Katijah Khoza-Shangase

Automated screening audiometry in the digital age: exploring uhear™ and its use in a resource-stricken developing country.

BACKGROUND The current study aimed to determine the accuracy of UHear™, a downloadable audiometer on to an iPod Touch©, when compared with conventional audiometry. METHODS Participants were enrolled primary school scholars. A total number of eighty-six participants (172 ears) were included. Of these eighty-six participants, forty-four were female and forty-two were male; with the age ranging from 8 years to 10 years (mean age, 9.0 years). Each participant underwent two audiological screening evaluations; one by means of conventional audiometry and the other by means of UHear™. Otoscopy and tympanometry was performed on each participant to determine status of their outer and middle ear before each participant undergoing pure tone air conduction screening by means of conventional audiometer and UHear™. The lowest audible hearing thresholds from each participant were obtained at conventional frequencies. RESULTS Using the Paired t-test, it was determined that there was a significant statistical difference between hearing screening thresholds obtained from conventional audiometry and UHear™. The screening thresholds obtained from UHear™ were significantly elevated (worse) in comparison to conventional audiometry. The difference in thresholds may be attributed to differences in transducers used, ambient noise levels and lack of calibration of UHear™. CONCLUSION The UHear™ is not as accurate as conventional audiometry in determining hearing thresholds during screening of school-aged children. Caution needs to be exercised when using such measures and research evidence needs to be established before they can be endorsed and used with the general public.

Protocols for early audiology intervention services : views from early intervention practitioners in a developing country

Objectives. To identify the protocols and practices for audiology early intervention (EI) in Gauteng government hospitals, and determine whether these protocols comply with the principles for effective EI in audiology. Methods and materials. Self-administered questionnaires were hand-delivered and distributed to participants in government hospitals in Gauteng. Participants. Eighty-six professionals consisting of speech therapists and audiologists (N=20), paediatricians (N=33), ear, nose and throat specialists (ENTs) (N=7), and nurses (N=26) working in EI were included in the study. Analysis of results. Findings were analysed via thematic content analysis which made it possible to determine the predominant themes with regard to EI protocols in government hospital settings. Additional quantitative descriptive statistics were also utilised to handle the data. Results. Findings indicate inconsistent perceptions among the EI practitioners regarding the protocols implemented and that these may influence referrals and early management of children with hearing impairment. Delay of identification and diagnosis (later than 2 years of age) as well as delayed amplification were identified by audiologists. Factors contributing to lack of provision of EI services in audiology included inadequate referrals by professionals, lack of neonatal screening, and poor parental knowledge. Although the medical team believed that identification occurs at less than 6 months of age, they reported intervention to occur much later than identification. Principles of EI tested were generally perceived to be applicable to the South African context and in agreement with best practice in EI.

Highly active antiretroviral therapy: Does it Sound toxic?

Objective The main objective of the current study is to monitor the auditory status in a group of adults with AIDS, receiving Highly Active Antiretroviral Therapy (HAART) (3TC -lamivudine, D4T – stavudine, and efavirenz) in a hospital outpatient clinic in Gauteng. A total sample of 54 adults (between the ages of 18 and 50 years) in the experimental group and 16 in the control group were assessed prospectively following a repeated measures design. All participants were assessed at baseline at three months, and at six months into the treatment. Materials and Methods The participants underwent case history interviews and medical record reviews, otoscopy, and tympanometry, as well as conventional pure tone audiometry and distortion product otoacoustic emission testing. Both descriptive and inferential statistics were used to analyze the data. Results On audiological monitoring, statistically significant changes (P<0.05) were established, only in the experimental group, for pure tone audiometry — with clinically significant changes found at high frequencies. Statistically significant changes with clinically significant changes were obtained for distortion product otoacoustic emissions (DPOAEs) in the experimental group, particularly at high frequencies — implying subclinical hearing function changes; while lack of statistically significant changes with no clinically significant changes were found in the control group. The subclinical hearing changes in the experimental group were also evident in the findings of the subclinical hearing loss group, who, although they had normal pure tone function after six months of follow up, presented with clinical changes on DPOAEs at 6 and 8 kHz. Conclusions Findings highlight the need for closer monitoring of the effects of antiretroviral drugs (ARVs) on hearing, through the use of more sensitive tools of assessment when conducting drug trials.

Evaluation of universal newborn hearing screening in South African primary care

Background: Universal Newborn Hearing Screening (UNHC) is the gold standard toward early hearing detection and intervention, hence the importance of its deliberation within the South African context. Aim: To determine the feasibility of screening in low-risk neonates, using Otoacoustic Emissions (OAEs), within the Midwife Obstetric Unit (MOU) three-day assessment clinic at a Community Health Centre (CHC), at various test times following birth. Method: Within a quantitative, prospective design, 272 neonates were included. Case history interviews, otoscopic examinations and Distortion Product OAEs (DPOAEs) screening were conducted at two sessions (within six hours and approximately three days after birth). Data were analysed via descriptive statistics. Results: Based on current staffing profile and practice, efficient and comprehensive screening is not successful within hours of birth, but is more so at the MOU three-day assessment clinic. Significantly higher numbers of infants were screened at session 2, with significantly less false-positive results. At session 1, only 38.1% of the neonates were screened, as opposed to more than 100% at session 2. Session 1 yielded an 82.1% rate of false positive findings, a rate that not only has important implications for the emotional well-being of the parents; but also for resource-stricken environments where expenditure has to be accounted for carefully. Conclusion: Current findings highlight the importance of studying methodologies to ensure effective reach for hearing screening within the South African context. These findings argue for UNHS initiatives to include the MOU three-day assessment to ensure that a higher number of neonates are reached and confounding variables such as vernix have been eliminated.

The influence of epidural anesthesia on new-born hearing screening: A pilot study

Objective: The main aim was to establish if epidural anesthesia had an influence on new-born hearing screening results in newborns born via elective Cesarean section in healthy pregnancies. Specific objectives included determining screening results in a group of newborns born to mothers who had undergone epidural anesthesia during Cesarean section childbirth (experimental group); and comparing the findings with those of a group of newborns born to mothers who had undergone natural delivery without epidural anesthesia (comparison group); while establishing if the time of screening following delivery had any effect on the overall screening results. Materials and Methods: The above objectives were achieved through the use of a prospective quasi-experimental repeated measures design with a comparison group, where 40 newborns (20 in the experimental and 20 in the comparison group) were screened at three different times through transient otoacoustic emissions (TEOAEs) and automated auditory brainstem response (AABR) measures. All participants were screened while resting quietly in open bassinets in an empty new-born nursery. For both test measures, the results were recorded as either pass or refer. Data were analyzed through both descriptive and inferential statistics. Results: Findings indicated that hearing screening earlier than four hours after birth, for both the experimental and comparison groups yielded more false positive findings than testing conducted after 24 hours. An index of suspicion in relation to the influence of epidural anesthesia on Automated Auditory Brainstem Response (AABR), when conducted less than four hours after birth, was raised, as statistically significant findings (P<0.05) were obtained. Conclusions: The findings have implications for timing of screening where universal newborn hearing screening is being implemented.

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.

HIV/AIDS and auditory function in adults: the need for intensified research in the developing world

This article reviews published research on auditory function in HIV-infected adults, while also highlighting the need for intensified research on this topic in Africa. It begins with an introduction to the effects of HIV disease and treatment on the auditory system, and so highlights the need to put auditory function in adults with HIV or AIDS on the healthcare and research agenda in developing countries. The discussion refers to this population in regard to: published prevalence and incidence data related to auditory manifestations; most prevalent types of auditory manifestations and hearing loss; degree, configuration, and symmetry of the hearing loss; types of onset of hearing loss; and the proposed direct and indirect causes of auditory manifestations in HIV disease. Finally, the possible effects of HIV/AIDS drug treatments on the auditory system, as an indirect cause of hearing loss, are also discussed. A review of the literature revealed that auditory manifestations in adults with HIV or AIDS are heterogeneous in nature and are possibly due to various causes. Auditory presentations, including hearing loss, tinnitus and vertigo (in varied combinations) can occur with hearing loss, which includes conductive, mixed, sensorineural, and central types of hearing loss. The severity of hearing loss can range from mild to profound, occurring either unilaterally or bilaterally, with the types of onset including sudden or gradual and progressive. The varied causes of hearing loss include HIV infection or AIDS illness as a primary cause, opportunistic infections, and antiretroviral treatments. The studies discussed are mainly from developed countries where the presentation and management of HIV and AIDS can be different to that in developing countries because the context is different. This suggests a need for more research in this area since the numbers of adults living with HIV or AIDS in developing countries like South Africa is relatively high.

Pathological vestibular symptoms presenting in a group of adults with HIV/AIDS in Johannesburg, South Africa

Aim: The current study aimed to explore the pathological vestibular symptoms presenting in a group of adults with HIV/AIDS in Johannesburg, South Africa.Design: A quantitative non-experimental research design was adopted where data was collected by means of a questionnaire with close-ended questions on 96 participants who were recruited from a teaching hospital’s HIV/AIDS research unit.Analysis: Data were analysed through descriptive statistics.Results: Findings from the current study revealed that 17% of the sample studied presented with an occurrence of pathological vestibular symptoms. The most prominently reported pathological vestibular symptoms found were vertigo, dizziness, light-headedness, unsteadiness and headaches. Of the participants experiencing vestibular symptoms, 69% reported experiencing co-occurring audiological symptoms. Collectively, these symptoms were found to have a significant effect on the participants’ quality of life and their ability to work. Interestingly, however, current fin...

Risk versus benefit: Who assesses this in the management of patients on ototoxic drugs?

The current paper is an attempt at highlighting important strategic indicators, as well as important variables, that the audiology community needs to consider in order to play a more central role in pharmaco-vigilance as part of pharmaco-audiology. Pharmaco-vigilance is an important aspect of pharmacological treatment of disease. In developing countries, where burden of disease is high with resource constraints dictating healthcare priorities; it is important to deliberate on risk/benefit of medications prescribed to treat disease. In the form of a literature review, the author presents current arguments with regards to audiology practice. In audiology, pharmaco-vigilance in the form of ototoxicity monitoring is gaining momentum within the South African research and clinical communities. This ototoxicity monitoring is however non-systematic, non-comprehensive, and does not seem to have a strategic plan behind it. This is fundamentally due to lack of involvement of audiologists in the risk/benefit evaluation of medications during the drug development and monitoring process. The current paper agues for an expanded role of the Audiologist which will ensure collaborative engagement with all relevant stakeholders in order to ensure that both quantity and quality of life are considered during the drug development and monitoring process.

Bridging the gap between early identification and intervention in the paediatric population with hearing impairments : hot topics

The aims of early hearing detection and Intervention (EHDI) policies are to identify and manage hearing loss as soon as possible, thereby minimising the effects of undetected hearing loss on the communication ability of the paediatric individual. The profession of audiology in South Africa is growing, and consequently the numbers of available audiologists who enforce the EHDI principles of early detection are also increasing. However South Africa, as a developing country, has additional barriers that prevent the EHDI principles from being fully achieved. These barriers have led to the existence of a significant gap between the identification of a hearing loss and the management of this communication disability. Hearing impaired paediatric individuals who seek medical assistance from the public health care sector are faced with the challenge of insufficient financial resources and funding to provide them with the appropriate hearing amplification apparatus to manage their hearing loss effectively. Paediatric individuals may wait for up to 2 years until these funds become available; thus leading to undesirable consequences for the development of speech, language and communication skills. The purpose of the current study was to explore how implementation of an alternative service provision model that advocates public-private partnership; in the form of a hearing aid bank, can facilitate the achievement of EHDI principles; thereby bridging this significant gap between detection of hearing loss and actual intervention. Findings highlight the need for thorough interrogation and exploration of such public-private partnerships, such as the Wits Hearing Aid Bank Project (Wits-HAB), as vehicles to providing the much needed services to the hearing-impaired paediatric populations in developing countries.