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Criter RE, Sheperd M, Northrup D, Shuster L. Perceptions of the Scope of Practice of Audiology. Am J Audiol 2023; 32:930-940. [PMID: 37783210 DOI: 10.1044/2023_aja-23-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
PURPOSE The primary purpose of this study was to determine which scope of practice roles and responsibilities are attributed to the profession of audiology (AUD) relative to other health care disciplines by a group of health and human services faculty and students. METHOD An online survey inquiring about participant knowledge of different health professions' scopes of practice, and experience with and attitude toward the profession of AUD, was sent to faculty and students in the Western Michigan University College of Health and Human Services. Students also completed two subscales of the Interprofessional Attitudes Scale. Descriptive statistics and chi-square and Kruskal-Wallis analyses evaluating response differences between groups are presented. RESULTS Thirty-six faculty and 118 students (48 graduate and 70 undergraduate) completed the survey. AUD was the profession most often associated with all hearing-related scope of practice activities. Speech-language pathology was often associated with hearing-related scope of practice activities. Audiologists were less commonly associated with vestibular, balance, and mobility scope of practice activities. Group was significant for four scope of practice activities. About half of respondents indicated they knew nothing or a little about AUD, and a majority had no or rare interactions with audiologists in class or clinic. Only about half of participants responded they were likely or very likely to refer patients to an audiologist. CONCLUSION Increased knowledge of the scope of practice and exposure to the profession of AUD may benefit other health care professionals and patients, possibly leading to increased interprofessional practice and an increased number of appropriate referrals.
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Affiliation(s)
- Robin E Criter
- Department of Speech, Language and Hearing Sciences, Western Michigan University, Kalamazoo
| | - Melanie Sheperd
- Department of Speech, Language and Hearing Sciences, Western Michigan University, Kalamazoo
| | | | - Linda Shuster
- Department of Speech, Language and Hearing Sciences, Western Michigan University, Kalamazoo
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Zhong Y, Li H, Liu G, Liu J, Mo JJ, Zhao X, Ju Y. Early detection of stroke at the sudden sensorineural hearing loss stage. Front Neurol 2023; 14:1293102. [PMID: 38020605 PMCID: PMC10646485 DOI: 10.3389/fneur.2023.1293102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Background and purpose Sudden sensorineural hearing loss (SSNHL) can be a prodromal symptom of ischemic stroke, especially posterior circulation strokes in the anterior inferior cerebellar artery (AICA) area. Early diagnosis and optimal treatment for vascular SSNHL provide an opportunity to prevent more extensive area infarction. The objective of our research was to find clues that suggest stroke at the stage of isolated sudden hearing loss. Methods We retrospectively investigated the medical records of patients who received an initial diagnosis of sudden sensorineural hearing loss upon admission from January 2017 to December 2022 at Capital Medical University Affiliated Beijing Tiantan Hospital. Among these patients, 30 individuals who developed acute ischemic stroke during their hospital stay were enrolled as the case group. To create a control group, we matched individuals from the nonstroke idiopathic SSNHL patients to the case group in terms of age (±3 years old) at a ratio of 1:4. We collected the clinical characteristics, pure tone hearing threshold test results, and imaging information for all patients included in the study. Results Three models were constructed to simulate different clinical situations and to identify vascular sudden sensorineural hearing loss (SSNHL). The results revealed that patients with SSNHL who had three or more stroke risk factors, bilateral hearing loss, moderately severe to total hearing loss, and any intracranial large artery stenosis and occlusion (≥50%) were at a higher risk of developing ischemic stroke during hospitalization. Consistent with previous studies, the presence of vertigo at onset also played a significant role in the early detection of upcoming stroke. Conclusion Clinicians should be alert to SSNHL patients with bilateral hearing loss, moderately severe to total hearing loss and other aforementioned features. Early pure tone audiometric hearing assessment and vascular assessment are necessary for high-risk patients with SSNHL.
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Affiliation(s)
| | | | | | | | | | | | - Yi Ju
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Stadulni ARP, Sleifer P, Berticelli AZ, Riesgo R, Rocha-Muniz CN, Schochat E. Stroke in children and adolescents: Analysis of electrophysiological and behavioral assessment findings of auditory processing. Clinics (Sao Paulo) 2023; 78:100286. [PMID: 37812955 PMCID: PMC10569949 DOI: 10.1016/j.clinsp.2023.100286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/25/2023] [Accepted: 09/06/2023] [Indexed: 10/11/2023] Open
Abstract
PURPOSE This study aimed to analyze the auditory processing behavior of children and adolescents diagnosed with stroke and compare it with that of typically developing individuals. METHODS This was an analytical cross-sectional study involving 48 participants aged between 7 and 17 years with adequate schooling for age and grade, allocated equally to two groups: Stroke (SG) and Control Groups (CG). For the SG, cases identified between 2003 and 2018 were considered. In the CG, school-aged participants with typical development were randomized. After screening for differential audiological assessment and confirmation of auditory pathway integrity at the brainstem level, binaural analyses of the auditory processing behavior were conducted using the Dichotic Digit Test (DDT), Frequency Pattern Test (FPT), and electrophysiological assessment (P300). The Shapiro-Wilk test for normality was conducted, followed by the T and Mann-Whitney tests, with a 95 % confidence level and significance offset at p < 0.05, using the SPSS software (IBM®, v. 22.) RESULTS: The CG performed better in terms of auditory processing. These differences were significant (p < 0.0001) for the binaural integration of DDT, FPT humming and Labeling, and P300 latency. The P300 results were similar; however, with a greater amplitude in the SG. CONCLUSION This study showed that children and adolescents with stroke performed worse in electrophysiological and behavioral tests of auditory processing assessed using the auditory evoked potentials. These data reinforce the hypothesis that stroke-related lesions compromise the neural mechanisms underlying auditory processing.
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Affiliation(s)
- Andréia Rodrigues Parnoff Stadulni
- Department of Physiotherapy, Speech Therapy and Occupational Therapy, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP, Brazil.
| | - Pricila Sleifer
- Department of Health and Human Communication, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Amanda Zanatta Berticelli
- Graduate Program in Child and Adolescent Health, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Rudimar Riesgo
- Graduate Program in Child and Adolescent Health, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Hospital de Clínicas (HCPA), Porto Alegre, RS, Brazil
| | - Carolina Nunes Rocha-Muniz
- Department of Physiotherapy, Speech Therapy and Occupational Therapy, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Eliane Schochat
- Department of Physiotherapy, Speech Therapy and Occupational Therapy, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Ye X, He P. Economic Burden of Hearing Loss inMiddle-Aged and Older Adults in China. J Appl Gerontol 2023; 42:76-88. [PMID: 36053131 DOI: 10.1177/07334648221124118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Our study aimed to estimate the economic burden of hearing loss. Using data from the China Health and Retirement Longitudinal Study (CHARLS), hearing loss attributed fraction based on the rate of hearing loss was derived. Then, we calculated the direct and indirect economic burden of hearing loss. The base year for the monetary amounts shown was 2015. For middle-aged and older people aged 45+ in China, the economic burden of hearing loss in 2011, 2013, and 2015 was US$6.13 billion, US$7.39 billion, and US$8.50 billion, respectively. The direct economic burden of hearing loss accounted for 46.99%-50.24%, the indirect economic burden of premature death accounted for 49.41%-52.70%, and the indirect economic burden of productivity loss accounted for the least proportion of 0.31%-0.35%. Immediate measures such as hearing loss prevention, hearing screening, and hearing aid wearing should be taken, so as to reduce the economic burden of hearing loss.
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Affiliation(s)
- Xin Ye
- Institute for Global Public Policy, 12478Fudan University, Shanghai, China.,China Center for Health Development Studies, 12465Peking University, Beijing, China
| | - Ping He
- China Center for Health Development Studies, 12465Peking University, Beijing, China
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Hazelton C, Thomson K, Todhunter-Brown A, Campbell P, Chung CS, Dorris L, Gillespie DC, Hunter SM, McGill K, Nicolson DJ, Williams LJ, Brady MC. Interventions for perceptual disorders following stroke. Cochrane Database Syst Rev 2022; 11:CD007039. [PMID: 36326118 PMCID: PMC9631864 DOI: 10.1002/14651858.cd007039.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Perception is the ability to understand information from our senses. It allows us to experience and meaningfully interact with our environment. A stroke may impair perception in up to 70% of stroke survivors, leading to distress, increased dependence on others, and poorer quality of life. Interventions to address perceptual disorders may include assessment and screening, rehabilitation, non-invasive brain stimulation, pharmacological and surgical approaches. OBJECTIVES To assess the effectiveness of interventions aimed at perceptual disorders after stroke compared to no intervention or control (placebo, standard care, attention control), on measures of performance in activities of daily living. SEARCH METHODS: We searched the trials registers of the Cochrane Stroke Group, CENTRAL, MEDLINE, Embase, and three other databases to August 2021. We also searched trials and research registers, reference lists of studies, handsearched journals, and contacted authors. SELECTION CRITERIA We included randomised controlled trials (RCTs) of adult stroke survivors with perceptual disorders. We defined perception as the specific mental functions of recognising and interpreting sensory stimuli and included hearing, taste, touch, smell, somatosensation, and vision. Our definition of perception excluded visual field deficits, neglect/inattention, and pain. DATA COLLECTION AND ANALYSIS One review author assessed titles, with two review authors independently screening abstracts and full-text articles for eligibility. One review author extracted, appraised, and entered data, which were checked by a second author. We assessed risk of bias (ROB) using the ROB-1 tool, and quality of evidence using GRADE. A stakeholder group, comprising stroke survivors, carers, and healthcare professionals, was involved in this review update. MAIN RESULTS We identified 18 eligible RCTs involving 541 participants. The trials addressed touch (three trials, 70 participants), somatosensory (seven trials, 196 participants) and visual perception disorders (seven trials, 225 participants), with one (50 participants) exploring mixed touch-somatosensory disorders. None addressed stroke-related hearing, taste, or smell perception disorders. All but one examined the effectiveness of rehabilitation interventions; the exception evaluated non-invasive brain stimulation. For our main comparison of active intervention versus no treatment or control, one trial reported our primary outcome of performance in activities of daily living (ADL): Somatosensory disorders: one trial (24 participants) compared an intervention with a control intervention and reported an ADL measure. Touch perception disorder: no trials measuring ADL compared an intervention with no treatment or with a control intervention. Visual perception disorders: no trials measuring ADL compared an intervention with no treatment or control. In addition, six trials reported ADL outcomes in a comparison of active intervention versus active intervention, relating to somatosensation (three trials), touch (one trial) and vision (two trials). AUTHORS' CONCLUSIONS: Following a detailed, systematic search, we identified limited RCT evidence of the effectiveness of interventions for perceptual disorders following stroke. There is insufficient evidence to support or refute the suggestion that perceptual interventions are effective. More high-quality trials of interventions for perceptual disorders in stroke are needed. They should recruit sufficient participant numbers, include a 'usual care' comparison, and measure longer-term functional outcomes, at time points beyond the initial intervention period. People with impaired perception following a stroke should continue to receive neurorehabilitation according to clinical guidelines.
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Affiliation(s)
- Christine Hazelton
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Katie Thomson
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
- Department of Occupational Therapy, Human Nutrition & Dietetics, Glasgow Caledonian University, Glasgow, UK
| | - Alex Todhunter-Brown
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Charlie Sy Chung
- Rehabilitation Services, Fife Health and Social Care Partnership, Dunfermline, UK
| | - Liam Dorris
- Paediatric Neurosciences, Royal Hospital for Children, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - David C Gillespie
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Susan M Hunter
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Kris McGill
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | | | - Linda J Williams
- Usher Institute, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
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Sharma S, Prajapati V, Sharma A, Tan BYQ, Sharma VK. Hearing Impairment in Stroke Patients- Findings from a Pilot Study Conducted in India. Indian J Otolaryngol Head Neck Surg 2022; 74:651-657. [PMID: 36032885 PMCID: PMC9411442 DOI: 10.1007/s12070-021-02474-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/16/2021] [Indexed: 10/22/2022] Open
Abstract
Auditory processing difficulties and hearing loss have been reported among stroke survivors, but is largely neglected. Post-stroke hearing impairment may affect communication between stroke survivors and healthcare professionals, thereby restricting rehabilitation and long-term patient outcome. In this prospective pilot study, we sought to determine the prevalence and pattern of hearing loss in stroke patients when compared to age and sex matched controls. 50 consecutive patients with first-ever stroke, both hemorrhagic and ischemic, and a comparison cohort of 50 age and sex matched controls were assessed. Pure Tone Audiogram was performed in all patients within 15 days of stroke onset and mean hearing loss was determined. Mean audiometric threshold was significantly higher in both ears in stroke patients (mean 44.0 ± 12.1 dB) when compared to the control subjects (36.1 ± 11.4 dB; p = 0.001). After adjusting for Diabetes mellitus and hypertension, sensorineural hearing loss was more common and severe in stroke compared to controls (p < 0.005). Most of the strokes were ischemic and involved middle cerebral artery territory. A modest correlation between hearing threshold and stroke severity in both ears was seen (mean B 0.775, R2 0.54, CI 0.122-1.427, p = 0.020). Our pilot study shows significant hearing impairment in patients with stroke, compared to age and sex matched controls with similar prevalence of cardiovascular risk factors, interestingly seen in a predominantly anterior circulation stroke population. Undetected hearing loss may impact post stroke functional recovery. Hence, current rehabilitation guidelines should include auditory screening in all patients of stroke for detection of hearing loss.
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Tan BKJ, Ng FYC, Song HJJMD, Tan NKW, Ng LS, Loh WS. Associations of Hearing Loss and Dual Sensory Loss With Mortality: A Systematic Review, Meta-analysis, and Meta-regression of 26 Observational Studies With 1 213 756 Participants. JAMA Otolaryngol Head Neck Surg 2022; 148:220-234. [PMID: 34967895 PMCID: PMC8719275 DOI: 10.1001/jamaoto.2021.3767] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Hearing loss (HL) and dual sensory loss (DSL) are prevalent, disabling, and associated with numerous age-related health conditions, including dementia and frailty. To date, no evidence-based summary of their mortality risk is available. OBJECTIVE To clarify the epidemiological associations between HL/DSL and mortality. DATA SOURCES PubMed, Embase, and Cochrane Library, from inception until June 18, 2021. STUDY SELECTION Two blinded reviewers selected observational or interventional studies, published as full-length English articles in peer-reviewed journals, that reported the presence or severity of HL or DSL (ie, comorbid HL and vision loss), whether objectively measured or self-reported, in association with any mortality estimate, among adults 18 years and older. DATA EXTRACTION AND SYNTHESIS Two reviewers extracted data and evaluated study bias using the Newcastle-Ottawa Scale, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)/Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines and a PROSPERO-registered protocol. The analysis pooled maximally adjusted estimates using mixed-effects models, measured heterogeneity using I2, investigated sources of heterogeneity using meta-regression and subgroup meta-analyses, examined and adjusted for publication bias, performed influence and cumulative meta-analyses, and assessed evidence quality using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. MAIN OUTCOMES AND MEASURES Hazard ratios (HRs) for all-cause, cardiovascular, or other mortality estimates. RESULTS This review included 14 retrospective and 12 prospective observational studies (1 213 756 participants) from 3220 records. Risk of bias was low to moderate; exclusion of 3 high-risk studies did not alter conclusions. Hearing loss was associated with excess all-cause mortality (HR, 1.13; 95% CI, 1.07-1.19; I2 = 77%; n = 21; 95% prediction interval [PI], 0.93-1.37) and cardiovascular mortality (HR, 1.28; 95% CI, 1.10-1.50; I2 = 60%; n = 6; 95% PI, 0.84-1.96), while DSL was associated with larger excess risks (all-cause: HR, 1.40; 95% CI, 1.30-1.51; I2 = 34%; n = 10; 95% PI, 1.18-1.66; cardiovascular: HR, 1.86; 95% CI, 1.31-2.65; I2 = 0%; n = 2), after adjustment for demographics and comorbidities. Prespecified meta-regression sufficiently explained heterogeneity, with longer follow-up duration weakening the pooled association, leaving low (29%) residual heterogeneity. Meta-regression among audiometric studies showed a dose-response association (doubling of HR per 30-dB increase in HL). Self-reported and audiometric effect sizes were similar, with lower heterogeneity in the latter. Associations were robust to trim-and-fill adjustment for publication bias and single-study influence and cumulative meta-analyses. Associations with accident/injury, cancer, and stroke mortality were inconclusive, with only 1 to 3 studies. Overall evidence quality was moderate. CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, HL and DSL were associated with excess all-cause and cardiovascular mortality. Physicians caring for patients with HL should consider its relevance to general health and longevity.
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Affiliation(s)
- Benjamin Kye Jyn Tan
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | - Faye Yu Ci Ng
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | | | - Nicole Kye Wen Tan
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | - Li Shia Ng
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore,Department of Otolaryngology–Head & Neck Surgery, National University Health System (NUHS), Singapore
| | - Woei Shyang Loh
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore,Department of Otolaryngology–Head & Neck Surgery, National University Health System (NUHS), Singapore
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Abstract
Purpose of the Review The goal of this review is to highlight current approaches to diagnosis and treatment for adult-onset hearing loss in patients likely to present to a neurologist's office. The review will discuss primary and secondary causes of acute and chronic hearing loss, and will discuss common situations that can be managed by a neurologist as well as situations that require immediate care and referral for further management by an otolaryngologist-head and neck surgeon. Recent Findings Hearing screening assessments using mobile applications and tablet devices are now available and can be integrated into many clinical practice settings, including in the evaluation of hearing concerns related to various neurological pathologies. For patients presenting with a sudden worsening in hearing, bedside evaluation, including with objective measures of hearing, can inform neurologists about diagnosis and subsequent management. For patients who present with gradual worsening in hearing, particularly those related to neurologic disorders, hearing care can be an important adjunct to ongoing neurologic care. More commonly encountered, age-related hearing loss is highly prevalent among older adults and may affect overall neurological assessment, including neurocognitive testing, as well as patient-provider communication, patient satisfaction, and care outcomes. Hearing loss is increasingly recognized as a potentially modifiable risk factor for dementia. Neurologists can support the hearing health of their patients through the routine use of communication strategies and by integrating simple, low-cost technology with their current clinical practices. Summary Both acute and chronic hearing loss can be a symptom of many conditions managed by neurologists. Few conditions are emergent, requiring immediate referral to and treatment by an otolaryngologist-head and neck surgeon. Despite the range of hearing interventions available, including hearing aids, over-the-counter devices, and aural rehabilitation, hearing loss is a common and under-treated chronic health condition. By promptly addressing a patient's hearing concerns, neurologists can improve patients' awareness of the deficit and support the overall importance of maintaining sensory health across the life course.
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Bailey RR, Conroy M. Diabetes and obesity are associated with disability in community-dwelling stroke survivors: A cross-sectional study of 37,955 Behavioral Risk Factor Surveillance System respondents. Top Stroke Rehabil 2021; 29:156-162. [PMID: 33775239 DOI: 10.1080/10749357.2021.1904537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose. Stroke increases risk for disability. Obesity and diabetes also increase risk for disability in the general population, but their association with disability in stroke survivors is unknown. We examined disability risk associated with obesity and diabetes in stroke survivors across six disability types: hearing, vision, cognition, mobility, and basic and instrumental activities of daily living (ADLs).Materials and Methods. Data from 37,955 community-dwelling US stroke survivors aged ≥18 years were analyzed from the 2017 and 2018 Behavioral Risk Factor Surveillance System. Linear regression was used to calculate prevalence of each disability type. Survivors were stratified by obesity versus normal weight and diabetes vs no diabetes, and logistic regression was used to calculate adjusted odds ratios (AOR) for each disability type, adjusted for demographic information.Results. Prevalences of disability types ranged from 14.2% to 36.0%. Among survivors with obesity, odds were elevated for mobility (AOR: 1.68) and basic ADL (AOR: 1.55) disability. Among survivors with diabetes, odds were elevated for all disability types (AOR range: 1.15-1.71).Conclusion. Stroke survivors with obesity or diabetes experience increased risk for disability compared to survivors without these chronic conditions. Interventions for managing disability, obesity, and diabetes concomitantly may be warranted and deserve further consideration.
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Affiliation(s)
- Ryan R Bailey
- Department of Occupational and Recreational Therapies, College of Health, University of Utah
| | - Molly Conroy
- Division of General and Internal Medicine, Department of Internal Medicine, School of Medicine, University of Utah
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Yoo HJ, Ham J, Duc NT, Lee B. Quantification of stroke lesion volume using epidural EEG in a cerebral ischaemic rat model. Sci Rep 2021; 11:2308. [PMID: 33504903 PMCID: PMC7841185 DOI: 10.1038/s41598-021-81912-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 01/08/2021] [Indexed: 01/01/2023] Open
Abstract
Precise monitoring of the brain after a stroke is essential for clinical decision making. Due to the non-invasive nature and high temporal resolution of electroencephalography (EEG), it is widely used to evaluate real-time cortical activity. In this study, we investigated the stroke-related EEG biomarkers and developed a predictive model for quantifying the structural brain damage in a focal cerebral ischaemic rat model. We enrolled 31 male Sprague-Dawley rats and randomly assigned them to mild stroke, moderate stroke, severe stroke, and control groups. We induced photothrombotic stroke targeting the right auditory cortex. We then acquired EEG signal responses to sound stimuli (frequency linearly increasing from 8 to 12 kHz with 750 ms duration). Power spectral analysis revealed a significant correlation of the relative powers of alpha, theta, delta, delta/alpha ratio, and (delta + theta)/(alpha + beta) ratio with the stroke lesion volume. The auditory evoked potential analysis revealed a significant association of amplitude and latency with stroke lesion volume. Finally, we developed a multiple regression model combining EEG predictors for quantifying the ischaemic lesion (R2 = 0.938, p value < 0.001). These findings demonstrate the potential application of EEG as a valid modality for monitoring the brain after a stroke.
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Affiliation(s)
- Hyun-Joon Yoo
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Korea
| | - Jinsil Ham
- Department of Biomedical Science and Engineering (BMSE), Institute Integrated Technology (IIT), Gwangju Institute of Science and Technology (GIST), 123 Cheomdan-gwagiro, Buk-gu, Gwangju, 61005, Korea
| | - Nguyen Thanh Duc
- Department of Biomedical Science and Engineering (BMSE), Institute Integrated Technology (IIT), Gwangju Institute of Science and Technology (GIST), 123 Cheomdan-gwagiro, Buk-gu, Gwangju, 61005, Korea
| | - Boreom Lee
- Department of Biomedical Science and Engineering (BMSE), Institute Integrated Technology (IIT), Gwangju Institute of Science and Technology (GIST), 123 Cheomdan-gwagiro, Buk-gu, Gwangju, 61005, Korea.
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11
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Abstract
Acute stroke assessment is classically supported by clinical localization whereby presenting disabilities are associated with key arterial territories in the brain. Clinical localization skills are rarely taught to nonneurologists; yet, these skills are essential to the provision of evidence-based nursing care of stroke, enabling rapid patient identification, diagnosis, and ultimately, the delivery of acute treatment. This article explores the process of clinical localization in relation to the physiology affected by stroke vascular insufficiency. Elements of the neurologic examination are described as they relate to discreet areas in the brain and the National Institutes of Health Stroke Scale.
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Affiliation(s)
- Wendy Dusenbury
- College of Nursing University of Tennessee Health Science Center, 920 Madison Avenue, Office Suite 568, Memphis, TN 38163.
| | - Anne W Alexandrov
- College of Nursing University of Tennessee Health Science Center, 920 Madison Avenue, Office Suite 568, Memphis, TN 38163
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12
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Clinical characteristics of cerebral hemorrhage with bilateral sudden deafness as the first symptom. Neurol Sci 2020; 42:141-150. [PMID: 32556747 DOI: 10.1007/s10072-020-04515-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 06/04/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To summarize and analyze the clinical data of 12 Chinese patients of cerebral hemorrhage with bilateral sudden deafness as the first symptom and to explore the relationship between cerebral hemorrhage and bilateral sudden deafness. METHODS Retrospective analysis of clinical data of patients, including age, clinical manifestations, location of cerebral hemorrhage, hearing loss, and recovery. RESULTS The average age of onset in 12 patients was 53.92 years, 9 had a history of hypertension, 7 had a history of stroke, and 6 had typical stroke symptoms. There were 7 cases of basal ganglia hemorrhage; 2 cases of cerebellum hemorrhage; and 1 case of pontine hemorrhage, temporal lobe hemorrhage, and thalamus infarction. The auditory brainstem evoked potential test results of 3 patients were normal, and 5 of 6 patients who completed pure tone audiometry had hearing impairment. Five out of 9 patients had basically or completely recovered hearing. CONCLUSION The results showed that patients were mostly middle-aged and elderly with no typical stroke symptoms, and a history of stroke and hypertension increased the risk of hearing loss. The cause of hearing loss in patients with cerebral hemorrhage may be related to the damage of the hearing conduction pathway or (and) the lack of blood supply to the central auditory nervous system. Detecting hearing impairment in time and actively intervening can help most patients to improve their hearing significantly. The degree of hearing damage and recovery is related to the bleeding site, the amount of bleeding, and the timely treatment.
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Liu W, Meng Q, Wang Y, Yang C, Liu L, Wang H, Su Z, Kong G, Zhao Y, Zhang L. The association between reduced kidney function and hearing loss: a cross-sectional study. BMC Nephrol 2020; 21:145. [PMID: 32321468 PMCID: PMC7178984 DOI: 10.1186/s12882-020-01810-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 04/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background The relationship between kidney function and hearing loss has long been recognized, but evidence of this association mostly comes from small observational studies or other populations. The aim of this study is to explore the association between reduced kidney function and hearing loss in a large population-based study among the middle-aged and elderly Chinese. Methods Data collected from the Chinese Health and Retirement Longitudinal Study (CHARLS) in 2015 were used for analysis. A cross-sectional study was conducted among 12,508 participants aged 45 years and older. Hearing loss, the outcome of this study, was defined according to interviewees’ responses to three survey questions related to hearing in the CHARLS. Estimated glomerular filtration rate (eGFR) was employed to assess kidney function, and participants were classified into three categories based on eGFR: ≥90, 60–89 and < 60 mL/min/1.73 m2. Multivariable logistic regression was employed to adjust for potential confounders, including demographics, health-related behaviors, and cardiovascular risk factors. Results The overall prevalence of self-reported hearing loss in the study population was 23.6%. Compared with participants with eGFR ≥90 mL/min/1.73 m2, participants with eGFR of 60–89 mL/min/1.73 m2 (odds ratio [OR]: 1.11, 95% confidence interval [CI]: 1.00–1.23) and eGFR < 60 mL/min/1.73 m2 (OR: 1.25, 95% CI: 1.04–1.49) showed increased risk of hearing loss after adjusting for potential confounders. Conclusions Reduced kidney function is independently associated with hearing loss. Testing for hearing should be included in the integrated management of patients with chronic kidney disease.
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Affiliation(s)
- Wenwen Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Qinqin Meng
- Institute of Social Science Survey, Peking University, Beijing, China
| | - Yafeng Wang
- Institute of Social Science Survey, Peking University, Beijing, China
| | - Chao Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Lili Liu
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Huaiyu Wang
- National Institute of Health Data Science, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Zaiming Su
- National Institute of Health Data Science, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Guilan Kong
- National Institute of Health Data Science, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China. .,Center for Data Science in Health and Medicine, Peking University, Beijing, China.
| | - Yaohui Zhao
- National School of Development, Peking University, 5 Yiheyuan Road, Haidian District, Beijing, 100871, China.
| | - Luxia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, 8 Xishiku Street, Xicheng District, Beijing, 100034, China. .,National Institute of Health Data Science, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China. .,Center for Data Science in Health and Medicine, Peking University, Beijing, China.
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14
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Hardy CJD, Frost C, Sivasathiaseelan H, Johnson JCS, Agustus JL, Bond RL, Benhamou E, Russell LL, Marshall CR, Rohrer JD, Bamiou DE, Warren JD. Findings of Impaired Hearing in Patients With Nonfluent/Agrammatic Variant Primary Progressive Aphasia. JAMA Neurol 2020; 76:607-611. [PMID: 30742208 PMCID: PMC6515576 DOI: 10.1001/jamaneurol.2018.4799] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Question What is the status of peripheral hearing in patients with nonfluent/agrammatic variant primary progressive aphasia (nfvPPA)? Findings Patients with nfvPPA performed worse on pure-tone audiometry than healthy older individuals or patients with Alzheimer disease, after controlling for age and general disease factors. In addition, these patients showed increased functional interaural audiometric asymmetry. Meaning Auditory system involvement in patients with nfvPPA is more substantial than previously recognized. Importance Despite being characterized as a disorder of language production, nonfluent/agrammatic variant primary progressive aphasia (nfvPPA) is frequently associated with auditory symptoms. However, to our knowledge, peripheral auditory function has not been defined in this condition. Objective To assess peripheral hearing function in individuals with nfvPPA compared with healthy older individuals and patients with Alzheimer disease (AD). Design, Setting, and Participants This cross-sectional single-center study was conducted at the Dementia Research Centre of University College London between August 2015 and July 2018. A consecutive cohort of patients with nfvPPA and patients with AD were compared with healthy control participants. No participant had substantial otological or cerebrovascular disease; all eligible patients fulfilling diagnostic criteria and able to comply with audiometry were included. Main Outcomes and Measures We measured mean threshold sound levels required to detect pure tones at frequencies of 500, 1000, 2000, 4000, and 6000 Hz in the left and right ears separately; these were used to generate better-ear mean and worse-ear mean composite hearing threshold scores and interaural difference scores for each participant. All analyses were adjusted for participant age. Results We studied 19 patients with nfvPPA (9 female; mean [SD] age, 70.3 [9.0] years), 20 patients with AD (9 female; mean [SD] age, 69.4 [8.1] years) and 34 control participants (15 female; mean [SD] age, 66.7 [6.3] years). The patients with nfvPPA had significantly higher scores than control participants on better-ear mean scores (patients with nfvPPA: mean [SD], 36.3 [9.4] decibels [dB]; control participants: 28.9 [7.3] dB; age-adjusted difference, 5.7 [95% CI, 1.4-10.0] dB; P = .01) and worse-ear mean scores (patients with nfvPPA: 42.2 [11.5] dB; control participants: 31.7 [8.1] dB; age-adjusted difference, 8.5 [95% CI, 3.6-13.4] dB; P = .001). The patients with nfvPPA also had significantly higher better-ear mean scores than patients with AD (patients with AD: mean [SD] 31.1 [7.5] dB; age-adjusted difference, 4.8 [95% CI, 0.0-9.6] dB; P = .048) and worse-ear mean scores (patients with AD: mean [SD], 33.8 [8.2] dB; age-adjusted difference, 7.8 [95% CI, 2.4-13.2] dB; P = .005). The difference scores (worse-ear mean minus better-ear mean) were significantly higher in the patients with nfvPPA (mean [SD], 5.9 [5.2] dB) than control participants (mean [SD], 2.8 [2.2] dB; age-adjusted difference, 2.8 [95% CI, 0.9-4.7] dB; P = .004) and patients with AD (mean [SD], 2.8 [2.1] dB; age-adjusted difference, 3.0 [95% CI, 0.9-5.1] dB; P = .005). Conclusions and Relevance In this study, patients with nfvPPA performed worse on pure-tone audiometry than healthy older individuals or patients with AD, and the difference was not attributable to age or general disease factors. Cases of nfvPPA were additionally associated with increased functional interaural audiometric asymmetry. These findings suggest conjoint peripheral afferent and more central regulatory auditory dysfunction in individuals with nfvPPA.
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Affiliation(s)
- Chris J D Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Chris Frost
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, London, United Kingdom.,Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Harri Sivasathiaseelan
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Jeremy C S Johnson
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Jennifer L Agustus
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Rebecca L Bond
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Elia Benhamou
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Lucy L Russell
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Charles R Marshall
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, London, United Kingdom.,Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Doris-Eva Bamiou
- University College London Ear Institute and University College London Hospitals Biomedical Research Centre, National Institute for Health Research, London, United Kingdom
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, London, United Kingdom
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15
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Koohi N, Vickers DA, Utoomprurkporn N, Werring DJ, Bamiou DE. A Hearing Screening Protocol for Stroke Patients: An Exploratory Study. Front Neurol 2019; 10:842. [PMID: 31447763 PMCID: PMC6691813 DOI: 10.3389/fneur.2019.00842] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 07/19/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Auditory impairment post stroke is common and may be due to both peripheral hearing loss and or central auditory processing disorder (CAPD). When auditory impairment remains untreated, it may impact on patient communication and rehabilitation after stroke. Offering a comprehensive audiological assessment to all stroke patients would be both costly and time-consuming. A brief hearing screening is thus required. Objective: The aim of this study was to determine whether a two-tiered hearing screening approach, with use of a handheld hearing screener and two validated hearing questionnaires could be used as a hearing screening for peripheral hearing loss and CAPD in stroke survivors. The sensitivity and specificity of the screening method was analyzed. Methods: This was a prospective study conducted in a tertiary neurology hospital. Forty-two consecutive stroke patients were recruited and tested within 3-12 months post-onset of their stroke. Three screening tools for the identification of hearing impairment were evaluated in this study: A handheld hearing screener for determination of peripheral audiometric hearing loss and two validated questionnaires (The Amsterdam Inventory Auditory for Disability (AIAD) and the Hearing Handicap Inventory for Elderly (HHIE) questionnaires) for determination of peripheral hearing loss and/or CAPD. Results: The hearing screener had a sensitivity of 92. 59% detecting a hearing loss and specificity of 100%. The greatest test accuracy in identifying a central auditory processing type hearing impairment in stroke patients was found when the handheld hearing screener and the AIAD questionnaire were combined. Conclusion: This study is a first step toward addressing the complex auditory needs of stroke survivors in a systematic manner, with the ultimate aim to support their communication needs and long-term recovery and wellbeing. Registration: Project Identification number 11/0469 and REC ref 11/LO/1675.
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Affiliation(s)
- Nehzat Koohi
- Department of Neuro-audiology, The Ear Institute, University College London, London, United Kingdom
- Neuro-otology Department, University College London Hospitals, London, United Kingdom
| | - Deborah A. Vickers
- Speech Hearing and Phonetic Sciences, University College London, London, United Kingdom
| | - Nattawan Utoomprurkporn
- Department of Neuro-audiology, The Ear Institute, University College London, London, United Kingdom
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - David J. Werring
- Neuro-otology Department, University College London Hospitals, London, United Kingdom
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, Institute of Neurology, University College London Hospitals, London, United Kingdom
| | - Doris-Eva Bamiou
- Department of Neuro-audiology, The Ear Institute, University College London, London, United Kingdom
- Neuro-otology Department, University College London Hospitals, London, United Kingdom
- Biomedical Research Centre, National Institute for Health Research, London, United Kingdom
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16
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Ghai S. Effects of Real-Time (Sonification) and Rhythmic Auditory Stimuli on Recovering Arm Function Post Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2018; 9:488. [PMID: 30057563 PMCID: PMC6053522 DOI: 10.3389/fneur.2018.00488] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/05/2018] [Indexed: 01/15/2023] Open
Abstract
Background: External auditory stimuli have been widely used for recovering arm function post-stroke. Rhythmic and real-time auditory stimuli have been reported to enhance motor recovery by facilitating perceptuomotor representation, cross-modal processing, and neural plasticity. However, a consensus as to their influence for recovering arm function post-stroke is still warranted because of high variability noted in research methods. Objective: A systematic review and meta-analysis was carried out to analyze the effects of rhythmic and real-time auditory stimuli on arm recovery post stroke. Method: Systematic identification of published literature was performed according to PRISMA guidelines, from inception until December 2017, on online databases: Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE, and PROQUEST. Studies were critically appraised using PEDro scale. Results: Of 1,889 records, 23 studies which involved 585 (226 females/359 males) patients met our inclusion criteria. The meta-analysis revealed beneficial effects of training with both types of auditory inputs for Fugl-Meyer assessment (Hedge's g: 0.79), Stroke impact scale (0.95), elbow range of motion (0.37), and reduction in wolf motor function time test (-0.55). Upon further comparison, a beneficial effect of real-time auditory feedback was found over rhythmic auditory cueing for Fugl-meyer assessment (1.3 as compared to 0.6). Moreover, the findings suggest a training dosage of 30 min to 1 h for at least 3-5 sessions per week with either of the auditory stimuli. Conclusion: This review suggests the application of external auditory stimuli for recovering arm functioning post-stroke.
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Affiliation(s)
- Shashank Ghai
- Institute for Sports Science, Leibniz University Hannover, Hannover, Germany
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17
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Wattamwar K, Qian ZJ, Otter J, Leskowitz MJ, Caruana FF, Siedlecki B, Spitzer JB, Lalwani AK. Association of Cardiovascular Comorbidities With Hearing Loss in the Older Old. JAMA Otolaryngol Head Neck Surg 2018; 144:623-629. [PMID: 29902313 PMCID: PMC6145783 DOI: 10.1001/jamaoto.2018.0643] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 03/20/2018] [Indexed: 01/04/2023]
Abstract
Importance In the United States, the population of individuals older than 80 years is expected to double in the next 40 years. Cardiovascular comorbidities are prevalent in this older old population, and their relationship with hearing loss has not been well characterized. Objective To investigate the association of cardiovascular disease (CVD)-related risk factors with auditory function among the older old (>80 years). Design, Setting, and Participants Audiological data and medical records from 2001 through 2014 of 433 patients aged 80 to 106 years at an academic medical center were analyzed in 2017. Main Outcomes and Measures The degree of low- and high-frequency hearing loss of participants with coronary artery disease, diabetes, hypertension, history of cerebrovascular accident, and smoking status was compared with that of disease-free individuals. Rate of hearing loss was also determined. Results Among the 433 patients (67% female; mean [SD] age, 89 [5.8] years), the presence of at least 1 cardiovascular morbidity was associated with elevated mean (SD) low-frequency pure-tone average (LFPTA) of 42.4 (1.6) vs 36.9 (3.5) decibels hearing loss (dB HL), a difference of 5.47 (95% CI, 4.15-9.49) dB HL. Among the 96 patients with 2 audiograms performed at age 80 years or older from which the rate of hearing loss could be calculated, 32 patients had CVD or related risk factors and 64 were healthy controls. Those with at least 1 disease had accelerated hearing loss. Patients with cardiovascular morbidity experienced a faster mean (SD) decline in LFPTA of 1.90 (0.27) vs 1.18 (0.42) dB HL/y, a difference of 0.72 (95% CI, 0.08-1.36) dB HL/y. Of the conditions studied, coronary artery disease had the highest association with audiometric thresholds and was associated with hearing loss at all frequencies tested and with poor word recognition score. Hearing loss was more strongly associated with CVD risk factors in men than in women. Conclusions and Relevance In this study of the older old, cardiovascular risk factors and disease were associated with worse hearing and a greater rate of hearing deterioration. Hearing loss in women was less associated with the presence of CVD, possibly owing to the cardioprotective effects of estrogen. The association of hearing with CVD severity and management remains to be determined.
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Affiliation(s)
| | - Z. Jason Qian
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Jenna Otter
- Department of Emergency Medicine, Temple University, Philadelphia, Pennsylvania
| | | | - Francesco F. Caruana
- Department of Otolaryngology, Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Barbara Siedlecki
- Department of Otolaryngology, Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Jaclyn B. Spitzer
- Department of Otolaryngology, Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Anil K. Lalwani
- Department of Otolaryngology, Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York, New York
- New York Presbyterian, Columbia University Medical Center, New York, New York
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18
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Kuo CL, Shiao AS, Wang SJ, Chang WP, Lin YY. Risk of sudden sensorineural hearing loss in stroke patients: A 5-year nationwide investigation of 44,460 patients. Medicine (Baltimore) 2016; 95:e4841. [PMID: 27603402 PMCID: PMC5023925 DOI: 10.1097/md.0000000000004841] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Poststroke sudden sensorineural hearing loss (SSNHL) can hinder communication between patients and healthcare professionals, thereby restricting participation in rehabilitation programs and limiting improvements in physical performance. However, the relationship between stroke and SSNHL remains unclear. This study employed a nationwide population-based dataset to investigate the relationship between stroke and SSNHL.The Taiwan Longitudinal Health Insurance Database was used to compile data from 11,115 stroke patients and a comparison cohort of 33,345 matched nonstroke enrollees. Each patient was followed for 5 years to identify new-onset SSNHL. Stratified Cox proportional-hazard regression analysis was used to examine the association of stroke with subsequent SSNHL.Among the 44,460 patients, 66 patients (55,378 person-years) from the stroke cohort and 105 patients (166,586 person-years) from the comparison cohort were diagnosed with SSNHL. The incidence of SSNHL was approximately twice as high among stroke patients than among nonstroke patients (1.19 and 0.63/1000 person-years, respectively). Stroke patients had a 71% increased risk of SSNHL, compared with nonstroke patients (adjusted hazard ratio [HR] 1.71, 95% confidence interval [CI] 1.24-2.36). We also observed a remarkable increase in risk of SSNHL in stroke patients within 1-year of follow-up (adjusted HR 5.65, 95% CI 3.07-10.41) or under steroid therapy during hospitalization (adjusted HR 5.14, 95% CI 2.08-12.75).Patients with stroke had a higher risk of subsequent SSNHL compared with patients without stroke. In particular, stroke patients within 1-year follow-up and those undergoing steroid therapy during hospitalization should be treated with the utmost caution, considering that the risk of SSNHL increases by more than 5-fold.
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Affiliation(s)
- Chin-Lung Kuo
- Institute of Brain Science, National Yang-Ming University
- Faculty of Medicine, National Yang-Ming University School of Medicine
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital
- Department of Otolaryngology, Taoyuan Armed Forces General Hospital, Taoyuan
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - An-Suey Shiao
- Faculty of Medicine, National Yang-Ming University School of Medicine
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Shuu-Jiun Wang
- Institute of Brain Science, National Yang-Ming University
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital
- Faculty of Medicine, National Yang-Ming University School of Medicine
| | - Wei-Pin Chang
- School of Health Care Administration, Taipei Medical University
- Correspondence: Dr Yung-Yang Lin, Institute of Brain Science, National Yang-Ming University; Department of Neurology, Taipei Veterans General Hospital, No. 201, Shih-Pai Rd., Taipei 112, Taiwan, ROC (e-mail: ); Dr Wei-Pin Chang, School of Health Care Administration, Taipei Medical University, 250 Wu-Hsing Street, Taipei, Taiwan, ROC (e-mail: )
| | - Yung-Yang Lin
- Institute of Brain Science, National Yang-Ming University
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital
- Laboratory of Neurophysiology
- Integrated Brain Research Laboratory, Taipei Veterans General Hospital
- Faculty of Medicine, National Yang-Ming University School of Medicine
- Institute of Physiology, National Yang-Ming University
- Institute of Clinical Medicine, National Yang-Ming University, Taipei
- Correspondence: Dr Yung-Yang Lin, Institute of Brain Science, National Yang-Ming University; Department of Neurology, Taipei Veterans General Hospital, No. 201, Shih-Pai Rd., Taipei 112, Taiwan, ROC (e-mail: ); Dr Wei-Pin Chang, School of Health Care Administration, Taipei Medical University, 250 Wu-Hsing Street, Taipei, Taiwan, ROC (e-mail: )
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19
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Vorlová T, Dlouhá O, Kemlink D, Šonka K. Decreased perception of high frequency sound in severe obstructive sleep apnea. Physiol Res 2016; 65:959-967. [PMID: 27539102 DOI: 10.33549/physiolres.933167] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by recurrent episodes of upper airway obstruction during sleep, which is manifested by apnea or hypopnea. Decreased blood oxygen saturation, changes in heart rate, fluctuations in brain perfusion, changes in intracranial pressure, snoring and vibration are factors that may potentially affect hearing in patients with OSA. The aim of the present study was to test the hypothesis that hearing is affected in OSA. 43 males aged 34-74 years (mean 48.2) with suspected sleep-disordered breathing without other comorbidity or medication that may affect sleep or hearing were included. Nocturnal polysomnography, pure tone audiometry (PTA), transient evoked otoacoustic emissions (TEOAE) and brainstem auditory evoked potentials (BAEP) were evaluated. The severity of OSA was indicated by the number of apneas and hypopneas per hour of sleep (apnoe/hypopnoe index - AHI). OSA (AHI>/=5) was detected in 28 patients by polysomnography. Mild OSA (AHI 5-15) was confirmed in 11 patients, severe OSA (AHI>/=30) in 17 patients. Simple snoring (AHI<5) was diagnosed in 15 males. In patients suffering from severe OSA, tone audiometry demonstrated higher auditory threshold at frequencies of 4000 and 8000 Hz than in patients with AHI<15 (p<0.005). Auditory threshold values correlated with age in all groups. At a frequency of 8000 Hz, auditory threshold additionally correlated with BMI, AHI, oxygen desaturation index and decreased oxygen saturation. No differences were detected in TEOAE and BAEP between subjects with OSA and snoring. PTA and TEOAE decreased with increasing age. The present results show decreased perception of high frequency sound in severe OSA.
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Affiliation(s)
- T Vorlová
- Department of Neurology and Center for Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
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20
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Purdy SC, Wanigasekara I, Cañete OM, Moore C, McCann CM. Aphasia and Auditory Processing after Stroke through an International Classification of Functioning, Disability and Health Lens. Semin Hear 2016; 37:233-46. [PMID: 27489401 DOI: 10.1055/s-0036-1584408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Aphasia is an acquired language impairment affecting speaking, listening, reading, and writing. Aphasia occurs in about a third of patients who have ischemic stroke and significantly affects functional recovery and return to work. Stroke is more common in older individuals but also occurs in young adults and children. Because people experiencing a stroke are typically aged between 65 and 84 years, hearing loss is common and can potentially interfere with rehabilitation. There is some evidence for increased risk and greater severity of sensorineural hearing loss in the stroke population and hence it has been recommended that all people surviving a stroke should have a hearing test. Auditory processing difficulties have also been reported poststroke. The International Classification of Functioning, Disability and Health (ICF) can be used as a basis for describing the effect of aphasia, hearing loss, and auditory processing difficulties on activities and participation. Effects include reduced participation in activities outside the home such as work and recreation and difficulty engaging in social interaction and communicating needs. A case example of a young man (M) in his 30s who experienced a left-hemisphere ischemic stroke is presented. M has normal hearing sensitivity but has aphasia and auditory processing difficulties based on behavioral and cortical evoked potential measures. His principal goal is to return to work. Although auditory processing difficulties (and hearing loss) are acknowledged in the literature, clinical protocols typically do not specify routine assessment. The literature and the case example presented here suggest a need for further research in this area and a possible change in practice toward more routine assessment of auditory function post-stroke.
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Affiliation(s)
- Suzanne C Purdy
- Discipline of Speech Science, School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Iruni Wanigasekara
- Discipline of Speech Science, School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Oscar M Cañete
- Discipline of Speech Science, School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Celia Moore
- Discipline of Speech Science, School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Clare M McCann
- Discipline of Speech Science, School of Psychology, The University of Auckland, Auckland, New Zealand
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21
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Koyama T, Domen K. A Case of Hearing Loss after Bilateral Putaminal Hemorrhage: A Diffusion-tensor Imaging Study. Prog Rehabil Med 2016; 1:20160003. [PMID: 32789200 DOI: 10.2490/prm.20160003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/15/2016] [Indexed: 12/27/2022] Open
Abstract
Background Magnetic resonance diffusion-tensor imaging (DTI) is a tool for the assessment of neural fiber integrity. We applied DTI in a patient with hearing loss that developed after bilateral putaminal hemorrhage. Case A 59-year-old woman was referred to our outpatient clinic for sequelae diagnosis. Six years earlier, she had suffered a left putaminal hemorrhage, but almost fully recovered. Four years later, she suffered a right putaminal hemorrhage, resulting in severe left hemiparesis and hearing loss. After receiving conservative acute care treatment, she was transferred to a long-term rehabilitation facility and returned home 7 months later, when her Functional Independence Measure score was 103 points. Although the patient could not respond to auditory stimuli, her writing and reading abilities were intact. Auditory examinations indicated that the brainstem response was normal, but pure tone audiometry was at the low end of the scale (105 dB). We examined the patient's brain using DTI, and the lesions were assessed in reference to the standard brain map transformed into her individual brain space. Fractional anisotropy and color brain maps indicated that the lesions were located within bilateral acoustic radiations. In addition, we applied fiber tracking analysis in which voxels of the medial geniculate bodies in the standard brain map were transformed into the patient's individual brain space and then taken as seeds for the fiber tracking. The resulting image showed bilateral disruption of acoustic radiation fibers. Conclusion By applying DTI, we identified the neuroanatomical pathology of hearing loss that developed after bilateral putaminal hemorrhage.
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Affiliation(s)
- Tetsuo Koyama
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, 11-1 Imazu-Yamanaka-cho, Nishinomiya, Hyogo 663-8211, Japan.,Department of Rehabilitation Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
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Koohi N, Vickers D, Chandrashekar H, Tsang B, Werring D, Bamiou DE. Auditory rehabilitation after stroke: treatment of auditory processing disorders in stroke patients with personal frequency-modulated (FM) systems. Disabil Rehabil 2016; 39:586-593. [PMID: 27008578 DOI: 10.3109/09638288.2016.1152608] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Auditory disability due to impaired auditory processing (AP) despite normal pure-tone thresholds is common after stroke, and it leads to isolation, reduced quality of life and physical decline. There are currently no proven remedial interventions for AP deficits in stroke patients. This is the first study to investigate the benefits of personal frequency-modulated (FM) systems in stroke patients with disordered AP. METHODS Fifty stroke patients had baseline audiological assessments, AP tests and completed the (modified) Amsterdam Inventory for Auditory Disability and Hearing Handicap Inventory for Elderly questionnaires. Nine out of these 50 patients were diagnosed with disordered AP based on severe deficits in understanding speech in background noise but with normal pure-tone thresholds. These nine patients underwent spatial speech-in-noise testing in a sound-attenuating chamber (the "crescent of sound") with and without FM systems. RESULTS The signal-to-noise ratio (SNR) for 50% correct speech recognition performance was measured with speech presented from 0° azimuth and competing babble from ±90° azimuth. Spatial release from masking (SRM) was defined as the difference between SNRs measured with co-located speech and babble and SNRs measured with spatially separated speech and babble. The SRM significantly improved when babble was spatially separated from target speech, while the patients had the FM systems in their ears compared to without the FM systems. CONCLUSIONS Personal FM systems may substantially improve speech-in-noise deficits in stroke patients who are not eligible for conventional hearing aids. FMs are feasible in stroke patients and show promise to address impaired AP after stroke. Implications for Rehabilitation This is the first study to investigate the benefits of personal frequency-modulated (FM) systems in stroke patients with disordered AP. All cases significantly improved speech perception in noise with the FM systems, when noise was spatially separated from the speech signal by 90° compared with unaided listening. Personal FM systems are feasible in stroke patients, and may be of benefit in just under 20% of this population, who are not eligible for conventional hearing aids.
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Affiliation(s)
- Nehzat Koohi
- a Department of Neuro-Otology , National Hospital for Neurology and Neurosurgery , London , UK.,b The Ear Institute , University College London , London , UK
| | - Deborah Vickers
- b The Ear Institute , University College London , London , UK
| | | | - Benjamin Tsang
- a Department of Neuro-Otology , National Hospital for Neurology and Neurosurgery , London , UK
| | - David Werring
- c The Institute of Neurology , University College London , London , UK
| | - Doris-Eva Bamiou
- a Department of Neuro-Otology , National Hospital for Neurology and Neurosurgery , London , UK.,b The Ear Institute , University College London , London , UK
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