Person-centered care: preferences and predictors in speech-language pathology and audiology practitioners.

Introduction: Increasingly person-centered care (PCC) is being recognized as an important aspect of speech-language pathology and audiology (SLP/A) service delivery. This study aimed to (i) identify preferences toward PCC; (ii) determine predictors of these preferences; and (iii) describe the understanding and views of PCC among SLP/A in South Africa. Methods: A mixed-method design was followed utilizing an online survey and four focus group discussions. The survey included demographic questions, the modified Patient-Practitioner Orientation Scale (mPPOS), the Ten-Item-Personality-Inventory (TIPI) and an open-ended question. The focus group discussions included prompting questions which facilitated an open-ended discussion. Results: A total of 91 practitioners (39.6% speech-language pathologists) completed the online survey, with nine (44.4% audiologists) participating in the focus group discussions. A high preference toward PCC was noted, with a total mean mPPOS score of 4.6 (0.6 SD). Quantile regression analysis revealed four predictors (age, home language, sector, and personality trait openness) associated with PCC preferences. Three main categories emerged from the open-ended question and focus group discussions: (i) Positive experiences with PCC; (ii) restrictions toward PCC, and (iii) PCC exposure. Discussion: Positive (age and personality trait openness) and negative (home language and sector of employment) predictors toward PCC exist among speech-language pathologists and audiologists, with an overall general preference toward PCC. Practitioners experience facilitators and barriers toward implementing PCC including the extent of personal experiences, available resources and tools as well as workplace culture. These aspects require further investigation.

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.

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.

An Ototoxicity Grading System Within a Mobile App (OtoCalc) for a Resource-Limited Setting to Guide Grading and Management of Drug-Induced Hearing Loss in Patients With Drug-Resistant Tuberculosis: Prospective, Cross-Sectional Case Series.

BACKGROUND: Tuberculosis (TB) affects millions of people worldwide and is treated with medication including aminoglycosides and polypeptides. Individuals respond differently to medications as a result of their genetic inheritance. These differences in genetic inheritance can result in the underdosing or overdosing of medication, which may affect the efficacy or, in the case of aminoglycosides and polypeptides used in the treatment of all forms of TB, result in ototoxicity. When ototoxicity is detected, physicians should adjust dosages to minimize further ototoxicity and hearing loss; however, there are no suitable grading systems to define significant hearing loss. OBJECTIVE: The aim of this study was to develop a standardized grading system by making use of an electronic health (eHealth) platform to ensure that a user-friendly method was available to interpret hearing test results, calculate significant hearing loss, and provide recommendations with regard to dosage adjustments and management. It further aimed to establish the sensitivity of the newly developed grading scale. METHODS: This grading system was developed in South Africa based on data that were obtained from an audiology and pharmacokinetic study on patients with drug-resistant TB (DR-TB) at two DR-TB units at state-run hospitals. This feasibility study employed a prospective, cross-sectional, exploratory, descriptive case series research design, with a total of 22 participants. Participants underwent audiological and pharmacological assessments at baseline and every 2 weeks for the first 3 months of treatment. Various professionals (8 in total) were subsequently involved in the development of the eHealth system, including a software engineer, four audiologists, a pharmacist, a medical doctor, and a nurse. The app underwent 14 modifications that involved aspects of data storage, ease of usability, grades, and the risk factor checklist. RESULTS: An ototoxicity grading system within a mobile app for use by doctors, nurses, and audiologists was developed for patients with DR-TB. The purpose of this user-friendly ototoxicity calculator, OtoCalc, is to (1) assist health professionals in assessing patients for ototoxicity, (2) establish the clinical significance of ototoxicity by calculating the grade of hearing loss, (3) monitor the progression of hearing loss, and (4) enable systematic referral and management of patients according to their needs. CONCLUSIONS: This newly developed system is more sensitive than the existing grading methods for determining ototoxicity in patients with DR-TB. This app needs to be trialed in a larger sample to establish data security, ease of use, and suitability within this population.

Contributing factors to high prevalence of hearing impairment in the Elias Motsoaledi Local Municipal area, South Africa: A rural perspective.

BACKGROUND:  There is evidence that the factors contributing to the prevalence and aetiology of hearing impairment vary widely from one country to another. In South Africa, as in other low-income and middle-income countries, more context-specific information on the estimated prevalence of hearing impairment and the factors that contribute to its onset is required. AIM:  The aim of this study was to provide decision-makers and hearing health professionals with local and accurate information on the prevalence of ear and hearing disorders in the Elias Motsoaledi Local Municipal (EMLM) area of the Limpopo province, South Africa. METHODS:  The World Health Organization (WHO) protocol for population-based surveys of prevalence and causes of deafness, hearing impairment and other ear diseases was utilised. A random multi-stage cluster sampling strategy, two-stage sampling, was utilised to select the seven municipal wards and 357 households through the probability proportional to size method. A total of 850 participants were included in the study. RESULTS:  The overall prevalence of hearing impairment was 19.88% (95% confidence interval [CI]: 0.15-0.2) and 8.94 (95% CI: 0.08-0.12) for disabling hearing impairment. The prevalence of ear disease was 13.19% (95% CI: 0.10-0.15), with impacted cerumen and otitis media reported most often. Associations with hearing impairment were established for age, gender and hypertension. CONCLUSION:  The study has shown a higher prevalence of disabling hearing impairment in the rural EMLM area of the Limpopo province compared to global prevalence rates. In addition, known factors associated with hearing impairment were confirmed.

Public awareness of audiology, hearing and hearing health in the Limpopo Province, South Africa.

BACKGROUND: The burden of hearing loss is on the increase, especially in low-income countries such as South Africa. The need for urgent action to prevent ear and hearing problems is a priority, especially as in many cases permanent hearing loss is preventable. In South Africa, as in other developing countries, there is a limited number of hearing health professionals and audiological resources. The lack of hearing health services may impact the general public's awareness of hearing and hearing health. Limited information is available on the South African public's knowledge of audiologists and the services they provide, especially in underserved rural communities. AIM: The aim of this study was to describe individuals' awareness of the audiology profession, hearing and hearing loss, and hearing health in a rural area of the Limpopo Province. METHOD: A cross-sectional survey design was employed for the purpose of this study. Using a random sampling strategy, 297 households in four rural villages were selected and a selfdeveloped questionnaire was administered to one individual (18 years and older) per household. The questionnaire consisted of 23 questions targeting awareness of the audiology profession, as well as knowledge of hearing, hearing loss and hearing health. RESULTS: Only 14% of participants were aware of the audiology profession, indicating that individuals living in rural communities are not aware of the role of audiologists and the services they provide. Doctors and nurses were identified by participants as the individuals who assist them with hearing-related problems. Although most participants (87%) acknowledged that it is very important to undergo a hearing test, only 5% have previously visited an audiologist. Most participants were aware that ear infections and excessive noise exposure can cause hearing loss. The majority also believed that ears must be kept clean at all times and used cotton buds to maintain ear hygiene. CONCLUSION: There is a general lack of public awareness of audiologists and the services they offer. This study highlighted the need for the National Department of Health in collaboration with professional associations and hearing health professionals to develop and implement effective strategies to increase the South African public's awareness of the profession and the services they provide. South African universities can also play a significant role in teaching students to develop context-relevant strategies to increase awareness of the profession.

Quality and readability of information pamphlets on hearing and paediatric hearing loss in the Gauteng Province, South Africa.

OBJECTIVES: The implementation of early hearing detection and intervention (EHDI) programmes is necessary in order to facilitate the early identification of hearing loss. An important component of EHDI is parental education. International and national guidelines stipulating that comprehensive, unbiased and appropriate information pamphlets should be provided to parents as part of EHDI programmes, however little is known about the availability and readability of such materials in South Africa. The objectives of this study were therefore to determine the availability of information pamphlets on hearing and hearing loss in children at public hospitals in the Gauteng Province of South Africa. In addition, the quality and readability levels of these pamphlets were determined. METHODS: A non-experimental, descriptive research design was employed for this study. Information on the availability of leaflets at public health hospitals was obtained through a telephonic survey. Twenty-one information pamphlets available at these hospitals were then evaluated to determine the quality and readability levels. RESULTS: It was found that 73% of audiology departments at public hospitals in Gauteng had information pamphlets available on hearing and hearing loss in children. Of the pamphlets evaluated, the majority were rated to 'present with serious problems' questioning the quality of the content included. In addition, it was found that on average the readability level of these pamphlets were at a sixth-grade level, much higher that the recommended fourth-grade reading level. CONCLUSIONS: The need for development of quality educational material focused on providing parents with unbiased, comprehensive and appropriate information on hearing and hearing loss in children has been highlighted. Proposed guidelines were recommended to assist audiologists in this endeavour. The importance of providing appropriate parental educational materials for the success of EHDI in South Africa should not be underestimated.

Availability of audiological equipment and protocols for paediatric assessment and hearing aid fitting in Gauteng, South Africa.

BACKGROUND: Accurate diagnosis and management of hearing loss (HL) is based on valid and accurate ear-specific and frequency-specific information. This is especially relevant as non-optimal hearing amplification as part of early hearing detection and intervention programmes may result in further delays in the speech and language development of children with HL. Audiological measures utilised may vary according to the age, cognitive ability and physical ability of the infant or child. It is therefore important to compare and critically evaluate current clinical practice in order to recommend guidelines for paediatric audiology in South Africa. OBJECTIVES: To determine the availability of audiological equipment and clinical protocols used by audiologists in Gauteng for paediatric audiological assessment and hearing aid (HA) fitting. METHOD: A descriptive, cross-sectional survey research design was utilised to describe the availability of clinical audiological equipment and protocols used by audiologists in Gauteng, South Africa for paediatric assessment and HA fitting. Eighteen audiology departments, eleven public hospitals and seven private practices were included in the study. RESULTS: Results revealed the limited availability of departmental protocols within departments for paediatric assessment and HA fitting. Although there appeared to be a wide variety of equipment available to audiologists in public sector hospitals and private practice, a lack of high-frequency tympanometers and equipment for real ear measurements was revealed. CONCLUSION: These findings highlight the need for the development and use of current, evidence-based practice guidelines for paediatric audiological assessment and HA fitting in South Africa. These guidelines should include a list of essential equipment required for paediatric assessment and HA fitting. Current, evidence-based practice guidelines for paediatric HA fitting are important in ensuring that secondary developmental delays associated with a delay in early intervention for children with HL are reduced.

Hearing-screening record-keeping practices at primary healthcare clinics in Gauteng.

OBJECTIVES: As little is known about hearing screening practices at primary healthcare (PHC) clinics in South Africa, the study aimed to describe hearing-screening and record-keeping practices of nurses during typical immunisation sessions at PHC clinics in Gauteng, South Africa. METHODS: Data were obtained through observations (N2 = 80) and questionnaires (N1 = 20) which were then cross-checked with retrospective information collected from the Road-to-Health Charts and City of Johannesburg Child Health Services Blue Cards of children observed during typical immunisation sessions. RESULTS: A key finding of this study was that PHC nurses who participated in this study do not adhere to the hearing-screening record-keeping practices as outlined by the national Department of Health. CONCLUSIONS: Poor record-keeping practices hinder the efficacy of hearing-screening programmes. Accurate record keeping is important in order to document outcomes which can be used to evaluate service delivery and the efficacy of hearing-screening programmes.

Motor Neuron Disease: The Impact of Decreased Speech Intelligibility on Marital Communication

Background: The onset of motor neuron disease (MND); a neurodegenerative disease; results in physical and communication disabilities that impinge on an individual's ability to remain functionally independent. Multiple aspects of the marital relationship are affected by the continuously changing roles and responsibilities. Communication is one of the most constructive ways of dealing with emotions that are elicited by these changes. decreased speech intelligibility; the relationship between the deteriorating speech and the couples' perception of marital communication was not statistically significant.Conclusion: Overall; the results proved that the supposition that communication between couples will invariably deteriorate as a result of progressively reduced speech intelligibility is not necessarily valid. The fundamental importance of effective communication in marriage is highlighted. It is well established that augmentative and alternative communication strategies can preserve the ability to develop and maintain intimate rewarding relationships; even in the face of profound physical disabilities. Method: This study explored the association between the deteriorating speech of persons with MND and couples' perception of marital communication. Fourteen couples participated in this non-experimental correlational research study. Data were collected over a 12-month period through the administration of objective and subjective measures.Results: Results showed that despite

The influence of epidural anesthesia on new-born hearing screening: A pilot study.

OBJECTIVE: The main aim was to establish if epidural anesthesia had an influence on new-born hearing screening results in newborns born via elective Cesarean section in healthy pregnancies. Specific objectives included determining screening results in a group of newborns born to mothers who had undergone epidural anesthesia during Cesarean section childbirth (experimental group); and comparing the findings with those of a group of newborns born to mothers who had undergone natural delivery without epidural anesthesia (comparison group); while establishing if the time of screening following delivery had any effect on the overall screening results. MATERIALS AND METHODS: The above objectives were achieved through the use of a prospective quasi-experimental repeated measures design with a comparison group, where 40 newborns (20 in the experimental and 20 in the comparison group) were screened at three different times through transient otoacoustic emissions (TEOAEs) and automated auditory brainstem response (AABR) measures. All participants were screened while resting quietly in open bassinets in an empty new-born nursery. For both test measures, the results were recorded as either pass or refer. Data were analyzed through both descriptive and inferential statistics. RESULTS: Findings indicated that hearing screening earlier than four hours after birth, for both the experimental and comparison groups yielded more false positive findings than testing conducted after 24 hours. An index of suspicion in relation to the influence of epidural anesthesia on Automated Auditory Brainstem Response (AABR), when conducted less than four hours after birth, was raised, as statistically significant findings (P<0.05) were obtained. CONCLUSIONS: The findings have implications for timing of screening where universal newborn hearing screening is being implemented.

Listeners' attitudes: speech supplementation strategies for improving effectiveness of speakers with mixed dysarthria as a result of motor neuron disease.

This study examined unfamiliar and familiar listener attitudes towards the use of combined alphabet-topic cues and a control condition (habitual speech with no cues) associated with the speech of three individuals with severe mixed dysarthria. Two listener groups (N = 36) were shown experimentally imposed visual images of the combined alphabet-topic cue strategy in conjunction with recorded auditory presentations with the habitual speech of three individuals with mixed dysarthria. Using a 7-point Likert scale, listeners were asked to rate how effective they thought the speakers communicated; how comfortable they were communicating with the speakers; and how persistent they were in trying to understand the speakers. The results revealed that there were no significant differences in the attitude ratings of familiar listeners as compared to unfamiliar listeners. However, results revealed that rating of communicative effectiveness, comfort communicating with speakers and listener persistence were each more favourable when using the combined cue condition than purely habitual speech.The results suggest that augmentative and alternative communication strategies providing frequent and specific cues regarding the content and constituent words of a message may enhance the attitudes of listeners.