Hearing function of gold miners with and without a history of tuberculosis treatment: a retrospective data review / Função auditiva de garimpeiros com e sem história de tratamento de tuberculose: uma revisão retrospectiva dos dados

Abstract Introduction: South Africa has a high prevalence of co-existing tuberculosis and HIV. As ototoxicity linked to the treatments for these conditions occurs with concomitant exposure to other ear toxins such as hazardous noise exposure, it is important to investigate the combination impact of these toxins. Limited published evidence exists on the co-occurrence of these conditions within this population. Objectives: The objective of this study was to compare the hearing function of gold miners with (treatment group) and without (non-treatment group) the history of tuberculosis treatment, in order to determine which group had increased risk of noise induced hearing loss. Furthermore, possible influence of age and HIV in these two groups was examined. Methods: A retrospective record review of 102 miners' audiological records, divided into two groups, was conducted, with data analyzed both qualitatively and quantitatively. Results: Findings suggest that gold miners with a history of tuberculosis treatment have worse hearing thresholds in the high frequencies when compared to those without this history; with evidence of a noise induced hearing loss notch at 6000 Hz in both groups. Pearson's correlations showed values between 0 and 0.3 (0 and −0.3) which are indicative of a weak positive (negative) correlation between HIV and hearing loss, as well as between hearing loss and age in this population. Conclusions: Current findings highlight the importance of strategic hearing conservation programs, including ototoxicity monitoring, and the possible use of oto-protective/chemo-protective agents in this population.

Resumo Introdução: A África do Sul apresenta uma alta prevalência de coinfecção de tuberculose e HIV. Como a ototoxicidade associada aos tratamentos para essas condições é observada na exposição concomitante a outros agentes ototóxicos, como a exposição a ruídos perigosos, é importante investigar o impacto da combinação desses agentes. São poucas as evidências publicadas sobre a co-ocorrência dessas condições nessa população. Objetivo: Comparar a função auditiva de garimpeiros com (grupo tratamento) e sem (grupo sem tratamento) história de tratamento de tuberculose, a fim de determinar que grupo apresentava maior risco de perda auditiva induzida por ruído. Além disso, avaliou-se a possível influência da idade e do HIV nesses dois grupos. Método: Os registros audiológicos de 102 garimpeiros, divididos em dois grupos, foram revisados de forma retrospectiva; os dados foram qualitativa e quantitativamente analisados. Resultados: Os achados indicam os garimpeiros com histórico de tratamento de tuberculose apresentam piores limiares auditivos nas altas frequências quando comparados àqueles sem esse histórico; em ambos os grupos, observou-se perda auditiva induzida por ruído com entalhe audiométrico a 6.000 Hz. As correlações de Pearson mostraram valores entre 0 e 0,3 (0 e -0,3), que são indicativos de uma fraca correlação positiva (negativa) entre o HIV e a perda auditiva, bem como entre a perda auditiva e a idade nessa população. Conclusões: Os resultados atuais destacam a importância de programas estratégicos de conservação auditiva, inclusive monitoramento de ototoxicidade, e o possível uso de agentes oto-/quimioprotetores nessa população.

Preservation of residual hearing after cochlear implant surgery: an exploration of residual hearing function in a group of recipients at cochlear implant units / Preservação da audição residual após cirurgia de implante coclear: avaliação da função auditiva residual em um grupo de receptores em unidades de implante coclear

Abstract Introduction: The preservation of residual hearing is becoming increasingly important in cochlear implant surgery. Conserving residual hearing is a positive prognostic indicator for improved hearing abilities. Objective: The primary aim of the study was to explore the preservation of residual hearing following cochlear implantation in a group of recipients at two major cochlear implant centers. Methods: A quantitative paradigm was adopted and exploratory research conducted within a retrospective data review design. The sample consisted of 50 surgical records and 53 audiological records from 60 observations (53 patients, seven of whom were implanted bilaterally). The records were selected using purposive sampling and consisted of records from participants ranging from six to 59 years of age. The average time of when the postoperative audiograms were performed in the current study was 24.7 months (s.d. = ±9.0). Data were analyzed through both qualitative and inferential statistics and a comparative analysis of unaided pre- and postoperative audiological test results was conducted. Results: Results indicated a high success rate of 92% preservation of residual hearing with half of the sample exhibiting complete preservation in cochlear implant recipients across all frequencies postoperatively. A total postoperative hearing loss was found in only 8% of cochlear implantees across all frequencies. There was no relationship between preoperative hearing thresholds and preservation of hearing postoperatively. The two main surgical techniques used in the current study were the contour on stylet and the advance off-stylet techniques, with the majority of surgeons utilizing a cochleostomy approach. From the findings, it became apparent that the majority of cases did not have any reported intraoperative complications. This is a positive prognostic indicator for the preservation of residual hearing. Conclusion: Findings suggest improved cochlear implant surgical outcomes when compared to previous studies implying progress in surgical techniques. The surgical skill and experience of the surgeon are evidenced by the minimal intraoperative complications and the high success rate of hearing preservation. This is a positive prognostic indicator for individuals with preoperative residual hearing as the preserved residual hearing allows for the potential of electro-acoustic stimulation, which in turn has its own hearing benefits.

Resumo Introdução: A preservação da audição residual tem se tornado cada vez mais importante na cirurgia de implante coclear. Conservar a audição residual é um indicador prognóstico positivo para melhorar as habilidades auditivas. Objetivo: Avaliar a preservação da audição residual pós-implante coclear em um grupo de pacientes de dois grandes centros de implantes cocleares. Método: Foram adotados um paradigma quantitativo e uma pesquisa exploratória em um projeto retrospectivo de revisão de dados. A amostra consistiu de 50 registros cirúrgicos e 53 registros audiológicos de 60 observações (53 pacientes, sete dos quais foram implantados bilateralmente). Os registros foram selecionados com amostragem proposital e consistiram em registros de participantes de seis a 59 anos. Neste estudo, o tempo médio para audiogramas no pós-operatório foi de 24,7 meses (dp = ± 9,0). Os dados foram analisados através de estatísticas qualitativas e inferenciais, foi feita uma análise comparativa de resultados de testes audiológicos pré e pós-operatórios, sem auxílio de aparelho auditivo. Resultados: Os resultados indicaram uma alta taxa de sucesso, de 92%, de preservação da audição residual, metade da amostra dos implantados exibia preservação completa em todas as frequências no pós-operatório. Perda auditiva total em todas as frequências no pós-operatório foi observada em apenas 8% dos implantes cocleares. Não houve relação entre limiares auditivos pré-operatórios e preservação auditiva no pós-operatório. As duas principais técnicas cirúrgicas usadas no presente estudo foram contour on stylet e a técnica advance off-stylet e a maioria dos cirurgiões usou uma abordagem por cocleostomia. A partir dos achados, tornou-se evidente que a maioria dos casos não apresentou complicação intraoperatória. Esse é um indicador prognóstico positivo para a preservação da audição residual. Conclusão: Os achados sugerem melhoria dos resultados cirúrgicos do implante coclear quando comparados com estudos prévios, sugerem um progresso nas técnicas cirúrgicas. A habilidade cirúrgica e a experiência do cirurgião são evidenciadas pelas complicações intraoperatórias mínimas e pela alta taxa de sucesso de preservação auditiva. Esse é um indicador prognóstico positivo para indivíduos com audição residual pré-operatória, uma vez que a audição residual preservada possibilita o potencial de estimulação eletroacústica (EAS - do inglês Electric Acoustic Stimulation), que, por sua vez, tem benefícios auditivos próprios.

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

Infant Hearing Screening at Primary Healthcare Immunisation Clinics in South Africa: The Current Status

Background. In the developing world; it is critical that the acceptable principle that early hearing detection and intervention (EHDI) programmes be contextually useful; given the extensive level of difficulties faced by these regions. The Health Professions Council of South Africa (HPCSA) has recommended specific contexts in which to actualise EHDI application. One of these contexts relates to hearing screening at immunisation clinics within the first 6 weeks of life.Objective. To explore the current status of the implementation of the HPCSA's 2007 guidelines for clinic-based hearing screening within the South African primary healthcare clinic (PHC) setting. Methods. Within a qualitative research design; 30 PHC nurses representing 30 PHC clinics in the North West and Gauteng Provinces were interviewed using a structured questionnaire. Qualitative as well as thematic content analysis strategies were adopted in analysing data.Results. There is a lack of formal EHDI implementation at PHC clinics in both provinces. Lack of equipment; budgetary constraints and human resource challenges are the reasons for this. Regardless of the province's socioeconomic development based on the deprivation index; EHDI implementation at clinic level is not feasible unless the barriers are addressed. Conclusion. There is a need to ensure that context-specific studies in EHDI are conducted. This will ensure that national position statements are sensitive to contextual challenges and that they allow for evidence-based practice. This is particularly relevant in developing countries where resource constraints dictate the success or failure of any well-intentioned programme. The HPCSA's 2007 position statement needs to be reviewed taking careful cognisance of feasibility study findings such as the current one. Findings have implications for nurses training; future studies; and policy formulation; as well as clinical plans for EHDI in developing contexts

Commuting and communication: an investigation of taxi drivers' experiences, attitudes and beliefs about passengers with communication disorders

Background: One of the most popular means of public transport within South Africa is mini-bus taxis. Objectives: As South Africa is made up of diverse cultures, religions and beliefs, the aim of this study was to explore Johannesburg based taxi drivers' experiences of beliefs about, and attitudes towards passengers who have a communication disability. Method: Semi-structured interviews were conducted with 10 mini-bus taxi drivers. Results: Interviews revealed that almost all the taxi drivers had encountered passengers with a communication disability, and had an awareness of passengers with a hearing disability as opposed to a speech disability. Furthermore mini-bus taxi drivers generally held a positive view of their passengers with a communication disability.Conclusion: Study findings contribute to existing literature within the fields of speech pathology and audiology, advocacy groups and policy makers, particularly research studies on participation experiences of persons with communication disabilities related to transportation access. The results of the study should also provide a foundation for disability policy development initiatives with the aim of increasing levels of public awareness

Evaluation of universal newborn hearing screening in South African primary care

Background: Universal Newborn Hearing Screening (UNHC) is the gold standard toward early hearing detection and intervention; hence the importance of its deliberation within the South African context. Aim: To determine the feasibility of screening in low-risk neonates, using Otoacoustic Emissions (OAEs), within the Midwife Obstetric Unit (MOU) three-day assessment clinic at a Community Health Centre (CHC); at various test times following birth.Method: Within a quantitative, prospective design, 272 neonates were included. Case history interviews, otoscopic examinations and Distortion Product OAEs (DPOAEs) screening were conducted at two sessions (within six hours and approximately three days after birth). Data were analysed via descriptive statistics. Results: Based on current staffing profile and practice, efficient and comprehensive screening is not successful within hours of birth, but is more so at the MOU three-day assessment clinic. Significantly higher numbers of infants were screened at session 2; with significantly less false-positive results. At session 1, only 38.1% of the neonates were screened; as opposed to more than 100% at session 2. Session 1 yielded an 82.1% rate of false positive findings, a rate that not only has important implications for the emotional well-being of the parents; but also for resource-stricken environments where expenditure has to be accounted for carefully. Conclusion: Current findings highlight the importance of studying methodologies to ensure effective reach for hearing screening within the South African context. These findings argue for UNHS initiatives to include the MOU three-day assessment to ensure that a higher number of neonates are reached and confounding variables such as vernix have been eliminated

Early Intervention in Audiology: Exploring the Current Status from a Developing Country Context.

Aims: Analysis of the current audio logical management protocols for children with hearing impairment in South Africa’s Gauteng state hospitals was investigated in this study. Study Design and Methods: A retrospective record review was conducted, with 70 files/medical records of paediatric patients between the ages of birth and three years. These records came from three state hospitals’ audiology clinics where full audio logical and otological services were available. Results: Findings of this study revealed concerning trends. Firstly, findings indicated that on average children were identified with a hearing loss at 23.65 months. Secondly, they received amplification 7.11 months after diagnosis and were only introduced into aural rehabilitation at the average age of 31.2 months. However, 81% of children received appropriate audio logical tests; with 85.7% of children who were identified with a hearing loss receiving amplification. All children identified with a bilateral hearing loss in the current sample were aided bilaterally. As far as communication development was concerned, 48.57% of the children identified with a hearing loss received the auditory verbal therapy approach, with 18.57% receiving sign language as a means of communication, while 11.43% received a total communication approach. A significant number (14.29%) were not receiving aural rehabilitation therapy. Conclusion: Findings raise important implications for the success of early hearing detection and intervention (EHDI) initiatives in South Africa. Improved and concerted efforts in the form of systematic planning and implementation of EHDI protocols are required.