Pediatric ENT Problems will be discussed.

Title

From Deaf Children to Local ENT Autonomy: Twenty Years of Pediatric Otology in Cambodia

Background

Chronic ear disease remains a major cause of preventable hearing loss in children living in low- and middle-income countries (LMICs). In Cambodia, the lack of ENT specialists, imaging facilities and surgical infrastructure initially limited access to adequate care. The ASEAR humanitarian program has provided pediatric otologic care for more than 20 years and offers a unique perspective on the evolution of hearing healthcare in a developing country.

Methods

We reviewed the evolution of the ASEAR program from 2000 to 2024 through three successive phases: establishment of a referral-based surgical program, development of local ENT training, and implementation of advanced otologic and hearing rehabilitation procedures. Historical surgical outcomes were compared with current practice after the emergence of trained Cambodian ENT surgeons and the introduction of cone-beam CT imaging.

Results

During the first phase, more than 5,000 patients were screened and over 700 ear procedures were performed. Children frequently presented with advanced chronic suppurative otitis media and cholesteatoma. Cholesteatoma represented one-third of operated cases and severe complications including facial paralysis, dead ear and intracranial infection were common. Because long-term follow-up was uncertain, disease eradication was prioritized through radical procedures.

The creation of local ENT residency programs and the training of Cambodian otologists, including Dr Sokdavy Touch, progressively transformed the model. The introduction of cone-beam CT imaging enabled more accurate staging and postoperative surveillance, allowing selected conservative cholesteatoma surgery and functional reconstruction. Current outcomes approach those reported in developed countries while reducing dependence on foreign surgical missions.

Seven bone-anchored hearing devices were implanted. Although hearing benefit was satisfactory in selected patients, a high rate of fixture loss and limited acceptance, particularly in unilateral hearing loss, highlighted the challenges of implantable hearing technologies in LMIC settings.

Conclusions

The major challenge in pediatric otology in LMICs is not only surgery but sustainable capacity building. Long-term improvements were achieved through infrastructure development, local specialist training, imaging availability and progressive transfer of expertise. The ultimate goal is to move from disease control toward durable hearing rehabilitation delivered by autonomous local teams.