Changing patient profile, hearing aid use and disability among first-time hearing aid users in Singapore over a decade.

OBJECTIVES: To examine the time trends in demographics, hearing characteristics, hearing aid (HA) choices, usage and patient-reported disability among first-time HA users in Singapore over a decade. DESIGN: Cross-sectional study. Study sample: 1052 subjects issued with HAs at a tertiary hospital from 2004 to 2013. RESULTS: An increase in number of first time HA users were seen from 2004 to 2013. Although mean age did not change significantly, the proportion of older adults (>80 years) being fitted increased (p for trend = 0.033). Inflation adjusted cost of HAs rose over time (p < 0.001 for trend). Bilateral HA uptake increased (adjusted odds ratio [AOR] = 1.58 (95% Confidence Interval [CI] 1.35-1.85) while use of customisable HAs decreased (AOR = 0.74, 95% CI 0.66-0.84) over the period. A decrease in the proportion of subjects reporting 5 or more disabilities (AOR = 0.45, 95% CI 0.34-0.59) and using their HAs >7 hours daily (AOR = 0.45, 95% CI 0.34-0.59) was seen. CONCLUSION: From 2004 to 2013, there was a positive trend towards HA uptake in Singapore. Bilateral HA uptake increased while customisable in ear type of HA use decreased. While hearing disability showed a decreasing trend, HA usage remained suboptimal.

Hearing impairment and hearing aid usage in Singapore.

OBJECTIVE: To examine the epidemiological and audiological profile, pattern of hearing aid (HA) fitting and usage among HA users in Singapore. DESIGN: Retrospective cross-sectional study. STUDY SAMPLE: Cohort of 1068 subjects issued with HAs at a tertiary hospital between 2001 and 2013. RESULTS: Mean age was 70 years with 50.8% male. Mean hearing loss (HL) was 63.1 dB and 69.5% had at least moderate-severe HL. Sensorineural HL was present in 66.4% and 69.8% had symmetrical HL. "Behind-the-Ear" HAs were cheaper than "In-Ear" HAs. Standard "Behind-The-Ear" HAs were also cheaper than "Receiver-in-Canal" HAs. Among In-Ear HAs, "In-the-Canal" and "Completely-in-Canal" were more popular than "In-the-Ear" HAs despite costing more. HA was used ≥4 days/week by 85.6% but >7 h per day by only 35.7%. Only 18% received bilateral first HA fitting. In multivariate analysis, younger age and symmetrical HL were predictors of bilateral HA uptake while better Pure-Tone-Audiometry of aided ear and >7 h of daily HA usage were predictors of successive HA fitting. CONCLUSIONS: HA users in Singapore were elderly and presented with advanced HL. Bilateral HA adoption and average daily use were low compared to other developed countries. Future research on understanding the suboptimal HA usage should explore patients' motivation, hearing disability, and HA effectiveness.

Factors influencing degree of hearing loss at presentation, hearing aid choice, and usage in first time hearing aid users in Singapore.

OBJECTIVE: To examine the factors associated with late presentation at first hearing aid (HA) fitting, HA choice and usage among users in Singapore. DESIGN: Retrospective cross-sectional study. STUDY SAMPLE: 1068 subjects issued with HAs at a tertiary hospital from 2001 to 2013. RESULTS: Half of the subjects presented with more severe (>55 dB) hearing loss (HL) in their better ear. In multivariable analysis, older age, Malay ethnicity, conductive and mixed HL, and combination type of HL were associated with more severe HL at first presentation. Over 70% of subjects were older than 65 years. Worse pure tone audiometry (PTA) thresholds of the better ear, gradual onset and sensorineural HL were associated with older age presentation. For unilaterally fitted subjects, PTA thresholds were the only determinant of having the better ear aided. Better PTA thresholds, younger age and sensorineural HL were associated with choosing in ear compared to behind the ear HAs. Younger age and worse PTA of the better ear were associated with ≥4 h of daily HA usage. CONCLUSIONS: Age, ethnicity and type of HL were important determinants for more severe HL at first HA fitting. Older patients and those with better hearing were less likely to use their HAs regularly.

Factors Influencing Hearing Disability and Reduction in Disability among First-time Hearing Aid Users in Singapore.

INTRODUCTION: This study aims to examine the factors associated with self-reported hearing disability and early reduction in disability after first-time hearing aid (HA) fitting in Singapore. METHODS: Retrospective record review of 1,068 subjects issued with HAs at a tertiary hospital from 2001 to 2013. RESULTS: Subjects reporting ≥5 disabilities reduced from 90% to 24% after HA fitting. 'Difficulty hearing in noise' was the commonest disability before and after HA fitting, while 'needs to increase volume of TV/radio' was the disability with most improvement after fitting. In multivariable models, having worse pure tone audiometry (PTA) thresholds of the better hearing ear and being ethnically Chinese were associated with subjects reporting more hearing disabilities. A higher proportion of subjects reported a reduction rather than an absence of disability after HA fitting. In multivariable models, daily HA usage for ≥4 hours, sensorineural hearing loss (HL) and worse PTA thresholds of the better hearing ear were associated with reduction in more disabilities after HA fitting. CONCLUSION: Hearing disability is high among first-time HA users in Singapore. Ethnicity and PTA thresholds were associated with self-reported hearing disability. After HA fitting, higher daily HA usage, sensorineural HL, and worse PTA thresholds of the better hearing ear were associated with early reduction in disability. Patient counselling on the benefits of HL rehabilitation could focus on hearing disability rather than PTA thresholds. The management of patients' expectations could focus on reducing rather than eliminating disability.

Alcohol Use Disorder and Heavy Episodic Drinking in Rural Communities in Cambodia: Risk Factors and Community-Perceived Strategies.

Alcohol misuse is increasing in Southeast Asia. We investigated the extent of and risk factors for alcohol use disorder (AUD) and heavy episodic drinking (HED) in a rural community in Cambodia. We also attempted to explore the communities' perception of alcohol misuse and elicited potential community-based strategies to address the alcohol problem. A mixed-methods study design was used, combining a cross-sectional questionnaire survey with qualitative interviews (focus group discussions and key informant interviews). AUD and HED were measured using the AUDs Identification Test Alcohol Consumption questionnaire. The prevalence of AUD and HED was high: 25% and 31%, respectively. Male sex, younger age, and increasing income were significant risk factors. The communities were well aware of the harmful effects of alcohol, expressed the importance of implementing community-based measures, and proposed various community-led solutions. Evidence-based strategies that are culturally appropriate, accepted, and driven by communities are urgently needed.