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Swords C, Twumasi E, Fitzgerald M, Fitzsimons-West E, Luo M, Dunne H, Lim KH, Jones O, Law S, Myuran T, Smith G, Tailor BV, Wakelam O, de Cates C, Borsetto D, Tysome J, Donnelly N, Axon P, Bance M, Smith ME. A Multicenter Validity Study of Four Smartphone Hearing Test Apps in Optimized and Home Environments. Laryngoscope 2024; 134:2864-2870. [PMID: 38214403 DOI: 10.1002/lary.31256] [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] [Received: 06/18/2023] [Revised: 10/20/2023] [Accepted: 12/11/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Pure tone audiometry (PTA) is the gold standard for hearing assessment. However, it requires access to specialized equipment. Smartphone audiometry applications (apps) have been developed to perform automated threshold audiometry and could allow patients to perform self-administered screening or monitoring. This study aimed to assess the validity and feasibility of patients using apps to self-assess hearing thresholds at home, with comparison to PTA. METHODS A multi-center, prospective randomized study was conducted amongst patients undergoing PTA in clinics. Participants were randomly allocated to one of four publicly-available apps designed to measure pure tone thresholds. Participants used an app once in optimal sound-treated conditions and a further three times at home. Ear-specific frequency-specific thresholds and pure tone average were compared using Pearson correlation coefficient. The percentage of app hearing tests with results within ±10 dB of PTA was calculated. Patient acceptability was assessed via an online survey. RESULTS One hundred thirty-nine participants submitted data. The results of two at-home automated smartphone apps correlated strongly/very strongly with PTA average and their frequency-specific median was within ±10 dB accuracy. Smartphone audiometry performed in sound-treated and home conditions were very strongly correlated. The apps were rated as easy/very easy to use by 90% of participants and 90% would be happy/very happy to use an app to monitor their hearing. CONCLUSION Judicious use of self-performed smartphone audiometry was both valid and feasible for two of four apps. It could provide frequency-specific threshold estimates at home, potentially allowing assessments of patients remotely or monitoring of fluctuating hearing loss. LEVEL OF EVIDENCE 2 Laryngoscope, 134:2864-2870, 2024.
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Affiliation(s)
- Chloe Swords
- Department of Otology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Cambridge Hearing Group, University of Cambridge, Cambridge, UK
| | - Emmanuel Twumasi
- Department of Otology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Maisie Fitzgerald
- Department of Otology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Erin Fitzsimons-West
- Department of Otology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Michael Luo
- Department of Otology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Henry Dunne
- Department of Otology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Kim Hui Lim
- Department of Otology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Oliver Jones
- Department of Otology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sarah Law
- Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Tharsika Myuran
- Department of Otology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Colchester Hospital, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Gareth Smith
- Southend Hospital, Mid and South Essex NHS Foundation Trust, Colchester, UK
| | - Bhavesh V Tailor
- Colchester Hospital, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Oliver Wakelam
- Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Catherine de Cates
- Southend Hospital, Mid and South Essex NHS Foundation Trust, Colchester, UK
| | - Daniele Borsetto
- Department of Otology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - James Tysome
- Department of Otology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Neil Donnelly
- Department of Otology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Patrick Axon
- Department of Otology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Manohar Bance
- Department of Otology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Cambridge Hearing Group, University of Cambridge, Cambridge, UK
| | - Matthew E Smith
- Department of Otology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Cambridge Hearing Group, University of Cambridge, Cambridge, UK
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Coco L, Leon K, Navarro C, Piper R, Carvajal S, Marrone N. "Close to My Community": A Qualitative Study of Community Health Worker-Supported Teleaudiology Hearing Aid Services. Ear Hear 2024:00003446-990000000-00286. [PMID: 38812073 DOI: 10.1097/aud.0000000000001507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
OBJECTIVES Given well-documented disparities in rural and minority communities, alternative service delivery models that help improve access to hearing care are needed. This article reports on a study of older Latino adults with hearing loss who received hearing aid services with Community Health Workers (CHWs) providing support via teleaudiology. The present study used qualitative data to explore perceptions of this novel service delivery model. DESIGN Participants completed semistructured interviews related to their experiences in the intervention approximately 17 weeks after the hearing aid fitting appointment. Two coders independently coded the data, using an iterative deductive and inductive thematic analysis approach. Inter-rater reliability was good (κ = 0.80). RESULTS Of the 28 participants, 19 were interviewed (CHW group: n = 9, 8 females; non-CHW group: n = 10, 9 females). Both groups of participants reported experiencing barriers in access to care and reported positive experiences with teleaudiology and with hearing aids as part of the trial. CHW group participants reported interactions with patient-site facilitators that were indicative of patient-centeredness. CONCLUSIONS Results demonstrate the feasibility and potential effectiveness of trained CHWs as patient-site facilitators in teleaudiology-delivered hearing aid services for adults.
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Affiliation(s)
- Laura Coco
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, California, USA
- Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, Arizona, USA
| | - Kimberly Leon
- Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, Arizona, USA
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | | | - Rosie Piper
- Mariposa Community Health Center, Nogales, Arizona, USA
| | - Scott Carvajal
- Health Promotion Sciences Department, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Nicole Marrone
- Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, Arizona, USA
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Pudrith C, Chen X, Buac M, Billingsly D, Hill E. Demographic Disparities in Drive Times to the Nearest Audiologist in the United States. Am J Audiol 2024:1-14. [PMID: 38758682 DOI: 10.1044/2024_aja-23-00279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024] Open
Abstract
PURPOSE Audiological services are underused, possibly because patients need to drive long distances to see a provider. In this study, we measured the association of drive times to the nearest audiologist with population density, income, ethnicity, race, and distance to the nearest audiology graduate program. METHOD Drive times for each census block group to the nearest audiologist were measured using census data, the National Provider Identifier Registry, and a geographic analyzing tool called ArcGIS for all block groups within the United States. The association between drive times and population density, income, ethnicity, race, and audiology program distance was evaluated with a population density-matched case-control study and multiple linear regression analyses. RESULTS Approximately 5.29 million Americans need to drive at least 1 hr to visit their closest audiologist. The 10% most rural-dwelling Americans drive an average of 33.8 min. The population density-matched case-control study demonstrated that percent below poverty, percent identifying as Hispanic, and travel times to the nearest audiology program were all significantly higher in census block groups with high drive times to the nearest audiologist. An average of 7.96% of individuals in census block groups with low drive times identified as Hispanic, but 18.8% identified as Hispanic in high drive time groups. The multiple linear regression showed that the effect of demographics and distance to the nearest audiology program was highest in rural areas. In both analyses, adjusting for poverty did not drastically change the effect of percent identifying as Hispanic on drive times. CONCLUSIONS Long drive times restrict access to audiological care for those who live in rural areas. This restriction disproportionately affects those in rural areas who identify as Hispanic or have low income.
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Affiliation(s)
- Charles Pudrith
- School of Allied Health and Communicative Disorders, Northern Illinois University, DeKalb
| | - Xuwei Chen
- Department of Earth, Atmosphere and Environment, Northern Illinois University, DeKalb
| | - Milijana Buac
- School of Allied Health and Communicative Disorders, Northern Illinois University, DeKalb
| | - Danica Billingsly
- School of Allied Health and Communicative Disorders, Northern Illinois University, DeKalb
| | - Elizabeth Hill
- School of Allied Health and Communicative Disorders, Northern Illinois University, DeKalb
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Burns SD, West JS. Country Differences in Older Men's Hearing Difficulty Disadvantage. J Aging Health 2024:8982643241251939. [PMID: 38710107 DOI: 10.1177/08982643241251939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Objectives: Hearing difficulty is prevalent in older adulthood and projected to increase via global aging, particularly among men. Currently, there is limited research on how this gender disparity might vary by country. Methods: Using 2018 data (n = 29,480) from the Health and Retirement Study (HRS) international family of studies, we investigate gender disparities in hearing difficulty among respondents ages 55-89 from the United States (n = 12,566), Mexico (n = 10,762), and Korea (n = 6152) with country-specific ordinal logistic regression models that progressively adjust for demographic, social, and health indicators. Results: In the United States, men's hearing difficulty disadvantage was consistently observed. In Mexico, men's hearing difficulty disadvantage was explained by the interactive effect of gender and age group but resurfaced after adjusting for comorbidities. In Korea, there was consistently no gender difference in hearing difficulty. Discussion: Our results highlight the heterogeneity in older men's hearing difficulty disadvantage among a diverse group of aging countries.
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Affiliation(s)
- Shane D Burns
- Population Studies Center, University of Michigan, Ann Arbor, MI, USA
| | - Jessica S West
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
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Lin MJ, Chen CK. Breaking Sound Barriers: Exploring Tele-Audiology's Impact on Hearing Healthcare. Diagnostics (Basel) 2024; 14:856. [PMID: 38667501 PMCID: PMC11049182 DOI: 10.3390/diagnostics14080856] [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: 03/10/2024] [Revised: 04/09/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Hearing impairment is a global issue, affecting billions of people; however, there is a gap between the population affected by hearing loss and those able to access hearing healthcare. Tele-audiology, the application of telemedicine in audiology, serves as a new form of technology which aims to provide synchronous or asynchronous hearing healthcare. In this article, we reviewed some recent studies of tele-audiology-related topics to have a glimpse of the current development, associated challenges, and future advancement. Through the utilization of tele-audiology, patients can conveniently access hearing healthcare, and thus save travel costs and time. Recent studies indicate that remote hearing screening and intervention are non-inferior to the performance of traditional clinical pathways. However, despite its potential benefits, the implementation of tele-audiology faces numerous challenges, and audiologists have varying attitudes on this technology. Overcoming obstacles such as high infrastructure costs, limited reimbursement, and the lack of quality standards calls for concerted efforts to develop effective strategies. Ethical concerns, reimbursement, and patient privacy are all crucial aspects requiring in-depth discussion. Enhancing the education and training of students and healthcare workers, along with providing relevant resources, will contribute to a more efficient, systematic hearing healthcare. Future research will aim to develop integrated models with evidence-based protocols and incorporating AI to enhance the affordability and accessibility of hearing healthcare.
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Affiliation(s)
- Mien-Jen Lin
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan;
| | - Chin-Kuo Chen
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung 204201, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan
- Department of Otolaryngology-Head and Neck Surgery and Communication Enhancement Center, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan
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Haile LM, Orji AU, Reavis KM, Briant PS, Lucas KM, Alahdab F, Bärnighausen TW, Bell AW, Cao C, Dai X, Hay SI, Heidari G, Karaye IM, Miller TR, Mokdad AH, Mostafavi E, Natto ZS, Pawar S, Rana J, Seylani A, Singh JA, Wei J, Yang L, Ong KL, Steinmetz JD. Hearing Loss Prevalence, Years Lived With Disability, and Hearing Aid Use in the United States From 1990 to 2019: Findings From the Global Burden of Disease Study. Ear Hear 2024; 45:257-267. [PMID: 37712826 PMCID: PMC10718207 DOI: 10.1097/aud.0000000000001420] [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] [Received: 04/29/2022] [Accepted: 06/17/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVES This article describes key data sources and methods used to estimate hearing loss in the United States, in the Global Burden of Disease study. Then, trends in hearing loss are described for 2019, including temporal trends from 1990 to 2019, changing prevalence over age, severity patterns, and utilization of hearing aids. DESIGN We utilized population-representative surveys from the United States to estimate hearing loss prevalence for the Global Burden of Disease study. A key input data source in modeled estimates are the National Health and Nutrition Examination Surveys (NHANES), years 1988 to 2010. We ran hierarchical severity-specific models to estimate hearing loss prevalence. We then scaled severity-specific models to sum to total hearing impairment prevalence, adjusted estimates for hearing aid coverage, and split estimates by etiology and tinnitus status. We computed years lived with disability (YLDs), which quantifies the amount of health loss associated with a condition depending on severity and creates a common metric to compare the burden of disparate diseases. This was done by multiplying the prevalence of severity-specific hearing loss by corresponding disability weights, with additional weighting for tinnitus comorbidity. RESULTS An estimated 72.88 million (95% uncertainty interval (UI) 68.53 to 77.30) people in the United States had hearing loss in 2019, accounting for 22.2% (20.9 to 23.6) of the total population. Hearing loss was responsible for 2.24 million (1.56 to 3.11) YLDs (3.6% (2.8 to 4.7) of total US YLDs). Age-standardized prevalence was higher in males (17.7% [16.7 to 18.8]) compared with females (11.9%, [11.2 to 12.5]). While most cases of hearing loss were mild (64.3%, 95% UI 61.0 to 67.6), disability was concentrated in cases that were moderate or more severe. The all-age prevalence of hearing loss in the United States was 28.1% (25.7 to 30.8) higher in 2019 than in 1990, despite stable age-standardized prevalence. An estimated 9.7% (8.6 to 11.0) of individuals with mild to profound hearing loss utilized a hearing aid, while 32.5% (31.9 to 33.2) of individuals with hearing loss experienced tinnitus. Occupational noise exposure was responsible for 11.2% (10.2 to 12.4) of hearing loss YLDs. CONCLUSIONS Results indicate large burden of hearing loss in the United States, with an estimated 1 in 5 people experiencing this condition. While many cases of hearing loss in the United States were mild, growing prevalence, low usage of hearing aids, and aging populations indicate the rising impact of this condition in future years and the increasing importance of domestic access to hearing healthcare services. Large-scale audiometric surveys such as NHANES are needed to regularly assess hearing loss burden and access to healthcare, improving our understanding of who is impacted by hearing loss and what groups are most amenable to intervention.
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Affiliation(s)
- Lydia M. Haile
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Aislyn U. Orji
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kelly M. Reavis
- National Center for Rehabilitative Auditory Research, US Department of Veterans Affairs—Portland Healthcare System, Portland, OR, USA
| | - Paul Svitil Briant
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Katia M. Lucas
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Fares Alahdab
- Mayo Evidence-based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, MN, USA
| | - Till Winfried Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Arielle Wilder Bell
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA
- Department of Social Services, Tufts Medical Center, Boston, MA, USA
| | - Chao Cao
- Program in Physical Therapy, Washington University in St. Louis, St. Louis, MO, USA
| | - Xiaochen Dai
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Simon I. Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | | | - Ibraheem M. Karaye
- School of Health Professions and Human Services, Hofstra University, Hempstead, NY, USA
| | - Ted R. Miller
- Pacific Institute for Research & Evaluation, Calverton, MD, USA
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Ali H. Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Ebrahim Mostafavi
- Department of Medicine, Stanford University, Palo Alto, CA, USA
- Stanford Cardiovascular Institute, Stanford University, Palo Alto, CA, USA
| | - Zuhair S. Natto
- Department of Dental Public Health, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Oral Health Policy and Epidemiology, Harvard University, Boston, USA
| | - Shrikant Pawar
- Department of Genetics, Yale University, New Haven, CT, USA
| | - Juwel Rana
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Research and Innovation Division, South Asian Institute for Social Transformation (SAIST), Dhaka, Bangladesh
| | - Allen Seylani
- National Heart, Lung, and Blood Institute, National Institute of Health, Rockville, MD, USA
| | - Jasvinder A. Singh
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Medicine Service, US Department of Veterans Affairs (VA), Birmingham, AL, USA
| | - Jingkai Wei
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Lin Yang
- Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, BC, Canada
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Kanyin Liane Ong
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jaimie D. Steinmetz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Wiese LK, Pratt BA, Heinze K, Besser L, Ifill A(A, Williams CL. Community-Based Strategies to Reduce Alzheimer's Disease and Related Dementia Incidence Among Rural, Racially/Ethnically Diverse Older Adults. CURRENT GERIATRICS REPORTS 2023; 12:205-219. [PMID: 38223294 PMCID: PMC10783445 DOI: 10.1007/s13670-023-00400-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 01/16/2024]
Abstract
Purpose of Review The purpose of this paper was to address the research question "What recent advances in Alzheimer's Disease and Related Dementias (ADRD) risk reduction strategies can be tailored for rural, racially/ethnically diverse populations?" A rural resident's life story that grounded the work is shared. Next, a brief description is provided regarding ADRD risk factors of importance in rural, multicultural settings. Gaps in U.S.-based research are highlighted. Policy actions and interventions that may make a difference in alleviating rural, ADRD-related disparities are offered. Recent Findings More than a dozen factors, including lack of built environment, periodontitis, poor air quality, and sensory loss, were identified that are of particular relevance to rural groups. Evidence of importance to underserved residents has also emerged regarding the harmful effects of ultra-processed foods on brain health, benefits of even minimal physical activity, and importance of social engagement, on brain health. Summary Resident-led initiatives will be key to creating change at the community level. Health providers are also called to assist in identifying and adapting culturally specific upstream approaches, in partnership with community stakeholders. These mechanisms are vital for decreasing ADRD burdens in underserved communities facing the largest disparities in preventive care.
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Affiliation(s)
- Lisa Kirk Wiese
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton FL 33431, USA
| | - Beth A. Pratt
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton FL 33431, USA
| | - Katherine Heinze
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton FL 33431, USA
| | - Lilah Besser
- Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Boca Raton, FL, USA
| | - Antoinita (Annie) Ifill
- Palm Health Foundation/Community Partners of South Florida, 491 E. Main Street Suite 5A, Pahokee FL 33476, USA
| | - Christine L. Williams
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton FL 33431, USA
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Amlani AM. Effect of Determinants of Health on the Hearing Care Framework: An Economic Perspective. Semin Hear 2023; 44:232-260. [PMID: 37484988 PMCID: PMC10361793 DOI: 10.1055/s-0043-1769611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Hearing care is expanding accessibility to consumers through new service delivery channels and methods of technology distribution (see Brice et al, this issue). This diversification has the potential to overcome longstanding consumer disparities (e.g., health, socioeconomic, psychological, environmental) in receiving care and provider constraints (e.g., accessibility, geography, direct access) to delivering care that adversely impacts quality of life (e.g., social isolation, depression, anxiety, self-esteem). In this article, the reader is provided with an overview of health outcomes factors (i.e., determinants of health)-in the context of an economic framework (i.e., supply, demand)-and their effect on consumer behavior and provider preferences toward hearing healthcare services. This overview also affords readers with strategic business insights to assess and integrate future hearing care services and technology to consumers in their local markets.
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Batool S, Burks CA, Bergmark RW. Healthcare Disparities in Otolaryngology. CURRENT OTORHINOLARYNGOLOGY REPORTS 2023; 11:1-14. [PMID: 37362031 PMCID: PMC10247342 DOI: 10.1007/s40136-023-00459-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/28/2023]
Abstract
Purpose of Review The purpose of this review is to summarize some of the recent research studies on healthcare disparities across various subspecialties within otolaryngology. This review also highlights the impact of COVID-19 pandemic on disparities and proposes potential interventions to mitigate disparities. Recent Findings Significant healthcare disparities in care and treatment outcomes have been reported across all areas of otolaryngology. Notable differences in survival, disease recurrence, and overall mortality have been noted based on race, ethnicity, socioeconomic status (SES), insurance status, etc. This is most well-researched in head and neck cancer (HNC) within otolaryngology. Summary Healthcare disparities have been identified by numerous research studies within otolaryngology for many vulnerable groups that include racial and ethnic minority groups, low-income populations, and individuals from rural areas among many others. These populations continue to experience suboptimal access to timely, quality otolaryngologic care that exacerbate disparities in health outcomes.
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Affiliation(s)
- Sana Batool
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Ciersten A. Burks
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, USA
| | - Regan W. Bergmark
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, USA
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women’s Hospital and Dana Farber Cancer Institute, 45 Francis Street, Boston, MA 02115 USA
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de Cates C, Jashek-Ahmed F, Bohara RB, Salter C, Youngs R. How chronic ear disease affects quality of life: a qualitative research study in Nepal. J Laryngol Otol 2023; 137:390-397. [PMID: 35485736 DOI: 10.1017/s0022215122001050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Hearing loss is the third leading cause globally for 'years lived with disability'. The majority of those affected live in low and middle-income countries. METHOD This study used qualitative research methods to explore the impact of chronic ear disease on quality of life in Nepal. Twenty face-to-face semi-structured interviews were conducted during a visiting ear camp at the Britain Nepal Otology Service Ear Care Centre in Nepal. Interviews were recorded, transcribed and translated with thematic content analysis performed manually by two researchers. RESULTS Chronic ear disease has a significant impact on social interactions, emotional well-being and functionality. Barriers to surgery are cost, accessibility, reputation, gender and fear of complications. CONCLUSION This study provided valuable new insight into patient perspectives on living with chronic ear disease in Nepal. Patients with chronic ear disease experience discrimination and stigmatisation across all levels of personal, family and social life, with their function across all domains being directly limited by symptoms.
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Affiliation(s)
- C de Cates
- Department of Otolaryngology, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, UK
| | - F Jashek-Ahmed
- West Middlesex Hospital, Chelsea & Westminster NHS Foundation Trust, London, UK
| | - R B Bohara
- Britain Nepal Otology Service Ear Care Centre, Nepalgunj, Nepal
| | - C Salter
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - R Youngs
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
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Knoetze M, Manchaiah V, Mothemela B, Swanepoel DW. Factors Influencing Hearing Help-Seeking and Hearing Aid Uptake in Adults: A Systematic Review of the Past Decade. Trends Hear 2023; 27:23312165231157255. [PMID: 36798964 PMCID: PMC9940236 DOI: 10.1177/23312165231157255] [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] [Indexed: 02/18/2023] Open
Abstract
This systematic review examined the audiological and nonaudiological factors that influence hearing help-seeking and hearing aid uptake in adults with hearing loss based on the literature published during the last decade. Peer-reviewed articles published between January 2011 and February 2022 were identified through systematic searches in electronic databases CINAHL, PsycINFO, and MEDLINE. The review was conducted and reported according to the PRISMA protocol. Forty-two articles met the inclusion criteria. Seventy (42 audiological and 28 nonaudiological) hearing help-seeking factors and 159 (93 audiological and 66 nonaudiological) hearing aid uptake factors were investigated with many factors reported only once (10/70 and 62/159, respectively). Hearing aid uptake had some strong predictors (e.g., hearing sensitivity) with others showing conflicting results (e.g., self-reported health). Hearing help-seeking had clear nonpredictive factors (e.g., education) and conflicting factors (e.g., self-reported health). New factors included cognitive anxiety associated with increased help-seeking and hearing aid uptake and urban residency and access to financial support with hearing aid uptake. Most studies were rated as having a low level of evidence (67%) and fair quality (86%). Effective promotion of hearing help-seeking requires more research evidence. Investigating factors with conflicting results and limited evidence is important to clarify what factors support help-seeking and hearing aid uptake in adults with hearing loss. These findings can inform future research and hearing health promotion and rehabilitation practices.
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Affiliation(s)
- Megan Knoetze
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa,Virtual Hearing Lab, University of Colorado School of Medicine, Aurora, CO, USA
| | - Vinaya Manchaiah
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa,Virtual Hearing Lab, University of Colorado School of Medicine, Aurora, CO, USA,Department of Otolaryngology–Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA,UCHealth Hearing and Balance, University of Colorado Hospital, Aurora, CO, USA,Department of Speech and Hearing, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Bopane Mothemela
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa,Virtual Hearing Lab, University of Colorado School of Medicine, Aurora, CO, USA
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa,Virtual Hearing Lab, University of Colorado School of Medicine, Aurora, CO, USA,Department of Otolaryngology–Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA,Ear Science Institute Australia, Subiaco, Australia,De Wet Swanepoel, Department of Speech-Language Pathology and Audiology, University of Pretoria, Lynnwood Road & Roper Street, Pretoria, South Africa.
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12
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Davis AG, Hicks KL, Dillon MT, Overton AB, Roth N, Richter ME, Dedmon MM. Hearing health care access for adult cochlear implant candidates and recipients: Travel time and socioeconomic status. Laryngoscope Investig Otolaryngol 2023; 8:296-302. [PMID: 36846426 PMCID: PMC9948562 DOI: 10.1002/lio2.1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/24/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023] Open
Abstract
Objectives Access to cochlear implantation may be negatively influenced by extended travel time to a cochlear implant (CI) center or lower socioeconomic status (SES) for the individual. There is a critical need to understand the influence of these variables on patient appointment attendance for candidacy evaluations, and CI recipients' adherence to post-activation follow-up recommendations that support optimal outcomes. Methods A retrospective chart review of adult patients referred to a CI center in North Carolina for initial cochlear implantation candidacy evaluation between April 2017 and July 2019 was conducted. Demographic and audiologic data were collected for each patient. Travel time was determined using geocoding. SES was proxied using ZCTA-level Social Deprivation Index (SDI) information. Independent samples t tests compared variables between those who did and did not attend the candidacy evaluation. Pearson correlations assessed the association of these variables and the duration of time between initial CI activation and return for first follow-up visit. Results Three hundred and ninety patients met the inclusion criteria. There was a statistically significant difference between SDI of those who attended their candidacy evaluation versus those who did not. Age at referral or travel time did not show statistical significance between these two groups. There was no significant correlation with age at referral, travel time, or SDI with the duration of time (days) between initial activation and the 1-month follow-up. Conclusions Our findings suggest that SES may influence a patient's ability to attend a cochlear implantation candidacy evaluation appointment and may further impact the decision to pursue cochlear implantation.Level of evidence: 4 - Case Series.
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Affiliation(s)
- Amanda G Davis
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Kelli L Hicks
- Department of Otolaryngology/Head & Neck Surgery University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Margaret T Dillon
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences University of North Carolina at Chapel Hill Chapel Hill North Carolina USA.,Department of Otolaryngology/Head & Neck Surgery University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Andrea B Overton
- Department of Audiology UNC Health Chapel Hill North Carolina USA
| | - Noelle Roth
- Department of Audiology UNC Health Chapel Hill North Carolina USA
| | - Margaret E Richter
- Department of Otolaryngology/Head & Neck Surgery University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Matthew M Dedmon
- Department of Otolaryngology/Head & Neck Surgery University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
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Coco L, Carvajal S, Navarro C, Piper R, Marrone N. Community Health Workers as Patient-Site Facilitators in Adult Hearing Aid Services via Synchronous Teleaudiology: Feasibility Results from the Conexiones Randomized Controlled Trial. Ear Hear 2023; 44:28-42. [PMID: 36253920 PMCID: PMC9780168 DOI: 10.1097/aud.0000000000001281] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the feasibility of Community Health Workers (CHWs) as patient-site facilitators in teleaudiology-facilitated hearing aid services to improve hearing aid rehabilitation outcomes for older Hispanic/Latino adults in a medically underserved, rural, US-Mexico border community. DESIGN A total of 28 adults (aged 55 to 89) with bilateral hearing loss participated in this study. Individuals were randomized to one of two teleaudiology intervention arms that differed at the level of the patient-site facilitator. Participants in the experimental group were assisted locally by trained CHW facilitators. Participants in the control group were assisted locally by trained university student facilitators. Synchronous (real-time) teleaudiology hearing aid services took place with participants located at a rural community health center and the clinician located a university 70 miles away. The results of this feasibility study are presented within the reach, effectiveness, adoption, implementation fidelity, and maintenance implementation framework. RESULTS Regarding reach, the participants in this study population are historically under-represented in research (primarily low-income Hispanic/Latino older adults). A total of 57 individuals were recruited, 47 were consented and assessed for eligibility and 28 individuals met inclusion criteria and were randomized. The average age of participants was 73.9 years, (range: 55 to 89 years) and most individuals were female (75%). Most participants (86%) reported having incomes less than $20,000 annually. Effectiveness results (via the Self Efficacy for Situational Communication Management Questionnaire) showed that both groups (CHW and control) significantly improved listening self-efficacy from pre-fitting baseline and no difference between groups was observed. Regarding datalogging, at the short-term follow-up, participants in the CHW group wore their hearing aids for more hours/day on average compared with participants in the control group. Implementation fidelity was high for both groups. Long-term maintenance of CHW-supported teleaudiology appears feasible given that training and institutional support is in place. CONCLUSIONS Teleaudiology-delivered hearing aid services were feasible when facilitated locally by trained CHWs. Future efficacy and effectiveness research is warranted with CHWs and teleaudiology, potentially leading to a significant reduction in barriers for rural and medically under-resourced communities.
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Affiliation(s)
- Laura Coco
- Department of Speech, Language, and Hearing Sciences, College of Science, University of Arizona, Tucson, AZ
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA
| | - Scott Carvajal
- Health Behavior Health Promotion, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | | | - Rosie Piper
- Mariposa Community Health Center, Nogales, AZ
| | - Nicole Marrone
- Department of Speech, Language, and Hearing Sciences, College of Science, University of Arizona, Tucson, AZ
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Schutte DL, Jenuwine ES, Templin T, Schutte BC. Perceived Hearing Impairment in a Rural Community. Res Gerontol Nurs 2023; 16:21-32. [PMID: 36692440 DOI: 10.3928/19404921-20230104-04] [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: 01/25/2023]
Abstract
CoSAGE Community Advisory and Ethics Committee; Age-related hearing impairment yields many negative outcomes, including alterations in mental health, functional impairments, and decreased social engagement. The purpose of the current study was to examine perceived hearing impairment and its relationship with person-centered outcomes among adults in a rural community setting. A cross-sectional, descriptive correlational design was used. Survey packets of validated instruments were distributed following all weekend services at a rural community church; 72 completed surveys were returned (26% response rate). Descriptive and inferential statistics, including Spearman's rank correlations (rs), were used to address the study aims. Mean age of participants was 54 years (SD = 17 years), 58% were female, and 97% attended church regularly. Thirty-one percent of respondents reported moderate to severe hearing impairment. Perceived hearing impairment was associated with more depressive symptoms (rs = 0.24, p = 0.052), poorer attentional function (rs = -0.29, p = 0.016), and decreased quality of life in the mental health domain (rs = -0.21, p = 0.081). Findings expand evidence supporting the relationship between hearing and person-centered outcomes, including a functional measure of cognition. These results serve as a foundation for the design of a community-driven, church-based hearing health intervention. [Research in Gerontological Nursing, 16(1), 21-32.].
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15
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Mangan AR, Davis KP, Anzalone CL, Saadi RA, Dornhoffer JL, King DL. Assessing Patient Barriers to Cochlear Implantation. Otol Neurotol 2022; 43:e1090-e1093. [PMID: 36190906 DOI: 10.1097/mao.0000000000003702] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Evaluate barriers that deter adult patients from following through with cochlear implantation. STUDY DESIGN Retrospective chart review and phone survey. SETTING Single tertiary referral center. PATIENTS Between January 2019 and August 2021, 113 patients, without a previous cochlear implant (CI), were determined to be candidates for cochlear implantation. Thirty-eight (33.6%) patients deferred cochlear implantation. Survey response rate was 61.1% (22/36). INTERVENTION None. MAIN OUTCOME MEASURES Demographic, socioeconomic, otologic history, and comorbidity factors associated with deferment of cochlear implantation. Patient survey assessment of factors that had the greatest impact, rated on a scale of 1 to 10 (10 being the most impactful), on their decision to defer a CI. RESULTS Out of the 113 patients who met inclusion criteria, 75 (66.3%) underwent cochlear implantation and 38 (33.6%) patients deferred. Comparing implanted versus deferred groups, there was no statistical difference in age (67.1 y versus 68.5 y; p = 0.690) or male sex (53.3% versus 57.9%; p = 0.692). The deferred group had higher mean neighborhood disadvantage state decile (5.3 versus 4.3; p = 0.064) and national percentile (73.0 versus 66.2; p = 0.106) scores, although neither were statistically significant. A greater proportion of the deferred group were not living independently at time of CI evaluation (13.2 versus 2.7%; p = 0.017). Fear of losing residual hearing was rated the highest among the survey respondents (mean rating of 5.1), followed by general medical health (4.9) and cost and financial concerns (3.6). CONCLUSION The greatest concern among the patients was the fear of losing residual hearing. Spending greater time educating patients about the success and failure rates of cochlear implantation may reduce patient hesitancy with implantation.
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Affiliation(s)
- Andrew R Mangan
- Department of Otolaryngology - Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
| | | | - C Lane Anzalone
- Department of Otolaryngology - Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Robert A Saadi
- Department of Otolaryngology - Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - John L Dornhoffer
- Department of Otolaryngology - Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Deanne L King
- Department of Otolaryngology - Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
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16
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Nieman CL, Suen JJ, Dean LT, Chandran A. Foundational Approaches to Advancing Hearing Health Equity: A Primer in Social Epidemiology. Ear Hear 2022; 43:5S-14S. [PMID: 35724250 PMCID: PMC9219014 DOI: 10.1097/aud.0000000000001149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Hearing health is inextricably linked to factors beyond biology. Social, demographic, environmental, geographic, and historical influences affect hearing health, but these factors are often unmeasured within traditional biological, clinical, and epidemiological studies of hearing health. With increasing recognition of hearing health over the life course as a public health priority, there is also a growing understanding of existing hearing health inequities at the individual, community, national, and global levels. To make progress in addressing these inequities, public health disciplines, such as social epidemiology, can provide valuable frameworks. With a focus on integrating the biological and functional with social and structural factors influencing health, social epidemiology provides key concepts and approaches for filling existing research and practice gaps. In this review, we introduce the discipline of social epidemiology and its associated concepts to inspire greater cross-disciplinary collaboration for the ultimate goal of advancing hearing health equity.
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Affiliation(s)
- Carrie L Nieman
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jonathan J Suen
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Abstract
Clinical trials are critically important to translate scientific innovations into clinical practice. Hearing healthcare depends on this translational approach to improve outcomes and quality of life. Across the spectrum of healthcare, there is a lack of diverse participation in clinical trials, a failure to recruit and retain underrepresented and underserved populations, and an absence of rigorous dissemination and implementation of novel research to broader populations. The field of hearing healthcare research would benefit from expanding the types and designs of clinical trials that extend hearing healthcare and novel interventions to diverse populations, as well as emphasizing trials that evaluate factors influencing how that care can be delivered effectively. This article explores the following: (1) the role, value, and design types of clinical trials (randomized controlled, cluster randomized, stepped wedge, and mixed methods) to address health equity; (2) the importance of integrating community and stakeholder involvement; and (3) dissemination and implementation frameworks and designs for clinical trials (hybrid trial designs). By adopting a broader range of clinical trial designs, hearing healthcare researchers may be able to extend scientific discoveries to a more diverse population.
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18
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Thai-Van H, Joly CA, Idriss S, Melki JB, Desmettre M, Bonneuil M, Veuillet E, Ionescu E, Reynard P. Online digital audiometry vs. conventional audiometry: a multi-centre comparative clinical study. Int J Audiol 2022; 62:362-367. [PMID: 35337229 DOI: 10.1080/14992027.2022.2052979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The primary objective of the current study was the validation of a cloud-centralized audiometry system for clinical practice. DESIGN A cross-sectional study design was used. STUDY SAMPLE A convenience sample of patients (>10 years old) booked for follow-up appointments were invited to participate. Participants completed both conventional and online digital audiometry in a standard sound treated clinic space during a single clinic visit; tests were completed in random order. Data for both ears were included. Patients were from one of three audiological practices. RESULTS A total of 41 participants completed both audiometric tests. Validation study results showed that the mean difference between the two audiometric test results remained within 5 dB HL for both air and bone conduction thresholds at all tested frequencies. CONCLUSIONS Online digital audiometry has been demonstrated as a clinically accurate method for hearing assessment.
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Affiliation(s)
- Hung Thai-Van
- Department of Audiology and Otoneurological Evaluation, Lyon University Hospital, French Society of Audiology, Paris Hearing Institute, Research Center of Institut Pasteur, Team Clinical and Translational Exploration of Sensorineural Hearing Loss, Paris, France
| | - Charles-Alexandre Joly
- Department of Audiology and Otoneurological Evaluation, Lyon University Hospital, Paris Hearing Institute, Research Center of Institut Pasteur, Team Clinical and Translational Exploration of Sensorineural Hearing Loss, Paris, France
| | - Samar Idriss
- Department of Audiology and Otoneurological Evaluation, Lyon University Hospital, Lyon, France
| | | | | | | | - Evelyne Veuillet
- Department of Audiology and Otoneurological Evaluation, Lyon University Hospital, Paris Hearing Institute, Research Center of Institut Pasteur, Team Clinical and Translational Exploration of Sensorineural Hearing Loss, Paris, France
| | - Eugen Ionescu
- Department of Audiology and Otoneurological Evaluation, Lyon University Hospital, Paris Hearing Institute, Research Center of Institut Pasteur, Team Clinical and Translational Exploration of Sensorineural Hearing Loss, Paris, France
| | - Pierre Reynard
- Department of Audiology and Otoneurological Evaluation, Lyon University Hospital, Paris Hearing Institute, Research Center of Institut Pasteur, Team Clinical and Translational Exploration of Sensorineural Hearing Loss, Paris, France
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Borre ED, Myers ER, Dubno JR, O'Donoghue GM, Diab MM, Emmett SD, Saunders JE, Der C, McMahon CM, Younis D, Francis HW, Tucci DL, Wilson BS, Ogbuoji O, Schmidler GDS. Development and validation of DeciBHAL-US: A novel microsimulation model of hearing loss across the lifespan in the United States. EClinicalMedicine 2022; 44:101268. [PMID: 35072020 PMCID: PMC8762067 DOI: 10.1016/j.eclinm.2021.101268] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/29/2021] [Accepted: 12/21/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Hearing loss affects over 50% of people in the US across their lifespan and there is a lack of decision modeling frameworks to inform optimal hearing healthcare delivery. Our objective was to develop and validate a microsimulation model of hearing loss across the lifespan in the US. METHODS We collaborated with the Lancet Commission on Hearing Loss to outline model structure, identify input data sources, and calibrate/validate DeciBHAL-US (Decision model of the Burden of Hearing loss Across the Lifespan). We populated the model with literature-based estimates and validated the conceptual model with key informants. We validated key model endpoints to the published literature, including: 1) natural history of sensorineural hearing loss (SNHL), 2) natural history of conductive hearing loss (CHL), and 3) the hearing loss cascade of care. We reported the coefficient of variance root mean square error (CV-RMSE), considering values ≤15% to indicate adequate fit. FINDINGS For SNHL prevalence, the CV-RMSE for model projected male and female age-specific prevalence compared to sex-adjusted National Health and Nutrition Examination Survey (NHANES) data was 4.9 and 5.7%, respectively. Incorporating literature-based age-related decline in SNHL, we validated mean four-frequency average hearing loss in the better ear (dB) among all persons to longitudinal data (CV-RMSE=11.3%). We validated the age-stratified prevalence of CHL to adjusted NHANES data (CV-RMSE=10.9%). We incorporated age- and severity-stratified time to first hearing aid (HA) use data and HA discontinuation data (adjusted for time-period of use) and validated to NHANES estimates on the prevalence of adult HA use (CV-RMSE=10.3%). INTERPRETATION Our results indicate adequate model fit to internal and external validation data. Future incorporation of cost and severity-stratified utility data will allow for cost-effectiveness analysis of US hearing healthcare interventions across the lifespan. Further research might expand the modeling framework to international settings. FUNDING This study was funded by the National Institute on Deafness and Other Communication Disorders and the National Institute on Aging (3UL1-TR002553-03S3 and F30 DC019846).
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Affiliation(s)
- Ethan D. Borre
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States of America
| | - Evan R. Myers
- Division of Women's Community and Population Health, Department of Obstetrics & Gynecology, Duke University School of Medicine, Durham, NC, United States of America
| | - Judy R. Dubno
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States of America
| | - Gerard M. O'Donoghue
- Department of Otolaryngology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Mohamed M. Diab
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Susan D. Emmett
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - James E. Saunders
- Department of Surgery, Geisel School of Medicine, Dartmouth University, Lebanon, NH, United States of America
| | - Carolina Der
- Facultad de Medicina Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile
| | | | - Danah Younis
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States of America
| | - Howard W. Francis
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - Debara L. Tucci
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, United States of America
| | - Blake S. Wilson
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, United States of America
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, United States of America
- Department of Electrical & Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC, United States of America
| | - Osondu Ogbuoji
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, NC, United States of America
| | - Gillian D. Sanders Schmidler
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States of America
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States of America
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Urban MJ, Shimomura A, Shah S, Losenegger T, Westrick J, Jagasia AA. Rural Otolaryngology Care Disparities: A Scoping Review. Otolaryngol Head Neck Surg 2022; 166:1219-1227. [PMID: 35015580 DOI: 10.1177/01945998211068822] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To broadly synthesize the literature regarding rural health disparities in otolaryngology, categorize findings, and identify research gaps to stimulate future work. STUDY DESIGN Scoping review. DATA SOURCES A comprehensive literature search was performed in the following databases: PubMed/MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Google Scholar, and CINAHL. REVIEW METHODS The methods were developed in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Peer-reviewed, English-language, US-based studies examining a rural disparity in otolaryngology-related disease incidence, prevalence, diagnosis, treatment, or outcome were included. Descriptive studies, commentaries, reviews, and letters to the editor were excluded. Studies published prior to 1980 were excluded. RESULTS The literature search resulted in 1536 unique abstracts and yielded 79 studies that met final criteria for inclusion. Seventy-five percent were published after 2010. The distribution of literature was as follows: otology (34.2%), head and neck cancer (20.3%), endocrine surgery (13.9%), rhinology and allergy (8.9%), trauma (5.1%), laryngology (3.8%), other pediatrics (2.5%), and adult sleep (1.3%). Studies on otolaryngology health care systems also accounted for 10.1%. The most common topics studied were practice patterns (41%) and epidemiology (27%), while the Southeast (47%) was the most common US region represented, and database study (42%) was the most common study design. CONCLUSION Overall, there was low-quality evidence with large gaps in the literature in all subspecialties, most notably facial plastic surgery, laryngology, adult sleep, and pediatrics. Importantly, there were few studies on intervention and zero studies on resident exposure to rural populations, which will be critical to making rural otolaryngology care more equitable in the future.
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Affiliation(s)
- Matthew J Urban
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Aoi Shimomura
- Loyola University of Chicago, Stritch School of Medicine, Maywood, Illinois, USA
| | - Swapnil Shah
- Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Tasher Losenegger
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Ashok A Jagasia
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Abstract
Hearing loss in adults is a significant public health problem throughout the world. Undiagnosed and untreated hearing loss causes a measurable impact on health and social, occupational, and emotional well-being of those affected. In spite of a wide array of health care resources to identify and manage hearing loss, there exist vast disparities in outcomes, as well as access to and utilization of hearing healthcare. Hearing rehabilitation outcomes may vary widely among different populations and there is a pressing need to understand, in a broader sense, the factors that influence equitable outcomes, access, and utilization. These factors can be categorized according to the widely accepted framework of social determinants of health, which is defined by the World Health Organization as "the conditions in which people are born, grow, work, live, and age." According to Healthy People 2030, these determinants can be broken into the following domains: healthcare access and quality, education access and quality, social and community context, economic stability, and neighborhood and built environment. This article defines these domains and examines the published research and the gaps in research of each of these domains, as it pertains to hearing health and healthcare. Herein, we review foundational sources on the social determinants of health and hearing-related research focused on the topic. Further consideration is given to how these factors can be evaluated in a systematic fashion and be incorporated into translational research and hearing health care.
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22
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Didczuneit-Sandhop B, Jóźwiak K, Jolie M, Holdys J, Hauptmann M. Hearing loss among elderly people and access to hearing aids: a cross-sectional study from a rural area in Germany. Eur Arch Otorhinolaryngol 2021; 278:5093-5098. [PMID: 33870450 PMCID: PMC8553687 DOI: 10.1007/s00405-021-06799-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 04/01/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE Hearing loss is common and associated with reduced quality of life, particularly among elderly people. However, many patients do not use hearing aids. We evaluated the use of hearing aids among people with hearing loss by health services availability near their residence in a rural area in the state of Brandenburg, Germany. METHODS Audiometry was performed in a convenience sample of subjects in ten towns and hearing loss was determined, defined as a threshold of ≥ 30 dB in at least one ear and at least one of the frequencies 0.5, 1.0, 2.0 and 4.0 kHz. For each participant, age and gender were collected and whether or not hearing aids were available. RESULTS Among 186 persons with an average age of 74 years (interquartile range 71-81), 97% had hearing loss [95% confidence interval (CI) 95-100]. Among 121 patients with hearing loss who reported whether or not they have a hearing aid, 93 had no hearing aid (77%, 95% CI 69-84). The proportion of hearing-impaired persons who do not have a hearing aid significantly increased with the absence of a hearing aid specialist or ear nose throat (ENT) physician or both in the town where the tests were performed (p trend = 0.001). CONCLUSION Hearing loss is common among elderly people in the study area and many people in rural areas in Germany may not be properly supplied with hearing aids due to lack of hearing aid specialists and/or ENT physicians close to their residence. Interventions to improve this situation are urgently required.
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Affiliation(s)
- Birgit Didczuneit-Sandhop
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg a.d. Havel, Germany.
| | - Katarzyna Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Manja Jolie
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg a.d. Havel, Germany
| | - Josefine Holdys
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg a.d. Havel, Germany
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
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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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Bush ML. Hearing Health Healthcare Disparities in Appalachia. JOURNAL OF APPALACHIAN HEALTH 2021; 3:5-10. [PMID: 35769824 PMCID: PMC9183795 DOI: 10.13023/jah.0304.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Hearing loss is a global public health issue with disproportionate negative impacts on those who live in rural regions, such as Appalachia. This commentary provides an overview of hearing health and healthcare disparities in rural regions along with discussion of the significance of recent research findings which highlight the incidence of hearing loss and the shortage of hearing specialists in Appalachia.
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Affiliation(s)
- Matthew L Bush
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center
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Lovett B, Welschmeyer A, Johns JD, Mowry S, Hoa M. Health Disparities in Otology: A PRISMA-Based Systematic Review. Otolaryngol Head Neck Surg 2021; 166:1229-1237. [PMID: 34488507 DOI: 10.1177/01945998211039490] [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] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Social determinants of health (SDOHs), including but not limited to sex, race, socioeconomic status, insurance status, and education level, play a significant role in health disparities and affect health outcomes. The purpose of this systematic review is to examine health disparities in otology within the United States and highlight areas warranting further research. DATA SOURCES PubMed, Ovid MEDLINE. REVIEW METHODS Our search encompassed all years through January 10, 2021. All peer-reviewed primary literature of any design and publication date regarding health disparities and otology outcomes in the United States was eligible for inclusion. Eligibility assessment was performed via 3 independent investigators. RESULTS Of the 6326 unique abstracts identified, 188 studies underwent full-text review, and 52 remained in the final review. The most frequently examined otologic condition was hearing loss (36.5%), followed by cochlear implantation (28.8%) and infection/effusion (15.4%). Vertigo/dizziness (1.9%), Ménière's disease (1.9%), and tinnitus (1.9%) were the least represented otologic conditions. Comprehensive articles on multiple disparity topics were the most common (n = 18), followed by articles on race/ethnicity (n = 11) and socioeconomic status (n = 9). Language (n = 2), education (n = 2), and gender (n = 1) were the least discussed. Over 5-fold the number of articles were published between 2011 and 2020 compared to the preceding decade (42 vs 8). CONCLUSION This study captures the existing literature regarding health disparities and outcomes in otology. The lack of robust data suggests the need for future quality studies aimed at investigating disparities in otologic care, as well as a broader push for recording and reporting SDOHs.
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Affiliation(s)
- Braeden Lovett
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - James Dixon Johns
- Department of Otolaryngology and Head and Neck Surgery, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Sarah Mowry
- Department of Otolaryngology, Case Western Reserve University School of Medicine, Ohio, USA
| | - Michael Hoa
- Department of Otolaryngology and Head and Neck Surgery, Medstar Georgetown University Hospital, Washington, DC, USA
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Coco L, Piper R, Marrone N. Feasibility of community health workers as teleaudiology patient-site facilitators: a multilevel training study. Int J Audiol 2021; 60:663-676. [PMID: 33403874 PMCID: PMC8628855 DOI: 10.1080/14992027.2020.1864487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We evaluated the feasibility of a multi-level teleaudiology patient-site facilitator training program for Community Health Workers (CHWs) at a partnering health centre in southern Arizona. DESIGN Three levels were offered: Introductory, with basic information on hearing loss and teleaudiology; Intermediate, on technology, team roles, and access issues; and Facilitator, on further knowledge and hands-on skills to serve as patient-site facilitators in synchronous hearing aid service delivery. Six domains of feasibility were addressed using a mixed-methods design. Quantitative data included survey responses and observation of hands-on skills. Qualitative data included field notes from group discussion and open-ended survey questions, and were analysed using CHW core competencies. STUDY SAMPLE Twelve CHWs participated in the introductory training, ten moved on to intermediate, and three continued to the facilitator. RESULTS Quantitative outcomes indicated that the trainings were feasible according to each of the six domains. CHWs in the facilitator training passed the practical hands-on skill assessment. Qualitative analyses revealed CHWs comments addressed eight of the ten possible CHW core competencies, and focussed on service coordination/navigation, and capacity building. CONCLUSIONS Teleaudiology trainings for CHWs were feasible, increasing service capacity for a potential pathway to improve access to hearing health care in low-resource areas.
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Affiliation(s)
- Laura Coco
- University of Arizona, College of Science, Department of Speech, Language, and Hearing Sciences, Tucson, Arizona, USA
| | - Rosie Piper
- Mariposa Community Health Center, Nogales, Arizona, USA
| | - Nicole Marrone
- University of Arizona, College of Science, Department of Speech, Language, and Hearing Sciences, Tucson, Arizona, USA
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Wilson HL, Crouch J, Schuh M, Shinn J, Bush ML. Impacts of the COVID-19 Pandemic on Communication and Healthcare Access for Adults With Hearing Loss. Otol Neurotol 2021; 42:1156-1164. [PMID: 34049333 PMCID: PMC8373686 DOI: 10.1097/mao.0000000000003203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Adults with hearing loss are at risk of negative impacts of the pandemic. Specific factors, such as hearing loss severity and location of residence, may disproportionately impact patients during the pandemic. The objective of this study was to assess the relative impact of the COVID-19 pandemic on hearing loss patients, based on hearing device type and location of residence. STUDY DESIGN Prospective cross-sectional questionnaire study. SETTING Tertiary referral center. PATIENTS Adults with hearing loss. MAIN OUTCOME MEASURES Data included sociodemographic data, communication challenges, pandemic preparedness, access to healthcare, and mental and emotional health. RESULTS A total of 614 patients responded (27.8% response rate). Compared with hearing aid users, cochlear implant users reported more difficulty communicating with family/friends (53% versus 41%, p = 0.017), obtaining pandemic information (10% versus 3%, p = 0.002), and understanding live broadcasts (47% versus 17%, p = 0.001) during the pandemic. CI users were less likely than hearing aid users to seek general (52% versus 69%, p = 0.001) and hearing healthcare services (20% versus 34%, p = 0.002). Rural residents reported greater difficulty than urban residents communicating with friends/family (53% versus 39%, p = 0.001), obtaining food/supplies (41% versus 20%, p = 0.004), understanding live broadcasts (31% versus 20%, p = 0.001) during the pandemic. Compared with urban residents, rural residents reported greater difficulty accessing general (57% versus 42%, p = 0.004) and hearing healthcare (49% versus 34%, p = 0.043). Rural residents reported poorer mental/emotional health than urban residents. CONCLUSIONS Among adults with hearing loss, cochlear implant users and rural residents experience greater challenges in communication, pandemic preparedness, and access to healthcare during the COVID-19 pandemic.
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Affiliation(s)
- Harper L Wilson
- Department of Surgery, University of Kentucky Medical Center, Lexington, KY, USA
| | - Jacob Crouch
- University of Kentucky College of Medicine, Lexington, KY, USA
| | - Marissa Schuh
- Department of Otolaryngology – Head and Neck Surgery, Lexington, KY, USA
| | - Jennifer Shinn
- Department of Otolaryngology – Head and Neck Surgery, Lexington, KY, USA
| | - Matthew L. Bush
- Department of Otolaryngology – Head and Neck Surgery, Lexington, KY, USA
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Liu DH, Ge M, Smith SS, Park C, Ference EH. Geographic Distribution of Otolaryngology Advance Practice Providers and Physicians. Otolaryngol Head Neck Surg 2021; 167:48-55. [PMID: 34428088 DOI: 10.1177/01945998211040408] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Advanced practice providers (APPs), namely physician assistants (PAs) and nurse practitioners (NPs), play an increasing role in meeting growing demands for otolaryngologic services, particularly in rural communities. This study analyzes the geographic distribution of otolaryngology providers, which is essential to addressing future demands. STUDY DESIGN Cross-sectional study. SETTING Medicare Provider Utilization and Payment Data for 2017. METHODS Current Procedural Terminology codes were used to identify APPs providing 10 common otolaryngologic services. Geographic distribution was evaluated by calculating densities of APPs and otolaryngologists per 100,000 persons in urban versus rural counties as defined by the National Center for Health Statistics Urban-Rural Classification Scheme. RESULTS We identified cohorts of 8573 otolaryngologists, 1148 NPs, and 895 PAs. There were significantly higher population-controlled densities of otolaryngologists and APPs in urban counties as compared with rural counties. The majority of otolaryngologists (92.1%) and APPs (83.3%) were in urban counties. However, the proportion of APPs (16.7%) in rural counties was significantly higher than the proportion of otolaryngologists (7.9%) in rural counties (P < .01). A significant majority of rural counties (72.2%) had zero identified providers, and a greater proportion of rural counties (5.0%) were served exclusively by APPs as compared with urban counties (3.2%). CONCLUSIONS Although otolaryngologists and APPs mostly practiced in urban counties, a relatively higher proportion of APPs practiced in rural counties when compared with otolaryngology physicians. The majority of rural counties did not have any otolaryngologic providers. Given the expected shortages of otolaryngology physicians, APPs may play a critical role in addressing these gaps in access.
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Affiliation(s)
- Derek H Liu
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Marshall Ge
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Stephanie Shintani Smith
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Christine Park
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Elisabeth H Ference
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Adeyemo A, Ogunkeyede S, Dania O. Hearing healthcare gaps in LMICS: snapshot from a semi-urban community in Nigeria. Afr Health Sci 2021; 21:912-918. [PMID: 34795751 PMCID: PMC8568223 DOI: 10.4314/ahs.v21i2.53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Low and middle-income countries (LMICs) have high prevalence of hearing loss which are mainly due to preventable causes. While urban communities in LMICs are likely to have functional hearing healthcare delivery infrastructure, rural and semi-urban communities may have different reality. OBJECTIVES This study aimed to provide: (i) a snapshot of the burden of ear diseases and (ii) a description of available hearing healthcare resources in a semi-urban Nigerian community. METHODS A cross-sectional study of households selected by multistage random sampling technique. Seventy-four participants: 39 males and 35 females with mean age of 34 years ± 5.24 were recruited and answered a structured questionnaire. In addition, the availability of hearing healthcare services in 15 health centers within the community were determined. RESULTS All participants reported recent occurrence of ear complaints or gave similar history in a household member. Common complaints were ear discharge, ear pain and hearing loss. Medical intervention was sought from patent medicine stores, hospitals and traditional healers. None of the assessed hospitals within the study site was manned by an ENT surgeon or ENT trained nurse. CONCLUSION Despite the heavy burden of ear complaints there is inadequate hearing healthcare delivery in a typical LMIC community. This highlights the need for urgent improvement of hearing healthcare.
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Affiliation(s)
- Adebolajo Adeyemo
- University of Ibadan, Institute of Child Health
- University College Hospital, Department of Otorhinolaryngology
| | - Segun Ogunkeyede
- University College Hospital, Department of Otorhinolaryngology
- University of Ibadan, Department of Otorhinolaryngology
| | - Oluyinka Dania
- University College Hospital, Department of Community Medicine
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Assessment of the Hearing Status of School-Age Children from Rural and Urban Areas of Mid-Eastern Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084299. [PMID: 33919574 PMCID: PMC8073182 DOI: 10.3390/ijerph18084299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/17/2022]
Abstract
(1) Background: The purpose of this study was to assess the prevalence of hearing loss in school-age children from rural and urban areas of mid-eastern Poland using standard audiological tests-pure tone audiometry (PTA), impedance audiometry (IA), and otoacoustic emissions (OAEs). (2) Methods: Data were collected from a group of 250 children aged 8 to 13, made up of 122 children from urban areas and 128 children from rural areas of mid-eastern Poland. Hearing was assessed in each of the subjects by means of PTA, IA (tympanometry), and transient-evoked OAEs (TEOAEs). Otoscopy was also performed. (3) Results: There were significantly fewer abnormal results in children from urban than rural areas: they were, respectively, 10.1% and 23.1% for IA, 3% and 9.7% for PTA, and 17.3% and 31.8% for TEOAEs. For hearing-impaired ears in rural areas (failed TEOAE), hearing thresholds were, on average, 11.5 dB higher at 0.5 kHz than for children in urban areas. Comparison of each PTA result with the corresponding IA showed that all cases of hearing loss were related to malfunction of the middle ear. (4) Conclusions: The results of all three hearing tests were significantly worse in children from rural areas compared to those from urban areas. This indicates that audiological healthcare in rural areas needs improvement and that universal hearing screening programs for school-age children would be helpful.
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Al-Shawi YA, Alrawaf FK, Al-Gazlan NS, Al-Qahtani MM, Almuhawas FA. Relationship between proximity to a cochlear implant center and early presentation in children with congenital hearing loss. Saudi Med J 2021; 41:314-317. [PMID: 32114606 PMCID: PMC7841559 DOI: 10.15537/smj.2020.3.24918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To determine whether distance from a cochlear implant (CI) center can influences the ages of presentation and intervention for CI, which thus may influence CI outcomes in Saudi Arabia. Methods: This study comprised a retrospective crosssectional analysis of 221 patients who presented to the CI committee between March 2016 and March 2018 at King Abdullah Ear Specialist Center, Riyadh, Saudi Arabia. Through phone interviews and patients’ files, age at suspicion, audiology testing, diagnosis, hearing aid fitting, and CI discussion were recorded for prelingually deaf children; additionally, demographic information were recorded. Patients were divided into 3 groups based on the distance between their place of residence and the nearest CI center (residing within 200 km, 200-500 km, and >500 km). Results: Patients living within 200 km showed the youngest mean age for all tested checkpoints; however, there were no statistically significant differences among the groups. Conclusion: In Saudi Arabia, distance from CI center does not have a significant effect on age of presentation for CI intervention.
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Affiliation(s)
- Yazeed A Al-Shawi
- Department of Otolaryngology and Head and Neck Surgery, King Abdullah Ear Specialist Center, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Tsimpida D, Kontopantelis E, Ashcroft DM, Panagioti M. Conceptual Model of Hearing Health Inequalities (HHI Model): A Critical Interpretive Synthesis. Trends Hear 2021; 25:23312165211002963. [PMID: 34049470 PMCID: PMC8165532 DOI: 10.1177/23312165211002963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 12/29/2020] [Accepted: 02/25/2021] [Indexed: 11/16/2022] Open
Abstract
Hearing loss is a major health challenge that can have severe physical, social, cognitive, economic, and emotional consequences on people's quality of life. Currently, the modifiable factors linked to socioeconomic inequalities in hearing health are poorly understood. Therefore, an online database search (PubMed, Scopus, and Psych) was conducted to identify literature that relates hearing loss to health inequalities as a determinant or health outcome. A total of 53 studies were selected to thematically summarize the existing literature, using a critical interpretive synthesis method, where the subjectivity of the researcher is intimately involved in providing new insights with explanatory power. The evidence provided by the literature can be summarized under four key themes: (a) There might be a vicious cycle between hearing loss and socioeconomic inequalities and lifestyle factors, (b) socioeconomic position may interact with less healthy lifestyles, which are harmful to hearing ability, (c) increasing health literacy could improve the diagnosis and prognosis of hearing loss and prevent the adverse consequences of hearing loss on people's health, and (d) people with hearing loss might be vulnerable to receiving low-quality and less safe health care. This study uses elements from theoretical models of health inequalities to formulate a highly interpretive conceptual model for examining hearing health inequalities. This model depicts the specific mechanisms of hearing health and their evolution over time. There are many modifiable determinants of hearing loss, in several stages across an individual's life span; tackling socioeconomic inequalities throughout the life-course could improve the population's health, maximizing the opportunity for healthy aging.
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Affiliation(s)
- Dialechti Tsimpida
- Centre for Primary Care and Health Services Research, Institute for Health Policy and Organisation (IHPO), School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Evangelos Kontopantelis
- Institute for Health Policy and Organisation (IHPO), School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Darren M. Ashcroft
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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Kaspar A, Pifeleti S, Faumuina PA, Newton O, Driscoll C. Ethical issues for large-scale hearing aid donation programmes to the Pacific Islands: a Samoan perspective. JOURNAL OF MEDICAL ETHICS 2020; 46:710-712. [PMID: 32847944 DOI: 10.1136/medethics-2020-106560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 06/11/2023]
Abstract
The Pacific Islands are estimated to have among the highest global burdens of hearing loss, however, hearing health services are limited throughout this region. The provision of hearing aid is desirable, but should be delivered in accordance with WHO recommendations of appropriate and locally sustainable services. Large-scale hearing aid donation programmes to the Pacific Islands raise ethical questions that challenge these recommendations.The aim of this paper is to consider the ethical implications of large-scale hearing aid donation programmes to Samoa, a nation of the Pacific Islands. Evaluation of both 'Western' and 'Pacific Island' perspectives reveals important cross-cultural differences regarding attitudes to donation programmes. We attempt to offer possible solutions that satisfy both ethical frameworks, and which should enable us to deliver an effective hearing health service for Samoa. These solutions may be translational and benefit other Pacific Island nations in a similar context.
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Affiliation(s)
- Annette Kaspar
- ENT Clinic, Tupua Tamasese Meaole Hospital, Apia, Tuamasaga, Samoa
- Audiology Division, Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Sione Pifeleti
- ENT Clinic, Tupua Tamasese Meaole Hospital, Apia, Tuamasaga, Samoa
| | - Penaia A Faumuina
- ENT Clinic, Tupua Tamasese Meaole Hospital, Apia, Tuamasaga, Samoa
- ENT Consultant, Wanganui Hospital, Wanganui, New Zealand
| | - Obiga Newton
- ENT Clinic, Tupua Tamasese Meaole Hospital, Apia, Tuamasaga, Samoa
- ENT Clinic, National Referral Hospital, Honiara, Solomon Islands
| | - Carlie Driscoll
- Audiology Division, Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
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Coco L, Davidson A, Marrone N. The Role of Patient-Site Facilitators in Teleaudiology: A Scoping Review. Am J Audiol 2020; 29:661-675. [PMID: 32692575 DOI: 10.1044/2020_aja-19-00070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose Teleaudiology helps improve access to hearing health care by overcoming the geographic gap between providers and patients. In many teleaudiology encounters, a facilitator is needed at the patient site to help with hands-on aspects of procedures. The aim of this study was to review the scope and nature of research around patient-site facilitators in teleaudiology. We focused on identifying the facilitators' background, training, and responsibilities. Method To conduct this scoping review, we searched PubMed, CINAHL, and Embase. To be included, studies needed to address teleaudiology; be experimental/quasi-experimental, correlational/predictive, or descriptive; be published in English; and include the use of a facilitator at the patient location. Results A total of 82 studies met the inclusion criteria. The available literature described a number of different individuals in the role of the patient-site facilitator, including audiologists, students, and local aides. Fifty-seven unique tasks were identified, including orienting the client to the space, assisting with technology, and assisting with audiology procedures. The largest number of studies (n = 42) did not describe the facilitators' training. When reported, the facilitators' training was heterogenous in terms of who delivered the training, the length of the training, and the training content. Conclusions Across studies, the range of duties performed by patient-site facilitators indicates they may have an important role in teleaudiology. However, details are still needed surrounding their background, responsibilities, and training. Future research is warranted exploring the role of the patient-site facilitator, including their impact on teleaudiology service delivery. Supplemental Material https://doi.org/10.23641/asha.12475796.
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Affiliation(s)
- Laura Coco
- Department of Speech, Language, and Hearing Sciences, College of Science, University of Arizona, Tucson
| | - Alyssa Davidson
- Department of Speech, Language, and Hearing Sciences, College of Science, University of Arizona, Tucson
| | - Nicole Marrone
- Department of Speech, Language, and Hearing Sciences, College of Science, University of Arizona, Tucson
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Urban MJ, Wojcik C, Eggerstedt M, Jagasia AJ. Rural-Urban Disparities in Otolaryngology: The State of Illinois. Laryngoscope 2020; 131:E70-E75. [PMID: 32249932 DOI: 10.1002/lary.28652] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/24/2020] [Accepted: 02/29/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS To highlight rural-urban disparities in otolaryngology, and to quantify the disparities in access to otolaryngology specialist care across Illinois. Several studies across disciplines have shown increased prevalence and severity of disease in rural communities, relative to their urban counterparts. There is very little published quantifying a disparity in rural access to otolaryngologists. STUDY DESIGN Population study. METHODS Counties in Illinois were classified based on urbanization level on a scale from I (most urban) to VI (least urban) using the 2013 National Center for Health Statistics (NCHS) Urban-Rural Classification scheme. The six urbanization levels include four metropolitan (I-IV) and two nonmetropolitan levels (V and VI). The name and practice location of all registered otolaryngologists in Illinois were collected using the American Academy of Otolaryngology website (ENTnet.org). Population data were recorded from the most recent US Census (2010). RESULTS Two hundred seventy-eight academy-registered otolaryngologists were identified in Illinois. One hundred fifty-one of these providers were located in a single county categorized as a level I by the NCHS scheme. There are over 18,000 square miles and 600,000 persons living in NCHS level VI counties in Illinois with zero registered otolaryngologists. Overall, metropolitan counties (I-IV) averaged 1.32 otolaryngologists per 100,000 population, whereas nonmetropolitan counties (V and VI) averaged 0.46 otolaryngologists per 100,000 (P < .01). CONCLUSIONS There is a paucity of academy-certified otolaryngologists with primary practice locations in rural counties of Illinois. There is a significant rural population and massive land area with limited spatial access to otolaryngologic specialist care. LEVEL OF EVIDENCE NA Laryngoscope, 131:E70-E75, 2021.
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Affiliation(s)
- Matthew J Urban
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois;, U.S.A
| | | | - Michael Eggerstedt
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois;, U.S.A
| | - Ashok J Jagasia
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois;, U.S.A
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Orji A, Kamenov K, Dirac M, Davis A, Chadha S, Vos T. Global and regional needs, unmet needs and access to hearing aids. Int J Audiol 2020; 59:166-172. [DOI: 10.1080/14992027.2020.1721577] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Aislyn Orji
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kaloyan Kamenov
- Department of noncommunicable diseases, World Health Organization, Geneva, Switzerland
| | - Mae Dirac
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Adrian Davis
- The Ear Institute, University College London, London, UK
| | - Shelly Chadha
- Department of noncommunicable diseases, World Health Organization, Geneva, Switzerland
| | - Theo Vos
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Audiologist availability and supply in the United States: A multi-scale spatial and political economic analysis. Soc Sci Med 2019; 222:216-224. [DOI: 10.1016/j.socscimed.2019.01.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/31/2018] [Accepted: 01/09/2019] [Indexed: 12/18/2022]
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Distance to Specialist Medical Care and Diagnosis of Obstructive Sleep Apnea in Rural Saskatchewan. Can Respir J 2019; 2019:1683124. [PMID: 30733845 PMCID: PMC6348862 DOI: 10.1155/2019/1683124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/23/2018] [Indexed: 12/18/2022] Open
Abstract
Obstructive sleep apnea (OSA) is the most common sleep-disordered breathing condition. Patients with OSA symptoms are often not diagnosed clinically, which is a concern, given the health and safety risks associated with unmanaged OSA. The availability of fewer practicing medical specialists combined with longer travel distances to access health care services results in barriers to diagnosis and treatment in rural communities. This study aimed to (1) determine whether the proportion of adults reporting OSA symptoms in the absence of a sleep apnea diagnosis in rural populations varied by travel distance to specialist medical care and (2) assess whether any distance-related patterns were attributable to differences in the frequency of diagnosis among adults who likely required this specialist medical care. We used a cross-sectional epidemiologic study design, augmented by analysis of follow-up survey data. Our study base included adults who completed a 2010 baseline questionnaire for the Saskatchewan Rural Health Study. Follow-up occurred until 2015. 6525 adults from 3731 households constituted our sample. Statistical models used log-binomial regression. Rural adults who reported the largest travel distances (≥250 km) to specialist medical care were 1.17 (95% CI: 1.07, 1.29) times more likely to report OSA symptoms in the absence of a sleep apnea diagnosis than those who reported the smallest (<100 km; referent) distances. However, the proportion of sleep apnea diagnoses was low and unaffected by reported travel distance among adults who likely required this specialist medical care. Our findings suggest factors other than travel distance may be contributing to the low sleep apnea diagnostic rate. This remains important as undiagnosed and untreated OSA has serious implications on the health of people and populations, but effective treatments are available. Health care access barriers to the diagnosis and treatment of OSA require evaluation to inform health care planning and delivery.
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Coco L, Titlow KS, Marrone N. Geographic Distribution of the Hearing Aid Dispensing Workforce: A Teleaudiology Planning Assessment for Arizona. Am J Audiol 2018; 27:462-473. [PMID: 30452750 DOI: 10.1044/2018_aja-imia3-18-0012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 05/20/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Teleaudiology helps connect patients in rural and underresourced areas to hearing health care providers, minimizing the barrier of geography (Swanepoel et al., 2010). In the United States, teleaudiology is at the initial stages of implementation (Bush, Thompson, Irungu, & Ayugi, 2016). Telehealth researchers recommend conducting a comprehensive planning assessment to optimize implementation and adoption (AlDossary, Martin-Khan, Bradford, Armfield, & Smith, 2017; Alverson et al., 2008; Krupinski, 2015). A geographic analysis of the hearing aid dispensing workforce served as the initial stage of a teleaudiology planning assessment in Arizona. METHOD The analysis used publically available data sets from the U.S. Census, Arizona Department of Health Services, and the U.S. Veterans Administration. Geographic information system tools were used to analyze and visually represent population, potential teleaudiology site data, and hearing aid dispensing workforce (defined as audiologists and hearing instrument specialists licensed to dispense hearing aids in Arizona). ArcGIS was used to generate road networks and travel distance estimations. RESULTS The number of audiologists per county ranged from 0 to 216 (average 22.1). Six out of Arizona's 15 counties lacked a single audiologist, and 2 counties lacked a hearing instrument specialist. Potential expansion sites for teleaudiology were located in areas of the state that lacked practice locations for hearing aid services. CONCLUSIONS There are geographic areas of Arizona that lack licensed hearing aid locations yet are populated by individuals who may need services. Resource availability data inform teleaudiology program expansion. Future research will include data from providers and community members on their perceived needs for services.
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Affiliation(s)
- Laura Coco
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson
| | | | - Nicole Marrone
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson
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Manchaiah V. Direct-to-Consumer Hearing Devices for Adults With Hearing Loss: Definitions, Summary of Literature, and Analysis of Risks and Benefits. ACTA ACUST UNITED AC 2018. [DOI: 10.1044/persp3.sig7.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University
Beaumont, TX
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal University
Karnataka, India
- Audiology India, Mysore
Karnataka, India
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