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Tolan MM, Choi JS, Tibesar MT, Adams ME. Cerumen impaction: Prevalence and associated factors in the United States population. Laryngoscope Investig Otolaryngol 2024; 9:e1228. [PMID: 38525118 PMCID: PMC10958939 DOI: 10.1002/lio2.1228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/03/2024] [Indexed: 03/26/2024] Open
Abstract
Objective To examine the prevalence of cerumen impaction in a nationally representative sample of the US population and the association of cerumen impaction with sociodemographic factors, hearing loss, and tinnitus. Methods The cohort included 14,230 individuals aged ≥12 years who completed otoscopy and audiometry in NHANES (2005-2016). Cerumen impaction (partial/complete) was determined by otoscopy. Hearing level was defined by speech-frequency pure-tone average (PTA). Multivariable regression analysis was performed to identify factors associated with cerumen impaction. Results The prevalence of any cerumen impaction was 18.6% [95% CI: 17.3%-19.9%] among individuals ≥12 years and 32.4% [29.9%-35.1%] among those ≥70 years. The prevalence of bilateral partial and complete cerumen impaction was 6.3% [5.6%-7.1%] and 1.2% [1.0%-1.9%], respectively. Any cerumen impaction was associated with male sex (OR 1.77 [1.5-2.1]), identifying as Black race (vs. Caucasian, OR: 1.78 [1.5-2.9]), lower level of education (OR: 0.84 [0.71-0.98]), and older age (OR: 1.02 [1.01-1.03]). After adjusting for sociodemographic and clinical factors, complete impaction was associated with increased PTA (right ear: β = 4.1 dB [2.4-5.8 dB], left ear: β = 1.9 dB [0.46-3.4 dB]), but not with tinnitus. Conclusions Cerumen impaction is highly prevalent in the US population, especially among older adults, and has disproportionate sociodemographic impacts. Complete impaction is associated with a small, statistically significant elevation in PTA, but there is no association with tinnitus. These findings emphasize the need to implement and disseminate best practices for ear hygiene and cerumen management broadly and equitably. Level of Evidence 2B.
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Affiliation(s)
- McKenzie M. Tolan
- Department of Otolaryngology‐Head & Neck SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Janet S. Choi
- Department of Otolaryngology‐Head & Neck SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
- Caruso Department of Otolaryngology—Head and Neck SurgeryUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Maria T. Tibesar
- University of North Dakota Medical SchoolGrand ForksNorth DakotaUSA
| | - Meredith E. Adams
- Department of Otolaryngology‐Head & Neck SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
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2
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Humes LE. Otoscopic Abnormalities for the U.S. Population Aged 6-80+ Years: Prevalence and Consequences for Hearing. Am J Audiol 2024:1-16. [PMID: 38241686 DOI: 10.1044/2023_aja-23-00181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024] Open
Abstract
PURPOSE U.S. national data for otoscopic examinations of 13,055 individuals aged 6-80+ years included in the National Health and Nutrition Examination Survey surveys for 2011-2012, 2015-2016, and 2017-2020 were analyzed and described. METHOD Analyses were primarily descriptive and relied on prevalence estimates, supported by logistic-regression analyses, and distribution-free medians. Otoscopic examinations were performed by trained technicians with review and supervision by a clinical audiologist. Effects of age, sex, and race/ethnicity were also examined. RESULTS Overall, the prevalence of abnormal otoscopy was approximately 12%-15% with higher prevalence among males at most ages and for both sexes for age ≥ 60 years. Typically, 93% or more of the observed abnormalities were due to excessive or impacted cerumen, mainly the former. Logistic-regression analyses for the 6-19-year-olds found that only race/ethnicity affected the odds with non-Hispanic Blacks and Asians have higher odds for otoscopic abnormalities than non-Hispanic Whites. For 20- to 69-year-old adults, the odds of having abnormal otoscopic findings were about twice as high for males versus females, 60-year-olds versus 20-year-olds, and non-Hispanic Blacks versus non-Hispanic Whites. Overall, the effect of otoscopic abnormalities on the pure-tone averages for 500, 1000, 2000, and 4000 Hz and 3000, 4000, and 6000 Hz were negligible (< 3 dB), and this did not vary substantially with sex, race/ethnicity, or age. CONCLUSION Abnormal otoscopy, typically excessive cerumen, was observed in about 12%-15% of the individuals in this national sample, but the presence of such abnormalities had minimal effect on hearing sensitivity.
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Affiliation(s)
- Larry E Humes
- Department of Speech, Language and Hearing Sciences, Indiana University, Bloomington
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3
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Sebothoma B, Khoza-Shangase K. Undergraduate audiology students' perceived competence and confidence in conducting otoscopic examination following video otoscopic training. BMC MEDICAL EDUCATION 2021; 21:510. [PMID: 34579717 PMCID: PMC8475473 DOI: 10.1186/s12909-021-02924-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Emerging research indicates that video otoscopy can be used as a teaching tool to enhance students' ability to identify outer and middle ear pathologies. However, there is little research on the perceptions of audiology students regarding their competence and confidence following video otoscopic training, and how they view the use of video otoscopy as a teaching tool. Therefore, this study aimed to determine undergraduate (UG) audiology students' perceived competence and confidence in conducting otoscopy following training by video otoscopic examination. METHODS A survey methodology with a cross sectional design was employed. An electronic questionnaire was distributed to all third and fourth year (senior) (N = 79) UG audiology students using Survey Monkey. Ethical approval and permission from relevant stakeholders were obtained. Data were analysed using both descriptive and inferential statistics. RESULTS 60 % of the students felt competent in performing otoscopy, while 63.3 % felt less competent in interpreting otoscopic examination findings. 43.3 % felt they can confidently and competently identify outer ear pathologies. There was no association between the number of video otoscopic examinations performed and perceived competence or/and confidence. There was also no statistically significant relationship between year of study (e.g., third year versus fourth year) and perceived competence or/and confident (p = 0.7131). Almost all (97 %) students felt that video otoscopic training should continue to be part of the clinical training as it helped them enhance their skills in performing otoscopy. CONCLUSIONS Current findings highlight the need to improve students' practical training, incorporating pathologic ears into the curriculum. These findings also highlight the importance of supplementing practical training methodologies with changing technological advancements, particularly where tele-audiology opportunities may exist.
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Affiliation(s)
- Ben Sebothoma
- Department of Speech pathology and Audiology, University of the Witwatersrand, Private Bag 3, Wits, 2050, Johannesburg, South Africa
| | - Katijah Khoza-Shangase
- Department of Speech pathology and Audiology, University of the Witwatersrand, Private Bag 3, Wits, 2050, Johannesburg, South Africa
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4
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Willems M, van Berlaer G, Maes L, Leyssens L, Koehler B, Marks L. Outcome of 10 years of ear and hearing screening in people with intellectual disability in Europe: A multicentre study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:123-133. [PMID: 34197010 DOI: 10.1111/jar.12923] [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] [Received: 01/31/2020] [Revised: 05/18/2021] [Accepted: 06/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Undetected ear and hearing problems negatively impact the quality of life of people with intellectual disability. METHODS This multicentre retrospective study describes the outcome of 10 years of ear and hearing screening in athletes with intellectual disability in seven European countries. The screening was conducted by a trained team using a strictly standardised protocol. RESULTS Of 15,363 screened athletes with intellectual disability, more than half (58.7%) needed referral for ear and/or hearing problems, ranging from 51.7% (<20 years old) to 81.4% (≥60 years old). The most commonly detected conditions were excessive/impacted earwax (40.3%), middle ear problems (30.1%) and hearing loss (27.0%), with significant differences between age groups and countries. DISCUSSION This study demonstrates an increased risk of ear and hearing problems in people with intellectual disability as compared to the general population. Considering the unawareness and impact of these problems, it is highly recommended to organise systematic screening. Follow-up for diagnostic elaboration, therapeutic management and long-term guidance should be provided.
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Affiliation(s)
- Melina Willems
- Audiology Department, Artevelde University of Applied Sciences, Ghent, Belgium.,Special Olympics Healthy Hearing Program, Washington, DC, USA
| | - Gerlant van Berlaer
- Department of Emergency Medicine, University Hospital Brussels, Brussels, Belgium
| | - Leen Maes
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.,Ear Nose Throat Department, Ghent University Hospital, Ghent, Belgium
| | - Laura Leyssens
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | | | - Luc Marks
- Ghent University Hospital, Oral Health in Special Needs, Ghent, Belgium
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5
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Leedy KM, Trees WJ, Mullins K. Educating Nursing Staff in a Long-Term Care Facility on Cerumen Impactions and Cerumenolytic Administration. J Gerontol Nurs 2021; 47:35-43. [PMID: 34038249 DOI: 10.3928/00989134-20210310-01] [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: 11/20/2022]
Abstract
The current article examines the importance of educating nursing staff in a long-term care facility (LTCF) on cerumen impactions and the proper administration of cerumenolytics. An educational session on cerumen impactions and cerumenolytic administration was provided to nursing staff with pre-, post-, and follow-up tests. Findings included an increase in confidence levels of the nursing learning objectives post-education, as well as an overall improvement in knowledge retention. According to the nurses surveyed, they had never been educated on either topic. It is estimated that up to 65% of residents aged >65 years living in LTCFs are affected by cerumen impactions and the many symptoms associated with them, including hearing loss. Therefore, education on these topics for nursing staff who care for this high-risk population would be beneficial. [Journal of Gerontological Nursing, 47(4), 35-43.].
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Govender SM, De Jongh M. Identifying hearing impairment and the associated impact on the quality of life among the elderly residing in retirement homes in Pretoria, South Africa. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2021; 68:e1-e9. [PMID: 33764149 PMCID: PMC8008190 DOI: 10.4102/sajcd.v68i1.788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/02/2020] [Accepted: 01/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background Age-Related Hearing Loss (ARHL) is the most widespread sensory disorder in the elderly. Poor audiological support within retirement homes is one of the fundamental issues impacting the Quality of Life (QoL). Objectives The objectives of this study were to: (1) Identify the presence of hearing impairment through a hearing screening test battery in a sample of elderly participants residing in three retirement homes. (2) Determine the psychological, communication-related and social impact of the hearing impairment on the QoL in a sample of elderly participants residing in retirement homes. Method A prospective cross-sectional research design with quantitative methods of data analysis was used to obtain data from 70 elderly participants (mean age = 79 years, 79% were female). Ten of them used hearing aids. Hearing screening was conducted using otoscopy, tympanometry and air conduction screening (500 Hz–4 kHz). The World Health Organization Quality of Life (WHOQoL) questionnaire was adapted and utilised for the present study. Results Findings revealed that 77% of the sample obtained a refer result from the hearing screening protocol indicating a high presence of hearing impairment. Twenty-nine per cent (n = 16) of the participants felt depressed, worried and anxious because of their hearing loss and 20% of participants felt unaccepted by their significant others as a result of their hearing impairment. Hearing difficulties were significantly associated with a reduced QoL (p = 0.045). Eight of the 10 participants who wore hearing aids reported an overall improvement in QoL since receiving and utilising their hearing aids and 20% (n = 2) of hearing aid users reported challenges with maintaining their hearing aids. Conclusion The findings of this study emphasised the need for an increased role for audiological services provided by audiologists within retirement homes, thereby contributing to an improved QoL.
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Affiliation(s)
- Samantha M Govender
- Department of Speech-Language Pathology & Audiology, School of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria.
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7
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Höbler F, McGilton KS, Wittich W, Dupuis K, Reed M, Dumassais S, Mick P, Pichora-Fuller MK. Hearing Screening for Residents in Long-Term Care Homes Who Live with Dementia: A Scoping Review. J Alzheimers Dis 2021; 84:1115-1138. [PMID: 34633326 PMCID: PMC8673512 DOI: 10.3233/jad-215087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hearing loss is highly prevalent in older adults, particularly among those living with dementia and residing in long-term care homes (LTCHs). Sensory declines can have deleterious effects on functioning and contribute to frailty, but the hearing needs of residents are often unrecognized or unaddressed. OBJECTIVE To identify valid and reliable screening measures that are effective for the identification of hearing loss and are suitable for use by nursing staff providing care to residents with dementia in LTCHs. METHODS Electronic databases (Embase, Medline, PsycINFO, CENTRAL, and CINAHL) were searched using comprehensive search strategies, and a stepwise approach based on Arksey & O'Malley's scoping review and appraisal process was followed. RESULTS There were 193 scientific papers included in the review. Pure-tone audiometry was the most frequently reported measure to test hearing in older adults living with dementia. However, measures including self- or other-reports and questionnaires, review of medical records, otoscopy, and the whisper test were found to be most suitable for use by nurses working with older adults living with dementia in LTCHs. CONCLUSION Although frequently used, the suitability of pure-tone audiometry for use by nursing staff in LTCHs is limited, as standardized audiometry presents challenges for many residents, and specific training is needed to successfully adapt test administration procedures and interpret results. The whisper test was considered to be more suitable for use by staff in LTCH; however, it yields a limited characterization of hearing loss. There remains an urgent need to develop new approaches to screen hearing in LTCHs.
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Affiliation(s)
- Fiona Höbler
- KITE – Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Katherine S. McGilton
- KITE – Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Walter Wittich
- École d’optométrie, Université de Montréal, Montréal, QC, Canada
- Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Longueuil, QC, Canada
- Centre de réadaptation Lethbridge-Layton-Mackay du CIUSSS du Centre-Ouest-de-l’Île-de-Montréal, Montréal, QC, Canada
| | - Kate Dupuis
- Sheridan Centre for Elder Research, Sheridan College, Oakville, ON, Canada
| | - Marilyn Reed
- Audiology, Baycrest Health Sciences, Toronto, ON, Canada
| | - Shirley Dumassais
- École d’optométrie, Université de Montréal, Montréal, QC, Canada
- Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Longueuil, QC, Canada
| | - Paul Mick
- Department of Surgery, Faculty of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Considering Age-Related Hearing Loss in Neuropsychological Practice: Findings from a Feasibility Study. Can J Aging 2018; 38:245-252. [DOI: 10.1017/s0714980818000557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
RÉSUMÉLa perte auditive représente une problématique répandue chez la population âgée. Cela peut poser des défis pour les neuropsychologues, étant donné que les méthodes d’intervention doivent être présentées oralement et donc entendues avec précision. Dans cette étude, le statut auditif de 20 clients (âge moyen= 71 ans) a été évalué au sein d’une clinique de neuropsychologie en milieu hospitalier et l’impact de cette évaluation sur la pratique des neuropsychologues a été étudié. Un assistant de recherche a administré un bref test de dépistage des troubles auditifs à chacun des clients. Nous avons demandé à quatre neuropsychologues de commenter le statut auditif de leurs clients avant et après leur avoir présenté les résultats des tests de dépistage. Le dépistage a révélé que la majorité des clients présentait au moins une perte auditive légère et que les neuropsychologues étaient relativement précis (60 %) dans leur estimation du statut auditif de leurs clients. Enfin, les neuropsychologues ont utilisé l’information sur le statut auditif de leurs clients en vue de les diriger vers des services en audiologie, ainsi que pour renseigner les clients et les familles sur la perte auditive et la communication.
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Abstract
The objective of this study was regarding sensory and cognitive interactions in older adults published since 2009, the approximate date of the most recent reviews on this topic. After an electronic database search of articles published in English since 2009 on measures of hearing and cognition or vision and cognition in older adults, a total of 437 articles were identified. Screening by title and abstract for appropriateness of topic and for articles presenting original research in peer-reviewed journals reduced the final number of articles reviewed to 34. These articles were qualitatively evaluated and synthesized with the existing knowledge base. Additional evidence has been obtained since 2009 associating declines in vision, hearing, or both with declines in cognition among older adults. The observed sensory-cognitive associations are generally stronger when more than one sensory domain is measured and when the sensory measures involve more than simple threshold sensitivity. Evidence continues to accumulate supporting a link between decline in sensory function and cognitive decline in older adults.
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10
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Trinkaus E, Wu XJ. External auditory exostoses in the Xuchang and Xujiayao human remains: Patterns and implications among eastern Eurasian Middle and Late Pleistocene crania. PLoS One 2017; 12:e0189390. [PMID: 29232394 PMCID: PMC5726651 DOI: 10.1371/journal.pone.0189390] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/26/2017] [Indexed: 11/30/2022] Open
Abstract
In the context of Middle and Late Pleistocene eastern Eurasian human crania, the external auditory exostoses (EAE) of the late archaic Xuchang 1 and 2 and the Xujiayao 15 early Late Pleistocene human temporal bones are described. Xujiayao 15 has small EAE (Grade 1), Xuchang 1 presents bilateral medium EAE (Grade 2), and Xuchang 2 exhibits bilaterally large EAE (Grade 3), especially on the right side. These cranial remains join the other eastern Eurasian later Pleistocene humans in providing frequencies of 61% (N = 18) and 58% (N = 12) respectively for archaic and early modern human samples. These values are near the upper limits of recent human frequencies, and they imply frequent aquatic exposure among these Pleistocene humans. In addition, the medial extents of the Xuchang 1 and 2 EAE would have impinged on their tympanic membranes, and the large EAE of Xuchang 2 would have resulted in cerumen impaction. Both effects would have produced conductive hearing loss, a serious impairment in a Pleistocene foraging context.
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Affiliation(s)
- Erik Trinkaus
- Department of Anthropology, Washington University, Saint Louis, MO, United States of America
- * E-mail:
| | - Xiu-Jie Wu
- Key Laboratory of Vertebrate Evolution and Human Origins, Institute of Vertebrate Paleontology and Paleoanthropology, Chinese Academy of Sciences, Beijing, China
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11
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Schwartz SR, Magit AE, Rosenfeld RM, Ballachanda BB, Hackell JM, Krouse HJ, Lawlor CM, Lin K, Parham K, Stutz DR, Walsh S, Woodson EA, Yanagisawa K, Cunningham ER. Clinical Practice Guideline (Update): Earwax (Cerumen Impaction). Otolaryngol Head Neck Surg 2017; 156:S1-S29. [DOI: 10.1177/0194599816671491] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective This update of the 2008 American Academy of Otolaryngology—Head and Neck Surgery Foundation cerumen impaction clinical practice guideline provides evidence-based recommendations on managing cerumen impaction. Cerumen impaction is defined as an accumulation of cerumen that causes symptoms, prevents assessment of the ear, or both. Changes from the prior guideline include a consumer added to the development group; new evidence (3 guidelines, 5 systematic reviews, and 6 randomized controlled trials); enhanced information on patient education and counseling; a new algorithm to clarify action statement relationships; expanded action statement profiles to explicitly state quality improvement opportunities, confidence in the evidence, intentional vagueness, and differences of opinion; an enhanced external review process to include public comment and journal peer review; and 3 new key action statements on managing cerumen impaction that focus on primary prevention, contraindicated intervention, and referral and coordination of care. Purpose The primary purpose of this guideline is to help clinicians identify patients with cerumen impaction who may benefit from intervention and to promote evidence-based management. Another purpose of the guideline is to highlight needs and management options in special populations or in patients who have modifying factors. The guideline is intended for all clinicians who are likely to diagnose and manage patients with cerumen impaction, and it applies to any setting in which cerumen impaction would be identified, monitored, or managed. The guideline does not apply to patients with cerumen impaction associated with the following conditions: dermatologic diseases of the ear canal; recurrent otitis externa; keratosis obturans; prior radiation therapy affecting the ear; previous tympanoplasty/myringoplasty, canal wall down mastoidectomy, or other surgery affecting the ear canal. Key Action Statements The panel made a strong recommendation that clinicians should treat, or refer to a clinician who can treat, cerumen impaction, defined as an accumulation of cerumen that is associated with symptoms, prevents needed assessment of the ear, or both. The panel made the following recommendations: (1) Clinicians should explain proper ear hygiene to prevent cerumen impaction when patients have an accumulation of cerumen. (2) Clinicians should diagnose cerumen impaction when an accumulation of cerumen, as seen on otoscopy, is associated with symptoms, prevents needed assessment of the ear, or both. (3) Clinicians should assess the patient with cerumen impaction by history and/or physical examination for factors that modify management, such as ≥1 of the following: anticoagulant therapy, immunocompromised state, diabetes mellitus, prior radiation therapy to the head and neck, ear canal stenosis, exostoses, and nonintact tympanic membrane. (4) Clinicians should not routinely treat cerumen in patients who are asymptomatic and whose ears can be adequately examined. (5) Clinicians should identify patients with obstructing cerumen in the ear canal who may not be able to express symptoms (young children and cognitively impaired children and adults), and they should promptly evaluate the need for intervention. (6) Clinicians should perform otoscopy to detect the presence of cerumen in patients with hearing aids during a health care encounter. (7) Clinicians should treat, or refer to a clinician who can treat, the patient with cerumen impaction with an appropriate intervention, which may include ≥1 of the following: cerumenolytic agents, irrigation, or manual removal requiring instrumentation. (8) Clinicians should recommend against ear candling for treating or preventing cerumen impaction. (9) Clinicians should assess patients at the conclusion of in-office treatment of cerumen impaction and document the resolution of impaction. If the impaction is not resolved, the clinician should use additional treatment. If full or partial symptoms persist despite resolution of impaction, the clinician should evaluate the patient for alternative diagnoses. (10) Finally, if initial management is unsuccessful, clinicians should refer patients with persistent cerumen impaction to clinicians who have specialized equipment and training to clean and evaluate ear canals and tympanic membranes. The panel offered the following as options: (1) Clinicians may use cerumenolytic agents (including water or saline solution) in the management of cerumen impaction. (2) Clinicians may use irrigation in the management of cerumen impaction. (3) Clinicians may use manual removal requiring instrumentation in the management of cerumen impaction. (4) Last, clinicians may educate/counsel patients with cerumen impaction or excessive cerumen regarding control measures.
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Affiliation(s)
- Seth R. Schwartz
- Department of Otolaryngology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Anthony E. Magit
- Division of Otolaryngology, Rady Children’s Hospital–San Diego, San Diego, California, USA
| | - Richard M. Rosenfeld
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | | | | | - Helene J. Krouse
- College of Nursing, Wayne State University, Detroit, Michigan, USA
| | - Claire M. Lawlor
- Department of Otolaryngology, Tulane University, New Orleans, Louisiana, USA
| | - Kenneth Lin
- Georgetown University School of Medicine, Washington, DC, USA
| | - Kourosh Parham
- Division of Otolaryngology, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - David R. Stutz
- University of Michigan Health System, East Ann Arbor Health Care Center, Ann Arbor, Michigan, USA
| | - Sandy Walsh
- Consumers United for Evidence-Based Healthcare, Davis, California, USA
| | | | - Ken Yanagisawa
- Yale New Haven Hospital and Southern New England Ear, Nose, Throat & Facial Plastic Surgery Group, LLP, New Haven, Connecticut, USA
| | - Eugene R. Cunningham
- American Academy of Otolaryngology—Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Hardy CJD, Marshall CR, Golden HL, Clark CN, Mummery CJ, Griffiths TD, Bamiou DE, Warren JD. Hearing and dementia. J Neurol 2016; 263:2339-2354. [PMID: 27372450 PMCID: PMC5065893 DOI: 10.1007/s00415-016-8208-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/13/2016] [Accepted: 06/14/2016] [Indexed: 02/04/2023]
Abstract
Hearing deficits associated with cognitive impairment have attracted much recent interest, motivated by emerging evidence that impaired hearing is a risk factor for cognitive decline. However, dementia and hearing impairment present immense challenges in their own right, and their intersection in the auditory brain remains poorly understood and difficult to assess. Here, we outline a clinically oriented, symptom-based approach to the assessment of hearing in dementias, informed by recent progress in the clinical auditory neuroscience of these diseases. We consider the significance and interpretation of hearing loss and symptoms that point to a disorder of auditory cognition in patients with dementia. We identify key auditory characteristics of some important dementias and conclude with a bedside approach to assessing and managing auditory dysfunction in dementia.
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Affiliation(s)
- Chris J D Hardy
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK
| | - Charles R Marshall
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK
| | - Hannah L Golden
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK
| | - Camilla N Clark
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK
| | - Catherine J Mummery
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK
- Cognitive Disorders Clinic for the Deaf, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Timothy D Griffiths
- Auditory Group, Institute of Neuroscience, The Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
- Central Auditory Disorders Clinic, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Doris-Eva Bamiou
- Department of Neuro-otology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Ear Institute, University College London, London, UK
- Central Auditory Disorders Clinic, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Jason D Warren
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK.
- Central Auditory Disorders Clinic, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
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Mori T, Takeuchi N, Suzuki S, Miki M, Kawase T, Izumi SI. Anodal transcranial direct current stimulation over the auditory cortex improved hearing impairment in a patient with brainstem encephalitis. J Int Med Res 2016; 44:760-4. [PMID: 26920927 PMCID: PMC5536694 DOI: 10.1177/0300060516630843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/14/2016] [Indexed: 11/16/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) can alter cortical excitability, and has been effective in treating some neurological disorders. This case report describes the use of tDCS in a 13-year-old female who developed bilateral hearing impairment after brainstem encephalitis when she was 6 years old. Her auditory function was more impaired in her right ear than her left. Anodal stimulation (1 mA) was applied for 10 min to the left auditory cortex once per day for 4 consecutive days to improve her right ear speech discrimination score. Sustained and significant improvement in maximum speech discrimination was observed after the four tDCS treatments. To our knowledge, this is the first case report of improvement in speech discrimination after anodal stimulation of the auditory cortex. These results encourage further studies investigating the beneficial effects of tDCS in patients with hearing impairments.
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Affiliation(s)
- Takayuki Mori
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoyuki Takeuchi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Sakiko Suzuki
- Department of Clinical Physiology, Tohoku University Hospital, Sendai, Japan
| | - Mika Miki
- Department of Clinical Physiology, Tohoku University Hospital, Sendai, Japan
| | - Tetsuaki Kawase
- Department of Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
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Sugiura S, Takeuchi S, Hisada M, Sumigaki C, Uchida Y, Nakashima T, Toba K. [The safety and effectiveness of earwax removal by nurse in cognitive impaired inpatients]. Nihon Ronen Igakkai Zasshi 2016; 53:164-167. [PMID: 27250224 DOI: 10.3143/geriatrics.53.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Nakashima T, Sugiura S, Naganawa S, Yasue M, Inui Y, Sakurai T, Uchida Y, Sone M, Teranishi M, Yoshida T, Ito K, Toba K. Cerumen impaction shown by brain magnetic resonance imaging in patients with cognitive impairment. Geriatr Gerontol Int 2015; 16:392-5. [PMID: 26017764 DOI: 10.1111/ggi.12529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2015] [Indexed: 11/26/2022]
Abstract
AIM Hearing loss is a risk factor for the progression of dementia. Cognitive improvement is occasionally found after removal of cerumen impaction. Because patients with dementia do not usually complain about cerumen impaction, detection methods are important. The present study aimed to investigate whether cerumen impaction is observable using brain magnetic resonance imaging. METHODS Participants were six patients whose hearing level improved 15 dB or more unilaterally or bilaterally after the removal of cerumen impaction. A radiologist who was blind to the impaction side and whether magnetic resonance imaging scans were taken before or after impaction removal classified cerumen impaction as positive, negative or unclear. RESULTS Three ears classified as impaction positive and five ears classified as impaction negative corresponded accurately to the presence or absence of cerumen impaction. Among four ears classified as unclear, two did and two did not have cerumen impaction. CONCLUSION Careful examination of the external ear canal on brain magnetic resonance imaging can be used to detect cerumen impaction.
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Affiliation(s)
- Tsutomu Nakashima
- Department of Otorhinolaryngology, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Otorhinolaryngology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Saiko Sugiura
- Department of Otorhinolaryngology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shinji Naganawa
- Department of Radiology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Minori Yasue
- Department of Otorhinolaryngology, Kamiiida Daiichi General Hospital, Nagoya, Japan
| | - Yoshitaka Inui
- Department of Radiology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yasue Uchida
- Department of Otorhinolaryngology, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Otorhinolaryngology, Aichi Medical University, Nagakute, Japan
| | - Michihiko Sone
- Department of Otorhinolaryngology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Masaaki Teranishi
- Department of Otorhinolaryngology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Tadao Yoshida
- Department of Otorhinolaryngology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Kengo Ito
- Department of Radiology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kenji Toba
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
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