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Lee J, Yoon CY, Lee J, Kong TH, Oh SH, Seo YJ. A situational analysis of ear and hearing care in South Korea using WHO ear and Hearing Care Situation Analysis tool. Front Public Health 2023; 11:1215556. [PMID: 37841711 PMCID: PMC10569215 DOI: 10.3389/fpubh.2023.1215556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/24/2023] [Indexed: 10/17/2023] Open
Abstract
Objectives The WHO emphasizes lifelong management of hearing diseases such as hearing loss and advocates for prevention. The Ear and Hearing Care Situation Analysis (EHCSA) tool was designed by the WHO for assessment and quality improvement of state-led management of hearing loss prevention and management programs. The purpose of this study was to use the EHCSA to assess the ear and hearing management program in Korea and to establish goals consistent with best practices for improving policies and services related to ear and hearing care. Methods The EHCSA was used as a need assessment of the ear and hearing management services in the country. The EHCSA consists of two sections. Section 1 consists of 41 questions to evaluate health policies and support services. Section 2 consists of 203 questions to evaluate human resources and services of the ear and hearing management sector. Results There are an estimated 800,000 people with hearing loss in Korea. Policies such as hearing aid support are in place, and outreach services such as free hearing tests are also being actively conducted. In all medical institutions, ear and hearing management treatment and medication prescriptions could be received without barriers. Workers in the fields of ear and hearing management, such as audiologists, language therapists, special education teachers, and sign language interpreters, are specialized and have well-established guidelines for training. Conclusion Overall, the domestic ear and hearing management sector has confirmed that policies and services are well-prepared in comparison with advanced countries such as the United States, Iran, and China. The use of the EHCSA was functional in collecting data on the current state of domestic ear and hearing management policies and services in Korea, can be used for continuous quality improvement and expansion of medical services, and can be used as a reporting mechanism to the WHO.
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Affiliation(s)
- Juhyeong Lee
- Research Institute of Hearing Enhancement, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Chul Young Yoon
- Research Institute of Hearing Enhancement, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Junhun Lee
- Research Institute of Hearing Enhancement, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Tae Hoon Kong
- Research Institute of Hearing Enhancement, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Seung Ha Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Joon Seo
- Research Institute of Hearing Enhancement, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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Amorim AAL, Alvarenga KDF, Jacob LCB, Araújo ES. Usability evaluation of the Agente Escuta application: translational research. Codas 2023; 35:e20220149. [PMID: 37729328 PMCID: PMC10546923 DOI: 10.1590/2317-1782/20232022149pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/22/2022] [Indexed: 09/22/2023] Open
Abstract
PURPOSE To evaluate the usability and satisfaction of users with the interface of the 'Agente Escuta' application, in addition to identifying problems and possibilities for improvement. METHODS Descriptive exploratory translational study, characterized by a usability test with a quantitative and qualitative approach, subdivided into three stages: (I) prior evaluation of usability by 10 judges, including students, primary care professionals, professors and researchers in Information Technology and Speech Therapy; (II) evaluation of the application by the target audience, that is, community health agents from six municipalities in Rio Grande do Norte; (III) evaluation of the satisfaction of the agents who used the application in their work routine. The System Usability Scale and the Net Promoter Score were used, in addition to a qualitative evaluation of the opinions. RESULTS Usability was rated as excellent by judges, regardless of category. In the evaluation by community health agents, usability was considered good and there was no effect of the city of origin. It was found that the perception of the judges and the target audience were different, with a lower score for the participants in the second stage. However, most would give positive publicity to the product. The heuristic with the highest score was ease of memorization and participants in the third stage were interested in continuing to use the tool in practice, even after the end of the study. CONCLUSION The Agente Escuta prototype showed good usability and satisfaction and aspects that could be improved in future solutions were identified.
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Affiliation(s)
- Alice Andrade Lopes Amorim
- Programa Associado de Pós-graduação em Fonoaudiologia, Universidade Federal do Rio Grande do Norte - UFRN - Natal (RN), Brasil.
| | | | | | - Eliene Silva Araújo
- Programa Associado de Pós-graduação em Fonoaudiologia, Universidade Federal do Rio Grande do Norte - UFRN - Natal (RN), Brasil.
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Frisby C, Eikelboom RH, Mahomed-Asmail F, Kuper H, Moore DR, de Kock T, Manchaiah V, Swanepoel DW. Mobile Health Hearing Aid Acclimatization and Support Program in Low-Income Communities: Feasibility Study. JMIR Form Res 2023; 7:e46043. [PMID: 37610802 PMCID: PMC10483300 DOI: 10.2196/46043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/06/2023] [Accepted: 07/04/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND The most common management option for hearing loss is hearing aids. In addition to devices, patients require information and support, including maintenance and troubleshooting. Mobile health (mHealth) technologies can support hearing aid management, acclimatization, and use. This study developed an mHealth acclimatization and support program for first-time hearing aid users and subsequently implemented and pilot-tested the feasibility of the program. The program was facilitated by community health workers (CHWs) in low-income communities in South Africa. OBJECTIVE This study aimed to evaluate the feasibility of an mHealth acclimatization and support program supported by CHWs in low-income communities. METHODS An application-based acclimatization and support was adapted and translated for use in low- and middle-income countries. This program was delivered in the form of 20 different voice notes accompanied by graphical illustrations via WhatsApp or 20 different SMS text messages. The program was provided to first-time hearing aid users immediately after a community-based hearing aid fitting in March 2021 in 2 low-income communities in the Western Cape, South Africa. The 20 messages were sent over a period of 45 days. Participants were contacted telephonically on days 8, 20, and 43 of the program and via open-ended paper-based questionnaires translated to isiXhosa 45 days and 6 months after the program started to obtain information on their experiences, perceptions, and accessibility of the program. Their responses were analyzed using inductive thematic analysis. RESULTS A total of 19 participants fitted with hearing aids received the mHealth acclimatization and support program. Most participants (15/19, 79%) received the program via WhatsApp, with 21% (4/19) of them receiving it via SMS text message. Participants described the program as helpful, supportive, informative, sufficient, and clear at both follow-ups. A total of 14 participants reported that they were still using their hearing aids at the 6-month follow-up. Three participants indicated that not all their questions about hearing aids were answered, and 5 others had minor hearing aid issues. This included feedback (n=1), battery performance (n=1), physical fit (n=2), and issues with hearing aid accessories (n=1). However, CHWs successfully addressed all these issues. There were no notable differences in responses between the participants who received the program via WhatsApp compared with those who received it through SMS text message. Most participants receiving WhatsApp messages reported that the voice notes were easier to understand, but the graphical illustrations supplemented the voice notes well. CONCLUSIONS An mHealth acclimatization and support program is feasible and potentially assists hearing aid acclimatization and use for first-time users in low-income communities. Scalable mHealth support options can facilitate increased access and improve outcomes of hearing care.
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Affiliation(s)
- Caitlin Frisby
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative initiative between the University of Colorado and the University of Pretoria, Aurora, CO, United States
| | - Robert H Eikelboom
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Ear Science Institute Australia, Subiaco, Australia
- Ear Sciences Centre, Medical School, The University of Western Australia, Nedlands, Australia
- Faculty of Health Sciences, Curtin University, Bentley, Australia
| | - Faheema Mahomed-Asmail
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative initiative between the University of Colorado and the University of Pretoria, Aurora, CO, United States
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - David R Moore
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, United States
- Manchester Centre for Audiology and Deafness, University of Manchester, Manchester, United Kingdom
| | | | - Vinaya Manchaiah
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative initiative between the University of Colorado and the University of Pretoria, Aurora, CO, United States
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, United States
- UCHealth Hearing and Balance, University of Colorado Hospital, Aurora, CO, United States
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, India
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative initiative between the University of Colorado and the University of Pretoria, Aurora, CO, United States
- Ear Science Institute Australia, Subiaco, Australia
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, United States
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Nieman CL, Betz J, Garcia Morales EE, Suen JJ, Trumbo J, Marrone N, Han HR, Szanton SL, Lin FR. Effect of a Community Health Worker-Delivered Personal Sound Amplification Device on Self-Perceived Communication Function in Older Adults With Hearing Loss: A Randomized Clinical Trial. JAMA 2022; 328:2324-2333. [PMID: 36538311 PMCID: PMC9856971 DOI: 10.1001/jama.2022.21820] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Age-related hearing loss that impairs daily communication is associated with adverse health outcomes, but use of hearing aids by older adults is low and disparities exist. OBJECTIVE To test whether an affordable, accessible hearing care intervention, delivered by community health workers using over-the-counter hearing technology, could improve self-perceived communication function among older adults with hearing loss compared with a wait-list control. DESIGN, SETTING, AND PARTICIPANTS Open-label randomized clinical trial conducted between April 2018 and October 2019 with 3-month data collection completed in June 2020. The trial took place at 13 community sites, including affordable independent housing complexes (n = 10), senior centers (n = 2), and an older adult social club (n = 1) in Baltimore, Maryland. A total of 151 participants aged 60 years or older with hearing loss were randomized. INTERVENTIONS Participants were randomized to receive a community health worker-delivered hearing care intervention (n = 78) or to a wait-list control group (n = 73). The 2-hour intervention consisted of fitting a low-cost amplification device and instruction. MAIN OUTCOMES AND MEASURES The primary outcome was change in self-perceived communication function (Hearing Handicap Inventory for the Elderly-Screening Version [HHIE-S]; score range, 0-40; higher scores indicate poorer function) from baseline to 3 months postrandomization. The average treatment effect was estimated using the doubly robust weighted least squares estimator, which uses an outcome regression model weighted by the inverse probability of attrition to account for baseline covariate imbalance and missing data. RESULTS Among 151 participants randomized (mean age, 76.7 [SD, 8.0] years; 101 [67.8%] women; 65 [43%] self-identified as African American; 96 [63.6%] with low income [<$25 000 annual household income]), 136 (90.1%) completed 3-month follow-up for the primary outcome. In the intervention group, 90.5% completed the intervention session and reported at least 1 hour of daily amplification use at 3 months postrandomization. Mean scores for the HHIE-S were 21.7 (SD, 9.4) at baseline and 7.9 (SD, 9.2) at 3 months (change of -13.2 [SD, 10.3]) in the intervention group, and 20.1 (SD, 10.1) at baseline and 21 (SD, 9.1) at 3 months (change of 0.6 [SD, 7.1]) in the control group. Self-perceived communication function significantly improved in the intervention group compared with the control group, with an estimated average treatment effect of the intervention of a -12.98-point HHIE-S change (95% CI, -15.51 to -10.42). No study-related adverse events were reported. CONCLUSIONS AND RELEVANCE Among older adults with hearing loss, a community health worker-delivered personal sound amplification device intervention, compared with a wait-list control, significantly improved self-perceived communication function at 3 months. Findings are limited by the absence of a sham control, and further research is needed to understand effectiveness compared with other types of care delivery models and amplification devices. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03442296.
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Affiliation(s)
- Carrie L. Nieman
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Joshua Betz
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Emmanuel E. Garcia Morales
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jonathan J. Suen
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins School of Nursing, Baltimore, Maryland
| | - Jami Trumbo
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nicole Marrone
- Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson
| | - Hae-Ra Han
- Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, Baltimore, Maryland
- Johns Hopkins School of Nursing, Baltimore, Maryland
| | - Sarah L. Szanton
- Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, Baltimore, Maryland
- Johns Hopkins School of Nursing, Baltimore, Maryland
| | - Frank R. Lin
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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5
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Saunders JE, Bessen S, Magro I, Cowan D, Gonzalez Quiroz M, Mojica-Alvarez K, Penalba D, Reike C, Neimczak C, Fellows A, Buckey J. School Hearing Screening With a Portable, Tablet-Based, Noise-Attenuating Audiometric Headset in Rural Nicaragua. Otol Neurotol 2022; 43:1196-1204. [PMID: 36351228 DOI: 10.1097/mao.0000000000003692] [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: 11/10/2022]
Abstract
OBJECTIVE To investigate the utility and effectiveness of a noise-attenuating, tablet-based mobile health system combined with asynchronous telehealth evaluations for screening rural Nicaraguan schoolchildren for hearing loss. STUDY DESIGN Prospective population-based survey. SETTING Rural Nicaraguan communities. PATIENTS There were 3,398 school children 7 to 9 years of age. INTERVENTIONS Diagnostic automated and manual audiometry, detailed asynchronous telehealth evaluations. MAIN OUTCOME MEASURES Referral rates, ambient noise levels, and audiometric results as well as hearing loss prevalence, types, and risk factors. RESULTS Despite high ambient noise levels during screening (46.7 dBA), no effect of noise on referral rates on automated audiometry or confirmatory manual audiometry in those who failed automated testing was seen. The overall audiometric referral rate was 2.6%. Idiopathic sensorineural hearing loss (SNHL) and cerumen impaction were the most common types of hearing loss in this population with an estimated prevalence of hearing loss (all types) of 18.3 per 1,000 children. SNHL was associated with both drug exposure during pregnancy (p = 0.04) and pesticide exposure in the home (p = 0.03). CONCLUSION Hearing screening using a tablet-based, noise-attenuating wireless headset audiometer is feasible and effective in rural low-resource environments with moderately elevated ambient noise levels. The referral rate with noise-attenuating headsets was much lower than that previous reports on this population. In addition, manual audiometry resulted in much lower referral rates than automated audiometry. The confirmed hearing loss rate in this study is comparable to reports from other low-income countries that use some form of noise attenuation during screening. Pesticide exposure and drug exposure during pregnancy are potential causes of SNHL in this population.
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Affiliation(s)
- James E Saunders
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth
| | - Sarah Bessen
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Isabelle Magro
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Devin Cowan
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | | | | | - Donoso Penalba
- Research Centre on Health, Work and Environment (CISTA) at National Autonomous University of Nicaragua, Leon (UNAN-Leon), Leon, Nicaragua
| | - Catherine Reike
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth
| | - Chris Neimczak
- Department of Medicine Dartmouth-Hitchcock Medical Center, Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Abigail Fellows
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth
| | - Jay Buckey
- Department of Medicine Dartmouth-Hitchcock Medical Center, Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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Malcolm KA, Suen JJ, Nieman CL. Socioeconomic position and hearing loss: current understanding and recent advances. Curr Opin Otolaryngol Head Neck Surg 2022; 30:351-357. [PMID: 36004788 PMCID: PMC10155234 DOI: 10.1097/moo.0000000000000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to describe recent literature examining the relationship between socioeconomic position (SEP) and hearing loss, including the impact of hearing loss on several socioeconomic outcomes over the life course. Additionally, we highlight current policy advances in recent years and review alternative models of hearing care that aim to address disparities related to SEP and hearing healthcare. RECENT FINDINGS Applying a social epidemiologic lens to hearing health gives insight into the role of material and social contexts in understanding and improving hearing health outcomes. Recent studies investigating the intersection of SEP and hearing health highlight the disparities that exist for individuals with low SEP as well as the influence of hearing loss on SEP. Individuals with hearing loss are more likely to be unemployed, have lower educational attainment, lower income, and are less likely to use hearing aids and access hearing care. Legislation addressing cost and access to hearing care as well as transforming the current landscape of hearing care, is essential to creating equitable care for individuals, especially older adults, with low SEP. SUMMARY With the expected rise in prevalence of hearing loss over the next 40 years, hearing care that is affordable and accessible is a public health priority. As hearing loss is associated with negative outcomes for individuals with low SEP, advances in legislation and care delivery models are necessary in order to include populations traditionally unserved by current hearing healthcare.
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Affiliation(s)
- Kelly A. Malcolm
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health
| | - Jonathan J. Suen
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health
- Johns Hopkins School of Nursing
| | - Carrie L. Nieman
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health
- Johns Hopkins School of Nursing
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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7
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Blustein J, Weinstein BE, Chodosh J. Over-the-counter hearing aids: What will it mean for older Americans? J Am Geriatr Soc 2022; 70:2115-2120. [PMID: 35397113 DOI: 10.1111/jgs.17781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/15/2022] [Accepted: 03/22/2022] [Indexed: 01/30/2023]
Abstract
In October 2021 the Food and Drug Administration released draft rules creating a new class of hearing aids to be sold over the counter. Since Medicare does not cover hearing aids, the ready availability of low-cost aids is potentially good news for the millions of older Americans with hearing loss, a disorder that is associated with isolation, depression and poor health. However, better financial access to hearing aids will not necessarily translate into better hearing: many older people will need assistance in fitting, using and maintaining their aids. Policymakers, managers, and clinicians need to consider how to structure, fund and deliver these vital adjunctive services.
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Affiliation(s)
- Jan Blustein
- Robert F Wagner Graduate School, New York University, New York, New York, USA.,Department of Population Health, NYU Grossman School of Medicine, New York University, New York, New York, USA
| | - Barbara E Weinstein
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, NYU Grossman School of Medicine, New York University, New York, New York, USA.,Doctor of Audiology Program, CUNY Graduate Center, The City University of New York, New York, New York, USA
| | - Joshua Chodosh
- Department of Population Health, NYU Grossman School of Medicine, New York University, New York, New York, USA.,Division of Geriatric Medicine and Palliative Care, Department of Medicine, NYU Grossman School of Medicine, New York University, New York, New York, USA.,VA New York Harbor Health Care System, New York, New York, USA
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A Machine Learning Approach to Screen for Otitis Media Using Digital Otoscope Images Labelled by an Expert Panel. Diagnostics (Basel) 2022; 12:diagnostics12061318. [PMID: 35741128 PMCID: PMC9222011 DOI: 10.3390/diagnostics12061318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Otitis media includes several common inflammatory conditions of the middle ear that can have severe complications if left untreated. Correctly identifying otitis media can be difficult and a screening system supported by machine learning would be valuable for this prevalent disease. This study investigated the performance of a convolutional neural network in screening for otitis media using digital otoscopic images labelled by an expert panel. Methods: Five experienced otologists diagnosed 347 tympanic membrane images captured with a digital otoscope. Images with a majority expert diagnosis (n = 273) were categorized into three screening groups Normal, Pathological and Wax, and the same images were used for training and testing of the convolutional neural network. Expert panel diagnoses were compared to the convolutional neural network classification. Different approaches to the convolutional neural network were tested to identify the best performing model. Results: Overall accuracy of the convolutional neural network was above 0.9 in all except one approach. Sensitivity to finding ears with wax or pathology was above 93% in all cases and specificity was 100%. Adding more images to train the convolutional neural network had no positive impact on the results. Modifications such as normalization of datasets and image augmentation enhanced the performance in some instances. Conclusions: A machine learning approach could be used on digital otoscopic images to accurately screen for otitis media.
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Yi JS, Garcia Morales EE, Reed NS, Willink A, Nieman CL. Racial and Ethnic Differences in Hearing Aid Use Among Medicare Beneficiaries. J Aging Health 2022; 34:1117-1124. [PMID: 35481806 DOI: 10.1177/08982643221095716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We examined individual-level factors associated with hearing aid use by race and ethnicity in a nationally representative sample of Medicare beneficiaries. METHODS We used the Medicare Current Beneficiary Survey (cycles 2016-2018) for 10,301 older adults with hearing loss and hearing aid use as the primary outcome. Covariates included education, income, urban residence, chronic conditions, functional limitations, and Medicaid eligibility. Multivariable logistic regression stratified by race and ethnicity was used to identify factors associated with hearing aid use. RESULTS Factors associated with hearing aid use included higher education among White (OR = 1.35, 95%CI:1.16, 1.58), Black (OR = 1.76, 95%CI:1.02, 3.05), and Hispanic (OR = 1.77, 95%CI:1.17, 2.68) beneficiaries. Urban residence was associated with hearing aid use for Black participants (OR = 3.06, 95%CI:1.17, 8.03) and Medicaid eligibility for Hispanic participants (OR = 1.58, 95%CI:0.97, 2.59), although the confidence interval included the null hypothesis. DISCUSSION ndividual-level factors associated with hearing aid use differed by race and ethnicity among Medicare beneficiaries.
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Affiliation(s)
- Julie S Yi
- 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Cochlear Center for Hearing & Public Health, 25802Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Emmanuel E Garcia Morales
- Cochlear Center for Hearing & Public Health, 25802Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Nicholas S Reed
- Cochlear Center for Hearing & Public Health, 25802Johns Hopkins University School of Public Health, Baltimore, MD, USA.,Department of Otolaryngology-HNS, Division of Otology, Neurotology & Skull Base Surgery, 1500Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amber Willink
- Cochlear Center for Hearing & Public Health, 25802Johns Hopkins University School of Public Health, Baltimore, MD, USA.,The University of Sydney Menzies Centre for Health Policy, Sydney, NSW, Australia.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carrie L Nieman
- Cochlear Center for Hearing & Public Health, 25802Johns Hopkins University School of Public Health, Baltimore, MD, USA.,Department of Otolaryngology-HNS, Division of Otology, Neurotology & Skull Base Surgery, 1500Johns Hopkins School of Medicine, Baltimore, MD, USA
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10
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Mamo SK, Wheeler KA, Plano Clark VL, Jacelon CS. A Mixed Methods Study of Hearing Loss, Communication, and Social Engagement in a Group Care Setting for Older Adults. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2022; 7:592-609. [PMID: 36340585 PMCID: PMC9632268 DOI: 10.1044/2021_persp-21-00218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE The purpose of this study is to characterize the communication needs of older adults in group care environments and understand the factors that foster engaged communication. METHOD This mixed methods study provides an in-depth analysis of communication and engagement for older adults at two Program for All-inclusive Care for the Elderly (PACE) sites. Seventy-two PACE participants (M age = 74 years) completed a hearing test, cognitive screener (MOST™), the Institute of Medicine (IOM) Measures of Social and Behavioral Determinants of Health Questionnaire, and the UCLA Loneliness Scale. Using maximum variation sampling based on hearing status and UCLA Loneliness scores, 19 participants were invited to do (and 11 participants completed) one-on-one semi-structured interviews. In addition, 35 staff members participated in 5 focus groups. Field observations were interspersed throughout the data collection period. RESULTS Results suggest that communication challenges such as hearing loss, cognitive decline, and social isolation are highly prevalent in this convenience sample. Sixty-seven percent have at least a mild hearing loss in the better hearing ear. Eighty-two percent scored in the "very" or "most isolated" range of the IOM Measures of Social and Behavioral Determinants of Health questionnaire. The mean score on the MOST™ cognitive screener was 17.6, which is below the dementia screening cutoff score of 18 points. A thematic analysis of the qualitative data suggests that the PACE programs support socialization and engagement. A conceptual framework was developed by integrating quantitative and qualitative findings to recognize what contributes to meaningful interactions or engaged communication. CONCLUSION Identifying communication challenges can enhance the benefits individuals can experience at care facilities and lessen the burden of the staff members trying to provide safe and effective care. In order to maximize the potential benefit of attending group-based day centers, the communication challenges and motivations of older adults need to be addressed.
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Affiliation(s)
- Sara K. Mamo
- Department of Communication Disorders, University of Massachusetts Amherst, Amherst, MA
| | - Kara A. Wheeler
- Department of Communication Disorders, University of Massachusetts Amherst, Amherst, MA
| | | | - Cynthia S. Jacelon
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA
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11
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Li Q, Zang Y, Sun Z, Zhang W, Liu H. Long noncoding RNA Gm44593 attenuates oxidative stress from age-related hearing loss by regulating miR-29b/WNK1. Bioengineered 2021; 13:573-582. [PMID: 34967279 PMCID: PMC8805810 DOI: 10.1080/21655979.2021.2012062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Long noncoding RNA has been reported to play important role in various disease. However, the function of lncRNA in age-related hearing loss still unclear. The aim of our study is to investigate the function and mechanism of lncRNA Gm44593 in AHL. ATP content, JC-1 assay, mitochondrial content, cell death rates and dual-luciferase reporter assay were performed to assess the function of lncRNA Gm44593 in HEI-OC1 cells. The expression of lncRNA Gm44593 was significantly upregulated upon H2O2 and starvation treatment. Overexpression of lncRNA Gm44593 manifestly reduced the cell death rates. The ATP content, mtDNA content and mitochondrial membrane potential were alleviated upon overexpression of lncRNA Gm44593. We also proved that miR-29b is the direct target of lncRNA Gm44593. Overexpression of miR-29b completely restored the effect induced by lncRNA Gm44593. In addition, we provided evidences that WNK1 is the direct target of miR-29b. Our research uncovers a potential role of lncRNA Gm44593 in age-related hearing loss. We provide new insights into potential therapeutic targets for the amelioration of age-related hearing loss.
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Affiliation(s)
- Qian Li
- Otolaryngology Head and Neck Surgery, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan Province, China
| | - Yanzi Zang
- Otolaryngology Head and Neck Surgery, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan Province, China
| | - Zhanwei Sun
- Otolaryngology Head and Neck Surgery, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan Province, China
| | - Wenqi Zhang
- Otolaryngology Head and Neck Surgery, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan Province, China
| | - Hongjian Liu
- Otolaryngology Head and Neck Surgery, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan Province, China
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12
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Willink A, Assi L, Nieman C, McMahon C, Lin FR, Reed NS. Alternative Pathways for Hearing Care May Address Disparities in Access. Front Digit Health 2021; 3:740323. [PMID: 34901925 PMCID: PMC8655113 DOI: 10.3389/fdgth.2021.740323] [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: 07/12/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background/Objectives: Low-uptake of hearing aids among older adults has long dogged the hearing care system in the U.S. and other countries. The introduction of over-the-counter hearing aids is set to disrupt the predominantly high-cost, specialty clinic-based delivery model of hearing care with the hope of increasing accessibility and affordability of hearing care. However, the current model of hearing care delivery may not be reaching everyone with hearing loss who have yet to use hearing aids. In this study, we examine the group of people who do not use hearing aids and describe their characteristics and health care utilization patterns. We also consider what other healthcare pathways may be utilized to increase access to hearing treatment. Design: Cross-sectional, the 2017 Medicare Current Beneficiary Survey. Setting: Non-institutionalized adults enrolled in Medicare, the U.S. public health insurance program for older adults (65 years and older) and those with qualifying medical conditions and disabilities. Participants: A nationally representative sample of 7,361 Medicare beneficiaries with self-reported trouble hearing and/or hearing aid use. Measurements: Survey-weighted proportions described the population characteristics and health care utilization of those with hearing loss by hearing aid use, and the characteristics of those with untreated hearing loss by health care service type utilized. Results: Women, racial/ethnic minorities, and low-income Medicare beneficiaries with self-reported hearing trouble were less likely to report using hearing aids than their peers. Among those who do not use hearing aids, the most commonly used health care services were obtaining prescription drugs (64%) and seeing a medical provider (50%). Only 20% did not access either service in the past year. These individuals were more likely to be young and to have higher educational attainment and income. Conclusion: Alternative models of care delivered through pharmacies and general medical practices may facilitate access to currently underserved populations as they are particularly high touch-points for Medicare beneficiaries with untreated hearing trouble. As care needs will vary across a spectrum of hearing loss, alternative models of hearing care should look to complement not substitute for existing access pathways to hearing care.
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Affiliation(s)
- Amber Willink
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia.,Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Lama Assi
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Carrie Nieman
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.,Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Catherine McMahon
- Department of Linguistics, Macquarie University, Sydney, NSW, Australia
| | - Frank R Lin
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.,Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Nicholas S Reed
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
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13
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Bailey JE, Gurgol C, Pan E, Njie S, Emmett S, Gatwood J, Gauthier L, Rosas LG, Kearney SM, Robler SK, Lawrence RH, Margolis KL, Osunkwo I, Wilfley D, Shah VO. Early Patient-Centered Outcomes Research Experience With the Use of Telehealth to Address Disparities: Scoping Review. J Med Internet Res 2021; 23:e28503. [PMID: 34878986 PMCID: PMC8693194 DOI: 10.2196/28503] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/04/2021] [Accepted: 10/03/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Health systems and providers across America are increasingly employing telehealth technologies to better serve medically underserved low-income, minority, and rural populations at the highest risk for health disparities. The Patient-Centered Outcomes Research Institute (PCORI) has invested US $386 million in comparative effectiveness research in telehealth, yet little is known about the key early lessons garnered from this research regarding the best practices in using telehealth to address disparities. OBJECTIVE This paper describes preliminary lessons from the body of research using study findings and case studies drawn from PCORI seminal patient-centered outcomes research (PCOR) initiatives. The primary purpose was to identify common barriers and facilitators to implementing telehealth technologies in populations at risk for disparities. METHODS A systematic scoping review of telehealth studies addressing disparities was performed. It was guided by the Arksey and O'Malley Scoping Review Framework and focused on PCORI's active portfolio of telehealth studies and key PCOR identified by study investigators. We drew on this broad literature using illustrative examples from early PCOR experience and published literature to assess barriers and facilitators to implementing telehealth in populations at risk for disparities, using the active implementation framework to extract data. Major themes regarding how telehealth interventions can overcome barriers to telehealth adoption and implementation were identified through this review using an iterative Delphi process to achieve consensus among the PCORI investigators participating in the study. RESULTS PCORI has funded 89 comparative effectiveness studies in telehealth, of which 41 assessed the use of telehealth to improve outcomes for populations at risk for health disparities. These 41 studies employed various overlapping modalities including mobile devices (29/41, 71%), web-based interventions (30/41, 73%), real-time videoconferencing (15/41, 37%), remote patient monitoring (8/41, 20%), and store-and-forward (ie, asynchronous electronic transmission) interventions (4/41, 10%). The studies targeted one or more of PCORI's priority populations, including racial and ethnic minorities (31/41, 41%), people living in rural areas, and those with low income/low socioeconomic status, low health literacy, or disabilities. Major themes identified across these studies included the importance of patient-centered design, cultural tailoring of telehealth solutions, delivering telehealth through trusted intermediaries, partnering with payers to expand telehealth reimbursement, and ensuring confidential sharing of private information. CONCLUSIONS Early PCOR evidence suggests that the most effective health system- and provider-level telehealth implementation solutions to address disparities employ patient-centered and culturally tailored telehealth solutions whose development is actively guided by the patients themselves to meet the needs of specific communities and populations. Further, this evidence shows that the best practices in telehealth implementation include delivery of telehealth through trusted intermediaries, close partnership with payers to facilitate reimbursement and sustainability, and safeguards to ensure patient-guided confidential sharing of personal health information.
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Affiliation(s)
- James E Bailey
- Tennessee Population Health Consortium, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Cathy Gurgol
- Patient-Centered Outcomes Research Institute, Washington, DC, United States
| | - Eric Pan
- Westat Inc, Center for Healthcare Delivery Research and Evaluation, Rockville, MD, United States
| | - Shirilyn Njie
- Westat Inc, Center for Healthcare Delivery Research and Evaluation, Rockville, MD, United States
| | - Susan Emmett
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Duke Global Health Institute, Durham, NC, United States
| | - Justin Gatwood
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Lynne Gauthier
- Department of Physical Therapy and Kinesiology, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, United States
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
- Department of Medicine, Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
| | - Shannon M Kearney
- Solution Insights & Validation, Highmark Health, Pittsburgh, PA, United States
| | | | - Raymona H Lawrence
- Community Health Behavior and Education, Jiann-Ping College of Public Health, Georgia Southern University, Statesboro, GA, United States
| | | | - Ifeyinwa Osunkwo
- Cancer Care, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States
| | - Denise Wilfley
- Department of Psychiatry, College of Medicine, Washington University in St. Louis, St Louis, MO, United States
| | - Vallabh O Shah
- Department of Internal Medicine and Biochemistry, School of Medicine, University of New Mexico, Albuquerque, NM, United States
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14
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AuD CP, Grider E, AuD BK. Perceived Hearing Loss and Availability of Audiologists in Appalachia. JOURNAL OF APPALACHIAN HEALTH 2021; 3:29-44. [PMID: 35769827 PMCID: PMC9183796 DOI: 10.13023/jah.0304.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction There is a high demand for audiologists throughout the United States. Previous research has supported an additional demand for these providers within Appalachia. Purpose The purpose of the study was to determine if Appalachia has a disproportionally high demand for audiologists compared to the rest of the United States. Methods A cross-sectional retrospective study was performed with population data from the Appalachian Regional Commission, the American Academy of Audiology, and the United States Census Bureau. County-level population-weighted averages of individuals with perceived hearing loss and number of audiologists per capita were compared between Appalachian and non-Appalachian counties. Results A mean weighted 5.76 % of individuals reported hearing loss within Appalachia, which was 1.1% higher than the rest of the United States. The 1.14 audiologists per 100,000 individuals in Appalachian counties was not significantly lower than the 1.32 audiologists per 100,000 individuals found in non-Appalachian counties. Audiologists per capita decreased with increases in Beale code and percent reporting hearing loss. Conclusion The high number of individuals reporting hearing loss supports an increased demand for audiologists in rural Appalachia. More research is needed to determine how to meet this demand or improve the efficacy of the limited number of providers.
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Affiliation(s)
- Charles Pudrith AuD
- School of Allied Health and Communicative Disorders, Northern Illinois University, DeKalb IL
| | - Ellyn Grider
- School of Allied Health and Communicative Disorders, Northern Illinois University, DeKalb IL
| | - Blythe Kitner AuD
- School of Allied Health and Communicative Disorders, Northern Illinois University, DeKalb IL
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15
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Kuschke S, Le Roux T, Scott AJ, Swanepoel DCDW. Decentralising paediatric hearing services through district healthcare screening in Western Cape province, South Africa. Afr J Prim Health Care Fam Med 2021; 13:e1-e7. [PMID: 34212742 PMCID: PMC8252164 DOI: 10.4102/phcfm.v13i1.2903] [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: 01/12/2021] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 12/02/2022] Open
Abstract
Background Childhood hearing loss is a global epidemic most prevalent in low- and middle-income countries where hearing healthcare services are often inaccessible. Referrals for primary care services to central hospitals add to growing lists and delays the time-sensitive treatment of childhood hearing loss. Aim To compare a centralised tertiary model of hearing healthcare with a decentralised model through district hearing screening for children in the Western Cape province, South Africa. Setting A central paediatric tertiary hospital in Cape Town and a district hospital in the South Peninsula region. Methods A pragmatic quasi-experimental study design was used with a 7-month control period at a tertiary hospital (June 2019 to December 2019). Decentralising was measured by attendance rates, travelling distance, number of referrals to the tertiary hospital and hearing outcomes. There were 315 children in the tertiary group and 158 in the district group. Data were collected from patient records and an electronic database at the tertiary hospital. Results Attendance rate at the district hospital was significantly higher (p < 0.001). Travel distance to the district hospital was significantly shorter (p < 0.001). Number of referrals to the tertiary hospital decreased significantly during the intervention period (p < 0.001). Most children in both the tertiary and district groups (78.7% and 80.4%, respectively) passed initial hearing screening bilaterally. Conclusion Hearing screening should be conducted at the appropriate level of care to increase access, reduce patient travelling distances and associated costs and reduce the burden on tertiary-level hospitals.
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Affiliation(s)
- Silva Kuschke
- Department of Audiology, Faculty of Allied Health - Communication Sciences, Red Cross War Memorial Children's Hospital, Cape Town.
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16
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Sabbagh S, Amiri M, Khorramizadeh M, Iranpourmobarake Z, Nickbakht M. Neonatal Hearing Screening: Prevalence of Unilateral and Bilateral Hearing Loss and Associated Risk Factors. Cureus 2021; 13:e15947. [PMID: 34336445 PMCID: PMC8313994 DOI: 10.7759/cureus.15947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2021] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Newborn hearing screening is essential for early identification of hearing loss to decrease the adverse effects of hearing loss. The objective of this study was to determine the prevalence of hearing loss and risk factors of congenital hearing loss in newborns. METHODS In this analytical case-control study, a hearing screening test was performed for all newborns aged 3-14 days. RESULTS Of 5,500 newborns evaluated, 24 newborns had hearing loss. The prevalence of hearing loss was 4.36 per 1,000. Of 24 hearing-impaired newborns, 15 had bilateral hearing loss (BHL) (62.5%) and nine had unilateral hearing loss (UHL) (37.5%). Among the neonates with hearing loss, the prevalence of hearing loss was higher (77.8%) in the right ear. The main risk factors identified in this study were low gestational age (P=0.001), hospitalization in the neonatal intensive care unit (NICU) (P=0.008), exposure to ototoxic drugs (P=0.001), gestational diabetes P=0.01), craniofacial anomalies (P=0.01), convulsion (P=0.03), consanguineous marriage of parents (P=0.001), low birth weight (P=0.01), and hyperbilirubinemia (P=0.001). CONCLUSION The prevalence of hearing loss was higher in the right ear than in the left ear. NICU stay, use of ototoxic drugs, low gestational age (<35 weeks), gestational diabetes, craniofacial anomalies, convulsion, consanguineous marriage of parents, low birth weight, and hyperbilirubinemia were significant risk factors for congenital hearing loss in studied newborns.
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Affiliation(s)
- Susan Sabbagh
- Department of Medical Anatomy, School of Medicine, Dezful University of Medical Sciences, Dezful, IRN
| | - Marzieh Amiri
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IRN.,Department of Audiology, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IRN
| | - Maryam Khorramizadeh
- Department of Medical Physics, School of Medicine, Dezful University of Medical Sciences, Dezful, IRN
| | - Zahra Iranpourmobarake
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IRN.,Department of Audiology, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IRN
| | - Mansoureh Nickbakht
- Department of Speech Pathology, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, AUS
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17
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Eksteen S, Eikelboom RH, Launer S, Kuper H, Swanepoel DW. Referral Criteria for Preschool Hearing Screening in Resource-Constrained Settings: A Comparison of Protocols. Lang Speech Hear Serv Sch 2021; 52:868-876. [PMID: 34061576 DOI: 10.1044/2021_lshss-21-00008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose This study aimed to describe and compare the performance of two screening protocols used for preschool hearing screening in resource-constrained settings. Method Secondary data analysis was done to determine the performance of two protocols implemented during a preschool hearing screening program using mobile health technology in South Africa. Pure-tone audiometry screening at 25 dB HL for 1000, 2000, and 4000 Hz in each ear was used by both protocols. The fail criterion for the first protocol (2,147 children screened) constituted a no-response on one or more frequencies in either ear. The second protocol required two or more no-responses (5,782 children). Multivariate logistic regression models were used to investigate associations between outcomes and protocol, age, gender, and duration. Results Fail rates for the one-frequency fail protocol was 8.7% (n = 186) and 4.3% (n = 250) for the two-frequency fail protocol. Children screened with the two-frequency fail protocol were 52.9% less likely to fail (p < .001; OR = 0.471; 95% confidence interval [0.385, 0.575]). Gender (p = .251) and age (p = .570) had no significant effect on screening outcome. A percentage of cases screened (44.7%) exceeded permissible noise levels in at least one ear at 1000 Hz across both protocols. True- and false-positive cases did not differ significantly between protocols. Protocol type (p = .204), gender (p = .314), and age (p = .982) did not affect the odds of being a true-positive result. Average screening time was 72.8 s (78.66 SD) and 64.9 s (55.78 SD) for the one-frequency and two-frequency fail protocols, respectively. Conclusions A two-frequency fail criterion and immediate rescreen of failed frequencies significantly reduced referral rate for follow-up services that are often overburdened in resourced-constrained settings. Future protocol adaptations can also consider increasing the screening levels at 1000 Hz to minimize the influence of environmental noise.
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Affiliation(s)
- Susan Eksteen
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Robert H Eikelboom
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.,Ear Science Institute Australia, Subiaco, Western Australia.,Ear Sciences Centre, The University of Western Australia, Nedlands, Australia
| | - Stefan Launer
- Sonova AG, Science & Technology, Stäfa, Switzerland.,School of Health and Rehabilitation Science, The University of Queensland, Brisbane, Australia
| | - Hannah Kuper
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.,Ear Science Institute Australia, Subiaco, Western Australia
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18
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Marrone NL, Wong AA. Taking the Pulse of Hispanic Hearing Health. JAMA Otolaryngol Head Neck Surg 2021; 147:387-388. [PMID: 33331882 DOI: 10.1001/jamaoto.2020.4836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Nicole L Marrone
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson
| | - Aileen A Wong
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson
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19
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McMahon CM, Nieman CL, Thorne PR, Emmett SD, Bhutta MF. The inaugural World Report on Hearing: From barriers to a platform for change. Clin Otolaryngol 2021; 46:459-463. [PMID: 33733605 DOI: 10.1111/coa.13756] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/07/2021] [Indexed: 12/20/2022]
Abstract
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.
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Affiliation(s)
- Catherine M McMahon
- HEAR Centre, Macquarie University, Sydney, NSW, Australia.,Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Carrie L Nieman
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Peter R Thorne
- Section of Audiology, University of Auckland, Auckland, New Zealand.,Eisdell Moore Centre, University of Auckland, Auckland, New Zealand
| | - Susan D Emmett
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, USA.,Duke Global Health Institute, Durham, NC, USA
| | - Mahmood F Bhutta
- University Hospitals Sussex, Brighton, UK.,Brighton & Sussex Medical School, Brighton, UK
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20
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Guest Editorial: Hearing Care for All-An Opportunity to Globally Unite to Address Inequities in Hearing Health. Ear Hear 2021; 42:487-491. [PMID: 33657575 DOI: 10.1097/aud.0000000000001047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Pittman CA, Willink A, Nieman CL. Hearing Loss and Home Health: An Unmet Need and an Opportunity for Action. Home Healthc Now 2021; 39:72-80. [PMID: 33662965 DOI: 10.1097/nhh.0000000000000938] [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: 11/26/2022]
Abstract
The purpose of this study was to identify unmet hearing care needs among older adults receiving home healthcare as a potential method to reach a population unserved by clinic-based care. Cross-sectional analyses were used to identify hearing loss and hearing aid use among beneficiaries enrolled in home care, using data from the nationally representative 2017 Medicare Current Beneficiary Survey (MCBS). Survey participants who reported enrollment in home healthcare services in 2017 (n = 3,183,693) were included for the purposes of analyses. Home health and hearing status were assessed through MCBS questionnaires, reported by Medicare beneficiaries or an appointed proxy, along with hearing status evaluated at initial home care intake. Among older Medicare beneficiaries receiving home healthcare, 51.8% self-reported hearing concerns. Of this population, only 16.1% reported hearing aid use. Recipients with hearing difficulty received an average of 30 visits per year, totaling to $5,208.25 in expenditure. By self-report, 44% of older home care recipients with hearing difficulty were misclassified as having "adequate" hearing on initial assessment and 31% of initial assessments identified hearing loss among those who self-reported no difficulty hearing. Effective management of chronic health conditions is core to healthy aging, including sensory health. Hearing loss represents a largely unaddressed need among home care recipients and frequently goes unidentified. Home-based hearing services that integrate into existing assessments and practices may be an avenue in identifying hearing loss and extending care to older adults who have traditionally gone without access to hearing intervention.
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Abstract
OBJECTIVE This study aimed to provide comprehensive global evidence on the availability of ear and hearing care (EHC) professionals and real-life examples that showcase the impact of workforce shortages on the workload faced by existing professionals. METHODS Six sources of data were used to estimate availability of EHC workforce: a scoping literature review, World Health Organization (WHO) National Health Workforce Accounts platform, WHO Member States survey and regional consultations, hearing care organizations survey, and official government statistics. EHC professionals' workload undertaking common interventions was estimated through the WHO workload indicators of staffing need human resource management tool. RESULTS With data on otolaryngologists from 138, audiologists from 102, speech and language therapists from 124, and teachers of the deaf from 86 countries, this study revealed large gaps in availability of EHC cadres. The majority of countries in the African region had less than one professional in each cadre per million in comparison with most European countries having up to 50 times higher densities. Workload indicators of staffing need calculations revealed the challenging workload faced by existing EHC professionals, with ratios between existing and required staff of 0.01-0.86. CONCLUSION There is an enormous shortage of EHC professionals and urgent actions are needed to ensure sufficient and equitable access to services. Task sharing, a novel approach for improving access to hearing care alongside the development of new cadres, can be a vital strategy in overcoming the shortage of highly qualified providers in many settings, even in well-resourced health systems, to facilitate equitable access to required EHC services.
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Dawood N, Mahomed Asmail F, Louw C, Swanepoel DW. Mhealth hearing screening for children by non-specialist health workers in communities. Int J Audiol 2020; 60:S23-S29. [PMID: 33043733 DOI: 10.1080/14992027.2020.1829719] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To compare outcomes of a community-based hearing screening programme using smartphone screening audiometry operated by specialist (School Health Nurses - SHNs) and non-specialist health workers (Community Health Workers - CHWs) in school children. DESIGN This study used a two-group comparison of screening outcomes as conducted by SHNs and CHWs using smartphone screening for children in communities. STUDY SAMPLE The study included 71 CHWs and 21 SHNs who conducted community-based hearing screening on 6805 children. One thousand one hundred and fifteen hearing screening tests were conducted by the CHWs and 5690 tests by the SHNs. RESULTS No significant difference in screening outcome was evident between CHWs and SHNs using a binomial logistic regression analysis considering age, test duration and noise levels as independent variables. Final screening result was significantly affected by age (p < 0.005), duration of test (p < 0.005) and noise levels exceeding at 1 kHz in at least one ear (p < 0.005). Test failure was associated with longer test duration (p < 0.005; B: 119.98; 95% CI: 112.65-127.30). CHWs had significantly (p < 0.005) longer test durations (68.70 s; 70 SD) in comparison to SHNs (55.85 s; 66.1 SD). CONCLUSION Low-cost mobile technologies with automated testing facilitated from user-friendly interfaces allow minimally trained persons to provide community-based screening comparable to specialised personnel.
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Affiliation(s)
- Nausheen Dawood
- Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Faheema Mahomed Asmail
- Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Christine Louw
- Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - De Wet Swanepoel
- Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa.,Ear Sciences Centre, School of Surgery, University of Western Australia, Nedlands, Australia.,Ear Science Institute Australia, Subiaco, Australia
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Abstract
Hearing loss is a pervasive global health care burden affecting up to one in every seven persons of whom 90% reside in low- and middle-income countries. Traditional service-delivery models are unable to support and promote accessible and affordable hearing care in these setting. Major barriers include a severe shortage of hearing health care professionals, costs associated with equipment, facilities and treatments, and centralized service-delivery models. Convergence of digital and connectivity revolutions are combining to enable new ways of delivering decentralized audiological services along the entire patient journey using integrated eHealth solutions. eHealth technologies are allowing nonprofessionals in communities (e.g., community health workers) to provide hearing services with point-of-care devices at reduced cost with remote surveillance and support by professionals. A growing body of recent evidence showcases community-based hearing care within an integrated eHealth framework that addresses some of the barriers of traditional service-delivery models at reduced cost. Future research, especially in low- and middle-income countries, must explore eHealth-supported hearing care services from detection through to treatment.
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Affiliation(s)
- De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.,Ear Sciences Centre, School of Surgery, University of Western Australia, Nedlands, Australia.,Ear Science Institute Australia, Subiaco, Australia
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Shan A, Lin FR, Nieman CL. Age-related Hearing Loss: Recent Developments in Approaching a Public Health Challenge. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00271-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Affiliation(s)
- Shelly Chadha
- Department of noncommunicable diseases, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Kaloyan Kamenov
- Department of noncommunicable diseases, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Alarcos Cieza
- Department of noncommunicable diseases, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
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