Interventions following hearing screening in adults: a systematic descriptive review.

OBJECTIVE: Adult hearing screening may be a solution to the under-diagnosis and under-treatment of hearing loss in adults. Limited use and satisfaction with hearing aids indicate that consideration of alternative interventions following hearing screening may be needed. The primary aim of this study is to provide an overview of all intervention types that have been offered to adult (≥ 18 years) screen-failures. DESIGN: Systematic literature review. Articles were identified through systematic searches in PubMed, EMBASE, Cinahl, the Cochrane Library, private libraries, and through reference checking. RESULTS: Of the initial 3027 papers obtained from the searches, a total of 37 were found to be eligible. The great majority of the screening programmes (i.e. 26) referred screen-failures to a hearing specialist without further rehabilitation being specified. Most of the others (i.e. seven) led to the provision of hearing aids. Four studies offered alternative interventions comprising communication programme elements (e.g. speechreading, hearing tactics) or advice on environmental aids. CONCLUSIONS: Interventions following hearing screening generally comprised referral to a hearing specialist or hearing aid rehabilitation. Some programmes offered alternative rehabilitation options. These may be valuable as an addition to or replacement of hearing aid rehabilitation. It is recommended that this be addressed in future research.

The prevalence and type of social noise exposure in young adults in England.

There have been several recent reports on the potential risk to hearing from various types of social noise exposure. However, there are few population-based data to substantiate a case for concern. During the last 10-20 years use of personal cassette players (PCPs) has become very much more prevalent, and sound levels in public nightclubs and discotheques are reported to have increased. This study investigated the prevalence and types of significant social noise exposure in a representative population sample of 356 18-25 year olds in Nottingham. Subjects were interviewed in detail about all types of lifetime noise exposure. Noise measurements were also made for both nightclubs and PCPs. In the present sample, 18.8% of young adults had been exposed to significant noise from social activities, compared with 3.5% from occupational noise and 2.9% from gunfire noise. This indicates that social noise exposure has tripled since the early 1980s in the UK. Most of the present day exposure, measured in terms of sound energy, comes from nightclubs rather than PCPs. Moreover, 66% of subjects attending nightclubs or rock concerts reported temporary effects on their hearing or tinnitus. As will be reported in a later publication, any persistent effect of significant noise exposure on 18-25 year olds is difficult to show, however these data suggest that further work is indicated to study the possibility of sub-clinical damage, and also to consider the implications for employees of nightclubs.

Diagnosing Patients with Age-Related Hearing Loss and Tinnitus: Supporting GP Clinical Engagement through Innovation and Pathway Redesign in Audiology Services.

The public health challenge of hearing impairment is growing, as age is the major determinant of hearing loss. Almost one in four (22.6%) over 75-year olds reports moderate or severe worry because of hearing problems. There is a 40% comorbidity of tinnitus and balance disorders. Good outcomes depend on early presentation and appropriate referral. This paper describes how the NHS Improvement Programme in England used service improvement methodologies to identify referral pathways and tools which were most likely to make significant improvements in diagnosing hearing loss, effective referrals and better patient outcomes. An audiometric screening device was used in GP surgeries to enable thresholds for effective referrals to be measured in the surgery. Revised referral criteria, the use of this device, new "assess and fit" technology in the audiology clinic, and direct access pathways can transform audiology service delivery so that patient outcomes are measurably better. This, in turn, changes the experience of GPs, so they are more likely to refer patients who can benefit from treatment. At the end of 2011, 51 GP practices in one of the audiology pilot areas had bought HearCheck screeners, a substantial development from the 4 practices who first engaged with the pilot.

Deformity of the tongue in an infant: Riga-Fede disease.

Riga-Fede is the rare condition of benign ulceration caused by repetitive trauma to the lingual tissues by the teeth in children younger than two years of age. The differential diagnosis includes infective and neoplastic conditions. Histological diagnosis is required when the symptoms fail to resolve with standard management. The case involving an 11-month-old girl who presented with ulceration of the tongue, resulting in a reasonable defect of the tongue tip, is reported in the present article. Following excisional biopsy, the lesion healed without subsequent recurrence. Riga-Fede disease should be considered in infants presenting with oral ulceration. Extraction of the offending teeth should be considered when associated with failure to thrive or failed conservative management.