Education Intervention on 'Hearing Impairment - Its Assessment and Management' among Medical Practitioners in Sikkim, India.

BACKGROUND: Health care providers must be aware of the choices in aural rehabilitation methods and assessment procedures available presently to those with hearing impairment in order to facilitate early identification and intervention and ensure quality of care to those hearing impaired individuals. The referrals from the medical fraternities for the audiological services are not uniform across India. Part of reason may be that awareness about the roles of and responsibilities of audiologist's is poor among medical practitioners. In some regions of India medical practitioners may be only grossly be aware of audiologists per se. They may not know enough to refer all individuals with hearing or balance disorders for the required audiological services. AIM: To evaluate changes in pre survey and post survey after education intervention specifically planned for medical practitioners in the state of Sikkim, India. Education intervention included awareness about hearing impairment and its assessment and management by audiologists. METHOD: A pre and post survey comparison research design with purposive convenient sampling technique was applied. Participants were medical practitioners working in geographical area of Sikkim at the time of the study. Inspection of demographic data of respondents showed that they were in their age range of 24 and 60 years and with work experience ranging 1-40 years. Participants were invited for an awareness talk which included, information about hearing loss, early identification and early intervention, tests and management of hearing loss in different age groups, need for hearing aids/cochlear implants, auditory training, and the role of an audiologist in the management of hearing loss and ways to prevent hearing loss. A pre and post awareness program responses were collected from all the participants using a customized questionnaire tool. RESULTS: Respondents exhibited, in the pre-survey questionnaire, lack of awareness in many aspects of audiology, including assessing hearing impairment, diagnosing hearing loss, and the role of an audiologist. There was an overall, statistically significant difference in the level of performance on the pre-awareness and post-awareness responses. CONCLUSION: Following an awareness campaign among the medical professionals in Sikkim, there was a considerable change in their level of awareness of hearing impairment, its assessment, and management by audiologists. The reach of the awareness campaign was significant as around 70% of subjects showed significant change in their knowledge and attitude towards hearing impairment, its management.

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.

Hearing Loss and Sociodemographic Barriers to Health Care Access Using the All of Us Research Program.

OBJECTIVE: To explore how gender and low-income status independently influence general health care access in patients with hearing loss. STUDY DESIGN: Cross-sectional study. SETTING: National database. METHODS: Patients with a diagnosis of sensorineural hearing loss from the National Institutes of Health All of Us database were included. Data entered from May 2018 to November 2022 was analyzed. Patient demographics such as age, gender, educational level, and insurance status were assessed. Multivariate logistic regressions were performed for statistical evaluation. RESULTS: A subset of 8875 patients (48.3% male, mean age 69) were evaluated. After multivariate analysis, female participants were more likely than male participants to report difficulty affording prescribed medications (odds ratio [OR]: 1.7, p < .0005) and specialists (OR: 1.4, p < 0.005). Female patients were also more likely to delay care due to elder care responsibilities (OR: 2.6, p < .0005), employment obligations (OR: 1.7, p < .0005), and feelings of apprehension in seeing a provider (OR: 1.7, p < .0005). Finally, female participants reported feeling less likely to be involved in their own medical care compared to males (OR: 1.2, p < .005). Low-income (<$25,000) participants reported less likely to feel respected (OR: 3.2, p < .0005) and delivered understandable health information (OR: 2.3, p < .0005) by providers compared to participants of higher income. CONCLUSION: This work suggests that patients with hearing loss, female gender, and lower socioeconomic status independently introduce barriers to health care access and utilization. These factors should be considered in efforts to promote equity in the care of patients with hearing loss.

A country-wide health policy in Chile for deaf adults using cochlear implants: Analysis of health determinants and social impacts.

BACKGROUND: Post-lingual deafness represents a critical challenge for adults' well-being with substantial public health burdens. One treatment of choice has been cochlear implants (CI) for people with severe to profound hearing loss (HL). Since 2018, Chile has implemented a high-cost policy to cover CI treatment, the "Ley Ricarte Soto" (LRS) health policy. However, wide variability exists in the use of this device. To date, no related study has been published on policy evaluation in Chile or other Latin American countries. OBJECTIVES: This study aimed to evaluate the impact of the LRS policy on the treatment success and labour market inclusion among deaf or hard of hearing (DHH) adults using CI. We examined and characterised outcomes based on self-reports about treatment success and occupation status between 2018 and 2020. DESIGN: We performed a prospective study using hospital clinical records and an online questionnaire with 76 DHH adults aged >15 who had received CIs since the introduction of the LRS policy in 2018. Using univariate and multivariate regression models, we investigated the relationship between demographic, audiological, and social determinants of health and outcomes, including treatment success for social inclusion (International Outcome inventory for Hearing Aids and CIs assessment: IOI-HA) and occupation status for labour market inclusion. RESULTS: Our study showed elevated levels of treatment success in most of the seven sub-scores of the IOI-HA assessment. Similarly, around 70% of participants maintained or improved their occupations after receiving their CI. We found a significant positive association between treatment success and market inclusion. Participants diagnosed at younger ages had better results than older participants in both outcomes. Regarding social determinants of health, findings suggested participants with high social health insurance and a shorter commute time to the clinic had better results in treatment success. For labour market inclusion, participants with high education levels and better pre- CI occupation had better post-CI occupation status. CONCLUSIONS: In evaluating the LRS policy for providing CIs for DHH adults in Chile, we found positive effects relating to treatment success and occupation status. Our study supports the importance of age at diagnosis and social determinants of health, which should be assessed by integrating public services and bringing them geographically closer to each beneficiary. Although evidence-based guidelines for candidate selection given by the LRS policy might contribute to good results, these guidelines could limit the policy access to people who do not meet the requirements of the guidelines due to social inequalities.

Retrospective assessment of the impact of an education specialist on the care of children with hearing loss.

OBJECTIVE: To assess the impact of an education specialist in a multidisciplinary pediatric hearing loss clinic. STUDY DESIGN: Retrospective review and cross-sectional survey. SETTING: Single tertiary care center. METHODS: Consultations held between an education specialist and families of pediatric deaf or hard of hearing (DHH) children within a two-year period were reviewed. Reasons for referral and services provided to each patient and family who subsequently worked with the educational specialist were assessed. Parents of patients who had previously worked with the education specialist were invited to complete a survey evaluating their experience. RESULTS: 102 patients were referred to the educational specialist in a two-year period. Most common reasons for referral included need for special education plans to accommodate their hearing deficit (32) or family request to support for revisions to such plans (37). 14 patient families completed our survey. 76.9 % of respondents confirmed that the education specialist recommended resources they had not been introduced to before. Given a scale of 1 ("completely dissatisfied") and 10 being "completely satisfied," the average rating of the 14 respondents was 9.0. CONCLUSION: The role of an education specialist in a pediatric hearing loss clinic is to optimize patient and family access to resources that could benefit their DHH child's academic development over time. Future studies should prospectively investigate the impact of education specialist services on the educational progress of DHH patients compared to outcomes without these supports.

Association between insurance status and hearing healthcare use in the United States.

OBJECTIVE: Despite the high prevalence and morbidity of hearing loss, many individuals with hearing loss do not have access to hearing healthcare. This study aims to assess the relationship between insurance status and prior audiogram, and hearing aid use among subjects with hearing loss. MATERIALS AND METHODS: This cross-sectional study of the 2009-10, 2011-12, and 2015-16 cycles of the U.S. National Health and Nutrition Examination Survey (NHANES) included 5270 adult subjects 18 years or older with subjective or audiometric hearing loss. Subjects were stratified by insurance: Medicare, Medicaid, private, uninsured, and 'other or unspecified'. RESULTS: After adjusting for covariates, among subjects with audiometric hearing loss, prior audiogram was not associated with insurance type, including no insurance (OR 0.80, 95 % CI 0.45 to 1.42), Medicare (OR 1.34, 95 % CI 0.69 to 2.59), Medicaid (OR 1.27, 95 % CI 0.55 to 2.93), or 'other or unspecified' (OR 1.73, 95 % CI 0.67 to 4.47). Hearing aid use was not associated with insurance type, including no insurance (OR 0.20, 95 % CI 0.03 to 1.29), Medicare (OR 0.56, 95 % CI 0.27 to 1.14), Medicaid (OR 2.03, 95 % CI 0.47 to 8.71), or 'other or unspecified' (OR 1.76, 95 % CI 0.59 to 5.23). CONCLUSIONS: Health insurance status was not associated with hearing healthcare use in our nationally-representative sample of individuals with hearing loss. Given variations in hearing coverage by Medicaid between states, future studies should compare the impact of Medicaid insurance on hearing aid use between states that cover hearing aids and those that do not.

Ear and hearing care programs for First Nations children: a scoping review.

BACKGROUND: Ear and hearing care programs are critical to early detection and management of otitis media (or middle ear disease). Otitis media and associated hearing loss disproportionately impacts First Nations children. This affects speech and language development, social and cognitive development and, in turn, education and life outcomes. This scoping review aimed to better understand how ear and hearing care programs for First Nations children in high-income colonial-settler countries aimed to reduce the burden of otitis media and increase equitable access to care. Specifically, the review aimed to chart program strategies, map the focus of each program against 4 parts of a care pathway (prevention, detection, diagnosis/management, rehabilitation), and to identify the factors that indicated the longer-term sustainability and success of programs. METHOD: A database search was conducted in March 2021 using Medline, Embase, Global Health, APA PsycInfo, CINAHL, Web of Science Core Collection, Scopus, and Academic Search Premier. Programs were eligible or inclusion if they had either been developed or run at any time between January 2010 to March 2021. Search terms encompassed terms such as First Nations children, ear and hearing care, and health programs, initiatives, campaigns, and services. RESULTS: Twenty-seven articles met the criteria to be included in the review and described a total of twenty-one ear and hearing care programs. Programs employed strategies to: (i) connect patients to specialist services, (ii) improve cultural safety of services, and (iii) increase access to ear and hearing care services. However, program evaluation measures were limited to outputs or the evaluation of service-level outcome, rather than patient-based outcomes. Factors which contributed to program sustainability included funding and community involvement although these were limited in many cases. CONCLUSION: The result of this study highlighted that programs primarily operate at two points along the care pathway-detection and diagnosis/management, presumably where the greatest need lies. Targeted strategies were used to address these, some which were limited in their approach. The success of many programs are evaluated as outputs, and many programs rely on funding sources which can potentially limit longer-term sustainability. Finally, the involvement of First Nations people and communities typically only occurred during implementation rather than across the development of the program. Future programs should be embedded within a connected system of care and tied to existing policies and funding streams to ensure long term viability. Programs should be governed and evaluated by First Nations communities to further ensure programs are sustainable and are designed to meet community needs.

Incidence and Management of Facial Paralysis After Skull Base Trauma, an Administrative Database Study.

OBJECTIVE: Report the incidence of and treatment patterns for facial nerve palsy after skull base fracture. STUDY DESIGN: Retrospective cohort study. SETTING: IBM MarketScan Commercial Database (2006-2019). PATIENTS: Human subjects with skull base fracture, per International Classification of Diseases-9th and 10th Revisions-Clinical Modification diagnosis codes. MAIN OUTCOME MEASURES: The primary outcomes were the incidence and median time to facial nerve palsy diagnosis within 30 days of skull base fracture. Secondary outcomes were treatments (corticosteroids, antivirals, facial nerve decompression, botulinum toxin, and facial reanimation), demographics, and rates of hearing loss, vertigo, tympanic membrane rupture, cerebrospinal fluid leak, comorbidities, and loss of consciousness. RESULTS: The 30-day incidence of facial nerve palsy after skull base trauma was 1.0% (738 of 72,273 patients). The median (95% confidence interval [CI]) time to diagnosis was 6 (6-7) days, and only 22.9% were diagnosed within 1 day. There were significantly higher rates (risk difference, 95% CI) of hearing loss (26%, 22-29%), tympanic membrane rupture (6.3%, 4.5-8.1%), cerebrospinal fluid leak (6.4%, 4.5-8.3%), comorbidity (14%, 10.4-17.6%), and loss of consciousness (24.3%, 20.7-27.9%). Loss of consciousness was associated with longer median (95% CI) time to facial nerve palsy diagnosis: 10 (9-10) days. Corticosteroids were the most common treatment but only reported for less than one-third of patients. Only eight patients underwent facial nerve decompression. CONCLUSIONS: Facial nerve palsy after skull base fracture is associated with higher comorbidity, and the diagnosis is often delayed. Few patients were treated with surgery, and there are inconsistencies in the types and timing of treatments.

Pediatric Hearing Loss Management in the COVID-19 Era: Possible Consequences and Resources for the Next Future.

Pediatric hearing loss early diagnosis and treatment have been limited by the current restrictions due to the coronavirus disease 2019 pandemic. The difficulty in accessing the multiple facilities required for the rehabilitative process is influencing the timing of each step of the process. Auditory hearing screening programs, etiological characterization, surgical timing, and speech therapies have all been limited in the past year. The current conditions have forced us to adopt different strategies to overcome the necessary social distancing prescriptions. Although their efficacy should be proved over time, some of these resources will be probably useful even in a nonpandemic future.

Global return on investment and cost-effectiveness of WHO's HEAR interventions for hearing loss: a modelling study.

BACKGROUND: To address the growing prevalence of hearing loss, WHO has identified a compendium of key evidence-based ear and hearing care interventions to be included within countries' universal health coverage packages. To assess the cost-effectiveness of these interventions and their budgetary effect for countries, we aimed to analyse the investment required to scale up services from baseline to recommended levels, and the return to society for every US$1 invested in the compendium. METHODS: We did a modelling study using the proposed set of WHO interventions (summarised under the acronym HEAR: hearing screening and intervention for newborn babies and infants, pre-school and school-age children, older adults, and adults at higher risk of hearing loss; ear disease prevention and management; access to technologies such as hearing aids, cochlear implants, or hearing assistive technologies; and rehabilitation service provision), which span the life course and include screening and management of hearing loss and related ear diseases, costs and benefits for the national population cohorts of 172 countries. The return on investment was analysed for the period between 2020 and 2030 using three scenarios: a business-as-usual scenario, a progress scenario with a scale-up to 50% of recommended coverage, and an ambitious scenario with scale-up to 90% of recommended coverage. Using data for hearing loss burden from the Global Burden of Disease Study 2019, a transition model with three states (general population, diagnosed, and those who have died) was developed to model the national populations in countries. For the return-on-investment analysis, the monetary value of disability-adjusted life-years (DALYs) averted in addition to productivity gains were compared against the investment required in each scenario. FINDINGS: Scaling up ear and hearing care interventions to 90% requires an overall global investment of US$238·8 billion over 10 years. Over a 10-year period, this investment promises substantial health gains with more than 130 million DALYs averted. These gains translate to a monetary value of more than US$1·3 trillion. In addition, investment in hearing care will result in productivity benefits of more than US$2 trillion at the global level by 2030. Together, these benefits correspond to a return of nearly US$15 for every US$1 invested. INTERPRETATION: This is the first-ever global investment case for integrating ear and hearing care interventions in countries' universal health coverage services. The findings show the economic benefits of investing in this compendium and provide the basis for facilitating the increase of country's health budget for strengthening ear and hearing care services. FUNDING: None.

Medicare Beneficiaries With Self-Reported Functional Hearing Difficulty Have Unmet Health Care Needs.

Hearing loss is associated with higher health care spending and use, but little is known about the unmet health care needs of people with hearing loss or difficulty. Analysis of 2016 Medicare Current Beneficiary Survey data for beneficiaries ages sixty-five and older reveals that those who reported a lot of trouble hearing in the past year were 49 percent more likely than those who reported no trouble hearing to indicate not having a usual source of care. Compared with those who reported no trouble hearing, those who reported some trouble hearing were more likely to indicate not having obtained medical care in the past year when they thought it was needed, as well as not filling a prescription, with the risk for both behaviors being greater among those reporting a lot of trouble hearing versus a little. Interventions that improve access to hearing services and aid communication may help older Medicare beneficiaries meet their health care needs.

An Integrative Review of Current Practice Models and/or Process of Family-Centered Early Intervention for Children Who Are Deaf or Hard of Hearing.

Over the past few decades, there has been an increasing shift toward emphasizing the importance of the child's family taking an active role in the habilitation process through family-centered early intervention (FCEI) programs. Accordingly, the Health Professions Council of South Africa recommends that early intervention services following confirmation of hearing loss must be family-centered within a community-based model of service delivery that is culturally congruent. The aim of this study was to explore and document current evidence reflecting trends in FCEI for children who are deaf or hard of hearing (DHH) by identifying and describing current practice models and/or processes of FCEI for these children. This study describes our first steps in formulating a framework for FCEI for children who are DHH in South Africa. An integrative literature review was conducted. Sage, Science Direct, PubMed, and Google Scholar databases were searched for studies published in English between January 2009 and January 2019 reporting on FCEI programs for children who are DHH. Studies that focused on the following were excluded from the study: speech and language outcomes of children, youth, and adults who are DHH; education for children who are DHH; universal newborn hearing screening; professionals' roles in early hearing detection and intervention; diagnosis of hearing loss; and sign language. Kappa statistics were performed to determine agreement between reviewers. Twenty-two studies were included in the review. Cohen's kappa revealed a substantial agreement (κ = 0.8) between reviewers for data extraction and synthesis in terms of the articles that met the criteria for inclusion in the review. Findings were discussed under 5 themes: caregiver involvement; caregiver coaching/information sharing; caregiver satisfaction; challenges with FCEI; and telehealth. Generally, there is sufficient evidence for FCEI, with caregivers indicating the need for full involvement in their children's care. Methods of caregiver involvement involving caregiver coaching/information sharing need to be culturally and linguistically appropriate, with sensitivities around time and manner. This increases caregiver satisfaction with intervention programs and improves outcomes for children who are DHH. Challenges identified by the studies raise implications for early hearing detection and intervention programs, as well as Departments of Health and Social Welfare. These included logistical challenges, professional-related challenges, and caregiver-related challenges. Various aspects of FCEI have been reported in the review. Findings of these studies have significant implications for the formulation of quality FCEI programs to ensure contextually relevant and contextually responsive care of children who are DHH.

[Lifetime Cost of Hearing Aids in Germany]. / Lebenszeitkosten der Hörgeräteversorgung in Deutschland.

OBJECTIVE: Hearing aids are the standard treatment of hearing loss, which is covered by the statutory health insurance (SHI) in Germany. In chronic cases, hearing aid therapy causes periodic costs until the patient's death. This analysis examines the average lifetime cost of adult patients with regard to the age at initial treatment and presents them both from the perspective of the SHI and the insured. METHODS: In the base case, we consider the supply of hearing aids free of charge. A treatment pathway is developed and used to identify the cost components incurred over the lifetime. Subsequently, the present value lifetime cost of monaural and binaural hearing aid supply are calculated. RESULTS: The binaural (monaural) hearing aid supply for an adult (first hearing aids received between 18 and 88 years) causes average present value lifetime cost of €â€Š4518 (€â€Š2536) from the perspective of the statutory health insurance. The patient bears an average of €â€Š4610 (€â€Š3672) total cost. There are specific lifetime costs for each individual age of initial treatment. Generally, lifetime cost decreases with the patient's increasing age at initial treatment. CONCLUSIONS: Patients finance a substantial part of the hearing aid treatment. If the patient decides for high-end hearing aids instead of hearing aids free of charge, the total patient cost increases to an average of €â€Š7953 for binaural supply. Due to continuous technical progress and development of hearing systems, rising expenses for hearing aid supply can be assumed.

Health Literacy and Hearing Healthcare Use.

OBJECTIVE: To assess whether health literacy is associated with: 1) degree of hearing loss at initial presentation for audiogram and 2) hearing aid adoption for hearing aid candidates. METHODS: We identified 1376 patients who underwent audiometric testing and completed a brief health literacy questionnaire at our institution. The association between health literacy and degree of hearing loss at initial presentation was examined using linear regression, adjusted for age, gender, marital status, education level, race, language, employment status, and insurance coverage. The association between health literacy and hearing aid adoption was examined in the subset of patients identified as hearing aid candidates using logistic regression, adjusted for demographic factors and insurance coverage. RESULTS: Patients with inadequate health literacy were more likely to present with more severe hearing loss (adjusted mean pure-tone average [PTA] difference, 5.38 dB, 95% confidence interval [CI] 2.75 to 8.01). For hearing aid candidates (n = 472 [41.6%]), health literacy was not associated with hearing aid adoption rate (odds ratio [OR] 0.85, 95% CI 0.40 to 1.76). Hearing aid coverage through Medicaid (OR 2.22, 95% CI 1.13 to 4.37), and moderate (OR 2.70, 95% CI 1.58 to 4.69) or moderate-severe (OR 2.23, 95% CI 1.19 to 4.16) hearing loss were associated with hearing aid adoption. CONCLUSIONS: In our population, patients with low health literacy are more likely to present with higher degrees of hearing loss, but no less likely to obtain hearing aids compared with patients with adequate health literacy. Hearing loss severity and hearing aid coverage by insurance appear to be the main drivers of hearing aid adoption. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E1688-E1694, 2021.

Hearing Loss in Children: A Review.

IMPORTANCE: Hearing loss in children is common and by age 18 years, affects nearly 1 of every 5 children. Without hearing rehabilitation, hearing loss can cause detrimental effects on speech, language, developmental, educational, and cognitive outcomes in children. OBSERVATIONS: Consequences of hearing loss in children include worse outcomes in speech, language, education, social functioning, cognitive abilities, and quality of life. Hearing loss can be congenital, delayed onset, or acquired with possible etiologies including congenital infections, genetic causes including syndromic and nonsyndromic etiologies, and trauma, among others. Evaluation of hearing loss must be based on suspected diagnosis, type, laterality and degree of hearing loss, age of onset, and additional variables such as exposure to cranial irradiation. Hearing rehabilitation for children with hearing loss may include use of hearing aids, cochlear implants, bone anchored devices, or use of assistive devices such as frequency modulating systems. CONCLUSIONS AND RELEVANCE: Hearing loss in children is common, and there has been substantial progress in diagnosis and management of these cases. Early identification of hearing loss and understanding its etiology can assist with prognosis and counseling of families. In addition, awareness of treatment strategies including the many hearing device options, cochlear implant, and assistive devices can help direct management of the patient to optimize outcomes.

Lifetime cost of unilateral cochlear implants in adults: a Monte Carlo simulation.

BACKROUND/OBJECTIVE: Due to increasing prevalence of hearing loss and relaxation of candidacy criteria of cochlear implant (CI) supply, the number of implantations is likely to further increase. Statutory health insurances are facing ever more urgent financing challenges since CI treatment causes high life-long costs. Additionally, increasing life expectancy and earlier implantation may extend therapy time and cost. With every case being individual, this study aims to calculate the possible lifetime cost of unilateral CI treatment in adults including stochastic uncertainties. METHODS: Taking a statutory health insurance perspective, relevant cost components of CI therapy and their values were identified. The Monte Carlo method was used to simulate lifetime cost considering age at first implantation and distributions of costrelevant variables. A sensitivity analysis was conducted to determine the most crucial variables impacting on lifetime cost. RESULTS: Lifetime cost of CI treatment varies according to age at first implantation, respectively remaining lifetime; the earlier the implantation, the higher the overall cost. According to our simulation, the average lifetime cost for an adult patient first implanted between the age of 20-80 is at 53,030 € (present value). Cost of implantation and periodic speech processor exchanges show the highest impact on the total cost. DISCUSSION: Health care systems could face rising expenses for CI supply by technical development. Innovative life-long CIs could achieve significant savings per case that could finance additional implant cost. Until then, further targeted research will be required. CONCLUSION: CI-related cost for statutory health insurance crucially depends on the patient-side demand for cochlear implants. Therefore, cost forecasts must also consider the development of demand.

Distribuição espacial de usuários de AASI de um serviço de saúde auditiva / Spatial distribution of hearing aids users from a hearing health service / Distribuición espacial de usuarios de audífonos de un servicio de salud auditiva

Objetivo: Analisar a distribuição espacial de usuários atendidos em uma Junta de Saúde Auditiva Microrregional, segundo aspectos sociodemográficos, clínicos e assistenciais. Métodos: Trata-se de estudo observacional descritivo transversal utilizando técnicas de geoprocessamento para descrever a distribuição de indivíduos atendidos no serviço de saúde auditiva de uma Junta de Saúde Auditiva Microrregional. A coleta foi obtida via análise de prontuários de usuários atendidos no período de maio de 2009 a maio de 2013. Para análise e apresentação dos dados, elaborou-se mapas temáticos a partir de base cartográfica da Divisão Territorial das Regionais do município de Betim (MG). Resultados: Da amostra de 745 indivíduos, 699 (94%) pertenciam a residentes de Betim e 46 (6%) de outros quatro municípios pertencentes à região de cobertura do serviço. Os usuários residentes em Betim foram distribuídos visualmente no mapa da cidade de acordo com a região que reside para análise dos aspectos sociodemográficos, clínicos e assistenciais segundo as regiões do município. Conclusão: A técnica de geoprocessamento possibilitou uma observação mais detalhada do serviço, com informações relevantes à gestão, o que pode servir de estratégia de trabalho para o desenvolvimento de ações de promoção de saúde auditiva.

Objective: To analyze the spatial distribution of users at a Microregional Auditory Health Center, according to sociodemographic, clinical and care aspects. Method: This is a cross-sectional descriptive observational study using geoprocessing techniques to describe the distribution of individuals attended at the hearing health service of a Microregional Auditory Health Center. The data collect was obtained through analysis of medical records of users served from May 2009 to May 2013. For the analysis and presentation of the data, thematic maps were elaborated from a cartographic base of the Territorial Division of the Regionals of the city of Betim (MG). Results: Of the sample of 745 individuals, 699 (94%) belonged to Betim residents and 46 (6%) from four other cities belonging to the service coverage region. Users residing in Betim were visually distributed on the city map according to the region that resides to analyze socio-demographic, clinical and care aspects according to the regions of the city. Conclusion: The geoprocessing technique allowed a more detailed observation of the service, with information relevant to management, which can serve as a work strategy for the development of actions to promote hearing health.

Objetivo: analizar la distribución espacial de los usuarios asistidos en una Junta de Salud Auditiva Microregional, de acuerdo con aspectos sociodemográficos, clínicos y asistenciales. Métodos: Este es un estudio observacional descriptivo de corte transversal que utiliza técnicas de mapas geográficos para describir la distribución de las personas tratadas en el servicio de salud auditiva de una Junta de Salud Auditiva Microregional. La colección se obtuvo a través del análisis de registros médicos de usuarios atendidos desde mayo de 2009 hasta mayo de 2013. Para el análisis y la presentación de datos, se prepararon mapas temáticos a partir de la base cartográfica de la División Territorial Regional de Betim (MG). Resultados: De la muestra de 745 individuos, 699 (94%) pertenecían a residentes de Betim y 46 (6%) de otros cuatro municipios pertenecientes a la región de cobertura de servicios. Los usuarios que residen en Betim se distribuyeron visualmente en el mapa de la ciudad de acuerdo con su región de residencia para el análisis de aspectos sociodemográficos, clínicos y de atención de acuerdo con las regiones del municipio. Conclusión: La técnica de distribución en mapas geográficos permitió una observación más detallada del servicio, con información relevante para la gestión, que puede servir como estrategia de trabajo para el desarrollo de acciones de promoción de la salud auditiva.

The Professional's experience with causes of delay in the diagnosis and management of children with a congenital hearing loss in Libya.

The aim of this study was to collect and interpret narrative and observational data from Audiologists and ENT doctors' experiences of delays in the identification and management of congenital hearing loss (CHL) in Libya. This qualitative study sought to explore and understand the reasons behind the delay. Participants were three Audiological Physicians and five Otolarngologists (ENT) working in public hospitals in four large cities in Libya. They were interviewed to explore the causes of such delays and themes were generated from their experiences. All participants revealed that the main causes might be associated with limited facilities and availability of audiology services, lack of awareness and knowledge of the magnitude of the issue and the importance of early detection and intervention for CHL in Libya. In contrast to other developing countries, the financial situation and poverty were not considered to be the main cause in Libya. Furthermore, socioeconomic status of the children's families appears relevant.