Tele-Audiology in India: Current and Future Trends in Knowledge, Attitude, and Practice Among Audiologists.

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic has led to widespread use of telepractice in hearing health care services. In this study, we investigated the knowledge, attitude, and practice (KAP) of tele-audiology among Indian audiologists. The current study is based on tele-practice guidelines recommended by the Indian Speech and Hearing Association for tele-audiology services in India. SUBJECTS AND METHODS: An internet-based KAP questionnaire survey was performed among 108 audiologists. The questionnaire included 33 items categorized under the following domains: demographic information and KAP of tele-audiology. Of the 108 audiologists included in the study, 38 admitted to the practice of tele-audiology previously and during the COVID-19 pandemic (tele-practitioners), and 70 respondents had no experience of tele-audiology (non-telepractitioners). RESULTS: Overall higher scores were observed with regard to the knowledge domain, and a mixed attitude regarding tele-practice was observed among audiologists. Most respondents acknowledged the advantages of tele-audiology in clinical practice. However, audiologists were hesitant to utilize this technology owing to the challenges associated with tele-practice. CONCLUSIONS: Despite adequate awareness and a positive attitude, a gap is observed between available knowledge and its actual application/utilization in tele-audiology. Tele-audiology practice was limited to counseling, hearing impairment treatment, and troubleshooting tips for hearing aids. Evidence-based practices to perform diagnostic test battery in tele-mode, hands-on training to run diagnostic test battery/rehabilitation using a tele-mode approach, and greater understanding of the technical requirements for tele-practice may result in a positive perception and encourage tele-audiology practice among audiologists. Specialized training and regular continuing education programmes are important to promote tele-audiology services in clinical practice.

Infection Control and Hygienic Measures Practiced Among Audiologists in India.

Audiologists extend their services to wide range of patients who vary across several factors like age, disease, nutritional status, pharmacological intervention, socioeconomic status and compromised immune systems. This involves direct or indirect contact with patients exposing the clinician to blood, and other bodily fluids which are considered to be potentially infectious substances. Thus infection control activities must be stressed with the goal of reducing or preventing the transmission of nosocomial pathogens to patients and staff. The aim of the study is to provide an in-depth assessment of current infection control strategies and hygienic measures followed among Audiologists in India. An internet based questionnaire survey was done among 172 Audiologists. The questionnaire focused on four domains: demography; knowledge, attitude and practice of infection control and hygienic measures followed in audiology clinic. Majority of the participants had a positive attitude towards infection control practice. Though most of them had an access to gloves (73.3%) and masks (60%), their usage was minimal and restricted to selected procedures. Hand hygienic measures were practiced by 89% of the participants only during few procedures. Irrespective of critical or non-critical instruments, majority of the participants preferred cleaning and disinfecting. Sterilisation of critical instruments was performed only by 30% of the audiologists. Audiologists knowledge and practice of infection control and hygienic measures was found to be inadequate. Specialized training program on infection control strategies should be targeted to the newly graduated and practicing audiologists to ensure patient safety and infection free clinical environment.

Distortion product otoacoustic emissions in very preterm infants: A longitudinal study.

BACKGROUND: Very preterm infants are at a greater risk of developing neurodevelopmental impairments such as neuro-motor delays, vision and hearing deficits (Roze and Breart, 2004; Saigal and Doyle, 2008) [1,2]. The hearing difficulties in preterm infants vary depending on the co-morbid conditions. However, prematurity itself is considered as a risk factor that influence the functioning of auditory system. AIM: The current study aims to compare the DPOAEs in very preterm infants and term infants at 1 month, 3 months and 6 months of age (corrected age in preterm infants). METHOD: DPOAEs were recorded in 72 very preterm infants and 30 term infants at 1 month, 3 months and 6 months of age. All these infants had obtained 'pass' results in newborn hearing screening using ABR. DPOAE f2 test frequency was measured at six frequencies (1500 Hz, 2000 Hz, 3000 Hz, 4500 Hz, 6000 Hz and 8000 Hz) with primary tone stimulus intensity L1 equal to 65 dBSPL and L2 equal to 55 dBSPL with primary tone f2/f1 frequency ratio of 1.2. Otoscopic examination and tympanometry was performed prior to DPOAE testing, to ascertain normal middle ear status. RESULTS: DPOAE amplitude did not change significantly between two groups from 1 month till 6 months of age (p > 0.05). DPOAE amplitude and noise floor in very preterm infants were not different from term infants and DPOAE amplitude did not vary significantly across f2 frequencies at various time periods. CONCLUSION: The current study findings provided evidence that prematurity did not constitute as a factor to influence the results of DPOAE in very preterm infants who passed newborn hearing screening test. Any significant reduction in DPOAE amplitude or absence of DPOAE in very preterm infants has to be considered and monitored effectively, as it may not reflect a developmental process of cochlear function; instead it could indicate the presence of inner ear or middle ear pathology.

Outer hair cell functioning in infants with iron deficiency anemia.

BACKGROUND: Distortion product otoacoustic emissions (DPOAE) in infants with Iron Deficiency Anemia (IDA) helps in understanding the cochlear status especially the functioning of outer hair cells. OBJECTIVES: To analyze the presence of DPOAE across frequencies and DP amplitude in infants with and without IDA. METHOD: DPOAE were recorded on 40 infants with IDA and 40 infants without IDA in the age range of 6-24 months. Cubic DPOAEs (2f1-f2) were measured at six f2 frequencies (1500 Hz, 2000 Hz, 3000 Hz, 4500 Hz, 6000 Hz & 8000 Hz) with primary tone stimulus of intensity L1 equal to 65 dBSPL and L2 equal to 55 dBSPL. Immittance audiometry was performed using 226 Hz probe tone prior to DPOAE recording to ascertain normal middle ear functioning. RESULTS: DPOAEs were present in all infants with and without IDA across frequencies tested. DP amplitude across the frequencies did not show any statistically significant difference (p < 0.05) between anemic and non-anemic groups. There was no statistically significant difference observed when both the groups were compared in terms of gender and age. CONCLUSION: The study indicated that reduced iron levels does not have any influence on outer hair cell functioning as there were no changes observed in the DPOAE amplitude levels between infants with IDA and infants without IDA. Iron status does not seem to have a direct effect on outer hair cell functioning in infants. However, fine structure DPOAEs can reveal even more precise changes (if any) that are caused due to iron deficiency.

Changes in Auditory Brainstem Response in very preterm and late preterm infants.

AIM: Aim of this study was to compare the absolute and interpeak latencies of Auditory Brainstem Responses (ABR) in very preterm and late preterm infants at 1 month and 3 months of corrected age. METHOD: ology: ABR traces were obtained from 80 preterm infants (40 very preterm and 40 late preterm) at 1 month and 3 months of corrected age in a prospective, comparative cohort study. Auditory click stimuli at 70 dBnHL and 30 dBnHL, with repetition rate of 11.1/s were used. Absolute latencies of peak I, III, V and interpeak latencies of peak I-V, I-III and III-V were analyzed and compared between preterm groups at 1 month and 3 months of corrected age. Wilcoxon Signed Ranks test was used to compare the ABR variables. Mann Whitney test was used to make inferences between groups. RESULTS: There was a statistically significant difference in absolute latencies and interpeak latencies between very preterm and late preterm infants at 1 month of corrected age (p < 0.05). Absolute latency of peak I was similar among both groups of preterms. Absolute latencies of peak III, V and interpeak latencies I-III, III-V and I-V were prolonged in very preterm infants at 1 month of corrected age. However, these latencies were significantly reduced at 3 months of corrected age. This indicated accelerated maturation/myelination of the central auditory nervous system in very preterm infants. Absolute latencies of peak III and V and interpeak interval I-V was reduced in late preterm infants at 3 months of corrected age and this was statistically significant. This reduction in latency was considered to be a normal age dependent change. CONCLUSION: Findings of the current study revealed that there was no deviation in the pattern of auditory maturation among preterms; it followed the typical 'caudal to rostral' form of maturation. Very preterm infants have less mature neuronal development compared with late preterm infants at 1 month of corrected age which catches up at 3 months of corrected age.

Auditory brainstem response in infants with iron deficiency anemia.

BACKGROUND: Auditory brainstem response (ABR) in infants with Iron Deficiency Anemia (IDA) helps in understanding the auditory aspects of central nervous system. OBJECTIVES: To analyse and compare absolute and interpeak latencies of ABR in infants with and without IDA. METHODS: ABR traces were obtained from 40 anemic ears and 40 non anemic ears, aged 6-24 months. ABR was recorded with 11.1/s clicks at different intensity levels. RESULTS: Absolute latencies of all the peaks were prolonged in infants with IDA at 70, 50 and 30 dBnHL except for peak I. Amplitude of peaks I, III and V was not statistically different between the two groups at 70 and 50 dBnHL. Reduced peak amplitude was noted only at 30 dBnHL in infants with IDA which was statistically significant (P < 0.05). Interpeak interval showed no significant difference between anemic and non-anemic infants at 70 dBnHL. Prolonged interpeak latency of peak III-V and I-V was noted at 50 and 30dBnHL. CONCLUSION: Functional development of auditory system seems to be affected due to iron deficiency. IDA has a long lasting effects on central auditory system when IDA is left untreated This will in turn lead to an alteration in the neuro-functional maturation.

F0 Characteristics of Newsreaders on Varied Emotional Texts in Tamil Language.

OBJECTIVE: The objective of this study was to profile speaking F0 and its variations in newsreaders on varied emotional texts. STUDY DESIGN: This study has a prospective, case-control study design. METHODS: Fifteen professional newsreaders and 15 non-newsreaders were the participants. The participants read the news bulletin that conveyed different emotions (shock, neutral, happy, and sad) in a habitual and "newsreading" voice. Speaking fundamental frequency (SFF) and F0 variations were extracted from 1620 tokens using Praat software (version 5.2.32) on the opening lines, headlines, news stories, and closing lines of each news item. Paired t test, independent t test, and Friedman test were used for statistical analysis. RESULTS: Both male and female newsreaders had significantly (P ≤ 0.05) higher SFFs and standard deviations (SDs) of SFF in newsreading voice than speaking voice. Female non-newsreaders demonstrated significantly higher SFF and SD of SFF in newsreading voice, whereas no significant differences were noticed in the frequency parameters for male non-newsreaders. No significant difference was noted in the frequency parameters of speaking and newsreading voice between male newsreaders and male non-newsreaders. A significant difference in the SD of SFF was noticed between female newsreaders and female non-newsreaders in newsreading voice. Female newsreaders had a higher frequency range in both speaking voice and newsreading voice when compared with non-newsreaders. CONCLUSIONS: F0 characteristics and frequency range determine the amount of frequency changes exercised by newsreaders while reading bulletins. This information is highly pedagogic for training voices in this profession.

Auditory brainstem response in very preterm, moderately preterm and late preterm infants.

BACKGROUND: Auditory brainstem response across preterm infants help in understanding difference if any in auditory maturation. OBJECTIVE: To analyze and compare absolute and interpeak latencies of ABR in very preterm, moderate preterm and late preterm infants at term age. METHOD: ABR traces were obtained from 148 ears of preterm infants (52 of very preterm, 44 of moderately preterm & 52 of late preterm) at term age. ABR was recorded with 11.1/s clicks at different intensity levels. RESULTS: Absolute latencies of peak I, III, V and interpeak latencies of peak I-V, I-III and III-V were analyzed and compared between three preterm groups. One way ANOVA was used to compare ABR parameters between three groups of preterm infants and also to compare ABR parameters across various gestation ages. There were no overall differences in absolute latencies, interpeak latencies and amplitude of ABR between preterm groups and across various gestation ages (P>0.05). Pearson correlation was used to find the correlation between gestation age and ABR parameters. However, no correlation was found. ABRs were similar among preterm groups at term age which reflects that the brainstem maturation is similar among preterm groups. CONCLUSION: Gestational age at birth does not seem to influence absolute and interpeak latencies of ABR at term age. In preterm neonates, the findings lead to suggest that maturation of auditory pathway occurs in a similar manner in preterm infants regardless of gestational age at birth. We conclude that preterm birth alone as a risk factor does not appear to have any marked effect on the development of ABR at term age.

Voice Needs and Voice Demands of Professional Newsreaders in Southern India.

OBJECTIVES: Newsreaders are elite vocal professionals who are highly dependent on their voice quality to meet professional commitments. Globally, the voice needs and demands of newsreaders could vary depending on technology and cultural variations. This study documents voice demands, voice needs, and vocal and nonvocal habits of professional newsreaders in Chennai, southern India through a questionnaire-based interview. STUDY DESIGN: Prospective, case-control study design. METHODS: Forty-seven professional newsreaders and 47 non-newsreaders participated in the questionnaire-based interview that elicited information relevant to their profession and voice use. RESULTS: Majority of the newsreaders were not formally trained for newsreading. A significantly larger percentage of female newsreaders felt their jobs to be vocally demanding. Most newsreaders also had other full-time jobs that required a lot of speaking. Ninety-four percent of newsreaders consciously altered their voices while rendering news, and majority of them reported their voices to have changed considerably since they began newsreading. When compared with non-newsreaders, a significantly larger number of newsreaders were aware of voice problems, and many experienced some type of vocal technical difficulties. Seventy-seven percent of newsreaders took active measures to conserve their voice as opposed to non-newsreaders. Majority reported that sitting upright and erect while reading news helped produce the best vocal output for newsreading. CONCLUSIONS: The findings on voice needs and vocal and nonvocal habits among newsreaders in Chennai, India, provide valuable first-time information from this part of the world. These have potential application for voice professionals, voice trainers, and prospective aspirant newsreaders in developing strategies for voice care and in preventing voice problems.