Browsing by Subject "Audiology"

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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 with the diagnosis of hearing loss
    (2015) Hagedorn, Elfriede; Kathard, Harsha; Taljaard, Dunay
    Knowledge of the impact of a diagnosis of hearing loss in children on their caregivers and the nature of their relationships with professionals during this process is inadequate in South Africa. The purpose of this study was to understand the experiences and perceptions of caregivers of diagnosis of hearing loss in their children. A qualitative, retrospective, narrative inquiry research design was used. Participants who were purposefully selected included one couple and 12 caregivers in the Tshwane Metropolitan area. They were interviewed using an in-depth interview method. The narrative data was subjected to in-depth thematic analysis. Three themes emerged from the data: 1) The catastrophic emotional impact of diagnosis, 2) The good and the bad of professional interaction, 3) Imbalanced relationships, strained resources and resulting identity threats. The discussion focused on the deeply emotional nature of the participants' experiences and the changes that ensued during and following the diagnosis of hearing loss in their relationship with their child and the wider community and how this impacted on their sense of identity. The study concluded that diagnosis has extensive, pervasive and disruptive effects on caregivers and that the professional plays an important role in shaping that experience. It thus makes recommendations for a humanistic, family-centred, paediatric audiology practice.
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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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    Clinical educators' expectations and experiences of supervising audiology students in South Africa a focus on race and language
    (2013) Keeton, Nicola; Singh, Shajila
    Includes abstract. Includes bibliographical references.
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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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    Current tele-audiology services in clinical practice and the influence of the Covid-19 pandemic on audiologists? perceptions of tele-audiology
    (2025) Davids, Tersia; Hlayisi, Vera-Genevey; Petersen, Lucretia
    Approximately 20% of patients who undergo anti-reflux surgery will report a recurrence of reflux symptoms or develop new symptoms, with 5% ultimately requiring revision fundoplication. The aim of this study is to document symptoms at representation, pre-operative work-up and intraoperative findings of patients presenting for revision fundoplication (RF). Methods: This is a single center descriptive retrospective review of 37 patients who required revision of a previous fundoplication for significant recurrent symptoms between January 2015 and December 2017 at Groote Schuur Hospital and UCT Private Academic Hospital. Patient data included demographics, body mass index (BMI), patient reported symptoms prompting initial fundoplication, interval to symptom recurrence and RF, technique of the first and subsequent revision surgery and perioperative morbidity. Recurrent symptoms at representation, results of pre-operative investigations and actual intraoperative assessment during RF were reviewed. Results: During the two-year study period 37 patients underwent RF. The mean age was 52.9 years (range 22 – 77 years, SD =13.3), with 25 (67.6%) females and 12 (32.4%) males included in the cohort. The most frequent patient-reported indication for index fundoplication was gastro- oesophageal reflux (GOR) (65%). Symptoms at representation prior to RF included dysphagia (51.4%) and heartburn (51.4%) equally, epigastric pain (48.6%), volume reflux (43.2%), atypical chest pain (24.3%), bloating (16.2%), nausea (13.5%) and early satiety (10.8%). The most observed endoscopic finding (available in 35 patients) was a recurrent sliding hiatus hernia (42.9%). All had a contrast swallow with evidence of delayed transit into the stomach present in 45.9%, recurrent sliding hernia and dilated distal oesophagus in 35.1% equally. The RF was performed at a median of 24 months (IQR 2.5 - 66 months) following prior fundoplication. Technique of RF included 17 (45.9%) conversions from full Nissen to partial anterior fundoplication (Dor), 10 (27.0%) re-do Nissen's, two (5.4%) conversions from full Nissen to partial posterior fundoplication's (Toupet), three (8.1%) complete reversal of fundoplication with oesophagogastric junction adhesiolysis, two (5.4%) Heller's myotomies with anterior fundoplication, two (5.4%) crural repairs only (intact wraps) and one (2.7%) opening of tight crura closure. The majority (83.8%) of revisions were completed laparoscopically. The most frequent intraoperative findings included significant oesophagogastric adhesions with wrap distortion (75.7%), recurrent crural defect (51.4%), slipped wrap (45.9%), distal oesophageal/crural fibrosis (37.8%), recurrent sliding hernia (35.1%), a tight crural inlet (24.3%), mixed herniation (10.8%) and three (8.1%) para-oesophageal hernias. Conclusion: This single-center review on revision fundoplication conforms with much of what is written in other studies. Dysphagia is the predominant symptom prompting repeat surgery and most patients present two years after their initial operation. Despite revision anti-reflux surgery remaining technically challenging, the vast majority of operations were completed laparoscopically with low associated morbidity. Larger, multi-center studies would allow for a bigger picture of revision anti-reflux surgery in the greater South African context.
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    The education programmes and perceived competence in using auditory brainstem response testing : the audiologists' perspective
    (2004) Lai, Pui Shan Sandy; Singh, Shajila
    Includes bibliographical references (leaves 84-93).
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    Emerging professional practices focusing on reducing inequity in speech-language therapy and audiology: a scoping review protocol
    (2022-04-21) Abrahams, Kristen; Mallick, Rizwana; Hohlfeld, Ameer; Suliaman, Tamzyn; Kathard, Harsha
    Background Human communication is essential for socialising, learning and working. Disabilities and social disadvantage have serious negative consequences on communication which can impact development from early life into adulthood. While speech-language therapists and audiologists (SLT/As) have an important role to play in addressing communication disability and disadvantage, services continue to be inaccessible, unaffordable and unattainable for the majority population. In order to support this large population, it is necessary to reimagine SLT/A practices in line with equity and social inclusion. Recently in the literature, there have been increasing calls for professions to reduce inequities in practice as indicated by the sustainable development goals, human rights and social inclusion approaches increasing in prominence. For the scoping review, equity is understood using the colonial matrix of power to understand how intersections of race, gender, class, disability, geography, heteronormativity and language create the context for inequity. As such, the aim of the scoping review is to address the following question: what are the emerging professional practices in SLT/A focused on reducing inequities? Methods Following the Joanna Briggs Institute guidelines, this scoping review will focus on systematically mapping the documented emerging clinical practices in SLT/A in the literature to identify how the professions are developing equitable practices. The search will include electronic databases and grey literature including PubMed, Scopus, EbscoHost, The Cochrane Library and Dissertation Abstracts International, Education Resource Information Centre from their inception onwards. Published and unpublished literature including all evidence sources will be considered. There should be a clear focus on clinical practice addressing equity in SLT/A. There will be no language limitations for the study. The authors will endeavour translate to have abstracts of articles translated. There will be no time restrictions on date of publication of the literature. Discussion We aim to review the current literature on emerging professional practices in relation to equity in SLT/A to identify emerging trends in clinical practice. It is our goal to provide a synthesis of emerging directions for practice, particularly to inform future practices in the Global South. Systematic review registration Open Science Framework ( osf.io/3a29w ).
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    Factors that influence the utilisation of ototoxicity monitoring services for patients on treatment for drug-resistant tuberculosis
    (2015) Nhokwara, Primrose Tinashe; Rogers, Christine; Ramma, Lebogang
    Multi-drug resistance is increasingly becoming a challenge to tuberculosis control programmes globally. Treatment of multi-drug resistance tuberculosis (MDR-TB) includes aminoglycoside antibiotics which are known to cause hearing loss. Ototoxicity monitoring services are often provided to patients undergoing treatment for MDR-TB for early detection of ototoxic hearing loss to facilitate alerting the patients and relevant medical staff about the presence and progression of any hearing loss. Previously, models of managing patients with MDR-TB required mandatory hospitalization for at least 6 months. This made it relatively easy to monitor the hearing status of patients during their stay in the hospital. However, with recent introduction of policy guidelines that support management of patients with MDR-TB on an outpatients basis, ototoxicity monitoring for these patients will need to be reorganized to align with the new policy guidelines. The extent of the uptake of these services when patients are accessing them as outpatients is however, unknown. This study therefore aimed to describe the patterns of utilisation and explore the barriers and factors that facilitate the use of ototoxicity monitoring services when provided on an outpatient basis in the Cape Town Metropolitan area, Western Cape, South Africa.
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    The feasibility of a computer-based hearing-screening programme among school learners in the Western Cape Province
    (2005) North-Matthiassen Craig; Singh, Shajila
    Includes bibliographical references.
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    Genetic and pharmacokinetics factors associated with susceptibility to kanamycin induced cochleotoxicity in a cohort of patients undergoing MDR/RR-TB treatment
    (2023) Ghafari, Nazanin; Ramma, Lebogang
    South Africa is one of the countries with a high incidence of multidrug-resistant tuberculosis (MDR-TB) and rifampicin resistance tuberculosis (RR-TB). The standard MDR/RR-TB regimen prescribed in South Africa, at the time of the present study included Kanamycin, an aminoglycoside with a known cochleotoxic effect. Although kanamycin has recently been removed from the WHO MDR/RR-TB regimen, amikacin, another aminoglycoside derived from kanamycin, with similar structure and cochleotoxic side effects, has remained as part of the regimen for MDR/RR-TB patients with limited treatment options. In addition, some countries (e.g. India and Nigeria) have not completely removed kanamycin from their treatment regimen for MDR/RR-TB. Research has shown that genetic factors and factors affecting the pharmacokinetic of the drug could potentially be useful in identifying those who may be at a higher risk of aminoglycoside-induced cochleotoxicity. However, not much is known about the pharmacokinetics of Kanamycin and there is currently limited research available on the role of mutations involved in aminoglycoside-induced cochleotoxicity in South Africa. Therefore, this study aimed to determine: (1) the incidence of cochleotoxicity in MDR/RR-TB patients who are receiving kanamycin, (2) the pharmacokinetic properties of kanamycin that are associated with increased risk of cochleotoxicity, and (3) the association between participant's susceptibility to develop cochleotoxicity and two potentially pathogenic mitochondrial mutations (T15312C (I189T in MT-CYB) and T10114C (I19T in MT-ND3)). The current study used a prospective cohort design. A total of 102 patients (median age was 34.9 years) on kanamycin-based MDR/RR-TB treatment participated in this study. The study site was the Metro Tuberculosis Hospital Centre, Cape Town. The majority of the participants were males (n = 58, 56.9%,). Sixty five (63.7%) participants were HIVpositive, and 24 (23.5%) had been treated for MDR/RR-TB previously. Participants' hearing thresholds (0.25 to16kHz) were prospectively monitored for cochleotoxicity at the start of their treatment (baseline), and at 4, 8 and 12 weeks. The American SpeechLanguage- Hearing Association criteria (ASHA, 1994) were used to identify significant threshold shift (STS). Kanamycin concentrations were determined using liquid chromatography tandem mass spectrometry (LC-MS/MS), at steady-state in serial plasma samples over 10 hours. The T15312C (I189T in MT-CYB) and T10114C (I19T in MTND3) mutations was detected using PCR, ABI PRISM® 3130xl Genetic Analyser and UniPro UGene. The results of the study revealed 82% (n = 84) of participants developed cochleotoxicity. The duration of treatment with kanamycin was associated with cochleotoxicity with a 120% and 220% increase in incidence of cochleotoxicity from week four of treatment to week eight and week 12 of treatment, respectively. Kanamycin exposure was significantly associated with cochleotoxicity with about 3% increased risk of hearing loss for every 10µg•hr/L increase in kanamycin AUC0-10. The statistical analysis of the relationship between cochleotoxicity and two potentially pathogenic mutations, T15312C and T10114C, was not possible due to the low frequency of these mutations in the sample size. However, T15312C and T10114C were detected in 4.5% and 6%, respectively. Based on the MAF cut-off of 0.01 (1%), they are considered as common mutations. In addition, as T15312C and T10114C were just detected among participants who developed cochleotoxicity and not those who did not, they may be potentially pathogenic. However, since the presence of the known mutations associated with aminoglycoside-induced hearing loss in participants who carry T15312C and T10114C mutations had not been 17 investigated, it was not possible to draw a definite conclusion about the pathogenicity of T15312C and T10114C. The results of the current study indicate that: (1) a high incidence of cochleotoxicity was detected among MDR/RR-TB patients receiving kanamycin, (2) the longer duration of treatment with kanamycin was associated with higher risk of cochleotoxicity, (3) higher Kanamycin AUC0-10 was strongly associated with an increased incidence of cochleotoxicity, and (4) the T15312C and T10114C were common mutations in South African MDR/RR-TB patients who participated in this study and they may be potentially pathogenic for cochleotoxicity, and that should be assessed in future studies. This study recommends that aminoglycoside-sparing regimens should be used for MDR/RR-TB patients. A routine ototoxic monitoring programme (at least once a month) including ultra-high frequency audiometry should be implemented for MDR/RR-TB patients who receive aminoglycosides, from the time of ototoxic drug exposure until six months post treatment. Therapeutic drug monitoring should be implemented for all the MDR/RR-TB patients on aminoglycosides and AUC value should be used for clinical decision making to reduce the risk of cochleotoxicity. Screening for the known mutations that contribute to the risk of cochleotoxicity, prior to the start of aminoglycoside therapy is recommended to lower the incidence of aminoglycoside induced hearing loss, especially in countries such as South Africa with a high incidence of MDR/RR-TB.
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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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    An investigation into the expectations of mothers of children with cochlear implants
    (1999) Perold, Jennifer Lynne; Ogilvy, Dale
    There is a paucity of research examining the expectations of parents whose children have received a cochlear implant. The process of implantation is fraught with expectations, and in order to ensure continued parental interest and motivation, it is important to have insight into and understanding of these expectations, as well as the factors which influence them. This study aimed to investigate the pre- and post-implant expectations of mothers whose children had received a cochlear implant, as well as the possibility of changes in their expectations with duration of cochlear implant use. It also aimed to examine satisfaction of mothers with the cochlear implant, and the influence this had on expectations. A qualitative research methodology was used in the form of in-depth interviews. Eight mothers of prelingually deafened children who had not yet started formal schooling were interviewed. The data obtained from the mothers was transcribed verbatim and then analysed according to a detailed qualitative analysis procedure. Important findings emerged which detailed the changing expectations based either on hope or knowledge over time. These expectations were influenced by many variables, including the mothers' response to the deafness of the child (i.e. the grief reaction), anxiety and stress, performance outcomes, satisfaction, and expectations of others, including family and friends. Numerous theoretical and clinical implications emerged from these findings, including the dynamic nature of expectations, as well as the impact these have on the importance of ongoing counselling of mothers whose children use cochlear implants.
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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 presence and nature of dizziness in adults living with HIV attending HIV clinics in the Western Cape
    (2013) Chouhan, Jay; Rogers, Christine; Taljaard, Dunay
    Includes abstract. Includes bibliographical references.
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    A profile of the auditory function of children with TB receiving ototoxic medication at Brooklyn Chest Hospital
    (2012) Ghafari, Nazanin; Singh, Shajila
    A descriptive survey research design was used to describe the auditory function of children with tuberculosis (TB) receiving ototoxic medication at Brooklyn Chest Hospital. A battery of audiologic tests (otoscopy, immittance, audiometry or OAE and AABR) were conducted on 29 children, aged 0 to 18 years, and the results were analysed using descriptive statistics and Generalized Linear Models. The results suggest that 55% of children had middle ear abnormality and 48% had hearing loss. The degree of hearing loss ranged from mild to profound in 41 % of the cases while 59% had hearing within the normal range with their loss restricted to high frequencies. No statistically significant associations were found between sex, duration of hospitalization, comorbid presentation of HIV and TB and middle ear abnormality.
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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.