Determinants of objective and subjective auditory disability in patients with normal hearing

A proportion of individuals consulting audiology clinics complain of difficulties discriminating speech in noisy environments but have clinically 'normal' hearing, do not have signs of middle ear pathology, nor any other obvious basis for their complaints. The syndrome was named 'Obscure Auditory Dysfunction (OAD)'. Following a small scale study, a Special Investigative Clinic was started to investigate factors underlying OAD. Patients' performance on psychoacoustic, central/cognitive and personality-related tests was compared with the performance of matched controls. Results showed OAD to be a multifactorial syndrome. Patients have a genuine performance deficit for discrimination of speech-in-noise, influenced by a combination of psychoacoustic and central/cognitive deficits. Patients' relatively minor performance deficit did not completely explain their reported disability and handicap; this was mainly influenced by their underestimating their hearing ability. Anxiety-related factors and a history of otological disorder were found to underlie the seeking of medical attention. Based on these results, a clinical package was devised to enable diagnosis and understanding of OAD in individuals consulting in the clinic. The parallels between OAD and another syndrome without obvious organic pathology (women complaining of lower abdominal pain) were investigated. A double dissociation between personality-related factors and psychoacoustic/cognitive factors was demonstrated. It was concluded that personality factors should be considered when dealing with individuals seeking medical advice for minor organic pathology, but that such individuals should not simply be dismissed as being neurotic. Finally, correlational analyses using the combined data of all subjects, were carried out to investigate relationships between self-rated auditory disability/handicap, psychoacoustic, central/cognitive and personality-related variables. Self-rated disability/handicap were found to correlate best with performance on a test of speech-in-noise, less well with subtle auditory function but not with pure tone sensitivity. Cognitive function also correlated with reported disability/handicap, as did anxiety level and otological history. It was concluded that performance measures could be used to validate reports of disability/handicap, but that personality factors should be taken into account when interpreting such reports. Performance on a speech-in-noise test correlated with psychoacoustic and central/cognitive functions, but not with personality factors. It was concluded that minor sensory dysfunction can be reflected in a sensitive performance test but that performance is not affected by 'normal' personality traits

Determinants of objective and subjective auditory disability in patients with normal hearing

A proportion of individuals consulting audiology clinics complain of difficulties discriminating speech in noisy environments but have clinically 'normal' hearing, do not have signs of middle ear pathology, nor any other obvious basis for their complaints. The syndrome was named 'Obscure Auditory Dysfunction (OAD)'. Following a small scale study, a Special Investigative Clinic was started to investigate factors underlying OAD. Patients' performance on psychoacoustic, central/cognitive and personality-related tests was compared with the performance of matched controls. Results showed OAD to be a multifactorial syndrome. Patients have a genuine performance deficit for discrimination of speech-in-noise, influenced by a combination of psychoacoustic and central/cognitive deficits. Patients' relatively minor performance deficit did not completely explain their reported disability and handicap; this was mainly influenced by their underestimating their hearing ability. Anxiety-related factors and a history of otological disorder were found to underlie the seeking of medical attention. Based on these results, a clinical package was devised to enable diagnosis and understanding of OAD in individuals consulting in the clinic. The parallels between OAD and another syndrome without obvious organic pathology (women complaining of lower abdominal pain) were investigated. A double dissociation between personality-related factors and psychoacoustic/cognitive factors was demonstrated. It was concluded that personality factors should be considered when dealing with individuals seeking medical advice for minor organic pathology, but that such individuals should not simply be dismissed as being neurotic. Finally, correlational analyses using the combined data of all subjects, were carried out to investigate relationships between self-rated auditory disability/handicap, psychoacoustic, central/cognitive and personality-related variables. Self-rated disability/handicap were found to correlate best with performance on a test of speech-in-noise, less well with subtle auditory function but not with pure tone sensitivity. Cognitive function also correlated with reported disability/handicap, as did anxiety level and otological history. It was concluded that performance measures could be used to validate reports of disability/handicap, but that personality factors should be taken into account when interpreting such reports. Performance on a speech-in-noise test correlated with psychoacoustic and central/cognitive functions, but not with personality factors. It was concluded that minor sensory dysfunction can be reflected in a sensitive performance test but that performance is not affected by 'normal' personality traits

Impact of SARS-CoV-2 Virus (COVID-19) preventative measures on communication : a scoping review

INTRODUCTION : Face coverings and distancing as preventative measures against the spread of the Coronavirus disease 2019 may impact communication in several ways that may disproportionately affect people with hearing loss. A scoping review was conducted to examine existing literature on the impact of preventative measures on communication and to characterize the clinical implications. METHOD : A systematic search of three electronic databases (Scopus, PubMed, CINAHL) was conducted yielding 2,158 articles. After removing duplicates and screening to determine inclusion eligibility, key data were extracted from the 50 included articles. Findings are reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews, including the PRISMA-ScR checklist. RESULTS : Studies fell into three categories: Studies addressing the impacts of personal protective equipment (PPE) and/or distancing on communication in healthcare contexts (n = 20); studies examining the impact of preventative measures on communication in everyday life (n = 13), and studies measuring the impact of face coverings on speech using acoustic and/or behavioral measures (n = 29). The review revealed that masks disrupt verbal and non-verbal communication, as well as emotional and social wellbeing and they impact people with hearing loss more than those without. These findings are presumably because opaque masks attenuate sound at frequencies above 1 kHz, and conceal the mouth and lips making lipreading impossible, and limit visibility of facial expressions. While surgical masks cause relatively little sound attenuation, transparent masks and face shields are highly attenuating. However, they are preferred by people with hearing loss because they give access to visual cues. CONCLUSION : Face coverings and social distancing has detrimental effects that extend well beyond verbal and non-verbal communication, by affecting wellbeing and quality of life. As these measures will likely be part of everyday life for the foreseeable future, we propose that it is necessary to support effective communication, especially in healthcare settings and for people with hearing loss.Sonova, AG and NIHR Manchester Biomedical Research Centre.https://www.frontiersin.org/journals/public-health#hj2022Speech-Language Pathology and Audiolog

Fitting a Hearing Aid on the Better Ear, Worse Ear, or Both: Associations of Hearing-aid Fitting Laterality with Outcomes in a Large Sample of US Veterans

Longitudinal electronic health records from a large sample of new hearing-aid (HA) recipients in the US Veterans Affairs healthcare system were used to evaluate associations of fitting laterality with long-term HA use persistence as measured by battery order records, as well as with short-term HA use and satisfaction as assessed using the International Outcome Inventory for Hearing Aids (IOI-HA), completed within 180 days of HA fitting. The large size of our dataset allowed us to address two aspects of fitting laterality that have not received much attention, namely the degree of hearing asymmetry and the question of which ear to fit if fitting unilaterally. The key findings were that long-term HA use persistence was considerably lower for unilateral fittings for symmetric hearing loss (HL) and for unilateral worse-ear fittings for asymmetric HL, as compared to bilateral and unilateral better-ear fittings. In contrast, no differences across laterality categories were observed for short-term self-reported HA usage. Total IOI-HA score was poorer for unilateral fittings of symmetric HL and for unilateral better-ear fittings compared to bilateral for asymmetric HL. We thus conclude that bilateral fittings yield the best short- and long-term outcomes, and while unilateral and bilateral fittings can result in similar outcomes on some measures, we did not identify any HL configuration for which a bilateral fitting would lead to poorer outcomes. However, if a single HA is to be fitted, then our results indicate that a better-ear fitting has a higher probability of long-term HA use persistence than a worse-ear fitting

A measure of long-term hearing-aid use persistence based on battery re-ordering data

Objective: We describe the construction of a hearing-aid long-term use persistence measure based on battery reorder data. The measure is derived from the notion that hearing-aid users keep using their devices for some time after placing a battery order. Design: A hearing-aid user is defined as persistent at time í µí± if they placed a battery order within a timespan í µí± preceding í µí±. We characterize and validate this measure using electronic health records from a large sample of US Veterans. Results: We describe how to choose parameters í µí± and í µí± for calculating persistence rates in the patient sample. For validation, the associations of persistence with (a) the duration over which users received outpatient hearing-aid care, (b) self-reported hearing-aid use shortly after fitting, (c) patient age and hearing loss are investigated. In all cases, plausible dependencies are observed. Conclusions: We conclude that our persistence measure is viable and hope this will motivate its use in similar studies

Barriers and facilitators to delivery of group audiological rehabilitation programs : a survey based on the COM-B model

OBJECTIVE : To canvas the views of Australia-based hearing healthcare clinicians regarding group audiological rehabilitation practices. DESIGN : A national cross-sectional self-report survey. Data were analysed using descriptive statistics and content analysis. STUDY SAMPLE : Sixty-two Australia-based hearing healthcare clinicians, with experience working in an adult rehabilitation setting. RESULTS : Clinicians appeared to positively view the provision of group audiological rehabilitation services, yet were limited in their ability to deliver these services due to organisational barriers. Although some organisational barriers were non-modifiable by the clinician (such as group AR services not prioritised within their workplace, a lack of support from colleagues/managers, lack of resources, and a lack of funding for the delivery of group AR services), others were within the clinicians’ ability to change (such as habit formation for recommending these services during clinical appointments). Participants expressed a desire for resources to assist them in delivering group AR, including downloadable lesson plans and information sheets for clients, clinician training videos and client educational videos. Clinicians called for increased diversity in program offerings, specifically relating to the emotional, relational and social impacts of hearing loss. CONCLUSIONS : These results provide a framework for the development of interventional studies to increase the utilisation of group audiological rehabilitation services.https://www.tandfonline.com/loi/iija202022-06-13hj2022Speech-Language Pathology and Audiolog

Dementia and hearing-aid use: a two-way street

ObjectivesHearing-aid use may reduce risk of dementia, but cognitive impairment makes use more challenging. An observed association between reduced hearing-aid use and incident dementia could reflect either or both of these causal paths. The objective was to examine the effects of each path while minimising contamination between paths.MethodsHealth records data from 380,794 Veterans who obtained hearing aids from the US Veterans Affairs healthcare system were analysed. Analysis 1 (n = 72,180) used multivariable logistic regression to model the likelihood of incident dementia 3.5–5 years post hearing-aid fitting for patients free of dementia and mild cognitive impairment (MCI). Analysis 2 (n = 272,748) modelled the likelihood of being a persistent hearing-aid user at 3 years 2 months after fitting, contrasting subgroups by level of cognitive function at the time of fitting. Analysis time windows were optimized relative to dataset constraints. Models were controlled for available relevant predictors.ResultsThe adjusted OR for incident dementia was 0.73 (95% CI 0.66–0.81) for persistent (versus non-persistent) hearing-aid users. The adjusted OR for hearing-aid use persistence was 0.46 (95% CI 0.43–0.48) in those with pre-existing dementia (versus those remaining free of MCI and dementia).ConclusionSubstantial independent associations are observed in both directions, suggesting that hearing-aid use decreases risk of dementia and that better cognitive function predisposes towards persistent use. Research studying protective effects of hearing-aid use against dementia needs to account for cognitive status. Clinically, hearing devices and hearing care processes must be accessible and usable for all, regardless of their cognitive status

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead