Browsing by Author "Hlayisi, Vera-Genevey"

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    Auditory characteristics and balance function of diabetic patients
    (2017) Hlayisi, Vera-Genevey; Ramma, Lebogang; Petersen, Lucretia; Rogers, Christine
    Aims and Objectives. This study aimed to describe auditory characteristics and balance function in patients with diabetes between 18-55 years of age as well as determine the association between patients' auditory and balance function with diabetes characteristics (type, duration and control). Background. Diabetes is one of the most prevalent non-communicable diseases worldwide with approximately 422 million people diagnosed globally. This number is projected to rise to 642 million by 2040 if no appropriate interventions are implemented to reverse the rise in the number of people with diabetes. South Africa has the second highest diabetes prevalence in Africa (after Nigeria) with 2.6 million cases. A rise in diabetes prevalence should be a concern for audiologists with increasing literature linking diabetes with the risk of acquiring hearing and balance disorders. However, there is currently a lack of research done in South Africa to investigate auditory and balance disorders in patients with diabetes. Therefore, the current study sought to investigate auditory characteristics and balance function in South African patients diagnosed with diabetes. It is anticipated that the study findings will yield evidence that will highlight the role of an audiologist in the clinical management of patients with diabetes. Research Design. The study utilised an observational cross-sectional matched groups design with a cohort (patients with diabetes) and control (volunteers without diabetes) group of participants. Participants were recruited from a Primary Health Care clinic in Polokwane, Limpopo using purposive and convenience sampling for the cohort and control group respectively. Methodology. Several methods were used to collect data pertinent to this study. These included case history interview and a medical folder review to obtain information related to participants' diabetes status. Furthermore, all participants underwent the following assessments: otoscopy, pure tone audiometry, diagnostic distortion product otoacoustic emissions (DPOAE), vision screening, peripheral neuropathy screening, Dynamic Gait Index test (DGI) and the Modified Clinical Test of Sensory Integration (MCTSIB). Data were analyzed using both descriptive and inferential statistical tests. Results. A total of 192 participants took part in this study; 110 in the cohort and 82 in the control group. There were similar distributions of gender in both groups with the following age distributions (in years) for each group; cohort; median =46, range =20-55, control; median =43, range =21-55. Pure tone audiometry assessments showed a significantly higher prevalence of hearing loss in the cohort (55%) when compared to the control (20%) group (p < .001). Participant age, gender and diabetes duration were associated with the likelihood of having hearing loss (age: odds ratio=2.90, 95% CI: 1.19-7.08, p=0.019; gender (male): odds ratio=.266, 95% CI: .104-.677, p=0.005; diabetes duration: odds ratio=1.12, 95% CI: 1.02-1.22, p=0.013). DPOAE assessments showed significantly higher percentages of abnormalities with signal to noise ratio (p < 0.01) and DPOAE level (p < 0.01) in the cohort compared to the control group. A significantly higher proportion (38%) of participants in the cohort group reported tinnitus when compared to 15% in the control (p < .001). Balance screening assessments with the DGI and the MCTSIB, showed significantly poorer performance in the cohort group than the control (DGI:, p < .001; MCTSIB: p < .001). Conclusion. Overall findings of this study showed that participants who were diagnosed with diabetes had a higher proportion of auditory and balance abnormalities when compared to those in the control group. Older age, male gender and longer duration since diabetes diagnosis were associated with a higher likelihood of having hearing loss. The findings of this study therefore suggest that auditory and balance dysfunction should be considered as comorbidities associated with diabetes. This study also highlighted the role of an audiologist in the managment of patients with diabetes with respect to early identification and management of auditory and balance dysfunctions amongst these patients.
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    Beyond hearing aid fitting: Investigating the feasibility of providing tele-rehabilitation for adult hearing aid users in a South African public health context
    (2021) Khatib, Nuha; Hlayisi, Vera-Genevey; Ramma, Lebogang
    Introduction: Disabling hearing loss is one of the most common sensory deficits; affecting approximately 466 million people worldwide. In the South African context, public health facilities have an uneven ratio between audiologists and patients in need and thus audiological services are often minimal. Successful application of tele-health may increase the scope of audiological services for hearing aid (HA) users. Research is needed to investigate feasibility of tele-health for audiological rehabilitation programmes such as auditory training (AT). Aim and Objectives: This study aimed to investigate the feasibility of implementing a telerehabilitation programme in a South African public health context. Objectives included: 1) determining online AT compliance; 2) determining the effect of online AT on speech perception in noise; 3) assessing experience and benefit of tele-rehabilitation through questionnaires and interviewing; and 4) cost estimation around tele-rehabilitation implementation. Research Design: A convergent mixed methods design with a feasibility approach was utilized. Data collection was through questionnaires, in-booth speech assessments, online AT and face-to-face interviewing. Participants undertook online AT over four weeks. Pre-/post- online AT: the APHAB, QuickSIN, Entrance/Exit Questionnaires, Interviews and System Usability Scale were administered. Descriptive statistics were used to analyse the quantitative data collected, and descriptive thematic analysis was used for the qualitative data. Study sample: Purposive sampling was used and three female adult (35 - 55 years) HA users from a public health facility participated. Results: 1) High compliance rate (84.82%) with 3 hours 25 minutes total clinician contact time, 2) clinical benefit with improvement in listening skills and perceived HA benefit, 3) positive participant feedback, and 4) estimated cost at R1350.00 per person. Conclusions: Findings from this feasibility study can be seen as positive indicators towards the use of tele-health as a delivery modality for audiological rehabilitation, also a tele-health hybrid model is recommended. However, larger-scaled research is needed.
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    Exploring the audiological management of young children (0-6 years) diagnosed with bacterial meningitis
    (2019) Tromp, Nikki; Ramma, Lebogang; Hlayisi, Vera-Genevey
    Background. Internationally, infectious diseases remain the greatest cause of morbidity among young children. Infectious disease burden is particularly high in low-to-mid income countries (LMIC). South Africa has a high prevalence of bacterial meningitis (BM), especially in children under the age of five. BM is also one of the commonest causes of acquired hearing loss in children. Given the fluctuating and transient nature of BM-related hearing loss, there is a need for an effective audiological protocol to facilitate timeous and appropriate audiological management. There is currently no universally accepted protocol for the audiological referral and management of children diagnosed with BM. Consequently, there is a need for an evidence-based protocol that will ensure timely referral and audiological testing of all children diagnosed with BM. Early identification of BM-related hearing loss in children will allow for timeous, appropriate audiological management and associated benefits, such as an option for placement in mainstream schooling. Objectives. This study aimed to explore the audiological management of children diagnosed with BM at a tertiary hospital in the Western Cape, South Africa, with reference to: patterns of referral for audiological assessment following a diagnosis of BM; current audiological protocols for the management of children diagnosed with BM. It was anticipated that this study would generate evidence that could potentially be used to develop appropriate protocols for the audiological management of children diagnosed with BM in LMICs, specifically South Africa. Methods. A retrospective record review was conducted using patient folders of children between 0 and 6 years who were treated for BM between May 2016 and May 2018. Data collection took place at Red Cross War Memorial Children's Hospital, which has a paediatric infectious diseases unit and an audiology department. Demographic and audiological data were recorded on a self-developed data abstraction form and data were analysed descriptively. Results. A total of 291 patient folders were accessed for review in this study. Of those, 40 (13.7%) met the inclusion criteria for the study and were selected for review. The majority of excluded folders were for patients not referred for audiological testing post-BM diagnosis. For those children referred to audiology, average referral time was 15 days (SD = 24 days) and each patient attended an average of only 2 audiology appointments. Otoacoustic emissions testing and tympanometry were the most commonly performed audiological tests in all children. BM-related hearing loss developed in 2/19 of these patients. All patients who were diagnosed with BM-related hearing loss were subsequently fitted with hearing aids – one of whom was fitted unilaterally with a hearing aid and the other, a cochlear implant candidate, was lost to follow-up. Conclusions. The key challenge experienced in this study was low referral rates to audiology (16%), which was followed by poor adherence to follow-up appointments – both of which were found to impede effective audiological management. Effective management and prevention of BM-related hearing loss pose challenges in LMICs. This study highlights the need for a well-defined referral pathway and an evidence-based protocol for the audiological management of children with BM within the South African health care setting. If this could be achieved, the early identification of hearing loss in these children has the potential to provide them with developmental, scholastic, and working opportunities in line with those of children with normal hearing.
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    Hearing Health Awareness among Medical Practitioners Managing Patients with Diabetes in South Africa
    (2023) Jinabhai, Divaksha; Hlayisi, Vera-Genevey
    Background. Research has shown that auditory symptoms can occur as diabetes mellitus (DM) related complications. DM related auditory symptoms can include hearing loss (HL), tinnitus and balance disorders. The negative impact of DM on hearing health in context of the rise in the prevalence of DM, lends impetus for audiological assessment and management of patients with diabetes (PWD). It is unknown as to whether medical practitioners (MPs) managing PWD are aware of DM related auditory symptoms and in turn counsel and refer PWD for audiological assessment and management. Aim and Objectives. The study had four aims and several objectives per aim. The first aim was to determine South African MPs' awareness of DM related auditory symptoms. The objectives for this aim included determining the proportion of MPs who are aware of DM related auditory symptoms, which DM related auditory symptoms MPs are aware of and how MPs became aware of the symptoms. The second aim was to determine whether MPs refer for DM related auditory symptoms and the objective to achieve this aim was to determine the proportion of and reasons for DM related auditory symptom referrals. The third aim was to investigate the relationship between awareness of and referral for DM related auditory symptoms among MPs. The objectives for this aim included investigating if there is a correlation between awareness of and referrals for DM related auditory symptoms and referrals of PWD and determining if MPs years of experience influenced awareness of and referrals for DM related auditory symptoms. The fourth and last aim of the study was to describe counselling practices of MPs on DM related auditory symptoms. The objectives for this aim were to determine whether information regarding DM related auditory symptoms is included in counselling sessions, MPs' familiarity on the audiologist's role in the management of DM related auditory symptoms and the relationship between MP's familiarity with the role of an audiologist and counselling on DM related auditory symptoms. Research design. The study employed a descriptive cross sectional survey design. Purposive sampling was utilised, and prospective participants were recruited online through the data bases of various medical associations in South African as well as social media. An 18-item online survey questionnaire was designed for this study, covering A) demographic details B) awareness of DM related auditory symptoms and C) referral information. The survey questionnaire was content validated and piloted prior to the main data collection. Data collection was facilitated online through SurveyMonkey™, over a four-and-a-half-month period. Data was analysed quantitatively using descriptive and non-parametric methods as well as qualitatively using content analysis. Results. A total of 379 participants consented to contribute to the survey and 236 responses were eligible for use in analysis. Most participants (n=46; 12.1%) were excluded for non-completion. Of the 236 participant responses analysed, majority were unaware (n=141; 59.7%) of, did not refer (n=119; 51.5%) for and never counselled (n=148; 65%) on DM related auditory symptoms. Majority of participants (n=102, 44.9%) were not at all familiar with the role of audiologists in the management of PWD. With participants who were aware of DM related auditory symptoms (n=95, 40.3%), there was an increased likelihood to refer PWD to an audiologist and/or ENT (p<0.001). Furthermore, counselling on DM related auditory symptoms was found to be significantly dependent on participant's familiarity with the role of audiologists in DM management (p<0.001). Conclusion. A high proportion of MPs were unaware of and do not refer or counsel PWD for DM related auditory symptoms. It was also found that majority of MPs were unaware of the role of audiologists in DM management. The findings of the study suggest the need to promote awareness surrounding DM related auditory symptoms among South African MPs, which in turn could improve management of DM related auditory symptoms in PWD. In addition, the study underscores the need to promote the multidisciplinary collaboration between audiologists and MPs in the management of PWD.
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    Living with hearing loss: exploring the lived experience of identity construction among adolescents and young adults
    (2022) Sekoto, Lieketseng; Hlayisi, Vera-Genevey; Petersen, Lucretia
    Background: Identity construction is the predominant developmental task in adolescence and young adulthood. Disabling hearing loss (HL) exacerbates the psychosocial challenges faced by adolescents and young adults (AYA) in their identity construction. The primary goal of this research study was to describe how AYA with disabling HL feel about and perceive their identity. Further, to understand the aspects underlying identity construction, with a focus on self-perception, navigating disability, social roles and relations, and community assimilation. Methodology: A qualitative interpretive phenomenological approach was adopted. Participants were a purposive sample of 5 Deaf and Hard-of-hearing AYA, aged 15 to 19 years. All participants were enrolled in schools for the deaf in the Western Cape and partook in semi-structured phenomenological conversations, where they narrated detailed accounts of their lived experiences with identity construction. Results: Interpretive phenomenological analysis was used to formulate themes. The superordinate themes of creating a self-concept, belonging, stress and being deaf emerged from participants' narratives. Identity construction occurs concurrently at several levels. At the personal level, deaf AYA create self-conceived ideals of who they are (Creating a self-concept), at relational level identity is nurtured through person-to-person and person-to-group interactions (Belonging). At societal level deaf AYA ascertain their position as individuals within the larger society (Being deaf). Protective factors, enabling factors and barriers that threaten positive identity construction, audiological health, and the psychosocial wellbeing of deaf AYA were identified. Overall, findings from this study indicate that the experience of identity construction for AYA with HL is layered and laden with challenges. Identity formation, albeit portrayed as a process of differentiation, is a balancing act. Identity is self-defined and equally exists in a collective identity with others. Identity construction also subjected participants to stress arising from the emotional burdens of HL, stigmatisation, and resultant psychological effects. Amid unique challenges, deaf AYA consciously developed coping mechanisms, some constructive and others detrimental to their audiological health, all while negotiating their position in the larger society. Conclusion: Study findings appeal to individuals in the caring professions such as audiologists, teachers, educational psychologists, and social workers to understand the nuances of identity construction for the successful transitional care of deaf adolescents moving into adulthood. Counselling needs to be responsive to the needs of deaf AYA, identity domains should be upheld in the provision of person-centered care and possible trajectories for identity crisis should be evaluated when considering school placement. Benefits of group counselling and peer support groups should be explored. There is a need for interventions that curb negative audiological health behaviours through assertiveness training and self-advocacy. The micro implementation of employment equity policies and legislation is critical to ensure the realisation of AYA's prospective identities in the South African workforce. Findings call for the reorientation of audiological rehabilitation and strengthening of interdisciplinary collaboration to meet the psychosocial needs of AYA with disabling HL.
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    Ototoxicity Monitoring using Automated Extended High-Frequency Audiometry and the Sensitive Range of Ototoxicity in Patients with MDR-TB
    (2020) Greeff, Wildine Marion; Petersen, Lucretia; Hlayisi, Vera-Genevey
    Background: Disabling hearing loss is a global burden. This burden is worsened by the emergence of multi-drug resistant tuberculosis (MDR-TB). Some of the medications used to treat MDR-TB are damaging to the cochlea and auditory nerve (ototoxic) and can lead to permanent hearing loss and/or balance disorders. Ototoxicity monitoring aims to reduce this burden by preventing or minimising the damage caused by ototoxic treatment as it can progress and worsen speech perception difficulties. However, the proposed test battery for ototoxicity monitoring is lengthy and demands active participation which is not ideal for ill patients (such as those on MDR-TB treatment). The Sensitive Range of Ototoxicity (SRO) technique is recommended to shorten the test time. The SRO consists of seven consecutive relatively high frequencies determined from the highest frequency the participant responded to. The SRO technique is time efficient. Although the SRO technique provides the prospect of a shortened test battery, there is still a global lack of audiologists. Automated audiometry is a vital application for testing especially when audiologists are not available to physically do the test. Automated audiometry has been previously validated. Clinically, automated audiometry is objective and allows for standardisation. Even though automated audiometry helps improve access to monitoring more patients, patient preference is an important factor when using automated audiometry to ensure patient-centred care is not compromised. Aims and Objectives: This study aimed to investigate the specificity and sensitivity of the SRO technique with automated audiometry compared to the gold standard (manual audiometry). This comparison was made by firstly, determining the testing time efficiency and the correlation of thresholds obtained with the different test methods and, secondly, testing the diagnostic value of automated audiometry using the SRO technique. The incidence of an ototoxicity-induced hearing loss was described by determining the time interval between starting ototoxic MDR-TB treatment and the onset of a significant threshold shift (STS) according to ASHA's criteria. Lastly, the test method preference of the participants with MDR-TB was described and compared using a short exit survey. Study Design: A prospective repeated-measures study design was used. Participants were chosen based on a risk factor (i.e. exposure to ototoxic medication) for an outcome of interest (i.e. the presence or absence of an STS). With a repeated measures study, multiple tests using different test methods can be compared with the same sample. Participants: Twenty-seven in-patients at Brooklyn Chest Hospital and DP Marais TB Hospital with normal hearing and on MDR-TB medication were included in the study. Their age range was from 19 to 51 years old with an average age of 33 years old. Non-probability convenience sampling was used as it was cost-effective, reduced data collection time and was relatively easy to execute. Data collection materials and procedures: The procedure for data collection included weekly follow-up testing for a maximum of four weeks. The test battery was as follows: an auditory symptom questionnaire, otoscopy examination, and manual and automated audiometry using the SRO technique with a fifteen-minute break in between. Participants were tested with the KUDUwave ™ in a non-sound treated room. The frequency range was determined with the SRO technique. If an STS was obtained, the patient was discharged from the study after completing an exit survey. Statistics: Analysis included descriptive statistics and inferential statistics. A Bonferroni corrected p-value (initially p ≤ 0.05) was used. Manual and automated audiometry thresholds were compared using the Pearson's Correlation Coefficient test. Manual and automated audiometry testing time and threshold means were compared using paired sample's t-tests. The diagnostic value of automated audiometry with the SRO technique was assessed with Receiver Operating Characteristics (ROC) Curves. Results: Manual audiometry was statistically more time-efficient compared to automated audiometry by an average of one minute and ten seconds (t (94) = -5.44; p< 0.003). There was a strong positive correlation for both left and right ears between the thresholds' obtained from manual and automated audiometry at 8kHz to 16 kHz (df> 28 = r > 0.70, p< 0.003). Automated audiometry was found to be a fair diagnostic test (area under the curve was 0.75; p= 0.002). Also, the ROC curve revealed that automated audiometry had a sensitivity of 61% and specificity of 90% when compared to manual audiometry (gold standard). Only participants that started data collection within 31 days after starting their MDR-TB treatment were included in the analysis of determining the incidence of an ototoxicity-induced hearing loss (n= 24 ears). This study found that 41.67% of ears (n= 10) had an ototoxicity-induced hearing loss. A box and whisker plot revealed that data was skewed to the right (i.e. more variation in data between the median and the maximum values) and that the median number of days for an ototoxicity-induced hearing loss to appear was 33 days. Secondly, 55.55% of participants (n=15 out of 27) reported auditory symptoms before data collection commencement. Aural fullness was the most reported symptom (n= eight out of 15). Ten out of 15 (66.66%) participants that reported auditory symptoms obtained an ototoxicity-induced hearing loss. Lastly, most participants (i.e. 13 out of 19; 68.42%) that completed the exit survey had no preference between manual or automated audiometry. The common rationale among these participants was “No difference noted.” Conclusion: This research study has revealed that manual audiometry was more time-efficient compared to automated audiometry in patients with MDR-TB. Also, automated audiometry was a fair diagnostic test. It may aid in reducing the disproportionate audiologist to patient ratio, especially in a developing country. However, manual audiometry (with the SRO technique) is more clinically appropriate in patients that are difficult-to-test. Secondly, audiometric settings can be changed to accommodate testing frequencies in 1/6 octaves so that the SRO technique can be clinically adopted. An ototoxicity-induced hearing loss seems to appear 33 days after ototoxic MDR-TB treatment commencement. Aural fullness was a commonly reported symptom among participants with MDRTB. Aural fullness is omnipresent in peripheral auditory pathologies. Therefore, auditory symptoms reported by patients' needs a comprehensive audiological investigation. Lastly, more research is needed on how patients (and clinicians) experience the advances in technology innovation especially in audiology where technology innovation is continuously evolving.
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    Patients' Perceptions of Person-Centred Care in Audiology: A South African Cross-Sectional Survey
    (2022) Blasl, Danielle; Hlayisi, Vera-Genevey; Petersen, Lucretia
    Background: Person-centred care (PCC) has gained momentum over recent years as essential in the practice of health care. This is largely due to research documenting the benefits of PCC to both patients and practitioners. PCC ensures that patients receive care that respects and accounts for their needs and preferences as individuals. However, until now studies have focused mainly on PCC from the audiologists' point of view; with few exploring the perceptions of PCC (P-PCC) held by patients, particularly within a South African context. One reason for this may be due to the variability around the definition of PCC among professionals. Subsequently, no universal tool to measure P-PCC and its underlying concepts exists, much less one that is suitable for a South African context. Developing and implementing a tool to measure South African audiology patients' perspectives of PCC (PP-PCC), will not only address this paucity in literature, but further inspire PCC strategies which could lead to improvement in clinical practice and quality of care. Aims: 1) To create a tool to assess PP-PCC in a South African audiology context; 2) Determine PP-PCC across 5 dimensions (i.e., communication, shared decision-making, audiologist-patient relationship, provision of individualized care, and holistic care); and 3) Determine associations between PP-PCC and patient characteristics (i.e. age; sex; level of education; socioeconomic status; number of previous consultations; frequency of consultations; public vs. private; nature of consultation; presence of hearing loss; use of amplification; in-patients vs. out-patients). Method: The Patient-and-Audiology-Reported Inventory (PARI) was adapted from the previously validated Patient-and-Dietician-Reported Inventory (PADRI) to an audiological context. To remain inclusive to the South African population, the PARI was translated into Afrikaans and IsiXhosa. A quantitative validation study was conducted using suggested translation and cross-cultural adaptation guidelines proposed by Gjersing, Caplehorn, and Clausen (2010). A group of six validators which consisted of audiology lecturers, researchers, clinicians, and audiology patients validated the PARI and its translated versions using the content validity index (CVI). Once validated a quantitative, descriptive, cross-sectional survey design was carried out using the PARI and a short self-developed demographic questionnaire. The PARI was distributed via electronic, telephonic, face-to-face and paper-based mediums. The initial target sample size was 150 participants, with an inclusion criterion of South African adults, who were able to communicate in English, IsiXhosa or Afrikaans and had attended at least one audiology consultation in South Africa within three months of participation in the study. Participants were purposely sampled, and recruited via advertisements on social media and in patient waiting rooms. Due to hindrances to data collection from the COVID-19 pandemic, the time-frame in which a participant had to have consulted an audiologist was revised to one year. After a year of data collection, a total sample size of 111 participants was obtained. Results: Data analysis employed a mixed methods (i.e. descriptive and inferential) approach to analyse the data, using Stata version 17. The final PARI consisted of 28-items, with CVI analysis indicating appropriate validity at both an item and scale level. Using the responses of 111 participants, the PARI was found to display excellent internal consistency (α = 0.95). Significant differences in scores were initially associated with patients' healthcare sector; in-patient versus out-patient status; age; education level; employment status; frequency of audiological consultations; nature of consultations; hearing loss status; and use of amplification. However, associations between scores and all patient characteristics were no longer statistically significant when scores were adjusted for the influence of healthcare sector (i.e. public vs. private) on PP-PCC. Patients from the private health sector displayed significantly more positive P-PCC than those from the public health sector. Nonetheless, scores from the PARI suggested that South African audiology patients generally held positive P-PCC and its five underlying dimensions. Conclusions: The newly developed PARI has shown to be a valid and reliable tool to measure the P-PCC among South African audiology patients. South African patients generally held a positive PPCC and its underlying dimensions however, disparities were observed among PARI scores between audiology patients from public and private healthcare sectors. This exhibits the stark differences in participant characteristics between the two sectors. This study has provided a foundation for addressing the paucity in PCC literature in South African hearing healthcare. Therefore, future research should focus on using the PARI as a self-reflection tool among practitioners, and an outcome measurement tool for PCC intervention strategies. Moreover, closer investigation between healthcare sectors is needed, especially in developing countries like South Africa.
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    TEDI 2 Week 2 - Interview: Facilitating Effective Language and Communication
    (2019-06-01) Swift, Odette; Hlayisi, Vera-Genevey
    In this video, Odette Swift once more, interviews the very eloquent Vera-Genevey Hlayisi who discusses how language and communication development can be facilitated in classrooms. She begins by cautioning teachers to beware of the subtle but important regional differences in Sign Language as in any other language and advises that teachers should consider these as they interact with deaf learners. She then discusses ways of facilitating communication between parents and their deaf children. This video lecture 11/11 of week 2 of the course: Educating Deaf Children: Becoming an Empowered Teacher.
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    TEDI 2 Week 2 - The Deaf Child's Language and Communication
    (2019-06-01) Hlayisi, Vera-Genevey
    In this video, Odette Swift interviews Vera-Genevey Hlayisi, an audiologist and lecturer at UCT who elaborately responds to questions relating to language and communication for deaf children. She explains how language mismatch negatively influences a deaf child’s understanding of what is taught in class and the consequent knock-on effect on their academic performance. Discussing the different linguistic demands of deaf learners and their hearing peers, she highlights the role of audiologists and language therapists in assisting the teacher to identify adaptations and support mechanisms that s/he can use to facilitate learning for deaf children. This video lecture 10/11 of week 2 of the course: Educating Deaf Children: Becoming an Empowered Teacher.