Reading Proficiency Trends Following Newborn Hearing Screening Implementation.

OBJECTIVES: To investigate trends in population-level school-aged reading scores among students with hearing loss in an urban Colorado school district after implementation of universal newborn hearing screening (UNHS) and Early Hearing Detection and Intervention. METHODS: The final sample included 1422 assessments conducted during the 2000-2001 through 2013-2014 school years for 321 children with hearing loss in grades 3 through 10. Longitudinal hierarchical linear modeling analyses were used to examine reading proficiency (controlling for birth year, grade in school, free and reduced lunch status, additional disability services, and English not spoken in the home). The Colorado Student Assessment Program was administered to students in third through 10th grades throughout the state. The test years chosen included children born before and after implementation of UNHS. RESULTS: After implementation of UNHS, significant longitudinal reading proficiency improvements were observed by birth year and grade overall and for all subgroups. However, gains in reading proficiency were substantially less for children eligible for free and reduced lunch and those with moderate-severe to profound hearing loss. With each succeeding birth cohort and grade, increased numbers of children participated in testing because of improved language skills, with higher proportions identified as proficient or advanced readers. CONCLUSIONS: Notable improvements in reading proficiency after Early Hearing Detection and Intervention implementation were demonstrated, as all groups of children with hearing loss became more likely to achieve proficient and advanced reading levels. On the other hand, some disparities increased, with greater improvements in reading proficiency for children in economically advantaged families.

Bilateral Auditory Brainstem Implants in Patients With Neurofibromatosis 2.

OBJECTIVE: To discuss indications for bilateral auditory brainstem implants (ABIs), compare audiometric outcomes of unilateral vs bilateral ABIs, and determine if patients have improved outcomes with addition of a second-side implant. STUDY DESIGN: Retrospective review of 24 patients with neurofibromatosis 2 (NF2) who underwent sequential placement of ABIs from 1989 to 2019. SETTING: Tertiary referral center. METHODS: Charts were reviewed for indication for second-side surgery, use of implants, and audiometric outcomes. Implants placed in the past 30 years were included in the study. Northwestern University Children's Perception of Speech (NU-CHIPS) and/or City University of New York (CUNY) sentence scores were compared in unilateral and bilateral conditions. RESULTS: Indications for a second-side implant included first-side implants with severe nonauditory symptoms (11), marginal audiometric results (9), outdated technology (2), or deterioration of first side (2). Seven patients are bilateral users and 1 patient discontinued bilateral use after a year due to no significant improvement over unilateral use. One patient with initial bilateral use was lost to follow-up. Thirteen patients are unilateral users due to nonaudiometric side effects or poor audiometric outcomes with the first side. Two patients are complete nonusers. Seventy-five percent had improved audiometric outcomes after the second-side implant, and 20% had stable findings. CONCLUSIONS: Second-side ABIs should be consider in patients with poor performance from a first-side implant. Most patients demonstrate subjective improvement with the second ABI. More research is needed for better objective assessments of improvements.

Audiological Performance in Children with Inner Ear Malformations Before and After Cochlear Implantation: A Cohort Study of 274 Patients.

BACKGROUND AND OBJECTIVE: Inner ear malformations (IEMs) are common in children with hearing loss. The different types of IEMs form a unique subgroup of cochlear implant (CI) candidates. We aimed to evaluate the auditory perception outcomes of CI in children with different types of IEMs and compare them with CI users without IEMs. METHODS: The study included 274 CI users with and without IEMs as two groups (n = 137, each). Both groups' chronological age at implantation and duration of CI usage was matched (± 8 months). All subjects were evaluated pre-operatively and post-operatively by the Ling's sound test and the auditory perception test battery, which includes the Meaningful Auditory Integration Scale (MAIS), closed-set Pattern Perception Test (PPT) and open-set Sentence Recognition Test (SRT). Besides, children with IEMs were assessed for language development. RESULTS: Progress in the IEMs' group differed according to the type of ear anomaly. CI users with enlarged vestibular aqueduct had the highest scores, while users with common cavity had the lowest. Children with IEMs performed well on the closed-set test while having difficulty with the open-set test. CONCLUSION: Cochlear implantation outcomes are favourable in IEMs' patients with a cochlear nerve visible on magnetic resonance imaging. Our results indicate that it is critical to take the anatomical differences into account during follow-up and rehabilitation programmes. Each CI user should be evaluated according to his or her individual needs.

Uso do sistema auxiliar de escuta com estudantes com deficiência auditiva: identificação de barreiras e facilitadores / Use of hearing assistance technology with students with hearing loss: identification of barriers and facilitators / Uso del sistema auxiliar de escucha com alunos com hipoacusia: identificación de barreras y facilitadores

Introdução: A relação sinal-ruído na sala de aula pode ser um vilão na inclusão na escola regular de alunos com deficiência auditiva, usuários de dispositivos eletrônicos, que utilizam a língua oral para se comunicar. Os recursos tecnológicos são determinantes para a melhor audibilidade de sons de fala em ambientes ruidosos e sua efetividade depende da adesão ao uso do dispositivo. Esse processo é determinado pela parceria entre profissionais da saúde, família e  escola. Objetivo: Identificar a relação entre a utilização consistente do sistema de microfone remoto (SMR) em estudantes com deficiência auditiva e o uso pelos professores, que favoreceram ou dificultaram sua adaptação e o desenvolvimento escolar desses estudantes. Método: Foram analisados 175 sujeitos entre 5 e 17 anos que receberam o SMR num serviço de saúde auditiva entre os anos de 2017 e 2018. Pais e professores de usuários também foram sujeitos do estudo. O funcionamento do SMR e a classificação quanto ao seu uso foram verificados. Resultado: Os indivíduos que mais 'usam' o SMR estão no ensino fundamental I, e os que 'não usam voluntariamente' estão no ensino médio e fundamental II. Considerando-se o tipo de escola, a maioria que 'não usa voluntariamente' o SMR está em escola ou sala para surdos com uso de libras e/ou tem intérprete na sala da escola regular. Conclusão: Houve associação entre uso do SMR e tipo de escola. Recomenda-se que o tipo de escola seja um critério de indicação do dispositivo. O nível educacional também foi uma variável determinante no uso do dispositivo na escola.

Introduction: The signal-to-noise ratio in the classroom can be a villain in the inclusion of hearing-impaired students in regular school, users of electronic devices, that use the oral language to communicate. The technological resources are determinant for better audibility of speech sounds in noisy environments and their effectiveness depends on adherence to the use of the device. This process is determined by the partnership between health professionals, family and school. Objective: Identify the relation between the use of remote microphone system (RMS) in hearing impaired students and the use by teachers, which favored or hindered their adaptation and the school development of hearing-impaired students. Method:175 subjects between 5 and 17 years of age who received the HAT in a hearing health service between the years 2017 and 2018 were analyzed. Parents and teachers of users were also subjects of the study. The functioning of the HAT and the classification regarding its use was verified. Result: Most of the individuals who 'use' HAT are in elementary school, and those who 'don't use it voluntarily' are in high school and middle school. Considering the type of school, most who 'don't use voluntarily' the HAT is in school or room for deaf students using sign language /or has interpreter in regular school. Conclusion:There was an association between the use of the HAT and the type of school. It is recommended that the type of school is a criterion for the indication of the device. The educational level was also a determinant variable in the use of the device at school.

Introducción: La relación señal-ruido en el aula puede ser un villano en la inclusión de estudiantes con discapacidad auditiva en la escuela normal, usuarios de dispositivos electrónicos que utilizan el lenguaje oral para comunicarse. Los recursos tecnológicos son cruciales para una mejor audibilidad de los sonidos del habla en ambientes ruidosos y su eficacia depende de la adherencia al uso del dispositivo. Este proceso está determinado por la asociación entre los profesionales de salud, familia y escuela. Objetivo: Identificar la relación entre el uso del sistema de micrófono remoto(SMR) en los alumnos con deficiencias auditivas y el uso por parte de los maestros, que han favorecido o dificultado su adaptación y el desarrollo escolar de los alumnos con deficiencias auditivas. Método: Se analizaron 175 sujetos de entre 5 y 17 años que recibieron el SMR en un servicio de salud auditiva entre los años 2017 y 2018. Los padres y maestros de los usuarios también fueron sujetos del estudio. Se ha comprobado el funcionamiento del SMR y la clasificación relativa a su uso. Resultado: Los individuos que "usan" más el SMR están en la escuela primaria, y los que "no usan voluntariamente" están en la secundaria. Considerando el tipo de escuela, la mayoría de los que "no usan voluntariamente" el SMR está en una escuela o sala para sordos con uso de libras y/o tiene un intérprete en la sala de la escuela regular. Conclusión: Hubo una asociación entre el uso del SMR y el tipo de la escuela. Se recomienda que el tipo de escuela sea un criterio para indicar el dispositivo. El nivel educativo, también fue una variable determinante en el uso del dispositivo en la escuela.

Comparison of primary musicality development between children with cochlear implants and children with normal hearing.

Background: It is beneficial for CI patients listen to music. However it is necessary to take steps to improve the musicality of CI patients.Objectives: The aims of the study were to evaluate the primary musicality of children with cochlear implants versus those with normal hearing.Material and methods: Children participating in this study were divided into two groups: the cochlear implant group (CI group) and the normal hearing group (NH group). The 'Musical Ears Evaluation Form for Professionals' was used to evaluate the subjects' primary musicality.Results: The scores for overall and the three subcategories of primary musicality in children with cochlear implants and in those with normal hearing also improved significantly over time (p < .05). The score for overall primary musicality was not significantly different between CI and NH groups in the same hearing age (p > .05). There were significant differences between the two groups in the same chronological age (p < .05).Conclusions and significance: The primary musicality in children with cochlear implants was not significantly different from normal hearing ones at the same hearing age. The primary musicality in children with cochlear implants was significantly lower than that of children with normal hearing at the same chronological age.

Don't forget ototoxicity during the SARS-CoV-2 (Covid-19) pandemic!

Aim of this communication is to remind clinical professionals to be aware of ototoxic side effects of several specific drugs proposed for the treatment of the new virus SARS-CoV-2 (Covid-19). In particular, chloroquine and hydroxychloroquine, azithromycin, as well as antiviral drugs such as remdesivir, favipiravir and lopinavir can all present potential ototoxic side effects. The data in the literature do not offer specific information on their potential synergetic effects nor on their interactions.

Exploring perceptions, barriers, and enablers for delivery of primary ear and hearing care by community health workers: a photovoice study in Mukono District, Uganda.

BACKGROUND: Hearing loss is a prevalent but neglected disease, especially in low- or middle-income countries. The role of Community Health Workers (CHWs) to deliver primary ear and hearing care has been explored in several studies from a technical standpoint, but understanding perceptions, barriers, and enablers of such an approach from the perspective of CHWs themselves through a health equity lens has been less well documented. METHODS: This qualitative study used photovoice to explore the views and experiences of CHWs in the Seeta Nazigo Parish of Mukono District in the delivery of ear and hearing care in the community. CHWs were trained in ear and hearing care, and provided with digital cameras to capture photographs related to their work in the community over the following 3 months. Individual interviews regarding the photographs were held at the end of each month, in addition to one focus group discussion. A community workshop was convened at the end of the study to display the photos. Thematic analysis of photographs was conducted using Braune and Clarkes six-step framework. We also used the data to explore potential roles for key stakeholders in primary ear and hearing care, and how photovoice may facilitate their engagement. RESULTS: 13 CHWs participated in the study. Several themes were generated from analysis. CHWs perceived a high burden of ear and hearing disorders in their community and recognised the role they could play in tackling that burden. Potential barriers identified included a lack of equipment, training, and supervision of CHWs; logistical, financial, or psychological barriers to community participation; and the widespread use of traditional medicine. CHWs identified roles for the government and NGO bodies to enable and support delivery of ear and hearing care in the community. The community workshop was a useful method to engage key stakeholders in this topic. CONCLUSIONS: Photovoice is a powerful method to capture issues affecting CHWs. Here it was used to identify a number of perceptions, barriers and enablers to the delivery of ear and hearing care. Our results may inform future strategy in the field of ear and hearing care, and the potential use of photovoice to enact sociocultural change.

A randomised controlled trial of hearing and vision support in dementia: Protocol for a process evaluation in the SENSE-Cog trial.

BACKGROUND: Optimising hearing and vision function may be important in improving a range of outcomes for people living with dementia (PwD) and their companions. The SENSE-Cog cross-national randomised controlled trial (RCT) is evaluating the effectiveness of a sensory intervention (SI) to improve quality of life for PwD with concurrent hearing and/or vision impairment, in five European countries. To ascertain how or why the intervention will, or will not, achieve its outcomes, we have designed a process evaluation to explore potential discrepancies between expected and observed outcomes. This will also help us to understand how context may influence the outcomes. Here we describe the protocol for this process evaluation, which is embedded within the RCT. METHODS/DESIGN: We will use a mixed methods approach with a theoretical framework derived from the UK Medical Research Council's' guidance on process evaluations. It will include the following: (1) evaluating how key aspects of the intervention will be delivered, which will be important to scale the intervention in real world populations; (2) characterising the contextual issues, which may shape the delivery and the impact of the intervention in different countries; and (3) investigating possible causal mechanisms through analyses of potential moderators and mediators. To avoid bias, we will analyse the process data before the analysis of the main effectiveness outcomes. DISCUSSION: This evaluation will provide insight into how the complex SENSE-Cog SI will be tailored, enacted and received across the different European contexts, all of which have unique health and social care economies. The findings will provide insight into the causal mechanisms effecting change, and will determine whether we should implement the intervention, if effective, on a wider scale for PwD and concurrent sensory impairment. TRIAL REGISTRATION: ISRCTN, ISRCTN17056211. Registered on 19 February 2018.

Historical Aspects of Gene Therapy and Stem Cell Therapy in the Treatment of Hearing and Balance Disorder.

This review presents many but not all the major historical events that have led to our current understanding of gene and stem cell therapies for the treatment of hearing and balance disorders in animal models of these disorders. In order to better understand the application of these emerging therapies to the treatment of inner ear disorders in a clinical setting, it has been necessary to provide some genetic and pathobiology backgrounds from both animal models and clinical disorders. The current focus and goal of gene and stem cell therapies are directed toward understanding the effective treatment of animal models that mimic human disorders of hearing and balance. This approach not only addresses the most effective ways to deliver the gene or stem cell therapies to affected inner ears, it also provides an assessment of the efficacy of the applied therapy(s) in achieving either partial or full restoration of either hearing and/or balance within the animal models receiving these therapeutic interventions. This review also attempts to present a realistic assessment of how close the research fields of gene and stem cell therapies are to application for the treatment of human disorders in a clinical setting. Progress made in developing these novel therapies toward clinical applications would not have been possible without the many pioneering studies and discoveries achieved by the investigators cited in this review. There were also many other excellent studies performed by gifted investigators that were not able to be included within this review. Anat Rec, 303:390-407, 2020. © 2019 American Association for Anatomy.

A Regenerative Medicine Approach to the Treatment of Hearing, Balance, and Olfactory Disorders: What Is in the Future for Otolaryngology?

Regenerative medicine is being applied to many fields of medicine and is now starting to be considered and developed for application to treat hearing, balance, olfaction, and voice disorders. This special issue of the Anatomical Record with a series of over 20 papers covers many aspects of gene and stem cell therapies as they are developed for clinical applications in both in vitro and in vivo laboratory studies. These studies cover a wide range of approaches from gene editing in zebrafish with the latest technology (i.e., CRISPR/Cas9) to the isolation of human inner ear progenitor cells, to tracking transplanted human umbilical cord stem cells in mini pigs, to the in vitro building of graft tissues to repair tracheal defects with adipose tissue-derived stem cells. Anat Rec, 303:385-389, 2020. © 2019 American Association for Anatomy.

Impact of an intervention to support hearing and vision in dementia: The SENSE-Cog Field Trial.

OBJECTIVES: Hearing, vision, and cognitive impairment commonly co-occur in older adults. Improving sensory function may positively impact outcomes in people with dementia (PwD). We developed a "sensory intervention" (SI) to support hearing and vision in PwD. Here, we report the findings of an international open-label field trial, and nested case series, to explore the impact of the SI on dementia-related outcomes. METHODS: This was a home-based trial conducted in France, England, and Cyprus. Participants were people with mild-to-moderate dementia and hearing and/or vision impairment (n = 19) and their study partners (unpaid carers; n = 19). The "basic" SI included a hearing and vision assessment and provision of glasses and/or hearing aids. A subsample received the "extended" SI with additional weekly visits from a sensory support therapist (SST). Exploratory analyses of dementia-related, health utility and resource utilisation outcomes were performed. RESULTS: Quality of life (QoL) and sensory functional ability improved. Change in QoL exceeded the threshold for a minimum clinically important difference. There was a modest improvement (in absolute terms) post intervention in behavioural disturbance, self-efficacy, and relationship satisfaction. Study partner time assisting instrumental activities of daily living (iADL) and supervision decreased by about 22 and 38 hours per month, respectively, although time for personal ADL support increased. Qualitative data supported effectiveness of the intervention: PwD were more socially engaged, less isolated, less dependent on study partners, and had improved functional ability and communication. CONCLUSIONS: These findings support the need for a definitive randomised controlled trial (RCT) to evaluate the effectiveness of the intervention.

Feasibility of early activation after cochlear implantation.

OBJECTIVES: The purpose of the study is to investigate feasibility of early activation after cochlear implantation by evaluating long-term impedance change and speech perception. DESIGN: Case-control study SETTING: Between July 2015 and December 2016, we prospectively enrolled 20 subjects for early activation (within 24 hours after cochlear implantation). On the other hand, from November 2013 to July 2015, 20 age- and sex-matched control subjects from the database of cochlear implantees treated with conventional activation schedule (4 weeks after surgery) were retrospectively enrolled. PARTICIPANT: Forty patients who underwent cochlear implantation surgeries. MAIN OUTCOME MEASURES: The series impedance and speech perception score of both groups were compared. RESULTS: No statistical difference in long-term follow-up between the two groups was found using GEEs and multivariate analysis. In the early activation group, impedance reached a steady level by the 2nd postoperative week, and the hearing perception ability significantly improved by the 4th postoperative week. CONCLUSION: This comparative study illustrated sequential impedance data during early activation (24 hours) and conventional activation (4 weeks) after CI surgery. There were no major complications in either group, and the safety of early activation with respect to impedance changes, postoperative residual hearing preservation and speech perception scores were non-inferior to that of the conventional group. Therefore, in this study, we established the feasibility of early activation 24 hours after cochlear implantation.

Why and how music can be used to rehabilitate and develop speech and language skills in hearing-impaired children.

This paper presents evidence for a strong connection between the development of speech and language skills and musical activities of children and adolescents with hearing impairment and/or cochlear implants. This conclusion is partially based on findings for typically hearing children and adolescents, showing better speech and language skills in children and adolescents with musical training, and importantly, showing increases of speech and language skills in children and adolescents taking part in musical training. Further, studies of hearing-impaired children show connections between musical skills, involvement in musical hobbies, and speech and language skills. Even though the field is still lacking large-scale randomised controlled trials on the effects of musical interventions on the speech and language skills of children and adolescents with hearing impairments and cochlear implants, the current evidence seems enough to urge speech therapists, music therapists, music teachers, parents, and children and adolescents with hearing impairments and/or cochlear implants to start using music for enhancing speech and language skills. For this reason, we give our recommendations on how to use music for language skill enhancement in this group.

Measuring temporal response properties of auditory nerve fibers in cochlear implant recipients.

Auditory nerve fibers' (ANFs) refractoriness and facilitation can be quantified in electrically evoked compound action potentials (ECAPs) recorded via neural response telemetry (NRT). Although facilitation has been observed in animals and human cochlear implant (CI) recipients, no study has modeled this in human CI users until now. In this study, recovery and facilitation effects at different masker and probe levels for three test electrodes (E6, E12 and E18) in 11 CI subjects were recorded. The ECAP recovery and facilitation were modeled by exponential functions and the same function used for +10 CL masker offset condition can be applied to all other masker offsets measurements. Goodness of fit was evaluated for the exponential functions. A significant effect of probe level was observed on a recovery time constant which highlights the importance of recording the recovery function at the maximum acceptable stimulus level. Facilitation time constant and amplitude showed no dependency on the probe level. However, facilitation was stronger for masker level at or around the threshold of the ECAP (T-ECAP). There was a positive correlation between facilitation magnitude and amplitude growth function (AGF) slope, which indicates that CI subjects with better peripheral neural survival have stronger facilitation.

Perceived Gaps in Genetics Training Among Audiologists and Speech-Language Pathologists: Lessons From a National Survey.

Purpose The aim of this study was to assess knowledge, self-rated confidence, and perceived relevance of genetics in the clinical practice of audiologists and speech-language pathologists (SLPs) toward a better understanding of the need for genetics education, given that genetics plays a growing role in the diagnosis of hearing impairment and communication disorders. Method A survey consisting of 8 demographic items and 16 content questions was returned by 233 audiologists and 283 SLPs. Knowledge of applied genetics was queried with clinical scenarios in a multiple-choice format. Self-assessment of clinical confidence and perceived relevance of genetics in one's field was queried with questions and statements rated on 5-point Likert scales. The benefit of additional training in genetics was rated with a yes/no question, and if answered with yes, suggested topics were entered. Results A large significant gap between confidence in one's own genetics skills and the perceived relevance of genetics was evident, regardless of professional group. Over one third of the audiologists and over two thirds of the SLPs indicated low or somewhat low confidence in their own ability to implement principles of genetics, whereas over two thirds of both groups agreed that genetics is relevant for their field. Regardless of group, confidence scores were significantly and positively associated with relevance scores. Over 80% of respondents in both groups indicated that they would benefit from additional training in genetics. Most commonly suggested topics included genetic causes, general information about genetics, and making referrals. Conclusion Both audiologists and SLPs felt that genetics is relevant for their fields and that additional training in genetics would be beneficial. Future studies should evaluate the effect of genetics training on patient outcomes and the need for incorporating genetics more extensively into audiology and speech-language pathology training programs.

How Mixed-Effects Modeling Can Advance Our Understanding of Learning and Memory and Improve Clinical and Educational Practice.

Purpose A key goal of researchers, clinicians, and educators within the fields of speech, language, and hearing sciences is to support the learning and memory of others. To do so, they consider factors relevant to the individual, the material to be learned, and the training strategy that can maximize learning and retention. Statistical methods typically used within these fields are inadequate for identifying the complex relationships between these factors and are ill equipped to account for variability across individuals when identifying these relationships. Specifically, traditional statistical methods are often inadequate for answering questions about special populations because samples drawn from these populations are usually small, highly variable, and skewed in distribution. Mixed-effects modeling provides advantages over traditional statistical techniques to answer complex questions while taking into account these common characteristics of special populations. Method and Results Through 2 examples, I illustrate advantages of mixed-effects modeling in answering questions about learning and memory and in supporting better translation of research to practice. I also demonstrate key similarities and differences between analysis of variance, regression analyses, and mixed-effects modeling. Finally, I explain 3 additional advantages of using mixed-effects modeling to understand the processes of learning and memory: the means to account for missing data, assess the contribution of variations in delay intervals, and model nonlinear relationships between factors. Conclusions Through mixed-effects modeling, researchers can disseminate accurate information about learning and memory to clinicians and educators. In turn, through enhanced statistical literacy, clinicians and educators can apply research findings to practice with confidence. Overall, mixed-effects modeling is a powerful tool to improve the outcomes of the individuals that researchers and practitioners serve within the fields of speech, language, and hearing sciences.

Feasibility of an Intervention to Support Hearing and Vision in Dementia: The SENSE-Cog Field Trial.

OBJECTIVES: People with dementia (PwD) frequently experience hearing and vision impairment that is underrecognized and undertreated, resulting in reduced quality of life. Managing these impairments may be an important strategy to improve outcomes in PwD. Our objective was to field-trial a multifaceted sensory intervention (SI) to enhance hearing and vision in PwD. DESIGN: An international single-arm open-label feasibility, acceptability, and tolerability study. SETTING: Home-based setting in the United Kingdom, France, and Cyprus. PARTICIPANTS: Adults aged 60 years and older with mild-to-moderate dementia and uncorrected or suboptimally corrected hearing and/or vision impairment, and their study partners (n = 19 dyads). INTERVENTION: A sensory intervention (SI), comprising assessment of hearing and vision, fitting of corrective devices (glasses, hearing aids), and home-based support from a sensory support therapist for device adherence and maintenance, communication training, referral to support services, environmental sensory modification, and optimization of social inclusion. MEASUREMENTS: Ratings of study procedure feasibility, and intervention acceptability/tolerability, ascertained through questionnaires, participant diaries, therapist logbooks, and semistructured interviews. RESULTS: We successfully delivered all intervention components, and these were received and enacted as intended in all those who completed the intervention. No serious adverse events were reported. Acceptability (ie, understanding, motivation, sense of achievement) and tolerability (ie, effort, fatigue) ratings of the intervention were within a priori target ranges. We met recruitment and retention (93.8%) targets in two of the three sites. Participants completed more than 95% of diary entries, representing minimal missing data. Delays in the logistics circuit for the assessment and delivery of hearing aids and glasses were identified, requiring modification. The need for minor modifications to some outcome measures and the inclusion criteria were identified. CONCLUSION: This is the first study combining home-based hearing and vision remediation in PwD. The positive feasibility, acceptability, and tolerability findings suggest that a full-scale efficacy trial, with certain modifications, is achievable.

Common Audiological Functional Parameters (CAFPAs): statistical and compact representation of rehabilitative audiological classification based on expert knowledge.

OBJECTIVE: As a step towards objectifying audiological rehabilitation and providing comparability between different test batteries and clinics, the Common Audiological Functional Parameters (CAFPAs) were introduced as a common and abstract representation of audiological knowledge obtained from diagnostic tests. DESIGN: Relationships between CAFPAs as an intermediate representation between diagnostic tests and audiological findings, diagnoses and treatment recommendations (summarised as "diagnostic cases") were established by means of an expert survey. Expert knowledge was collected for 14 given categories covering different diagnostic cases. For each case, the experts were asked to indicate expected ranges of diagnostic test outcomes, as well as traffic light-encoded CAFPAs. STUDY SAMPLE: Eleven German experts in the field of audiological rehabilitation from Hanover and Oldenburg participated in the survey. RESULTS: Audiological findings or treatment recommendations could be distinguished by a statistical model derived from the experts' answers for CAFPAs as well as audiological tests. CONCLUSIONS: The CAFPAs serve as an abstract, comprehensive representation of audiological knowledge. If more detailed information on certain functional aspects of the auditory system is required, the CAFPAs indicate which information is missing. The statistical graphical representations for CAFPAs and audiological tests are suitable for audiological teaching material; they are universally applicable for real clinical databases.