Browsing by Author "Chandrasekara, J.M.A.U."

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Effectiveness of gaze stability exercises on perceived disability in patients with chronic dizziness from peripheral vestibular dysfunction in National Hospital of Sri Lanka
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Colonne, C.A.U.T.; Chandrasekara, J.M.A.U.
BACKGROUND: Gaze Stability Exercises (GSE) are commonly used, effective and simple vestibular rehabilitation exercises used in the treatment of dizziness from peripheral vestibular disorders (PVD). However, due to lack of trained therapists and facilities, vestibular rehabilitation is not used widely in Sri Lankan settings. OBJECTIVES: To determine the effectiveness of home-based GSE to improve the functional, emotional, physical and total disability perceived by patients with chronic dizziness from PVD. METHODS: This single group pretest - post test study was conducted at the Vertigo Clinic of ENT unit, National Hospital of Sri Lanka. Eighteen patients with PVD were treated using a home-based GSE program, designed for practice on a daily basis, three times per day over a six-week period. Patients were evaluated at pre and post treatment assessments by Dizziness Handicap Inventory (DHI). The pre and post treatment DHI mean scores were compared by paired sample t-test and Wilcoxon signed rank test, and DHI severity was compared by McNemar-Bowker test. RESULTS: Significant improvement in DHI mean scores (emotional, functional, physical, and total) and DHI severity were observed in patients after the exercise program (P< 0.05). CONCLUSIONS: The results of this study suggest that short but intense home-based GSE program is effective in improving disability perceived by patients with PVD. However, this exercise program needs to be further customized to the patients’ rate of progression and the factors aggravating their dizziness.
Implementing Newborn Hearing Screening at the University Pediatric Unit of the North Colombo Teaching Hospital, Ragama
(Staff Development Center, University of Kelaniya, Sri Lanka, 2015) Chandrasekara, J.M.A.U.; Jayasena, B.N.; Illeperuma, D.; de Silva, D.; Chathurika, E.
Background and rationale:Hearing loss is a multifaceted condition with profound medical, social, and cultural implications (Smith et al., 2005). If hearing loss is not detected in infancy, it can lead to delayed speech and language acquisition, impaired social and emotional development and poor academic performance. Adverse consequences of late detection is minimized when hearing is screened by as early as 1 month of age. However, very few state sector hospitals in Sri Lanka implement hearing screening. Hence it is essential that newborn hearing screening programmes are implemented in a wider scale. Aim: This study aims to initiate a newborn hearing screening programme at the North Colombo Teaching Hospital, Ragama by identifying hearing impairment among all newborn well-babies and the Neonatal Intensive Care Unit (NICU) babies-University Pediatric Unit. Conceptual framework: The Joint Committee on Infant Hearing (JCIH) recommends a 1-3-6 benchmark on infant hearing. This includes screening hearing of all newborns no later than 1 month of age; those not passing screening to have a diagnostic hearing evaluation no later than 3 months of age; infants with confirmed hearing loss to receive appropriate intervention no later than 6 months of age(JCIH, 2007). Proposed Methodology: Hearing screening will be conducted using Otoacoustic Emission (OAE) for well-babies and a combination of OAE and Auditory brainstem Response (ABR) for babies admitted to the NICU. Those who fail the initial screenwill be rescreened at no later than 1 month of age. Those who fail the rescreen will be referred for detailed audiological evaluation by 3 months of age. The gathered data will be subjected to descriptive and inferential statistics. Expected outcomes: The proposed study will provide an initiative step towards including newborn hearing screening as a compulsory component to the hospital’s newborn care services.
Parental expectations and experiences of their child’s cochlear implantations
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Jayawaruni, U.C.; Chandrasekara, J.M.A.U.
BACKGROUND: Cochlear Implantation (CI) has become a most popular amplification option for children with severe, to profound pre-lingual deafness, in both developed and developing countries. Although several studies have done in other countries in terms of parental perspectives of CI, enough studies have not done to describe relationships of expected and true outcomes of CI in Sri Lankan context. OBJECTIVES: To describe parental pre-implant expectations and post-implant experiences of their child’s CI. METHODS: A descriptive cross-sectional study design was implemented, employing a self-administered questionnaire. A purposive sampling method was utilized for recruiting parents from a special pre-school setting and two cochlear rehabilitation centers. The survey compared parents’ pre-implant expectations with their post-implant experiences in five domains: communication abilities, general function, social skills, academic achievements and happiness and well-being. Results: The participants comprised of 44 child/parent pairs of 38 mothers and 6 fathers. There was no statistically significant difference between parents’ pre-implant expectations and post-implant experiences, except in the communication abilities domain (P<0.05). CONCLUSIONS: The overall findings indicated that the majority of parents’ pre-implant expectations met with their post-implant experiences. Parents were satisfied with their decision to proceed with CI and accordingly the anticipated improvements achieved by their children after CI. The study suggested that parents should be supported to synthesize more realistic expectations to perceive the outcomes optimistically as child’s progression takes time.
Prevalence of External and Middle Ear Pathologies among Students with Hearing Impairment in School Settings
(Faculty of Medicine, University of Kelaniya, 2014) Perera, N.C.S.; Chandrasekara, J.M.A.U.; Jayasena, B.N.
Hearing impairment is a major health problem in children. The incidence of external and middle ear diseases is greater for children with severe to profound hearing impairment. This study was aimed at determining the prevalence of external and middle ear pathologies among students with hearing impairment in school settings. A descriptive cross sectional study was carried out in two selected schools for children with hearing impairment (6-9, 10-13 and 14-16 years). A total of 195 participants were selected using two stage stratified sampling method. Otoscopy and Tympanometry were performed. Intact tympanic membranes were found in 316 ears (81 %), which was high in the age group of 14 -16 years. 74 (19 %) reported non occluded ear cerumen, occluded ear cerumen, tympanic membrane perforation, bulging tympanic membrane, external ear infection, foreign bodies and discharge. Most common pathology was non occluded ear cerumen in 49 (12.6 %), and high in 10 -13 age group. Only 383 ears were examined by Tympanometry due to occluded ear cerumen, presence of foreign bodies and external ear infection in 7 ears. Type “A” tympanograms were found in 282 ears (74%) and those were normal middle ears. Remaining 101 ears (26%) were pathological middle ears. Type “As” (47 ears; 12%) and type “Ad” (23 ears; 12%) were the most frequent pathological tympanograms, which was high in the 14 -16 group. There is a noticeable prevalence of external and middle ear pathologies among students with hearing impairment. The study findings highlight importance of regular ear examinations and promoting hearing hygiene in children with hearing impairment.
Subjective Measures of Hearing Aid Outcome in Hearing Impaired School Children
(Faculty of Medicine, University of Kelaniya, 2014) Rupasinghe, W.B.S.R.; Chandrasekara, J.M.A.U.; Jayasena, B.N.
It is imperative to ensure that hearing aids provide maximum benefit to the wearer, especially in case of children with prelingual hearing impairment. The current study aimed at exploring the status of hearing aid use among children in two schools for the hearing impaired in and around Colombo, and to measure whether the students are benefitted from their hearing aids. 104 hearing aid users in school setting for the hearing impaired in the age range of 6-16 years were tested during the study. Otoscopic examination, Pure tone Audiometry, Aided audiogram, Speech Identification Score (SIS) and Ling’s six sounds test were performed. Subjective measures of hearing aid outcome were measured using the aided performance for SIS and Ling’s six sounds test. The relative benefit was measured using the difference between the aided and unaided scores of respective tests. Only 17.31% (n=18) participants from the whole study population receive at least ≥50% benefit from the hearing aids and only 41.34% (n= 43) participants had demonstrated at least ≥50% aided performance score at SIS. Aided performances were better for those with Pure Tone Average (PTA) <90dBHL compared to participants with PTA ≥90dBHL, indicating that there is an association between the degree of hearing loss in the ear with amplification and the aided performance. Results suggest that the benefit provided by the hearing aids used by students with hearing impairment in Sri Lankan school setting is not satisfactory as the speech identification and sounds detection and identification ability with those hearing aids were very poor even at quiet condition and will be more affected in real life listening conditions with challenging signal-to-noise ratios. Potential factors that may have contributed to the results were identified as unaidable hearing loss, inconsistent use, inadequate aural rehabilitation, improper fitting and programming of hearing aids and less compliance for hearing aid use due to use of sign language.