Outcomes and device use in children with bone-conduction hearing devices in South Africa.

BACKGROUND:  Bone-conduction hearing devices (BCHD) can provide hearing solutions in settings where middle ear pathology is rife. OBJECTIVES:  Describe functional hearing outcomes and device use of children fitted with BCHD. METHOD:  Retrospective review of 79 children fitted with BCHD between January 2017 and May 2022. Outcomes included device use and subjective reports measured with the Parents' Evaluation of Aural/Oral Performance of Children (PEACH) and the Teachers' Evaluation of Aural/Oral Performance of Children (TEACH). Analysis of variance established association between mean data logging and type and degree of hearing loss. Thematic analyses were done for qualitative outcomes. RESULTS:  Average usage was 7.0 h/day (5.4 SD; range 0.1-24). PEACH ratings indicated 93.3% of children wore their BCHD 'always' or 'often', with 80% displaying Typical auditory performance at 1-month follow-up. TEACH ratings indicated 84.2% of children wore their BCHD 'always' or 'often', with 78.9% showing typical auditory behaviour. Increased usage was noted for conductive, mixed, moderate and severe hearing losses. There was a mean delay of 17.2 months (23.4 SD; range 0-90) between age of diagnosis and fitting. Thematic analyses identified two main themes: advantages and barriers to BCDH use. CONCLUSION:  Average device use fell short of the internationally recommended 10 h/day. Higher BCHD use was associated with higher functional listening performance scores. Long waiting times for medical or surgical intervention for conductive hearing losses can delay BCHD fitting.Contribution: Limited information is available to examine outcomes in children fitted with BCHD.

Parents' Perceptions of the Factors Influencing the Uptake of Remote Pediatric Hearing Aid Support: Development of a Conceptual Framework.

BACKGROUND: To achieve effective integration of virtual care into family-centered audiology practices, participatory research methods, including parents as vital participants in the delivery of pediatric audiology care, should be considered. A better understanding of the barriers and facilitators influencing the adoption of virtual care for families is warranted. OBJECTIVE: This study aimed to develop a conceptual framework of the factors perceived to influence the adoption of remote pediatric hearing aid support among the parents of children with hearing loss. METHODS: A total of 12 parents of children who wear hearing aids, between the ages of 0-17 years, were recruited to participate in group or individual interviews as part of the 6-step participatory-based concept mapping (CM) process. Data collection was specific to parents in a Canadian context. Analyses included multidimensional scaling and hierarchical cluster analysis. RESULTS: The CM process resulted in 6 main themes, displayed in a cluster map according to their order of importance. These themes include access to timely, consistent care; technology considerations; convenience; child engagement; cost; and partnership considerations. Key underlying statements and subthemes are highlighted per theme. CONCLUSIONS: Findings from this study demonstrate the use of CM in participatory research with parents and as part of a family-centered care model. Future research should aim to investigate the factors that influence the uptake of remote hearing aid support in different contexts, for example, in low- to middle-income countries versus those in high-income countries.

Ten years' experience with bone conduction hearing aids in the Western Cape, South Africa.

Untreated conductive and mixed hearing losses as a result of middle ear pathology or congenital ear malformations can lead to poor speech, language and academic outcomes in children. Lack of access to centralised hearing healthcare in resource-constrained environments limits opportunities for children with hearing loss. Red Cross War Memorial Children's Hospital (RCWMCH) is one of only two dedicated paediatric hospitals in sub-Saharan Africa. Between 2016 and 2021, 29 children received implanted bone conduction hearing devices, and 104 children were fitted with bone conduction devices on softbands. The authors' experience at RCWMCH suggests that bone-anchored hearing devices, either fitted on softbands or on implanted abutments, can provide solutions in settings where patients have limited access to hearing healthcare and optimal classroom environments. Hearing healthcare should be accessible and delivered at the appropriate level of care to mitigate the adverse effects of hearing loss in children.Contribution: This article describes strategies employed at RCWMCH such as fitting bone conduction hearing devices on a softband immediately after hearing loss diagnosis and conducting follow-up via remote technology to make hearing healthcare more accessible to vulnerable populations.

Corrigendum: Decentralising paediatric hearing services through district healthcare screening in Western Cape province, South Africa.

No abstract available.

Outcomes of children with sensorineural hearing loss fitted with binaural hearing aids at a pediatric public hospital in South Africa.

OBJECTIVE: To describe hearing aid outcomes for children with bilateral sensorineural hearing loss (SNHL) at a pediatric public hospital in South Africa in terms of daily use and oral/aural performance. MATERIALS AND METHODS: Retrospective review of clinical data and caregiver reported outcomes of children aged 0-13 years with bilateral SNHL at one-month and three-months post-fitting. Oral/aural performance was measured by the Parents' Evaluation of Aural/Oral Performance of Children (PEACH) questionnaire. Multiple linear regression was used to evaluate factors associated with hearing aid use. Thematic analysis was applied for qualitative caregiver-reported outcomes. STUDY SAMPLE: Sixty-eight children with confirmed bilateral SNHL who were fitted with binaural air-conduction hearing aids at Red Cross War Memorial Children's Hospital in Cape Town, South Africa, between January 2017 and December 2019. RESULTS: Average daily hearing aid use increased significantly (p < 0.05) from one-month (5.0; 3.0 SD; range 0.3-14.0) to three-months post-fitting (5.9; 3.4 SD; range 1.1-16.8). Average PEACH scores were higher in Quiet (73.4%) than in Noise (69.6%). More than half (52.2%) of children required review based on their overall percentage PEACH scores. Higher average daily hearing aid use was significantly associated with higher overall PEACH scores (p < 0.05). Neuro-typically developing children had significantly higher hearing aid use than children with additional disabilities (p < 0.001). Qualitative caregiver feedback revealed themes pertaining to advantages and barriers to hearing aid use. CONCLUSION: Outcomes of children with SNHL fitted with binaural hearing aids at a pediatric public hospital in South Africa demonstrated increased average daily hearing aid use from one-month to three-months post-fitting. Aural/oral performance was typical for one in two children. Children with additional disabilities had significantly poorer hearing aid use and aural/oral performance requiring more support for this vulnerable group to realize sufficient benefit from hearing aid use.

Decentralising paediatric hearing services through district healthcare screening in Western Cape province, South Africa.

BACKGROUND: Childhood hearing loss is a global epidemic most prevalent in low- and middle-income countries where hearing healthcare services are often inaccessible. Referrals for primary care services to central hospitals add to growing lists and delays the time-sensitive treatment of childhood hearing loss. AIM: To compare a centralised tertiary model of hearing healthcare with a decentralised model through district hearing screening for children in the Western Cape province, South Africa. SETTING: A central paediatric tertiary hospital in Cape Town and a district hospital in the South Peninsula region. METHODS: A pragmatic quasi-experimental study design was used with a 7-month control period at a tertiary hospital (June 2019 to December 2019). Decentralising was measured by attendance rates, travelling distance, number of referrals to the tertiary hospital and hearing outcomes. There were 315 children in the tertiary group and 158 in the district group. Data were collected from patient records and an electronic database at the tertiary hospital. RESULTS: Attendance rate at the district hospital was significantly higher (p 0.001). Travel distance to the district hospital was significantly shorter (p 0.001). Number of referrals to the tertiary hospital decreased significantly during the intervention period (p 0.001). Most children in both the tertiary and district groups (78.7% and 80.4%, respectively) passed initial hearing screening bilaterally. CONCLUSION: Hearing screening should be conducted at the appropriate level of care to increase access, reduce patient travelling distances and associated costs and reduce the burden on tertiary-level hospitals.

Profile of childhood hearing loss in the Western Cape, South Africa.

OBJECTIVES: To describe the nature, associated risk factors and age of diagnosis for childhood hearing loss in a South African cohort from the Western Cape Province. METHODS: A retrospective review of clinical data from children under six years of age with confirmed hearing loss at Red Cross War Memorial Children's Hospital (RCWMCH) was conducted between 1 January 2019 and 31 July 2019. Data collected included demographic information, type and degree of hearing loss, documented risk factors associated with hearing loss, and age of suspicion and diagnosis of hearing loss. RESULTS: The study sample included 240 children with hearing loss, with a mean age of 42 months (21.8 SD; range 2-72). More than two thirds (68.3%) of the children presented with bilateral hearing loss. The majority presented with conductive hearing loss (64.6%), followed by sensorineural (28.7%) and mixed hearing loss (3.3%) or auditory neuropathy spectrum disorder (3.3%). More than half (51.8%) of the bilateral sensorineural hearing losses were of a profound degree. The most prominent risk factor for conductive hearing loss was otitis media, for sensorineural hearing loss it was a family history of childhood hearing loss, and for auditory neuropathy spectrum disorder it was hyperbilirubinaemia. Approximately one third of patients (27.1%) with sensorineural hearing loss did not have any associated risk factors. The mean age of diagnosis of permanent congenital or early-onset hearing loss was 31.4 months (22.8 SD; range 2-72), with a mean delay of nine months (13.2 SD; range 0-60) between age of suspicion and diagnosis of hearing loss (n = 93). CONCLUSIONS: The large proportion of preventable hearing losses in this sample highlights the importance of maximising primary health care efforts to treat preventable causes timeously. Age of diagnosis of permanent congenital or early-onset hearing loss was severely delayed undermining prospects of positive outcomes through early intervention. Infant hearing screening services in the public health sector of South Africa should be prioritised alongside primary health care efforts to reduce preventable risks for hearing loss.

The Viability of Percutaneous Bone-Anchored Hearing Systems in the HIV Population.

OBJECTIVE: To determine the viability of percutaneous bone-anchored hearing systems (BAHS), in terms of local soft tissue complications, in the HIV population. STUDY DESIGN: Retrospective folder review. SETTING: Two tertiary-level academic state hospitals in Cape Town, South Africa. PATIENTS: Twenty patients, of which six (30%) were HIV-positive. All HIV-positive patients had CD4 counts greater than 200, and were on highly-active antiretroviral therapy (HAART). INTERVENTION: Percutaneous BAHS implantation surgery was performed on all patients. MAIN OUTCOME MEASURE: Comparisons were made between HIV-positive and HIV-negative patients in terms of incidence of local soft tissue complications post-implantation. RESULTS: Soft tissue complications occurred in 50% of patients, and most were easily managed with topical treatment. No significant differences were found when comparing incidence of local soft tissue complications between HIV-positive and HIV-negative patients (p = 0.314). Similarly, surgical technique did not influence soft tissue complication incidence (p = 0.143). CONCLUSIONS: No significant differences in incidence of local soft tissue complications after percutaneous BAHS implantation were found between HIV-positive and HIV-negative patients. In a resource-constrained country like South Africa, where cost and time management are vital, these results indicate that the use of percutaneous BAHS implantation is a viable option, even in HIV-positive patients.