Research Articles (Speech-Language Pathology and Audiology)

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Longitudinal analysis of the risk factors for onset and change in tinnitus in the Busselton Healthy Ageing Study
Fuchten, Denise; Stegeman, Inge; Mao, Yinan; Eikelboom, Robert H.; Hunter, Michael L.; Smit, Adriana L. (Public Library of Science, 2026-01)
INTRODUCTION : Effective prevention and intervention strategies for tinnitus rely on identifying risk factors and understanding its progression over time. However, longitudinal data on these aspects are limited. This study therefore aimed to (1) assess the incidence of tinnitus and identify risk factors associated with tinnitus development, and (2) assess the impact of tinnitus and change in impact over time and identify factors associated with this change. METHODS : Data from the Busselton Healthy Ageing Study, a population-based cohort of individuals born between 1946–1964, were used. Information on tinnitus presence and impact, general health, ear-related health and mental health was collected from 3863 participants through questionnaires and physical measurements at two time points with a six-year interval. Logistic regression analysis was used to examine risk factors for tinnitus development. Multinomial logistic regression analysis was used to examine factors associated with changes in impact. RESULTS : The 6-year incidence of tinnitus was 12.1%. Statistically significant risk factors for developing tinnitus included male gender, higher BMI, larger waist circumference, fair subjective health, hearing loss, occupational noise exposure with occasional use of hearing protection, hyperacusis, migraine, and diagnosed anxiety disorder. Among participants with pre-existing tinnitus, 21.4% reported an increase in tinnitus impact over time, while 16.5% experienced a decrease. Changes in impact were influenced by general health and ear-related health factors. CONCLUSION : The high incidence of tinnitus and its notable impact on daily life emphasize the importance of gaining a better understanding of the broad range of identified risk factors for developing tinnitus and change in impact. The multifaceted nature of these factors, comprising hearing-related issues, general health conditions and psychological aspects, underscore the complexity of tinnitus etiology and impact. By gaining more insight into these factors, we can inform future research efforts aimed at developing targeted prevention and intervention strategies tailored to specific demographic groups.
Cochlear implant recipient volunteer partnerships : perceptions of an adult peer community
Diffenthal, Carli; Pottas, Lidia; Soobrayen, Victoria; Le Roux, Talita (Taylor and Francis, 2026)
PURPOSE : To describe adult cochlear implant (CI) recipient volunteer partnerships, as perceived by CI volunteers, in terms of support and informational counselling. By exploring the dynamics of these partnerships, valuable insights are gained into the effectiveness of volunteer support systems, contributing to peer-based interventions and the overall well-being of CI recipients navigating the complexities of cochlear implantation. MATERIALS AND METHODS : Focus group discussions were conducted with eight adult CI volunteers, and qualitative data were thematically analysed. RESULTS : Four overarching themes were identified: (1) Sharing personal experiences, (2) Information broker, (3) Providing support, and (4) Recommendations for CI volunteer partnerships. CONCLUSIONS : Insights from CI volunteers highlight the value of peer support in enhancing person-centred audiological care. The study identifies a need for structured volunteer involvement in CI programs and marks an initial exploration of CI volunteering and mentoring. IMPLICATIONS FOR REHABILITATION • Collaboration between CI volunteers and hearing healthcare professionals highlights the importance of CI programs providing comprehensive informational counselling. • Counselling should integrate technical aspects of CIs with personal experiences shared by CI volunteers, addressing both clinical and human dimensions of the CI journey. • CI volunteers play a critical role in providing emotional support throughout the CI journey, suggesting the need to integrate peer mentoring into rehabilitation programs to sustain CI recipients’ psychological well-being. • CI programs should involve CI volunteers in advocacy efforts to raise awareness and foster supportive CI communities.
Tele-intervention for adults with tinnitus in Ghana, a low- and middle-income country : a feasibility study
Boateng, Joseph Omane; Soer, Maggi E. (Magdalena Elizabeth); Biagio-de Jager, Leigh (Springer, 2026-03-12)
BACKGROUND : Tinnitus may be associated with anxiety and depression which can affect quality of life. In low- and middle-income countries like Ghana, a shortage of specialized clinicians suggests online interventions could alleviate clinician caseloads, but the feasibility of online intervention is yet to be explored. This study assessed the feasibility of providing tele-intervention in the form of online educational counselling (OEC) for adults with tinnitus in Ghana. METHODS : This single-arm trial included 53 Ghanaian adults (female = 21, median age = 34 years) with significant tinnitus severity, internet access, email, and English literacy. Standardized questionnaires were used to assess tinnitus severity, anxiety, and depression levels pre- and post-intervention. Online educational counselling was provided using a free downloadable tinnitus self-help resource over three weeks. Pre- and post-intervention scores were compared and participant perceptions were recorded. RESULTS : Significant reductions in tinnitus severity, anxiety, and depression levels occurred post-intervention. Over half (54.7%) of the participants reported significant reductions in tinnitus severity post-intervention. Bivariate comparisons showed the reduction was associated with baseline tinnitus severity and depression level but not with sex (p = 0.400), hearing status (p = 0.530), or anxiety levels (p = 0.058). Participants demonstrated high adherence (93%) and provided positive feedback on the tele-intervention. CONCLUSION : Online educational counselling for tinnitus is feasible in Ghana based on adherence and feedback. These findings support integrating OEC into tinnitus care in low-resource settings as an initial, scalable option or within a multi-faceted program.
Adaptation of a developmental milestone resource for parents from diverse, low-income communities in South Africa
Eccles, Renata; Du Toit, Maria; Bellini, Ashley; Masule, Kabuba Hendrietta; Molongoana, Palesa N.; Masekela, Mbali M.N.; Bahadoor, Zeneera; Abdoola, Shabnam Salim; Van der Linde, Jeannie (Sage, 2026)
Knowledge of developmental milestones allows parents to support the developmental needs of their children and monitor their behaviour. Many available developmental resources, however, do not apply to culturally, economically, and linguistically diverse communities in low– and middle-income countries. There is a need to adapt established resources to improve contextual relevance. As primary stakeholders, parents should contribute to the adaptations. An existing developmental milestone resource was adapted for parents from low-income communities in South Africa using a mixed-method research design. In phases 1 and 2, a six-member expert panel reviewed and adapted the existing resource for the parents of children aged 2–47 months using a questionnaire and focus group. In phase 3, 18 parents of young children from low-income communities were interviewed to gain their perspectives on the adapted milestone. Most developmental milestones were deemed applicable, but they require adaptation to be relevant for use in low-income communities. The four themes identified were: language use, access to materials indicated in the resource, context and developmental literacy. Parents found the adapted resource relevant to promoting developmental literacy. International developmental milestone resources require contextual adaptation for diverse communities. Parents were included in developing the resource, increasing its relevance. The adapted resource should be trialled to evaluate the effectiveness of promoting parents’ developmental literacy.
Person-centered care in adult auditory rehabilitation : a scoping review
Graham, Marien Alet; Nicholson, Nannette; Glade, Rachel; Delport, Sonja; Mahomed-Asmail, Faheema (Taylor and Francis, 2026)
OBJECTIVE : To scrutinise the efficacy of person-centered care (PCC) in enhancing outcomes for adults navigating hearing loss through a comprehensive examination of literature on PCC in auditory rehabilitation (AR). DESIGN : A scoping review was conducted following Joanna Briggs Institute guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) reporting standards. A context framework guided the research question. STUDY SAMPLE : Structured searches across multiple databases identified 36 records which were categorised by research design, mapped by the first author's country, and depicted by number of publications per year. Six identified elements of PCC were anaylzed across four components of PCC using deductive qualitative analysis. RESULTS : Most studies were published in the US and Australia; with a gradual increase to four publications per year. From the six PCC elements of person-centered care, family involvement, individualised preferences and treatment uniqueness were most frequently addressed. Notably, active listening and empathy received limited attention. CONCLUSION : Evidence suggests advancement of PCC practices effectively fosters more effective and personalised approaches in adult AR. By pinpointing trends and gaps, we contribute to the advancement of PCC practices, fostering more effective and personalised approaches in AR for improved patient outcomes and experiences.
Image use in aphasia rehabilitation : practices of speech-language pathologists in South Africa and international contexts
Pillay, Bhavani Sarveshvari; Van der Linde, Jeannie; Graham, Marien Alet; Dada, Shakila (Taylor and Francis, 2026)
PURPOSE : The study aimed to explore speech-language pathologists' practices regarding image selection and use in the treatment of people living with aphasia. Images are widely utilised with people living with aphasia, however, supporting their communication optimally remains challenging. METHOD : Ninety-two speech-language pathologists from South Africa, Australia, USA, and the UK completed a custom-designed online survey. Descriptive and inferential statistics, with structured-tabular thematic analysis were used. RESULTS : Sixty-two (82.7%) of the 75 participants who conduct assessments with people living with aphasia mostly use images. Sixty-seven (72.8%) of the total sample include images during treatment. South African respondents reported using black-and-white line drawings (28.1%) less frequently than speech-language pathologists from other countries (9.8%). Coloured images were preferred overall. South African participants significantly reported culture (62.5%) and religious orientation as "always important" (63.3%) compared to their counterparts (34.1%, 12.2%). Respondents use images to support learning and language; and less frequently in discourse with people living with aphasia. The more experienced a respondent was, the more knowledgeable and confident they felt incorporating images. Themes of client considerations and clinical settings for images emerged. Speech-language pathologists' perceived barriers were time, larger caseloads, people living with aphasia's variable responses to images, and lack of resources. CONCLUSION : Speech-language pathologists in this sample have a knowledge base of image types and factors that may contribute to image interpretation in people living with aphasia. However, further research globally is needed. A structured approach to image selection is lacking in both low and middle-income, and high-income countries. Considering people living with aphasia's skills, preferences, and communication partner involvement may optimise image use. Development of a framework for systematically organising image features for people living with aphasia is warranted.
Community-based hearing aid fitting model for adults in low-income communities facilitated by community health workers : a feasibility study
Mothemela, Bopane; Frisby, Caitlin; Mahomed-Asmail, Faheema; De Kock, Tersia; Moore, David R.; Manchaiah, Vinaya; Swanepoel, De Wet (Taylor and Francis, 2025)
BACKGROUND : Hearing loss affects more than 1.5 billion people worldwide, yet fewer than 10% of those who could benefit from hearing aids are able to access them. Barriers such as high costs, limited availability, and a critical shortage of trained professionals in low- and middle-income countries contribute to this gap, while emerging models of care-such as task-shifting to community healthcare workers (CHWs) supported by mHealth technologies-show promise in improving access, affordability, and outcomes in underserved communities. OBJECTIVE : To determine the feasibility and outcomes of a community-based hearing aid fitting model designed for low-income communities facilitated by community health workers (CHWs). METHOD : Using Bowen's framework, feasibility was evaluated according to service delivery and patient outcomes. A total of 25 (six male) participants were fitted with bilateral Go Prime preset, over-the-counter (OTC) hearing aids by CHWs in Khayelitsha, a low-income community in Cape Town, South Africa. Benefit and satisfaction were measured using the International Outcome Inventory for Hearing Aids (IOI-HA). An open-ended survey used to obtain their perceptions on the impact of the hearing aids on communication, the mHealth program, and willingness to purchase the hearing aids was analyzed using inductive thematic analysis. RESULTS : Pure Tone Average across participants was 57.3 dB HL (11.5 SD) in the left ear and 54 dB HL (14.2 SD) int he right ear. The majority of participants self-reported positive outcomes while using hearing aids, including good hearing in background noise. IOI-HA showed above standardized average scores of 3.91 for daily use, 4.46 for benefit, and 4.58 for satisfaction. 92% of the participants reported the hearing aids as extremely helpful, with 87.5% recommending hearing aids for others with hearing loss. Additionally, participants reported positive experiences with them Health support program and described the program as clear and helpful. CONCLUSION : The community-based hearing aid fitting model is feasible and demonstrated positive hearing aid outcomes in a low-income community. This approach, supported by mHealth technologies and CHWs, presents a promising solution to address the hearing care gap in low- and middle-income countries (LMICs).
Self-reported vocal demands, perceptions, and knowledge of occupational voice users in South Africa
Vermeulen, Rouxjeanne; Du Toit, Maria; Van Lierde, K.M. (Kristiane); Graham, Marien Alet; Van der Linde, Jeannie (Elsevier, 2025-07)
OBJECTIVES : The study aimed to describe daily vocal demands, perceptions and knowledge as reported by occupational voice users. STUDY DESIGN : A descriptive, cross-sectional research design was employed. METHODS : A survey on vocal demands, perceptions and knowledge was distributed to 102 occupational voice users via a snowball sampling technique. RESULTS : Slightly more than half of the participants (55%) reported using their voice for work 36.5 hours a week on average (SD = 15.5, range: 33–40). Participants reported that, on average, their daily voice use is 6.3 hours (SD = 2.7) for work and the majority (81%) reported a decrease in voice quality after work; Three-quarters (75%) also reported vocal fatigue at the end of day. Approximately one-third (33%) reported being exposed to environments where they are expected to shout, scream or cheer loudly. More than half of the participants (61%) reported that they have previously received vocal health education but 40% reported that they felt this training was insufficient. High vocal demands are significantly correlated to an increase in perceived vocal handicap rs = 0.242; (P = 0.018), tiredness of voice rs = 0.270; (P = 0.008), physical discomfort rs = 0.217; (P = 0.038) as well as how occupational voice users experience improvement of symptoms with rest rs = −0.356 (P < 0.001). Other risk factors highlighted by occupational voice users are the ingestion of liquid caffeine, alcohol, and carbonated drinks, smoking or the presence of chronic cough, chronic laryngitis, and gastroesophageal reflux disease. CONCLUSIONS : Occupational voice users are subjected to high daily vocal demands that can be seen to be linked to vocal fatigue, changes in voice quality and vocal symptoms experienced. It is essential that occupational voice users as well as treating clinicians are aware of certain significant predictors of both vocal handicap and vocal fatigue. These findings provide insights for developing strategies for training and cultivating vocal health consciousness and preventive voice care initiatives that focus on occupational voice users in South Africa.
Partners’ perceptions of aphasia on communication interaction in their relationship
Van der Riet, Sonika; Kruger, Esedra; Pillay, Bhavani Sarveshvari (University of Toronto Press, 2025-04)
Aphasia impacts relationships by altering communication dynamics, potentially leading to emotional disconnection or, alternatively, bringing partners closer as they support each other through challenges. The study aimed to describe how partners in a relationship perceive the impact of aphasia on their communication interactions. Five couples participated in this qualitative case study design, each comprising a partner with chronic stroke-related aphasia. Initial brief intake surveys were conducted followed by in-depth interviews. Five main themes were constructed through thematic analysis: aphasia alters conversational role dynamics and interactions; couples employ strategies to overcome communication challenges; communication difficulties lead to conflict and hinder resolution; partners of a couple experience diverse emotional reactions to the effects of aphasia; and perceptions of support differ between partners of a couple. Speech-language pathologists play a key role in restoring a more balanced distribution of listener–speaker roles in couples' communication post-aphasia. Understanding both partners' emotional reactions to communication challenges can better equip healthcare professionals to manage these within relationships, ensuring couple-centered care.
Internet-based behavioral cough suppression therapy for refractory chronic cough : a randomized controlled trial
Salois, Jane R.; Heinle, Kassidi L.; Slovarp, Laurie J.; Jette, Marie E.; Manchaiah, Vinaya; Vlaescu, George; Andersson, Gerhard (American Speech-Language-Hearing Association, 2025-09)
Please read abstract in the article.
Marketing practices and information quality for over-the-counter (OTC) hearing aids on Amazon.com
Conway, Kylie; Knoetze, Megan Clarissa; Swanepoel, De Wet; Sharma, Anu; Nassiri, Ashley; Manchaiah, Vinaya (Lippincott, Williams and Wilkins, 2026-02)
INTRODUCTION : Over-the-counter (OTC) hearing aids have become increasingly accessible, yet limited information exists regarding their online listings and marketing practices. This study evaluated cost, satisfaction ratings, review, volume, readability of product descriptions, and Food and Drug Administration (FDA) clearance status of OTC hearing aid listings on Amazon.com. MATERIALS AND METHODS : This cross-sectional, descriptive study analyzed 138 Amazon OTC hearing aid listings. Listing characteristics were extracted, and FDA clearance or registration was verified. Analyses included descriptive data on listing characteristics and nonparametric analysis of key variables: price, FDA-clearance status, device type, and form factor. Readability indices were used to assess the accessibility of product descriptions. RESULTS : Of the 138 listings analyzed, 92 listings (66.7%) identified their product as “OTC hearing aids,” while only 37 (26.8%) were verified as FDA-cleared or registered. FDA-cleared/registered devices cost significantly more than non-FDA-cleared devices. Behind-the-ear (BTE) devices had a significantly higher number of reviews compared with in-the-ear (ITE) devices. The readability of product descriptions was advanced, ranging from 11th-grade to college graduate levels. In addition, 52 listings (37.7%) lacked specific marketing for mild-to-moderate hearing loss, and 13 (9.4%) were marketed to those with hearing loss beyond mild-to-moderate. DISCUSSION : Amazon listings for OTC hearing aids reveal significant inconsistencies in marketing and labeling, including misleading FDA clearance claims and inadequate accessibility of product information. Advanced readability levels and marketing for hearing loss degrees beyond mild-to-moderate further impede consumers’ ability to make informed purchasing decisions. These findings highlight the urgent need for stricter regulatory oversight and improved dissemination of accurate, accessible consumer information.
Establishing linguistic categories for hearing aid experiences in adults : a modified Delphi study
Oosthuizen, Ilze; Manchaiah, Vinaya; Launer, Stefan; Swanepoel, De Wet (American Academy of Audiology, 2025-07)
BACKGROUND : Recent advancements in automated natural language processing (NLP) methods and tools have enhanced the efficacy and accuracy of quantitative analysis of natural language data. NLP offers significant potential for audiology by providing valuable insights from open-text responses about users’ lived hearing aid experiences. PURPOSE : This study aimed to establish linguistic categories pertinent to the experiences of adults using hearing aids, with the ultimate goal of developing a specialized text processing module to facilitate natural language analysis of textual data on hearing aid experiences. RESEARCH DESIGN : A modified electronic Delphi (e-Delphi) design was employed. STUDY SAMPLE : A panel of 16 audiology experts from seven countries. DATA COLLECTION AND ANALYSIS : Two survey rounds were conducted. In round 1, experts rated categories from the Linguistic Inquiry and Word Count (LIWC) software and categories from principal component analysis of open-ended text data on hearing aid experiences. Experts also responded to open-ended prompts regarding categories derived from qualitative studies on hearing aid experiences. Responses were condensed and refined into items for rating during round 2. In round 2, experts reconsidered their ratings in light of the group answers of round 1. All ratings used a four-point Likert scale of importance. Measures of central tendency, levels of dispersion, and Cronbach’s α reliability coefficients were conducted in both rounds for comparative purposes. RESULTS : The open-ended section generated 26 items. Consensus was met on 53 linguistic categories encompassing social (e.g., social situations, social support), emotional (e.g., positive tone, negative tone), cognitive (e.g., cognitive processes, causation), lifestyle (e.g., work, leisure), hearing aid–related (e.g., sound quality, use and handling), and service delivery–related dimensions. CONCLUSIONS : The linguistic categories identified provide a foundation for developing a customized LIWC text processing module tailored to the analysis of hearing aid experiences. Future research is needed to refine and validate the custom text processing module. CLINICAL RELEVANCE STATEMENT : The findings provide a framework to enable the development of a customized hearing aid LIWC dictionary. Such a tool may enhance clinicians’ ability to explore hearing aid outcomes and improve patient-centered care by integrating real-world experiences into clinical practice.
Linguistic and cultural adaptation of internet-based cognitive behavioral therapy for tinnitus to Indian English : methods and readability outcomes
Palaniswamy, Hari Prakash; Vasudevan, Harini; Oak, Aparna; Rajanbabu, Keerthana; Manchaiah, Vinaya; Beukes, Eldre W.; Andersson, Gerhard (Elsevier, 2026-02)
BACKGROUND : Tinnitus often causes distress, irritability, difficulty sleeping, and lack of concentration due to its consistent persistence. Cognitive behavioral therapy (CBT) is a proven psychological treatment that can reduce tinnitus-related distress and can be provided via the Internet (ICBT). Such evidence-based, accessible treatments are not yet available in India. The increasing access to eHealth interventions in India will support and increase access to interventions like ICBT. This study aims to adapt ICBT for tinnitus to Indian English, ensuring it is culturally, linguistically, and contextually appropriate for the Indian population. METHOD : The material was carefully reviewed by an audiologist, a linguist, a psychologist and a psychiatrist. The adaptation procedure primarily followed the ISPOR Principles of Good Practice for the translation and cultural adaptation, with a few adaptations from the Ecological validity model. Conflicts were resolved with consensus among all professionals. Then, the content was validated by the psychologist and psychiatrist. Additionally, readability adjustments ensured comprehensibility of the target population. RESULTS : A total of 76 (54 words and 22 phrases) were recommended for modification for reasons including cultural adaptation, lexicon, linguistic relevance, and concept coverage. Lexicons were the highest reason (52%) for modification. The material was critically validated by the expert committee and finalized based on comprehensibility, cultural appropriateness, and concept coverage, as the average scores were above 8 (benchmark pre-determined) for all modules. The readability scores also fell within the pre-determined criteria to finalize the material. CONCLUSION : This material has been adapted and validated for the Indian population, and it can now be further developed as a treatment program. This represents a significant step towards establishing standard, evidence-based tinnitus treatment protocols in India. Further studies should examine the feasibility, efficacy, and effectiveness of ICBT for the Indian population through clinical trials.
Development and psychometric validation of tinnitus qualities and impact questionnaire
Manchaiah, Vinaya; Andersson , Gerhard; Beukes, Eldre W.; Fagelson, Marc A.; Swanepoel, De Wet; Heffernan , Eithne; Maidment, David (MDPI, 2025-04-27)
BACKGROUND : To develop and validate the Tinnitus Qualities and Impact Questionnaire (TQIQ), a new tool for evaluating the perceived qualities of tinnitus sound. METHOD : The study was part of two clinical trials on internet-based tinnitus interventions, using cross-sectional (n = 380) and pretest–posttest data (n = 280). Participants completed various questionnaires online, including the newly developed TQIQ and measures of tinnitus severity (Tinnitus Functional Index; TFI), anxiety (Generalized Anxiety Disorder 7; GAD-7), depression (Patient Health Questionnaire 9; PHQ-9), insomnia (Insomnia Severity Index; ISI), and health-related quality of life (EQ-5D-5L Visual Analog Scale; VAS). The psychometric properties of the TQIQ were assessed, including construct validity, internal consistency reliability, floor and ceiling effects, interpretability, and responsiveness to treatment. RESULTS : Exploratory factor analysis resulted in two factors that accounted for 57% of the variance—internal and external tinnitus qualities. Overall, 92% convergent validity predictions were confirmed; TQIQ total scores strongly (≥0.6) or moderately (0.30 to 0.59) correlated with the TFI, GAD-7, PHQ-9, and ISI. The known-groups validity prediction was confirmed as individuals with an overall TFI score > 50 (severe) obtained significantly higher TQIQ scores. All internal consistency reliability statistics were within the required range (Cronbach’s α > 0.8). Floor and ceiling effects were negligible. ROC established clinically important cut-off scores, enhancing the interpretability of tinnitus severity classification. Finally, 89% convergent validity predictions were confirmed; TQIQ and TFI change scores were moderately correlated, indicating good responsiveness of the former to treatment. CONCLUSIONS : The TQIQ has adequate psychometric properties, providing a standardized measure for the assessment of characteristics of tinnitus sound in clinical practice.
Application of the International Classification of Health Interventions for coding interventions in adults with sensorineural hearing loss
Mahomed-Asmail, Faheema; Oosthuizen, Ilze; Sykes, Catherine; Maart, Soraya; Madden, Richard; Swanepoel, De Wet; Manchaiah, Vinaya (Oxford University Press, 2025-06)
OBJECTIVE : The International Classification of Health Interventions (ICHI), currently being developed, seeks to span all sectors of the health system. Our objective was to determine the coverage of the ICHI for hearing interventions commonly delivered to adults with sensorineural hearing loss (SNHL). MATERIALS AND METHODS : A 3-phase content mapping method was used, which included (1) identification of source terms with an expert panel in audiology rehabilitation; (2) 3 coders independently applied the classification to the source terms; and (3) the coders reached a consensus for each intervention and identified reasons for initial discrepancies with options not linked to a specific code were identified. RESULTS : Nineteen different ICHI Target categories were identified, with 23 different ICHI Action categories and 82% of the means being "Other and unspecified." There was consensus in codes for 54.3% of source terms, with no ICHI code found for 8.5% of source terms. The greatest number of discrepancies arose from the action, followed by the target. Coding discrepancies occurred as a result of misunderstanding of source terms, the clinical use thereof, and difficulty determining the type of Target. DISCUSSION : Despite its broad scope, ICHI's current framework has gaps in its coverage of audiological interventions, particularly those related to sensorineural hearing loss. Addressing these gaps is crucial for improving global data standardization and facilitating the development of more targeted hearing health policies. CONCLUSION : This study makes an important contribution to the further development and refinement of the classification, specifically in the context of hearing healthcare.
The transition from first to second language instruction : South African year 4 learners
Le Roux, Mia; Geertsema, Salome; Milton, Carmen; Graham, Marien Alet; Wittstock, Kate; Gardee, Humayra; Carrim, Diyaanah Sattar; Veerasamy, Helene (Universidad de Castilla la Mancha, 2025)
ABSTRACT : The precursor literacy skills phonological and phonemic awareness play a central role in later literacy skills acquisition, especially during the transition from first language to second language mode of learning and teaching. Various research projects in South Africa found that English second language learners, even those who receive instruction in English from Year 0, do not have sufficient precursor and later literacy skills to support academic requirements. Learners who transfer from first-language instruction to second-language instruction in Year 4 may have even lower skills due to less exposure to the medium of instruction (English) on an academic level. This may further influence their literacy abilities. This study intended to analyse and determine the association of precursor literacy and later literacy skill competency measures of Year 4 learners who have recently transitioned from being taught in their L1 to English as their language of learning and teaching (LoLT). A quantitative, cross-sectional, descriptive, and correlational design was used. Non-probability, convenient sampling was employed. Results indicated that participants had limited precursor literacy and later literacy skills in English, demonstrating that transferring to their second language as the language of learning and teaching in Year 4 may be challenging. These challenges impact literacy skills necessary for academic success. Additionally, strong positive correlations between precursor and literacy skills assessed were determined. Therefore, intervention is essential to equip learners with strong literacy skills in the language of learning and teaching. RESUMEN : Las habilidades precursoras de lectoescritura y la conciencia fonológica desempeñan un papel fundamental en la adquisición posterior de habilidades de lectoescritura, especialmente durante la transición de la primera lengua a la segunda. Diversos proyectos de investigación en Sudáfrica han revelado que los estudiantes de inglés como segunda lengua, incluso aquellos que reciben instrucción en inglés desde el primer año (Año R), carecen de las habilidades de lectoescritura precursoras y posteriores necesarias para cumplir con los requisitos académicos. Los estudiantes que pasan de la instrucción en la primera lengua a la instrucción en la segunda lengua en el cuarto año pueden presentar habilidades aún menores debido a una más escasa exposición al inglés a nivel académico. Esto puede influir decisivamente en sus habilidades lectoescritoras. Este estudio tuvo como objetivo determinar y analizar la asociación entre las medidas de competencia en lectoescritura precursora y lectoescritura posterior de los estudiantes de cuarto año que recientemente han pasado de recibir instrucción en su primera lengua (L1) al inglés como lengua de aprendizaje y enseñanza (LDA). Se utilizó un diseño cuantitativo, transversal, descriptivo y correlacional. Se empleó un muestreo no probabilístico por conveniencia. Los resultados indicaron que los participantes tenían un nivel de alfabetización precursora y posterior limitada en inglés, lo que demuestra que la transición a su segunda lengua como lengua de aprendizaje y enseñanza en cuarto año puede ser difícil. Estas dificultades afectan las habilidades de lectoescritura necesarias para el éxito académico. Además, se determinaron correlaciones positivas y significativas entre las habilidades precursoras y de lectoescritura evaluadas. Por lo tanto, la intervención es esencial para dotar a los estudiantes de sólidas habilidades de lectoescritura en la lengua de aprendizaje y enseñanza.
Feasibility, efficacy and effectiveness of community health worker-facilitated hearing aid provision : a systematic review
Frisby, Caitlin; Manchaiah, Vinaya; Swanepoel, De Wet (BMJ Publishing Group, 2025-11)
OBJECTIVES : The WHO recommends task-sharing with community health workers (CHWs) to help overcome the limited access to hearing healthcare and hearing aids in low-income and middle-income settings (LMIs). This systematic review examined the feasibility, efficacy and effectiveness of CHW-facilitated hearing aid provision. DESIGN : Systematic review guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. DATA SOURCES : PubMed, Scopus and Web of Science were searched through 4 June 2025. ELIGIBILITY CRITERIA : Studies in which CHWs facilitated hearing aid provision in any context. DATA EXTRACTION AND SYNTHESIS : Data on study characteristics, CHW training and roles, hearing-aid outcomes and implementation factors were extracted. Study quality was determined using the National Institute of Health quality assessment tool, and level of evidence was determined using the Centre for Evidence-Based Medicine. A narrative synthesis was conducted. RESULTS : Six studies published between 2013 and 2025 were included. Two were conducted in high-income countries but implemented in LMI communities. Four studies were conducted in LMI countries. All provided CHW training, though content and duration varied; only one used WHO-endorsed materials. Sustained device use was high as reported at follow-ups, though only one included 12-month outcomes. All studies included validated outcome measures, including the International Outcome Inventory for Hearing Aids, Hearing Handicap Inventory for the Elderly-Screening version, Abbreviated Profile of Hearing Aid Benefit and Self-Efficacy for Situational Communication Management Questionnaire. Implementation facilitators included use of local CHWs, delivery in participants' home languages, comprehensive CHW training and employing mHealth tools. Barriers included CHW scope constraints and unfamiliarity with outcome subscales in rural contexts. Only two studies used formal feasibility frameworks. CONCLUSIONS : CHW-facilitated hearing aid provision is feasible and effective. However, variation in training and implementation highlights the need for standardised training materials, supervision models and culturally adapted outcome measures. Further research should examine long-term outcomes, cost-effectiveness and scalability using formal implementation frameworks.
Changes in perceived tinnitus sound qualities following internet-based cognitive behavioral therapy for tinnitus
Manchaiah, Vinaya; Andersson , Gerhard; Beukes, Eldre W.; Fagelson, Marc A.; Swanepoel, De Wet; Maidment, David (MDPI, 2025-03-27)
BACKGROUND : To examine the changes in perceived tinnitus sound qualities following internet-based cognitive behavioral therapy (ICBT) for tinnitus. METHOD : This study was embedded within several clinical trials evaluating the efficacy of ICBT and used a quasi-experimental design (N = 152). Participants completed a series of online questionnaires, including measures of tinnitus sound qualities (Tinnitus Qualities and Impact Questionnaire; TQIQ), tinnitus severity (Tinnitus Functional Index; TFI), anxiety (Generalized Anxiety Disorder-7; GAD-7), depression (Patient Health Questionnaire-9; PHQ-9), insomnia (Insomnia Severity Index; ISI), and health-related quality of life (EQ-5D-5L Visual Analog Scale; VAS). Data were analyzed using a range of parametric and non-parametric statistics, and Cohen’s d effect sizes were reported. RESULTS : There were no significant differences between the intervention and control groups in sociodemographic and clinical variables at baseline except for anxiety and depression symptoms, which were higher in the intervention group. A statistically significant reduction in tinnitus severity, anxiety, depression, and insomnia was noted post-intervention, with small-to-moderate effect sizes. Statistically significant improvements were also noted for the TQIQ (overall and all subscales) following ICBT compared to the no-intervention group (p ≤ 0.028), all with small-to-large effect sizes, except for the loud sounds subscale and for participants with a TQIQ < 38 at baseline, or “mild” perceived qualities of tinnitus (p ≥ 0.136). A significantly greater proportion of participants in the intervention group had minimum clinically important differences (38%) on the TQIQ compared to the no-intervention group (9%). CONCLUSIONS : ICBT can lead to changes in the perceived qualities of tinnitus sound in addition to reducing tinnitus severity and other aspects, such as anxiety, depression, and insomnia. While these findings are preliminary, they highlight that tinnitus distress and perception may be related. However, the study has several limitations including a lack of audiological variables and objective measures. For this reason, the study results must be viewed with caution and must be treated as preliminary.
Preset hearing aid program selection in low-income communities: a longitudinal study
Croucamp, Anné; Frisby, Caitlin; Manchaiah, Vinaya; De Kock, Tersia; Swanepoel, De Wet (MDPI, 2025-10-11)
PURPOSE : Decentralized hearing care models facilitated by community health workers (CHWs) can improve access to care in low-income settings. Preset hearing aids, which offer user-selectable pre-developed amplification programs, may support such models, but little is known about their real-world use and alignment with clinical recommendations. METHOD : This longitudinal study formed part of a feasibility project implementing the World Health Organization's (WHO's) hearing aid service delivery approach in three low-income South African communities. Adults (≥18 years) with confirmed moderate-to-severe bilateral hearing loss were fitted with preset hearing aids by trained CHWs. Devices offered four preset amplification programs. Participant-driven selections were recorded at four distinct time points: fitting and follow-ups at 2 weeks, 2 months, and 6 months post-fitting. RESULTS : In total, 36 participants (mean age = 76 years, SD = 8.9, range 50-96) were fitted with devices. Although over half (right: 52.8%, left: 58.3%) presented with high-frequency loss, only 34% initially selected the corresponding program. Most participants (80.6%, n = 29) changed their selections at least once over the six months. Significant associations between hearing loss configuration and selection occurred at some time points only in the left ear, but agreement with clinically recommended programs declined from 42% at baseline to 28% at six months. CONCLUSIONS : CHW-facilitated hearing aid delivery supports user autonomy in low-resource settings. However, frequent changes and divergence from clinically recommended programs suggest reliance on user-driven trial-and-error adjustments rather than audiometric fit, which may limit long-term benefit. Ongoing, person-centred guidance is needed for the effective use of preset hearing aids.
Severe-to-profound hearing loss and mental health : initial evidence that cochlear implantation helps alleviate symptoms of anxiety and stress
McIlhiney, Paul; Almeida, Osvaldo P.; Sucher, Catherine M.; Eikelboom, Robert H.; Jayakody, Dona M. P. (Wiley, 2025-09)
OBJECTIVES : Mental-health issues accounted for 418 million disability-adjusted life years in 2019, costing the world economy approximately $5 trillion. Untreated hearing loss is a well-known modifiable risk factor for mental-health issues, with severe-to-profound hearing loss having the largest impact. Therefore, treatment of severe-to-profound hearing loss, namely with cochlear implantation, could help to alleviate psychological distress. However, previous studies have failed to include comprehensive measures of mental health or adequate controls. The current study thus aimed to conduct a controlled, longitudinal investigation of how cochlear implantation affects depression, anxiety and stress levels. PARTICIPANTS : Participants were 87 adults assigned to conditions based on hearing status: normal hearing (n = 44), received cochlear implant (n = 26) or untreated hearing loss (n = 17). MAIN OUTCOMES MEASURES : The short-form Depression Anxiety Stress Scale was given at four timepoints (baseline, 3 months, 6 months, 12 months). Data were analysed using linear mixed-effects modelling. RESULTS : Results showed that cochlear implants helped to stabilise anxiety and stress symptoms, while depression symptoms were observed to worsen over time despite treatment. CONCLUSION : Our findings suggest that treatment of severe-to-profound hearing loss with cochlear implantation was associated with a lessening of anxiety and stress scores, although the clinical significance of such changes remains uncertain. Due to the current study's non-randomised treatment allocation, future randomised controlled trials are required for confirmation. The present findings help inform clinical and societal interventions for mental-health issues associated with hearing loss. SUMMARY • Severe-to-profound hearing loss can negatively impact mental health. • We longitudinally assessed cochlear implants' influence on mental health. • A cochlear-implanted group was compared to untreated and normal controls with linear mixed-effects analyses. • Cochlear implantation was associated with lessening of anxiety and stress, but not depressive symptoms. • The current findings encourage post-implantation mental-health care for cochlear-implant recipients.

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