Ear Diseases and Hearing in the Thai Elderly Popula
tion. Part I. A Comparative Study of the Accuracy of
Diagnosis and Treatment by General Practitioners vs
ENT Specialists
CHA WEEW AN BUNNAG, M.D.*, SUNANTA POLPATHAPEE, M.D.*,
SUCHITRA PRASANSUK, M.D.*, CHANA SIRIYANANDA, M.D.*,
APINAN NA NAKORN, M.D.*, CHEERASOOK CHONGKOLWATANA, M.D.*,
PERAPUN JAREONCHARSRI, M.D.*, KITIRAT UNGKANON, M.D.*,
SUV AJANA AT IPA S, M.D.*, SAMUT CHONGVISAL, M.D.*,
THANA ANGSUWARANGSEE, M.D.*, PHAWIN KESKOOL,M.D.*,
PRA YUTH TANSURIYA WONG, M.D.*, WEERACHAI TANTINIKORN, M.D.*,
M.L.KUNTHONG THONGYAI, M.D.*
Affiliation : *Department of Otolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
AbstractThe prevalence of ear disease and hearing disability in elderly Thais in 14 urban commu
nities around Siriraj Hospital was studied. The accuracy of diagnosis and treatment of common ear
diseases and of screening for hearing loss in the elderly between general practitioners (GP) and
Ear, Nose and Throat (ENT) specialists was also compared. Elderly people aged 60 years or more
who had registered with the health care program had their ear and hearing check-up performed by
GPs and ENT specialists from mobile team. Altogether, 980 subjects were included, 332 were males,
648 were females, (male : female ratio 1 : 2). Their ages ranged from 60-96 years with an average
age of 68.5 years. The prevalence of ear disease diagnosed by ENT specialists was 16.3 per cent
=
(95% Cl 14.0-18.6), 12.5 per cent was external ear disease and 2.7 per cent middle ear disease.
The most common ear problem was impacted ear wax (8%), the second most common problem was
otitis extema (4.3%). Compared with anENT specialist, the ability of a GP to diagnose ear diseases
had a sensitivity of 46.5 per cent and a specificity of 80.3 per cent, the positive predictive value
of their diagnoses was 31.5 per cent. The efficacy of the treatment of ear diseases in 51 elderly
people by GPs and in 63 elderly people by ENT specialists was statistically significantly different
=
(p 0.02).
Hearing screening by the GP using whisper or the watch test performed in 650 elderly
people revealed abnormal findings (could not hear) in 70 cases or 10.8 per cent. Hearing screening
using pure tone audiometry in 980 elderly people showed abnormal hearing level in 508 cases
(52.4%). 9.5 per cent of them had a bilateral moderate to severe degree of hearing impairment. There
was no difference in the level of hearing impairment between males and females or between right
and left ears. The prevalence of hearing loss increases with' increasing age. Tympanometry per
formed by an acoustic impedance machine in 980 of the elderly showed a conductive hearing loss
in 85 cases (9.1%).
The authors conclude that the prevalence of ear disease in elderly people living in the
urban community around Siriraj Hospital is quite high. Although the ear diseases commonly
encountered were not serious, if left untreated they may lead to complication and decreased hear
ing. Therefore, the proficiency of GPs in the management of common ear diseases in every com
munity should be regularly maintained. Hearing impairment is very prevalent and increases with age.
Thus, screening for hearing loss using an audiometer and/or acoustic impedance is recommended
for all senior citizens in their community at least once a year. Early detection of elderly persons
who could benefit from a properly fitted hearing aid will certainly improve the quality of life and
may prevent psychiatric and functional impairment of the Thai elderly population.
Keywords : Ear Diseases, Hearing, Thai Elderly, Diagnosis and Treatment, GP vs ENT Specialist
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