Associations among hearing loss, hospitalization, readmission and mortality in older adults: A systematic review

Sensory intelligence for extraction of abstract auditory rules from a speech sound stream in children with cochlear implants

OBJECTIVE

Sensory intelligence in the brain helps listeners automatically extract abstract auditory rules formed by invariant acoustic features from complex speech sound streams, presumably serving as the neural basis for speech comprehension. However, whether this intelligence is deficient in children with cochlear implants (CIs) remains unclear.

METHODS

Mandarin Chinese monosyllables shared a flat lexical tone contour to form an abstract auditory rule but differed in other acoustic features to construct a complex speech sound stream. The abstract rule was occasionally violated by monosyllables with a rising or falling lexical tone.

RESULTS

In normal hearing (NH) children, the abstract auditory rule could be extracted, as revealed by a mismatch negativity (MMN) and a late discriminative negativity (LDN). However, the MMN and LDN were only evoked in CI children with good hearing and speech performance. NH children with a higher speech perception or spatial hearing score had a greater MMN. The LDN was attenuated with increasing age in NH children.

CONCLUSIONS

The sensory intelligence for extraction of auditory abstract rules, associated with speech perception, is deficient in CI children. This intelligence may gradually develop during childhood and adolescence.

SIGNIFICANCE

Deficient sensory intelligence in CI children may aid in understanding poor speech comprehension in complex environments.

Association of intrinsic capacity and medication non-adherence among older adults with non-communicable diseases in Taiwan

OBJECTIVES

Medication non-adherence among older adults with non-communicable diseases (NCDs) remains prevalent worldwide, which causes hospitalization and mortality. Our study aimed to examine the association of medication non-adherence with level of overall intrinsic capacity (IC), pattern of IC, and specific IC component among older adults with NCDs.

METHODS

A cross-sectional questionnaire-based survey of 1268 older adults aged 60 years and above was conducted in 2022 in southern Taiwan. Among them, 894 suffered from 1 more NCD were included in this study. The Integrated Care for Older People Screening Tool for Taiwanese and the Adherence to Refills and Medication Scale were used to assess IC and medication non-adherence, respectively. Latent class analysis (LCA) was used to identify patterns of IC impairment, and binary logistic regression was used to assess the association between medication non-adherence and IC.

RESULTS

Older adults in the moderate (score: 1-2) or low (score≧3) overall IC groups were more likely to experience medication non-adherence (moderate: adjusted odds ratio (aOR) 1.57 [95% CI: 1.05-2.36]; low: 2.26 [1.40-3.67]). The "physical and nutritional impairments accompanied by depressive symptoms" group was associated with statistically higher odds of medication non-adherence (aOR 1.66 [1.01-2.73]). Older adults with cognitive impairment, hearing loss, or depressive symptoms showed greater likelihood of medication non-adherence (cognitive impairment: aOR 1.53 [1.03-2.27]; hearing loss: aOR 1.57 [1.03-2.37]; depressive symptoms: aOR 1.81 [1.17-2.80]).

CONCLUSIONS

Intervention for improving medication non-adherence among older adults with NCDs should consider IC.

Hearing Loss: Self-Reported Onset and Etiology Among Older Adults in the United States

This study investigated self-reported age of onset and etiology of hearing loss among older adults in the United States. Study cohort included older adult (≥70 years) survey respondents from the 2017 to 2020 National Health and Nutrition Examination Survey (n = 797). Overall, 51.1% [95% confidence interval [CI]: 46.1-56.1] of older adults self-reported hearing loss. Among older adults who reported hearing loss, the most reported age of onset was age 70 or older (41.7% [95% CI: 38.1%-45.3%]), followed by sequentially younger age brackets including ages 60 to 69 years (27.3% [95% CI: 23.6%-31.3%]) and ages 40 to 59 years (15.7% [95% CI: 12.9%-19.0%]). The most common etiology of hearing loss was aging (66.3% [95% CI: 60.8%-71.4%]) followed by loud long-term noise (30.3% [95% CI: 26.2%-34.9%]) and loud brief noise (13.8% [95% CI: 10.3%-18.4%]). Our study describes the most common age of onset and etiologies of hearing loss among a representative sample of United States older adults.

Association between hearing aid use and mortality in adults with hearing loss in the USA: a mortality follow-up study of a cross-sectional cohort

BACKGROUND

Hearing loss has been identified as an independent risk factor for negative health outcomes and mortality. However, whether rehabilitation with hearing aid use is associated with lower mortality is currently unknown. This study aimed to examine the associations of hearing loss, hearing aid use, and mortality in the USA.

METHODS

In this cross-sectional, follow-up study, we assessed 9885 adults (age 20 years and older) who participated in the National Health and Nutrition Examination Survey between 1999 and 2012 and completed audiometry and hearing aid use questionnaires (1863 adults with hearing loss). Main measures included hearing loss (speech-frequency pure-tone average) and hearing aid use (never users, non-regular users, and regular users). Mortality status of the cohort was linked to the National Death Index up to Dec 31, 2019. Cox proportional regression models were used to examine the association between hearing loss, hearing aid use, and mortality while adjusting for demographics and medical history.

FINDINGS

The cohort consisted of 9885 participants, of which 5037 (51·0%) were female and 4848 (49·0%) were male with a mean age of 48·6 years (SD 18·1) at baseline. The weighted prevalence of audiometry-measured hearing loss was 14·7% (95% CI 13·3-16·3%) and the all-cause mortality rate was 13·2% (12·1-14·4) at a median 10·4 years of follow-up (range 0·1-20·8). The rate of regular hearing aid use among adults with hearing loss was 12·7% (95% CI 10·6-15·1). Hearing loss was an independent risk factor associated with higher mortality (adjusted hazard ratio [HR] 1·40 [95% CI 1·21-1·62]). Among individuals with hearing loss, the adjusted mortality risk was lower among regular hearing aid users in comparison with never users (adjusted HR 0·76 [0·60-0·95]) accounting for demographics, hearing levels, and medical history. There was no difference in adjusted mortality between non-regular hearing aid users and never users (adjusted HR 0·93 [0·70-1·24]).

INTERPRETATION

Regular hearing aid use was associated with lower risks of mortality than in never users in US adults with hearing loss when accounting for age, hearing loss, and other potential confounders. Future research is needed to investigate the potential protective role of hearing aid use against mortality for adults with hearing loss.

FUNDING

None.

Knowledge and experience of paramedics concerning patients with hearing and visual disability

BACKGROUND

A 2017 nationwide disability survey conducted by the General Authority of Statistics in Saudi Arabia, a sample representing the whole population living in Saudi Arabia, reported that approximately 5% and 2% of the Saudi population suffers from visual or hearing impairments, respectively. Patients with these disabilities find it difficult to convey their medical history and chief complaints to paramedics, causing communication breakdowns that can lead to misinterpretation of patient history, leave medical problems unaddressed, and reduce patient engagement and autonomy. We aimed to assess paramedics' knowledge, attitude, and level of confidence when managing patients with visual or hearing problems.

METHODS

Descriptive cross-sectional design was used to report the knowledge and experience of paramedics towards patients with hearing/vision disabilities in Saudi Arabia. A validated questionnaire was distributed to our study sample of paramedics in Riyadh, Saudi Arabia between 01, July 2020 and 31, December 2020. Ethical approval was obtained from King Abdullah International Medical Research Center.

RESULTS

Ninety-seven participants completed the survey. Male paramedics accounted for 77% of the study participants; 24% were Saudi Red Crescent employees, and 57% were 20-25 years old. Most participants encountered 1-5 cases of patients with hearing disability (55%) as well as patients with visual disability (48%) during their career. Taking medical history was a challenge indicated by 42% of the participants, and 30% reported difficulties in explaining procedures. Of the participants, 44% were confident in handling patients with hearing or visual impairment. There was a strong association between participants who indicated higher confidence levels and those who had obtained specific training for patients with hearing or visual impairments.

CONCLUSION

Assisting patients with hearing or visual impairments is challenging, especially during an emergency. We recommend programs that provide specific training in handling hearing or visually impaired patients to close the communication gap in emergent medical situations handled by paramedics or other emergency medicine doctors and nurses.

Healthcare communication access among deaf and hard-of-hearing people during pregnancy

OBJECTIVE

Deaf and hard-of-hearing (DHH) people report ineffective healthcare communication. Limited research has been conducted on healthcare communication during pregnancy. This study's aim was to assess communication accommodations and experiences during pregnancy for DHH people.

METHODS

An accessible web-based survey was administered to a non-probability sample of DHH people through national organizations, social media, and snowball sampling. Eligibility criteria included being 21 years or older; given birth in the U.S. within the past 10 years, report hearing loss prior to the most recent birth. Questions focused on healthcare experiences and information access during their last pregnancy. The sample included 583 respondents for the present analysis. We describe the communication accommodations requested and received during pregnancy, segmented by preferred language.

RESULTS

Most DHH participants reported communication with prenatal clinicians as "good" or "very good". On-site interpreter services were most commonly requested by American Sign Language (ASL) only and bilingual DHH people. Interpersonal communication modification requests (e.g., speaking louder) were rarely obliged.

CONCLUSION

This study is the first national examination of requested and received communication accommodations for DHH patients during the perinatal period.

PRACTICE IMPLICATIONS

Healthcare providers should work closely with patients to ensure effective communication access is provided.

Hearing screening and amplifier uptake results in a multidisciplinary head and neck cancer survivorship clinic

PURPOSE

Hearing loss and tinnitus are prevalent among survivors of head and neck cancer (HNC), but auditory issues are under-addressed in the survivorship literature. The purpose of this study was to describe the hearing loss and management experience of a group of survivors provided with a hearing screening and amplifier assistance if needed during their visit.

METHODS

A retrospective chart review of 1176 individuals seen in the HNC Survivorship Clinic between December 2016 and October 2020 who interacted with audiology was performed.

RESULTS

Of these survivors, 72% failed the 30-dB HL hearing screening at one or more frequencies. Thirty-three percent of the sample reported tinnitus. Consistent with the general population, this group has a low prevalence of hearing aid use. In this clinic, individuals who fail the hearing screening at all frequencies are offered a simple, non-custom amplifier for use during their visit. Thirty-one percent of individuals offered the amplifier used it during their Survivorship Clinic visit to enhance communication and reduce listening effort. Only 54% of individuals who failed the hearing screening self-reported hearing loss. The poor sensitivity and specificity associated with the self-perception of hearing loss data support the need for hearing screening that consists of responding to tones. Of individuals who received a recommendation for a comprehensive hearing test, 21% received a hearing test with 68% of these individuals receiving the hearing test the same day of their Survivorship Clinic visit.

CONCLUSIONS

The data from 1176 survivors of HNC seen by audiology over the past few years as part of the UPMC HNC Survivorship Clinic support the need for hearing management in this population to improve communication during and after the Survivorship Clinic visit.

IMPLICATIONS FOR CANCER SURVIVORS

Survivors of HNC have a high prevalence of greater than mild hearing loss and tinnitus (both issues known to negatively impact health-related communication and quality of life). This manuscript describes a hearing screening program within a Survivorship Clinic that identifies individuals in need of non-custom amplification during their appointment to support effective communication. Survivors should be referred to audiologists for evaluation and management of treatment-related issues of hearing.

Validating Four Hmong Word Recognition Tests With Normal-Hearing Bilingual Hmong Individuals

Purpose:

The purpose of this study was to validate four digitally recorded and phonetically balanced 50-word recognition lists in the White Hmong dialect with normal-hearing bilingual Hmong adults.

Method:

Using a randomized, incomplete-block design, each participant listened to and repeated four unique Hmong lists delivered by a female and a male talker. Participants were also tested with an English word list—List 1A of the Northwestern University Auditory Test No. 6. Participants' correct pronunciation of each word was scored. A nonparametric Mann–Whitney U Location Difference Test for Equivalence using two one-sided tests equivalence hypothesis: −0.02 < [(List_1) – (List_2)] < 0.02 was conducted to assess equivalence among all four Hmong and the English lists.

Results:

Seventy Hmong speakers participated in this study (35 women, 35 men; M age = 29.5 years, SD = 7.1). In all four Hmong lists, 93.5% (187/200) words met the validation criteria for ≥ 92% correct pronunciation. The 13 difficult words were deemed adequate by a Hmong panel and, therefore, were included to maintain four unique, balanced word lists. The test revealed that the Hmong and English word lists were considered equivalent at the 2% bound.

Conclusion:

The four Hmong word lists were validated to ensure an equal range of word difficulty across the lists.

Digital Technology for Remote Hearing Assessment—Current Status and Future Directions for Consumers

Globally, more than 1.5 billion people have hearing loss. Unfortunately, most people with hearing loss reside in low- and middle-income countries (LMICs) where traditional face-to-face services rendered by trained health professionals are few and unequally dispersed. The COVID-19 pandemic has further hampered the effectiveness of traditional service delivery models to provide hearing care. Digital health technologies are strong enablers of hearing care and can support health delivery models that are more sustainable. The convergence of advancing technology and mobile connectivity is enabling new ways of providing decentralized hearing services. Recently, an abundance of digital applications that offer hearing tests directly to the public has become available. A growing body of evidence has shown the ability of several approaches to provide accurate, accessible, and remote hearing assessment to consumers. Further effort is needed to promote greater accuracy across a variety of test platforms, improve sensitivity to ear disease, and scale up hearing rehabilitation, especially in LMICs.

An observational study of older patients' experiences of involvement in discharge planning

The discharge of older patients is complex and healthcare professionals focus more on organizational and coordinating tasks rather than on patient involvement. The study aims to describe older medical patients' experiences of involvement in discharge planning and to identify associations between their experiences of involvement and readmissions. This observational study included 210 older medical inpatients from a Danish university hospital. Data were collected from a questionnaire survey and the patients' medical records. Involvement was measured using the subscales: information, communication, participation, time of discharge, relatives & general impression. Most participants reported receiving the overall information needed before discharge. There was a lack of specific information, regarding medicine and symptoms. Fewer participants reported positively on participation. 23.8% of the participants were readmitted within 30 days. Longer hospitalization, comorbidities and less perceived information were associated with a higher risk of readmission. There were associations between patient involvement and the 30-day readmission rate.

Unilateral Cochlear Implants for Severe, Profound, or Moderate Sloping to Profound Bilateral Sensorineural Hearing Loss: A Systematic Review and Consensus Statements

Importance

Cochlear implants are a treatment option for individuals with severe, profound, or moderate sloping to profound bilateral sensorineural hearing loss (SNHL) who receive little or no benefit from hearing aids; however, cochlear implantation in adults is still not routine.

Objective

To develop consensus statements regarding the use of unilateral cochlear implants in adults with severe, profound, or moderate sloping to profound bilateral SNHL.

Design, Setting, and Participants

This study was a modified Delphi consensus process that was informed by a systematic review of the literature and clinical expertise. Searches were conducted in the following databases: (1) MEDLINE In-Process & Other Non-Indexed Citations and Ovid MEDLINE, (2) Embase, and (3) the Cochrane Library. Consensus statements on cochlear implantation were developed using the evidence identified. This consensus process was relevant for the use of unilateral cochlear implantation in adults with severe, profound, or moderate sloping to profound bilateral SNHL. The literature searches were conducted on July 18, 2018, and the 3-step Delphi consensus method took place over the subsequent 9-month period up to March 30, 2019.

Main Outcomes and Measures

A Delphi consensus panel of 30 international specialists voted on consensus statements about cochlear implantation, informed by an SR of the literature and clinical expertise. This vote resulted in 20 evidence-based consensus statements that are in line with clinical experience. A modified 3-step Delphi consensus method was used to vote on and refine the consensus statements. This method consisted of 2 rounds of email questionnaires and a face-to-face meeting of panel members at the final round. All consensus statements were reviewed, discussed, and finalized at the face-to-face meeting.

Results

In total, 6492 articles were identified in the searches of the electronic databases. After removal of duplicate articles, 74 articles fulfilled all of the inclusion criteria and were used to create the 20 evidence-based consensus statements. These 20 consensus statements on the use of unilateral cochlear implantation in adults with SNHL were relevant to the following 7 key areas of interest: level of awareness of cochlear implantation (1 consensus statement); best practice clinical pathway from diagnosis to surgery (3 consensus statements); best practice guidelines for surgery (2 consensus statements); clinical effectiveness of cochlear implantation (4 consensus statements); factors associated with postimplantation outcomes (4 consensus statements); association between hearing loss and depression, cognition, and dementia (5 consensus statements); and cost implications of cochlear implantation (1 consensus statement).

Conclusions and Relevance

These consensus statements represent the first step toward the development of international guidelines on best practices for cochlear implantation in adults with SNHL. Further research to develop consensus statements for unilateral cochlear implantation in children, bilateral cochlear implantation, combined electric-acoustic stimulation, unilateral cochlear implantation for single-sided deafness, and asymmetrical hearing loss in children and adults may be beneficial for optimizing hearing and quality of life for these patients.

Pregnancy and Neonatal Outcomes Among Deaf or Hard of Hearing Women: Results From Nationally Representative Data

BACKGROUND

Although the literature suggests that women with disabilities are at increased risk for pregnancy complications and adverse birth outcomes, there are few population-based studies of the pregnancy outcomes among deaf and hard of hearing (DHH) women in the United States.

OBJECTIVE

To compare pregnancy complications and neonatal outcomes between deliveries to DHH and non-DHH women using national hospitalization discharge record data.

STUDY DESIGN

We used the 2007-2016 Healthcare Cost and Utilization Project National Inpatient Sample to compare pregnancy complications and outcomes among deliveries to DHH women with deliveries to non-DHH women using bivariate and Poisson regressions, controlling for sociodemographic, hospital, and clinical characteristics.

RESULTS

DHH women had an increased risk of adverse pregnancy outcomes and chronic medical conditions, including preexisting diabetes (relative risk [RR], 2.01; 95% confidence interval, 1.68-2.42; p < .001), gestational diabetes (RR, 1.31; 95% CI, 1.19-1.44; p < .001), chronic hypertension (RR, 1.51; 95% CI, 1.33-1.72; p < .001), preeclampsia and eclampsia (RR, 1.35; 95% CI, 1.21-1.51; p < .01), placenta previa (RR, 1.62; 95% CI, 1.22-2.16; p < .01), placental abruption (RR, 1.43; 95% confidence interval, 1.15-1.78; p < .01), labor induction (RR, 1.16; 95% CI, 1.05-1.27; p < .01), chorioamnionitis (RR, 1.43; 95% CI, 1.22-1.69; p < .001), cesarean delivery (RR, 1.09; 95% CI, 1.04-1.14; p < .001), premature rupture of membranes (RR, 1.34; 95% CI, 1.20-1.50; p < .001), antepartum hemorrhage (RR, 1.36; 95% CI, 1.13-1.64; p < .001), and postpartum hemorrhage (RR, 1.30; 95% CI, 1.13-1.49; p < .001). After adjustment for socioeconomic and hospital characteristics, the risk for gestational diabetes, preeclampsia and eclampsia, placenta previa, and chorioamnionitis remained unexplained.

CONCLUSIONS

DHH women are at an increased risk for adverse pregnancy, fetal, and neonatal outcomes, illuminating the need for awareness among obstetric and primary care providers as well as the need for systematic investigation of outcomes and evidence-based guidelines.

The inaugural World Report on Hearing: From barriers to a platform for change

The inaugural World Report on Hearing was recently published by the World Health Organisation, and outlines the burden of hearing loss, and strategies to overcome this through preventative and public health approaches. Here, we identify barriers to wide-scale adoption, including historic low prioritisation of hearing loss against other public health needs, a lack of a health workforce with relevant training, poor access to assistive technology, and individual and community-level stigma and misunderstanding. Overcoming these barriers will require multi-sector stakeholder collaboration, involving ear and hearing care professionals, patients, communities, industry and policymakers.

Coffee consumption and risk of hearing impairment in men and women

BACKGROUND

Hearing loss is the fifth leading cause of disability in the world. Coffee consumption might have a beneficial effect on hearing function because of the antioxidant and anti-inflammatory properties of some of its compounds. However, no previous longitudinal study has assessed the association between coffee consumption and the risk of hearing impairment.

OBJECTIVE

To assess the prospective association between coffee consumption and risk of disabling hearing impairment in middle and older men and women from the UK Biobank study.

METHODS

Analytical cohort with 36,923 participants (16,142 men and 20,781 women) [mean (SD): 56.6 (7.8) years, 1.6 (1.4) cups/d, and -7.6 (1.3) dB for age, total coffee consumption and speech reception threshold in noise at baseline, respectively]. At baseline, coffee consumption was measured with 3-5 multiple-pass 24-h food records. Hearing function was measured with a digit triplet test, and disabling hearing impairment was defined as a speech reception threshold in noise > -3.5 dB in any physical exam during the follow-up. Analyses were stratified by sex and Cox regression models were used to assess the prospective association proposed.

RESULTS

Over 10 years of follow-up, 343 men and 345 women developed disabling hearing impairment. Among men, compared with those who consumed <1 cup/d of coffee, those who consumed 1, and ≥2 cups/d had a lower risk of hearing impairment (hazard ratio [95% confidence interval]: 0.72 [0.54-0.97] and 0.72 [0.56-0.92], respectively; P-trend: 0.01). This association was similar for caffeinated and decaffeinated coffee, and for filtered and non-filtered coffee, and was stronger in those with obesity (hazard ratio [95% confidence interval] for consumption of ≥2 vs. <1 cups/d: 0.39 [0.21-0.74]). No association was found between coffee and hearing function among women.

CONCLUSIONS

Coffee consumption was associated with lower risk of disabling hearing impairment in men but not in women. The association appeared to be independent of the coffee type and the preparation method.

Development and Validation of an Instrument to Measure Nurses' Beliefs Toward Deaf and Hard of Hearing Interaction

BACKGROUND AND PURPOSE

Nurse-patient communication has a significant effect on health outcomes and quality of care. The purpose of this research was to develop and validate an instrument to measure nurses' beliefs toward interacting with Deaf signers, non-signing deaf, and hard of hearing (DdHH) patients.

METHODS

Initial pool items created based on literature review. Content validated by DdHH and hearing registered nurses (RNs) and certified interpreters working in healthcare. Resulting D/deaf and Hard of Hearing Interaction Beliefs Scale for Registered Nurses (DdHH-IBS/RN) administered to two groups of RNs. Two validation studies conducted.

RESULTS

Analyses demonstrated high inter-item reliability, internal consistency reliability, and stability reliability of a 25-item DdHH-IBS/RN. Confirmatory factor analysis supported hypothesized structure of the scale.

CONCLUSION

The DdHH-IBS/RN is a reliable and valid scale to measure nurses' beliefs towards DdHH interaction.