Browsing by Subject "audiology"

Now showing 1 - 4 of 4
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    Open Access
    A South African perspective: audiologists' and otologists' orientation to, and use of evidence-based practice with reference to benign paroxysmal positional vertigo
    (2021) Naidoo, Tanaya Ellen Ravi; Rogers, Christine
    Evidence-based practice, whose roots emanate from the mid-1960s, aims to provide fair, high-quality, and soundly researched health care with patients' best interests as a priority. Clinical practice guidelines are evidence-based and designed to assist clinicians with sound decision making. Despite the importance of evidence-based practice and the efforts invested into its development and dissemination, its uptake and implementation are poor. The disconnect between evidence-based practice and its translation into clinical practice was previously reported in low-to-middle income countries. This study investigated South African audiologists' and otorhinolaryngologists' (ear, nose and throat specialists') self-reported orientation to evidence-based practice. Second, adherence to evidence-based clinical practice guidelines was assessed with reference to the diagnosis and management of benign paroxysmal positional vertigo, a common vestibular condition for which a firm evidence base supporting treatment exists. A two-part quantitative approach was adopted. Part one surveyed South African audiologists and otorhinolaryngologists with the Evidence-Based Practice Profile Questionnaire and an additional researcher-developed questionnaire pertaining to the diagnosis and management of benign paroxysmal positional vertigo. A total of 130 survey responses were included in this study. Independent sample t-tests, one-way ANOVAs and Fisher's Exact tests were used to analyse the survey data. Part two used a retrospective record review at a tertiary academic hospital in the Western Cape of South Africa. Medical folders of patients diagnosed with benign paroxysmal positional vertigo, between 2010 – 2018 (n = 80), were analysed. The diagnosis and management strategies were recorded and compared against a gold standard evidence based guideline for congruence. Descriptive statistics were used to analyse and understand the data. Survey scores showed a positive association between increased years of experience and healthcare professionals' knowledge (p = .008) and confidence (p = .003) in evidence-based practice. Otorhinolaryngologists might be more knowledgeable than audiologists in evidence-based practice due to their increased training and exposure to evidence-based practice in their specialising years. Findings from the retrospective record review suggested adherence to the clinical practice guidelines in the diagnosis and management of posterior semi circular canal benign paroxysmal positional vertigo. The study outcomes propose that evidence-based clinical practice guidelines developed in the Global North may not be appropriate for the different health contexts that exist in low-to-middle income South Africa (e.g., rural settings). However, the benign paroxysmal positional vertigo clinical practice guidelines were adhered to at a tertiary, academic hospital in Cape Town. The results also support the notion that increased exposure to evidence-based practice reinforces its approach. Outcomes from this study raise implications for the development and dissemination of context-appropriate, evidence-based clinical practice guidelines.
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    Open Access
    Contextually relevant resources in speech-language therapy and audiology in South Africa-are there any?
    (AOSIS, 2011) Pascoe, Michelle; Norman, Vivienne
    In this editorial introduction we aim to explore the notion of contextually-relevant resources. We argue that it is the responsibility of Speech Language Therapists (SLTs) and Audiologists (As) working in South Africa to develop contextually relevant resources, and not to rely on the countries or cultures where the professions originated to do so. Language is often cited as the main barrier to contextually relevant resources: most SLTs and As are aware of the need for more resources in the indigenous local languages. However, the issue is not as straightforward as translating resources from English into other languages. The challenges related to culture, e.g. formal education, familiarity with the test situation, have to be considered; as well as the population on which norms were obtained; the nature of vocabulary or picture items. This paper introduces four original research papers that follow in this edition of the journal, and showcases them as examples of innovative development in our field. At the same time we call for the further development of assessment materials, intervention resources, and contributions to the evidence base in our context. We emphasise the importance of local knowledge to drive the development of these resources in innovative and perhaps unexpected ways, and suggest that all clinicians have an important role to play in this process.
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    Influential factors in driving confidence among hearing-impaired older adults in Cape Town
    (2020) Cohen, Romy; Rogers, Christine; Chouhan Jay
    Research has shown that age-related hearing loss may have profound implications on all aspects of an individual's life, including cognitive abilities. The relationship between hearing loss and cognition has led to research which indicates an association between objective hearing loss and reduced driving performance in older adults. However, little research exists on the relationship between self-perceived hearing loss and driving confidence, particularly in the South African context. The current study aimed to identify possible associations between driving confidence and hearing loss, age, sex and driving safety among older adults. Data analysis indicated a significant increase in driving confidence after one month of first-time hearing aid use. An insignificant or weak relationship was found between self-perceived hearing loss and level of driving confidence. Age, sex and a combination of both were significantly associated with level of driving confidence. No association was found between pure-tone average and level of driving confidence or between pure-tone average and driving safety. Further research in this area could assist in advising legislation relating to licensing and road safety campaigns targeted at older adults, as well as expanding audiologists' duty of care to include counselling on the potential positive effects of hearing aid use on driving confidence.
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    The efficacy of strategies used to minimise and prevent cisplatin ototoxicity in patients
    (2018) Chakara, Zenzo Stanford; Ramma, Lebogang
    This study aimed to evaluate the efficacy of different treatment modifications used to prevent or minimise hearing loss during Cisplatin-based chemotherapy as part of patient management at Groote Schuur Hospital. The study also sought to compare different ototoxicity grading criteria; namely the National Cancer Institute Common Terminology Criteria for Adverse Events Version 4 (CTCAE v4) and TUNE criteria, with respect to early identification of changes in the patient’s hearing thresholds following treatment with ototoxic drugs as well as ability to guide recommendations for aural rehabilitation including hearing amplification. Background Non-communicable diseases (NCD) (including cancer, diabetes, cardiovascular and chronic respiratory diseases) are responsible for an estimated 36 million deaths annually across the world. Approximately 80 % of these deaths occur in developing countries. Cancer, the NCD of interest in this study, causes an estimated 8.2 million deaths per year, globally and about 70 % of these occur in developing countries. In South Africa, cancer is estimated to cause approximately 40 000 deaths per annum, which is more than the number of deaths caused by a combination of HIV/AIDS, TB and malaria every year. Cisplatin is the most common and effective anti-cancer drug for most types of cancers. However, it is also associated with severe adverse effects, including hearing loss. Cisplatin-induced hearing loss is usually bilateral, highfrequency sensorineural hearing loss and is permanent. Cisplatin-induced hearing loss can lead to communication difficulties, lack of participation, loss of employment and social isolation. This decreases patients’ quality of life. Prevention of ototoxicity relies on serial audiologic monitoring to detect any significant change in patients’ hearing thresholds that may be resulting from chemotherapy treatment. When a deterioration in the patient’s hearing thresholds is detected, treating physician(s) can decide on whether to modify the patient’s treatment to prevent further deterioration of hearing or not. Some of the common treatment modifications used by physicians include; reducing the drug dose administered to the patient, changing from Cisplatin to a less ototoxic drug such as Carboplatin or keeping a patient on Cisplatin only regimen (no treatment modification). However, there is 8 currently lack of research evidence that document the effectiveness of these treatment modifications with respect to preservation of the patient’s hearing thresholds. Also, given that there are several ototoxicity grading scales available that can be used to grade severity of ototoxicity-induced hearing loss, there is currently a lack of uniformity regarding communication of the severity of hearing loss across different professionals. There is a need to identify or develop an ototoxicity grading criterion which can be adopted by different professionals to communicate results during ototoxicity monitoring of patients. Research design This study employed a descriptive, quantitative retrospective cohort design. Medical folders of patients who underwent cisplatin chemotherapy treatment and had their hearing thresholds monitored at Groote Schuur Hospital during from 2011 up to 2016 were reviewed. Methods A non-probability, convenience sampling method was used to select medical folders that underwent review. Data which were extracted from the patients’ medical folders includes demographic information (for example age and sex,), chemotherapy treatment information including type and dose of treatment; and audiological information including baseline, checkup and exit audiogram thresholds. Data obtained from the folders were analysed using R, a software environment for statistical computing and graphics. Descriptive statistics and the following inferential statistical tests, Chi-squared, Fisher’s exact tests and the Wilcoxon signed-rank test for paired samples, were used to determine significant associations between hearing loss and several factors revealed in the data. The American Speech-Language and Hearing (ASHA, 1994) criteria were used to determined incidence of significant threshold shift whilst the CTCAE v4 was used to determine both incidence of hearing loss and severity of the loss. The CTCAE v4 and TUNE criteria were compared based on incidence of hearing and ability to predict need for hearing amplification Results A total of 128 medical folders met inclusion criteria for this study and the following were the patient characteristics; median age = 43 years (range: 18 – 75 years); 92 males, 36 females; average length on treatment: 13.45 weeks). Out of these, 64 had information on the type and dose information of chemotherapy drug used during the period when monitoring of ototoxicity was conducted. The American Speech-Language and Hearing (ASHA) criteria revealed 9 ototoxicity in 74.2 % (95/128) of the sample. The Wilcoxon signed-rank test for paired samples showed a significant difference (p = 0.0000000039, p < 0.05) between follow-up and exit monitoring thresholds which indicated a significant decline of patients’ hearing thresholds throughout the treatment duration. There were no statistically significant associations between age, duration of treatment and treatment modification. The study showed three treatment modifications which included dose adjustment (reduction), switching drug and continuing with the same drug. There was no significant association between treatment modifications and hearing loss. The CTCAEv4 criteria identified more people (53.9 %) who experienced a deterioration in their hearing thresholds than TUNE criteria (41.7%). However, TUNE performed better with respect to identifying patients who are likely to be candidates for further audiological rehabilitation including hearing amplification. Conclusion This study found a high incidence of cisplatin-induced hearing loss despite the possible modification of treatment. This shows that current strategies that are used by physicians at GSH Radiation Oncology department to prevent or minimize further deterioration of the patient’s hearing thresholds during cisplatin chemotherapy can arguably be rendered ineffective. This is owing to the inability of conventional audiometry to detect hearing loss before it affects the speech frequencies. There was no significant association between hearing loss and age, dose, duration of treatment and treatment modification. The study also showed that CTCAE v4 grading criteria detected a higher incidence of ototoxicity than the TUNE criteria. However, the TUNE criteria were better at detecting the number of patients who need further audiological rehabilitation than the CTCAE v4. Therefore, both scales have their strengths and weaknesses. Implications of the study include the incorporation of Extended High Frequency Audiometry (EHF) and Distortion Product Otoacoustic Emission (DPOAE) testing into the monitoring protocol where possible to allow for early detection and intervention of ototoxicity. Incorporation of otoprotectors into the prevention protocol is suggested as they have recently shown otoprotective efficacy in animal models without interrupting Cisplatin’s therapeutic agency. Finally, more studies are required to validate the TUNE grading criteria to explore its utility as an ototoxicity grading criterion that can be universally used to communicate ototoxicity outcomes during Cisplatin chemotherapy.