Theses and Dissertations (Speech-Language Pathology and Audiology)

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Help-seeking and hearing aid uptake in adults: a qualitative analysis of enablers and barriers
Van Heerden, Lisa-Marie (University of Pretoria, 2025-11-25)
Hearing aid help-seeking and uptake have remained consistently low over the past decades despite technological advancements and increased accessibility. Understanding the enablers and barriers that influence these behaviours from the user’s perspective is essential for improving strategies to promote hearing-health care use and to ensure timely intervention for adults with hearing loss. This study, therefore, aimed to provide an in-depth analysis of user perspectives on help-seeking and hearing aid uptake in the United States (U.S.), with particular attention to the experiences of both prescription hearing aid and over-the-counter (OTC) device users. A qualitative design using an inductive thematic analysis framework was employed. Participants (n=41) were purposively selected using maximum variation sampling from the Hearing Tracker (n=37) and Lexie Hearing (n=4) databases, following an initial survey and consent for virtual interviews. The study's participants had an average age of 69 years (11 SD), ranging from 36 to 88, and 68% were male. Semi-structured interviews were conducted virtually, transcribed verbatim, and analysed using Braun and Clarke’s six-phase thematic analysis approach with ATLAS.ti software. Coding was conducted by the primary researcher and independently verified by co-supervisors, with discrepancies resolved by consensus. Emerging themes and sub-themes were identified and systematically mapped onto the Capability, Opportunity, Motivation: Behaviour (COM-B) model, which provided a structured framework for examining the behavioural drivers influencing help-seeking and hearing aid uptake. Trustworthiness was enhanced through adherence to COREQ guidelines, independent coding, and an audit trail. The analysis, framed within the COM-B model, identified 20 themes and 55 sub-themes across two domains of (a) enablers and (b) barriers to help-seeking and hearing aid uptake. The study identified Capability factors that highlighted the importance of adjustable features, such as app-based volume control, while negative beliefs about hearing aids deterred engagement, emphasizing the need for targeted counselling. Opportunity factors underscored the role of external support and technological innovations, such as AI integration and Bluetooth connectivity, in increasing hearing aid adoption. Motivation factors, including improved communication and reduced social isolation, supported uptake, but stigma and fear of dependence acted as barriers. OTC users, while prioritising autonomy and affordability, often still sought professional input, indicating a hybrid approach combining self-management with expert guidance. These findings demonstrate that help-seeking and hearing aid uptake are shaped by a complex interplay of individual capabilities, environmental opportunities, and intrinsic motivations. Targeted counselling, policy reform to reduce financial barriers, and flexible service models that integrate user-led management with professional guidance are needed to improve adoption rates and ensure more adults with hearing loss receive timely and effective intervention.
Early communication characteristics of a case of SYNGAP1-related disorder
Patel, Meghna B (University of Pretoria, 2025-12-15)
Background: Synaptic Ras GTPase activating protein 1-related disorder (SYNGAP1-RD) is a rare genetic condition caused by mutations found in the SYNGAP1 gene, often resulting in severely impaired early communication abilities. Despite early signs of communication delay, there is currently limited research describing the detailed communication profile of young children with SYNGAP1-RD. Given its complexity and severity, speech-language therapists need a greater understanding of the disorder’s influence on early communication characteristics to inform early communication intervention (ECI). Aim: This study aimed to describe the early communication characteristics of a young child diagnosed with SYNGAP1-RD. Method: An intrinsic single-case design utilised retrospective and prospective components to provide a comprehensive developmental continuum of the child’s early communication development between 2019 and 2024. Quantitative and qualitative data were collected and analysed using descriptive statistics and thematic analysis, respectively. Results: The findings underpinned communication as a core impairment of SYNGAP1-RD, with severe-to-profound delays (six-to-12 months and above) spanning across all communication domains. Minimal verbal expressive language of single-word utterances was reported after age three, before rapid deterioration was observed, leading to the child being non-verbal by age five. Speech motor planning and control symptoms were also evident; however, through early introduction of aided and unaided AAC, communication frustration following the deterioration of speech was reduced. The child was able to achieve single-word non-verbal expressive language to interact with others by age 7, demonstrating increased reliance on AAC over time. Conclusion: Team-based, family-centred ECI fostered active participation in daily interactions despite verbal speech and language deficits. The findings highlighted the importance of early and accurate identification, followed by a multimodal intervention approach to positively influence communication outcomes for children with SYNGAP1-RD.
Exploring acoustic reflex latencies in evaluating auditory neural function in sport-related concussions
Smuts, Vené (University of Pretoria, 2025)
Objective: The auditory brainstem response (ABR) is a validated tool capable of detecting subtle auditory deficits in adults following concussion, despite normal hearing thresholds. The current study aimed to investigate auditory-neural function in individuals with prior sport-related concussions (SRC) using neuro-diagnostic ABR and acoustic reflex thresholds (ART) and- latency (ARL) measurements. Method: Twenty-eight participants with normal hearing (14 concussion group and 14 gender-matched controls) underwent cross-sectional pure-tone audiometry, distortion product otoacoustic emissions, ART, ABR, and ARL testing. ABR absolute latencies, interpeak latencies, and wave I amplitudes were measured alongside ipsilateral and contralateral ARTs and ARLs, using tonal and broadband noise (BBN) stimuli. Results: Concussion participants displayed significantly prolonged ABR absolute wave V and interpeak latencies (wave III–V and I–V; p < 0.05). ARLs revealed significantly prolonged terminal latencies and rise times, particularly under BBN stimulation (p < 0.05), indicating delayed reflex processing post-concussion. No significant group differences were measured for initial latencies, ARTs or acoustic reflex response rates. Conclusion: The present study provides evidence that ARLs can measure subtle auditory-neural timing delays caused by SRCs despite the absence of elevated hearing thresholds, abnormal OAEs, or abnormal ARTs, similarly to ABRs. ARL measures, particularly with BBN stimulation, are rapid and widely accessible methods of detecting subtle post-SRC auditory deficits. Significance: These findings support incorporating ARLs as a novel tool for objective auditory-neural assessments of individuals with SRC.
Reported auditory complaints and extended high-frequency hearing loss in call centre workers
Cheele, Thato (University of Pretoria, 2025-08)
Background: The call centre (CC) industry is rapidly expanding and relies heavily on headsets for service delivery, exposing call centre employees (CCEs) to occupational health risks, including noise-induced hearing loss (NIHL). NIHL is traditionally detected in the high frequencies via pure tone (PT) audiometry. However, extended high-frequency audiometry (EHFA) can identify subclinical signs early, aiding in the timely implementation of hearing loss prevention programs. Aim: This study aimed to assess reported auditory complaints among CCEs and correlate them with PT audiometry and EHFA results. Method: In this descriptive cross-sectional study, 57 participants (Male = 22,8%; Female = 77,2%; mean age 30,0 years) completed an online auditory complaints survey and 49 underwent PT audiometry and EHFA testing. Results: One-third of CCEs experienced earache/infection, with 52,4% occurring within the past year. Symptoms post-headset use included itching ears, tinnitus, headache, and stress. More than half reported symptoms resembling acoustic shock, with 36,7% experiencing it daily. Following these shocks, 36,7% reported hearing changes, including reduced sensitivity and tinnitus. Additionally, 12,2% presented reduced hearing sensitivity, and 38,8% had high-frequency notches. EHFA indicated early signs of cochlear damage in 51,0% of participants. Conclusion: The study highlights a high prevalence of NIHL signs among CCEs, with EHFA suggesting even higher early cochlear damage. Urgent implementation of hearing loss prevention programs in these settings is warranted.
Early communication characteristics of a child with SATB2-associated Syndrome: a case report
Sega, Ljuba Gisella (University of Pretoria, 2025-11-13)
Background: There is limited literature on the early communication characteristics of children with SATB2-associated syndrome, a rare genetic disorder that has a profound impact on speech and language. Understanding these characteristics can guide early intervention and therapy selection. Purpose: This case report describes the early communication development of one child with SATB2-associated syndrome from 14 months to five years and six months. Method: The child’s communication profile was developed from retrospective and prospective data. Clinical assessments at 14, 26, and 38 months examined hearing, language, gestures, speech, and play, and a caregiver interview provided additional perspectives. Results: Convergent findings from the retrospective file review and prospective semi-structured interview revealed moderate-to-severe delays across all communication domains. Receptive language and gesture use improved, whereas expressive language gains were limited. The child mostly used single words, emerging sound combinations, basic gestures, and mainly nonverbal means (eye contact, facial expressions) for expression. South African Sign Language and a picture communication board were also frequently used to express herself. Fine motor difficulties partly limited signing, and comprehension remained moderately delayed. Discussion: Unique features included slow consonant acquisition, mis-articulations, and reduced signing intelligibility. Early, multimodal intervention using AAC, signs, and caregiver-led strategies supported functional communication, participation, and receptive language development, emphasizing the need for multi-partner, multidisciplinary support. Conclusions: This study illustrates pervasive communication delays in a child with SATB2-associated syndrome from 14 months and underscores the value of early multimodal and AAC- interventions to enhance communication, reduce frustration, and behavioural challenges. These insights may inform early intervention for similar children.
Translation and adaptation of the bilingual language profile tool from English into isiZulu
Wildenboer, Corine (University of Pretoria, 2025-09-01)
Background: Bilingualism is a multifaceted concept influenced by childhood language exposure, academic experiences, socio-cultural experiences, and geographical contexts. Speech-language therapists (SLTs) benefit from insights into their patients’ language profiles to accurately assess and treat patients in a country with a majority of non-English first-language speakers. The Bilingual Language Profile tool, translated and culturally adapted into isiZulu, could offer beneficial clinical insights for the South African SLT working in a multi-cultural setting. Objectives: The study aimed to translate and culturally adapt the Bilingual Language Profile from English into isiZulu and field-test the translated questionnaire on a small sample of isiZulu-English bilingual individuals. Method: A questionnaire translation and cultural adaptation method was implemented by using a meticulous six-step translation process along with a translation panel consisting of various professionals. The isiZulu translation was reviewed by eight isiZulu-English bilingual individuals across multiple provinces and education levels, who made further recommendations to achieve an appropriate and accurate translation. Data from the translation process and the field-testing feedback were collected qualitatively. Results: An accurate and appropriate preliminary isiZulu translation and cultural adaptation of the Bilingual Language Profile was created. Conclusions: A South African translated and culturally adapted version of the Bilingual Language Profile is now available for validation with a larger stratified sample. SLTs can implement this tool locally to establish language profiles in English-IsiZulu speakers in clinical and research settings. Keywords: Bilingual Language Profile, bilingualism, isiZulu, translation, cultural adaptation, language proficiency measure
Reliability and effect of stimulus parameters on the acoustic reflex latency test in adults with normal hearing
Ranjith, Shanel (University of Pretoria, 2025-11-30)
Abstract Purpose The current study aimed to investigate the effect of different procedural variables on the acoustic reflex latency (ARL) in a population of adults with normal hearing. In addition to normative values, the study also evaluated the test-retest reliability of tonal and broadband ARL measures. Method The study followed a descriptive, within-subject research design. Participants included 31 normal hearing individuals (aged 18 – 30 years old, mean age 23.08 SD 2.42). Participants were required to present with normal behavioural pure tone thresholds, distortion product otoacoustic emissions, and acoustic reflex threshold (ART). ARL testing was completed using 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz, broadband noise (BBN), high (HBN) and low-band noise (LBN) stimuli, presented ipsi- and contralaterally. Participants underwent ARL measurement sessions with the repeat assessment within one week. Results Ipsilateral P1 latencies were significantly shorter (mean 53.00 ms SD 2.91) at 15 dB above ART than contralateral P1 (initial onset) latencies (mean 64.00 ms SD 3.92). No significant P1 differences were found between ears or gender either ipsi- or contralaterally. A linear regression analysis found intensity at 10 dB above ART to significantly influence P1 ipsi- and contralateral latencies. No significant test-retest difference was found at 10 dB above ART for P1 ARL (p<0.05). Significant P1 differences were, however, evident at 5 and 15 dB above ART (p>05). Conclusion ARL measurement at 10 dB above ART elicited reliable ARL measurements, facilitating more accurate ARL measurements than 5 or 15 dB above ART. The study highlights the clinical utility of ARL measurements within the context of modern, digital equipment.
Characteristics, practices and needs of speech-language therapists in Kenya
Shah, Jinagna (University of Pretoria, 2025-09-30)
BACKGROUND : Speech-language therapy in Kenya is an emerging profession. While research from the sub-Saharan African region have documented the profession and its’ workforce practices, the entirety of the Kenyan context is not well-understood and the needs of the professionals in the country have yet to be determined. OBJECTIVE : To describe current characteristics, practices and needs of speech-language therapists (SLTs) rendering services in Kenya. METHOD : A mixed-method (primarily quantitative) design was used. An electronic survey (adapted from Wylie et al., 2016; 2018) was completed by 46 SLTs across Kenya. Participants were recruited via purposive and snowball sampling via groups and the researchers networks. Descriptive and inferential statistics were used for quantitative responses, and open-ended questions were analysed qualitatively using content analysis and thematic coding. RESULTS : The majority of Kenyan SLTs (78.4%) were mostly located in the urban setting. Many SLTs work in multiple counties, and all participants (100.0%) were multilingual. The majority of participants (93.5%) had formal training, and some (76.1%) had prior trainings in other fields. Participants commonly worked in more than one setting, serving a wide caseload both adult (53.0%) and paediatric (67.0%) clients. Challenges included limited resources (69.6%), high caseloads (52.0%), and a limited workforce. Participants recognised the need for improving standards of practice, need for peer support, and a need for culturally and linguistically apt guidelines and tools to improve the quality of their services. CONCLUSION : While the speech-language therapy profession in Kenya has grown notably, structural and workforce obstacles persist. This study highlights the challenges faced by Kenyan SLTs and argues that standardising care and achieving equal access requires a unified approach. Strengthening the profession will rely on fostering collaborations, strategic advocacy, and capacity building. Ultimately, addressing these systemic barriers is key to ensuring that high-quality services are accessible to all individuals across the Kenyan population.
Ocular Vestibular Evoked Myogenic Potentials: a comparison of toneburst and CE-Chirp stimuli in children
Moll, Jared (University of Pretoria, 2025)
Background: Vestibular Evoked Myogenic Potentials (VEMP) form an essential component of the vestibular test battery. There are two main VEMPs, namely cervical VEMPs (cVEMPs) and ocular VEMPs (oVEMPs). oVEMPs are used to evaluate functioning of the utricle and superior vestibular nerve. oVEMPs have been investigated in adults and children, primarily with the toneburst stimulus. A Narrowband CE-Chirp stimulus had led to higher response rates, larger N1-P1 amplitudes, shorter N1 and P1 latencies recorded in healthy adult oVEMPs, thus emerging as an alternative to the 500 Hz toneburst. However, the same conclusion cannot yet be applied to children, as NB CE-Chirp evoked oVEMPs have not yet been investigated in this population. Objectives: The aim of this study was to compare oVEMP response parameters that were elicited by the 500 Hz TB and 500 Hz NB CE-Chirp stimulus, in children. These response parameters included N1 latency, P1 latency, N1-P1 amplitude, asymmetry ratio and overall response rate. Method: This cross-sectional study employed a quantitative methodology, utilizing a within-subjects comparative approach. Thirty-six children aged 7- to 18-years were included in this study. To ensure fair dispersion of participants across age ranges, participants divided into two age groups: 7- to 13-year-olds and 14- to 18-year-olds. Each participant underwent both the 500 Hz toneburst and NB CE-Chirp oVEMP procedures in a randomized order, at 95 dB nHL. Results: Findings indicated statistically significant differences for N1-P1 amplitudes, N1 latencies and P1 latencies between the 500 Hz NB CE-Chirp and 500 Hz TB stimulus. The 500 Hz NB CE-Chirp stimulus resulted in higher response rates for both age groups (97% for the 7- to 13-year age group; 94% for the 14- to 18-year age group), than the TB stimulus (78% for the 7- to 13- year age group; 67% for the 14- to 18-year age group). The NB CE-Chirp stimulus resulted in significantly larger N1-P1 amplitudes and significantly shorter N1 and P1 latencies than the TB in oVEMP procedures. No statistically significant difference was noted between asymmetry ratios for each stimulus. Age did not have a statistically significant difference for all response parameters. Conclusion: The 500 Hz NB CE-Chirp stimulus is a promising option in clinical use for oVEMP testing in children. It provides larger N1-P1 amplitudes, higher response rates, and shorter N1 and P1 latencies than the 500 Hz TB stimulus. The use of 500 Hz NB CE-Chirp thus leads to easier and faster detection of waveforms, reducing examination time and potentially noise exposure.
Preset hearing aid program selection and longitudinal changes in low-income communities
Croucamp, A. (University of Pretoria, 2025-10-15)
Hearing loss, projected to affect one in four people by 2050, disproportionately impacts low- and middle-income (LMI) settings where approximately 80% of those with disabling hearing loss reside. Decentralized hearing care models facilitated by community health workers (CHWs) can improve access to hearing healthcare in these settings. This can be achieved by task-sharing, a World Health Organization (WHO) recommended strategy, whereby trained CHWs facilitate service delivery through models that bridge service-delivery gaps while leveraging hearing care professionals’ expertise in training, program management, and remote support. In line with WHO recommendations, preset hearing aids have been identified as suitable for structured, community-based programs, offering a high-quality, easy-to-fit solution in contexts where professional audiological services are limited. However, little is known about users’ selections and longitudinal modifications of programs within such models. This study therefore evaluated how adults fitted with preset hearing aids through a CHW-facilitated service in LMI South African communities selected and adjusted programs over time, and whether choices aligned with audiologist-recommended profiles. This longitudinal study formed part of a feasibility project implementing the WHO’s Hearing Aid Service Delivery Approach for Low- and Middle-Income Settings in three low-income South African communities, specifically Atteridgeville in Gauteng and Khayelitsha and Mbekweni in the Western Cape. Adults (≥18 years) with self-reported hearing difficulties were recruited, and those with confirmed moderate-to-severe (35-79 dB) bilateral hearing loss were fitted with preset hearing aids by trained CHWs. Devices offered four preset amplification programs: (1) general amplification, (2) high-frequency amplification, (3) low-frequency amplification, and (4) all-frequency amplification. User selections were recorded at the fitting and follow-ups at two weeks, two months, and six months post-fitting. The study included 36 community members who were fitted with hearing aids, with an average age of 76 years (SD = 8.9; range 50-96), 63.9% (n = 23) female and 36.1% (n = 13) male. The majority, 52.8% (right ear) and 58.3% (left ear), had high-frequency loss, yet only 34% initially selected the corresponding program. Across six months, 80.6% (n = 29) changed their selections at least once. Significant associations between hearing loss configuration and selection occurred at some time points only in the left ear, but agreement with clinically recommended programs declined from 42% at baseline to 28% at six months. In conclusion, CHW-facilitated hearing aid delivery supports user autonomy in low-resource settings where professional follow-up is limited, as participants were able to actively engage in adjusting their programs. Program selections changed frequently and often diverged from hearing loss configuration or clinical recommendations, suggesting user-driven experimentation through real-world listening experiences. While such misalignment may influence objective performance outcomes, it remains uncertain whether user-selected programs can enhance factors such as daily wear time and self-reported benefit. These findings underscore the value of hybrid hearing care models that combine user choice with ongoing, person-centred guidance to optimize the effective use of preset hearing aids.
mHealth technologies for voice disorders: a scoping review
Du Toit, Linette (University of Pretoria, 2025-10-24)
Technological advancements in healthcare offer the potential to enhance patient outcomes, clinician productivity and access to care, yet evidence regarding their availability, clinical application and long-term effectiveness in voice disorders remains unclear, highlighting the need for a comprehensive scoping review. This research study aimed to map and describe existing evidence on the use of mobile health (mHealth) technologies for the early detection, assessment and treatment of voice disorders. Conducted according to the Joanna Briggs Institute (JBI) framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Checklist (PRISMA-ScR), the review identified 84 studies, most of which were published between 2016-2025 and conducted in mostly high-income countries (n = 77). The majority of studies focused on adult populations (67%) and involved the use of smartphones (51%) or telehealth platforms (19%). These mHealth solutions primarily targeted neurological (27%) and functional voice disorders (20%), and demonstrated feasibility, accessibility and potential for early detection, monitoring and therapy. Most studies (31%) relied on acoustic assessments, while only 4% used gold standard laryngeal imaging techniques, such as stroboscopy or endoscopy. This review suggests that mHealth technologies hold significant potential to enhance accessibility, equity and cost-effectiveness in voice disorder care, particularly in underserved regions. Further research is needed to expand applications in early detection, diagnosis and management. These mHealth solutions could potentially transform care into a preventative and globally sustainable model. Keywords: Scoping review, mHealth, voice disorders, telehealth, smartphone applications, management.
Ecological momentary assessment in hearing healthcare: a scoping review
Jacobs, Magdalena Petronella Daneel (University of Pretoria, 2026-08-29)
Ecological momentary assessment (EMA) has become a common approach in hearing healthcare for capturing real-time listening experiences and device outcomes in everyday environments. Unlike retrospective questionnaires, EMA reduces recall bias and provides more context-specific insights. The objective of this scoping review was to map the application of EMA in hearing healthcare research, evaluating auditory experiences and hearing device outcomes among individuals with hearing loss and device users. A comprehensive search was performed in PubMed, Scopus, and Web of Science using predefined terms. Studies were eligible if participants of any age (a) had diagnosed hearing loss, (b) used hearing devices such as hearing aids, cochlear implants, bone conduction devices, over-the-counter devices, or Personal Sound Amplification Products, or (c) accessed hearing healthcare services such as diagnostics, rehabilitation, or patient experience evaluations. Forty-nine studies were included, all conducted in high-income countries. Most participants were adults (98%; n = 48), with the largest group being those aged 61–70 years (51%; n = 25). EMA was most often delivered via smartphones (86%; n = 42). Data logging was used in 55% of studies (n = 27), mainly through hearing devices. Survey administration varied, with 38% (n = 21) relying solely on prompted surveys. The most common study duration was one week (33%; n = 17). Survey length ranged from 1 to 32 questions, with four, five, and seven questions being the most frequent (8%; n = 5 each). None of the studies offered voice response or speech-to-text options. Study aims were grouped into eight thematic categories. Common themes included ‘Auditory environments and contextual factors’ (20%; n = 10), which examined real-world listening conditions, noise exposure, and communication settings, and ‘User experience and device outcomes’ (20%; n = 10), which assessed listening experiences, device satisfaction, and perceived effectiveness in daily life. The largest single category was ‘Other’ (22%; n = 11), encompassing studies with complex or specific aims that did not fit into the main categories. Reported compliance rates were generally high (above 80%), although barriers to EMA participation, such as technological challenges, participant burden, and contextual factors, were noted. Overall, EMA shows strong potential for assessing real-world hearing experiences and device outcomes. However, its application remains inconsistent, with limited demographic diversity and a lack of standardised protocols. Future research should prioritise broader participant representation, greater methodological consistency, and the integration of multimodal input options (e.g., voice response, speech-to-text) to enhance the value of EMA in both research and clinical practice.
Extended high-frequency audiometry for early detection of noise-induced hearing loss
Mkwanazi, Hilda (University of Pretoria, 2025)
Noise-induced hearing loss (NIHL) is a common occupational health challenge that often develops gradually and remains unnoticed until significant damage has occurred. Conventional audiometry, which assesses pure tone thresholds up to 8 000 Hz, may not always detect early cochlear changes caused by noise exposure. Extended high-frequency audiometry (EHFA), which measures thresholds beyond 8 000 Hz, has been proposed as being more effective in identifying hearing loss not yet visible on conventional audiometry. This study investigated the effect of different categories of occupational noise exposure on EHFA thresholds to assess its potential as an early indicator of occupational noise-induced hearing loss (ONIHL). The study aimed to determine the effects that varying noise levels may have on EHFA and whether these effects are more pronounced in workers exposed to higher noise levels. A retrospective, quantitative study design was used to analyse audiometric data from 180 participants divided into three occupational noise exposure groups based on A-weighted decibels: category 1 (<85 dBA), category 2 (85–104 dBA), and category 3 (≥105 dBA). A hearing conservation programme (HCP) was implemented in the study setting, and hearing protection devices (HPDs) were mandatory within designated noise zones. Participants in categories 2 and 3 were subject to the administrative controls specified in the HCP and were provided with HPDs by their employer to meet these requirements. To focus on early auditory changes, stratified random sampling included participants with clinically normal hearing thresholds at conventional audiometric frequencies (500 – 4 000 Hz, thresholds <25 dB HL). All participants underwent both conventional pure tone audiometry (500 – 8 000 Hz) and EHFA (9 000 – 20 000 Hz). Audiometric thresholds were analysed using multivariate analysis of variance (MANOVA) and logistic regression to assess the effects of varying noise exposure levels, age, and years of service on EHFA thresholds. Conventional audiometry thresholds ranged from -10 dB to 50 dB HL, while EHFA thresholds ranged from -10 dB to 100 dB HL. Overall threshold patterns were comparable across noise exposure categories, with no statistically significant differences observed in either conventional or EHFA thresholds based on noise exposure level (p = 0.511) or years of service (p = 0.745). However, age emerged as a significant factor affecting hearing thresholds, particularly at 6 000 Hz, 8 000 Hz, and across all extended high-frequency (EHF) thresholds (p < 0.05). This study found limited evidence to support the use of EHFA as a tool for detecting early NIHL in the occupational setting. Instead, a strong influence of age on EHF thresholds was found, which underscores the need to account for age-related changes when interpreting EHFA data. The absence of significant EHF threshold deterioration across noise exposure categories may suggest that the HCP is effective in mitigating new cases of ONIHL. However, it is essential to note that the audiometer's limited maximum output intensity at EHFs may also contribute to the lack of significant findings. Future research using longitudinal designs should explore the applicability of EHFA in diverse occupational contexts and whether EHFA may be helpful in assessing the effectiveness of HCPs.
Caregivers of infants with cleft lip and palate: stress management and self-compassion during early feeding difficulties
Forman, Tarryn B (University of Pretoria, 2025)
Feeding difficulties are among the earliest and most stressful challenges faced by caregivers of infants with cleft lip and/or palate (CL/P). These challenges often disrupt the caregiver-infant relationship and contribute to heightened stress, anxiety and emotional strain. Understanding how caregivers manage these demands is essential to inform holistic and family-centred feeding interventions. Objective: To describe stress management and self-compassion of caregivers of infants with CL/P during early feeding difficulties. Design: An electronic survey, rendering predominantly quantitative data, was shared on social media platforms. Setting: The study was conducted online, targeting caregivers in South Africa. Participants: Criteria included caregivers of children with CL/P from birth to five years who had early feeding difficulties, who were proficient in English. Thirty-seven primary caregivers of infants with CL/P in South Africa responded to the survey. Main Outcome Measure(s): An electronic survey assessing: (1) caregivers’ feeding experiences with infants with CL/P, (2) stress management using the Perceived Stress Scale and (3) self-compassion using the Self-Compassion Scale. Results: Feeding difficulty severity (M = 6.06, SD = 2.27) was rated lower than related distress (M = 7.43, SD = 2.27). Perceived Stress Scale (PSS) scores (M = 21.90, SD = 6.65) negatively correlated with Self-Compassion Scale (SCS) scores (M = 2.82, SD = 0.70; rs = –0.714, p < .001). Thematic qualitative analysis yielded two themes: (1) mechanisms of support and their positive consequences, and (2) lack of support and their negative consequences. Conclusions: Caregivers experienced high levels of emotional distress during early feeding challenges, despite rating feeding difficulty severity as only moderate. Higher self-compassion was strongly associated with lower stress, indicating its potential clinical relevance for speech-language pathologists and lactation consultants. Findings support incorporating psychosocial support into early feeding interventions.
South African Speech-Language Therapists’ Perceived Competencies and Use of Makaton
Mc Geer, Chriséle (née du Preez) (University of Pretoria, 2025)
Background: Makaton is widely used by speech-language therapists (SLTs) as a total, multimodal communication approach within the augmentative and alternative communication (AAC) framework. It combines signs, symbols, and speech in diverse clinical and educational settings. Despite its wide applicability for individuals with complex communication needs, there is limited research on how South African SLTs perceive, use, and experience Makaton in practice. This gap is significant given South Africa’s multilingual context, resource disparities, and the need for culturally relevant AAC strategies. Understanding SLTs’ perspectives is essential for informing clinical practice and promoting the effective integration of Makaton into AAC service delivery within South Africa’s multilingual context. This study explores SLTs' perceived competencies and use of Makaton, contributing to the development of contextually appropriate AAC practices in South Africa. Objective: To explore South African SLTs’ perceived competencies and use of Makaton in clinical contexts. Method: This study employed a mixed-methods design. Data was gathered using an online survey administered via Qualtrics. The survey, which included both open– and closed-ended questions, was distributed to SLTs across South Africa and yielded responses from 57 participants. The majority of respondents were based in urban provinces such as Gauteng and the Western Cape, with a smaller proportion (12.3%) from rural areas. Quantitative data were analysed using descriptive and inferential statistics, while qualitative responses were analysed thematically. Results: Most participants (98.2%) correctly identified Makaton and reported using it, particularly with paediatric clients with autism spectrum disorder (ASD), Down syndrome, or cerebral palsy (CP). While 54.4% viewed Makaton as effective, only 5.5% reported feeling very confident using it. Most participants had completed only basic training levels. No statistically significant difference between recommending Makaton to parents and team members (WSR = -1.386, p = 0.166).Four themes captured Makaton’s perceived value: (1) multimodal communication, (2) accessibility and practicality, (3) support for speech and language development, and (4) inclusion and social interaction. Reported challenges included: (1) limited awareness and training, (2) financial / resource constraints, (3) poor consistency and carryover, (4) motor / cognitive limitations, and (5) cultural and regional mismatches. Conclusion: The findings reveal that South African SLTs recognise the value of Makaton as an AAC tool, particularly for supporting communication in multilingual contexts. However, most reported only moderate confidence in using it and had completed only the basic levels of training. Qualitative data highlighted both the perceived benefits and challenges of implementation, along with practical suggestions for improvement. While Makaton is positively regarded by SLTs, limited training, confidence, and implementation support hinder its consistent use. These results underscore the need for greater awareness, comprehensive training, and national AAC guidelines, as well as embedding Makaton in professional education, to enhance AAC service delivery in the multilingual South African context. Contribution: This study addresses the limited research about Makaton in the South African context by providing valuable insights into how SLTs perceive and use it in practice. The findings highlight areas of confidence and areas of need, offering practical suggestions and identifying directions for future research to strengthen AAC service delivery in multilingual contexts. Keywords: Augmentative and Alternative Communication, Multimodal communication, Makaton, Communication Disorders, Speech-language therapists, South Africa, low- and middle-income countries
South African Speech-Language Therapists' views on dysphagia in head and neck cancer patients
Gungadeen, Mishta (University of Pretoria, 2025)
Background: A significant gap in literature exists regarding speech-language therapists' (SLTs') guidelines for swallowing management in patients with head and neck cancer (HNC), particularly in low and middle-income countries like South Africa. Objectives: This study explored a sample of South African SLTs' views of swallowing management in patients with head and neck cancer. Method: A custom-designed online questionnaire was shared on social media platforms and completed by 14 South African SLTs with experience in the swallowing management of patients with HNC. Quantitative data were analysed using descriptive statistics and structured tabular thematic analysis for qualitative data. Results: Participants (𝑛 = 14) believed they have a key role in the swallowing management of patients with HNC. Yet, they often face obstacles, such as late inclusion as a team member, cultural and linguistic barriers, and/or limited access to resources and standard operating protocols. Most SLTs in this sample (𝑛 = 8) include instrumental assessments during initial evaluation. Treatment varied for each patient [e.g. type of surgical procedure (𝑛 = 14), anatomical and physiological changes (𝑛 =14). SLTs highlighted the importance of multidisciplinary collaboration, cultural and linguistic considerations, and professional development. Conclusion: This population requires increased SLT involvement in multidisciplinary teams to ensure timely and appropriate evidence-based swallowing intervention. Contribution: This study describes SLTs’ views on the swallowing management of patients with HNC. Continued professional development is needed for South African SLTs to enhance evidence-based decision-making in HNC management, thus enhancing the quality of care.
Using images to support communication in aphasia rehabilitation
Pillay, Bhavani Sarveshvari (University of Pretoria, 2025-07)
BACKGROUND : Images – a widely used tool in aphasia rehabilitation – reduce the degree to which persons living with aphasia (PWA) must rely on symbolic processing and may support their communication. However, variability exists in how speech-language therapists (SLTs) select and use images. Research on how PWA select and use image types is limited. Across three studies, presented in three journal manuscripts, this research project sought to explore SLTs’ image selection and use when working with PWA, PWA’s image preferences, and PWA’s experiences with image self-capture respectively. METHOD : The first study used a custom-designed electronic survey to describe the perspectives of South African SLTs and SLTs from other international contexts on image use in aphasia rehabilitation. The second study investigated a sample of the image preferences of individuals with mild to moderate aphasia through an adapted verbal survey conducted on a video-conferencing platform. The third study involved a multiple case study design and described the experiences of adults with mild to moderate aphasia in capturing photographs using mobile phones. RESULTS AND DISCUSSION : Most of the SLTs were found to use images in assessment (n=62 out of 75; 82.7%) and treatment (n=77 out of 92; 72.8%) of PWA. Study 1 showed that SLTs preferred coloured images. South African SLTs more frequently considered culture and religious orientation than did SLTs from other countries. Time constraints and large caseloads, PWA’s variable responses to images, and a lack of resources were the main challenges to image selection and use. Study 2 revealed that PWA in this sample also preferred coloured images, particularly photographs (n=11, 91.7%). Images had to be clear, transparent and meaningful to be considered for selection. The images that were preferred depended on the communication need. Also, participants felt more confident using images (n=10, 83.3%) than selecting them (n=8, 66.7%). Participants in Study 3 reported a positive experience of photograph capture. High-context photographs (n=75 of 116, 64.7%) predominated, and included more objects than people. However, photographs were low in content (85 of 116, 73.3%). CONCLUSION : The findings of this research project highlight the importance of image considerations in designing and selecting images as communication supports for PWA. Collaboration with the person with aphasia is crucial and warrants a systematic approach to functional image selection and use.
Early childhood development practitioner’s perceptions and use of technology for language and literacy development : a South African study
Bell, Mikaela (University of Pretoria, 2025)
Background: Early Childhood Development Practitioners (ECDPs) increasingly incorporate technology into teaching to support language and literacy development. Despite the benefits of technology in early childhood development (ECD), such as promoting early literacy skills, technology use in ECD classrooms may present challenges. A lack of teacher preparedness, and concerns surrounding technology’s impact on ECD are multifaceted. The COVID-19 pandemic accelerated the transition to technology-dependent education and exposed inconsistencies in technology access and training, particularly in lower-middle and upper-middle income countries like South Africa. Aim: To explore how ECDPs use and perceive technology to facilitate the development of language and literacy skills in ECD classrooms. Method: A mixed method design was used. Thirty three participants from seven different ECD centres completed an online questionnaire, which gathered information on their biographical information, technology use, and the benefits of using technology. Subsequently, seven of these participants took part in two focus group discussions on ECDPs perceptions and use of technology in ECD classrooms for language and literacy development. Results : The majority of participants (n=22; 66,7%) use technology at least once a month for teaching language and literacy, and most participants (n=24; 77,5%) were at least somewhat confident in their ability to use technology effectively in the classroom. However, focus group participants highlighted challenges including a lack of focus among young children and concerns about speech and language development. ECDPs suggested approaches to address the challenges of technology use, such as adopting a balanced approach to technology use in the classroom and at home. Discussion: ECDPs highlighted that AI tools are helpful in developing lesson plans and encouraging multisensory language and literacy learning. Focus group discussions highlighted challenges, such as difficulty with attention in the classroom, but emphasised using technology as a supportive tool, rather than a replacement for high quality teacher-student and caregiver-child interactions or hands-on learning. Conclusion and Contribution: This study highlights that technology is widely used in middle-income countries’ ECD classrooms, by ECDPs of all ages and experience levels, primarily through laptops, televisions, and online resources such as YouTube. While it enhances lesson planning and provides hands-on, multisensory learning experiences, it is crucial that technology serves as a supplement for high quality teacher-child and caregiver-child interactions.
Clinical utility of vestibular evoked myogenic potentials elicited by chirp stimuli
Reddy, Tarryn Marisca (University of Pretoria, 2024-09-06)
The research explores the clinical utility of chirp stimuli in eliciting cervical and ocular vestibular evoked myogenic potentials (c&oVEMPs), with a focus on improving vestibular assessment protocols. Through a series of experimental studies, the dissertation evaluates response rates, waveform characteristics, test-retest reliability, and diagnostic accuracy for superior canal dehiscence syndrome (SCDS). The findings reveal that the 500 Hz narrowband CE-Chirp stimulus produces higher response rates, shorter latencies, and greater amplitudes compared to broadband CE-Chirp, tone bursts, and clicks, positioning it as a more reliable alternative for VEMP testing. By demonstrating the advantages of chirp stimuli in enhancing response consistency and diagnostic precision, this research contributes to advancing clinical vestibular assessments and optimizing protocols for detecting vestibular dysfunction.
Understanding hearing aid use and non-use in adult hearing aid recipients : a qualitative content analysis
Cumming, Jane (University of Pretoria, 2024-08-30)
The increase in hearing loss statistics continues to be a growing global health concern. Despite the critical role that hearing aids play in the clinical management of hearing loss, many recipients have reported that they do not use their devices consistently. However, over the past decade, there have been rapid advancements in the hearing aid industry with new innovations that aim to improve the functionality of the devices in general as well as user experiences. The aim of the present study was to explore the self-perceived reasons for hearing aid use and non-use among a large cohort of adult hearing aid recipients. Utilizing a cross-sectional survey design, the study analyzed qualitative responses from 680 adult American hearing aid users, aged 19 to 93 years, collected through the Hearing Tracker and Lexie Hearing platforms. The open-ended responses were examined using content analysis, which identified key themes related to the use and non-use of hearing aids. The findings were linked to two domains namely, hearing aid use and hearing aid non-use. Within these domains, three primary categories emerged: personal factors, situational aspects, and device-related issues. In the non-use domain, 24 sub-categories were identified, including self-consciousness, discomfort, the need for fine-tuning, and fears related to device damage or loss. Conversely, the hearing aid use domain comprised 11 sub-categories, highlighting reliance on the device for daily functioning, environmental safety and awareness, and the benefits of streaming and connectivity features. This study highlights the importance of addressing the personal concerns of hearing aid users, particularly in enhancing the comfort and practicality of devices. By providing targeted support in challenging situations, satisfaction with hearing aids can be improved, potentially leading to more consistent use and better overall outcomes for individuals with hearing loss.

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