South African audiologists’ use of speech-in-noise testing for adults with hearing difficulties

Thakor, Hema
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Background: The appropriate diagnostic assessment of adults with hearing difficulties enables an effective and evidence-based management plan for the complaints reported and identified. The primary complaint of adults with hearing difficulties is hearing and understanding speech in the presence of background noise. Despite the availability of speech-in-noise (SIN) assessment tools to describe and quantify this concern, audiologists in South Africa do not standardly administer these tests. No study has previously described South African audiologists’ use of SIN tests in assessing and addressing this concern, or the factors influencing the application of SIN testing. Objective: The aim of this study was to describe the South African audiologists’ speech audiometry practices with specific reference to SIN testing. Furthermore, it aimed to describe factors influencing the practice of SIN testing in the South African context. Method: This research utilised a cross-sectional, descriptive, exploratory research design within a mixed methods research approach. The study first employed a descriptive, cross-sectional, survey followed by content analysis of focus group discussions. A sample of 107audiologists, who administered diagnostic hearing assessments on adults in South Africa, completed the online survey and were represented in the study. Their mean age was 31.28 years and they had on average 4.46 years of work experience. More than half of the participants worked in the private sector whilst others worked in the public healthcare sector or NGO’s. Two focus groups were then held which included six participants each, purposively selected from the survey sample. The mean age of these participants was 38.17 years and the average duration of work experience was 11.5 years. Results :The results of the study revealed that whilst the majority of participants administered speech recognition threshold(87%, n1= 93) and word recognition (85%, n1= 91)testing, speech-in-noise testing was only administered by36% (n1=37) of participants. The three most commonly used languages for speech audiometry were English, Afrikaans and isiZulu, presented using live voice. Interestingly, most participants were not extremely confident about the results obtained from speech audiometry. The main factors which influenced the implementation of SIN testing were the patients’ main listening complaint, participants' perceptions of SIN testing, patient counselling, availability of resources, testing validity, and training and knowledge; and they shared their ideal SIN test description.. Conclusions: The unique information gathered through this research project highlights the urgency to develop national guidelines for speech audiometry practices; and identify or develop SIN tests most appropriate for use in the South African context, based on factors influencing the implementation of SIN testing identified in this study
A dissertation submitted for the fulfilment of a degree of Masters in Audiology at the Faculty of Humanities, Department of Speech Pathology and Audiology, University of the Witwatersrand, 2020