Michelene N. Chenault

Societal effects of hearing aid fitting among the moderately hearing impaired.

The objective of this study was to evaluate hearing aid fitting from a societal viewpoint, rather than the more traditional patient perspective. The effects of hearing aid fitting on generic quality of life (EuroQol), social functioning (SF36), auditory disability, productivity at paid and unpaid labour, and medical consumption, were assessed in a prospective study among 80 moderately hearingimpaired first-time hearing aid applicants. The study showed that hearing aid fitting solved problems with paid employment, but did not seem to affect unpaid work. Use of medical services remained relatively stable after first-time hearing aid fitting. The Amsterdam Inventory proved to be a useful questionnaire to assess the effects on hearing disability. No effects of hearing aid fitting on generic quality of life could be determined with the EuroQol, while hearing aid fitting did lead to an improvement in one aspect of generic quality of life; namely social functioning. El objetivo de este estudio fue evaluar la adaptación de auxiliares auditivos desde un punto de vista social, más que desde la perspective tradicional del paciente. Los efectos de la adaptación de auxiliares auditivos en la calidad genérica de vida (EuroQWol), funcionamiento social (SF36), discapacidad auditiva, productividad en el trabajo remunerado o no remunerado, además de gastos médicos, fueron evaluados en un estudio prospectivo con 80 pacientes con impedimentos auditivos moderados a quienes se les adaptó por primera vez un auxiliar auditivo. El estudio mostró que la adaptación de auxiliares auditivos resuelve problemas en los empleos remunerados pero no parece afectar el trabajo sin remuneración. El uso de servicios médicos permaneció relativamente estable después de la primera adaptación. El cuestionario Amsterdam probó ser un instrumento útil para evaluar los efectos en la discapacidad auditiva. No se pudieron determinar los efectos de la adaptación de auxiliares auditivos en la calidad genérica de vida por medio del EuroQol, mientras que la adaptación de auxiliares auditivos condicionó la mejoría en un aspecto de la calidad genérica de vida, que es concretamente, el funcionamiento social.

Otitis Media and Speech-in-Noise Recognition in School-Aged Children

The present study examined the long-term consequences of otitis media (OM) on speech perception abilities in noise. 55 children with a prospective 3-monthly documented middle-ear status and hearing loss between birth and 24 months completed a ‘speech-in-noise’ (SPiN) test at the age of 7 years. Both hearing loss and the cumulation of uni- and bilateral OM incidents in early life were significantly correlated to the performance on the SPiN test at school age. Other background factors such as socio-economic status, language perception and cognitive development did not predict the performance on the SPiN test. Only the language production score at age 7 was also significantly related to the score on the SPiN test. The present study deals with the risk of OM in early life and its accompanied hearing loss on auditory processing, specifically speech perception in noise, up to school age.

Speech Perception after Early-Life Otitis Media with Fluctuating Hearing Loss

The present study examined the effect of early-life otitis media and its associated fluctuating hearing loss on categorical speech perception in 7-year-old Dutch children. The middle ear status of these children had been followed prospectively in their first 2 years of life. Identification and discrimination of speech sounds differing in place of articulation were tested at school age and outcomes were significantly related to otitis media-related hearing loss. Results revealed that phoneme identification and discrimination were affected by early-life hearing loss. It is not otitis media per se, but rather the relative severity of hearing loss resulting from early-life otitis media which is related to poorer categorical speech perception abilities in school-age children.

Willingness to pay for a hearing aid: comparing the payment scale and open-ended question.

RATIONALE & OBJECTIVES Different question formats elicit different willingness-to-pay (WTP) results, but there is no consensus on which method elicits the most valid WTP. In spite of the methodological controversies, WTP is a potentially valuable tool in health economics to value health services. Our general objective was to provide additional evidence on the validity of two WTP elicitation formats: the open-ended question and the payment scale. METHODS We elicited WTP for a hearing aid among hearing aid users (n = 108), using both a payment scale and an open-ended question. We compared the results from both formats. We tested criterion validity by comparing both formats with the actual out-of-pocket payment. Construct validity was tested by examining whether WTP was consistent with positive income elasticity. RESULTS The WTP results elicited with the payment scale and open-ended question were not statistically significantly different. Both formats showed good criterion validity, although the open-ended question showed a stronger association with the actual out-of-pocket payment. The open-ended format showed better construct validity, as it was influenced by family income. CONCLUSION The results of the present study showed that the open-ended question was more valid than the payment scale question. We, therefore, recommend that in future WTP studies on hearing aids the open-ended question is used to directly elicit WTP values. The same recommendation may apply to other studies where respondents are familiar with costs or payments for the intervention under evaluation.

Otoacoustic emissions at compensated middle ear pressure in children

Middle ear pathology has a negative effect on the detectability of otoacoustic emissions. In this study, we investigated the effect of compensating a deviant static middle ear pressure while measuring transient evoked otoacoustic emissions (TEOAEs). In 59 children (mean age 4 years, 5 months) TEOAEs were measured twice in one session: first at ambient pressure and than at compensated middle ear pressure. On average, TEOAE amplitudes increased by 1.9 dB as a result of middle ear pressure compensation. The amplitude increase was largest in frequency bands centred at 1 and 2 kHz and a statistically significant correlation was found between the amount of compensated pressure and the TEOAE amplitude increase. In the higher frequency bands centred at 3 and 4 kHz, TEOAE amplitudes were almost insensitive to pressure compensation. These results show that measuring OAEs at compensated middle ear pressure enhances the amplitude of TEOAEs, and thus improves the detectability.

Optimizing Intracochlear Electrical Stimulation to Suppress Tinnitus

Objectives: Research on tinnitus suppression by intracochlear electrical stimulation has gained interest over the past few decades and it has become easier to apply since the introduction of cochlear implants (CI). This study attempted to gain more insight into optimal stimulation characteristics for tinnitus suppression. Design: Eleven subjects with unilateral CI and tinnitus were recruited from our CI clinic. Electrical stimulation, independent of acoustic sounds, was generated using their CI. The current prospective (single blinded) experimental study systematically assessed two stimulation parameters, namely current level and the anatomical stimulation site inside the cochlea and their short-term effect on tinnitus. Results: Approximately one-third of the tested conditions were successful in which case tinnitus loudness was reduced by at least 30%. At least one successful condition was achieved for nine subjects (82%). Complete suppression was achieved in 6 out of 107 tested conditions (6%). The effect of subthreshold electrical stimulation on tinnitus suppression did not differ significantly from above threshold electrical stimulation. However, a positive relation between mean percentage tinnitus suppression and current level was observed. Pitch-matched electrical stimulation did not appear to suppress tinnitus better than other tested conditions. Conclusions: The majority of the subjects were able to experience tinnitus reduction through intracochlear electrical stimulation independent of acoustic sounds. Tinnitus can be reduced with audible or even inaudible, subthreshold stimuli. Clear trends in optimal stimulation characteristics were not found. Optimal stimulus characteristics for tinnitus reduction therefore appear to be highly subject-specific.

Informed consent and nurses’ roles A survey of Indonesian practitioners

Background: In Southeast Asia, the process of obtaining informed consent is influenced by both culture and policy at the hospital and national level. Both physicians and nurses play vital roles in this process, but physicians influence the roles of nurses. Objectives: Since the physicians and nurses often have different perspectives, it is important to investigate their views about the informed consent process and nurses’ roles therein and whether there is a difference between ideal and experienced practice (reality), and whether this differs across hospitals. Methods: A questionnaire was developed and a survey was conducted among physicians and nurses. Using exploratory factor analysis a three factor structure was determined: ‘nurses’ roles’, ‘barriers in informed consent’, and ‘adequacy of information’. Non-parametric tests were applied to compare nurses and physicians, and hospital setting. Participants and research context: Responses were obtained from 129 physicians and 616 nurses from two Indonesian hospitals. Those hospitals differ in ownership, location, and size. Ethical consideration: The study was reviewed by the hospital ethical committee. Participation was voluntary and confidentiality was ensured by keeping the responses anonymous. Findings: Physicians and nurses differ significantly on all three factors. The scores reflecting disparity between ideal and reality regarding nurses’ roles varied across professions, while barriers in informed consent differed between hospitals. Discussion: The differences between ideal and reality indicated that improvement in the informed consent process and nurses’ roles therein is called for. Varying views between physicians and nurses on nurses’ roles may hinder collaboration. The differences between hospital settings showed interventions may have to be customized for different settings. Conclusion: Views on nurses’ roles vary across professions. Views on barriers in informed consent vary across hospitals. Therefore interprofessional education is needed to promote interprofessional collaboration and intervention to improve informed consent practice should be tailored to the hospital context.

Functional impairment of the auditory pathway after perinatal asphyxia and the short-term effect of perinatal propofol anesthesia in lambs

Background:Sensorineural hearing loss (SNHL) is a common feature in the postasphyxial syndrome in newborns. Several anesthetic drugs have been proposed to attenuate secondary neuronal injury elicited by hypoxia–ischemia. We hypothesized that propofol anesthesia reduces auditory impairment after perinatal asphyxia in comparison with isoflurane.Methods:Twenty-three pregnant ewes were randomized to propofol or isoflurane anesthesia and sedation. The lambs underwent in utero umbilical cord occlusion (isoflurane n = 5; propofol n = 7) and were compared with sham-treated animals (isoflurane n = 5; propofol n = 6) at a gestational age of 133 d. For 8 h after delivery by cesarean section, repeated auditory brainstem responses (ABRs) were recorded to obtain hearing thresholds, peak amplitudes, latencies, and interpeak latencies.Results:Significantly elevated mean thresholds, diminished amplitudes, and elevated latencies were observed in the asphyxia group relative to the control group through the observation period. Comparison of anesthetic treatment in the asphyxia group revealed a significantly lower elevation in threshold and less impairment in the ABR amplitudes and latencies during propofol anesthesia as compared with isoflurane anesthesia.Conclusion:Our results support the hypothesis that anesthesia with propofol has a preventive effect on the functional changes to the auditory pathway in the event of perinatal asphyxia.

Amplitude Modulation Detection and Speech Recognition in Late-implanted Prelingually and Postlingually Deafened Cochlear Implant Users

Objectives: Many late-implanted prelingually deafened cochlear implant (CI) patients struggle to obtain open-set speech understanding. Because it is known that low-frequency temporal-envelope information contains important cues for speech understanding, the goal of this study was to compare the temporal-envelope processing abilities of late-implanted prelingually and postlingually deafened CI users. Furthermore, the possible relation between temporal processing abilities and speech recognition performances was investigated. Design: Amplitude modulation detection thresholds were obtained in eight prelingually and 18 postlingually deafened CI users, by means of a sinusoidally modulated broadband noise carrier, presented through a loudspeaker to the CI user’s clinical device. Thresholds were determined with a two-down-one-up three-interval oddity adaptive procedure, at seven modulation frequencies. Phoneme recognition (consonant-nucleus-consonant [CNC]) scores (percentage correct at 65 dB SPL) were gathered for all CI users. For the prelingually deafened group, scores on two additional speech tests were obtained: (1) a closed-set monosyllable-trochee-spondee test (percentage correct scores at 65 dB SPL on word recognition and categorization of the suprasegmental word patterns), and (2) a speech tracking test (number of correctly repeated words per minute) with texts specifically designed for this population. Results: The prelingually deafened CI users had a significantly lower sensitivity to amplitude modulations than the postlingually deafened CI users, and the attenuation rate of their temporal modulation transfer function (TMTF) was greater. None of the prelingually deafened CI users were able to detect modulations at 150 and 200 Hz. High and significant correlations were found between the results on the amplitude modulation detection test and CNC phoneme scores, for the entire group of CI users. In the prelingually deafened group, CNC phoneme scores, word scores on the monosyllable-trochee-spondee test, and speech tracking scores correlated significantly with the mean amplitude modulation detection threshold of the modulation frequencies between 5 and 100 Hz and with almost all separate amplitude modulation thresholds. High correlations with these speech measures were also found for the attenuation rate of and the surface area below the TMTF. In postlingually deafened CI users, CNC phoneme scores only correlated significantly with the 100-Hz and 150-Hz amplitude modulation thresholds, as well as with the attenuation rate of and surface area below the TMTF. Conclusions: Prelingually deafened CI users were less sensitive to temporal modulations than postlingually deafened CI users, and the attenuation rate of their TMTF was steeper. For all CI users, subjects with better amplitude modulation detection skills tended to score better on measures of speech understanding. Significant correlations with low modulation frequencies were found only for the prelingually deafened CI users and not for the postlingually deafened CI users.

Help-Seeking Behavior for Children with Acute Respiratory Infection in Ethiopia: Results from 2011 Ethiopia Demographic and Health Survey.

Background Acute respiratory infection is a major contributor to morbidity and mortality among children under five years of age in Ethiopia. While facilities have been implemented to address this problem they are underused due to a lack in help-seeking behavior. This study investigates factors related to the help-seeking behavior of mothers for children with acute respiratory infection using data from the 2011 Ethiopia Demographic and Health Survey. Methods Data on 11,030 children aged 0–59 months obtained through interviewing women aged 15–49 years throughout Ethiopia was available. Descriptive statistics and logistic regression analyses were performed to determine which factors are related to help-seeking behavior for acute respiratory infection. Results In the two weeks prior to the survey, 773(7%) of the children were reported to have symptoms of acute respiratory infection while treatment was sought for only 209 (27.2%). The odds ratio for acute respiratory infection was 1.6 (95% CI: 1.2–2.0) for rural residence with only 25.2% of these mothers seeking help compared to 46.4% for mothers with an urban residence. Smaller family size, younger mothers’ age and having had prenatal care had a statistically significant odds ratio greater than 1 for both urban and rural residences. Highest wealth index had a statistically significant odds ratio greater than 1 for rural residence only, whereas primary education or higher had a statistically significant odds ratio greater than 1 for urban residence. Conclusions Children from rural areas are more at risk for acute respiratory infection while their mothers are less likely to seek help. Nevertheless, there is also underuse of available services in urban areas. Interventions should target mothers with less education and wealth and older mothers. Expanding prenatal care among these groups would encourage a better use of available facilities and subsequently better care for their children.