School of Human and Community Development (ETDs)

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    Investigation of Middle Ear Function Through Wideband Absorbance Measure in Adults Living with Human Immunodeficiency Virus in Gauteng Province, South Africa
    (University of the Witwatersrand, Johannesburg, 2022-06) Sebothoma, Ben; Khoza-Shangase, Katjah
    Background: The association between the human immunodeficiency virus (HIV) and auditory pathologies, including middle ear pathologies, has been extensively researched. However, most of this research has documented the middle ear pathologies of people living with HIV using conventional tympanometry with single probe tone, which has been shown to have poor sensitivity and specificity. Consequently, middle ear function and pathologies of people living with HIV may not have been accurately represented. While wideband acoustic immittance (WAI) such as wideband reflectance or/and absorbance measures emerged as a potential measure that can accurately identify early signs of middle ear pathologies and provide an accurate picture of the middle ear function, little is known about middle ear function and pathologies of adults living with HIV using wideband acoustic immittance. The value of preventive audiology in this population that comprises a big component of South Africa’s quadruple burden of disease cannot be overemphasized. Purpose: The primary purpose of this study was to investigate middle ear function through WAI in adults living with HIV. Specific objectives included to: review evidence on trends of middle ear pathologies in adults living with HIV; determine current practices employed by South African audiologists in identifying middle ear pathologies; determine the usefulness of using tele-practice to identify middle ear pathologies in adults living with HIV; determine the usefulness of wideband absorbance measures in identifying middle ear pathologies in adults living with HIV; determine the sensitivity, specificity, and characteristics of wideband absorbance measures in adults with and without HIV; determine the combined effects of HIV and comorbidities on hearing function; and explore risk factors that influence the development of middle ear pathologies in adults living with HIV. Participants: A non-probability purposive sampling was used to recruit and select participants. South African adults aged 18 years and above who were diagnosed and living with HIV in the Gauteng Province and attending an HIV clinic, as well as adults who are HIV negative as a control group were recruited and included in the study. Design: While the general methodology for this research comprised of a quantitative, cross-sectional design, each research article that forms part of this study has its own specific research design and methodology, and this is presented in each article. Data analysis: Data were analysed using the STATA version 1.5. For each paper (presented as chapters in this thesis), specific statistical analysis procedures were adopted, and are reflected in each of the chapters. Results: Findings in this study revealed that middle ear pathologies are common and highly prevalent in adults living with HIV, reaching approximately 60% in the current sample. These pathologies vary according to type and severity, and this is influenced by the middle ear measure used for assessment. The common middle ear pathologies in this study were otitis media with effusion, chronic suppurative otitis media, with conductive hearing loss. Despite the existence and occurrence of middle ear pathologies, some audiologists do not regularly incorporate tympanometry into their clinical practice. Asynchronous tele practice, through video-otoscopy, was found to be useful and feasible in the identification of middle ear pathologies in adults living with HIV, with substantial agreement (K=0.5801 to 0.6047) between otorhinolaryngologists. The wideband absorbance measure was found to be more accurate in identifying middle ear pathologies than the tympanometry with 226Hz probe tone and pure tone audiometry using air/bone gap. The sensitivity of wideband absorbance reached 88%, while that for tympanometry with 226Hz probe and pure tone audiometry was below 20%. In addition, the wideband absorbance patterns, measured at ambient pressure and tympanometric peak pressure, were also established for participants with normal middle ear function and middle ear pathology. While there was a difference between the wideband absorbance pattern of participants with normal middle ear function and middle ear pathologies, with middle ear pathologies being lower in the low to mid frequencies (226Hz to approximately 3000) for both ambient pressure and tympanometry peak pressure, this difference was not statistically significant between and within groups. Finally, findings of this study indicated that adults living with HIV, with comorbidities such as hypertension and hypercholesterolemia, and risk factors such as advancing age and an extended use of ART, have an increased the risk of developing various types of hearing loss. Conclusion: Current findings highlight the importance of preventive tailored care for adults living with HIV. The study indicated that middle ear pathologies and hearing loss are high in adults living with HIV. The development of these pathologies is associated with comorbidities and other risk factors. Wideband absorbance measures appear to offer promise as a diagnostic measure for middle ear pathologies in this population. However, wideband absorbance must be used in conjunction with other middle ear measures such as video otoscopy to improve early identification and intervention of middle ear pathologies. While this study indicates that middle ear pathologies are common in adults living with HIV, the patterns of wideband absorbance suggest that middle ear function in this population may not be different to HIV negative control group. Findings of this study also highlighted the importance of training facilitators to capture quality video otoscopic images that can be used for tele practice in a South African context where demand versus capacity challenges exist in as far as ear and hearing care healthcare practitioners are concerned. Finally, this study raises implication for resource distribution, ensuring that accurate measures such as wideband absorbance measures are available in clinical setting, which will improve early identification and intervention in adults living with HIV.