Browsing by Author "Petersen, Lucretia"

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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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    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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    Caregivers' experiences, perspectives and expectations regarding diagnosis and management in children with MMHL: Information and support
    (2022) Ntshangase, Ntombenhle; Petersen, Lucretia
    Less severe hearing loss such mild to moderate hearing loss tend be given less attention by caregivers and there is little attention given by researchers compared to more severe hearing loss. There is a gap in literature about caregivers' experiences and perspectives regarding overall diagnosis and management process of children with MMHL aged 6 to 12 years especially in South Africa. The study aimed to describe caregivers' experiences, perspectives and expectations regarding the diagnostic process and management related to mild to moderate hearing loss. The study further aimed to identify strength and gaps of the diagnostic and management process. Data was collected using both quantitative and qualitative methods. Quantitatively, 20 caregivers participated in a questionnaire; qualitatively seven caregivers participated in semi-structured interviews. The questionnaire utilised consisted of demographic information and closed ended questions. The majority of the closed ended questions were demographic questions; others were in a form of Likert scale method in order to measure the satisfaction level of caregivers regarding audiological services. After questionnaire completion, one-on-one semi structured interviews were conducted by the researcher. Interviews were audio recorded and the researcher took notes while recording the interview. Descriptive data analysis was done for quantitative data and interview data was analysed using thematic analysis. Findings indicated that there are both satisfaction and dissatisfactions regarding overall diagnosis and management of children with MMHL. Caregivers expressed satisfaction with the audiologist management however gaps such as poor provision of written information and social support groups were observed as dissatisfactions. Most caregivers delayed the process of seeking hearing health care by using traditional medicine which in turn did not help restoring hearing difficulties. Moreover, caregivers expressed concern about their children's hearing levels and tended to compare them with normal hearing children. Furthermore, caregivers wished for a cure for MMHL and recommended that children with MMHL get a care disability grant. The findings of the current study affirm the previous research by highlighting the importance of providing caregivers with unbiased information. Results of the current study also highlight the importance of early identification and management of hearing loss in children. Also, more effort is needed in terms of providing caregivers with information on all available technology options such as hearing aids, as well as evidence on the pros and cons to support informed choices. This research contributes information regarding the diagnosis and management process of mild to moderate hearing loss from the perspectives of families, which may have important implications for program planners, decision-makers and audiologists delivering services.
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    A comparison of pure tone thresholds and distortion product otoacoustic emission measures in patients with Tuberculosis receiving aminoglycosides
    (2005) Petersen, Lucretia; Singh, Shajila
    Includes bibliographical references (leaves 116-131).
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    Developing human rights competencies for South African health professional graduates.
    (2007) London, Leslie; Baldwin-Ragaven, Laurel; Kalebi, Ahmed; Maart, Soraya; Petersen, Lucretia; Kasolo, Josephine
    Human rights are social or material entitlements which are recognised universally in national and international law and that address fundamental human needs. They inhere in all people by virtue of their humanity, and represent a standard to which governments can be held accountable.
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    Effectiveness of different medical interventions implemented when a change in hearing status is detected during ototoxicity monitoring
    (2022) Gangerdine, Kayleen; Ramma, Lebogang; Petersen, Lucretia
    Background: Fourteen thousand (14, 000) people fell ill with Multi-Drug Resistant (MDR) or Rifampicin-Resistant (RR) Tuberculosis (TB) in South Africa (SA) in 2019. Aminoglycosides, which are commonly used anti-tuberculosis drugs in the treatment for RR/MDR-TB patients, are associated with ototoxicity (cochlear or vestibular). Aminoglycoside-induced cochleotoxicity is characterised by permanent, bilateral, highfrequency (HF) sensorineural hearing loss (SNHL). The impact of hearing loss (HL) due to aminoglycoside-induced cochleotoxicity can influence a patient's communication, psychological, physical functioning and overall well-being negatively and lead to a reduced quality of life (QoL). To reduce the risk of aminoglycoside-induced cochleotoxicity, patients' hearing thresholds are monitored (i.e., cochleotoxicity monitoring) when they are being treated with cochleotoxic aminoglycosides. Cochleotoxicity monitoring is performed to detect a significant threshold shift (STS) early and prevent further deterioration of hearing thresholds and avoid hearing loss which may end up affecting frequencies that are important for speech perception. When a STS or hearing loss is detected during cochleotoxicity monitoring, there are various intervention strategies that can be implemented by the treating medical personnel to avoid further deterioration of patient's hearing thresholds. These strategies may include discontinuing the aminoglycoside, changing the aminoglycoside to a less cochleotoxic alternative in the regimen or changing the frequency of administration of the aminoglycoside. This study, therefore, aimed to determine the effectiveness of different strategies used when a STS in hearing occurred during cochleotoxicity monitoring to prevent further deterioration in hearing thresholds. Methodology: A descriptive prospective repeated-measures design was used in this study. Patients who underwent RR/MDR-TB treatment with Kanamycin, a cochleotoxic aminoglycoside, at Brooklyn Chest Tuberculosis Hospital (BCH) between June to December 2016 were recruited to participate in the study. Only patients (n= 69) with normal hearing thresholds (i.e., pure tone average (PTA) at 500 Hz, 1 kHz and 2 kHz ≤ 25 dB HL) at baseline and age 18 – 55 years were included. Patients who were receiving two aminoglycosides, were retreatment patients or had active middle ear (ME) pathology were excluded from this study. Participants were sampled via a purposive sampling strategy. All audiological testing was performed in a sound-treated booth and participants underwent the following types of assessment; baseline, periodic monitoring, and diagnostic assessment (when indicated). The following tests were performed at baseline: case history, otoscopy (OT), tympanometry (TYMP), conventional pure tone audiometry (cPTA) including air conduction (AC) and bone conduction (BC), and ultra-high frequency audiometry (UHFA). Follow-up monitoring assessment occurred monthly if there was no significant change in hearing thresholds, and biweekly if an STS was detected. The ASHA criteria were used to determine STS. The degree of hearing loss was described as mild, moderate, moderately-severe, severe or profound and the type of hearing loss was either conductive, sensorineural, or mixed. Both descriptive and inferential (Chi-squared, Mann-Whitney U and Kruskal-Wallis) statistical tests were used for data analysis. Results: A total of sixty-nine (69) patients who were undergoing treatment for RR/MDR-TB were recruited to participate in this study. Five participants dropped out of the study due to various reasons, therefore, leaving 64 participants in the study. There was 38 males and 26 females. The median age was 31 [range; 18 - 55] years old. An aminoglycoside-induced cochleotoxicity incidence of 90.6% (58/64) was found in this study. There were no statistically significant associations between the occurrence of STS and age (p = 0.487), sex (p = 0.329) and HIV status (p = 0.764). Three types of intervention strategies were used when a participant experienced an STS: (i) discontinue Kanamycin (Strategy A), (ii) modify the frequency of Kanamycin administration (Strategy B), (iii) and leave the regimen unchanged, i.e., no intervention (Strategy C). A smaller proportion of participants, 12 out of 33, experienced further deterioration of hearing thresholds after intervention strategy A (discontinue Kanamycin) was used, when compared to participants who underwent intervention strategies B and C, but the difference was not statistically significant (p = 0.056). Conclusion: This study found a high incidence of cochleotoxicity among patients receiving Kanamycin treatment for RR/MDR-TB. The results showed that discontinuing Kanamycin led to fewer participants developing further deterioration of hearing thresholds, although not statistically significant. There were no statistically significant associations between the occurrence of STS and age, sex, and HIV status. This study had some limitations; only cochlear hearing loss was investigated, participants were not followed up beyond six months, and genetic testing was not performed. Nonetheless, this study revealed that fewer participants had further significant threshold shifts after discontinuing Kanamycin, and for those patients who still receive regimens containing aminoglycosides, these findings are relevant.
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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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    Normative data for Frequency Patterns Test in assessment of Central Auditory Processing Disorders for South African children aged 8 to 11 years.
    (2023) Mbele, Nomhle; Petersen, Lucretia
    Background: A central auditory processing disorder (CAPD) is a disorder that presents in individuals as having difficulty understanding fast and degraded speech, understanding verbal instructions, and struggling to hear in background noise, these difficulties are not due to a peripheral hearing loss. Additional secondary effects of CAPD have been well documented to affect school aged children, therefore, making early diagnosis and intervention important for their development. The central tests currently used for testing in South Africa have materials and normative data that were developed from an American population of English first language speakers. In addition, many of the tests in the assessment battery have a high linguistic load. This raises a challenge in the South African population of first language English speakers and the majority of the population who are not first language English speakers. To reduce misdiagnosis, it is important to generate context-specific normative data from a South African test population. By developing normative data for the FPT in SA children it may assist in the accurate diagnosis of CAPD following assessment and contribute to the development of SA specific data. Aim 1: To develop context-specific normative data for the FPT in SA children aged 8- 11 years. Aim 2: To determine the relationship between existing American normative data and newly generated South African normative data. Methodology: A non-experimental comparative descriptive study design was conducted. There were 35 potential participants from 5 schools within the vicinity of the university. Results from 26 participants were included in the study analysis of the FPT and these results were developed into the normative data set. Results: The results from the 26 participants showed that results from the humming response were higher than the verbal response bilaterally. This was noted for all the age groups. In addition, the comparison for the generated normative data and the American data showed no significant difference between the two data sets in the description response. The comparison of the humming response revealed significantly higher responses in the generated normative data over the American data. This was seen across all the age groups. Conclusion: In addressing aim 1, the findings reveal that the FPT as an assessment is not affected by language however, the performance in the test may be affected by the language it is administered in. Additionally, the findings confirm a need for age specific data as the results improved with age showing the neuromaturation of the CANS as the children grow. Regarding aim 2, the results of this study show that there are some differences between the data sets from the two populations which is seen in other studies as well confirming the need for context specific normative data. The data set for this study was small and cannot be generalised to the whole S.A. population, therefore the data may be used as a first step in the development of a full set of normative data for the FPT. The study does inform the need for further research and a larger scale study for context specific data.
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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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    The challenges and coping strategies of communication partners of older adults with disabling hearing loss using assistive hearing technology. a South African study
    (2022) Mustapha, Safoora; Petersen, Lucretia; Hlayisi, Vera
    The effects of disabling hearing loss can create communication barriers that do not only affect the person with hearing loss (PHL), but also the communication partner's (CP) quality of life. Literature has previously been centred around the individual with hearing loss, thus leaving an information gap in South Africa that focuses on providing family centred care that includes the CP in the audiological rehabilitation process. It is important for hearing health professionals to consider the CP's wellbeing when managing older adults with hearing loss, as they have been found to play a significant role in the audiological rehabilitation process. Therefore, exploring the Goal Sharing for Partners Strategy (GPS) tool in a South African context will contribute to the knowledge in the field of audiological rehabilitation. Furthermore, gaining insight into the challenges and coping strategies that CPs experience will improve on the approach to the service provided in audiological rehabilitation. A qualitative research design was employed with a sample of 10 couples who completed the GPS tool and semi-structured interviews. The data was analysed using thematic analysis. The results revealed four overarching themes that presented the effects of disabling hearing loss on the CP. The impact of disabling hearing loss resulted in daily life communication challenges for the CP. These challenges affected CPs emotionally as well as transformed the way they communicated in their relationships, however the values, beliefs and personality of the CPs allowed them to cope and develop resilience to the burden of third-party disability. Additionally, the usability questionnaire demonstrated that the GPS tool was an appropriate tool to use in South Africa when adopting a family centred approach to audiological rehabilitation and was most beneficial when implemented as an interview guide administered by an audiologist. The information from this study can be used to provide support to other CPs as well as enhance the success of audiological rehabilitation for PHLs through a family centred approach.
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    The development of a modified 2 pair Dichotic Digit test recorded in a South African English Accent
    (2020) Segoneco, Selekisho; Cloete, Tracey-Lee; Petersen, Lucretia
    The impact of Central Auditory Processing Disorders (CAPD) on language and communication of children and adults is well documented in research. Several tests and normative data exist to assess and diagnose for CAPD, but these tests are not valid for use in South Africa due mismatch in the language or accent of the test recording and the language spoken in South Africa as well as normative data that were collected in the United States of America. As such CAPD may remain undiagnosed, misdiagnosed or designed management plans may be inappropriate as they arose from invalid tests. This study employed a developmental study design in order to adapt an existing 2-pair dichotic digit test (2-pair DDT) to a South African English accent to better suit the South African context. The study further investigated the effect of accent on dichotic digit test performance by comparing the performance of South African adults on the newly adapted South African accent 2-pair DDT and the existing 2-pair DDT, specified by the Department of Veteran Affairs (DVA), using a Wilcoxon-signed ranked test. Lastly, the study collected normative data for the 2-pair DDT that can be used in South Africa. The study successfully used a developmental study design to produce a South African accent 2-pair DDT that meets the international specifications as outlined by the DVA. A Wilcoxon signed ranked test showed that South Africans performed better on the South African accent 2- pair DDT than on the DVA specified test. The latter finding was supported by qualitative reports from the participants who found the DVA specified 2-pair DDT stimuli to be more difficult to listen to as compared to the South African accent test. Furthermore, the study produced preliminary normative data for the South African accent 2-pair DDT that met international standards and may be used to score 2-pair DDT performance. The successful use of the developmental study design to adapt the 2-pair DDT shows promising possibilities as a systematic process for adapting or developing tests that are more contextually appropriate for various contexts.
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    The Epidemiology of Auditory Dysfunction in Type 2 Diabetic Adults in Africa: 4 A Systematic Review and Meta-analysis
    (2022) Fihla, Achuma; Engel, Mark; Petersen, Lucretia; Hohlfeld, Ameer
    Background: There is a growing rate of diabetes related hearing loss (HL) worldwide. However, in under-developed countries, HL is still under-recognised as a complication of type 2 diabetes mellitus (T2DM). Although Africa presents a significant rise in T2DM every year, it is met with limited resources to assist its growing and ageing population. Objectives: This systematic review and meta-analysis brings awareness to diabetes-related HL in the form of reliable medical evidence measuring the prevalence of T2DM-related HL in an African population. Methods: Studies were screened using Rayyan QCRI. STATA software and the random-effects metaanalysis model was used to aggregate prevalence estimates with a 95% confidence interval. The Freeman Tukey Transformation was used to account for between study variability. The study protocol is published in PROSPERO international Register of Systematic Reviews (registration number CRD42021227801). Results: We identified a total of 99 studies, 14 duplicates were removed and 67 were excluded. After full review only five studies were included for quantitative synthesis. All the studied were crosssectional and used purposive sampling as their recruitment method. Conclusions: Findings show most participants with T2DM experienced mild HL and slight delays in objective hearing assessments. Audiometric resources and qualified Audiologists are scarce in Africa. Therefore, the available evidence does not justify the added costs needed for routine audiometric assessments for patients with T2DM. However, it does serve to recommend prioritising further research regarding risk factors associated with developing auditory disorders in people with T2DM.
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    Towards the identification of a contextually-relevant school hearing screening protocol in the Western Cape
    (2011) Cloete, Tracey-Lee; Kathard, Harsha; Petersen, Lucretia
    This research study stemmed from my experience as a community-based Audiologist in the Mitchell's Plain sub-district in Cape Town, South Africa. During this time, I worked closely with the local school nurses and witnessed first-hand the many challenges that these health workers are faced with. Through my collaborative work with the Mitchell's Plain school health nurses I identified the urgent need for a contextually relevant hearing screening protocol to assist the school nurses in improving the current state of the school-based hearing screening service. I therefore embarked on this research process taking on the role of a 'clinician-researcher' who had prior relationships with the primary research participants i.e. the local school nurses.
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    Translation and Adaptation of the Self Assessment of Communication (SAC) and Significant Other Assessment of Communication (SOAC) into Afrikaans
    (2022) Liu, Chiawen Juoe; Petersen, Lucretia; Rogers, Christine
    Abstract The Self Assessment of Communication (SAC) and Significant Other Assessment of Communication (SOAC) are self-report outcome measures that are based on the World Health Organization's (WHO) International Classification of Functioning in Disability and Health (ICF) framework. The SAC and SOAC focus on hearing-related activity limitations, participation restrictions, quality of life, hearing aid use, and satisfaction from the perspective of the hearingimpaired individual and the communication partner or significant other (SO). The SAC is administered to the hearing-impaired individual, while the SOAC is the companion questionnaire that is administered to the SO. The SOAC focuses on the hearing disability and handicap of the hearing-impaired individual from the perspective of the SO. The SAC and SOAC were initially developed in English and standardised for a developed country population, the United States of America (USA). Thus, to make the outcome measures more relevant to a multicultural and multilingual country like South Africa (SA), the most practical solution is to translate and adapt the measure for the SA population. In SA, few audiological outcome measures have been translated and adapted. Therefore, to add value to the limited research available, the study aimed 1) to adapt and translate the SAC and SOAC into Afrikaans using the American Association of Orthopaedic Surgeons (AAOS) guidelines; and 2) to describe the usability of the Afrikaans SAC and SOAC by South African audiologists through surveys and verbal feedback interviews. The AAOS translation and adaptation guideline is a multi-step translation method that involves five stages: (i) Forward Translation from the source language (English) to the target language (Afrikaans); (ii) Synthesis of the forward translations; (iii) Backward Translation from the target language (Afrikaans) back to the source language (English); (iv) Expert Committee Review by analysing all the translations to create a pre-final Afrikaans SAC and SOAC measure; and (v) Field testing the pre-final Afrikaans SAC and SOAC. The field testing stage involved the target population (Afrikaans speaking hearing-impaired individuals and SOs) who analysed the pre-final Afrikaans SAC and SOAC. The participants in the field testing stage were sampled using purposive, convenience, and snowball sampling methods within the Western Cape Province in private practice. For the second aim of the study, 16 bilingual Afrikaans and English audiologists (referred to as audiologist participants) were sampled using purposive and snowball sampling. The audiologist participants were invited to use the Afrikaans SAC and SOAC in their practice for one to two months. Following implementation, the audiologist participants were required to comment on the usability of the Afrikaans SAC and SOAC by completing a survey. Three audiologists agreed to do a verbal feedback interview reporting their experience with the Afrikaans SAC and SOAC. Overall, audiologist participants' responses (survey and verbal feedback interview) indicated positive feedback regarding the translated Afrikaans SAC and SOAC. Most felt that the measure was a useful counselling tool, was user friendly and provides valuable information on the perception of hearing loss. However, some implementation challenges were reported such as (i) limited time available, which caused a delay in appointments with other patients, and (ii) patients' SO were not always present in consultation, as such, the SOAC could not be administered. In conclusion, findings revealed that following a multi-step approach when translating and adapting a measure is valuable, as it allows researchers to identify inaccuracies and discrepancies during the translation process to achieve a good quality translation. Furthermore, based on audiologists' perspectives, the Afrikaans SAC and SOAC can be used in clinical practice by South African audiologists. However, it is recommended that further research is necessary to explore psychometric properties such as criterion and concurrent validity.