Browsing by Author "Harris, Tashneem"

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    Aminoglycoside-induced hearing loss: South Africans at risk
    (2009) Bardien, Soraya; de Jong, Greetje; Schaaf, H Simon; Harris, Tashneem; Fagan, Johan; Petersen, Lucretia
    South Africa is currently experiencing a TB epidemic with an estimated incidence of 940/100 000 population/year, and the country has been ranked 4th among the 22 high-burden TB countries worldwide by the World Health Organization (WHO). A potentially devastating threat to TB control is the emergence of multidrug-resistant TB (MDR-TB) and, more recently, extensively drug-resistant TB (XDR-TB), mainly as a result of poor drug adherence by TB patients and incorrect management or treatment regimens by health providers; however, direct transmission of drug-resistant strains also plays an important role. The MDR/XDR-TB strains necessitate prolonged chemotherapy for up to 2 years or more, and the use of more toxic second-line drugs including the aminoglycoside (streptomycin, kanamycin and amikacin) and polypeptide (capreomycin) antibiotics. In South Africa, in accordance with WHO guidelines, streptomycin is used for retreatment of TB while kanamycin, amikacin and capreomycin are used to treat MDR/XDR-TB.
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    Audit of outcomes of endoscopic cholesteatoma ear surgery
    (2019) Diale, Ndivhuwo; Harris, Tashneem
    Background: Endoscopic ear surgery has gained acceptance as a complementary tool to microscopic ear surgery, but perhaps not so much as an instrument for exclusive use.With this approach becoming popular, there is scarce data on cholesteatoma recidivism and hearing outcomes, when exclusively used. Objectives: Auditing outcomes of endoscopic ear surgery for the surgical management of cholesteatoma in the Groote Schuur hospital (above13 year age group) and the Red Cross War Memorial Children’s hospital (below 13 year age group) , with a secondary aim of comparing recidivism and hearing outcomes of 4 different surgical techniques for cholesteatoma resection, namely, exclusive endoscopic (EES), microscopic canal wall down (CWD), microscopic canal wall up (CWU) and combined endoscopic-microscopic techniques. Methods: A retrospective chart review was conducted at our two tertiary academic referral hospitals in Cape Town, namely, Red Cross War Memorial Children’s Hospital and Groote Schuur Hospital from January 2012 to December 2016. Results: A total of 128 cholesteatoma ear surgeries were done; 110 patients were above the age of 13 years and 18 patients were below the age of 13 years. Eight Red Cross patients underwent EES, 7 had CWU, 2 had CWD and 1 had a combined technique. Overall recidivism rate in this population was 33% (6/18), of which 2 were approached exclusively endoscopically, 2 underwent a microscopic CWU, 1 had a CWD and 1 had combined endoscopic-microscopic approach. The mean postoperative hearing in this group was 40dB compared to a preoperative mean of 50,3 decibels (dB). In the Groote Schuur group, 23 underwent an exclusive endoscopic approach; 42 had a CWU, 40 had a CWD and 5 had a combined endoscopic-microscopic approach. Overall recidivism rate for the above 13 year old group was 17% (19/110). Of those, 7 were from the endoscopic group, 8 from the CWU group, 1 from CWD group and 3 from the combined technique group. Mean postoperative hearing was 47,4dB compared to a preoperative hearing of 48,4dB. Conclusions: The CWD technique demonstrated superior outcomes in both the above and below 13 year age groups. In the above 13 year old group, the EES approach had the same recurrence rate as CWU. While paediatric cholesteatomas have much higher recidivism rates compared to adults, our below 13 year old group was too small to conclude any statistical significant differences between the different approaches, and therefore, further studies are required in this age group. Management of cholesteatoma requires a highly individualized approach that takes into account anatomic, clinical and social factors to determine the most appropriate surgical treatment paradigm
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    Incidence of aminoglycoside-induced hearing loss in HIV positive and HIV negative multidrug-resistant tuberculosis patients
    (2011) Harris, Tashneem
    Aims of the study: To document the incidence and severity of aminoglycoside-induced ototoxicity at Brooklyn Chest Hospital; To determine the prevalence of the 6 known aminoglycoside-induced deafness mutations in the MT-RNR1 gene (A1555G, C1494T, T1095C, T1291C, A827G and 961 indel C) in a cohort of MDR-TB patients; To determine whether HIV positive MDR-TB patients are more likely to develop aminoglycoside-induced hearing loss than HIV negative MDR-TB patients; To provide clinical guidelines to the medical fraternity on the use of aminoglycoside antibiotics with regard to the side-effect of ototoxicity.
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    Perceived disability in children and adults with single sided deafness at two tertiary institutions
    (2021) Elfallah, Balgeis; Harris, Tashneem
    Background: Single-sided deafness is defined as a severe-to-profound hearing loss in one ear and normal or near-normal hearing in the other ear. The handicap experienced by patients with bilateral sensorineural hearing loss is well known, but the consequences of single-sided deafness are often underestimated based on the assumption that a person with normal hearing in the contralateral ear is not likely to face a major handicap. Objectives: To determine the handicap level in patients with single-sided deafness, and compare the handicap between employed and unemployed patients. Also, to investigate the relationship between perceived disability and noise in the workplace. The effect of age and duration of hearing loss on the perceived disability of single-sided deafness was also examined. Methods: Two validated questionnaires (1) Speech, Spatial and Qualities of Hearing Scale (SSQ12); and (2) Hearing Handicap Inventory for adults (HHIA) were handed to participants with SSD. This research was conducted in two tertiary hospitals in Cape Town, namely, Groote Schuur Hospital and Red Cross War Memorial Children's Hospital, over the period from November 2018 to August 2020. Results: Fifty-four participants were included in the study, 44 adults and 10 children. Employing the HHIA questionnaire, the results show that 39% of adult participants have a significant handicap compared to 32% who have a moderate handicap and 30% who have no handicap. Also, there was no significant difference in the total handicap scores between the employed and unemployed groups, and the presence of noise in the workplace did not influence the total handicap score in the employed group. There was no influence on age or duration of hearing loss on the total handicap score. The mean of the responses in the SSQ12 questionnaire was between 3.42 and 7; thus, some participants experience major hearing difficulties, while others have minor difficulties. Most of the participants are struggling to follow a conversation with background noise and have difficulty localizing sounds. They also struggle to identify the sound distance. They report increased effort when listening to someone or something. Conclusions: A majority of the patients with single-sided deafness in our population either have a severe or a mild-moderate handicap. A good assessment of the individual's degree of handicap is required to adequately counsel the patient and assist in the decision regarding treatment options.
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    Radiological differences between HIV-positive and HIV-negative children with cholesteatoma
    (2017) Mc Guire, Jessica Kate; Harris, Tashneem; Fagan, Johannes J
    Introduction: HIV-positive children are possibly more prone to developing cholesteatoma. Chronic inflammation of the middle ear cleft may be more common in patients with HIV and this may predispose HIV-positive children to developing cholesteatoma. There are no studies that describe the radiological morphology of the middle ear cleft in HIV-positive compared to HIV-negative children with cholesteatoma. Aim: Compare the radiological differences of the middle ear cleft in HIV-positive and HIV-negative children with cholesteatoma. Method A retrospective, cross-sectional, observational analytical review of patients with cholesteatoma at Red Cross War Memorial Children's Hospital over a 6 year period. Results: Forty patients were included in the study, 11 of whom had bilateral cholesteatoma and therefore 51 ears were eligible for our evaluation. HIV-positive patients had smaller (p=0.02) mastoid air cell systems (MACS). Forty percent of HIV-positive patients had sclerotic mastoids, whereas the rate was 3% in HIV-negative ears (p<0.02). Eighty-two percent of the HIV-positive patients had bilateral cholesteatoma compared to 7% of the control group (p<0.02). There was no difference between the 2 groups with regards to aeration of the middle ear cleft, bony erosion of middle ear structures, Eustachian tube obstruction or soft tissue occlusion of the post-nasal space. Conclusion: HIV-positive paediatric patients with cholesteatoma are more likely to have smaller, sclerotic mastoids compared to HIV-negative patients. They are significantly more likely to have bilateral cholesteatoma. This may have implications in terms of surveillance of HIV-positive children, as well as, an approach to management, recurrence and follow-up. HIV infection should be flagged as a risk factor for developing cholesteatoma.
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    A rapid method for detection of five known mutations associated with aminoglycoside-induced deafness
    (BioMed Central Ltd, 2009) Bardien, Soraya; Human, Hannique; Harris, Tashneem; Hefke, Gwynneth; Veikondis, Rene; Schaaf, H Simon; van der Merwe, Lize; Greinwald, John; Fagan, Johan; de Jong, Greetje
    BACKGROUND:South Africa has one of the highest incidences of multidrug-resistant tuberculosis (MDR-TB) in the world. Concomitantly, aminoglycosides are commonly used in this country as a treatment against MDR-TB. To date, at least five mutations are known to confer susceptibility to aminoglycoside-induced hearing loss. The aim of the present study was to develop a rapid screening method to determine whether these mutations are present in the South African population. METHODS: A multiplex method using the SNaPshot technique was used to screen for five mutations in the MT-RNR1 gene: A1555G, C1494T, T1095C, 961delT+C(n) and A827G. A total of 204 South African control samples, comprising 98 Mixed ancestry and 106 Black individuals were screened for the presence of the five mutations. RESULTS: A robust, cost-effective method was developed that detected the presence of all five sequence variants simultaneously. In this pilot study, the A1555G mutation was identified at a frequency of 0.9% in the Black control samples. The 961delT+C(n) variant was present in 6.6% of the Black controls and 2% of the Mixed ancestry controls. The T1095C, C1494T and A827G variants were not identified in any of the study participants. CONCLUSION: The frequency of 0.9% for the A1555G mutation in the Black population in South Africa is of concern given the high incidence of MDR-TB in this particular ethnic group. Future larger studies are warranted to determine the true frequencies of the aminoglycoside deafness mutations in the general South African population. The high frequencies of the 961delT+C(n) variant observed in the controls suggest that this change is a common non-pathogenic polymorphism. This genetic method facilitates the identification of individuals at high risk of developing hearing loss prior to the start of aminoglycoside therapy. This is important in a low-resource country like South Africa where, despite their adverse side-effects, aminoglycosides will continue to be used routinely and are accompanied with very limited or no audiological monitoring.