Development of a case definition for hearing loss in community-based older adults: a cross-sectional validation study.

BACKGROUND: Research based in primary care suggests that hearing loss may be underreported as well as inconsistently recorded in patient histories. In this study, we aimed to develop and validate a case definition for hearing loss among older adults in primary care, using electronic medical records. METHODS: We used data from adult patients aged 55 years and older from 13 practices in the Southern Alberta Primary Care Research Network database, part of the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), from Dec. 1, 2014, to Dec. 31, 2016. We developed a hearing loss case definition that was translated into an electronic algorithm. A record review was undertaken as the reference standard, followed by application of the algorithm to the sample. Validation metrics included sensitivity, specificity, positive predictive value and negative predictive value, as well as prevalence. We assessed risk factors using the Fisher exact test and odds ratios. RESULTS: The sample included 1000 patients; 496 (49.6%) were female and the mean age was 67.5 (standard deviation 9.6) years. Sensitivity of the case definition algorithm was determined to be 87.3% (95% confidence interval [CI] 76.5%-94.4%) with specificity valued at 94.8% (95% CI 93.1%-96.1%). Positive and negative predictive values were 52.9% (95% CI 42.8%-62.8%) and 99.1% (95% CI 98.2%-99.6%), respectively. The prevalence of hearing loss within the sample was 6.3% (95% CI 4.9%-7.9%). Older age was a significant risk factor for hearing loss (t = 4.98, 95% CI 3.76-8.65). Men had greater odds of hearing loss than women (odds ratio 1.65, 95% CI 0.98-2.79). INTERPRETATION: The validated case definition for hearing loss in community-based older adults had high sensitivity and specificity. It may be applied to surveillance and future epidemiologic research within the CPCSSN database.

Efficacy of Auditory Implants for Patients With Conductive and Mixed Hearing Loss Depends on Implant Center.

INTRODUCTION: Although from a technological point of view, progress is impressive, most implantable hearing devices for conductive or mixed hearing loss have a limited capacity. These devices all bypass the impaired middle ear; therefore, the desired amplification (gain) should be based on the cochlear hearing loss (component) only. The aim of the study is to review the literature with regard to accomplished gain with current implantable devices. METHOD: Thirty-one articles could be included. Aided thresholds were compared with prescribed values, based on cochlear hearing loss (bone-conduction thresholds), according to the well-validated NAL rule. RESULTS: For the majority of the studies, NAL targets were not met. Variation in accomplished gain between implant teams was unacceptably large, largely independent of the type of device that was used. NAL targets were best met at 2 kHz, with worse results at the other frequencies. CONCLUSION: Large variations in reported results were found, which primarily depended on implant center. Based on the analyses, a pragmatic fitting procedure is proposed which should minimize the differences between implant centres.

Hearing Loss and Cognitive-Communication Test Performance of Long-Term Care Residents With Dementia: Effects of Amplification.

Purpose: The study aims were (a) to explore the relationship between hearing loss and cognitive-communication performance of individuals with dementia, and (b) to determine if hearing loss is accurately identified by long-term care (LTC) staff. The research questions were (a) What is the effect of amplification on cognitive-communication test performance of LTC residents with early- to middle-stage dementia and mild-to-moderate hearing loss? and (b) What is the relationship between measured hearing ability and hearing ability recorded by staff using the Resident Assessment Instrument-Minimum Data Set 2.0 (RAI-MDS; Hirdes et al., 1999)? Method: Thirty-one residents from 5 long-term care facilities participated in this quasiexperimental crossover study. Residents participated in cognitive-communication testing with and without amplification. RAI-MDS ratings of participants' hearing were compared to audiological assessment results. Results: Participants' speech intelligibility index scores significantly improved with amplification; however, participants did not demonstrate significant improvement in cognitive-communication test scores with amplification. A significant correlation was found between participants' average pure-tone thresholds and RAI-MDS ratings of hearing, yet misclassification of hearing loss occurred for 44% of participants. Conclusions: Measuring short-term improvement of performance-based cognitive communication may not be the most effective means of assessing amplification for individuals with dementia. Hearing screenings and staff education remain necessary to promote hearing health for LTC residents.

Exploratory benchtop study evaluating the use of surgical design and simulation in fibula free flap mandibular reconstruction.

BACKGROUND: Surgical design and simulation (SDS) is a useful tool to help surgeons visualize the anatomy of the patient and perform operative maneuvers on the computer before implementation in the operating room. While these technologies have many advantages, further evidence of their potential to improve outcomes is required. The present benchtop study was intended to identify if there is a difference in surgical outcome between free-hand surgery completed without virtual surgical planning (VSP) software and preoperatively planned surgery completed with the use of VSP software. METHODS: Five surgeons participated in the study. In Session A, participants were asked to do a free-hand reconstruction of a 3d printed mandible with a defect using a 3d printed fibula. Four weeks later, in Session B, the participants were asked to do the same reconstruction, but in this case using a preoperatively digitally designed surgical plan. Digital registration computer software, hard tissue measures and duration of the task were used to compare the outcome of the benchtop reconstructions. RESULTS: The study revealed that: (1) superimposed images produced in a computer aided design (CAD) software were effective in comparing pre and post-surgical outcomes, (2) there was a difference, based on hard tissue measures, in surgical outcome between the two scenarios and (3) there was no difference in the time it took to complete the sessions. CONCLUSION: The study revealed that the participants were more consistent in the preoperatively digitally planned surgery than they were in the free hand surgery.

Pilot study: evaluation of the use of the convergent interview technique in understanding the perception of surgical design and simulation.

BACKGROUND: It is important to understand the perceived value of surgical design and simulation (SDS) amongst surgeons, as this will influence its implementation in clinical settings. The purpose of the present study was to examine the application of the convergent interview technique in the field of surgical design and simulation and evaluate whether the technique would uncover new perceptions of virtual surgical planning (VSP) and medical models not discovered by other qualitative case-based techniques. METHODS: Five surgeons were asked to participate in the study. Each participant was interviewed following the convergent interview technique. After each interview, the interviewer interpreted the information by seeking agreements and disagreements among the interviewees in order to understand the key concepts in the field of SDS. RESULTS: Fifteen important issues were extracted from the convergent interviews. CONCLUSION: In general, the convergent interview was an effective technique in collecting information about the perception of clinicians. The study identified three areas where the technique could be improved upon for future studies in the SDS field.

Evaluation of the accuracy of cone beam computerized tomography (CBCT): medical imaging technology in head and neck reconstruction.

BACKGROUND: With the introduction, development and commercialization of Cone Beam Computerized Tomography (CBCT) technologies in the field of head and neck reconstruction, clinicians now have increased access to the technology. Given the growth of this new user group, there is an increasing concern regarding proper use, understanding, quality and patient safety. METHODS: The present study was carried out to evaluate data acquisition of CBCT medical imaging technology and the accuracy of the scanning at three different machine warming times. The study also compared the accuracy of CBCT at 0.2 mm slice thickness and Computerized Tomography (CT) at 1 mm slice thickness. A control model was CT scanned at five random intervals, at 1 mm slice thickness and CBCT scanned at specialized intervals, at 0.2 mm slice thickness. The data was then converted and imported into a software program where a digital registration procedure was used to compare the average deviations of the scanned models to the control. RESULTS: The study found that there was no statistically significant difference amongst the three CBCT machine warming times. There was a statistically significant difference between CT scanning with 1 mm slice thickness and CBCT scanning with 0.2 mm slice thickness. CONCLUSIONS: The accuracy of the i-CAT CBCT scans used in the present study with a parameter at voxel size 0.2, will remain consistent and reliable at any warming stage. Also the difference between the CBCT i-CAT scans and the CT scans was not clinically significant based on suggested requirements of clinicians in head and neck reconstruction.

Can Uhear me now? Validation of an iPod-based hearing loss screening test.

OBJECTIVE: To evaluate the uHear iPod-based application as a test for hearing loss. METHODS: We recruited 100 adult participants through a single otology practice. Patients with otorrhea and cognitive impairment were excluded. All patients completed the uHear test in the clinic and in the sound booth and underwent a standard audiogram by the same audiologist. We compared the results of the uHear test to the standard audiogram. RESULTS: The uHear was able to correctly diagnose the presence of hearing loss (pure-tone average [PTA] > 40 dB) with a sensitivity of 98% (95% CI = 89-100), a specificity of 82% (95% CI = 75-88), and a positive likelihood ratio of 9 (95% CI = 6.0-16). Compared to the audiogram, the uHear overestimated the PTA among all ears by 14 dB in the clinic and by 8 dB in the sound booth (p < .0001). Compared to the audiogram, the uHear overestimated the PTA among ears with hearing loss by 6 dB in the clinic and by 4 dB in the sound booth. CONCLUSIONS: The uHear application is a reasonable screening test to rule out moderate hearing loss (PTA > 40 dB) and and is valid at quantifying the degree of hearing loss in patients known to have abnormal hearing.

Automated hearing tests: applying the otogram to patients who are difficult to test.

OBJECTIVE: The Otogram is an automated audiometer capable of determining air and bone conduction thresholds with masking when appropriate. The manufacturer claims that testing can be done in a quiet physician's consultation room without a sound-treated booth. We aimed to test the validity of the Otogram on "difficult-to-test" patients, all of whom require masking. METHODS: Twenty-eight difficult-to-test patients underwent three audiograms: two by an audiologist and one by the Otogram. First, audiograms performed by the audiologists were compared, establishing test-retest reliability. Second, audiograms performed by the Otogram were compared to those of the audiologists. We calculated the percentage of pure-tone thresholds that were in agreement by 10 dB. Weighted kappa statistical analyses demonstrated levels of agreement. RESULTS: Comparisons between audiologists demonstrated a very high degree of agreement. More than 90% of air and bone conduction thresholds fell within 10 dB of each other. Comparisons between audiologists and the Otogram also demonstrated a high degree of agreement. CONCLUSIONS: The Otogram has the capability to accurately ascertain air and bone conduction thresholds. It appropriately used masking when indicated. The Otogram has great potential as a diagnostic tool to improve access to health care, especially where hearing test facilities are limited or unavailable.

Indications for bone-anchored hearing AIDS: a functional outcomes study.

OBJECTIVE: To assess the functional outcomes of patients previously fitted with a bone-anchored hearing aid (BAHA) for unilateral conductive (UC), unilateral mixed (UM), or sensorineural (single-sided deafness [SSD]) hearing loss and compare them with those of patients with bilateral conductive hearing loss (BCHL). STUDY DESIGN: Cross-sectional cohort study. SETTING: The Institute for Reconstructive Sciences in Medicine (iRSM) at the Misercordia Hospital, Edmonton, Alberta. METHODS: Fifty patients with multiple types of hearing loss participated in this study. Postoperative subjective evaluation was completed with the Speech, Spatial and Qualities of Hearing Scale (SSQ) and the Abbreviated Profile of Hearing Aid Benefit questionnaire (APHAB). Objective evaluation was completed with the Hearing in Noise Test (HINT). RESULTS: The APHAB indicates that patients in all four groups find significant subjective improvement with their BAHA. SSQ data indicate that patients with BCHL and UCHL show a significantly higher preference for the sound quality of aided speech than patients with UMHL. Additionally, provision of a BAHA to patients with SSD does not allow them to subjectively localize sounds as well as it does the other groups. Significant improvements were found on the HINT in patients with BCHL, UCHL, and UMHL. There is no improvement in patients with SSD. CONCLUSION: BCHL, UCHL, and UMHL patients, both subjectively and objectively, do well with unilateral BAHA placement. Patients with SSD note subjective improvement but cannot localize sounds. More patients with UMHL and UCHL should be considered viable BAHA candidates. Patients with SSD should be cautioned that they may not experience similar objective benefits.