The Use of Tele Practice in Assessment of Middle Ear Function in Adults Living with HIV During the COVID-19 Pandemic.

Coronavirus disease (COVID-19) pandemic is the latest threat to global health that causes severe acute respiratory syndrome (SARS). Tele-practice has inadvertently sprung to the forefront to become a common practice amongst healthcare providers during COVID-19. Limited evidence exists on the use of tele-practice in assessing middle ear function in adults living with HIV during the COVID-19 pandemic. The aims of this study were to investigate the use of tele-practice for assessment of middle ear function in adults with HIV during the COVID-19 pandemic. A quantitative observational, cross-sectional design was adopted. A total of 134 adults diagnosed with HIV were purposively selected from the HIV clinic. An audiology researcher, in the role of site-facilitator, captured video otoscopic images of the tympanic membrane using a video otoscopy for all participants through asynchronous tele-practice. All captured images were sent to two independent otorhinolaryngologists for diagnosis. Findings of this study indicated that tele-practice can be used to assess middle ear function in adults living with HIV during COVID-19 pandemic. When asynchronous tele-practice was used, there was a moderate diagnostic agreement (k = 0.58) between the two otorhinolaryngologists on abnormality versus normality, but poor agreement (k = 0.15) on the nature of abnormality (e.g. OME vs CSOM). Current findings highlight the urgent need for a widespread use of tele-practice during the continued clinical follow up and management of adults living with HIV, and the implementation of tele-practice, particularly in low- and middle-income countries (LMICs) where capacity versus demand challenges related to ear and hearing care continue to exists.

Acoustic immittance measures and middle ear assessment: Current practice by South African audiologists.

BACKGROUND: Limited research exists regarding South African audiologists' practice with acoustic immittance. This study was part of a bigger study titled 'Wideband acoustic immittance in adults living with human immunodeficiency virus'. OBJECTIVES: The purpose of the study was to explore current practice of South African audiologists regarding acoustic immittance measures, and to explore their perceived knowledge and views on acoustic immittance advancements. METHOD: A quantitative survey with a cross sectional design was employed. An electronic questionnaire was distributed to participants via professional associations of audiologists. Data was analysed through descriptive and inferential statistics. RESULTS: Most audiologists worked in private practice and conducted tympanometry with 226Hz probe tone and ipsilateral acoustic reflexes. There was no association between clinical setting, levels of qualification, and the use of tympanometry. None of the participants included multifrequency and multicomponent tympanometry (MFT) and/or wideband acoustic immittance (WAI) in their test battery. Most of the participants were not familiar with MFT and WAI. Familiarity with MFT and WAI were only associated with the level of qualification. Limited training and lack of equipment were major barriers to conducting some of the acoustic immittance measures. Most participants believed that they would include MFT and/or WAI in their test battery if they had access to the equipment. CONCLUSION: Current findings raise training and clinical implications for the South African audiologists, including training institutions. These findings provide motivation for strategic resource allocation, planning and distribution of audiology clinics in the country if positive preventive audiology outcomes are to be achieved.

In Pursuit of Preventive Audiology in South Africa: Scoping the Context for Ototoxicity Assessment and Management.

AIM: The study explored the South African healthcare context for ototoxicity assessment and management from the audiologists' perspectives. MATERIALS AND METHODS: This was done through a survey research methodology that adopted a cross-sectional research design. South African audiologists were recruited from professional associations databases using specific inclusion criteria; and 31 audiologists from across the country participated. The study used an 18-item web-based survey guided by the Health Professions Council of South Africa (HPCSA) (2018) guidelines. Data were analyzed through both descriptive and inferential statistics. RESULTS: Findings revealed serious contextual challenges influencing the implementation of assessment and management programs within the South African context. Over two-thirds of the participants engage with ototoxicity monitoring and management, but the practices adopted are not aligned to international standards nor the national HPCSA guidelines on assessment and management of patients on ototoxic medications. Findings speak to the frequency of practice; the referral pathways audiologists use; prevention and promotion methods used; availability of resources for the implementation of ototoxicity assessment and management; barriers to ototoxicity assessment and management; the influence of language and culture in ototoxicity assessment and management; as well as information management practices within this context. No relationship could be established between knowledge regarding ototoxicity, communication, caseload, and ototoxicity assessment and management on the chi-square. CONCLUSION: Implications for strategic planning, budget allocation, collaborative multidisciplinary within the same institution approaches; training; policy formulation; and translation of policies and guidelines into practice are raised by these findings.

An Integrative Review of Current Practice Models and/or Process of Family-Centered Early Intervention for Children Who Are Deaf or Hard of Hearing.

Over the past few decades, there has been an increasing shift toward emphasizing the importance of the child's family taking an active role in the habilitation process through family-centered early intervention (FCEI) programs. Accordingly, the Health Professions Council of South Africa recommends that early intervention services following confirmation of hearing loss must be family-centered within a community-based model of service delivery that is culturally congruent. The aim of this study was to explore and document current evidence reflecting trends in FCEI for children who are deaf or hard of hearing (DHH) by identifying and describing current practice models and/or processes of FCEI for these children. This study describes our first steps in formulating a framework for FCEI for children who are DHH in South Africa. An integrative literature review was conducted. Sage, Science Direct, PubMed, and Google Scholar databases were searched for studies published in English between January 2009 and January 2019 reporting on FCEI programs for children who are DHH. Studies that focused on the following were excluded from the study: speech and language outcomes of children, youth, and adults who are DHH; education for children who are DHH; universal newborn hearing screening; professionals' roles in early hearing detection and intervention; diagnosis of hearing loss; and sign language. Kappa statistics were performed to determine agreement between reviewers. Twenty-two studies were included in the review. Cohen's kappa revealed a substantial agreement (κ = 0.8) between reviewers for data extraction and synthesis in terms of the articles that met the criteria for inclusion in the review. Findings were discussed under 5 themes: caregiver involvement; caregiver coaching/information sharing; caregiver satisfaction; challenges with FCEI; and telehealth. Generally, there is sufficient evidence for FCEI, with caregivers indicating the need for full involvement in their children's care. Methods of caregiver involvement involving caregiver coaching/information sharing need to be culturally and linguistically appropriate, with sensitivities around time and manner. This increases caregiver satisfaction with intervention programs and improves outcomes for children who are DHH. Challenges identified by the studies raise implications for early hearing detection and intervention programs, as well as Departments of Health and Social Welfare. These included logistical challenges, professional-related challenges, and caregiver-related challenges. Various aspects of FCEI have been reported in the review. Findings of these studies have significant implications for the formulation of quality FCEI programs to ensure contextually relevant and contextually responsive care of children who are DHH.

What Are the Current Audiological Practices for Ototoxicity Assessment and Management in the South African Healthcare Context?

The study was an initial exploration of the current ototoxicity assessment and management practices by audiologists in South Africa. An exploratory survey research methodology through a cross-sectional research design was adopted where audiologists were recruited from professional associations' databases in South Africa, using specific inclusion criteria. The study made use of an 18-item web-based survey guided by the Health Professions Council of South Africa (HPCSA) (2018) guidelines which were developed from reviewing international guidelines such as the American Speech-Language-Hearing Association (ASHA,1994) and the American Academy of Audiology (AAA, 2009). The study surveyed 31 audiologists from across the country. Data were analyzed through descriptive statistics. Findings implied significant gaps between knowledge and translation of this knowledge into practice. Over two thirds of the participants engage with ototoxicity monitoring and management, but the practices adopted by them do not align with international standards nor with the national HPCSA guidelines on assessment and management of patients on ototoxic medications. Most participants do not conduct baseline assessments, and the frequency of monitoring is irregular and reduced from the recommended; thus influencing ability for early detection and intervention of ototoxicity within this context. Non-standard assessment battery is used for assessment and monitoring, raising questions about the reliability and validity of the data used to make preventive treatment decisions. Lack of collaborative work between audiologists and the rest of the clinical team involved in the treatment of patients on ototoxic medications was found to be an important contributing factor to the less than optimal ototoxicity management practices. Of factors potentially influencing adherence to guidelines, the institution of employment, specifically employment in a tuberculosis hospital, seemed to have a positive influence, possibly due to the focused nature of the audiologists' scope of practice there as well as availability of resources. The level of education appeared to have no influence. Current findings provide contextually relevant evidence on ototoxicity assessment and management within this context. They raise important implications for guidelines adherence and translating knowledge, policies and guidelines into practice, clinical assessment and management protocols followed, appropriate resource allocation per programme, as well as strategic planning for national ototoxicity assessment and management programmes in context. The findings also raise important implications for low- and middle-income countries, in terms of adopting international guidelines without considering context.

South African hearing conservation programmes in the context of tele-audiology: A scoping review.

BACKGROUND: The limited involvement of audiologists in occupational noise-induced hearing loss (ONIHL) management through hearing conservation programmes (HCPs) is a global issue. In low- and middle-income (LAMI) countries such as South Africa, this is also exacerbated by demand versus capacity challenges. Tele-audiology is an option requiring serious deliberation by the audiology community within HCPs in LAMI contexts. OBJECTIVES: This scoping review explores if tele-audiology has a potential value in HCPs and reviews what has been documented in the literature on the use of tele-audiology in HCPs. METHOD: A scoping review was conducted using the Arksey and O'Malley's framework. A search was conducted in five electronic bibliographic databases including Science Direct, PubMed, Scopus Medline, ProQuest and Google Scholar and the grey literature to identify publications presenting considerations around tele-audiology in the implementation of HCPs. RESULTS: Findings revealed significant dearth of evidence specific to the use or application of tele-audiology in ONIHL and/or HCPs both within the African context and internationally, despite the purported potential benefit of this service delivery model, particularly in resource-constrained contexts such as LAMI countries. Of the publications deemed potentially relevant to this scoping review, none were found that specifically investigated or addressed the use of tele-audiology in ONIHL or HCPs as their main objective. Nuanced analysis of publications revealed that in the last decade, indication for potential growth in the use of tele-audiology within occupational audiology is indicated. CONCLUSION: Because of the significant demand versus capacity challenges in LAMI countries, and because of the need for scaling up audiology professionals' management of HCPs, careful consideration of teleaudiology as a platform to deliver services in these contexts is required.

Risk versus benefit: Should not audiologists assess this in the context of occupational noise-induced hearing loss in the mining industry?

BACKGROUND: Hearing conservation programmes (HCPs) are an important aspect of occupational health efforts to prevent occupational noise-induced hearing loss (ONIHL). In low- and middle income (LAMI) countries, where the incidence of ONIHL is significant, it is important to deliberate on the risk or benefit of HCPs. OBJECTIVES: This article is an attempt at highlighting important strategic indicators as well as important variables that the occupational health and audiology community need to consider to plan efficacious HCPs within the South African mining context. METHOD: The current arguments are presented in the form of a viewpoint publication. RESULTS: Occupational audiology vigilance in the form of engagement with HCPs in the mining industry has been limited within the South African research and clinical communities. When occupational audiology occurs, it is conducted by mid-level workers and paraprofessionals; and it is non-systematic, non-comprehensive and non-strategic. This is compounded by the current, unclear externally enforced accountability by several bodies, including the mining industry regulating body, with silent and/or peripheral regulation by the Health Professions Council of South Africa and the Department of Health. The lack of involvement of audiologists in the risk or benefit evaluation of HCPs during their development and monitoring process, as well as their limited involvement in the development of policies and regulations concerning ear health and safety within this population are probable reasons for this. CONCLUSIONS: Increased functioning of the regulatory body towards making the employers accountable for the elimination of ONIHL, and a more central and prominent role for audiologists in HCPs, are strongly argued for.

Burden of disease: A scoping review of HIV/AIDS and TB in occupational noise-induced hearing loss.

BACKGROUND: Occupational noise-induced hearing loss (ONIHL) does not occur in isolation from other influencing factors such as health conditions and illnesses like human immunodeficiency virus and acquired immunodeficiency syndrome (HIV and AIDS), as well as tuberculosis (TB). How the burden of disease influences the occurrence and/or management of ONIHL becomes a key if the goal of hearing conservation programmes (HCPs) is to be achieved within these contexts. OBJECTIVES: The purpose of this scoping review was to conduct an investigation on how the burden of disease's influence on ONIHL is reported in literature, with a specific focus on the most prevalent diseases in South African mines - HIV and AIDS and TB. METHOD: A scoping review was conducted using the Arksey and O'Malley's framework. A search was conducted in five electronic bibliographic databases and the grey literature. RESULTS: The search procured 10 publications, with two specific to ONIHL within the South African context. In addition to the two publications specific to TB and ONIHL, findings revealed a serious gap in the evidence around the scoping review question globally. This obvious lack of investigations into the influence of these two conditions in the South African mining context raises serious implications about the responsiveness, and proactive nature of HCPs within this population. CONCLUSION: Considering the burden of diseases on otology and audiology is critical as certain diseases cause hearing impairment either as a primary effect, as a secondary/opportunistic effect or as a side effect of treatment options for that disease. An employee suffering from any such disease with concomitant exposure to hazardous noise levels presents an even bigger challenge to HCPs if such is not taken into consideration in the conception, implementation and monitoring of HCPs.

Early hearing detection and intervention in South Africa: Exploring factors compromising service delivery as expressed by caregivers.

AIM: The main aim of this study was to explore factors compromising early intervention (EI) service delivery to hearing impaired children in South Africa, as expressed by their caregivers. METHODS: Within a qualitative survey design, a sample of 19 hearing impaired children's caregivers completed structured self-administered questionnaires on factors that they perceive compromise EI for their children. These caregivers included mothers, fathers, grandparents, and legal guardians or adoptive parents of children with hearing impairment. Descriptive analysis of the data was undertaken. RESULTS: Findings indicated various factors compromising EI as reported by caregivers. These included limited availability of appropriate schools and health care facilities for their hearing impaired children; long distances between the few services that are available and the places of residence of the service users; significant costs linked to the services (such as medical expenses, boarding school facilities costs); limited skills and knowledge of professionals and teachers regarding hearing impairment; inconsistent and conflicting professional opinions about the child's diagnosis and treatment; as well as limited community awareness about hearing impairment along with services available for hearing impaired children. CONCLUSION: These findings have important clinical, training, policy, and advocacy implications within the South African context; if both access to and success within the EI services will be successful.

Speech-language assessment in a linguistically diverse setting: preliminary exploration of the possible impact of informal 'solutions' within the South African context.

Speech-language therapists (SLTs) working in the context of cultural and linguistic diversity face considerable challenges in providing equitable services to all clients. This is complicated by the fact that the majority ofSLTs in South Africa are English or Afrikaans speakers, while the majority of the population have a home language other than English/Afrikaans. Consequently, SLTs are often forced to call on untrained personnel to act as interpreters or translators, and to utilise informally translated materials in the assessment and management of clients with communication impairments. However, variations in translation have the potential to considerably alter intervention plans. This study explored whether the linguistic complexity conveyed in translation of the Western Aphasia Battery (WAB) test changed when translated from English to isiZulu by five different first-language IsiZulu speakers. A qualitative comparative research design was adopted and results were analysed using comparative data analysis. Results revealed notable differences in the translations, with most differences relating to vocabulary and semantics. This finding holds clinical implications for the use of informal translators as well as for the utilisation of translated material in the provision of speech-language therapy services in multilingual contexts. This study highlights the need for cautious use of translators and/or translated materials that are not appropriately and systematically adapted for local usage. Further recommendations include a call for intensified efforts in the transformation of the profession within the country, specifically by attracting greater numbers of students who are fluent in African languages.