Targeted Re-Instruction for Hearing Aid Use and Care Skills

Purpose: Approximately 30% of hearing aid owners do not wear their hearing aids. One of the main reasons reported for hearing aid non-use is that hearing aid owners cannot successfully use and/or care for their hearing aids (Lupsakko, Kautiainen, & Sulkava 2005; Popelka et al. 1998; Vuorialho, Karinen, & Sorri 2006). The primary purpose of the present study was to evaluate the benefit of identifying specific hearing aid use and care skills that a hearing aid user cannot perform or has difficulty performing and providing re-instruction on those specific skills. This is operationally defined in the present study as targeted re-instruction. A second purpose was to determine if adding targeted re-instruction to a hearing aid fitting would result in greater hearing aid satisfaction and more hours of daily hearing aid use. Last, factors that may influence an individual’s learning and remembering of hearing aid use and care skills were also assessed. Method: Twenty-six participants (13 experimental; 13 control) were included in this randomized control trial. All participants were new hearing aid users who had never worn or tried hearing aids before. Participants were fit with ReSound Linx 3D 962 RIC-style hearing aids for a four-week trial period and provided a standard hearing aid orientation. Participants assigned to the experimental group were also administered the Practical Hearing Aid Skills Test – Revised (PHAST-R; Desjardins & Doherty 2009; Doherty & Desjardins 2012) and provided targeted re-instruction. Hearing aid use and care skills were measured using the Hearing Aid Skills and Knowledge (HASK; Saunders et al. 2018) test immediately following the hearing aid fitting and then again at four weeks post-hearing aid fitting. The relationship between hearing aid use and care skills and measures of hearing handicap, hearing aid-related attitudes, and working memory were assessed. In addition, hearing aid satisfaction was measured at two and four weeks post-hearing aid fitting. Data logging was used to determine average daily hours of hearing aid use. Results: Participants in the experimental group maintained their hearing aid use and care skills over the four week hearing aid trial, but participants in the control group showed a significant decline in their hearing aid use and care skills over the same time period. None of the factors assessed in the present study were significantly correlated to learning and remembering of hearing aid use and care skills. Also, no significant difference in average daily hours of hearing aid use was observed between the two groups of participants. Level of satisfaction was significantly different between the two groups at two weeks post-hearing aid fitting, but not at the end of the four week trial period. Last, it took an average of 9 minutes and 15 seconds (SD = 3 minutes and 13 seconds) to administer the PHAST-R app and provide targeted re-instruction. Conclusions: Targeted re-instruction prevented a decline in hearing aid use and care skills after four weeks of hearing aid use. Participants who did not receive targeted re-instruction showed a decline in their hearing aid use and care skills after only four weeks of hearing aid use. This indicates that targeted re-instruction can help new hearing aid users maintain their hearing aid use and care skills over time. It took an average of less than 10 minutes to administer the PHAST-R app and provide targeted re-instruction

Familial thrombophilia : Resistance to activated protein C and protein S deficiency

Inherited resistance to activated protein C (APC-resistance) and protein S deficiency are associated with functional impairment of the protein C anticoagulant system, resulting in lifelong hypercoagulability andincreased risk of thrombosis. APC-resistance is the most common genetic cause of thrombosis being present in 20% to 60% of thrombosis patients.A linkage study was performed in a large thrombophilic family with independent inheritance of APCresistance and protein S deficiency. APC-resistance was found to co-segregate with two neutral polymorphisms in the factor V gene. A point mutation changing Arg506 to a Gln in the factor V gene was the cause of APC-resistance in the family. The mutation (FV:Q506) is localised in one of the APC-cleavage sites of factor V, rendering mutated factor Va resistant to cleavage by activated protein C (APC). The factor V mutation was analysed in 308 members from 50 thrombosis-prone families with inherited APC-resistance.In 94% (47/50) of APC-resistant families the same factor V gene mutation was identified. The magnitude of thrombotic risk was dependent on the factor V genotype. We investigated 327 individuals in 18 thrombosis-prone families with inherited deficiency of free protein S. Deficiency of free protein S was caused by equimolar relationship between total protein S and B-chain containing isoforms of C4BP. Moreover, type I deficiency (low free and total protein S) and type IIIdeficiency (low free but normal total protein S) coexisted in 14 out of 18 families, demonstrating the twotypes to be phenotypic variants of the same genetic disease. Deficiency of free protein S was a strong riskfactor for thrombosis in these families. However, thrombophilia penetrance was highly variable. TheFV:Q506 mutation causing APC-resistance was identified as an additional genetic risk factor in 39% (7/18)of the families. Thus, familial thrombophilia isa multiple genetic disorder.Biochemically affected family members had higher levels of prothrombin fragment Fl +2 than their normalrelatives. The results demonstrate that individuals with APC-resistance or protein S deficiency have animbalance between pro- and anti-coagulant forces, resulting in increased thrombin generation andhypercoagulability

Slow cortical auditory evoked potentials and auditory steady-state evoked responses in adults exposed to occupational noise

In individuals claiming compensation for occupational noise induced hearing loss, a population with a high incidence of nonorganic hearing loss, a reliable and valid behavioural pure tone (PT) threshold is not always achievable. Recent studies have compared the accuracy of behavioural PT threshold estimation using the slow cortical auditory evoked potentials (SCAEP) and auditory steady-state responses (ASSR) but there is no consensus regarding recommended technique. A review of the literature indicated that no comparison has been completed on the use of SCAEP and a single frequency ASSR technique. A research project was therefore initiated with the aim of comparing the clinical effectiveness (accuracy) and clinical efficiency (time required) of SCAEP and ASSR for behavioural PT threshold estimation in adults exposed to occupational noise. Adult participants were divided into a group with normal hearing (behavioural PT thresholds < 20 dBHL; n = 15) and a group of participants with hearing loss (n = 16 adults), the latter of which were recruited from individuals referred for audiometric screening, as part of hearing conservation programs, and who were, therefore, exposed to occupational noise. The GSI Audera electrophysiological system was used for both SCAEP and ASSR threshold measurement at 0.5, 1, 2 and 4 kHz. Use was made of tone burst stimuli for the SCAEP (rise and fall of 10 ms with 80 ms plateau), while amplitude and frequency modulated (AM/FM) stimuli was used during ASSR testing. The system’s 40 Hz protocol was chosen for use during ASSR recording while participants slept because this led to lparticipants. ASSR thresholds could not be measured in two of the three sleeping participants in the preliminary study using an 80 Hz modulation rate due to excessive noise. The mean SCAEP difference scores (SCAEP threshold minus behavioural PT threshold) for both participant groups were -0.2+10.2, 2.8+10.1,5.8+9.7, 0.5+10.4 at 0.5, 1, 2, and 4 kHz respectively, while ASSR difference scores were 25.3+12.8, 21.7+11.3,32.3+12.2, 27.1+13.8. The SCAEP correlations with behavioural PT thresholds across frequencies (r = 0.85) were also stronger than ASSR correlations (r = 0.75). Therefore, with regard to proximity of auditory evoked potentials (AEP) to behavioural PT thresholds and consistency of this relationship, the SCAEP, rather than ASSR, is the AEP of choice. However, the SCAEP took on average 10.1 minutes longer to complete than the ASSR. Clinical effectiveness was given comparably more weight than the clinical efficiency of the AEP technique to estimate behavioural PT thresholds due to the impact on overcompensation for occupational noise induced hearing loss. As such, the study acknowledged the SCAEP as the AEP of choice for the purpose of behavioural PT thresholds in adults exposed to occupational noise. It is important to note that the conclusion reached in the current study arose from the comparison of the SCAEP with a specific ASSR technique. Accuracy of ASSR estimation of behavioural PT thresholds is strongly influenced by stimulus and recording parameters of the system used, and by the participant variables. CopyrightDissertation (MCommunication Pathology)--University of Pretoria, 2010.Speech-Language Pathology and AudiologyUnrestricte