Amisha Kanji

Caregiver recall and understanding of paediatric diagnostic information and assessment feedback.

Abstract Objective: Providing appropriate feedback to caregivers is an important part of the paediatric audiological assessment. This preliminary study explored caregiver recall and understanding of audiological diagnostic information subsequent to an initial paediatric diagnostic assessment. Design: A qualitative study was conducted at an audiology clinic at a hospital in South Africa. Data collection included observation and video-recording of assessment and feedback sessions as well as post-session semi-structured interviews with the audiologists and caregivers. Recorded sessions were analysed using sociolinguistic methods and a transcription-less approach. Interviews were analysed via content analysis. Study sample: Participants included four audiologists and five caregivers whose children had been referred for an initial audiological assessment. Results: Feedback sessions included explanations of the hearing mechanism, tests, audiogram, diagnosis and recommendations. Most caregivers were able to recall the final diagnosis and recommendations, but demonstrated poor recall and understanding of explanations of the audiogram and hearing mechanism. Conclusions: Results highlight the importance of tailoring information towards specific caregiver needs during feedback sessions and acknowledging the goals and agenda of the caregiver. There is a need for a greater focus on information counselling in curricula and training programmes, and several suggestions are made in this regard.

Hearing screening follow-up return rate in a very low birth weight project : a retrospective record review

Objectives. To determine the follow-up return rate for a hearing screening programme implemented as part of a very low birth weight project (VLBWP). Design. This was a retrospective, passive archival design. Data were collected from the VLBWP records and participant files from the Department of Audiology, Charlotte Maxeke Johannesburg Academic Hospital. Setting. Charlotte Maxeke Johannesburg Academic Hospital, South Africa, a public sector hospital. Subjects. Eighty-six participants were included for retrospective analysis, consisting of 35 males and 51 females with a birth weight range of 680 - 1 500 g. Outcome measures. Return rate for all neonates referred for follow-up oto-acoustic emissions screening. Results. Of the 86 neonates who were referred for a follow-up screening, only 31.4% (27) returned for a repeat outpatient hearing screening appointment. Conclusions. The follow-up return rate is significantly poor and may influence implementation of early hearing detection and intervention (EHDI). Efforts to improve the return rate should be intensified. These may involve parental education and counselling, as well as involvement of nursing staff and medical professionals in implementation of EHDI programmes. It may be possible to improve followup by aligning follow-up screening with the day of neonatal follow-up clinics in provincial hospitals where such services are available, including it in such clinics, or ensuring follow-up screening at immunisation clinics closer to where patients live.

Recall and understanding of feedback by adult patients following diagnostic audiological evaluation

Abstract Objective: Patient recall and understanding of information provided during feedback sessions may impact on adherence to treatment recommendations and may be affected by the audiologists information giving style. This study examined patients’ recall and understanding of diagnostic audiological information provided in a feedback session after an initial assessment. Design: An exploratory, qualitative research design was used and involved: (1) observation of audiological assessments; (2) video recording of feedback sessions between audiologists and patients; (3) audio recorded semi-structured interviews with participants. Transcription-less analysis was used for the videoed interactions and content analysis for the interviews. Study sample: Participants included five adult second-language English speaking patients and five audiologists at an audiology clinic. Results: Patients correctly recalled and understood diagnoses and recommendations but struggled to recall other information provided. There appeared to be a mismatch between the information audiologists deemed important, versus what patients actually recalled and understood. Both facilitatory and inhibitory information giving strategies were used by audiologists in feedback sessions. Conclusion: This study suggests the need for a greater focus on communication skills training in the audiology curriculum with particular attention paid to information giving strategies and patient-centredness. Implications for teaching and practice are discussed.

Audiological practices and findings post HPCSA position statement: Assessment of children aged 0 - 35 months

Background. Early detection of hearing loss is important to ensure optimal development, and may be influenced by the audiological assessment process. Objective. To describe the actual practices and audiological findings with regard to the assessment of 0 - 35-month-old children referred for a hearing assessment at a public hospital. Methods. A retrospective record review was conducted. The study sample comprised 100 participant files. Results. The mean age of initial hearing screening was 13.1 months. Of the participants, 99% received an initial hearing screening and 44% received a second hearing screening. Only four of the eight participants who were referred underwent auditory brainstem response testing and were diagnosed with hearing loss. These four participants were diagnosed after the age of 2 years. The audiological protocol differed from that recommended by the Health Professions Council of South Africa, resulting in limited diagnostic assessment results. Conclusion. The study highlighted gaps in the practice of recommended, age-appropriate audiological protocols as well as the ages at which the initial hearing screenings were conducted, which affects early diagnosis of hearing loss.

Pediatric physicians’ referral of children aged 0-3 years for audiological evaluation in the public health care sector

The current study aimed to determine the current practice of pediatric physicians in the referral of children (0-3 years) for further audiological evaluation in the South African public health care sector. Sixty three pediatric physicians comprising of pediatricians, neonatologists, medical officers, registrars and interns from three academic hospitals completed a self- administered questionnaire. Most participants reported referrals to an audiologist when hearing loss was suspected. An average of eight risk factors for hearing loss listed on the Health Professionals Council of South Africa (HPCSA) 2007 position statement were identified by participants, indicating the need for referral. Generally, participants reported that referral/s occurred easily within the respective hospitals. Results highlight that pediatric physicians are aware of the role that audiologists play in the diagnosis and management of hearing loss, are involved in the referral of children that are at risk for hearing loss, and have awareness of some of the known risk factors associated with hearing loss. Further education regarding other risk factors is required in order to increase referral/s, and ensure appropriate referral of children at risk for hearing loss.

Feasibility of newborn hearing screening in a public hospital setting in South Africa: A pilot study

OBJECTIVES The current pilot study aimed to explore the feasibility of newborn hearing screening (NHS) in a hospital setting with clinical significance for the implementation of NHS. Context-specific objectives included determining the average time required to screen each neonate or infant; the most suitable time for initial hearing screening in the wards; as well as the ambient noise levels in the wards and at the neonatal follow-up clinic where screening would be conducted. METHOD A descriptive, longitudinal, repeated measures, within-subjects design was employed. The pilot study comprised 11 participants who underwent hearing screening. Data were analysed using descriptive statistics. RESULTS The average time taken to conduct hearing screening using otoacoustic emissions and automated auditory brainstem response was 18.4 minutes, with transient evoked otoacoustic emissions taking the least time. Ambient noise levels differed between wards and clinics with the sound level readings ranging between 50 dBA and 70 dBA. The most suitable screening time was found to be the afternoons, after feeding times. CONCLUSION Findings highlight important considerations when embarking on larger scale NHS studies or when planning a hospital NHS programme. Current findings suggest that NHS can be efficiently and effectively conducted in public sector hospitals in South Africa, provided that test time is considered in addition to sensitivity and specificity when deciding on a screening protocol; bar recognised personnel challenges.Objectives The current pilot study aimed to explore the feasibility of newborn hearing screening (NHS) in a hospital setting with clinical significance for the implementation of NHS. Context-specific objectives included determining the average time required to screen each neonate or infant; the most suitable time for initial hearing screening in the wards; as well as the ambient noise levels in the wards and at the neonatal follow-up clinic where screening would be conducted. Method A descriptive, longitudinal, repeated measures, within-subjects design was employed. The pilot study comprised 11 participants who underwent hearing screening. Data were analysed using descriptive statistics. Results The average time taken to conduct hearing screening using otoacoustic emissions and automated auditory brainstem response was 18.4 minutes, with transient evoked otoacoustic emissions taking the least time. Ambient noise levels differed between wards and clinics with the sound level readings ranging between 50 dBA and 70 dBA. The most suitable screening time was found to be the afternoons, after feeding times. Conclusion Findings highlight important considerations when embarking on larger scale NHS studies or when planning a hospital NHS programme. Current findings suggest that NHS can be efficiently and effectively conducted in public sector hospitals in South Africa, provided that test time is considered in addition to sensitivity and specificity when deciding on a screening protocol; bar recognised personnel challenges.

Early hearing detection and intervention: Reflections from the South African context

For researchers and clinicians in developing contexts like South Africa, the establishment of universal newborn hearing screening (UNHS) programmes is something which we have strived to achieve. However, we need to ask the question as to whether we have attempted to view our ultimate goal of achieving mandated UNHS programmes from the perspective of the South African healthcare system as a whole. The current manuscript is aimed at providing an overview of audiological services within a broader context, with reflections from a South African perspective, and a suggestion to consider alternatives to UNHS, particularly in the South African public health care sector.

The management of occupational noise–induced hearing loss in the mining sector in Africa: A systematic review – 1994 to 2016

Literature into exposure to occupational noise in developing countries suggests that the prevalence of occupational noise–induced hearing loss is still high. There is also evidence that the mining industry is aware of this epidemic; however, the efforts to curb occupational noise–induced hearing loss are currently unsuccessful. Therefore, the aim of this study was to explore and document current evidence reflecting trends in the management of occupational noise–induced hearing loss in the mining industry in Africa from 1994 to 2016. A systematic literature review was conducted in line with the Cochrane collaboration guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Electronic bibliographic databases such as ScienceDirect, PubMed and Scopus MEDLINE were searched. A total of 1212 titles and abstracts were identified; of which only nine papers formed part of this study. The results indicated that there is a dearth of research on the management of occupational noise–induced hearing loss in Africa. The limited research on the management of occupational noise–induced hearing loss focuses on some aspects of the hearing conservation programme pillars and not on all the pillars as suggested by some scholars in the field. Furthermore, these studies had small sample sizes thereby, minimizing their generalization. There is therefore a need for more studies on the management of occupational noise–induced hearing loss in the mining sector, as there is evidence to suggest that occupational noise–induced hearing loss in African countries is still on the rise.

Hearing impairment detection and intervention in children from centre-based early intervention programmes

The study aimed to describe ages at identification and initiation of early intervention (EI) services for children enrolled in centre-based EI programmes in Gauteng, as well as to describe the nature of EI services that the children received. The researchers conducted retrospective record reviews of the EI programme files. In addition, caregivers of eight children identified with hearing impairments and enrolled in centre-based EI programmes in Gauteng completed a newly constructed questionnaire. The caregiver questionnaire produced data pertaining to the childs family demographics, background information and schooling history. Descriptive statistics were used to analyse the data, using frequency distribution and measures of central tendency. None of the children received newborn hearing screening services, thus they were identified late following maternal suspicion of hearing impairment. Late identification of the hearing impairment resulted in suboptimal initiation of EI services. All the children received aural habilitation and/or speech–language therapy services. These findings indicate that there is a great need for the establishment of widespread early hearing detection and intervention programmes that will lead to earlier identification of infant and childhood hearing impairment and timely initiation of EI services.

Newborn hearing screening protocols and their outcomes: A systematic review

OBJECTIVE To conduct a review of the most current research in objective measures used within newborn hearing screening protocols with the aim of exploring the actual protocols in terms of the types of measures used and their frequency of use within a protocol, as well as their outcomes in terms of sensitivity, specificity, false positives, and false negatives in different countries worldwide. METHODS A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Electronic databases such as PubMed, Google Scholar and Science Direct were used for the literature search. A total of 422 articles were identified, of which only 15 formed part of the current study. The 15 articles that met the studys criteria were reviewed. Pertinent data and findings from the review were tabulated and qualitatively analysed under the following headings: country; objective screening and/or diagnostic measures; details of screening protocol; results (including false positive and negative findings, sensitivity and/or specificity), conclusion and/or recommendations. These tabulated findings were then discussed with conclusions and recommendations offered. RESULTS Findings reported in this paper are based on a qualitative rather than a quantitative analysis of the reviewed data. Generally, findings in this review revealed firstly, that there is a lack of uniformity in protocols adopted within newborn hearing screening. Secondly, many of the screening protocols reviewed consist of two or more tiers or stages, with transient evoked otoacoustic emissions (TEOAEs) and automated auditory brainstem response (AABR) being most commonly used. Thirdly, DPOAEs appear to be less commonly used when compared to TEOAEs. Lastly, a question around routine inclusion of AABR as part of the NHS protocol remains inconclusively answered. CONCLUSIONS There is sufficient evidence to suggest that the inclusion of AABR within a NHS programme is effective in achieving better hearing screening outcomes. The use of AABR in combination with OAEs within a test-battery approach or cross-check principle to screening is appropriate, but the inclusion of AABR to facilitate appropriate referral for diagnostic assessment needs to be systematically studied.