Social representation of hearing aids among people with hearing loss: an exploratory study.

OBJECTIVE: The aim of the current study was to examine the social representation (SR) of hearing aids in people with hearing loss (PHL) in India, the Republic of Korea (ROK), the United Kingdom (UK), and the United States of America (US). DESIGN: The study used a cross-sectional survey design. The data collected by using a free association task were analysed qualitatively (i.e. content analysis) and quantitatively (i.e. chi-square analysis, similarities analysis, prototypical analysis). STUDY SAMPLE: 424 participants with hearing loss. RESULTS: The most commonly reported categories across all countries were "beneficial," "cost and time," and "appearance and design." Approximately 50% of the associations reported were negative. There were variations in terms of the categories that were predominant in the SR of each country. "Others actions and attitude" category was predominantly reported by PHL in India. "Disturbance" and "dissatisfaction" of hearing aids and the "repairs and maintenance of hearing aids" categories were mainly reported from the ROK and the US, respectively. CONCLUSIONS: The current results highlight the main aspects that PHL report spontaneously when they think about hearing aids. The findings will help to further inform public health campaigns and will contribute to develop culturally appropriate media materials regarding hearing aids.

Social Representations of "Tinnitus" and "Health" among Individuals with Tinnitus Seeking Online Psychological Interventions.

(1) Objective: Social representations theory (SRT) is a body of theory within social psychology concerned with how individuals, groups, and communities collectively make sense of socially relevant or problematic issues, ideas, and practices. SRT has been increasingly sued in the area of health and disability. The current study examined the social representations of "tinnitus" and "health" among individuals with tinnitus who are seeking online psychological interventions. (2) Materials/Method: The data were gathered using a free association task about their "tinnitus" and "health" from 399 individuals with tinnitus. The data were analyzed using both qualitative and quantitative analyses methods. (3) Results: The responses resulted in 39 and 30 categories respectively, for "tinnitus" and "health". The most commonly occurring categories for tinnitus included: descriptions of tinnitus (18%), annoying (13.5%), persistent (8%), and distracting (5%). The most commonly occurring categories for health included: content (12%), conditions (8%), active (7%), take control (6%), and overweight (5%). The responses to tinnitus had predominantly negative connotations (i.e., 76.9%) whereas a larger proportion of responses toward their health was related to positive connotations (i.e., 46.4%). These frequently occurring items were also dominant in similarities analysis. Prototypical analysis of tinnitus responses identified categories horrible and bothersome to be key items in the central zone. The categories in central zone of health responses included: content, active, healthy, grateful, and overweight. (4) Conclusions: Individuals with tinnitus have very negative view of their tinnitus impacting their psychological status. Tinnitus management should focus on reducing the negative associations toward their tinnitus and strengthen the positive aspects related to their general health.

Experiential Characteristics among Individuals with Tinnitus Seeking Online Psychological Interventions: A Cluster Analysis.

OBJECTIVE: This study was designed to gain insights regarding patterns of social representations (values, ideas, beliefs) of tinnitus and their relation to demographic and clinical factors. METHOD: A cross-sectional survey design was used including 399 adults seeking help and reporting interest in internet-based cognitive behavior therapy for tinnitus. Data were collected using a free association task and analysis used qualitative (content analysis) and quantitative (cluster analysis and chi-square analysis) using the Iramuteq software. RESULTS: The social representations identified the negative impact of tinnitus and included the way it sounded (descriptions of the way tinnitus sounds (18%), annoyance (13.5%), and persistence (8%)). Four clusters were identified representing four levels of tinnitus severity, namely debilitating tinnitus (24%), distressing tinnitus (10%), annoying tinnitus (46%), and accepting tinnitus (20%). Cluster identity was associated with demographic and clinical variables. DISCUSSION: The identified clusters represented tinnitus severity experience in four stages, ranging from debilitating tinnitus to acceptance of tinnitus. These findings are important for clinical practice where tinnitus descriptions can indicate the stage of the tinnitus experience and which intervention pathway may be most appropriate.

Acute otitis externa: Consensus definition, diagnostic criteria and core outcome set development.

OBJECTIVE: Evidence for the management of acute otitis externa (AOE) is limited, with unclear diagnostic criteria and variably reported outcome measures that may not reflect key stakeholder priorities. We aimed to develop 1) a definition, 2) diagnostic criteria and 3) a core outcome set (COS) for AOE. STUDY DESIGN: COS development according to Core Outcome Measures in Effectiveness Trials (COMET) methodology and parallel consensus selection of diagnostic criteria/definition. SETTING: Stakeholders from the United Kingdom. SUBJECTS AND METHODS: Comprehensive literature review identified candidate items for the COS, definition and diagnostic criteria. Nine individuals with past AOE generated further patient-centred candidate items. Candidate items were rated for importance by patient and professional (ENT doctors, general practitioners, microbiologists, nurses, audiologists) stakeholders in a three-round online Delphi exercise. Consensus items were grouped to form the COS, diagnostic criteria, and definition. RESULTS: Candidate COS items from patients (n = 28) and literature (n = 25) were deduplicated and amalgamated to a final candidate list (n = 46). Patients emphasised quality-of-life and the impact on daily activities/work. Via the Delphi process, stakeholders agreed on 31 candidate items. The final COS covered six outcomes: pain; disease severity; impact on quality-of-life and daily activities; patient satisfaction; treatment-related outcome; and microbiology. 14 candidate diagnostic criteria were identified, 8 reaching inclusion consensus. The final definition for AOE was 'diffuse inflammation of the ear canal skin of less than 6 weeks duration'. CONCLUSION: The development and adoption of a consensus definition, diagnostic criteria and a COS will help to standardise future research in AOE, facilitating meta-analysis. Consulting former patients throughout development highlighted deficiencies in the outcomes adopted previously, in particular concerning the impact of AOE on daily life.

Social Representation of "Hearing Loss" Among People with Hearing Loss: An Exploratory Cross-Cultural Study.

BACKGROUND: Hearing loss can have an effect on the physical, psychosocial, and cognitive wellbeing of an individual. Despite the research on attitudes and stigma associated with hearing loss, people with hearing loss (PHL) continue to delay seeking help. Thus, it is vital to look at alternative theories which have been successfully used in disability research to better understand how PHL perceive hearing loss. PURPOSE: The aim of the current exploratory study was to examine the social representation (SR) of "hearing loss" in PHL in India, Republic of Korea (ROK), United Kingdom (UK), and the United States (US). RESEARCH DESIGN: The study used a cross-sectional survey design. STUDY SAMPLE: In this study, 424 participants were recruited using a consecutive sampling method in four countries (India, Republic of Korea, United Kingdom, and United States). DATA COLLECTION AND ANALYSIS: Data collection was conducted using a questionnaire. Data were analyzed using content analysis, similarities analysis, prototypical analysis, and chi-square analysis. RESULTS: The free associations of the PHL were grouped into 37 categories. The most commonly reported categories were communication difficulties, negative mental state, aging, assessment and management, causes of hearing loss, hearing ability or disability, hearing instruments, and symptoms of hearing loss. Similarities analysis and prototypical analysis highlighted two main negative categories (negative mental state and communication difficulties) which form the central elements of SR of hearing loss. PHL associated hearing loss mainly as a negative phenomenon, but with some positive and neutral aspects. Respondents from ROK reported a greater number of neutral associations compared with other countries. There were cross-cultural similarities and differences in terms of PHL's SR of hearing loss, but there were more similarities than differences. CONCLUSION: The study provides an insight into how PHL collectively view their "hearing loss" and helps to develop our understanding of the influence of culture on the SR of "hearing loss." The results will aid the development of culturally appropriate public education campaigns, marketing material, and appropriate rehabilitation for PHL.

Audiogram and cochlear implant candidacy--UK perspective.

OBJECTIVE AND IMPORTANCE: The candidacy for cochlear implant has changed over time and includes people with lesser degrees of hearing loss. Candidacy is based on the pure-tone audiometry thresholds and aided speech testing. The audiogram does not reflect the actual problems faced by an individual with and without hearing aids. The variability in the actual functional hearing and the pure-tone thresholds makes it difficult for the patients whose audiogram is borderline for cochlear implantation and they are not deriving enough benefit from hearing aids. CASE PRESENTATION: Retrospective report of the audiological findings of two patients whose cochlear implant funding was refused based on their audiogram. In both instances, they were not deriving benefit from hearing aids and the pure-tone audiometry results were just outside the National Institute for Health and Care Excellence guidelines at 4 kHz. CONCLUSIONS: Cochlear implant candidacy should be individually based and needs to take into account other factors such as work, quality of life, and social impact rather than just adhering to the pure-tone audiometry guidelines. These guidelines should not be considered as strict criteria nor used to deny the benefit of a cochlear implant at the earliest possible opportunity.

Audiologists' knowledge of cochlear implants and their related referrals to the cochlear implant centre: Pilot study findings from UK.

OBJECTIVE: The guidelines for cochlear implantation are well defined and have changed over time with the improvement in technology. The ease with which audiologists can make a referral to a cochlear implant (CI) centre may affect the time it takes before a candidate can gain benefit from a CI. The current service evaluation explores audiologists' awareness of CIs, and whether this could influence referrals for cochlear implantation in the UK. METHOD: A 31-item questionnaire was developed by the authors, to be completed in about 10 minutes. It was designed to elicit information about the training, experience, and practice of audiologists. The questionnaire was designed based on National Institute for Health and Clinical Excellence guidelines and questions used in the previous studies reported in the literature. RESULTS: The majority of the respondents (97%) agreed that CIs can provide more than just environmental awareness. Almost half of the respondents were confident in determining whether a particular patient meets the guidelines of cochlear implantation in the UK, and in discussing CIs with patients and their families. Audiologists who responded felt that more and regular training in referral criteria, benefits, and outcomes would be beneficial. DISCUSSION: The results show a trend that clinical scientists (audiology)/audiologists support cochlear implantation, but due to a lack of training and familiarity, not all are confident in discussing CIs with patients and making an appropriate referral.

Patients' involvement in choosing a cochlear implant.

OBJECTIVE: The study describes the procedure followed by the South of England Cochlear Implant Centre, Southampton in involving the patients in their choice of device and it also describes the reasons given by patients for choosing a particular device. METHODS: A retrospective service evaluation of 43 adults and 19 children was carried out and the data was analysed. RESULTS: A wide range of reasons for choosing a particular device were reported. However, it is notable that the single most common reason for choosing a particular device was related to the aesthetics. DISCUSSION: The data suggest that the main reason for choosing a particular device related more to the aesthetics and comfort of the device irrespective of the technical aspects.

Parental reported benefits and shortcomings of cochlear implantation: Pilot study findings from Southeast Asia.

OBJECTIVE: The aim of the study was to understand the reported benefits and shortcomings by parents of children with cochlear implants and who contribute towards the cost of the implant. METHOD: Thirty parents of children with cochlear implants from a hearing impaired school in Southeast Asia completed open-ended questionnaires and the data were analysed using content analysis. RESULTS: A wide range of benefits and shortcomings were reported. However, it is notable that the single most reported shortcoming was related to cost. DISCUSSION: The results suggest that, even though, in general, the reports about benefits and shortcomings were similar to previous results from western countries, the emphasis given to various aspects of shortcomings was different. In particular, it appears that parentally reported outcomes could be related to many factors including the hearing healthcare system with the costs involved for the implanted individuals and their families. These findings help us understand the parental perspectives of the success of cochlear implantation and will be useful during parental counselling sessions.

Audiological practice in India: an internet-based survey of audiologists.

The field of Audiology in India has expanded exponentially in recent years. Audiologists practice in a variety of work places. However, little is known about the practice trends across these several work places. An Internet-based survey probing into Audiology practice was conducted between June and September 2012. The survey focused on four domains, namely, demography, assessment, hearing aid (HA) fitting and protocol usage. A total of 199 audiologists completed the survey. A large proportion of these audiologists were from Southern India. Majority of the respondents provide hearing assessment and HA services for children and adults. Results indicate diverse practice among respondents, even in essential procedures such as otoscopy. Although a large proportion of audiologists reported performing HA fitting in children as well as adults, less than 12 % of them performed real ear or simulated real ear verification during any HA fitting. Implications for the development of preferred practice guidelines in India have been discussed.