working in the camps. In addition to this, we have conducted a field trip with a group of international ENT surgeons who carried out push-through tympanoplasty using an endoscopic approach. We are looking to develop local surgical capacity.