Associate Professor Joseph Kei

Associate Professor in Audiology

School of Health and Rehabilitation Sciences
Faculty of Health and Behavioural Sciences
k.kei@uq.edu.au
+61 7 336 52824

Overview

I am the Founder and Director of the Hearing Research Unit for Children, leading three research teams investigating (1) middle ear assessments in neonates and infants, (2) hearing screening and diagnostic assessment of school-aged children, and (3) assessment of auditory function of adults and children using electrophysiologic measures including otoacoustic emissions, auditory brainstem response, steady-state evoked potentials, wideband absorbance and wideband tympanometry. My special interest in technological advances and my mission to improve hearing health services through the use of cutting-edge technologies have inspired me to become a world leader in detecting ear diseases in newborns, infants and children. As a world leader in the field of tympanometry and advanced middle ear assessments for children, I have been invited to present on the use of wideband tympanometry with infants and children at international seminars and institutions.

As of July 2024, I have a career total of 249 publications - consisting of 1 book, 4 book chapters, 2 chapters in the Encyclopedia of Human Communication Sciences and Disorders, 132 peer-reviewed journal papers and 110 conference abstracts. Internationally, I am ranked as the most productive author in the world in the field of Tympanometry (a test of middle ear function) and advanced middle ear assessments for all years (1994-2024) and for the last 5 years (Web of Science, February 2024). My work has been cited in 25 different subject categories including Medicine, Health Professions, Neuroscience, Physics, Astronomy, Engineering and Computer Science (Scopus, February 2024). Furthermore, my work has been widely cited internationally by authors in 83 countries ranging from the United States to Europe, Asia and the Middle East (Scopus, February 2024).

Research Interests

  • Assessment of outer and middle ear function in infants and children
    With my background in physical sciences, I am interested in the use of advanced technology to assess the function of the outer ear and middle ear in infants and children. Currently, I am investigating the use of an innovative wideband absorbance technology to detect otitis media in infants and children.
  • Assessing hearing ability in children with learning difficulties
    Children who experience poor academic performance at school have been described as having learning difficulties (LD). Recent studies indicate that these children are at high risk for peripheral and central hearing deficits. I am interested in investigating whether hearing deficits affect the learning ability of these children.
  • Assessment of outer and middle ear function in children with Aboriginal and Torres Strait Islanders background using wideband tympanometry
    Children with Aboriginal and Torres Strait Islanders (ATSI) background are more susceptible to middle ear infection than non-ATSI children. Wideband absorbance (WBA) is an innovative technology to evaluate outer/middle ear function in children. I am interested in applying this technology to ATSI children in North Queensland.

Research Impacts

Prior to 2000, there were no efficient tests of middle ear function for neonates. There was a delay of 7 months in diagnosing middle ear effusion (MEE) in newborns. To address this shortcoming, our research program investigated the use of advanced technologies to detect MEE in newborns. To date, our research program has contributed to improving the health services, policy and guidelines for clinical practice in three phases as shown below.

(1) The successful application of high frequency tympanometry (HFT) to neonates did not only make detection of MEE earlier by 7 months, but it also facilitated early intervention to reduce the risk of chronic otitis media and eardrum perforation. My research team was the first in the world to publish the article, Kei et al. (2003), on the successful use of HFT with healthy newborns. This study has been cited 81 times in publications from 117 institutions around the world, including highly ranked universities such as Harvard Medical School and Albert Einstein College of Medicine of Yeshiva University. Subsequently, the Joint Committee on Infant Hearing (JCIH) Year 2007 Position statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs recommended the use of HFT with newborns. In 2012, I published a book [Kei, J. & Zhao, F. (Eds.) Assessing Middle Ear Function in Infants. San Diego: Plural Publishing] which describes all available methods to detect conductive conditions in infants. This book is being held in 1094 libraries worldwide (WorldCat, Feb 2024) and is currently a useful reference for postgraduate audiology students and clinicians around the world.

(2) Before 2009, the traditional acoustic stapedial reflex (ASR) test was not performed on newborns in any part of the world because it could not reliably predict MEE and auditory neuropathy spectrum disorders. I investigated the use of an advanced technology (high-frequency ASR test) with newborns and young infants, and published three articles at national and international journals from 2009 to 2012. In particular, the Kei (2012) article which established clinical guidelines and standards for testing neonates, attracted international attention and was cited in JCIH (2019), American Academy of Audiology Clinical Guidance Document: Assessment of Hearing in Infants and Young Children (2020), and World Health Organization & International Telecommunication Union (‎2019).

(3) Since 2009, I have been investigating the use of an innovative wideband absorbance (WBA) technology with neonates and infants in Australia. WBA tests are objective measures of outer/middle ear function across a range of frequencies from 0.25 to 8 kHz. WBA has been shown to be more sensitive than traditional tympanometry in the assessment of middle ear function in newborns and infants. Recent research in WBA has indicated age-related changes in middle ear function in children aged 0-13 years, suggesting that age-specific WBA norms are necessary for accurate detection of outer/middle ear diseases in children.

However, despite its merits, the uptake of the WBA technology by clinicians is low. One of the barriers to the widespread use of the technology by clinicians is the difficulty in interpreting WBA results. To tackle this problem, I have worked with imminent scientists from Australia, Canada and USA to publish a series of articles in Seminars in Hearing 2023: 44. Overall, my research in WBA has made a strong impact on the international policy and guidelines such as the JCIH (2019) and American Academy of Audiology Clinical Guidance Document (2020).

Qualifications

  • Doctor of Philosophy, The University of Queensland
  • Postgraduate Diploma in Audiology, University of Melbourne
  • Postgraduate Diploma, University of Melbourne
  • Bachelor (Honours) of Science (Advanced), University of Hong Kong

Publications

View all Publications

Available Projects

  • This is a PhD project.

    Otitis media (OM), inflammation of the middle ear, affects 80% of Australian children overall by the age of 3 years. Clinically, OM can be broadly classified into acute otitis media (AOM) and otitis media with effusion (OME). AOM is the second most common cause for a visit to the medical doctor. With bacterial infection, the onset of AOM is usually abrupt, with fever and irritability being the common symptoms. Children with AOM is usually treated with antibiotics, and it is the single diagnosis responsible for most prescriptions of antibiotics. OME is the most common cause of acquired hearing loss in childhood with 80% of all children under 4 years old have had at least one episode of the disease. OME is insidious with no obvious infection symptoms apart from a mild to moderate hearing loss.

    Otitis media is mostly diagnosed with the use of an otoscope, allowing the medical doctor to get a visual image of the tympanic membrane. Ear-Nose-Throat specialists (ENTs) usually use more advanced and specialized otoscopes to make a diagnosis. Modern otoscopes are equipped with digital cameras, making the images suited for automated detection of OM. Research has indicated that paediatricians correctly distinguished among No-OM, OME, and AOM 50% of the time, while the accuracy of the ENTs was 75%. These results indicate the need for ENTs or properly trained primary care physicians to better diagnose otitis media. The aim of this research is to evaluate the predictive accuracy of classifying No-OM, OME, and AOM in otoscopic images obtained from children using a machine learning (artificial intelligence) approach.

  • This is a PhD project.

    Hearing Australia provides hearing aids for children with hearing loss. While appropriate amplifications are needed for children with chronic otitis media (OM) to reduce the effects of auditory deprivation on speech, language, psychological and cognitive development, the uptake and low use of hearing aids by these children presents a challenge to audiologists and professionals working with their families. As these children may experience chronic OM and otorrhoea (discharging ear), they are prescribed with a bone-conduction hearing aid (BCHA), whereby a transducer (bone vibrator) has to be held tightly against the mastoid bone using a headband. However, there are disadvantages in using the BCHAs resulting in low uptake and use of these aids. To overcome the shortcomings of BCHAs, Professor Hosoi of Nara Medical School in Japan developed a new behind-the-ear cartilage-conduction (CCHA) for use with people with chronic outer and middle ear conditions. As the CCHA does not occlude the ear canal, it would be suitable for children with chronic OM or discharging ears. This project aims to evaluate the functional benefits of wearing a CCHA versus a BCHA in terms of hearing capability and usage by children with chronic OM.

  • This is a Master of Philosophy project.

    Children aged 2-5 years have the highest incidence rates of otitis media (OM).The pathogenesis of OM is multi-factorial with numerous risk factors. An appreciation of the risk factors for OM is crucial as education of the community to mitigate these factors is amongst the most effective strategies to reduce the burden of OM. Although the prevention and treatment of OM in Aboriginal and Torres Strait Islander (ATSI) children have been broadly studied, risk factors for OM in the general population of Australian children have not been systematically investigated. This project aims to identify the risk factors for OM with a view to reduce the incidence of OM in young children.

View all Available Projects

Publications

Book

Book Chapter

Journal Article

Conference Publication

Other Outputs

Grants (Administered at UQ)

PhD and MPhil Supervision

Current Supervision

  • Doctor Philosophy — Associate Advisor

Completed Supervision

Possible Research Projects

Note for students: The possible research projects listed on this page may not be comprehensive or up to date. Always feel free to contact the staff for more information, and also with your own research ideas.

  • This is a PhD project.

    Otitis media (OM), inflammation of the middle ear, affects 80% of Australian children overall by the age of 3 years. Clinically, OM can be broadly classified into acute otitis media (AOM) and otitis media with effusion (OME). AOM is the second most common cause for a visit to the medical doctor. With bacterial infection, the onset of AOM is usually abrupt, with fever and irritability being the common symptoms. Children with AOM is usually treated with antibiotics, and it is the single diagnosis responsible for most prescriptions of antibiotics. OME is the most common cause of acquired hearing loss in childhood with 80% of all children under 4 years old have had at least one episode of the disease. OME is insidious with no obvious infection symptoms apart from a mild to moderate hearing loss.

    Otitis media is mostly diagnosed with the use of an otoscope, allowing the medical doctor to get a visual image of the tympanic membrane. Ear-Nose-Throat specialists (ENTs) usually use more advanced and specialized otoscopes to make a diagnosis. Modern otoscopes are equipped with digital cameras, making the images suited for automated detection of OM. Research has indicated that paediatricians correctly distinguished among No-OM, OME, and AOM 50% of the time, while the accuracy of the ENTs was 75%. These results indicate the need for ENTs or properly trained primary care physicians to better diagnose otitis media. The aim of this research is to evaluate the predictive accuracy of classifying No-OM, OME, and AOM in otoscopic images obtained from children using a machine learning (artificial intelligence) approach.

  • This is a PhD project.

    Hearing Australia provides hearing aids for children with hearing loss. While appropriate amplifications are needed for children with chronic otitis media (OM) to reduce the effects of auditory deprivation on speech, language, psychological and cognitive development, the uptake and low use of hearing aids by these children presents a challenge to audiologists and professionals working with their families. As these children may experience chronic OM and otorrhoea (discharging ear), they are prescribed with a bone-conduction hearing aid (BCHA), whereby a transducer (bone vibrator) has to be held tightly against the mastoid bone using a headband. However, there are disadvantages in using the BCHAs resulting in low uptake and use of these aids. To overcome the shortcomings of BCHAs, Professor Hosoi of Nara Medical School in Japan developed a new behind-the-ear cartilage-conduction (CCHA) for use with people with chronic outer and middle ear conditions. As the CCHA does not occlude the ear canal, it would be suitable for children with chronic OM or discharging ears. This project aims to evaluate the functional benefits of wearing a CCHA versus a BCHA in terms of hearing capability and usage by children with chronic OM.

  • This is a Master of Philosophy project.

    Children aged 2-5 years have the highest incidence rates of otitis media (OM).The pathogenesis of OM is multi-factorial with numerous risk factors. An appreciation of the risk factors for OM is crucial as education of the community to mitigate these factors is amongst the most effective strategies to reduce the burden of OM. Although the prevention and treatment of OM in Aboriginal and Torres Strait Islander (ATSI) children have been broadly studied, risk factors for OM in the general population of Australian children have not been systematically investigated. This project aims to identify the risk factors for OM with a view to reduce the incidence of OM in young children.

  • This is a PhD project.

    Early detection of otitis media (OM) is vital for timely management of the disease. However, diagnosing OM in young children (2-5 years) presents a great challenge to audiologists and otolaryngologists. Traditional audiologic measures such as pure tone audiometry, tympanometry and otoacoustic emission tests are failing to diagnose otitis media with effusion (OME) in young children because these measures are not highly accurate and young children are not always cooperative in undertaking these tests, making the diagnosis of OME unreliable or uncertain. This issue can be addressed by using an innovative wideband tympanometry (WBT) test that is capable of not only showing abnormal middle ear function results due to OME, but also determining if a significant hearing loss is present. This project aims to determine the predictive accuracy of WBT in diagnosing OME in young children using a statistical modelling approach and machine learning algorithms.