Validity of automated threshold audiometry in school aged children.

BACKGROUND: Automated hearing tests have the potential to reduce the burden of disease amongst learners by introducing such services within the school context. METHODS: The aim of the study was to conduct a validation study on normal and hearing impaired learners, comparing air and bone conduction automated test results to conventional test results in 50 school aged learners (n = 100 ears) within a noise controlled school environment using a cross sectional comparative study design. The KuduWave 5000 (Emoyo.net) was used in this study. DATA ANALYSIS: The spearman's correlation coefficient was calculated to determine test-retest reliability. The mean and standard deviation (SD) was measured for each frequency. The absolute mean difference (AMD) and SD was calculated for both air and bone conduction testing at each frequency for automated testing. A paired sampled t-test and a one way ANOVA was used to identify any significant differences. Alpha was set as 0.05. RESULTS: There was significant correlation between thresholds obtained for automated test one and test two for normal hearing and hearing impaired group. The spearmans correlation coefficient was high (close to +1) for majority of the results for both groups across the frequency range. Both air and bone conduction testing across the frequency range of 250 Hz-2000 Hz and at 8000 Hz were not statistically signfiicant (p < .005) for both groups, however at 4000 Hz for bone conduction testing in the hearing impaired group, there was a statisticially signficant difference (p = .003). This was attirubted to the variaibilty in bone conduction test results often due to force and placement of the bone vibrator. CONCLUSION: The findings indicate that automated audiometry can yield relaible results that are comparable to conventional test results. Key clinical considerations include extending the response time, regular rest periods, improving instructions and comfort levels.

The use of telehealth services to facilitate audiological management for children: A scoping review and content analysis.

Approximately 32 million children globally present with disabling hearing loss. Despite evidence describing the negative consequences of hearing loss, there is still a lack of hearing screening programmes in South Africa. Audiologists have been exploring the use of information and communication technologies (tele-audiology) to provide services to children and it is currently being evaluated to determine its feasibility. Aims We aim to describe tele-audiology services conducted to facilitate audiological management for children in both the rural and urban context and to determine the strengths, challenges and clinical implications of such services. Methods A scoping review was conducted by searching for peer-reviewed publications from five databases. Inclusion criteria and search strategies were outlined. Results Of the 23 studies that met the inclusion criteria, reliability of automated testing was comparable to conventional testing; however, these studies were based primarily on screening programmes. Eight (35%) of the 23 papers were concordance studies evaluating feasibility and validity of tele-audiology systems when compared with conventional testing, while one study (4%) evaluated a tele-audiology service. A further four studies (17%) evaluated the feasibility of introducing telehealth methods to evaluate middle ear pathology. Tele-auditory brainstem response was investigated in three studies (13%) and another five (22%) used smartphone and/or iPad technology to screen hearing. Only two studies (9%) evaluated the feasibility of providing intervention through telehealth methods. All included studies demonstrated improved access to and coverage of rural areas. Services such as video otoscopy and synchronous (online) hearing testing in remote areas were successfully implemented. Challenges included lack of diagnostic studies, inadequate training of staff and the need to standardize protocols and procedures in order to ensure that tele-audiology services are provided in a standardized and valid manner. Conclusion Tele-audiology services are feasible and can be useful in identifying auditory pathology for children in rural and remote areas.

Cochlear function in patients with chronic kidney disease.

OBJECTIVE: To evaluate cochlear functioning in patients (18-45 years old) with varying stages of chronic kidney disease (CKD). Using purposive sampling, 50 participants, 10 in each of the 5 stages of CKD, were selected and underwent pure tone audiometric testing and distortion product otoacoustic emissions (DPOAEs). RESULTS: Significant differences (p < 0.05) were found between pure tone audiometry and DPOAEs in detecting early cochlear dysfunction in the high-frequency range in stages 3 (6,000/5,000 Hz; p = 0.00), 4 (6,000/5,000 Hz; p < 0.03) and 5 (4,000/3,333 Hz; p < 0.01, 8,000/6,667 Hz: p < 0.05) with DPOAEs being more sensitive in identifying early cochlear dysfunction. Patients in stages 1 and 2 presented with normal puretone thresholds and DPOAEs, suggesting that cochlear functioning in these patients was normal. Early cochlear dysfunction, thereby indicating a subclinical hearing loss, was identified in stages 3, 4 and 5 by DPOAE testing. In addition, blood test results, drug intake and concomitant conditions were recorded and analysed which suggested a relationship between reduced cochlear functioning and increased electrolyte levels, treatment regimens and concomitant conditions. CONCLUSION: Participants in the later stages of CKD presented with early cochlear dysfunction, presenting with subclinical hearing loss. It was postulated that this subclinical hearing loss resulted from a combination of electrolytic, urea and creatinine imbalances, together with concomitant medical conditions and ototoxic drug intake. It was concluded that audiological monitoring be included in the management of patients with CKD and that DPOAEs be introduced as part of the test battery to monitor cochlear function in patients with varying degrees of CKD.