Prophylactic nimodipine treatment improves hearing outcome after vestibular schwannoma surgery in men: a subgroup analysis of a randomized multicenter phase III trial.

A 2016 published randomized multicenter phase III trial of prophylactic nimodipine treatment in vestibular schwannoma surgery showed only a tendency for higher hearing preservation rates in the treatment group. Gender was not included in statistical analysis at that time. A retrospective analysis of the trial considering gender, preoperative hearing, and nimodipine treatment was performed. The treatment group received parenteral nimodipine from the day before surgery until the seventh postoperative day. The control group was not treated prophylactically. Cochlear nerve function was determined by pure-tone audiometry with speech discrimination preoperatively, during in-patient care, and 1 year after surgery and classified according to the Gardner-Robertson grading scale (GR). Logistic regression analysis showed a statistically significant effect for higher hearing preservation rates (pre- and postoperative GR 1-4) in 40 men comparing the treatment (n = 21) and the control (n = 19) groups (p = 0.028), but not in 54 women comparing 27 women in both groups (p = 0.077). The results were also statistically significant for preservation of postoperative hearing with pre- and postoperative GR 1-3 (p = 0.024). There were no differences in tumor sizes between the treatment and the control groups in men, whereas statistically significant larger tumors were observed in the female treatment group compared with the female control group. Prophylactic nimodipine is safe, and an effect for hearing preservation in 40 men with preoperative hearing ability of GR 1-4 was shown in this retrospective investigation. The imbalance in tumor size with larger tumors in females of the treatment group may falsely suggest a gender-related effect. Further investigations are recommended to clarify whether gender has impact on nimodipine's efficacy.

Effects of auditory and socio-demographic variables on discontinuation of hearing aid use among older adults with hearing loss fitted in the Chilean public health sector.

BACKGROUND: The percentage of older adults with hearing loss who stop using their hearing aids and the variables associated with this phenomenon have not been systematically investigated in South America. This problem is relevant to the region since countries such as Colombia, Brazil and Chile have public programmes that provide hearing aids to older adults. The aims of this study were to determine the percentage of older adults fitted with a hearing aid at a public hospital in Chile who subsequently stop using it and the auditory and socio-demographic variables associated with the hazard of discontinuing hearing aid use. METHODS: A group that included 355 older adults who had been fitted with a hearing aid was studied retrospectively. In a structured interview, participants were asked about socio-demographic variables and answered part of the Chilean National Survey on Health, evaluating self-perceived hearing loss and responding to questions about discontinuation of hearing aid use and their satisfaction with the device. Survival models were applied to determine the hazard of stopping hearing aid use in relation to the variables of interest. RESULTS: The rate of discontinuation of hearing aid use reached 21.7%. Older adults stopped using their hearing aids mainly during the first 5-6 months post-fitting, and then this number steadily increased. The income fifth quintile was 2.56 times less likely to stop using the hearing aid compared to the first. Those who self-reported that they could not hear correctly without the hearing aid were 2.62 times less likely to stop using it compared to those who reported normal hearing. The group that was very dissatisfied with the hearing aid was 20.86 times more likely to discontinue use than those who reported satisfaction with the device. CONCLUSIONS: Socio-demographic variables such as economic income and auditory factors such as self-perceived hearing loss and satisfaction with the device were significantly associated with the hazard of stopping hearing aid use. Self-perceived hearing loss should be considered part of the candidacy criteria for hearing aids in older adults in Chile and other (developing) countries.

Treatment Outcomes and Dose Rate Effects Following Gamma Knife Stereotactic Radiosurgery for Vestibular Schwannomas.

BACKGROUND: Gamma Knife radiosurgery (GKRS; Elekta AB) remains a well-established treatment modality for vestibular schwannomas. Despite highly effective tumor control, further research is needed toward optimizing long-term functional outcomes. Whereas dose-rate effects may impact post-treatment toxicities given tissue dose-response relationships, potential effects remain largely unexplored. OBJECTIVE: To evaluate treatment outcomes and potential dose-rate effects following definitive GKRS for vestibular schwannomas. METHODS: We retrospectively reviewed 419 patients treated at our institution between 1998 and 2015, characterizing baseline demographics, pretreatment symptoms, and GKRS parameters. The cohort was divided into 2 dose-rate groups based on the median value (2.675 Gy/min). Outcomes included clinical tumor control, radiographic progression-free survival, serviceable hearing preservation, hearing loss, and facial nerve dysfunction (FND). Prognostic factors were assessed using Cox regression. RESULTS: The study cohort included 227 patients with available follow-up. Following GKRS 2-yr and 4-yr clinical tumor control rates were 98% (95% CI: 95.6%-100%) and 96% (95% CI: 91.4%-99.6%), respectively. Among 177 patients with available radiographic follow-up, 2-yr and 4-yr radiographic progression-free survival rates were 97% (95% CI: 94.0%-100.0%) and 88% (95% CI: 81.2%-95.0%). The serviceable hearing preservation rate was 72.2% among patients with baseline Gardner-Robertson class I/II hearing and post-treatment audiological evaluations. Most patients experienced effective relief from prior headaches (94.7%), tinnitus (83.7%), balance issues (62.7%), FND (90.0%), and trigeminal nerve dysfunction (79.2%), but not hearing loss (1.0%). Whereas GKRS provided effective tumor control independently of dose rate, GKRS patients exposed to lower dose rates experienced significantly better freedom from post-treatment hearing loss and FND (P = .044). CONCLUSION: Whereas GKRS provides excellent tumor control and effective symptomatic relief for vestibular schwannomas, dose-rate effects may impact post-treatment functional outcomes. Further research remains warranted.

[The importance of the quantitative assessment of the hearing impairment in the subjects employed under conditions of enhanced noise]. / Znachenie kolichestvennoi otsenki poteri slukha u lits, rabotaiushchikh v usloviiakh vozdeistviia povyshennoi shumovoi nagruzki.

The article describes the domestic modern diagnostic and expert approaches to the quantitative assessment of the hearing impairment in the subjects employed under conditions of enhanced occupational noise. It is concluded that the quantitative criteria for the determination of the severity of hearing loss in the workers of the 'noisy' professions adopted in this country are comparable with the respective international standards of and approaches to the medico-social examination practiced worldwide.

Current practice of ototoxicity management across the United Kingdom (UK).

OBJECTIVE: Effective management of patients diagnosed with ototoxicity is needed to reduce hearing and balance damage which affects communication and life quality. Despite widespread recommendations to monitor and manage ototoxicity in an early and effective manner, there is limited evidence to support the actual implementation of these recommendations for affected patient groups in healthcare services across the UK with limited publications available. In this study, an online questionnaire analysed the current practice of ototoxicity management and patient pathways across the UK once the diagnosis of ototoxicity was confirmed, targeting Audiologists, ENTs/AVPs and GPs. DESIGN: Qualitative Survey Study. STUDY SAMPLE: A randomised sample of hearing services in the UK, including audiology departments; GP practices and local health settings were targeted with a total of 134 completed surveys. RESULTS: About 72% reported the absence of ototoxicity management protocols within their centre. Results depicted great inconsistency and variation across the UK in ototoxicity management services provided, treatment modification, monitoring and referral pathways. CONCLUSION: Developing and advocating national guidelines are intended not only to inform clinical decision making but to provide minimum standards of care in ototoxicity management and offer greater awareness and education to improve patients' quality of life.

Leaflets and continual educational offerings led to increased coverage rate of newborn hearing screening in Akita.

OBJECTIVE: Newborn hearing screening (NHS) has been actively performed in Japan since 2001. The NHS coverage rate has increased each year in Akita Prefecture. We analyzed the details of the NHS program and how the Akita leaflets and the many educational offerings about the importance of NHS led to the high NHS coverage rate. METHODS: A retrospective study was conducted in liveborn newborns in hospitals and in clinics where hearing screening was performed from the program's beginning in 2001 through the end of 2015. We describe the chronological history of NHS. The outcome data of NHS were collected from our department and analyzed. RESULTS: From the founding of the program in 2001 to 2015, the live birth rate in Akita continually declined. Nevertheless, the number of infants receiving NHS rose each year. Since 2012, the coverage rate of NHS has been over 90%. From 2001 to 2015, 75,331 newborns constituted the eligible population for the NHS program. Since 2012, the number of NHS tests has stabilized. We prepared educational leaflets for Akita Prefecture early in 2002. We also provided many educational classes about the importance of NHS for not only pregnant women but also professionals including obstetricians and gynecologists, pediatricians and municipal staff members. The NHS program received the complete endorsement of the Akita Association of Obstetricians and Gynecologists in 2010. The largest increase in the NHS coverage rate occurred from 2001 to 2002, and the second largest increase occurred from 2009 to 2010. The number of participating institutions increased the coverage rate. The coverage rate is strongly correlated with the number of participating institutions (rs=0.843, p<0.001, Spearman's rank correlation coefficient). Comparing the coverage rate for 5 years before and after the Akita Association of Obstetricians and Gynecologists reached their consensus on the importance of NHS, the coverage rate after 2010 was significantly higher than before 2010 (p<0.001, paired sample t-test). CONCLUSION: The NHS coverage rate ultimately reached 95.4% without need for legislation or subsidization. The number of participating institutions increased each year, and the number of NHS tests and the coverage rate increased proportionately. The number of participating institutions statistically has a strong correlation with the number of NHS tests and the coverage rate. Our research indicates that the Akita leaflets and the provision of educational sessions about the importance of NHS were the most significant factors in establishing the high NHS coverage rate.

[Spatial and temporal analysis of the coverage for neonatal hearing screening in Brazil (2008-2015)]. / Análise espacial e temporal da cobertura da triagem auditiva neonatal no Brasil (2008-2015).

This article seeks to establish the coverage of neonatal hearing screening in Brazil between January 2008 and June 2015. It is an ecological study that uses the country, through the Urban Articulation Regions, as a base. To calculate the screening coverage percentage, the Live Births Information System, the Outpatient Information System and the Beneficiaries of the National Supplementary Health Agency Information System were used. An exploratory analysis of maps and spatial statistical analysis was conducted using TerraView 4.2.2 software. The coverage of neonatal hearing screening saw an increase of 9.3% to 37.2% during the study period. In 2008-2009 it was observed that the percentage of coverage ranged from 0% to 79.92%, but most areas received coverage from 0% to 20%, though in 2014-2015 coverage ranged from 0% to 171.77%, and there was a visible increase in the percentage of coverage in the country, mainly in the Southern Region. The screening coverage has increased over time, but is still low with an uneven distribution in the territory, which may be explained by local laws and policies and by the existence of different types of auditory health service in the country.

O objetivo deste artigo é conhecer a cobertura da triagem auditiva neonatal no Brasil de janeiro de 2008 a junho de 2015. Trata-se de um estudo ecológico que utiliza como base o território nacional, através das Regiões de Articulação Urbana. Para o cálculo da porcentagem da cobertura da triagem foram utilizados o Sistema de Informação de Nascidos Vivos, o Sistema de Informações Ambulatoriais e o Sistema de Informações de Beneficiários da Agência Nacional de Saúde Suplementar. Foi realizada a análise exploratória dos mapas e a análise espacial estatística por meio do programa TerraView 4.2.2. A cobertura da triagem auditiva neonatal apresentou uma evolução de 9,3 para 37,2 % no período estudado. Em 2008-2009 observa-se que a porcentagem da cobertura variou de 0,00 a 79,92% e a maioria das regiões obteve cobertura entre 0,0 e 20%, já em 2014-2015 a cobertura variou entre 0,0 a 171,77% e observou-se um visível aumento da porcentagem da cobertura no país, principalmente na Região do Sul. A cobertura da triagem tem crescido ao longo do tempo, mas ainda é baixa e apresenta uma distribuição desigual no território, o que pode ser explicado pelas leis e políticas locais e pela disposição das diferentes modalidades de serviço de saúde auditiva no país.

Análise espacial e temporal da cobertura da triagem auditiva neonatal no Brasil (2008-2015) / Spatial and temporal analysis of the coverage for neonatal hearing screening in Brazil (2008-2015)

Resumo O objetivo deste artigo é conhecer a cobertura da triagem auditiva neonatal no Brasil de janeiro de 2008 a junho de 2015. Trata-se de um estudo ecológico que utiliza como base o território nacional, através das Regiões de Articulação Urbana. Para o cálculo da porcentagem da cobertura da triagem foram utilizados o Sistema de Informação de Nascidos Vivos, o Sistema de Informações Ambulatoriais e o Sistema de Informações de Beneficiários da Agência Nacional de Saúde Suplementar. Foi realizada a análise exploratória dos mapas e a análise espacial estatística por meio do programa TerraView 4.2.2. A cobertura da triagem auditiva neonatal apresentou uma evolução de 9,3 para 37,2 % no período estudado. Em 2008-2009 observa-se que a porcentagem da cobertura variou de 0,00 a 79,92% e a maioria das regiões obteve cobertura entre 0,0 e 20%, já em 2014-2015 a cobertura variou entre 0,0 a 171,77% e observou-se um visível aumento da porcentagem da cobertura no país, principalmente na Região do Sul. A cobertura da triagem tem crescido ao longo do tempo, mas ainda é baixa e apresenta uma distribuição desigual no território, o que pode ser explicado pelas leis e políticas locais e pela disposição das diferentes modalidades de serviço de saúde auditiva no país.

Abstract This article seeks to establish the coverage of neonatal hearing screening in Brazil between January 2008 and June 2015. It is an ecological study that uses the country, through the Urban Articulation Regions, as a base. To calculate the screening coverage percentage, the Live Births Information System, the Outpatient Information System and the Beneficiaries of the National Supplementary Health Agency Information System were used. An exploratory analysis of maps and spatial statistical analysis was conducted using TerraView 4.2.2 software. The coverage of neonatal hearing screening saw an increase of 9.3% to 37.2% during the study period. In 2008-2009 it was observed that the percentage of coverage ranged from 0% to 79.92%, but most areas received coverage from 0% to 20%, though in 2014-2015 coverage ranged from 0% to 171.77%, and there was a visible increase in the percentage of coverage in the country, mainly in the Southern Region. The screening coverage has increased over time, but is still low with an uneven distribution in the territory, which may be explained by local laws and policies and by the existence of different types of auditory health service in the country.

Prognostic Factors of Hearing Outcome in Untreated Vestibular Schwannomas: Implication of Subdivision of Their Growth by Volumetric Analysis.

BACKGROUND: Conservative wait-and-scan management for vestibular schwannomas (VSs) is an important treatment option, but its role is unclear because of discordance between tumor growth and hearing outcomes. METHODS: The present study was a retrospective analysis of 97 patients with sporadic VSs without treatment who were followed-up between 2003 and 2012. Tumor volume was measured by 3-dimensional volumetry at each follow-up visit. The median follow-up duration was 47 months (range, 13-122 months). The relationship between the tumor growth rate and hearing outcome was compared according to stratification of the initial tumor volumes. RESULTS: Hearing impairment was related significantly to the initial hearing status (Gardner-Robertson grade ≥2), initial tumor volume (≥0.1 cm3), and tumor growth (≥0.10 cm3/year). During 4 years of follow-up, 26% and 42% of the patients with untreated VS showed rapid tumor growth and hearing impairment, respectively. For tumors with an initial volume of 0.1-3.0 cm3, hearing impairment during the conservative management period was inversely proportional to the tumor volume. CONCLUSIONS: Conservative management could be especially valid for small (<0.10 cm3), noncystic VSs in patients with Gardner-Robertson grade 1 at diagnosis. However, for tumors with a small-to-medium initial volume (0.10-3.0 cm3), future hearing impairment might be inversely proportional to tumor growth rate. Therefore, small-to-medium sized tumors should be followed-up more closely regardless of the initial hearing impairment.

Evolution of Italian Universal Newborn Hearing Screening Programs.

BACKGROUND: The aim of this study was to evaluate the state of implementation of the Universal Newborn Hearing Screening Programs in Italy and to determine the effect that an ad hoc legislation may have on the percentage of infants screened for detection of hearing impairment in nurseries. MATERIAL AND METHODS: Italian Newborn Hearing Screening data were obtained during four national surveys (years 2003, 2006, 2008, and 2011). The screening rates obtained by the Regions which adopted or did not adopt a legislation to increase the newborns' coverage were compared. RESULTS: In 2011, the average coverage rate was 78.3%, but in 12 out of 20 Regions it exceeded 95%. Coverage rate was greater in Regions that implemented an ad hoc legislation compared to Regions that did not. As a matter of fact, Regions which passed the legislation screened more than 95% of infants, whereas Regions without legislation reported a mean screening rate of nearly 67% of newborns. CONCLUSION: Current results seem to confirm that a specific legislation might have a decisive effect on the increase of rate of coverage of newborn hearing screenings.

[Quality of universal newborn hearing screening results : Multicenter analysis of data recorded between 2009 and 2012 in four German states]. / Ergebnisqualität im universellen Neugeborenen-Hörscreening : Multizentrische Analyse von Daten der Jahre 2009 bis 2012 aus 4 Bundesländern.

BACKGROUND: Bearing in mind the impending evaluation of newborn hearing screening in Germany, this study investigated whether multicenter analysis of the screening results from four German states is possible and to what extent the results meet national quality and outcome criteria. MATERIALS AND METHODS: The screening data from 170 hospitals and a total of 533,150 newborns (21 % of all German newborns) from 2009 to 2012 were evaluated according to definite rules and analyzed in terms of averages, as well as over time. RESULTS: During the investigated period and averaged over the hospitals, the quality criteria "percentage of screened newborns" (91.4 %) and "percentage requiring further follow-up" (5.0 %), the "day of screening" (day 4), as well as the target parameter "age at diagnosis" (4.8 months) were not met. Steady improvements were observed over time: in the last year of the evaluation, 95.3 % of children were examined; only 4.8 % required follow-up and the age at diagnosis decreased to 4.2 months. On average, 83 % of the babies were screened before day 4. The steady reduction in variance of most of the variables from the participating hospitals indicates continual improvement. CONCLUSION: A multicenter analysis of screening data is possible and valid in the case of good quality data.

[Present situation and future perspectives on newborn hearing screening system in Japan].

Childhood hearing impairment is a serious and relatively common condition. The earlier childhood hearing impairment is diagnosed, the less developmentally disadvantaged children become. Newborn hearing screening (NBS) programs have been implemented in Japan. NBS is important for identifying hearing loss at an early age and for adequate intervention at an early developmental stage. According to a survey questionnaire by the Japan Association of Obstetricians and Gynecologists, 62% of the newborn babies were audiologically and medically examined. The average age of examinees has become younger since the beginning of NBS. Here, we summarized the NBS programs in Japan including behavioral audiometry and examinations of auditory brainstem response, auditory-steady state response, and otoacoustic emissions. NBS can lead to advantages in terms of language developmental outcome for children with hearing impairment. However, there is no sufficient support system existing for children who are advised to undergo further auditory diagnostic tests after NBS. It is necessary for government agencies, medical and educational institutions to communicate together for clarifying their responsibilities in order to support the children with hearing impairment.

Universal newborn hearing screening in 2010.

PURPOSE OF REVIEW: The objectives of this review are to provide the reader with a current and concise review of the data and trends in universal newborn hearing screening. Within a relatively short period of time, the concept of screening all infants for hearing loss at the time of birth has evolved from a nascent process to a truly universal system in most developed countries. As a result, the focus and challenges of universal newborn hearing screening have shifted to topics of developing even more efficient and cost-effective approaches, and potentially melding physiologic hearing screenings with ancillary screening techniques. RECENT FINDINGS: Enhancement of the universal newborn hearing screening process is likely to be accomplished by implementation of novel tools such as wideband reflectance technologies and intelligent incorporation of screening for common genetic and viral causes of congenital hearing loss. SUMMARY: With such a rapidly evolving process, it will be critical for clinicians to understand the benefits and limitations of various newborn hearing screening methodologies in order to determine the most appropriate management of children referred from their universal newborn hearing screening. This will entail a working knowledge of emerging audiologic tools as well as infectious and genetic causes of pediatric hearing loss.