Italian validation of the Hearing Handicap Inventory for Elderly - Screening version (HHIE-S-It).

Objective: Validate the Italian version of the Hearing Handicap Inventory for Elderly - Screening version (HHIE-S-It). Methods: After translation, psychometric properties and attributes were analysed by administering the HHIE-S-It to 167 elderly outpatients together with the Psychological General Well-Being Index (PGWBI). Results: The Cronbach's α coefficient was 0.908 for the total score, and 0.832 and 0.816 for its two subscales. Significant test-retest reliability was observed (p < 0.001). Moderate to high correlations were found between HHIE-S-It and pure tone average in the better ear (p < 0.001). The ANOVA test confirmed the significant difference in HHIE-S-It scores across groups according to the degree of hearing loss (p < 0.001). Only very low and low significant correlations were observed between HHIE-S-It and PGWBI. The criterion HHIE-S-It > 11 was observed as the best cut-off with highest sensitivity (86.4%), specificity (72.4%), positive predictive value (52.8%), negative predictive value (93.7%) and likelihood ratios (3.12 and 0.19). Conclusions: Since the HHIE-S-It presented acceptable psychometric properties, its adoption is justified for both clinical and research purposes. Acceptable diagnostic attributes allow its use as a screening tool for age-related hearing loss.

The Effect of Alpha-Lipoic Acid in the Treatment of Chronic Subjective Tinnitus through the Tinnitus Handicap Inventory Scores.

BACKGROUND AND OBJECTIVES: Tinnitus affects millions of adults. Many therapies, including complementary and alternative medicine and tinnitus retraining therapies, have been trialed, but an effective option, particularly for chronic subjective tinnitus (CTS), is still lacking. MATERIALS AND METHODS: This study investigated the effects of alpha-lipoic acid (600 mg. per day for two months) on two groups of patients using a questionnaire. One group (A) was affected by tinnitus associated with likely cochlear dysfunction and metabolic syndrome, and the other (B) was composed of subjects with acoustic nerve lesions. All the patients were asked to complete the Italian version of the tinnitus handicap inventory (THI) to determine the overall degree of perceived annoyance at the beginning and end of therapy. Pure tone averages for speech frequencies and for high frequencies were computed, and psychoacoustic pitch and loudness matches were determined for each subject before and after treatment. RESULTS: The pure tone audiometry, pitch, loudness, and THI scores of both groups were reported. In group A, statistically significant differences were observed for the "functional" and "emotional" subscales. The total score of THI and the loudness of tinnitus were also significantly reduced. No statistically significant differences were observed in group B. CONCLUSIONS: These findings suggest a possible contribution of the antioxidant effect to the organ of Corti in subjects with metabolic syndrome and CST.

Italian validation of the Penn Acoustic Neuroma Quality of Life Scale (PANQOL-It).

Objective: translate and validate the Penn Acoustic Neuroma Quality of Life Scale into Italian language (PANQOL-It). Methods: the instrument was translated and psychometric properties were subsequently assessed by administering the PANQOL-It to 124 outpatients together with the Depression Anxiety Stress Scale (DASS21) and the Understanding and Communicating domain of the World Health Organization Disability Assessment Schedule II (WHODAS II-D1). The internal consistency, test-retest reliability, construct and criterion-related validity were assessed. Results: Cronbach's alpha coefficient was 0.92 for the total score and ranged from 0.44 to 0.90 in the seven domains. Significant test-retest reliability was observed (intraclass-correlation = 0.75; p < 0.01). Moderate correlation was reported between facial dysfunction domain and objective facial involvement (p < 0.01). Moderate to strong correlations were observed between anxiety, general health domains and all subscales of the DASS21, and between WHODAS II-D1 and general health and energy domains (p < 0.01). These latter results indicated good construct and criterion-related validity respectively. Conclusions: PANQOL-It presented more than acceptable psychometric properties and its adoption is justified for both clinical and research purposes.

Validity of the Italian adaptation of the Hearing Handicap Inventory for the Elderly (HHIE-It).

Objective: The aim of this study was to assess the validity and reliability of the Italian translation of the Hearing Handicap Inventory for the Elderly (HHIE). Methods: A sample of 275 adults, aged > 65 years, filled out the Italian version of the HHIE (HHIE-It) together with the MOS 36-Item Short Form Health Survey (SF-36). Seventy-one participants answered the questionnaire a second time after six weeks. The internal consistency, test-retest reliability, construct and criterion validity were evaluated. Results: Cronbach's alpha was 0.94 and suggested a high internal consistency. There was also a significant intraclass correlation coefficient (ICC) between test and retest scores. In addition, Pearson's correlation coefficient between the two scores was high and significant. High and significant correlation coefficients were also found between the HHIE-It score and the pure tone average threshold of the better ear and between the HHIE-It and the subscales Role-emotional, Social Functioning and Vitality of the SF-36. These latter results indicate good construct and criterion validity, respectively. Conclusions: The HHIE-It maintained the reliability and validity of the English version suggesting its utility for both clinical and research purposes.

Psychological Profile and Social Behaviors of Patients with Hyperacusis.

Increased noise sensitivity refers to the abnormal subjective response to external sounds, with a prevalence of between 8% and 15.2% in the adult population as suggested by epidemiological studies. The basic neural mechanism of hyperacusis still remains obscure, so therapies for this often-devastating symptom remain elusive. The aim of this study was to assess psychological profiles in patients with presbycusis without tinnitus in a perspective case-control design. All subjects were initially submitted to audiological evaluation (tympanometry, recordings of the acoustic reflex thresholds, pure tone audiometry) and subsequently were administered the following questionnaires: the hyperacusis questionnaire (HQ), the brief symptom inventory (BSI), and the modified somatic perception questionnaire (MSPQ). Patients with hyperacusis reported a total score and subscales (attentional, social, and emotional) of the HQ significantly higher than controls. They also reported higher scores of the MSPQ and significantly higher mean values with concern to the somatization, obsessive-compulsive, interpersonal sensitivity, depression, and anxiety subscales of the BSI. These results show that psychological distress, as expressed by higher level of somatic attention, somatization, anxiety, and depression, is a significant factor to consider for a complete diagnosis and effective treatment of hyperacusis. For a correct diagnosis of patients seeking help for hyperacusis, their psychological distress should also be assessed, regardless of their hearing abilities. Further studies are required to investigate the pathological mechanisms that are involved in the onset of hyperacusis in patients with normal hearing and those with sensorineural hearing loss.

The Effect of the Use of Hearing Aids in Elders: Perspectives.

Older adults with hearing loss have difficulties during conversation with others because an elevated auditory threshold reduces speech intelligibility, especially in noisy environments. Listening and comprehension often become exhausting tasks for hearing-impaired elders, resulting in social isolation and depression. The aim of the present study was to investigate the advantages of hearing aid use in relation to relief from listening-related fatigue, which is still controversial. Participants included a sample of 49 hearing-impaired elders affected by presbycusis for whom hearing aids were prescribed. The Modified Fatigue Impact Scale was used to assess cognitive, physical and psychosocial fatigue. The vitality subscale of the Short Form Health Survey 36 and a single item of the multi-dimensional Speech, Spatial and Quality Hearing Scale ("Do you have to put a lot of effort to hear what is being said in conversation with others?") were also used. The Cognitive Failures Questionnaire was used to investigate daily errors related to lack of memory and reduced mindedness. Hearing aids rehabilitation resulted in improved speech intelligibility in competing noise, and a significant reduction in cognitive and psychosocial fatigue and listening effort in conversation. Vitality was also improved and a significant reduction in the Cognitive Failures Questionnaire scores was observed. Findings from the study indicate that the use of hearing aids in older impaired-listeners provide them not only with an increased auditory function but also with a reduction in listening-related fatigue and mindedness.

Evaluation of Performance and Tolerability of Nebulized Hyaluronic Acid Nasal Hypertonic Solution in the Treatment of Chronic Rhinosinusitis.

BACKGROUND: Nasal solutions are part of the recommended therapy of chronic rhinosinusitis (CRS). Formulations containing hyaluronic acid (HA) may represent a promising topical treatment in CRS patients in light of the anti-inflammatory and protective effect of HA on the sinonasal mucosa. OBJECTIVE: Primary aim was to evaluate the performance of a new nebulized HA nasal hypertonic solution in the relief of symptoms of CRS. Secondarily, evaluation of symptoms improvement, endoscopic nasal findings, and safety profile were assessed. METHODS: A monocenter, single arm, not controlled, premarket clinical trial on a new nasal solution containing HA was performed. All the included patients had a history of previously diagnosed or recurrent CRS or they had received a clinical diagnosis of CRS defined, according to the European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Each patient was evaluated on 3 visits. Endoscopic nasal examination and Nasal Obstruction Symptom Evaluation Instrument questionnaire filling were performed during each visit. Patients' adherence to treatment and overall satisfaction, patients' and investigator's global evaluation of performance, and safety parameters were also assessed. RESULTS: Eighty patients were enrolled. The use of the investigated HA nasal solution revealed to be significantly effective in the relief of symptoms of CRS. According to daily patients' diaries, several signs and symptoms significantly improved after therapy. The comparison between endoscopic assessments before and after treatment confirmed improvement of the condition in at least 75% of patients. Seventy-four percent of the patients were quite or very satisfied with the treatment and 80% reported an improvement. The investigator's global assessment of performance was in agreement with this view, as more than 80% of the patients were considered clinically improved. CONCLUSIONS: The use of the investigated new nebulized HA nasal hypertonic solution is an effective and safe the treatment of CRS.

A case-control study of visually evoked postural responses in childhood with primary headaches.

BACKGROUND: Disorientation, nausea, confusion, dizziness, and displacement are frequently complained by headache-suffering children. Anyhow, the cause of these symptoms is still unclear, and a dysfunction of vestibular pathways or their alteration due to central pain pathways hyper-activation, has been proposed. The aim of this study is to use posturography to explore the balance function of headache-suffering children during pain-free periods. METHODS: Posturography was performed on 19 migraineurs, 11 tension-type headache sufferers, and 20 healthy controls. Posturographic measures were performed during headache-free periods under different conditions: with eyes opened, eyes closed, and during right and left optokinetic stimulation. The last 2 conditions were used to mimic unreliable visual signals that can confound vestibular system. RESULTS: During eyes-closed conditions, headache-suffering children displayed higher displacements than healthy controls, since statokinesiogram surface was higher in tension-type headache sufferers and migraineurs compared with controls (P value = 0.0095). Romberg's index, indicating the overall stability of the subject, was lower in healthy controls than in headache sufferers (P = 0.0139), thus suggesting a vestibular impairment in the seconds. Moreover, both during right and left optokinetic stimulation, the statokinesiogram length was higher in headache-suffering children (P < 0.0001). Thereafter, statokinesiogram surface was higher in migraineurs during right optokinetic stimulation (P = 0.0388) than in tension-type headache sufferers when stimulation was directed on the opposite side (P = 0.0249). CONCLUSIONS: These results suggest a central alteration of vestibular pathways in headache-suffering children, that makes balance function more dependent from visual inputs than healthy subjects, even in inter-ictal phases.

Acquired Hearing Loss, Anger, and Emotional Distress: The Mediating Role of Perceived Disability.

The aim of the study was to test whether acquired hearing loss (AHL)-related perceived disability mediates the association between AHL and psychological outcomes, including anger. Two-hundred ninety-seven consecutive outpatients with AHL assessed by pure tone average (PTA) loss completed the following: Hearing Handicap Inventory for Adults (HHIA), State-Trait Anger Expression Inventory-2 (STAXI-2), Brief Symptom Inventory (BSI), Diagnostic Criteria for Use in Psychosomatic Research (DCPR), and Social Functioning Questionnaire. In the sample, composed of 44.5% males with a mean age of 53.8 and a mean PTA of 30.7, AHL was associated to perceived hearing handicap, also correlating to all psychological measures except DCPR demoralization. Associations were stronger between the HHIA-Emotional Subscale, STAXI-2 State Anger and Feeling Angry, and BSI-Somatization, Interpersonal Sensitivity, Depression, and Psychoticism. Perceived disability predicted the presence of almost all psychosocial outcomes and confirms to be the most significant target of clinical action.

Posturographic stabilisation of healthy subjects exposed to full-length mirror image is inversely related to body-image preoccupations.

Affective states, anxiety in particular, have been shown to negatively influence human postural control efficiency as measured by posturographic means, while exposure to a full-length mirror image of one's body exerts a stabilizing effect. We tested the hypothesis that body image concerns and preoccupations would relate negatively to this stabilising effect. Sixty-six healthy students, who screened negative for psychiatric disorders, completed rating scales for anxiety, depression and body image concerns. Posturography recordings of body sway were taken under three conditions: with eyes closed, looking at a vertical bar and looking at a full-length mirror. The Eyes Open/Mirror Stabilometric Quotient [EOMQ=(sway path with eyes closed/sway path looking at the mirror)x100], an index of how much postural control is stabilized by mirror feedback in comparison to the visual vertical bar condition, was significantly inversely related to body image concerns and preoccupations, and to trait anxiety. This finding confirms the impact of emotional factors on human postural control, which warrant further studies. If confirmed in clinical populations characterized by high levels of body image disturbances, e.g. eating disorders, it could lead to developments in the assessment and monitoring of these patients.