De Wet Swanepoel

Telehealth in audiology: The need and potential to reach underserved communities

Abstract Permanent hearing loss is a leading global health care burden, with 1 in 10 people affected to a mild or greater degree. A shortage of trained healthcare professionals and associated infrastructure and resource limitations mean that hearing health services are unavailable to the majority of the world population. Utilizing information and communication technology in hearing health care, or tele-audiology, combined with automation offer unique opportunities for improved clinical care, widespread access to services, and more cost-effective and sustainable hearing health care. Tele-audiology demonstrates significant potential in areas such as education and training of hearing health care professionals, paraprofessionals, parents, and adults with hearing disorders; screening for auditory disorders; diagnosis of hearing loss; and intervention services. Global connectivity is rapidly growing with increasingly widespread distribution into underserved communities where audiological services may be facilitated through telehealth models. Although many questions related to aspects such as quality control, licensure, jurisdictional responsibility, certification and reimbursement still need to be addressed; no alternative strategy can currently offer the same potential reach for impacting the global burden of hearing loss in the near and foreseeable future. Sumario La pérdida auditiva permanente es una importante carga para los cuidados de la salud a nivel mundial, con 1 de cada 10 personas afectadas en grado ligero o mayor. La escasez de profesionales entrenados en cuidados de la salud y de infraestructura asociada y la limitación de recursos determina que los servicios de salud auditiva no estén disponibles para la mayoría de la población mundial. La utilización de información y tecnología de la comunicación para los cuidados de la salud auditiva o teleaudiología, combinada con la automatización, ofrece oportunidades únicas para mejorar los cuidados clínicos, ampliar el acceso a los servicios y tener cuidados de salud auditiva costoefectivos y sustentables. La Teleaudiología ha demostrado un potencial significativo en áreas como las de educación y adiestramientio de profesionales de la salud auditiva, profesionales afines, padres y adultos con problemas auditivos; tamiz de problemas auditivos; diagnóstico de pérdidas auditivas y servicios de intervención. La conectividad global está creciendo rápidamente y ha aumentado de manera generalizada su distribución en comunidades con pocos servicios, en donde los servicios audiológicos pueden facilitarse a través de modelos de telesalud. No obstante, existen muchas dudas que deben resolverse y que están relacionadas con aspectos como control de calidad, regulación del ejercicio profesional, responsabilidad jurisdiccional, certificación y reembolso de servicios, pero no existe como alternativa ninguna otra estrategia que pueda ofrecer actualmente el mismo potencial, para impactar el peso global de las pérdidas auditivas en el futuro cercano o previsible.

A systematic review of telehealth applications in audiology.

Abstract Hearing loss is a pervasive global healthcare concern with an estimated 10% of the global population affected to a mild or greater degree. In the absence of appropriate diagnosis and intervention it can become a lifelong disability with serious consequences on the quality of life and societal integration and participation of the affected persons. Unfortunately, there is a major dearth of hearing healthcare services globally, which highlights the possible role of telehealth in penetrating the underserved communities. This study systematically reviews peer-reviewed publications on audiology-related telehealth services and patient/clinician perceptions regarding their use. Several databases were sourced (Medline, SCOPUS, and CHINAL) using different search strategies for optimal coverage. Though the number of studies in this field are limited available reports span audiological services such as screening, diagnosis, and intervention. Several screening applications for populations consisting of infants, children, and adults have demonstrated the feasibility and reliability of telehealth using both synchronous and asynchronous models. The diagnostic procedures reported, including audiometry, video-otoscopy, oto-acoustic emissions, and auditory brainstem response, confirm clinically equivalent results for remote telehealth-enabled tests and conventional face-to-face versions. Intervention studies, including hearing aid verification, counseling, and Internet-based treatment for tinnitus, demonstrate reliability and effectiveness of telehealth applications compared to conventional methods. The limited information on patient perceptions reveal mixed findings and require more specific investigations, especially post facto surveys of patient experiences. Tele-audiology holds significant promise in extending services to the underserved communities but require considerable empirical research to inform future implementation.

Progress towards early detection services for infants with hearing loss in developing countries

BackgroundEarly detection of infants with permanent hearing loss through infant hearing screening is recognised and routinely offered as a vital component of early childhood care in developed countries. This article investigates the initiatives and progress towards early detection of infants with hearing loss in developing countries against the backdrop of the dearth of epidemiological data from this region.MethodsA cross-sectional, descriptive study based on responses to a structured questionnaire eliciting information on the nature and scope of early hearing detection services; strategies for financing services; parental and professional attitudes towards screening; and the performance of screening programmes. Responses were complemented with relevant data from the internet and PubMed/Medline.ResultsPilot projects using objective screening tests are on-going in a growing number of countries. Screening services are provided at public/private hospitals and/or community health centres and at no charge only in a few countries. Attitudes amongst parents and health care workers are typically positive towards such programmes. Screening efficiency, as measured by referral rate at discharge, was generally found to be lower than desired but several programmes achieved other international benchmarks. Coverage is generally above 90% but poor follow-up rates remain a challenge in some countries. The mean age of diagnosis is usually less than six months, even for community-based programmes.ConclusionLack of adequate resources by many governments may limit rapid nationwide introduction of services for early hearing detection and intervention, but may not deter such services altogether. Parents may be required to pay for services in some settings in line with the existing practice where healthcare services are predominantly financed by out-of-pocket spending rather than public funding. However, governments and their international development partners need to complement current voluntary initiatives through systematic scaling-up of public awareness and requisite manpower development towards sustainable service capacities at all levels of healthcare delivery.

Early hearing detection and intervention in South Africa

Early hearing detection and intervention programs have become the standard of care to ensure optimal outcomes for infants with hearing loss, their families and society at large. The overwhelming majority of infants with congenital or early-onset permanent bilateral hearing loss are however born in developing countries like South Africa where services are scarce and awareness poor. Despite its comparatively well-developed economic and reasonably developed health care infrastructure in sub-Saharan Africa, limited information on infant hearing loss and the status of early hearing detection and intervention has been available for South Africa. Recently however, an increasing number of initiatives and reports have highlighted the extent of infant hearing loss and the status of identification and intervention services offered in the country. This report provides a review of the available evidence on infant hearing loss and the status of current early hearing detection and intervention services in South Africa.

Hearing assessment-reliability, accuracy, and efficiency of automated audiometry.

OBJECTIVE This study investigated the reliability, accuracy, and time efficiency of automated hearing assessment using a computer-based telemedicine-compliant audiometer. MATERIALS AND METHODS Thirty normal-hearing subjects and eight hearing-impaired subjects were tested with pure-tone air conduction audiometry (125-8,000 Hz) in a manual and automated configuration in a counterbalanced manner. For the normal-hearing group each test was repeated to determine test-retest reliability and recording time, and preference for threshold-seeking method (manual vs. automated) was documented. RESULTS Test-retest thresholds were not significantly different for manual and automated testing. Manual audiometry test-retest correspondence was 5 dB or less in 88% of thresholds compared to 91% for automated audiometry. Thresholds for automated audiometry did not differ significantly from manual audiometry with 87% of thresholds in the normal-hearing group and 97% in the hearing-impaired group, corresponding within 5 dB or less of each other. The largest overall average absolute difference across frequencies was 3.6 +/- 3.9 dB for the normal-hearing group and 3.3 +/- 2.4 for the hearing-impaired group. Both techniques were equally time efficient in the normal-hearing population, and 63% of subjects preferred the automated threshold-seeking method. CONCLUSIONS Automated audiometry provides reliable, accurate, and time-efficient hearing assessments for normal-hearing and hearing-impaired adults. Combined with an asynchronous telehealth model it holds significant potential for reaching underserved areas where hearing health professionals are unavailable.

Early hearing detection and intervention services in the public health sector in South Africa

The purpose of this study was to examine the current status of newborn/infant hearing screening programs in public sector hospitals in South Africa by means of a descriptive survey. Data was gathered using a self-administered postal questionnaire, which included questions on screening resources and protocols, follow-up, diagnostic, and information management procedures as well as timing of intervention. The questionnaire was sent to 86 speech therapy and audiology departments within public sector hospitals throughout South Africa and 44 questionnaires were returned. The findings indicated that 27% (n=12) of respondents were conducting some form of hearing screening. The most frequently reported reasons for the absence of a screening program were a lack of appropriate equipment and a shortage of staff. Institutions with active screening programs face many challenges and programs are mostly unsystematic. Reported findings make a valuable contribution to the field of early hearing detection and intervention by providing a baseline for the development and structuring of early hearing detection and intervention services as a priority in the public healthcare sector of South Africa.

International classification of functioning, disability, and health core sets for hearing loss: a discussion paper and invitation

Abstract The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) has adopted a multifactorial understanding of functioning and disability, merging a biomedical paradigm with a social paradigm into a wider understanding of human functioning. Altogether there are more than 1400 ICF-categories describing different aspects of human functioning and there is a need to developing short lists of ICF categories to facilitate use of the classification scheme in clinical practice. To our knowledge, there is currently no such standard measuring instrument to facilitate a common validated way of assessing the effects of hearing loss on the lives of adults. The aim of the project is the development of an internationally accepted, evidence-based, reliable, comprehensive and valid ICF Core Sets for Hearing Loss. The processes involved in this project are described in detail and the authors invite stakeholders, clinical experts and persons with hearing loss to actively participate in the development process. Sumario La Clasificación sobre Funcionalidad, Discapacidad y Salud de la Organización Mundial de la Salud (ICF) ha adoptado un acercamiento multifactorial de la funcionalidad y la discapacidad, fusionando un paradigma biomédico con un paradigma social de una forma más amplia. En su conjunto hay más de 1400 categorías ICF que describen diferentes aspectos de la funcionalidad humana y existe la necesidad de desarrollar una lista corta de categorías ICF para facilitar el uso de la clasificación en un esquema para la práctica clínica. Es de nuestro conocimiento que actualmente no existe un instrumento de medición estándar que facilite una forma válida y cómoda para evaluar los efectos de la hipoacusia en la vida de los adultos. El propósito de este proyecto es desarrollar un conjunto básico de condiciones de salud ICF para la hipoacusia que sea internacionalmente aceptado, basado en evidencia, confiable e integral. Se describen en detalle los procesos implicados en este proyecto y los autores invitan a las personas interesadas, a los expertos clínicos y a las personas con hipoacusia a participar activamente en el desarrollo de este proceso.

Audiology in South Africa

Audiology in South Africa is an established profession facing the challenge of serving a diverse population in predominantly developing contexts. The profession has developed over the last half century from an adjunct to speech-language pathology into a profession in its own right. Several tertiary institutions offer undergraduate training in audiology with optional postgraduate qualifications. Institutions are continually adapting to a profession characterised by rapid change – evidenced even in the very composition of the profession itself. This article aims to provide an overview of the development and current status of audiology as a profession in South Africa.

Intercontinental hearing assessment - a study in tele-audiology

We evaluated the validity of remote pure tone audiometric testing conducted from North America on subjects in South Africa. Desktop-sharing computer software was used to control an audiometer in Pretoria from Dallas, and PC-based videoconferencing was employed for clinician and subject communication. Thirty adult subjects were assessed, and the pure tone audiometric thresholds (125–8000 Hz) obtained through conventional face-to-face and remote testing were compared. Face-to-face and remote audiometry thresholds differed by 10 dB in only 4% of cases overall. The limits of agreement between the two techniques were −8 and 7 dB with a 90% confidence interval of −5 to 5 dB. The average reaction times to stimulus presentations were similar, within −108 and 121 ms. The average test duration was 21% longer for remote testing (10.4 vs. 8.2 min). There were no clinically significant differences between the results obtained by remote intercontinental audiometric testing and conventional face-to-face audiometry. It may therefore be possible to expand the reach of audiological services into remote underserved regions of the world.

Sentence recognition in noise: Variables in compilation and interpretation of tests.

Abstract Tests of sentence recognition in noise constitute an essential tool for the assessment of auditory abilities that are representative of everyday listening experiences. A number of recent articles have reported on the development of such tests, documenting different approaches and methods. However, both the development and interpretation of these tests require careful consideration of many variables. This article reviews and categorizes the stimulus, presentation, subject, response, and performance variables influencing the development and interpretation of tests of sentence recognition in noise. A systematic framework is utilized to document published findings on these variables. Recommendations and guidelines, based on test performance requirements and test objectives, are provided concerning the interpretation of results and the development of new test materials. Sumario La ECoG ha mostrado desde hace mucho que complementa el diagnóstico de la MD, primariamente por la medición de la tasa de amplitud SP/AP. Aunque se reporta en la literatura como una prueba de alta especificidad para este trastorno, la sensibilidad de la ECoG, en la población general de MD, se mantiene relativamente baja (rango de 20-65%), El presente estudio evaluó la sensibilidad y la especificidad del protocolo de ECoG que empleamos para pacientes con sospecha de MD, que incluyó la medición de la amplitud y las áreas de los SP y AP ante clicks (para derivar las tasas de amplitud y de área de SP/AP) y la amplitud del SP ante bursts tonales de 1000 y 2000 Hz. Se condujo un cuadro de revisión retrospectivo para comparar los resultados de de la ECoG de 178 pacientes sospechosos de MD, con su diagnóstico eventual. Las medidas de la mayor sensibilidad y especificidad (determinadas utilizando un análisis logístico de regresión) incluyeron: amplitud del PS, área del PS, tasa de área SP/AP y área total de SP-AP. Los valores de sensibilidad y especificidad asociados con esas medidas fueron de 92% y 84%, respectivamente. El valor de sensibilidad fue considerablemente mayor que el previamente reportado y esto es atribuible a la inclusión de mediciones de área en nuestro protocolo.