Reported Unmet Hearing Aid Need in Older People With Dementia: The US National Core Indicators Survey.

OBJECTIVES: Hearing aids have important health benefits for older adults with Alzheimer disease and related dementias (ADRD); however, hearing aid adoption in this group is low. This study aimed to determine where to target hearing aid interventions for American long-term care recipients with ADRD by examining the association of ADRD and residence type with respondent-reported unmet hearing aid need. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the United States National Core Indicators-Aging and Disabilities survey (2015-2019) for long-term care recipients aged ≥65 years. METHODS: We used multivariable logistic regression to model the likelihood of reporting unmet hearing aid need conditional on ADRD status and residence type (own/family house or apartment, residential care, or nursing facility/home), adjusting for sociodemographic factors and response type (self vs proxy). RESULTS: Of the 25,492 respondents [median (IQR) age, 77 (71, 84) years; 7074 (27.8%) male], 5442 (21.4%) had ADRD and 3659 (14.4%) owned hearing aids. Residence types were 17,004 (66.8%) own/family house or apartment, 4966 (19.5%) residential care, and 3522 (13.8%) nursing home. Among non-hearing aid owners, ADRD [adjusted odds ratio (AOR) 0.90, 95% CI 0.80-1.0] and residence type were associated with respondent-reported unmet hearing aid need. Compared to the nursing home reference group, respondents in their own/family home (AOR 1.85, 95% CI 1.61-2.13) and residential care (AOR 1.30, 95% CI 1.10-1.53) were more likely to report unmet hearing aid need. This pattern was significantly more pronounced in people with ADRD than in those without, stemming from an interaction between ADRD and residence type. CONCLUSIONS AND IMPLICATIONS: American long-term care recipients with ADRD living in their own/family home are more likely to report unmet hearing aid need than those with ADRD in institutional and congregate settings. This information can inform the design and delivery of hearing interventions for older adults with ADRD.

Longitudinal Policy Surveillance of Private Insurance Hearing Aid Mandates in the United States: 1997-2022.

Objectives. To produce a database of private insurance hearing aid mandates in the United States and quantify the share of privately insured individuals covered by a mandate. Methods. We used health-related policy surveillance methods to create a database of private insurance hearing aid mandates through January 2023. We coded salient features of mandates and combined policy data with American Community Survey and Medicare Expenditure Panel Survey-Insurance Component data to estimate the share of privately insured US residents covered by a mandate from 2008 to 2022. Results. A total of 26 states and 1 territory had private insurance hearing aid mandates. We found variability for mandate exceptions, maximum age eligibility, allowable frequency of benefit use, and coverage amounts. Between 2008 and 2022 the proportion of privately insured youths (aged ≤ 18 years) living where there was a private insurance hearing aid mandate increased from 3.4% to 18.7% and the proportion of privately insured adults (19-64 years) increased from 0.3% to 4.6%. Conclusions. Hearing aid mandates cover a small share of US residents. Mandate exceptions in several states limit coverage, particularly for adults. Public Health Implications. A federal mandate would improve hearing aid access. States can also improve access by adopting exception-free mandates with limited utilization management and no age restrictions. (Am J Public Health. 2024;114(4):407-414. https://doi.org/10.2105/AJPH.2023.307551).

Post-implantation clinical cost analysis between transcutaneous and percutaneous bone conduction devices.

INTRODUCTION: Bone conduction devices (BCD) are effective for hearing rehabilitation in patients with conductive and mixed hearing loss or single-sided deafness. Transcutaneous bone conduction devices (tBCD) seem to lead to fewer soft tissue complications than percutaneous BCDs (pBCD) but have other drawbacks such as MRI incompatibility and higher costs. Previous cost analyses have shown a cost advantage of tBCDs. The purpose of this study is to compare long-term post-implantations costs between percutaneous and transcutaneous BCDs. MATERIALS AND METHODS: Retrospective data from 77 patients implanted in a tertiary referral centre with a pBCD (n = 34), tBCD (n = 43; passive (tpasBCD; n = 34) and active (tactBCD; n = 9) and a reference group who underwent cochlear implantation (CI; n = 34), were included in a clinical cost analysis. Post-implantation costs were determined as the sum of consultation (medical and audiological) and additional (all post-operative care) costs. Median (cumulative) costs per device incurred for the different cohorts were compared at 1, 3 and 5 years after implantation. RESULTS: After 5 years, the total post-implantation costs of the pBCD vs tpasBCD were not significantly different (€1550.7 [IQR 1174.6-2797.4] vs €2266.9 [IQR 1314.1-3535.3], p = 0.185), nor was there a significant difference between pBCD vs tactBCD (€1550.7 [1174.6-2797.4] vs €1428.8 [1277.3-1760.4], p = 0.550). Additional post-implantation costs were significantly highest in the tpasBCD cohort at all moments of follow-up. CONCLUSION: Total costs related to post-operative rehabilitation and treatments are comparable between percutaneous and transcutaneous BCDs up to 5 years after implantation. Complications related to passive transcutaneous bone conduction devices appeared significantly more expensive after implantation due to more frequent explantations.

Use of Socioeconomic Demographic Data in Studies on Pediatric Unilateral Hearing Loss: A Scoping Review.

OBJECTIVES: Social determinants of health (SDOH) (healthcare access and quality, education access and quality, socioeconomic status, social and cultural context, neighborhood and built environment) ( Healthy People 2030 ) have been shown to impact a wide range of health-related outcomes and access to care. Given the medical and nonmedical costs associated with children with unilateral hearing loss (UHL), the varied insurance coverage for hearing healthcare services, and the differences in hearing aid utilization rates between children of different sociodemographic classes, the sociodemographic information of children with UHL enrolled in research studies should be collected to ensure the generalizability of hearing healthcare interventions. Therefore, the objective of this scoping review is to assess the reporting of SDOH data for participants in studies of pediatric UHL and its comparison to population trends. DESIGN: Two searches of published literature were conducted by a qualified medical librarian. Two reviewers then evaluated all candidate articles. Study inclusion parameters were from 2010 to present, peer-reviewed studies with prospective study design, and participant population including children (age 0 to 18 years old) with UHL. RESULTS: Two literature searches using PubMed Medline and Embase found 442 and 3058 studies each for review. After abstract and paper review, 87 studies were included in final qualitative review, with 22 of these studies reporting race distribution of participants, 15 reporting insurance status or family income, and 12 reporting the maternal education level. CONCLUSIONS: Sociodemographic data are not commonly reported in research studies of children with UHL. In reported samples, research participants are more likely to have private insurance and higher family income compared with overall population distribution. These demographic biases may affect the generalizability of study results to all children with UHL. Further evaluation is warranted to evaluate whether participant recruitment affects outcomes that reflect the overall population.

Hearing Loss Prevalence, Years Lived With Disability, and Hearing Aid Use in the United States From 1990 to 2019: Findings From the Global Burden of Disease Study.

OBJECTIVES: This article describes key data sources and methods used to estimate hearing loss in the United States, in the Global Burden of Disease study. Then, trends in hearing loss are described for 2019, including temporal trends from 1990 to 2019, changing prevalence over age, severity patterns, and utilization of hearing aids. DESIGN: We utilized population-representative surveys from the United States to estimate hearing loss prevalence for the Global Burden of Disease study. A key input data source in modeled estimates are the National Health and Nutrition Examination Surveys (NHANES), years 1988 to 2010. We ran hierarchical severity-specific models to estimate hearing loss prevalence. We then scaled severity-specific models to sum to total hearing impairment prevalence, adjusted estimates for hearing aid coverage, and split estimates by etiology and tinnitus status. We computed years lived with disability (YLDs), which quantifies the amount of health loss associated with a condition depending on severity and creates a common metric to compare the burden of disparate diseases. This was done by multiplying the prevalence of severity-specific hearing loss by corresponding disability weights, with additional weighting for tinnitus comorbidity. RESULTS: An estimated 72.88 million (95% uncertainty interval (UI) 68.53 to 77.30) people in the United States had hearing loss in 2019, accounting for 22.2% (20.9 to 23.6) of the total population. Hearing loss was responsible for 2.24 million (1.56 to 3.11) YLDs (3.6% (2.8 to 4.7) of total US YLDs). Age-standardized prevalence was higher in males (17.7% [16.7 to 18.8]) compared with females (11.9%, [11.2 to 12.5]). While most cases of hearing loss were mild (64.3%, 95% UI 61.0 to 67.6), disability was concentrated in cases that were moderate or more severe. The all-age prevalence of hearing loss in the United States was 28.1% (25.7 to 30.8) higher in 2019 than in 1990, despite stable age-standardized prevalence. An estimated 9.7% (8.6 to 11.0) of individuals with mild to profound hearing loss utilized a hearing aid, while 32.5% (31.9 to 33.2) of individuals with hearing loss experienced tinnitus. Occupational noise exposure was responsible for 11.2% (10.2 to 12.4) of hearing loss YLDs. CONCLUSIONS: Results indicate large burden of hearing loss in the United States, with an estimated 1 in 5 people experiencing this condition. While many cases of hearing loss in the United States were mild, growing prevalence, low usage of hearing aids, and aging populations indicate the rising impact of this condition in future years and the increasing importance of domestic access to hearing healthcare services. Large-scale audiometric surveys such as NHANES are needed to regularly assess hearing loss burden and access to healthcare, improving our understanding of who is impacted by hearing loss and what groups are most amenable to intervention.

Effects of Economic Status on Changes in Social Networks and Mental Health after Using Hearing Aids.

OBJECTIVES: Hearing impairment affects social networks and mental health. Hearing aids (HA) can improve these deficits. However, their effects might be affected by various factors such as economic status (ES). This study aimed to identify how ES could moderate the effects of HA on social networks, depressive mood, and cognition. METHODS: A prospective cohort for new HA users was established and classified into two groups based on their ES: a low ES group (LES group) and a medium to high ES group (MHES group). Audiological examination, Lubben social network scale-18 (LSNS-18), Short form of Geriatric Depression Score, Mini-Mental State Examination in the Korean version of the CERAD Assessment Packet, and surveys for satisfaction with HA were conducted before and at six months after wearing HA. RESULTS: Post-HA application LSNS-18 scores were not improved in the LES group whereas they revealed significant improvement in the MHES group (p = 0.003). The LES group showed lower LSNS-18 score (p = 0.020) and its change (p = 0.042) than the MHES group. Additionally, patients with depressive moods in the MHES group showed better improvements than those in the LES group (p = 0.048). The effects of wearing HA on cognition and satisfaction with HA were not significantly different between the two groups. CONCLUSIONS: HA did not improve social relationships and depressive moods in the LES group. Comprehensive and multidirectional support as well as hearing rehabilitation may be important for patients with LES. LEVEL OF EVIDENCE: 3 (Nonrandomized controlled cohort/follow-up study) Laryngoscope, 134:2387-2394, 2024.

Hearing Loss, Hearing Aids, and Satisfaction With Health Care in the National Health Interview Survey.

OBJECTIVE: Hearing loss may negatively impact satisfaction with health care via patient-provider communication barriers and may be amenable to hearing care treatment. STUDY DESIGN: Cross-sectional. SETTING: National Health Interview Survey, a nationally representative survey of noninstitutionalized US residents, 2013 to 2018 pooled cycles. METHODS: Participants described satisfaction with health care in the past year, categorized as optimal (very satisfied) versus suboptimal (satisfied, dissatisfied, very dissatisfied) satisfaction. Self-report hearing without hearing aids (excellent, good, a little trouble, moderate trouble, a lot of trouble) and hearing aid use (yes, no) were collected. Weighted Poisson regression models adjusted for sociodemographic and health covariates were used to estimate prevalence rate ratios (PRRs) of satisfaction with care by hearing loss and hearing aid use. RESULTS: Among 137,216 participants (mean age 50.9 years, 56% female, 12% black), representing 77.2 million Americans in the weighted model, 19% reported trouble hearing. Those with good (PRR = 1.20, 95% confidence interval [CI]: 1.18-1.23), a little trouble (PRR = 1.27, 95% CI, 1.23-1.31), moderate trouble (PRR = 1.29, 95% CI, 1.24-1.35), and a lot of trouble hearing (PRR = 1.26, 95% CI, 1.18-1.33) had a higher prevalence rate of suboptimal satisfaction with care relative to those with excellent hearing. Among all participants with trouble hearing, hearing aid users had a 17% decrease in the prevalence rate of suboptimal satisfaction with care (PRR = 0.83, 95% CI, 0.78-0.88) compared to nonusers. CONCLUSION: Hearing loss decreases patient satisfaction with health care, which is tied to Medicare hospital reimbursement models. Hearing aid use may improve patient-provider communication and patient satisfaction, although prospective studies are warranted to truly establish their protective effect.

Bone-anchored hearing aids: Percutaneous versus transcutaneous attachments - a health economics comparison in paediatric patients.

INTRODUCTION: Bone anchored hearing aids (BAHA) are a useful support when conventional hearing aids are not suitable. The two types of attachment of the aid are onto a percutaneous abutment or a transcutaneous magnet. Anecdotally, the abutment requires more care, revision procedures and causes more infections than magnet-based devices. METHODS: A multicentre, retrospective review was conducted of all patients that underwent a BAHA since our programme began, identified through a prospectively maintained database of patients. Patients' charts were audited for outpatient clinic visits, skin complications and revision surgeries. Developmental delay was also recorded. Patients were censored if the hearing aid was removed, replaced or the patient reached 16 years old. Bilateral or reimplanted patients were recorded as separate implants. Statistical analysis was performed using SAS version 9.4. RESULTS: 150 implants were assessed over 126 patients: 115 transcutaneous and 35 percutaneous. Percutaneous patients had significantly more outpatient clinic attendances (Least square mean 4.19 vs. 1.39 p = 0.00), skin complications (mean 4.82 v 0.11 p = 0.00) and theatre visits (mean 2.8 vs. 1.03 p = 0.00) compared to transcutaneous patients. 77 implants were in patients that had developmental delay; having same made no significant difference to above outcomes. CONCLUSION: There is a significant difference in healthcare burden between percutaneous and transcutaneous systems in a paediatric population. The increased cost of the percutaneous implant to the healthcare system and inconvenience to the patient is cause to consider a transcutaneous system in the first instance.

Assessment of Vestigial Auriculomotor Activity to Acoustic Stimuli Using Electrodes In and Around the Ear.

Recently, it has been demonstrated that electromyographic (EMG) activity of auricular muscles in humans, especially the postauricular muscle (PAM), depends on the spatial location of auditory stimuli. This observation has only been shown using wet electrodes placed directly on auricular muscles. To move towards a more applied, out-of-the-laboratory setting, this study aims to investigate if similar results can be obtained using electrodes placed in custom-fitted earpieces. Furthermore, with the exception of the ground electrode, only dry-contact electrodes were used to record EMG signals, which require little to no skin preparation and can therefore be applied extremely fast. In two experiments, auditory stimuli were presented to ten participants from different spatial directions. In experiment 1, stimuli were rapid onset naturalistic stimuli presented in silence, and in experiment 2, the corresponding participant's first name, presented in a "cocktail party" environment. In both experiments, ipsilateral responses were significantly larger than contralateral responses. Furthermore, machine learning models objectively decoded the direction of stimuli significantly above chance level on a single trial basis (PAM: ≈ 80%, in-ear: ≈ 69%). There were no significant differences when participants repeated the experiments after several weeks. This study provides evidence that auricular muscle responses can be recorded reliably using an almost entirely dry-contact in-ear electrode system. The location of the PAM, and the fact that in-ear electrodes can record comparable signals, would make hearing aids interesting devices to record these auricular EMG signals and potentially utilize them as control signals in the future.

Prevalence of Hearing Loss and Hearing Aid Use Among US Medicare Beneficiaries Aged 71 Years and Older.

Importance: National prevalence estimates are needed to guide and benchmark initiatives to address hearing loss. However, current estimates are not based on samples that include representation of the oldest old US individuals (ie, aged ≥80 years), who are most at-risk of having hearing loss. Objective: To estimate the prevalence of hearing loss and hearing aid use by age and demographic covariates in a large, nationally representative sample of adults aged 71 years and older. Design, Setting, and Participants: In this cohort study, prevalence estimates of hearing loss by age, gender, race and ethnicity, education, and income were computed using data from the 2021 National Health Aging and Trends Study. Survey weights were applied to produce nationally representative estimates to the US older population. Data were collected from June to November 2021 and were analyzed from November to December 2022. Main Outcomes and Measures: Criterion-standard audiometric measures of hearing loss and self-reported hearing aid use. Results: In this nationally representative sample of 2803 participants (weighted estimate, 33.1 million individuals) aged 71 years or older, 38.3% (95% CI, 35.5%-41.1%) were aged 71 to 74 years, 36.0% (95% CI, 33.1%-38.8%) were aged 75 to 79 years, 13.8% (95% CI, 12.6%-14.9%) were aged 80 to 84 years, 7.9% (95% CI, 7.2%-8.6%) were aged 85 to 89 years, and 4.0% (95% CI, 3.5%-4.6%) were aged 90 years or older; 53.5% (95% CI, 50.9%-56.1%) were female and 46.5% (95% CI, 43.9%-49.1%) were male; and 7.5% (95% CI, 6.2%-8.7%) were Black, 6.5% (95% CI, 4.4%-8.7%) were Hispanic, and 82.7% (95% CI, 79.7%-85.6%) were White. An estimated 65.3% of adults 71 years and older (weighted estimate, 21.5 million individuals) had at least some degree of hearing loss (mild, 37.0% [95% CI, 34.7%-39.4%]; moderate, 24.1% [95% CI, 21.9%-26.4%]; and severe, 4.2% [95% CI, 3.3%-5.3%]). The prevalence was higher among White, male, lower-income, and lower education attainment subpopulations and increased with age, such that 96.2% (95% CI, 93.9%-98.6%) of adults aged 90 years and older had hearing loss. Among those with hearing loss, only 29.2% (weighted estimate, 6.4 million individuals) used hearing aids, with lower estimates among Black and Hispanic individuals and low-income individuals. Conclusions and Relevance: These findings suggest that bilateral hearing loss is nearly ubiquitous among older US individuals, prevalence and severity increase with age, and hearing aid use is low. Deeper consideration of discrete severity measures of hearing loss in this population, rather than binary hearing loss terminology, is warranted.

Health Economic Cost Analysis for Percutaneous Bone Conduction Devices: The Minimally Invasive Ponto Surgery Versus Linear Incision Technique with Tissue Preservation.

OBJECTIVES: To identify differences in mean cost per patient between the Minimally Invasive Ponto Surgery (MIPS) and the linear incision technique with tissue preservation (LITT-P). STUDY DESIGN: Health economic cost analysis. SETTING: The analysis was performed in a randomized multicenter controlled trial cohort. PATIENTS: Adult patients eligible for unilateral bone conduction device surgery. INTERVENTIONS: MIPS versus LITT-P surgery for bone conduction device implantation. MAIN OUTCOME MEASURES: Perioperative and postoperative costs were identified and compared. RESULTS: The difference in mean cost per patient between both techniques was €77.83 in favor of the MIPS after 22 months follow-up. The mean costs per patient were lower in the MIPS cohort for surgery (€145.68), outpatient visits (€24.27), systemic antibiotic therapy with amoxicillin/clavulanic acid (€0.30) or clindamycin (€0.40), abutment change (€0.36), and abutment removal (€0.18). The mean costs per patient were higher for implant and abutment set (€18.00), topical treatment with hydrocortison/oxytetracycline/polymyxine B (€0.43), systemic therapy with azithromycin (€0.09) or erythromycin (€1.15), local revision surgery (€1.45), elective explantation (€1.82), and implant extrusion (€70.42). Additional analysis of scenarios in which all patients were operated under general or local anesthesia or with recalculation when using current implant survival rates showed that differences in mean cost per patient were also in favor of the MIPS. CONCLUSION: The difference between the MIPS and the LITT-P in mean cost per patient was €77.83 in favor of the MIPS after 22 months of follow-up. The MIPS is an economically responsible technique and could be promising for the future.

Cost-Effectiveness Analysis of Hearing Aids for Middle-Aged and Older Adults in China: A Randomized Controlled Trial.

OBJECTIVE: To assess the cost-effectiveness of hearing aid interventions to middle-aged and older adults in rural China. STUDY DESIGN: Randomized controlled trial. SETTING: Community centers. PATIENTS: A total of 385 subjects 45 years and older with moderate or above hearing loss participated in the trial, of which 150 were in the treatment group and 235 in the control group. INTERVENTION: Participants were randomly assigned to the treatment group prescribing with hearing aids or to the control group with no intervention. MAIN OUTCOME AND MEASURES: The incremental cost-effectiveness ratio was calculated by comparing the treatment group with the control group. RESULTS: Assuming that the average life span of hearing aids is N years, the cost of the hearing aid intervention included the annual purchase cost of 10,000/N yuan, the annual maintenance cost of 41.48 yuan. However, the intervention led to annual healthcare costs of 243.34 yuan saved. The effectiveness of wearing a hearing aid included an increase of 0.017 quality-adjusted life years. It can be calculated that if N > 6.87, the intervention is very cost-effective; if 2.52 < N < 6.87, the increased cost-effectiveness of the intervention is acceptable; if N < 2.52, the intervention is not cost-effective. CONCLUSION: In general, the average life span of hearing aids is between 3 and 7 years, so hearing aid interventions can be considered cost-effective with high probability. Our results can provide critical reference for policy makers to increase accessibility and affordability of hearing aids.

Listening Effort in Quiet and Noisy Environments in the Daily Life of Adults With Hearing Aids: An Extended Version of the Effort Assessment Scale (EEAS).

This study was aimed at assessing listening effort (LE) in quiet and in noisy daily life situations, in 481 adults with hearing aids (HAs) and 62 adults with normal hearing, using an Extended version of the Effort Assessment Scale (EEAS). Participants were invited to self-assess their LE in daily life, on a visual analog scale graded from 0 (no effort) to 10. The EEAS's internal structure identified two separate constructs pertaining to LE in quiet and LE in noise, each with good consistency (Cronbach's α > 0.83). A three-factor model explained 12% of the variance of the EEAS scores, with HA experience the most important one, and better ear hearing threshold (averaged across 0.5-4 kHz) and ear asymmetry as the other two factors. The EEAS subscales differed in behavior, with the LE in noise being the most dependent on HA experience, whereas LE in quiet depended more on better ear hearing threshold. In a subgroup of people with 6 months to less than 24 months HA experience, a significant decrease in LE in noise was observed with increasing HA experience (0.26 points decrease per year of HA experience), whereas in a group of people with at least 24 months of HA experience, a small increase in LE in noise was observed. This effect was not mediated by age, nor hearing threshold. The extended Effort Assessment Scale is therefore offering an assessment of both LE in quiet and LE in noise, with different dependence on HA experience and hearing thresholds.

Percepção de familiares e autopercepção de idosos usuários de dispositivos de amplificação quanto à restrição de participação causada pela deficiência auditiva / Perception of family members and self -perception of the elderly users of amplification devices regarding the restriction of participation caused by hearing impairment / Percepción de los miembros de la familia y la autopercepción de los ancianos usuarios de dispositivos de amplificación sobre la restricción de la participación causada por la discapacidad auditiva

Introdução: A deficiência auditiva tem um efeito profundo na vida dos idosos. O apoio dos familiares no processo de reabilitação cria meios para facilitar a aceitação da deficiência e o uso dos dispositivos auditivos. Objetivo: Analisar a percepção dos familiares quanto à restrição da participação causada pela deficiência auditiva em indivíduos idosos usuários de aparelho de amplificação sonora individual (AASI) e compará-la com a autopercepção do próprio idoso quando a este aspecto. Métodos: A amostra foi composta por 48 indivíduos, que foram divididos em dois grupos, sendo GI o grupo de idosos, composto por 24 idosos com perda auditiva sensorioneural bilateral usuários de AASI; e GF o grupo de familiares, composto por 24 familiares, que acompanhavam esses idosos. Os participantes do GI responderam ao questionário de autoavaliação Hearing Handicap Inventory for the Elderly (HHIE) e os participantes do GF responderam ao questionário Hearing Handicap Inventory for the Elderly for Spouses (HHIE-SP). Resultados: Não houve correlação entre o tempo de uso do AASI e o escore obtido no questionário. Observou-se que, quanto maior a idade do idoso, piores foram os resultados encontrados no domínio "emocional" do HHIE para o grupo GI e para os domínios "social" e "emocional" para o grupo GF. Além disso, houve correlação entre os dois grupos, indicando que, quanto piores os resultados no HHIE para o GI, também foram piores os resultados no HHIE-SP respondido pelo GF. Conclusão: Arestrição de participação social e os aspectos emocionais influenciados pela perda auditiva em indivíduos idosos usuários de AASI são fatores percebidos pelos familiares que os acompanham nas consultas fonoaudiológicas. (AU)

Introduction: Hearing loss has a profound effect on the lives of the elderly. The support of family members in the rehabilitation process creates ways to facilitate the acceptance of the disability and the use of hearing devices. Objective: To analyze the perception of family members regarding the restriction of participation caused by hearing impairment in elderly individuals users of hearing aids and compare it with the self-perception of the elderly in this regard. Methods: The sample consisted of 48 individuals, who were divided into two groups, EG being the elderly group, composed of 24 elderly people with bilateral sensorineural hearing loss, who use HA; and FG the group of family members, composed of 24 family members, who accompanied these elderly people. EG participants answered the Hearing Handicap Inventory for the Elderly (HHIE) self-assessment questionnaire and FG participants answered the Hearing Handicap Inventory for the Elderly for Spouses (HHIE-SP). Results: There was no correlation between the time of HA use and the score obtained in the questionnaire. It was observed that the older the person, the worse the results found in the "emotional" domain of the HHIE for the EG group, and the "social" and "emotional" domains for the FG group. In addition, there was a correlation between the two groups, indicating that the worse the results in the HHIE for the EG, the worse the results in the HHIE-SP answered by the GF. Conclusion: The restriction of social participation and the emotional aspects influenced by hearing loss in the elderly who use HA are factors perceived by family members who accompany them in audiology appointments. (AU)

Introducción: La discapacidad auditiva tiene un profundo efecto en la vida de los adultos mayores. El apoyo de los familiares en el proceso de rehabilitación crea vías para facilitar la aceptación de la discapacidad y el uso de audífonos. Objetivo: Analizar la percepción de los familiares sobre la restricción de la participación causada por la deficiencia auditiva en ancianos usuarios de audífonos y compararla con la autopercepción de los ancianos al respecto. Métodos: La muestra estuvo conformada por 48 individuos, quienes fueron divididos en dos grupos, siendo GI el grupo de adultos mayores, compuesto por 24 adultos mayores con hipoacusia neurosensorial bilateral, que utilizan audífonos; y GF el grupo de familiares, compuesto por 24 familiares, que acompañaban a estos individuos. Los participantes del GI respondieron el cuestionario Hearing Handicap Inventory for the Elderly (HHIE) y los participantes del GF respondieron el cuestionario Hearing Handicap Inventory for the Elderly for Spouses (HHIE-SP). Resultados: No hubo correlación entre el tiempo de uso del audífono y la puntuación obtenida en el cuestionario. Se observó que a mayor edad del adulto mayor, peores resultados encontrados en el dominio "emocional" del HHIE para el grupo GI y para los dominios "social" y "emocional" para el grupo GF. Además, hubo correlación entre los dos grupos, indicando que a peores resultados en el HHIE para el GI, peores resultados en el HHIE-SP contestado por el GF. Conclusión: La restricción de la participación social y los aspectos emocionales influenciados por la hipoacusia en adultos mayores usuarios de audífonos son factores percibidos por los familiares que los acompañan en las consultas de audiología.(AU)

Potential Clinical and Economic Outcomes of Over-the-Counter Hearing Aids in the US.

Importance: Over-the-counter (OTC) hearing aids are now available in the US; however, their clinical and economic outcomes are unknown. Objective: To project the clinical and economic outcomes of traditional hearing aid provision compared with OTC hearing aid provision. Design, Setting, and Participants: This cost-effectiveness analysis used a previously validated decision model of hearing loss (HL) to simulate US adults aged 40 years and older across their lifetime in US primary care offices who experienced yearly probabilities of acquiring HL (0.1%-10.4%), worsening of their HL, and traditional hearing aid uptake (0.5%-8.1%/y at a fixed uptake cost of $3690) and utility benefits (0.11 additional utils/y). For OTC hearing aid provision, persons with perceived mild to moderate HL experienced increased OTC hearing aid uptake (1%-16%/y) based on estimates of time to first HL diagnosis. In the base case, OTC hearing aid utility benefits ranged from 0.05 to 0.11 additional utils/y (45%-100% of traditional hearing aids), and costs were $200 to $1400 (5%-38% of traditional hearing aids). Distributions were assigned to parameters to conduct probabilistic uncertainty analysis. Intervention: Provision of OTC hearing aids, at increased uptake rates, across a range of effectiveness and costs. Main Outcomes and Measures: Lifetime undiscounted and discounted (3%/y) costs and quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). Results: Traditional hearing aid provision resulted in 18.162 QALYs, compared with 18.162 to 18.186 for OTC hearing aids varying with OTC hearing aid utility benefit (45%-100% that of traditional hearing aids). Provision of OTC hearing aids was associated with greater lifetime discounted costs by $70 to $200 along with OTC device cost ($200-$1000/pair; 5%-38% traditional hearing aid cost) due to increased hearing aid uptake. Provision of OTC hearing aids was considered cost-effective (ICER<$100 000/QALY) if the OTC utility benefit was 0.06 or greater (55% of the traditional hearing aid effectiveness). In probabilistic uncertainty analysis, OTC hearing aid provision was cost-effective in 53% of simulations. Conclusions and Relevance: In this cost-effectiveness analysis, provision of OTC hearing aids was associated with greater uptake of hearing intervention and was cost-effective over a range of prices so long as OTC hearing aids were greater than 55% as beneficial to patient quality of life as traditional hearing aids.

A Systematic Comparison of High-End and Low-Cost EEG Amplifiers for Concealed, Around-the-Ear EEG Recordings.

Wearable electroencephalography (EEG) has the potential to improve everyday life through brain-computer interfaces (BCI) for applications such as sleep improvement, adaptive hearing aids, or thought-based digital device control. To make these innovations more practical for everyday use, researchers are looking to miniaturized, concealed EEG systems that can still collect neural activity precisely. For example, researchers are using flexible EEG electrode arrays that can be attached around the ear (cEEGrids) to study neural activations in everyday life situations. However, the use of such concealed EEG approaches is limited by measurement challenges such as reduced signal amplitudes and high recording system costs. In this article, we compare the performance of a lower-cost open-source amplification system, the OpenBCI Cyton+Daisy boards, with a benchmark amplifier, the MBrainTrain Smarting Mobi. Our results show that the OpenBCI system is a viable alternative for concealed EEG research, with highly similar noise performance, but slightly lower timing precision. This system can be a great option for researchers with a smaller budget and can, therefore, contribute significantly to advancing concealed EEG research.

Racial and Ethnic Disparities Among Hearing Aid and Cochlear Implant Patients at a Tertiary-Level Academic Otology Practice.

OBJECTIVE: Utilization of hearing aids (HAs) and cochlear implants (CIs) is limited, with our group previously demonstrating that non-White patients pursue CI less than White patients. The aim of this study was to compare the demographic makeup of patients more recently evaluated for both interventions in our clinic, exploring the influence of insurance on pursuit of HA, and whether changes have occurred in CI uptake. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary-level academic otology clinic. METHODS: All patients (18 yr or older) evaluated for an HA or CI in 2019 were included. Demographic variables (including race, insurance, and socioeconomic status) were compared between patients who did and did not obtain an HA or CI. RESULTS: In 2019, 390 patients underwent an HA evaluation, and 195 patients received a CI evaluation. Relative to patients evaluated for CI, patients evaluated for HA were more likely to be White (71.3% versus 79.4%, p = 0.027). Examining factors that affected HA purchase, Black race (odds ratio, 0.32; 95% confidence interval, 0.12-0.85; p = 0.022), and lower socioeconomic status (odds ratio, 0.99; 95% confidence interval, 0.98-1.00; p = 0.039) were associated with decreased odds. Demographic variables and AzBio quiet scores were not associated with decision to pursue CI surgery. CONCLUSIONS: White patients comprised a larger proportion of HA evaluations than CI evaluations. Furthermore, White patients and those of higher socioeconomic status were more likely to purchase HA. Improved outreach and expanded insurance benefits for HA are needed to ensure equal access to aural rehabilitation.

Familiar and unfamiliar speaker recognition assessment and system emulation for cochlear implant users.

In the area of speech processing, human speaker identification under naturalistic environments is a challenging task, especially for hearing-impaired individuals with cochlear implants (CIs) or hearing aids (HAs). Motivated by the fact that electrodograms reflect direct CI stimulation of input audio, this study proposes a speaker identification (ID) investigation using two-dimensional electrodograms constructed from the responses of a CI auditory system to emulate CI speaker ID capabilities. Features are extracted from electrodograms through an identity vector (i-vector) framework to train and generate identity models for each speaker using a Gaussian mixture model-universal background model followed by probabilistic linear discriminant analysis. To validate the proposed system, perceptual speaker ID for 20 normal hearing (NH) and seven CI listeners was evaluated with a total of 41 different speakers and compared with the scores from the proposed system. A one-way analysis of variance showed that the proposed system can reliably predict the speaker ID capability of CI (F[1,10] = 0.18, p = 0.68) and NH (F[1,20] = 0, p = 0.98) listeners in naturalistic environments. The impact of speaker familiarity is also addressed, and the results show a reduced performance for speaker recognition by CI subjects using their CI processor, highlighting limitations of current speech processing strategies used in CIs/HAs.