Prediction of the pure-tone average from the speech reception and auditory brainstem response thresholds in a geriatric population.

BACKGROUND: Although the pure-tone average (PTA) remains the standard assessment of hearing status, its results are questionable in the difficult-to-test geriatric population. In this study, we assessed the relationship between the 4-frequency PTA, speech reception threshold (SRT) and auditory brainstem response (ABR) threshold in the aged. We developed an equation as a tool to predict the actual PTA. METHODS: Forty-six subjects more than 60 years of age were consecutively enrolled in the study. All subjects underwent hearing threshold evaluation by means of PTA, SRT and ABR testing on both ears. Using simple linear and multiple regressions, the correlation and multiple regression models between PTA, SRT and ABR thresholds were calculated. RESULTS: The Pearson correlation coefficient between pure-tone thresholds (PTTs) and SRT was highest at 0.5-2 kHz (r = 0.948). The Pearson correlation coefficient between PTTs and ABR thresholds was highest at 2-4 kHz (r = 0.690). The resultant multiple regression model to predict actual PTA was: PTA = 3.274 + 0.774 (SRT) + 0.245 (ABR). CONCLUSIONS: In this study, we delineated the relationship between the PTA, SRT and ABR threshold, and established an equation to predict the actual PTA from the SRT and ABR threshold in difficult-to-test patients, allowing accurate assessment of the hearing threshold in geriatric populations.

Recurrent autoimmune inner ear disease (AIED) and polyarteritis nodosa in a patient with large cell lung carcinoma.

Autoimmune inner ear disease (AIED) is a very rare disorder with distinct clinical features and can occur in patients with malignancy or autoimmune diseases. We report a 72-year-old male patient with polyarteritis nodosa treated continuously for 5 years with aggressive immunosuppressive drugs, including cyclophosphamide, who experienced three episodes of acute hearing loss during treatment. Organic lesions of the external and middle ear were excluded by repeated examinations, and if one subscribes to McCabe's (Ann Otol Rhinol Laryngol 88:585-589, 1979) definition of AIED, this condition must be considered as the likely cause of the hearing loss. During the period of treatment, three episodes of AIED occurred, and eventually, lung cancer developed. From the time relationship and clinical manifestations of neuropathy and livedo reticularis, the first episode of hearing loss was more likely to be related to vasculitis itself, while the third episode may well have been associated with the development of lung cancer given the dramatic improvement in the clinical condition following treatment of the tumor by excision and cancer chemotherapy. Coexistence of AIED, vasculitis, and malignancy in the same patient has only been reported infrequently, and our case suggests that this coexistence may not be coincidental. For those patients with autoimmune disease who are on long-term immunosuppressive drug therapy, active surveillance for a nascent malignant tumor should be exercised if AIED recurs or persists.

Relationship between Mandarin speech reception thresholds and pure-tone thresholds in the geriatric population.

BACKGROUND/PURPOSE: In the geriatric population, the reliability of pure-tone threshold (PTT) is sometimes poorer than that in young adults because of various reasons. This study assessed the relationship between Mandarin speech reception thresholds (SRTs) and PTTs in the aged and developed SRT as a measure for corroborating PTT. METHODS: This prospective study enrolled 46 consecutive subjects over 60 years of age. The results of SRT and PTT were collected from one ear randomly selected from each subject. Simple linear and multiple regressions were used to determine the correlation and linear regression coefficients between SRTs and PTTs at various frequencies. RESULTS: In the simple regression analysis, the correlation coefficient was highest at 1000 Hz (r = 0.949) and 500 Hz (r = 0.922), followed by 250 Hz (r = 0.850) and 2000 Hz (r = 0.792). In the multiple regression model with SRT as the dependent variable and PTTs as predictor variables, the resultant multiple correlation coefficient R was 0.967, while R2 was 0.936. In this model, PTTs at the frequencies of 500 Hz and 1000 Hz contributed significantly to the variance in SRTs with p values of 0.029 and < 0.001, respectively. These results demonstrated that the Mandarin SRT is strongly associated with PTTs at the frequencies of 500 Hz and 1000 Hz. CONCLUSION: This study established the agreement between Mandarin SRTs and PTTs in the low tone area of speech frequencies in the geriatric population. In clinical settings, SRT test can be rapidly and easily performed and is relatively inexpensive. It is a vital indicator of the accuracy of PTT measurement.

Applying revised gap analysis model in measuring hotel service quality.

INTRODUCTION: With the number of tourists coming to Taiwan growing by 10-20 % since 2010, the number has increased due to an increasing number of foreign tourists, particularly after deregulation allowed admitting tourist groups, followed later on by foreign individual tourists, from mainland China. The purpose of this study is to propose a revised gap model to evaluate and improve service quality in Taiwanese hotel industry. Thus, service quality could be clearly measured through gap analysis, which was more effective for offering direction in developing and improving service quality. CASE DESCRIPTION: The HOLSERV instrument was used to identify and analyze service gaps from the perceptions of internal and external customers. The sample for this study included three main categories of respondents: tourists, employees, and managers. DISCUSSION AND EVALUATION: The results show that five gaps influenced tourists' evaluations of service quality. In particular, the study revealed that Gap 1 (management perceptions vs. customer expectations) and Gap 9 (service provider perceptions of management perceptions vs. service delivery) were more critical than the others in affecting perceived service quality, making service delivery the main area of improvement. CONCLUSION: This study contributes toward an evaluation of the service quality of the Taiwanese hotel industry from the perspectives of customers, service providers, and managers, which is considerably valuable for hotel managers. It was the aim of this study to explore all of these together in order to better understand the possible gaps in the hotel industry in Taiwan.

An empirical research on customer satisfaction study: a consideration of different levels of performance.

Customer satisfaction is the key factor for successful and depends highly on the behaviors of frontline service providers. Customers should be managed as assets, and that customers vary in their needs, preferences, and buying behavior. This study applied the Taiwan Customer Satisfaction Index model to a tourism factory to analyze customer satisfaction and loyalty. We surveyed 242 customers served by one tourism factory organizations in Taiwan. A partial least squares was performed to analyze and test the theoretical model. The results show that perceived quality had the greatest influence on the customer satisfaction for satisfied and dissatisfied customers. In addition, in terms of customer loyalty, the customer satisfaction is more important than image for satisfied and dissatisfied customers. The contribution of this paper is to propose two satisfaction levels of CSI models for analyzing customer satisfaction and loyalty, thereby helping tourism factory managers improve customer satisfaction effectively. Compared with traditional techniques, we believe that our method is more appropriate for making decisions about allocating resources and for assisting managers in establishing appropriate priorities in customer satisfaction management.

Office-based treatment of vocal fold polyp with flexible laryngosvideostroboscopic surgery.

OBJECTIVES: To evaluate the usefulness and safety of flexible laryngovideostroboscopic (FLVS) surgery in patients with vocal fold polyp and to discuss its advantages and limitations in comparison with traditional direct microlaryngoscopic technique under general anesthesia. DESIGN: Retrospective analysis. PATIENTS AND METHODS: Twenty patients with vocal fold polyp treated by FLVS surgery under topical anesthesia were reviewed. The results were evaluated by videostroboscopy and grade of the severity of dysphonia, roughness, and breathiness (GRB) scales. Phonatory results, including maximum phonation time, jitter, shimmer, and noise to harmonic ratio, were also reviewed for objective evaluations. RESULTS: All patients completed the surgery smoothly, and seven of them had a higher risk for general anesthesia because of their medical diseases. The procedure was typically accomplished within 20 minutes, and no complications were noted. Videostroboscopy showed improved degree of glottic closure (p < .001), regularity (p = .046), phase symmetry (p = .008), and mucosal wave (p = .008) after FLVS. A significant improvement was noted between preoperative and postoperative results with regard to GRB scale (p < .001, p = .001, and p = .013, respectively). Maximum phonation time also increased significantly after surgery (p = .002). Trivial mucosal residual was noted in one patient. No recurrence was found after a 6-month follow-up period. CONCLUSIONS: FLVS surgery is a highly applicable procedure with low invasiveness and minimal morbidity. It offers a simple and cost-effective alternative to the traditional direct microlaryngoscopic procedure, especially for those who are not candidates for general anesthesia or suspension of the larynx.