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During leisure-time activities, young people expose themselves regularly to sound levels that may hamper the auditory system. In Flanders (Belgium), there is a noise legislation for indoor and outd...

Objectives: Based on limited evidence from case reports and small cohort studies of metal-on-metal (MoM) hip implant patients with presumed systemic cobalt (Co) toxicity, and a few animal studies on Co-induced damage to the otovestibular system, it was hypothesised that Co exhibits an ototoxic potential alongside other systemic manifestations. Preliminary investigations from our research group in MoM patients confirmed this assumption for the auditory system, whereas no signs of Co-induced vestibular impairment were detected, and a clear dose-response relationship between the auditory function and the blood Co levels was lacking. Therefore, the current study aimed to extend and validate these findings in a larger sample of MoM patients and control subjects, to explore the potential clinical value of audiovestibular outcome measures in the risk estimation of systemic Co toxicity in this patient population. Design: Fifty patients (32 to 68 years) with a primary unilateral/bilateral MoM hip implant were matched for age, gender, and noise exposure to 50 nonimplanted control subjects. Both groups underwent the same protocol, consisting of an objective auditory [i.e., conventional and high-frequency audiometry, transient-evoked and distortion (TEOAEs and DPOAEs), auditory brainstem responses] and vestibular (i.e., cervical and ocular vestibular evoked myogenic potentials, horizontal and vertical video head impulse tests) test battery, a questionnaire inquiring auditory, balance, and general neurological symptoms, and a blood sample collection to determine the plasma Co concentration. Results: The auditory test battery presented consistently higher audiometric thresholds in the MoM patient group, with group differences ranging from 2.1 to 5.7 dB in the lower frequencies (0.25 to 6.0 kHz) and from 4.6 to 9.3 dB in the high frequencies (8.0 to 14.0 kHz). Group differences at high frequencies were statistically significant (p 0.01). Six patients had elevated Co levels according to our local institutional threshold (>4 or 5 mu g/l for unilateral or bilateral MoM hip implants, resp.), but their audiovestibular outcome measures did not differ significantly from those of the other patients. Conclusions: Corresponding to our preliminary investigations, the results indicate possibly Co-induced (predominantly high-frequency) auditory impairment, probably triggered by toxic damage to the cochlear structures. However, the low mean difference values, the lack of group differences for the patient-reported outcome measures, and the lack of any relationship with the blood Co levels strongly reduce the clinical relevance of these findings. Therefore, the risk of Co-induced ototoxic impairment is considered to be clinically negligible for the majority of MoM hip implant patients, and the use of auditory tests in the risk estimation of systemic Co toxicity should be decided on a case-by-case basis.

Objective: To describe health-related quality of life (HRQoL) outcomes of school-going paediatric cochlear implant (CI) recipients in a South African cohort from the perspectives of parents.Design:...

Adolescents frequently engage in noisy leisure activities which can result in hearing-related problems. However, the effect of leisure noise exposure is liable to an individual’s risk-taking behavior. Identifying leisure noise activities and relevant factors related to risk-taking behavior in adolescents, are important to optimize hearing conservation programs targeting youngsters. The purpose of the study was to explore the presence of hearing-related symptoms, as well as noise exposure during various activities, and the use of hearing protector devices (HPDs) in adolescents in two educational programs in Flanders. In addition, their attitudes and beliefs towards noise, hearing loss, and HPDs were investigated. The final sample consisted of 247 adolescents. The most important hearing-related symptoms after noise exposure were tinnitus and noise sensitivity. With regard to leisure noise exposure, listening to PMPs was most frequently reported. The use of HPDs during most noisy activities was limited, in accordance with the presence of hearing-related symptoms, considering noise as unproblematic, and having worse scores on subscales of the beliefs about hearing protection and hearing loss scale. In the future, hearing conservation programs should target adolescents specifically for a more health-orientated behavior towards noise exposure, hearing loss, and HPDs.

PurposeThe objective of the current study was to investigate the short-term test–retest reliability of contralateral suppression (CS) of click-evoked otoacoustic emissions (CEOAEs) using commercially available otoacoustic emission equipment.MethodTwenty-three young normal-hearing subjects were tested. An otoscopic evaluation, admittance measures, pure-tone audiometry, measurements of CEOAEs without and with contralateral acoustic stimulation (CAS) to determine CS were performed at baseline (n= 23), an immediate retest without and with refitting of the probe (only CS of CEOAEs;n= 11), and a retest after 1 week (n= 23) were performed. Test–retest reliability parameters were determined on CEOAE response amplitudes without and with CAS, and on raw and normalized CS indices between baseline and the other test moments.ResultsRepeated-measures analysis of variance indicated no random or systematic changes in CEOAE response amplitudes without and with CAS, and in raw and normalized CS indices between the test moments. Moderate-to-high intraclass correlation coefficients with mostly high significant between-subjects variability between baseline and each consecutive test moment were found for CEOAE response amplitude without and with CAS, and for the raw and normalized CS indices. Other reliability parameters deteriorated between CEOAE response amplitudes with CAS as compared to without CAS, between baseline and retest with probe refitting, and after 1 week, as well as for frequency-specific raw and normalized CS indices as compared to global CS indices.ConclusionsThere was considerable variability in raw and normalized CS indices as measured using CEOAEs with CAS using commercially available otoacoustic emission equipment. More research is needed to optimize the measurement of CS of CEOAEs and to reduce influencing factors, as well as to make generalization of test–retest reliability data possible.

Objective This study aimed to systematically investigate the ototoxic potential of cobalt in patients with a metal-on-metal (MoM) hip implant, using objective auditory and vestibular assessments and a questionnaire. The results of the objective evaluation were published previously, whereas the current study focused on the questionnaire outcome and its relationship to the blood cobalt level. Design and study sample:Twenty patients (33-65 years) with a primary MoM hip implant and 20 non-implanted control subjects, matched for age, gender, and noise exposure, received a questionnaire to evaluate the presence of several hearing and balance symptoms (part 1) and general neurological issues (part 2). Results Concerning part 1, the proportion of auditory-related symptoms in general (p = 0.022) and tinnitus (p = 0.047) was significantly higher in the MoM patient group, whereas no group difference was found for hyperacusis, increased listening effort, and decreased speech understanding. Concerning part 2, no significant group differences were detected. Within the MoM patient group, the questionnaire outcome was not significantly different between the low-exposure and high-exposure subgroups according to the blood Co level. Conclusions In line with our previous study, these results potentially imply Co-induced impairment to the auditory system, despite the lack of a clear dose-response relationship.

Objectives: During the past decade, the initial popularity of metal-on-metal (MoM) hip implants has shown a progressive decline due to increasingly reported implant failure and revision surgeries. Local as well as systemic toxic side effects have been associated with excessive metal ion release from implants, in which cobalt (Co) plays an important role. The rare condition of systemic cobaltism seems to manifest as a clinical syndrome with cardiac, endocrine, and neurological symptoms, including hearing loss, tinnitus, and imbalance. In most cases described in the literature, revision surgery and the subsequent drop in blood Co level led to (partial) alleviation of the symptoms, suggesting a causal relationship with Co exposure. Moreover, the ototoxic potential of Co has recently been demonstrated in animal experiments. Since its ototoxic potential in humans is merely based on anecdotal case reports, the current study aimed to prospectively and objectively examine the auditory and vestibular function in patients implanted with a MoM hip prosthesis. Design: Twenty patients (15 males and 5 females, aged between 33 and 65 years) implanted with a primary MoM hip prosthesis were matched for age, gender, and noise exposure to 20 non-implanted control subjects. Each participant was subjected to an extensive auditory (conventional and high-frequency pure tone audiometry, transient evoked and distortion product otoacoustic emissions [TEOAEs and DPOAEs], auditory brainstem responses [ABR]) and vestibular test battery (cervical and ocular vestibular evoked myogenic potentials [cVEMPs and oVEMPs], rotatory test, caloric test, video head impulse test [vHIT]), supplemented with a blood sample collection to determine the plasma Co concentration. Results: The median [interquartile range] plasma Co concentration was 1.40 [0.70, 6.30] mu g/L in the MoM patient group and 0.19 [0.09, 0.34] mu g/L in the control group. Within the auditory test battery, a clear trend was observed toward higher audiometric thresholds (11.2 to 16kHz), lower DPOAE (between 4 and 8kHz), and total TEOAE (1 to 4kHz) amplitudes, and a higher interaural latency difference for wave V of the ABR in the patient versus control group (0.01

Objective: To identify and describe predictors of health-related quality of life (HRQoL) outcomes for adult cochlear implant (CI) recipients in South Africa. Design: A retrospective study of adult CI recipients was conducted and cross-sectional HRQoL outcome data were added at the time of data collection, using the Nijmegen Cochlear Implant Questionnaire (NCIQ). Twenty-two potential predictive factors were identified from the retrospective dataset, including demographic, hearing loss, CI and risk-related factors. Multiple regression analyses were performed to identify predictor variables that influence HRQoL outcomes. Study sample: The study sample included 100 adult CI recipients from four CI programs, implanted for at least 12 months. Results: History of no tinnitus prior to CI, bilateral implantation and mainstream schooling were strongly predictive of better overall HRQoL outcomes. Factors such as age, age at implant, gender, onset of hearing loss, duration of CI use and presence of risk factors did not predict HRQoL scores. Conclusion: A range of significant prognostic indicators were identified for HRQoL outcomes in adult CI recipients. These predictors of HRQoL outcomes can guide intervention services’ informational counselling.

In a previous study Moodley, Kritzinger and Vinck (2014) found that formal English Additional Language (EAL) instruction contributed significantly better to listening and speaking skills in Grade R learners, than did a play-based approach. The finding in multilingual rural Mpumalanga schools was in agreement with numerous studies elsewhere. Additional extraneous variables such as teachers’ first language, qualifications, age and experience, and learners’ first language and gender may also relate to EAL performance. The aim of the present study has been to determine whether these variables were significantly associated with learners’ EAL performance scores. A matched two group comparison study was conducted, utilising 175 learners and 10 teachers from isiNdebele, isiZulu, Sepedi, siSwati and Xitsonga first language backgrounds. The English Language Proficiency standards assessment tool was used. Learners of IsiNdebele teachers and young qualified teachers performed better than other learners. Learners with isiNdebele as first language performed better than learners from other languages. No association between gender and learner performance was found. The advantage of isiNdebele speaking teachers and learners in EAL teaching and learning may relate to the many borrowed phonemes and words from English. Further research is required to strengthen the evidence. Keywords: English Additional Language instruction; English Language Proficiency (ELP) standards assessment tool; Grade R; isiNdebele; isiZulu; Sepedi; siSwati; teacher qualifications; Xitsonga

The Early Childhood Development Manager in Mpumalanga is faced with the problem of providing evidence-based guidance of the best facilitation approach in the Grade R context. An investigation on the effect of facilitation, i.e. play-based or formal instruction, on Grade R performance scores in English Additional Language (EAL) learning was conducted. Literature findings attest to formal learning contributing to better performance scores than play-based learning, yet most rural schools in Mpumalanga use the play-based approach. The English Language Proficiency (ELP) standards assessment tool is reported to have no cultural bias and was used to collect the data. The tool assessed learners’ listening and speaking skills in EAL. A quantitative methodology was followed, using a static two-group comparison design. Participants in the two groups were matched according to age and all had a similar exposure period to EAL learning, a rural upbringing, poverty level, and all were mainstream learners. Inter-rater reliability was obtained since two raters assessed learners’ proficiency in EAL skills. A one-way Analysis of Variance (ANOVA) was used to analyse the data. It was found that the formal based approach contributed to better EAL scores when compared to the play-based approach. Implications for practice are discussed. Keywords : EAL learning; ELP standards assessment tool; formal instruction;Grade R facilitation; learners’ first language; play-based approach

Objective To determine and describe parent-perceived challenges related to the pediatric cochlear implantation process and support services received. Method A multicenter survey study across six cochlear implant (CI) programs in South Africa (SA) was conducted. The study sample included 82 parents of pediatric (≤18 years) CI recipients with at least 12 months CI experience. A self-administered questionnaire was developed for the purpose of this study, exploring parental challenges regarding the CI process, education of their implanted children and the support services received. Results The financial implications of cochlear implantation, including CI device maintenance, were identified by parents as the most prominent challenge. Financing issues were the highest scoring reason that attributed to the delay between diagnosis of hearing loss and cochlear implantation, as well as the greatest barrier to bilateral implantation. Parent-perceived educational challenges included finding adequate educational settings specific to the individual needs of their child and a shortage of trained teachers equipped to support children with CIs. The presence of one/more additional developmental conditions and grade repetition were associated with more pronounced parent-perceived educational challenges. Parents considered speech-language therapy as the most critical support service for their implanted children to achieve optimal outcomes, while parent guidance was indicated to be the most critical support service required for parents of pediatric CI recipients. Conclusion A greater understanding of parent-perceived challenges will guide CI professionals to promote optimal outcomes, evidence-based service delivery and on-going support to pediatric CI recipients and their families. Study results imply a call for action regarding financial and educational support for pediatric CI recipients in SA.

Personal hearing protectors are widely used to prevent occupational noise-induced hearing loss. These devices have to be worn both correctly and consistently while exposed to noise, therefore substantial research has been devoted to barriers and opportunities associated with effective hearing conservation. The current paper focuses on the company's hearing conservation approach to identify from a practical point of view major policy aspects that can stimulate effective hearing conservation and are also feasible within a real industrial context. In four companies from different branches of industry, surveys have been carried out among safety advisors and workers to asses the companies' hearing conservation program from both perspectives and relate it to reported use of hearing protectors. The findings highlight the benefits of strict policy: reported consistent wearing is much higher in the establishment where actual control and even sanctions are in place. Workers' risk perception of noise levels at the work floor is also found to be important, but less associated with final use than the safety culture. Finally, the safety climate reported by safety advisors corresponds closely to the workers' perception, suggesting that (adequate) policy making can get really through to daily working routines. These findings stress once more the managements' responsibilities and opportunities to create a healthy occupational environment. Relevance to industry As stated in this abstract, the current findings are very relevant for industry because they identify the major influential factors for use of hearing protection at the work floor. This way, the results can serve as a base and inspiration for focused hearing conservation programs, improving the prevention of noise-induced hearing loss with effective efforts.

Cobalt (Co) and its compounds are widely distributed in nature and are part of numerous anthropogenic activities. Although cobalt has a biologically necessary role as metal constituent of vitamin B-12, excessive exposure has been shown to induce various adverse health effects. This review provides an extended overview of the possible Co sources and related intake routes, the detection and quantification methods for Co intake and the interpretation thereof, and the reported health effects. The Co sources were allocated to four exposure settings: occupational, environmental, dietary and medical exposure. Oral intake of Co supplements and internal exposure through metal-on-metal (MoM) hip implants deliver the highest systemic Co concentrations. The systemic health effects are characterized by a complex clinical syndrome, mainly including neurological (e.g. hearing and visual impairment), cardiovascular and endocrine deficits. Recently, a biokinetic model has been proposed to characterize the dose-response relationship and effects of chronic exposure. According to the model, health effects are unlikely to occur at blood Co concentrations under 300 [mu g/1(100 mu g/1 respecting a safety factor of 3) in healthy individuals, hematological and endocrine dysfunctions are the primary health endpoints, and chronic exposure to acceptable doses is not expected to pose considerable health hazards. However, toxic reactions at lower doses have been described in several cases of malfunctioning MoM hip implants, which may be explained by certain underlying pathologies that increase the individual susceptibility for Co-induced systemic toxicity. This may be associated with a decrease in Co bound to serum proteins and an increase in free ionic Co2+. As the latter is believed to be the primary toxic form, monitoring of the free fraction of Co2+ might be advisable for future risk assessment. Furthermore, future research should focus on longitudinal studies in the clinical setting of MoM hip implant patients to further elucidate the dose-response discrepancies.

Objective: The objective was to determine the preliminary psychometric performance of a new clinical feeding scale to diagnose oropharyngeal dysphagia (OPD) in neonates.Methods: Twenty neonates with a median gestational age of 35 weeks were evaluated using the Neonatal Feeding Assessment Scale (NFAS) and modified barium swallow studies (MBSS). The results were compared.Results: Nine of the 20 participants presented with OPD on the NFAS. Comparison of the scale’s results with instrumental MBSS indicated that all participants without OPD were correctly excluded (100% sensitivity). The specificity was 78.6%, indicating that three participants were falsely identified with OPD on the scale. Inter-rater reliability was determined on 50% (n = 10) of the sample. Substantial agreement (80%) was obtained between two raters in five of the six sections of the scale and on the diagnostic outcome.Conclusion: The preliminary performance of the scale appears to be promising. A further validation study will take place.

This study explores the relationship between tonal synchrony and maternal-infant social engagement based on free-play recordings of 15 mothers and their 3-month-old infants in a laboratory setting. Moment-by-moment analyses on a microlevel were used to study social engagement and vocal interaction. We analysed and categorized 854 vocalization periods (mother-only vocalizations, tonal interaction periods, nontonal interaction periods, and mutual silence). Tonal synchrony was analysed in terms of harmonic and pentatonic series based on pitch frequency analyses. Social engagement was microanalyzed in terms of matched and mismatched engagement states. ANOVA-repeated measures revealed, most importantly, a significant relationship between TIPs and social interaction repair, which indicates the importance of tonal synchrony in the flow of social engagement in mother-infant dyads. Other significant relationships were found between (a) nTIPs/mismatch-mismatch, and, (b) MOV/affect loss. As mentioned in the discussion, the findings are suggestive for clinical applications (e.g., music therapy) and warrant further research. © International Society on Infant Studies (ISIS).

Anxiety is found to play an important role in the severity complaint of tinnitus patients. However, when investigating anxiety in tinnitus patients, most studies make use of verbal reports of affect (e.g., self-report questionnaires and/or interviews). These methods reflect conscious appraisals of anxiety, but do not map underlying processing mechanisms. Nonetheless, such mechanisms, like the automatic processing of affective information, are important as they modulate emotional experience and emotion-related behaviour. Research showed that highly anxious people process threatening information (e.g., fearful and angry faces) faster than non-anxious people. Therefore, this study investigates whether tinnitus patients process affective stimuli (happy, sad, fearful, and angry faces) in the same way as highly anxious people do. Our sample consisted out of 67 consecutive tinnitus patients. Relationships between tinnitus severity, pitch, loudness, hearing loss, and the automatic processing of affective information were explored. Results indicate that especially in severely distressed tinnitus patients, the severity complaint is highly related to the automatic processing of fearful (r = 0.37, p < 0.05), angry (r = 0.44, p < 0.00) and happy (r = -0.44, p < 0.00) faces, and these relationships became even stronger after controlling for hearing loss. Furthermore, in contrast with findings on the relation between audiological characteristics (pitch and loudness) and conscious report of anxiety, we did find that the audiological characteristic, loudness, tends to be in some degree related to the automatic processing of fearful faces (r = 0.25, p = 0.08). We conclude that tinnitus is an anxiety-related problem on an automatic processing level.

Tinnitus has been defined as a phantom auditory perception. Research indicates the necessity to make a distinction between the physical symptom and the subjective severity of the tinnitus symptom, since especially the latter seems to vary among patients. The relationship between tinnitus severity and psychological variables has been well established. Anxiety is considered to be an important variable for understanding the differences in the subjective tinnitus severity. Although many studies confirm the relationship between anxiety and tinnitus severity, most studies do not take the possibility of shared method variance and content overlap between questionnaires into account. Furthermore, anxiety is a broad concept and contains both a cognitive and somatic dimension. Research including both dimensions of anxiety in tinnitus population is rare. According to us two conditions must be fulfilled before theorization on the relation is useful: (1) the presence of clinically relevant cognitive and/or somatic anxiety, (2) evidence of a substantial or "real" relationship. In our sample, almost 60% reported more than average cognitive anxiety and 40.8% reported clinical relevant somatic anxiety. After controlling for content overlap between the questionnaires used, the relation between tinnitus severity and cognitive and somatic anxiety remains significant. Two hypothetical models concerning this relationship that deserve future research attention are described.

Objective: The aim of this study was to investigate the diagnostic capacity of three different rotatory tests, and to investigate the clinical effectiveness of the caloric, rotatory, and vestibular evoked myogenic potential (VEMP) test. Design and study sample: Several rotatory testssinusoidal harmonic acceleration test (SHAT), pseudorandom rotation test (PRRT), velocity step test (VST)and a caloric and a VEMP test, were given to 77 patients (mean age 52 years) with a unilateral peripheral vestibular pathology, and 80 control subjects (mean age 48 years). Results: For the rotatory test, the highest diagnostic capacity was obtained with the 0.01 Hz SHAT frequency, followed by 0.1 and 0.05 Hz. A higher diagnostic accuracy was reached for the caloric and VEMP test. The caloric test demonstrated high sensitivity and specificity values, but the 0.01 Hz SHAT rotation appeared more sensitive, and the VEMP more specific, than the caloric test. Conclusion: A selection of the 0.01, 0.05, and 0.1 Hz SHAT rotations is suggested as the most ideal rotatory test protocol, and a combination of rotatory, caloric, and VEMP testing will result in a more complete examination of our vestibular system.

Objective The present study aimed at establishing clinically efficient stopping criteria for a multiple 80-Hz auditory steady-state response (ASSR) system. Methods In Experiment 1, data of 31 normal-hearing subjects were analyzed off-line to propose stopping rules. Consequently, ASSR recordings will be stopped when (1) all 8 responses reach significance and significance can be maintained for 8 consecutive sweeps; or (2) the mean noise levels were ⩽4nV (if p -values were between 0.05 and 0.1, measurements were extended once by 8 sweeps); or (3) a maximum amount of 48 sweeps was attained; whichever occurred first. In Experiment 2, these stopping criteria were applied on 10 normal hearing and 10 hearing-impaired adults to assess the efficiency. Results The application of these stopping rules resulted in ASSR threshold values that were comparable to other ASSR research. Furthermore, preliminary analysis of the response and noise amplitudes demonstrated slightly higher values for hearing impaired than normal-hearing subjects. Conclusions The proposed stopping rules can be used in adults to determine accurate ASSR thresholds within a time-frame of about 1h. Significance The use of these a priori stopping criteria might assist the clinician in their decision to terminate ASSR recordings.

The performance of hearing protectors can be assessed in situ by measuring the sound pressure inside the ear canal following the Microphone In Real Ear (MIRE) protocol. Thus a custom-made earplug has been designed with an inner bore, allowing the insertion of the MIRE measurement microphone. However, the actual exposure level can only be accurately predicted if the relationship, henceforth called transfer function, between the sound level at the microphone and at the eardrum is known. Previous research has revealed that the transfer function can be precisely approximated with an individualized FDTD model, but a simplified method is needed for practical implementation due to the time-consuming nature of this numerical technique. In this matter, a one-dimensional analytical model appears inadequate, hence an approximation to the detailed FDTD model based on digital filter design is proposed instead. Two different approaches have been applied to estimate the individualized filter coefficients: multiple linear regression and Multivariate Orthonormal Vector Fitting (MOVE). In general, both methods can predict an individual's transfer function quite accurately if the length of the earplug's inner bore and the length of the residual part of the ear canal behind the protector are known. However, MOVE seems more reliable for ears with a longer residual part.

The microphone in real ear (MIRE) protocol allows the assessment of hearing protector's (HPD) attenuation in situ by measuring the difference between the sound pressure outside and inside the ear canal behind the HPD. Custom-made earplugs have been designed with an inner bore to insert the MIRE probe containing two microphones, the reference microphone measuring the sound pressure outside and the measurement microphone registering the sound pressure behind the HPD. Previous research on a head and torso simulator reveals a distinct difference, henceforth called transfer function, between the sound pressure at the MIRE measurement microphone and the sound pressure of interest at the eardrum. In the current study, similar measurements are carried out on humans with an extra microphone to measure the sound pressure at the eardrum. The resulting transfer functions confirm the global frequency dependency found earlier, but also show substantial variability between the ears with respect to the exact frequency and amplitude of the transfer functions' extrema. In addition, finite-difference time-domain numerical models of an ear canal with earplug are developed for each individual ear by including its specific geometrical parameters. This approach leads to a good resemblance between the simulations and their corresponding measurements.

Objective The purpose of this study was to evaluate the reliability of the vestibular evoked myogenic potential (VEMP) response in a clinical setting when only a feedback mechanism is available for monitoring background EMG. Methods Sixty-one healthy subjects participated in the investigation of the within-session reliability, whereas fourteen of them were retested after one week for examination of the between-session reliability. VEMPs were recorded using 500Hz tone bursts with the subjects in a sitting position and their heads turned away from the test ear to the contralateral shoulder, thereby pushing their chin against the inflatable cuff of a blood pressure manometer, serving as feedback method. Results The feedback method revealed latency and amplitude values comparable to other data in the literature where different test conditions were applied. Excellent reliability with ICC values ranging from 0.78 to 0.96 and CV ME values ranging from 4% to 36%, was achieved for P1 and N1 latency, threshold and interpeak amplitude. Good reliability with ICC values of 0.65 and 0.68 and CV ME values of 170% and 189%, was obtained for the asymmetry ratio. Conclusions A unilateral muscle contraction controlled by a feedback mechanism resulted in reliable response parameters, comparable right to left and corresponding to literature data obtained in different test conditions. Significance The use of a blood pressure manometer as feedback mechanism combined with a meticulously controlled positioning of the head and contraction of the SCM muscle provides a reliable alternative in clinical settings, when the background muscle contraction cannot be measured or software related correction algorithms are not accessible.

BACKGROUND: Many risk factors may result in a communication delay. Reliable identification methods are essential to identify infants at risk of communication difficulties in the primary healthcare context. Literature on identifying both at-risk and established risk factors associated with communication disorders in South Africa is limited. OBJECTIVE: To identify and describe risk factors for communication delays in infants 0 - 12 months of age at Daspoort Polyclinic in Gauteng. METHODS: A structured interview schedule was utilised to conduct an interview with the caregiver participants. Convenience sampling was used to select 96 caregiver participants. RESULTS: The results obtained indicated that all infant participants presented with exposure to one or more risk factors that may possibly impact communication development. High frequencies of risk factors included colds and/or flu during pregnancy, previous miscarriages, maternal smoking, low educational levels and unemployment. CONCLUSION: The high frequency of at-risk conditions within the Daspoort population justifies the importance of implementation of early communication intervention services in primary healthcare.

Background: There is a need for validated neonatal feeding assessment instruments in South Africa. A locally developed instrument may contribute to standardised evaluation procedures of high-risk neonates and address needs in resource constrained developing settings. Objective: The aim of the study was to develop and validate the content of a clinical feeding assessment scale to diagnose oropharyngeal dysphagia (OPD) in neonates. Method: The Neonatal Feeding Assessment Scale (NFAS) was developed using the Delphi method. Five international and South African speech-language therapists (SLTs) formed the expert panel, participating in two rounds of electronic questionnaires to develop and validate the content of the NFAS. Results: All participants agreed on the need for the development of a valid clinical feeding assessment instrument to use with the neonatal population. The initial NFAS consisted of 240 items across 8 sections, and after the Delphi process was implemented, the final format was reduced to 211 items across 6 sections. The final format of the NFAS is scored using a binary scoring system guiding the clinician to diagnose the presence or absence of OPD. All members agreed on the format, the scoring system and the feeding constructs addressed in the revised final format of the NFAS. Conclusion: The Delphi method and the diverse clinical and research experience of participants could be integrated to develop the NFAS which may be used in clinical practice in South Africa or similar developing contexts. Because of demographically different work settings marked by developed versus developing contexts, participants did not have the same expectations of a clinical dysphagia assessment. The international participants contributed to evidence-based content development. Local participants considered the contextual challenges of South African SLTs entering the field with basic competencies in neonatal dysphagia management, thereby justifying a comprehensive clinical instrument. The NFAS is aimed at clinicians working in Neonatal Intensive Care Units where they manage large caseloads of high-risk neonates. Further validation of the NFAS is recommended to determine its criterion validity in comparison with a widely accepted standard such as the modified barium swallow study.

The aim of the present study was to construct and compare two caloric test protocols, one for water irrigation, and one for air insufflation. A set of reference data was constructed and tabulated as well as the intersubject variability. The effect of age, sex, ear, and temperature, as well as a possible priming effect and order effect were investigated. Forty-seven subjects (18-58 years) without otological or vestibular history participated. Four response parameters were investigated: slow component velocity (SCV), frequency, unilateral weakness (UW), and directional preponderance (DP). Statistically higher SCV values were obtained for water compared to air, with statistically higher standard deviations for SCV water values. No influences of age, sex, ear, or temperature could be demonstrated on any of the response parameters. The same applied for the presence of an order effect and a priming effect. Comparing the two protocols to one another led the present authors to favour water as the standard irrigation medium, and air only in situations where water is contra-indicated.

The present study utilized a commercially available multiple auditory steady-state response (ASSR) system to test normal hearing adults (n=55). The primary objective was to evaluate the impact of the mixed modulation (MM) and the novel proposed exponential AM(2)/FM stimuli on the signal-to-noise ratio (SNR) and threshold estimation accuracy, through a within-subject comparison. The second aim was to establish a normative database for both stimulus types. The results demonstrated that the AM(2)/FM and MM stimulus had a similar effect on the SNR, whereas the ASSR threshold results revealed that the AM(2)/FM produced better thresholds than the MM stimulus for the 500, 1000, and 4000 Hz carrier frequency. The mean difference scores to tones of 500, 1000, 2000, and 4000 Hz were for the MM stimulus: 20+/-12, 14+/-9, 10+/-8, and 12+/-8 dB; and for the AM(2)/FM stimulus: 18+/-13, 12+/-8, 11+/-8, and 10+/-8 dB, respectively. The current research confirms that the AM(2)/FM stimulus can be used efficiently to test normal hearing adults.

Objective To identify and describe predictors of pediatric cochlear implantation outcomes in a South African population. Methods A retrospective study of 301 pediatric cochlear implant (CI) recipients from five CI programs was conducted and cross-sectional outcome data were added at the time of data collection. Twenty potential prognostic factors were identified from the retrospective dataset, including demographical, CI, risk and family factors. Multiple regression analyses were performed to identify predictor variables that influence outcomes in terms of auditory performance (CAP scores), speech production (SIR scores), communication mode and educational placement. Results Although implanted children within this sample did not have equal opportunity to access a second implant, bilateral implantation was strongly predictive of better auditory performance and speech production scores, an oral mode of communication and mainstream education. NICU admittance/prematurity were associated with poorer auditory performance and speech production scores, together with a higher probability for non-oral communication and non-mainstream education. The presence of one or more additional developmental condition was predictive of poorer outcomes in terms of speech production and educational placement, while a delay between diagnosis and implantation of more than one year was also related to non-mainstream education. Ethnicities other than Caucasian were predictive of poorer auditory performance scores and a lower probability for mainstream education. Conclusion An extensive range of prognostic indicators were identified for pediatric CI outcomes in South Africa. These predictive factors of better and poorer outcomes should guide pediatric CI services to promote optimal outcomes and assist professionals in providing evidence-based informational counseling.

In order to develop a sensitive audiometric protocol for identifying ototoxicity in children, a retrospective study of 16 children treated with cisplatin and/or carboplatin was performed. Audiometric testing was done by means of pure-tone threshold audiometry (PTA), high-frequency audiometry (HFA), and distortion product otoacoustic emissions (DPOAEs).Cisplatin caused a sensorineural high-frequency hearing loss in the study group compared to the controls (p

Objective This study involved the assessment of the otologic and audiologic characteristics of a group of patients with Turner syndrome. Study design Prospective study consisting of a questionnaire (77 of 123 responders) and an otologic and audiologic evaluation in patients with Turner syndrome (41 participants). Setting Tertiary academic medical setting. Patients Children, adolescents, and adults with Turner syndrome (median age, 24 yr). Interventions Otomicroscopy, audiometry, immittance measurements, and diagnostic imaging. Results Otologic disease is an important characteristic in Turner syndrome. Sixty-six percent of the patients studied via the questionnaire reported a history of chronic or recurrent middle ear disease. Analysis of audiometric data in 40 patients tested reveals an equal amount of normal ears (38.8%) and pure sensorineural ears (38.8%), each constituting approximately one-third of the patient population. Pure conductive losses represent only one-fifth (21.3%) of auditory abnormality encountered. Conclusions Careful follow-up during early childhood of children with Turner syndrome is necessary to detect middle ear disease and prevent sequelae. However, long-term periodic review is mandatory even after resolution of middle ear disease to detect sensorineural hearing loss.

The purpose of this study was to determine and to compare the overall intelligibility, articulation, resonance, and voice characteristics in children using cochlear implants (CI) and children using conventional hearing aids (HA). Nine prelingually deaf children using CI and six children with a prelingual severe hearing loss using HA, were selected to participate. Objective (DSI, nasalance scores) as well as subjective assessment techniques (perceptual evaluations) were used. Both the CI and HA children demonstrated normal vocal quality and resonance but showed the presence of articulation disorders. In the CI children, intelligibility was significantly better compared to the HA children. Significantly more phonetic and phonological disorders were present in the HA children. The results of this study show a poorer intelligibility of the HA children in comparison with the CI children which is probably due to the occurrence of significantly more phonetic and phonological disorders. Future detailed analysis i...

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