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.

Hearing loss in older adults - From epidemiological insights to national initiatives.

The broader implications of hearing loss for the health and functioning of older adults have begun to be demonstrated in epidemiologic studies. These research findings on the association between hearing loss and poorer health outcomes have formed the foundation for national initiatives on hearing loss and public health. These national initiatives range from the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) clinical trial to the recent passage of the bipartisan Over-The-Counter Hearing Aid Act. Utilizing population health research methodologies to study hearing loss can provide the foundation for initiating top-down approaches to increase the adoption and accessibility of hearing care for older Americans with hearing loss.

Establishing a pharmacotherapy induced ototoxicity programme within a service-learning approach.

Pharmacotherapy-induced ototoxicity is growing, especially in developing countries such as South Africa. This highlights the importance of ototoxicity monitoring and management of hearing loss. This article focuses on the establishment of an ototoxicity clinic as a site for the implementation of a service-learning module in the Audiology programme. The clinic offers a unique opportunity of collaboration between pharmacists and an audiologist where pharmacotherapy-induced ototoxicity is uniquely monitored. The Sefako Makgatho Health Sciences University (SMU) provides training to both the disciplines, audiology and pharmacy. The main aim of this article is to describe how ototoxicity monitoring is implemented in the curriculum within such an academic service-learning approach. Through service learning students develop a deeper understanding of course content, acquire new knowledge and engage in civic activity. It simultaneously provides a unique opportunity for interdisciplinary collaboration between the disciplines of audiology and pharmacy. The objectives for this programme are therefore to facilitate learning and to provide a service to the local community by identifying, preventing and monitoring medicine-induced hearing loss in in-hospital and out-patients; as well as to establish inter-disciplinary collaboration between the disciplines and stakeholders for more effective service delivery. The constant interdisciplinary teamwork between the audiologist, pharmacist, physician and nursing staff in the wards results in best practice and management of patients with ototoxic damage.

Development of a progressive audiologic tinnitus management program for Veterans with tinnitus.

Tinnitus is the most prevalent service-connected disability awarded to Veterans. However, clinical protocols for management of tinnitus have been inconsistent across Department of Veterans Affairs (VA) medical centers. A study was funded to develop and pilot test a protocol to provide tinnitus services consistently across VA audiology clinics. Drawing on a series of prior VA and external research projects, a clinical model was formulated, supporting materials in multimedia were developed, and a pilot study was conducted. Five hierarchical levels of care were defined and labeled the Progressive Audiologic Tinnitus Management (PATM) model. The model facilitates access to medical services for tinnitus and includes detailed protocols for evaluation, education, and counseling of patients. Patients at each level of care have the option to "progress" to the next level of PATM if further services are required. Clinical procedures were defined for each level and materials were produced for audiologists and patients. The PATM model was then piloted with clinical patients at the James A. Haley Veterans' Hospital (JAHVH) in Tampa, Florida. Throughout the pilot study, feedback from patients and clinicians was carefully noted. Training materials for audiologists, incorporation of the protocol into clinic activities, and patient outcomes were evaluated. The model was implemented within the JAHVH Audiology Clinic and to assist Veterans with tinnitus management. The most notable finding was how little tinnitus-specific intervention was required for the majority of patients. This finding supports a clinical model that offers stepped-care ("progressive") levels of care until tinnitus management is achieved by the patient.

Contextually relevant resources in speech-language therapy and audiology in South Africa--are there any?

In this editorial introduction we aim to explore the notion of contextually relevant resources. We argue that it is the responsibility of speech-language therapists (SLTs) and audiologists (As) working in South Africa to develop contextually relevant resources, and not to rely on the countries or cultures where the professions originated to do so. Language is often cited as the main barrier to contextually relevant resources: most SLTs and As are aware of the need for more resources in the local languages. However, the issue is not as straightforward as translating resources from English into other languages. The challenges related to culture, e.g. formal education and familiarity with the test situation, have to be considered, as well as the population on which norms were obtained and the nature of vocabulary or picture items. This paper introduces four original research papers that follow in this edition of the journal, and showcases them as examples of innovative development in our field. At the same time we call for the further development of assessment materials, intervention resources, and contributions to the evidence base in our context. We emphasise the importance of local knowledge to drive the development of these resources in innovative and perhaps unexpected ways, and suggest that all clinicians have an important role to play in this process.

The impact of telehealth on wait time for ENT specialty care.

Audiology in rural Alaska has changed dramatically in the past 6 years by integrating store and forward telemedicine into routine practice. The Audiology Department at the Norton Sound Health Corporation in rural Nome Alaska has used store-and-forward telemedicine since 2002. Between 2002 and 2007, over 3,000 direct audiology consultations with the Ear, Nose, and Throat (ENT) Department at the Alaska Native Medical Center in Anchorage were completed. This study is a 16-year retrospective analysis of ENT specialty clinic wait times on all new patient referrals made by the Norton Sound Health Corporation providers before (1992-2001) and after the initiation of telemedicine (2002-2007). Prior to use of telemedicine by audiology and ENT, 47% of new patient referrals would wait 5 months or longer to obtain an in-person ENT appointment; this dropped to 8% of all patients in the first 3 years with telemedicine and then less than 3% of all patients in next 3 years using telemedicine. The average wait time during the first 3 years using telemedicine was 2.9 months, a 31% drop compared with the average wait time of 4.2 months for the preceding years without telemedicine. The wait time then dropped to an average of 2.1 months during the next 3 years of telemedicine, a further drop of 28% compared with the first 3 years of telemedicine usage.

Decision-analytic modeling to assist decision making in organizational innovation: the case of shared care in hearing aid provision.

OBJECTIVE: To illustrate the use of decision-analytic modeling to assist decision making in organizational innovations. STUDY SETTING/DATA SOURCES: Regarding an organizational innovation (shared care in hearing aid provision) available evidence from different sources was synthesized. STUDY DESIGN: A probabilistic Markov model was constructed. DATA COLLECTION/EXTRACTION: We modeled the long-term cost-effectiveness of different organizational formats of shared care as opposed to the current organization. We assessed the expected value of perfect information (EVPI) for several groups of parameters in the model. PRINCIPAL FINDINGS: The current organization had the highest probability of being cost-effective. Additional research is worthwhile, especially on access to care and safety (sensitivity to detect pathology). CONCLUSIONS: Decision-analytic modeling in an early stage of organizational innovation is a valuable tool to facilitate evidence-based decision making.

Readiness of paediatric audiology services for newborn hearing screening: findings and implications from the programme in England.

As well as evaluating the newborn hearing screen itself, the government-funded evaluation of the implementation of a Newborn Hearing Screening Programme (NHSP) in England is assessing the impact of the screen on follow-up services. In the UK context, these are principally paediatric audiology, education, and social services. This article presents results from a mixed method research study involving paediatric audiology services specifically. Results demonstrate significant variety in current practice with regard to routine tests and procedures, considerable variability in number of current referrals and time allocated to caseloads, and considerable variability in expectations of how the numbers will change following newborn screening implementation. The challenges of and opportunities afforded by NHSP which were identified by respondents, highlight the urgent need for further training. The study has implications for paediatric audiology services that are yet to start NHSP in the UK, as well as for services and professionals in other countries.

[The examination card for a child with suspected hearing loss or deafness]. / Karta badania dziecka podejrzanego o niedosluch lub gluchote.

An audiological examination card for a child has been worked out, allowing a detailed collection of anamnestic data concerning: family history, gestation, labour, neonatal period, infancy and early childhood. The items and possible answers contained in the card are so prepared that it can be used for computer analysis of the data obtained.

Family-centered care: thriving in Hawaii under Part H.

Hawaii's system of prevention and early intervention embodies Part H principles that a child with a disability is first surrounded by a family, then by a community. Since 1986, families in Hawaii have been active in early intervention, first by persuading the governor to name the Department of Health as the lead agency, and then by writing much of the original grant application, interviewing and selecting staff members, and serving on the Hawaii Early Intervention Coordinating Council and its subcommittees. Families helped develop Hawaii's broad definition of the population to be served and were vocal advocates before the legislature to obtain funding for the program. Under Part H, Hawaii serves 6% of all children under the age of three, a larger percentage than any other state. Services focus on the family's needs as much as on the child's. The Individualized Family Support Plan (IFSP), developed jointly by the parents and professionals, recognizes families as the final decision-maker on the IFSP team. Families choose options that fit their needs. IFSP meetings are at times and places convenient to families and, to the extent feasible, in the family's native language. Care coordinators, of whom several are parents of children with special needs, monitor services to ensure that families receive quality care. Families receive (1) services at no cost, (2) preference when applying for positions in the Zero-to-Three Hawaii Project, and (3) compensation when serving in advisory or policy-making areas. In Hawaii, families are the center of early intervention services.