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Lin MJ, Chen CK. Breaking Sound Barriers: Exploring Tele-Audiology's Impact on Hearing Healthcare. Diagnostics (Basel) 2024; 14:856. [PMID: 38667501 PMCID: PMC11049182 DOI: 10.3390/diagnostics14080856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/09/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Hearing impairment is a global issue, affecting billions of people; however, there is a gap between the population affected by hearing loss and those able to access hearing healthcare. Tele-audiology, the application of telemedicine in audiology, serves as a new form of technology which aims to provide synchronous or asynchronous hearing healthcare. In this article, we reviewed some recent studies of tele-audiology-related topics to have a glimpse of the current development, associated challenges, and future advancement. Through the utilization of tele-audiology, patients can conveniently access hearing healthcare, and thus save travel costs and time. Recent studies indicate that remote hearing screening and intervention are non-inferior to the performance of traditional clinical pathways. However, despite its potential benefits, the implementation of tele-audiology faces numerous challenges, and audiologists have varying attitudes on this technology. Overcoming obstacles such as high infrastructure costs, limited reimbursement, and the lack of quality standards calls for concerted efforts to develop effective strategies. Ethical concerns, reimbursement, and patient privacy are all crucial aspects requiring in-depth discussion. Enhancing the education and training of students and healthcare workers, along with providing relevant resources, will contribute to a more efficient, systematic hearing healthcare. Future research will aim to develop integrated models with evidence-based protocols and incorporating AI to enhance the affordability and accessibility of hearing healthcare.
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Affiliation(s)
- Mien-Jen Lin
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan;
| | - Chin-Kuo Chen
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung 204201, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan
- Department of Otolaryngology-Head and Neck Surgery and Communication Enhancement Center, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan
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Wang Z, Kempen J, Luo G. Using Smartphones to Enhance Vision Screening in Rural Areas: Pilot Study. JMIR Form Res 2024; 8:e55270. [PMID: 38573757 PMCID: PMC11027048 DOI: 10.2196/55270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/16/2024] [Accepted: 02/29/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND While it is treatable, uncorrected refractive error is the number one cause of visual impairment worldwide. This eye condition alone, or together with ocular misalignment, can also cause amblyopia, which is also treatable if detected early but still occurs in about 4% of the population. Mass vision screening is the first and most critical step to address these issues, but due to limited resources, vision screening in many rural areas remains a major challenge. OBJECTIVE We aimed to pilot-test the feasibility of using smartphone apps to enhance vision screening in areas where access to eye care is limited. METHODS A vision screening program was piggybacked on a charity summer camp program in a rural county in Sichuan, China. A total of 73 fourth and fifth graders were tested for visual acuity using a standard eye chart and were then tested for refractive error and heterophoria using 2 smartphone apps (a refraction app and a strabismus app, respectively) by nonprofessional personnel. RESULTS A total of 5 of 73 (6.8%, 95% CI 2.3%-15.3%) students were found to have visual acuity worse than 20/20 (logarithm of minimal angle of resolution [logMAR] 0) in at least one eye. Among the 5 students, 3 primarily had refractive error according to the refraction app. The other 2 students had manifest strabismus (one with 72-prism diopter [PD] esotropia and one with 33-PD exotropia) according to the strabismus app. Students without manifest strabismus were also measured for phoria using the strabismus app in cover/uncover mode. The median phoria was 0.0-PD (IQR 2.9-PD esophoria to 2.2-PD exophoria). CONCLUSIONS The results from this vision screening study are consistent with findings from other population-based vision screening studies in which conventional tools were used by ophthalmic professionals. The smartphone apps are promising and have the potential to be used in mass vision screenings for identifying risk factors for amblyopia and for myopia control. The smartphone apps may have significant implications for the future of low-cost vision care, particularly in resource-constrained and geographically remote areas.
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Affiliation(s)
- Zheng Wang
- School of Medicine, Jiaxing University, Jiaxing, China
| | - John Kempen
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
- Department of Ophthalmology, Harvard Medical School, Boston, MA, United States
- Sight for Souls, Bellevue, WA, United States
- Eye Unit, MyungSung Christian Medical Center General Hospital, MyungSung Medical School, Addis Ababa, Ethiopia
| | - Gang Luo
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
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Kaspar A, Swanepoel DW, Pifeleti S. The PEN Fa'aSamoa Initiative: An Integrated Platform for Hearing and Vision Screening in Samoa. Glob Pediatr Health 2023; 10:2333794X231203504. [PMID: 37822475 PMCID: PMC10563456 DOI: 10.1177/2333794x231203504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/30/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023] Open
Affiliation(s)
- Annette Kaspar
- Tupua Tamasese Meaole Hospital, Ministry of Health, Apia, Samoa
- Ministry of Education, Sports, and Culture, Apia, Samoa
| | | | - Sione Pifeleti
- Tupua Tamasese Meaole Hospital, Ministry of Health, Apia, Samoa
- Ministry of Education, Sports, and Culture, Apia, Samoa
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Oosthuizen I, Frisby C, Chadha S, Manchaiah V, Swanepoel DW. Combined hearing and vision screening programs: A scoping review. Front Public Health 2023; 11:1119851. [PMID: 36998276 PMCID: PMC10043331 DOI: 10.3389/fpubh.2023.1119851] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/20/2023] [Indexed: 03/17/2023] Open
Abstract
Background and aim The World Health Organization (WHO) estimates that 1.5 billion and 2.2 billion people have hearing and vision impairment, respectively. The burden of these non-communicable diseases is highest in low- and middle-income countries due to a lack of services and health professionals. The WHO has recommended universal health coverage and integrated service delivery to improve ear and eye care services. This scoping review describes the evidence for combined hearing and vision screening programs. Method A keyword search of three electronic databases, namely Scopus, MEDLINE (PubMed), and Web of Science, was conducted, resulting in 219 results. After removing duplicates and screening based on eligibility criteria, data were extracted from 19 included studies. The Joanna Briggs Institute Reviewer Manual and the Preferred Reporting Items for Systematic Reviews and Meta-analyzes (PRISMA) Extension for Scoping Reviews were followed. A narrative synthesis was conducted. Results Most studies (63.2%) were from high-income countries, with 31.6% from middle-income and 5.2% from low-income countries. The majority of studies (78.9%) involved children and the four studies reporting on adults all included adults above 50 years of age. Vision screening was most commonly performed with the "Tumbling E" and "Snellen Chart," while hearing was typically screened using pure tone audiometry. Studies reported referral rates as the most common outcome with sensitivity and specificity rates not reported in any included articles. Reported benefits of combined vision and hearing screenings included earlier detection of vision and hearing difficulties to support functioning and quality of life as well as resource sharing for reduced costs. Challenges to combined screening included ineffective follow-up systems, management of test equipment, and monitoring of screening personnel. Conclusions There is limited research evidence for combined hearing and vision screening programs. Although potential benefits are demonstrated, especially for mHealth-supported programs in communities, more feasibility and implementation research are required, particularly in low- and middle-income countries and across all age groups. Developing universal, standardized reporting guidelines for combined sensory screening programs is recommended to enhance the standardization and effectiveness of combined sensory screening programs.
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Affiliation(s)
- Ilze Oosthuizen
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative Initiative Between University of Colorado School of Medicine, Aurora, CO, United States
- University of Pretoria, Pretoria, South Africa
| | - Caitlin Frisby
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative Initiative Between University of Colorado School of Medicine, Aurora, CO, United States
- University of Pretoria, Pretoria, South Africa
| | - Shelly Chadha
- WHO Programme for Prevention of Deafness and Hearing Loss, World Health Organization, Geneva, Switzerland
| | - Vinaya Manchaiah
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative Initiative Between University of Colorado School of Medicine, Aurora, CO, United States
- University of Pretoria, Pretoria, South Africa
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, United States
- UCHealth Hearing and Balance, University of Colorado Hospital, Aurora, CO, United States
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, India
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative Initiative Between University of Colorado School of Medicine, Aurora, CO, United States
- University of Pretoria, Pretoria, South Africa
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, United States
- Ear Science Institute Australia, Subiaco, WA, Australia
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Saunders JE, Bessen S, Magro I, Cowan D, Gonzalez Quiroz M, Mojica-Alvarez K, Penalba D, Reike C, Neimczak C, Fellows A, Buckey J. School Hearing Screening With a Portable, Tablet-Based, Noise-Attenuating Audiometric Headset in Rural Nicaragua. Otol Neurotol 2022; 43:1196-1204. [PMID: 36351228 DOI: 10.1097/mao.0000000000003692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate the utility and effectiveness of a noise-attenuating, tablet-based mobile health system combined with asynchronous telehealth evaluations for screening rural Nicaraguan schoolchildren for hearing loss. STUDY DESIGN Prospective population-based survey. SETTING Rural Nicaraguan communities. PATIENTS There were 3,398 school children 7 to 9 years of age. INTERVENTIONS Diagnostic automated and manual audiometry, detailed asynchronous telehealth evaluations. MAIN OUTCOME MEASURES Referral rates, ambient noise levels, and audiometric results as well as hearing loss prevalence, types, and risk factors. RESULTS Despite high ambient noise levels during screening (46.7 dBA), no effect of noise on referral rates on automated audiometry or confirmatory manual audiometry in those who failed automated testing was seen. The overall audiometric referral rate was 2.6%. Idiopathic sensorineural hearing loss (SNHL) and cerumen impaction were the most common types of hearing loss in this population with an estimated prevalence of hearing loss (all types) of 18.3 per 1,000 children. SNHL was associated with both drug exposure during pregnancy (p = 0.04) and pesticide exposure in the home (p = 0.03). CONCLUSION Hearing screening using a tablet-based, noise-attenuating wireless headset audiometer is feasible and effective in rural low-resource environments with moderately elevated ambient noise levels. The referral rate with noise-attenuating headsets was much lower than that previous reports on this population. In addition, manual audiometry resulted in much lower referral rates than automated audiometry. The confirmed hearing loss rate in this study is comparable to reports from other low-income countries that use some form of noise attenuation during screening. Pesticide exposure and drug exposure during pregnancy are potential causes of SNHL in this population.
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Affiliation(s)
- James E Saunders
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth
| | - Sarah Bessen
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Isabelle Magro
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Devin Cowan
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | | | | | - Donoso Penalba
- Research Centre on Health, Work and Environment (CISTA) at National Autonomous University of Nicaragua, Leon (UNAN-Leon), Leon, Nicaragua
| | - Catherine Reike
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth
| | - Chris Neimczak
- Department of Medicine Dartmouth-Hitchcock Medical Center, Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Abigail Fellows
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth
| | - Jay Buckey
- Department of Medicine Dartmouth-Hitchcock Medical Center, Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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Abstract
PURPOSE Implementation science aims to facilitate the use of evidence-based programs, practices, and policies in routine care settings. In audiology, as in other health disciplines, there is a persistent research-to-practice gap. Improving the adoption, reach, implementation, and sustainment of effective interventions in audiology would increase their public health impact, ensuring that all individuals needing hearing health care services could benefit from innovations and evidence-based best practices. This tutorial provides an introductory overview of implementation science relevant to the field of audiology, including Internet-based practices and interventions. METHOD Major concepts and themes of implementation science are presented, including implementation outcomes, implementation science frameworks, implementation strategies, current topics in implementation science, and study design considerations. Recent publications in audiology are highlighted to illustrate implementation science concepts and themes. The relevance of each topic to the use of evidence-based programs, practices, and policies in audiology is highlighted with reference to recent research in the field. CONCLUSIONS Challenges in the widespread delivery of evidence-based audiological practices and interventions limit their public health impact. The application of implementation science principles and methods in audiology research, as demonstrated in other areas of health research, can increase our focus on ensuring that effective practices are widely available, accessible, equitable, and sustainable to improve the lives of those who need them.
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Affiliation(s)
- Christina R. Studts
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora
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Saunders JE, Bessen S, Magro I, Cowan D, Quiroz MG, Mojica-Alvarez K, Penalba D, Reike C, Niemczak CE, Fellows A, Buckey JC. Community health workers and mHealth systems for hearing screening in rural Nicaraguan schoolchildren. J Glob Health 2022; 12:04060. [PMID: 35938885 PMCID: PMC9359107 DOI: 10.7189/jogh.12.04060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background We aimed to investigate the effectiveness of using minimally trained community health workers (CHW) to screen schoolchildren in rural Nicaragua for hearing loss using a tablet-based audiometric system integrated with asynchronous telehealth evaluations and mobile health (mHealth) appointment reminders. Methods A population-based survey was conducted using community health workers (CHWs) to perform tablet-based audiometry, asynchronous telehealth evaluations, and mHealth reminders to screen 3398 school children (7-9 years of age) in 92 rural Nicaraguan communities. The accuracy of screening, test duration, testing efficiency, telehealth data validity, and compliance with recommended clinic visits were analyzed. Results Minimally trained CHWs successfully screened children within remote rural schools with automated audiometry (test duration = 5.8 minutes) followed by manual audiometry if needed (test duration = 4.3 minutes) with an estimated manual audiometry validity of 98.5% based on a review of convergence patterns. For children who were referred based on audiometry, the otoscopy and tympanometry obtained during telehealth evaluations were high quality (as reviewed by 3 experts) in 44.6% and 80.1% of ears, respectively. A combination of automated short message service (SMS) text messages and voice reminders resulted in a follow-up compliance of 75.2%. No families responded to SMS messages alone. Conclusions Tablet-based hearing screening administered by minimally trained CHWs is feasible and effective in low- and middle-income countries. Manual audiometry was as efficient as automated audiometry in this setting. The physical exam tasks of otoscopy and tympanometry require additional training. Mobile phone messages improve compliance for confirmatory audiometry, but the utility of SMS messaging alone is unclear in this population.
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Affiliation(s)
- James E Saunders
- Department of Surgery Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Sarah Bessen
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Isabelle Magro
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Devin Cowan
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Marvin Gonzalez Quiroz
- Research Centre on Health, Work and Environment (CISTA) at National Autonomous University of Nicaragua, Leon (UNAN-Leon), Leon, Nicaragua.,Centre for Nephrology, University College London, London, UK
| | | | - Donoso Penalba
- Department of Public Health at National Autonomous University of Nicaragua, Leon (UNAN-Leon), Leon, Nicaragua
| | - Catherine Reike
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Christopher E Niemczak
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.,Department of Medicine Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Abigail Fellows
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Jay C Buckey
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.,Department of Medicine Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Eksteen S, Eikelboom RH, Kuper H, Launer S, Swanepoel DW. Prevalence and characteristics of hearing and vision loss in preschool children from low income South African communities: results of a screening program of 10,390 children. BMC Pediatr 2022; 22:22. [PMID: 34986809 PMCID: PMC8728966 DOI: 10.1186/s12887-021-03095-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The majority of children with sensory impairments live in low- and middle-income countries. More studies of hearing and vision impairment prevalence are needed, in order to generate more accurate estimates of trends in sensory impairments. This study aimed to estimate the prevalence and describe the characteristics of hearing and vision loss among preschool children (4-7 years) in an underserved South African community following community-based mobile health (mHealth) supported hearing and vision services. METHODS A screening program of sensory impairments was undertaken of children attending preschools in the communities of Khayelitsha and Mitchell's Plain, Cape Town, from September 2017 until June 2019. Hearing and vision screening were done by trained community health workers using mHealth technology. Children who failed hearing and vision screening were seen for follow-up assessments at their preschools. Follow-up assessments were conducted using smartphones that host point-of-care validated and calibrated hearing and vision testing applications (hearTest app, hearX Group, South Africa and PeekAcuity app, Peek Vision, United Kingdom). Descriptive statistical analysis and logistic regression analysis were conducted after extracting data from a secure cloud-based server (mHealth Studio, hearX Group) to Microsoft Excel (2016). RESULTS A total of 10,390 children were screened at 298 preschools over 22 months. Of the children screened, 5.6 and 4.4% of children failed hearing and vision screening respectively. Community-based follow-up hearing tests were done at the preschools on 88.5% (514) of children of whom 240 children (54.2% female) presented with hearing loss. A preschool-based follow-up vision test was done on 400 children (88.1%). A total of 232 children (46.1% female) had a vision impairment, and a further 32 children passed the test but had obvious signs of ocular morbidity. Logistic regression analysis found that age was a significant predictor of vision loss (p < 0.05), but not for hearing loss (p = 0.06). Gender was not a significant predictor of hearing (p = 0.22) or vision loss (p = 0.20). CONCLUSIONS Hearing loss is prevalent in at least 22 per 1000 and vision loss in at least 23 per 1000 preschool children in an underserved South African community. Timely identification of sensory losses can be facilitated through community-based hearing and vision services supported by mHealth technology.
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Affiliation(s)
- Susan Eksteen
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Lynnwood Rd, Hatfield, Pretoria, Gauteng, South Africa.
| | - Robert H Eikelboom
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Lynnwood Rd, Hatfield, Pretoria, Gauteng, South Africa.,Ear Science Institute Australia, Subiaco, Australia.,Ear Sciences Centre, The University of Western Australia, Nedlands, Australia
| | - Hannah Kuper
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine (LSHTM), London, England
| | - Stefan Launer
- Sonova AG, Science & Technology, Stäfa, Switzerland.,School of Health and Rehabilitation Science, University of Queensland, Brisbane, Australia
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Lynnwood Rd, Hatfield, Pretoria, Gauteng, South Africa.,Ear Science Institute Australia, Subiaco, Australia
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Eksteen S, Eikelboom RH, Launer S, Kuper H, Swanepoel DW. Referral Criteria for Preschool Hearing Screening in Resource-Constrained Settings: A Comparison of Protocols. Lang Speech Hear Serv Sch 2021; 52:868-876. [PMID: 34061576 DOI: 10.1044/2021_lshss-21-00008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose This study aimed to describe and compare the performance of two screening protocols used for preschool hearing screening in resource-constrained settings. Method Secondary data analysis was done to determine the performance of two protocols implemented during a preschool hearing screening program using mobile health technology in South Africa. Pure-tone audiometry screening at 25 dB HL for 1000, 2000, and 4000 Hz in each ear was used by both protocols. The fail criterion for the first protocol (2,147 children screened) constituted a no-response on one or more frequencies in either ear. The second protocol required two or more no-responses (5,782 children). Multivariate logistic regression models were used to investigate associations between outcomes and protocol, age, gender, and duration. Results Fail rates for the one-frequency fail protocol was 8.7% (n = 186) and 4.3% (n = 250) for the two-frequency fail protocol. Children screened with the two-frequency fail protocol were 52.9% less likely to fail (p < .001; OR = 0.471; 95% confidence interval [0.385, 0.575]). Gender (p = .251) and age (p = .570) had no significant effect on screening outcome. A percentage of cases screened (44.7%) exceeded permissible noise levels in at least one ear at 1000 Hz across both protocols. True- and false-positive cases did not differ significantly between protocols. Protocol type (p = .204), gender (p = .314), and age (p = .982) did not affect the odds of being a true-positive result. Average screening time was 72.8 s (78.66 SD) and 64.9 s (55.78 SD) for the one-frequency and two-frequency fail protocols, respectively. Conclusions A two-frequency fail criterion and immediate rescreen of failed frequencies significantly reduced referral rate for follow-up services that are often overburdened in resourced-constrained settings. Future protocol adaptations can also consider increasing the screening levels at 1000 Hz to minimize the influence of environmental noise.
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Affiliation(s)
- Susan Eksteen
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Robert H Eikelboom
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.,Ear Science Institute Australia, Subiaco, Western Australia.,Ear Sciences Centre, The University of Western Australia, Nedlands, Australia
| | - Stefan Launer
- Sonova AG, Science & Technology, Stäfa, Switzerland.,School of Health and Rehabilitation Science, The University of Queensland, Brisbane, Australia
| | - Hannah Kuper
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.,Ear Science Institute Australia, Subiaco, Western Australia
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