Different Audiologic Outcomes in Twins with Congenital Cytomegalovirus Infection.

Congenital cytomegalovirus (cCMV) infection is a major cause of hearing loss in children. A few cases of cCMV twin pregnancies are reported in the literature. Twins can react differently to maternal infection, but hearing loss is rarely evaluated. Two couples of twins with cCMV infection and different audiologic outcomes are reported. The first couple of twins was composed by two male twins, both affected by cCMV infection. The first born had normal hearing function, and the second born had sensorineural hearing loss (SNHL). In the second couple, a male and a female twin, only the male twin was affected by cCMV infection, and both had normal hearing function. In this case series, an interesting finding was the association between the presence of viral DNA in liquor and hearing loss in one newborn. Further research is needed to better understand the pathophysiology of SNHL caused by cCMV infection.

Common Audiological Functional Parameters (CAFPAs) for single patient cases: deriving statistical models from an expert-labelled data set.

Objective: Statistical knowledge about many patients could be exploited using machine learning to provide supporting information to otolaryngologists and other hearing health care professionals, but needs to be made accessible. The Common Audiological Functional Parameters (CAFPAs) were recently introduced for the purpose of integrating data from different databases by providing an abstract representation of audiological measurements. This paper aims at collecting expert labels for a sample database and to determine statistical models from the labelled data set.Design: By an expert survey, CAFPAs as well as labels for audiological findings and treatment recommendations were collected for patients from the database of Hörzentrum Oldenburg.Study sample: A total of 287 single patient cases were assessed by twelve highly experienced audiological experts.Results: The labelled data set was used to derive probability density functions for categories given by the expert labels. The collected data set is suitable for estimating training distributions due to realistic variability contained in data for different, distinct categories. Suitable distribution functions were determined. The derived training distributions were compared regarding different audiological questions.Conclusions: The method-expert survey, sorting data into categories, and determining training distributions - could be extended to other data sets, which could then be integrated via the CAFPAs and used in a classification task.

An Analysis of Nonsignificant Results in Audiology Using Bayes Factors.

Purpose Null hypothesis significance testing is commonly used in audiology research to determine the presence of an effect. Knowledge of study outcomes, including nonsignificant findings, is important for evidence-based practice. Nonsignificant p values obtained from null hypothesis significance testing cannot differentiate between true null effects or underpowered studies. Bayes factors (BFs) are a statistical technique that can distinguish between conclusive and inconclusive nonsignificant results, and quantify the strength of evidence in favor of 1 hypothesis over another. This study aimed to investigate the prevalence of BFs in nonsignificant results in audiology research and the strength of evidence in favor of the null hypothesis in these results. Method Nonsignificant results mentioned in abstracts of articles published in 2018 volumes of 4 prominent audiology journals were extracted (N = 108) and categorized based on whether BFs were calculated. BFs were calculated from nonsignificant t tests within this sample to determine how frequently the null hypothesis was strongly supported. Results Nonsignificant results were not directly tested with BFs in any study. Bayesian re-analysis of 93 nonsignificant t tests found that only 40.86% of findings provided moderate evidence in favor of the null hypothesis, and none provided strong evidence. Conclusion BFs are underutilized in audiology research, and a large proportion of null findings were deemed inconclusive when re-analyzed with BFs. Researchers are encouraged to use BFs to test the validity and strength of evidence of nonsignificant results and ensure that sufficient sample sizes are used so that conclusive findings (significant or not) are observed more frequently. Supplemental Material https://osf.io/b4kc7/.

Improving transition outcomes in adolescents with permanent hearing loss.

Young people with permanent hearing loss need to transition into adult services and engagement with the transition process is required to achieve this. Although there are clear national recommendations about the transition process and transfer to the adult services limited evidence has been published about the implementation and efficacy of transition programmes in young adults with permanent hearing loss. The primary aim of this quality improvement project was to significantly increase the number of teenagers with a clear transition protocol documented in their notes. The secondary aims were to ensure good medical and audiological outcomes based on all completing their medical investigations prior to transfer to the adult services and also based on a survey regarding attitudes to hearing aids use. A multiphase intervention programme was developed; (1) staff update with national transition protocols, (2) development of a clear transition protocol, (3) allocated key worker (4) access and (5) engagement. Through these interventions we increased the number of teenagers who had a clear transition protocol documented in their notes from 11% to 91%. 84% of our teenagers had completed their medical investigations, although documented discussion about the investigations had been done with 100% of the cohort. 9.2 % of adolescents felt pressurised to use hearing aids compared to 35% prior to the interventions. This project resulted in clear, measurable conclusions and we have shown that we better understand the needs of our patients and the improvement is sustainable.

The Circle of Care for Older Adults With Hearing Loss and Comorbidities: A Case Study of a Geriatric Audiology Clinic.

Purpose Older adults seeking audiologic rehabilitation often present with medical comorbidities, yet these realities of practice are poorly understood. Study aims were to examine (a) the frequency of identification of selected comorbidities in clients of a geriatric audiology clinic, (b) the influence of comorbidities on audiology practice, and (c) the effect of comorbidities on rehabilitation outcomes. Method The records of 135 clients ( M age = 86 years) were examined. Information about comorbidities came from audiology charts (physical paper files) and hospital electronic health records (EHRs). Data about rehabilitation recommendations and outcomes came from the charts. Focus groups with audiologists probed their views of how comorbidities influenced their practice. Results The frequency of identification was 68% for visual, 50% for cognitive, and 42% for manual dexterity issues; 84% had more than one comorbidity. Also noted were hypertension (43%), falls (33%), diabetes (13%), and depression (16%). Integrating information from the audiology chart and EHR provided a more complete understanding of comorbidities. Information about hearing in the EHR included logs of outpatient audiology visits (75% of 135 cases), audiologists' care notes for inpatients and long-term care residents (25%), and entries by other health professionals (60%). Modifications to audiology practice were common and varied depending on comorbidity. High rates of success were achieved regardless of comorbidities. Conclusions In this clinic, successful outcomes were achieved by modifying audiology practice for clients with comorbidities. Increased interprofessional communication among clinicians in the circle of care could improve care planning and outcomes for older adults with hearing loss.

Common Audiological Functional Parameters (CAFPAs): statistical and compact representation of rehabilitative audiological classification based on expert knowledge.

OBJECTIVE: As a step towards objectifying audiological rehabilitation and providing comparability between different test batteries and clinics, the Common Audiological Functional Parameters (CAFPAs) were introduced as a common and abstract representation of audiological knowledge obtained from diagnostic tests. DESIGN: Relationships between CAFPAs as an intermediate representation between diagnostic tests and audiological findings, diagnoses and treatment recommendations (summarised as "diagnostic cases") were established by means of an expert survey. Expert knowledge was collected for 14 given categories covering different diagnostic cases. For each case, the experts were asked to indicate expected ranges of diagnostic test outcomes, as well as traffic light-encoded CAFPAs. STUDY SAMPLE: Eleven German experts in the field of audiological rehabilitation from Hanover and Oldenburg participated in the survey. RESULTS: Audiological findings or treatment recommendations could be distinguished by a statistical model derived from the experts' answers for CAFPAs as well as audiological tests. CONCLUSIONS: The CAFPAs serve as an abstract, comprehensive representation of audiological knowledge. If more detailed information on certain functional aspects of the auditory system is required, the CAFPAs indicate which information is missing. The statistical graphical representations for CAFPAs and audiological tests are suitable for audiological teaching material; they are universally applicable for real clinical databases.

Hearing loss and access to audiology services in rural victoria: Findings from the crossroads study.

CONTEXT: Rural residents can be exposed to high levels of agricultural machinery noise and are at risk of hearing loss. AIMS: This study aimed to determine audiology service use and rates of hearing loss in a regional area of Australia, using both self-report and audiology testing. SETTING AND DESIGN: A survey of randomly selected households was undertaken and 6432 participants were interviewed face to face about their health, hearing, and use of audiology services. A total of 1454 participants were randomly selected to undertake standard audiology testing. MATERIAL AND METHODS: Material Hearing was evaluated using conventional audiometry. STATISTICAL ANALYSIS USED: Independent t-tests, cChi-squared tests, and logistic regression were used to examine the association amongbetween hearing loss, use of audiology services, and demographic factors. RESULTS: Hearing issues were present in 12.5% of the survey participants. The rate of hearing loss increased significantly with age. Males were significantly more likely to have hearing loss than females (9.5% vs. 5.2%, pP << 0.01). The majority of people who reported accessing audiology services in the past 12 months were satisfied with the care they received (85.2%), and experienced short waiting times for these services (68.2% waited ≤≤ 7 days). CONCLUSIONS: Males had higher rates of hearing issues than females in this rural area. Audiology services in the region were accessible within short waiting times, and clients were satisfied with the service.

Prevalence of Publication Bias Tests in Speech, Language, and Hearing Research.

Purpose: The purpose of this research note is to systematically document the extent that researchers who publish in American Speech-Language-Hearing Association (ASHA) journals search for and include unpublished literature in their meta-analyses and test for publication bias. Method: This research note searched all ASHA peer-reviewed journals for published meta-analyses and reviewed all qualifying articles for characteristics related to the acknowledgment and assessment of publication bias. Results: Of meta-analyses published in ASHA journals, 75% discuss publication in some form; however, less than 50% test for publication bias. Further, only 38% (n = 11) interpreted the findings of these tests. Conclusion: Findings reveal that more attention is needed to the presence and impact of publication bias. This research note concludes with 5 recommendations for addressing publication bias. Supplemental Material: https://doi.org/10.23641/asha.7268648.

Irish School Entry Screening referral trends and cohort comparison with preschool specialist referrals.

OBJECTIVE: To analyse referral cohorts from School Entry Screening, Hearing (SHS) and Vision Screening (SVS) before and after documented changes. To compare referrals to pre-school specialists with subsequent group SHS outcomes. DESIGN: Randomized cohort, audit analysis of Community Nursing Developmental and SES records (CHRs), plus Audiology file review for SHS referrals. STUDY SAMPLE: Six hundred and sixty-eight mainstream pupils' CHRs were analysed in four birth cohorts, post-SES, using coded anonymized records. RESULTS: Significant referral rate differences existed between SHS and SVS. SHS, not SVS, referrals were impacted by nursing staff changes but not by SHS protocol changes. Preschool Audiology referrals outnumbered SHS referrals. All PCHI children with amplification were detected prior to SHS. SHS program yielded conductive hearing loss only. Similar SHS referral rates occurred for pre-school Speech Language Therapy referrals compared to children not referred; just 16% of pre-school Speech Language Therapy primary referrals were referred on to Audiology. CONCLUSIONS: SHS referral percentage fell slightly; SVS referral percentage remained unchanged. Low referral rates and low SHS hearing loss yield has modest impact upon Audiology services, but audiometrically screened referrals deserve higher priority. UNHS children born after 2011 create bigger Audiology service impact. International comparisons and European SHS research collaboration are encouraged.

Survey of ENT services in sub-Saharan Africa: little progress between 2009 and 2015.

BACKGROUND: A 2009 survey of ENT, audiology, and speech therapy services and training opportunities in 18 Sub-Saharan African countries reported that the availability of services was extremely poor, the distribution of services was very inequitable, and training opportunities were limited. ​​Objective: We conducted a new survey to determine the current status of ear, nose, and throat (ENT), audiology, and speech therapy services in sub-Saharan Africa. METHOD: This study is a cross-sectional study. A questionnaire was distributed by email to an ad hoc group of ENT surgeons and audiologists in 30 sub-Saharan African countries. Data from the current survey were compared to those of a 2009 survey. The numbers of ENT surgeons, audiologists, and speech therapists/100,000 people were compared to the ratios in the United Kingdom. RESULTS: A total of 22 countries responded to the questionnaire. When data of the 15 countries that responded in both 2009 and 2015 are compared, the number of ENT surgeons had increased by 43%, audiologists had increased by 2.5%, and speech therapists by 30%. When the 23% population growth is taken into account, the numbers of ENT surgeons, audiologists, and speech therapists per 100,000 people had declined in four countries, and there remains a severe shortfall of ENT surgeons, audiologists, and speech therapists when compared to the UK Respondents cited lack of availability of basic equipment as the most frequent limitation in providing ENT services. Other important factors causing limitations in daily practice were: lack of ENT training facilities and audiological rehabilitation, low awareness of the burden of ENT pathology, as well as poor human resources management. CONCLUSIONS: There has been a lack of progress in ENT, audiology, and speech therapy services and training opportunities in sub-Saharan Africa between 2009 and 2015. There is a need to look at increased collaboration with developed countries and non-governmental organisations, establishing new and improving existing training centres in Africa, and task-shifting of some ENT services to primary health workers.

[Publication rates of audiology master and doctoral theses in peer-reviewed journals]. / Odyoloji alaninda yapilan yüksek lisans ve doktora tezlerinin bilimsel dergilerde yayinlanma oranlari.

OBJECTIVES: Theses are the prime indicators of the scientific productivity of a country and one of the main and strongest resources for the emergence of scientific articles. This study aims to examine, by using the survey method, how many of the audiology master and/or doctoral theses in Turkey were turned into a scientific work. PATIENTS AND METHODS: Individuals who received a master's degree in audiology were surveyed whether their theses had been reviewed as a paper or publication. RESULTS: Forty-five of the 230 audiology specialists and 22 audiologists with a doctorate degree working in Turkey participated in the study by answering the survey questions. In general, while 45.4% of master theses were presented orally or as a poster presentation in a national convention, 20.4% were presented orally or as a poster presentation in an international convention. While 18.1% of theses were published as an article in a national journal, 15.9% were published as an article in an international SCI or SCI-E journal. The distribution of the doctoral theses is 26.6%, 33.3%, 13.3% and 26.6%, respectively. CONCLUSION: We found the rate of theses in audiology turning into a scientific article to be below the desired level, as in other fields. The reasons for this should be emphasized and efforts should be made to raise these rates to the desired level.

Audiology patient fall statistics and risk factors compared to non-audiology patients.

OBJECTIVE: To compare fall statistics (e.g. incidence, prevalence), fall risks, and characteristics of patients who seek hearing healthcare from an audiologist to individuals who have not sought such services. DESIGN: Case-control study. STUDY SAMPLE: Two groups of community-dwelling older adult patients: 25 audiology patients aged 60 years or older (M age: 69.2 years, SD: 4.5, range: 61-77) and a control group (gender- and age-matched ±2 years) of 25 non-audiology patients (M age: 69.6, SD: 4.7, range: 60-77). RESULTS: Annual incidence of falls (most recent 12 months) was higher in audiology patients (68.0%) than non-audiology patients (28.0%; p = .005). Audiology patients reported a higher incidence of multiple recent falls (p =.025) and more chronic health conditions (p = .028) than non-audiology patients. CONCLUSIONS: Significantly more audiology patients fall on an annual basis than non-audiology patients, suggesting that falls are a pervasive issue in general hearing clinics. Further action on the part of healthcare professionals providing audiologic services may be necessary to identify individuals at risk for falling.

Contralateral acoustic hearing aid use in adult unilateral cochlear implant recipients: Current provision, practice, and clinical experience in the UK.

OBJECTIVES: The study surveyed practising cochlear implant (CI) audiologists with the aim of: (1) characterizing UK clinical practice around the management and fitting of a contralateral hearing aid (HA) in adult unilateral CI users ('bimodal aiding'); (2) identifying factors that may limit the provision of bimodal aiding; and (3) ascertaining the views of audiologists on bimodal aiding. METHODS: An online survey was distributed to audiologists working at the 20 centres providing implantation services to adults in the UK. RESULTS: Responses were received from 19 of the 20 centres. The majority of centres reported evaluating HAs as part of the candidacy assessment for cochlear implantation. However, a majority also indicated that they do not take responsibility for the contralateral HA following implantation, despite identifying few practical limiting factors. Bimodal aiding was viewed as more beneficial than wearing the implant alone, with most respondents actively encouraging bimodal listening where possible. Respondents reported that fitting bimodal devices to take account of each other's settings was potentially more beneficial than independently fit devices, but such sympathetic fitting was not routine practice in any centre. DISCUSSION: The results highlight some potential inconsistencies in the provision of bimodal aiding across the UK as reported by practising audiologists. The views of audiologists about what is best practice appear to be at odds with the nature and structure of the services currently offered. CONCLUSION: Stronger evidence that bimodal aiding can be beneficial for UK patients would be required in order for service providers to justify the routine provision of bimodal aiding and to inform guidelines to shape routine clinical practice.

Narrowing Care Gaps for Early Language Delay: A Quality Improvement Study.

BACKGROUND AND OBJECTIVE: Poverty is a risk factor for both language delay and failure to access appropriate therapies. The objective of this study was to increase the percentage of children 0 to 3 years old referred from an urban primary care center who attended an initial appointment with speech pathology or audiology within 60 days from 40% to 60%. METHODS: The Model for Improvement was used to develop and test the intervention, which addressed potential logistical barriers faced by low-income families. Adherence was plotted on run charts in time series to assess overall improvement, and subgroups were analyzed to identify reduction in disparities. RESULTS: Median referral adherence improved from 40% to 60%. Families from lower income neighborhoods had lower preintervention adherence; these differences were eliminated postintervention. CONCLUSIONS: System-level changes improved access to evaluation and treatment for low-income children with language delay and narrowed the gap in access between families in lower versus higher income neighborhoods.

Factors affecting recruitment and retention of rehabilitation professionals in Northern Ontario, Canada: a cross-sectional study.

INTRODUCTION: Historically, Northern Ontario, Canada, has been an underserviced area for health care, including the rehabilitation professions of occupational therapy, physiotherapy, speech-language pathology and audiology. The Rehabilitation Studies and Northern Studies Stream programs were created in the 1990s to improve the recruitment and retention of rehabilitation professionals to Northern Ontario. However, no recent research has been conducted examining the factors that lead to rehabilitation professionals relocating to and remaining in the region. METHODS: A cross-sectional survey of rehabilitation professionals living and working in Northern Ontario was administered in 2009. Information collected included demographics and a rating of the personal and professional factors that had an impact on an individual's decision to continue living and working in Northern Ontario. RESULTS: A total of 345 individuals completed the survey (response rate 57%). Multiple personal and professional factors were closely linked to recruitment and retention with differences noted between those individuals originally from Northern Ontario and those who were not. Rural or remote education experiences and rural/remote origin were identified as important recruitment factors while job satisfaction and lifestyle options were important factors for retention of rehabilitation professionals to rural and remote areas of practice. CONCLUSIONS: This study has provided updated information specific to the recruitment and retention of rehabilitation professionals in Northern Ontario, Canada. These findings support previous work examining health professions worldwide and have clear implications for educational programs, funding agencies, and health human resource planning in underserviced areas.

Quality and readability of information pamphlets on hearing and paediatric hearing loss in the Gauteng Province, South Africa.

OBJECTIVES: The implementation of early hearing detection and intervention (EHDI) programmes is necessary in order to facilitate the early identification of hearing loss. An important component of EHDI is parental education. International and national guidelines stipulating that comprehensive, unbiased and appropriate information pamphlets should be provided to parents as part of EHDI programmes, however little is known about the availability and readability of such materials in South Africa. The objectives of this study were therefore to determine the availability of information pamphlets on hearing and hearing loss in children at public hospitals in the Gauteng Province of South Africa. In addition, the quality and readability levels of these pamphlets were determined. METHODS: A non-experimental, descriptive research design was employed for this study. Information on the availability of leaflets at public health hospitals was obtained through a telephonic survey. Twenty-one information pamphlets available at these hospitals were then evaluated to determine the quality and readability levels. RESULTS: It was found that 73% of audiology departments at public hospitals in Gauteng had information pamphlets available on hearing and hearing loss in children. Of the pamphlets evaluated, the majority were rated to 'present with serious problems' questioning the quality of the content included. In addition, it was found that on average the readability level of these pamphlets were at a sixth-grade level, much higher that the recommended fourth-grade reading level. CONCLUSIONS: The need for development of quality educational material focused on providing parents with unbiased, comprehensive and appropriate information on hearing and hearing loss in children has been highlighted. Proposed guidelines were recommended to assist audiologists in this endeavour. The importance of providing appropriate parental educational materials for the success of EHDI in South Africa should not be underestimated.

The feasibility of audiologists removing earwax.

Although cerumen management (CM) is routinely performed by audiologists in some countries, this is currently not the case in the Republic of Ireland. This study involved surveying the opinions of Audiologists and Ear Nose and Throat specialists (ENTs) in relation to audiologists conducting CM. In total, 20 ENT Consultants (29%) and 51 audiologists (64%) in the public services responded to an online survey. There was agreement that CM should be within audiologists' remit. However, with regard to risk, opinions were significantly different, with 15 ENTs (75%), compared to 14 audiologists (27%), in agreement that CM management by audiologists was more risky to patients. Nevertheless, 62 respondents (87%) supported future CM training for audiologists. The. overall similarities of opinion between the two groups contrasted to previous studies that reported strong opposition from ENTs with regard to audiologists managing earwax.

A need for health literacy curriculum: knowledge of health literacy among U.S. audiologists and speech-language pathologists in Arkansas.

CONTEXT: We assessed the general knowledge of health literacy and the impact of limited health literacy on patients and to society in United States (US) audiologists and speech-language pathologists in Arkansas. METHODS: A 10-item survey was completed by 198 professionals and students in communication sciences and disorders in Arkansas. The 10-items were divided into one demographic question, six patient-related health literacy questions, and three systems-related health literacy questions. RESULTS: Most professionals and students were aware that limited health literacy can be an obstacle for patients, but they were only somewhat or not aware of existing data on the average US adult reading grade level, the readability of clinic forms, or the estimated economic healthcare cost as a result of low health literacy. DISCUSSION: Increasing the awareness of health literacy and the impact of limited health literacy among all healthcare providers would be a worthwhile endeavor. More work is needed to study health literacy in various patient populations and to develop effective approaches to combat low health literacy in the field of communication sciences and disorders, as well as other healthcare disciplines, across the globe. This study suggests that health literacy awareness training may be needed, not only in Arkansas, but also throughout the US and other countries. The outcome should bridge the health literacy and communication gap between providers and their patients.

Parent hearing aid experiences in the United States.

BACKGROUND: Children born with permanent hearing loss have the opportunity to receive services earlier as a result of newborn hearing screening (NHS). We conducted a survey to address three aspects within the early hearing detection and intervention (EHDI) process: (1) timeliness of service delivery, (2) hearing device access, and (3) hearing aid management. Parent experiences provide valuable information in identifying existing challenges for these components of the EHDI system. PURPOSE: The aim was to investigate parent experiences as they access and manage hearing aids for their child. RESEARCH DESIGN: A cross-sectional, population-based survey was used. STUDY SAMPLE: Three hundred fifty-two completed surveys from parents of children born between 1977 and 2010 were returned from 45 states in the United States. DATA COLLECTION AND ANALYSIS: Responses were obtained online and through the mail, and were analyzed using descriptive statistics. RESULTS: Over time, the age of hearing loss identification has decreased to a median of 2 mo, age of first hearing aid fitting has decreased to a median of 5 mo, and the delay between hearing loss identification and hearing aid fitting has remained the same with a median of 2 mo. For children born between 2007 and 2010, the top three challenges parents reported in obtaining hearing aids were (1) paying for hearing aids, (2) accepting the need for hearing aids, and (3) wait time for an appointment. Almost one-half (48%) of the parents reported that they did not receive adequate support from their audiologist in how to check the function of their child's hearing aids. CONCLUSIONS: Significant progress has been made over the past two decades in reducing the age of hearing loss identification and hearing aid fitting for children who do not pass the NHS. However, many children continue to experience delays between hearing loss diagnosis and hearing aid fitting that exceed Joint Committee on Infant Hearing recommendations. The experiences parents reported provide valuable information about areas that need further investigation to improve the process for children with hearing loss.