A good practice guide for translating and adapting hearing-related questionnaires for different languages and cultures.

OBJECTIVES: To raise awareness and propose a good practice guide for translating and adapting any hearing-related questionnaire to be used for comparisons across populations divided by language or culture, and to encourage investigators to publish detailed steps. DESIGN: From a synthesis of existing guidelines, we propose important considerations for getting started, followed by six early steps: (1) Preparation, (2, 3) Translation steps, (4) Committee Review, (5) Field testing and (6) Reviewing and finalising the translation. STUDY SAMPLE: Not applicable. RESULTS: Across these six steps, 22 different items are specified for creating a questionnaire that promotes equivalence to the original by accounting for any cultural differences. Published examples illustrate how these steps have been implemented and reported, with shared experiences from the authors, members of the International Collegium of Rehabilitative Audiology and TINnitus research NETwork. CONCLUSIONS: A checklist of the preferred reporting items is included to help researchers and clinicians make informed choices about conducting or omitting any items. We also recommend using the checklist to document these decisions in any resulting report or publication. Following this step-by-step guide would promote quality assurance in multinational trials and outcome evaluations but, to confirm functional equivalence, large-scale evaluation of psychometric properties should follow.

Analysing use of the Chinese HHIE-S for hearing screening of elderly in a northeastern industrial area of China.

OBJECTIVE: The aim of the present study was to investigate the use of Chinese version of HHIE-S as a hearing screening tool for the elderly in an industrial area in northeast China. DESIGN: Prevalence, sensitivity and specificity of Chinese version of HHIE-S were calculated. Factors that had impact on HHIE-S were analysed. STUDY SAMPLE: Five hundred and seventy Mandarin speaking participants, aged from 50 to 85 years were included. They were tested with pure tone audiometry and Chinese version of HHIE-S. RESULTS: The prevalence of hearing handicap was 55.3%. The sensitivity and specificity of HHIE-S were 84.5% and 58.3% respectively when the pass/fail criteria were set at PTA0.5-4kHz >40 dBHL. In general, HHIE-S total and subscale scores were significantly associated with severity of hearing impairment. After stratified by severity of hearing impairment, both the prevalence of reported handicap and the scores of HHIE-S were not significantly associated with age. Male participants had significantly higher HHIE-S scores than female participants did. CONCLUSIONS: The Chinese version of HHIE-S contributes useful information to identifying hearing handicap and addressing the rehabilitative needs in the elderly in an industrial city in Mainland China.

Vision and Hearing Health Inequities in the Roma population: A National Cross-Sectional Study in Spain.

We analyzed vision and hearing health status in the Spanish Roma population compared with the general population and its influence on mental health and social participation. We conducted a Cross-sectional study on Roma population (n = 1.167) compared to general population in Spain (n = 21.007). We analyzed the use of optical and hearing aids, vision and hearing limitations and associations with mental health, diagnosed depression and social participation; through prevalence, odds ratio adjusted by age (AOR), Chi square independence test and contrast of proportions (p < 0.05). The Roma population are more likely to present vision limitations-far sight AOR = 3.76 (3.13-4.55), near sight AOR = 3.18 (2.33-4.35)-, hearing difficulties-AOR = 1.41 (1.15-1.72)-, and lower use of corrective aids than the general population. These findings were associated with poor mental health and lower social participation (p < 0.01). Vision and hearing limitations affect unequally in Spain. Addressing avoidable vision and hearing impairment among Roma population is needed to reduce health inequities.

Examining a sample of Black deaf individuals on the Deaf Acculturation Scale.

The current study sought to identify and analyze how Black deaf and hard-of-hearing people conceptualize their deaf and hard-of-hearing identities. That is, what cultural and linguistic factors are involved and how do they interact? An existing measure of Deaf cultural identity, the Deaf Acculturation Scale (DAS), was used to evaluate these questions. Review of the measure's normative sample (n = 3,070) indicated that fewer than 300 self-identified as racial/ethnic minorities (Hispanic/Latino, Black, or Asian). Results of a preliminary study revealed that Non-White deaf individuals responded to DAS items in ways that significantly differed from responses provided by White deaf individuals. Moreover, the existing 5-factor correlated model of the DAS did not fit well with the Non-White group. The current study administered the DAS to a new sample of 106 Black deaf individuals. Principal components analysis determined an appropriate factor structure for this population. In addition to the existing 5 factors, a sixth factor emerged that appears to reflect identity concerns specific to Black deaf people. Ideas for future research, including how to examine the intersections of Deaf identity and racial identity, are discussed.

Wideband acoustic immittance normative data: ethnicity, gender, aging, and instrumentation.

This article describes the effect of ethnicity, gender, aging, and instrumentation on wideband acoustic immittance (WAI). This is an important topic to investigate as the goal of any audiological test is optimize the test's sensitivity and specificity. One way to improve the test's sensitivity and specificity is to reduce the variability of the normative data. The impact of the aforementioned demographic characteristics on WAI norms has been reviewed, and where applicable its potential impact on clinical outcome has been discussed. Overall, differences observed between Caucasian and Chinese ethnic groups in adults population may warrant the use of ethnicity-specific norms especially for detection of otosclerosis; however, these differences in the school-aged children are not large enough to warrant the use of ethnicity-specific norms. It is important to explore whether the observed differences between Caucasian and Chinese ethnic groups is due to body-size indices and whether these differences can be replicated in other East Asian ethnic groups that share similar body-size indices. The differences observed between school-aged children and adults could also potentially impact clinical decision analysis. Therefore, use of age-specific norm is recommended. The differences in WAI between different systems are not clinically significant, and the use of instrument-specific norms does not result in improved test performance at least for the detection of otosclerosis. However, measuring WAI at ambient pressure (static) or at pressure corresponding to the peak (dynamic mode) could potentially impact the normative data and may prove to be clinically useful in cases of negative and positive middle ear pressure.

Hearing-aid assembly management among adults from culturally and linguistically diverse backgrounds: toward the feasibility of self-fitting hearing aids.

OBJECTIVE: The purpose of the study was twofold: (1) to assess the ability of hearing-impaired adults in the developing world to independently and accurately assemble a pair of hearing aids by following instructions that were written and illustrated according to best-practice health literacy principles; and (2) to determine which factors influence independent and accurate task completion. DESIGN: Correlational study. STUDY SAMPLE: Forty South African and 40 Chinese adults with a hearing loss and their partners. The participant group included 42 females and 38 males ranging in age from 32 to 92 years. RESULTS: Ninety-five percent of South African and 60% of Chinese participants completed the assembly task, either on their own or with assistance from their partners. Better health literacy, younger age, and a more prestigious occupation were significantly associated with independent task completion for the South African and Chinese participants. Task accuracy was significantly linked to higher levels of cognitive function among South African participants, while a paucity of valid data prevented an analysis of accuracy from being conducted with the Chinese data. CONCLUSION: Individuals of diverse backgrounds can manage the self-fitting hearing-aid assembly task as long as health literacy levels and cultural differences are considered.

Black-white differences in self-reported disability outcomes in the U.S.: early childhood to older adulthood.

OBJECTIVE: We examined black-white differences in activities of daily living (ADLs), functional limitations (FLs), vision/hearing/sensory impairment, and memory/learning problems in a large, nationally representative sample of community-dwelling and institutionalized people across the lifespan. METHODS: Data are from the 2006 American Community Survey (n=2,288,800). We included data on non-Hispanic black respondents (125,985 males and 145,780 females) and non-Hispanic white respondents (977,792 males and 1,039,243 females) ≥5 years of age. We used logistic regression to examine the black-white odds for each disability outcome. The overall response rate was 97.5%. RESULTS: For FLs, ADL limitations, and memory/learning problems, black people experienced higher odds of disability across the adult lifespan compared with white people. Black-white differences narrowed in older age. For vision/hearing problems, a black-white crossover was found in older age (≥85 years), where odds of vision/hearing problems were lower among black people than among white people. For all disability outcomes, black-white differences peaked in midlife (50-69 years of age), with black people having approximately 1.5 to two times the odds of disabilities as their white peers. CONCLUSIONS: The study findings suggest the need to address black-white disparities across a range of disability outcomes throughout the lifespan. Future work identifying the factors accounting for this pattern of disparities will help inform the development of appropriate prevention strategies.

Hearing screening and middle ear measures in American Indian infants and toddlers.

UNLABELLED: American Indian children have three times the rate of otitis media compared to the general population, yet prospective cohort studies of OME and hearing loss have not been previously reported in American Indian infants. Between 1997 and 2003, a cohort of 421 infants was enrolled at birth from Minnesota American Indian reservations and an urban clinic and followed to age 2 years. This study reports OAE hearing screening results related to OME diagnoses, as well as risk for recurrent hearing screening failure and OME in American Indian infants and children. METHODS: Infants were prospectively assessed at regular intervals with pneumatic otoscopy, distortion product otoacoustic emissions, and tympanometry by nurses who were trained in all procedures and validated on pneumatic otoscopy. RESULTS: In the newborn period, 23.5% of infants failed hearing screening in at least one ear. Hearing screening failures increased to 29.9% from 2 to 5 months of age. Technical fail results due to excessive noise occurred frequently in infants 6-24 months of age, making interpretation of true pass and fail rates questionable in older infants. OAE test result was associated with OM diagnosis, and this relationship strengthened with age, with the strongest association above 6 months of age. CONCLUSIONS: A high rate of hearing screening failures occurred among American Indian infants in the first 5 months of age, and was significantly associated with a correspondingly high rate of otitis media. Only one infant out of 366 was identified with sensorineural hearing loss, thus essentially all of the hearing screening failures reflected either a middle ear origin or other temporary problems. OAE screening provided a valuable hearing screening measure in this population at high risk for recurrent otitis media, but due to excessive noise in infants 6 months and older, practical use of OAE screening is limited. Use of behavioral assessment is needed after 6 months of age, when high rates of OME persist in this population. Increased efforts to develop public and medical education, as well as screening, diagnosis and treatment programs are needed to detect and decrease recurrent OME in American Indian infants and children.

Otitis media: health and social consequences for aboriginal youth in Canada's north.

OBJECTIVES: Otitis media is endemic among Inuit, First Nations and Métis children in northern Canada, with prevalence rates in some communities as high as 40 times that found in the urban south. Hearing impairment, much of it attributable to chronic otitis media, is the most common health problem in parts of the arctic, and conductive hearing loss among children may affect as many as two-thirds. STUDY DESIGN AND METHODS: There is a need for systematic data based on consistent disease definitions and measures, and taking account of cross-cultural methodological issues and sampling. RESULTS: Otitis media is most likely to develop in infancy. Susceptibility has been linked to immune defects and to a variety of environmental factors. Among the most significant are diet, the decline in initiation and maintenance of breastfeeding, and exposure to cigarette smoke. Hearing loss has been related to difficulties in language acquisition, and to subsequent issues with literacy and school achievement, including learning disabilities and attention deficits. The economic and social costs of otitis media are substantial. CONCLUSION: Approaches to treatment and prevention have enjoyed limited success. Public health and medical practice need to be informed by the traditional knowledge and practices of indigenous peoples.

Hearing function in Nigerian children with a family history of type 2 diabetes.

OBJECTIVE: Consequent on our previous observations [F.E. Ologe, E.O. Okoro, Type 2 diabetes and hearing loss in black Africans, Diabetic Med. (in press).], we investigated whether abnormality in auditory function can precede overt diabetes in individuals with a genetic predisposition to type 2 diabetes. METHOD: Frequency specific pure tone audiograms (125, 250, 500, 1000, 2000, 3000, 4000, 8000 Hz) and fasting blood glucose (FBG) and 2h post prandial blood glucose (2hrPBG) levels were measured in Nigerian children aged 9-19 years with at least a biologic parent with type 2 diabetes and compared with controls (contemporaries with non-diabetic parents). RESULTS: : Both groups were similar in gender mix, age, body sizes, FBS, 2PPhr BG, SBP; the values being (chi(2) = 0.04, d.f. = 1, p = 0.84); 14.32 +/- 2.29 years versus 14.77 +/- 3.10 years, 19.47 +/- 1.82 kg/m(2) versus 18.66 +/- 3.12 kg/m(2); 4.26 +/- 0.68 mmol versus 4.04 +/- 0.61 mmol; 5.07 +/- 0.95 mmol versus 5.16 +/- 1.04 mmol; 103.73 +/- 9.62 mmHg versus 100.07 +/- 13.77 mmHg for control and offspring of diabetic individuals, respectively. Similarly, pure-tone air-conduction audiograms were comparable (p > 0.5) in both groups. CONCLUSION: The data shows normal glucose metabolism in teenage offspring of type 2 diabetes and a pattern of audiogram not different from those observed in their counterparts without a genetic predisposition to type 2 diabetes.

Middle ear problems in Aboriginal school children cause developmental and educational concerns.

An epidemiological study was carried out in the year 2000 and sought to measure the occurrences of middle ear disease and hearing loss within school aged (4 years to 12 years) Aboriginal children. A number of the local schools and preschools in Coraki and Lismore with a high percentage of Aboriginal students were selected in an effort to identify service gaps regarding essential hearing screenings and assessments. A total of 185 (370 ears) Aboriginal children aged 4 years to 12 years were examined from four schools and three preschools. This examination included otoscopy, tympanometry and audiometry. Data were collected as each child was tested and this was then entered into a computer database on returning to the work place. Results indicated that 61.08% of these children had middle ear problems of some type. Unilateral hearing loss of 30 dB or greater was found in 10.80% of children, bilateral hearing loss of 30 dB and greater was found in 22.16%, and perforation of tympanic membranes in 3.24%. Suggestions are made in relation to the need for ongoing training of Aboriginal Community Audiometrists to provide community, school and preschool screening programs together with health related promotional activities to minimise the occurrences of ear infections.

Functional study of GJB2 in hereditary hearing loss.

OBJECTIVES/HYPOTHESIS: The gene of the gap junction protein connexin 26 (Cx26) was found to be the main causative gene of autosomal recessive nonsyndromic hearing loss (DFNB1). Although 35delG has been known as the major mutation in Western countries, 235delC was reported to be a specific form of mutation in Asian populations. The objective of the study was to identify how 235delC and E114G changes found in the Korean population affected the function of using molecular biological techniques. METHODS: Genes containing 235delC and E114G were cloned into the pcDNA3 vector, and HeLa cells were transfected with the recombinant DNA samples by the liposome complex method. The expression and subcellular localization of Cx26 were determined, using antibodies against amino acid sequences in the intracellular loop (IL) and N-terminal (NT) portions of Cx26. To analyze functions of the as a gap junction channel, we examined Lucifer yellow dye transfer between cells with a scrape-loaded technique. Wild-type (WT) with normal hearing was used as a positive control, and mock transfected cells were used as a negative control. RESULTS: Immunocytochemical analysis showed that cells transfected with E114G and WT gave characteristic punctate patterns of reaction in the cell membrane with both antibodies. However, 235delC cells were not stained with anti-IL antibody but stained slightly just around the nucleus only with anti-NT antibody. In a functional study of, transfer of Lucifer yellow into contiguous cells was detected in both WT and E114G, but no transfer activity was observed in 235delC. CONCLUSIONS: The 235delC mutation showed a loss of targeting activity to the cell membrane and severe deterioration of gap junction activity. For the E114G, we did not find any difference from WT transfected cells.

The Hearing Handicap Inventory for the Elderly screening version adapted for use with elderly Chinese American individuals.

The purpose of this study was to determine whether the Hearing Handicap Inventory for the Elderly (HHIE) screening version translated into Chinese can be used as a valid screening instrument for the identification of hearing impairment in Chinese-speaking elderly persons. One hundred elderly Chinese Americans were screened, and the majority of the subjects did not report hearing handicap. A comparison among different screening protocols (ASHA, 40 dB HL at 1000 and 2000 Hz; HHIE-S > 10 and HHIE-S > 10 and 40 dB HL at 1 and 2 kHz) suggested that the combined HHIE-S and 40 dB HL cutoff at 1000 and 2000 Hz achieved the best referral rates. Some hypotheses explaining the results are discussed relative to cultural and linguistic differences between elderly Chinese Americans and their white English-speaking counterparts.

Connexin26 mutations associated with nonsyndromic hearing loss.

OBJECTIVE: Mutations in the GJB2 gene are a major cause of autosomal recessive and sporadic types of congenital deafness. The 35delG mutation is the most frequent type of mutation in white populations. However, several other forms were reported, such as 167delT among Ashkenazi Jews and R143W in Africans. The present study investigated the mutations of connexin26 (Cx26) found in patients with nonsyndromic hearing loss (NSHL) and newborns in the Korean population. STUDY DESIGN: The sequencing data for 147 unrelated patients with congenital NSHL and 100 audiologically screened newborns were included in this prospective study. METHODS: Genomic DNA samples from all patients and newborns were sequenced in both directions for detection of Cx26 mutations. RESULTS: Thirteen different types of mutations were found in the patients and newborns. V27I and E114G are the popular types of polymorphic mutations in both groups. 235delC-deletion and frameshift--was detected in patients (15 in 294 alleles) and newborns (1 in 200 alleles). 35delG was rarely found in both group. In addition to above mutations, several types of mutations--S85P, K41R, S72C, V84A, 176-191del, and 299-300del-were identified. The family study of the 235delC showed a typical autosomal recessive trait of NSHL in their audiological evaluation of hearing threshold. CONCLUSION: The frequency of 235delC allele showed much higher in the patients (5%) than in newborns (0.5%). We rarely found 35delC mutant in both groups. These results suggest that the different types of Cx26 mutations affect autosomal recessive NSHL according to ethnic background.

Hearing problems in Mexican American elderly.

OBJECTIVE: To investigate hearing problems in a sample of elderly Mexican Americans. STUDY DESIGN: A longitudinal field study of a cohort of 3,050 subjects with in-person baseline and a 2-year follow-up. Population-based, cross-sectional, weighted data were analyzed. SETTINGS AND SUBJECTS: Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) consisting of Mexican Americans aged 65 and older provided basic health data using area probability sampling in five southwestern states during 1993 and 1994. MAIN OUTCOME MEASURES: Information was collected regarding demographics, medical conditions, smoking, and alcohol consumption. Hearing problems were identified through a series of self-perceived hearing problem questions, hearing aid use, and inability to hear a normal voice. RESULTS: A hearing problem was identified in 24.5% of this cohort (weighted, 748/3,049). Statistical analysis using a multiple logistic regression model was performed to identify factors jointly associated with hearing problems. Age group (odds ratio [OR] = 2.7, p<0.0001), male sex (OR = 1.9, p< 0.0001), hypertension (OR = 1.4, p<0.001), arthritis (OR = 1.5, p<0.0005), significant depressive symptomatology (OR = 1.4, p<0.002), and ever having consumed alcohol (OR = 1.4, p<0.005) were jointly statistically significantly associated with hearing problems. Number of cigarettes smoked daily (e.g., 0, 1-10, 11-20, etc.) was nearly significantly associated with a hearing problem in the multivariate model (OR = 1.1 for each increased in category, p<0.07). CONCLUSIONS: Hearing problems are common in this population. Control of hypertension, an amelioration of arthritis, and decreasing the consumption of alcohol and cigarettes may lower the likelihood of development of a hearing problem. Initial depressive symptomatology may have occurred subsequent to the hearing loss. A longitudinal study would allow determination of the direction of causation.

Language of early- and later-identified children with hearing loss.

OBJECTIVE: To compare the language abilities of earlier- and later-identified deaf and hard-of-hearing children. METHOD: We compared the receptive and expressive language abilities of 72 deaf or hard-of-hearing children whose hearing losses were identified by 6 months of age with 78 children whose hearing losses were identified after the age of 6 months. All of the children received early intervention services within an average of 2 months after identification. The participants' receptive and expressive language abilities were measured using the Minnesota Child Development Inventory. RESULTS: Children whose hearing losses were identified by 6 months of age demonstrated significantly better language scores than children identified after 6 months of age. For children with normal cognitive abilities, this language advantage was found across all test ages, communication modes, degrees of hearing loss, and socioeconomic strata. It also was independent of gender, minority status, and the presence or absence of additional disabilities. CONCLUSIONS: Significantly better language development was associated with early identification of hearing loss and early intervention. There was no significant difference between the earlier- and later-identified groups on several variables frequently associated with language ability in deaf and hard-of-hearing children. Thus, the variable on which the two groups differed (age of identification and intervention) must be considered a potential explanation for the language advantage documented in the earlier-identified group.

Sociodemographic and educational correlates of hearing loss in Hispanic children.

Sociodemographic and educational correlates of hearing loss were examined in Cuban-American, Mexican-American and Puerto Rican children 6-19 years of age. Logistic regression analyses indicated a greater risk of bilateral hearing loss among children living in crowded housing conditions or without health insurance, as well as among those who were below expected school grade level and whose parents reported low educational attainment levels. However, the strengths of these associations were small to moderate in magnitude and were not always consistent across the ethnic subgroups. These findings provide some evidence that hearing-impaired Hispanic children are more likely to reside in economically disadvantaged families and to be below their expected school grade level.

Mitochondrial gene mutation is a significant predisposing factor in aminoglycoside ototoxicity.

PURPOSE: Aminoglycoside-induced deafness caused by mutations in the mitochondrial 12S ribosomal RNA gene has been described in a number of Asian patients. The purpose of the current study is to analyze ethnically diverse patients in the United States with hearing loss after aminoglycoside exposure for presence or absence of these mitochondrial DNA mutations, and establish the frequency and clinical presentation associated with them. PATIENTS AND METHODS: Clinical histories, medical records, and blood samples were obtained from 41 unrelated American individuals with hearing loss after aminoglycoside exposure. DNA was extracted from the blood of these individuals, amplified by the polymerase chain reaction, and analyzed for mitochondrial ribosomal RNA gene mutations by allele-specific oligonucleotide hybridization, restriction fragment length polymorphism analysis, and sequencing. RESULTS: The nucleotide 1555 A-->G mutation was identified in 7 of 41 individuals (17%). None of the other known mutations was found. The ethnic origin of the individuals with predisposing mutations included Caucasians, Hispanics, and Asians. Four of the 7 patients with the 1555 A-->G mutation had a family history of aminoglycoside-induced ototoxicity. Particularly unexpected was the late onset of hearing loss in 3 of these patients, years after the aminoglycoside exposure. The 12S ribosomal RNA gene was sequenced in these patients, and a second sequence change that could be responsible for the milder phenotype was detected in 1 of the 3 patients. CONCLUSION: These findings imply that a significant proportion of patients with aminoglycoside-induced ototoxicity harbor mutations in the 12S rRNA gene, which can be detected by DNA screening. Also, the majority of these hearing losses could have been easily prevented by the simple taking of a clinical history. In these individuals, a genetic susceptibility to the ototoxic effects of aminoglycosides can be diagnosed, and deafness can be prevented in maternal relatives by avoidance of these antibiotics.

Prevalence of childhood hearing loss. The Hispanic Health and Nutrition Examination Survey and the National Health and Nutrition Examination Survey II.

Comparative analysis of the epidemiology of childhood hearing loss was undertaken among African-American, Hispanic-American, and non-Hispanic white children. Audiometric data on children aged 6-19 years were obtained from 688 African Americans, 330 Cuban Americans, 2,602 Mexican Americans, 1,025 Puerto Ricans, and 3,243 non-Hispanic whites who participated in either the National Health and Nutrition Examination Survey II, 1976-1980, or the Hispanic Health and Nutrition Examination Survey, 1982-1984. Hearing loss was defined as a pure-tone decibel hearing threshold level (averaged over 500, 1,000, and 2,000 Hz) greater than 15 in the ear with the best response. The prevalence (per 1,000) of bilateral hearing loss was 17.0 for African-American, 68.3 for Cuban-American, 27.6 for Mexican-American, 57.7 for Puerto Rican, and 15.5 for non-Hispanic white children. Differences in prevalence by ethnicity/race diminished when a more stringent definition of hearing loss (i.e., moderate or greater than 30 dB hearing threshold level) was used. There were no adolescent African-American males aged 16-19 years who had a hearing loss. After adjustment for age, the odds of hearing loss was significantly greater in males than in females only in non-Hispanic whites (odds ratio = 2.2; 95% confidence interval 1.6-3.3). On the basis of 1993 census population estimates in the United States, over 819,000 children aged 6-19 years have some degree of hearing impairment, and over 216,000 of these children have moderate or greater hearing impairment.