Reducing Childhood Hearing Loss in an Alaska Native Population Through a New School Screening and Referral Process That Utilizes Mobile Health and Telemedicine

Hearing loss is a common health problem in Alaska. Up to 75% of children growing up in
Alaskan villages experience frequent ear infections, one of the major treatable causes of
hearing loss. Children with even mild hearing loss face many challenges. These children often
experience speech and language delays and have trouble in school. Teens with hearing loss are
more likely to drop out of school, and are at risk for having difficulty finding jobs as
adults. Promptly diagnosing and treating hearing loss is important for preventing these
consequences. Alaska mandates school-based hearing screening, but many children with hearing
loss are not identified by the current screening protocol, and most who are referred never
make it into the healthcare system for diagnosis and treatment.

Alaska has already developed innovative strategies to address hearing loss. A network of
village health clinics staffed by community health aides provide local care, and telemedicine
has been adopted in over 250 village clinics statewide. Despite being widely available,
telemedicine has not yet been used in school hearing screenings to speed up the referral
process.

Norton Sound Health Corporation has partnered with Duke and Johns Hopkins Universities to
explore whether a new school screening and referral process that incorporates mobile, or
mHealth, screening and telemedicine referral will reduce childhood hearing loss disparities
in the Norton Sound region. Children from kindergarten through 12th grade in 15 Norton Sound
villages will receive the current school screening protocol and the new mHealth screen.
Villages will then be randomized to continue the current primary care referral process or to
adopt telemedicine referral for school screenings. The investigators hypothesize that the new
mHealth screening protocol will identify more children with hearing loss, and telemedicine
referral will reduce time to diagnosis. By better identifying hearing loss and speeding up
diagnosis and treatment, the investigators expect the burden of childhood hearing loss to
drop, hearing-related quality of life to improve, and school performance to improve in
villages with telemedicine referral compared to current primary care referral villages. If
the study shows these positive effects, mHealth screening and the telemedicine referral
process could be implemented in school districts across the state of Alaska to reducing
childhood hearing loss disparities statewide.