Impact of the COVID-19 pandemic on audiology services in South Africa: A preliminary study.

Background: Hygiene-, work practices, travel, personal interactions and access to healthcare services changed for the majority of the world during the pandemic. Aim: This study aimed to discover the knowledge, impact and attitudes towards COVID-19 on the professional practices of public and private sector audiologists in South Africa. Setting: The study included 76 audiologists registered with the Health Professions Council of South Africa (HPCSA) and employed in the public, educational, tertiary or private practice and private sector in South Africa. Methods: A cross-sectional self-administered electronic survey study design was implemented. Results: Audiologists had appropriate knowledge regarding COVID-19. During hard lockdown, 69% of respondents saw less than 40% of their usual patient load, only 31% saw 60% - 100% of their usual patient load. During lower lockdown levels, majority of respondents (73.7%) saw 60% - 100% of their patient load while 26.3% still saw less than 40% of their usual patient load. Only hearing aid reprogramming, hearing aid trouble shooting, cochlear implant pre-counselling and adult hearing screening could be offered via tele-audiology. The main challenges faced were fear of infection, infection control measures in the workplace, accessibility and limited services provided during the various lockdown levels. Conclusion: The pandemic and lockdown levels had a definite impact on audiological service provision and many adaptations regarding service delivery and infection control in the workplace were required. Contribution: The relevance of this work for health services is the identification of the challenges experienced by audiologists during the pandemic and the opportunities to prepare for the future.

Changes in vestibular and cochlear function following platinum-based chemotherapy: A preliminary report.

OBJECTIVES: This study investigated the changes in vestibular and cochlear function in patients receiving platinum-based chemotherapy. METHODS: A longitudinal study of 32 participants (10-70 years) receiving chemotherapy participated in the study. Baseline and exit vestibular and hearing assessments that included video head impulse (VHIT) testing, cervical and ocular vestibular evoked myogenic potentials (VEMP), dynamic visual acuity (DVA) and pure-tone audiometry were performed at the patient's treatment venue. RESULTS: Half (50%) of the participants showed cochleotoxicity from baseline to exit testing, with left ears significantly more affected than right ears. There was no consistent relationship between hearing loss and vestibular dysfunction. DVA yielded normal results at baseline and exit testing in all participants. VEMP responses were absent in 28.1% of participants at baseline, reflecting the challenges of using VEMP for monitoring. VEMP and VHIT results showed a statistically significant (p < 0.05) decline in results from baseline to exit testing; however, participants did not report symptoms related to vestibular dysfunction. VHIT also showed left ears significantly (p < 0.05) more affected than right ears. CONCLUSION: VHIT proved to be a valuable measure of changes in vestibular function secondary to ototoxicity. Future investigations should determine vestibulotoxicity criteria and optimal protocols for vestibulotoxicity monitoring at the patient's treatment venue.

Ototoxicity monitoring in South African cancer facilities: A national survey.

BACKGROUND: National information regarding ototoxicity monitoring practices are limited for patients undergoing chemotherapy in South Africa. OBJECTIVES: To determine (1) the national status of ototoxicity monitoring implemented in private and public cancer facilities, (2) the knowledge and ototoxicity monitoring approaches implemented, and (3) reported challenges. METHOD: A descriptive quantitative survey was conducted in public and private oncology units and audiology referral clinics. Private (60%) and public (43%) oncology units that provide platinum-based chemotherapy in South Africa and audiology referral units (54%) were: (1) surveyed telephonically to determine if ototoxicity monitoring takes place; and (2) a self-administered survey was sent to qualifying oncology units and audiology referral clinics. RESULTS: All public oncology units reported that ototoxicity monitoring only occurs on referral and is not standard practice. All private oncology units indicated that monitoring is on a patient self-referral basis when symptoms occur. Poor awareness of ototoxicity monitoring best practice guidelines was reported by all oncology units and 14% of audiology referral clinics. Audiology referral clinics reported adequate knowledge of ototoxicity protocols although they are not widely used with only 43% following best practice guidelines. The most prominent challenges reported by participants was referral system (67% oncology units; 57% audiology referral clinics), environmental noise (83% oncology units; 86% audiology referral clinics) and the compromised status of cancer patients (67% oncology units; 57% audiology referral clinics). CONCLUSION: Ototoxicity monitoring is not routinely implemented across oncology units in South Africa. Multidisciplinary teamwork and a simplified national ototoxicity monitoring protocol may improve hearing outcomes for patients.

Maternal knowledge and views regarding early hearing detection and intervention in children aged 0-5 years at a semi-urban primary care clinic in South Africa.

BACKGROUND: South Africans have an increasing burden of hearing loss, especially in low-income rural areas. Limited information is available regarding caregivers' knowledge and views regarding infant hearing loss, which is essential for the successful implementation of early hearing detection and intervention (EHDI) programmes. OBJECTIVES: The main aim of the study was to describe the knowledge and views of mothers with children aged between 0 and 5 years old regarding hearing screening, risk factors, symptoms of hearing loss, and intervention options for hearing loss. METHOD: A survey was employed at a primary care clinic to gain insight into the maternal views on hearing loss and early intervention services for children aged 0-5 years old. RESULTS: The majority (83.2%) of the mothers believed that hearing can be tested at birth, 90.7% believed in the biomedical model of intervention which is based on cure, prevention, and pathology as opposed to traditional or alternative medicinal beliefs, and 95.3% indicated that they would seek medical attention if they noticed symptoms of hearing loss. Consequences of hearing loss, such as academic, communication and social problems, were indicated by 65.4% of mothers. CONCLUSION: The findings demonstrated that although cultural beliefs regarding superstitious causes of hearing loss and use of traditional medicine exist, satisfactory maternal knowledge regarding detection and intervention for hearing loss is present. Maternal views are favourable and a general willingness to participate in EHDI programmes was present. This study advocates for the implementation of EHDI programmes at all primary healthcare clinics across South Africa.

Perceptions of public primary school teachers regarding noise-induced hearing loss in South Africa.

BACKGROUND: Noise-induced hearing loss (NIHL) is an increasingly growing problem in young children. This is attributed to recreational noise being the most common cause of this problem. In young children, hearing problems can delay language development and reduce academic achievements. South Africa, in particular, has limited information and protective measures regarding the conservation of hearing in school-aged children. OBJECTIVES: The main aim of the study was to determine the perception of primary school teachers regarding NIHL. The study also aimed to determine if any hearing conservation programmes are being implemented in schools and the need for training of primary school teachers regarding NIHL. METHOD: A survey was conducted. In order to cover the population of interest, the sampled schools in Pretoria were clustered into urban, semi-urban and rural areas. RESULTS: The majority of the teachers included in this study are aware of NIHL and its effects. They, however, lack the necessary resources and knowledge to effectively use this information. Most (67.5%) of the teachers indicated that they have never been exposed to children with NIHL in a school setting. It was also found that the majority (84%) of the schools included in the study do not implement hearing screening and conservation programmes. CONCLUSION: Although the sample size was limited, the results correlate with other research in this field indicating a need for planning and implementation of hearing conservation programmes in schools, including training of teachers in order for these programmes to be effective.

Establishing a pharmacotherapy induced ototoxicity programme within a service-learning approach.

Pharmacotherapy-induced ototoxicity is growing, especially in developing countries such as South Africa. This highlights the importance of ototoxicity monitoring and management of hearing loss. This article focuses on the establishment of an ototoxicity clinic as a site for the implementation of a service-learning module in the Audiology programme. The clinic offers a unique opportunity of collaboration between pharmacists and an audiologist where pharmacotherapy-induced ototoxicity is uniquely monitored. The Sefako Makgatho Health Sciences University (SMU) provides training to both the disciplines, audiology and pharmacy. The main aim of this article is to describe how ototoxicity monitoring is implemented in the curriculum within such an academic service-learning approach. Through service learning students develop a deeper understanding of course content, acquire new knowledge and engage in civic activity. It simultaneously provides a unique opportunity for interdisciplinary collaboration between the disciplines of audiology and pharmacy. The objectives for this programme are therefore to facilitate learning and to provide a service to the local community by identifying, preventing and monitoring medicine-induced hearing loss in in-hospital and out-patients; as well as to establish inter-disciplinary collaboration between the disciplines and stakeholders for more effective service delivery. The constant interdisciplinary teamwork between the audiologist, pharmacist, physician and nursing staff in the wards results in best practice and management of patients with ototoxic damage.

Infection prevention and control measures currently applied in South African audiology.

BACKGROUND: To counter the global increase in infection-related deaths, infection control has recently developed into an active area of research. Many diseases can be prevented by infection control. In the confines of the audiology clinic, cross-contamination by micro-organisms associated with opportunistic infections remains a real concern. OBJECTIVE: The primary aim of the study was to ascertain the methods that audiologists in South Africa use to prevent and control the spread of infections during and after consultation with clients. METHOD: A survey study was conducted, using a self-administered questionnaire. Fifty currently practising audiologists participated in the study. RESULTS: The majority (84%; n = 42) of respondents acknowledged the importance of hand hygiene for the purpose of infection control, with 76% (n = 38) making use of no-rinse hand sanitisers. Approximately a third of audiologists wear gloves during procedures such as otoscopy and immittance, and while handling hearing aids. Disinfecting audiological equipment seem to be the preferred choice of infection control, with only 60% (n = 30) of respondents sterilising audiological equipment after each individual patient consultation. Less than half of the respondents disinfected touch surfaces and toys in the reception area. CONCLUSIONS: Based on the results, further education and training should focus on measures implemented in infection control, awareness of possible risk factors at work settings, and vaccination as an effective means of infection control.