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    Cisplatin-associated ototoxicity: perspectives from a single institution cervical cancer cohort and implications for developing a locally responsive monitoring programme in a public healthcare setting
    (BioMed Central Ltd, 2022-06-18) Paken J; Govender CD; Pillay M; Sewram V
    Background Ototoxicity monitoring is uncommon in South Africa, despite the increased use of ototoxic medication to manage the burden of disease in the country. The successful implementation of such a protocol requires cognisance of contextual realities and multiple dimensions for consideration from both patients and service providers. As part of an ongoing cohort study on cisplatin-associated ototoxicity and efforts to better inform the implementation of such programmes, the perspectives of cervical cancer patients and healthcare workers towards ototoxicity monitoring were assessed. Methods This concurrent-triangulation mixed-methods study was conducted at a tertiary hospital in South Africa. Self-reported questionnaires from patients (n = 80) and healthcare personnel comprising clinicians, oncology nurses, pharmacists, and radiotherapists (n = 32), results of audiological evaluations, researcher field notes, and estimated patient and service provider costs contributed to data for this study. Data analysis included descriptive statistics, comparison of test characteristics and deductive thematic analysis. Results The ototoxicity monitoring programme was positively received by the participants, with 90.6% of healthcare personnel and 89% of patients reporting it to be beneficial. The clinicians (76.6%) were identified as the main providers of information on the effects of chemotherapy medication and made the necessary referrals for audiological evaluation. The approximate cost of setting up such a programme included purchase of equipment (US56 700) and the appointment of an audiologist (US 26 250). The approximate costs to patients included transport costs (US$ 38) and the loss of income for the day (US 60), calculated at the minimum wage per hour, if employed. Creative appointment scheduling, easy facility access and detailed locally comprehensible couselling improved patient compliance to the programme. Whilst the sequential use of American Speech-Language-Hearing Association (ASHA) and National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) criteria aided in an evidence-informed approach to aural rehabilitation, DPOAEs and speech discrimination displayed low sensitivity (range 1.45% – 22.39%) but high specificity (range 77.78% – 100%) when identifying ototoxic change. Conclusion This novel study, through a ‘real-world’ experience, has revealed that an ototoxicity monitoring programme is feasible in South Africa, through meaningful engagements with- and considerations from- patients and service providers regarding planning, delineation of responsibilities and cost implications. The findings can potentially serve as a roadmap for other limited resource environments.
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    Chemicals, noise and occupational hearing health in South Africa: A mapping study
    (AOSIS, 2020-03-10) Pillay M
    Background: Chemical exposure leading to ototoxicity is a fresh challenge for occupational healthcare in South Africa. Objectives: The critical question is: ‘what is known about occupational ototoxic chemicals with or without noise exposure in South Africa?’ Method: This qualitative, mapping study was completed with published (peer-reviewed) and grey literature from 1979-2019. Data was analysed using the Preferred Reporting Items for Systematic reviews and Meta-Analyses: extension for Scoping Reviews and the Nursing and Allied Health Resources Section subcommittee on Mapping the Literature of Nursing and Allied Health (adapted). Numerical analysis of article type was completed, but the primary focus was on capturing patterns/trends using thematic analysis and ideology critique. Results: The African Journal of Disability, African Journal of Primary Health Care and Family Medicine, South African Medical Journal, The South African Journal of Communication Disorders [SAJCD] and Health SA Gesondheid) were included with the SAJCD containing one relevant item and seventeen other items were analysed. Research focusses on the mining sector (gold) in Gauteng, and ototoxic medication (tuberculosis and/or human immunodeficiency virus) take precedence. In KwaZulu-Natal, the focus is on commerce and industry across formal and informal sectors. There are no governmental policies that refer to chemical ototoxicity. Occupational hearing loss is configured exclusively on the meme that noise exposure is the only toxin. Conclusion: Chemical exposures are only just beginning to be recognised as ototoxic in South Africa. Hearing conservation programmes should always serve the workers’ interests and never bow down to the econometric interests of employers.
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    Attitudes to noise and behaviour towards hearing protection among Pasifika university students in New Zealand
    (Taylor and Francis Group on behalf of the Royal Society of New Zealand, 2021-01-17) Reddy R; Nosa V; Mafi I; Welch D; Gaffney JS
    It is estimated that 1.1 billion young people worldwide are at risk of hearing loss due to high levels of noise exposure. Hearing loss can contribute to low self-esteem, poor employment prospects and social problems. The aim of this research was to explore the attitudes and beliefs towards noise, hearing loss and hearing protection among Pasifika university students in New Zealand. 96 Pasifika students completed the Youth Attitude to Noise Scale (YANS) and Beliefs About Hearing Protection and Hearing Loss (BAHPHL) questionnaire electronically using a Qualtrics survey. The findings show that the study sample had higher mean scores in the BAHPHL scales related to susceptibility to hearing loss, severity of hearing loss, and benefits of preventive action compared to findings of similar international research. This implies that Pasifika participants had more positive beliefs than their international peers on some factors. Despite their greater awareness, the Pasifika sample had similarly poor attitudes related to minimising loud sounds in the daily environment, perceived barriers towards prevention, behavioural intention and social norms towards hearing conservation. This study provides a good foundation to develop a culturally appropriate hearing conservation intervention aimed at improving hearing-health outcomes among young Pasifika people.
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    Hearing in various age groups of orchestral musicians and progression of hearing loss with increased number of years of music exposure : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy at Massey University, Wellington, New Zealand
    (Massey University, 2011) Sivaraj, Sargunamoorthy
    In Orchestra musicians hearing plays a very important role, and slight alterations in their hearing will have a significant impact on their performance ability as musicians. Although the effect of orchestra music on hearing is documented, existing researches have several drawbacks, and in most studies measurement of musical sound exposure is not linked to audiological test results. Some variables that may have a significant influence on resulting hearing loss are not taken into consideration. The literature review shows a confusing picture, and some studies identify high-frequency notches suggestive of noise induced threshold shift while others suggest musicians’ hearing levels are not significantly different from a non-exposed population. There are strict legal requirements for the daily noise exposure a worker can receive in workplace but nothing to regulate non-occupational noise and music exposure. This research work sets out to study the effects of playing in an orchestra on various age groups of musicians, to identify important variables that may potentially contribute to resulting hearing loss, and how playing in an orchestra or a band affects children in particular. In this study 37 out of 61 adult musicians (61%), 19 out of 85 youth musicians (22%) and six out of 37 children musicians (16%) were found to have a hearing loss. The sound exposure measurements confirm that there is an increased risk for hearing loss of all ages and the majority of musicians are also exposed to high impulse noise with the peak level of above 140dB. There is a broad individual difference in sensitivity and vulnerability. It is often difficult to estimate total sound exposure for every musician. Individual susceptibility seems to depend on known and unknown factors and interaction between intrinsic and extrinsic factors. Personal ear protection devices are seldom used among the musicians. Hence this study stresses the importance of an individualised hearing conservation programme that includes identifying all potential variables/factors that may increase the risk. This thesis addresses the development of hearing loss in orchestra musicians, audio logical findings among players of different musical instruments, and methods of effective hearing conservation programmes for preventing hearing loss in musicians.
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    Dyadic partner perspectives of ageing with hearing handicap in the audible world : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Palmerston North
    (Massey University, 2007) Blakey, Judy Ann
    Grounded in Green and Kreuter's (1991) flexible research framework (the PRECEDE model), the prime purpose of this doctoral research agenda has been to enhance our understanding of the frequently obscure psychosocial implications of ageing with hearing handicap (HH) in the audible world, by focusing on the dyadic perspectives of older New Zealand (NZ) ex-service personnel and their spouses. Glass and Balfour's (2003) Ecological Model of Ageing guided the multidisciplinary literature review, in order to accommodate the functional implications of age-related losses which could potentially exacerbate the social and emotional sequelae of ageing with HH and tinnitus. In addition, Cohen's (1992) Transactional Model of Stress (which integrates three social support constructs with Lazarus and Folkman's [1984] model describing adaptations to stressful events), illustrates how on-going social and emotional adjustments to hearing losses could potentially affect older adults' health-related quality of life (H-QoL). Infused by these transdisciplinary ecological perspectives, a composite model of Ageing with Hearing Handicap was proposed to explore older dyadic partner perspectives of NZ veterans' adjustment to ageing with hearing handicap; and to identify which factors exerted the most influence over the veterans' self-reported perceptions of HH and H-QoL. Methods: A purposive pilot study sample (N=51 veterans) initially guided the appropriate selection of ecologically relevant biopsychosocial variables and data collection methods (self-report mail out booklets) for two subsequent studies: (i) The main 'parent' study (referred to as the Hearing Aid Research Project [HARP]), which examined the predictors of hearing aid use in veterans aged 50 year and older; and (ii) The doctoral study, which explored dyadic perspectives of ageing with HH. The doctoral study's dyadic partner sample (N=671 dyads) comprised a subset of the 1249 HARP veterans. This subset met the doctoral study's inclusion criteria of male veterans aged 65 years plus, who had responded with a female partner/spouse residing in the same household. Only dyads with reasonably complete mail out survey response sets were selected. The dyadic partner response sets included social demographic details and responses to a number of constructs relevant to the doctoral research context including: aural rehabilitation, HH, H-QoL, emotional wellbeing, social support and memory in everyday life. Results: The results describe significantly different aural rehabilitation coping trajectories between the self-identified 'first time' and more experienced hearing aid users; and dyadic partner comparisons which highlight that the female partners were more acutely aware of the stigmatising impact of hearing losses on the veterans' social and emotional agency. Analyses of the intersecting structural and functional features of social support illustrated that increasing levels of the veterans' hearing handicap (HH) exacerbated both partners' social isolation. Wenger's (1994) support network typology illustrated how both partners' depressive symptoms and the veterans' frequency of forgetting increased significantly across a socially integrated to isolated support network continuum. The composite model of Ageing with Hearing Handicap accounted for 71.5% of the variation in the veterans' self-reported HH; 62.6% of their physical and 37.3% of their mental H-QoL. The multivariate analyses also demonstrated that HH produced a direct and negative impact on the veterans' mental H-QoL, by constraining their social and emotional agency; but only indirectly on their physical H-QoL, through reducing their energy levels and constraining their social participation. Conclusions: These transdisciplinary perspectives provide cross-sectional insights about the social and emotional wellbeing of veterans ageing with HH and their spouses, and suggest downstream links that affect their H-QoL. These findings highlight the importance of hearing health policy agendas and the communication contexts of health service delivery across all age groups. Moreover, by resolving the complex methodological and conceptual challenges inherent in focussing on older dyadic partners' everyday experiences, targets have become apparent for further investigation, to enhance and refine our understandings of engaging ecological perspectives when conducting health research.