Audiological practices employed by audiologists in the management of adult patients with multi-drug resistant tuberculosis in South Africa.

Abstract

Aminoglycosides, such as amikacin and kanamycin, are part of the treatment for Multi-Drug Resistant Tuberculosis; however, it is ototoxic and the need for audiological monitoring is, therefore, emphasised. However, there are currently no explicit guidelines for monitoring ototoxicity in the South African context. Consequently, there is no standardised method for monitoring ototoxicity; however, audiologists are providing the service. Often adaptations to international protocols make them contextually relevant. Therefore, this study aims to describe the audiological practices employed by audiologists in the management of adult patients with MDR-TB in South Africa. A descriptive survey design was used. A questionnaire was developed and included the following aspects such as: identification and criteria used for patients with MDR-TB, baseline practices, monitoring procedures and post treatment management. Ninety-three audiologists contributed data for this study. Descriptive statistics and inferential statistics were used in the analysis of data. Results revealed that 80% of audiologists are aware of international guidelines, 93% reportedly provide pre-treatment counselling; while, 87% of audiologists conduct baseline assessments prior to the administration of MDR-TB treatment. Furthermore, 19% of audiologists conduct HFA and indicated that there is a lack of high frequency audiometers due is to financial constraints. The following were cited as reasons for the modification to the international guidelines: lack of specialised equipment, time constraints and large caseloads, as well as, understaffed departments. In addition, 74% of the audiologists are able to conduct periodic assessments monthly, while 72% of audiologists conduct a full audiological assessment after the cessation of MDR-TB treatment and 96% of audiologists conduct post treatment counselling. The findings of this study may, thus, inform policy by allowing for evidence-based ototoxicity monitoring protocols in South Africa.