There is a paucity of research examining the expectations of parents whose children have received a cochlear implant. The process of implantation is fraught with expectations, and in order to ensure continued parental interest and motivation, it is important to have insight into and understanding of these expectations, as well as the factors which influence them. This study aimed to investigate the pre- and post-implant expectations of mothers whose children had received a cochlear implant, as well as the possibility of changes in their expectations with duration of cochlear implant use. It also aimed to examine satisfaction of mothers with the cochlear implant, and the influence this had on expectations. A qualitative research methodology was used in the form of in-depth interviews. Eight mothers of prelingually deafened children who had not yet started formal schooling were interviewed. The data obtained from the mothers was transcribed verbatim and then analysed according to a detailed qualitative analysis procedure. Important findings emerged which detailed the changing expectations based either on hope or knowledge over time. These expectations were influenced by many variables, including the mothers' response to the deafness of the child (i.e. the grief reaction), anxiety and stress, performance outcomes, satisfaction, and expectations of others, including family and friends. Numerous theoretical and clinical implications emerged from these findings, including the dynamic nature of expectations, as well as the impact these have on the importance of ongoing counselling of mothers whose children use cochlear implants.

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Less severe hearing loss such mild to moderate hearing loss tend be given less attention by caregivers and there is little attention given by researchers compared to more severe hearing loss. There is a gap in literature about caregivers' experiences and perspectives regarding overall diagnosis and management process of children with MMHL aged 6 to 12 years especially in South Africa. The study aimed to describe caregivers' experiences, perspectives and expectations regarding the diagnostic process and management related to mild to moderate hearing loss. The study further aimed to identify strength and gaps of the diagnostic and management process. Data was collected using both quantitative and qualitative methods. Quantitatively, 20 caregivers participated in a questionnaire; qualitatively seven caregivers participated in semi-structured interviews. The questionnaire utilised consisted of demographic information and closed ended questions. The majority of the closed ended questions were demographic questions; others were in a form of Likert scale method in order to measure the satisfaction level of caregivers regarding audiological services. After questionnaire completion, one-on-one semi structured interviews were conducted by the researcher. Interviews were audio recorded and the researcher took notes while recording the interview. Descriptive data analysis was done for quantitative data and interview data was analysed using thematic analysis. Findings indicated that there are both satisfaction and dissatisfactions regarding overall diagnosis and management of children with MMHL. Caregivers expressed satisfaction with the audiologist management however gaps such as poor provision of written information and social support groups were observed as dissatisfactions. Most caregivers delayed the process of seeking hearing health care by using traditional medicine which in turn did not help restoring hearing difficulties. Moreover, caregivers expressed concern about their children's hearing levels and tended to compare them with normal hearing children. Furthermore, caregivers wished for a cure for MMHL and recommended that children with MMHL get a care disability grant. The findings of the current study affirm the previous research by highlighting the importance of providing caregivers with unbiased information. Results of the current study also highlight the importance of early identification and management of hearing loss in children. Also, more effort is needed in terms of providing caregivers with information on all available technology options such as hearing aids, as well as evidence on the pros and cons to support informed choices. This research contributes information regarding the diagnosis and management process of mild to moderate hearing loss from the perspectives of families, which may have important implications for program planners, decision-makers and audiologists delivering services.

The effects of disabling hearing loss can create communication barriers that do not only affect the person with hearing loss (PHL), but also the communication partner's (CP) quality of life. Literature has previously been centred around the individual with hearing loss, thus leaving an information gap in South Africa that focuses on providing family centred care that includes the CP in the audiological rehabilitation process. It is important for hearing health professionals to consider the CP's wellbeing when managing older adults with hearing loss, as they have been found to play a significant role in the audiological rehabilitation process. Therefore, exploring the Goal Sharing for Partners Strategy (GPS) tool in a South African context will contribute to the knowledge in the field of audiological rehabilitation. Furthermore, gaining insight into the challenges and coping strategies that CPs experience will improve on the approach to the service provided in audiological rehabilitation. A qualitative research design was employed with a sample of 10 couples who completed the GPS tool and semi-structured interviews. The data was analysed using thematic analysis. The results revealed four overarching themes that presented the effects of disabling hearing loss on the CP. The impact of disabling hearing loss resulted in daily life communication challenges for the CP. These challenges affected CPs emotionally as well as transformed the way they communicated in their relationships, however the values, beliefs and personality of the CPs allowed them to cope and develop resilience to the burden of third-party disability. Additionally, the usability questionnaire demonstrated that the GPS tool was an appropriate tool to use in South Africa when adopting a family centred approach to audiological rehabilitation and was most beneficial when implemented as an interview guide administered by an audiologist. The information from this study can be used to provide support to other CPs as well as enhance the success of audiological rehabilitation for PHLs through a family centred approach.

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South Africa is one of the countries with a high incidence of multidrug-resistant tuberculosis (MDR-TB) and rifampicin resistance tuberculosis (RR-TB). The standard MDR/RR-TB regimen prescribed in South Africa, at the time of the present study included Kanamycin, an aminoglycoside with a known cochleotoxic effect. Although kanamycin has recently been removed from the WHO MDR/RR-TB regimen, amikacin, another aminoglycoside derived from kanamycin, with similar structure and cochleotoxic side effects, has remained as part of the regimen for MDR/RR-TB patients with limited treatment options. In addition, some countries (e.g. India and Nigeria) have not completely removed kanamycin from their treatment regimen for MDR/RR-TB. Research has shown that genetic factors and factors affecting the pharmacokinetic of the drug could potentially be useful in identifying those who may be at a higher risk of aminoglycoside-induced cochleotoxicity. However, not much is known about the pharmacokinetics of Kanamycin and there is currently limited research available on the role of mutations involved in aminoglycoside-induced cochleotoxicity in South Africa. Therefore, this study aimed to determine: (1) the incidence of cochleotoxicity in MDR/RR-TB patients who are receiving kanamycin, (2) the pharmacokinetic properties of kanamycin that are associated with increased risk of cochleotoxicity, and (3) the association between participant's susceptibility to develop cochleotoxicity and two potentially pathogenic mitochondrial mutations (T15312C (I189T in MT-CYB) and T10114C (I19T in MT-ND3)). The current study used a prospective cohort design. A total of 102 patients (median age was 34.9 years) on kanamycin-based MDR/RR-TB treatment participated in this study. The study site was the Metro Tuberculosis Hospital Centre, Cape Town. The majority of the participants were males (n = 58, 56.9%,). Sixty five (63.7%) participants were HIVpositive, and 24 (23.5%) had been treated for MDR/RR-TB previously. Participants' hearing thresholds (0.25 to16kHz) were prospectively monitored for cochleotoxicity at the start of their treatment (baseline), and at 4, 8 and 12 weeks. The American SpeechLanguage- Hearing Association criteria (ASHA, 1994) were used to identify significant threshold shift (STS). Kanamycin concentrations were determined using liquid chromatography tandem mass spectrometry (LC-MS/MS), at steady-state in serial plasma samples over 10 hours. The T15312C (I189T in MT-CYB) and T10114C (I19T in MTND3) mutations was detected using PCR, ABI PRISM® 3130xl Genetic Analyser and UniPro UGene. The results of the study revealed 82% (n = 84) of participants developed cochleotoxicity. The duration of treatment with kanamycin was associated with cochleotoxicity with a 120% and 220% increase in incidence of cochleotoxicity from week four of treatment to week eight and week 12 of treatment, respectively. Kanamycin exposure was significantly associated with cochleotoxicity with about 3% increased risk of hearing loss for every 10µg•hr/L increase in kanamycin AUC0-10. The statistical analysis of the relationship between cochleotoxicity and two potentially pathogenic mutations, T15312C and T10114C, was not possible due to the low frequency of these mutations in the sample size. However, T15312C and T10114C were detected in 4.5% and 6%, respectively. Based on the MAF cut-off of 0.01 (1%), they are considered as common mutations. In addition, as T15312C and T10114C were just detected among participants who developed cochleotoxicity and not those who did not, they may be potentially pathogenic. However, since the presence of the known mutations associated with aminoglycoside-induced hearing loss in participants who carry T15312C and T10114C mutations had not been 17 investigated, it was not possible to draw a definite conclusion about the pathogenicity of T15312C and T10114C. The results of the current study indicate that: (1) a high incidence of cochleotoxicity was detected among MDR/RR-TB patients receiving kanamycin, (2) the longer duration of treatment with kanamycin was associated with higher risk of cochleotoxicity, (3) higher Kanamycin AUC0-10 was strongly associated with an increased incidence of cochleotoxicity, and (4) the T15312C and T10114C were common mutations in South African MDR/RR-TB patients who participated in this study and they may be potentially pathogenic for cochleotoxicity, and that should be assessed in future studies. This study recommends that aminoglycoside-sparing regimens should be used for MDR/RR-TB patients. A routine ototoxic monitoring programme (at least once a month) including ultra-high frequency audiometry should be implemented for MDR/RR-TB patients who receive aminoglycosides, from the time of ototoxic drug exposure until six months post treatment. Therapeutic drug monitoring should be implemented for all the MDR/RR-TB patients on aminoglycosides and AUC value should be used for clinical decision making to reduce the risk of cochleotoxicity. Screening for the known mutations that contribute to the risk of cochleotoxicity, prior to the start of aminoglycoside therapy is recommended to lower the incidence of aminoglycoside induced hearing loss, especially in countries such as South Africa with a high incidence of MDR/RR-TB.

Background: A central auditory processing disorder (CAPD) is a disorder that presents in individuals as having difficulty understanding fast and degraded speech, understanding verbal instructions, and struggling to hear in background noise, these difficulties are not due to a peripheral hearing loss. Additional secondary effects of CAPD have been well documented to affect school aged children, therefore, making early diagnosis and intervention important for their development. The central tests currently used for testing in South Africa have materials and normative data that were developed from an American population of English first language speakers. In addition, many of the tests in the assessment battery have a high linguistic load. This raises a challenge in the South African population of first language English speakers and the majority of the population who are not first language English speakers. To reduce misdiagnosis, it is important to generate context-specific normative data from a South African test population. By developing normative data for the FPT in SA children it may assist in the accurate diagnosis of CAPD following assessment and contribute to the development of SA specific data. Aim 1: To develop context-specific normative data for the FPT in SA children aged 8- 11 years. Aim 2: To determine the relationship between existing American normative data and newly generated South African normative data. Methodology: A non-experimental comparative descriptive study design was conducted. There were 35 potential participants from 5 schools within the vicinity of the university. Results from 26 participants were included in the study analysis of the FPT and these results were developed into the normative data set. Results: The results from the 26 participants showed that results from the humming response were higher than the verbal response bilaterally. This was noted for all the age groups. In addition, the comparison for the generated normative data and the American data showed no significant difference between the two data sets in the description response. The comparison of the humming response revealed significantly higher responses in the generated normative data over the American data. This was seen across all the age groups. Conclusion: In addressing aim 1, the findings reveal that the FPT as an assessment is not affected by language however, the performance in the test may be affected by the language it is administered in. Additionally, the findings confirm a need for age specific data as the results improved with age showing the neuromaturation of the CANS as the children grow. Regarding aim 2, the results of this study show that there are some differences between the data sets from the two populations which is seen in other studies as well confirming the need for context specific normative data. The data set for this study was small and cannot be generalised to the whole S.A. population, therefore the data may be used as a first step in the development of a full set of normative data for the FPT. The study does inform the need for further research and a larger scale study for context specific data.

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