Infant hearing screening from a developing country context: status from two South African provinces

Background: New-born hearing screening (NHS) programmes are an important step toward early detection of hearing loss and require careful examination and planning within each context. The Health Professions Council of South Africa (HPCSA) has recommended specific contexts in which to actualise early hearing detection and intervention (EHDI) application. It is imperative therefore to explore if and how the current experience measures up to these recommendations.Objective: to explore the feasibility of and the current status of the implementation of NHS at various levels of health care within the South African context.Methods: A non-experimental, descriptive, cross-sectional survey research design was employed, using a combination of questionnaires and face-to-face semi-structured interviews. Participants comprised 30 primary health care (PHC) nursing managers across two provinces (Gauteng and North West) and 24 speech-language therapists and/or audiologists directly involved with NHS in secondary and tertiary levels of care within Gauteng.Results: Current findings indicated lack of formal, standardised, and systematic EHDI implementation at all three levels of health care (primary, secondary and tertiary) with valuable reasons such as insufficient knowledge, lack of equipment, budgetary constraints, and human resource challenges being provided for this. Regardless of the level of care and their varied resource allocations and levels of specialisation; EHDI implementation as advocated by the HPCSA (2007) position statement currently does not seem feasible, unless the number of barriers identified are addressed, and NHS becomes mandated.Conclusion: Current findings have highlighted the need for ensuring that context specific studies in EHDI are conducted to ensure that national position statements are sensitive to contextual challenges and therefore allow for evidence-based practice, particularly in developing countries where resource constraints dictate success and/or failure of any well-intentioned programme

Audiological Findings in a Group of Neurologically Compromised Children: A Retrospective Study

Background. Hearing loss is more prevalent in developing countries. Later diagnosis of hearing loss will result in delayed access to rehabilitation. It is typically more difficult to obtain subjective information required in a hearing test from neurocompromised children; causing audiologists to frequently turn to objective measures such as the auditory brainstem response (ABR) measure to obtain this information.Objective. To describe the ABR results in a group of neurologically compromised children and to establish a relationship between ABR findings and behavioural audiometry results; where these existed.Methods. A retrospective review was conducted on 40 ABR patient records of neurologically compromised participants aged 5 months - 10 years. Behavioural audiometry results were sought where these existed. Hearing status was described per ear for objective and behavioural results; and descriptive statistics were conducted.Results. Behavioural audiometry results were obtained in 72.5% of ears. Results correlated between ABR and behavioural audiometry for only 7.5% of ears; which were all diagnosed with normal hearing. About12.5% of ears were misdiagnosed with behavioural audiometry. Premature infants were most likely to cope with behavioural audiometry. Hearing loss was highest in participants with cerebral palsy; Down syndrome; prematurity and retroviral disease.Conclusions. Behavioural audiometry appears to be a largely unreliable method of testing the hearing of children diagnosed with neurological disorders; as results were obtained in only 27.5% of the study sample; however; it remains the gold standard in paediatric hearing testing to evaluate the entire auditory system and provides information on how a child processes sound. Hearing thresholds should be established via objective testing. Conditioning should continue for a behavioural audiological test battery; with adaptations for the child's developmental ability

Effect of Spinal Anaesthesia on Hearing Threshold

Background: Hearing loss following spinal anaesthesia is a known yet uncommonly reported complication. This study was aimed at determining the incidence and type of hearing loss (HL) following spinal anaesthesia (SA) and the relationship with the size of spinal needle. Methods: A prospective study of patients scheduled for spinal anaesthesia for surgery at the Operating room and Otorhinolaryngology department in a tertiary centre was undertaken. The audiometry was done and the pre- and post - anaesthesia results were compared.Results: Ninety - four ears of 47 patients; 16 males and 31 females; age range between 21 and 63 years (mean + SD= 41+5) were included. The duration of anaesthesia was between 90 and 150 minutes (mean + SD= 116+9). HL was seen in 9 ears of 7 patients (15) and tinnitus in 14 ears. The preoperative and postoperative BC PTA were 10 - 45dB (mean + SD= 26+ 5) and 25 - 65dB (mean + SD=38+5) respectively; (P= 0.02) while the preoperative and postoperative AC PTA in the early frequency range (0-100Hz) were between 5 - 45dB (mean + SD= 20+ 5) and 25 - 50dB (mean + SD=25+7) respectively; (P= 0.08). There was significant difference in the mean BC PTA between those who had procedure less than 1 hour; 37.2dB and those greater than 1 hour 38.4dB; (P=0.004). According to the Quincke needle sizes; the mean BC PTA among those who had 26G and 27G were 37.4dB and 38.1dB respectively (P=0.2). Conclusion: HL complicating SA is significant and associated with duration of procedure thus should be included in informed consent for medico-legal and ethical reasons and measures must be taken to avoid the leak of cerebrospinal fluid

Identifying Hearing Loss by means of Iridology

Isolated reports of hearing loss presenting as markings on the iris exist; but to date the effectiveness of iridology to identify hearing loss has not been investigated. This study therefore aimed to determine the efficacy of iridological analysis in the identification of moderate to profound sensorineural hearing loss in adolescents. A controlled trial was conducted with an iridologist; blind to the actual hearing status of participants; analyzing the irises of participants with and without hearing loss. Fifty hearing impaired and fifty normal hearing subjects; between the ages of 15 and 19 years; controlled for gender; participated in the study. An experienced iridologist analyzed the randomised set of participants' irises. A 70correct identification of hearing status was obtained by iridological analyses with a false negative rate of 41compared to a 19false positive rate. The respective sensitivity and specificity rates therefore came to 59and 81. Iridological analysis of hearing status indicated a statistically significant relationship to actual hearing status (P 0.05). Although statistically significant sensitivity and specificity rates for identifying hearing loss by iridology were not comparable to those of traditional audiological screening procedures