The analysis of an audiological protocol in measuring hearing amongst people with drug resistant TB

Cassim, Zarreen
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South Africa is in the midst of a DR TB pandemic, and due to treatment, ototoxic hearing loss has become a significant area for audiological intervention. Changes in DR TB treatment guidelines include non-ototoxic options, yet ototoxicity monitoring still continues as drugs such as amikacin are still prescribed. Thus, the focus is now placed on accuracy and precision in audiological service provision within ototoxicity. This study examined a specific ototoxicity monitoring protocol which used a KUDUwave audiometer operated by nursing staff and once cured, patients received full diagnostic evaluations from audiologists. Thus, the study explored patient related factors, and audiological findings using a KUDUwave and diagnostic audiometer, to determine trends within this population in a tertiary hospital in Gauteng. The experiences of nurses who operated the KUDUwave were explored, providing insight into factors affecting this process. A mixed methods approach, using a quantitative prospective review of 120 patient files, in conjunction with qualitative interviews of six nurses was utilized. Findings revealed that DR TB is multi-faceted, influenced by individual, and environmental systems, which affect DR TB, ototoxicity, and treatment. Results indicated that the KUDUwave was able to detect the presence of ototoxicity in a timeous manner. Challenges in the ototoxicity monitoring programme resulted in the omission of baseline hearing evaluations and inconsistencies in follow-up testing. Nurses viewed KUDUwave testing positively, however they require further support to enhance their knowledge and practice. Implications of this study include that audiologists should assume a more active role in ototoxicity monitoring programmes, and protocols should be developed and standardized, to ensure greater accuracy in ototoxicity monitoring, especially for patients on amikacin
A Master's research dissertation submitted to The Department of Speech Pathology and Audiology, in the Faculty of Humanities, University of the Witwatersrand, Johannesburg, 2019