Publications by authors named "De Wet Swanepoel"

154 Publications

Experiences With Hearing Health Care Services: What Can We Learn From Online Consumer Reviews?

Am J Audiol 2021 Sep 7;30(3):745-754. Epub 2021 Sep 7.

Ear Science Institute Australia, Subiaco, Western Australia.

Objective The aim of this study was to examine experiences of hearing health care services as described in online consumer reviews. Design This study used a cross-sectional design. Online consumer reviews about hearing health care services generated from Google.com to an open-ended question "Share details of your own experience at this place" and perceived overall experience (indicated on a 5-point rating scale: "very good" to "very poor") were extracted from 40 different cities across the United States. The open text contributed a text corpus of 9,622 unique consumer reviews. These responses were analyzed with the cluster analysis approach using an open-source automated text analysis software program, IRaMuTeQ, to identify key themes. Association between clusters and consumer experience ratings as well as consumer metadata (percentage of older adults in the city, region) were examined using the chi-square analysis. Results The majority of consumers appeared satisfied with their hearing health care services, with nearly 95% of consumers reporting "very good" and "good" on the global experience scale. The analysis of text responses resulted in seven clusters within two domains. Domain 1 (Clinical Processes) included the three clusters: and Domain 2 (Staff and Service Interactions) included the four clusters: , and . Content relating to was associated with overall rating regarding the hearing health care service experience. Consumer's reviews relating to mostly described negative experiences, and these participants were more inclined to provide poorer overall experience ratings. In addition, city characteristics (i.e., percentage of older adults, region) had bearing toward what elements of hearing health care services are highlighted more in the consumer reviews. Conclusions Consumers comment on a variety of elements when describing their experiences with hearing health care services. Experiences reported in most clusters were generally positive, although some concerns in the "clinical process" are associated with lower satisfaction. Employing patient-centered strategies and ensuring patients have good experiences in the areas of concern may help improve both patient experience and their satisfaction. Supplemental Material https://doi.org/10.23641/asha.16455924.
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http://dx.doi.org/10.1044/2021_AJA-21-00041DOI Listing
September 2021

An analytical method to convert between speech recognition thresholds and percentage-correct scores for speech-in-noise tests.

J Acoust Soc Am 2021 Aug;150(2):1321

Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, Gauteng, South Africa.

Speech-in-noise tests use fixed signal-to-noise ratio (SNR) procedures to measure the percentage of correctly recognized speech items at a fixed SNR or use adaptive procedures to measure the SNR corresponding to 50% correct (i.e., the speech recognition threshold, SRT). A direct comparison of these measures is not possible yet. The aim of the present study was to demonstrate that these measures can be converted when the speech-in-noise test meets specific criteria. Formulae to convert between SRT and percentage-correct were derived from basic concepts that underlie standard speech recognition models. Information about the audiogram is not being used in the proposed method. The method was validated by comparing the direct conversion by these formulae with the conversion using the more elaborate Speech Intelligibility Index model and a representative set of 60 audiograms (r = 0.993 and r = 0.994, respectively). Finally, the method was experimentally validated with the Afrikaans sentence-in-noise test (r = 0.866). The proposed formulae can be used when the speech-in-noise test uses steady-state masking noise that matches the spectrum of the speech. Because pure tone thresholds are not required for these calculations, the method is widely applicable.
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http://dx.doi.org/10.1121/10.0005877DOI Listing
August 2021

Hearing Aid Consumer Reviews: A Linguistic Analysis in Relation to Benefit and Satisfaction Ratings.

Am J Audiol 2021 Sep 26;30(3):761-768. Epub 2021 Aug 26.

Ear Science Institute Australia, Subiaco, Western Australia.

Purpose Online reviews have been used by hearing aid owners to share their experiences and to provide suggestions to potential hearing aid buyers, although they have not been systematically examined. The study was aimed at examining the hearing aid consumer reviews using automated linguistic analysis, and how the linguistic variables relate to self-reported hearing aid benefit and satisfaction ratings. Method The study used a cross-sectional design. One thousand three hundred seventy-eight consumer hearing aid reviews (i.e., text response to open-ended question), self-reported benefit and satisfaction ratings on hearing aids in a 5-point scale with meta-data (e.g., hearing aid brand, technology level) extracted from the Hearing Tracker website were analyzed using automated text analysis method known as the Linguistic Inquiry and Word Count. Results Self-reported hearing aid benefit and satisfaction ratings were high (i.e., mean rating of 4.04 in a 5-point scale). Examining the association between overall rating and the key linguistic variables point to two broad findings. First, the more people were personally, socially, and emotionally engaged with the hearing device experience, the higher they rated their hearing device(s). Second, a minimal occurrence of clinic-visit language dimensions points to factors that likely affect benefit and satisfaction ratings. For example, if people mention paying too much money (money), their overall ratings are generally lower. Conversely, if people write about their health or home, the ratings were higher. There was no significant difference in linguistic analysis across different hearing aid brands and technology levels. Conclusions Hearing aid consumers are generally satisfied with their hearing device(s), and their online reviews contain information about social/emotional dimensions as well as clinic-visit related aspects that have bearing toward hearing aid benefit and satisfaction ratings. These results suggest that the natural language used by consumers provide insights on their perceived benefit/satisfaction from their hearing device.
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http://dx.doi.org/10.1044/2021_AJA-21-00061DOI Listing
September 2021

Speech Recognition in Noise Using Binaural Diotic and Antiphasic Digits-in-Noise in Children: Maturation and Self-Test Validity.

J Am Acad Audiol 2021 05 10;32(5):315-323. Epub 2021 Aug 10.

Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, Gauteng, South Africa.

Background: Digits-in-noise (DIN) tests have become popular for hearing screening over the past 15 years. Several recent studies have highlighted the potential utility of DIN as a school-aged hearing test. However, age may influence test performance in children due to maturation. In addition, a new antiphasic stimulus paradigm has been introduced, allowing binaural intelligibility level difference (BILD) to be measured by using a combination of conventional diotic and antiphasic DIN.

Purpose: This study determined age-specific normative data for diotic and antiphasic DIN, and a derived measure, BILD, in children. A secondary aim evaluated the validity of DIN as a smartphone self-test in a subgroup of young children.

Research Design: A cross-sectional, quantitative design was used. Participants with confirmed normal audiometric hearing were tested with a diotic and antiphasic DIN. During the test, arrangements of three spoken digits were presented in noise via headphones at varying signal-to-noise ratio (SNR). Researchers entered each three-digit spoken sequence repeated by the participant on a smartphone keypad.

Study Sample: Overall, 621 (428 male and 193 female) normal hearing children (bilateral pure tone threshold of ≤ 20 dB hearing level at 1, 2, and 4 kHz) ranging between the ages of 6 and 13 years were recruited. A subgroup of 7-year-olds ( = 30), complying with the same selection criteria, was selected to determine the validity of self-testing.

Data Collection And Analysis: DIN testing was completed via headphones coupled to a smartphone. Diotic and antiphasic DIN speech recognition thresholds (SRTs) were analyzed and compared for each age group. BILD was calculated through subtraction of antiphasic from diotic SRTs. Multiple linear regressions were run to determine the effect of age on SRT and BILD. In addition, piecewise linear regressions were fit across different age groups. Wilcoxon signed-rank tests were used to determine differences between self- and facilitated tests.

Results: Age was a significant predictor, of both diotic and antiphasic DIN SRTs ( < 0.05). SRTs improved by 0.15 dB and 0.35 dB SNR per year for diotic and antiphasic SRTs, respectively. However, age effects were only significant up to 10 and 12 years for antiphasic and diotic SRTs, respectively. Age significantly ( < 0.001) predicted BILD, which increased by 0.18 dB per year. A small SRT advantage for facilitated over self-testing was seen but was not significant ( > 0.05).

Conclusions: Increasing age was significantly associated with improved SRT and BILD using diotic and antiphasic DINs. DIN could be used as a smartphone self-test in young children from 7 years of age with appropriate quality control measures to avoid potential false positives.
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http://dx.doi.org/10.1055/s-0041-1727274DOI Listing
May 2021

International survey of audiologists during the COVID-19 pandemic: use of and attitudes to telehealth.

Int J Audiol 2021 Aug 9:1-10. Epub 2021 Aug 9.

Ear Science Institute Australia, Subiaco, Western Australia, Australia.

Objective: To determine the attitudes of audiologists towards telehealth and use of telehealth for the delivery of ear and hearing services pre-, during- and post- the COVID-19 pandemic, and to identify the perceived effects of telehealth on services and barriers to telehealth.

Design: An online survey distributed through the International Society of Audiology and member societies.

Study Sample: A total of 337 audiologists completing the survey between 23 June and 13 August 2020.

Results: There was a significant increase in the perceived importance of telehealth from before (44.3%) to during COVID-19 (87.1%), and the use of telehealth previous (41.3%), current (61.9%) and expected use of telehealth (80.4%). Telehealth was considered adequate for many audiology services, although hearing assessment and device fitting by telehealth received least support. Matters related to timeliness of services and reduction of travel were reported as the main advantages, but relationships between practitioners and clients may suffer with telehealth. Important barriers were technologies related to the client or remote site; clinic-related items were moderate barriers, although more clinician training was a common theme provided through open-ended responses.

Conclusion: The COVID-19 pandemic has resulted in audiologists having a more positive attitude towards and greater use of telehealth, but with some reservations.
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http://dx.doi.org/10.1080/14992027.2021.1957160DOI Listing
August 2021

Online Consumer Reviews on Hearing Health Care Services: A Textual Analysis Approach to Examine Psychologically Meaningful Language Dimensions.

Am J Audiol 2021 Sep 23;30(3):669-675. Epub 2021 Jul 23.

Ear Science Institute Australia, Subiaco, Western Australia.

Purpose The study examined psychologically meaningful language dimensions (i.e., social and emotional dimensions, health dimensions, and personal concerns) within online consumer reviews on hearing health care services using an automated textual analysis approach. Method Nine thousand six hundred twenty-two consumer reviews of hearing health care services, including an open-ended question (i.e., free text response to the prompt "share details of your own experience at this place") and an overall rating (on a 5-point scale ranging from "very good" to "very poor") were extracted from Google.com from 40 different cities across the United States. In addition, some metadata about the cities (i.e., region, population size, median age, percentage of older adults) were also recorded. Text responses were analyzed using the automated Linguistic Inquiry and Word Count software for selected language dimensions. The language dimensions of online hearing health care reviews were descriptively compared with language dimensions observed in the natural language of typical bloggers. Language dimensions from free text responses were correlated with quantitative overall experience ratings. Results Automated linguistic analysis showed that consumer reviews on hearing health care services had higher social processes, positive emotions, hearing, health, money, and work, and lower negative emotions and time-awareness when compared to typical bloggers. Examining the association between overall experience rating and the language dimensions revealed two broad findings. First, higher engagement of consumers in terms of social processes, positive emotions, hearing, and work dimensions was related to higher experience ratings. Second, higher engagement of consumers in terms of negative emotions, time awareness, and money was related to lower experience ratings. Conclusions Online reviews contain information about various dimensions (i.e., social and emotional dimensions as well as personal concerns) that have bearing toward the way in that they rate their health care experiences. Automated linguistic analysis of consumer reviews appears helpful in identifying gaps in service delivery that may influence consumer experience.
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http://dx.doi.org/10.1044/2021_AJA-20-00223DOI Listing
September 2021

International survey of audiologists during the COVID-19 pandemic: effects on the workplace.

Int J Audiol 2021 Jun 17:1-8. Epub 2021 Jun 17.

Ear Science Institute Australia, Subiaco, Western Australia, Australia.

Objective: This study surveyed the effects of the COVID-19 pandemic on the audiology workplace.

Design: The study used a cross-sectional survey design for audiologists across the globe ( = 337) using an online survey (June-August 2020) focussing on changes to the workplace during the pandemic.

Results: Participants represented varied work settings and audiology services. Only a third (31.5%) provided psychosocial support, which may be important during the pandemic, as part of their services. Almost all (97%) audiologists reported changes to their workplace, with 76.4% reporting reduced caseloads during the COVID-19 pandemic. When rating their current and anticipated work conditions, 38.7% reported reduced working hours although only 13.8% anticipated reduced working hours in 6-months' time. Audiologists ranked services such as access to hearing assessment, hearing device adjustment and maintenance, and general audiological support as being more important during the pandemic than services such as psychosocial, emotional and tinnitus support.

Conclusions: The COVID-19 pandemic has resulted in significant disruptions to audiological practice that highlights the need to adapt and incorporate new audiological practices including telehealth, to ensure patients have continued access to care and clinics remain sustainable during the ongoing COVID-19 pandemic and recovery phase.
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http://dx.doi.org/10.1080/14992027.2021.1937348DOI Listing
June 2021

Hearing aid acquisition and ownership: what can we learn from online consumer reviews?

Int J Audiol 2021 Jun 13:1-10. Epub 2021 Jun 13.

Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA.

Objective: To explore the publicised opinions of consumers actively participating in online hearing aid reviews.

Design: A retrospective design examining data generated from an online consumer review website (www.HearingTracker.com). Qualitative data (open text responses) were analysed using the open source automated topic modelling software IRaMuTeQ (http://www.iramuteq.org/) to identify themes. Outputs were compared with quantitative data from the consumer reviews (short response questions exploring hearing aid performance and benefit, and some meta-data such as hearing aid brand and years of hearing aid ownership).

Study Sample: 1378 online consumer hearing aid reviews.

Results: Six clusters within two domains were identified. The domain Device Acquisition included three clusters: The domain Device Use included three clusters: ; and .

Conclusions: Although online hearing aid consumers indicate positive performance on multiple-choice questions relating to hearing aid performance and benefit, their online reviews describe a number of barriers limiting their success. Hearing healthcare clinicians must employ a personalised approach to audiological rehabilitation to ensure individual clients' needs are met.
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http://dx.doi.org/10.1080/14992027.2021.1931487DOI Listing
June 2021

Referral Criteria for Preschool Hearing Screening in Resource-Constrained Settings: A Comparison of Protocols.

Lang Speech Hear Serv Sch 2021 07 1;52(3):868-876. Epub 2021 Jun 1.

Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.

Purpose This study aimed to describe and compare the performance of two screening protocols used for preschool hearing screening in resource-constrained settings. Method Secondary data analysis was done to determine the performance of two protocols implemented during a preschool hearing screening program using mobile health technology in South Africa. Pure-tone audiometry screening at 25 dB HL for 1000, 2000, and 4000 Hz in each ear was used by both protocols. The fail criterion for the first protocol (2,147 children screened) constituted a no-response on one or more frequencies in either ear. The second protocol required two or more no-responses (5,782 children). Multivariate logistic regression models were used to investigate associations between outcomes and protocol, age, gender, and duration. Results Fail rates for the one-frequency fail protocol was 8.7% ( = 186) and 4.3% ( = 250) for the two-frequency fail protocol. Children screened with the two-frequency fail protocol were 52.9% less likely to fail ( < .001; = 0.471; 95% confidence interval [0.385, 0.575]). Gender ( = .251) and age ( = .570) had no significant effect on screening outcome. A percentage of cases screened (44.7%) exceeded permissible noise levels in at least one ear at 1000 Hz across both protocols. True- and false-positive cases did not differ significantly between protocols. Protocol type ( = .204), gender ( = .314), and age ( = .982) did not affect the odds of being a true-positive result. Average screening time was 72.8 s (78.66 ) and 64.9 s (55.78 ) for the one-frequency and two-frequency fail protocols, respectively. Conclusions A two-frequency fail criterion and immediate rescreen of failed frequencies significantly reduced referral rate for follow-up services that are often overburdened in resourced-constrained settings. Future protocol adaptations can also consider increasing the screening levels at 1000 Hz to minimize the influence of environmental noise.
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http://dx.doi.org/10.1044/2021_LSHSS-21-00008DOI Listing
July 2021

Predictors of hearing technology use in children.

Int J Audiol 2021 May 13:1-8. Epub 2021 May 13.

Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa.

Objective: To identify and describe predictors of daily hearing technology (HT) use in children.

Design: Retrospective review of clinical records. Multiple regression analyses were performed to identify predictors.

Study Sample: The sample included 505 children (<11 years of age) using hearing aids (HAs), cochlear implants (CIs), and bone conduction hearing devices (BCHDs).

Results: Average HT use was 9.4 h a day. Bivariate analyses yielded 31 potential predictors from the 42 variables included. The general linear model ( < 0.01, = 0.605) identified 10 interacting factors that significantly associated with increased HT use. Intrinsic predictors of increased HT use included older chronological age, more severe degrees of hearing loss and older ages at diagnosis and initial HA fitting. Extrinsic predictors included the child's ability to independently use HT, at least one CI as part of the HT fitting, coordinated onsite audiological management, self-procured batteries, auditory-oral communication mode and regular caregiver intervention attendance.

Conclusions: Average HT use was high, approximating hearing hours of peers with normal hearing. CI recipients demonstrated higher HT use compared to children using other HT. The newly identified factors can predict and increase HT use in children while contributing to evidence-based intervention services that promote optimal auditory-based outcomes.
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http://dx.doi.org/10.1080/14992027.2021.1913521DOI Listing
May 2021

Sound-level Monitoring Earphones With Smartphone Feedback as an Intervention to Promote Healthy Listening Behaviors in Young Adults.

Ear Hear 2021 Mar 29;42(5):1173-1182. Epub 2021 Mar 29.

Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa.

Objectives: More than a billion adolescents and youngsters are estimated to be at risk of acquiring recreational noise-induced hearing loss (RNIHL) due to the unsafe use of personal audio systems. RNIHL is preventable; therefore, the present study aimed to determine (i) the accuracy and reliability of dbTrack (Westone) sound-level monitoring earphones and (ii) the effect of sound-level monitoring earphones with smartphone feedback and hearing-health information as an intervention to promote healthy listening behaviors in young adults.

Design: The study consisted of two phases: the first phase investigated the accuracy and reliability of dbTrack sound-level monitoring earphones. Accuracy was determined by comparing earphone measurements to sound level meter measurements. Intradevice reliability was determined by comparing earphone measurements during test-retest conditions. Nineteen participants were recruited through convenience sampling to determine within-subject reliability by comparing in-ear sound levels measured by the earphones during test-retest conditions. For the second phase of the study, a single-group pretest-posttest design was utilized. Forty participants, recruited through snowball sampling, utilized the sound-level monitoring earphones with the accompanying dbTrack smartphone application for 4 weeks. The application's smartphone feedback was disabled during the first 2 weeks (pretest condition) and enabled during the last 2 weeks (posttest condition). Average daily intensities, durations, and sound dosages measured during pre- and posttest conditions were compared.

Results: Phase 1 dbTrack earphone measurements were within 1 dB when compared with sound level meter measurements. Earphones were also within 1 dB in repeated measures across earphones and across participants. Phase 2 posttest average daily intensity decreased by 8.7 dB (18.3 SD), duration decreased by 7.6 minutes (46.6 SD), and sound dose decreased by 4128.4% (24965.5% SD). Differences in intensity and sound dose were significantly lower with a small and medium effect size, respectively.

Conclusions: This study's preliminary data indicate that dbTrack (Westone) sound-level monitoring earphones with a calibrated in-ear microphone can reliably and accurately measure personal audio systems sound exposure. Preliminary results also suggest that feedback on sound exposure using the accurate sound-level monitoring earphones with the accompanying dbTrack application can potentially promote safe listening behavior in young adults and reduce the risk of acquiring an RNIHL.
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http://dx.doi.org/10.1097/AUD.0000000000001029DOI Listing
March 2021

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

Ear Hear 2013 05 31. Epub 2013 May 31.

Department of Communication Pathology, University of Pretoria, Pretoria, South Africa.

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.
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http://dx.doi.org/10.1097/AUD.0b013e3182944bdfDOI Listing
May 2013

Improved Sensitivity of Digits-in-Noise Test to High-Frequency Hearing Loss.

Ear Hear 2020 09 22;42(3):565-573. Epub 2020 Sep 22.

Communication Sciences Research Center, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.

Objectives: Hearing loss is most commonly observed at high frequencies. High-frequency hearing loss (HFHL) precedes and predicts hearing loss at lower frequencies. It was previously shown that an automated, self-administered digits-in-noise (DIN) test can be sensitized for detection of HFHL by low-pass filtering the speech-shaped masking noise at 1.5 kHz. This study was designed to investigate whether sensitivity of the DIN to HFHL can be enhanced further using low-pass noise filters with higher cutoff frequencies.

Design: The US-English digits 0 to 9, homogenized for audibility, were binaurally presented in different noise maskers including one broadband and three low-pass (cutoff at 2, 4, and 8 kHz) filtered speech-shaped noises. DIN-speech reception thresholds (SRTs) were obtained from 60 normal hearing (NH), and 40 mildly hearing impaired listeners with bilateral symmetric sensorineural hearing loss. Standard and extended high-frequency audiometric pure-tone averages (PTAs) were compared with the DIN-SRTs.

Results: Narrower masking noise bandwidth generally produced better (more sensitive) mean DIN-SRTs. There were strong and significant correlations between SRT and PTA in the hearing impaired group. Lower frequency PTALF 0.5,1, 2, 4 kHz had the highest correlation and the steepest slope with SRTs obtained from the 2-kHz filter. Higher frequency PTAHF 4,8,10,12.5 kHz correlated best with SRTs obtained from 4- and 8-kHz filtered noise. The 4-kHz low-pass filter also had the highest sensitivity (92%) and equally highest (with the 8-kHz filter) specificity (90%) for detecting an average PTAHF of 20 dB or more.

Conclusions: Of the filters used, DIN sensitivity to higher frequency hearing loss was greatest using the 4-kHz low-pass filter. These results suggest that low-pass filtered noise may be usefully substituted for broadband noise to improve earlier detection of HFHL using DIN.
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http://dx.doi.org/10.1097/AUD.0000000000000956DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087866PMC
September 2020

Listening Effort in School-Age Children With Normal Hearing Compared to Children With Limited Useable Hearing Unilaterally.

Am J Audiol 2021 Jun 22;30(2):309-324. Epub 2021 Apr 22.

Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.

Objectives Children with limited hearing unilaterally might experience more listening effort than children with normal hearing, yet previous studies have not confirmed this. This study compared listening effort in school-age children with normal hearing and children with limited hearing unilaterally using behavioral and subjective listening effort measures. Design Two groups of school-age children (aged 7-12 years) participated: 19 with limited hearing unilaterally and 18 with normal hearing bilaterally. Participants completed digit triplet recognition tasks in quiet and in noise (-12 dB SNR) in three loudspeaker conditions: midline, direct, and indirect. Verbal response times during the recognition task were interpreted as behavioral listening effort. Subjective ratings of "task difficulty" and "hard to think" were interpreted as subjective listening effort. Participant age was included as a covariate in analysis of behavioral data. Results Noise negatively affected digit triplet recognition for both groups in the midline loudspeaker condition and for participants with limited hearing unilaterally in the direct and indirect conditions. Relative to their peers with normal hearing, children with limited hearing unilaterally exhibited significantly longer response times and higher ratings of effort only in the noisy, indirect condition. Differences between groups were evident even when age differences were controlled for statistically. Conclusions Using behavioral and subjective indices of listening effort, children with limited unilateral hearing demonstrated significantly more listening effort relative to their peers with normal hearing during the difficult indirect listening condition. Implications include classroom accommodations to limit indirect listening situations for children with limited useable hearing unilaterally and consideration of intervention options.
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http://dx.doi.org/10.1044/2021_AJA-20-00082DOI Listing
June 2021

ENT from afar: Opportunities for remote patient assessment, clinical management, teaching and learning.

Clin Otolaryngol 2021 Jul 5;46(4):689-691. Epub 2021 May 5.

Division of Otolaryngology, University of Cape Town, Cape Town, South Africa.

Remote communication in ENT has been expanding, spurred by the COVID-19 pandemic. Conferences and teaching have moved online, enabling easier participation and reducing financial and environmental costs. Online multi-disciplinary meetings have recently been instigated in Africa to discuss management of cases in head and neck cancer, or cochlear implantation, expanding access and enhancing patient care. Remote patient consultation has also seen an explosion, but existing literature suggests some caution, particularly because many patients in ENT need an examination to enable definitive diagnosis. Ongoing experience will help us to better understand how remote communication will fit into our future working lives, and also where face-to-face interaction may still be preferable.
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http://dx.doi.org/10.1111/coa.13784DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250515PMC
July 2021

Validation of teleaudiology hearing aid rehabilitation services for adults: a systematic review of outcome measurement tools.

Disabil Rehabil 2021 Mar 31:1-18. Epub 2021 Mar 31.

Ear Sciences Centre, Medical School, The University of Western Australia, Perth, Australia.

Purpose: To investigate outcome measurement tools for the validation of teleaudiology hearing aid rehabilitation services for adults.

Methods: A search strategy was developed to identify tools used to evaluate standard and teleaudiology hearing aid rehabilitation services for adults. A seven-domain hearing-health-care service model for validation was defined and used to analyse the applicability and suitability of patient- and service-centred tools. This model and the applicability and suitability criteria were based on the literature, the International Classification of Functioning (ICF) framework, and gold standard professional practice guidelines, which together formed the validation framework used in this study.

Results: Eighteen tools were identified and assessed against the validation framework. These tools were found to primarily assess aspects in the patient communication domain and rarely in the domain of service provision. All the included tools had some applicable items for teleaudiology hearing aid services; three tools were judged as suitable and four partially suitable for validating these services.

Conclusion: Although there is a set of suitable tools available to validate teleaudiology hearing aid rehabilitation services, none of them cover all the seven domains of the validation model used by this review and few are focussed on a specific domain. Further improvement and/or development of new tools to comprehensively validate these services is still necessary. At this stage, this still limits clinical audiology practice research, especially in teleaudiology.IMPLICATIONS FOR REHABILITATIONOutcome measurement tools are crucial for assessing the validity of hearing rehabilitation services.Findings of this study inform clinicians and researchers on how and what to assess and use to evaluate teleaudiology and standard hearing aid rehabilitation services.The use of the proposed validation framework may facilitate the standardisation of validation of both face-to-face and remotely delivered audiology rehabilitation services and improve consistency of methodology and reported real-world outcomes across studies and thus, the evidence.
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http://dx.doi.org/10.1080/09638288.2021.1900928DOI Listing
March 2021

Computational Audiology: New Approaches to Advance Hearing Health Care in the Digital Age.

Ear Hear 2021 Mar 4. Epub 2021 Mar 4.

Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center Nijmegen, the Netherlands Department of Pathology, Radboud University Medical Center Nijmegen, the Netherlands Center for Medical Image Science and Visualization, Linköping University, Sweden The Eargroup, Antwerp, Belgium Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Department of Otolaryngology, University of Cincinnati, Cincinnati, Ohio, USA Manchester Centre for Audiology and Deafness, University of Manchester, Manchester, United Kingdom Department of Biomedical Engineering. Washington University in St. Louis, St. Louis, Missouri, USA.

The global digital transformation enables computational audiology for advanced clinical applications that can reduce the global burden of hearing loss. In this article, we describe emerging hearing-related artificial intelligence applications and argue for their potential to improve access, precision, and efficiency of hearing health care services. Also, we raise awareness of risks that must be addressed to enable a safe digital transformation in audiology. We envision a future where computational audiology is implemented via interoperable systems using shared data and where health care providers adopt expanded roles within a network of distributed expertise. This effort should take place in a health care system where privacy, responsibility of each stakeholder, and patients' safety and autonomy are all guarded by design.
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http://dx.doi.org/10.1097/AUD.0000000000001041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8417156PMC
March 2021

Listening Effort in School-Aged Children With Limited Useable Hearing Unilaterally: Examining the Effects of a Personal, Digital Remote Microphone System and a Contralateral Routing of Signal System.

Trends Hear 2021 Jan-Dec;25:2331216520984700

Department of Speech-language Pathology and Audiology, University of Pretoria, Pretoria, South Africa.

Technology options for children with limited hearing unilaterally that improve the signal-to-noise ratio are expected to improve speech recognition and also reduce listening effort in challenging listening situations, although previous studies have not confirmed this. Employing behavioral and subjective indices of listening effort, this study aimed to evaluate the effects of two intervention options, remote microphone system (RMS) and contralateral routing of signal (CROS) system, in school-aged children with limited hearing unilaterally. Nineteen children (aged 7-12 years) with limited hearing unilaterally completed a digit triplet recognition task in three loudspeaker conditions: midline, monaural direct, and monaural indirect with three intervention options: unaided, RMS, and CROS system. Verbal response times were interpreted as a behavioral measure of listening effort. Participants provided subjective ratings immediately following behavioral measures. The RMS significantly improved digit triplet recognition across loudspeaker conditions and reduced verbal response times in the midline and indirect conditions. The CROS system improved speech recognition and listening effort only in the indirect condition. Subjective ratings analyses revealed that significantly more participants indicated that the remote microphone made it easier for them to listen and to stay motivated. Behavioral and subjective indices of listening effort indicated that an RMS provided the most consistent benefit for speech recognition and listening effort for children with limited unilateral hearing. RMSs could therefore be a beneficial technology option in classrooms for children with limited hearing unilaterally.
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http://dx.doi.org/10.1177/2331216520984700DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903353PMC
April 2021

The World Report on Hearing - a new era for global hearing care.

Int J Audiol 2021 Mar 11;60(3):161. Epub 2021 Feb 11.

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http://dx.doi.org/10.1080/14992027.2021.1881318DOI Listing
March 2021

Community-Based Hearing and Vision Screening in Schools in Low-Income Communities Using Mobile Health Technologies.

Lang Speech Hear Serv Sch 2021 04 26;52(2):568-580. Epub 2021 Jan 26.

Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.

Introduction Globally, more than 50 million children have hearing or vision loss. Most of these sensory losses are identified late due to a lack of systematic screening, making treatment and rehabilitation less effective. Mobile health (mHealth), which is the use of smartphones or wireless devices in health care, can improve access to screening services. mHealth technologies allow lay health workers (LHWs) to provide hearing and vision screening in communities. Purpose The aim of the study was to evaluate a hearing and vision school screening program facilitated by LHWs using smartphone applications in a low-income community in South Africa. Method Three LHWs were trained to provide dual sensory screening using smartphone-based applications. The hearScreen app with calibrated headphones was used to conduct screening audiometry, and the Peek Acuity app was used for visual acuity screening. Schools were selected from low-income communities (Gauteng, South Africa), and children aged between 4 and 9 years received hearing and vision screening. Screening outcomes, associated variables, and program costs were evaluated. Results A total of 4,888 and 4,933 participants received hearing and vision screening, respectively. Overall, 1.6% of participants failed the hearing screening, and 3.6% failed visual acuity screening. Logistic regression showed that female participants were more likely to pass hearing screening ( = 1.61, 95% CI [1.11, 2.54]), while older children were less likely to pass visual acuity screening ( = 0.87, 95% CI [0.79, 0.96]). A third (32.5%) of referred cases followed up for air-conduction threshold audiometry, and one in four (25.1%) followed up for diagnostic vision testing. A high proportion of these cases were confirmed to have hearing (73.1%, 19/26) or vision loss (57.8%, 26/45). Conclusions mHealth technologies can enable LHWs to identify school-age children with hearing and/or vision loss in low-income communities. This approach allows for low-cost, scalable models for early detection of sensory losses that can affect academic performance.
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http://dx.doi.org/10.1044/2020_LSHSS-20-00089DOI Listing
April 2021

Is Phonological Awareness Related to Pitch, Rhythm, and Speech-in-Noise Discrimination in Young Children?

Lang Speech Hear Serv Sch 2021 01 2;52(1):383-395. Epub 2020 Dec 2.

Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.

Purpose Phonological awareness (PA) requires the complex integration of language, speech, and auditory processing abilities. Enhanced pitch and rhythm discrimination have been shown to improve PA and speech-in-noise (SiN) discrimination. The screening of pitch and rhythm discrimination, if nonlinguistic correlates of these abilities, could contribute to screening procedures prior to diagnostic assessment. This research aimed to determine the association of PA abilities with pitch, rhythm, and SiN discrimination in children aged 5-7 years old. Method Forty-one participants' pitch, rhythm, and SiN discrimination and PA abilities were evaluated. To control for confounding factors, including biological and environmental risk exposure and gender differences, typically developing male children from high socioeconomic statuses were selected. Pearson correlation was used to identify associations between variables, and stepwise regression analysis was used to identify possible predictors of PA. Results Correlations of medium strength were identified between PA and pitch, rhythm, and SiN discrimination. Pitch and diotic digit-in-noise discrimination formed the strongest regression model (adjusted = .4213, = .649) for phoneme-grapheme correspondence. Conclusions The current study demonstrates predictive relationships between the complex auditory discrimination skills of pitch, rhythm, and diotic digit-in-noise recognition and foundational phonemic awareness and phonic skills in young males from high socioeconomic statuses. Pitch, rhythm, and digit-in-noise discrimination measures hold potential as screening measures for delays in phonemic awareness and phonic difficulties and as components of stimulation programs.
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http://dx.doi.org/10.1044/2020_LSHSS-20-00032DOI Listing
January 2021

Developmental Risks in Vulnerable Children from a Low-Income South African Community.

Matern Child Health J 2021 Apr 2;25(4):590-598. Epub 2021 Jan 2.

Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, 0001, South Africa.

Objective: To describe the developmental risks, and its influence, in young children from a low-income South African community.

Method: An exploratory, cross-sectional research study design was employed. Developmental screening was conducted during home visits with 126 caregivers and children between 0 and 42 months of age from a low-income South African community. Children who failed the rescreen were referred for diagnostic assessment. A binomial logistic regression was used to determine the effect of developmental risks on developmental outcomes.

Results: Seventy-three percent of children screened were identified with a possible developmental delay (n = 59) according to caregiver-report using the PEDS tools. The regression model was statistically significant (χ (3) = 34.902, p < 0.001) with exposure to multiple languages (p < 0.05; odds ratio 3.810, CI 1.2-12.4) most indicative of potential developmental delay. Older children (19-42 months) were also more at risk of developmental delay (p < 0.001) than younger children (0-18 months).

Conclusions For Practice: Healthcare professionals serving these vulnerable populations should create awareness amongst caregivers about the effect of developmental risks, in particularly multiple language exposure, on development.
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http://dx.doi.org/10.1007/s10995-020-03111-1DOI Listing
April 2021

Validation of the Brief International Classification of Functioning, Disability and Health (ICF) core set for hearing loss: an international multicentre study.

Int J Audiol 2021 Jun 18;60(6):412-420. Epub 2020 Nov 18.

Faculty of Medicine and Health, Audiological Research Centre, Örebro University, Örebro, Sweden.

Objective: Hearing loss (HL) affects the everyday functioning of millions of people worldwide. The Brief International Classification of Functioning Disability and Health (ICF) core sets for HL was developed to meet the complex health care needs of adults with HL. Because the brief core set for HL has not yet been validated internationally, this study aimed to investigate its validity from an international perspective.

Design: A cross-sectional validation study based on data from structured interviews with adults with HL.

Study Sample: Participants ( = 571) from India, South Africa, Sweden and the US were included.

Results: A six-factor solution explained 71% of the variance, focussing on issues related to ( = 0.915). Three ICF categories demonstrated low reliability - and .

Conclusion: The Brief ICF core set for HL is valid for adults with HL internationally. However, to further increase its international validity, we recommend adding the categories and replacing with the more inclusive block,
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http://dx.doi.org/10.1080/14992027.2020.1846088DOI Listing
June 2021

What Influences Decision-Making for Cochlear Implantation in Adults? Exploring Barriers and Drivers From a Multistakeholder Perspective.

Ear Hear 2020 Nov/Dec;41(6):1752-1763

Ear Science Institute Australia, Subiaco, Australia.

Objectives: To explore the factors influencing the uptake of cochlear implants in adults, determine the impact of each factor, and to conceptualize the journey to implantation from a multistakeholder perspective.

Design: Concept mapping was used to integrate input from multiple stakeholders, each with their own experience and expertise. This mixed participatory method collects qualitative and quantitative data collection and enables further quantitative analysis. There were two participant cohorts: clients (cochlear implant recipients, candidates, and family members) and professionals (cochlear implant audiologists, ear, nose, and throat surgeons, administration staff, managers. and manufacturer representatives). A total of 93 people participated in the study: client cohort (n = 60, M age = 66.60 years) and professional cohort (n = 33, M age = 45.24 years). Participants brainstormed statements in response to the question "What influences people's decision to get/not get a cochlear implant?" They subsequently grouped the statements and named each group. They rated each statement as to its impact on the decision and prioritized the need for each to be changed/improved using a five-point Likert scale. Multidimensional scaling was used to produce a visual representation of the ideas and their relationship in the form of concepts. Further analysis was conducted to determine the differences between the cohorts, subcohorts, and concepts.

Results: One hundred ten unique statements were generated and grouped into six concepts which either directly affected the client or their environment. These concepts were: external influences (awareness and attitude of non-implant professionals about uptake, cost, logistics, the referral pathway, public awareness); uncertainties, beliefs, and fears (fears, negative effect of word of mouth, unsuccessful previous ear surgery, cosmetics of the device, misunderstanding of how a cochlear implant functions, eligibility for an implant and outcomes after implantation); health problems (mental and physical health); hearing difficulties (social, emotional, and communication impacts of hearing loss, severity of hearing loss, benefit from and experience with hearing aids); implant professionals (implant team's attitude, knowledge and relationship with clients, quality of overall service); and goals and support (clients 'hearing desires and goals, motivation, positive impact of word of mouth, family support, having a cochlear implant mentor. The six concepts fell into two overarching domains: the client-driven domain with four concepts and the external domain with two concepts. The mean rating of concepts in terms of impact on a client's decision to get an implant ranged from 2.24 (external influences, the main barrier) to 4.45 (goals and support, the main driver). Ratings significantly differed between the client and professional cohorts.

Conclusions: This study increases our understanding of the factors, which influence a client's decision choose a cochlear implant as a hearing treatment. It also provides new information on the influence of the other stakeholders on the client journey. The magnitude of the generated statements in the client-driven domain highlights the pivotal role of individualized care in clinical settings in influencing a client's decision and the need for the professionals to understand a client's needs and expectations. A client's persistent hearing difficulties, goals, and support network were identified as drivers to the uptake of cochlear implants. However, the barriers identified highlight the need for a collaborative multi- and interdisciplinary approach to raise awareness in and educate non-implant hearing professionals about the cochlear implant process, as well as providing information to empower clients to make educated decisions and consider a cochlear implant as a hearing management option.
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http://dx.doi.org/10.1097/AUD.0000000000000895DOI Listing
July 2021

mHealth developmental screening for preschool children in low-income communities.

J Child Health Care 2020 Oct 30:1367493520970012. Epub 2020 Oct 30.

Department of Speech-Language Pathology and Audiology, 56410University of Pretoria, South Africa.

Children are often only identified with a developmental delay when they enter primary school due to developmental delays hindering academic progress. Detection of at-risk children in low-income communities is typically unavailable due to several challenges. This study validated an mHealth-based developmental screening tool as a potential time- and cost-effective way of delivering services for preschool children. This cross-sectional within-subject study screened 276 preschool children from low-income communities using the mHealth Parents' Evaluation of Developmental Status (PEDS) tools. The mHealth PEDS tools' performance was then evaluated by comparing caregiver concerns according to the PEDS tools with results obtained using a reference standard assessment tool, the Vineland-3. The mHealth PEDS tools identified 237 (85.9%) of children at risk of developmental delay compared to 80.1% ( = 221) of children identified with a developmental delay using the Vineland-3. Sensitivity of the PEDS tools was high (92.6%) with low specificity (22.5%) using US standardised criteria. Literacy skills were found to be most delayed, according to the PEDS: DM (89.3%; = 142) and Vineland-3 (87.1%; = 134). Low specificity of the prescribed criteria may require the implementation of adapted referral criteria within low socio-economic status (SES) settings. The mHealth PEDS tools may still be valuable for preschool developmental surveillance of children within low SES settings. It is recommended, however, that children who are identified with a developmental concern undergo a second screen to reduce false positives.
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http://dx.doi.org/10.1177/1367493520970012DOI Listing
October 2020

Mhealth hearing screening for children by non-specialist health workers in communities.

Int J Audiol 2021 Apr 12;60(sup1):S23-S29. Epub 2020 Oct 12.

Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa.

Objectives: To compare outcomes of a community-based hearing screening programme using smartphone screening audiometry operated by specialist (School Health Nurses - SHNs) and non-specialist health workers (Community Health Workers - CHWs) in school children.

Design: This study used a two-group comparison of screening outcomes as conducted by SHNs and CHWs using smartphone screening for children in communities.

Study Sample: The study included 71 CHWs and 21 SHNs who conducted community-based hearing screening on 6805 children. One thousand one hundred and fifteen hearing screening tests were conducted by the CHWs and 5690 tests by the SHNs.

Results: No significant difference in screening outcome was evident between CHWs and SHNs using a binomial logistic regression analysis considering age, test duration and noise levels as independent variables. Final screening result was significantly affected by age ( < 0.005), duration of test ( < 0.005) and noise levels exceeding at 1 kHz in at least one ear ( < 0.005). Test failure was associated with longer test duration ( < 0.005; : 119.98; 95% CI: 112.65-127.30). CHWs had significantly ( < 0.005) longer test durations (68.70 s; 70 SD) in comparison to SHNs (55.85 s; 66.1 SD).

Conclusion: Low-cost mobile technologies with automated testing facilitated from user-friendly interfaces allow minimally trained persons to provide community-based screening comparable to specialised personnel.
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http://dx.doi.org/10.1080/14992027.2020.1829719DOI Listing
April 2021

Telehealth tinnitus therapy during the COVID-19 outbreak in the UK: uptake and related factors.

Int J Audiol 2021 05 1;60(5):322-327. Epub 2020 Oct 1.

Department of Experimental Psychology, University of Cambridge, Cambridge, UK.

Objective: The Audiology Department at the Royal Surrey County Hospital usually offers face-to-face audiologist-delivered cognitive behavioural therapy (CBT) for tinnitus rehabilitation. During COVID-19 lockdown, patients were offered telehealth CBT via video using a web-based platform. This study evaluated the proportion of patients who took up the offer of telehealth sessions and factors related to this.

Design: Retrospective service evaluation.

Study Sample: 113 consecutive patients whose care was interrupted by the lockdown.

Results: 80% of patients accepted telehealth. The main reasons for declining were not having access to a suitable device and the belief that telehealth appointments would not be useful. Compared to having no hearing loss in the better ear, having a mild or moderate hearing loss increased the chance of declining telehealth by factors of 3.5 ( = 0.04) and 14.9 ( = 0.038), respectively. High tinnitus annoyance as measured via the visual analogue scale increased the chance of declining telehealth appointments by a factor of 1.4 ( = 0.019).

Conclusions: Although CBT via telehealth was acceptable to most patients, alternatives may be necessary for the 20% who declined. These tended to have worse hearing in their better ear and more annoying tinnitus.
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http://dx.doi.org/10.1080/14992027.2020.1822553DOI Listing
May 2021

Digital Proficiency Is Not a Significant Barrier for Taking Up Hearing Services With a Hybrid Online and Face-to-Face Model.

Am J Audiol 2020 Dec 30;29(4):785-808. Epub 2020 Sep 30.

Oticon Medical A/S, Copenhagen, Denmark.

Purpose The aim of this study was to determine the effect of self-perceived digital proficiency on the uptake of hearing services through a hybrid online and face-to-face hearing health care model. Method Adults were recruited via online methods to complete an online hearing screening test within the greater Durban area in South Africa. On submission of contact details after failing the screening, contact was made via telephone to assess readiness for further hearing care. If motivated and willing to continue, a face-to-face appointment for diagnostic hearing testing was confirmed, at which time an e-mail with an online mobile device and computer proficiency survey was sent. Hearing services were offered using combined online and face-to-face methods. Results Within 2 years (June 2017 to June 2019), 1,259 people from the target location submitted their details for the clinic audiologist to contact, of whom 931 participants (73.95%) failed the screening test. Of these participants, 5.69% (53/931, 57.41% men) attended a face-to-face diagnostic hearing evaluation. Mobile device and computer proficiency scores were not a predictor of acquiring hearing services. Age was the only significant predictor ( = .018) for those continuing with hearing care. Patients who continued with hearing care by acquiring hearing aids and support services were older ( = 73.63 years, = 11.62) and on average aware of their hearing loss for a longer time ( = 14.71 years, = 15.77), as compared to those who discontinued hearing health care who were younger ( = 59.21 years, = 14.42) and on average aware of their hearing loss for a shorter time ( = 6.37 years, = 9.26). Conclusions Digital proficiency is not a predictor for acquiring hearing services through a hybrid online and face-to-face hearing care model. Hybrid services could allow professionals to assist patients in a combination of face-to-face and online services tailored to meet individual needs, including convenience and personalized care.
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http://dx.doi.org/10.1044/2020_AJA-19-00117DOI Listing
December 2020

Teleaudiology hearing aid fitting follow-up consultations for adults: single blinded crossover randomised control trial and cohort studies.

Int J Audiol 2021 Apr 23;60(sup1):S49-S60. Epub 2020 Sep 23.

Ear Sciences Centre, Medical School, The University of Western Australia, Perth, Australia.

Objective: To evaluate and compare the effectiveness and quality of standard face-to-face and teleaudiology hearing aid fitting follow-up consultations and blended services for adult hearing aid users.

Design And Study Sample: Fifty-six participants were randomly allocated to two equal groups, with equal numbers of new and experienced users. One standard and one teleaudiology follow-up consultation were delivered by an audiologist, the latter assisted by a facilitator. The order was reversed for the second group. Outcome measurement tools were applied to assess aspects of participants' communication, fitting (physical, sensorial), quality of life, and service. Cross-sectional and longitudinal outcomes were analysed.

Results: Most participants presented with moderate, sloping, and symmetrical sensorineural hearing loss. The duration of teleaudiology (42.96 ± 2.73 min) was equivalent to face-to-face consultations (41.25 ± 2.61 min). All modes of service delivery significantly improved outcomes for communication, fitting, and quality of life ( > 0.05). Satisfaction for both consultation modes was high, although significantly greater with standard consultations. The mode and order of delivery of the consultations did not influence the outcomes.

Conclusion: Teleaudiology hearing aid follow-up consultations can deliver significant improvements, and do not differ from standard consultations. Blended services also deliver significant improvements. Satisfaction can be negatively impacted by technical or human-related issues.
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http://dx.doi.org/10.1080/14992027.2020.1805804DOI Listing
April 2021

Early Childhood Development Risks and Protective Factors in Vulnerable Preschool Children from Low-Income Communities in South Africa.

J Community Health 2021 04;46(2):304-312

Department of Speech-Language Pathology and Audiology, University of Pretoria, Lynnwood Road, Pretoria, 0001, South Africa.

Age-appropriate early childhood development is greatly influenced by exposure to various mediating and moderating factors. Developmental outcomes cannot be viewed in isolation, but by considering the interaction of the various risks and protective factors that influence early child development. A non-experimental, cross-sectional research design was employed. Data was collected in a low-income community in Gauteng, South Africa. Caregivers with children (n = 276) between the ages of 3 years and 6 years 11 months (mean 51.57 months; SD ± 12.4) whose children were in a preschool were invited to participate in the research study. Participants were divided into two groups, children with developmental delays and children without a developmental delay. The study sample included high risk, vulnerable preschool children, with a developmental delay prevalence of 80.1% (221/276). Families included were exposed to an average of five (SD ± 1.86) environmental and/or biological risks. According to a logistic regression model, three factors were significantly associated with increasing resilience amongst children with no developmental delay: living with both parents (p < 0.031, OR 4.5, 95% CI 1.2-17.2), caregivers having at least completed Grade 8 to 12 (p < 0.027, OR 11.9, 95% CI 1.4-10.5) and parents being married (p < 0.023, OR 5.1, 95% CI 1.3-20.9). Important protective factors in low-income communities like caregiver education, living with both parents and parental marriage can inform public health messaging and other population-based interventions to support early childhood development.
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http://dx.doi.org/10.1007/s10900-020-00883-zDOI Listing
April 2021
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