Contralateral suppression of transient evoked otoacoustic emissions in adults: A normative study.

BACKGROUND:  Whilst otoacoustic emission (OAE) testing has proved to be valuable in revealing information about cochlear outer hair cell integrity, it does not provide insight into the afferent and efferent pathways once the stimulus has reached neural receptors. This information can be obtained objectively through contralateral acoustic stimulation (CAS) suppression. However, obtaining normative data is essential in the implementation of such tests. OBJECTIVES:  The primary aim was to undertake a small pilot study to collect the CAS suppression across a predefined frequency range in order to provide a preliminary normative data set to be used with the newly developed transient evoked otoacoustic emission (TEOAE)-CAS module (PATH MEDICAL, Germering, Germany). Secondary aims included the analysis of the relationships between left and right CAS suppression, between male and female CAS suppression and between TEOAE signal-to-noise ratio (SNR) and CAS suppression. METHODS:  The purpose of this study was to determine preliminary normative data for contralateral TEOAE suppression from 40 normal ears of 20 healthy young adults (10 males and 10 females). Subjects were recruited using purposive sampling. The CAS suppression responses were obtained automatically by means of the data-collection protocol on the device used. From the data obtained, correlations between TEOAE SNR and CAS suppression were made using Pearson's correlation coefficient. RESULTS:  The data were statistically processed to form a normative database which possesses the potential of serving as a basis for further research aimed at determining the utility of CAS suppression testing when evaluating ear pathology. A mean CAS suppression of 0.8 decibels (dB) (0.61 SD) was obtained. There was no statistically significant relationship between TEOAE SNR and CAS suppression. There was no significant suppression difference in terms of laterality of ears or gender. CONCLUSION:  Normative values for CAS suppression of TEOAEs in a group of normal-hearing individuals were obtained using the newly developed TEOAE-CAS module (PATH MEDICAL, Germering, Germany). The availability of normative data for contralateral TEOAE suppression using the studied module allows for it to become commercially available, which will enable researchers and audiologists to perform this measurement in different populations in the evaluation of ear pathology.

Development and Utility of an International Classification of Functioning, Disability and Health Code Set for Younger-Old Adults With Fall Risk: Implications for Audiologists.

PURPOSE: Falling is a multifactorial condition that can cause severe injury and even death in older adults. Early identification of fall risk factors, as the first step of preventive health care, can assist in reducing the negative and often debilitating effects of falls in older adults. By using the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework to develop an ICF code set to identify fall risk factors in older adults, health care practitioners could obtain health information in a multidimensional way. METHOD: This study describes the final phase of a comprehensive, three-phase, mixed-methods sequential study. For this third phase, a pre-post group design that focused on the audiologist's perceptions of the clinical utility of a newly developed ICF code set was employed. The questionnaire that was used for this purpose consisted of two distinct sections: clinical application and clinical utility (viz., appropriateness, accessibility, practicability, acceptability, and professional utility). Thirty practicing audiologists participated in the study. Data were analyzed for each of the two sections of the questionnaire. RESULTS: Results related to clinical application indicated that regardless of the audiologists' experience in routine fall risk assessment or fall risk factor identification, the use of the developed ICF code set increased their ability to correctly identify relevant clinical aspects. Results related to clinical utility showed high scores across all five measure components, with the highest clinical utility component being acceptability, closely followed by appropriateness and professional utility, and the lowest being accessibility. CONCLUSION: Several clinical implications have emerged from this study, including the usefulness of the ICF code set to identify and document fall risk factors in older adults, the code set's ability to guide audiologists to determine individualized assessment needs either by themselves or by other health care disciplines, and that the code set could be used by audiologists regardless of their experience in vestibular assessments.

A Systematic Review of Ethics Knowledge in Audiology Literature: A Follow-Up Study (2011-2020).

PURPOSE: This systematic review aimed to update and explore the extant literature (2011-2020) regarding ethics knowledge in audiology and to compare the findings to an earlier study (2001-2010). METHOD: This systematic review employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS: MEDLINE, CINAHL, ERIC, MasterFILE Premier, E-Journals, Africa-Wide information and Academic Search Premier electronic databases, and non-peer-reviewed papers in Seminars in Hearing yielded a total of 63 papers. Following systematic screening using inclusion and exclusion criteria, a total of 12 full-text papers were included in this review. Pertinent data and findings from the review were tabulated and analyzed using a qualitative, deductive approach. Results showed that the 12 papers were published in nine peer-reviewed journals with a predominantly social scientific approach. This differs from the earlier review that reported only five papers with a predominantly philosophical approach. However, both the current and earlier studies focused on the rehabilitation/management role of the audiologist. In the earlier study, the focus was on moral judgment (as one of the components of moral behavior), whereas this was the focus of only half of the papers identified in this study, with the remaining papers focusing on moral sensitivity and moral motivation. CONCLUSIONS: The focus of papers had evolved and continued to include more elements related to the multiple perspectives used to analyze and describe ethics research. The body of knowledge of ethics in audiology specifically expanded in the area of social scientific research, focusing on beneficence and nonmaleficence, including moral motivation and basing research on moral judgment with the emphasis on the rehabilitation/management and education/research/administration role of audiologists.

Professional Guidelines and Reported Practice of Audiologists Performing Fall Risk Assessment With Older Adults: A Systematic Review.

PURPOSE: This systematic review aimed to explore the recommended fall risk assessment practices in audiology, identify audiologists' reported practices in fall risk assessment, and recognize the barriers and facilitators affecting fall risk assessment in clinical practice. METHOD: This systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS: CINAHL, PubMed, and gray literature yielded 262 articles. A total of 27 full-text articles were included in this review article. An additional 16 scope of practice and guideline documents were also reviewed. Pertinent data and findings from the review were tabulated and analyzed using a qualitative, inductive approach. CONCLUSIONS: Results revealed that despite fall risk assessment measures and protocols being mentioned, discussed, and reportedly implemented clinically in audiology literature, many audiologists are not conducting fall risk assessments clinically. The main challenges presented appear to be due to limited guidance within audiology documentation and inadequate training and knowledge of audiologists on fall risk factors and measures. This review article highlighted that all audiologists have an important role to play in reducing the global crisis of falls in older adults. However, without further research to aid in the development of standardization of documentation and training programs, we may continue to see a lack of awareness and education on fall risk and on the audiologist's role in the screening and early detection hereof.

The Impact of Pass/Refer Criteria in the Use of Otoacoustic Emission Technology for Newborn Hearing Screening.

Purpose The current study aimed to compare the specificity of transient evoked otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs) in isolation and in combination, with varying pass/refer criteria for DPOAE technology. Method A longitudinal, repeated-measures design was employed. The current study sample comprised 91 of the initial 325 participants who returned for the repeat screening and diagnostic audiological assessment within a risk-based newborn hearing screening program. Results TEOAE screening had the highest specificity in comparison to DPOAE screening at the initial and repeat screening, irrespective of differences in DPOAE pass/refer criteria. DPOAE screening had a slightly higher specificity, with a three out of six rather than the four out of six frequency pass criteria. Conclusions Pass/refer criteria alone do not influence referral rates and specificity. Instead, consideration of other factors in combination with these criteria is important. More research is required in terms of the sensitivity and specificity of OAE screening technology using repeated-measures and diagnostic audiological evaluation as the gold standard.

Older Adults' Perspectives on Fall Risk: Linking Results to the ICF.

The aim of this study is to establish the perceptions of older adults in the South African context regarding falls and to link these perceptions to the International Classification of Functioning, Disability and Health (ICF). Data were analyzed by a summative, conventional, and deductive approach. The analysis indicated that the Body Function and Structure codes were most frequently used during the discussions, but the contextual analysis of the most frequently used categories indicated that Activities and Participation were the participants' main focus. The main focus of fall assessment in older adults should therefore be on Activities and Participation, as this can assist them in decreasing their fall risk, irrespective of whether they had a previous fall. Contrary to the majority of current literature on falls, this study included both participants who had fallen and those who hadn't, resulting in richer data and themes gathered from the focus groups.

Prevalence of Peripheral Vestibular Impairment in Adults with Human Immunodeficiency Virus.

BACKGROUND AND OBJECTIVES: Globally, the human immunodeficiency virus (HIV) is responsible for one of the most serious pandemics to date. The vulnerability of the vestibular system in individuals with HIV has been confirmed, and central vestibular impairments have been frequently reported. However, there are disagreements on the impact of HIV on peripheral vestibular function. Thus, the current study aimed to determine the prevalence of peripheral vestibular impairment, specifically related to the semi-circular canals (SCCs), in HIV-positive individuals receiving antiretroviral (ARV) treatment. SUBJECTS AND METHODS: A total of 92 adults between the ages of 18 and 50 years (divided into two groups) participated in the study. The first group comprised HIV-positive individuals receiving ARV treatment (n1=60), and the second group comprised HIV-negative participants (n2=32). The video head impulse test was used to conduct the head impulse paradigm (HIMP). RESULTS: Bilateral normal HIMP results were obtained in 95% of the HIV-positive participants and all HIV-negative participants. The gain of the left posterior SCCs was significantly lower in the HIV-positive group, while the gains of all other canals between the two groups were comparable. CONCLUSIONS: The prevalence of peripheral vestibular impairment in the HIV-positive group was not significantly different from that of the HIV-negative group. The reduced prevalence in the current study may be attributed to participant characteristics, the test battery employed, and the central compensation of the vestibular dysfunctions at the later stages of infection.

The perspectives of healthcare practitioners on fall risk factors in older adults.

BACKGROUND: Accidental falls could have severe and far-reaching consequences for older adults, their families and society at large. Healthcare practitioners' (HCPs) perspectives on fall risk factors in older adults could assist in reducing and even preventing falls. Currently, no universal tool exists for this purpose. The World Health Organization's globally accepted International Classification of Functioning, Disability and Health (ICF) was used. AIM: This study aimed to (1) describe the perspectives of HCPs on fall risk factors in older adults in South Africa and (2) link these factors to the ICF. SETTING: Eighteen HCPs participated in two focus groups. METHODS: Using a qualitative research design, an inductive thematic analysis allowed for the identification of important themes, which were linked to the ICF. RESULTS: The factors mentioned by participants were categorised into 38 themes, which were linked to 142 ICF codes, of which 43% (n = 61) were linked to the Body Function category, 23% (n = 32) to the Environmental Factors category, 18% (n = 26) to the Body Structure category and 16% (n = 23) to the Activities and Participation category. HCPs revealed two relevant factors that were not captured in existing fall risk assessment tools (FRATs), namely 'muscle-power functions' and 'mobility-of-joint functions', which directly relate to the ability to execute mobility activities. Combining HCPs' perspectives with other stakeholders and with literature provides a holistic picture of fall risk factors in older adults.

Prevalence of hearing loss and tinnitus in a group of adults with Human Immunodeficiency Virus.

BACKGROUND: The Human Immunodeficiency Virus (HIV) has become a global pandemic. With the improvement of antiretroviral (ARV) treatment regimens, life-expectancy of HIV-positive individuals has increased. HIV literature suggests that head and neck manifestations may be the first indication of supressed immunity. Therefore, research regarding the effects of HIV and new treatment regimens on auditory function remains a priority. OBJECTIVES: To describe the audiological characteristics and determine the prevalence of hearing loss and tinnitus in a group of HIV-positive individuals on ARV treatment residing in a rural province. METHODS: The study employed a cross-sectional descriptive research design. Participants were recruited from the clinic and pharmacy waiting areas of a medical centre in a rural area of Limpopo province, South Africa. Two participant groups, an HIV-positive group (N1 = 60) and an HIV-negative group (N2 = 32) were included in the study. The test battery comprised a comprehensive case history and a routine audiological test battery, which included otoscopy, tympanometry and pure tone audiometry (250 Hz to 8000 Hz). RESULTS: No statistically significant difference was found regarding the prevalence of hearing loss in the two participant groups (p = 0.709). However, the prevalence of tinnitus was significantly higher in the HIV-positive group (p = 0.05). CONCLUSION: The insignificant difference in the audiological test battery results found between the two participant groups may be due to improved ARV treatment regimens and management strategies employed at the medical centre. However, the increased prevalence of tinnitus in the HIV-positive group may also be attributed to the ARV regimen and/or the result of subtle damage to the auditory system, which was not identified by the current audiological test battery. More insight may be obtained about the effects of HIV on hearing by employing a longitudinal research design and inclusion of a more ototoxicity sensitive test battery.

Measuring Instrument for Ethical Sensitivity in the Therapeutic Sciences.

There are currently no instruments available to measure ethical sensitivity in the therapeutic sciences. This study therefore aimed to develop and implement a measure of ethical sensitivity that would be applicable to four therapeutic professions, namely audiology, occupational therapy, physiotherapy, and speech-language pathology. The study followed a two-phase, sequential exploratory mixed-methods design. Phase One, the qualitative development phase, employed six stages and focused on developing an instrument based on a systematic review: an analysis of professional ethical codes, focus group discussions, in-depth interviews, a review of public complaints websites, and an expert panel review. The development phase culminated in the Measuring Instrument for Ethical Sensitivity in the Therapeutic Sciences (MIEST), a pen-and-paper measure for studying ethical sensitivity in the therapeutic sciences. Phase Two, the quantitative stage, focused on implementing the MIEST in two different stages. A total of 100 participants completed the instrument. MIEST scores were found to be comparable for all four professions, which confirmed the multidisciplinary usability of the instrument. Participants tended to base decisions on the ethical principle of beneficence. The MIEST is effective to assess and describe the ethical sensitivity of professionals in the four specified therapeutic sciences. The constructed vignettes also make the MIEST appropriate for use in problem-based learning programs.

A systematic review of ethics knowledge in audiology (1980-2010).

PURPOSE: The purpose of this research was to apply multiple perspectives as part of a systematic review to analyze literature regarding ethics in audiology. Audiologists are particularly vulnerable to the changing requirements of the discipline that compel them to straddle both professional obligations and business principles, creating a hybrid professional. METHOD: The authors used a 2-phase mixed-method approach to analyze publications. Publications were sorted into categories, namely, ethics approach, author, decade, role of the audiologist, component of morality, and common themes. The sample consisted of peer-reviewed articles cited in MEDLINE, CINAHL, ERIC, MasterFILE Premier, E-Journals, Africa-Wide Information, and Academic Search Premier electronic databases and non-peer-reviewed articles in Seminars in Hearing. RESULTS: The publications were predominantly philosophical, focused on the rehabilitative role of the audiologist, and addressed the moral judgment component of moral behavior. CONCLUSIONS: Despite the fact that knowledge of ethics grew between 1980 and 2010, this retrospective analysis identified gaps in current knowledge. Research is needed to address the unique ethical problems commonly encountered in all 8 roles of the audiologist; patient perspectives on ethics; ethical approaches; factors affecting moral judgment, sensitivity, motivation, and courage; and cultural dimensions of ethical practice in audiology.

Infection prevention and control measures currently applied in South African audiology.

BACKGROUND: To counter the global increase in infection-related deaths, infection control has recently developed into an active area of research. Many diseases can be prevented by infection control. In the confines of the audiology clinic, cross-contamination by micro-organisms associated with opportunistic infections remains a real concern. OBJECTIVE: The primary aim of the study was to ascertain the methods that audiologists in South Africa use to prevent and control the spread of infections during and after consultation with clients. METHOD: A survey study was conducted, using a self-administered questionnaire. Fifty currently practising audiologists participated in the study. RESULTS: The majority (84%; n = 42) of respondents acknowledged the importance of hand hygiene for the purpose of infection control, with 76% (n = 38) making use of no-rinse hand sanitisers. Approximately a third of audiologists wear gloves during procedures such as otoscopy and immittance, and while handling hearing aids. Disinfecting audiological equipment seem to be the preferred choice of infection control, with only 60% (n = 30) of respondents sterilising audiological equipment after each individual patient consultation. Less than half of the respondents disinfected touch surfaces and toys in the reception area. CONCLUSIONS: Based on the results, further education and training should focus on measures implemented in infection control, awareness of possible risk factors at work settings, and vaccination as an effective means of infection control.

An Overview of Pharmacotherapy-Induced Ototoxicity

This article provides an overview of ototoxic medication; as well as different pharmacological and audiological monitoring strategies. Although ototoxic medications play an important role in modern medicine; they also have the capacity to do great harm and lead to significant morbidity. Physicians have to be aware of the potential effects of medication in order to identify patients who are at increased risk of developing ototoxicity. Precaution should be taken to prevent any auditory impairment that might occur through appropriate administration and monitoring. Although some otoprotective substances have been used successfully in certain studies; further trials must be performed to assess their clinical utility. The clinical pharmacist and audiologist form an important part of the ototoxicity management healthcare team