The Glasgow Benefit Inventory: a systematic review of the use and value of an otorhinolaryngological generic patient-recorded outcome measure.

BACKGROUND: The Glasgow Benefit Inventory (GBI) is a validated, generic patient-recorded outcome measure widely used in otolaryngology to report change in quality of life post-intervention. OBJECTIVES OF REVIEW: To date, no systematic review has made (i) a quality assessment of reporting of Glasgow Benefit Inventory outcomes; (ii) a comparison between Glasgow Benefit Inventory outcomes for different interventions and objectives; (iii) an evaluation of subscales in describing the area of benefit; (iv) commented on its value in clinical practice and research. TYPE OF REVIEW: Systematic review. SEARCH STRATEGY: 'Glasgow Benefit Inventory' and 'GBI' were used as keywords to search for published, unpublished and ongoing trials in PubMed, EMBASE, CINAHL and Google in addition to an ISI citation search for the original validating Glasgow Benefit Inventory paper between 1996 and January 2015. EVALUATION METHOD: Papers were assessed for study type and quality graded by a predesigned scale, by two authors independently. Papers with sufficient quality Glasgow Benefit Inventory data were identified for statistical comparisons. Papers with <50% follow-up were excluded. RESULTS: A total of 118 eligible papers were identified for inclusion. A national audit paper (n = 4325) showed that the Glasgow Benefit Inventory gave a range of scores across the specialty, being greater for surgical intervention than medical intervention or 'reassurance'. Fourteen papers compared one form of surgery versus another form of surgery. In all but one study, there was no difference between the Glasgow Benefit Inventory scores (or of any other outcome). The most likely reason was lack of power. Two papers took an epidemiological approach and used the Glasgow Benefit Inventory scores to predict benefit. One was for tonsillectomy where duration of sore throat episodes and days with fever were identified on multivariate analysis to predict benefit albeit the precision was low. However, the traditional factor of number of episodes of sore throat was not predictive. The other was surgery for chronic rhinosinusitis where those with polyps on univariate analysis had greater benefit than those without. Forty-three papers had a response rate of >50% and gave sufficient Glasgow Benefit Inventory total and subscales for meta-analysis. For five of the 11 operation categories (vestibular schwannoma, tonsillectomy, cochlear implant, middle ear implant and stapes surgery) that were most likely to have a single clear clinical objective, score data had low-to-moderate heterogeneity. The value in the Glasgow Benefit Inventory having both positive and negative scores was shown by an overall negative score for the management of vestibular schwannoma. The other six operations gave considerable heterogeneity with rhinoplasty and septoplasty giving the greatest percentages (98% and 99%) most likely because of the considerable variations in patient selection. The data from these operations should not be used for comparative purposes. Five papers also reported the number of patients that had no or negative benefit, a potentially a more clinically useful outcome to report. Glasgow Benefit Inventory subscores for tonsillectomy were significantly different from ear surgery suggesting different areas of benefit CONCLUSIONS: The Glasgow Benefit Inventory has been shown to differentiate the benefit between surgical and medical otolaryngology interventions as well as 'reassurance'. Reporting benefit as percentages with negative, no and positive benefit would enable better comparisons between different interventions with varying objectives and pathology. This could also allow easier evaluation of factors that predict benefit. Meta-analysis data are now available for comparison purposes for vestibular schwannoma, tonsillectomy, cochlear implant, middle ear implant and stapes surgery. Fuller report of the Glasgow Benefit Inventory outcomes for non-surgical otolaryngology interventions is encouraged.

Positive pressure therapy for Meniere's syndrome/disease with a Meniett device: a systematic review of randomised controlled trials.

BACKGROUND: Incidence rates of Meniere's syndrome/disease vary considerably from 157 per 100 000 in the United Kingdom to 15 per 100 000 in the United States. A wide range of treatments are used for the treatment of the condition with no consensus on the most effective intervention. OBJECTIVES: To assess the effectiveness of the Meniett device in reducing the frequency and severity of vertigo in Meniere's syndrome/disease. SEARCH METHODS: The Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific abstracts; ICTRP and additional sources for published and unpublished trials were searched. The date of the last search was 13th May 2014. SELECTION CRITERIA: Four randomised controlled trials (RCTs) were identified that compared the efficacy of the Meniett device versus a placebo device in patients with Meniere's 'disease' as defined by the AAOO criterion. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility and risk of bias and extracted data. The outcome data were dichotomous for all the included trials. MAIN RESULTS: The four RCTs compared 123 patients with the Meniett device against 114 patients with the placebo device from four RCT's over a follow-up period of 2 weeks to 4 months. There was a significant overall 61% reduction in the frequency of vertigo in both groups (mean no vertigo days per month of 8-3). However, this reduction was not significantly different between the two groups in any study or on meta-analysis [mean difference in vertigo-free days between Meniett and placebo device of 0.77 days over a 1-month period (95% CI - 0.82, 1.83) P = 0.45]. There were also no substantive data to support a greater reduction in the severity of the vertigo or any other outcome with the Meniett device compared with the placebo device. AUTHORS CONCLUSIONS: No evidence was found to justify the use of the Meniett device in Meniere's syndrome/disease.

Ventilation tube non-function due to blockage in children: the frequency, course and effect on hearing. A prospective cohort study.

OBJECTIVE: To assess the effect on hearing of non-functioning ventilation tubes due to blockage during the first six months post-operatively, using UK national guidelines. METHOD: A prospective, observational study was conducted on 37 children who underwent bilateral ventilation tube insertion. Air and bone conduction thresholds were measured before and following surgery, and at one, three and six months post-operatively. Tube non-function was assessed by tympanometry supported by otoscopy. RESULTS: Post-operatively, an average of 21 per cent of ventilation tubes were non-functioning. Ears with non-functioning tubes had significantly (p = 0.0001) poorer mean air conduction thresholds than functioning tubes, with a magnitude of 6 dB HL. Ears with otorrhoea were most affected (15 per cent). At any one visit, the air-bone gap was closed to 10 dB or less in 76 per cent of ears. Non-functioning tubes reduced this to 56 per cent. Compared with tympanometry, otoscopy underdiagnosed tube non-function due to blockage by 22 per cent. CONCLUSION: Non-functioning of ventilation tubes occurs frequently and can be missed on otoscopy. Although it is associated with poorer air conduction thresholds, the magnitude of this difference is unlikely to warrant further intervention unless there is otorrhoea or recurrence of bilateral hearing impairment.

The Glasgow Benefit Plot: a new method for reporting benefits from middle ear surgery.

Conventionally, the results of middle ear surgery are reported in terms of postoperative closure of the air-bone gap or the improvement in air-conduction thresholds. While these are relevant in that they assess the technical success of the procedure and the lessening of monaural disability, they do not necessarily assess whether the patient has benefited. This is determined by many factors, not least of which is the hearing in the nonoperated ear. In this paper, we suggest that preoperative and postoperative plots of the air-conduction thresholds in both ears be used as an additional method of presenting the results. First, the proportion of patients that fall into each of three main preoperative impairment groups are identified. This is important, as the potential benefits from surgery are not the same in each group. Thereafter, the percentages of patients that achieve various postoperative hearing categories can be calculated, allowing surgeons to audit their results and make comparisons between series.

Estimation of the benefit of bone-anchored hearing aids.

Implantable bone conduction hearing aids are a valuable alternative to conventional aids for those who cannot use a conventional air conduction aid or find it difficult to use because of an aural discharge, most commonly due to chronic otitis media. Previously reported series of the use of a bone-anchored hearing aid (BAHA) come from the originators of this device, and an independent report of their benefit and use, especially in previous air conduction aid users, would be of value. Twenty-three patients were evaluated at least 6 months after implantation of a BAHA. All 7 previous bone conduction aid users were delighted with their BAHA, reporting increased comfort and hearing benefit that was backed by audiometric evidence. Of the 16 individuals who previously used an air conduction aid, 11 (69%) were delighted users of their BAHA. Unfortunately, the other 5 (31%) reverted to solely using their air conduction aid. There was no obvious predictor as to how these individuals might have been identified prior to implantation. In particular, their pure tone thresholds, especially the bone conduction thresholds, were no different from those of the 11 BAHA users. However, in free field audiometry, the users gained superior benefit from their BAHA compared to their air conduction aid, whereas the nonusers did not. In conclusion, in all series to date, previous users of a conventional bone conduction aid have been delighted users of a BAHA and have gained superior audiometric benefit. This is not necessarily the case with previous air conduction aid users.(ABSTRACT TRUNCATED AT 250 WORDS)

Hearing in chronic suppurative otitis media.

In individuals with chronic otitis media, mixed hearing impairments are common but it is unclear whether the raised bone conduction thresholds are a reflection of the pathologic process affecting the inner ear or a combination of the high prevalence of sensorineural hearing impairments in the population along with the artificial elevation of bone conduction thresholds associated with a conductive defect. A total of 395 ears with chronic otitis media but without cholesteatoma were studied. In them, once the artificial elevation (Carhart effect) of the bone conduction thresholds, which occurs whenever there is an abnormality of the sound conduction mechanism, had been taken into account, there was no difference in the bone conduction thresholds compared with those in 920 control ears. In addition, in 100 instances, the contralateral ear was normal and there was no difference in the bone conduction thresholds between the diseased and the normal ears. Raised bone conduction thresholds in chronic otitis media are considerably likely to reflect both the Carhart effect and the high prevalence of sensorineural impairments, rather than disease damage to the inner ear.

Sensorineural hearing loss in stapedial otosclerosis.

Controversy exists as to whether individuals with stapedial otosclerosis have elevated bone conduction thresholds due to cochlear involvement by the focus. A comparison was made between the Carhart-corrected bone conduction thresholds in 45 unoperated, non-noise-exposed individuals with stapedial otosclerosis and the thresholds in a matched random sample of the population with no conductive hearing loss. No consistent, significant difference was discerned. It is considered that individuals with stapedial otosclerosis do not in general have elevated bone conduction thresholds compared with control subjects. However, there was a suggestion that there may be a small, progressive elevation of bone conduction thresholds in older patients.