Practices employed by audiologists in the management of adult patients with multidrug-resistant tuberculosis in South Africa

Abstract

Introduction: Aminoglycosides used for treating multi-drug resistant tuberculosis are ototoxic, leading to a need for audiological monitoring. While audiologists monitor ototoxicity, currently there are no guidelines on monitoring in the South African context. Therefore, the findings of this study may help to motivate the establishment of a more in-depth ototoxicity monitoring policy, which facilitates uniformity among audiologists managing patients with MDR tuberculosis. Therefore, the study aimed to describe the audiological practices employed by audiologists in the management of adult patients with MDR tuberculosis in South Africa. Methods: A descriptive survey design was used. A questionnaire was developed and included elements of the American Speech and Hearing Association (1994) guidelines for monitoring ototoxicity. Ninety-three audiologists contributed data to this study. Descriptive statistics were used in the analysis of data. Results: Sixty-eight per cent (%) of the respondents were aware of the international guidelines, 93% provided pre-treatment counselling and 87% conducted baseline assessment. Nineteen per cent of the respondents conducted high-frequency audiometry,while 74% carried out a monthly evaluation, 72% performed a full audiological assessment after the cessation of MDR tuberculosis treatment, and 96% conducted post treatment counselling. Modifications to international guidelines include not conducting speech and immittance audiometry as well as testing certain frequencies. The reasons for these modifications include limited specialised equipment, time constraints, large caseloads and understaffed departments. Conclusion: There are no explicit guidelines for ototoxicity monitoring in South Africa. Consequently, audiologists are modifying international guidelines. Thus, there is no consistency in managing patients with MDR tuberculosis. This highlights the need for South Africa to develop context-relevant ototoxicity monitoring guidelines to appropriately manage patients with MDR tuberculosis. (Full text available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2015; DOI: 10.1080/20786190.2015.1085222