Knowledge of and Attitudes Toward Hearing Loss Among Primary Care Physicians in the Public Health Sector of Mauritius

Introduction  Primary care physicians are essential first points of contact for patients with hearing loss. Thus, knowledge of hearing loss and related aspects is essential to ensure the optimal management of individuals with suspected hearing loss. Objective  This study aimed to determine the knowledge of and attitudes toward hearing loss among primary care physicians in the public health sector in Mauritius. Methods  In this cross-sectional descriptive cohort study, 320 primary care physicians completed an online questionnaire adapted from previous questionnaires on knowledge of and attitudes toward hearing loss. Responses were analyzed using descriptive statistics and cross-sectional analyses. Results  Primary care physicians showed limited knowledge of hearing loss in areas such as early identification and intervention, professionals responsible for hearing assessments, and hearing tests used for assessing hearing sensitivity. However, the responses also showed positive attitudes toward hearing loss. Significant associations between knowledge of and attitudes toward hearing loss were obtained regarding the type of physician, length of practice, and department posted in. Ear, nose, and throat specialists, as well as pediatricians, demonstrated significantly higher scores for both knowledge of and positive attitudes toward hearing loss. Conclusions  The findings highlight a strong need for ongoing medical education to spread awareness about hearing loss among primary care physicians in the public health sector of Mauritius.

The public healthcare sector of Mauritius: knowledge of and attitudes toward hearing loss among community health workers

Mauritius does not have community health workers trained in identifying risk factors for hearing loss or in referring patients for diagnostic testing. It is crucial to gather information about the knowledge of and attitudes toward hearing loss among community health workers before involving them in the identification and intervention of hearing loss in Mauritius. To describe the knowledge of and attitudes toward hearing loss among community health workers in Mauritius. A descriptive survey design with quantitative analysis was used. Using non-probability purposive sampling, 125 community health workers which included 94 community health officers and 31 community-based rehabilitation officers were recruited from the five catchment areas of the public healthcare sector. Participants filled in a 15-item paper-based questionnaire on the knowledge of and attitudes toward hearing loss. The questionnaire was internally consistent, with Cronbach alpha scores of 0.759 and 0.863. The overall knowledge of community health workers regarding risk factors and the identification of hearing loss was poor (38.3%). 92.6% of community health workers reported positive attitudes toward hearing loss. General knowledge of hearing loss (P=0.015) and knowledge of risk factors and identification of hearing loss (P=0.005) were significant predictors of attitudes toward hearing loss. Knowledge of and attitudes toward hearing loss were significantly associated with working experience and practice setting (P=0.004). There remains a need to educate community health workers about the risk factors and identification of hearing loss to ensure timely diagnosis and management of hearing loss at the community level.

A Comparison of the Digits-in-Noise Test and Extended High Frequency Response between Formally Trained Musicians and Non-Musicians

Background and Aim: Musical training has been hypothesised to result in enhanced Speech Perception in Noise (SPIN) abilities, but prolonged exposure to music  also  increases  the risk for Music-Induced Hearing Loss (MIHL). The Signal-to-Noise Ratios (SNR) and the Extended High Frequency (EHF) thresholds between formally trained musicians and non- musicians were compared to determine the effect of musical training on musicians’ SPIN and hearing abilities. Methods: This cross-sectional study included 40 musicians and 39 non-musicians 18–30 years, with mean age (SD) 22.43(2.71) years. EHF audiometry and the Digits-in-Noise (DIN) test were conducted via a smartphone. Results: Differences found between the two groups regarding the DIN test and EHF thresholds were statistically insignificant. Musicians displayed early signs of MIHL as the musicians reported significantly more (p=0.004) instances of tinnitus than non-musicians. A statistically significant correlation was found only for the non-musician group between the 12.5 kHz threshold left and the SNR obtained in the diotic listening condition (rs=-0.465; p=0.003). Conclusion: The results suggested that musicians did not display a significant advantage for SPIN and did not appear to have significantly poorer EHF hearing sensitivity. However, slight trends were noticeable in the musicians which gravitated more towards studies that found enhanced SPIN abilities and elevated EHF thresholds in the musician population. In the future, it may be useful to include additional speech tests (open-set) alongside the DIN test (closed-set). The present study suggests that EHF audiometry may be used for the early detection of MIHL. Keywords: Music; audiometry; hearing loss; noise-induced; pitch discrimination; sound localization

The use of the Feather Squadron to identify auditory processing disorders in South African children: a comparative study

OBJECTIVE

Development of the Feather Squadron (FS) has created a cost-effective, accessible form of assessment through tele-audiology. As accessibility to reliable, cost-effective assessment of auditory processing (AP) skills is limited in South Africa (SA), this study aims to establish whether there is correlation between the FS and traditional tests of AP viz. Frequency Pattern and Dichotic Digits Test, and to establish its relevance to the SA population.

DESIGN

Retrospective, within-subject, comparative design used to compare performance on the FS and the traditional tests. Data were considered in two ways: Firstly, using the traditional -2SD cut-off on some subtests of the FS compared to the same traditional tests, and secondly, by comparing the Z-scores obtained on the FS compared to Z-scores on the same traditional tests obtained by applying a double arcsine transformation.

STUDY SAMPLE

Sixty-six subjects (35 males, 31 females) aged between 8.08 and 9.75 years (mean = 8.73; SD = 0.51) seen for AP assessments between 2016 and 2019.

RESULTS

-2SD criteria yielded no significant association (p > 0.05). Z-score comparison suggested a statistically significant correlation (p < 0.05).

CONCLUSION

A statistically significant correlation between certain subtests of FS with traditional tests of AP to merit its use in the SA population is suggested.

Speech perception in noise in children with learning difficulties: A scoping review

BACKGROUND

Children with learning difficulties (LD) face multiple challenges in classrooms settings while having to meet various auditory demands, such as understanding verbal instructions in the presence of background noise. These challenges pose a risk for academic failure, underachievement, and underemployment. Well-developed skills regarding speech perception in noise promote learning, communication, and academic success. These skills need further investigation to promote evidence-based practice and intervention within the audiological and educational fields.

OBJECTIVE

To identify and review published literature on the speech perception in noise abilities of children with LDs.

DESIGN

A systematic search strategy was used to identify literature on five electronic databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Literature from 2011 to 2021 reporting on speech perception in noise in children with LDs was included.

RESULTS

Of 1295 articles identified, five articles met the inclusion criteria and were included in this scoping review. All studies used comparative study designs to determine the speech perception in noise skills of children with LDs. Results indicated that children with LDs have poorer speech perception in noise skills when compared to typically developing children. Trisyllabic words were better perceived in noise than monosyllabic and disyllabic words.

CONCLUSION

Children with LDs require greater signal-to-noise ratios if they are to be given the same academic opportunities as typically developing (TD) children. Future studies can investigate the functional outcomes of children with LDs to promote evidence-based practice and intervention.

Effects of language experience on selective auditory attention and speech-in-noise perception among English second language learners: Preliminary findings

OBJECTIVE

The purpose of the study was to examine the effects of language experience on selective auditory attention and speech-in-noise perception in English Second Language (ESL) learners aged seven to eight years.

METHOD

A quantitative, descriptive, comparative cross-sectional research design was used to determine the effect of age of exposure to English on the selective auditory attention abilities and speech-in-noise perception skills of 40 children with normal hearing in first or second grade (aged seven to eight years). The control group comprised of 20 English first language (EFL) learners (mean age = 7.35 years ±0.49) and the research group included 20 s language learners (mean age = 7.70 years ±0.47). In order to compare the control and research groups with respect to the age of exposure to English through various sources, the Mann Whitney test was used. Information regarding the age of exposure was gathered by a case history questionnaire, completed by the parents/guardians of the participants. The Selective Auditory Attention Test (SAAT) and Digits-in-Noise (DIN) test were performed in one sitting.

RESULTS

No statistically significant differences between the EFL and ESL groups were found for the SAAT and DIN. However, a statistically significant difference was obtained between the SAAT lists 1 and 3 & the DIN: diotic listening condition for the ESL group only (r_s = -0.623; p = 0.003). The difference between the EFL and ESL groups in the mean age of exposure to English was statistically significant (p = 0,019), with mean age of exposure to English in the ESL group (mean age = 2.82 ± 0.53) being higher than the mean age of exposure in the EFL group (mean age = 1.81 ± 1.53). However, this difference did not influence the results of the SAAT and DIN significantly.

CONCLUSION

The main finding was that selective auditory attention and speech-in-noise perception were not significantly affected in the ESL learners who participated in the study - learners who were recruited from private schools located in an urban area and thus from higher socio-economic status (SES) households. There is a need for additional research with a larger sample size to determine the selective auditory attention abilities and speech-in-noise perception skills of ESL learners in government-funded schools located in rural areas and from various socio-economic backgrounds.

Short-term effects of simultaneous cardiovascular workout and personal music device use on the outer hair cell function of young adults

Background: Recreational noise exposure, including personal music device use (PMD), has become a growing public health concern, as it may potentially result in the development of hearing difficulties.Objectives: The aim of the study was to determine the differential impact and short-term effects of simultaneous cardiovascular workout and PMD use on the outer hair cell (OHC) function of young adults.Method: A quantitative research approach was followed. In this study a pre-test post-test approach was used and twelve subjects participated in three 1 h testing conditions with altered variables including: (i) exposure to PMD use in isolation, (ii) exposure to cardiovascular workout in isolation, and (iii) simultaneous exposure to the latter mentioned. Distortion product otoacoustic emissions (DPOAEs) were conducted pree and post exposure for each testing condition as primary indicator of cochlear responses. The process consisted of a cycling procedure through the preset stimulus frequency sequence, measuring the 2f₁—f₂ (75—70 dBSPL) and constructing a plot of DPOAE levels as a function offrequency.Results: Individual testing conditions did not result in statistically significant changes of the DPOAE response, however a significantly different profile in the DPOAE response level increase/decrease for the higher frequencies (6—8 kHz) was obtained when comparing the different sessions. Exposure to cardiovascular workout condition in isolation indicated a clear trend of an increased DPOAE response level between the pre-exposure and post exposuretesting from 2 kHz to 8 kHz with a maximum increase at 6 kHz. Both the music-only condition and the combined condition resulted in a clear trend of decreased DPOAE response amplitudes between the pre-exposure and post-exposure testing for the higher frequencies.Conclusion: Findings support the notion of a clear effect of cardiovascular workout with and without music exposure on the OHC function at higher test frequencies, as measured by DPOAEs. Decreased DPOAE amplitudes between 2 kHz and 8 kHz were observed with music exposure and the opposite effect was observed for cardiovascular workout in isolation.

Deaf or hard of hearing children in Saudi Arabia: Status of early intervention services

OBJECTIVE

This study aims to determine the status of early intervention services provided to children who are deaf or hard of hearing and their parents/caregivers from birth to five years of age at two main state hospitals in Riyadh, Saudi Arabia, based on their parents' perceptions.

METHOD

A descriptive quantitative research design was used to determine the status of early intervention services for deaf or hard of hearing children in Saudi Arabia based on their parents' perceptions. Semistructured interviews based on a questionnaire were conducted with 60 research participants from two main state hospitals where early detection and intervention services are provided. A purposive sampling technique was employed. Descriptive and inferential statistical analyses were performed on the data collected.

RESULTS

The participants' children were diagnosed at a substantially late age, resulting in delayed ages for initial hearing aid fitting and enrolment in early intervention services. A significant relationship was found between the residential area of the participants and timely access to intervention services. The results indicated that participants residing in Riyadh were fitted with hearing aids and enrolled into EI services earlier than those living outside of Riyadh. The delivery of information also emerged as a weakness in the EI system for the majority of participants.

CONCLUSION

The findings of the study suggested that limited services of detection and intervention for deaf or hard of hearing children and residential area of participants are likely to be barriers to early access to intervention services. It is proposed that the benefits of UNHS accompanied by appropriate early intervention services should be made available in all regions throughout Saudi Arabia.

Predictors of pediatric cochlear implantation outcomes in South Africa

OBJECTIVE

To identify and describe predictors of pediatric cochlear implantation outcomes in a South African population.

METHODS

A retrospective study of 301 pediatric cochlear implant (CI) recipients from five CI programs was conducted and cross-sectional outcome data were added at the time of data collection. Twenty potential prognostic factors were identified from the retrospective dataset, including demographical, CI, risk and family factors. Multiple regression analyses were performed to identify predictor variables that influence outcomes in terms of auditory performance (CAP scores), speech production (SIR scores), communication mode and educational placement.

RESULTS

Although implanted children within this sample did not have equal opportunity to access a second implant, bilateral implantation was strongly predictive of better auditory performance and speech production scores, an oral mode of communication and mainstream education. NICU admittance/prematurity were associated with poorer auditory performance and speech production scores, together with a higher probability for non-oral communication and non-mainstream education. The presence of one or more additional developmental condition was predictive of poorer outcomes in terms of speech production and educational placement, while a delay between diagnosis and implantation of more than one year was also related to non-mainstream education. Ethnicities other than Caucasian were predictive of poorer auditory performance scores and a lower probability for mainstream education.

CONCLUSION

An extensive range of prognostic indicators were identified for pediatric CI outcomes in South Africa. These predictive factors of better and poorer outcomes should guide pediatric CI services to promote optimal outcomes and assist professionals in providing evidence-based informational counseling.

Comparison of the South African Spondaic and CID W-1 wordlists for measuring speech recognition threshold

BACKGROUND

The home language of most audiologists in South Africa is either English or Afrikaans, whereas most South Africans speak an African language as their home language. The use of an English wordlist, the South African Spondaic (SAS) wordlist, which is familiar to the English Second Language (ESL) population, was developed by the author for testing the speech recognition threshold (SRT) of ESL speakers.

OBJECTIVES

The aim of this study was to compare the pure-tone average (PTA)/SRT correlation results of ESL participants when using the SAS wordlist (list A) and the CID W-1 spondaic wordlist (list B - less familiar; list C - more familiar CID W-1 words).

METHOD

A mixed-group correlational, quantitative design was adopted. PTA and SRT measurements were compared for lists A, B and C for 101 (197 ears) ESL participants with normal hearing or a minimal hearing loss (<26 dBHL; mean age 33.3).

RESULTS

The Pearson correlation analysis revealed a strong PTA/SRT correlation when using list A (right 0.65; left 0.58) and list C (right 0.63; left 0.56). The use of list B revealed weak correlations (right 0.30; left 0.32). Paired sample t-tests indicated a statistically significantly stronger PTA/SRT correlation when list A was used, rather than list B or list C, at a 95% level of confidence.

CONCLUSIONS

The use of the SAS wordlist yielded a stronger PTA/SRT correlation than the use of the CID W-1 wordlist, when performing SRT testing on South African ESL speakers with normal hearing, or minimal hearing loss (<26 dBHL).

Audiology practice management in South Africa: What audiologists know and what they should know

Background

In future, the South African Department of Health aims to purchase services from accredited private service providers. Successful private audiology practices can assist to address issues of access, equity and quality of health services. It is not sufficient to be an excellent clinician, since audiology practices are businesses that must also be managed effectively.

Objective

The objective was to determine the existing and required levels of practice management knowledge as perceived by South African audiologists.

Method

An electronic descriptive survey was used to investigate audiology practice management amongst South African audiologists. A total of 147 respondents completed the survey. Results were analysed by calculating descriptive statistics. The Z-proportional test was used to identify significant differences between existing and required levels of practice management knowledge.

Results

Significant differences were found between existing and required levels of knowledge regarding all eight practice management tasks, particularly legal and ethical issues and marketing and accounting. There were small differences in the knowledge required for practice management tasks amongst respondents working in public and private settings.

Conclusion

Irrespective of their work context, respondents showed that they need significant expansion of practice management knowledge in order to be successful, to compete effectively and to make sense of a complex marketplace.

Validity of Automated Threshold Audiometry: A Systematic Review and Meta-Analysis

OBJECTIVES

A systematic literature review and meta-analysis on the validity (test-retest reliability and accuracy) of automated threshold audiometry compared with the gold standard of manual threshold audiometry was conducted.

DESIGN

A systematic literature review was completed in peer-reviewed databases on automated compared with manual threshold audiometry. Subsequently a meta-analysis was conducted on the validity of automated audiometry. A multifaceted approach, covering several databases and using different search strategies was used to ensure comprehensive coverage and to cross-check search findings. Databases included: MEDLINE, SCOPUS, and PubMed with a secondary search strategy reviewing references from identified reports. Reports including within-subject comparisons of manual and automated threshold audiometry were selected according to inclusion/exclusion criteria before data were extracted. For the meta-analysis weighted mean differences (and standard deviations) on test-retest reliability for automated compared with manual audiometry were determined to assess the validity of automated threshold audiometry.

RESULTS

In total, 29 reports on automated audiometry (method of limits and the method of adjustment techniques) met the inclusion criteria and were included in this review. Most reports included data on adult populations using air conduction testing with limited data on children, bone conduction testing, and the effects of hearing status on automated audiometry. Meta-analysis test-retest reliability for automated audiometry was within typical test-retest variability for manual audiometry. Accuracy results on the meta-analysis indicated overall average differences between manual and automated air conduction audiometry (0.4 dB; 6.1 SD) to be comparable with test-retest differences for manual (1.3 dB; 6.1 SD) and automated (0.3 dB; 6.9 SD) audiometry. Nosignificant differences (p > 0.01; summarized data analysis of variance) were seen in any of the comparisons between test-retest reliability of manual and automated audiometry compared with differences between manual and automated audiometry.

CONCLUSIONS

Automated audiometry provides an accurate measure of hearing threshold, but validation data are still limited for (a) automated bone conduction audiometry; (b) automated audiometry in children and difficult-to-test populations; and (c) different types and degrees of hearing loss.

Predicting hearing loss from otoacoustic emissions using an artificial neural network

Normal and impaired pure tone thresholds (PTTs) were predicted from distortion product otoacoustic emissions (DP using a feed-forward artificial neural network (ANN) with a back-propagation training algorithm. The ANN used a present and absent DPOAEs from eight DP grams, (2fl -f2 = 406 - 4031 Hz) to predict PTTs at 0.5, 1, 2 and 4 kHz. With normal hearing as < 25 dB HL, prediction accuracy of normal hearing was 94% at 500, 88% at 1000, 88% at 2000 and 93% at 4000 Hz. Prediction of hearing-impaired categories was less accurate, due to insufficient data for the ANN to train on. This research indicates the possibility of accurately predicting hearing ability within 10 dB in normal hearing individuals and in hearing-impaired listeners with DPOAEs and ANNsfrom 500 - 4000 Hz.

Predicting hearing loss from otoacoustic emissions using an artificial neural network

Normal and impaired pure tone thresholds (PTTs) were predicted from distortion product otoacoustic emissions (DPOAEs) using a feed-forward artificial neural network (ANN) with a back-propagation training algorithm. The ANN used a map of present and absent DPOAEs from eight DPgrams, (2f1-f2 = 406-4031 Hz) to predict PTTs at 0.5, 1, 2 and 4 kHz. With normal hearing as < 25 dB HL, prediction accuracy of normal hearing was 94% at 500, 88% at 1000, 88% at 2000 and 93% at 4000 Hz. Prediction of hearing-impaired categories was less accurate, due to insufficient data for the ANN to train on. This research indicates the possibility of accurately predicting hearing ability within 10 dB in normal hearing individuals and in hearing-impaired listeners with DPOAEs and ANNs from 500-4000 Hz.

Speech discrimination by elderly hearing instrument users

This study investigates the influences of aging on the speech discrimination abilities of elderly hearing instrument users. A survey method was used and thirty subjects, with the same degree of peripheral hearing loss, were divided into two groups of fifteen persons each. Group 1 consisted of elderly hearing instrument users who experienced little or no speech discrimination problems while group 2 consisted of persons with severe speech discrimination problems. The Synthetic Sentence Identification test, the Staggered Spondaic Word test and phonemically balanced words with an ipsi-competitive speech noise, were used to ascertain their speech discrimination capabilities in different listening situations. The elderly also completed a self-evaluation scale. The results of the study indicate that the aging process and changes in central auditory processing contribute to the complexity and diversity of elderly hearing instrument user's speech discrimination problems. The results also stress the importance of comprehensive intervention programmes for elderly hearing instrument users.

Spraakdiskriminasie by bejaarde gehoorapparaatgebruikers

In hierdie studie is die invloed van veroudering op die spraakdiskriminasievermoe van bejaarde gehoorapparaatgebruikers ondersoek. 'n Opname-metode is gebruik en dertig proefpersone, met dieselfde graad van perifere gehoorafname, is in twee groepe van vyftien persone elk verdeel. Groep 1 het bestaan uit bejaarde gehoorapparaatgebruikers wat geen of geringe spraakdiskriminasieprobleme ervaar, terwyl Groep 2 ernstige spraakdiskriminasieprobleme ervaar. 'n Verskeidenheid toetse, naamlik die Sintetiese Sinsidentifikasietoets, die Verspringende Spondeewoordtoets en die aanbieding van monosillabiese woorde tesame met 'n ipsi-kompeterende spraakboodskap, is gebruik om hul spraakdiskriminasievermoe in verskillende luistersituasies te bepaal. 'n Selfevaluasieskaal is ook deur die bejaardes voltooi.Die resultate van hierdie studie toon dat die verouderingsproses en die effek hiervan op veral sentrale ouditiewe prosessering, bydra tot die kompleksiteit en uiteenlopendheid van bejaarde gehoorapparaatgebruikers se spraakdiskriminasieprobleme. Die resultate beklemtoon verder die noodsaaklikheid van volledige intervensieprogramme vir bejaarde gehoorapparaatgebruikers.