Improving quality of life in the elderly: hearing loss treatment with cochlear implants.

BACKGROUND: Hearing loss impacts health-related quality of life and general well-being and was identified in a Lancet report as one of the largest potentially modifiable factors for the prevention of age-related dementia. There is a lack of robust data on how cochlear implant treatment in the elderly impacts quality of life. The primary objective was to measure the change in health utility following cochlear implantation in individuals aged ≥ 60 years. METHODS: This study uniquely prospectively recruited a large multinational sample of 100 older adults (mean age 71.7 (SD7.6) range 60-91 years) with severe to profound hearing loss. In a repeated-measures design, pre and post implant outcome measures were analysed using mixed-effect models. Health utility was assessed with the Health Utilities Index Mark III (HUI3). Subjects were divided into groups of 60-64, 65-74 and 75 + years. RESULTS: At 18 months post implant, the mean HUI3 score improved by 0.13 (95%CI: 0.07-0.18 p < 0.001). There was no statistically significant difference in the HUI3 between age groups (F[2,9228] = 0.53, p = 0.59). The De Jong Loneliness scale reduced by an average of 0.61 (95%CI: 0.25-0.97 p < 0.014) and the Lawton Instrumental Activities of Daily Living Scale improved on average (1.25, 95%CI: 0.85-1.65 p < 0.001). Hearing Handicap Inventory for the Elderly Screening reduced by an average of 8.7 (95%CI: 6.7-10.8, p < 0.001) from a significant to mild-moderate hearing handicap. Age was not a statistically significant factor for any of the other measures (p > 0.20). At baseline 90% of participants had no or mild depression and there was no change in mean depression scores after implant. Categories of Auditory perception scale showed that all subjects achieved a level of speech sound discrimination without lip reading post implantation (level 4) and at least 50% could use the telephone with a known speaker. CONCLUSIONS: Better hearing improved individuals' quality of life, ability to communicate verbally and their ability to function independently. They felt less lonely and less handicapped by their hearing loss. Benefits were independent of age group. Cochlear implants should be considered as a routine treatment option for those over 60 years with bilateral severe to profound hearing loss. TRIAL REGISTRATION: ClinicalTrials.gov ( http://www. CLINICALTRIALS: gov/ ), 7 March 2017, NCT03072862.

Healthy aging in elderly cochlear implant recipients: a multinational observational study.

BACKGROUND: Given an increase in the aging population and its impact on healthcare systems, policy makers for provision of health and social services are aiming to keep older adults in good health for longer, in other words towards 'healthy aging'. Our study objective is to show that rehabilitation with cochlear implant treatment in the elderly with hearing impairment improves the overall health-related quality of life and general well-being that translate into healthy aging. METHODS: The multicentre, prospective, repeated measures, single-subject, clinical observational study will accrue 100 elderly, first-time, unilateral CI recipients (≥ 60 years) and analyze changes on specific measurement tools over ca. 20 months from preimplant to postimplant. Evaluations will consist of details collected through case history and interview questionnaires by clinicians, data logging, self-report questionnaires completed by the recipients and a series of commonly used audiometric measures and geriatric assessment tools. The primary indicator of changes in overall quality of life will be the HUI-3. DISCUSSION: The protocol is designed to make use of measurement tools that have already been applied to the hearing-impaired population in order to compare effects of CI rehabilitation in adults immediately before their implantation, (pre-implant) and after gaining 1-1.5 years of experience (post-implant). The broad approach will lead to a greater understanding of how useful hearing impacts the quality of life in elderly individuals, and thus improves potentials for healthy aging. Outcomes will be described and analyzed in detail. TRIAL REGISTRATION: This research has been registered in ClinicalTrials.gov (http://www.clinicaltrials.gov/), 7 March 2017 under the n° NCT03072862 .

Early prelingual auditory development in Italian infants and toddlers analysed through the Italian version of the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS).

PURPOSE: To evaluate the reliability and validity of the Italian version of the Infant-Toddler Meaningful Auditory Integration Scale (I-IT-MAIS), and to assess the normal trajectory of early prelingual auditory (EPLAD) development from birth to 24 months in a group of normal-hearing Italian children using the I-IT-MAIS. METHODS: The study consisted of four phases: item generation, reliability analysis, assessment of the normal trajectory for EPLAD, and validity analysis. A group of 120 normal-hearing children and a group of 31 deaf children wearing hearing aids and on a waiting list for cochlear implantation were enrolled. All the parents completed the I-IT-MAIS. Sixty of them completed the I-IT-MAIS twice, 2 weeks apart, for test-retest reliability analysis. The I-IT-MAIS scores were used to assess the normal trajectory of EPLAD development from birth to 24 months in normal-hearing children. For criterion validity analysis, the I-IT-MAIS scores were correlated with production of infant scale evaluation (PRISE) scores in 60 normal-hearing children. For discriminant validity analysis, the I-IT-MAIS scores obtained in normal and deaf children were compared. RESULTS: Internal consistency of I-IT-MAIS was satisfactory as well as individual item reliability, test-retest reliability, and discriminant validity. EPLAD development in normal-hearing Italian-speaking children was evaluated. As far as the criterion validity of the I-IT-MAIS is concerned, a strong correlation between I-IT-MAIS and PRISE scores was found. CONCLUSION: I-IT-MAIS is reliable and valid. Its application is recommended for clinical practice and outcome research.

An innovative method for trans-impedance matrix interpretation in hearing pathologies discrimination.

Trans-impedance measurement is a novel methodology for assessing the positioning of a cochlear implant (CI). This study proposes an innovative use of trans-impedance measurements to characterize specific hearing pathologies by means of the trans-impedance matrix (TIM) quantitative analysis. Three indices are used: Shannon Entropy, the Exponential Decay constant and Spatial Correlation. These indices were computed on the TIMs of two groups of patients, clustered in terms of hearing pathology: (i) congenital hearing loss (CONG) and (ii) otosclerosis (OTO). The study aimed to demonstrate the sensitivity of the above synthetic indices in relation to the considered hearing pathologies. Furthermore, the first two indices were employed to explore the influence of the positioning of the electrode, either over (i) the basal or (ii) the apical regions, on the TIMs patterns. The results suggest that the indices were statistically different for the patient groups and the positioning impacted solely on OTO patients. In particular: (i) CONG patients displayed significantly higher Shannon Entropy (p = 0.0002) and (ii) a lower Exponential Decay constant than OTO patients (p = 0.001); (iii) the OTO patients exhibited a lower Shannon Entropy and a higher Exponential Decay constant over the basal regions than the apical regions (p < 0.008); (iv) Spatial Correlation demonstrated that TIMs had specific patterns according to the hearing pathology (p < 0.008).

Cochlear implantation in delayed sudden hearing loss after conservative vestibular schwannoma surgery.

This is a case of successful cochlear implantation in a 50-year-old man who experienced sudden hearing loss and developed ipsilateral severe tinnitus at three years following conservative stage 1 vestibular schwannoma retrosigmoid surgery. After cochlear implantation, tinnitus improved from THI grade 4 to 2. Localisation skills improved. Hearing in noise (S/N + 7 dB) with target signal from the operated side improved from 38 to 100% of correct answers. A significant improvement of spatial and speech items of the "speech, spatial and qualities of sounds" questionnaire was also measured. In conclusion, cochlear implantation is a feasible and effective solution after conservative vestibular schwannoma surgery should delayed hearing loss occur.

[Psychoacoustic tuning in normal and pathological ears]. / La sintonia psicoacustica in orecchi normali e patologici.

Since simplified methods have been generated to measure psychoacoustic tuning curves (PTC), they have proved to be useful in clinical workup. Nevertheless, further research is necessary for high level tuning. In the present study PTCs have been generated utilizing a discrete simultaneous masking tone-on-tone paradigm. Thresholds were determined using an adaptive up-down transformed procedure, thus obtaining normative data. The experimental groups allowed frequency-independent, mild to moderate hearing loss, in order to minimize such variable. Results indicate that PTCs were normal in 8 subjects suffering from conductive hearing loss and abnormal in 8 subjects with cochlear loss. Normative high level data and a new quantifying index confirms these results.

[Quantification of communication difficulty in subjects with hearing loss: a pilot study]. / La quantificazione delle difficoltà di comunicazione del soggetto ipoacusico: studio pilota.

A brief questionnaire concerning auditory disability in every day listening was developed. The aim was to generate a simple, practical test for rehabilitational purposes. The questionnaire was administered to 255 hearing-impaired subjects coming under observation consecutively. The only requirement for participation was an expression of communicational difficulties due to adult onset of hearing loss. Some items were not applicable for all subjects. The higher scores were observed for hearing problems related to speech-in-noise. Good linear correlations were found between better-ear auditory and questionnaire score-based indexes in the 'family' and 'social' sections.

[Nasal packing and antibiotic prophylaxis in septoplasty: a controlled study]. / Tamponamento nasale e profilassi antibiotica nella settoplastica: uno studio controllato.

Systematic use of preoperative antibiotic prophylaxis (PAP) and nasal packing (NP) in septoplasty-both directly and indirectly affecting the cost of surgery (length of hospitalization)-appear based on controversial scientific data and, at times, even on unjustified clinical "habits". A controlled study was thus performed on 100 adults undergoing exclusive nasal septoplasty to determine whether these techniques are actually useful. The subjects were randomly divided into four groups: TN-PAP-(29 subjects), TN-PAP+ (25 subjects), TN+ PAP- (21 subjects) and TN+ PAP+ (25 subjects). Surgery was always performed by the same surgeon and was concluded with continuous suture of the mucoperichondrial layers. Only one patient (TN-PAP-) presented complications of infection (vestibulitis). Three patients in the TN- group required nasal packing a few hours after surgery because of moderate bleeding. As of three months after surgery no other complications had arisen. Postoperative pain, evaluated on an analogicalvisual scale, was higher during the 12 hours after surgery. Analysis of variance showed that the only pain-related factor was nasal packing while PAP and the interaction between TN and PAP did not prove significant. The above results suggest that PAP and TN should not be systematically used, thus reducing the hospitalization period for septoplasty to the day of surgery (Day surgery).

[Elaboration of a hearing disability scale]. / Elaborazione di una scala di disabilità uditiva.

On the basis of a previous pilot study a multiple-choice questionnaire about hearing disabilities was developed. The questionnaire (SDU) allowed 20 items. The answers were tailored to the single question and scaled in increasingly order of disability (form A) or in random order (form B). Modalities of administration (self-report or interview) and form (A or B) were randomized in a group of 123 adult subjects with different degree of hearing impairment. Only one factor, attributable to hearing disability, was extracted by a factor analysis. This factor explains a major variance ratio of items related to speech perception in difficult listening context. A good correlation (r = .74) was found between SDU total score and hearing threshold in the better ear. No difference in mean score, variance and time of reduction of the SDU was found between form A and B. The Authors so propose the use of form A because of a more easy compute of the total score. Self-report was more time-consuming respect to interview (11.7' vs. 8.4'). Furthermore, self-report was non possible in 13.8% of subjects for severe virus impairment and illiteracy and in 6.1% some form of support was necessary. No difference of mean score and variance between self-report and interview was found. SDU represents a tool for hearing disability evaluation useful in aural rehabilitation protocols. The principal advantage is high applicability thanks to short time required, simplicity of task and flexibility in the modality of administration.

[Allergologic evaluation in chronic rhinitis: study of 411 cases]. / La valutazione allergologica nella rinite cronica: studio su 411 casi.

The present work reports the results of an allergological evaluation performed on 411 patients suffering from chronic rhinitis alone or associated with bronchial asthma. Allergic diagnosis was based on the results of skin prick tests, serum RAST, nasal provocation, allergy avoidance diets and food provocation. 207 patients were sensitized to one or more allergens (50.4%); mean age for onset of rhinitis was 14.9. The first ten years of age proved most relevant for onset of symptoms, while late onset was significant in females. The most common reactions were to house dust mites, most likely due to the local environmental-climatic conditions which favor the growth of Dermatophagoides. Olive-sensitization was frequently found in pollen-positive subjects. Careful allergological evaluation of chronic rhinitis is very important so as to establish the best treatment and environment prophylaxis for the disease.

[Diurnal hypersomnolence and chronic snoring: an epidemiological study]. / Ipersonnolenza diurna e roncopatia cronica: indagine epidemiologica.

Excessive daytime somnolence (EDS) is highly correlated to the presence of obstructive sleep apnea syndrome (OSAS). It appears that interest in such disorders may also be extended to extraneurological fields. The Authors report the results of a study on EDS in 1,146 adult subjects seen consecutively by different physicians. Excessive Somnolence during normal activity was reported in 4.5% of the subjects studied. In a subgroup of habitual snorers, EDS was observed in 8.3% of the subjects and in 2.0% in a group of non-snorers. The subjects with EDS has a mean age and body mass index (BMI) greater than those of the control group and a higher frequency of certain performance disturbances. No sex differences were found. EDS and habitual snoring had a similar age-related trend.

[Elaboration of the hearing disability scale]. / Elaborazione di una scala delle disabilità uditive.

On the basis of a previous pilot study, a multiple-choice questionnaire regarding hearing disabilities was developed. The questionnaire (SDU) was made up of 20 items. The answers were tailored to the single question and scaled according to the increasing degree of disability (form A) or in random order (form B). Administration modality (self-report or interview) and form (A or B) were randomized in a group of 123 adult subjects with different degrees of hearing impairment. Only one factor, attributable to hearing disability, was extracted by factor analysis. This factor explains a major variance ratio of items related to speech perception in difficult listening context. A good correlation (r = .74) was found between SDU total score and hearing threshold in the better ear. No difference in mean score, variance and necessary scoring time of the SDU was found between form A and B. The Authors thus propose the use of form A because of a more easy computation of the total score. Self-report was more time consuming with respect to interview (11.7' vs. 8.4'). Furthermore, self-report was non possible in 13.8% of subjects for severe sign impairment and illiteracy and in 6.1% some form of support was necessary. No difference in mean score and variance between self-report and interview was found. SDU represent a tool for hearing disability evaluation useful in aural rehabilitation protocols. The principal advantage is high applicability thanks to the short time required, simplicity of task and flexibility of administration modality.

[The variability of functional gain and insertion gain in hearing aid fitting]. / Variabilità del guadagno funzionale e del guadagno di inserzione nell'adattamento protesico.

Functional gain (FG) and insertion gain (IG) are currently used as real ear gain measurement of hearing aids. The gain differences observed with hearing aid modifications made in order to achieve the desired prescriptive target must be greater than the variability associated with repetition of measurement in order to be really useful. Limited research is available on FG and IG intratester variability. In order to evaluate single variability factors, some studies use experimental designs not common in clinical work-up while others use equipment mot available commercially. The present study evaluates intratester variability of FG and IG (Madsen IGO 1500 equipment) in a typical clinical configuration in 42 users of behind-ear hearing aids. Mean standard deviation of FG test-retest differences was 5.19 dB. Range of variability was expressed in term of centiles. 5-- and 95-- centiles were -9.8 and 8.7 dB respectively. Mean s.d. of IG test-retest differences was 3.18 dB; 5-- and 95-- centiles were -5.2 and 6.05 dB respectively. Major variability was found at higher frequencies. High variability at lower frequencies was also found probably due to sealing problems of ear molds in the ear canal. Accord between FG and IG was also examined. A good mean correspondence in mid frequency range was found (FG-IG mean difference less than 5 dB) with large inter-subject differences between the two measurements (s.d. 11 dB).

[Snoring: an epidemiological study on 1146 adult subjects]. / Il russamento: indagine epidemiologica su 1146 soggetti di età adulta.

An epidemiological survey of the prevalence of snoring was performed on 1146 adults consecutively observed in the offices of several practitioners. A reliable, previously assessed snoring questionnaire was given to all patients. Snoring was found as a common sign as 31% of the subjects referred to this symptom. However, the prevalence of every-night snoring was 13.5-17.7%. Snoring was an age-related phenomena: its prevalence raised with age. Males more frequently proved to be heavy snorers although no great difference was found between sexes in the later decades of life.

[Test-retest reliability of anamnestic data on chronic obstructive apnea]. / Replicabilità test-retest dei dati anamnestici correlati alla roncopatia cronica.

A questionnaire concerning problems inherent to ronchopathy was evaluated in order to assess its test-retest reliability and the interobserver variability of the items. The results indicate the existence of three orders of variables. The first (class A) was characterized by good intra- and inter- observer reliability. It included all interval variables (i.e. weight, height, arterial pressure) and most ordinal variables (i.e. grading of snoring, excessive daytime somnolence, morning headache, smoking, etc.). The second (class B) was characterized by good intra-observer and poor inter-observer reliability. It included snoring onset time and morning somnolence. The third class (class C) was characterized by both poor intra- and inter-observer reliability. It included sleep apnea. For large epidemiological survey purposes the authors suggest that only class A variables be used.

[The prevalence and evolution of hypoacusis in Cooley's disease]. / Prevalenza ed evoluzione dell'ipoacusia nel morbo di Cooley.

With the improved life expectation of patients with beta-thalassemia-major (BTM) or Cooley's Disease, new clinical problems, such as hearing damage, have emerged. The authors describe audiometric data of 50 patients with BTM. High-frequency thresholds were higher in BTM than those of a control group. Prevalence of hearing loss in BTM was 14-26%, depending on the frequency range considered, while in the control group it was between 4.3-19.1%. The prevalence of hearing loss in BTM with respect to that of the general population was 7-10% higher. Hearing loss ranged from mild to moderate. A good correlation was found between hearing loss and the cumulative dose of desferoxamine administered. These data were indicative of an ototoxic effect of this drug. Many patients (28.6%) showed significant hearing threshold deterioration after 3 years. On the light of these results, the authors suggest regular audiologic follow-up of patients with BTM.

Focused tight dressing does not prevent cochlear implant magnet migration under 1.5 Tesla MRI.

We report a retrospective case of inner magnet migration, which occurred after 1.5 Tesla MRI scanning in an adult recipient of a bilateral cochlear implant (CI) despite a focused head dressing. The patient, bilaterally implanted with Nucleus 5 CIs (Cochlear LTD, Sydney, Australia), underwent a 1.5 Tesla cholangio-MRI scan for biliary duct pathology. In subsequent days, a focal skin alteration appeared over the left inner coil. Plain skull radiographs showed partial magnet migration on the left side. Surgical exploration confirmed magnet twisting; the magnet was effectively repositioned. Left CI performance was restored to pre-migration level. The wound healed without complications. Thus, focused dressing does not prevent magnet migration in CI recipients undergoing 1.5 Tesla MRI. All patients should be counselled on this potential complication. A minor surgical procedure is required to reposition the magnet. Nevertheless, timely diagnosis is necessary to prevent skin breakdown and subsequent device contamination. Plain skull radiograph is very effective in identifying magnet twisting; it should be performed systematically after MRI or minimally on all suspected cases.