Outcomes of Direct-to-Consumer Hearing Devices for People with Hearing Loss: A Review

As the population of those with mild to moderate hearing loss increases the need remains for amplification solutions. There is a trend to offer alternative amplification options beyond traditional hearing aids. Due to reduced medical risk associated with the most common types of hearing loss (i.e., presbycusis and noise induced), many individuals with such audiological configurations may have success with direct-to-consumer hearing devices (DCHD). The current paper presents a literature review of studies focused on the outcomes of DCHDs for people with hearing loss. Search of electronic databases were used to identify relevant articles for review. Studies on outcomes of DCHDs mainly focused on older adults and reported consistently positive results in clinical and self-reported outcome measures. Improvements in auditory ability, communicative function, social engagement, quality of life, and reduction of self-reported hearing disability were observed. The nature of the direct-to-consumer method makes it challenging to design studies that will accurately represent outcomes for patients due to the extensive dissimilarities in patient journey and device selection options. Accordingly, a majority of the studies conducted on this topic are of low quality of evidence and only provide short-term (i.e., less than one year) outcomes. In addition, results may have been influenced by researcher and/or clinician involvement in choosing the devices and by provision of additional support (i.e., incorporation of a communication partner and communication strategies training). Overall, the literature suggests positive outcomes and self-reported benefit of DCHDs in older adults with hearing loss. However, additional research is needed in this area to verify outcomes.

Ototoxicity: A Challenge in Diagnosis and Treatment

Ototoxicity is the pharmacological adverse reaction affecting the inner ear or auditory nerve, characterized by cochlear or vestibular dysfunction. The panorama of drug-induced hearing loss has widened over last few decades. Although ototoxic medications play an imperative role in modern medicine, they have the capacity to cause harm and lead to significant morbidity. Evidence has shown early detection of toxicity through prospective ototoxicity monitoring allows for consideration of treatment modifications to minimize or prevent permanent hearing loss and balance impairment. Although many ototoxicity monitoring protocols exist, their practicality is questionable due to several factors. Even though the existing protocols have proven to be effective, certain lacunae in practice have been encountered due to discrepancies among recommended protocols. Implementation of these protocols is mostly held back due to the incapacitated status of the patient. The choice of early ototoxicity identification techniques is still debatable due to variables such as high degree of sensitivity, specificity and reliability, less time consumption and less labour-intensive to the patient. Hence, the diagnosis and effective treatment of ototoxicity is challenging, even today. A stringent protocol with more practicality encompassing all elements aimed at profiling the effects of ototoxicity is greatly needed. This review describes an efficient application of ototoxicity monitoring and treatment protocol as an attempt to reduce the challenges in diagnosis and management of ototoxicity.

Examination of Previously Published Data to Identify Patterns in the Social Representation of ‘Hearing Aids’ Across Countries

BACKGROUND AND OBJECTIVES: Societal factors seem to exercise a strong influence on hearing aid uptake, use, and satisfaction. In particular, knowledge, perception, and attitude of people will have bearing towards their and others health behavior and decisions. The current study aimed at understanding the perception of hearing aids by adults belonging to the general population in different countries. SUBJECTS AND METHODS: The study employed a crosssectional design. A sample of 404 adults from India, Iran, Portugal, and the United Kingdom were recruited by relying on a convenience sampling. Previously published data was re-analyzed but it was applied for different approach. Free association task was used to collect the data. They were asked to provide up to five words or phrases that come to mind when thinking about “hearing aids.” The data was initially analyzed based on qualitative content analysis. This was followed by quantitative cluster analysis and chi square analysis. RESULTS: The content analysis suggested 39 main categories of responses related to hearing aids. The cluster analysis resulted in five main clusters, namely: 1) positive attitude, 2) external factors, 3) hearing aid use and satisfaction, 4) etiology, and 5) benefits and limitations of technology. A few demographic factors (i.e., education, occupation type, country) showed association with different clusters, although country of origin seemed to be associated with most clusters. CONCLUSIONS: The study provides us with unique insights into the perception of hearing aids by the general public, and additionally, the way demographic variables may influence these perceptions.

Examination of an Audiologist's Response to Patient's Expression of Symptoms: A Pilot Study

This pilot study explores audiologist-patient interactions during initial evaluations or consultations. In particular, an audiologist's response to patient symptoms is examined. Conversations between audiologist and patients were recorded using a digital recorder, which were transcribed, and analyzed using the Codes for Human Analysis of Transcripts and Child Language Analysis computer programs. Mean length of turn and frequency of utterances related to explicit discussion or description of symptoms or the patient's interpretation of symptoms was determined. Study sample: six audiologist-patient interactions were recorded and transcribed. A single audiologist was used for this pilot investigation. Results suggest that during the initial audiological consultations related to hearing difficulties the audiologist produced more utterances related to explicit description of the symptoms, whereas when during the sessions about complex disorder and hearing aid consultation the audiologist produced more utterances related to the patient's interpretation of the symptoms. Also, a more equitable distribution of words and utterances per turn are observed during the initial consultation about hearing difficulties when compared to complex disorders and hearing aid consultation sessions where the audiologist was dominant within the interaction. This preliminary study reveals unique insights to audiologist's communication behavior during audiology consultation session. Efforts are needed to educate and promote appropriate communication between audiologists' and patients, which could result in increased patient satisfaction.

Auditory Brainstem Response Improvements in Hyperbillirubinemic Infants

BACKGROUND AND OBJECTIVES: Hyperbillirubinemia in infants have been associated with neuronal damage including in the auditory system. Some researchers have suggested that the bilirubin-induced auditory neuronal damages may be temporary and reversible. This study was aimed at investigating the auditory neuropathy and reversibility of auditory abnormalities in hyperbillirubinemic infants. SUBJECTS AND METHODS: The study participants included 41 full term hyperbilirubinemic infants (mean age 39.24 days) with normal birth weight (3,200-3,700 grams) that admitted in hospital for hyperbillirubinemia and 39 normal infants (mean age 35.54 days) without any hyperbillirubinemia or other hearing loss risk factors for ruling out maturational changes. All infants in hyperbilirubinemic group had serum bilirubin level more than 20 milligram per deciliter and undergone one blood exchange transfusion. Hearing evaluation for each infant was conducted twice: the first one after hyperbilirubinemia treatment and before leaving hospital and the second one three months after the first hearing evaluation. Hearing evaluations included transient evoked otoacoustic emission (TEOAE) screening and auditory brainstem response (ABR) threshold tracing. RESULTS: The TEOAE and ABR results of control group and TEOAE results of the hyperbilirubinemic group did not change significantly from the first to the second evaluation. However, the ABR results of the hyperbilirubinemic group improved significantly from the first to the second assessment (p=0.025). CONCLUSIONS: The results suggest that the bilirubin induced auditory neuronal damage can be reversible over time so we suggest that infants with hyperbilirubinemia who fail the first hearing tests should be reevaluated after 3 months of treatment.

Preferences to Patient-Centeredness in Pre-Service Speech and Hearing Sciences Students: A Cross-Sectional Study

BACKGROUND AND OBJECTIVES: Patient-centeredness is a critical approach to rehabilitation in allied health professions and is an imperative component of evidence-based practice. However, it is unknown if patient-centeredness is valued by students enrolled in allied health. This study was aimed at determining preferences to patient-centeredness in pre-service speech and hearing students in the field of speech and hearing sciences. SUBJECTS AND METHODS: Pre-service speech and hearing students (n=93) completed the Patient-Practitioner Orientation Scale (PPOS) and were grouped according to low, medium, or high exposure to curriculum content. RESULTS: Across exposure levels, students exhibited high preference to patient centeredness with a mean PPOS score of 4.13 (standard deviation–0.5). A pairedsample t-test revealed a significant difference (p≤0.0001) between the caring and sharing subscales of the PPOS with lower mean scores on the caring subscale. No significant differences were noted across levels of exposure for sharing subscale, caring subscale, or PPOS full-scale. CONCLUSIONS: Results suggest a need for curriculum enhancement focused on improved caring and empathy.

Positive, Neutral, and Negative Connotations Associated with Social Representation of 'Hearing Loss' and 'Hearing Aids'

BACKGROUND AND OBJECTIVES: In our previous studies we explored the social representation of hearing loss and hearing aids. In this study we aimed at exploring if the positive, neutral and negative connotations associated with the social representation of 'hearing loss' and 'hearing aids' for the same categories vary across countries. In addition, we also looked at if there is an association between connotations and demographic variables. SUBJECTS AND METHODS: A total of 404 individuals from four countries were asked to indicate the words and phrases that comes to mind when they think about 'hearing loss' and 'hearing aids'. They also indicated if the words and phrases they reported had positive, neutral or negative association, which were analyzed and reported in this paper. RESULTS: There are considerable differences among the countries in terms of positive, neutral and negative associations report for each category in relation to hearing loss and hearing aids. However, there is limited connection between demographic variables and connotations reported in different countries. CONCLUSIONS: These results suggesting that the social representation about the phenomenon hearing loss and hearing aids are relatively stable within respondents of each country.

Does Hearing Aid Use Increase the Likelihood of Cerumen Impaction?

BACKGROUND AND OBJECTIVES: Impacted cerumen is a common condition in adults. It is commonly believed that wearing hearing aids may increase the cerumen impaction, although no empirical evidence exist. The current study was aimed at studying if the use of hearing aids increase the likelihood of impaction of cerumen. SUBJECTS AND METHODS: The study used retrospective design. The study sample included 164 consecutive patients who were referred to cerumen clinic from Royal Glamorgan Hospital, Wales. Audiologist classified the cerumen impaction into four categories (i.e., no cerumen; non-occluding cerumen; occluding cerumen; and fully non-occluding cerumen and debris). Chi-square analysis was performed to study the association between hearing aid use and cerumen impaction. RESULTS: The current study results showed no association between hearing aid use and cerumen impaction. Also, there was no association between right/left ear and cerumen impaction. CONCLUSIONS: These results interesting and contrary to our assumption that hearing aid use increases the likelihood of cerumen impaction. More well-controlled studies with prospective designs are needed to confirm if these results are accurate.

Isolation and partial characterisation of α-amylase components evolved during early wheat germination.

The development of α-amylase (EC 3.2.1.1) activity in wheat was followed during 4 days of germination. The enzyme was purified and separated by gel chromotography into two distinct entities (α-amylase I and α-amylase II), with different molecular weights and isoelectric points. α-Amylase I contained a much higher content of sugars than α-amylase II, which decreased as the germination proceeded. The time sequence analysis of the starch degradation pattern showed that on the 4th day of germination, 15% of the total activity was present in α- amylase I and the rest in α-amylase II. Similarly, differences in the relative rates of synthesis of their isoenzymes were observed. α-Amylase I was resolved on the 4th day of germination, only into 3 isoenzymes, whereas α-amylase II could separate into 4 isoenzymes. The enzyme activity was however maximal in the most electropositive isoenzyme in both the components.