Utility measures of health-related quality of life in patients treated for benign paroxysmal positional vertigo.

OBJECTIVES: Comparing the effects of different disorders and interventions on health-related quality of life (HRQoL) is important for healthcare policy and accountability. There are two basic approaches to measure HRQoL: questionnaires derived from psychometrics and preference-based measures or utilities derived from econometrics. While disease-specific HRQoL questionnaires, such as the Dizziness Handicap Inventory (DHI), are important because they focus on the impact of a specific problem and its treatments (i.e., vestibular disorders), economic comparisons of the impacts of diseases/disorders and their treatments are typically based on utility assessment. The utility measures for audiology application (UMAA) were developed to measure utilities for various audiologic conditions using a standard computer. The purpose of this study was to determine if the UMAA provides stable, valid, and sensitive utility measures of the effects of benign paroxysmal positional vertigo (BPPV) and its treatment on HRQoL. It was hypothesized that utilities, as measured by the UMAA, would indicate improvement in HRQoL post-treatment for BPPV comparable to a disease-specific health status measure (DHI). DESIGN: The UMAA incorporates three techniques to measure utility: rating scale, standard gamble, and time tradeoff. A utility is a cardinal measure of strength of preference and is measured on a continuum basis from 0.0 (incapacitating dizziness) to 1.0 (no dizziness). Fifty-two adults with BPPV of the posterior semicircular canal completed the UMAA and DHI before treatment and again post-treatment. A subgroup of 15 participants completed the UMAA on two occasions before treatment to assess test-retest stability and to establish critical difference values. RESULTS: Results from this investigation demonstrate that utilities as measured through the UMAA are stable, valid, and comparable to the DHI. Post-treatment utilities were also significantly higher than pretreatment utilities, indicating that the utilities, as measured through the UMAA, are sensitive to improvement in HRQoL after BPPV treatment. CONCLUSIONS: Utilities as measured through the UMAA seem sensitive to changes in HRQoL after treatment of BPPV. Since the UMAA can be used to measure patient preference (i.e., utility), it may be useful for comparison of specific audiologic conditions, such as BPPV, to nonaudiologic conditions, such as cardiovascular disease and kidney disease.

Evidence for the use of hearing assistive technology by adults: the role of the FM system.

Hearing assistive technologies include listening, alerting, and/or signaling devices that use auditory, visual, and/or tactile modalities to augment communication and/or facilitate awareness of environmental sounds. The importance of hearing assistive technologies in the management of adults with hearing loss was recently acknowledged in an evidence-based clinical practice guideline developed by the American Academy of Audiology. Most currently available evidence for hearing assistive technology use by adults focuses on frequency-modulated (FM) technology. Previous research is reviewed that demonstrates the efficacy of FM devices for adults in terms of laboratory measures of speech understanding in noise. Also reviewed are the outcomes from field trials of FM use by community-dwelling adults, which, to date, have been disappointing. Few to no individuals, in previous studies, elected to use FM devices at the end of the trial periods. Data are presented from a 1-group pretest-posttest study examining the role of extensive counseling, coaching, and instruction on FM use by adults. In addition, the potential influence of the cost of devices to the individual was eliminated by conducting the study with veterans who were eligible to receive FM systems through the Veterans Affairs National Hearing Aid Program. Positive outcomes were obtained at the end of a 6-week trial period and were found to remain 1 year after study completion. Implications for increasing the evidence base for the use of FM devices by adults are discussed.

A systematic review of health-related quality of life and hearing aids: final report of the American Academy of Audiology Task Force On the Health-Related Quality of Life Benefits of Amplification in Adults.

This is the final report of the American Academy of Audiology Task Force on the Health-Related Quality of Life (HRQoL) Benefits of Amplification in Adults. A systematic review with meta-analysis examined evidence pertaining to the use of hearing aids for improving HRQoL for adults with sensorineural hearing loss (SNHL). Relevant search strings applied to the CENTRAL, CINAHL, Cochrane Reviews, ComDisDome, EBMR, and PubMed databases identified randomized controlled trial, quasi-experimental, and nonexperimental pre-post test designed studies. Sixteen studies met a priori criteria for inclusion in this review. A random-effects meta-analysis showed differential results for generic versus disease-specific HRQoL measures for within- and between-subject designs. Although generic measures used for within-subject designs did not demonstrate HRQoL benefits from hearing aids, mean effect sizes and confidence intervals for within-subject designs and disease-specific instruments suggested that hearing aids have a small-to-medium impact on HRQoL. Further, the between-subject studies supported at least a small effect for generic measures, and when measured by disease-specific instruments, hearing aids had medium-to-large effects on adults' HRQoL. This review concludes that hearing aids improve adults' HRQoL by reducing psychological, social, and emotional effects of SNHL. Future studies should include control groups using randomized controlled trials.

Computerized dynamic visual acuity with volitional head movement in patients with vestibular dysfunction.

OBJECTIVES: Patients with uncompensated vestibular dysfunction frequently report blurred vision during head movement, a symptom termed oscillopsia. One way to measure the functional deficit associated with an impaired vestibulo-ocular reflex is by comparing visual acuity from a baseline condition in which there is no head movement to visual acuity obtained during a dynamic condition with head movement. A previously described test incorporated a treadmill upon which patients walked during assessment of visual acuity. The objective of the current investigation was to evaluate an alternative method of assessing dynamic visual acuity that uses volitional head movement instead of walking on a treadmill. METHODS: Fifteen participants with normal vestibular function and 16 participants with impaired vestibular function were enrolled. All participants performed the visual acuity task under baseline conditions with no movement and also under dynamic conditions that included 1) walking on a treadmill and 2) volitionally moving their head in the vertical plane. RESULTS: No difference in performance was observed between the treadmill task and the volitional head movement task. Participants with impaired vestibular function performed more poorly under the dynamic conditions than did participants with normal vestibular function. CONCLUSIONS: The results suggest that the volitional head movement paradigm may be useful in identification of patients with functional deficits of the vestibulo-ocular reflex.

When hearing aids go bad: an FM success story.

Both clinical and research findings support the effectiveness of frequency-modulated (FM) technology among individuals who continue to encounter significant communication problems despite the use of conventional hearing instruments. The use rate of FM devices throughout the nation, however, remains disappointingly low. The authors present a case of a longtime hearing aid user whose hearing aids provided decreasing benefit as his hearing impairment increased to the extent that cochlear implantation was considered. Through the establishment of patient-specific treatment goals, the provision of appropriate FM technology as verified through real-ear measurements, and careful and deliberate counseling and follow-up, this patient was able to realize significant communication benefits as reported through several self-assessment measures. The cost-benefit implications of FM technology versus cochlear implantation are discussed.

Doctor of audiology (AuD) program at the University of South Florida.

This article describes the doctor of audiology (AuD) program at the University of South Florida (USF). The USF AuD program has been operational since the fall of 1999 and, to date, 47 students have graduated from either the postbaccalaureate track or the post-master's track. The faculty consists of 9 full-time and 8 part-time adjunct members who provide a curriculum that covers the audiology scope of practice. Being located in a major metropolitan area allows for diverse clinical practicum experiences that result in students being prepared to become autonomous professional practitioners.

Learning to listen again: the role of compliance in auditory training for adults with hearing loss.

PURPOSE: To examine the role of compliance in the outcomes of computer-based auditory training with the Listening and Communication Enhancement (LACE) program in Veterans using hearing aids. METHOD: The authors examined available LACE training data for 5 tasks (i.e., speech-in-babble, time compression, competing speaker, auditory memory, missing word) from 50 hearing-aid users who participated in a larger, randomized controlled trial designed to examine the efficacy of LACE training. The goals were to determine: (a) whether there were changes in performance over 20 training sessions on trained tasks (i.e., on-task outcomes); and (b) whether compliance, defined as completing all 20 sessions, vs. noncompliance, defined as completing less than 20 sessions, influenced performance on parallel untrained tasks (i.e., off-task outcomes). RESULTS: The majority, 84% of participants, completed 20 sessions, with maximum outcome occurring with at least 10 sessions of training for some tasks and up to 20 sessions of training for others. Comparison of baseline to posttest performance revealed statistically significant improvements for 4 of 7 off-task outcome measures for the compliant group, with at least small (0.2 < d < 0.3) Cohen's d effect sizes for 3 of the 4. There were no statistically significant improvements observed for the noncompliant group. CONCLUSION: The high level of compliance in the present study may be attributable to use of systematized verbal and written instructions with telephone follow-up. Compliance, as expected, appears important for optimizing the outcomes of auditory training. Methods to improve compliance in clinical populations need to be developed, and compliance data are important to report in future studies of auditory training.

Short- and long-term outcomes of adult audiological rehabilitation.

OBJECTIVE: To examine short- and long-term subjective benefits of providing a counseling-oriented audiological rehabilitation (AR) program as an adjunct to hearing aid intervention for individuals with adult-onset hearing loss. DESIGN: One hundred six veterans (68 men and 38 women), fit binaurally with digitally programmable analog hearing aids, participated. The Communication Profile for the Hearing Impaired (CPHI; ) was administered to all participants before hearing aid fitting. Half the patients were randomly assigned to receive hearing aids alone (i.e., control); the other patients were assigned to participate in a 4-wk group AR program in conjunction with receiving hearing aids (i.e., HA + AR). At the end of the AR program, the CPHI was again administered to all participants to assess short-term benefit and at 6 mo and 1 yr after hearing aid fitting to assess long-term benefit. RESULTS: A separate repeated-measures version of the general linear model was used to examine short- and long-term benefits for the CPHI factor scores (communication importance, communication performance, adjustment, interaction, and reaction) and for individual importance ratings and scale scores. Hearing aid use improved both short- and long-term self-perception of communication performance, with no additional benefits from participation in the AR program. Consistent with the goals of a counseling-oriented AR program, differential short-term treatment effects were found for communication strategy usage, which led to differential short-term benefits for the interaction and reaction factors. Although failing to reach strict criteria for statistical significance, there was an observable difference in short-term outcomes between the two groups for the adjustment factor, with greater improvements occurring for the HA + AR group. Over the course of the year, benefits measured for the HA + AR group remained stable, whereas scores for the control group continued to increase, resulting in no differences in factor scores between groups at 1 yr after intervention. CONCLUSIONS: The finding of a short-term differential treatment benefit for AR in terms of interaction and reaction, and possibly for adjustment, was important, as better outcomes in these areas may be important in the decision to keep hearing aids. If this is the case, then the data support the inclusion of a counseling-oriented AR program. Differential treatment effects in interaction and reaction appeared to result from communication strategy use, indicating that the AR program is meeting many of its goals in this area. The lack of long-term differential effects appeared as the result of continued changes in adjustment, interaction, and reaction with continued hearing aid experience.

A cost-utility analysis of adult group audiologic rehabilitation: are the benefits worth the cost?

The purpose of this study was to conduct a cost-utility analysis comparing two treatment approaches: (1) hearing aid use alone (HA) and (2) hearing aid use with short-term group postfitting audiologic rehabilitation (HA + AR). A total of 105 veterans, 67 males and 38 females, with at least a mild sensorineural hearing loss participated in this study. The SF-36V was administered to each participant before and after treatment. This instrument measures both mental component summary (MCS) scales and physical component summary (PCS) scales of quality of life. As a whole, the participants exhibited a statistically significant improvement in mean MCS scores pre- to postintervention, with average improvements of 1.4 and 3.0 points for the HA and HA + AR groups, respectively. With the use of the MCS scores, the results of a cost-utility analysis revealed that HA treatment cost $60.00 per quality-adjusted life year (QALY) gained, while HA + AR cost only $31.91 per QALY gained, making HA + AR the more cost-effective treatment.

The aging auditory system: anatomic and physiologic changes and implications for rehabilitation.

Over the last century, research in the area of age-related hearing loss has provided a vast amount of knowledge regarding age-related effects on the anatomy and physiology of the auditory system. As we enter the new millennium, researchers are beginning to shift their attention towards developing methods of modulating the effects of age-related hearing loss and the development of efficacious intervention strategies to meet all of an individual's hearing-related rehabilitative needs. The purpose of this review is to provide a framework for considering how the biological aspects of the aging auditory system interact with the most common current therapeutic intervention for age-related hearing loss--the use of amplification--and also how the biological aspects point to other potential intervention strategies.