A country-wide health policy in Chile for deaf adults using cochlear implants: Analysis of health determinants and social impacts.

BACKGROUND: Post-lingual deafness represents a critical challenge for adults' well-being with substantial public health burdens. One treatment of choice has been cochlear implants (CI) for people with severe to profound hearing loss (HL). Since 2018, Chile has implemented a high-cost policy to cover CI treatment, the "Ley Ricarte Soto" (LRS) health policy. However, wide variability exists in the use of this device. To date, no related study has been published on policy evaluation in Chile or other Latin American countries. OBJECTIVES: This study aimed to evaluate the impact of the LRS policy on the treatment success and labour market inclusion among deaf or hard of hearing (DHH) adults using CI. We examined and characterised outcomes based on self-reports about treatment success and occupation status between 2018 and 2020. DESIGN: We performed a prospective study using hospital clinical records and an online questionnaire with 76 DHH adults aged >15 who had received CIs since the introduction of the LRS policy in 2018. Using univariate and multivariate regression models, we investigated the relationship between demographic, audiological, and social determinants of health and outcomes, including treatment success for social inclusion (International Outcome inventory for Hearing Aids and CIs assessment: IOI-HA) and occupation status for labour market inclusion. RESULTS: Our study showed elevated levels of treatment success in most of the seven sub-scores of the IOI-HA assessment. Similarly, around 70% of participants maintained or improved their occupations after receiving their CI. We found a significant positive association between treatment success and market inclusion. Participants diagnosed at younger ages had better results than older participants in both outcomes. Regarding social determinants of health, findings suggested participants with high social health insurance and a shorter commute time to the clinic had better results in treatment success. For labour market inclusion, participants with high education levels and better pre- CI occupation had better post-CI occupation status. CONCLUSIONS: In evaluating the LRS policy for providing CIs for DHH adults in Chile, we found positive effects relating to treatment success and occupation status. Our study supports the importance of age at diagnosis and social determinants of health, which should be assessed by integrating public services and bringing them geographically closer to each beneficiary. Although evidence-based guidelines for candidate selection given by the LRS policy might contribute to good results, these guidelines could limit the policy access to people who do not meet the requirements of the guidelines due to social inequalities.

Self-reported hearing performance in workers exposed to solvents.

OBJECTIVE: To compare hearing performance relating to the peripheral and central auditory system between solvent-exposed and non-exposed workers. METHODS: Forty-eight workers exposed to a mixture of solvents and 48 non-exposed control subjects of matched age, gender and educational level were selected to participate in the study. The evaluation procedures included: pure-tone audiometry (500 - 8,000 Hz), to investigate the peripheral auditory system; the Random Gap Detection test, to assess the central auditory system; and the Amsterdam Inventory for Auditory Disability and Handicap, to investigate subjects' self-reported hearing performance in daily-life activities. A Student t test and analyses of covariance (ANCOVA) were computed to determine possible significant differences between solvent-exposed and non-exposed subjects for the hearing level, Random Gap Detection test and Amsterdam Inventory for Auditory Disability and Handicap. Pearson correlations among the three measures were also calculated. RESULTS: Solvent-exposed subjects exhibited significantly poorer hearing thresholds for the right ear than non-exposed subjects. Also, solvent-exposed subjects exhibited poorer results for the Random Gap Detection test and self-reported poorer listening performance than non-exposed subjects. Results of the Amsterdam Inventory for Auditory Disability and Handicap were significantly correlated with the binaural average of subject pure-tone thresholds and Random Gap Detection test performance. CONCLUSIONS: Solvent exposure is associated with poorer hearing performance in daily life activities that relate to the function of the peripheral and central auditory system.

Self-reported hearing performance in workers exposed to solvents / Autoavaliação de funções auditivas em trabalhadores expostos a solventes / Autoevaluación de funciones auditivas en trabajadores expuestos a solventes

OBJECTIVE: To compare hearing performance relating to the peripheral and central auditory system between solvent-exposed and non-exposed workers. METHODS: Forty-eight workers exposed to a mixture of solvents and 48 non-exposed control subjects of matched age, gender and educational level were selected to participate in the study. The evaluation procedures included: pure-tone audiometry (500 - 8,000 Hz), to investigate the peripheral auditory system; the Random Gap Detection test, to assess the central auditory system; and the Amsterdam Inventory for Auditory Disability and Handicap, to investigate subjects' self-reported hearing performance in daily-life activities. A Student t test and analyses of covariance (ANCOVA) were computed to determine possible significant differences between solvent-exposed and non-exposed subjects for the hearing level, Random Gap Detection test and Amsterdam Inventory for Auditory Disability and Handicap. Pearson correlations among the three measures were also calculated. RESULTS: Solvent-exposed subjects exhibited significantly poorer hearing thresholds for the right ear than non-exposed subjects. Also, solvent-exposed subjects exhibited poorer results for the Random Gap Detection test and self-reported poorer listening performance than non-exposed subjects. Results of the Amsterdam Inventory for Auditory Disability and Handicap were significantly correlated with the binaural average of subject pure-tone thresholds and Random Gap Detection test performance. CONCLUSIONS: Solvent exposure is associated with poorer hearing performance in daily life activities that relate to the function of the peripheral and central auditory system.

OBJETIVO: Comparar o desempenho das atividades diárias relacionadas a funções do sistema auditivo periférico e central entre trabalhadores expostos e não expostos a solventes. MÉTODOS: Participaram do estudo 96 trabalhadores, sendo 48 expostos a solventes e 48 não expostos, pareados por escolaridade, idade e sexo. Os procedimentos de avaliação incluíram: audiometria de tons puros (500 a 8.000 Hz), para avaliar o sistema auditivo periférico; teste de Random Gap Detection, para avaliar o sistema auditivo central; e o Amsterdam Inventory for Auditory Disability and Handicap, para estudar a performance em atividades da vida diária que envolvem a audição, por meio de autoavaliação. Teste t de student e a análise de covariância (ANCOVA) foram utilizados. Foram calculadas as correlações de Pearson entre os resultados dos três testes. RESULTADOS: Sujeitos expostos a solventes tiveram limiares auditivos significativamente piores na orelha direita que os sujeitos não expostos. Apresentaram também resultados significativamente piores no teste de Random Gap Detection e funcionamento autorreportado significativamente mais alterado que os sujeitos não expostos. Foi observada correlação significativa entre os resultados do Amsterdam Inventory for Auditory Disability and Handicap e a média binaural dos limiares auditivos e com os resultados do teste de Random Gap Detection. CONCLUSÕES: A exposição a solventes está associada com as dificuldades da vida diária relacionadas com as funções do sistema auditivo periférico e central.

OBJETIVO: Comparar el desempeño de las actividades diarias relacionadas a funciones del sistema auditivo periférico y central entre trabajadores expuestos y no expuestos a solventes. MÉTODOS: Participaron del estudio, 96 trabajadores, siendo 48 expuestos a solventes y no expuestos, pareados por escolaridad, edad y sexo. Los procedimientos de evaluación incluyeron: audiometría de sonidos puros (500 a 8.000 Hz), para evaluar el sistema auditivo periférico; prueba de Random Gap Detection, para evaluar el sistema auditivo central; y el Amsterdam Inventory for Auditory Disability and Handicap, para estudiar la performance en actividades de la vida diaria que envuelven la audición, por medio de auto-evaluación. Prueba t de Student y el análisis de covarianza (ANCOVA) fueron utilizados. Se calcularon las correlaciones de Pearson entre los resultados de las tres pruebas. RESULTADOS: Sujetos expuestos a solventes tuvieron umbrales auditivos significativamente peores en el oído derecho que los sujetos no expuestos. Se presentaron también resultados significativamente peores en la prueba de Random Gap Detection y funcionamiento auto-reportado significativamente más alterado que los sujetos no expuestos. Se observó correlación significativa entre los resultados del Amsterdam Inventory for Auditory Disability and Handicap y el promedio binaural de los umbrales auditivos y con los resultados de la prueba de Random Gap Detection. CONCLUSIONES: La exposición a solventes está asociada con las dificultades de la vida diaria relacionadas con las funciones del sistema auditivo periférico y central.

Adaptation of the Amsterdam Inventory for Auditory Disability and Handicap into Spanish.

PURPOSE: Self-report questionnaires have been suggested as valuable assessment tools in audiology, especially when investigating the effect of hearing impairment on the everyday lives of adults. Many self-report questionnaires have been developed for English-speaking populations; however, there is a lack of this type of questionnaire for Spanish-speaking patients. The aim of the present research was to adapt the Amsterdam Inventory for Auditory Disability and Handicap (AIADH) into Spanish. METHODS: The AIADH consists of 30 questions that deal with real-life listening situations. Each question is accompanied by a picture representing the situation being addressed. Six Spanish-English bilingual speakers and one Spanish-English bilingual speaker participated in the translations and back translations of the English version of the AIADH. Once the adaptation was finalized, 189 normal-hearing and hearing-impaired Spanish-speaking participants completed the Spanish version of the AIADH (S-AIADH). RESULTS: Statistical analysis showed a high Cronbach's alpha coefficient, indicating good internal reliability. Test-retest scores were highly correlated. Also, the S-AIADH showed good criterion validity. Statistically significant differences for all questionnaire item responses were observed between normal-hearing and hearing-impaired respondents. CONCLUSIONS: The AIADH has been adapted into Spanish. Normative data in percentiles have been obtained for clinical use with Spanish-speaking populations, to explore self-reported performance for the hearing functions proposed by the ICF. [Box: see text].