Hearing loss, most specifically noise-induced hearing loss (NIHL) due to exposure to vuvuzela noise, received extended media coverage before and during the 2010 Federation Internationale de Football Association (FIFA) soccer world cup tournament. This study aimed to evaluate the impact that this media coverage had on raising awareness about NIHL due to exposure to vuvuzela noise at soccer matches among South African soccer spectators. A descriptive survey study, using a 24-item, self-administered questionnaire was used for this study. One hundred and forty seven (147) soccer spectators were surveyed before (N1 =73) and after (N2 =74) the tournament. Systematic sampling strategy was used to select the participants. Participants completed the questionnaire before the start of matches. Sixteen percent of the participants surveyed reported having had some media exposure about NIHL due to exposure to vuvuzela noise during soccer matches before the tournament in comparison to 26% of the participants after the tournament. This increase in the level of awareness was not statistically significant. Further, most participants were still not aware of the risk of NIHL to them from exposure to excessive noise during matches and did not consider hearing loss from noise exposure during soccer matches a serious concern both before and after the tournament. The results of this study therefore seem to suggest that vuvuzela media coverage during the 2010 FIFA soccer world cup tournament did not significantly raise the level of awareness about NIHL due to exposure to excessive noise during matches among the spectators surveyed.
Keywords: Awareness, hearing loss, noise-induced hearing loss, soccer, spectators, vuvuzela
|How to cite this article:|
Ramma L. Vuvuzela media coverage during the 2010 FIFA soccer world cup tournament: Impact on raising awareness of noise-induced hearing loss. Noise Health 2011;13:415-22
|How to cite this URL:|
Ramma L. Vuvuzela media coverage during the 2010 FIFA soccer world cup tournament: Impact on raising awareness of noise-induced hearing loss. Noise Health [serial online] 2011 [cited 2020 Apr 4];13:415-22. Available from: http://www.noiseandhealth.org/text.asp?2011/13/55/415/90302
| Introduction|| |
Noise-induced hearing loss (NIHL) is a significant social and public health concern.  Further, despite the fact that major effects of noise exposure has been known since the early 1960s, noise exposure continued to be a major public health problem at the beginning of the 21 st century.  Subsequently, this implies that NIHL is also likely to continue to be a challenge in the years to come. The World Health Organization (WHO) has also identified NIHL in developing countries as an increasing risk factor for hearing impairment.  Although most countries, South Africa included, have laws and policies regulating occupational noise exposure, there is typically no regulation or guidelines on non-occupational noise exposure such as the type of noise people are exposed to at sporting events. 
In South Africa, Premiere Soccer League (PSL) matches have been shown to be very noisy social events. The biggest contributor to noise levels during matches is the vuvuzela, a trumpet-like instrument that is usually blown by South African soccer fanatics at matches.  Peak sound pressure levels at some PSL matches can be as high as 115-132 dBA, which is more than noise level at an average rock concert. 
Most agencies that are responsible for developing noise standards used for regulating occupational noise exposure (e.g. International Organization for Standardization, ISO, South African National Standards, SANS) specify a Criterion Level, which is the maximum permissible exposure to accumulated noise, to be an 8-h equivalent continuous noise level of 85 dBA. Therefore, any workplace that exposes employees to noise levels ≥85 dBA for 8 h risks harm to their hearing. While there are currently no such standards developed specifically for non-occupational noise exposure, criterion levels currently used in occupational settings can also be utilized for social noise exposure.  Therefore, when judging the noise levels reported at some of the PSL matches using the ISO's criterion level specified in standard 1999:1990(E),  it becomes evident that some of these noise levels can be potentially harmful to human hearing if people are exposed to them for extended durations.
A number of studies have shown that the general public's knowledge of NIHL due to recreational activities is usually low. ,, The outcome of one study done in USA revealed that despite widely available information about NIHL, most American youth appear uninformed, with only 16% of respondents surveyed reporting having read, heard or seen anything related to the issue of hearing loss.  A similar study, also done in the USA, revealed a gap between what American youth know about NIHL and their choices based on that knowledge.  For instance, it was found that 72% of respondents in that study reported never wearing hearing protection when in loud noise even through they knew the dangers of exposure to loud noises.
Awareness about NIHL due to exposure to vuvuzela noise during soccer matches received extended media coverage in South African during the build-up to the world cup tournament (i.e. during the 2009 Federation Internationale de Football Association [FIFA] Confederations Cup) as well as during the 2010 FIFA soccer world cup tournament. This media coverage was mainly directed at the vuvuzela and its noise's potential to among other things, cause hearing loss. Therefore, while it can be argued that most of the media coverage before and during the tournament was about the vuvuzela as an instrument, and not necessarily about NIHL per se, the fact remains that most of the objections towards the vuvuzela expressed in all media outlets were about its 'annoying noise' and the potential of the vuvuzela noise in causing NIHL.
With respect to specific media coverage, at the start of the world cup tournament, there was a series of newspaper articles in all major South African newspapers calling for the ban of the vuvuzela. For instance, in the period June 11-13, 2010, Times Live, the online-based publication to one of the major South African newspapers The Times, published at least thirteen (13) articles expressing an 'anti-vuvuzela' sentiment. The Mail and Guardian and City Press also carried four and three articles, respectively, conveying the same message during the first few days of the opening of the tournament. In addition to these newspaper articles, a number of high profile sports personalities added their voice to the 'anti-vuvuzela' movement, requesting FIFA to ban the use of the vuvuzela during the 2010 soccer world cup tournament. 
In addition to the newspaper articles, two scientific articles confirming the potential of the noise emitted by the vuvuzela to cause NIHL were also published in the South African Journal of Medicine prior to the start of the tournament. , There were also several appearances on local television stations by audiologists from two of the country's top universities during the tournament warning members of the public about the potential of the vuvuzela to cause NIHL. During the tournament, images of some spectators wearing hearing protection devices were often flashed across TV screens during televised matches to highlight the vuvuzela noise problem. The South African Association of Audiologists (SAAA) also launched a campaign dubbed 'Operation Jumbo Ears' in which it was reported that over 14 000 pairs of earplugs were distributed at no cost to spectators during the month-long tournament. 
Sports and sporting activities are generally known to be effective in raising awareness about social issues.  Further, the power of mass media (both print and television) in influencing behavior is well documented.  Therefore, in light of this focused and intense media coverage on the vuvuzela noise and its potential risks for NIHL to spectators, it would be useful to find out whether this media coverage had any impact on raising awareness about NIHL. Further, it would also be useful to find out whether this media coverage had any influence on soccer spectators' behavior with respect to exposing themselves to vuvuzela noise during matches.
This study therefore aimed to evaluate the impact of mass media coverage on vuvuzela noise during the 2010 soccer world cup on raising awareness about NIHL among South African soccer spectators. Specific objectives included determining before and after the 2010 FIFA soccer world cup tournament: i) the level of awareness about NIHL due to exposure to vuvuzela noise, ii) attitudes towards vuvuzela noise exposure during soccer matches, iii) attitudes towards the use of hearing protection during soccer matches, as well as, iv) strategies that can be used to encourage hearing protection use.
| Research Method and Design|| |
This study employed a non-experimental, pre-post, descriptive questionnaire survey design to achieve the aim and objectives specified above. The questionnaire used in this study was developed at Massachusetts Eye and Ear Infirmary, Harvard School of Public Health, and Congent Research, Inc.  This questionnaire was first adapted by inserting items that dealt specifically with exposure to vuvuzela noise. For instance, items such as 'night club' and 'concert' were replaced with 'soccer match.' However, the format of the questionnaire was left mostly unchanged.
The adapted questionnaire was first piloted on 10 individuals prior to the commencement of the survey to ensure that it was suitable for use in this study. No further changes to the questionnaire were indicated by the outcome of the pilot study. The questionnaire contained five sections and 24 questions. The first section of the questionnaire contained questions about participants' demographic information. The second section contained five questions about views towards general health issues or concerns (including NIHL) that were thought to be relevant to the South African soccer spectators. The remaining three sections dealt with hearing loss, personal exposure to vuvuzela noise, and hearing protection. The type of the questions in this questionnaire were multi-dichotomous, multiple choice, and open-ended questions. The questionnaire also contained two questions with multiple sub-questions that required respondents to rate the importance of answers about health problems in question on a Likert scale.
Context and study participants
Data collection for this study for both pre- and post-tournament phases took place at a 96 000 seat-capacity stadium that was a flagship venue for the 2010 FIFA soccer world cup tournament held in South Africa. Participants were soccer spectators attending a PSL cup final match on May 22, 2010 (pre-tournament - a month before the start of the tournament), and soccer spectators attending a PSL cup competition match on September 10, 2010, (post-tournament-two months after the tournament) at this venue. Participants were sampled via systematic sampling strategy to participate in this study. To take part in this study, participants had to be at least 18 years old (legal age to give consent in South Africa). Furthermore, since this was a self-administered questionnaire in English language, a minimum of secondary level of education was required to participate in this study (i.e. most South Africans with a secondary level education can write and communicate in English). Finally, participants were required to have attended at least one match prior to taking part in this study.
Eighty-two participants (47 males and 35 females) completed the questionnaire for the study. Nine of the completed questionnaires had to be discarded because they were missing key information required for this study. The remaining questionnaires (N1 =73): 41 males and 32 females, age range 18-59 years old (median age 30 years old) were analyzed.
Seventy-six participants (52 males, 22 females and 2 did no specify sex) completed the questionnaire for the study. Two of the completed questionnaires had to be discarded because they had missing or incomplete information required for the study The remaining questionnaires (N2 =74): 52 males and 22 females, age range 20-62 years old (median age 28 years old) were analyzed. Demographic information of the respondents for both pre- and post-tournament is presented in [Table 1].
|Table 1: Demographic profile of the participants (pre- and post-tournament)|
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Ethical clearance to conduct the study was first obtained from the University of Cape Town Faculty of Health Sciences Human Research Ethics Committee (REC REF: 373/2009). Permission was then obtained from the stadium management to conduct the survey. Data collection for both matches took place for three hours on match dates and stopped at least one hour before commencement of the match. Two research assistants waited at two specified stadium entrances and approached participants as they entered the stadium. Participants were approached as they went into the stadium to avoid surveying the same individuals multiple times. Every fifth spectator entering the stadium was approached, informed about the study, and invited to complete the self-administered questionnaire. Participants were further informed that their participation in this study was voluntary and that they had the right to withdraw from this study without any negative consequence to them. They were also informed that there were no risks or harm associated with taking part in the study as well as the fact that there were no immediate benefits to them for taking part in this study. Finally, participants were assured that their responses will be kept confidential and none of their identifying information was required for this study. Participants who consented to take part in this study were given an informed consent form to sign, and then a self-administered questionnaire to complete. The researcher was available to answer any questions about the study or the questionnaire that the respondent may have. The completed questionnaire was then received from the respondent once it was completed.
Validity and reliability
When planning a research study, interpreting the findings or determination of the value of the findings of a study, it is important to be mindful of two important concepts: Validity and reliability. Validity is concerned with the question "does the study's measurement process or assessment actually measure what was intended to be measured or assessed?" Reliability addresses whether repeated measurements or assessments provide a consistent result given the same initial circumstances. 
Validity concerns in this study were addressed through the use a pre-existing questionnaire that has been developed and empirically validated at Massachusetts Eye and Ear Infirmary, Harvard School of Public Health.  Further, after minor adaptations were made to the study questionnaire to make it more relevant to this study, a pilot study was also conducted before the start of this study to ensure its validity and suitability for use in the South African context. Participants in the pilot study reported that the questionnaire was acceptable therefore no further adaptations were made to it.
Threats to reliability related to the administration of the questionnaire were addressed by training two research assistants who were part of this study on the questionnaire administration protocol prior to the commencement of the study. This was done to ensure consistency of administration. The questionnaire was self-administered, and research assistants were required to be available at all time to answer questions from the participants related to the completion of the questionnaire. To minimize variability that may be introduced by use of multiple languages, English language was selected as the language of this study and only participants who could communicate in English (i.e. at least secondary level education) were recruited to participate in this study.
Both descriptive and inferential statistics were used to analyze the results of the study. Descriptive statistics in the form of medians and proportions (i.e. percentages with 95% confidence intervals [CI]) were used to analyze the results. Bar charts were also used to present a graphical display of patterns of responses from the participants. The Mann Whitney U-test (inferential statistics), a non-parametric statistical test was used to analyze the difference between the medians of the two data sets.  The significance level was set at P≤0.05.
| Results|| |
Awareness of hearing loss
To determine participants' level of awareness about hearing loss and NIHL prior to and after the 2010 FIFA soccer world cup tournament, the following questions were posed to them: Have you watched, heard, or read anything in the past 6-12 onths related to the issue of hearing loss due to vuvuzela noise at soccer matches (i.e. media exposure about NIHL)?; Have you ever experienced a hearing-related problem or ringing in your ears after a football match?; Do you know that the vuvuzela noise can cause hearing loss (i.e. awareness of risk of NIHL from vuvuzela noise)? The results indicate that slightly more participants (26%) reported having seen, read or heard something about NIHL post-tournament than pre-tournament (16%). However, the difference was not statistically significant (P=0.12). Participants' responses are displayed in [Figure 1].
Participants were then given five issues or concerns pertinent to people who attend soccer matches in South Africa and asked to 'rate how big of a problem' they considered each of the concerns to be. Participants considered the following issues or concerns to be 'very big problems ': Cigarette smoking in the stands (38% (CI: 27.1, 50.2%) pre-tournament versus 57 %(CI: 45.0, 68.3%) post-tournament), drug and alcohol abuse (42% [CI: 30.7, 54.1%] pre-tournament versus 47% (CI: 35.4, 58.9%) post-tournament), acts of violence during matches (37% (CI: 26.2, 49.2%) pre-tournament versus 49% (CI: 37.3, 60.8%) post-tournament) and concerns regarding catching infectious diseases at the stadium (18% (CI: 10.3, 29.1%) pre-tournament versus 36% (CI: 25.4, 48.1%)). Hearing loss due to excessive noise during matches was considered to be 'a very big problem' by 13% (CI: 6.4, 24.0%) of the participants pre-tournament in comparison to 12.2% (CI: 6.1, 22.4%) post-tournament. None of the observed changes in the pre-tournament and post-tournament responses were statistically significant with the exception of cigarettes smoking in the stands (P=0.021) and concerns regarding catching infectious diseases (P=0.01) [Figure 2].
|Figure 2: Rating of soccer spectators' concerns by the participants ( N1=73, N2=74)|
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Attitude towards self-exposure to vuvuzela noise during matches
Seventy-five percent (CI: 63.6, 84.4%) of the participants pre-tournament and 70% (CI: 50.4, 80.1%) post-tournament reported owning a vuvuzela and using or blowing it at all matches they attend. In response to the question, 'Are you going to stop blowing the vuvuzela during matches?' 76% (CI: 63.3, 86.0%) of the participants (pre-tournament) and 69% (CI: 56.3, 78.9%) of the participants (post-tournament) answered 'NO'. Eighty-eight percent (CI: 77.3, 94.3%) of the participants (pre-tournament)) and 78% (CI: 63.1, 87.8) of the participants (post-tournament) did not want the vuvuzela to be banned during soccer matches. None of the observed changes between pre-tournament and post-tournament responses were statistically significant.
Attitudes toward hearing protection
Eight percent 8% (CI: 2.9, 17.8%) of the pre-tournament participants and 10% (CI: 4.3, 19.6%) of post-tournament participants reported that they have worn earplugs during a football match. Twenty-two percent (CI: 13.1, 33.6%) (pre-tournament) and 34% (CI: 22.3, 46.1) (post-tournament) reported that they have seen someone wearing hearing protection devices during a football match. While an increase in the proportion of participants who reported having seen someone hearing protection devices was noted amongst respondents during the post-tournament survey, that difference was not statistically significant (P=0.08).
Twenty-nine percent (29%) (CI: 18.7, 40.8%) (pre-tournament) and 37% (CI: 26.2, 49.2) (post-tournament) of the participants said that they were 'very likely' to use earplugs during matches if they were provided for free at the stadium. Twenty-two percent (CI: 12.7, 33.8%) (pre-tournament) and 31% (CI: 16.6, 49.9) (post-tournament) of the participants reported that they were 'very likely' to use earplugs next time when they attend a match. Most of the of the participants at pre-tournament (45%) (CI: 32.5, 57.4%) and 53% (CI: 37.4, 68.1) at post-tournament reported that they did not know where they could obtain or buy earplugs. Again, the trend in the post-tournament survey showed an increase in the proportion of respondents who intend on using hearing protection but the noted increase was not statistically significant (P=0.22).
Strategies that can be used to communicate with participants and encourage hearing protection use
Participants were given four options of potential sources of information and or agents that can make recommendation regarding hearing protection use. They were asked to rate how each one of the four options is likely to influence their likelihood of using hearing protection devices during football matches. Their responses indicated that doctor or a nurse is more likely to influence respondents' likelihood of using hearing protection (43% pre-tournament and 44% post-tournament). Participants also reported that they were more likely to use hearing protection if they found out that even limited exposure to loud sounds can permanently damage their hearing (40% pre-tournament and 42% post-tournament). Generic radio and television programs about earplugs were reported to be less likely to influence the likelihood of hearing protection use by the participants [Table 2].
|Table 2: Factors likely to increase the 'very likelihood' of wearing earplugs at football matches|
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| Discussion|| |
Concerns about intense noise levels generated during South African soccer matches dominated news headlines both before and during the 2010 FIFA soccer world cup tournament. This study aimed to evaluate the impact of this extensive media coverage on raising awareness about NIHL due to exposure to vuvuzela noise during PSL soccer matches. The study also investigated behavior changes with respect to noise exposure during soccer matches. Changes in attitudes towards the use of hearing protection during soccer matches brought about by this media coverage as well as strategies that can be used to encourage hearing protection use during matches were also investigated. The sections that follow will present a discussion of the findings of this study in line with these broad study aim and objectives.
The proportion of participants in this study who reported having seen, heard of read something about hearing loss was low, especially for pre-tournament participants. It was expected that given the widespread media coverage about the vuvuzela noise and its potential to cause hearing loss, most participants in this study will be aware of this issue. Slightly more respondents (but not statistically significant) surveyed during the post-tournament match reported having read, heard or seen something on the issue of hearing loss during the past 6-12 months before this study. Further, almost half of the respondents (52% pre-tournament and 49% post-tournament) in this study reported that they were unaware of the risk posed by too much noise during soccer matches on their hearing. These findings were consistent with the results of similar studies, , in which it was found that despite widely available information about the issue of NIHL, few participants reported awareness about this issue. It was expected in this study that given the media coverage of this issue before and during the tournament, an overwhelming majority of the participants will report some level of awareness about NIHL risk from too much noise exposure at soccer matches. Therefore, this limited awareness of the risk of NIHL from vuvuzela noise at matches amongst participants, despite widespread media coverage on this issue, seems to suggest the ineffectiveness of untargeted and opportunistic awareness campaigns as it was the case here. That is, this media coverage could possibly have been utilized more effectively if there was a targeted awareness campaign towards this issue. A possible strategy for increasing awareness about NIHL includes involvement of the population for which the awareness campaign is meant for.  Unfortunately, that was not the case during this tournament.
A focused media coverage of an issue such as the vuvuzela and its noise as it was the case during the 2010 FIFA soccer world cup is known to be effective in motivating the general public to consider an issue as socially important and worth allocating their sympathy and concern to.  However, it was found that despite the extensive media coverage about the issue of excessive noise during soccer matches before and during the 2010 world cup tournament, participants in this study did not consider the risk of hearing loss from too much noise during matches a socially important problem. This was revealed in their consistent low ranking of hearing loss as a concern in comparison to other concerns (e.g. smoking in stands during matches) for this population group. However, low ranking of hearing loss in comparison to other concerns was expected because unlike other concerns such as violent acts during matches that are dramatic and therefore could be perceived as potentially deadly,  hearing loss due to excessive noise during matches is less likely to be of sudden onset, hence its low ranking. This however, does not mean that the risk of NIHL as a result of noise exposure during matches is not an important concern for this population. It is likely that there is currently low level of awareness about this issue among participants, hence the reason why they do not consider it a serious concern.
An unexpected finding in this study was the reluctance of most participants to modify their patterns of self-exposure to vuvuzela noise during matches even though they were aware of its potential risk to damage their hearing. That is, 48 and 51% of the participants during pre- and post-tournament, respectively, reported being aware of the risk of vuvuzela noise to their hearing and yet did not intend on stop blowing the vuvuzela during matches. Even after being told about the potential danger of vuvuzela noise to their hearing, 76% of the participants (pre-tournament) and 69% of the participants (post-tournament) reported that they did not plan on discontinuing vuvuzela use during matches. A gap between what individuals know and how they use the knowledge they have has been reported previously. For instance, in one study it was found that participants reported never using hearing protection when in noise despite being aware of the risks associated with excessive noise exposure.  Likewise, participants in the present study reported that they will continue exposing themselves to loud noise despite knowing the risk it has on their hearing. Finally, an overwhelming majority of participants in this study (88% pre-tournament and 78% post-tournament) were opposed to the banning of vuvuzela use during PSL soccer matches.
Participants in this study reported low level use of hearing protection during football matches. However, a slight increase was noted in the number of participants who reported having seen someone using hearing protection post-tournament in comparison to pre-tournament. However, this increase was not statistically significant. It was also encouraging to observe an increase, albeit statistically insignificant, the number of participants who reported the likelihood of using hearing protection during matches should hearing protection devices be made available at no charge post-tournament in comparison to pre-tournament. The number of participants who reported intention to use hearing protection devices during their next match attendance also increased slightly post-tournament in comparison to pre-tournament. This is somewhat a promising finding in this study because intentions are known to determine behavior,  therefore, the more an individual intends to perform an action, the more likely the action. The fact that slightly more participants in this study intended on using hearing protection in future match attendance holds promise that they can be persuaded through properly targeted campaigns to use these devices, especially if these campaigns are led by health professionals.
A major concern in this study was the finding that majority of the participants (similar proportions for both pre and post-tournament) did not know where they could obtain hearing protection devices. Lack of knowledge about where to get these devices could potentially have a negative impact on participants' self-efficacy with respect to minimizing their exposure to noise during PSL matches which in turn could discourage them from using these devices. Bandura defines self-efficacy as 'the belief in one's capabilities to organize and execute the courses of action required managing prospective situations'  and self-efficacy is highly dependent on knowledge related to a specific course of action.  In this study, the course of action of interest is obtaining hearing protection devices for use in future matches and most participants indicated lack of knowledge about where to get these devices. It therefore could be expected that they will be less likely to use these devices. A possible solution will be to make these available at place where match tickets are sold or at match venues. These could either be included in the price of a match ticket to make them more affordable (i.e. economies of scale) or potentially be provided for free.
| Conclusion|| |
This study set out to evaluate the impact of extended mass media coverage on the vuvuzela noise during the 2010 FIFA soccer world cup tournament on raising awareness of NIHL among South African soccer spectators pre- and post-tournament. The findings of this study showed that this extended media coverage did not appear to have significantly raised awareness about the hearing loss or NIHL. Further, the media coverage during the tournament failed to elevate the status of the risk of hearing loss from excessive noise exposure during matches to be considered a serious health concern among the participants who took part in this study. However, willingness to use hearing protection was reported by participants in this study especially if it was provided at no cost. Even more encouraging was the identification of possible strategies that could be used to increase the likelihood of hearing protection use by the participants in this study. Those strategies were identified to be: Hearing protection devices recommended by a doctor or a nurse and if participants were made aware that noise could potentially cause permanent damage to their hearing.
The results of this study should be interpreted in light of its methodological limitations (i.e. small sample size); therefore, caution should be exercised before generalizing it to the entire South African soccer spectator population. Despite its limitations, the findings of this study seem to suggest that the efforts to curb the problem of excessive noise exposure at PSL matches, and hence reduction of the risk of potential NIHL for spectators at these matches is less likely going to succeed through restrictions and or prohibitions on vuvuzela use alone. The findings of this study also raised doubts about the likelihood of succeeding in raising awareness about NIHL through opportunistic ad hoc campaigns such as untargeted media coverage during major events such as the soccer world cup. The findings of this study therefore seem to suggest that traditional public health approaches (i.e. planned, focused, and targeted health promotion and health education campaigns), involving healthcare professionals, may have better odds at succeeding in raising awareness of NIHL among South African soccer spectators who participated in this study.
It is therefore recommended that in future, should South African associations of hearing healthcare professionals hope to use this type of avenue for their awareness campaigns, more planning needs to be done to better position their messages. Finally, since majority of the respondents indicated willingness to follow the recommendation to use hearing protection, if that recommendation was given by health professionals, it is recommended that doctors, nurses, and audiologists and their respective associations should be actively involved in NIHL awareness campaign. The South African Football Association should also consider providing hearing protection at minimum or no cost to spectators during soccer matches to encourage wide use of these devices. It is also recommended that future studies include more participants as well as investigate the prevalence of hearing loss in this population.
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Division of Communication Sciences and Disorders, University of Cape Town, Faculty of Health Sciences, Groote Schuur Hospital, Old Main Building, F-45, Observatory, Cape Town, 7925
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2]
[Table 1], [Table 2]