Enhancing ear and hearing health access for children with technology and connectivity

PURPOSE : Technology and connectivity advances are demonstrating increasing potential to improve access of service delivery to persons with hearing loss. This article demonstrates use cases from community-based hearing screening and automated diagnosis of ear disease. METHOD : This brief report reviews recent evidence for school- and home-based hearing testing in underserved communities using smartphone technologies paired with calibrated headphones. Another area of potential impact facilitated by technology and connectivity is the use of feature extraction algorithms to facilitate automated diagnosis of most common ear conditions from video-otoscopic images. RESULTS : Smartphone hearing screening using calibrated headphones demonstrated equivalent sensitivity and specificity for school-based hearing screening. Automating test sequences with a forced-choice response paradigm allowed persons with minimal training to offer screening in underserved communities. The automated image analysis and diagnosis system for ear disease demonstrated an overall accuracy of 80.6%, which is up to par and exceeds accuracy rates previously reported for general practitioners and pediatricians. CONCLUSION : The emergence of these tools that capitalize on technology and connectivity advances enables affordable and accessible models of service delivery for community-based ear and hearing care.The National Research Foundation (South Africa) for funding part of this research through a Competitive Programme for Rated Researchers (Grant #87757).http://aja.pubs.asha.orghj2017Speech-Language Pathology and Audiolog

Smartphone-based national hearing test launched in South Africa

The hearZA App – South Africa’s National Hearing Test - was launched on World Hearing Day 3 March 2016 (www.hearZA.co.za). More than 3000 people tested their hearing in the first 24 hours on iOS and Android versions of this South African English digits-in-noise test developed and validated at the University of Pretoria (Potgieter et al, 2016). The digits-in-noise test, which is self-administered, is quick and provides a valuable indication of real-life hearing ability – understanding speechin- noise.The hearZA App – South Africa’s National Hearing Test - was launched on World Hearing Day 3 March 2016 (www.hearZA.co.za). More than 3000 people tested their hearing in the first 24 hours on iOS and Android versions of this South African English digits-in-noise test developed and validated at the University of Pretoria (Potgieter et al, 2016). The digits-in-noise test, which is self-administered, is quick and provides a valuable indication of real-life hearing ability – understanding speechin-noise.http://journals.lww.com/thehearingjournal/pages/default.aspx2018-01-31hb2017Speech-Language Pathology and Audiolog

Advancing equitable hearing care through innovations in technology and service-delivery

BACKGROUND : Hearing loss is a neglected global health priority affecting 1.5 billion persons. Global access to hearing care is severely limited with management options, like hearing aids, inaccessible to most. The cost and centralised nature of traditional service-delivery approaches in hearing care have undermined equitable access alongside poor awareness. SUMMARY : Recent innovations in digital and mHealth hearing technologies used by health workers through task shifting are enabling novel community-based services across the continuum of care. This narrative review explores technology-enabled hearing care in communities. We provide examples focused on our work over the past decade to explore more equitable hearing care across primary, secondary, and tertiary levels of prevention. KEY MESSAGES : Hearing health innovations have the potential to increase access to care, improve the quality of life for those affected by hearing loss, and reduce global costs associated with untreated hearing loss. More equitable hearing care is a global health priority that requires scalable service-delivery models enabled by innovative technologies within communities and integrated into public health initiatives including hearing health promotion.https://karger.com/fplhj2023Speech-Language Pathology and Audiolog

Global epidemic of infant hearing loss - priorities for prevention

Paper by : Swanepoel D (2010). The global challenge of infant hearing loss. Sound Foundation Through Early Amplification. Judith Gravel Lecture. Chicago, USA, 8-10 November 2010 as published in the Proceedings of the Fifth International Conference, edited by Richard C. Seewald and John M. BamfordPhonaknf201

Clinical status of the auditory steady-state response in infants

Pediatric audiology has seen the inclusion of the auditory steady-state response (ASSR) in slinical test batteries as a valuable diagnostic tool. Its unique stimuli, recording and analysis characteristics allow for applications not previously possible with other auditory evoked responses in infants and young children. Althought the longstanding research and clinical validation history of the frequency-specific auditory brain stem response (ABR) make it the current gold standard for estimating hearing thresholds, accumulating evidence is establishing the ASSR as a reliable and accurate tool for the diagnosis of hearing loss in infants. Current test-protocol efficiency and accuracy may be improved by including the ASSR to supplement ABR data and to cross-check test results. This article reviews the ASSR and its current clinical applications and limitations for determining hearing thresholds in infants and young children.https://www.thieme-connect.com/ejournals/toc/sihnf201

Speech-perception-in-noise and bilateral spatial abilities in adults with delayed sequential cochlear implantation

Objective: To determine speech-perception-in-noise (with speech and noise spatially distinct and coincident) and bilateral spatial benefits of head-shadow effect, summation, squelch and spatial release of masking in adults with delayed sequential cochlear implants. Study design: A cross-sectional one group post-test-only exploratory design was employed. Eleven adults (mean age 47 years; range 21 – 69 years) of the Pretoria Cochlear Implant Programme (PCIP) in South Africa with a bilateral severe-to-profound sensorineural hearing loss were recruited. Prerecorded Everyday Speech Sentences of The Central Institute for the Deaf (CID) were used to evaluate participants’ speech-in-noise perception at sentence level. An adaptive procedure was used to determine the signal-to-noise ratio (SNR, in dB) at which the participant’s speech reception threshold (SRT) was achieved. Specific calculations were used to estimate bilateral spatial benefit effects. Results: A minimal bilateral benefit for speech-in-noise perception was observed with noise directed to the first implant (CI 1) (1.69 dB) and in the speech and noise spatial listening condition (0.78 dB), but was not statistically significant. The head-shadow effect at 180° was the most robust bilateral spatial benefit. An improvement in speech perception in spatially distinct speech and noise indicates the contribution of the second implant (CI 2) is greater than that of the first implant (CI 1) for bilateral spatial benefit. Conclusion: Bilateral benefit for delayed sequentially implanted adults is less than previously reported for simultaneous and sequentially implanted adults. Delayed sequential implantation benefit seems to relate to the availability of the ear with the most favourable SNR

Asynchronous video-otoscopy with a telehealth facilitator

Objective: The study investigated whether video-otoscopic images taken by a telehealth clinic facilitator are sufficient for accurate asynchronous diagnosis by an otolaryngologist within a heterogeneous population. Subjects and Methods: A within-subject comparative design was used with 61 adults recruited from patients of a primary healthcare clinic. The telehealth clinic facilitator had no formal healthcare training. On-site otoscopic examination performed by the otolaryngologist was considered the gold standard diagnosis. A single video-otoscopic image was recorded by the otolaryngologist and facilitator from each ear, and the images were uploaded to a secure server. Images were assigned random numbers by another investigator, and 6 weeks later the otolaryngologist accessed the server, rated each image, and made a diagnosis without participant demographic or medical history. Results: A greater percentage of images acquired by the otolaryngologist (83.6%) were graded as acceptable and excellent, compared with images recorded by the facilitator (75.4%). Diagnosis could not be made from 10.0% of the video-otoscopic images recorded by the facilitator compared with 4.2% taken by the otolaryngologist. A moderate concordance was measured between asynchronous diagnosis made from video-otoscopic images acquired by the otolaryngologist and facilitator (kappa = 0.596). The sensitivity for video-otoscopic images acquired by the otolaryngologist and the facilitator was 0.80 and 0.91, respectively. Specificity for images acquired by the otolaryngologist and the facilitator was 0.85 and 0.89, respectively, with a diagnostic odds ratio of 41.0 using images acquired by the otolaryngologist and 46.0 using images acquired by the facilitator. Conclusions: A trained telehealth facilitator can provide a platform for asynchronous diagnosis of otological status using video-otoscopy in underserved primary healthcare settings

Online reviews provide insight into consumer satisfaction

Consumer satisfaction is one of the key concepts in health care and refers to how happy our consumers are with the health care services they receive. Reported satisfaction is also an indicator of healthcare quality, specifically as perceived by the end users. The growth and increasing popularity of online review platforms, including Google or Yelp, has meant that consumers can now easily share their experiences with wider audiences, allowing them to assess potential services and reported outcomes.http://journals.lww.com/thehearingjournal/pages/default.aspxhj2022Speech-Language Pathology and Audiolog

Does parental experience of the diagnosis and intervention process differ for children with auditory neuropathy?

OBJECTIVES : This study compared parental experience of the audiological diagnosis and intervention process in children with auditory neuropathy spectrum disorder and sensory neural hearing loss. METHODS : A matched group survey was used with parents of children with auditory neuropathy spectrum disorder (ANSD) matched with a control group of parents and children with sensorineural hearing loss (SNHL). The two groups were matched in terms of the child’s gender, age, amplifications used, social background and utilisation of private or public health care sectors. An interview questionnaire, consisting of 45 questions in six categories (1. biographic information, 2. experiences of audiological diagnosis, 3. hearing aid benefit, 4. parental experience of the rehabilitation decision making process, 5. parental needs for emotional support and 6. parental needs for information) using a 5-point Likert scale for categories 2–7, was administered by the same audiologist. RESULTS : Children with ANSD experienced a significantly longer waiting period from diagnosis to hearing aid fitting (p = 0.025) and/or cochlear implantation (p = 0.036). Parents of children with ANSD reported significantly different experiences of the diagnostic process (p = 0.001) with poorer understanding of the diagnosis and reporting insufficient time allowed for asking questions. During the rehabilitation decision-making process 47% of parents with ANSD children (vs. 0% of parents with SNHL children) reported receiving conflicting information. Parents of children with ANSD were also less likely to recommend hearing aids to other parents. Information needs were similar between groups. CONCLUSIONS : Parents of children with ANSD have different experiences and greater uncertainty during the diagnostic and rehabilitation process. Providing regular consultation and structured timelines through the diagnostic process and decision-making process may facilitate this process with less uncertainty.http://www.elsevier.com/locate/ijporlhb201

Developmental screening in South Africa : comparing the national developmental checklist to a standardized tool

Background: Worldwide, more than 200 million children in low- and middle-income countries have developmental delays and/or disabilities. In South Africa the only nationally implemented developmental 'screening' tool is integrated as part of 'The Road to Health Booklet (RTHB). Method: The study employed a comparative cross-sectional within-subject design to evaluate the accuracy of the RTHB developmental checklist against a standardized international tool i.e. the PEDS tools, consisting of the PEDS and PEDS: DM. A total of 201 participants were included through convenience sampling at primary health care facilities in Tshwane, South Africa. Results: Sensitivity of the RTHB developmental checklist is low, but specificity is high. The RTHB developmental checklist failed to identify more than half the infants at risk of delays or disorders. The nationally implemented developmental checklist is ineffective to identify at-risk infants. It should be adapted and validated or replaced in order to improve identification of at-risk infants