International Classification of Functioning, Disability, and Health in adult and older users of audiology services / Classificação internacional de funcionalidade, incapacidade e saúde em adultos e idosos usuários de um serviço de audiologia

ABSTRACT Purpose: to describe aspects of functioning and disability related to hearing and sociodemographic factors of audiology service users. Methods: an exploratory study with a probabilistic sample comprising 152 participants who answered a socioeconomic and assistance questionnaire. The functioning and disability were analyzed by means of the International Classification of Functioning, Disability, and Health. Descriptive data analyses were conducted. Results: most users of the Hearing Health Care Service considered they had mild (41.2%) or moderate (34.2%) disability in b1560 Auditory perception, and mild (36%) and moderate (35.1%) disability in b230 Hearing Functions. In Activities and Participation, the users of the Hearing Health Care Service obtained better results in d330 Speaking (83.3%), d315 Communicating with and receiving nonverbal messages (65.8%), and d760 Family relationships (65.1%). The hearing aid was a facilitator in these subjects' social interaction with the environment. Most of those attending the Audiology Outpatient Center did not have disabilities or difficulties in the activities and participation, and the environment was a facilitator. Conclusion: most of the participants attending the Hearing Health Care Service had a disability in auditory perception and hearing functions. However, such a disability was not a limiting factor in the performance of most of the activities and participations assessed.

RESUMO Objetivo: descrever aspectos da funcionalidade e incapacidade, relacionados à audição e fatores sociodemográficos de usuários de um serviço de audiologia. Métodos: estudo exploratório com amostra probabilística composta por 152 indivíduos que responderam um questionário socioeconômico e assistencial. A funcionalidade e incapacidade foram analisadas por meio da Classificação Internacional de Funcionalidade, Incapacidade e Saúde. Foram realizadas análises descritivas dos dados. Resultados: a maior parte dos usuários do Serviço de Saúde Auditiva considerou ter deficiência ligeira 41,2% e moderada 34,2% em b1560Percepção Auditiva e deficiência ligeira 36% e moderada 35,1% em b230Funções Auditivas. Em Atividades e Participação os usuários do Serviço de Saúde Auditiva obtiveram melhores resultados em d330Falar 83,3%, d315Comunicar e receber mensagens não verbais 65,8% e d760Relacionamentos familiares 65,1%. O Aparelho de Amplificação Sonora Individual foi um facilitador na interação social desses sujeitos com o ambiente. A maioria dos indivíduos atendidos no Ambulatório de Audiologia não apresentou deficiência ou dificuldades nas atividades e participação e o ambiente atuou como um facilitador. Conclusão: a maior parte dos participantes atendidos no Serviço de Saúde Auditiva apresentou deficiência na percepção auditiva e funções auditivas, porém essa deficiência não atuou como um fator limitante no desempenho da maioria das atividades e participações avaliadas.

Common Audiological Functional Parameters (CAFPAs): statistical and compact representation of rehabilitative audiological classification based on expert knowledge.

OBJECTIVE: As a step towards objectifying audiological rehabilitation and providing comparability between different test batteries and clinics, the Common Audiological Functional Parameters (CAFPAs) were introduced as a common and abstract representation of audiological knowledge obtained from diagnostic tests. DESIGN: Relationships between CAFPAs as an intermediate representation between diagnostic tests and audiological findings, diagnoses and treatment recommendations (summarised as "diagnostic cases") were established by means of an expert survey. Expert knowledge was collected for 14 given categories covering different diagnostic cases. For each case, the experts were asked to indicate expected ranges of diagnostic test outcomes, as well as traffic light-encoded CAFPAs. STUDY SAMPLE: Eleven German experts in the field of audiological rehabilitation from Hanover and Oldenburg participated in the survey. RESULTS: Audiological findings or treatment recommendations could be distinguished by a statistical model derived from the experts' answers for CAFPAs as well as audiological tests. CONCLUSIONS: The CAFPAs serve as an abstract, comprehensive representation of audiological knowledge. If more detailed information on certain functional aspects of the auditory system is required, the CAFPAs indicate which information is missing. The statistical graphical representations for CAFPAs and audiological tests are suitable for audiological teaching material; they are universally applicable for real clinical databases.

[Prevalence of hearing disorders in China: a population-based survey in four provinces of China].

Objective: To investigate the prevalence, severity of hearing disorders and demographics of people with hearing disorders based on the whole population in Jilin, Guangdong, Shannxi and Gansu provinces in China. Methods: According to " WHO Ear and Hearing Disorders Survey Protocol" , 144 clusters were chosen with probability proportional sampling(PPS) method from the four provinces covering 194, 688, 061 residents. Audiological test, otological examination and questionnaire surveying were conducted for all samples from August, 2014 to September, 2015. The hearing disorders were classified according to WHO criteria and classification. Results: Among 47 511 targeted residents, 45, 052 individuals (94.82% response rate) participated in the survey. The standardized prevalence rates of hearing disorders and disabling hearing disorders were 15.84 % and 5.17 % respectively. Almost 50% of people with hearing disorders had no awareness of it or its starting time. There was significant difference in the prevalence among people of different ages, genders, occupations, provinces, marital status and education levels. The prevalence of hearing disorders increased significantly as age grew. People above 60 years old occupied 55.31% of the total hearing disorders. The prevalence of hearing disorders among male, people of low education and those who lost husband or wife, as well as workers and farmers was relatively higher. Conclusions: The prevalence of hearing disorders is high, and hearing disorders are " invisible" . Demographics and socioeconomic factors significantly influence the prevalence of hearing disorders.

[Hearing disorders in patients of older age groups].

Results of the investigation of hearing of elderly people living in nursing houses in Saint-Petersburg, obtained through a tonal threshold audiometry are described in this article. The analysis of hearing-loss prevalence depending on the age, the hearing-loss degrees, the presence of complaints about the hearing loss are also represented as well as the discussion about the possible causes of hearing loss (accompanying somatic diseases, working in noisy environment, hearing diseases inheritance).

[Universal newborn hearing screening : Definition of uniform parameters by the Association of German Hearing Screening Centers as a requirement for nationwide evaluation with valid results]. / Universelles Neugeborenen-Hörscreening : Definition einheitlicher Parameter durch den Verband Deutscher Hörscreening-Zentralen (VDHZ) als Voraussetzung für eine flächendeckende Evaluation mit validen Ergebnissen.

BACKGROUND: Since 2009, all newborns in Germany have been entitled to universal neonatal hearing screening (UNHS). UNHS with tracking of test results leads to earlier detection of hearing disorders. The Association of German Hearing Screening Centers (Verband Deutscher Hörscreening-Zentralen, VDHZ) was founded to promote nationwide tracking, validity and quality control of UNHS results. OBJECTIVES: A comparable data structure in the different screening centers, with uniform definitions of primary parameters is essential for the nationwide evaluation of UNHS results. To address the question of whether a data structure with comparable definitions already exists or still has to be created, the existing structures and primary parameter definitions in the hearing screening centers should be investigated and compared. METHODS: A survey was conducted in all hearing screening centers to assess how data on the primary UNHS parameters defined in pediatric guidelines was gathered. In the case of discrepancies, uniform definitions were created. Finally, the practicability of these definitions was evaluated. RESULTS: Due to differing definitions of primary parameters, some of the data were not comparable between the individual centers. Therefore, uniform definitions were created in a consensus process. In the centers, the screening method, the two-step first screening and the result of the first screening now correspond to these uniform definitions. Other parameters, e.g. the total number of newborns, still vary widely, rendering the comparison of screening rates almost impossible. CONCLUSION: Valid evaluation of UNHS not only requires nationwide establishment of hearing screening centers, but also unified data structures and parameter definitions.

Listening effort and fatigue: what exactly are we measuring? A British Society of Audiology Cognition in Hearing Special Interest Group 'white paper'.

OBJECTIVE: There is growing interest in the concepts of listening effort and fatigue associated with hearing loss. However, the theoretical underpinnings and clinical meaning of these concepts are unclear. This lack of clarity reflects both the relative immaturity of the field and the fact that research studies investigating listening effort and fatigue have used a variety of methodologies including self-report, behavioural, and physiological measures. DESIGN: This discussion paper provides working definitions for listening effort and listening-related fatigue. Using these definitions as a framework, methodologies to assess these constructs are reviewed. RESULTS: Although each technique attempts to characterize the same construct (i.e. the clinical presentation of listening effort and fatigue), different assumptions are often made about the nature of these phenomena and their behavioural and physiological manifestations. CONCLUSION: We suggest that researchers consider these assumptions when interpreting their data and, where possible, make predictions based on current theoretical knowledge to add to our understanding of the underlying mechanisms of listening effort and listening-related fatigue. FOREWORD: Following recent interest in the cognitive involvement in hearing, the British Society of Audiology (BSA) established a Special Interest Group on Cognition in Hearing in May 2013. In an exploratory group meeting, the ambiguity surrounding listening effort and fatigue was discussed. To address this problem, the group decided to develop a 'white paper' on listening effort and fatigue. This is a discussion document followed by an international set of commentaries from leading researchers in the field. An approach was made to the editor of the International Journal of Audiology who agreed to this suggestion. This paper, and the associated commentaries that follow, are the result.

Hatred of sounds: misophonic disorder or just an underreported psychiatric symptom?

BACKGROUND: Misophonia, or selective sound sensitivity syndrome, is a preoccupation with or aversion to certain types of sounds that evokes feelings of irritability, disgust, or anger. Recently, it has been suggested that misophonia is a discrete clinical entity deserving of its own place in psychiatric diagnostic manuals. In this paper, we describe 3 patients whose misophonia could be attributed to different underlying primary psychiatric disorders. METHODS: Case series report. RESULTS: In these patients, we argue that misophonia is better described as a symptom of a) obsessive-compulsive disorder, b) generalized anxiety disorder, and c) schizotypal personality disorder. CONCLUSIONS: The nosological status of misophonia remains a matter of debate. Patients who exhibit misophonia as a major complaint should be assessed for other conditions. Further studies on the prevalence, natural history, and additional features of misophonia are needed.

Predictive value of electrocochleography for determining hearing outcomes in Ménière's disease.

OBJECTIVE: To evaluate the clinical effectiveness of performing electrocochleography (ECoG) at the initial visit in predicting hearing outcomes. STUDY DESIGN: Retrospective study. SETTING: Tertiary hospital. PATIENTS: Ninety patients with unilateral, definite Ménière's disease. INTERVENTIONS: The summating potential (SP)/action potential (AP) ratio was obtained using ECoG at the initial visits. An SP/AP ratio greater than 0.34 was considered abnormal. MAIN OUTCOME MEASURES: Audiogram types, hearing fluctuations, hearing thresholds at the initial and last visits, hearing changes, caloric response, and treatment outcomes were analyzed in subjects with normal and abnormal ECoGs. Correlation analyses between the SP/AP ratio at the initial visit, hearing thresholds at each visit, and hearing changes were performed. RESULTS: The mean follow-up period was 22.6 months. Abnormal ECoGs were found in 50 (55.6%) of the 90 subjects. No significant differences regarding audiogram types, hearing fluctuations, caloric response, or treatment outcomes were observed between subjects with normal and abnormal ECoGs. Ipsilateral SP/AP ratios at the initial visit were correlated with both hearing thresholds at the initial (r = 0.347, p < 0.001) and last (r = 0.435, p < 0.001) visits. Furthermore, there was a significant correlation between SP/AP ratio and hearing change during follow-up (r = 0.280, p = 0.008). After stratification by initial hearing level, Stage 1 and 2 subjects (hearing threshold, 0-40 dB) with abnormal ECoGs at the initial visit showed a decrease in hearing over time compared with those with normal ECoGs (p = 0.008). CONCLUSION: A high SP/AP ratio at the initial visit may be used as a predictor of poor hearing outcomes in subjects with Ménière's disease, especially with initial hearing Stage 1 and 2.

Auditory filter shapes and high-frequency hearing in adults who have impaired speech in noise performance despite clinically normal audiograms.

Some individuals complain of hearing difficulties in the presence of background noise even in the absence of clinically significant hearing loss (obscure auditory dysfunction). Previous evidence suggests that these listeners have impaired frequency resolution, but there has been no thorough characterization of auditory filter shapes in this population. Here, the filter shapes of adults (n = 14) who self-reported speech recognition problems in noise and performed poorly on a sentence-in-noise perception test despite having clinically normal audiograms were compared to those of controls (n = 10). The filter shapes were evaluated using a 2-kHz probe with a fixed level of 30, 40, or 50 dB sound pressure level (SPL) and notched-noise simultaneous maskers that were varied in level to determine the masker level necessary to just mask the probe. The filters of the impaired group were significantly wider than those of controls at all probe levels owing to an unusual broadening of the upper slope of the filter. In addition, absolute thresholds were statistically indistinguishable between the groups at the standard audiometric frequencies, but were elevated in the impaired listeners at higher frequencies. These results strengthen the idea that this population has a variety of hearing deficits that go undetected by standard audiometry.

[The advantage of multidisciplinary treatment of presbycusis]. / Intérêt d'une prise en charge pluridisciplinaire de la presbyacousie.

Attributable to the ageing of the hearing system, presbycusis presents a wide variability in the general population. Early detection is necessary in order to be able to provide the patient with a suitable hearing aid. Collaboration between otolaryngologists and geriatricians proves to be advantageous as a consultation for a memory complaint may be the opportunity to detect presbycusis and vice versa.

Hearing Disorders in HIV Positive Adult Patients

Background: This study was aimed at determining the prevalence and type of hearing disorders in HIV positive patients and any correlationship with the CD4 counts/stage of HIV/AIDS in patients attending the omprehensive care clinic (CCC). Methods: Case control study of 194 HIV positive patients attending CCC recruited into the study after informed consent. A thorough clinical examination and otoscopy done followed by tuning fork tests; Pure Tone Audiometry and tympanometric tests. This was compared with 124 HIV negative subjects matched for age and sex who were recruited from the voluntary counseling and testing centre. The world health organization staging of the HIV/AIDS disease and the CD4 positive lymphocyte cell count were carried out and correlated with any hearing disorder. Results were analyzed using statistical package for social sciences version 10.0. Results: Hearing loss (HL) was present in 33.5of HIV positive compared to 8.1in negative subjects. No gender bias in HL but HL worsened with advancement of age. SNHL was the most common and the higher frequencies were the most affected. Low CD4 cell count and advanced HIV disease were associated with increased chance of having a hearing loss. Conclusion: Hearing loss is more prevalent in HIV positive individuals than negative normal subjects and tends to worsen with the advancement of the HIV disease. This may negatively impact on the overall care and standard of living of HIV positive patients; hence otological care should be part of the comprehensive care

Report on hearing loss in oncology.

UNLABELLED: Cisplatin is used frequently as an antineoplastic drug in the treatment of many different cancers. However, when used in doses over 360mg/m(2), ototoxicity may ensue, resulting in loss of hearing. Criteria for identifying and quantifying hearing loss have been devised. AIM: To describe the features of different hearing loss classification systems and to identify their implications and use in oncologic patients. METHOD: Hearing loss was classified in 31 patients before and after chemotherapy, according to different criteria, assessing the sensitivity and specificity of each classification system. RESULTS: Hearing loss results were highly variable (ranging from 29% to 61%). Only 4 of 31 subjects with post-therapy hearing loss were identified by all the methods. A few subjects with hearing loss were classified as normal hearing in some of the criteria. A normal PTA was found in 18 of 31 subjects in the post-treatment evaluation. CONCLUSION: None of the criteria assesses the complaints of patients. The criteria described in this study were inadequate to identify hearing loss following chemotherapy, requiring additional information for physicians to better understand the hearing losses and their implications for the quality of life of patients.

[Management of hearing impairment in adults]. / Prise en charge du handicap auditif de l'adulte.

Hearing impairment, mainly the deafness with possible distortions, assorted with tinnitus concerns about 4 million of the French population. It can be of variable severity. Deafness is an invisible disability until we must answer a question. The permanent improvement of the computer and microelectronics sciences benefit to the prosthetic devices: cochlear implants compensate for complete hearing loss, hearing aids are hidden by being miniaturized, being partially or totally implantable. The management of disability is not limited to this material part: human assistance and assistive devices are part of the armory. Rest to continue and to increase the financial support. This claim is obviously not specific to disability hearing although the hearing aid is only refunded 138 Euro per device for a unit cost from 1300 Euro to 2500 Euro with an observed lifetime of 4 or 5 years.

Report on hearing loss in oncology / Classificações das perdas auditivas em Oncologia

Cisplatin is used frequently as an antineoplastic drug in the treatment of many different cancers. However, when used in doses over 360mg/m², ototoxicity may ensue, resulting in loss of hearing. Criteria for identifying and quantifying hearing loss have been devised. AIM: To describe the features of different hearing loss classification systems and to identify their implications and use in oncologic patients. METHOD: Hearing loss was classified in 31 patients before and after chemotherapy, according to different criteria, assessing the sensitivity and specificity of each classification system. RESULTS: Hearing loss results were highly variable (ranging from 29 percent to 61 percent). Only 4 of 31 subjects with post-therapy hearing loss were identified by all the methods. A few subjects with hearing loss were classified as normal hearing in some of the criteria. A normal PTA was found in 18 of 31 subjects in the post-treatment evaluation. CONCLUSION: None of the criteria assesses the complaints of patients. The criteria described in this study were inadequate to identify hearing loss following chemotherapy, requiring additional information for physicians to better understand the hearing losses and their implications for the quality of life of patients.

A cisplatina é um antineoplásico muito utilizado no tratamento de diferentes neoplasias, porém quando utilizada em doses acima de 360mg/m² pode causar ototoxicidade. Esta produz lesões cocleares que resultam em perda auditiva. Existem critérios que visam identificar e quantificar as perdas auditivas. OBJETIVO: Descrever as características das classificações e identificar implicações e aplicações de cada uma, dentro das necessidades do acompanhamento ao paciente oncológico. MATERIAL E MÉTODO: Avaliamos 31 pacientes pré e pós-tratamento quimioterápico. Classificamos as perdas auditivas de acordo com os critérios e verificamos a sensibilidade e especificidade de cada um. RESULTADO: Houve grande variabilidade na detecção das alterações auditivas (de 29 por cento a 61 por cento). Somente 4 dos 31 indivíduos com alterações auditivas no exame pós-tratamento foram identificados por todos os critérios. Por vezes o indivíduo portador de perda auditiva era classificado com normal por algum critério. Dos 31 indivíduos, 18 apresentaram PTA normal no exame pós-tratamento. CONCLUSÃO: Nenhum dos critérios considera a queixa do paciente. Os critérios descritos mostraram inadequações para descrever as alterações auditivas encontradas, fazendo-se necessária a descrição de informações adicionais, para que o médico compreendesse a natureza da perda auditiva. É importante o refinamento desses instrumentos para melhor compreensão e tratamento dos pacientes oncológicos, assim como de sua qualidade de vida.

Alterations in early auditory evoked potentials in multiple sclerosis patients.

UNLABELLED: Alterations in early auditory evoked potentials (EAEP) in individuals with demyelinating disease are suggestive of lesions in the brainstem. AIM: this study aims to evaluate the prevalence of hearing disorders and altered EAEP in multiple sclerosis (MS) patients. MATERIALS AND METHOD: sixteen female and nine male patients with a defined diagnosis of multiple sclerosis took part in this study. All individuals underwent hearing and EAEP tests. The wave forms were categorized according to Jerger (1986). RESULTS: fifty EAEP tests were carried out; 70% were classified as type I (normal response) according to Jerger's criteria. Altered EAEP results in at least one ear were classified into types II, III, IV or V according to Jerger. Females accounted for 31.25% of alterations, and males 44.44%, adding up to 36% of all cases. CONCLUSIONS: these findings stress the importance of looking at EAEP in cases where there is suspicion of demyelinating disease and in patients with a defined diagnosis for MS.

Alterações dos potenciais evocados auditivos do tronco encefálico em pacientes com esclerose múltipla / Alterations in early auditory evoked potentials in multiple sclerosis patients

A presença de alterações nos potenciais evocados auditivos do tronco encefálico (PEATE) em indivíduos com doenças desmielinizantes sugere lesão do tronco encefálico. OBJETIVOS: O objetivo do presente estudo foi avaliar a incidência de alterações auditivas e dos PEATE em indivíduos com esclerose múltipla (EM). MATERIAL E MÉTODO: Participaram do estudo 16 pacientes do sexo feminino e 9 do sexo masculino com diagnóstico definido de EM. Testes audiométricos e pesquisa dos PEATE foram realizados em todos os indivíduos. Para a classificação dos PEATE utilizou-se a classificação proposta por Jerger (1986) na análise da morfologia das ondas. FORMA DE ESTUDO: Estudo de coorte contemporânea com corte transversal. RESULTADOS: Dos 50 PEATE realizados, 70 por cento foram classificados como tipo I (resposta normal) pela classificação de Jerger. Considerando-se como alterados os PEATE dos tipos II, III, IV ou V da classificação de Jerger em pelo menos um dos lados, encontrou-se 31,25 por cento de alterações no sexo feminino e 44,44 por cento no masculino, totalizando 36 por cento. CONCLUSÕES: Estes achados enfatizam a relevância do estudo dos PEATE em casos de suspeita clínica de doenças desmielinizantes e naqueles com diagnóstico definido de EM.

Alterations in early auditory evoked potentials (EAEP) in individuals with demyelinating disease are suggestive of lesions in the brainstem. AIM: this study aims to evaluate the prevalence of hearing disorders and altered EAEP in multiple sclerosis (MS) patients. MATERIALS AND METHOD: sixteen female and nine male patients with a defined diagnosis of multiple sclerosis took part in this study. All individuals underwent hearing and EAEP tests. The wave forms were categorized according to Jerger (1986). RESULTS: fifty EAEP tests were carried out; 70 percent were classified as type I (normal response) according to Jerger's criteria. Altered EAEP results in at least one ear were classified into types II, III, IV or V according to Jerger. Females accounted for 31.25 percent of alterations, and males 44.44 percent, adding up to 36 percent of all cases. CONCLUSIONS: these findings stress the importance of looking at EAEP in cases where there is suspicion of demyelinating disease and in patients with a defined diagnosis for MS.

Access to special care dentistry, part 2. Communication.

This article considers what communication is, its elements, what helps and what hinders it, and why it matters. It also considers managing people with communication differences and when communication is affected in special care dentistry (SCD). The article focuses on patients with hearing and visual impairments and considers how communication is affected and what techniques can be used to improve the situation. It offers recommendations for communicating with patients with neurological impairments typically seen after stroke, such as aphasia and dysarthria, with tips for the listener including the use of communication aids where appropriate. Finally it will consider communicating with patients who have autistic spectrum conditions and discuss how effective techniques and a tailored approach to their specific needs and anxieties can increase the likelihood of a successful dental visit.

When your patient cannot hear you.

Communication is vitally important in relationships and a hearing loss can have a profound impact on a person's desire to interact with others. Embarrassment and frustration can cause a person to withdraw and avoid social situations leading to isolation and depression. Persons who recognize they have a hearing problem, seek treatment, and have benefited from available therapies are able to have better relationships with friends and family, feel better about themselves, have improved mental health, and feel greater security and independence. It is in the best interest of the patient that the nurse actively assess for any kind of hearing difficulty and provide appropriate education and referral.