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published_or_final_version / Speech and Hearing Sciences / Master / Master of Science in Audiology

published_or_final_version / abstract / toc / Speech and Hearing Sciences / Master / Master of Science in Audiology

published_or_final_version / abstract / Speech and Hearing Sciences / Master / Master of Science in Audiology

Thesis (MTech (Omgewingsgesondheid))--Cape Peninsula University of Technology, 2011. / Occupational related diseases (ORD) which result in permanent disability are compensable in South Africa. During the 2005/6 – 2007/8 financial years compensation for ORD’s totalled approximately R200 million per annum of which this study indicated, R92 milllion on average possibly related to hearing loss. This expense must surely result in negative financial consequences for both the South African government and employers. The manner in which compensation for hearing loss relating to the work place, is to be determined, was changed by Instruction 171 published in the Government Gazette dated 16 November 2001. A baseline audiogram is required for every employee who enters a noise zone during the course of employ and Instruction 171 specified that the percentage hearing loss has to be used to determine this baseline audiogram. A baseline audiogram, which is valid for the total working career of an employee, is used to monitor the hearing status of employees for purposes of possible future compensation. It consequently serves as a reference point from which hearing threshold shifts (HTS) are determined. The significance of the accuracy of this test is thus evident.Prior to the implementation of Instruction 171, various audiometric measuring tools were, in accordance with South African Standards, used in industry for purposes of hearing conservation. These measuring tools referred to above were used for various purposes which included, the determination of; compensable HL, the need for diagnostic procedures, when HL had to be reported to the Department of Labour as “an incident” and the efficiency of a hearing conservation program. With implementation of Instruction 171, these various measuring tools were reduced to a single tool namely the PLH.Naturally the accuracy of PLH determination is also important to employees as it may affect possible compensation of an individual’s hearing loss. Considering the significance of baseline audiograms for purposes of compensation, the following questions arose in this study; (i) does PLH, in its current format, measure the hearing threshold (HT) sufficiently accurately to (a) establish the baseline audiogram, (b) monitor HL for purposes of compensation, and (ii) is the PLH, as currently determined, suitable to identify further diagnostic procedures for purposes of hearing conservation?A more accurate PHL calculation procedure would be to the advantage of all parties concerned. A database which included baseline audiograms of 1101 respondents was studied to determine if the PLH, in its current format, was suitable to comply with the needs pertaining to industrial audiometry. The respondents were employees working in noise zones at various industries, located in the Western Cape and were all tested in accordance with South African audiometry standards.The current PLH determination procedure was studied and current audiometry baseline test results were reconstructed in a manner to calculate an alternative PLH. This reconstructed PLH was consequently used to determine a new B-baseline audiogram. StatSoft Statistica, software was used to statistically compare the current baseline audiogram with the B-baseline audiogram. The study revealed that the B-baseline audiogram succeeded to on average produce a 17% improvement (more accurate) in the determination of the PLH. The PLH of the B-baseline audiogram can thus be regarded as more representative of the true HT of employees.Based on the results of this study it is recommended that the current determination of the PLH used to establish the baseline, be amended. The proposed amendment (B-baseline audiogram) still uses the HT of the two tests done in accordance with Instruction 171 and no amendment of the test procedure is thus required. As the PLH of the baseline and the diagnostic baseline audiogram is currently used for compensation purposes, it is recommended that the B-baseline method be used for both the baseline and diagnostic baseline audiograms.

Introdução: As particularidades da anatomia e a localização topográfica da orelha a tornam uma estrutura única no corpo humano, existindo diversas situações clínicas em que a sua reconstrução (total ou parcial) pode ser necessária. Devido à dificuldade técnica, as complicações pós-operatórias são freqüentes. Objetivos: Realizar análise epidemiológica dos pacientes submetidos à reconstrução de orelha devido a causas congênitas (microtia) e adquiridas (trauma, queimaduras e outras), com avaliação comparativa dos resultados, para definir qual grupo teria menores índices de complicações. Método: Realizada análise retrospectiva de 279 casos de reconstrução de orelha realizados de 1994 a 2004 na Disciplina de Cirurgia Plástica da Faculdade de Medicina da Universidade de São Paulo. Os pacientes foram separados em portadores de deformidades congênitas ou adquiridas e analisados comparativamente. Resultados: O sexo masculino foi mais prevalente tanto entre os pacientes portadores de deformidades congênitas (61,3%) quanto entre aqueles com deformidades adquiridas (68,75%). A média de idade no início dos procedimentos cirúrgicos foi de 14,3 anos nos pacientes com deformidades congênitas e 29,5 nas deformidades adquiridas. Trauma foi a principal causa de deformidade adquirida (55% dos casos adquiridos), seguido pelas queimaduras (29% dos casos adquiridos) e a única deformidade congênita observada no estudo foi a microtia. Em média, os pacientes dos grupos necessitaram de 4,2 cirurgias, mas aqueles com seqüelas de queimaduras foram submetidos a um número significativamente maior de procedimentos (5,9 - p < 0,01). As principais complicações foram a exposição de cartilagem (15,1% do total de casos), sem diferença entre os grupos, e a brida retroauricular (16,5% do total de casos), sendo esta última mais freqüente nos casos de microtia e seqüelas de queimaduras. Conclusões: Os casos de perda traumática mostraram menor índice de complicações quando comparados àqueles submetidos a reconstrução por microtia ou após queimadura. / Introduction: The distinctive anatomic features and topography render the ear unique in the human body. Total or partial reconstruction of the ear may be required in many clinical conditions, but because technical difficulties are common, the rate of postoperative complications increases. Objectives: To analyze the epidemiologic data of patients who underwent surgery for reconstruction of the ear due to congenital conditions (microtia) or acquired deformities (trauma, burns and others), and to compare the results in order to define which group had the lowest rate of complications. Methods: A retrospective analysis was conducted with 279 cases of ear reconstruction performed between 1994 and 2004 by the Discipline of Plastic Surgery of the University of São Paulo Medical School. The patients were initially separated in two groups, according to their condition (congenital or acquired), to compare their data. Results: Male was the prevailing gender in both groups of ear deformities: congenital (61.3%) and acquired conditions (68.7%). The patients with congenital deformities had a mean age of 14.3 years at the beginning of the treatment, whereas the patients with acquired deformities were 29.5 years old, in average. The major causes of acquired deformities were trauma (55% of the cases in this group) and burns (29%). The only cause of congenital deformity observed was microtia. Patients required an average of 4.2 surgical procedures. However, those with sequelae of burn injuries were submitted to a significantly higher number of procedures (5.9 - p < 0.01). Cartilage exposure (15.1% of the total) and postauricular bridles (16.5%) were the major complications observed in this study. The latter was more common among those cases with microtia and sequelae of burns. Conclusions: Patients with traumatic injuries had a better outcome after surgery than those with microtia or burn injuries, because of a lower rate of complications.

Introdução: As particularidades da anatomia e a localização topográfica da orelha a tornam uma estrutura única no corpo humano, existindo diversas situações clínicas em que a sua reconstrução (total ou parcial) pode ser necessária. Devido à dificuldade técnica, as complicações pós-operatórias são freqüentes. Objetivos: Realizar análise epidemiológica dos pacientes submetidos à reconstrução de orelha devido a causas congênitas (microtia) e adquiridas (trauma, queimaduras e outras), com avaliação comparativa dos resultados, para definir qual grupo teria menores índices de complicações. Método: Realizada análise retrospectiva de 279 casos de reconstrução de orelha realizados de 1994 a 2004 na Disciplina de Cirurgia Plástica da Faculdade de Medicina da Universidade de São Paulo. Os pacientes foram separados em portadores de deformidades congênitas ou adquiridas e analisados comparativamente. Resultados: O sexo masculino foi mais prevalente tanto entre os pacientes portadores de deformidades congênitas (61,3%) quanto entre aqueles com deformidades adquiridas (68,75%). A média de idade no início dos procedimentos cirúrgicos foi de 14,3 anos nos pacientes com deformidades congênitas e 29,5 nas deformidades adquiridas. Trauma foi a principal causa de deformidade adquirida (55% dos casos adquiridos), seguido pelas queimaduras (29% dos casos adquiridos) e a única deformidade congênita observada no estudo foi a microtia. Em média, os pacientes dos grupos necessitaram de 4,2 cirurgias, mas aqueles com seqüelas de queimaduras foram submetidos a um número significativamente maior de procedimentos (5,9 - p < 0,01). As principais complicações foram a exposição de cartilagem (15,1% do total de casos), sem diferença entre os grupos, e a brida retroauricular (16,5% do total de casos), sendo esta última mais freqüente nos casos de microtia e seqüelas de queimaduras. Conclusões: Os casos de perda traumática mostraram menor índice de complicações quando comparados àqueles submetidos a reconstrução por microtia ou após queimadura. / Introduction: The distinctive anatomic features and topography render the ear unique in the human body. Total or partial reconstruction of the ear may be required in many clinical conditions, but because technical difficulties are common, the rate of postoperative complications increases. Objectives: To analyze the epidemiologic data of patients who underwent surgery for reconstruction of the ear due to congenital conditions (microtia) or acquired deformities (trauma, burns and others), and to compare the results in order to define which group had the lowest rate of complications. Methods: A retrospective analysis was conducted with 279 cases of ear reconstruction performed between 1994 and 2004 by the Discipline of Plastic Surgery of the University of São Paulo Medical School. The patients were initially separated in two groups, according to their condition (congenital or acquired), to compare their data. Results: Male was the prevailing gender in both groups of ear deformities: congenital (61.3%) and acquired conditions (68.7%). The patients with congenital deformities had a mean age of 14.3 years at the beginning of the treatment, whereas the patients with acquired deformities were 29.5 years old, in average. The major causes of acquired deformities were trauma (55% of the cases in this group) and burns (29%). The only cause of congenital deformity observed was microtia. Patients required an average of 4.2 surgical procedures. However, those with sequelae of burn injuries were submitted to a significantly higher number of procedures (5.9 - p < 0.01). Cartilage exposure (15.1% of the total) and postauricular bridles (16.5%) were the major complications observed in this study. The latter was more common among those cases with microtia and sequelae of burns. Conclusions: Patients with traumatic injuries had a better outcome after surgery than those with microtia or burn injuries, because of a lower rate of complications.