{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T21:25:34Z","timestamp":1790717134787,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2019,5,9]],"date-time":"2019-05-09T00:00:00Z","timestamp":1557360000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine whether a non\u2010specialist health worker can accurately undertake audiometry and otoscopy, the essential clinical examinations in a survey of hearing loss, instead of a highly skilled specialist (i.e. <jats:styled-content style=\"fixed-case\">ENT<\/jats:styled-content> or audiologist).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A clinic\u2010based diagnostic accuracy study was conducted in Malawi. Consecutively sampled participants\u00a0\u2265\u00a018\u00a0years had their hearing tested using a validated tablet\u2010based audiometer (hearTest) by an audiologist (gold standard), an audiology officer, a nurse and a community health worker (<jats:styled-content style=\"fixed-case\">CHW<\/jats:styled-content>). Otoscopy for diagnosis of ear pathologies was conducted by an <jats:styled-content style=\"fixed-case\">ENT<\/jats:styled-content> specialist (gold standard), an <jats:styled-content style=\"fixed-case\">ENT<\/jats:styled-content> clinical officer, a <jats:styled-content style=\"fixed-case\">CHW<\/jats:styled-content>, an <jats:styled-content style=\"fixed-case\">ENT<\/jats:styled-content> nurse and a general nurse. Sensitivity, specificity and kappa (<jats:italic>\u03ba<\/jats:italic>) were calculated. 80% sensitivity, 70% specificity and kappa of 0.6 were considered adequate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Six hundred and seventeen participants were included. High sensitivity (&gt;90%) and specificity (&gt;85%) in detecting bilateral hearing loss was obtained by all non\u2010specialists. For otoscopy, sensitivity and specificity were &gt;80% for all non\u2010specialists in diagnosing any pathology except for the <jats:styled-content style=\"fixed-case\">ENT<\/jats:styled-content> nurse. Agreement in diagnoses for the <jats:styled-content style=\"fixed-case\">ENT<\/jats:styled-content> clinical officer was good (<jats:italic>\u03ba<\/jats:italic>\u00a0=\u00a00.7) in both ears. For other assessors, moderate agreement was found (<jats:italic>\u03ba<\/jats:italic>\u00a0=\u00a00.5).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A non\u2010specialist can be trained to accurately assess hearing using mobile\u2010based audiometry. However, accurate diagnosis of ear conditions requires at least an <jats:styled-content style=\"fixed-case\">ENT<\/jats:styled-content> clinical officer (or equivalent). Conducting surveys of hearing loss with non\u2010specialists could lower costs and increase data collection, particularly in low\u2010 and middle\u2010income countries, where <jats:styled-content style=\"fixed-case\">ENT<\/jats:styled-content> specialists are scarce.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.13238","type":"journal-article","created":{"date-parts":[[2019,4,19]],"date-time":"2019-04-19T06:43:56Z","timestamp":1555656236000},"page":"817-828","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Diagnostic accuracy of non\u2010specialist <i>versus<\/i> specialist health workers in diagnosing hearing loss and ear disease in Malawi"],"prefix":"10.1111","volume":"24","author":[{"given":"Tess","family":"Bright","sequence":"first","affiliation":[{"name":"International Centre for Evidence in Disability London School of Hygiene &amp; Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wakisa","family":"Mulwafu","sequence":"additional","affiliation":[{"name":"Audiology Department Queen Elizabeth Central Hospital Blantyre Malawi"},{"name":"Department of Surgery University of Malawi Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mwanaisha","family":"Phiri","sequence":"additional","affiliation":[{"name":"Audiology Department Queen Elizabeth Central Hospital Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robbert J. 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