Knowledge of and Attitudes Toward Hearing Loss Among Primary Care Physicians in the Public Health Sector of Mauritius.

Introduction Primary care physicians are essential first points of contact for patients with hearing loss. Thus, knowledge of hearing loss and related aspects is essential to ensure the optimal management of individuals with suspected hearing loss. Objective This study aimed to determine the knowledge of and attitudes toward hearing loss among primary care physicians in the public health sector in Mauritius. Methods In this cross-sectional descriptive cohort study, 320 primary care physicians completed an online questionnaire adapted from previous questionnaires on knowledge of and attitudes toward hearing loss. Responses were analyzed using descriptive statistics and cross-sectional analyses. Results Primary care physicians showed limited knowledge of hearing loss in areas such as early identification and intervention, professionals responsible for hearing assessments, and hearing tests used for assessing hearing sensitivity. However, the responses also showed positive attitudes toward hearing loss. Significant associations between knowledge of and attitudes toward hearing loss were obtained regarding the type of physician, length of practice, and department posted in. Ear, nose, and throat specialists, as well as pediatricians, demonstrated significantly higher scores for both knowledge of and positive attitudes toward hearing loss. Conclusions The findings highlight a strong need for ongoing medical education to spread awareness about hearing loss among primary care physicians in the public health sector of Mauritius.

Knowledge of and Attitudes Toward Hearing Loss Among Primary Care Physicians in the Public Health Sector of Mauritius

Abstract Introduction Primary care physicians are essential first points of contact for patients with hearing loss. Thus, knowledge of hearing loss and related aspects is essential to ensure the optimal management of individuals with suspected hearing loss. Objective This study aimed to determine the knowledge of and attitudes toward hearing loss among primary care physicians in the public health sector in Mauritius. Methods In this cross-sectional descriptive cohort study, 320 primary care physicians completed an online questionnaire adapted from previous questionnaires on knowledge of and attitudes toward hearing loss. Responses were analyzed using descriptive statistics and cross-sectional analyses. Results Primary care physicians showed limited knowledge of hearing loss in areas such as early identification and intervention, professionals responsible for hearing assessments, and hearing tests used for assessing hearing sensitivity. However, the responses also showed positive attitudes toward hearing loss. Significant associations between knowledge of and attitudes toward hearing loss were obtained regarding the type of physician, length of practice, and department posted in. Ear, nose, and throat specialists, as well as pediatricians, demonstrated significantly higher scores for both knowledge of and positive attitudes toward hearing loss. Conclusions The findings highlight a strong need for ongoing medical education to spread awareness about hearing loss among primary care physicians in the public health sector of Mauritius.

The public healthcare sector of Mauritius: knowledge of and attitudes toward hearing loss among community health workers.

Mauritius does not have community health workers trained in identifying risk factors for hearing loss or in referring patients for diagnostic testing. It is crucial to gather information about the knowledge of and attitudes toward hearing loss among community health workers before involving them in the identification and intervention of hearing loss in Mauritius. To describe the knowledge of and attitudes toward hearing loss among community health workers in Mauritius. A descriptive survey design with quantitative analysis was used. Using non-probability purposive sampling, 125 community health workers which included 94 community health officers and 31 community-based rehabilitation officers were recruited from the five catchment areas of the public healthcare sector. Participants filled in a 15-item paper-based questionnaire on the knowledge of and attitudes toward hearing loss. The questionnaire was internally consistent, with Cronbach alpha scores of 0.759 and 0.863. The overall knowledge of community health workers regarding risk factors and the identification of hearing loss was poor (38.3%). 92.6% of community health workers reported positive attitudes toward hearing loss. General knowledge of hearing loss (P=0.015) and knowledge of risk factors and identification of hearing loss (P=0.005) were significant predictors of attitudes toward hearing loss. Knowledge of and attitudes toward hearing loss were significantly associated with working experience and practice setting (P=0.004). There remains a need to educate community health workers about the risk factors and identification of hearing loss to ensure timely diagnosis and management of hearing loss at the community level.

The use of the Feather Squadron to identify auditory processing disorders in South African children: a comparative study.

OBJECTIVE: Development of the Feather Squadron (FS) has created a cost-effective, accessible form of assessment through tele-audiology. As accessibility to reliable, cost-effective assessment of auditory processing (AP) skills is limited in South Africa (SA), this study aims to establish whether there is correlation between the FS and traditional tests of AP viz. Frequency Pattern and Dichotic Digits Test, and to establish its relevance to the SA population. DESIGN: Retrospective, within-subject, comparative design used to compare performance on the FS and the traditional tests. Data were considered in two ways: Firstly, using the traditional -2SD cut-off on some subtests of the FS compared to the same traditional tests, and secondly, by comparing the Z-scores obtained on the FS compared to Z-scores on the same traditional tests obtained by applying a double arcsine transformation. STUDY SAMPLE: Sixty-six subjects (35 males, 31 females) aged between 8.08 and 9.75 years (mean = 8.73; SD = 0.51) seen for AP assessments between 2016 and 2019. RESULTS: -2SD criteria yielded no significant association (p > 0.05). Z-score comparison suggested a statistically significant correlation (p < 0.05). CONCLUSION: A statistically significant correlation between certain subtests of FS with traditional tests of AP to merit its use in the SA population is suggested.

Speech perception in noise in children with learning difficulties: A scoping review.

BACKGROUND: Children with learning difficulties (LD) face multiple challenges in classrooms settings while having to meet various auditory demands, such as understanding verbal instructions in the presence of background noise. These challenges pose a risk for academic failure, underachievement, and underemployment. Well-developed skills regarding speech perception in noise promote learning, communication, and academic success. These skills need further investigation to promote evidence-based practice and intervention within the audiological and educational fields. OBJECTIVE: To identify and review published literature on the speech perception in noise abilities of children with LDs. DESIGN: A systematic search strategy was used to identify literature on five electronic databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Literature from 2011 to 2021 reporting on speech perception in noise in children with LDs was included. RESULTS: Of 1295 articles identified, five articles met the inclusion criteria and were included in this scoping review. All studies used comparative study designs to determine the speech perception in noise skills of children with LDs. Results indicated that children with LDs have poorer speech perception in noise skills when compared to typically developing children. Trisyllabic words were better perceived in noise than monosyllabic and disyllabic words. CONCLUSION: Children with LDs require greater signal-to-noise ratios if they are to be given the same academic opportunities as typically developing (TD) children. Future studies can investigate the functional outcomes of children with LDs to promote evidence-based practice and intervention.

Effects of language experience on selective auditory attention and speech-in-noise perception among English second language learners: Preliminary findings.

OBJECTIVE: The purpose of the study was to examine the effects of language experience on selective auditory attention and speech-in-noise perception in English Second Language (ESL) learners aged seven to eight years. METHOD: A quantitative, descriptive, comparative cross-sectional research design was used to determine the effect of age of exposure to English on the selective auditory attention abilities and speech-in-noise perception skills of 40 children with normal hearing in first or second grade (aged seven to eight years). The control group comprised of 20 English first language (EFL) learners (mean age = 7.35 years ±0.49) and the research group included 20 s language learners (mean age = 7.70 years ±0.47). In order to compare the control and research groups with respect to the age of exposure to English through various sources, the Mann Whitney test was used. Information regarding the age of exposure was gathered by a case history questionnaire, completed by the parents/guardians of the participants. The Selective Auditory Attention Test (SAAT) and Digits-in-Noise (DIN) test were performed in one sitting. RESULTS: No statistically significant differences between the EFL and ESL groups were found for the SAAT and DIN. However, a statistically significant difference was obtained between the SAAT lists 1 and 3 & the DIN: diotic listening condition for the ESL group only (rs = -0.623; p = 0.003). The difference between the EFL and ESL groups in the mean age of exposure to English was statistically significant (p = 0,019), with mean age of exposure to English in the ESL group (mean age = 2.82 ± 0.53) being higher than the mean age of exposure in the EFL group (mean age = 1.81 ± 1.53). However, this difference did not influence the results of the SAAT and DIN significantly. CONCLUSION: The main finding was that selective auditory attention and speech-in-noise perception were not significantly affected in the ESL learners who participated in the study - learners who were recruited from private schools located in an urban area and thus from higher socio-economic status (SES) households. There is a need for additional research with a larger sample size to determine the selective auditory attention abilities and speech-in-noise perception skills of ESL learners in government-funded schools located in rural areas and from various socio-economic backgrounds.

Listening Effort in School-Age Children With Normal Hearing Compared to Children With Limited Useable Hearing Unilaterally.

Objectives Children with limited hearing unilaterally might experience more listening effort than children with normal hearing, yet previous studies have not confirmed this. This study compared listening effort in school-age children with normal hearing and children with limited hearing unilaterally using behavioral and subjective listening effort measures. Design Two groups of school-age children (aged 7-12 years) participated: 19 with limited hearing unilaterally and 18 with normal hearing bilaterally. Participants completed digit triplet recognition tasks in quiet and in noise (-12 dB SNR) in three loudspeaker conditions: midline, direct, and indirect. Verbal response times during the recognition task were interpreted as behavioral listening effort. Subjective ratings of "task difficulty" and "hard to think" were interpreted as subjective listening effort. Participant age was included as a covariate in analysis of behavioral data. Results Noise negatively affected digit triplet recognition for both groups in the midline loudspeaker condition and for participants with limited hearing unilaterally in the direct and indirect conditions. Relative to their peers with normal hearing, children with limited hearing unilaterally exhibited significantly longer response times and higher ratings of effort only in the noisy, indirect condition. Differences between groups were evident even when age differences were controlled for statistically. Conclusions Using behavioral and subjective indices of listening effort, children with limited unilateral hearing demonstrated significantly more listening effort relative to their peers with normal hearing during the difficult indirect listening condition. Implications include classroom accommodations to limit indirect listening situations for children with limited useable hearing unilaterally and consideration of intervention options.

Listening Effort in School-Aged Children With Limited Useable Hearing Unilaterally: Examining the Effects of a Personal, Digital Remote Microphone System and a Contralateral Routing of Signal System.

Technology options for children with limited hearing unilaterally that improve the signal-to-noise ratio are expected to improve speech recognition and also reduce listening effort in challenging listening situations, although previous studies have not confirmed this. Employing behavioral and subjective indices of listening effort, this study aimed to evaluate the effects of two intervention options, remote microphone system (RMS) and contralateral routing of signal (CROS) system, in school-aged children with limited hearing unilaterally. Nineteen children (aged 7-12 years) with limited hearing unilaterally completed a digit triplet recognition task in three loudspeaker conditions: midline, monaural direct, and monaural indirect with three intervention options: unaided, RMS, and CROS system. Verbal response times were interpreted as a behavioral measure of listening effort. Participants provided subjective ratings immediately following behavioral measures. The RMS significantly improved digit triplet recognition across loudspeaker conditions and reduced verbal response times in the midline and indirect conditions. The CROS system improved speech recognition and listening effort only in the indirect condition. Subjective ratings analyses revealed that significantly more participants indicated that the remote microphone made it easier for them to listen and to stay motivated. Behavioral and subjective indices of listening effort indicated that an RMS provided the most consistent benefit for speech recognition and listening effort for children with limited unilateral hearing. RMSs could therefore be a beneficial technology option in classrooms for children with limited hearing unilaterally.

Listening Effort in Native and Nonnative English-Speaking Children Using Low Linguistic Single- and Dual-Task Paradigms.

Purpose It is not clear if behavioral indices of listening effort are sensitive to changes in signal-to-noise ratio (SNR) for young children (7-12 years old) from multilingual backgrounds. The purpose of this study was to explore the effects of SNR on listening effort in multilingual school-aged children (native English, nonnative English) as measured with a single- and a dual-task paradigm with low-linguistic speech stimuli (digits). The study also aimed to explore age effects on digit triplet recognition and response times (RTs). Method Sixty children with normal hearing participated, 30 per language group. Participants completed single and dual tasks in three SNRs (quiet, -10 dB, and -15 dB). Speech stimuli for both tasks were digit triplets. Verbal RTs were the listening effort measure during the single-task paradigm. A visual monitoring task was the secondary task during the dual-task paradigm. Results Significant effects of SNR on RTs were evident during both single- and dual-task paradigms. As expected, language background did not affect the pattern of RTs. The data also demonstrate a maturation effect for triplet recognition during both tasks and for RTs during the dual-task only. Conclusions Both single- and dual-task paradigms were sensitive to changes in SNR for school-aged children between 7 and 12 years of age. Language background (English as native language vs. English as nonnative language) had no significant effect on triplet recognition or RTs, demonstrating practical utility of low-linguistic stimuli for testing children from multilingual backgrounds.

Oropharyngeal Dysphagia in Breastfeeding Neonates with Hypoxic-Ischemic Encephalopathy on Therapeutic Hypothermia.

Purpose: To identify symptoms of oropharyngeal dysphagia (OPD) in breastfeeding neonates with hypoxic-ischemic encephalopathy (HIE) on therapeutic hypothermia (TH). Early identification of feeding problems in neonates with HIE by speech-language therapists (SLTs) may prevent secondary complications of OPD such as aspiration pneumonia and death. Materials and Methods: Twenty-eight full-term neonates with HIE (mean chronological age = 4.5 days) and 30 healthy term controls were prospectively recruited for this case-control study. Participants with HIE (mild [n = 15], moderate [n = 11], severe [n = 2]), diagnosed by pediatricians, received whole-body TH. Feeding was clinically evaluated by an SLT using the Preterm Infant Breastfeeding Behavior Scale. Results: Twenty-five neonates (89.2%) had at least one symptom of OPD. Falling asleep during feeding, noticeable oral secretions, coughing, and flaring nostrils were symptoms of OPD most frequently identified. The HIE group displayed limited arousal during breastfeeding and had less obvious rooting, shallower latching onto the breast, and more single sucks in comparison to term newborns. The HIE group had significantly more closed eyes and minimal movement during breastfeeding, while controls showed the quiet-alert state ideal for breastfeeding. Conclusions: OPD was identified in the majority of infants with HIE. Underlying the appearance of an inactive neonate with HIE may be OPD that could be overlooked if not investigated. Interprofessional collaboration between SLTs, pediatricians and nurses to determine feeding-readiness is imperative. SLTs may assist in decision-making to improve safety of breastfeeding in this population. This study contributes to the small body of research on early breastfeeding of neonates with HIE.

Breastfeeding skills of full-term newborns and associated factors in a low-and-middle-income setting.

BACKGROUND: Normative information on the breastfeeding of term newborns may guide clinicians in early identification of breastfeeding difficulties and oro-pharyngeal dysphagia (OPD), and may support optimal breastfeeding practices. OBJECTIVE: To describe breastfeeding skills of term newborn infants in a South African hospital, a lower-middle-income setting, and investigate associations between infants' feeding and other factors. METHOD: One breastfeeding session of each of the 71 healthy newborn full-term infants (mean chronological age=1.9 days; mean gestation=39.1 weeks) was evaluated using the Preterm Infant Breastfeeding Behavior Scale (PIBBS), suitable for use with term newborns. RESULTS: All participants were exclusively breastfed. Thirteen participants (18%) were HIV-exposed. There was no significant difference in the findings of the PIBBS between HIV-exposed and unexposed participants. Most newborns had obvious rooting, latched deeply onto the nipple and some of the areola, had repeated long sucking bursts (mean length=16.82 sucks/burst), and swallowed repeatedly. Most participants were in either the drowsy or quiet-alert state, which are optimal behavioural states for breastfeeding. One to two-hourly on-demand feeds was significantly associated with mothers who had normal births and did not use galactogogues to promote lactation. CONCLUSION: Results may be used for early identification of OPD in newborns. The findings may be useful to primary care clinicians.

Breastfeeding and swallowing in a neonate with mild hypoxic-ischaemic encephalopathy.

BACKGROUND: Specific breastfeeding and swallowing characteristics in neonates with hypoxic-ischaemic encephalopathy (HIE) have not yet been well described in the literature. Considering the relatively high incidence of HIE in resource-poor settings, speech-language therapists should be cognisant of the feeding difficulties in this population during breastfeeding. OBJECTIVE: To systematically describe the breastfeeding and swallowing of a single case of a neonate diagnosed with mild HIE from admission to discharge. METHOD: A case study of a 2-day old neonate with mild HIE in a neonatal intensive care unit at an urban teaching hospital, is presented. Data were prospectively collected during four sessions in a 12-day period until the participant's discharge. Feeding and swallowing were assessed clinically, as well as instrumentally using a video-fluoroscopic swallow study. RESULTS: After parenteral feeding, nasogastric tube feeding commenced. Breastfeeding was introduced on Day 6, as it was considered a safe option, and revealed problematic rooting, shallow latching, short sucking bursts, infrequent swallowing, and a drowsy state of arousal, with coughing and choking. No penetration or aspiration was identified instrumentally. After 13 days, the neonate was breastfeeding safely. CONCLUSION: Although the pharyngeal stage of swallowing was intact, symptoms of oral stage dysphagia were revealed using a combination of clinical and instrumental measures. Breastfeeding difficulties were identified, exacerbated by poor state regulation, which lead to prolonged hospitalisation. The case study highlights the unexpected long duration of feeding difficulties in an infant with mild HIE and indicates further research.

Deaf or hard of hearing children in Saudi Arabia: Status of early intervention services.

OBJECTIVE: This study aims to determine the status of early intervention services provided to children who are deaf or hard of hearing and their parents/caregivers from birth to five years of age at two main state hospitals in Riyadh, Saudi Arabia, based on their parents' perceptions. METHOD: A descriptive quantitative research design was used to determine the status of early intervention services for deaf or hard of hearing children in Saudi Arabia based on their parents' perceptions. Semistructured interviews based on a questionnaire were conducted with 60 research participants from two main state hospitals where early detection and intervention services are provided. A purposive sampling technique was employed. Descriptive and inferential statistical analyses were performed on the data collected. RESULTS: The participants' children were diagnosed at a substantially late age, resulting in delayed ages for initial hearing aid fitting and enrolment in early intervention services. A significant relationship was found between the residential area of the participants and timely access to intervention services. The results indicated that participants residing in Riyadh were fitted with hearing aids and enrolled into EI services earlier than those living outside of Riyadh. The delivery of information also emerged as a weakness in the EI system for the majority of participants. CONCLUSION: The findings of the study suggested that limited services of detection and intervention for deaf or hard of hearing children and residential area of participants are likely to be barriers to early access to intervention services. It is proposed that the benefits of UNHS accompanied by appropriate early intervention services should be made available in all regions throughout Saudi Arabia.

Comparison of the South African Spondaic and CID W-1 wordlists for measuring speech recognition threshold.

BACKGROUND: The home language of most audiologists in South Africa is either English or Afrikaans, whereas most South Africans speak an African language as their home language. The use of an English wordlist, the South African Spondaic (SAS) wordlist, which is familiar to the English Second Language (ESL) population, was developed by the author for testing the speech recognition threshold (SRT) of ESL speakers. OBJECTIVES: The aim of this study was to compare the pure-tone average (PTA)/SRT correlation results of ESL participants when using the SAS wordlist (list A) and the CID W-1 spondaic wordlist (list B - less familiar; list C - more familiar CID W-1 words). METHOD: A mixed-group correlational, quantitative design was adopted. PTA and SRT measurements were compared for lists A, B and C for 101 (197 ears) ESL participants with normal hearing or a minimal hearing loss (<26 dBHL; mean age 33.3). RESULTS: The Pearson correlation analysis revealed a strong PTA/SRT correlation when using list A (right 0.65; left 0.58) and list C (right 0.63; left 0.56). The use of list B revealed weak correlations (right 0.30; left 0.32). Paired sample t-tests indicated a statistically significantly stronger PTA/SRT correlation when list A was used, rather than list B or list C, at a 95% level of confidence. CONCLUSIONS: The use of the SAS wordlist yielded a stronger PTA/SRT correlation than the use of the CID W-1 wordlist, when performing SRT testing on South African ESL speakers with normal hearing, or minimal hearing loss (<26 dBHL).

The influence of non-linear frequency compression on the perception of music by adults with a moderate to sever hearing loss: subjective impressions.

OBJECTIVE: To date, the main direction in frequency-lowering hearing aid studies has been in relation to speech perception abilities. With improvements in hearing aid technology, interest in musical perception as a dimension that could improve hearing aid users' quality of life has grown. The purpose of this study was to determine the influence of non-linear frequency compression (NFC) on hearing aid users' subjective impressions of listening to music. DESIGN & SAMPLE: A survey research design was implemented to elicit participants' (N=40) subjective impressions of musical stimuli with and without NFC. RESULTS: The use of NFC significantly improved hearing aid users' perception of the musical qualities of overall fidelity, tinniness and reverberance. Although participants preferred to listen to the loudness, fullness, crispness, naturalness and pleasantness of music with the use of NFC, these benefits were not significant. CONCLUSION: The use of NFC can increase hearing aid users' enjoyment and appreciation of music. Given that a relatively large percentage of hearing aid users express a loss of enjoyment of music, audiologists should not ignore the possible benefits of NFC, especially if one takes into account that previous research indicates speech perception benefits with this technology.

Auditory steady-state responses to bone conduction stimuli in children with hearing loss.

OBJECTIVE: The auditory steady-state response (ASSR) to air-conduction (AC) stimuli has been widely incorporated into audiological test-batteries for the pediatric population. The current understanding of ASSR to bone conduction (BC) stimuli, however, is more limited, especially in the case of infants and children. There are few reports on ASSR thresholds to BC stimuli in infants and young children, and none for infants or children with hearing loss. The objective of this study was to investigate BC ASSR thresholds in young children with normal hearing and various types and degrees of hearing loss. METHODS: AC and BC ASSR thresholds are reported for 48 young children (mean age+/-SD=2.8+/-1.9 years; age range=0.25-11.5 years; 23 female). Hearing status was classified by assessing all children with a comprehensive test battery including tympanometry, diagnostic distortion-product otoacoustic emissions, click-evoked AC auditory brainstem response, AC and BC ASSR thresholds, and an otologic examination. The subjects were assigned to the categories normal hearing, conductive loss, and sensorineural loss (mild-to-moderate or severe-to-profound), for group analysis. AC and BC ASSR stimuli (carrier frequencies: 0.25-4 kHz; 67-95 Hz modulation rates; 100% amplitude and 10% frequency modulated) were presented using the GSI Audera system. RESULTS: Minimum levels at which spurious BC ASSR occur were established in the group of children with severe-to-profound sensorineural hearing loss (25, 40, 60, 60 and 60 dB for 0.25, 0.5, 1, 2, and 4 kHz, respectively). Children with normal hearing presented mean (1 SD) BC ASSR thresholds of 19 (9), 18 (7), 16 (11), 24 (7), and 26 (8) dB HL at 0.25, 0.5, 1, 2, and 4 kHz, respectively. Significantly lower thresholds (p<0.0001) were obtained for 0.25, 0.5 and 1 kHz than for 2 and 4 kHz. At 0.25 kHz, 39% of thresholds were at the minimum level of spurious response occurrence. More than half (54%) of the BC thresholds in the group with mild-to-moderate sensorineural hearing loss were recorded at or above the minimum levels at which spurious response occurred. In children with conductive hearing loss, the average BC ASSR thresholds corresponded closely to those in the normal hearing group except at 1 kHz and revealed an air-bone gap. CONCLUSIONS: Spurious bone conduction ASSR responses limit the intensity range for which the technique may be employed in infants and children, especially at lower frequencies. Consequently, the 0.25 kHz stimulus is not recommended for clinical use. In infants and young children, sensorineural hearing loss of a moderate or greater degree in the high frequencies (1-4 kHz), and of a mild or greater degree in the low frequencies (0.5 kHz), cannot be quantified using BC ASSR. This is due to the presence of the stimulus artifact. In cases of conductive hearing loss, BC ASSR can effectively quantify sensory hearing between 0.5 and 4 kHz, but interpretations must be made cautiously within the limitations of stimulus artifact occurrence across frequencies.

Infant hearing loss in South Africa: age of intervention and parental needs for support.

Hearing loss is referred to as the silent, overlooked epidemic in developing countries, and data reporting the mean age of diagnosis and intervention is virtually non-existent due to limited systematic or routine screening programs. The objective of this paper is to present findings of recent practice in early diagnosis and intervention services in an urban South African context, with specific reference to parental needs for support. Data was collected by means of questionnaire surveys for 54 parents of children with congenital or early-onset hearing loss, followed by focus group discussions conducted with 10 parents. The results of this study indicate the mean age of diagnosis to be 23 months (+/-18 SD), the mean age of initial hearing-aid fitting to be 28 months (+/-19 SD), and the mean age of enrollment into an early intervention program to be 31 months (+/-19 SD). In addition, results signify that this diverse and challenging population of parents of young hearing-impaired children largely depends on the ongoing support, guidance, and commitment of the pediatric audiologist.