| Age |
0-4 |
1 |
| 5-9 |
2 |
| 10-14 |
3 |
| 15-19 |
4 |
| 20-29 |
5 |
| 30-39 |
6 |
| 40-49 |
7 |
| 50-59 |
8 |
| 60-69 |
9 |
| 70-79 |
10 |
| 80+ |
11 |
| Gender |
Male |
1 |
| Female |
2 |
| Residence |
Urban |
1 |
| Rural |
2 |
| Remote |
3 |
| Administration of ototoxic medication |
Yes |
1 |
| No |
2 |
| Meningitis causal pathogen |
H. influenzae |
1 |
| S. pneumoniae |
2 |
| N. meningitidis |
3 |
| Other bacteria |
4 |
| Viral |
5 |
| unknown |
6 |
| ENT - otoscopy |
NAD |
1 |
| AOM |
2 |
| AOMwiP |
3 |
| CSOM |
4 |
| Dry TM Perforation |
5 |
| OME |
6 |
| ETD |
7 |
| Impacted Cerumen |
8 |
| Foreign Body |
9 |
| Fungal Otitis Externa |
10 |
| Could not assess |
11 |
| Audiology - tympanometry |
A |
1 |
| As |
2 |
| Ad |
3 |
| B small |
4 |
| B norm |
5 |
| B large |
6 |
| C1 |
7 |
| C2 |
8 |
| Tympanometry contra-indicated |
9 |
| Could not perform |
10 |
| Audiology – hearing level |
Normal |
1 |
| Mild |
2 |
| Moderate |
3 |
| Severe |
4 |
| Profound |
5 |
| Incomplete result |
6 |
| No result obtained |
7 |
| Audiology – nature of hearing loss |
Conductive |
1 |
| Sensorineural |
2 |
| Mixed |
3 |
| Could not determine |
4 |
| Outcome |
No further action |
1 |
| Review by ENT |
2 |
| Refer to SENESE |
3 |
| Review by ENT & refer to SENESE |
4 |