Hearing loss and work participation: a cross-sectional study in Norway

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Hearing tests are just child’s play: the sound scouts game for children entering school

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Headphone listening habits, hearing thresholds and listening levels in Swedish adolescents with severe to profound HL and adolescents with normal hearing

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Hearing Aid Use Reduces Hospital and ER Visits in Older Adults

Hearing aid use among older adults is associated with fewer hospitalizations and emergency visits and fewer nights at the hospital, study finds.

Examining the data of 1,336 adults aged 65 to 85 years with severe hearing loss, researchers from University of Michigan found out that the 602 adults (42% of the study participants) who used hearing aids had fewer adverse health events than those who do not use hearing aids.  The study reported that while the difference of the incidence of hospitalization or emergency room visit was only approximately two percentage points, it was large enough to be significant. Also, the research found out that those with hearing aids had shorter stays in the hospital.

The data used came from a self-reported survey by the U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. The researchers had no objective measurement of how severe the participant's hearing loss, the number of hearing aids they use and the how consistently the hearing aids were used. "This was a cross-sectional study and had many limitations, yet I am still very confident about the findings," lead author Dr. Elham Mahmoudi, PhD, MBA. said. "We are involved in a longitudinal analysis of the effect of hearing aids among individuals with severe hearing loss and conducting a cost-effectiveness analysis of hearing aids."

Results of the study included cost implications. The use of hearing aid correlated with reduced Medicare expense, and higher annual health care spending and out-of-pocket spending.

"Hearing aids are not covered by Medicare. If they are covered by insurance, the out-of-pocket costs are relatively high. These financial barriers prevent many individuals from having access to proper hearing aids. Severe hearing loss affects a growing number of individuals, but it is an addressable disability issue. We are hoping that our findings encourage insurers—particularly Medicare—to cover hearing aids and the related care," Mahmoudi explained.

When asked about what inspired the study, Mahnmoudi told The Hearing Journal that it was personal. "My dad is 82 years old and has been suffering from severe hearing loss for many years. Hearing aids are expensive and are not covered by health insurance. If not fitted well by a specialist, they can be noisy and annoying. Consequently, my dad resisted using hearing aids despite his apparent need. As a result, I personally witnessed his hearing difficulty result in social isolation and fewer meaningful conversation with friends and family members. In February 2017, I started working in the Department of Family Medicine. I was amazed that the Chair of our Department, Dr. Phillip Zazove, and another faculty member, Dr. Michael McKee (both co-authors in this manuscript), are deaf yet, with the use of hearing devices, are excellent physicians and researchers. My motivation to complete this study was inspired by them."

Mahmoudi and colleagues are already examining five-year insurance data and patient data from the University of Michigan's academic medical center to further study the issue to see if hearing aids might be, in the longer run, more cost-effective.

Published: 4/27/2018 3:21:00 PM

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Effects of Cerebral Blood Flow and Vessel Conditions on Speech Recognition in Patients With Postlingual Adult Cochlear Implant: Predictable Factors for the Efficacy of Cochlear Implant

Objectives: Cochlear implantation (CI) has been the most successful procedure for restoring hearing in a patient with severe and profound hearing loss. However, possibly owing to the variable brain functions of each patient, its performance and the associated patient satisfaction are widely variable. The authors hypothesize that peripheral and cerebral circulation can be assessed by noninvasive and globally available methods, yielding superior presurgical predictive factors of the performance of CI in adult patients with postlingual hearing loss who are scheduled to undergo CI. Design: Twenty-two adult patients with cochlear implants for postlingual hearing loss were evaluated using Doppler sonography measurement of the cervical arteries (reflecting cerebral blood flow), flow-mediated dilation (FMD; reflecting the condition of cerebral arteries), and their pre-/post-CI best score on a monosyllabic discrimination test (pre-/post-CI best monosyllabic discrimination [BMD] score). Correlations between post-CI BMD score and the other factors were examined using univariate analysis and stepwise multiple linear regression analysis. The prediction factors were calculated by examining the receiver-operating characteristic curve between post-CI BMD score and the significantly positively correlated factors. Results: Age and duration of deafness had a moderately negative correlation. The mean velocity of the internal carotid arteries and FMD had a moderate-to-strong positive correlation with the post-CI BMD score in univariate analysis. Stepwise multiple linear regression analysis revealed that only FMD was significantly positively correlated with post-CI BMD score. Analysis of the receiver-operating characteristic curve showed that a FMD cutoff score of 1.8 significantly predicted post-CI BMD score. Conclusions: These data suggest that FMD is a convenient, noninvasive, and widely available tool for predicting the efficacy of cochlear implants. An FMD cutoff score of 1.8 could be a good index for determining whether patients will hear well with cochlear implants. It could also be used to predict whether cochlear implants will provide good speech recognition benefits to candidates, even if their speech discrimination is poor. This FMD index could become a useful predictive tool for candidates with poor speech discrimination to determine the efficacy of CI before surgery.

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Use of Electrically Evoked Compound Action Potentials for Cochlear Implant Fitting: A Systematic Review

Objectives: The electrically evoked compound action potential (eCAP) is widely used in the clinic as an objective measure to assess cochlear implant functionality. During the past decade, there has been increasing interest in applying eCAPs for fitting of cochlear implants. Several studies have shown that eCAP-based fitting can potentially replace time-consuming behavioral fitting procedures, especially in young children. However, a closer look to all available literature revealed that there is no clear consensus on the validity of this fitting procedure. This study evaluated the validity of eCAP-based fitting of cochlear implant recipients based on a systematic review of the recent literature. Design: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used to search the PubMed, Web of Science, and Cochrane Library databases. The term “eCAP” was combined with “cochlear implants,” “thresholds,” and “levels,” in addition to a range of related terms. Finally, 32 studies met the inclusion criteria. These studies were evaluated on the risk of bias and, when possible, compared by meta-analysis. Results: Almost all assessed studies suffered from some form of risk of bias. Twenty-nine of the studies based their conclusion on a group correlation instead of individual subject correlations (analytical bias); 14 studies were unclear about randomization or blinding (outcome assessment bias); 9 studies provided no clear description of the populations used, for example, prelingually or postlingually implanted subjects (selection bias); and 4 studies had a high rate of loss (>10%) for patients or electrodes (attrition bias). Meta-analysis of these studies revealed a weak pooled correlation between eCAP thresholds and both behavioral T- and C-levels (r = 0.58 and r = 0.61, respectively). Conclusions: This review shows that the majority of the assessed studies suffered from substantial shortcomings in study design and statistical analysis. Meta-analysis showed that there is only weak evidence to support the use of eCAP data for cochlear implant fitting purposes; eCAP thresholds are an equally weak predictor for both T- and C-levels. Based on this review, it can be concluded that research on eCAP-based fitting needs a profound reflection on study design and analysis to draw well-grounded conclusions about the validity of eCAP-based fitting of cochlear implant recipients.

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Combined Amplification and Sound Generation for Tinnitus: A Scoping Review

Objectives: In most cases, tinnitus is accompanied by some degree of hearing loss. Current tinnitus management guidelines recognize the importance of addressing hearing difficulties, with hearing aids being a common option. Sound therapy is the preferred mode of audiological tinnitus management in many countries, including in the United Kingdom. Combination instruments provide a further option for those with an aidable hearing loss, as they combine amplification with a sound generation option. The aims of this scoping review were to catalog the existing body of evidence on combined amplification and sound generation for tinnitus and consider opportunities for further research or evidence synthesis. Design: A scoping review is a rigorous way to identify and review an established body of knowledge in the field for suggestive but not definitive findings and gaps in current knowledge. A wide variety of databases were used to ensure that all relevant records within the scope of this review were captured, including gray literature, conference proceedings, dissertations and theses, and peer-reviewed articles. Data were gathered using scoping review methodology and consisted of the following steps: (1) identifying potentially relevant records; (2) selecting relevant records; (3) extracting data; and (4) collating, summarizing, and reporting results. Results: Searches using 20 different databases covered peer-reviewed and gray literature and returned 5959 records. After exclusion of duplicates and works that were out of scope, 89 records remained for further analysis. A large number of records identified varied considerably in methodology, applied management programs, and type of devices. There were significant differences in practice between different countries and clinics regarding candidature and fitting of combination aids, partly driven by the application of different management programs. Conclusions: Further studies on the use and effects of combined amplification and sound generation for tinnitus are indicated, including further efficacy studies, evidence synthesis, development of guidelines, and recommended procedures that are based on existing knowledge, expert knowledge, and clinical service evaluations.

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