Audiology and Speech Pathology - Theses
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ItemAn evidence-based pathway to early cochlear implantation in infants: reducing the reliance on the behavioural audiogram( 2023-03)ABSTRACT Background and Aims Cochlear implantation has emerged as a leading hearing intervention for infants born with severe to profound hearing loss. Research has shown that early intervention with a cochlear implant (CI) can significantly improve speech perception and oral language development in infants, providing them with access to the sounds that are critical for language acquisition. However, studies investigating the relationship between initial electrophysiological hearing thresholds and subsequent behavioural thresholds have demonstrated uncertainty as to whether initial results are able to provide an accurate estimation of an infant’s functional hearing. This estimation must be accurate if a CI is to be considered before behavioural audiometry has been obtained, as CI surgery is likely to remove any remaining natural hearing. This study aims to explore the variance between initial electrophysiological thresholds and subsequent behavioural hearing thresholds in young infants with suspected severe to profound hearing loss in a clinical setting, to determine under which conditions initial electrophysiological results can be used to support a CI recommendation in the absence of behavioural audiology. It also aims to propose evidence-based recommendations for implementation of a paediatric CI candidacy pathway for cases in which reliance on behavioural audiometry can be reduced. Method A prospective cohort study of 63 infants with suspected severe to profound hearing loss, referred to the Cochlear Implant Clinic, Melbourne, before 12 months of age. Assessment protocol included auditory brainstem response, auditory steady-state response, otoacoustic emissions, tympanometry, cortical auditory evoked response, and behavioural audiometry. Data was explored using correlational analysis, linear regression, and clinical decision analysis. Results 90.8% of all individuals who met CI candidacy criteria with initial electrophysiological testing (3FAHL>85dB) also met criteria upon behavioural testing. This proportion increased to 95% once certain exclusion criteria were placed on the group, excluding children born prematurely and children with auditory neuropathy. This result indicates that, under certain conditions, initial electrophysiological thresholds may be reliable enough to form the basis of a CI recommendation. Sensitivity and specificity of diagnostic electrophysiological testing was also found to increase once exclusion criteria were applied. Conclusion For most infants undergoing CI candidacy evaluation, initial electrophysiological thresholds were an accurate reflection of their subsequent behavioural hearing thresholds. An alternative CI candidacy pathway is recommended for infants who show profound sensorineural hearing loss on initial electrophysiological testing in the absence of middle ear effusion or auditory neuropathy features, to provide CI recommendations before behavioural thresholds are obtained. This would lead to reduced timeframes between hearing loss identification, diagnosis, and implantation, which can improve oral speech and language outcomes.
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ItemPsychologically Informed Practice in Hearing Healthcare: Perspectives and Needs of Clients and Audiologists( 2022)For many people, the sense of hearing provides a connection with others and the world around them. Losing one’s hearing can have a deleterious impact on many psychological and social aspects of life. Hearing loss can compromise psychological wellbeing, resulting in an increase in loneliness or reduced self-esteem, and it can also increase the odds of experiencing psychological symptoms, such as depression and anxiety. Given this association, audiologists are likely to encounter clients with psychological concerns on a regular basis. Understanding how these clients experience audiological rehabilitation may be an important way for audiologists to provide relevant and optimal services. Psychological factors, including mental health and illness, can also significantly influence the initiation, adherence, and success of audiological rehabilitation. Despite this, psychological factors are not adequately considered within hearing healthcare, so the recommended approach of person-centred care may need to be further extended to better address these factors. Psychologically informed practice (PIP) may provide a suitable framework that can be used to extend upon person-centred care, especially for clients with comorbid psychological symptoms. A PIP framework recognises the role of psychological factors in chronic health conditions and addresses these using psychological theories and frameworks. PIP has shown success in other rehabilitation settings and may therefore provide benefits within hearing healthcare. The aim of this thesis was therefore to explore the nature of mental illness, mental health, and psychological symptoms within audiological rehabilitation, from the perspective of clients and audiologists, and to provide a foundation of support for the implementation of PIP into hearing healthcare. Four studies were conducted to achieve the aims of this thesis. The first study included in-depth, semi-structured qualitative interviews to understand the experience of hearing loss and audiological rehabilitation for older adults with comorbid psychological symptoms. A novel theme found in this study was the bi-directional and cumulative relationship between hearing loss and psychological symptoms. Given the relationship between hearing loss and psychological symptoms, the second study included a systematic review and meta-analysis to determine the effect of interventions targeted at hearing loss on psychological symptom outcomes in adult clients. The meta-analysis showed that hearing aids, cochlear implants, and communication and education programs resulted in a small decrease in depression and anxiety symptoms. A mixed-method survey of audiologists working in adult audiological rehabilitation in Australia was then conducted to understand the nature of client-audiologist discussions about client mental health within audiological rehabilitation. This study found that audiologists occasionally discuss mental health, and clients are more likely than clinicians to initiate these conversations. The final study aimed to determine the barriers and facilitators to audiologists discussing and addressing client mental health, and to determine audiologists’ preparedness and willingness to implement aspects of PIP in audiological rehabilitation. Audiologists were generally motivated to incorporate PIP into audiological rehabilitation; however, a lack of knowledge about mental health and organisational barriers, such as time and resources, would need to be overcome. Overall, the studies in this thesis provide an understanding of how psychological symptoms are experienced, recognised, discussed, and addressed within audiological rehabilitation and suggested that the current way of delivering audiological rehabilitation is insufficient to achieve optimal outcomes for clients with psychological symptoms. These studies form an evidence-based foundation and rationale for the implementation of PIP within hearing healthcare.