Applications of Grounded Theory Methodology to Investigate Hearing Loss: A Methodological Qualitative Systematic Review With Developed Guidelines.

OBJECTIVES: Qualitative methodologies are commonly adopted in hearing loss research. Grounded theory methodology is increasingly used to establish novel theories explaining experiences related to hearing loss. Establishing and improving the quality of grounded theory studies has been emphasized as critical to ensuring theoretical trustworthiness. Thus, the primary aim of the present study was to systematically review hearing loss research studies that have applied grounded theory methodology and assess the methodological quality of those grounded theory applications. Secondarily aims were to (i) explore how grounded theory methodology has been applied to investigate hearing loss, and (ii) use the findings of the review to develop a set of guidelines to aid the future high-quality application of grounded theory methodology to hearing loss research. DESIGN: Original peer-reviewed studies applying grounded theory methodology and published in English were identified through systematic searches in 10 databases; Applied Social Sciences Index and Abstracts, British Nursing Index, Cumulative Index to Nursing and Allied Health Literature, EBSCO, Global Health, MEDLINE (OvidSP), PsycINFO, PubMed, Scopus, and Web of Science. The quality of studies was assessed according to 12 grounded theory principles using the Guideline for Reporting, Evaluating, and applying the core principles of Grounded Theory studies (GUREGT) tool. Data were analyzed using qualitative inductive thematic analysis. RESULTS: After the removal of duplicates, 155 articles were retrieved. Of those, 39 met the criteria for inclusion in the systematic review. An increase in the adoption of grounded theory methodology to investigate hearing loss was identified with the number of published studies tripling in the last 5 years. Critical appraisal using the GUREGT tool identified four studies as high-quality. Most included studies were of moderate study quality (n = 25), and 10 were classified as being of low study quality. Using inductive thematic analysis, the included studies investigated one of four areas relating to hearing loss: (a) Living with hearing loss, (b) Identity and hearing loss, (c) Coping strategies for hearing loss, and (d) Audiological counseling and rehabilitation. Analysis also identified four main grounded theory factors frequently overlooked in hearing loss research: the different schools of grounded theory, sampling strategy, sample size, and the depth of grounded theory application. CONCLUSIONS: Use of grounded theory methodology is increasing at a rapid rate in hearing loss research. Despite this, studies conducted in the field to date do not meet and apply the full spectrum of grounded theory principles, as outlined by the GUREGT tool. To improve methodological rigor in future studies using grounded theory, we propose a set of guidelines that address the most commonly overlooked methodological considerations in hearing loss studies to date. The guidelines are designed to aid researchers to achieve high methodological quality in any field, improve qualitative rigor, and promote theoretical credibility.

Help-seeking journey to accessing audiology services in a peri-urban community in South Africa.

BACKGROUND:  Hearing impairment is an invisible disability affecting one in five people globally. Its ability to affect participation in activities of daily living means that it requires prompt identification and intervention. OBJECTIVE:  This article aims to define the process of accessing audiologists from the onset of symptoms for adults with hearing impairment in a peri-urban community in South Africa. METHOD:  Twenty-three participants were recruited through purposive sampling from an audiology department of a public hospital. Semi-structured interviews were conducted using an interview guide, and data were mapped according to the participants' responses from the onset of ear and hearing symptoms to the point of audiologist consultation for analysis. RESULTS:  Seventeen (74%) participants had long journeys to accessing the audiologist after seeking help from multiple providers, with those with short journeys (26%) being referred mostly by public healthcare providers. Despite participants being from one peri-urban community, their journeys were influenced by socio-economics, health illiteracy and other structural factors. Finally, Ear-Nose-Throat specialists linked participants with audiology services. CONCLUSION:  Accessing audiology services is a complex process in some contexts. The disparities in the social environment, lifestyle factors and pluralistic healthcare models influence access to audiologists. Healthcare providers must take cognisance of the journeys of adults with hearing impairment in their clinical interventions. Universal health coverage, in the form of the planned National Health Insurance (NHI) for all South African citizens, will play an important role in addressing the societal inequalities in accessing healthcare. Factors leading to long journeys should be addressed to facilitate early intervention.Contribution: The study raises implications for the planned NHI in South Africa, suggesting that universal health coverage could play a vital role in addressing societal inequalities in accessing healthcare, including audiology services.

Impact of the Covid-19 pandemic on audiology service delivery: Observational study of the role of social media in patient communication.

The Covid-19 pandemic has highlighted an era in hearing health care that necessitates a comprehensive rethinking of audiology service delivery. There has been a significant increase in the number of individuals with hearing loss who seek information online. An estimated 430 million individuals worldwide suffer from hearing loss, including 11 million in the United Kingdom. The objective of this study was to identify National Health Service (NHS) audiology service social media posts and understand how they were used to communicate service changes within audiology departments at the onset of the Covid-19 pandemic. Facebook and Twitter posts relating to audiology were extracted over a six week period (March 23 to April 30 2020) from the United Kingdom. We manually filtered the posts to remove those not directly linked to NHS audiology service communication. The extracted data was then geospatially mapped, and themes of interest were identified via a manual review. We also calculated interactions (likes, shares, comments) per post to determine the posts' efficacy. A total of 981 Facebook and 291 Twitter posts were initially mined using our keywords, and following filtration, 174 posts related to NHS audiology change of service were included for analysis. The results were then analysed geographically, along with an assessment of the interactions and sentiment analysis within the included posts. NHS Trusts and Boards should consider incorporating and promoting social media to communicate service changes. Users would be notified of service modifications in real-time, and different modalities could be used (e.g. videos), resulting in a more efficient service.

Listening Effort, An Overview of App Validation and Testing by the Audiology 4 all Project.

OBJECTIVE: To describe an application's development and validation process that aims to track hearing difficulties in adverse environments (a listening effort application). DESIGN: 71 subjects were evaluated, divided into two groups: 30 subjects aged between 18 and 30, and 41 subjects aged between 40 and 65. All subjects had European Portuguese as their native language; the Montreal Cognitive Assessment (MOCA) scored above 24, and all could read and write. All subjects performed the intelligibility test in noise and the test of listening effort. The two tests were randomly applied in the free field in the audiometric cabin and the application. RESULTS: There were no statistically significant differences between the results of the two methods (p>0.05). For the group aged between 40 and 65 years old, the ROC curve showed that intelligibility inferior to 68.5% and the number of correct answers lower than 1,5 in the listening effort test are the optimal cut-off for referral to further management. Both tests showed low sensitivity and specificity regarding individuals between 18 and 30 years old, indicating that the application is inappropriate for this age group. CONCLUSIONS: The application is valid and can contribute to the screening and self-awareness of listening difficulties in middle age, with a reduction in the prevalence of dementia soon.

Over-the-Counter Hearing Aids Challenge the Core Values of Traditional Audiology.

PURPOSE: Regulatory changes in the United States introduced over-the-counter (OTC) hearing aids with the goal of increasing the accessibility and affordability of hearing health care. It is critical to understand the values inherent to hearing health care systems to evaluate their effectiveness in serving people with hearing difficulty. In this study, we evaluated the relative importance of values across service delivery models and the extent to which the introduction of OTC hearing aids represents a values shift relative to traditional audiology. METHOD: We performed a qualitative content analysis of two document categories: critique documents that motivated the creation of OTC hearing aids and regulatory documents that defined OTC hearing aids. Team members coded portions of text for the values they expressed. In total, 29,235 words were coded across 72 pages in four documents. Rank-order analyses were performed to determine the prioritization of values within each category of documents and subsequently compare values between OTC and traditional audiology documents analyzed in a previous study. RESULTS: Critique and regulatory documents both prioritized values related to reducing barriers to hearing aid access and use, but the lack of a significant correlation in the rank order of values in these documents was evidence of inconsistency between the motivation and implementation of OTC hearing aids. Differences in the rank order of values in the OTC documents compared to traditional audiology were consistent with a values shift. CONCLUSIONS: The introduction of OTC as a solution to low hearing aid use represents a values shift, challenging the values of traditional audiology. This research demonstrates a need to establish the values of hearing health care service delivery through a consensus of stakeholders, including individuals from diverse backgrounds underserved by the traditional model.

Use of Diagnostic Audiology and Cochlear Implantation in the US.

This study examined if cochlear implant (CI) use varies geographically within the US and if diagnostic audiology use correlates with CI usage.

Preparing for Otoferlin gene therapy trials: A survey of NHS Paediatric Audiology and Cochlear Implant services on diagnosis and management of Auditory Neuropathy Spectrum Disorder.

OBJECTIVES: Gene therapy for monogenic hearing loss is on the horizon. The first trials in patients with Auditory Neuropathy Spectrum Disorder (ANSD) due to pathogenic variants in the Otoferlin (OTOF) gene will open this year. In the UK, the new NHS Genomic Medicine Service (GMS) offers genetic testing in each child diagnosed with congenital or early onset sensorineural hearing loss. This survey study aims to map preexisting clinical pathways for the diagnosis and management of children with ANSD and identify opportunities for improvement in early identification of OTOF- related ANSD. METHODS: A Google form with 24 questions in English covering the ANSD clinical pathway was developed with clinicians involved in the diagnosis and management ANSD. The survey was disseminated via email to all Lead clinicians of NHS Tertiary Paediatric Audiology and Cochlear Implant Services within the UK. RESULTS: Data was received from 27 (34 %) NHS Tertiary Paediatric Audiology Services and 8 (n = 57 %) Paediatric Cochlear Implant Services. Services follow existing national guidance and provide multidisciplinary care with structured patient pathways for referral, diagnosis, and management of children with ANSD and multidisciplinary input throughout. Clinicians are aware of the genetic causes of ANSD and new processes for genetic testing, but do not uniformly refer children with ANSD for testing for OTOF pathogenic variants. As such, they had difficulty estimating numbers of children with OTOF pathogenic variants under their care. CONCLUSION: Those results highlight the urgency of implementing hearing gene panel sequencing for all children with ANSD to provide opportunities for early diagnosis and candidacy for OTOF gene therapy trials.

Evaluation of the Ask-Inform-Manage-Encourage-Refer Intervention and Its Implementation Targeting the Provision of Mental Wellbeing Support Within the Audiology Setting.

OBJECTIVES: The ask, inform, manage, encourage, refer (AIMER) program is a behavior change intervention designed to increase the frequency with which hearing healthcare clinicians (HHCs) ask about and provide information regarding mental wellbeing within adult audiology services. The objective of this study was to systematically evaluate the first iteration of the AIMER program to determine whether the intervention achieved the changes in HHC behaviors anticipated and to evaluate feasibility of implementing the AIMER program based on the implementation protocol. DESIGN: The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide this evaluation. Data were collected from October 2020 to February 2022 and included both quantitative and qualitative measures (i.e., observation reports, staff surveys, clinical diaries, clinical file audits, and interviews). RESULTS: Comparison between pre- and post-implementation data showed that the AIMER intervention successfully increased: (i) HHC's skills and confidence for discussing mental wellbeing; (ii) how often HHCs ask about mental wellbeing within audiology consultations; (iii) how often HHCs provide personalized information and support regarding mental wellbeing within audiology consultations; and (iv) how often HHCs use mental wellbeing terms within clinical case notes and general practitioner reports. The factors affecting feasibility of implementing the AIMER program within the clinical setting could be classified into three major categories: (i) the AIMER program itself and its way of delivery to clinical staff; (ii) people working with the AIMER program; and (iii) contextual factors. Key recommendations to improve future implementation of the AIMER program were provided by the participants. CONCLUSIONS: The AIMER program was shown to be effective at increasing the frequency with which HHCs ask about and provide information regarding mental wellbeing within routine audiological service delivery. Implementation of the AIMER program was feasible but leaves room for improvement. Use of the reach, effectiveness, adoption, implementation, and maintenance framework facilitated systematic evaluation of multiple indicators providing a broad evaluation of the AIMER program. Our analysis helps to better understand the optimal levels of training and facilitation and provides recommendations to improve future scale-up of the AIMER program. The findings of this study will be used to further adapt and improve the AIMER program and to enhance program implementation strategies before its further dissemination.

Original Research Clinical attendance rate at a tertiary adult audiological service in South Africa.

BACKGROUND:  Clinical non-attendance to audiological appointments may negatively affect early diagnosis and intervention as well as treatment outcomes for adults with hearing impairments. OBJECTIVES:  This study aimed to explore the attendance rate and factors influencing attendance and non-attendance at an adult audiology diagnostic clinic at a tertiary hospital in Gauteng, South Africa. METHOD:  A mixed-methods research design, utilising structured questionnaires and a retrospective record review was adopted. A total of 31 adult patients at a diagnostic audiology clinic were interviewed. RESULTS:  Findings revealed an attendance rate of 47.62%, with 52.38% rate failure to return for follow-up appointments. Key reasons for attendance included understanding the need for appointments (57%), staff attitudes (42%) and appointment reminders (17%), and those for non-attendance included multiple appointments (33%), work commitments (28%), transport (8%) and forgetting about the appointment (8%). Six reasons for non-attendance were prominent in the current study: having multiple appointments (33%), work commitments (28%), forgetting the appointment (8%), transport difficulties (8%), attitudes and/or perceptions of the healthcare system (4%) and sequelae of hearing impairment (8%). CONCLUSION:  This study reinforces previous research findings while highlighting that health literacy and Batho Pele (people first) ethos by staff positively influence attendance.Contribution: Current findings contribute towards contextually relevant evidence on the attendance rate in this sector for ear and hearing care, as well as additional insights into factors influencing this within the South African context. This information is crucial for clinical services provision planning as well as for policy formulation around resource allocation in the public healthcare sector.

A Cytomegalovirus (CMV) Case Study to Promote Interprofessional Learning (IPL) Between Audiology and Biomedical Science Students in Higher Education.

Modern and effective patient care requires specialist healthcare professionals working together. Interprofessional learning (IPL) seeks to provide opportunities for different healthcare disciplines to learn with, from and about each other. This study focused on the delivery and evaluation of a cytomegalovirus (CMV) case study workshop to facilitate IPL between two Health and Care Professions Council (HCPC) regulated courses: Biomedical Science and Audiology. The 2 h online workshop consisted of 1) defining the roles, responsibilities and skills of the two healthcare professions, 2) the structure of the Biomedical Science and Audiology departments, 3) routes to HCPC registration, 4) core curriculum of both degree programmes and 5) interpreting interdisciplinary data related to a CMV patient case. The workshop was interactive, with the virtual learning environment promoting peer discussions and the use of online polling. Student responses were collected through an online questionnaire. A total of 108 respondents completed a post-event survey and Mann-Whitney U tests revealed there were no significant differences in the responses between the two student cohorts in response to each of the survey statements (p > 0.05). A total of 82.4% of students agreed that they need to know the role of other healthcare professionals for their future practice, whilst 84.2% agreed that the CMV case study was a good format to facilitate effective IPL. A total of 93.5% of respondents recognised the importance of both professions in diagnosing a patient with CMV. Thematic analysis identified four common themes, including appreciation of shared roles, recognition of similarities in registration pathways, working together to provide holistic patient care and the role of clinicians in the patient journey. This novel collaboration between Biomedical Science and Audiology facilitated effective IPL whilst meeting the interprofessional education HCPC requirements. Collaborative working is an essential component of delivering effective patient care and allied healthcare degrees need to provide opportunities within their curriculum to foster this. We hope this study encourages other higher education institutes to expand and develop their current IPL activities to include a broader spectrum of healthcare courses.

Barriers and facilitators influencing hearing help-seeking behaviors for adults in a peri-urban community in South Africa: a preventive audiology study.

Objective: This study aims to examine the barriers and facilitators to accessing ear and hearing care experienced by adults with hearing impairment in a developing South African context. Methods: A total of 23 participants were recruited through purposive sampling from an audiology department of a public hospital in peri-urban South Africa. Individual semi-structured interviews were conducted to capture a broad range of perspectives. Data were analyzed through thematic analysis. Results: Socio-economic factors acted as the primary barrier while structural and health system factors were the main facilitator in influencing participants' journeys toward hearing help-seeking. Conclusion: Help-seeking decisions made by adults with hearing impairment are impacted by numerous factors. Individual, providers, and environmental factors combine to play a significant role in resolving ear and hearing complaints. Socio-economic and healthcare level gaps reveal the inequalities that affect help-seekers, which, therefore, need to be addressed. The provision of equitable audiology services within hearing health policy is critical for the prevention of severe consequences of hearing impairment. Plans to implement universal healthcare through the National Health Insurance (NHI) by the South African government must include the universal access to preventive audiology services.

Hyperacusis Diagnosis and Management in the United States: Clinical Audiology Practice Patterns.

PURPOSE: Hyperacusis often leads to debilitating psychosocial consequences, but there is no standard protocol for its diagnosis and management in the United States. In this study, we surveyed U.S. clinical audiologists to understand their education and clinical practices surrounding the evaluation and treatment of hyperacusis. METHOD: An online survey was distributed to clinical audiologists across the United States. Survey responses were quantified using descriptive statistics and inductive content analysis. RESULTS: Hyperacusis definitions and clinical practice patterns varied widely across the 102 respondents. Respondents cited a lack of education and training as the primary barrier to effective audiological diagnosis and management of hyperacusis, with most respondents reporting ≤ 5 hr of hyperacusis education. Other primary barriers to effective audiological management of hyperacusis included time constraints, reimbursement, poor sensitivity and specificity of available diagnostic tools, and poor efficacy of available treatments and management strategies. Most respondents (82.5%) agreed that audiologists are the primary professionals who are responsible for implementing hyperacusis interventions. However, 63.3% of respondents reported that their clinic does not have a hyperacusis management protocol, and 80.0% routinely recommend treatment that is outside their scope of practice to implement (cognitive behavioral therapy). CONCLUSIONS: Clinical audiologists in the United States do not receive uniform education on hyperacusis, and they report multiple barriers to its evidence-based diagnosis and management. Effective hyperacusis management necessitates a multidisciplinary approach. The information obtained via this survey will pave the way toward the refinement of interprofessional education programs and the development of systematic, evidence-based clinical protocols for hyperacusis. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24431188.

Linking Affective and Hearing Sciences-Affective Audiology.

A growing number of health-related sciences, including audiology, have increasingly recognized the importance of affective phenomena. However, in audiology, affective phenomena are mostly studied as a consequence of hearing status. This review first addresses anatomical and functional bidirectional connections between auditory and affective systems that support a reciprocal affect-hearing relationship. We then postulate, by focusing on four practical examples (hearing public campaigns, hearing intervention uptake, thorough hearing evaluation, and tinnitus), that some important challenges in audiology are likely affect-related and that potential solutions could be developed by inspiration from affective science advances. We continue by introducing useful resources from affective science that could help audiology professionals learn about the wide range of affective constructs and integrate them into hearing research and clinical practice in structured and applicable ways. Six important considerations for good quality affective audiology research are summarized. We conclude that it is worthwhile and feasible to explore the explanatory power of emotions, feelings, motivations, attitudes, moods, and other affective processes in depth when trying to understand and predict how people with hearing difficulties perceive, react, and adapt to their environment.

Implementation factors influencing the sustained provision of tele-audiology services: insights from a combined methodology of scoping review and qualitative semistructured interviews.

OBJECTIVES: The objectives of the current study were to (a) identify long-term tele-audiology services reported to be implemented beyond the research phase and determine whether they are sustained, (b) map the implementation process to Standards for Reporting Implementation Studies guidelines and (c) map the factors that influenced its sustainability to the Implementation Outcomes Framework (IOF) to understand the gaps from an implementation research perspective. STUDY DESIGN, SETTING AND PARTICIPANTS: This cross-sectional study included a scoping review of articles describing long-term tele-audiology services from around the world to determine the factors influencing the implementation. Six electronic databases (PubMed, Cochrane Library, Web of Science, Scopus, Google Scholar and ProQuest) were searched for literature published between 2010 and 2023. This was followed by semistructured interviews (SSIs), which were guided by the IOF. Six project implementers were interviewed to obtain an in-depth understanding of factors that influenced sustainability of these tele-audiology services. Thematic analysis of the interview transcripts was carried out using a hybrid inductive-deductive approach. RESULTS: Data were extracted from 32 tele-audiology studies included in the review, which were then mapped to 21 projects. The findings of the scoping review reveal that tele-audiology services were predominantly provided using synchronous telepractice methods. The 'professional-facilitator-patient' model was most commonly used. None of the studies reported the use of implementation research and/or outcome frameworks. Factors that influenced sustainability of tele-audiology services were identified from the combined results of the scoping review and the SSIs. These factors could be mapped to implementation outcomes of acceptability, adoption, feasibility, implementation cost and sustainability. CONCLUSION: Implementation research and/or outcome framework should be used to guide the implementation processes, its evaluation and measurement of outcomes systematically in tele-audiology service delivery. When such frameworks are used, gaps in information regarding the context influencing implementation, reporting of fidelity and adaptability measures can be addressed.

Perceptions of the Scope of Practice of Audiology.

PURPOSE: The primary purpose of this study was to determine which scope of practice roles and responsibilities are attributed to the profession of audiology (AUD) relative to other health care disciplines by a group of health and human services faculty and students. METHOD: An online survey inquiring about participant knowledge of different health professions' scopes of practice, and experience with and attitude toward the profession of AUD, was sent to faculty and students in the Western Michigan University College of Health and Human Services. Students also completed two subscales of the Interprofessional Attitudes Scale. Descriptive statistics and chi-square and Kruskal-Wallis analyses evaluating response differences between groups are presented. RESULTS: Thirty-six faculty and 118 students (48 graduate and 70 undergraduate) completed the survey. AUD was the profession most often associated with all hearing-related scope of practice activities. Speech-language pathology was often associated with hearing-related scope of practice activities. Audiologists were less commonly associated with vestibular, balance, and mobility scope of practice activities. Group was significant for four scope of practice activities. About half of respondents indicated they knew nothing or a little about AUD, and a majority had no or rare interactions with audiologists in class or clinic. Only about half of participants responded they were likely or very likely to refer patients to an audiologist. CONCLUSION: Increased knowledge of the scope of practice and exposure to the profession of AUD may benefit other health care professionals and patients, possibly leading to increased interprofessional practice and an increased number of appropriate referrals.

Audiological findings of family farmers exposed to pesticides. / Achados audiológicos de agricultores familiares paranaenses expostos a agrotóxicos.

PURPOSE: To analyze the possible differences among the hearing of farmers and their families when compared to the population not exposed to pesticides. METHODS: Cross-sectional study with 70 smallholder family farmers (research group), with the mean age of 39.7 years, of both sexes and a mean of 23.7 years of exposure to pesticides. We included a control group with 71 participants of both sexes with the mean age of 39.5 years, not exposed to either noise or chemical substances, to compare the results. In stage 1, both groups were submitted to conventional and high-frequency audiometry, and acoustic immittance. In stage 2, only people with normal hearing were submitted to the evoked otoacoustic emissions and suppression effect on transient otoacoustic emissions. RESULTS: Significant differences were observed between the groups in the conventional pure-tone and in the high-frequency audiometry, as well as in the acoustic reflex. The most affected frequencies in the conventional pure-tone audiometry ranged from 3 to 6 kHz and, in the high-frequency audiometry, from 9000 to 11200 Hz. As for the transient otoacoustic emissions, the worse suppression effect results were found in the research group. CONCLUSION: There were differences among the hearing of family farmers and the control group. The conventional auditory thresholds are related to the group, age and sex. Farming is associated with impairments in the basal region of the cochlea, absence of acoustic reflex, reduced signal-to-noise ratio of the transient otoacoustic emissions, and dysfunction in the olivocochlear efferents of the auditory system.

OBJETIVO: Analisar as possíveis diferenças na audição de agricultores e suas famílias em comparação com população não exposta aos agrotóxicos. MÉTODO: Estudo transversal, com 70 participantes (grupo pesquisa), com média de idade de 39,7 anos, de ambos os sexos, proprietários de pequenos estabelecimentos agrícolas vinculados a agricultura familiar e tempo de exposição médio aos agrotóxicos de 23,7 anos. Um grupo controle com 71 participantes de ambos os sexos, sem exposição a ruído e agentes químicos, com idade média de 39,5 anos, foi incluído para a comparação dos resultados. Na etapa 1, ambos os grupos foram submetidos a audiometria convencional e de altas frequências e imitanciometria. Na etapa 2, somente os normoouvintes foram submetidos as emissões otoacústicas evocadas e efeito de supressão das emissões otoacústicas transientes. RESULTADOS: Observou-se diferenças significativas entre os grupos para audiometria tonal convencional e de altas frequências, e no reflexo acústico. As frequências mais afetadas na audiometria tonal convencional foram 3 a 6kHz e na audiometria de altas frequências foram as frequências de 9.000 e 11.200 Hz. Nas emissões otoacusticas transientes, observou-se no efeito de supressão piores resultados no grupo de pesquisa. CONCLUSÃO: Conclui-se que houve diferenças na audição dos agricultores familiares em comparação com o grupo controle. Os limiares auditivos convencionais estão relacionados em função do grupo, idade e gênero. O trabalho na agricultura está associado com o comprometimento na região basal da cóclea, à ausência de reflexo acústico, à redução da relação sinal/ruído das emissões otoacústicas transientes e à disfunção do sistema auditivo eferente olivococlear.

E-Learning Simulations for Teaching Clinical Decision-Making in an Audiology Training Program.

PURPOSE: Clinical decision-making is an essential component of most clinical processes across the health sector and an ongoing challenge for clinical education programs to teach to students. The traditional methods of teaching these skills outside of lectures are mainly through clinical placements and problem-based learning (PBL) sessions, but availability and consistency can be variable and resource heavy. To address these challenges, an e-simulation module specific to pediatric infant diagnostic testing has been developed and implemented into the teaching program. We aimed to establish whether e-simulation resulted in student skill acquisition. METHOD: Academic performance measures for 67 audiology students who used a traditional PBL and 108 students who used the e-simulation module were collected and analyzed. Student survey results generated both quantitative and qualitative data, which were analyzed using a thematic analysis with an inductive approach. RESULTS: Findings indicated that the e-simulation platform introduced in this study yielded learning outcomes similar to the traditional PBL format previously used. Participants experienced a significant in situ increase in understanding of infant diagnostic testing concepts following the use of the e-simulation and evaluated the e-simulation platform positively. CONCLUSION: The data support that an e-simulation-based approach in clinical education presents pedagogical benefits and can provide a meaningful sustainable inclusion in today's clinical teaching programs.

Post-COVID-19 Syndrome: Audiometric Findings in Patients with Audiological Symptoms.

Since the SARS-CoV-19 pandemic, the possibility of audiological involvement by this virus has been speculated without being able to generate a true cause-effect relationship. The objective of this observational, descriptive cross-sectional study is to describe the audiometric findings of post-COVID-19 patients with audiological symptoms. A sample of 47 patients with a diagnosis of COVID-19 infection was included: The age range was between 18 and 50 years old, the mean age was 37.0 years with a standard deviation of ±8.3 years, and 32 patients (68.1%) were female and 15 male patients (31.9%). Patients were recruited by the Otolaryngology service at Civil Fray Antonio Mayor Hospital from September 2020 to December 2022. Tonal audiometry was performed in a window of no more than 3 months from the onset of symptoms. The Chi-square test was used and odds ratios (OR) were established to associate the variables of post-COVID-19 audiological symptoms and the prevalence of hearing loss. A 95% confidence interval (CI) and statistical significance were considered of p ≤ 0.05. The audiological symptoms presented a prevalence of 74.4% for a sensation of ear fullness, 59.6% for tinnitus, and 51.1% for a sensation of hearing loss.