Psychometric properties of the Swedish version of the international outcome inventory - alternative interventions (IOI-AI) - ear surgery (IOI-AIop).

OBJECTIVE: The aims of this study were to adapt the Swedish version of the International Outcome Inventory for Hearing Aids (IOI-HA) to the International Outcome Inventory for Alternative Interventions (IOI-AI) in the context of ear surgery (IOI-AIop) and to test the psychometric properties. DESIGN: The validated Swedish questionnaire IOI-HA was adapted to the IOI-AIop by omitting the question about hearing aid use and changing the term "hearing aid" to "surgery" in the remaining items. The validity, component structure and reliability of the IOI-AIop were assessed. STUDY SAMPLE: Subjects diagnosed with otosclerosis and undergoing stapedotomy were included in the study (n = 162). RESULTS: High mean scores were noted for all items. Ceiling effects were noted, most pronounced for the satisfaction item. Principal component analysis (PCA) yielded a two-component structure explaining 77.5% of the variance. The test-retest reliability measured by intra class correlation coefficient was >0.9, and the internal consistency coefficient measured by Cronbach's alfa was >0.8. CONCLUSION: The IOI-AIop showed good psychometric properties. However, ceiling effects were observed. The two-component solution was in line with previous factor analyses of the IOI-HA and the IOI-AI. The comprehensive IOI-AIop is recommended as a useful tool to evaluate patient perspectives after ear surgery.

Are there differences in revision stapes surgery outcomes between university and county clinics? A study from the quality register for otosclerosis surgery in Sweden.

PURPOSE: The aim of the study was to investigate hearing outcomes in stapes revision surgery with regard to the type of clinic (university clinic or county clinic). Furthermore, the aim was to investigate the risk of complications with a focus on tinnitus, hearing deterioration, and taste disturbance 1 year after surgery. METHODS: The study is based on data from the Swedish Quality Register for Otosclerosis Surgery (SQOS). Two study protocols were completed by the surgeon, and a questionnaire was distributed to the patients 1 year after surgery. A total of 156 revisions were available for analysis with both preoperative and postoperative audiometry data. RESULTS: Seventy-five percent of the patients reported better to much better hearing 1 year after revision surgery. An air bone gap ≤ 20 dB postoperatively was seen in 77% of the patients. Four percent had hearing deterioration ≥ 20 dB PTA4 AC. Eleven percent had worsened or newly developed tinnitus, 5% had taste disturbance, and 3% had dizziness 1 year after surgery. Preoperative and postoperative hearing did not differ between patients operated on in university vs. county clinics. CONCLUSIONS: Revision surgery in otosclerosis is a challenge for otologists, but no differences in hearing outcomes between university and county clinics were found in this nationwide study. The risk of hearing deterioration and deafness is higher than in primary stapes surgery, and revision surgery should be recommended primarily in cases with a large air-bone gap and moderate to severe preoperative hearing loss.

Otosclerosis revision surgery in Sweden: hearing outcome, predictive factors and complications.

PURPOSE: To describe the procedures and investigate the hearing outcomes and complications after revision surgery for patients with otosclerosis in Sweden and compare these with previously published reports and to investigate factors that may predict the outcomes of revision surgery. METHODS: A total of 254 patients from the Swedish Quality Register for otosclerosis surgery who underwent surgery at 21 clinics were identified as having undergone revision surgery for otosclerosis from 2003 to 2013. Clinical records and audiograms from each of these patients were collected and analyzed. RESULTS: Improvement in hearing by 20 dB or more and closure of air-bone gap (≤ 20 dB) was achieved in 43% and 69% of patients after a first revision operation and in 46% and 70% of patients after a second revision operation. Most patients who underwent surgery because of dizziness were relieved of their dizziness. Postoperative deafness occurred in 2.3% of patients. Prior successful otosclerosis surgery predicted successful revision surgery, especially after a second revision operation. Fixation of the incus or malleus and finding of no obvious reason for the conductive hearing loss predicted a worse hearing outcome. CONCLUSIONS: The hearing results after revision surgery in Sweden is somewhat inferior to those of previously published results involving large centers. Postoperative deafness may be as much as fivefold more common after revision surgery than after primary surgery. Meticulous reading of previous charts and honest counseling regarding the risks and expectations is mandatory before planning revision surgery for otosclerosis.

When Can Stable AutoNRT Thresholds be Expected? A Clinical Implication When Fitting Young Children.

BACKGROUND: Objective measurements are important for programming cochlear implants in young children and other individuals who cannot participate in behavioral measurements. AutoNRT, the automatic method used to record responses from the auditory nerve in the Cochlear Ltd., implant system, is often used as a basis for estimating the threshold level and comfort level (C-level) for these patients. However, it has not been sufficiently established if AutoNRT measurements remain consistent over time. PURPOSE: This study aimed to determine if/when AutoNRT thresholds stabilize. RESEARCH DESIGN: The study design was a longitudinal prospective study. STUDY SAMPLE: AutoNRT thresholds were obtained from 52 young children and 80 adults. All subjects received the same implant (CI24RE Contour Advance). DATA COLLECTION AND ANALYSIS: AutoNRT thresholds were measured on all intracochlear electrodes during the surgery and at the initial activation. During the following year, children were measured at 1, 3, 6, and 12 months, and adults were measured at 6 and 12 months. The results were analyzed based on mean values, correlation, and absolute mean differences. RESULTS: There were large variations for all electrodes between the intraoperative and postoperative AutoNRT thresholds of both children and adults. For children, the thresholds were considered to be stable from 1 month. The correlations obtained between the last two measurements, 6 and 12 months, for both children and adults were generally high for all electrodes. CONCLUSION: The present results demonstrate the importance of repeating the AutoNRT measurement postoperatively, at about 1 month after initial activation, to obtain reliable and stable thresholds for estimating the T- and C-level profiles.

Stapes surgery in Sweden: evaluation of a national-based register.

The aim of the National Quality Registries is to monitor the outcome of healthcare given to patients. The Swedish Quality register for otosclerosis surgery is one of the nine official national registers for ear, nose and throat diseases in Sweden. Since 2004, surgical and audiological results and patient satisfaction scores have been systematically collected from a majority of the ear, nose and throat clinics performing stapes surgery in Sweden. The results of 1688 patients who underwent primary operations for otosclerosis were evaluated for 24 out of totally 26 clinics performing stapes surgery, between 2004 and 2010. The most common surgical technique reported was stapedotomy accomplished in an overnight stay. A majority of patients experienced improved hearing, and were satisfied with the preoperative counselling. Successful surgery, defined as an ABG closure ≤10 dB HL, was achieved in 69%, improvement in AC by ≥20 dB in 63% and BC not worsened by more than ≥5 dB in 93% of the patients. An overall low incidence of postoperative complications was reported. The outcome for ABG and BC was demonstrated to be independent of the number of operations performed by each clinic. An evaluation of the register and the results from the SQOS revealed that stapes surgery is a safe procedure with good hearing outcomes, low complication rates and a high rate of patient's satisfaction on a national level.