Left to right: The Ear Unit with the waiting area observing social distancing along the open-air hallway. Services are strictly by appointment and transactions through the window; Receiving area of The Ear Unit with staff observing strict protocols on wearing mask, face shield, hand hygiene and social distancing; Engineering controls such as exhaust fans in all rooms, HEPA filters, UV light, sterilizers, barriers, taffeta covers for the equipment and PVC blinds that can easily be disinfected were installed.
The Ear Unit, the hearing and balance laboratory and epicenter of service and research of the Philippine National Ear Institute (PNEI) located at the second floor of the Philippine General Hospital Central Block, has resumed full operations starting January 2021.
The Ear Unit was closed from March 15, 2020 to May 15, 2020 during the first lockdown in Metro Manila in compliance with protocols and guidelines for the temporary cessation of non-emergency health services. The PGH’s designation as a Covid 19 referral center was also another reason for the closure, the Ear Unit being in the middle of the PGH, less than 10 meters away from four COVI-19 wards.
The resignation of a staff member and two others’ inability to report to office due to public transport shortage contributed to the decision to partly cease operations. Despite the lockdown, some patients still went to the hospital to meet their previous appointments. A staff member, Ms. Ma. Luz San Agustin, a registered nurse and clinical audiologist, continued to report to work to perform newborn hearing screening. walking several kilometers to and from office for lack of public transport.
PNEI Director Dr. Maria Rina Reyes-Quintos, also Newborn Hearing Screening Reference Center (NHSRC) OIC, sent advisories to all Newborn Hearing Centers (NHCs) in the country which was consistent with the Philippine InterAgency Task Force for Emerging Infectious Diseases and PhilHealth Guidelines on the Provision of Special Privileges to Those Affected by a Fortuitous Event.
The first NHSRC advisory dated March 18, 2020 recommended that all NHCs defer initial screening with Oto Acoustic Emissions (OAE) or Automated Auditory Brainstem Response for up to two months after birth and that rescreening with OAE be done two weeks after initial screening. Confirmatory testing can still be done before three months and will still fall within the recommended 1-3-6-month algorithm.
During the lockdown, the NHSRC was unable to supply the Newborn Hearing Screening Registry Cards due to the unavailability of staff to process orders. The move was to ensure protection for the hearing screening personnel, nurses and doctors who may be exposed to COVID. The risk of infecting infants as well as of further exposure of the personnel to the COVID 19 virus in the birthing facilities far outweighed the benefits of hearing screening before the infant is discharged. This was during the time when the mode of transmission of the coronavirus was not yet determined.
The second advisory dated April 15, 2020 that is still in effect and will most likely be the new normal in the next one to two years states that hearing centers follow the hospital’s or institution’s procedural protocols on disinfection and attire. However, the NHSRC recommended wearing at least a surgical mask, eye protection in the form of face shield or goggles, and gloves in all procedures to ensure the safety of the patients and personnel while performing hearing tests in infants.
The Ear Unit, with its soundproofing, was understandably a confined space. Administrative controls were set such as a strict appointment system through text, email and Viber, contact tracing information, and temperature checks before entering the facility. Walk-in patients were and are still no longer allowed.
The Ear Unit had to invest on a dedicated cellphone and redundant internet providers as the UP-Manila system was not reliable due to congestion. Engineering controls such as exhaust fans, HEPA filters, barriers and UV lamps were installed. A three-month supply of PPEs such as masks, face shields, gloves, 70% ethyl alcohol, germicidal hand soaps was ensured in place of the monthly replenishment. All of these were accomplished through generous donations from the PGH Department of Otorhinolaryngology and The Ear Study Group.
Despite limited resources, personnel and the COVID restrictions, the Ear Unit rose to the challenge of serving patients albeit on a limited scale. The Philhealth Z-Package for Hearing Impaired Children was pilot launched in December 2020. The Ear Unit is the first in the country to provide hearing aids to infants and children through the national insurance program led by Dr. Ma. Leah Tantoco an Otolaryngologist-Clinical Audiologist. and Dr. Christopher Malorre Calaquian. Of 51 applicants, 19 children have been fitted with the device as of February 2021.
The National Cochlear Implant Program led by Dr. Charlotte Chiong, former PNEI and NHSRC Director and UP College of Medicine Dean, was also started amidst this crisis. Partner institutions of this program are the Corazon Locsin Montelibano Memorial Medical Center in Bacolod and Southern Philippines Medical Center in Davao that will receive cochlear implants as well as diagnostic hearing equipment necessary to function as hearing implant centers. The program is envisioned to support families with children who need further surgical intervention after undergoing hearing amplification and speech therapy with minimal benefit. This is the final component in providing complete care for hearing impaired children in the Philippines.
*This article was contributed by the PNEI Ear Study Group composed of Rosario Ricalde, Christopher Malorre Calaquian, Ma. Leah Tantoco, Maria Rina Reyes-Quintos, Abner Chan, Nathaniel Yang, Teresa Luisa G. Cruz, Erasmo Gonzalo Llanes, Kimberly Mae Ong, and Charlotte Chiong.
(This article was first published in the UP Manila Healthscape Special COVID-19 Issue No. 30 and in the UP Manila website.)