Measuring parent satisfaction with a neonatal hearing screening program

The primary aim of the present study was to investigate parent satisfaction with a neonatal hearing screening program through use of a valid and reliable questionnaire developed for this purpose (Parent Satisfaction Questionnaire with Neonatal Hearing Screening Program; PSQ-NHSP). Eighty parents whose children had received hearing screening participated in this study. High levels of satisfaction were reported with more than 90% of parents satisfied with all aspects of the program. The PSQ-NHSP was analyzed for validity and reliability and demonstrated excellent internal consistency reliability (sigma = 0.94) and excellent test-retest reliability (rho = 0.97). Content validity of the PSQ-NHSP was partially established by reviewing available literature on parent satisfaction studies in other pediatric health-care service programs. Construct validity of the PSQ-NHSP was indicated by a significant positive relationship between overall satisfaction and the three specific dimensions in the questionnaire. The satisfaction questionnaire was found to be a useful instrument for identifying service shortfalls, and routine use of the PSQ-NHSP in other neonatal hearing screening programs is recommended

Kesan pendedahan konsep kepelbagaian budaya terhadap tahap kompetensi dalam kalangan pelajar prasiswazah sains rehabilitasi

Kompetensi budaya adalah penting bagi anggota kesihatan profesional dalam menyediakan perawatan dan khidmat yang bersesuaian kepada individu daripada pelbagai latar belakang budaya. Pendidikan yang berstruktur dapat meningkatkan tahap kompetensi budaya dalam kalangan anggota kesihatan profesional. Objektif kajian ini adalah untuk menilai tahap kompetensi budaya dan perubahannya dalam kalangan pelajar prasiswazah setelah mengikuti kursus elektif Kepelbagai Budaya. Seramai 152 orang pelajar prasiswazah Tahun 3 dari Program Fisioterapi, Audiologi, dan Sains Pertuturan di Universiti Kebangsaan Malaysia telah melengkapkan satu soal selidik yang menilai kompetensi budaya sebelum dan selepas tamat kursus tersebut. Lebih daripada 80% pelajar mempunyai pengalaman bekerjasama dengan individu yang berbeza latar belakang budaya. Tahap kompetensi budaya para pelajar meningkat secara signifikan setelah mengikuti kursus. Kajian ini membuktikan keperluan bimbingan kepada pelajar di peringkat prasiswazah dalam membentuk anggota kesihatan profesional yang kompeten secara menyeluruh dalam menyediakan khidmat kepada pelbagai golongan masyarakat

'Serene classroom' minimizes noise for more conducive learning

Noise pollution can be categorized as a danger in silence. In school, noise pollution inhibits the focus of learning, impairs learning and cognitive development, for example, students' skills to think and understand both oral and written comprehension may be hampered by noise. Many schools in Malaysia experience excessive noise pollution as their locations are very near busy roads. This will be one factor that hinders the implementation of the education system in producing holistic students in order to prepare for the 4IR era. Knowing the importance of this problem, a group of researchers from UTM GREENPrompt, School of Civil Engineering, Universiti Teknologi Malaysia together with industry partners have built a special class called 'Serene Classroom' through a community project to overcome this problem. A classroom on the second floor of Sekolah Kebangsaan Kampong Pasir, Johor Bahru that has traffic noise exposure from the Skudai-Johor Bahru highway was selected for this purpose. The community project is in collaboration with the Johor State Education Department, Ministry of Education Malaysia and industrial partners, such as Vibrant Echo Company, Sanjung Sempurna Sdn. Bhd. and DZAZ Collection. The implementation of the project, the lessons learned from the project and challenges for the implementation are discussed. Technically, Serene classrooms significantly reduce the level of noise pollution for more conducive learning and have received better perceptions from students and teachers. Therefore, hopefully more ‘Serene Classroom’ community projects can be implemented in schools, especially in urban areas affected by high noise levels as a way to reduce the renovation costs on schools

HIGH FREQUENCY (1000 HZ) TYMPANOMETRY AND ACOUSTIC REFLEX FINDINGS IN NEWBORN AND 6-WEEK-OLD INFANTS

Tympanometry and acoustic stapedial reflex (ASR) are routinely used in audiology clinics to assess the functional integrity of the eardrum and middle ear system in humans. Conventional tympanometry (which delivers a probe tone of 226 Hz into the ear canal and measures the mobility of the eardrum as the air pressure in the ear canal is varied) and acoustic reflex testing are effective in detecting middle ear pathologies in children and adults. However, the clinical application of these two tests to infants younger than 7 months has major limitations. In recent years, high frequency tympanometry (HFT) with a probe tone of 1000 Hz has been trialled successfully in young infants (< 7 months) and research on ASRs as they apply to this age group is continuing. Although preliminary HFT data for this population are emerging, there has been no detailed study that describes the effect of age on HFT and ASR results, no clear guideline on ways to interpret the HFT results, and no investigation to measure the feasibility and reliability of the ASR findings. For these reasons, systematic investigation into the use of HFT and ASR measures for evaluating the middle ear function of young infants is warranted. This thesis aimed to: (i) investigate the feasibility of obtaining HFT and ASR findings from newborn and 6-week-old infants, and study the characteristics of the immittance findings in these two age groups; (ii) investigate methods within HFT to measure the middle ear admittance of newborn babies; (iii) establish normative HFT data from healthy newborn babies using the new component compensation method; (iv) examine the test-retest reliability of the ASR test in healthy neonates; and (v) investigate the test-retest reliability of the ASR test in 6-week-old infants. The aims of the thesis were met through five studies. In study one (Chapter 2), a pilot study was conducted to examine the feasibility of performing HFT and ASR in 42 healthy infants and study the characteristics of the immittance findings obtained from these infants using a longitudinal study design. In this pilot study, all infants were tested at birth and then re-tested approximately 6 weeks after the first test. This study confirmed the feasibility of obtaining valid immittance findings from healthy young infants. Most importantly, the findings of this pilot study revealed that the mean values of the majority of HFT parameters and acoustic stapedial reflex threshold (ASRT) obtained at 6 weeks were significantly greater than those obtained at birth, indicating the need to have separate sets of normative data for both tests for newborn and 6-week-old infants. In study 2 (Chapter 3), three different methods to measure middle ear admittance (often described as peak compensated static admittance) in 36 healthy neonates were compared. The three methods were the traditional baseline compensation method (compensated for the susceptance component at 200 daPa pressure) and two new component compensated methods (compensated for both the susceptance and conductance components at 200 daPa and -400 daPa). The results showed that the mean middle ear admittances obtained by compensating for the two components of admittance at a pressure of 200 daPa (YCC200) and -400 daPa (YCC-400) were significantly greater than that using the traditional baseline compensation method (YBC). The higher mean admittance results obtained using the new component compensated methods suggests that the two new methods have the potential to better separate normal from abnormal admittance results. The test-retest reliability of YBC, YCC200 and YCC-400 was investigated, with the result that a lower test-retest reliability was obtained for YCC-400 than for the other two measures. It was, therefore, concluded that the component compensation method compensated at 200 daPa may serve as an alternative method for estimating middle ear admittance, especially in the context of assessing neonates using HFT. In study 3 (Chapter 4), normative data were gathered using the new component compensation method (compensated at 200 daPa) on a group of 157 healthy newborn babies. In addition to the component compensated static admittance (YCC), normative data showing the 90 % ranges for tympanometric peak pressure, admittance at 200 daPa, uncompensated peak admittance, and traditional baseline compensated static admittance (YBC) were established in this study. No gender effect was found on any of the tympanometric measures. In study 4 (Chapter 5), the use of ASR to evaluate middle ear function in neonates was studied. The feasibility of obtaining ipsilateral ASR from neonates by stimulating their ears with a 2 kHz tone and broadband noise (BBN) was demonstrated. ASRs were elicited from 91.3% of 219 full-term normal neonates, while the remaining 8.7% of neonates who had flat tympanograms and no transient evoked otoacoustic emissions did not exhibit ASRs. Good test-retest reliability was demonstrated in the ASRT obtained using both the 2 kHz and BBN stimulus; there was no significant difference between test and retest conditions and intra-correlation coefficients of 0.83 for the 2 kHz tone and 0.76 for the BBN stimulus. In the last study (Chapter 6), the test-retest reliability of ASRT obtained from 70 6-week-old infants was investigated. The methodology described in Chapter 5 was followed. No significant difference in ASRT between test and retest conditions was found for the 2 kHz tone (mean ASRT = 67.3 dB HL versus 67.1 dB HL) and BBN stimulus (mean ASRT = 80.9 dB HL versus 81.6 dB HL). Good test-retest reliability of ASRT with intra-correlation coefficients of 0.78 was found for both the 2 kHz tone and the BBN stimulus. In essence, through achieving the aforementioned aims, the current research program was able to enhance the minimal literature available concerning the use of HFT and ASR testing in young infants. Ultimately, the findings presented in this thesis will inform clinicians of the recent developments in HFT and ASR testing, and assist them in evaluating the middle ear function of young infants with accuracy and confidence

A 10-year retrospective analysis of newborn hearing screening in a tertiary hospital in Malaysia

Abstract Background Universal newborn hearing screening (UNHS) has been widely adopted worldwide as a standard of care because it enables the detection of congenital hearing loss early in life. Therefore, the concepts of regular measurement of performance using pre-determined quality measures are recommended for continuous improvement of the program. This study aimed to evaluate and update the performance of a UNHS program by measuring the recommended quality measures between 2010 and 2019. A retrospective study analyzing data of 50569 babies screened between January 2010 and December 2019 was performed. The pre-determined quality measures of coverage rate, initial referral rate, return to follow-up rate, diagnosis rate, and age at diagnosis were measured. Results The average coverage rate was 95.5%, with all years achieving the recommended benchmark of ≥ 95% except 2014 (91.8%) and 2019 (89.5%). Generally, the initial referral rate (10%) exceeded the benchmark of ≤ 4%. The program only managed to reach the benchmark for initial referral rate in 2013, 2014, and 2015. Both quality indicators for return to follow-up and diagnosis rates also did not meet the ≥ 95% and ≥ 90% standards, respectively. The return to follow-up ranged from 62 to 72.7%, while the average diagnosis rate was 73.4% (60–100%). One hundred thirty-seven infants were diagnosed with hearing loss at a median age of 3.8 months (± 0.4 months), resulting in a prevalence of 0.27%. Conclusion The findings demonstrated an excellent coverage rate but unsatisfactory performance for other quality indicators. Hence, the current program needs to be revisited to remain relevant and effective

A longitudinal analysis of pressurized wideband absorbance measures in healthy young infants

Objectives: Wideband absorbance (WBA) is an emerging technology to evaluate the conductive pathway (outer and middle ear) in young infants. While a wealth of research has been devoted to measuring WBA at ambient pressure, few studies have investigated the use of pressurized WBA with this population. The purpose of this study was to investigate the effect of age on WBA measured under pressurized conditions in healthy infants from 0 to 6 months of age. Design: Forty-four full-term healthy neonates (17 males and 27 females) participated in a longitudinal study. The neonates were assessed at 1-month intervals from 0 to 6 months of age using high-frequency tympanometry, acoustic stapedial reflex, distortion product otoacoustic emissions, and pressurized WBA. The values of WBA at tympanometric peak pressure (TPP) and 0 daPa across the frequencies from 0.25 to 8 kHz were analyzed as a function of age. Results: A linear mixed model analysis, applied to the data, revealed significantly different WBA patterns among the age groups. In general, WBA measured at TPP and 0 daPa decreased at low frequencies

Pressurized wideband absorbance findings in healthy neonates: A preliminary study

Purpose: The present study aimed to establish normative data for wideband absorbance (WBA) measured at tympanometric peak pressure (TPP) and 0 daPa and to assess the test–retest reliability of both measurements in healthy neonates. Method: Participants of this cross-sectional study included 99 full-term neonates (165 ears) with mean chronological age of 46.7 hrs (SD = 26.3 hrs). Of the 99 neonates, 58 were Malay, 28 were Indian, and 13 were Chinese. The neonates who passed high-frequency (1 kHz) tympanometry, acoustic stapedial reflex, and distortion product otoacoustic emission screening tests were assessed using a pressurized WBA test (wideband tympanometry). To reduce the number of measurement points, the WBA responses were averaged to 16 one-third octave frequency bands from 0.25 to 8 kHz. A mixed-model analysis of variance was applied to the data to investigate the effects of frequency, ear, gender, and ethnicity on WBA. The analysis of variance was also used to compare between WBA measured at TPP and 0 daPa. An interclass correlation coefficient test was applied at each of the 16 frequency bands to measure the test–retest reliability of WBA at TPP and 0 daPa. Results: Both WBA measurements at TPP and 0 daPa exhibited a multipeaked pattern with 2 maxima at 1.25–1.6 kHz and 6.3 kHz and 2 minima at 0.5 and 4 kHz. The mean WBA measured at TPP was significantly higher than that measured at 0 daPa at 0.25, 0.4, 0.5, 1.25, and 1.6 kHz only. A normative data set was developed for absorbance at TPP and at 0 daPa. There was no significant effect of ethnicity, gender, and ear on both measurements of WBA. The test–retest reliability of WBA at TPP and 0 daPa was high with the interclass correlation coefficient ranging from 0.77 to 0.97 across the frequencies. Conclusions: Normative data of WBA measured at TPP and 0 daPa for neonates were provided in the present study. Although WBA at TPP was slightly higher than the WBA measured at 0 daPa at some frequencies below 2 kHz, the WBA patterns of the 2 measurements were nearly identical. Moreover, the test–retest reliability of both WBA measurements was high

Measuring Middle Ear Admittance in Newborns Using 1000 Hz Tympanometry: A Comparison of Methodologies

The present study aimed to compare three measures to estimate middle ear admittance in neonates using 1000 Hz tympanometry. Data were obtained from 36 full-term newborns, aged between 24 and 123 hours, who passed a transient evoked otoacoustic emissions test and assessed using a Madsen Otoflex impedance meter. The results showed that the mean middle ear admittances obtained by compensating for the susceptance and conductance components at a pressure of 200 daPa and -400 daPa (Y-CC200 = 1.00 mmho and YCC-400 = 1.24 mmho, respectively) were significantly greater than that using the traditional baseline compensation method (Y-BC = 0.65 mmho). Although Y-CC400 has attained the highest mean value, it has the lowest test-retest reliability. Hence, the component compensation approach compensated at 200 daPa holds promise as an alternative method for estimating middle ear admittance in neonates. Further research to evaluate its test performance using clinical decision theory is required to determine its clinical significance