Ototoxicity: A review of South African studies

Background: Ototoxicity is damage to cells in the inner ear after administering a toxic drug, with a resultant hearing loss. Drugs used to treat illnesses such as cancer, tuberculosis, human immuno-deficiency virus (HIV) and infections are potentially ototoxic. South Africa has one of the highest rates of HIV and tuberculosis, and thus a potentially greater degree of the population is being affected by hearing loss from the medications used to treat these illnesses.Methods: To determine the current status of research in ototoxicity, a systematic literature review was carried out to determine the focus areas of South African studies for the period 1989–2019. From the database search engines used (Science Direct, Ebscohost and Proquest), a total of 33 relevant articles were identified, including the themes of pharmacology, audiology and knowledge.Results: Studies were conducted in the three most resourced provinces in South Africa. Findings indicate that there is a need for educating doctors regarding ototoxicity and a delineation of the role of the audiologist in monitoring and management of ototoxic hearing loss. There is a resultant need for audiology training on the pharmacology of ototoxic medication, otoprotective strategies and adherence to recommended guidelines. This has implications for university audiology training programmes and curriculum planning. The need for development of South Africa-specific audiology guidelines was highlighted.Conclusion: Whilst it is noted that there is a lack of resources for effective implementation of ototoxicity-monitoring protocols, it is also noted that there are measures and otoprotective strategies that can be put in place without additional resources.

A Cross-Sectional Survey Evaluating Awareness of Congenital Cytomegalovirus Among Audiologists and Speech-Language Pathologists

Purpose Congenital cytomegalovirus (cCMV) is the most common congenital infection worldwide and a leading environmental cause of pediatric hearing loss (HL). The objective of this study was to evaluate audiologists and speech-language pathologists (SLPs) on awareness and knowledge of cCMV. Method A multiple-choice survey assessing awareness, knowledge, and practice patterns was sent electronically to audiologists and SLPs of the American Speech-Language-Hearing Association. Results were compared between audiologists and SLPs and within stratified groups of audiologists. Data were collected, and descriptive analysis was performed. Results Ninety-four audiologists and 317 SLPs responded. Most audiologists were somewhat or very familiar with cCMV (85.9%), while only 26% of SLPs responded that they were at least somewhat familiar with cCMV ( p < .0001). When comparing audiologists' and SLPs' knowledge of symptoms, transmission, and diagnostic age for cCMV, audiologists had higher scores in all categories ( p < .0001). Audiologists were then stratified into subgroups to evaluate the association of the given subgroup with their overall knowledge. The more advanced audiology training, the more knowledgeable the respondent was regarding HL progression ( p = .002). Audiologists who were more familiar with cCMV scored better in most categories compared to those reporting somewhat or less familiar; these findings were only significant for knowledge of symptoms ( p < .0001). Audiologists who were sometimes or frequently evaluating children less than 5 years of age had a better understanding of HL presentation among cCMV patients than those who rarely saw this patient population. Those who were in practice for < 20 years frequently knew the time-sensitive age of diagnosis than respondents in practice longer. Conclusions As a leading environmental cause of pediatric HL, cCMV is frequently encountered by audiologists and SLPs. This study highlights knowledge gaps and areas where targeted education is needed for both groups.

Counseling Issues: Addressing Behavioral and Emotional Considerations in the Treatment of Communication Disorders

Purpose Counseling is an important fundamental professional activity and an established component of the speech-language pathology/audiology scope of practice as documented by the American Speech-Language-Hearing Association (2004a, 2016a). Appropriate incorporation of counseling into practice can optimize service provision, help address comorbid behavioral and emotional reactions to communication disorders, and enhance prognosis. Practitioner insecurity in incorporating counseling into practice has been documented by Phillips and Mendel (2008), as well as Atkins (2007). This tutorial seeks to present general counseling constructs and treatment applications primarily utilizing a humanistic counseling perspective. Method This tutorial incorporated relevant publications from communication disorders and counseling psychology literature databases over a 3-year period. The tutorial evolved through interviews with practicing speech-language pathology practitioners and educators and was undertaken to provide transparency and clarity to support the assertions and recommendations offered. Results This tutorial organizes and presents general counseling considerations along with specific suggestions, which can help practitioners who are seeking to expand their understanding, skill, and confidence in incorporating counseling into their practice. The tutorial identifies some of the potential and impactful comorbid emotional and behavioral responses to experiencing a communication disorder and/or to the treatment process for the communication disorder issue(s). Theoretically grounded considerations for mitigating such potentially impactful responses are offered. Conclusion Continued and enhanced efforts may be necessary to meet American Speech-Language-Hearing Association's mandate for universal incorporation of empirically supported counseling approaches and in advancing universal speech-language pathology/audiology training in this area. It is hoped that this tutorial serves as an initial guide for addressing this need until universal preparation and practice is achieved.

Telepractice in University Au.D. Programs: Survey of Program Directors

Permanent hearing loss is a global health care burden; 360 million people, including 32 million (9%) children, have disabling hearing loss (Chadha & Stevens, 2013, p. 2). About 80 percent of these people live in developing nations without access to hearing care services. The American Academy of Audiology (AAA, 2014) has reported “ongoing efforts to explore and enhance the use of telepractice…to expand the availability and accessibility of hearing and balance care” to individuals across the world. The American Speech-Language-Hearing Association (2014c) has also endorsed advances in telepractice for the world's millions with hearing loss and related disorders, and encouraged institutional involvement as a future direction for audiology training. In the first publishing of this nature, this report shares survey responses from 28 of the nation's 74 graduate programs about their inclusion of telepractice in the Clinical Doctor of Audiology (Au.D.) curriculum. Results suggest a slow response from university programs and challenges in addressing telepractice in current course and clinical offerings. Results also support a direction of change to include telepractice in future Au.D. curricula.

Professionalism and the Audiology Student: Characteristics of Master's versus Doctoral Degree Students

Only scarce documentation is available concerning the professional characteristics of students within audiology training programs. In the current study, audiology students were asked to complete a questionnaire that explored some of the major issues of student professionalism. Equal numbers of questionnaires were sent to both Doctor of Audiology (AuD) and master's degree programs to determine the characteristics of students being attracted to and trained within two different courses of study. Audiology students as a whole ranked low in most aspects of professionalism when compared with other students in health care. Similarities were observed between the two student groups for the majority of questions. Statistically significant differences were calculated with regard to future employment, income, and autonomy. Master's students more commonly wished to become employees rather than employers. Significantly higher numbers of master's than AuD students expect audiology to provide them with a secondary source of income. Finally, more master's than AuD students report doubt concerning the future autonomy of audiology.