Identifying hearing impairment and the associated impact on the quality of life among the elderly residing in retirement homes in Pretoria, South Africa.

BACKGROUND: Age-Related Hearing Loss (ARHL) is the most widespread sensory disorder in the elderly. Poor audiological support within retirement homes is one of the fundamental issues impacting the Quality of Life (QoL). OBJECTIVES: The objectives of this study were to: (1) Identify the presence of hearing impairment through a hearing screening test battery in a sample of elderly participants residing in three retirement homes. (2) Determine the psychological, communication-related and social impact of the hearing impairment on the QoL in a sample of elderly participants residing in retirement homes. METHOD: A prospective cross-sectional research design with quantitative methods of data analysis was used to obtain data from 70 elderly participants (mean age = 79 years, 79% were female). Ten of them used hearing aids. Hearing screening was conducted using otoscopy, tympanometry and air conduction screening (500 Hz-4 kHz). The World Health Organization Quality of Life (WHOQoL) questionnaire was adapted and utilised for the present study. RESULTS: Findings revealed that 77% of the sample obtained a refer result from the hearing screening protocol indicating a high presence of hearing impairment. Twenty-nine per cent (n = 16) of the participants felt depressed, worried and anxious because of their hearing loss and 20% of participants felt unaccepted by their significant others as a result of their hearing impairment. Hearing difficulties were significantly associated with a reduced QoL (p = 0.045). Eight of the 10 participants who wore hearing aids reported an overall improvement in QoL since receiving and utilising their hearing aids and 20% (n = 2) of hearing aid users reported challenges with maintaining their hearing aids. CONCLUSION: The findings of this study emphasised the need for an increased role for audiological services provided by audiologists within retirement homes, thereby contributing to an improved QoL.

The effects of combined exposure of solvents and noise on auditory function - A systematic review and meta-analysis.

BACKGROUND:  Chemical substances can negatively affect the auditory system. Chemical substances alone or combined with high-level noise have recently become a major concern as a cause of occupational hearing loss. OBJECTIVE:  To assess the combined effect of solvents and noise versus solvents only, or noise only, on the auditory function of workers. METHOD:  Published articles which included noise and/or solvent exposure or combined effects of solvents and noise, studies conducted on human beings only and the use of audiological tests on participants. RESULTS:  Thirteen papers were eligible for inclusion. The participants' ages ranged from 18 to 68 years. Results revealed that 24.5% presented with hearing loss as a result of noise exposure only; 18% presented with hearing loss owing to solvent exposure only; and a total of 43.3% presented with hearing loss owing to combined noise and solvent exposure. Furthermore, the prevalence of hearing loss in the noise and solvent group was significantly (p < 0.001) higher than the other groups in 10 out of the 13 studies analysed, with a pooled odds ratio (OR) of 2.754. Of the 178 participants (total of all participants exposed to solvents), a total of 32 participants presented with auditory pathology as a result of exposure to solvents only. There was a significantly higher pooled odds of hearing loss in noise and solvent-exposed group compared to solvent-only group (pooled OR = 2.15, 95% CI: 1.24-3.72, p = 0.006). CONCLUSION:  The findings revealed significantly higher odds of acquiring hearing loss when workers were exposed to a combination of solvents and noise as opposed to solvents only, motivating for its inclusion into hearing conservation programmes.

Assessing the efficacy of asynchronous telehealth-based hearing screening and diagnostic services using automated audiometry in a rural South African school.

BACKGROUND:  Asynchronous automated telehealth-based hearing screening and diagnostic testing can be used within the rural school context to identify and confirm hearing loss. Objective: The aims of the study were to evaluate the efficacy of an asynchronous telehealth-based service delivery model using automated technology for screening and diagnostic testing as well as to describe the prevalence, type and degree of hearing loss. Method: A comparative within-subject design was used. Frequency distributions, sensitivity, specificity scores as well as the positive and negative predictive values were calculated. Testing was conducted in a non-sound-treated classroom within a school environment on 73 participants (146 ears). The sensitivity and specificity rates were 65.2% and 100%, respectively. Diagnostic accuracy was 91.7% and the negative predictive values (NPV) and positive predictive values (PPV) were 93.8% and 100%, respectively. Results: Results revealed that 23 ears of 20 participants (16%) presented with hearing loss. Twelve per cent of ears presented with unilateral hearing impairment and 4% with bilateral hearing loss. Mild hearing loss was identified as most prevalent (8% of ears). Eight ears obtained false-negative results and presented with mild low- to mid-frequency hearing loss. The sensitivity rate for the study was low and was attributed to plausible reasons relating to test accuracy, child-related variables and mild low-frequency sensory-neural hearing loss. Conclusion: The study demonstrates that asynchronous telehealth-based automated hearing testing within the school context can be used to facilitate early identification of hearing loss; however, further research and development into protocol formulation, ongoing device monitoring and facilitator training is required to improve test sensitivity and ensure accuracy of results.

Knowledge and Cultural Beliefs of Mothers Regarding the Risk Factors of Infant Hearing Loss and Awareness of Audiology Services.

The aim of the paper is to describe the knowledge of mothers in Durban, South Africa, regarding risk factors of hearing loss in infants and their awareness of audiology services, and to describe their cultural beliefs about the risk factors for hearing loss in infants. A descriptive survey design with quantitative methods of analysis were used. Conveniently sampled mothers (n=102) receiving postnatal care for their infants from eight provincial clinics within Durban consented to participate, yielding a response rate of 48%. A questionnaire was used to collect the data and the Cronbach α was calculated yielding a score of 0.835, indicating good internal consistency and reliability of the questionnaire. Sixty percent of the mothers were aware of risk factors, such as middle ear infections, ototoxic medication and consumption of alcohol during pregnancy. Seventy percent were unaware that NICU/mechanical ventilation for more than 5 days, prematurity, rubella and jaundice are considered risk factors for hearing loss, implying a need to create awareness amongst mothers regarding such risk factors. Sixty percent (n=62) believed that bewitchment and ancestral curses can cause hearing loss. Cultural beliefs were associated with hearing loss, therefore, health professionals need to demonstrate cultural competence when providing audiology services, especially in a culturally and linguistically diverse countries such as South Africa. Although the mothers had an average knowledge about risk factors, two thirds did not know which professional to seek help from. There is a need to create awareness amongst mothers regarding the risk factors of infant hearing loss as well as audiology services in order to facilitate early detection and intervention. There is a need for health professionals to demonstrate cultural competence when working with their patients.

Self-ear cleaning practices and the associated risk of ear injuries and ear-related symptoms in a group of university students.

Self-ear cleaning is the insertion of objects into the ear canal to clean it, a widespread practice that has the potential to compromise its integrity as a natural, selfcleansing mechanism, and a risk factor for possible injuries. The practice is common among young adults and highest in university than any other graduates. This study aimed to determine the self-ear cleaning practices and associated risk of injury and related symptoms in undergraduate students at KwaZulu-Natal University. The descriptive survey utilized a self-administered questionnaire. Of the 206 participants that responded, 98% engaged in self-ear cleaning, with 75% indicating that it was beneficial. The commonest method (79.6%) being the use of cotton buds, with an associated injury rate of 2.4%. There was no statistically significant associations between those who used or did not use cotton buds and the symptoms experienced. The complications indicate that self-ear cleaning does pose a risk for injury, necessitating more community information and education.

Self-ear cleaning practices and the associated risk of ear injuries and ear-related symptoms in a group of university students

Self-ear cleaning is the insertion of objects into the ear canal to clean it, a widespread practice that has the potential to compromise its integrity as a natural, selfcleansing mechanism, and a risk factor for possible injuries. The practice is common among young adults and highest in university than any other graduates. This study aimed to determine the self-ear cleaning practices and associated risk of injury and related symptoms in undergraduate students at KwaZulu-Natal University. The descriptive survey utilized a self-administered questionnaire. Of the 206 participants that responded, 98% engaged in self-ear cleaning, with 75% indicating that it was beneficial. The commonest method (79.6%) being the use of cotton buds, with an associated injury rate of 2.4%. There was no statistically significant associations between those who used or did not use cotton buds and the symptoms experienced. The complications indicate that self-ear cleaning does pose a risk for injury, necessitating more community information and education

The practices, challenges and recommendations of South African audiologists regarding managing children with auditory processing disorders.

Audiologists managing children with auditory processing disorders (APD) encounter challenges that include conflicting definitions, several classification profiles, problems with differential diagnosis and a lack of standardised guidelines. The heterogeneity of the disorder and its concomitant childhood disorders makes diagnosis difficult. Linguistic and cultural issues are additional challenges faced by South African audiologists. The study aimed to describe the practices, challenges and recommendations of South African audiologists managing children with APD. A quantitative, non-experimental descriptive survey was used to obtain data from 156 audiologists registered with the Health Professions of South Africa. Findings revealed that 67% screened for APD, 42% assessed while 43% provided intervention. A variety of screening and assessment procedures were being administered, with no standard test battery identified. A range of intervention strategies being used are discussed. When the relationship between the number of years of experience and the audiologists' level of preparedness to practice in the field of APD was compared, a statistically significant difference (p = 0.049) was seen in that participants with more than 10 years of experience were more prepared to practice in this area. Those participants having qualified as speech-language therapists and audiologists were significantly more prepared (p = 0.03) to practice than the audiologists who comprised the sample. Challenges experienced by the participants included the lack of linguistically and culturally appropriate screening and assessment tools and limited normative data. Recommendations included reviewing the undergraduate audiology training programmes, reinstituting the South African APD Taskforce, developing linguistically and culturally appropriate normative data, creating awareness among educators and involving them in the multidisciplinary team.

Evaluating the Outcomes of a Hearing Screening Service for Grade One Learners in Urban Areas at Durban, South Africa.

Early intervention through hearing screening can reduce the negative impact of hearing loss for children. Optimal outcomes are achieved when an appropriate screening protocol is selected, a pathway for follow up care is established, and when a hearing conservation component is included. This study aimed to describe the outcomes of a hearing screening service provided to grade one learners in urban areas at Durban. A cross-sectional design was employed. Learners (n=241) were conveniently sampled from six randomly selected schools. They were screened using otoscopy, tympanometry and pure tone audiometry. Fifty eight participants (24%) obtained a refer result, with 33% referred for diagnostic assessments, 29% for middle ear pathology and 38% for cerumen management. Findings further revealed that only 33% of referrals were followed up indicating poor compliance. Association between test results and income levels (P=0.38) as well as distance to the nearest health care facility (P=0.22) did not influence test outcomes. School aged children do present with common ear problems. Appropriate protocol selection, ensuring compliance to recommendations and education on hearing conservation are essential components of any health initiative.

Clinical outcomes in patients with isolated left ventricular noncompaction and heart failure.

BACKGROUND: We prospectively evaluated long-term clinical outcomes of patients diagnosed with isolated left ventricular noncompaction (ILVNC) and heart failure from a sub-Saharan African population. METHODS AND RESULTS: Patients in this single-center study were followed at a tertiary care institution. Clinical follow-up was performed with the use of protocol-driven echocardiographic screening for ventricular thrombus every 4 months. Warfarin was maintained or initiated only if thrombus was detected with the use of echocardiography. Fifty-five patients were followed for 16.7 ± 5.9 (range 12-33) months. All individuals had left ventricular (LV) ejection fraction <50% (mean 29.6 ± 11.8%). Of the 55 patients, 7 (12.7%) died, and sudden cardiac death was the cause in 5 (71.4%). There were no differences in baseline clinical, echocardiographic, or electrocardiographic characteristics between survivors and nonsurvivors. Recurrent heart failure developed in 12 patients (21.8%); 1 patient developed a ventricular arrhythmia. No thromboembolic or major bleeding complications occurred in the 16 patients on warfarin; 1 episode of thromboembolism occurred in the 39 patients not on warfarin. Mean survival probability at 33 months was 0.64. CONCLUSIONS: Sudden cardiac death was the most common cause of death in patients with ILVNC and heart failure. Recurrent heart failure occurred in 21.8% of patients. Development of LV thrombus and cardioembolism is uncommon in this population.

Relationship between left ventricular twist and circulating biomarkers of collagen turnover in hypertensive patients with heart failure.

BACKGROUND: Left ventricular (LV) twist may be a compensatory mechanism to preserve ejection fraction (EF). In patients with hypertension, twist varies depending on the left ventricle's degree of remodeling and systolic function; it is increased in those with hypertension with normal EF (HTNEF) and diminished in those with hypertension with low EF (HTLEF). The ratio of collagen-degradation biomarkers in patients with hypertension is higher in those with low EFs than those with preserved EFs and may contribute to remodeling and systolic dysfunction. METHODS: The aim of this study was to evaluate the relationship between these biomarkers and LV twist in 82 patients with hypertension, 41 with EFs < 50% (HTLEF group) and 41 with EFs ≥ 50% (HTNEF group). Net LV twist was measured using speckle-tracking echocardiography. Markers of collagen turnover, including serum concentrations of matrix metalloproteinase-1 (MMP1), tissue inhibitor of MMP1 (TIMP1), and the ratio of MMP1 to TIMP1, were measured. RESULTS: Log TIMP1, log MMP1, and log MMP1/TIMP1 ratio levels were higher in the HTLEF group than the HTNEF group (12.3 ± 0.3 vs 11.8 ± 0.1 [P < .0001], 9.1 ± 0.3 vs 8.0 ± 0.2 [P < .0001], and -3.3 ± 0.3 vs -3.8 ± 0.2 [P < .0001], respectively). Net LV twist was lower in the HTLEF group than the HTNEF group (3.3 ± 1.1 vs 11.7 ± 0.7, P < .0001). An inverse correlation existed between log MMP1/TIMP1 and net LV twist after adjusting for age, EF, duration of heart failure, systolic blood pressure, LV mass index, and LV sphericity index at end-diastole (r = -0.43, P < .0001). CONCLUSIONS: This inverse correlation between twist and loss of myocardial collagen scaffolding in patients with hypertension with heart failure suggests that the integrity of the extracellular matrix may play an important role in preserving myocardial deformation.