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Altamimi AA, Brennan-Jones CG, Robinson M, Kuthubutheen J, Herbert H, Tran TT, Veselinović T, Edmunds M, Oremulé B, Alenezi EM, Richmond PC, Choi RS, Li I. A hospital-based asynchronous ENT telehealth service for children with otitis media: Cost-minimisation and improved access. J Telemed Telecare 2024:1357633X231223994. [PMID: 38295365 DOI: 10.1177/1357633x231223994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
AIM The purpose of this study is to explore the effectiveness of a hospital-based asynchronous ear, nose, and throat (ENT) telehealth service (the Ear Portal) in reducing cost and improving access for children with otitis media. METHODS Participants were recruited to the Ear Portal from a tertiary hospital ENT waiting list. Ear and hearing assessments were conducted during appointments by the Ear Portal research assistant, and data was stored for an asynchronous review by the Ear Portal multidisciplinary team. A cost-minimisation analysis was conducted for the Ear Portal and the standard care pathways. Waiting times to provide care for both pathways were calculated for children with semi-urgent (i.e. Category 2) and non-urgent (i.e. Category 3) referrals. RESULTS The running cost for the Ear Portal was $67.70 for initial appointments and $37.34 for follow-up appointments. Conversely, the running cost for the standard care pathway was $154.65 for initial appointments and $86.10 for follow-up appointments. A total of 223 appointments were required to offset the initial Ear Portal investment of $19,384.00. The median waiting time for the Ear Portal from initial contact to care plan delivery was <30 days, whereas the median waiting times for children in the standard care pathway were 291 days (interquartile range (IQR) = 117) for Category 2 and 371 days (IQR = 311) for Category 3 referrals. CONCLUSION Under the current circumstances, the Ear Portal service can reduce costs for the health care system by reducing marginal costs per patient in addition to providing ENT specialist care within the clinically recommended timeframes.
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Affiliation(s)
- Ali Ah Altamimi
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- Medical School, The University of Western Australia, Perth, Western Australia
- Faculty of Life Sciences, Kuwait University, Kuwait
| | - Christopher G Brennan-Jones
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- Medical School, The University of Western Australia, Perth, Western Australia
- Perth Children's Hospital, Perth, Western Australia
- School of Allied Health, Curtin University, Perth, Western Australia
| | - Monique Robinson
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
| | - Jafri Kuthubutheen
- Medical School, The University of Western Australia, Perth, Western Australia
- Perth Children's Hospital, Perth, Western Australia
| | - Hayley Herbert
- Medical School, The University of Western Australia, Perth, Western Australia
- Perth Children's Hospital, Perth, Western Australia
| | | | - Tamara Veselinović
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- School of Human Sciences, The University of Western Australia, Perth, Western Australia
| | - Melinda Edmunds
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- School of Allied Health, Curtin University, Perth, Western Australia
| | - Babatunde Oremulé
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Paediatric ENT Department, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Eman Ma Alenezi
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- Medical School, The University of Western Australia, Perth, Western Australia
- Faculty of Allied Health Sciences, Kuwait University, Kuwait
| | - Peter C Richmond
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- Medical School, The University of Western Australia, Perth, Western Australia
- Perth Children's Hospital, Perth, Western Australia
| | - Robyn Sm Choi
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- School of Human Sciences, The University of Western Australia, Perth, Western Australia
| | - Ian Li
- School of Management and Marketing, Curtin University, Perth, Western Australia
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Pokorny MA, Thorne PR, Whitfield BCS, Wilson WJ. Diagnostic and management plan concordance across advanced audiologists, paediatric audiologists and non-specialist ENT doctors. Int J Audiol 2024; 63:69-73. [PMID: 36384388 DOI: 10.1080/14992027.2022.2145515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/30/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare the concordance of advanced audiologists (AA), junior doctors (JD) and paediatric audiologists (PA) with an Ear, Nose and Throat (ENT) specialist on the diagnosis and management of children with middle ear or hearing concerns. DESIGN A clinical equivalence (concordance) study. STUDY SAMPLE Three AAs, five JDs, three PAs and one ENT specialist asynchronously reported diagnoses and management plans for ten, online paediatric cases consisting of video-otoscopic images and clinical findings. RESULTS For medical diagnosis, significant agreement with the ENT specialist was observed at moderate and near-perfect levels for two AAs (k = 0.561 and 0.815), moderate levels for four JDs (k = 0.5 to 0.603) and near-perfect level for one PA (k = 0.815). For management decisions, significant agreement with the ENT specialist was observed at substantial (k = 0.636) and near-perfect (k = 0.818) levels for two AAs, and at a moderate level (k = 0.538) for one PA. Within group inter-rater agreement for management plans was substantial for AAs and JDs, and moderate for PAs. CONCLUSIONS For children with middle ear disease or hearing concerns, AAs, JDs and PAs showed similar levels of agreement with an ENT specialist on diagnosis, but AAs were more likely than JDs or PAs to agree with an ENT specialist on management.
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Affiliation(s)
- Michelle A Pokorny
- Discipline of Audiology, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Peter R Thorne
- Section of Audiology, School of Population Health, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
- Eisdell Moore Centre, University of Auckland, Auckland, New Zealand
| | - Bernard C S Whitfield
- Logan Hospital Integrated Specialist ENT Service, Metro South Health Service District, Queensland Health, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Wayne J Wilson
- Discipline of Audiology, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Downie S, Walsh J, Kirk-Brown A, Haines TP. How can scope of practice be described and conceptualised in medical and health professions? A systematic review for scoping and content analysis. Int J Health Plann Manage 2023; 38:1184-1211. [PMID: 37434288 DOI: 10.1002/hpm.3678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/11/2023] [Accepted: 06/22/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND The term scope of practice (SOP) refers to the limits of a health professional's knowledge, skills and experience and reflects all tasks and activities they undertake within the context of their professional role. Inconsistency in definitions of SOP contributes to uncertainty and confusion regarding professional practice boundaries and potentially impacts societal access to safe, effective and efficient healthcare options. The aim of this paper is to understand the conceptual diversity that may exist in terminology used to describe medical, nursing/midwifery and allied health SOP within an Australian practice context exemplar. METHODS A systematic review for scoping and content analysis of SOP definitions and concepts, involving inductive thematic analysis and synthesis of published and grey literature. RESULTS The initial search strategy yielded 11,863 hits, of which 379 were suitable for inclusion. Data coding identified various SOP terms and definitions and the emergence of six, conceptual elements underpinning the theoretical construct. These were subsequently proposed as a preliminary conceptual model ('Solar') to explain how the six conceptual elements may be applied across various professions, clinical settings and jurisdictions to better understand and address current and evolving SOP issues. CONCLUSION The findings of this study highlight limited consistency in SOP definitions and terminology within a single jurisdiction, and the conceptual complexity of the underlying theoretical construct. Further research is required to build on the proposed 'Solar' conceptual model and create a universal SOP definition across jurisdictions, to enhance understanding of the importance of SOP to workforce policy, clinical governance, service models and patient outcomes.
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Affiliation(s)
- Sharon Downie
- Medical Workforce, The Royal Children's Hospital, Victoria, Australia
- Executive Health Management Program, Monash University, Victoria, Australia
| | - Jill Walsh
- Medical Workforce, The Royal Children's Hospital, Victoria, Australia
- Executive Health Management Program, Monash University, Victoria, Australia
| | - Andrea Kirk-Brown
- Department of Management, Faculty of Business and Economics, Monash University, Victoria, Australia
| | - Terry P Haines
- Head of School, School of Primary and Allied Health Care & National Centre for Healthy Ageing, Monash University, Victoria, Australia
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Alenezi EM, Veselinović T, Tao KF, Altamimi AA, Tran TT, Herbert H, Kuthubutheen J, McAullay D, Richmond PC, Eikelboom RH, Brennan-Jones CG. Ear Portal: An urban-based ear, nose, and throat, and audiology referral telehealth portal to improve access to specialist ear-health services for children. J Telemed Telecare 2023:1357633X231158839. [PMID: 36916156 DOI: 10.1177/1357633x231158839] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Shortage of ear, nose, and throat specialists in public hospitals can result in delays in the detection and management of otitis media. This study introduced a new hospital-based telehealth service, named the Ear Portal, and investigated its role in improving access to specialist care. METHODS The study included 87 children (aged 6 months to 6 years) referred to a tertiary children's hospital due to otitis media-related concerns. A specialist multidisciplinary team met fortnightly to review pre-recorded data and provide care plans. RESULTS The service resulted in a median waiting time of 28 days to receive a diagnosis and care plan by the multidisciplinary team, compared to a mean waiting time of 450 days for a reference group receiving standard healthcare services. Most children (90.3%) received bilateral ear diagnosis. Normal findings were found in 43.9%. However, the majority required further ear, nose, and throat with or without audiology face-to-face follow-up due to a diagnosis of middle-ear disease, unknown hearing status, or concerns not related to ears. The mean time required for clinical assessments completion by research assistants and multidisciplinary team review was 37.6 and 5.1 min per participant, respectively. DISCUSSION Children in the Ear Portal service received a diagnosis and care plan in a median of 28 days, which is within the clinically recommended timeframes. With sufficient clinical information, this service can provide faster access to specialist care than the standard healthcare pathway. The service can reduce the time required by the specialist to provide a diagnosis and care plan which may help increase the specialists' capacity.
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Affiliation(s)
- Eman Ma Alenezi
- Medical School, 2720The University of Western Australia, Perth, WA, Australia.,Ear Health, 117610Telethon Kids Institute, 2720The University of Western Australia, Nedlands, WA, Australia.,Faculty of Allied Health Sciences, Kuwait University, Kuwait
| | - Tamara Veselinović
- Medical School, 2720The University of Western Australia, Perth, WA, Australia.,Ear Health, 117610Telethon Kids Institute, 2720The University of Western Australia, Nedlands, WA, Australia
| | - Karina Fm Tao
- Ear Health, 117610Telethon Kids Institute, 2720The University of Western Australia, Nedlands, WA, Australia.,60081Perth Children's Hospital, Nedlands, WA, Australia
| | - Ali Ah Altamimi
- Medical School, 2720The University of Western Australia, Perth, WA, Australia.,Ear Health, 117610Telethon Kids Institute, 2720The University of Western Australia, Nedlands, WA, Australia.,Faculty of Life Sciences, Kuwait University, Kuwait
| | - Tu Trang Tran
- 60081Perth Children's Hospital, Nedlands, WA, Australia
| | - Hayley Herbert
- Medical School, 2720The University of Western Australia, Perth, WA, Australia.,60081Perth Children's Hospital, Nedlands, WA, Australia
| | - Jafri Kuthubutheen
- Medical School, 2720The University of Western Australia, Perth, WA, Australia.,60081Perth Children's Hospital, Nedlands, WA, Australia
| | - Daniel McAullay
- Medical School, 2720The University of Western Australia, Perth, WA, Australia.,Kurongkurl Katitjin, 2498Edith Cowan University, Joondalup, WA, Australia
| | - Peter C Richmond
- Medical School, 2720The University of Western Australia, Perth, WA, Australia.,Ear Health, 117610Telethon Kids Institute, 2720The University of Western Australia, Nedlands, WA, Australia.,60081Perth Children's Hospital, Nedlands, WA, Australia
| | - Robert H Eikelboom
- Faculty of Health Sciences, Curtin University, Perth, WA, Australia.,Ear Science Institute Australia, Subiaco, WA, Australia.,Centre for Ear Sciences, 2720The University of Western Australia, Nedlands, WA, Australia.,Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Christopher G Brennan-Jones
- Medical School, 2720The University of Western Australia, Perth, WA, Australia.,Ear Health, 117610Telethon Kids Institute, 2720The University of Western Australia, Nedlands, WA, Australia.,60081Perth Children's Hospital, Nedlands, WA, Australia.,Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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Kaur N, Lewis C, Staffieri S, Ruddle J, Goranitis I, Stiles J, Dabscheck G. Cost Analysis of Orthoptist-Led Neurofibromatosis Type 1 Screening Clinics. Br Ir Orthopt J 2023; 19:26-34. [PMID: 37063611 PMCID: PMC10103737 DOI: 10.22599/bioj.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/24/2023] [Indexed: 04/18/2023] Open
Abstract
Purpose To conduct a costing study comparing orthoptist-led with consultant-led clinics screening for optic pathway gliomas (OPGs) in children with neurofibromatosis Type 1 (NF1) attending the Royal Children's Hospital (RCH), Melbourne. Methods Patients with NF1 examined in the orthoptist-led NF1 screening clinic and/or consultant-led clinics during the study period were identified. The workflow management software Q-Flow 6® provided data documenting patient's time spent with the orthoptist, nurse, and ophthalmologist. Time points were converted into minutes and multiplied by the cost-per-minute for each profession. A bottom-up micro-costing approach was used to estimate appointment level costs. Bootstrap simulations with 1000 replications were used to estimate 95% confidence intervals (CIs) for the difference in mean appointment time and cost between clinics. Results Data for 130 consultant-led clinic appointments and 234 orthoptist-led clinic appointments were extracted for analysis. The mean time per appointment for the consultant-led clinic was 45.11 minutes, and the mean time per appointment for the orthoptist-led clinic was 25.85 minutes. The mean cost per appointment for the consultant-led clinic was A $84.15 (GBP £39.60) compared to the orthoptist-led clinic at A $20.40 (GBP £9.60). This represents a mean reduction of 19.25 minutes per appointment (95% CI, -24.85 to -13.66) and a mean reduction of A $63.75 (GBP £30.00) per appointment (95% CI, (A $-75.40 to $-52.10 [GBP £ -35.48 to £ -24.52]). Conclusion An orthoptist-led clinic screening for OPGs in patients with NF1 can be a more cost-efficient model of care for ophthalmic screening in this patient group.
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Affiliation(s)
- Navdeep Kaur
- Department of Ophthalmology, The Royal Children’s Hospital, Victoria, AU
| | - Catherine Lewis
- Department of Ophthalmology, The Royal Children’s Hospital, Victoria, AU
| | - Sandra Staffieri
- Department of Ophthalmology, The Royal Children’s Hospital, Victoria, AU
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, AU
- Murdoch Children’s Research Institute, Melbourne, AU
| | - Jonathan Ruddle
- Department of Ophthalmology, The Royal Children’s Hospital, Victoria, AU
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, AU
| | - Ilias Goranitis
- Murdoch Children’s Research Institute, Melbourne, AU
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, AU
| | - Jay Stiles
- Murdoch Children’s Research Institute, Melbourne, AU
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, AU
| | - Gabriel Dabscheck
- Department of Ophthalmology, The Royal Children’s Hospital, Victoria, AU
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Alenezi EMA, Jajko K, Reid A, Locatelli-Smith A, Tao KFM, Bright T, Richmond PC, Eikelboom RH, Brennan-Jones CG. The reliability of video otoscopy recordings and still images in the asynchronous diagnosis of middle-ear disease. Int J Audiol 2021; 61:917-923. [PMID: 34596478 DOI: 10.1080/14992027.2021.1983217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare the asynchronous assessment of video otoscopic still images to recordings by an audiologist and ear, nose and throat surgeon (ENT) for diagnostic reliability and agreement in identifying middle-ear disease. DESIGN A prospective cross-sectional study, asynchronously assessing video otoscopy, tympanometry and case history (Dx1). A subset was re-diagnosed (Dx2). STUDY SAMPLE Video otoscopy and data from 146 children recruited at two public community events; a sub-set of 47 were re-assessed. RESULTS The intra-rater diagnostic agreement between Dx1 and Dx2 was moderate (k = 0.445-0.552) for the ENT surgeon, and almost-perfect (k = 0.928) for the audiologist, in both procedures. The agreement between the two procedures was substantial (k = 0.624) and moderate (k = 0.416) for the ENT surgeon in Dx1 and Dx2 respectively, and almost-perfect for the audiologist (k = 0.854-0.978) in both rounds. In Dx1, the inter-rater agreement between the clinicians was substantial using still images (k = 0.672) and moderate using recordings (k = 0.593); in Dx2 it was moderate using both procedures (k = 0.477-0.488). CONCLUSION Both video otoscopic procedures, in addition to tympanometry and case history information, can be reliably used for asynchronous diagnosis of childhood middle-ear disease. An audiologist has a potential role in triaging children with middle-ear abnormalities and, therefore, improving access to ear-health services.
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Affiliation(s)
- Eman M A Alenezi
- Division of Paediatrics, The University of Western Australia, Nedlands, Western Australia.,Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia
| | - Kathryn Jajko
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia
| | - Allison Reid
- Division of Ear, Nose, and Throat, Perth Children's Hospital, Perth, Western Australia
| | | | - Karina F M Tao
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia
| | - Tess Bright
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel St, London
| | - Peter C Richmond
- Division of Paediatrics, The University of Western Australia, Nedlands, Western Australia.,Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia.,Division of Ear, Nose, and Throat, Perth Children's Hospital, Perth, Western Australia
| | - Robert H Eikelboom
- Department of Clinical Research, Ear Science Institute Australia, Subiaco, Western Australia.,Ear Sciences Centre, The University of Western Australia, Nedlands, Western Australia.,Department of Speech Language Pathology and Audiology, University of Pretoria, South Africa.,Faculty of Health Sciences, Curtin University, Perth, Western Australia
| | - Christopher G Brennan-Jones
- Division of Paediatrics, The University of Western Australia, Nedlands, Western Australia.,Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia.,Division of Ear, Nose, and Throat, Perth Children's Hospital, Perth, Western Australia.,Faculty of Health Sciences, Curtin University, Perth, Western Australia
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Pokorny MA, Thorne PR, Lee AC, Whitfield BCS, Wilson WJ. Parental satisfaction with an advanced audiology-led triage service in paediatric ENT outpatient clinics. Int J Audiol 2021; 61:159-165. [PMID: 34061705 DOI: 10.1080/14992027.2021.1930207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The advanced audiology-led service is designed to triage and manage children who are referred to Ear Nose and Throat (ENT) outpatient services with middle ear or hearing concerns. This service has resulted in shorter waiting times for children to receive ENT treatment, and improved ENT capacity. The aim of this study was to explore parental satisfaction with the advanced audiology-led ENT service and to determine if there were cultural or process factors affecting satisfaction. DESIGN Prospective cross-sectional study using a modified Visit-Specific Satisfaction Questionnaire (VSQ-9) survey. STUDY SAMPLE One hundred and thirteen parents of children consecutively attending a first appointment in the advanced audiology-led service recruited between October 2016 and October 2017. RESULTS There were a total of 100 valid responses (rate of 88.5%). The survey showed high levels of satisfaction. Satisfaction scores were significantly higher for items related to interactions with the audiologist compared to items related to waiting times. There were no differences in satisfaction across cultural groups. Parents were equally satisfied with the service whether their child was managed independently by the audiologist or required another appointment for medical input. CONCLUSIONS The advanced audiology-led service had high levels of satisfaction from parents attending with their children.
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Affiliation(s)
- Michelle A Pokorny
- Discipline of Audiology, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Peter R Thorne
- Section of Audiology, School of Population Health, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand.,Eisdell Moore Centre, University of Auckland, Auckland, New Zealand
| | - Arier C Lee
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Bernard C S Whitfield
- Logan Hospital Integrated Specialist ENT Service, Metro South Health Service District, Queensland Health, Queensland, Australia
| | - Wayne J Wilson
- Discipline of Audiology, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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