Table 1.

Service needs according to diagnosis

Need	Diagnosis	Hearing test result	Description
Diagnostic audiology assessment (possible hearing aid)	Sensorineural (acquired or congenital) or mixed hearing loss in both ears	Bilateral hearing loss (> 25 dB HL)	This involves air and bone conduction audiometry in sound proof room to confirm hearing levels and potential hearing aid fitting (depending on degree, and duration of loss). If a hearing aid is not suitable, other interventions such as cochlear implants, or sign language training may be suitable [32]. For mixed hearing loss, the underlying cause of the conductive component also needs to be treated.
Surgical assessment	Chronic otitis media – wet perforation Chronic otitis media – dry perforation Chronic otitis media – possible cholesteatoma	N/Aa	Chronic otitis media – wet or dry require tympanoplasty to mend tympanic membrane [33] Chronic otitis media – possible cholesteatoma requires surgery to remove
Medication	Acute otitis media (AOM) Chronic otitis media – wet perforation Chronic otitis media – possible cholesteatoma Otitis externa (OE)	N/Aa	AOM requires analgesics, and antibiotics [34] Chronic otitis media – wet perforation requires aural toilet, and ear drops (medication) to allow otorrhea (discharge) to clear prior to surgery [33]. Chronic otitis media – cholesteatoma may also require medication OE requires antifungal or antibiotic ear drops [35]
Impacted wax or foreign body removal	Impacted wax (IW) Foreign body (FB)	Hearing loss > 25 dB HL in either ear	IW and FB are removed using suction or hooks depending on skill and equipment availability [51]
Review (“watchful waiting”)	Otitis media with effusion (OME)	Hearing loss > 25 dB HL in either ear	OME requires re-examination of ears, and repeat audiometry [37]

^aNeed for service does not depend on whether hearing loss is present