Subjective benefits from wearing self-fitting over-the-counter hearing aids in the real world.

Introduction: In 2022, the US Food and Drug Administration enacted final regulations to establish the category of over-the-counter (OTC) hearing aids aimed at reducing barriers to access hearing health care for individuals with self-perceived mild to moderate hearing loss. However, given the infancy of this device category, the effectiveness of OTC hearing aids in real-world environments is not yet well understood. Methods and results: To gain insights into the perceived benefit of self-fitting OTC hearing aids, a two-pronged investigation was conducted. In the primary investigation, 255 active users of a self-fitting OTC hearing aid were surveyed on their perceived benefit using an abridged form of the Satisfaction with Amplification in Daily Living (SADL) scale. The mean global (4.9) and subscale scores (Positive Effect (PE): 4.3; Negative Features (NF): 4.3; Personal Image (PI): 6.1) were within the range of those previously reported for users of prescription hearing aids. In the secondary investigation, 29 individuals with self-reported hearing impairment but no prior experience with the investigational self-fitting OTC hearing aids used the devices and reported their perceived benefit and satisfaction following short-term usage. For this prospective group, the global SADL (5.4) and subscale scores (PE: 4.8; NF: 4.9; PI: 6.5) following a minimum of 10 weeks of real-world use were also within the range of those previously reported for traditional hearing aid users. In addition, this prospective group was also asked quality of life questions which assessed psychological benefits of hearing aid use. Responses to these items suggest hearing aid related improvements in several areas spanning emotional health, relationships at home and at work, social life, participation in group activities, confidence and feelings about one's self, ability to communicate effectively, and romance. Discussion: Converging data from these investigations suggest that self-fitting OTC hearing aids can potentially provide their intended users with a level of subjective benefit comparable to what prescription hearing aid users might experience.

Visually enhanced vestibulo-ocular reflex gain in patients with vestibular disease.

Objective: Vestibular migraine (VM) is a diagnostic challenge. Visually enhanced vestibulo-ocular reflex (VVOR) gain, a measure of the visual-vestibular interaction, has been proposed as a tool for diagnosing VM. This study seeks to evaluate VVOR gain's diagnostic capability to predict VM and to compare the phenotypes of vestibular patients with elevated versus normal/low VVOR gain. Methods: A retrospective review of consecutive adult patients at a dizziness clinic from October 2016 and December 2020 was conducted. VVOR gain's diagnostic performance was assessed with the area under the receiver operating characteristic (AUROC) analysis. Demographic factors and clinical presentations were compared between vestibular patients with elevated versus normal/low VVOR gain. Results: One hundred forty patients (70 with VM) were analyzed. VVOR gain was elevated in 68.6% of patients with VM, compared to 52.9% of patients without VM (p = .057). The AUROC of VVOR gain was 0.5902 (95% confidence interval: 0.4958-0.6846). Vestibular patients with elevated VVOR gain were younger than those with normal/low VVOR gain (mean age 50 vs. 62, p < .0001). A higher proportion of subjects with elevated VVOR gain had symptoms triggered by certain foods (17.6% vs. 5.5%, p = .040) and experienced sound sensitivity (34.1% vs. 18.2%, p = .040) and motion sensitivity (23.5% vs. 9.1%, p = .041). A greater proportion of VM patients with elevated VVOR gain were triggered by certain foods (27.1% vs. 0%, p = .006). Conclusion: VVOR gain alone has limited ability to discriminate VM from other vestibular conditions and must be interpreted carefully. VVOR gain elevation may be associated with food triggers and motion and sound sensitivity. Level of Evidence: IV.

Examining Migraine as a Predictor of Benign Paroxysmal Positional Vertigo Onset, Severity, Recurrence, and Associated Falls.

INTRODUCTION: The comorbidity of migraine and benign paroxysmal positional vertigo (BPPV) is well-established, yet the impact of migraine on the BPPV phenotype remains understudied. METHODS: A retrospective analysis of patients at a tertiary dizziness/vertigo clinic diagnosed with BPPV from 2015 and 2020 was conducted. The study's primary outcomes were the age of BPPV onset, Dizziness Handicap Index (DHI), BPPV recurrence, and dizziness-related falls. RESULTS: In our cohort of 255 BPPV patients, 44.7% had a history of migraine. Those with migraine had an earlier age of BPPV onset than individuals without migraine (60.2 vs. 65.4, p = 0.0018). Migraineurs and non-migraineurs did not differ in their DHI (44.7 vs. 41.6, p= 0.44), recurrence rates (48.3% vs. 40.4%, p= 0.21), and falls (32.5% vs. 37.6%, p = 0.39). Among individuals with horizontal canal BPPV, a higher proportion of migraineurs experienced falls than non-migraineurs (50.0% vs. 6.3%, p = 0.02). CONCLUSIONS: Migraineurs experience BPPV at a younger age than those without migraine. This finding suggests that migraine, which has been shown to cause inner ear damage, predisposes individuals to developing BPPV earlier. Migraine was also associated with a higher rate of falls among patients with horizontal canal BPPV, indicating that a migraine history may impact the phenotype of BPPV.

Broadening vestibular migraine diagnostic criteria: A prospective cohort study on vestibular migraine subtypes.

BACKGROUND: Current Bárány Society criteria for vestibular migraine (VM) include only episodic symptoms. Anecdotal observations suggest that some patients have episodic forms and others have chronic forms of VM, with interplay and evolution of both subtypes over time. OBJECTIVE: To better understand VM subtypes and evaluate a more inclusive diagnostic schema. METHODS: Four VM groups were studied: definite episodic (dVM), probable episodic (pVM), definite chronic (dCVM), and probable chronic (pCVM). Chronic VM was defined as having more than 15 dizzy days per month. Sociodemographic and clinical characteristics were analyzed, along with Dizziness Handicap Inventory (DHI) and Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI) scores. RESULTS: 54 adults with a mean age of 47.0 years (SD 13.7) were enrolled. 10 met criteria for dVM, 11 pVM, 22 dCVM, and 11 pCVM. Overall, there were strong similarities in clinical characteristics between dVM, pVM, dCVM, and pCVM. Compared to subjects with episodic VM, those with chronic VM had a higher average number of VM triggers (8.7 vs. 6.4, P = 0.019), including motion (93.9% vs. 66.7%, P = 0.009), scrolling on a screen (78.8% vs. 47.6%, P = 0.018), skipped meal (57.6% vs. 23.8%, P = 0.015), and air travel (57.6% vs. 23.8%, P = 0.015). They also had higher symptom severity (DHI = 53.3, P = 0.194) and burden of disease (VM-PATHI = 48.2, P = 0.030) scores. CONCLUSIONS: Many patients do not meet current Bárány Society criteria for VM based on their duration of vestibular symptoms. Yet, these patients with chronic VM endorse several indistinguishable symptoms from those who do meet criteria. A more inclusive diagnostic schema should be adopted where patients with vestibular symptoms shorter than 5 minutes or longer than 72 hours are also recognized as having VM.

Vestibular Test Results in Patients With Horizontal Canal Benign Paroxysmal Positional Vertigo.

Introduction While the mechanism of posterior canal benign paroxysmal positional vertigo (BPPV) is widely accepted as canalolithiasis, the pathophysiology of horizontal canal BPPV remains controversial. We seek to analyze vestibular test results of patients with horizontal canal BPPV with ageotropic nystagmus (AHC) and geotropic nystagmus (GHC) in comparison to patients with posterior canal BPPV (PC) to better understand its pathophysiology. Methods In a retrospective chart review of adults with BPPV at a tertiary referral balance center, we reviewed the clinical characteristics and compared videonystagmography, caloric, rotary chair, subjective visual vertical (SVV)/ subjective visual horizontal (SVH), and vestibular evoked myogenic potential (VEMP) results between groups. Results We included 11 AHC and seven GHC patients and randomly selected 20 PC patients as the comparison group. All groups had a high rate of migraine and low rates of diabetes and head trauma, but no difference between groups. Ipsilateral caloric weakness was more prevalent in the GHC group compared to the PC group (p=0.02). One of two AHC patients and both GHC patients who had SVV/SVH testing had abnormal findings. The only AHC patient who had ocular VEMP testing had abnormal results. Additionally, we observed a significant downbeating component to nystagmus (4 deg/sec or greater) exclusively in the AHC group (5/10 patients, p=0.001). Conclusions Patients with AHC and GHC have unique vestibular testing results. In particular, only AHC patients showed a downbeating component to their nystagmus, which may suggest utricular dysfunction in the pathophysiology of AHC.

Understanding Dizzy Patients a Cross-Sectional Analysis of Attitudes toward Diagnosis, Providers, and Treatment.

OBJECTIVE: To evaluate patients' attitudes regarding their dizziness, provider capabilities, and receptiveness toward treatment. STUDY DESIGN: Cross-sectional study. SETTING: Tertiary care vestibular clinic. PATIENTS: Ages 18 years or older, fluent in English, and who presented with a chief complaint of dizziness or vertigo. INTERVENTION(S): N/A. MAIN OUTCOMES MEASURE(S): Non-validated questionnaire surveying patients' beliefs regarding the cause of their dizziness, likelihood of successful treatment, and openness to various treatment modalities. RESULTS: Patients were asked to complete an online non-validated survey regarding their dizziness prior to being evaluated in neurotology clinic. About 67 surveys were completed between January 2017 and September 2018. A majority of patients attributed their dizziness to their ears (n = 47, 70%), followed by the brain (n = 29, 43%). Most subjects chose "neither agree nor disagree" about whether their provider could identify the cause of their dizziness (27%). Most subjects also chose "neither agree nor disagree" that their dizziness would resolve with treatment (31%). These attitudes were not influenced by demographics, dizziness severity, anxiety, depression, or quality of life on multivariate ordinal regression modeling. CONCLUSIONS: Patients who experience dizziness have neutral attitudes with regards to believing that their provider will be able to identify the cause of their dizziness and whether their dizziness will resolve with treatment. These neutral attitudes are experienced by a plurality of patients and do not differ by demographic information, dizziness handicap, quality of life, depression, or anxiety.

Episodic versus Chronic Dizziness: An Analysis of Predictive Factors.

OBJECTIVES: To elucidate differences in demographic and clinical characteristics between patients with episodic and chronic dizziness. METHODS: A cross-sectional, observational study of 217 adults referred for dizziness at 1 tertiary center was undertaken. Subjects were split into a chronic dizziness group (>15 dizzy days per month) and an episodic dizziness group (<15 dizzy days per month). RESULTS: 217 adults (average age, 53.7 years; 56.7% female) participated. One-third (n = 74) met criteria for chronic dizziness. Dizziness handicap inventory (DHI) scores were significantly higher in those with chronic dizziness compared to those with episodic dizziness (53.9 vs 40.7; P < .001). Comorbid depression and anxiety were more prevalent in those with chronic dizziness (44.6% and 47.3% vs 37.8% and 35.7%, respectively; P > .05). Abnormal vestibular testing and abnormal imaging studies did not differ significantly between the 2 groups. Ménière's disease and BPPV were significantly more common among those with episodic dizziness, while the prevalence of vestibular migraine did not differ according to chronicity of symptoms. A multivariate regression that included age, sex, DHI, history of anxiety and/or depression, associated symptoms, and dizziness triggers was able to account for 15% of the variance in the chronicity of dizziness (pseudo-R2 = 0.15; P < .001). CONCLUSIONS: Those who suffer from chronic dizziness have significantly higher DHI and high comorbid rates of depression and anxiety than those with episodic dizziness. Our findings show that factors other than diagnosis alone are important in the chronification of dizziness, an observation that could help improve on multimodal treatment options for this group of patients.

Understanding Extremely Elevated Dizziness Handicap Inventory Scores: An Analysis of Predictive Factors.

BACKGROUND: The Dizziness Handicap Inventory (DHI) measures impairment in quality of life due to dizziness, with higher scores indicating greater impairment. Little is known about the clinical features that predict extremely elevated DHI scores (eeDHI). OBJECTIVE: To identify clinical features associated with eeDHI. METHODS: A retrospective analysis was conducted of 217 patients with dizziness between October 2016 and April 2019. Patients with eeDHI had DHI scores 1 standard deviation higher than the mean. Analyses were performed to generate odds ratios (OR) for having eeDHI based on clinical features and exam findings. RESULTS: The cut-off for eeDHI scores was 71. In total, 20.7% had eeDHI. Logistic regression identified 6 independent predictors for eeDHI scores: numbness in the face or body during dizziness (OR = 5.99, 95% CI 1.77-20.30), history of falls (OR = 4.37, 95% CI 1.74-10.97), female sex (OR = 2.81, 95% CI 1.18-6.66), caloric weakness (OR = 2.61, 95% CI 1.36-5.01), total number of diagnoses associated with dizziness (OR = 2.17, 95% CI 1.11-4.28), and total number of symptoms during dizziness (OR = 1.25, 95% CI 1.07-1.45). CONCLUSIONS: These findings suggest that patients with eeDHI have severe disease and should be screened for falls. By understanding the drivers of high DHI scores, we can alleviate disease related suffering for vestibular disorders.

Development and Validation of VM-PATHI: Vestibular Migraine Patient Assessment Tool and Handicap Inventory.

OBJECTIVE: The aim of this article is to develop and validate a disease-specific, patient-reported outcome measure for vestibular migraine. SETTING: Tertiary care vestibular center. PATIENTS: Adult patients with definite or probable vestibular migraine per Barany Society Criteria. STUDY DESIGN: This was a prospective cohort study. VM-PATHI (Vestibular Migraine Patient Assessment Tool and Handicap Inventory) was developed with expert input, literature review, and patient feedback. VM-PATHI scores were compared between those with vestibular migraine and controls, across several time points, and to other dizziness and quality of life (QoL) measures. RESULTS: A 25-item questionnaire was developed. Cronbach's α was high at 0.92. Test-retest reliability was excellent (r = 0.90, p < 0.001). Scores were much higher in patients with vestibular migraine (mean 42.5, SD = 16.1) than control patients (mean = 9.6, SD = 8.5). VM-PATHI scores were responsive to treatment (p = 0.01). Scores were well correlated with general QoL, depression, and anxiety scores. Scores were also correlated with the Dizziness Handicap Inventory (r = 0.69). An exploratory factor analysis was performed, which revealed 6 distinct factors that corresponded well to different aspects of disease-related symptomatology. CONCLUSION: VM-PATHI is a valid, reliable, and responsive measure of disease severity in vestibular migraine.

Comparison of Clinical and Traditional Gap Detection Tests.

BACKGROUND: Temporal resolution is important for speech recognition and may contribute to variability in speech recognition among patients. Clinical tests of temporal resolution are available, but it is not clear how closely results of those tests correspond to results of traditional temporal resolution tests. PURPOSE: The purpose of this study was to compare the Gaps-in-Noise (GIN) test to a traditional measure of gap detection. STUDY SAMPLE: This study included older adults with hearing loss and younger adults with normal hearing. DATA COLLECTION AND ANALYSIS: Participants completed one practice and two test blocks of each gap detection test, and a measure of speech-in-noise recognition. Individual data were correlated to examine the relationship between the tests. RESULTS: The GIN and traditional gap detection were significantly, but not highly correlated. The traditional gap detection test contributed to variance in speech recognition in noise, while the GIN did not. CONCLUSIONS: The brevity and ease of implementing the GIN in the clinic make it a viable test of temporal resolution. However, it differs from traditional measures in implementation, and as a result relies on different cognitive factors. The GIN thresholds should be interpreted carefully and not presumed to represent an approximation of traditional gap detection thresholds.