加纳成人人群感觉神经性听力损失诊断的评估：一项使用布莱顿协作标准病例定义的回顾性研究

Abstract

背景：听力损失已被列为世界范围内残疾年龄排名第四的主要因素，这是一个沉默寡言的，报告不足的公共健康问题，在财务和社会生活上有许多不利因素。这在发展中国家的贫困弱势人群中最明显，那里有80％的听力损失者居住。世卫组织预测，到2050年，将有9亿多人遭受各种形式的听力损失。 目的：本研究使用布莱顿协作标准病例定义评估了加纳成年人口的感音神经性听力丧失（SNHL）的诊断。 方法：本研究设计是一项回顾性研究方法，旨在对加纳的科莫·安诺克耶教学医院眼耳鼻喉科的SNHL患者的诊断进行回顾性研究，这些患者年龄从18岁到59岁不等。基于Brighton Collaboration标准案例定义的2018年1月至2020年6月。 结果：本研究的300名参与者中，男性165名，女性135名。 根据BC病例分类，SNHL在300例患者中的诊断确定性水平分布在三个分类水平上。 （L1）253级（84.3％），2级（L2）2级（0.6％）和4级（L4）45级（15％），在300例中，有45例无法分类（4级）。当将男性和女性分开时，总体数据显示，男性患者的1级百分比较低，而4级的百分比高于女性。当分别来自不同来源的患者出现时，手动数据患者的诊断确定性水平的男女差异是相同的，但对于电子数据患者则无显着性。 比较了来自人工数据的患者的两种数据来源的SNHL诊断确定性水平的分布，其中电子数据的患者具有较高的1级百分比和较低的4级百分比。 结论：根据这项研究的结果，可以很好地确定BC标准病例定义适用于加纳的三级医院。数据证据表明，大多数病例是在1级诊断。这可能意味着在加纳和其他西非国家的三级医院中，可以满足BC标准，并且大多数诊断将在BC标准定义之内。 。但是，八项关键要素考试中有四项是：没有可用的脑干反应，耳声发射异常，行为/神经发育评估异常和远程筛查异常，因此，医院管理部门必须努力建立基础设施来满足此类需求。

Background: Hearing loss has been ranked as the fourth leading contributor to years lived with disability worldwide and this is a silent and under-reported public health problem with numerous financial and social life disadvantages. This is mostly visible among poor vulnerable populations in developing countries where more than eighty percent of people with hearing loss reside. The WHO projects in the year 2050 more than 900 million people will be suffering from various forms of hearing loss. Aim: This study evaluated the diagnosis of sensorineural hearing loss (SNHL) in the adult population of Ghana using the Brighton Collaboration standard case definition. Methods: The research design was a retrospective study approach, conducted to review the diagnosis of patients with SNHL in the Komfo Anokye Teaching Hospital in Ghana at the Eye Ear Nose Throat Department who were within the ages of 18 – 59 years from the period of January, 2018 to June, 2020 based on the Brighton Collaboration standard case definition. Results: Among 300 participants of this study, 165 were males and 135 females. The distributions of SNHL levels of diagnosis certainty among 300 patients according to the BC case classifications were on three classification levels; level (L1) 253 (84.3%), level 2 (L2) 2 (0.6%) and level 4 (L4) 45 (15%) respectively and out of 300, 45 cases were unclassifiable (at level 4). When separated for males and females shows that, the overall data, male patients had a lower percentage of level 1 and higher percentage of level 4 than female patients did. When patients from different sources were presented separately, the male-female differences in the distribution of diagnosis certainty level were the same for patients from Manual Data but became non-significant for patients from Electronic Data. The distributions of SNHL levels of diagnosis certainty were compared between two sources of data of patients from Manual Data had a higher percentage of level 1 and a lower percentage of level 4 than patients from Electronic Data. Conclusion: Based on the findings of this study, it is well established that, the BC standard case definition is applicable in Ghana at the tertiary hospital level. The evidence of the data indicates that, majority of the cases were diagnosis at level 1. This could mean at tertiary hospital level in Ghana and other West African countries the BC criteria can be met and majority of the diagnosis will fall within the BC standard definition. However, four out of the eight key element examinations namely; Acoustic Brainstem Response, Abnormal Otoacoustic Emission, Abnormal Behavior/Neurodevelopment Assessment, and Abnormal Remote Screening were not available, so therefore it is important for the hospital management to work towards putting infrastructure to meet such demands. Recommendations: The study suggests the BC should fund further studies to conduct evaluation of SNHL diagnosis at the district, municipal and regional hospital levels in Ghana and the other West African countries. Also, hospitals participating in Lassa fever vaccine trials should put in place systems to record cases. Moreover, physicians should ensure that patients referred to private clinics for Otoacoustic emission and Abnormal Brainstem Response examinations should bring back the reports to be entered onto the medical records. Keywords: Hearing loss, Sensorineural Hearing Loss, Lassa fever, Vaccine, Komfo Anokye Teaching Hospital.