King-Kopetzky syndrome: A biopsychosocial approach to adult APD

This paper discusses the relationship between King-Kopetzky syndrome and auditory processing disorder (APD). King-Kopetzky syndrome is the term applied to adults who present for help in the presence of normal audiometric thresholds. These adults may or may not have an APD and this paper discusses the factors that influence help-seeking and what is known about audiological diagnosis and management

An ethnography study exploring factors that influence social isolation in care home residents living with dementia and hearing loss

Background Hearing loss and dementia are highly prevalent conditions amongst older adults living in residential care. The consequences of living with these conditions may include social withdrawal and reduced communication opportunities. We sought to examine patterns of communication and interaction in residential care and explore resident, staff, and relative perspectives within two care homes located in Birmingham, UK. This enabled an understanding of how communication environments contributed to social isolation. Methods This work used ethnography methodology to explore mechanisms that created and maintained social isolation in older adults living with dementia and hearing loss. A planning and engagement phase took place in four care homes. This was followed by an environmental audit, observations, and interviews. Data generated were analysed using Grounded Theory methods. Results There were 33 participants (16 residents, 11 care staff, and six relatives) who took part in the observations and interviews. Residents experienced social isolation through lack of meaningful conversation with others and being misunderstood. Additionally, observations of residents’ interactions informed the overall findings. A Grounded Theory model was employed to explain the core phenomenon of social isolation. The main contributors were internal and external barriers to communication, and reduced opportunities for meaningful conversation. Conclusions There is a wide range of social isolation that care home residents experience. This was not always associated with the severity of hearing loss but rather communication ability. Simple interventions such as staff dining with residents and focussing on improving communication could reduce social isolation within residential care settings. Keywords Communication, Social isolation, Dementia, Hearing, Ethnograp

How can sound generating devices support coping with tinnitus?

Objectives To understand how individuals with tinnitus perceive their sound generating devices help them in managing their tinnitus Design A qualitative interview based study employing grounded theory methodology to establish a theory as to the mechanisms that sound therapies contribute to coping with tinnitus. Ten National Health Service patient participants (who had been issued with sound generating devices from an Audiology department in England) participated in in depth interviews. Results This study identified that sound therapies helped create a sense of escapism and control. In addition, the process of obtaining devices created a sense of validation of the patient and their tinnitus. These mechanisms restore the previously disrupted harmony between the self and body. Conclusion Sound generating devices can assist coping through a number of mechanisms. There is no evidence that they ablate or remove perception of tinnitus. This study contributes novel theory based on patient accounts as to the potential benefits of sound generating device use

What makes someone choose cochlear implantation?:An exploration of factors that inform patient decision making

Objective: Our objective was to understand the factors that determine whether an adult who is eligible for cochlear implantation (CI) choose to take up or not take up the implant. Design: We conducted a qualitative in-depth interview study, informed by grounded theory methods of constant comparison to build a theory to describe why and how people decide to opt for CI or not. Study sample: Our samples were patients from an audiology service in England. Results: Our results describe the key factors in weighing up risks and benefits. These are influenced by living context and support, information and social identity. We identify the key features that impact decision making for adults eligible for cochlear implants. The importance of the patient lifeworld view is discussed. Conclusions: This qualitative study provides the first in depth examination of how and why patients do and do not take up the offer of cochlear implants. It highlights the complex and iterative nature of this decision making and the individualised risks that trade off benefits of implantation

Measuring the impact of illness perception on NHS audiology service usage in presbycusis patients – a feasibility study

Objective: Coping behaviour in adult hearing loss is still not well understood. Despite the high prevalence of hearing loss in those over 65, many people do not seek help for hearing loss. The common sense model of illness perceptions suggests that illness perceptions are a strong predictor of adapted coping behaviours, including help-seeking and take-up of treatments. This study aimed to determine the feasibility of using the brief illness perceptions questionnaire (bIPQ) to measure the impact of illness perception in predicting usage of NHS audiology services. Study design: Twenty-four volunteers were recruited from a standard NHS audiology outpatient clinic and illness perception was measured using the bIPQ. Two different recruitment strategies were explored and compared in terms of recruitment and retention rates. Comprehensibility of the questionnaire was assessed by Think Aloud Analysis in a subset of participants, while possible risks and burdens were monitored in structured telephone interviews. Results: The questionnaire is a comprehensive and quick tool to measure individual illness perception at minimal cost. We suggested minor adaptations of three questionnaire items to increase comprehension. Participants preferred to complete the questionnaire after their appointment at the clinic facilities rather than at home prior to their hearing assessment appointment. There were no identified risks or burdens to participants in this study. Conclusions: This approach met our criteria for feasibility. Understanding the impact of illness perception on patients’ coping behaviour in presbycusis could improve treatment outcomes and increase patient satisfaction, while promoting a more efficient and individualized audiology service

Lifeworld interpretation of tinnitus

Lifeworld-led care provides a route through which research and practice can navigate the 'biopsychosocial' allowing us to overcome the shortfalls of the medical model and enabling us to prioritise humanity in the care of people living with tinnitus. In this article, we sought to explore qualitative descriptions of life with tinnitus. We aimed to address the question 'what it is like to live with tinnitus?' In doing so we examined qualitative studies and provide suggestions about key themes that seem consistent. This is a narrative, thematic overview of the way lifeworld has been conceptualised and explored in tinnitus research

'I'm confused about what my problems actually are':Managing King-Kopetzky syndrome

Why do some people complain of hearing difficulties when their hearing esholds are normal? How should Audiology professionals respond to their presentation? This problem will be considered in the light of the literature from audiology, psychology, and medical sociology disciplines. The different evidence for and implications of bio-medical and bio psychosocial explanations for such experiences are discussed. In particular the role of help seeking is considered as a coping mechanism and as a key part of the diagnostic case definition applied to this population of audioiogy patients. Two original studies will be presented which consider this phenomenon from different viewpoints. The first explored the lived experience of the patients.Two original studies will be presented which consider this phenomenon from different viewpoints. The first explored the lived experience of the patient who is coping with hearing difficulties and investigated how seeking help forms part of the process of coping.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Auditory training and adult rehabilitation:a critical review of the evidence

Auditory Training (AT) describes a regimen of varied listening exercises designed to improve an individual’s ability to perceive speech. The theory of AT is based on brain plasticity (the capacity of neurones in the central auditory system to alter their structure and function) in response to auditory stimulation. The practice of repeatedly listening to the speech sounds included in AT exercises is believed to drive the development of more efficient neuronal pathways, thereby improving auditory processing and speech discrimination. This critical review aims to assess whether auditory training can improve speech discrimination in adults with mild-moderate SNHL. The majority of patients attending Audiology services are adults with presbyacusis and it is therefore important to evaluate evidence of any treatment effect of AT in aural rehabilitation. Ideally this review would seek to appraise evidence of neurophysiological effects of AT so as to verify whether it does induce change in the CAS. However, due to the absence of such studies on this particular patient group, the outcome measure of speech discrimination, as a behavioural indicator of treatment effect is used instead. A review of available research was used to inform an argument for or against using AT in rehabilitative clinical practice. Six studies were identified and although the preliminary evidence indicates an improvement gained from a range of AT paradigms, the treatment effect size was modest and there remains a lack of large-sample RCTs. Future investigation into the efficacy of AT needs to employ neurophysiological studies using auditory evoked potentials in hearing-impaired adults in order to explore effects of AT on the CAS

Exploring how parents of children with unilateral hearing loss make habilitation decisions: a qualitative study

Objective This study sought to explore the decision making needs of parents managing the hearing and communication needs of children with unilateral hearing loss. Design An inductive, qualitative method was used. The data were analysed using a constant comparative approach, consistent with Grounded Theory method. Study sample Twenty one families participated in interviews yielding data on twenty two children. Each of these families had at least one child with unilateral hearing loss. The age range of the children varied from four months to sixteen years old. All parents were English speaking and received care from National Health Service Audiology departments across the United Kingdom. Results Parents valued professionals’ opinions, but information provision was inconsistent. As their children mature, parents increasingly valued their child’s input. Parent-child discussions focussed on how different management strategies fit their child’s preferences. Parents were proactive in obtaining professional advice, and integrating this with their own iterative assessment of their child’s performance. Conclusions Decision making is an iterative process. Parents make nuanced decisions which aim to preserve a sense of what is normal for them. Clinicians need to recognise the parental view, including where it may contrast with a medicalised or clinical view

How do patients decide on interventions for single sided deafness? A qualitative investigation of patient views

Background: Single-sided deafness presents communication challenges for adults. There are a range of care options, including CROS hearing aids, available but little is known about patient preferences for these interventions. Objective: The objective of this study was to understand the viewpoints of patients making decisions about audiological interventions they use. Methods: A constructivist worldview using thematic analysis to undertake a constant comparative analysis of 8 semi-structured interviews. Sampling: Participants were recruited from Portsmouth Hospitals University NHS Trust audiology service in England. Findings: The results of the study describe ongoing iterative judgements being made by participants, informed by their access to information, effectiveness of audiological interventions, stigma, barriers to accessing care, and constant cost-benefit analyses being made. The key factors involved in decision-making by individuals with Single-sided deafness (SSD) are discussed. Conclusions: This study represents the first in-depth exploration of the individual's lifeworld related to which factors influence use of different audiological interventions by individuals with SSD. It highlights the complex and ongoing nature of how decisions are made by these individuals and identifies the need for greater information provision by clinicians, such as through use of a decision aid tool