The effects and costs of a hearing screening and rehabilitation program in residential care homes for the elderly in the Netherlands1.

PURPOSE: This study describes the effects and costs of hearing screening and rehabilitation in residential care homes for the elderly. It was hypothesized that offering an in-house hearing screening and rehabilitation program would be an effective strategy to increase hearing aid ownership among the residents. METHOD: All 705 residents of 8 residential care homes in the Netherlands were invited to participate in a hearing screening (pure-tone audiometry) and rehabilitation (hearing aids) program. Resident participation was analyzed, and the costs were calculated. RESULTS: A total of 243 residents (34%) participated in the screening, 222 (91%) of whom had hearing loss. Ninety-one (41%) of the screening participants with hearing loss started rehabilitation, which was successful for 50 (55%) of them. Hearing aid ownership among the residents with hearing loss increased from 28% at the start of the program to 33% at the end. The costs were €1,896 (US $2,480) per successfully rehabilitated resident. Hearing aid trials and hearing aids together accounted for 83% of the total costs. CONCLUSION: The effectiveness of the program was limited, as hearing aid ownership increased only slightly. Cost reduction measures should focus on decreasing the number of unsuccessful hearing aid trials.

Neurophysiologic, audiometric and vestibular function tests in patients with hyperostosis cranialis interna.

OBJECTIVE: Hyperostosis cranialis interna (HCI) is an autosomal dominant sclerosing bone dysplasia affecting the skull base and the calvaria, characterized by cranial nerve deficits due to stenosis of neuroforamina. The aim of this study is to describe the value of several neurophysiological, audiometric and vestibular tests related to the clinical course of the disorder. METHODS: Ten affected subjects and 13 unaffected family members were recruited and tested with visual evoked potentials, masseter reflex, blink reflex, pure tone and speech audiometry, stapedial reflexes, otoacoustic emissions, brainstem evoked response audiometry and electronystagmography. RESULTS: Due to the symmetrical bilateral nature of this disease, the sensitivity of visual evoked potentials (VEPs), masseter reflex and blink reflex is decreased (25-37.5%), therefore reducing the value of single registration. Increased hearing thresholds and increased BERA latency times were found in 60-70%. The inter-peak latency I-V parameter in BERA has the ability to determine nerve encroachment reliably. 50% of the patients had vestibular abnormalities. No patient had disease-related absence of otoacoustic emissions, because the cochlea is not affected. CONCLUSION: In patients with HCI and similar craniofacial sclerosing bone dysplasias we advise monitoring of vestibulocochlear nerve function with tone and speech audiometry, BERA and vestibular tests. VEPs are important to monitor optic nerve function in combination with radiological and ophthalmologic examination. We do not advise the routine use of blink and masseter reflex.

Selecting infants with OM that need referral and further assessment: creating a case-finding instrument.

OBJECTIVE: In the Netherlands, many children are surgically treated for OM. Recent publications question the need for surgical treatment in common uncomplicated OM, although there is certainly a subgroup of infants that do need further assessment and possible treatment. The present study explores the possibility of using known and presumed risk factors for OM as an instrument for selecting and routing an infant with OM to further care. METHODS: Two questionnaires were used. A questionnaire embracing a wide range of OM-related factors was sent to 6531 children aged nine months that were routinely invited for the hearing screen at nine months. In a second stage, a structured history questionnaire regarding ear and/or hearing problems, subsequent referral and/or treatment, was sent to all parents of children at age 21 months, responding to the first questionnaire. Univariate analysis was performed for identification of potential predictors for surgical treatment of OM for the whole sample as well as for 4 different subsets. Multivariable regression analysis with stepwise backward deletion was applied to arrive at a model for optimal prediction of tube insertion. A ROC (receiver operating characteristic) curve and the accompanying sensitivity and specificity values were analyzed to determine cut off values. RESULTS: Univariate analysis found 10 items predicting surgical treatment for OM. Multivariable regression analysis resulted in a model with a ROC curve having an area of 0.801 and estimated coefficients for risk factors which were used to calculate a OM-score for each case. CONCLUSION: The developed scoring sheet, e.g., to be used in combination with physical examinations and/or tympanometry looks promising as a predictor for those children that might benefit from further assessment and eventually surgically treatment for OM.

Implementation of neonatal screening for hearing impairment: influence on pediatric otitis media surgery in The Netherlands.

OBJECTIVE: Screening for hearing impairment in the Netherlands took place at the age of 9 months for many years but was recently moved to the neonatal period. Since otitis media has its highest prevalence at the age of 9 months, it might be that screening for hearing impairment at this age is linked to treatment of otitis media. We were interested in what the impact would be on the number of children treated with ventilation tubes or adenoidectomy when they were no longer screened at the age of 9 months. METHODS: National birth rates, data regarding screening for hearing impairment at the age of 9 months and at the neonatal period, as well as data regarding adenoidectomy and tube placement were used to study treatment of otitis media in children aged 0-2 years in the Netherlands. RESULTS: The percentage of children treated with ventilation tubes after implementation of neonatal screening for hearing impairment did not decline (OR 1.198-1.112), and more children were treated at a younger age. The number of children treated with adenoidectomy did however decline (OR 0.724-0.890). CONCLUSION: There seems to be an association between the implementation of neonatal screening for hearing impairment and the treatment of otitis media. During the whole studied period there was a slight but statistical significant increase in the odds for tube placement in all children aged 0-23 months. After implementation of the neonatal screen there was a distinct increase in the number of children aged 6-11 months treated with tubes. In the same period a statistical significant decline in the odds of undergoing adenoidectomy was observed.

Otitis media and speech-in-noise recognition in school-aged children.

The present study examined the long-term consequences of otitis media (OM) on speech perception abilities in noise. 55 children with a prospective 3-monthly documented middle-ear status and hearing loss between birth and 24 months completed a 'speech-in-noise' (SPiN) test at the age of 7 years. Both hearing loss and the cumulation of uni- and bilateral OM incidents in early life were significantly correlated to the performance on the SPiN test at school age. Other background factors such as socio-economic status, language perception and cognitive development did not predict the performance on the SPiN test. Only the language production score at age 7 was also significantly related to the score on the SPiN test. The present study deals with the risk of OM in early life and its accompanied hearing loss on auditory processing, specifically speech perception in noise, up to school age.

Psychometric qualities of questionnaires for the assessment of otitis media impact.

BACKGROUND: The assessment of impact and evaluation of treatment effects in chronic otitis media (OM) calls for a much broader approach than just examining the presence of middle ear effusion or hearing loss. It is increasingly recognised that this condition may result in a comprised quality of life. Several studies have used proxy completed questionnaires to objectify the illness experience associated with chronic OM. OBJECTIVE OF REVIEW: To review questionnaires which have been developed to describe the effects of chronic OM on the daily functioning of children. Psychometric properties have been evaluated, in addition to discriminative and evaluative qualities. TYPE OF REVIEW: A systematic review of publications pertaining to developed questionnaires related with chronic OM. SEARCH STRATEGY: Systematic literature searches of PubMed (1966-January 2007) and EMBASE (1989-January 2007) were conducted, supplemented by using free text words to identify publications after January 2005. RESULTS: The included 15 questionnaires were developed for children with recurrent or persistent OM, describing functional health status (FHS), while two questionnaires also evaluate the effect of tympanostomy tubes insertion. The questionnaires generally cover six impact areas (physical symptoms, child development, educational performance, emotional/practical burden and general health status) with physical symptoms being the most prominant. CONCLUSIONS: The OM8-30, OMO-22 and OM-6 adequately reflect the multidimensional aspects of FHS in chronic OM. The OMO-22 and OM8-30 show the best psychometric properties for the discrimination of impact severity between children, while the OM-6 was found to have the best qualities for the evaluation of clinical change. Clinical applicability is crucial for the assessment of FHS in chronic OM, but requires a trade-off with necessary psychometric properties.

Otoacoustic emissions at compensated middle ear pressure in children.

Middle ear pathology has a negative effect on the detectability of otoacoustic emissions. In this study, we investigated the effect of compensating a deviant static middle ear pressure while measuring transient evoked otoacoustic emissions (TEOAEs). In 59 children (mean age 4 years, 5 months) TEOAEs were measured twice in one session: first at ambient pressure and than at compensated middle ear pressure. On average, TEOAE amplitudes increased by 1.9 dB as a result of middle ear pressure compensation. The amplitude increase was largest in frequency bands centred at 1 and 2 kHz and a statistically significant correlation was found between the amount of compensated pressure and the TEOAE amplitude increase. In the higher frequency bands centred at 3 and 4 kHz, TEOAE amplitudes were almost insensitive to pressure compensation. These results show that measuring OAEs at compensated middle ear pressure enhances the amplitude of TEOAEs, and thus improves the detectability.

Does cognitive function in older adults with hearing impairment improve by hearing aid use?

In the present study, the effects of hearing aid use by hearing-impaired older individuals on different aspects of cognitive function, such as memory, attention, executive functioning, and processing speed, were investigated. Fifty-six participants (mean age = 72.5) who were fitted with hearing aids were compared with 46 control participants (mean age = 74.5) with an equivalent hearing impairment, but who were not fitted with a hearing aid. After a dual baseline measurement and fitting of the hearing aids, all participants were assessed again with neurocognitive tests after 12 months. While the participants with hearing aids had improved aided hearing thresholds, they did not demonstrate an improved performance on the cognitive tests compared to the controls. Thus improved hearing did not improve cognitive functioning. These findings may suggest that hearing aid use only restores impairments at the level of the sensory organ, but does not affect the central nervous system and, as a consequence, cognitive functioning.

A two-step scenario for hearing assessment with otoacoustic emissions at compensated middle ear pressure (in children 1-7 years old).

OBJECTIVE: Otoacoustic emissions (OAEs) are widely used for assessing congenital and early-acquired sensorineural hearing loss in young children. Middle ear pathology has a negative effect on the presence of OAEs. In this study we investigated whether measuring OAEs at compensated middle ear pressure (CMEP) resulted in a higher pass rate than at ambient pressure. Secondly, we analysed the influence of 12 different pass definitions on the pass rates. METHODS: One hundred and eleven children (age 1-7 years, mean 4 years and 5 months) were measured twice in one session: first at ambient pressure and then at CMEP. RESULTS: The study showed a higher pass rate of OAEs at CMEP than at ambient pressure. A two-step scenario reduced the number of fails by 18-26%, depending on the pass/fail definition used. CONCLUSION: Measuring OAEs at CMEP results in higher pass rates. Secondly, pass/fail definitions have a large influence on pass rates and this issue deserves further attention. Further studies must be done, before this method is readily applicable to universal neonatal screening.

Help-seeking behaviour of hearing-impaired persons aged > or = 55 years; effect of complaints, significant others and hearing aid image.

OBJECTIVE: To determine factors influencing help-seeking behaviour in hearing-impaired persons aged > or = 55 years MATERIAL AND METHODS: The study comprised 1,419 persons (480 females, 939 males) aged > or = 55 years who participated voluntarily in a driving test. Pure-tone audiometry was performed in all subjects. Participants without a hearing aid with an average hearing loss of > or = 30 dB in the better ear for the frequencies 0.5, 1, 2 and 4 kHz were asked how they perceived their hearing by means of a structured questionnaire. The questionnaire provided insight into why some hearing-impaired people seek help from a general practitioner (GP) and others do not. Four factors were examined. RESULTS: A total of 483/1.419 (34%) participants tested had a hearing loss exceeding 30 dB. Fewer than half of these had visited their GP with complaints of hearing impairment. Of those who had not sought help from a GP, 57% nevertheless judged their hearing as poor. Social pressure exerted by significant others was less in the non-consulters group. Hearing aid image did not differ significantly between the two groups. CONCLUSION: The help-seeking behaviour of hearing-impaired elderly people is related to the degree of hearing disability and the social pressure exerted by significant others as well as the willingness to try hearing aids.

Effects of early auditory deprivation and stimulation on auditory brainstem responses in the rat.

The purpose of this study was to investigate the effect of auditory sound deprivation or stimulation on auditory brainstem responses (ABRs) during the maturation period of the rat auditory system. At postnatal day (PND) 21, 40 newborn Norway Brown male rats were categorized into 3 groups: (i) an auditory deprivation group in which a bilateral average conductive hearing loss of 27 dB was induced; (ii) an auditory activation group exposed to 65-90 dB sound pressure level; and (iii) a control group. ABR recordings were made on PND 84. In order to compare group differences in interpeak latency (IPL), sensation level (SL), defined as stimulus intensity above threshold, was used. IPL measurements and analysis were restricted to the 20-60 dB SL range. No differences were observed in the IPLs of peaks I-IV between the three groups. Small, but not statistically significant, differences in mean estimated IPLs of peaks I-IV were shown in the ranges > 50 dB SL and < 25 dB SL. Possible confounding factors explaining the apparent discrepancy between these results and those of other animal studies are reviewed.

Response shift in the measurement of quality of life in hearing impaired adults after hearing aid fitting.

UNLABELLED: REASON FOR THE STUDY: Response shift is the change in the meaning of one's self-evaluation of a target construct, like quality of life (QOL). The objective of this study was to investigate whether response shift in the measurement of generic and specific QOL occurred in persons with a relatively mild health condition. For this purpose hearing impairment was used as a research model. MAJOR FINDINGS: Response shift effects were observed in the scores on the dimensions of hearing related QOL. In the scores on overall hearing related QOL, and in the scores on the generic control items, no response shift occurred. CONCLUSIONS: This study showed that response shift effects can take place in a relatively mild condition as well. The occurrence of response shift in QOL ratings over time could have large implications for the estimation of the effectiveness of medical interventions and for the use of these estimations in cost-effectiveness analyses. After a successful treatment the conventional change could be an underestimation of the effectiveness of the treatment, although it has also been argued that psychological adaptation is a welcome capacity of human beings, and that then-test changes do no justice to this capacity.

[Compliance of family physicians with the recommendations of 'Hearing Impairment' guideline by the Dutch College of General Practitioners in treatment of simulated paper cases of hearing loss]. / Overeenstemming tussen het handelen van de huisarts bij papieren casussen van slechthorendheid en de aanbevelingen in de standard 'Slechthorendheid' van het Nederlands Huisartsen Genootschap.

OBJECTIVE: To assess the extent to which the practice of general practitioners (GPs) in dealing with adult hearing-impaired patients complies with the recommendations in the NHG standard on 'Hardness of hearing', one year after its publication. DESIGN: Descriptive. METHOD: Eight paper cases concerning hearing-impaired patients were presented to 10 GPs. The compliance of the GPs' approach with the NHG standard was recorded, and the differences found were motivated by the GPs. RESULTS: Compliance was low for 'anamnesis' (27%), reasonable for 'supplementary examination'--'audiography' (42%) and 'whispered voice test' (12%)--and 'evaluation' (65%), and high for 'physical examination' ('otoscopy' 82%). Adapted questioning for the purpose of establishing the case history was observed. The questioning was adapted in so far as it took into account the information that had already been obtained. 'Management' gave high scores for 'instruction' (85%) and 'referral' (72%). For mostly practical reasons, the whispered voice test, recommended in the NHG standard was scarcely used (12%) whereas the tuning fork tests, which are not advocated in the NHG standard, were often used (43%). CONCLUSION: For the aspects 'otoscopy', 'instruction' and 'referral' the GPs' practice reflected the recommendations contained in the NHG standard 'Hardness of hearing'.

Mild hearing impairment can reduce verbal memory performance in a healthy adult population.

We studied to what extent immediate and delayed recall in an auditory verbal learning paradigm was affected by basic information processing speed (digit copying) and hearing acuity (average hearing acuity at 1, 2 and 4 KHz at the better ear). A group of 453 individuals in the age between 23 and 82 years with no overt hearing pathology was recruited from a larger study of cognitive aging (Maastricht Aging Study, MAAS). After controlling for age, sex, educational level, and processing speed it was found that a mild to moderate hearing loss predicted lower verbal memory performance. Auditory administered verbal memory tests can underestimate true memory performance, particularly in older individuals with unknown hearing status.

Chronic otitis media with effusion during infancy, have parent-reported symptoms prognostic value? A prospective longitudinal study from 0 to 2 years of age.

As a part of a prospective study (age, 0-2 years), the prognostic value of parent-reported symptoms relative to chronic otitis media with effusion (COME) was examined in a group of 122 infants. The occurrence of hearing loss, ear infection, mouth breathing, snoring and common cold was inventoried using a standardised questionnaire filled in by parents at 3-monthly intervals. Tympanometric and otoscopic records were combined for assessment of middle ear status. Subjects were categorized into three groups: none (n = 13), mild (n = 78) and severe (n = 31) COME. Analysis revealed that all symptoms in the first year of life were significantly associated with severe COME. In the second year, only hearing loss was associated with a higher risk for severe COME. The risk for severe COME increased when symptoms were combined. In conclusion, a questionnaire based on only symptoms during the first year of life may assist in screening and managing severe COME.

Definition of hearing impairment and its effect on prevalence figures. A survey among senior citizens.

In order to explain the variation found in the literature, this article describes how the definition of hearing impairment affects reported prevalence when applied to the same population. The study comprised 1041 persons (354 women, 687 men) aged 55 years or older (mean age 67 years, SD 7 years). Pure tone audiometry was performed on all subjects. They were asked about their hearing by means of a structured questionnaire. The prevalences of hearing impairment were calculated based on nine criteria including: participants' subjective impression, five Dutch and international audiometric definitions, consultation of a General Practitioner, referral to an ENT specialist and hearing aid possession. Results showed a variation in prevalence figures from 6 to 30% and 10 to 49%, for women and men, respectively. Definitions including 4 kHz emphasized sex differences more strongly. In conclusion, gross differences in prevalence figures on hearing impairment are found as a result of the definition used. The variation in prevalence figures found in the literature can, at least partly, be explained by the use of different definitions.

[Utilization of middle ear ventilatory tubes for children, ages 0-12 years, in the Netherlands during 1990-1994]. / Incidentie van behandeling met trommelvliesbuisjes bij kinderen van 0-12 jaar in Nederland in 1990-1994.

OBJECTIVE: To explore the incidence of treatment with ventilation tubes in the Netherlands in children from birth to 12 years of age in the period from 1990 to 1994. DESIGN: Secondary data analysis. METHODS: Data on bilateral treatment with ventilation tubes in 1990-1994 in the Netherlands were obtained from the National Medical Register of SIG Health Care Information. Incidence rates of the treatment in children aged 0-12 years were calculated using population estimates issued by the National Department of Statistics. RESULTS: Whereas from 1990 to 1992 the total number of bilateral inserted tubes increased from 39.923 to 51.615, a decrease to 48.635 was observed in 1994. The average incidence rate of treatment with ventilation tubes was 1.97% (range: 0.12%-5.08%) in children from birth to 12 years. Peak incidences were found around 2 years and 6 years of age. Prevalence rates of otitis media with effusion as found in the literature were higher, especially during infancy.

A longitudinal study of the validity of parental reporting in the detection of otitis media and related hearing impairment in infancy.

A total of 150 full-term and 66 pre-term infants were selected at birth and prospectively examined at three-monthly intervals from birth until the age of 27 months. Parental reports of middle ear infection and/or hearing impairment were obtained prior to otoscopic and audiometric evaluation. The relationships between parental reports and the diagnoses acute otitis media (AOM), otitis media with effusion (OME) and hearing impairment (HI), were assessed in terms of sensitivity, specificity and positive and negative predictive values, using the data obtained during the follow-up period. AOM and OME were diagnosed using otoscopy and tympanometry. Hearing was assessed by conditioned orientation reflex audiometry. HI was defined as averaged thresholds > or = 20 dB compared with age-appropriate response levels. Despite the repeated feedback which parents received on the middle ear condition and hearing of their infants, the majority fail to recognize the presence of AOM, OME and HI. The limited sensitivity of parental reporting should discourage both researchers and clinicians from using it as a diagnostic or monitoring instrument, but they should not disregard parental concern when confronted with it.

The initial development of an instrument for the description of "otitis media with effusion specific behavior" in young children.

The objective of this study was a preliminary evaluation of a newly developed questionnaire concerning behavior of young children with recurrent Otitis Media with Effusion (OME) and documenting behavioral change after tympanostomy tube insertion. A sample of 95 parent-child pairs were interviewed using an age specific questionnaire: after diagnosing OME and scheduling for surgery, at the day care theatre a few weeks later, and 6 weeks after the intervention. The levels of internal consistency were varying from still insufficient to fairly good for the different subscales of the construct "OME-specific behavior" and these levels were comparable for both age specific questionnaires. As expected, parental report proved to be stable during time, but behavioral changes were reported after tympanostomy tubes insertion. The questionnaires seem to assess a decline in behavior expected to be specific for OME. Implications for future research are discussed, while considering the influence of parental concerns on behavioral reports.