What Are the Current Audiological Practices for Ototoxicity Assessment and Management in the South African Healthcare Context?

Abstract

The study was an initial exploration of the current ototoxicity assessment and management practices by audiologists in South Africa. An exploratory survey research methodology through a cross-sectional research design was adopted where audiologists were recruited from professional associations’ databases in South Africa, using specific inclusion criteria. The study made use of an 18-item web-based survey guided by the Health Professions Council of South Africa (HPCSA) (2018) guidelines which were developed from reviewing international guidelines such as the American Speech-Language-Hearing Association (ASHA,1994) and the American Academy of Audiology (AAA, 2009). The study surveyed 31 audiologists from across the country. Data were analyzed through descriptive statistics. Findings implied significant gaps between knowledge and translation of this knowledge into practice. Over two thirds of the participants engage with ototoxicity monitoring and management, but the practices adopted by them do not align with international standards nor with the national HPCSA guidelines on assessment and management of patients on ototoxic medications. Most participants do not conduct baseline assessments, and the frequency of monitoring is irregular and reduced from the recommended; thus influencing ability for early detection and intervention of ototoxicity within this context. Non-standard assessment battery is used for assessment and monitoring, raising questions about the reliability and validity of the data used to make preventive treatment decisions. Lack of collaborative work between audiologists and the rest of the clinical team involved in the treatment of patients on ototoxic medications was found to be an important contributing factor to the less than optimal ototoxicity management practices. Of factors potentially influencing adherence to guidelines, the institution of employment, specifically employment in a tuberculosis hospital, seemed to have a positive influence, possibly due to the focused nature of the audiologists’ scope of practice there as well as availability of resources. The level of education appeared to have no influence. Current findings provide contextually relevant evidence on ototoxicity assessment and management within this context. They raise important implications for guidelines adherence and translating knowledge, policies and guidelines into practice, clinical assessment and management protocols followed, appropriate resource allocation per programme, as well as strategic planning for national ototoxicity assessment and management programmes in context. The findings also raise important implications for low- and middle-income countries, in terms of adopting international guidelines without considering context.

Impact of drug-resistant tuberculosis treatment on hearing function in South African adults: Bedaquiline versus kanamycin

“…These findings highlight the importance of carefully deliberating on benefit–risk evaluation of medications prescribed to treat diseases within LMICs. With recent evidence indicating that ototoxicity monitoring is gaining momentum within the South African research and clinical communities, although this is non-systematic, non-comprehensive and non-strategic in nature (Khoza-Shangase & Masondo, 2020 ), the value of benefit–risk assessments is highlighted by current findings.…”

“…This is because hearing loss may lead to a communication breakdown, frustration, resentment and ultimately decreased interaction, thus often affecting relationships (Packer, 2017 ). Moreover, even though hearing aids can be used to improve one’s quality of life when ototoxicity has occurred, resource constraints within the South African public health sector, which are used by over 80% of the South African population, make this intervention not universally accessible to those needing it (Khoza-Shangase & Masondo, 2020 ). Current findings, therefore, on G-BDQ not being ototoxic in nature are positive and imply that the quality of life for the DR-TB-affected individuals and their families and communication partners will not be reduced as a result of debilitating hearing loss or tinnitus because of DR-TB treatment, as was the case with G-KCIN treatment.…”

“…As far as hearing function is concerned, Khoza-Shangase ( 2017 ) argues that despite the curative benefits that one may gain from the potentially ototoxic medication, the hearing loss that may occur as a result may be a persistent or significant disability to the person affected, minimising the life-sustaining benefits of the drug for the individual affected. Thus, with appropriate ototoxicity monitoring, the patient’s hearing loss can be minimised and/or its impact mitigated as much as possible (Khoza-Shangase et al, 2020 ; Petersen & Rogers, 2015 ).…”

“…Early identification of ototoxicity allows for preventive treatment modifications to be instituted, thus preventing further hearing loss (Khoza-Shangase et al, 2020 ). Additionally, ototoxicity monitoring provides an opportunity for counselling and management during and post-treatment (Khoza-Shangase & Masondo, 2020 ), which has benefits for the medical and audiological management in terms of treatment adherence (Khoza-Shangase, 2017 ).…”

“…Early identification of ototoxicity allows for preventive treatment modifications to be instituted, thus preventing further hearing loss (Khoza-Shangase et al, 2020 ). Additionally, ototoxicity monitoring provides an opportunity for counselling and management during and post-treatment (Khoza-Shangase & Masondo, 2020 ), which has benefits for the medical and audiological management in terms of treatment adherence (Khoza-Shangase, 2017 ). Management may include counselling the patients and their family, teaching them appropriate communication strategies, as well as providing audiological rehabilitation and amplification, such as hearing aids and cochlear implants (Petersen & Rogers, 2015 ).…”