Hearing aid effectiveness after aural rehabilitation - individual versus group (HEARING) trial: RCT design and baseline characteristics

<p>Abstract</p> <p>Background</p> <p>Hearing impairment is the most common body system disability in veterans. In 2008, nearly 520,000 veterans had a disability for hearing loss through the Department of Veterans Affairs (VA). Changes in eligibility for hearing aid services, along with the aging population, contributed to a greater than 300% increase in the number of hearing aids dispensed from 1996 to 2006. In 2006, the VA committed to having no wait times for patient visits while providing quality clinically-appropriate care. One approach to achieving this goal is the use of group visits as an alternative to individual visits. We sought to determine: 1) if group hearing aid fitting and follow-up visits were at least as effective as individual visits, and 2) whether group visits lead to cost savings through the six month period after the hearing aid fitting. We describe the rationale, design, and characteristics of the baseline cohort of the first randomized clinical trial to study the impact of group versus individual hearing aid fitting and follow-up visits.</p> <p>Methods</p> <p>Participants were recruited from the VA Puget Sound Health Care System Audiology Clinic. Eligible patients had no previous hearing aid use and monaural or binaural air-conduction hearing aids were ordered at the evaluation visit. Participants were randomized to receive the hearing aid fitting and the hearing aid follow-up in an individual or group visit. The primary outcomes were hearing-related function, measured with the first module of the Effectiveness of Aural Rehabilitation (Inner EAR), and hearing aid adherence. We tracked the total cost of planned and unplanned audiology visits over the 6-month interval after the hearing aid fitting.</p> <p>Discussion</p> <p>A cohort of 659 participants was randomized to receive group or individual hearing aid fitting and follow-up visits. Baseline demographic and self-reported health status and hearing-related measures were evenly distributed across the treatment arms.</p> <p>Outcomes after the 6-month follow-up period are needed to determine if group visits were as least as good as those for individual visits and will be reported in subsequent publication.</p> <p>Trial Registration</p> <p>NCT00260663</p

Nasolacrimal system aeration on computed tomographic imaging: effects of patient positioning&nbsp;and scan orientation

Craig N Czyz,1 Thomas S Bacon,2 Andrew W Stacey,3 Eva N Cahill,4 Bryan R Costin,5 Boris I Karanfilov,6 Kenneth V Cahill5 1Section Oculofacial Plastic and Reconstructive Surgery, Ohio University/OhioHealth, 2Department of Medical Education, Mount Carmel Health Systems, Columbus, OH, USA; 3Department of Ophthalmology, University of Michigan, Ann Arbor, MI, USA; 4Department of Biology, Wittenberg University, Springfield, OH, USA; 5Department of Ophthalmology, William H Havener Eye Institute, Ohio State University Wexner Medical Center, Columbus, OH, USA; 6The Sinus Institute of Ohio, Dublin, OH, USA Purpose: To determine the impact of patient positioning and scan orientation on the appearance of air in the nasolacrimal drainage system on computed tomography (CT) imaging, and the repeatability of the observations.Methods: This was a retrospective analysis of CT images for 92 patients.Results: Air was found to be present more fully in the upright-position group as compared with the supine-position group. Comparing axial and coronal scan orientation, no difference in aeration was found, except for the nasolacrimal duct in the upright-position group.Conclusion: Patient position should be accounted for in diagnostic conclusions and treatment decisions based on CT. Keywords: axial, coronal, nasolacrimal sac, nasolacrimal duc

Reliability of Estimating Ductions in Thyroid Eye Disease An International Thyroid Eye Disease Society Multicenter Study

Abstract: Purpose: To determine intraobserver and interobserver reliability of 3 clinical techniques for measuring ocular ductions in patients with thyroid eye disease and to compare these with an established method using a Goldmann perimeter. Our secondary goals were to compare the clinical methods for test duration, ease of learning and performance, and whether these differed between novices and experts. Design: Multicenter, prospective, comparative trial. Participants: We recruited 38 patients with thyroid orbitopathy and reduced ocular motility from 7 academic centers. Methods: At each center, 2 novices and 2 experts measured the ocular ductions of each eye of each patient in 4 directions (0 degrees, 90 degrees, 180 degrees, and 270 degrees) using 3 techniques (best guess [BG], light reflex [LR], and a ruler measuring [RU] technique). Test duration and clinicians' feedback were recorded. A subjective and objective measurement for ocular ductions using a Goldmann perimeter was performed for each subject by a trained technician. The 3 clinical measurements and the perimetry measurements were performed twice, separated by >= 1 hour. Main Outcome Measures: We measured the intraobserver and interobserver reliability of the 3 clinical techniques and intraobserver reliability of Goldmann perimeter. Clinical testing reliability was compared between experts and novices. We also examined test duration and clinician feedback. Results: The LR technique had significantly better intraobserver and interobserver repeatability compared with the BG or RU clinical measurements and statistically was equivalent to the gold-standard perimetric technique. Reliability was constant regardless of the amount of restriction in ocular movement. There was no difference between reliability values for experts and novices. The LR and BG techniques were significantly faster than the RU or perimetry techniques and were considered easiest to learn and perform, but clinicians had most confidence in the LR technique results. Conclusions: The LR technique for measuring ocular ductions in thyroid orbitopathy is more reliable than other clinical techniques and as reliable as the established technique using the perimeter. However, unlike the latter method, it is easier to learn and perform by both novices and experts, is significantly faster, and can be performed by the clinician without machinery or a trained technicia