Charles E. Bishop

The current status of audiologic rehabilitation for profound unilateral sensorineural hearing loss

Audiologic rehabilitation of individuals with profound unilateral sensorineural hearing loss (USNHL) has traditionally been limited to the use of air‐conduction contralateral routing of sound (CROS) hearing aids. Treatment for these individuals has expanded with new applications of the bone‐anchored hearing aid (BAHA), transcranial hearing aid (t‐CROS), and the cochlear implant. In this article, the authors review the literature that addresses these various treatment options.

Relationship between dietary quality, tinnitus and hearing level: data from the national health and nutrition examination survey, 1999–2002

Abstract Objective: To examine the relationship between the healthy eating index (HEI), a measure of dietary quality based on United States Department of Agriculture recommendations and report of tinnitus. Design: This cross-sectional analysis was based on HEI data and report of tinnitus. Study sample: Data for adults between 20 and 69 years of age were drawn from the National Health and Nutrition Examination Survey (NHANES), 1999–2002. The NHANES is a programme of studies, to assess the health and nutritional status of adults and children in the United States. Two thousand one hundred and seventy-six participants were included in the analytic sample. Results: Of the sample, 21.1% reported tinnitus within the past year and 11.7% reported persistent tinnitus, defined as tinnitus experienced at least monthly or greater. Controlling for age, sex, race/ethnicity, diabetes, noise exposure and smoking status, we found that with healthier diet (poorer vs. better HEI) there was decreased odds of reported persistent tinnitus [odds ratio (OR); 0.67; 95% confidence interval (CI) 0.45–0.98; p = 0.03].Conclusions: The current findings support a possible relationship between healthier diet quality and reported persistent tinnitus.

Relationships among measures of physical activity and hearing in African Americans: The Jackson Heart Study.

To evaluate the relationships among measures of physical activity and hearing in the Jackson Heart Study.

Relationship of stroke risk and hearing loss in African Americans: The Jackson Heart Study

To evaluate the relationships among measures of stroke risk and hearing in an African American cardiovascular study cohort.

Patient Complexity Charge Matrix for Audiology Services: A New Perspective on Unbundling.

Traditional approaches to unbundling hearing aid services often take existing bundled charges and then separate the charges across all potential services associated with dispensing the devices. However, this method results in every patient being charged the same amount even though the complexity of the service varies across patients. We describe a model of charging for hearing aid services that takes into account three elements associated with patient services (i.e., assessing hearing status, audiologic decision making and interpretation, and counseling and treatment options) and two levels of complexity (straightforward and complex). Using this approach, there is negligible long-term financial impact on a practice however patients will perceive a lower overall cost for amplification. Additionally, this approach provides a payment structure more representative of the professional value of each visit.

Tinnitus and its risk factors in african americans: The Jackson Heart Study: Tinnitus Risk Factors in African Americans

To describe the prevalence of reported tinnitus and tinnitus handicap in the all–African American Jackson Heart Study (JHS) cohort, with assessment of the relationship to cardiometabolic risk and depression.

Outcomes of Hearing Aid Use by Individuals with Unilateral Sensorineural Hearing Loss (USNHL)

Background: Unilateral sensorineural hearing loss (USNHL) can have a negative impact on functions associated with the advantages of balanced, binaural hearing. Although single‐sided deafness, which is a complete loss of audibility in one ear, has gained increased interest in the published research, there is a gap in the literature concerning hearing aid outcomes for individuals with residual, or otherwise “aidable,” hearing in the affected ear. Purpose: To assess hearing aid outcomes for a group of individuals with USNHL with residual, aidable function. Research Design: A quasi‐experimental study of hearing aid outcomes with paired comparisons made between unaided and aided test conditions. Study Sample: A convenience sample of twenty‐two individuals with USNHL, with sufficient residual hearing in the affected ear as to receive audibility from use of a hearing aid, were recruited into the study from September 2011 to August 2012. Intervention: Each participant was fit with a digital behind‐the‐ear hearing aid coupled to a custom ear mold. Data Collection and Analysis: Assessments were performed at baseline (unaided) and after a three‐month field trial (aided) with primary outcomes involving objective measures in sound field yielding signal‐to‐noise ratio loss (SNR Loss) via the Quick Speech‐in‐Noise Test and word recognition scores (WRS) via the Northwestern University Auditory Test, No. 6. Outcomes also involved the administration of two well‐established subjective benefit questionnaires: The Abbreviated Profile of Hearing Aid Benefit (APHAB) and the 49‐item Speech, Spatial, and Qualities of Hearing Scale (SSQ49). Results: As a group, participants showed significantly improved median SNR Loss thresholds when aided in a test condition that included spatial separation of speech and noise, with speech stimuli directed toward the worse ear and noise stimuli directed toward the better ear (diff. = −4.5; p < 0.001). Hearing aid use had a small, though statistically significant, negative impact on median SNR Loss thresholds, when speech and noise stimuli originated from the same 0° azimuth (diff. = 1.0; p = 0.018). This was also evidenced by the median WRS in sound field (diff. = −6.0; p = 0.006), which was lowered from 98% in the unaided state to 92% in the aided state. Results from the SSQ49 showed statistically significant improvement on all subsection means when participants were aided (p < 0.05), whereas results from the APHAB were generally found to be unremarkable between unaided and aided conditions as benefit was essentially equal to the 50th percentile of the normative data. At the close of the study, it was observed that only slightly more than half of all participants chose to continue use of a hearing aid after their participation. Conclusions: We observed that hearing aid use by individuals with USNHL can improve the SNR Loss associated with the interference of background noise, especially in situations when there is spatial separation of the stimuli and speech is directed toward the affected ear. In addition, hearing aid use by these individuals can provide subjective benefit, as evidenced by the APHAB and SSQ49 subjective benefit questionnaires.

Self reported hearing difficulty, tinnitus, and normal audiometric thresholds, the National Health and Nutrition Examination Survey 1999–2002

Abstract Perceived hearing difficulty (HD) and/or tinnitus in the presence of normal audiometric thresholds present a clinical challenge. Yet, there is limited data regarding prevalence and determinant factors contributing to HD. Here we present estimates generalized to the non‐institutionalized population of the United States based on the cross‐sectional population‐based study, the National Health and Nutrition and Examination Survey (NHANES) in 2176 participants (20–69 years of age). Normal audiometric thresholds were defined by pure‐tone average (PTA4) of 0.5, 1.0, 2.0, 4.0 kHz ≤ 25 dBHL in each ear. Hearing difficulty (HD) and tinnitus perception was self‐reported. Of the 2176 participants with complete data, 2015 had normal audiometric thresholds based on PTA4; the prevalence of individuals with normal PTA4 that self‐reported HD was 15%. The percentage of individuals with normal audiometric threshold and persistent tinnitus was 10.6%. Multivariate logistic regression adjusting for age, sex, and hearing thresholds identified the following variables related to increased odds of HD: tinnitus, balance issues, noise exposure, arthritis, vision difficulties, neuropathic symptoms, physical/mental/emotional issues; and for increased odds or reported persistent tinnitus: HD, diabetes, arthritis, vision difficulties, confusion/memory issues, balance issues, noise exposure, high alcohol consumption, neuropathic symptoms and analgesic use. Analyses using an alternative definition of normal hearing, pure‐tone thresholds ≤25 dBHL at 0.5, 1.0, 2.0, 4.0, 6.0, and 8.0 kHz in each ear, revealed lower prevalence of HD and tinnitus, but comparable multivariate relationships. The findings suggest that prevalence of HD is dependent on how normal hearing is defined and the factors that impact odds of reported HD include tinnitus, noise exposure, mental/cognitive status, and other sensory deficits. HighlightsThe prevalence of hearing difficulty (HD) and persistent tinnitus (PT) was 15% and 10.6% limited to persons with normal audiometric thresholds.The prevalence was dependent on how normal audiometric threshold was defined. More stringent criteria resulted in lower prevalence estimates.Multivariate models indicated tinnitus, balance, noise, arthritis, vision, neuropathy, and physical/mental issues were related to HD.Multivariate models indicated HD, diabetes, balance, noise, arthritis, vision, neuropathy, and analgesics were related to PT.

Hearing Aid Use by Unilaterally Impaired Individuals: Outcome of the Tinnitus Handicap Inventory

Tinnitus is a problem commonly associated with unilateral sensor neural hearing impairments; however, little has been published on the most efficacious approach to treating tinnitus in this population. Previous studies have shown that hearing aids are beneficial in treating tinnitus in individuals with hearing loss, but this has not been thoroughly assessed in individuals with strictly unilateral sensor neural impairments. This is a pertinent area of investigation as conditions that commonly result in unilateral sensor neural hearing loss may lead to different outcomes. Between September 2011 and August 2012, 16 individuals with unilateral sensor neural hearing loss and tinnitus were dispensed a hearing aid for a three month field trial. Each participant was given the Tinnitus Handicap Inventory (THI) in pre- and posthearing aid fitting conditions. Differences in THI total scores as well as sub-scale item scores were assessed between test conditions. The amount of reduction in individual THI sub-scale item group scores varied greatly between test conditions. The items with an ‘unaided’ starting score of 38 or higher, and saw the greatest reduction from ‘unaided’ to ‘aided’ conditions, involved the impact of tinnitus on hearing function. Paired differences t-test of THI total score group means was significantly reduced (p<0.05) from the ‘unaided’ to the ‘aided’ condition. A similar result was seen with the visual analog scale (VAS). A statistically significant positive correlation was observed between the THI total score and the VAS in both test conditions. The current study demonstrated that use of a hearing aid by individuals with unilateral sensorineural hearing loss may lessen the handicapping effects of tinnitus. Consistent with existing literature in the area, observed benefits were variable with some individuals reporting greater benefit than others. The reason for this variability is not clearly understood.