Krishna Yerraguntla

Follow-up in newborn hearing screening – A systematic review

INTRODUCTION The quality and efficiency of newborn hearing screening programs (NHS) rely heavily on appropriate follow-up. The Joint Committee on Infant Hearing recommends a follow-up rate of more than 95% of infants who fail the initial hearing screening. However, a 70% benchmark is considered to be more feasible. This high loss to follow-up (LTF) rate acts as a threat to the overall success of NHS programs. The objective of the study was to identify and examine the reported rates of LTF, attributed reasons for LTF and strategies undertaken to reduce LTF. METHODS Using a systematic search, articles published between 2005 to December 2015 were identified from PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Educational Resources Information Center (ERIC), Scopus, Ovid, ProQuest, and Cochrane Library. To be included in the review, the study should be exploring the loss to follow-up or drop-out rate in newborn hearing screening programs and be published in an indexed peer-reviewed journal in the English language. The main outcome measures were overall rate of LTF, factors leading to LTF and measures adopted to overcome LTF. RESULTS 53 articles were short-listed for data extraction. Out of these, 27 were single-centre studies, 19 were multi-centre, 3 compared multiple databases, and 4 used survey-based methods. Overall LTF rates of 20% in single-centre and 21% in multiple-centre studies were observed. Educational disparity and lack of adequate knowledge among parents were associated with LTF. The most commonly used strategy to overcome LTF suggested by studies was the use of an adequate data management system. CONCLUSION This review is a novel attempt to explore the LTF among NHS studies, reasons for LTF and strategies to reduce LTF. This review can act as a basis for planning and execution of effective NHS programs.

Knowledge and attitude (KA) survey regarding infant hearing loss in Karnataka, India

INTRODUCTION The support provided and the decisions taken by mothers determine the success of Universal Newborn Hearing Screening (UNHS). Attempts at exploring the existing knowledge-attitude among mothers is crucial to create/modify the existing screening programs. The present study attempts to explore the knowledge and attitude toward infant hearing loss (HL) among mothers of newborns in the Indian state of Karnataka. METHOD A cross-sectional survey was conducted among 219 mothers of newborns in Karnataka, India. The questionnaire was framed from existing literature and consisted of 19 questions assessing knowledge and attitude toward infant HL to be rated on a three-point scale (no, not sure, yes). Descriptive statistics and Cronbachs α were used to analyze the data. RESULTS Mothers exhibited good knowledge of risk factors; noise (70.3%) and ear discharge (54.3%). More than 75% agreed that treatment for HL is available and that these children can attend school. The questions of superstitions and cultural beliefs yielded mixed responses. A large number of mothers expressed desire to have their children tested at birth (84.9%) and were concerned about their childrens hearing (87.7%). Yet only 54.3% stated that they would allow their children to wear hearing aids. SUMMARY AND CONCLUSION The present study is an attempt to understand the knowledge and attitude of mothers toward infant HL in Karnataka and facilitate identification of potential areas of less knowledge as a reference for endeavors of enhancement. It further highlights the need for implementing public awareness programs to improve knowledge and attitude of mothers toward infant HL for better implementation of UNHS.

A national survey of knowledge, attitude and practices among pediatricians towards newborn hearing screening in India

INTRODUCTION Pediatricians have a key role in ensuring that infant has undergone hearing screening and required follow-up. Attempts in various countries and centers have been made at exploring their knowledge, attitude and practices towards universal newborn hearing screening. In India, such a program is at its preliminary stage, and hence a need was felt to study this aspect in pediatricians working in India. METHOD A cross-sectional online survey was carried out among 112 pediatricians working in India. The questionnaire was framed after reviewing the existing questionnaires. Descriptive statistics was used to summarize the findings. RESULTS A response rate of 7.99% (112/1402) was obtained of which only 20.5% reported of availability of screening program in their work set-up. The majority of the pediatricians (95%) were aware of the newborn hearing screening while 98.3% were affirmative about the importance of screening of all infants. Very few pediatricians reported of a screening program in their set-up or in their close locality. Overall the pediatricians were confident about their knowledge on this topic yet expressed a need to know more about several intricacies about hearing screening. The pediatricians also provided an input on the most preferred method of receiving more information. SUMMARY AND CONCLUSION The success of the universal newborn hearing screening program lies in the support and cooperation of health care providers such as pediatricians. The present study draws attention to the positive attitude and practices exhibited by them. It also sheds light on the knowledge gaps that are present and need the due attention of the policy makers. Further, it highlights the need for having more continuing medical education program and awareness drives for ensuring a better implementation of UNHS.

The Effect of Intensity on the Speech Evoked Auditory Late Latency Response in Normal Hearing Individuals.

OBJECTIVE Among the stimulus factors, the influence of presentation level is less studied in normal-hearing individuals when using speech stimuli withvarious presentation levels for the auditory late latency response (ALLR). Hence, the present study aimed to explore the Latency-Intensity (L-I) function, i.e., how the latency and amplitude change as a function of intensity using speech stimuli. MATERIALS AND METHODS Speech-evoked ALLR was obtained from 15 normal-hearing individuals. The syllable/ta/ was used to record ALLR with an intensity of 30, 50, 70, and 90 dBSPL. Electroencephalography (EEG) from five channels was recorded and analyzed offline. RESULTS The overall results revealed that there is an influence of intensity on P1 and N1 latencies in a nonlinear fashion. The latency change is consistent at lower intensities than at moderate and high intensities. The amplitude changes did not reach significance, though a decrease with a reduction in intensity was obvious. CONCLUSION There is a significant effect of intensity on the latency and amplitude of ALLR in speech stimulus. However, this effect may vary for different speech stimuli.

Knowledge and attitude of parents/caregivers towards hearing loss and screening in newborns – a systematic review

Abstract Objective: The parents/caregivers of a newborn play a pivotal role in the process of hearing screening and intervention. The decisions taken by them depend on their knowledge and attitude. The purpose of this study was to review the literature systematically on knowledge and attitude of parents/caregivers towards infant hearing loss and newborn hearing screening. Design: A systematic search was conducted using electronic databases for the periods from 1990 to March 2016. Two authors scrutinized the studies and extracted the data based on predetermined criteria. Study sample: Ten studies. Results: Ear discharge was correctly identified as a risk factor for hearing loss along with measles, drugs/medication, family history, congenital causes and noise exposure. The studies revealed mixed results for knowledge about newborn hearing screening. Overall, the parents/caregivers showed positive attitudes towards hearing screening and intervention options. However, due to heterogeneity in the studies, it’s hard to derive a conclusion. Conclusions: The present review sheds light on the common areas of misconception among parents/caregivers about risk factors of infant hearing loss and newborn hearing screening. The review also draws attention to the need to have more studies exploring this knowledge and attitude of parents/caregivers among diverse populations.

Knowledge and attitude of pediatric hearing impairment among general physicians and medical interns in coastal Karnataka, India

Objective: The objectives of the present study were to investigate and compare the knowledge and attitude among general physicians in primary health-care centers and medical interns. Materials and Methods: A questionnaire-based observational study design was implemented to assess and compare the knowledge and attitude of physicians and medical interns regarding pediatric hearing impairment in setups that have speech and hearing services and that do not offer these services. Results: The general physicians and medical interns showed a positive attitude toward different issues such as importance of hearing in development of speech and language, importance of hearing as a sense, need of hearing screening in newborns, consideration of suspicion of hearing loss by parents, and need of speech therapy. Conclusion: Even though the participants showed adequate knowledge and attitude toward pediatric hearing impairment, there are certain areas that need attention and awareness development. There is also a need to introduce speech and hearing settings at all hospitals as this will ensure a better awareness about the role of the professionals and enable more referrals.

CORTICAL AUDITORY EVOKED POTENTIALS IN TWO PRELINGUALLY DEAFENED ADULTS

Background: It has been reported that in prelingually deafened adults there is maturation of the late latency response (LLR) after rehabilitation using cochlear implants. Other evidence suggests that the auditory system, like any other sensory system, receives multimodal stimulation, a factor which could help the auditory system mature even in the absence of any auditory input. The current study was done on two prelingually deaf adults who had not received rehabilitation, and their latencies were within the normal mature range, suggesting their auditory cortex responses were maturely developed prior to rehabilitation. Material and methods: Two male participants took part in the study: one was 21 years old and the other was 36, and both had congenital profound hearing loss. Using pure tone thresholds obtained earlier, a strong class hearing aid (Siemens Infiniti Pro SP) was programmed using NOAH software and fitted to the right ear using the NALNL-1 fitting formula. As an objective measure of verification of hearing aid effect, auditory P1, N1, P2, and N2 were recorded using the free-field facility available in the IHS SmartEP system: a 1000 Hz pure tone was presented at 70 dB SPL (30 dB SL) and 50 dB SPL (10 dB SL) from a loudspeaker at a distance of 1 m and 45° angle. Results: The latencies of P1, N1, P2, and N2 for both participants were recorded for 70 and 90 dB HL; all latencies were well within normal limits. Conclusions: The results indicate that, with adequate amplification, a mature response from the auditory cortex can be obtained even in adults who have profound hearing loss and who have been deprived of auditory stimuli since a prelingual age.

Knowledge and Perceptions of Teleaudiology Among Audiologists: A Systematic Review

Background and Objectives The knowledge and perception of teleaudiology among audiologists will determine the acceptance and success of teleaudiology practice. This systematic review was conducted to review the published literature on knowledge and perceptions of teleaudiology application among audiologists. Materials and Methods Five studies exploring knowledge and perceptions of teleaudiology application among audiologists published in the English language up to May 2017 were included. Results Positive attitudes was observed across the studies regarding acceptance towards application of teleaudiology. The most common sources of knowledge were on the job, graduate studies, and continuing education programs. The major barriers to the uptake of application of teleaudiology were in terms of limitations in infrastructure, reimbursement, and licensure. Conclusions The study sheds light on the existing knowledge and perceptions of teleaudiology applications among audiologists. This will help in improving the existing teleaudiology services as well as overcome the challenges faced.

CAEPs in non-habilitated congenitally deaf adults: a paradox

Abstract Objective: Most evidences from animal models and human subjects with auditory deprivation report that the children rehabilitated later than 5–6 years of age show abnormal CAEPs (absence of N1) even after a long period of cochlear implant usage and attributed to cortical decoupling. The current study aims to explore the auditory cortical activation in congenitally deaf adults who never received any rehabilitation. Design: Aided CAEPs were elicited using 1000 Hz pure tone at 30 dB SL from 11 congenitally deaf adults and age/gender matched controls aged between 17 and 45 years. The latencies and amplitudes of the P1–N1–P2 obligatory responses were measured and compared using topographic ANOVA (TANOVA). Results: The morphology of CAEP responses from the deaf group was similar to that of the normal hearing group except the presence of a broader P2. The amplitude measures between the groups did not reveal statistical significance; however, P2 latency revealed a significant difference between the groups. TANOVA revealed that the topographic maps between the groups did not significantly differ. Conclusions: The matured cortical response for acoustic stimulus, especially the presence of N1, clearly signifies the activation of auditory cortex. The presence of matured CAEPs might be due to the abnormal synaptogenesis of auditory neurons transforming into multisensory neurons and continues the normal course of maturation. These matured CAEP responses will be an indication of closure of critical period and limited benefit with rehabilitation.

Professional Quality of Life in Audiologists and Speech Language Pathologists Working in India

ABSTRACT The study aimed to investigate professional quality of life as reported by audiologists and speech language pathologists (SLPs) working in India. Questionnaire-based cross-sectional e-mail survey design using the Professional Quality of Life scale (ProQOL) was carried out. The sample consisted of professionals registered under the Indian Speech and Hearing Association. The questionnaire was sent through the personal registered e-mail-id to 500 professionals of which 155 complete responses were obtained. Descriptive statistics were used to summarize the demographic variables. Internal consistency was checked using Cronbach’s alpha. Independent sample t test was used to check the relation of occupation, gender and work setting with the ProQOL subscales. ANOVA and post hoc Tukey HSD was performed to determine the effect of years of experience. A statistically significant difference was found between occupation and secondary traumatic stress (STS) levels and years of work experience and burnout. Post hoc analysis revealed a significant difference between 11 and 20 and more than 21 years of experience. Strong negative correlation between compassion satisfaction and burnout whereas a moderate positive correlation between burnout and STS was observed. The study identifies factors such as occupation type and years of experience have an influence on the professional quality of life.