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Masters Degrees (Audiology)

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    The professional knowledge development of community service audiologists in KwaZulu-Natal- a phenomenographic study.
    (2019) Mbhele, Sphilile.; Makhoba, Goodenough Musawenkosi.
    The Department of Health implemented the community service programme in the year 2003 in allied health professions. This allowed for service provision in underserved communities while facilitating skills development in new graduates as a work-based programme, preparing community service offices for independent practice. It was, therefore, recognized by the Health Professions Council of South Africa, which certifies all new graduates who complete the programme as independent practitioners. However, due to the possibly of vast differences in experiences among community service officers’ experiences, the lack of clarity on the minimum requirement of clinical and professional exposure, and the lack of baseline assessment of competences in completion of the programme, makes the contribution of the programme in developing new graduates largely unknown and somewhat questionable. This has become a problem, necessitating a probe into the impact of qualitative differences in community service experiences, as a means of contributing to the identified knowledge gap. This research study aimed to explore the qualitatively different ways in which community service officer: Audiologists experience and conceive their development of professional knowledge during their community service year in KZN, South Africa. A qualitative semi-structured interview method was used to collect data from 12 community service officers: Audiologists who were selected through purposive sampling. This was aligned with the principles of phenomenography. Subsequently, qualitative content analysis was conducted with the use of the NVivo software. The variations in the results were hierarchically represented in the form of categories of descriptions and conceptions. The conceptions reflected qualitative differences between the participants’ experiences and their perceptions of knowledge development. The outcome space revealed three categories of description: “Category 1: Transitioning from graduate to professional”; “Category 2: Learning in the workplace during CS” and “Category 3: Professional development”. Each category of description revealed qualitative differences in conceptions of the experiences of professional knowledge development among community service officers. The identified qualitative differences were attributed to the variations in work environments, supervision, resource allocations, socialization and infrastructure at their respective placements. The differences among community service officers were reported to have had an impact on their knowledge development; advantaging some and disadvantaging others. In conclusion, while the community service programme positively contributed to professional knowledge development regardless of the limitations experienced, this study revealed a dire need to review the current model of the community service programme regarding fixed-placements of community service officers and lack of minimum experiential or learning requirements. The findings of this study served to inform future community service officers, universities, the relevant health professions council and the Department of Health, of room to improve the community service programme in allied health professions.
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    The psychosocial impact of hearing loss on the quality of adults with multi drug-resistant tuberculosis.
    (2020) Thusi, Amanda Bernice.; Paken, Jessica.
    Aminoglycosides used in the treatment of Multi Drug-Resistant Tuberculosis (MDR-TB) is an ototoxic agent, known to result in hearing loss. Hearing loss has been reported to have far-reaching psychological, physical, and social consequences, while the diagnosis of MDR-TB has negative impacts such as stigma, and financial implications. The effects of an acquired hearing loss with an MDR-TB diagnosis may, therefore, have an increased adverse impact on the overall Quality of life of an individual; however, there is minimal research in the area. A Qualitative Phenomenological research study was conducted on 10 participants, with a confirmed diagnosis of MDR-TB, and hearing loss. The researcher used a semi-structured questionnaire to collect data during face-to-face, audio-recorded interviews. Thematic analysis of results revealed that hearing loss in patients diagnosed with MDR-TB has a significant adverse impact on the patients‟ Quality of life. All participants were unable to return their „normal‟ lives, i.e., life before the diagnosis of MDR-TB and hearing loss. Stigma, discrimination, psychological distress, adverse changes in family status and family relationships, financial constraints, and social challenges were some of the common issues reported by participants. Unemployment posed a significant challenge, resulting in participants having no economic stability due to MDR-TB, which was then worsened by the hearing loss; consequently, generating a great deal of stress. Participants reported feelings of worthlessness, a loss of identity, lack of motivation, feelings of embarrassment, and loss of independence. Cultural and ethnic factors also appeared to have influenced the participant‟s willingness to seek assistance for the psychosocial challenges they had been experiencing. Consequently, there is a significant irreversible social, psychological, and economic impact of hearing loss that has a direct impact on the Quality of life of MDR-TB patients and their families, which are likely to persist even after MDR-TB has been cured. There is a need for improved treatment methods that are less toxic to hearing together with psychosocial intervention strategies that equip patients diagnosed with MDR-TB and hearing loss to alleviate the adverse effects they experience. Without such interventions, the fight against the psychosocial impact of hearing loss in MDR-TB patients remains incomplete.
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    Perceptions of adult aural rehabilitation services for a patient with an acquired hearing loss post multidrug-resistant tuberculosis (MDR-TB) treatment: a case study.
    (2020) Brijlal, Navishka.; Shezi, Zandile Marilyn.
    Background: There is a problem regarding the provision and accessibility of aural rehabilitation (AR) in South Africa (SA). Statistics suggest a discrepancy between number of audiologists in relation to nwnber of patients who present with an acquired hearing loss post multidrug-resistant tuberculosis (MDR-TB) treatment requiring AR services. Although there is evidence of patients receiving some form of AR, a gap in literature regarding the extent to which AR is provided post hearing aid fitting exists. Therefore, the objective of the study was to explore the perceptions of a single participant who had an acquired hearing loss post MDR-TB treatment towards adult AR services. Method: The participant, a 41-year-old female, was randomly selected from King Dinuzulu Hospital Complex (KDHC) based on the study's inclusion and exclusion criteria. As a result of MDR-TB treatment, she presented with a severe to profound hearing loss bilaterally and received hearing aids. A qualitative case study was adopted via a face to face semi-structured interview, using an interview schedule and audio recorder. Three interviews were conducted in total, with a duration of 8 hours 30 minutes. Data analysis was facilitated via thematic analysis. Results: The study's findings found that adult AR appears to be currently not facilitated at KDHC, especially for patients with hearing loss post MDR-TB treatment. The absence of intervention beyond hearing aid fittings contributed to the participant's lack of awareness regarding AR services. Although there was willingness to participate in AR, challenges were evident, such as transport constraints, communication partner non- attendance and health issues. Perceptions of adult AR services were established as helpful by the participant in assisting with better communication. Conclusion: There is a need for the provision of AR for patients with an acquired hearing loss post MDR-TB in SA. The lack of literature pertaining to AR service provision in SA is highlighted. It is hoped that by more audiologists being involved in providing AR services, more patients become aware of such services and therefore interested to participate. Study implications and recommendations are discussed.
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    Early hearing detection and intervention in KwaZulu-Natal: analysis of barriers and facilitators from guideline generation to clinical application.
    (2020) Naidoo, Naedene.; Khan, Nasim Banu.
    Background: There is slow progress in early hearing detection and intervention (EHDI) services within South Africa. Despite enabling guidelines, such as the Joint committee on Infant Hearing (JCIH) and Health Professionals Council of South Africa (HPCSA), EHDI guidelines supporting EHDI as a standard of care, various barriers hinder the translation of these guidelines into clinical practice, as envisaged. Audiologists are EHDI gatekeepers and can provide valuable insights into these challenges, as well as strengths or opportunities that can progressively move EHDI towards best practice in South Africa. Objective: The study aimed to determine the barriers and facilitators to EHDI in KwaZulu-Natal (KZN) as reported by audiologists/speech therapists and audiologists’ (A/STAs). Method: An exploratory-descriptive qualitative approach was used, by conducting telephonic interviews with 12 A/STAs working in public and private healthcare facilities, within KwaZulu-Natal. Data was analysed using thematic analysis, in conjunction with NVivo software. Results: Five main themes emerged from the data as follows: improving EHDI guidelines; investing in resources and infrastructure for EHDI service provision; facilitating professional development, training and education and strengthening intersectoral collaboration for EHDI services; managing follow-up and evaluating protocols and procedures for screening; and engaging, understanding and supporting caregivers/families. Conclusion: Despite the availability of EHDI guidelines and some progress in service delivery, participants indicated that implementation of EHDI remains a challenge. Strategies such as an increase in resources, further education and training, development of contextually relevant, culturally and linguistically diverse practices and protocols need to be in place to improve EHDI implementation.
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    Curriculum engagement: educators’ experiences in Audiology and Speech-Language Pathology at a South African university.
    (2020) Inarman, Suraksha.; Pillay, Mershen.; Khan, Nasim Banu.
    Educator’s experiences have not been awarded due recognition within the curriculum. If educators are key agents in curriculum change then non-recognition of their experiences, power relations, identity construction and its influence on the curriculum leaves a gap in understanding curriculum engagement. Hence, this study aimed to explore educators’ experiences on curriculum engagement in the Audiology and Speech-Language Pathology (SLP) Disciplines at the University of KwaZulu-Natal (UKZN). Educators’ experiences in relation to students, educators, content, method of engagement and context together with the influence of socio-demographic, socio-emotional and socio-political factors are described. A qualitative study design that was exploratory and descriptive in nature was undertaken. Educators’ experiences were explored via a semi-structured interview method and analysed with the use of a qualitative computer software, NVivo as well as through thematic analysis. Five main themes emanated from 59 codes and 15 categories. The results and discussion are presented per theme and the findings suggest that the political environment impacted greatly on the curriculum in terms of its structure, policies, staff and student profiles. Staff identities and emotional engagement further influenced their interaction with the curriculum and facilitated their role as agents of curriculum change. Whilst validating knowledge by experience may be considered a less orthodox approach, this study has demonstrated that providing Audiologists and SLP’s with a platform to share their personal experiences through narrative may be a way forward in expanding new knowledge, developing skills and gaining competencies as the professions move progressively towards engaging a contextually relevant curriculum.
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    An audiological and genetic profile of hearing of learners suspected of familial hearing loss attending schools for the deaf in KwaZulu-Natal.
    (2017) Pillay, Karen.; Joseph, Lavanithum.; Aldous, Arnolg Clifford.
    This study focused on genetic familial hearing loss, concentrating on learners attending schools for the Deaf in Kwazulu Natal .The study sought to identify the audiological profile characteristics of suspected genetic familial hearing loss in the learners and their family members with hearing loss. Currently there is a scarcity of research in the area of genetics and hearing loss in South Africa. The study aimed at providing both an audiological and genetic profile of familial hearing loss of learners with a history of hearing loss in the family. A quantitative multicase study research design was chosen. Participants were identified based on a positive family history of hearing loss in learner records and the referral from the school Audiologists. An audiological assessment and family pedigree was conducted on affected learners and their families who volunteered to participate in the research. The study sample consisted of 40 learners from 25 families with 70 affected participants who underwent audiological assessments and a family pedigree analysis, of which 31 were male and 39 were female. The pedigree analysis of the 25 families also presented 417 individuals who were reported to have normal hearing and 20 individuals with a reported hearing loss that were unable to undergo audiological testing in the study. The study identified an autosomal dominant inheritance present in 32% (8) of families an autosomal recessive inheritance in 56% (14) and a presumed co-incidental familial hearing loss in 12% (3) of families. The audiological and genetic profile of families within the study, revealed significant differences between the profile of autosomal dominant and autosomal recessive hearing loss. The autosomal recessive group revealed a profile of hearing loss that was predominately congenital, prelingual, sensorineural, severe to profound in severity and flat in configuration. The autosomal dominant inheritance revealed a profile that was both prelingual and postlingual in onset with a moderate to severe sensorineural hearing loss and a sloping configuration. The results of the study are supported by other studies with regard to the description and auditory profile differences of autosomal recessive and autosomal dominant hearing loss. An understanding of the audiometric profiles of genetic familial hearing loss, will be useful to health professionals when assessing and managing these families with a history of hearing loss. It is believed that a standard method of profiling genetic familial hearing loss and the use of a family pedigree analysis, would be beneficial to professionals who encounter families with hearing loss. The role of the multidisciplinary team which includes Audiologists, geneticists and genetic counsellors in the family with a familial hearing loss are invaluable. This study provided data on the current incidence of genetic familial hearing loss at schools for the deaf in the province of KwaZulu-Natal. It is expected that with the advancement of research in the area of genetic familial hearing loss, an increase in professionals in the field of genetics such as geneticists and genetic counsellors will be available.
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    Exploring communication between first language english speaking audiologists and Isizulu patients at public sector hospitals in KwaZulu-Natal.
    (2018) Gopaul, Shadette.; Panday, Seema.
    Effective communication between health professionals and patients is central in providing quality health care. A cultural and linguistic mismatch between audiologists and their patients may create a barrier in communication. Therefore, the aim of the present study was to explore communication between First Language English speaking (FLES) audiologists and isiZulu patients, based on isiZulu being dominant in KZN. A concurrent triangulation mixed design was used. The study consisted of three phases. The first phase included a survey of 31 FLES audiologists. The second phase included the Photovoice narratives and interviews with two FLES audiologists. The final phase included a survey of 98 isiZulu patients. The results revealed that overall FLES audiologists showed poor cultural (71%) and linguistic (97%) competency in isiZulu. Inferential statistics revealed significant associations between cultural competency and FLES audiologists years of experience (p value=0,021), gender (p value=0.042) and type of institution based in terms of rural or urban (p value=0.038).The above competency levels of FLES audiologists coincided with the perspectives of isiZulu patients. Furthermore, it was revealed that factors such as consent, trust, collaboration, empathy, attitude and professional superiority influenced cross cultural and cross linguistic communication between FLES audiologists and isiZulu patients. The use of informal interpreters emerged as the most common communication strategy employed by FLES audiologists. The implementation of isiZulu courses, formally-trained interpreters and isiZulu audiology resources emerged as strong recommendations. In addition, FLES audiologists identified initiative as important to improving cross cultural/linguistic communication. The results from this study may inform changes to University curricular as well as policy at public sector hospitals.
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    An analytical study investigating noise levels in neonatal intensive care units within the public sector in the eThekwini district.
    (2018) Ismail, Sabah.; Panday, Seema.
    Noise is a well-documented environmental stressor in the NICU and has emerged as a public health problem. The aim of this study was to investigate noise levels and identify contributing factors to the high noise levels, in NICUs within the public sector in the eThekwini District. The study used an analytical observational research design and a purposive sampling method. Noise measurements were conducted in four hospitals with the sound level meter (CEL 450 C) placed in the centre of each NICU for 48 hours on two consecutive days of the week (Sunday and Monday). A sample of sources of noise and their frequency of occurrence were identified through direct observation in the morning, as well as a frequency analysis using one-third octave bands were conducted. Mean LAeqs were above 45dBA in all hospitals and a marginal difference between LAeqs during the morning, afternoon and night was seen in hospital D (p=0,046). A significant difference between LAeqs on Sunday and Monday was found in hospital C (p=0,028). The majority of the sources of noise were from alarms of devices and human-related noise, with the most frequently occurring sources of noise being staff conversations (30.9%), alarms (21,0%) and closing of metal pedal bins (20,0%). Multiple high frequency alarms increased the LAeq to 74,6dBA and dropping a metal object increased the LZpeak to 116,0dBA. LAeqs higher than 45dBA were seen in the mid and high frequencies (250Hz-6300Hz) specifically during the afternoon in all hospitals. The findings have implications for education and training, as well as for the development of practice and policy guidelines in NICUs.
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    The employment of individuals with hearing impairment in the KwaZulu-Natal private sector: current employers’ perceptions and experiences.
    (2018)   Doolabh, Nishita Ashwin.; Khan, Nasim Banu.
    Background: Despite policies and legislation mandating the employment of persons with disabilities, individuals with hearing impairment continue to face barriers and challenges accessing the labour market and have typically experienced higher rates of unemployment or underemployment. In South Africa, the majority of individuals with disabilities remain dependent on social-welfare to meet basic needs and as a result, their potential remains grossly untapped. Misconceptions regarding the capabilities of hearing impaired individuals have resulted in the occupational marginalization of this population. Objective: This study aimed to investigate employers’ perceptions and experiences in recruiting and retaining individuals with hearing impairment in KwaZulu-Natal Provinces’ private sector. Method: A descriptive survey with quantitative methods of analysis was used to obtain information from employers, human resource personnel or management in various industries who have employed individuals with hearing loss. The Chronbach Alpha suggested that the self-administered questionnaire had good internal consistency (p = 0.858). A total of 30 responses were obtained from the 19 companies who agreed to participate. Results: Approximately 75% of participants indicated either a medium or low level of awareness regarding disability. Legislation such as the Employment Equity Act (EEA, no 55 of 1998) and the Skills Development Act (SDA, no 97 of 1998) were considered the most useful legislature, as indicated by 66.7% of participants. Those who indicated that external services or resources, such as the KZN Blind and Deaf Society and eDeaf were used during recruitment and retention were more likely to report to the benefits of employing hearing impaired individuals, this being statistically significant (p < 0.001). Less than half of the participants reported that reasonable accommodations were provided for their employees, and half indicated that they were willing to provide sign language interpreters. Most participants (70%) suggested that communication difficulties, particularly in meetings, contributed towards poor employment rates amongst individuals with hearing impairment. Communication difficulties were further endorsed by 73.3% of participants as a major challenge when recruiting and hiring persons with hearing impairment. Other concerns related to the safety of employees and attitudes of co-workers. Conclusion: The findings suggest that a lack of familiarity of disability and disability legislature can manifest in reliance on erroneous stereotypes that individuals with disabilities are poor job performers and incapable of working independently. However, with the use of reasonable accommodations which includes sign language interpreters and desensitization workshops, employers were able to successfully integrate hearing impaired employees into the workforce.
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    The auditory effects of occupational exposure to chemical solvents.
    (2016) Nakhooda, Faatima.; Govender, Samantha Marlanie.
    Recently emerging literature indicates that the combination of solvents and noise have the potential to cause auditory dysfunction. There is limited literature available relating to the effects of SIHL exposure on the auditory system and this highlights the need for this study. The study firstly aimed to determine the combined effects of exposure to solvents and noise on auditory function in workers by conducting a systematic review and meta-analysis. The study further aimed at profiling the audiological results of a group of workers exposed to a variety of solvents at various exposure levels within high and low noise factories. A longitudinal prospective research design was used. The researcher collected data at multiple follow-up times over a six month period to obtain multiple measurements on each worker. The final study sample comprised of 12 workers. Results: Aim one: Heterogeneity was assessed in the selected studies by using the I2 test. Results revealed that significantly higher odds (p=0.006) of acquiring hearing loss when workers are exposed to a combination of solvents and noise as opposed to solvents only. Aim two: Participants were exposed to noise and solvents within the limits, however, pure tone threshold results revealed that all workers experienced hearing loss at 12KHz with a mean of 45dB across all the phases. Results for DPOAEs revealed that all workers had reduced amplitudes across all three phases with the exception of one pass result at one phase for one worker. When pure tone thresholds and OAEs were compared, the statistics indicated that there were no significant differences (p=0.68 and p =0.38) between pure tone audiometry and DPOAEs. The sample size of the study was too small to yield significant results. Participants reported on various symptoms experienced from exposure to solvents dizziness, headaches and blurry eyes. The present study supports that exposure to solvents may increase the risk of hearing loss due to noise exposure. The researcher recommends that industries should prioritize noise and solvent reduction to prevent hearing loss and the audiologist‟s role within audiological monitoring of solvent induced hearing loss is emphasized.
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    Young adults' awareness and experience of tinnitus : a survey of a sample of students at a University of KwaZulu-Natal.
    (2014) Bagwandin, Vedika Vimaldev Premdutt.; Joseph, Lavanithum.
    The focus of this study was the awareness and experience of tinnitus in young adults. Historically, most literature focused on tinnitus in the older population group. However, recent studies have revealed that tinnitus has become more prevalent in young adults. This has resulted in an increased interest and need for research regarding tinnitus in this young age group. Current studies have raised awareness that young adults are at risk of acquiring tinnitus because of their exposure to causes such as excessive noise. However, despite this risk young adults seem to still continue in risk-taking behaviours because of social norms and the lack of awareness of tinnitus. Thus the aim of this study was to describe young adults’ awareness and experience of tinnitus with regards to their awareness of the existence, causes, effects and management of tinnitus. A descriptive study design was employed. A purposive sampling method was used. The study sample consisted of 75 university students who volunteered to take part in the study. Participant’s age range was between 18 and 30 years. Participants were required to complete an online survey, developed by the researcher, which they accessed from the university notice system. The results obtained revealed that the majority (69.23%) of participants were not aware of tinnitus. Most of the participants did not know about the causes or effects of tinnitus. Only a few participants experienced tinnitus; 10 (13.89%) participants experienced it themselves and 9 (12.50%) participants knew someone who suffered from tinnitus. The majority of the participants requested further information about tinnitus. These results have implications for health care professionals who need to be aware of the rising prevalence of tinnitus in the young adult population. This will impact on the manner in which audiologists approach young adults with regards to assessment and management. Awareness programmes about the association of noise to tinnitus, and its implications should be fostered through promotion programmes.
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    Audiological practices employed by audiologists in the management of adult patients with multi-drug resistant tuberculosis in South Africa.
    (2015) Govender, Melesha.; Paken, Jessica.
    Aminoglycosides, such as amikacin and kanamycin, are part of the treatment for Multi-Drug Resistant Tuberculosis; however, it is ototoxic and the need for audiological monitoring is, therefore, emphasised. However, there are currently no explicit guidelines for monitoring ototoxicity in the South African context. Consequently, there is no standardised method for monitoring ototoxicity; however, audiologists are providing the service. Often adaptations to international protocols make them contextually relevant. Therefore, this study aims to describe the audiological practices employed by audiologists in the management of adult patients with MDR-TB in South Africa. A descriptive survey design was used. A questionnaire was developed and included the following aspects such as: identification and criteria used for patients with MDR-TB, baseline practices, monitoring procedures and post treatment management. Ninety-three audiologists contributed data for this study. Descriptive statistics and inferential statistics were used in the analysis of data. Results revealed that 80% of audiologists are aware of international guidelines, 93% reportedly provide pre-treatment counselling; while, 87% of audiologists conduct baseline assessments prior to the administration of MDR-TB treatment. Furthermore, 19% of audiologists conduct HFA and indicated that there is a lack of high frequency audiometers due is to financial constraints. The following were cited as reasons for the modification to the international guidelines: lack of specialised equipment, time constraints and large caseloads, as well as, understaffed departments. In addition, 74% of the audiologists are able to conduct periodic assessments monthly, while 72% of audiologists conduct a full audiological assessment after the cessation of MDR-TB treatment and 96% of audiologists conduct post treatment counselling. The findings of this study may, thus, inform policy by allowing for evidence-based ototoxicity monitoring protocols in South Africa.
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    Auditory Processing Disorders in children : the perspectives and practices of South African audiologists/STA's.
    (2015) Fouché-Copley, Claire.; Khan, Nasim Banu.; Govender, Samantha Marlanie.
    Audiologists/ Speech Therapists and Audiologists (STA’s) practicing in the field of Auditory Processing Disorders (APD) globally, encounter several challenges that include but are not limited to conflicting definitions, variable diagnostic criteria, several classification profiles and lack of standardised guidelines for screening, assessment and intervention. In South Africa, audiologists/ STA’s experience further challenges related to working within a diverse multicultural and multilingual context when attempting to manage children with APD. This study investigated the perspectives and practices of South African audiologists/ STA’s in screening, assessing and providing intervention for children with APD. A descriptive survey design, with quantitative methods of analysis, was used to obtain information from audiologists/ STA’s registered with the Health Professions Council of South Africa (HPCSA, 2014), of which 156 responded. The data was analysed using descriptive and inferential statistics. Overall 68% (n = 106) of the participants did not feel adequately prepared to practice in the field of APD. Seventy five percent (p = 0.00) of audiologists and 35% of STA’s reported their level of experience as being ‘limited’, which was statically significant. Forty percent (n = 62) of the sample felt that they were either ‘poorly’ or ‘very poorly’ informed to screen for APD, 44% (n = 68) to assess for APD, and 53% (n = 82) to provide intervention. Sixty percent (n = 93) screened for APD, whilst only 42% (n = 66) assessed for APD. Some of the reasons cited include; lack of exposure to APD during their undergraduate programme, inappropriate screening and assessment material due to cultural and linguistic barriers and limited resources to manage children with APD. Eighty five percent (n = 133) received referrals from other practitioners for the management of APD, yet only 43% (n = 67) of the participants offered intervention. Similar findings were reported in studies conducted locally and internationally. It can therefore be concluded that service provision in the area of APD in South Africa, is limited which is exacerbated by several contextual constraints. Based on the study findings of the current study, relevant research and clinical implications were recommended.
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    Counselling of adults who need amplification : practices of South African audiologists.
    (2014) Ratanjee, Husmita Narendra.; Joseph, Lavanithum.
    This study focused on adult rehabilitative audiology, in particular the counseling offered to adults who require hearing aids; and examined the practices and views of South African Audiologists. Counseling within the audiology profession has gained increased attention over the years as the profession has evolved with the technological advancements of modern hearing aids. On a global scale the educational qualification as well as curriculum has shifted in recent years. The current practises of counseling adults, who need amplification, needs to be understood more widely in South Africa and these topics were investigated in this research, with the purpose of highlighting and influencing best practice. The barriers faced by audiologists need to be better understood in order to improve service delivery and to look at curriculum needs of the new graduating students of the profession. The study reviews literature available regarding the scope of audiology practise, and the challenges faced by adult clients acquiring hearing amplification. The aim of the study was to describe the current practice of audiologists who counsel adult clients who require amplification by focusing on the nature and scope of services offered and the perceptions of factors affecting practice within the South African context. An online descriptive survey was selected as the research design. Information was gathered on the educational and clinical background, current practise, skills and challenges audiologists faced in dealing with the complex task of counseling adult clients with acquired hearing loss. The study sample consisted of 152 participants of which 148 (97%) were female and 4 (3%) were male. All practitioners were registered with either of the two professional audiology associations, the South African Association of Audiologists (SAAA) and the South African Speech Language and Hearing Association (SASLHA). The majority of participants were qualified as Speech Therapists and Audiologists, and worked in the private sector. The results revealed that Audiologists spend more time on informational counseling than rational acceptance or adjustment counseling. They also reported more time spent on counseling the client only rather than the client and significant other. The majority spent up to 15 minutes on counseling, and tended to offer counseling mostly after audiological evaluation and during hearing aid fitting and evaluation. Even though audiologists rated their skills in counseling high, especially for informational counseling and adjustment counseling, the majority of the participants indicated the need to improve their counseling skills to serve adult clients who need hearing aids. The results have valuable clinical implications for the rendering of adult rehabilitative audiological services in South Africa by incorporating more focus on counseling within the curricula of audiology training and by offering courses to qualified professionals to increase knowledge and skills in the area of counseling. Another implication is the need for supervision during clinical training of audiology students in order to develop skills in informational, rational acceptance and adjustment counseling.
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    An audiological profile of school aged children with HIV/AIDS at an antiretroviral clinic in KwaZulu-Natal.
    Peter, Vuyelwa Zandile.; Joseph, Lavanithum.; Paken, Jessica.
    There is limited research on hearing loss in the paediatric population infected with HIV/AIDS in South Africa. There is a need to establish an audiological profile in HIV infected children, as the prevalence of hearing loss is not known and there is limited published research available. This information will assist the audiologist to ascertain the extent of the disorder, establish a profile of hearing loss using hearing loss type, degree, configuration and symmetry, and dictate the necessary audiological and medical management strategies required. The aim of the study was to determine the audiological profile of school age children with HIV/AIDS at an antiretroviral clinic in KwaZulu-Natal. The study had the following objectives: To describe the prevalence and nature of hearing loss in terms of degree, type, configuration and symetry. To determine whether children with a hearing loss have received medical management and the type of treatment receive and to determine whether children with a hearing loss have received audiological management for their hearing loss and the nature of these interventions. This was achieved through a non-experimental descriptive exploratory design. The research was carried out at the Philani Family Clinic which is an ARV clinic at King Edward VIII hospital in KwaZulu-Natal, South Africa. Convenience sampling was used to recruit 30 participants aged between 6-12 years. Seventeen (60%) participants were males and 13 (40%) were females. The participants underwent diagnostic audiological evaluation, which included a case history questionnaire, medical record review, otoscopic examination, immittance audiometry, pure tone audiometry, speech audiometry, Distortion Product Otoacoustic emissions (DPOAE) and a neurological Auditory Brainstem Response (ABR) test. The results revealed, abnormal otoscopic findings in the right ear of 17 (57%) participants and the left ear of 19 (63%) participants. Tympanometry results revealed abnormal tympanograms in the right ear of 13 (43%) participants and the left ear of 12 (40%) participants. Ipsilateral acoustic reflex thresholds were abnormal in the right ear of 8 (27%) participants and in the left ear of 7 (24%) participants. Contra lateral acoustic reflex thresholds were abnormal in the right ear of 13 (44%) participants and in the left ear of 12 (40%) participants. Of the 28 participants assessed for pure tone audiometry, 15 (54%) presented with normal hearing in the right ear and 13 (46%) presented with normal hearing in the left ear. Conductive hearing loss was the most prevalent type of hearing loss, followed by sensorineural hearing loss and mixed hearing loss. Good SRT-PTA correlation was obtained in majority of the participants, indicating good test reliability. Only 18 participants underwent DPOAE testing and pass results were obtained in the right ear of 15 (50%) participants and the left ear of 12 (40%) participants. The ABR results revealed auditory dysfunction suggestive of neural dysnchrony. Seventeen (43%) participants reported a history of ear infections with 15 (50%) participants reporting having receiving medical attention for ear infections. Three (10%) participants were fitted with hearing aids. Fourteen (46%) participants reported to have repeated a school grade. Fifteen (50%) participants reported not coping academically. Study limitations included time constraints to conduct a more in depth protocol. A small sample size limited generalisation to the entire population under study. The study concluded that there was a prevalence of 53% hearing loss among children with HIV/AIDS. Therefore, the prevalence of hearing loss requires the expertise of the audiologist in the multi-disciplinary team, to both monitor and manage hearing loss and thereby improve quality of life of children with compromised immune systems . “It is always seems impossible until it is done” Nelson Mandela
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    The feasibility of including Distortion Product Otoacoustic Emissions (DPOAEs) in the annual medical surveillance test battery for the identification of noise-induced hearing loss in a group of workers in a beverage manufacturing industry.
    (2013) Reddy, Tarryn Marisca.; Panday, Seema.; Govender, Cyril Devadas.
    The study investigated the feasibility of including DPOAEs in the annual medical surveillance test battery for the identification of NIHL in a group of employees in a manufacturing industry in KwaZulu-Natal. Feasibility was investigated by exploring the sensitivity, specificity and predictive efficiency of DPOAEs, the ability of DPOAEs to detect subtle noise-induced cochlea changes, the test-retest reliability of DPOAEs and lastly, the duration of time taken to conduct the DPOAE test bilaterally. A cross-sectional and repeated measures within-in participant design was utilized in the study. A purposive convenience sampling technique was used, as well as a stratified sampling approach in order to realize objective two of the study. The study consisted of 60 participants, which were further stratified into four test groups, i.e. Group A: 0-3 years, Group B: 3.1-6 years and Group C: 6.1-9 years and Group D: 9.1-13 years of working within the beverage manufacturing industry. A high sensitivity and negative predictive value was reported in the current study, suggesting that DPOAEs may be able to identify those who present with subtle cochlea changes as a result of exposure to occupational noise. The sensitivity of DPOAEs was 100% at 1, 2, 4, 6 and 8kHz in the right ear and at 4 and 6kHz in the left ear. The specificity of DPOAEs in the current study ranged between 55%-97% across the frequency range in the right ear and 49%-88% in the left ear. A negative predictive value of 100% was obtained bilaterally across the frequency range, except at 8kHz in the left ear. Visual inspection of the DPgram in the current study revealed a bilateral reduction in DPOAE amplitudes for all test groups in the high frequency region of the DP-Gram, namely, 5477Hz and 7303Hz, in the absence of a statistically significant difference (p>0.05). A greater frequency range appears to be affected in this group of workers, indicating that the type of noise, namely, impulse noise, may result in cochlea changes. Corresponding changes on the pure tone audiogram were not observed, however, noise notch configurations were observed for the groups with a longer history of noise exposure. This was not seen bilaterally as is typically expected with NIHL. Good test-retest reliability across the frequency range obtained in the current study further indicates the feasibility of including DPOAEs in the annual medical surveillance test battery. Additionally, the current study calculated an average of 86 seconds (1 minute 26 seconds) to conduct the DPOAE test bilaterally, confirming that DPOAEs are a quick test to administer. The findings of this study suggest that DPOAEs may be used to monitor early subtle noise-induced cochlea changes for workers exposed to noise in the beverage manufacturing industry as part of the annual medical surveillance test battery.
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    An investigation into the effects of sex difference and contralateral masking on the monaural brainstem auditory evoked response (Baer) obtained in a group of normal hearing Indian undergraduate university students.
    (1989) Govender, Cyril Devadas.; Fernandes, Carlos M. C.; Lazarus, Theophilus.
    The objectives of the investigation were to establish diagnostic reference data; and to examine and report on the effects of sex difference and contralateral masking on the normal BAER. BAERs were elicited from the target (R) ear using clicks presented at 70dBnHL both in the absence and presence of three (50, 6O and 70dBHL) levels of contralateral broadband masking noise. Relevant latency and amplitude data were obtained from 60 selected normal hearing Indian undergraduate female (N=30; X age = 20.33 years) and male (N=30; X age = 21.33 years) students aged between 18 and 25 years (X age = 20.73 years). Diagnostic reference data were established for the absolute latencies of peaks I to VI; relative latencies of peaks I-III; III-V and I-V; absolute amplitudes of peaks I and V and the relative amplitude ratio of peaks V:I. The application of the MANOVA revealed an overall significant (p < 0,05) sex difference effect while no significant differences were observed between the masked and non-masked normal BAER. Furthermore, there were no significant overall interactional effects of sex difference and masking on the BAER. These results are discussed in terms of the literature and implications for clinical application and further research.
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    The development of a Zulu speech reception threshold test for Zulu first language speakers in KwaZulu-Natal (KZN).
    (2006) Panday, Seema.; Govender, Cyril Devadas.; Kathard, Harsha Mothilall.; Pillay, Mershen.
    The measurement of speech reception threshold (SRT) is best evaluated in an individual's first language. Currently there is a paucity of linguistically matched materials to measure the SRT of Zulu First Language Speakers (ZFLS) in Kwa Zulu-Natal (KZN). Therefore, the present study focused on developing and assessing a Zulu SRT word list for Zulu First language Speakers (ZFLS) in KZN, according to adapted criteria for SRT in Zulu. In addition, the application of the developed list was evaluated. The study therefore followed a two phase methodological framework. Phase one focused on the development and assessment of the word list. Phase two focused on the application of the word list in a normal hearing population from KZN. Phase one of the study was realized within a descriptive survey design and Phase two was realized using a within- participant quasi experimental design. Phase one included aims one and two of the study. Phase two included aim three of the study. However, each aim had several objectives which were realized consecutively. For aim one of the study, three objectives were achieved i.e. for objective one, 131 common bisyllabic words were identified by two Zulu speaking language interpreters and two tertiary educators. Eighty two percent of these words were described as bisyllabic verbs. The outcome of objective two concluded that 58 bisyllabic verbs were rated as being familiar, phonetically dissimilar and low tone verbs by five linguistic experts, using a three point Likert scale. The agreement among the raters was generally good for each criterion, according to the Kendall's co-efficient of concordance at 95% level of confidence. Two objectives were generated to realize aim two of the study. These included, the measurement of homogeneity of audibility of the 58 words selected in aim one and the acoustic analysis of the words. The findings for the homogeneity of audibility were based on a logistic regression analysis. Thirty normal hearing adult ZFLS (18-25 years) participated in this aim of the study. The mean slope of 50% for 28 words was 5.98%/dB. Therefore, 28 words were measured as being most homogenous. The 28 words were also assessed acoustically. The acoustic analysis indicated that the pitch contours confirm the prosodic pattern of the words selected in terms of Zulu linguistic structure, as the majority of the verbs (89%) indicated a difference in the pitch pattern between the two syllables. Furthermore, trends were noted with regard to the energy contours. The acoustical analysis supports the findings of objective one of aim two. For aim three of the study, twenty six normal hearing adult ZFLS, with functional proficiency in English were assessed. The SRT was measured using the developed Zulu SRT word list. In addition, the SRT was measured using the original CIDW2 list. The Pearson product moment correlation co-efficient was utilized for the measurement of the relationship between the SRT (Zulu) and the Pure Tone Average (PTA). Similarly, the Pearson product moment correlation between the SRT (English) and PTA was obtained. A good relationship between the SRT scores and PTA was reported when both lists were used. However, a stronger correlation between the Zulu SRT and PTA (r=.76) than with the English SRT and PTA (r=0.62) were noted. The results in aim one and aim two of the study highlighted the importance of adapting the criteria for SRT to suit the structure of the language. Aim three confirmed this premise as the implication of a stronger correlation may be related to the familiarity of the stimuli to the Zulu First Language Speaker. The study therefore contributed to both research and clinical implications. Some of the important research implications for the study include: the application of the Zulu SRT word list to a varied clinical population with a hearing disorder or loss, the standardization of the developed Zulu SRT word list on a larger sample, the development of SRT materials in other African languages in South Africa. Important clinical implications of the study include that the findings in the study support the need for speech material to be appropriate to the language of the client and the developed SRT word list in Zulu is applicable to adult ZFLS in KZN.