Children with Conductive Hearing Loss Fitted with Hearing Aids: Outcomes and Caregiver Experiences in South Africa

Abstract Introduction Hearing aids are a frequent management option for children with conductive hearing loss (CHL) and it is necessary to determine the efficacy of outcomes. Limited information regarding caregivers' perceptions and experiences are available to examine outcomes in this population. Objectives To describe hearing aid outcomes and caregivers' experiences for children with CHL who wear behind-the-ear (BTE) hearing aids. Methods Retrospective review of clinical data from 19 children between 0 and 13 years of age with CHL, who were fitted with BTE hearing aids between January 2017 and March 2020. Hearing aid outcomes were documented at one month post-hearing aid fitting, via average daily use and caregiver and teacher reports obtained through the Parents' Evaluation of Aural/oral performance of Children (PEACH) and the Teachers' Evaluation of Aural/oral performance of Children (TEACH). Telephonic surveys were conducted with 13 caregivers to explore their experiences. Qualitative data from open-ended questions were analyzed thematically. Results The average hearing aid use was 6.5 hours/day (2.0 standard deviation, SD; range 4.1-10.3) for bilateral hearing aid users. Questionnaire results indicated that most children (PEACH - 83.3% and TEACH - 92.3%) used their hearing aids more than 75% of the time. Participants performed better in quiet environments with limited sensitivity to loud sounds at home and at school. Reported challenges included stigma and device compliance. Conclusions Children with CHL used their hearing aids for comparable hours (5- 8 hours/day), as reported for children with sensorineural hearing loss, but less than the recommended 10 hours/day required for adequate language development. Caregivers reported benefits equivalent to expectations, with challenges similar to those reported in high-income countries.

Hearing and vision screening for preschool children using mobile technology, South Africa

Objective:To implement and evaluate a community-based hearing and vision screening programme for preschool children in the Western Cape, South Africa, supported by mobile health technology (mHealth) and delivered by community health workers (CHWs).Methods:We trained four CHWs to provide dual sensory screening in preschool centres of Khayelitsha and Mitchells Plain during September 2017­December 2018. CHWs screened children aged 4­7 years using mHealth software applications on smartphones. We used logistic regression analysis to evaluate the association between screening results and age, sex and test duration, and, for hearing, excessive background noise levels.Results:CHWs screened 94.4% (8023/10 362) of eligible children at 271 centres at a cost of 5.63 United States dollars per child. The number of children who failed an initial hearing and visual test was 435 (5.4%) and 170 (2.1%), respectively. Hearing test failure was associated with longer test times (odds ratio, OR: 1.022; 95% confidence interval, CI: 1.021­1.024) and excessive background noise levels at 1 kilohertz (kHz) (e.g. OR for left ear: 1.688; 95% CI: 1.198­2.377). Visual screening failure was associated with longer test duration (OR: 1.003; 95% CI: 1.002­1.005) and younger age (OR: 0.629; 95% CI: 0.520­0.761). Of the total screened, 111 (1.4%) children were diagnosed with a hearing and/or visual impairment.Conclusion:Health-supported CHW-delivered hearing and vision screening in preschool centres provided a low-cost, acceptable and accessible service, contributing to lower referral numbers to resource-constrained public health institutions

Identifying hearning 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