Who are you trying to help? What issue are you trying to address?

Our project is aiming at building capacity towards the prevention, mitigation and treatment of ear disease and hearing loss by improving ear and hearing health care services for children with HIV/AIDS.

The Need:

The prevalence of HIV/AIDS in Cambodia is among the highest in Asia. Cambodia’s HIV/AIDS epidemic is spread primarily through heterosexual transmission and revolves largely around the sex trade. HIV transmission occurs mainly in sexual partnerships where one partner has engaged in high-risk behaviours. Women constitute a growing share of people living with HIV/AIDS, comprising an estimated 47 percent of people living with HIV/AIDS. This increased proportion of infections among women may reflect declining prevalence rates among males, as well as deaths among males infected in the early years of Cambodia’s epidemic. Significantly, a low prevalence rate in the general population masks far higher prevalence rates in certain sub-populations, such as injecting drug users, people in prostitution, male homosexuals, karaoke hostesses and beer girls, and mobile and migrant populations.

Children with HIV are generally more prone to opportunistic infections so middle ear disease tends to be more common in this group. It is also more refractory. Generally, infections in the ear, nose and throat through HIV are very common. They occur in about 40% of HIV patients. Outer ear infections include diffuse otitis externa, otomycosis, malignant otitis externa, and Kaposi’s sarcoma. The most common middle ear infections seen in HIV patients are acute otitis media, otitis media with effusion, and mastoiditis. Middle ear problems are most commonly seen in children with AIDS. HIV infection may also lead to neuropathy of the auditory nerve and sensorineural hearing loss (SNHL). Up to 60% of HIV patients have SNHL, the viral infection having a direct effect. Typically, the hearing loss affects the high frequencies, the loss progressing with the disease. The facial nerve may also be involved, occurring in the early stage of HIV infection. Problems include Bell’s palsy and Ramsay Hunt syndrome.

Target Beneficiaries:

All Ears Cambodia (AEC) will provide dedicated ear clinics for children with HIV/AIDS. The focus will be on children under the wing of four partner NGOs plus onward paediatric referrals from Preah Ang Duong Hospital. Target groups include children infected with HIV, ones with AIDS and those orphaned by AIDS. The anticipated caseload is ~800 children in a one-year period. Clinics shall be used for the purpose of providing audiology and primary/secondary ear health care services. With the support of the local partners NGOs these services will be promoted within the target communities.

Project Activities:

1) Clinical Work at Outreach Level

1.1 Diagnostics: Full audiological test battery including case history, examination by otoscopy, pure tone audiometry, tympanometry, acoustic reflex thresholds, speech audiometry and advanced electro-physiological measurements (TEOAEs and ABAER);

1.2 Primary/Secondary Ear Health Care: Common and easily treatable ear pathology shall be handled by the AEC staff including the management of impacted/excessive cerumen, foreign body removal, and medical treatment of diffuse otitis externa, otomycosis, and otitis media. Cases requiring specialist opinion/management shall be advised regarding referral to Preah Ang Duong Hospital during one of the bi-monthly ear surgery missions conducted by visiting foreign oto-surgeons;

1.3 Rehabilitation Services: AEC shall provide on-site rehabilitation services for those in need. Post-aural analogue or digital hearing instruments will be offered to those cases where indicated. On-going support will be given wherever necessary;

1.4 Ear Health Education: Educational materials shall be provided for patients and their families, and health staff, especially regarding the early identification and management of ear disease and children with hearing impairment;

1.5 Further Educational Support: In addition to the support of the caregivers of hearing impaired children, there will be drive for special educational placement where indicated and possible.

2) Community-based Education and Training

The programme aims to provide preventive educational measures at the community level in order to promote a reduction in ear and hearing disorders. Primary ear health care (PEHC) programmes should be focused on local action and self-reliance for the prevention of ear disease. These are highly cost effective ways of reducing or eliminating long-term morbidity and mortality caused by ear disease.

Basic PEHC training shall be provided for the health staff of AEC partner organisations to support and strengthen the clinical service being offered. Staff shall be given basic training in order to understand more about ear health, how to identify ear and hearing problems, and the advice that should be given on how to prevent these problems.

Time Frame:
Two years

Estimated Budget:
USD7200 (US Dollars)

Funding will be used on:

• Primary ear health care consumables
• Anti-microbial and therapeutic agents
• Ear mould manufacture
• Hearing aid accessories and hearing aid battery supply
• Teaching materials and educational leaflet production
• General running costs