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Smartphone hearing screening
The participant’s name, surname and date of birth were entered in the hearScreenTM application. If the participant was between the ages of 3 and 15 years, the child protocol was selected, whilst the adult protocol was selected if the participant was 16 years or older (WHO, 2012). The screening intensity for the child protocol was 25 dB HL whilst the screening intensity for the adult protocol was 35 dB HL. The participant was instructed to raise their hand when a tone was heard. Sennheiser HD 202 II headphones were placed over the participant’s ears. The initial presentation level at 1 kHz was raised 10 dB above the screening level for conditioning purposes after which the screening continued on the test intensity. A 1, 2, and 4 kHz sweep was then performed at 35 dB HL for adults and 25 dB HL for children (ASHA, 1997). Stimulus presentation was repeated once if the participant did not respond at a specific intensity level. Left ears were tested first, followed by testing of right ears in the same way. Participants who responded to all the frequencies on both ears passed the screening. A two-step hearing screening protocol was followed; thus when a participant failed to respond to one or more frequencies in either ear, the results constituted an initial fail and an immediate rescreen was initiated. This standard practice is in accordance with screening guidelines (AAA, 2011; ASHA, 1997) recommending an immediate rescreen, which represents the final screening outcome (AAA, 2011). The two-step protocol was followed to minimize over-referrals. All test results were uploaded from the smartphones to the cloud-based server from where data were exported for analysis and interpretation. A diagnostic hearing test was conducted on the same day if participants failed the screening for a second consecutive time. In the case of children between the age of 3 and 4 years, the procedure was adapted to a play-based method i.e. the student conditioned the child to respond to the stimulus through a play activity such as dropping a block in a bucket when the sound was heard.
Diagnostic audiometry
The KUDUwave (MoyoDotNet, Johannesburg, South Africa) Type 2 Clinical Audiometer (IEC 60645-1/2) was used to conduct diagnostic pure tone audiometry on participants who failed the hearing screening. The audiometer hardware was contained within the circumaural ear cups and connected to a notebook (Dell Inspiron running Microsoft Windows 7) via USB cables. Circumaural ear cups were placed over the insert earphones for additional attenuation to make hearing tests in a
non-optimal environment outside a soundproof booth possible (Maclennan-Smith et al., 2013). A B-71 bone oscillator (Kimmetrics, Smithsburg, USA) was placed on the forehead with a standard adjustable spring head-band held in place on the centre of the circumaural headband with a screw fitting. The circumaural ear cups had two microphones that provided constant monitoring of environmental noise in octave bands during testing. An electronic response was connected to the headset software interface (eMoyo) that controlled the KUDUwave audiometer. The audiometer was calibrated prior to commencement of the study using a Type 1 sound level meter (Larson Davis System 824, Larson Davis, Provo, Utah) with a G.R.A.S. (Holte, Denmark) IEC 711 coupler for insert earphones and an AMC493 Artificial Mastoid on an AEC101 coupler (Larson Davis) with 2559 ½ inch microphone for the Radioear B 71 bone oscillator. Insert earphones and the bone oscillator were calibrated in accordance with ISO 389-2:1994 and ISO 389-3:1994 standards respectively.
CHAPTER 1: INTRODUCTION
1.1 Background
1.2 Primary health and hearing care services
1.3 New solutions for access to primary health care hearing detection
1.4 Rationale
CHAPTER 2: METHOD
2.1 Research objectives
2.2 Research design and methods
2.3 Research context
2.4 Research participants
2.5 Research Equipment
2.6 Ethical Considerations
2.7 Research Procedures
2.8 Data processing and analysis
CHAPTER 3: SMARTPHONE-BASED HEARING SCREENING AT PRIMARY HEALTH CARE CLINICS
3.1 Abstract
3.2 Introduction
3.3 Materials and method
3.4 Data analysis
3.5 Results
3.6 Discussion
CHAPTER 4: SELF-REPORTED HEARING LOSS AND PURE TONE AUDIOMETRY FOR SCREENING AT PRIMARY HEALTH CARE CLINICS
4.1 Abstract
4.2 Introduction
4.3 Methods
4.4 Data analysis
4.5 Results
4.6 Discussion
CHAPTER 5: PREVALENCE OF HEARING LOSS AT PRIMARY HEALTH CARE CLINICS IN SOUTH AFRICA
5.1 Abstract
5.2 Introduction
5.3 Materials and methods
5.4 Data analysis
5.5 Results
5.6 Discussion
5.7 Study limitations
CHAPTER 6: DISCUSSION, CLINICAL IMPLICATIONS AND CONCLUSION
6.1 Summary of findings
6.2 Clinical implications
6.3 A model for hearing detection at primary health care clinics
6.4 Study strengths and limitations
6.5 Recommendations for future research
6.6 Conclusion
