Exploring quality of life post sudden onset hearing loss: A convergent parallel approach.

BACKGROUND:  Sudden onset hearing loss (SOHL) is rare and presents differently to individuals; hence, it is complex to diagnose. The impact on the quality of life (QoL) varies for individuals and their support structure. However, the exploration of research designs is warranted. OBJECTIVES:  This study explored the lived experiences of adults post-SOHL diagnosis and the impact on the QoL. Facilitators of emotional and social aspects of counselling provided by audiologists post-SOHL diagnosis were established. METHOD:  This was a convergent parallel research study. Data were collected from the two primary participants and three secondary participants, face-to-face and telephonically. The Hearing Handicap Inventory for Adults (HHIA) screening tool and the semi-structured interviews were used for data collection. The data sets were analysed independently, viz. descriptive analysis and thematic analysis, to confirm the impact on the QoL post-SOHL diagnosis. RESULTS:  The HHIA scores obtained were 84% and 50% for P1 and P2, respectively. Key themes that emerged from the interviews revealed that communication difficulties mostly impacted the QoL, which in turn influenced their mental and social well-being. Aural rehabilitation was perceived as ineffective support, thus the inability to reduce the impact on the QoL post-SOHL diagnosis. CONCLUSION:  The integrated findings indicated the impact on the QoL post-SOHL diagnosis. Convergent parallel methods should be considered by researchers to understand rare auditory pathologies and their impact on the QoL.Contribution: Person-centred care (PCC) and family-centred care (FCC) are facilitators of counselling that audiologists can employ as QoL management strategies post-SOHL diagnosis.

Occupational Hearing Loss for Platinum Miners in South Africa: A Case Study of Data Sharing Practices and Ethical Challenges in the Mining Industry.

BACKGROUND: The relevant legislation ensures confidentiality and has paved the way for data handling and sharing. However, the industry remains uncertain regarding big data handling and sharing practices for improved healthcare delivery and medical research. METHODS: A semi-qualitative cross-sectional study was used which entailed analysing miners' personal health records from 2014 to 2018. Data were accessed from the audiometry medical surveillance database (n = 480), the hearing screening database (n = 24,321), and the occupational hygiene database (n = 15,769). Ethical principles were applied to demonstrate big data protection and sharing. RESULTS: Some audiometry screening and occupational hygiene records were incomplete and/or inaccurate (N = 4675). The database containing medical disease and treatment records could not be accessed. Ethical challenges included a lack of clarity regarding permission rights when sharing big data, and no policy governing the divulgence of miners' personal and medical records for research. CONCLUSION: This case study illustrates how research can be effectively, although not maliciously, obstructed by the strict protection of employee medical data. Clearly communicated company policies should be developed for the sharing of workers' records in the mining industry to improve HCPs.

The impact of medical interventions for reducing ototoxicity during treatment for multi-drug resistant tuberculosis / Impacto de las intervenciones médicas para reducir la ototoxicidad durante el tratamiento de la tuberculosis multirresistente a los fármacos

INTRODUCTION: The impact of medical interventions for reducing ototoxicity requires focus in contexts where safe non-ototoxic alternative drugs are not yet available. OBJECTIVES: The goal was to investigate the impact of medical intervention strategies for reducing the ototoxic effects of long-term use of aminoglycosides for the treatment of Multi-Drug Resistant Tuberculosis (MDR-TB) in adults at a rural hospital in the Eastern Cape, South Africa. METHODS: A retrospective record review with a control group design was used, with audiological and medical record reviews of all participants' files over a six-month period. A total of 86 participants (intervention group n = 32 and control group n = 54) were included. Descriptive and inferential statistics were used to analyze the data. RESULTS: Results revealed progressive hearing loss in both groups, with worsening of thresholds at each subsequent assessment session. The progression of the hearing loss, however, was much slower in the intervention group, with degree of hearing loss being more severe in the control group in the final session of assessment (36.78-71.74 dB), when compared to the intervention group (33-44.39 dB). Furthermore, the hearing loss in the intervention group remained in the high frequencies while that in the control group progressed to involve the lower frequencies on the audiogram. The most common medical intervention strategies employed in the current study were to reduce the dosage of the ototoxic drug (61%), with the daily dosage reduced to 800 mg in 39% of participants, while the administration of the drug was reduced from daily to thrice weekly in 22% of participants. CONCLUSIONS: The results reveal better hearing sensitivity over the treatment period in the intervention group when compared to the control group; thus suggesting that early medical strategies implemented had a significant preventive impact. Current findings are relevant to the audiological, medical and pharmaceutical fields, particularly within the South African context where resource constraints are a consideration in all treatment measures

INTRODUCCIÓN: El impacto de las intervenciones médicas para reducir la ototoxicidad requiere concentrarse en los contextos en los que no se dispone de fármacos alternativos no ototóxicos seguros. OBJETIVOS: El objetivo fue investigar el impacto de las intervenciones médicas para reducir los efectos ototóxicos del uso prolongado de aminoglucósidos para el tratamiento de la tuberculosis multirresistente a los fármacos (MDR-TB) en adultos, en un hospital rural en Cabo Oriental, Sudáfrica. MÉTODOS: Se realizó una revisión retrospectiva de historias con grupo control de las revisiones audiológicas y médicas de todos los participantes durante un periodo de 6 meses, incluyéndose a un total de 86 participantes (grupo intervención n = 32 y grupo control n = 54). Se utilizaron estadísticas descriptivas e inferenciales para analizar los datos. RESULTADOS: Los resultados revelaron hipoacusia progresiva en ambos grupos, con empeoramiento de los umbrales en cada examen sucesivo. Sin embargo, la progresión de la hipoacusia fue menor en el grupo intervención, siendo más severo el grado de pérdida auditiva en el grupo control en el examen final de evaluación (36,78-71,74 dB), en comparación con el grupo intervención (33-44,39 dB). Además, la hipoacusia se mantuvo en frecuencias altas en el grupo intervención, mientras que en el grupo control experimentó una progresión, incluyendo las frecuencias bajas en el audiograma. Las intervenciones médicas más comunes utilizadas en el presente estudio fueron la reducción de la dosis de fármacos ototóxicos (61%), reduciéndose la dosis diaria a 800 mg en el 39% de los participantes, mientras que la administración del fármaco se redujo de una a tres veces por semana en el 22% de los participantes. CONCLUSIONES: Los resultados revelan mejor sensibilidad auditiva a lo largo del periodo de tratamiento en el grupo intervención, en comparación con el grupo control, lo cual sugiere que las estrategias médicas tempranas implementadas tuvieron un impacto preventivo significativo. Los hallazgos actuales son relevantes para los campos audiológico, médico y farmacéutico, particularmente en el contexto de Sudáfrica, donde las limitaciones de recursos son dignas de consideración en todas las medidas de tratamiento

The impact of medical interventions for reducing ototoxicity during treatment for multi-drug resistant tuberculosis.

INTRODUCTION: The impact of medical interventions for reducing ototoxicity requires focus in contexts where safe non-ototoxic alternative drugs are not yet available. OBJECTIVES: The goal was to investigate the impact of medical intervention strategies for reducing the ototoxic effects of long-term use of aminoglycosides for the treatment of Multi-Drug Resistant Tuberculosis (MDR-TB) in adults at a rural hospital in the Eastern Cape, South Africa. METHODS: A retrospective record review with a control group design was used, with audiological and medical record reviews of all participants' files over a six-month period. A total of 86 participants (intervention group n=32 and control group n=54) were included. Descriptive and inferential statistics were used to analyze the data. RESULTS: Results revealed progressive hearing loss in both groups, with worsening of thresholds at each subsequent assessment session. The progression of the hearing loss, however, was much slower in the intervention group, with degree of hearing loss being more severe in the control group in the final session of assessment (36.78-71.74dB), when compared to the intervention group (33-44.39dB). Furthermore, the hearing loss in the intervention group remained in the high frequencies while that in the control group progressed to involve the lower frequencies on the audiogram. The most common medical intervention strategies employed in the current study were to reduce the dosage of the ototoxic drug (61%), with the daily dosage reduced to 800mg in 39% of participants, while the administration of the drug was reduced from daily to thrice weekly in 22% of participants. CONCLUSIONS: The results reveal better hearing sensitivity over the treatment period in the intervention group when compared to the control group; thus suggesting that early medical strategies implemented had a significant preventive impact. Current findings are relevant to the audiological, medical and pharmaceutical fields, particularly within the South African context where resource constraints are a consideration in all treatment measures.

The hearing function of sound engineers: A hearing conservation perspective.

BACKGROUND: Occupational activities performed by sound engineers are associated with hearing loss. However, there is a dearth of research on the hearing functions and the related hearing loss for sound engineers. OBJECTIVES: To determine the hearing function and early effects of noise on the hearing ability of sound engineers, and to establish whether there are hearing conservation programmes (HCPs) available for sound engineer participants in Johannesburg. METHODS: A quantitative cross-sectional design was used. Eight sound engineers from the Academy of Sound Engineering (ASE) participated in the study. The following data were collected from the participants: case history data, ear-related symptoms and hearing conservation data. Hearing screening followed by full diagnostic audiological assessments was conducted for each participant. Descriptive statistics and one-sample t-test were used to analyse the data (confidence interval [CI] = 95%). RESULTS: Participants reported tinnitus and aural fullness as common complaints. Only one participant had a unilateral impacted cerumen. All the participants presented with hearing within normal limits bilaterally, with a percentage loss of hearing (PLH) of 1.1% for all the participants. However, five participants presented with a notched configuration that was ≥ 10 decibel (dB), in the high frequency region at 3000 Hz and 6000 Hz bilaterally. One-sample t-test (p = 0.001) inferred that at a mean age of 27.6 years (standard deviation [SD] = 3.85), a notch at 3000 Hz and 6000 Hz was associated with an early sign of a hearing loss for the study participants. An HCP was not in place at the study site. CONCLUSION: The study indicated a younger age as an associated early sign of noise-induced hearing loss (NIHL) for the study participants, and that audiologists' clinical practice needs to explore HCP strategies specific for the sound engineers in order to prevent hearing loss.

Estimating miners at risk for occupational noise-induced hearing loss: A review of data from a South African platinum mine.

BACKGROUND: Occupational noise-induced hearing loss (ONIHL) is a complex, but preventable, health problem for South African miners. Meticulously collected data should be made use of to design interventions to address this health issue. OBJECTIVES: A single mine's electronic data were reviewed in a secondary data review to determine, from the records, factors that hearing conservation practitioners deemed useful for identifying 'at risk' miners and to establish factors that would pave the way for the integration of the 2014 hearing conservation programme (HCP) milestones into the mine's current proactive data management system (PDMS). The objectives of this article were to establish how miners with published risk factors associated with ONIHL were managed by the mine's hearing conservation practitioners as part of the HCP; to determine if the mine's hearing conservation practitioners could estimate miners' risk of ONIHL using baseline percentage loss of hearing (PLH) as a hearing conservation measure; and to estimate the contribution of noise exposure to ONIHL risk. METHOD: In a secondary data review design, records in a platinum mine's two electronic data sets were reviewed: the first contained diagnostic audiometry records (N = 1938) and the second comprised a subset of miners diagnosed with ONIHL (n = 73). Data were available for the period 2014-2017 and included demographic, occupational, audiometry and ONIHL diagnosis data. Miners' risk factors associated with ONIHL were identified using the functional risk management structure. A logistic regression model was used for the baseline PLH margins of 0% - 40% (in 5% increments) to estimate the adjusted predictions for miners at risk of developing ONIHL. The contribution of noise exposure as a risk for ONIHL was estimated using a two-way sample proportion test. RESULTS: The mean age of the miners (all male candidates) was 47 ± 8.5 years; more than 80% had worked for longer than 10 years. Valid baseline audiometry records were available for only 34% (n = 669) of the miners. Miners with a 0% baseline PLH had a 20% predicted risk of ONIHL, and a 45% predicted risk if they had a 40% baseline PLH - these employees were referred. The noise exposure risk rankings revealed that 64.9% (n = 1250) of the miners were exposed to 91 dBA - 105 dBA noise exposure levels and that 59 (80.8%) diagnosed with ONIHL were exposed to noise levels of up to 104 dBA. CONCLUSION: These findings indicate significant gaps in the mine's PDMS, requiring attention. Nonetheless, the mine's current data capturing may be used to identify miners at risk of developing ONIHL. The PLH referral cut-off point (≥2.5%) used by the mine's hearing conservation practitioners, when used in conjunction with baseline PLH shifts, was the major factor in early identification of ONIHL in miners exposed to ≥85 dBA noise. An inclusive integrative data management programme that includes the medical surveillance data set of the miners' noise exposure levels, occupations, ages and medical treatments for tuberculosis and human immunodeficiency syndrome is recommended, as these are important risk indicators for developing ONIHL, particularly within the South African context.

Noise-induced hearing loss: what South African mineworkers know.

PURPOSE: The current study aimed to investigate the knowledge of mineworkers regarding noise-induced hearing loss in the South African gold and non-ferrous mining subsectors. METHOD: A descriptive research design was adopted. Semi-structured interviews were conducted with 90 participants who comprised managers, supervisors and miners. Data were analysed qualitatively. RESULTS: The majority of participants (97%) acknowledged working in a noisy environment and demonstrated knowledge of the consequences of this exposure on their hearing function. Although all but one participant indicated having known the importance of using hearing protection devices (HPDs), less than 50% reported consistent use of HPDs. This highlights gaps in education and training, as well as implementation monitoring. All participants reported knowledge regarding the importance of hearing monitoring, but a lack of understanding of their test results. CONCLUSIONS: Current findings contribute towards evidence regarding internal barriers to effective application of best practice in hearing conservation programmes (HCPs). Findings highlight the important role of occupational audiologists in South African mines and the need for individualized education during medical surveillance to enhance efficacy of HCPs. Comprehensive education and training programmes regarding noise exposure and exposure measurements with consistent HPD efficiency assessments are recommendations emanating from these findings.