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  1. Wong YA, Mukari SZS, Harithasan D, Mazlan R
    Int J Pediatr Otorhinolaryngol, 2019 Sep;124:79-84.
    PMID: 31174022 DOI: 10.1016/j.ijporl.2019.05.040
    OBJECTIVES: Maternal knowledge and attitude towards childhood hearing loss play an important role in determining the success of early diagnosis and intervention of hearing loss programs in children. This study aimed to 1) assess the knowledge and attitude of childhood hearing loss among mothers, 2) compare knowledge and attitude of childhood hearing loss in urban and rural mothers, 3) investigate the relationship between knowledge and attitude on childhood hearing loss, and 4) identify socio-demographic factors that influence mothers' knowledge and attitude on childhood hearing loss.

    METHOD: A cross-sectional survey was conducted on 362 mothers and mothers-to-be (mean age: 31.9 ± 4.9 years, range: 20-48 years old) recruited from Hospital Universiti Kebangsaan Malaysia in Cheras, Kuala Lumpur and two health clinics in Lenggeng, Negeri Sembilan and Beranang, Selangor representing the urban and rural areas respectively. All participants were interviewed in person using a newly developed and reliable questionnaire that tested their knowledge and attitude on childhood hearing loss.

    RESULTS: Generally, the majority of mothers had a moderate level of knowledge and positive attitude towards childhood hearing loss. Urban mothers had a significantly higher knowledge than those of the rural area (p 

  2. Ismail AI, Abdul Majid AH, Zakaria MN, Abdullah NAC, Hamzah S, Mukari SZS
    Int J Pediatr Otorhinolaryngol, 2018 Jun;109:78-84.
    PMID: 29728190 DOI: 10.1016/j.ijporl.2018.03.030
    OBJECTIVE: The current study aims to examine the effects of human resource (measured with the perception of health workers' perception towards UNHS), screening equipment, program layout and screening techniques on healthcare practitioners' awareness (measured with knowledge) of universal newborn hearing screening (UNHS) in Malaysian non-public hospitals.

    METHODS: Via cross sectional approach, the current study collected data using a validated questionnaire to obtain information on the awareness of UNHS program among the health practitioners and to test the formulated hypotheses. 51, representing 81% response rate, out of 63 questionnaires distributed to the health professionals were returned and usable for statistical analysis. The survey instruments involving healthcare practitioners' awareness, human resource, program layout, screening instrument, and screening techniques instruments were adapted and scaled with 7-point Likert scale ranging from 1 (little) to 7 (many). Partial Least Squares (PLS) algorithm and bootstrapping techniques were employed to test the hypotheses of the study.

    RESULTS: With the result involving beta values, t-values and p-values (i.e. β=0.478, t=1.904, p<0.10; β=0.809, t=3.921, p<0.01; β= -0.436, t=1.870, p<0.10), human resource, measured with training, functional equipment and program layout, are held to be significant predictors of enhanced knowledge of health practitioners. Likewise, program layout, human resource, screening technique and screening instrument explain 71% variance in health practitioners' awareness. Health practitioners' awareness is explained by program layout, human resource, and screening instrument with effect size (f2) of 0.065, 0.621, and 0.211 respectively, indicating that program layout, human resource, and screening instrument have small, large and medium effect size on health practitioners' awareness respectively. However, screening technique has zero effect on health practitioners' awareness, indicating the reason why T-statistics is not significant.

    CONCLUSION: Having started the UNHS program in 2003, non-public hospitals have more experienced and well-trained employees dealing with the screening tools and instrument, and the program layout is well structured in the hospitals. Yet, the issue of homogeneity exists. Non-public hospitals charge for the service they render, and, in turn, they would ensure quality service, given that they are profit-driven and/or profit-making establishments, and that they would have no option other than provision of value-added and innovative services. The employees in the non-public hospitals have less screening to carry out, given the low number of babies delivered in the private hospitals. In addition, non-significant relationship between screening techniques and healthcare practitioners' awareness of UNHS program is connected with the fact that the techniques that are practiced among public and non-public hospital are similar and standardized. Limitations and suggestions were discussed.

  3. Harithasan D, Mukari SZS, Ishak WS, Shahar S, Yeong WL
    Int J Geriatr Psychiatry, 2020 04;35(4):358-364.
    PMID: 31736109 DOI: 10.1002/gps.5237
    OBJECTIVES: The objective of this study was to evaluate the relationship between sensory impairment (hearing loss only, vision loss only, and dual sensory impairment [DSI]) and depression, loneliness, quality of life, and cognitive performance in older adults.

    METHODS: A total of 229 community-dwelling older adults aged 60 years or older participated in this study. Variables were measured using the Geriatric Depression Scale (GDS-15), Revised University of California at Los Angeles Loneliness Scale (R-UCLA), Satisfaction with Life Scale (SWLS), and Mini-Mental State Examination (MMSE).

    RESULTS: There was an independent association between DSI and quality of life (P < .05) and between DSI and hearing loss alone and cognitive function (P < .05) in older adults. In addition, higher education was associated with better quality of life and cognitive function.

    CONCLUSIONS: DSI is a significant factor affecting the quality of life and cognitive function in older adults. Sociodemographic factors such as education play an important role in improving quality of life and cognitive function. Thus, increasing the awareness of this disability is important to ensure that older adults receive the necessary support services and rehabilitation to improve their level of independence.

  4. Yusof Y, Mukari SZS, Dzulkifli MA, Chellapan K, Ahmad K, Ishak I, et al.
    Geriatr Gerontol Int, 2019 Aug;19(8):768-773.
    PMID: 31237107 DOI: 10.1111/ggi.13710
    AIM: To evaluate the efficacy of a newly developed auditory-cognitive training system on speech recognition, central auditory processing and cognition among older adults with normal cognition (NC) and with neurocognitive impairment (NCI).

    METHODS: A double-blind quasi-experiment was carried out on NC (n = 43) and NCI (n = 33) groups. Participants in each group were randomly assigned into treatment and control programs groups. The treatment group underwent auditory-cognitive training, whereas the control group was assigned to watch documentary videos, three times per week, for 8 consecutive weeks. Study outcomes that included Montreal Cognitive Assessment, Malay Hearing in Noise Test, Dichotic Digit Test, Gaps in Noise Test and Pitch Pattern Sequence Test were measured at 4-week intervals at baseline, and weeks 4, 8 and 12.

    RESULTS: Mixed design anova showed significant training effects in total Montreal Cognitive Assessment and Dichotic Digit Test in both groups, NC (P 

  5. Mukari SZS, Umat C, Chan SC, Ali A, Maamor N, Zakaria MN
    J Audiol Otol, 2020 Jan;24(1):35-39.
    PMID: 31914504 DOI: 10.7874/jao.2019.00262
    BACKGROUND AND OBJECTIVES: The cortical auditory evoked potential (CAEP) is a useful objective test for diagnosing hearing loss and auditory disorders. Prior to its clinical applications in the pediatric population, the possible influences of fundamental variables on the CAEP should be studied. The aim of the present study was to determine the effects of age and type of stimulus on the CAEP waveforms.

    Subjects and METHODS: Thirty-five healthy Malaysian children aged 4 to 12 years participated in this repeated-measures study. The CAEP waveforms were recorded from each child using a 1 kHz tone burst and the speech syllable /ba/. Latencies and amplitudes of P1, N1, and P2 peaks were analyzed accordingly.

    RESULTS: Significant negative correlations were found between age and speech-evoked CAEP latency for each peak (p< 0.05). However, no significant correlations were found between age and tone-evoked CAEP amplitudes and latencies (p>0.05). The speech syllable /ba/ produced a higher mean P1 amplitude than the 1 kHz tone burst (p=0.001).

    CONCLUSIONS: The CAEP latencies recorded with the speech syllable became shorter with age. While both tone-burst and speech stimuli were appropriate for recording the CAEP, significantly bigger amplitudes were found in speech-evoked CAEP. The preliminary normative CAEP data provided in the present study may be beneficial for clinical and research applications in Malaysian children.

  6. Abdul Majid AH, Zakaria MN, Abdullah NAC, Hamzah S, Mukari SZS
    Int J Pediatr Otorhinolaryngol, 2017 Oct;101:107-111.
    PMID: 28964278 DOI: 10.1016/j.ijporl.2017.07.036
    OBJECTIVE: This paper aims to investigate the effects of perceived attitude and anxiety on awareness of UNHS among caregivers in Malaysia.

    METHODS: Using cross sectional research approach, data were collected and some 46 out of 87 questionnaires distributed to caregivers attending UNHS programs at selected public hospitals were usable for analysis (response rate of 52.8%). Partial Least Squares Method (PLS) algorithm and bootstrapping technique were employed to test the hypotheses of the study.

    RESULTS: R square value is 0.205, and it implies that exogenous latent variables explained 21% of the variance of the endogenous latent variable. This value indicates moderate and acceptable level of R-squared values. Findings from PLS structural model evaluation revealed that anxiety has no significant influence (β = -0.091, t = 0.753, p > 0.10) on caregivers' awareness; but perceived attitude has significant effect (β = -0.444, t = 3.434, p 

  7. Mukari SZS, Ishak WS, Maamor N, Wan Hashim WF
    Ann Otol Rhinol Laryngol, 2017 Oct;126(10):697-705.
    PMID: 28845678 DOI: 10.1177/0003489417727547
    OBJECTIVES: Studies in cognitive aging demonstrated inconsistent association between hearing and cognition in older adults. Furthermore, it is still unclear if hearing loss at high frequencies, which is the earliest to be affected, is associated with cognitive functioning. This study aimed to determine the association between global cognitive status and pure tone average (PTA) at 0.5, 1, and 2 kHz (PTA low) and PTA at 4 and 8 kHz (PTA high).

    METHODS: This study involved 307 adults aged 60 years and older. Participants had their hearing and cognition measured using pure tone audiometry and Mini Mental State Examination (MMSE), respectively.

    RESULTS: Pure tone average (low) accounted for significant but minimal amount of variance in measure of MMSE. Multiple regression analyses were also performed on normal and impaired hearing cohorts and cohorts with younger (60-69 years) and older (≥70 years) groups. The results revealed a significant relationship between PTA (low) and MMSE only in the younger age group. In contrast, no significant relationship was found between PTA (high) and cognition in any of the cohorts.

    CONCLUSION: Pure tone average (low) is significantly but minimally related to measure of general cognitive status. Similar relationship is not observed between high-frequency hearing and cognition. Further research using a more comprehensive cognitive test battery is needed to confirm the lack of association between high-frequency hearing and cognition.

  8. Umat C, Mukari SZS, Nordin N, A/L Annamalay T, Othman BF
    Int J Pediatr Otorhinolaryngol, 2018 Apr;107:69-74.
    PMID: 29501315 DOI: 10.1016/j.ijporl.2018.01.031
    OBJECTIVES: The aims of the study were to compare the mainstream school readiness skills of young cochlear implant (CI) users to that of a group of normal hearing (NH) children and assessed the inter-rater agreement between parents and teachers on school readiness skills of the CI children.

    METHODS: A total of 11 parents and 8 teachers of the 6-year old CI children participated and rated the children using the School Readiness Scale to Year One. Data from 207 6-year old NH children from five states in Malaysia were also collected using the same scale which has nine domains. Results from the NH children were categorized into the 25th and 75th percentile scores to be the reference cut-offs for below average (below the 25th percentile), average (25th to 75th percentile) and above average (above 75th percentile).

    RESULTS: The school readiness skills of the CI children were lower than the NH group as rated by teachers especially in the civic and language and communication domains. Comparisons between parents' and teachers' ratings for 8 CI children indicated that teachers tended to rate the CI children's school readiness poorer than that of parents especially in the academic domain. Intra-class correlation analysis revealed poor inter-rater agreement.

    CONCLUSIONS: The results suggest that our CI children, generally, need an intervention 'bridging' program to improve their school readiness skills. Parents and teachers had different views on the readiness of the CI children at school entry level.

  9. Ooi TC, Ishak WS, Sharif R, Shahar S, Rajab NF, Singh DKA, et al.
    Clin Interv Aging, 2021;16:2033-2046.
    PMID: 34949916 DOI: 10.2147/CIA.S340432
    Purpose: This study evaluates the prevalence of and the multidimensional risk factors associated with age-related hearing loss (ARHL) among community-dwelling older adults in Malaysia.

    Patients and Methods: A total of 253 participants aged 60 years and above participated in this cross-sectional study. The participants were subjected to pure tone audiometric assessment. The hearing threshold was calculated for the better ear and classified into pure-tone average (PTA) for the octave frequencies from 0.5 to 4 kHz and high-frequency pure-tone average (HFA) for the octave from 2 to 8kHz. Then, the risk factors associated with PTA hearing loss (HL) and HFAHL were identified by using multivariate logistic regression analysis.

    Results: The prevalence of ARHL based on PTA and HFA among the community-dwelling older adults was 75.5% and 83.0%, respectively. Following multifactorial adjustments, being older (OR: 1.239; 95% CI: 1.062-1.445), having higher waist circumference (OR: 1.158; 95% CI: 1.015-1.322), lower intake of niacin (OR: 0.909; 95% CI: 0.831-0.988) and potassium (OR: 0.998; 95% CI: 0.996-1.000), and scoring lower in RAVLT T5 (OR: 0.905; 95% CI: 0.838-0.978) were identified as the risk factors of PTAHL. Meanwhile, being older (OR: 1.117; 95% CI: 1.003-1.244), higher intake of carbohydrate (OR: 1.018; 95% CI: 1.006-1.030), lower intake of potassium (OR: 0.998; 95% CI: 0.997-0.999), and lower scores on the RAVLT T5 (OR: 0.922; 95% CI: 0.874-0.973) were associated with increased risk of having HFAHL.

    Conclusion: Increasing age, having higher waist circumference, lower intake of niacin and potassium, higher intake of carbohydrates and having lower RAVLT T5 score were associated with increased risk of ARHL. Modifying these risk factors may be beneficial in preventive and management strategies of ARHL among older persons.

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