AN ANALYSIS OF AUDITORY MANIFESTATIONS IN A GROUP OF ADULTS WITH AIDS PRIOR TO ANTIRETROVIRAL THERAPY

The chief objective of the current study was to investigate the auditory status in a group of adults with AIDS before commencing antiretroviral therapy (ART) in a hospital outpatient clinic in Gauteng, South Africa. A total sample of 150 participants, aged between 18 and 50 years, was assessed prospectively following a cross sectional qualitative research design. All participants underwent case history interviews and medical record reviews, otoscopy and tympanometry, as well as conventional pure tone audiometry testing. Descriptive statistics was used to analyse data obtained. Prevalence, type, degree, configuration, and symmetry of the auditory manifestations; as well as type of onset of hearing loss and the possible causes of the auditory manifestations were analysed. Findings indicated that auditory manifestations in adults with AIDS are heterogeneous in nature and are possibly due to various causes. Manifestations including hearing loss, tinnitus and vertigo (in varied combinations) were found; with the types of hearing loss being mainly sensorineural in nature. The severity of hearing loss ranged from mild to severe, occurred either unilaterally or bilaterally; with the type of onset being mainly gradual and progressive in nature. The varied causes of hearing loss included HIV infection or AIDS illness as a primary cause, opportunistic infections, and various ototoxic therapies that the patients had undergone. Implications for future research as well as future assessment and management of patients with AIDS are raised

VESTIBULAR FUNCTION IN A GROUP OF ADULTS WITH HIV/AIDS ON HAART

Background: The high prevalence of HIV/AIDS and the established otological manifestations of the disease have important implications for research into vestibular function in this population. Materials and Methods: The main aim of the current study was to investigate and monitor the vestibular status in a group of adult patients with AIDS receiving Highly Active Antiretroviral Therapy (HAART) and other therapies in a hospital outpatient clinic in Gauteng, South Africa. The study was exploratory and observational in nature, with repeated measures in the form of pre- and post-treatment survey; and a control group. The measures were taken before commencement of antiretroviral therapy (ARVs), three months after initiation of treatment and six months into therapy. A comparison of results of the control group and treatment group was done for all objectives. A total of 150 (104 in the treatment group and 46 in the control group) participants who were recruited through a nonprobability convenience sampling technique were included in the study. All participants were at stage three of HIV/AIDS according to their CD4+ T-cell counts at baseline. Data were analysed through descriptive statistics. Results: Findings from the current study revealed occurrence of acute vertigo which spontaneously resolved in adults with AIDS on HAART over a monitoring period of six months; with this occurrence being higher in participants on HAART than in the control group. The symptoms occurred after diagnosis with HIV and mostly after HAART initiation; and participants who experienced vertigo did not report this to their attending doctor. Furthermore, there was a lack of a relationship between the increasing occurrences of hearing loss in the group to the presentation of vertigo over the six months of monitoring. Conclusion: Findings from the present study which revealed occurrence of possible acute vertigo that spontaneously resolves in adults with AIDS on HAART, over a monitoring period of six months, add to the existing literature on vestibular function in this population. These findings raise important research as well as clinical assessment and management implications in this population

HEARING SCREENING IN A GROUP OF PAEDIATRIC PATIENTS ATTENDING AN HIV/AIDS CLINIC: A PILOT STUDY

The aim of this investigation is to screen hearing function in a group of paediatric patients attending a HIV/AIDS clinic at a hospital in Gauteng, South Africa. There is a dearth of published research in this area, particularly from developing countries. A total of 62 paediatric patients attending a virology clinic at a teaching hospital in Johannesburg participated in the study. The sample included both males and females from ages 18 months to 6 years. An exploratory descriptive, non-experimental and observational design with no control group and non-randomization of participants was used. The participants’ age and medical history were the independent variables, while the audiological tests (otoscopy, tympanometry & otoacoustic emissions) were the dependant variables. Audiological measures that included case history and medical record reviews, otoscopic examination, immittance, as well as otoacoustic emissions testing were conducted on participants. After completing the test measures, each participant was classified as having either pass or refer screening findings. A closer descriptive analysis was then conducted of the participants who presented with refer findings. Both qualitative and quantitative analysis of the data was performed. The estimated prevalence of abnormal hearing screening results among the participants assessed was found to be 26% in the current study. These findings were found at the various stages of the disease, and the symmetry, estimated type and degree of the auditory dysfunction was variable. Furthermore, otitis media was found to be prevalent in 23% of participants and was the most prevalent possible cause of hearing loss in the sample evaluated. These findings highlight the need for audiologists and otolaryngologists’ involvement in the assessment and management of this population

Language and culture in speech-language and hearing professions in South Africa: The dangers of a single story

Background: Speech-language and hearing (SLH) professions in South Africa are facing significant challenges in the provision of clinical services to patients with communication disorders from a context that is culturally and linguistically diverse because of historic exclusions of black and African language speaking candidates in higher education training programmes. Over 20 years post the democratic dispensation, minimal changes have been noted in terms of the training, research as well as clinical service provision in these professions, although the demographic profile of students is seen to be transforming gradually.   Objectives: We offer this viewpoint publication as a challenge to the professions to interrogate their academic and clinical orientation in respect of African contextual relevance and responsiveness.   Method: We do this by identifying gaps within the higher education context, highlighting the influencing factors to the provision of linguistically and culturally appropriate SLH training and clinical services in South Africa, while asking questions about what SLH students and practitioners need to carefully consider.   Results: We make recommendations about what needs to happen within the SLH professions in South Africa in order to stay safe from the dangers of a single story.   Conclusion: We invite debate in order to allow for constructive engagement with this complex issue within the South African SLH professions

Speech-Language Pathology and Audiology in South Africa: Clinical Training and Service in the Era of COVID-19

Introduction and purpose: The novel coronavirus (COVID-19) presented new and unanticipated challenges to the provision of clinical services, from student training to the care of patients with speech-language and hearing (SLH) disorders. Prompt changes in information and communication technologies (ICT), were required to ensure that clinical training continued to meet the Health Professions Council of South Africa’s regulations and patients received effective clinical care. The purpose of this study was to investigate online clinical training and supervision to inform current and future training and clinical care provision in SLH professions. Methodology: A scoping review was conducted using the Arksey and O'Malley (2005) framework. The electronic bibliographic databases Science Direct, PubMed, Scopus, MEDLINE, and ProQuest were searched to identify publications about online clinical training and supervision and their impact on clinical service during COVID-19. Selection and analysis were performed by three independent reviewers using pretested forms. Results and Conclusions: The findings revealed important benefits of teletraining and telepractice with potential application to South African clinical training and service provision. Five themes emerged: (1) practice produces favorable outcomes, (2) appreciation for hybrid models of training and service delivery, (3) cost effectiveness is a “big win” (4) internationalization of remote clinical training and service provision, and (5) comparable modality outcomes. These findings may have significant implications for teletraining and telepractice in low-and-middle income countries (LMICs) in the COVID-19 era and beyond, wherein demand versus capacity challenges (e.g., in human resources) persist. Current findings highlight the need for SLH training programmes to foster a hybrid clinical training model.  Few studies were conducted in LMICs, indicating a gap in such research. &nbsp

Exploration of factors influencing the preservation of residual hearing following cochlear implantation

Background: Increasing access to cochlear implants within the resource-constrained South African context calls for careful investigation of all factors that might influence benefit from this technological advancement. Objective: The aim of this study was to investigate preservation of hearing following cochlear implant surgery and whether a relationship existed between the post-operative hearing findings and certain factors. Methods: Within a quantitative paradigm, a retrospective data review design was adopted where a sample consisting of audiological records from 60 observations and surgical records from two cochlear implant units in South Africa was investigated. These records were selected using purposive sampling and consisted of records from participants ranging from 6 to 59 years. Comparative analysis of unaided audiological test results was pre- and post-operatively performed, where all paitents were implanted with cochlear devices. Factors documented to have a possible influence on post-operative outcomes were examined in an attempt to establish relationships that may exist. Findings were analysed by means of both inferential and descriptive statistics. Results: The findings indicated 92% success rate in preservation of residual hearing. There was a direct correlation between surgical techniques, as well as cochlear implant type and the successful hearing findings, in the absence of surgical complications. Other factors explored did not have any negative effect on the hearing findings. Conclusion: The study findings suggest improved surgical outcomes with enhanced surgical techniques and advanced technology, with a clear negative impact of intraoperative complications on the outcomes

Preservation of residual hearing after cochlear implant sur-gery: Evaluation of residual hearing function in a group of re-cipients in cochlear implant units

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PAEDIATRIC MENINGITIS AND HEARING LOSS IN A DEVELOPING COUNTRY: EXPLORING THE CURRENT PROTOCOLS REGARDING AUDIOLOGICAL MANAGEMENT FOLLOWING MENINGITIS

The purpose of this study was to establish audiology referral protocols for post meningitis paediatric populations in two academic hospitals in Gauteng, South Africa. Specific objectives of this study included determining if audiological assessment referrals were made following infection; determining the time of referral post meningitis diagnosis; establishing what audiological assessments were conducted on this population, as well as determining any correlations between signs and symptoms of meningitis and referrals for audiology assessments. Medical records of 47 children admitted to hospital with a diagnosis of meningitis between the ages of birth and 6 years were reviewed following a retrospective record review design. Data relevant to the current study were obtained from hospital records and this was captured in a data spreadsheet. Both descriptive and inferential statistics were implemented in analysis of the data. Inferential statistics in the form of logistic regression analysis was used to establish any significant factor that may predict referral for audiological assessment. The findings indicated that almost half (40%) of the cases were not referred for audiological services. Of those cases referred for assessment, 89% were referred as in-patients before hospital discharge, with minimal referrals occurring after discharge from hospital. Screening, rather than diagnostic audiology measures were conducted on a majority of the cases. Logistic regression analysis identified fever as the only predictor variable (

Communication and school readiness abilities of children with hearing impairment in South Africa: A retrospective review of early intervention preschool records

Background: The national prevalence of hearing impairment in South Africa is estimated to be four to six in every 1000 live births in the public health care sector. An undetected hearing impairment in childhood can lead to delayed speech and language development as well as put the child at risk of not achieving the necessary school readiness abilities that will enable them to achieve academic success. However, through early hearing detection and intervention services, children with hearing impairment can develop communication and school readiness abilities on par with children with normal hearing. Objective: The aim of the study was to describe communication and school readiness abilities of children who were identified with hearing impairment and enrolled in early intervention (EI) preschools in Gauteng. Methods: Within a descriptive research study design, a retrospective record review was conducted on files of eight children, ranging in age from 9 years and 7 months to 12 years and 7 months, identified with a hearing impairment and enrolled in EI preschools in Gauteng, South Africa. Descriptive statistics were used to analyse the data, using frequency distribution and measures of central tendency. Results: Current findings revealed that children with hearing impairment who were enrolled in EI preschools in Gauteng were identified late. This consequently led to delayed ages at initiation of EI services when compared to international benchmarks and the Health Professions Council of South Africa’s (HPCSA) guidelines of 2018. Consequently, participants presented with below average communication and school readiness abilities, which are characteristic of hearing impairment that is identified late. Conclusions: Transference of current contextually relevant research findings into practice by both the Department of Health and the Department of Basic Education forms part of future directions from this study. This conversion of research findings into service delivery must be conducted in a systematic manner at all levels in these two sectors to facilitate achievement of Early Hearing Detection and Intervention (EHDI), resulting in better communication and school readiness outcomes

Preventive audiology

This book is an original scholarly book that introduces the concept of preventive audiology, with a specific focus on the African context, which is in line with the South African re-engineered primary healthcare strategy as well as the World Health Organisation’s approach. The book reflects on contextually relevant and responsive evidence-based perspectives, grounded in an African context on preventive audiology, in four major ear and hearing burdens of disease within the South African context: (1) early hearing detection and intervention, (2) middle ear pathologies, (3) ototoxicity, and (4) noise-induced hearing loss. The book represents innovative research, seen from both a South African and global perspective. It offers new discourse and argues for a paradigm shift in how audiology is theorised and performed, particularly in low-and-middle-income country contexts. The goal of this book is to motivate a paradigm shift in how the ear and hearing care is approached within this low-and-middle-income country context while arguing for Afrocentric best practice evidence that leads to next practice