Telehealth and Humanitarian Assistance in Otolaryngology




A significant worldwide need exists for humanitarian assistance in the specialty of otolaryngology. The field of telehealth has provided applications that have successfully expanded access to care in many fields of medicine, in both developed and developing countries. Collaboration, planning, and persistence are essential to developing successful telehealth applications. This article describes the need for otolaryngologic specialty care, current humanitarian outreach within the field of otolaryngology, and examples of successful programs that incorporate telehealth in otolaryngology care.








  • Worldwide many underserved regions have a large burden of head and neck disease. In many of these region there are insufficient specialists to provide care.



  • Otolaryngology as a specialty has a strong history of humanitarian involvement to help meet the needs of these regions.



  • Telehealth uses asynchronous or synchronous technology to provide health services over a distance and is an evolving tool that can enhance humanitarian efforts.



  • Simple everyday technology, such as e-mail and image store and forwarding, is already used successfully to provide medical care to underserved areas worldwide.



  • Evolving telehealth issues include medicolegal clarification, international regulations, cost, and advancing technology. Most successful telehealth programs result from humanitarian partnerships based on collaboration, planning, and persistence.



  • Telehealth is an evolving field with tremendous potential, but further research is necessary to establish its efficacy, safety, and impact.



Key Points: H umanitarian A ssistance I n O tolaryngology T hrough T elehealth


Humanitarian efforts include a broad range of measures to assist underserved populations. These efforts can include needs assessment, environmental projects, infrastructure improvement, public health education, and medical services. Many otolaryngologists are familiar with the medical aspects of humanitarian activities (HAs). Several actively participate in clinical field missions, and some have been involved in policy development, education, and promotion of otolaryngology services at the global level. Most physicians involved with HAs have a tremendous sense of gratification and satisfaction from helping the less fortunate. However, most will also readily attest to the daunting clinical need and frustration associated with the inability to accomplish more. Regardless of the setting or location, the need for humanitarian medical care is extensive, and the need to augment and expand HA is widely recognized. Telehealth, through the use of information and communication technology (ICT), is an obvious and practical tool to achieve this goal.


For the purposes of this article, “telehealth” refers to any field of health care that uses telecommunication to transmit medical information across distances, and would include a means of providing professional and public education and patient care. Telemedicine is one aspect of telehealth that generally refers to the clinical aspect and includes consultative services. In HAs, telemedicine allows patients in underserved regions to receive specialty consultation.


World Health Organization (WHO) Director General, Dr Hiroshi Nakajima, said in 1997, “Developing an adequate and affordable telecommunication infrastructure can help to close the gap among the haves and the have-nots in health care.” The potential of telehealth to reduce inequalities in health care is immense but remains underdeveloped. Providing care and consultation at a distance using ICT is an enterprise that continues to expand and develop in stride with developing technology and changing policies. This article explores some of the important features of telehealth use in humanitarian projects and provides examples of successful applications.


Otolaryngic burden of disease


A large need for otolaryngology services exists in the developing world. This is because of a extensive disease burden and a paucity of trained otolaryngologists. Major contributors to higher disease incidences include environmental factors, nutritional deficiencies, limited public health measures, and behavioral risk factors. Of equal significance is the limited availability of otolaryngology specialists. Most developing countries have little or no capacity to provide subspecialty care, such as otolaryngology, audiology, or speech pathology. For instance, in Africa the average number of otolaryngologists per 100,000 people is 0.11 compared with 3.1 (in 2004) in the United States.


Examples illustrating the burden of otolaryngic disease include chronic otitis media, oral and oropharyngeal cancer, and thyroid disease. The WHO estimates that chronic otitis media is a major contributor to acquired hearing loss in developing countries, with the worldwide global burden of illness from chronic suppurative otitis media involving 65 to 330 million individuals. Of these individuals, 60% (39–200 million) have significant hearing impairment, meaning that chronic suppurative otitis media may contribute more than half the global burden of hearing impairment, and eliminating it can potentially reduce the global burden by four-fifths.


Two-thirds of the worldwide burden of oral and oropharyngeal cancer is from developing nations. In many regions, such as Sri Lanka, India, Pakistan, and Bangladesh, oral cancer is the most common cancer in men. Higher cancer rates and poorer outcomes are correlated with more disadvantaged populations. The 5-year survival rate for oral cavity and oropharyngeal cancers in these countries is as low as 50%. This low survival rate is caused by multiple factors, including delayed detection and decreased access to care.


Surgical thyroid disease represents another condition often managed by otolaryngologists with a high global burden. Iodine deficiency resulting in thyroid goiter was estimated to affect nearly 10% of the world’s population (536 million people worldwide). Prevention with iodine replacement is critical, but surgical management is often beneficial for large existing goiters. Randolph published an excellent review with a more complete picture of the global distribution, impact, and management of thyroid disease.




Otolaryngology humanitarian efforts


Because of limited resources, most developing countries focus their efforts on public health, preventive measures, and primary health care needs. Therefore, the tremendous need for specialty care is often deemphasized or overlooked. The high otolaryngologic disease burden and insufficient number of trained specialists has led many otolaryngologists within these countries and from the developed world to reach out and provide assistance to these underserved populations. As specialists, the role of otolaryngologists in HA is typically to provide direct patient care and consultation, but often they also act as consultants in education, training, and policy development. Direct patient care may occur within a focused otolaryngology mission or as a component of a multidisciplinary team.


Otolaryngologists specialize in the surgical and medical management of head and neck disorders. Therefore, they can play a critical role in the development of public health programs, allied health services, and educational programs for these diseases. As a specialty, otolaryngology has a strong history of humanitarian involvement. The Humanitarian Efforts Committee of the American Academy of Otolaryngology Head and Neck Surgery Foundation (AAO-HNSF) was founded in 1985 and serves to support the humanitarian activities of its members and to advocate for programs that improve the prevention and treatment of otolaryngologic disorders within underresourced areas of the United States and abroad. More information is available at http://www.entnet.org/Community/public/Becoming-Involved.cfm .




Otolaryngology humanitarian efforts


Because of limited resources, most developing countries focus their efforts on public health, preventive measures, and primary health care needs. Therefore, the tremendous need for specialty care is often deemphasized or overlooked. The high otolaryngologic disease burden and insufficient number of trained specialists has led many otolaryngologists within these countries and from the developed world to reach out and provide assistance to these underserved populations. As specialists, the role of otolaryngologists in HA is typically to provide direct patient care and consultation, but often they also act as consultants in education, training, and policy development. Direct patient care may occur within a focused otolaryngology mission or as a component of a multidisciplinary team.


Otolaryngologists specialize in the surgical and medical management of head and neck disorders. Therefore, they can play a critical role in the development of public health programs, allied health services, and educational programs for these diseases. As a specialty, otolaryngology has a strong history of humanitarian involvement. The Humanitarian Efforts Committee of the American Academy of Otolaryngology Head and Neck Surgery Foundation (AAO-HNSF) was founded in 1985 and serves to support the humanitarian activities of its members and to advocate for programs that improve the prevention and treatment of otolaryngologic disorders within underresourced areas of the United States and abroad. More information is available at http://www.entnet.org/Community/public/Becoming-Involved.cfm .

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Apr 1, 2017 | Posted by in OTOLARYNGOLOGY | Comments Off on Telehealth and Humanitarian Assistance in Otolaryngology

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