Hearing loss prevalence and years lived with disability, 1990-2019: findings from the Global Burden of Disease Study 2019

Integrating sensory assessments in preventive home visits: a cross-sectional study of the Faroe Islands

Background: Sensory impairments, including hearing and vision loss, are common in older adults and can affect quality of life. This study examines the integration of hearing and vision assessments in preventive home visits (PHVs) for older adults in the Faroe Islands, comparing outcomes between urban and rural settings.Aim: To evaluate the feasibility of including sensory assessments in PHVs and compare sensory measurements between Tórshavn (urban) and rural districts.Methods: A cross-sectional study with 175 participants aged 76 was conducted in Tórshavn and five rural areas. Data included demographics, self-assessments, and clinical evaluations using standardized tools.Results: Visual impairments were slightly more prevalent in rural areas, while hearing impairments showed no significant differences. Discrepancies between self-reported and measured impairments emphasized the importance of objective assessments. Sensory acreenings during PHVs improved early detection and highlighted inequities in access to specialized services.Conclusion: Integrating sensory assessments in PHVs is feasible and beneficial, adressing disparities between urban and rural areas. These screenings support equitable healthcare and early intervention, promoting better quality of life for older adults across diverse settings.

The impact of occupational noise exposure and daily headphone use on hearing loss among petroleum workers

OBJECTIVE

This study analyzes the impact of occupational noise exposure and daily headphone use on noise-induced hearing loss (NIHL) in petroleum workers.

METHODS

The study included 2092 workers from a Chinese petroleum enterprise. Occupational health examinations and baseline questionnaires were conducted from 2017 to 2018, with annual follow-ups from 2019 to 2024. The daily headphone use score (DHUS) was constructed using the XGBOOST+SHAP model. Associations between cumulative noise exposure (CNE), DHUS, and NIHL were analyzed using Cox proportional hazards and restricted cubic spline regression, with sensitivity analyses.

RESULTS

The incidence of NIHL among petroleum workers was 24.0 %. After adjusting for confounders, CNE and DHUS were positively associated with the risk of NIHL. The HR (95 % CI) for CNE < 80, 80~, 85~, 90~, and ≥ 95 dB·years were 1.47 (1.09, 1.98), 1.49 (1.13, 1.96), 1.66 (1.26, 2.20), 1.75 (1.36, 2.27), and 1.85 (1.43, 2.41), respectively. For DHUS <31.9, 31.9~, 52.9~, and ≥ 73.0, the HR (95 % CI) were 1.54 (1.08, 2.19), 1.94 (1.42, 2.65), 2.11 (1.51, 2.96), and 2.48 (1.78, 3.47). Additionally, we found non-linear relationships between CNE, DHUS, and NIHL (P was 0.003 and 0.007).

CONCLUSIONS

As CNE and DHUS rise, the risk of NIHL among petroleum workers increases. Therefore, individuals exposed to occupational noise should reduce improper headphone use in daily life to help lower the risk of NIHL and improve the health of petroleum workers.

Global trends and burden of age-related hearing loss: 32-year study

BACKGROUND

Age-related hearing loss (ARHL) is a major cause of disability and diminished quality of life in older adults. This study uses data from the 2021 Global Burden of Disease (GBD) study to assess global ARHL.

METHODS

We evaluated ARHL prevalence, DALYs (Disability-Adjusted Life Years), ASPR (Age-Standardized Prevalence Rate), and ASDR (Age-Standardized DALYs Rate). Trend analysis was conducted using Estimated Annual Percentage Change (EAPC), with projections to 2050.

RESULT

From 1990 and 2021, global ARHL prevalence cases and DALYs increased by 109 %, reaching 1.55 billion and 44.45 million, respectively. The ASPR increased from 17,106.88 to 18,070.26, while the crude prevalence rate significantly from 13,890.66 to 19,587.14. Both ASPR and ASDR demonstrated significant age-related increases, particularly for moderate and moderately severe ARHL, with EAPC values of 1.39 and 1.49 for ASDR, respectively. Among individuals aged over 85 years, the ASPR of ARHL is expected to reach 80 %. Prevalence cases peaked in the 55-69 age group, with the highest number of cases (179.43 million) observed in the 55-59 subgroup. High-middle SDI regions and East Asia exhibited the most rapid growth. By 2050, ARHL cases are projected to reach 2.31 billion, with ASPR and ASDR expected to continue rising.

CONCLUSION

ARHL has increased globally over the past three decades, largely due to population aging. The burden is most severe in middle SDI regions, East Asia, and the 55-69 age group, primarily due to their substantial population bases. Addressing this escalating challenge requires enhanced public awareness, early screening initiatives, and targeted interventions.

Novel_circ_0004013 targeting miR-29a-3p affects age-related hearing loss in miR-29a mouse model by RNA-seq analysis

Age-related hearing loss (ARHL) is a gradual, symmetrical sensorineural disorder. Exploring the pathogenesis of ARHL from a biological perspective is important for its treatment. In this study, we analyzed the circRNA expression profiles of 2-month-old miR-29a+/+ mice and miR-29a-/- mice by transcriptome sequencing to investigate the role of circRNAs in ARHL. We identified 12 differentially expressed circRNAs in the two groups. Our focus was on circRNAs predicted to regulate miR-29a, with novel_circ_0004013 identified as having a targeted binding relationship with miR-29a-3p. Dual luciferase assays confirmed that miR-29a-3p is a direct target of novel_circ_0004013. Fluorescence in situ hybridization (FISH) was employed to localize the novel_circ_0004013 in HEI-OC1 cells and the cochlea. Novel_circ_0004013 was mainly expressed in the cytoplasm. In the hair cells (HCs) and stria vascularis (SV) regions of miR-29a-/- mice, novel_circ_0004013 expression was higher than the corresponding regions in miR-29a+/+ mice. Furthermore, Western blot assays revealed that levels of oxidative stress and apoptosis were significantly decreased in HEI-OC1 cells following the knockdown of novel_circ_0004013, whereas these levels were significantly increased in HEI-OC1 cells after the knockdown of miR-29a-3p. It was indicated in rescue assays that novel_circ_0004013 expedited oxidative stress and apoptosis of HEI-OC1 cells via modulation on miR-29a-3p. These findings may reveal the important role of novel_circ_0004013 in hearing loss and provide a new perspective and theoretical basis for the molecular mechanism of ARHL.

Virally mediated enhancement of efferent inhibition reduces acoustic trauma in wild-type murine cochleas

Noise-induced hearing loss (NIHL) poses an emerging global health problem with only ear protection or sound avoidance as preventive strategies. The cochlea receives some protection from medial olivocochlear efferent neurons, providing a potential target for therapeutic enhancement. Cholinergic efferents release acetylcholine (ACh) to hyperpolarize and shunt the outer hair cells (OHCs), reducing sound-evoked activation. The (α9)2(α10)3 nicotinic ACh receptor (nAChR) on the OHCs mediates this effect. Transgenic knockin mice with a gain-of-function nAChR (α9L9'T) suffer less NIHL. α9 knockout mice are more vulnerable to NIHL but can be rescued by viral transduction of the α9L9'T subunit. In this study, an HA-tagged gain-of-function α9 isoform was expressed in wild-type mice to reduce NIHL. Synaptic integration of the virally expressed nAChR subunit was confirmed by HA immunopuncta localized to the postsynaptic membrane of OHCs. After noise exposure, AAV2.7m8-CAG-α9L9'T-HA (α9L9'T-HA)-injected mice had less hearing loss (auditory brainstem response [ABR] thresholds and threshold shifts) than did control mice. ABRs of α9L9'T-HA-injected mice also had larger wave-1 amplitudes and better recovery of wave-1 amplitudes post noise exposure. Thus, virally expressed α9L9'T combines effectively with native α9 and α10 subunits to mitigate NIHL in wild-type cochleas.

Paucity of rhinological services and training in sub-Saharan Africa

PURPOSE OF REVIEW

The aim of this review was to evaluate the current information available on the provision of rhinological services in sub-Saharan Africa and discuss the challenges and opportunities for improving care.

RECENT FINDINGS

We found that there were very little data available. Some information had been gathered as part of ENT surveys and there were some local and regional reports looking at rhinological care.

SUMMARY

Despite the lack of data, it is clear that specialist rhinological services in sub-Saharan Africa are generally very poor, particularly in rural areas. There are exceptions in some major cities but there exists a huge unmet need in this part of the world. We discussed the importance of the availability of endoscopy for evaluation and management of diseases of the nose and sinuses. We also look at ways of providing training. Partnership and collaboration with high income countries offer benefits for all. Fellowships are particularly valuable in developing specialist services. The availability of the internet provides a powerful way of imparting knowledge through lectures, guidance, courses and educational material such as open access journals and books. It is incumbent on high income countries to help develop healthcare services in areas of greatest need.

Drug-induced hearing loss: a real-world pharmacovigilance study using the FDA adverse event reporting system database

Drug-induced hearing loss (DIHL) is highly prevalent, but a comprehensive picture of ototoxicity associated with drugs are still lacking. In order to comprehensively summarize the hearing safety information of current drugs, we used the real-world data from 2004 to 2023 in the FDA Adverse Event Reporting System (FAERS) database to integrate the reported ototoxicity information of drugs and applied disproportionality analysis to evaluate the hearing impairment risk induced by drugs. A total of 108,435 adverse event (AE) reports of hearing impairment were extracted from the FAERS database, involving 1300 reported culprit-drugs. On the whole, acetylsalicylic acid was the most frequently reported potential ototoxic drug, followed by levothyroxine sodium, adalimumab, omeprazole, and ergocalciferol. Immunosuppressants was the most frequently reported drug class, followed by analgesics, psychoanaleptics, agents acting on the renin-angiotensin system, and antineoplastic agents. In risk signal detection, 432 of 1300 drugs exhibited potential ototoxic risk, in which tafenoquine showed the strongest statistical correlation with hearing impairment, followed by teprotumumab, amyl nitrite, potassium iodide, and paromomycin. Among main drug classes, antibacterials for systemic use was the drug class contained the maximum number of drugs with positive ototoxic risk signals, followed by psychoanaleptics, agents acting on the renin-angiotensin system, antineoplastic agents, and analgesics. In conclusion, our study summarized a comprehensive drug list containing 1300 reported potential ototoxic drugs in the FAERS database and profiled their ototoxicity risk characteristic from the aspect of reporting frequency and risk signal strength, which can provide reference for clinical medical staff to strengthen monitoring and management of DIHL.

Access to Cochlear Implantation: Trends in Surgeon Volume and Training

OBJECTIVES

Evaluate the training background of surgeons performing high volumes of cochlear implants (CIs) and estimate the ratio of providers trained in otology/neurotology (O&N) to the number of traditional CI candidates and audiologists.

METHODS

A retrospective review of US surgeon registration data from a single CI manufacturer was performed to determine CI volume based on surgeon training. The prevalence of traditional candidates for CIs was estimated from US census population data and compared with the number of O&N providers. The ratio of audiologists to O&N providers was estimated from the Bureau of Labor and Statistics and American Speech-Language-Hearing Association databases.

RESULTS

From 2021 to 2023, a mean of 88% of providers performing ≥25 CIs per year and 90% performing ≥40 per year had training in O&N. All surgeons registering ≥100 implants per year were O&N providers. The mean percentage of O&N providers performing ≥25 CIs per year and ≥ 40 per year was higher than the percentage of General and Pediatric Otolaryngology providers performing the same volume: mean difference = 76%, p < 0.001 and mean difference = 79%, p < 0.001, respectively. The mean estimated prevalence of traditional CI candidates per O&N provider is 3,354 with an estimated mean of 32 audiologists (3.5 trained in CIs) per O&N provider.

CONCLUSION

88% of high-volume CI surgeons have fellowship training in O&N. To meet the current state of CI underutilization and anticipated growing population of CI candidates, we propose increasing the surgical capacity of O&N providers and the number of surgeons proficient in CIs.

LEVEL OF EVIDENCE

NA Laryngoscope, 135:2146-2153, 2025.

Country Differences in Older Men's Hearing Difficulty Disadvantage

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.

Hearing Screening in Private Family Practice Medicine Using Tablet Applications

PURPOSE

Hearing loss is a common deficit that remains underdiagnosed. To address this issue, automatic self-hearing tests have been developed. These tools are based on pure-tone detection and speech-in-noise evaluation. The present study evaluated the acceptability and the feasibility of hearing screening for patients consulting in private family practice medicine.

METHODS

Data were collected in 3 French medical care centers from May through November 2022. Fast pure-tone (SoTone) and speech-in-noise (SoNoise) tests were available on the SONUP application. Three parameters were measured: (1) duration of the protocol; (2) pertinence of performing both pure-tone and speech-in-noise tests; and (3) number of hearing-impaired patients detected and their follow-up (ie, consultation with an ear, nose, and throat [ENT] specialist, and hearing aid fitting).

RESULTS

Of the 516 eligible patients, 219 (42%) were able to perform both tests. Among the screened patients, 161 (74%) had negative test results, while 59 (27%) had positive results indicating hearing loss. Although patients were encouraged to consult an ENT specialist, only 14 did so, and 8 agreed to be fitted with hearing aids. The average duration of the tests, including the explanation (1 minute 43 seconds), was 6 minutes 8 seconds. Interestingly, the SoTone (1 minute 10 seconds), appears to be sufficient for detecting hearing loss.

CONCLUSIONS

This study supports integration of app-based hearing screenings into family medical care, as it is compatible with routine consultations. The use of tablet-based applications may assist general practitioners by enhancing the diagnosis of hearing disorders.

L-shaped relationship between dietary magnesium intake and hearing loss in US adults: National Health and Nutrition Examination Survey

OBJECTIVE

The association between dietary magnesium intake and hearing loss (HL) at various frequencies remains unclear; therefore, we aimed to explore this association.

DESIGN

A cross-sectional study of the National Health and Nutrition Survey database from 2011-2012 and 2015-2016.

STUDY SAMPLE

This study included 7,675 adults aged 20-69 years.

RESULTS

The mean age was 44.0 ± 14.3 years, and 50.4% of participants were female. Compared to the lowest magnesium intake group (27.0-190.5 mg/day, OR = 1.00), the adjusted odds ratios (ORs) for low-frequency HL (LFHL) were significantly lower in the middle and higher magnesium intake groups: 191.0-247.5 mg/day (OR: 0.76; 95% confidence interval [CI], 0.59-0.98; p = 0.037) and 248.0-306.5 mg/day (OR: 0.73; 95% CI, 0.55-0.96; p = 0.027). For speech-frequency HL (SFHL), the adjusted ORs were significantly lower in the middle and higher magnesium intake groups: 191.0-247.5 mg/day (OR: 0.68; 95% CI, 0.54-0.86; p = 0.001) and 248.0-306.5 mg/day (OR: 0.69; 95% CI, 0.53-0.88; p = 0.003). Restricted cubic spline analysis revealed an "L-shaped" relationship between magnesium intake and LFHL and SFHL.

CONCLUSION

An "L-shaped" association between dietary magnesium intake and the risk of LFHL and SFHL was identified, with an inflection point at 275.5 mg/day.

Global burden and prevalence of otitis media-induced hearing loss in children: 32-year study

BACKGROUND

Hearing loss in children has become a pressing public health issue, with otitis media (OM) being a leading cause. This study aims to comprehensively assess the prevalence and burden of OM-induced hearing loss in children.

METHODS

Data from the Global Burden of Disease (GBD) database were used. We evaluated the Age-standardized Prevalence Rates (ASPR), Age-standardized Years Lived with Disability rates (ASYR), and Estimated Annual Percentage Changes (EAPC) over the past 32 years. The analysis included stratification, correlation analysis, and projections.

RESULTS

From 1990 to 2021, the global prevalence of OM-induced hearing loss in children under 15 years increased from 31.18 million cases to 34.71 million cases, representing an 11.32% increase. The ASPR slightly decreased from 1793.38 to 1725.39 per 100,000 children, with an EAPC of -0.13. Boys had a higher prevalence and burden compared to girls, and the highest ASPR and ASYR were observed in children aged 5-9 years. Regions with higher Socio-Demographic Index (SDI) showed significant reductions in both prevalence and burden, while low-middle SDI regions bore a heavier burden, with ASPR 1.81 times higher and cases number 6.08 times higher than high SDI regions. Additionally, East Asia showed the largest decrease, while South Asia had the highest ASPR.

CONCLUSION

Although the global burden of OM-induced hearing loss has improved, South Asia and low-middle SDI regions continue to face a significant burden, with insufficient healthcare resources likely being a major issue. Additionally, continuing to advance pneumococcal vaccination and other preventive measures is equally crucial for alleviating this burden.

KCNQ4 c.546C>G variant is associated with early-onset high-frequency hearing loss, tinnitus, and cardiovascular comorbidities in Taiwanese adults

KCNQ4 encodes a voltage-gated potassium channel essential for ion balance and membrane potential regulation in inner ear hair cells. Mutations in KCNQ4 are associated with late-onset, high-frequency hearing loss that progressively worsens. This study aimed to compare carriers of the KCNQ4 c.546C>G variant with non-carriers to examine the relationship between this mutation and hearing loss, tinnitus, and cardiovascular diseases. This case-control study used data from the Taiwan Precision Medicine Initiative (TPMI) at Taichung Veterans General Hospital. A total of 95 KCNQ4 c.546C>G carriers and 95 non-carriers were recalled between August 2022 and June 2023. Participants underwent pure-tone audiometry, completed the Tinnitus Handicap Inventory (THI), and provided medical histories. Chi-square and Fisher's exact tests were used to compare categorical variables, and logistic regression assessed associations between various factors, THI scores, and hearing loss. The KCNQ4 carrier group showed significant hearing loss at 4 kHz (21.3 ± 16.1 dB) and 8 kHz (26.4 ± 21.6 dB), with greater severity at higher frequencies. The proportion of hearing loss was highest at 8 kHz (49.5%), followed by 4 kHz (33.7%) and 2 kHz (21.1%). THI scores and incidence of cardiovascular diseases were also significantly higher among carriers. Factors affecting mid- and high-frequency hearing loss included the KCNQ4 variant (odds ratio [OR], 2.07) and age (OR, 1.12). After adjusting for cardiovascular disease, carriers still exhibited significant hearing loss at 4 kHz and 8 kHz. Carriers younger than 40 years had a higher risk of hearing loss at 8 kHz (OR, 4.89). Genetic testing for the KCNQ4 c.546C>G variant and annual audiometric evaluations are strongly recommended for patients under 40 years old with high-frequency hearing loss, tinnitus, and cardiovascular comorbidities.

Globally applicable solution to hearing loss screening: a diagnostic accuracy study of tablet-based audiometry

OBJECTIVES

Hearing loss (HL) affects 20% of the world's population, with shortages of audiologists and audiometric sound booths unable to meet demand for hearing care services. We aimed to assess the accuracy of tablet-based audiometry (TA) to screen for HL at standard (0.25-8 kHz) and extended high frequencies (>8 kHz).

DESIGN

Diagnostic accuracy study.

SETTING

Two secondary care audiology and ear, nose and throat outpatient clinics in the UK between April 2022 and September 2023.

PARTICIPANTS

Adults aged≥16 years undergoing sound booth audiometry (SBA).

INTERVENTIONS

TA, hearing-related questionnaires and patient usability questionnaires.

OUTCOME MEASURES

Sensitivity, specificity and accuracy of TA compared with SBA for detecting HL. Patient usability assessment of TA and SBA.

RESULTS

129 patients were enrolled with 127 patients (254 ears) included in the final analysis. Median age was 43 years (IQR 33-56), 55% (70/127) were women. 76% (96/127) and 68% (86/127) of patients had HL defined by British Society of Audiology (BSA) and American Speech-Language-Hearing Association (ASHA) criteria. Age was significantly associated with HL (p<0.0001); however, hearing-related questionnaire scores were not significantly different between those with or without HL. There was no significant difference in detecting HL between TA and SBA using either BSA or ASHA criteria at each frequency. Overall, 92% (1612/1751) of TA results were within 10 dB agreement with SBA results. Sensitivity and specificity of TA for detecting HL were 77-100% and >85%, respectively, between 0.25 and 12.5 kHz. In terms of patient usability, TA showed significantly higher scores in attractiveness (p<0.0001), novelty (p<0.0001), efficiency (p=0.0003), stimulation (p=0.003) and perspicuity (p=0.02).

CONCLUSIONS

TA demonstrated good sensitivity with high specificity for detecting HL at frequencies 0.25-12.5 kHz and would be an acceptable accurate alternative to SBA. This would increase the accessibility of HL screening and has the potential to be used as a diagnostic test in those without tinnitus where resources are limited.

TRIAL REGISTRATION NUMBER

NCT05847556.

Association between the number of pregnancies and hearing loss: NHANES 1999-2018

BACKGROUND

Hearing loss represents an escalating global health concern with profound implications for individuals and society. While prior studies suggest that reproductive factors may influence women's auditory health, the specific association between the number of pregnancies and auditory function remains inadequately understood. This research aimed to investigate the association between the number of pregnancies and hearing loss in U.S. women.

METHODS

We conducted a cross-sectional analysis of 5,269 U.S. women aged 20 years and older from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. Reproductive health data, including the number of pregnancies, were obtained via self-reported questionnaires. Hearing loss was defined as a pure-tone average ≥ 25 dB HL at speech frequencies (0.5, 1, 2, and 4 kHz) in the better-hearing ear. All analyses incorporated NHANES sample weights. Weighted multivariable logistic regression and restricted cubic spline regression were employed to evaluate the relationship between the number of pregnancies and hearing loss. Subgroup and sensitivity analyses were used to test the consistency and robustness of the association. And mediation analyses explored the roles of white blood cells and high-density lipoprotein in this association.

RESULTS

A total of 5,269 adult women were included in the analysis, of whom 624 (9.81%) exhibited hearing loss. After adjusting for confounders, the number of pregnancies was significantly associated with hearing loss (OR: 1.12; 95% CI: 1.05-1.20; P < 0.001). Conversely, the use of birth control pills was associated with lower odds of hearing loss (OR: 0.67; 95% CI: 0.47-0.94; P < 0.05). Restricted cubic spline regression demonstrated a linear increase in the odds of hearing loss with a greater number of pregnancies. This positive association was consistent across most subgroups. Mediation analyses revealed that white blood cells and high-density lipoprotein partially mediated this association. Sensitivity analyses, including alternative definitions of hearing loss and multiple imputation for missing covariates, confirmed the robustness of the results.

CONCLUSION

Our findings demonstrated that a higher number of pregnancies was significantly associated with hearing loss, while birth control pill use appeared protective. These findings highlight the importance of recognizing potential auditory health implications associated with multiple pregnancies and may inform future public health strategies aimed at supporting women's hearing health across the reproductive lifespan.

Leonurine protects against cisplatin-induced ototoxicity through its anti-oxidation and anti-apoptosis properties

Cisplatin has a high efficacy for treating solid tumors, but it is generally accompanied by ototoxic side effects. Leonurine (LEO) has anti-oxidative and anti-apoptotic effects, although its role in the treatment of cisplatin-induced hearing impairment (CIHI) remains unclear. Here, we explored in vitro and in vivo models of cisplatin injury and analyzed the efficacy of LEO on cisplatin-induced ototoxicity by immunofluorescence, otoacoustic assessment, qRT-PCR, and Western blot. At the cellular level, LEO reduced oxidative stress and apoptosis, while at the organism level LEO protected guinea pigs against CIHI and maintained the hearing thresholds of cisplatin-treated guinea pigs at 50-55dB. LEO effectively prevented cisplatin-induced decreases in hair cells, supporting cells, spiral ganglion neurons and ribbon synapses; reduced Cleaved Caspase 3 expression through activation of Bcl-2 and reducing reactive oxygen species (ROS) accumulation and improving mitochondrial membrane potential and reduced cisplatin-induced apoptosis by increasing the expression of Nrf2/Nqo1. In conclusion, the present study expands the application range of LEO and suggests that LEO is a potential therapeutic agent for preventing cisplatin ototoxicity.

Barriers and enablers to general practitioner referral of older adults to hearing care: a systematic review using the theoretical domains framework

PURPOSE

The purpose of this systematic review was to identify and synthesise the literature regarding barriers and enablers affecting general practitioner (GP) referral to hearing care for their older patients (50 years and over).

METHODS

A search of peer-reviewed articles reporting primary empirical studies was conducted across CINAHL, Ovid Medline and Scopus, with search terms relating to the search domains "General Practitioner", "Referral", "Hearing loss", and "adults aged 50 and older". Qualitative and quantitative studies were included if they reported barriers or enablers to referral. A mixed-methods approach was used to synthesise the findings of the included studies, firstly into the Theoretical Domains Framework of behaviour change, and then into more granular sub-themes.

RESULTS

The initial search yielded 859 unique studies. Title and abstract screening identified 21 studies of possible relevance, and full text review identified seven studies for inclusion in this review. A total of 19 unique themes were identified and coded to 10 of the 14 domains of the Theoretical Domains Framework; however thematic overlap between studies was low and fewer than half of these themes were consistently identified as either a barrier or enabler. Four main barriers to referral to hearing care were identified: Lack of time, lack of familiarity with diagnostic criteria and tools, lack of knowledge of treatments and higher relative importance of other health conditions.

CONCLUSION

The minimal overlap of themes and low agreement on which of these constitute barriers and enablers for referral indicates a need for further research to provide greater clarity in this area and explain the heterogeneity of these results.

Hearing Impairment Among Drug-Resistant Tuberculosis Patients in Rural Eastern Cape: A Retrospective Analysis of Audiometric Findings

Hearing loss (HL) is a major global health concern, with drug-induced ototoxicity contributing significantly, particularly in patients undergoing treatment for drug-resistant tuberculosis (DR-TB). In South Africa, where both TB and HIV are prevalent, the risk of treatment-related auditory damage is especially high. This study aimed to assess the prevalence and predictors of hearing impairment among DR-TB patients in rural Eastern Cape, South Africa. A retrospective analysis was conducted on 438 DR-TB patients treated between 2018 and 2020, using pure tone audiometry (PTA) to assess hearing status post-treatment. Demographic, clinical, and lifestyle data were extracted from patient records and analyzed using logistic regression. The overall prevalence of hearing loss was 37.2%. Risk was significantly associated with an older age, a male gender, DR-TB classification (MDR, pre-XDR, and XDR), unsuccessful treatment outcomes, and substance use. Prevalence of HL increased notably in patients aged 70 and older. Lifestyle factors, particularly combined use of tobacco, alcohol, and drugs, were linked to higher odds of HL. These findings underscore the need for routine audiometric screening and personalized treatment monitoring in DR-TB care, especially for high-risk populations. Early identification of ototoxicity risk factors can inform safer treatment regimens and improve patient outcomes in resource-limited settings.

Changes in Home Care Clients' Sensory Impairment Status and Its Association With Functioning Over 18 Months: A Longitudinal Register-Based Study

We investigated the changes in home care clients' vision and hearing over 18 months and examined the role of sensory impairments in maintaining their functioning. We used data from the Finnish Resident Assessment Instrument (RAI) database (n = 7013). Sensory impairment status was categorized by type (single or dual) and severity (mild or moderate/severe). The association between sensory impairment and functioning over 18 months was examined using binary logistic regression analysis with generalized estimating equations. Of 7013 home care clients, 48% had sensory impairment at baseline. Over 18 months, sensory impairment improved in 7% (n = 482) and worsened in 23% (n = 1605) of the clients. Sensory impairments were associated with impaired physical, cognitive, and psychosocial functioning at baseline. Especially moderate to severe dual impairment was associated with increased impairment in cognitive and physical functioning over time. Sensory impairments should be considered as an integral part of maintaining home care clients' overall health and well-being.

"I feel a little bit clueless" perceived barriers and enablers to help-seeking and informed decision-making in hearing care: a qualitative study

OBJECTIVE

To explore perceived barriers and enablers to help-seeking and informed decision-making in hearing care in order to inform an intervention targeted at maximising uptake of hearing care (HearChoice).

DESIGN

Data were collected using semi-structured interviews and analysed qualitatively using a hybrid deductive and inductive thematic analysis approach based on the COM-B model of behaviour change.

STUDY SAMPLE

Sixteen adults with hearing difficulty took part (9 male, 7 female, age range 27 - 90), nine of whom had sought professional help for hearing difficulties and seven of whom had not.

RESULTS

Participants described a range of interacting barriers and enablers to help-seeking and decision-making for hearing care that relate to psychological capability (e.g. knowledge; skills), environmental and social opportunity (e.g. supportive social circle and health care providers) and automatic and reflective motivation (e.g. shame; trust; beliefs about effectiveness of hearing aids).

CONCLUSION

Interventions to facilitate help-seeking and informed decision-making about care options for adults with hearing difficulties are likely to be most effective if factors that increase psychological capability, environmental and social opportunity, and automatic and reflective motivation are maximised. The framework developed from this study will inform the development of HearChoice and future research on help-seeking and decision-making.

Self-reported hearing measures can predict risk of falling and balance problems

INTRODUCTION

Falls in the elderly are a major source of injury that can result in disability and hospitalization. Early detection of balance deterioration and the risk of falling is thus crucial to preventive care. Older adults with hearing loss are 2.4 times more likely to experience falls than their normal-hearing peers. This study explored the utility of a self-reported hearing measure (The Amsterdam Inventory for Auditory Disability and Handicap-AIADH) as a predictor of balance problems and the risk of falling.

METHODS

A sample of 148 individuals (18-90 years) completed two objective hearing tests (Standard Pure-Tone Audiometry and Words-in-Noise), one self-reported hearing inventory-AIADH, one balance test-Timed Up and Go, and the Activity-Specific Balance Confidence Scale that self-reports balance. The analysis included correlation and regression analyses, moderation, sensitivity, and specificity analyses.

RESULTS

The findings suggest that AIADH constitutes a good predictor of a decline in balance and an increased risk of falling, which complements objective hearing measures in adults aged forty and over. Prediction accuracy rises with age. The findings also reveal that out of all the AIADH subscales, the detection subscale is the best predictor of balance problems and risk of falling.

CONCLUSIONS

Thus, using an available self-report hearing inventory can be a useful and potentially cost-effective tool for the early detection of balance problems and hearing deterioration. Health authorities should consider incorporating this type of evaluation as a remote screening tool for large populations at risk.

Can you hear me? Physicians' attitudes and knowledge on the principles of communicating with hearing-impaired older adult

BACKGROUND

Hearing impairment is a prevalent barrier to communication that significantly affects older adults. This study explores family physicians' knowledge and attitudes towards communicating with hearing-impaired older patients.

METHODS

A cross-sectional study was conducted among family physicians at Clalit Healthcare Services clinics in southern Israel. The study included a video illustrating 12 common errors made when communicating with hearing-impaired older patients.

RESULTS

Among the 101 participating family physicians, only 15.8% reported adequate training in medical school on treating these patients, and 17.8% during residency. On average, physicians identified 2.25 ± 1.35 errors of the 12 possible ones shown in the video. Ten physicians (9.9%) failed to identify any errors. Twenty-three (22.8%) identified one error, 25 (24.8%) found two, and 24 (23.8%) identified three, thirteen (11.9%) four, and 6 (5.9%) found five mistakes. No participant identified six or more mistakes. The only statistically significant variable for identifying more than three communication errors was the physician's perceived low or very low comfort level with communication skills during visits with hearing-impaired older adults (OR = 0.337, 95% CI: 0.126-0.900, p = 0.030).

CONCLUSIONS

The findings highlight the importance of ongoing medical education programs to improve communication strategies for healthcare providers treating hearing-impaired older adults.

Reclassification of candidate splicing variants refines clinically conflicting interpretations in SLC26A4-associated hearing loss

PURPOSE

Variants in the human SLC26A4 gene are a major cause of hereditary hearing loss. Many splice site variants have been identified, but their pathogenicity is not well understood.

METHODS

In accordance with the guidelines from the American College of Medical Genetics and Genomics and the Association for Molecular Pathology, we analysed the spectrum of SLC26A4 gene variants. We performed in silico analysis and in vitro splicing assays to evaluate novel or known variants of uncertain significance that may contribute to aberrant alternative splicing.

RESULTS

In a cohort of 178 patients carrying SLC26A4 variants, selected from 202 hearing loss patients with or without inner ear malformations who underwent SLC26A4 gene testing, we identified a total of 50 variants. Among these, 10 intronic variants potentially affecting splicing collectively accounted for 54.8% of the total allele frequency of all identified variant types and were prioritised for messenger RNA (mRNA) splicing analysis. Further investigation demonstrated that four variants led to distinct types of aberrant splicing outcomes. Overall, the clinical significance of seven splice site variants was reclassified, representing at least 4.34% (14/323) of the variants within our cohort.

CONCLUSION

By using the standard classification of SLC26A4 variants, our results were able to interpret novel or uncertain SLC26A4 gene variants in a pathogenic or benign variant direction. This approach facilitates more refined genetic counselling for patients carrying SLC26A4 gene variants.

Cochlear neural contributions to triple network changes in tinnitus, hyperacusis & misophonia? A perspective review

What do tinnitus, the perception of sounds without an internal or external source of noise, hyperacusis, the pathological hypersensitivity to noise, or misophonia, an intolerance to certain everyday noises, have in common, and what differentiates them? A large number of excellent studies focused in the last few decades on identifying the neural correlates of tinnitus, hyperacusis, or misophonia on the basis of central triple-network changes. In this perspective review we explicitly examine, possible differential and causal involvement of peripheral components as a presumptive trigger that may drive observed triple-network changes. Based on our results, we venture to hypothesize that: (i) tinnitus, hyperacusis, and misophonia can occur despite clinically normal hearing thresholds, and are likely causally independent of sex and age, (ii) tinnitus and hyperacusis, but possibly also misophonia are related to altered auditory processing that through desynchronized (tinnitus) or hyperactive (hyperacusis, misophonia) bottom-up ascending processing potentially explains the activity changes in, e.g., default or salient brain networks, as suggested in various studies of these different diseases. (iii) In misophonia a stress-induced top-down influence, as deep as the auditory nerve fibers, may be discussed as a contributor to generating misophonia-trigger sounds, a hypothesis that can be tested in future studies. We hope that the selective consideration of a possible interaction between peripheral and central components will help to minimize the greatest handicap of these pathologies to date towards successful therapy: the lack of clarification of the underlying causative mechanism of the diseases.

Effects of Resilience, Self-Perceived Hearing Difficulty, and Demographic Factors on Psychological Distress in Adults With Hearing Loss

PURPOSE

Although hearing loss can have a substantial impact on mental health, relatively little research has focused on factors that predict mental health outcomes among adults with hearing loss. In this study, we examined the effects of self-perceived hearing difficulty and resilience on psychological distress in adults.

METHOD

Adult patients with hearing loss (N = 118) completed several questionnaires, including a demographic questionnaire, the Abbreviated Profile of Hearing Aid Benefit, the Brief Resilience Scale, and Kessler 6 Psychological Distress Scale. The relationships between demographic characteristics, self-perceived hearing difficulty, resilience, and psychological distress were assessed using bivariate analyses and multiple regressions.

RESULTS

Self-perceived hearing difficulty and resilience both predict psychological distress in adults with hearing loss, while controlling for age and income.

CONCLUSIONS

Findings suggest that both audiologic and mental health interventions support positive mental health outcomes in adults with hearing loss. Improving patients' resilience may be a particularly important goal for audiologists and mental health professionals who are working with adults with hearing loss.

Health service use, health outcomes and treatment costs of adults with a cochlear implant: a retrospective cohort study

BACKGROUND

Data about the ongoing health service use, health outcomes and healthcare treatment costs of adult cochlear implant users are limited. This study examined health service use, health outcomes and treatment costs of adults who had a cochlear implant.

METHODS

This was a retrospective cohort study of adults aged ≥ 18 years who received a cochlear implant during 2011-2021. Linked hospitalisation, non-admitted patient (NAP) services and mortality data in New South Wales (NSW), Australia were used. Health service use, health outcomes and treatment costs were compared for younger (18-64 years) and older (≥ 65 years) adults. A negative binomial regression model was used to examine factors associated with hospitalisation and health outcomes.

RESULTS

There were 3071 adults who had a cochlear implant; 47.6% aged 18-64 years and 52.4% aged ≥ 65 years. Older adults had a higher proportion of all-cause hospital admissions (34.1% vs. 18.4%, respectively), readmission within 28 days (7.8% vs. 4.7%, respectively), ≥ 13 NAP service contacts (33.9% vs. 24.9%, respectively) and mean treatment costs (AUD$44,101 vs. AUD$41,663, respectively) than younger adults. Charlson comorbidities and mental health disorders were key predictors of both hospitalisations and NAP service contacts for younger adults. Postoperative mechanical complications and prior hospital admissions were predictors of hospitalisation and NAP service contacts, respectively for younger adults. Having ≥13 NAP service contacts and a cochlear implant removed were predictors of hospitalisation and NAP service contacts, respectively for older adults. Having a longer hospital length of stay (LOS) was associated with cochlear implant removal, treatment cost, and other health conditions for both younger and older adults.

CONCLUSIONS

Adults with multimorbidity used more hospital-based services or incurred large treatment costs. Early detection and treatment of comorbidities and long-term post-cochlear implant follow-up to identify any potential complications may reduce unplanned hospitalisations, adverse health outcomes, and associated hospital utilisation costs.

Rational Design of Inner Ear Drug Delivery Systems

The number of people with hearing loss disorders is enormous, causing great physical and mental stress to patients, as well as a huge social burden. Among these patients, hearing loss caused by inner ear lesions accounts for a large proportion. Therefore, treatment of the inner ear is important. Inner ear drug delivery systems, which can reduce the side effects of systemic drug administration by delivering drugs directly to the inner ear, are important in sensorineural hearing loss. Here, the development of inner ear drug delivery systems is focused, including the complex physiological structure that they face, types of drugs delivered, routes of administration, and forms of drug delivery carrier platforms. Recent studies in this process are presented and it is concluded with a summary and outlook on the problems faced and possible solutions.

Association between obstructive sleep apnea and hearing loss among a cohort of emergency responders

PURPOSE

We sought to determine whether risk for obstructive sleep apnea (OSA) and OSA severity are associated with sensorineural hearing loss (HL) among emergency responders.

METHODS

We evaluated two independent variables: OSA risk, categorized using Berlin Questionnaire criteria, and OSA severity, determined by polysomnogram (PSG) apnea-hypopnea indices (AHI). Logistic regression, adjusted for confounders, was used to assess the association between each OSA exposure and the outcome of HL among a cohort of emergency responders.

RESULTS

The study cohort included 13,909 participants with audiometric data, 12,834 with Berlin Questionnaire data, and 4,024 participants with PSG data. Those with high and very high OSA risk showed significantly elevated odds of HL at speech frequencies, with adjusted odds ratios (OR) of 1.34 (95% CI: 1.14-1.58; p < 0.01) and 1.56 (95% CI: 1.30-1.88; p < 0.01), respectively, compared to those with no OSA risk. Combining very high and high risk validated category groupings for the Berlin, those individuals had 41% higher odds for HL over speech frequencies compared to those with no risk (OR = 1.41; 95% CI = 1.21-1.65; p < 0.01). Those with PSG-determined severe OSA had higher adjusted odds of HL at speech frequencies than those with no OSA; OR of 1.33 (95% CI: 1.00-1.78; p = 0.04).

CONCLUSIONS

We report a significant association between OSA and HL among emergency responders. Our results underscore a need for an analysis of the longitudinal association between OSA and HL to identify potential causality and for integrated health interventions that target both conditions in this responder population.

Loneliness and Risk of Incident Hearing Loss: The UK Biobank Study

Background: Hearing loss (HL) is one major cause of disability and can lead to social impairments. However, the relationship between loneliness and the risk of incident HL remains unclear. Our study aimed to investigate this association among adults in the UK. Methods: This cohort study was based on data from the UK Biobank study. Loneliness was assessed by asking participants if they often felt lonely. Incident HL was defined as a primary diagnosis, ascertained via linkage to electronic health records. Cox proportional hazard regression models were used to examine the association between loneliness and risk of incident HL. Results: Our analyses included 490,865 participants [mean (SD) age, 56.5 (8.1) years; 54.4% female], among whom 90,893 (18.5%) reported feeling lonely at baseline. Over a median follow-up period of 12.3 years (interquartile range, 11.3 to 13.1), 11,596 participants were diagnosed with incident HL. Compared to non-lonely participants, lonely individuals exhibited an increased risk of HL [hazard ratio (HR), 1.36; 95% confidence interval (CI), 1.30 to 1.43]. This association remained (HR, 1.24; 95% CI, 1.17 to 1.31) after adjusting for potential confounders, including age, sex, socioeconomic status, biological and lifestyle factors, social isolation, depression, chronic diseases, use of ototoxic drugs, and genetic risk of HL. The joint analysis showed that loneliness was significantly associated with an increased risk of incident HL across all levels of genetic risks for HL. Conclusions: Loneliness was associated with the risk of incident HL independent of other prominent risk factors. Social enhancement strategies aimed at alleviating loneliness may prove beneficial in HL prevention.

Patients' satisfaction and efficacy of modern conventional hearing aids: A comprehensive analysis of the self-reported user experiences in adult people

OBJECTIVE

Hearing loss is a widespread condition that impacts the quality of life, affecting communication, social interactions, and cognitive functions. This study aimed to evaluate the subjective benefit and satisfaction of using hearing aids among patients since the adoption rate of hearing aids remains low.

METHODS

The study retrospectively analysed data from 133 patients with hearing aids, using the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Satisfaction with Amplification in Daily Life (SADL) questionnaires. Patients were divided into two groups based on this median age and sex for comparative analysis. The Mann Whitney test was applied with references to numerical parameters (APHAB and SADL) to assess differences between male vs female subjects and adults vs elderly. The Spearman correlation test was applied to assess the possible correlation between APHAB and SADL. A p-value lower than 0.05 was considered statistically significant.

RESULTS

Results indicated no significant gender differences in most APHAB and SADL subscales, except for the SADL "personal image" subscale, which showed lower scores for women (p =  0.023). Age-based comparison revealed no significant differences in APHAB scores; the SADL scores showed significant differences in the "positive effect" (p = 0.013), "negative features" (p = 0.005), and overall scores (p = 0.039), with lower satisfaction in older patients. Correlation analysis identified a positive relationship between the SADL "negative features" and APHAB "aversiveness" subscales (p = 0.042, correlation coefficient ρ = 0.176).

CONCLUSIONS

The study highlights the importance of addressing subjective perceptions and aesthetic concerns in hearing aid adoption, emphasizing the need for personalized rehabilitation strategies to improve patient outcomes and satisfaction.

LEVEL OF EVIDENCE

Level 3.

The costs of dementia care by US state: Medical spending and the cost of unpaid caregiving

BackgroundThere are 5.5 million people living with dementia in the United States (US), with the cost of unpaid care making up a significant portion of the care costs.ObjectiveSummarize variation in the cost of dementia care across the US and examine the association between medical spending and costs of unpaid care at the state level.MethodsWe estimated total cost for dementia by combining recent medical spending estimates from the Disease Expenditure project and unpaid care cost estimates from Lastuka and colleagues. Hours of unpaid care were valued as the hourly wage of a home health aide. We used linear regression to measure the association between the cost of unpaid care and medical spending. The spending that would have occurred if unpaid care had been provided by professional home health care workers was used to measure the cost of unpaid care.ResultsThe annual cost of care attributable to dementia in 2019 was $53,502 (95% uncertainty interval [UI] 46,135-60,594) per case. The contribution of unpaid care to total costs varied by state, ranging from 70.2% (95% UI 64.3-75.4) in the District of Columbia to 89.9% (95% UI 87.8-91.5) in Arizona. We found that higher costs of unpaid care were associated with lower medical spending on nursing facility care.ConclusionsThe large variation in total costs of dementia shows that the economic burden of dementia care is distributed unevenly throughout the US.

Impact of Disability on Postoperative Outcomes After Gastrointestinal Cancer Surgery

INTRODUCTION

Approximately 61 million individuals in the United States have a disability and face unique challenges, resulting in healthcare disparities.

OBJECTIVE

We aimed to evaluate the impact of disability on postoperative outcomes and number of healthy days at home (HDAH).

METHODS

Patients who underwent surgery for gastrointestinal (GI) cancer between 2017 and 2020 were identified using the Medicare database. Multivariable regression models were used to examine the association between disability and postoperative complications, discharge disposition, and the number of HDAH.

RESULTS

A total of 72,452 individuals underwent GI cancer surgery (pancreas: n = 7614, 10.5%; hepatobiliary: n = 4994, 6.9%; colorectal: n = 59,844, 82.6%). Median patient age was 75 years (interquartile range 71-81) with most patients being female (n = 37,167, 51.3%). Overall, 5432 individuals (7.2%) had a disability. Following surgery, patients with a disability were more likely to experience complications (4.6% vs. 3.3%), be discharged to a skilled nursing facility (SNF; 26.6% vs. 12.3%), and experience hospital readmission (20.0% vs. 13.5%) [all p < 0.001]. Consequently, individuals with disabilities were more likely to spend fewer (<20th percentile) HDAH (33% vs. 19.2%) [all p < 0.001]. On multivariable analysis, disability was associated with higher odds of complications (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.19-1.56) and hospital readmission (OR 1.55, 95% CI 1.44-1.66). Additionally, disability was associated with higher odds of spending fewer HDAH (OR 1.88, 95% CI 1.77-1.99).

CONCLUSION

Following GI cancer surgery, individuals with disabilities had a higher risk of complications and spent fewer HDAH. There is a need for targeted interventions to improve the care of patients with disabilities and ensure equitable oncological and surgical outcomes.

The Challenge in Burden of Pulmonary Arterial Hypertension: A Perspective From the Global Burden of Disease Study

Pulmonary arterial hypertension (PAH) poses significant clinical management challenges due to gaps in understanding its global epidemiology. We analyzed PAH-related disability-adjusted life years (DALYs), deaths, and prevalence from 1990 to 2021. Age-period-cohort models and regression analyses assessed temporal trends and projected burdens to 2050. Globally, PAH-related DALYs declined by 6.6%, but increased by 13.9% in high socio-demographic index (SDI) countries. Middle SDI regions reported the highest DALYs in 1990 and 2021. Deaths rose by 48.5% worldwide, with high SDI nations experiencing a 76.6% surge. Age-standardized rates (ASRs) of DALYs and deaths decreased across SDI countries, with high-middle SDI regions showing the steepest declines. Younger age groups, especially males, had a higher proportion of global DALYs in earlier years, but the burden shifted toward older populations over time, with this trend more pronounced in high-SDI countries. Age-period-cohort analysis revealed declining DALYs in younger ages but rising rates in older cohorts. By 2050, deaths and prevalence are projected to rise, disproportionately affecting females. Significant regional disparities in PAH burden persist, necessitating targeted policies, improved healthcare access, and early detection strategies, especially in underserved areas. Addressing these disparities is critical for mitigating PAH' s global impact.

The Impact of Early Childhood Otitis Media on Hearing Abilities: A Scoping Review

OBJECTIVES

Otitis media (OM) is among the most common childhood diseases. Many studies have suggested that recurrent OM episodes during early childhood can have long-lasting adverse effects on essentially every level of the auditory system. However, the literature on this topic is heterogeneous and results are mixed. Hence, a need exists to structure the available evidence. Here, a scoping review was conducted, aiming to (1) map the many different outcome measures used to assess the long-term impact of OM, (2) appraise the quality of the available OM documentation, and (3) provide a summary of the available evidence and its potential link with OM documentation.

DESIGN

Original articles were identified through systematic searches in the PubMed, Embase, and Cochrane Library databases. To be included, studies were required to assess the long-term impact of resolved early childhood OM on hearing abilities. Two reviewers independently screened studies for inclusion. A data charting form, developed by author LVY, was used to extract information about the publication (year, journal, country of data collection) and study characteristics (sample size, outcome measures, OM documentation).

RESULTS

The search identified 16,267 records, out of which 94 articles were included. Most of the current evidence is based on retrospective data from high-income countries, using a wide range of outcome measures. The retrospective study design poses challenges for thorough OM documentation, especially regarding OM history of the controls. A narrative synthesis showed consistently elevated audiometric thresholds in the extended high-frequency range and poorer gap detection abilities in children with a history of early childhood OM. Mixed results were found in terms of speech perception and binaural unmasking.

CONCLUSIONS

This scoping review demonstrates the breadth of the literature on this topic. A wide range of outcome measures have been used, and the quality of OM documentation varies greatly across studies. Variability of the literature results may-at least to some extent-be explained by inadequate OM documentation, recruitment bias, and variability in the time since the last OM episode. Recommendations for future research are provided.

Hearing Loss and Falls: A Systematic Review and Meta-Analysis

Importance

Falls constitute a significant public health concern worldwide and have been associated with increased morbidity and mortality across all ages. Identifying potentially modifiable risk factors for falls is a key public health priority. Literature surrounding the association between hearing loss (HL) and falls remains inconclusive.

Objective

To conduct a systematic review and meta-analysis to comprehensively synthesize evidence surrounding the impact of HL on falls.

Data Sources

PubMed, Embase, and Cochrane Library from database inception through April 9, 2024.

Study Selection

Observational studies investigating the association between HL and falls were selected. Only studies reporting covariate-adjusted estimates were included to minimize confounding.

Data Extraction and Synthesis

Two independent reviewers evaluated studies for eligibility, extracted data, and assessed the risk of bias of included studies. Using a random-effects model, adjusted estimates were pooled in meta-analyses. Heterogeneity was evaluated using subgroup and sensitivity analyses, and publication bias was assessed.

Main Outcomes and Measures

The cross-sectional odds and longitudinal risk of falls among patients with HL compared with those without HL.

Results

A total of 5 071 935 participants were included from 27 studies; approximately 49.2% of participants were female, and 14 studies were conducted in Asia, 7 in North America, 3 in Europe, and 3 in Oceania, represented by Australia. Patients with HL exhibited an increased cross-sectional odds of falls (odds ratio, 1.51; 95% CI, 1.37-1.67; I2 = 64%) and longitudinal risk of falls (risk ratio, 1.17; 95% CI, 1.06-1.29; I2 = 69%) than those without HL. Further stratification by self-reported or validated hearing assessments, fall reporting duration, continent, community-dwelling adults, and studies adjusting for other sensory deficits identified as fall risk factors by the World Falls Guideline did not change significance. These results remained robust to sensitivity analyses, and publication bias was absent.

Conclusions and Relevance

This systematic review and meta-analysis found that overall, HL may be a risk factor for falls. With a rapidly aging global population, it is crucial to acknowledge the public health concerns surrounding falls and consider if HL could be a potentially modifiable risk factor. Nonetheless, further randomized clinical trials are needed to elucidate any benefit of treating HL on fall prevention.

"Real world" medical care of patients with Fabry disease by primary care physicians, internists or general practitioners

Background

Fabry disease (FD) is a rare hereditary X-linked disorder of glycosphingolipid metabolism caused by a deficiency of α-galactosidase A leading to the accumulation of glycosphingolipids in lysosomes. Clinical manifestations vary widely, involving multiple organs. Delays in diagnosis and deficits in primary care are common due to the limited familiarity with this rare disease in primary care providers [PCPs; including general practitioners (GPs), family physicians, and specialists in internal medicine]. This study aims to assess the real-world healthcare situation of FD patients in Germany through a questionnaire-based approach.

Methods

In this cross-sectional study, 103 FD patients were consecutively recruited from several medical institutions in Germany and Austria between August 2022 and April 2024. The study adhered to ethical guidelines and received approvals from all relevant ethics committees. Inclusion criteria included confirmed FD diagnosis, age 18 years or older, and the ability to provide informed consent. Data were collected using a 32-question survey covering demographics, comorbidities, care structures, information needs, quality of life (QoL), and challenges. Descriptive statistical methods were used for data analysis of the study population.

Results

The analysis included 103 completed questionnaires. The average age of the patient cohort was 49.3±16.2 (range, 18-94) years, with a higher proportion of women (61.2%) participating. The most common symptoms reported were hearing loss/tinnitus (45.6%), followed by thermal sensory disturbances and hypohidrosis (43.7%). A majority of PCP (86.4%) were aware of their patients' FD diagnosis. Overall, 61.2% of patients were not primarily treated by their PCP, but in collaboration with Fabry specialists. Only 63.1% of the patients had received care in a FD competence centre. There was a significant need for advice, especially regarding old-age security (40.0%), nutrition/exercise (39.8%), and resilience in everyday life (37.9%). The awareness among patients, that Fabry competence centers exist which are specialized in Fabry treatment, was limited, with only 64.7% of patients being sufficiently informed. Also, knowledge regarding specific FD self-help groups was limited to 61.2% of patients. FD patients reported a reduced mean QoL score of 78.8±16.7, with pain having the most significant impact on QoL (64.1%).

Conclusions

Using a novel patient-reported questionnaire, this study reveals for the first time the state of medical care of FD-patients under "real life" conditions. This study highlights significant deficiencies in the medical care of FD patients in Germany, including insufficient knowledge of specialized centers and patient organizations, as well as unmet counselling needs. Despite the availability of at least 24 FD competence centers in Germany, many patients remain under the care of GPs who may lack specific knowledge about FD. Since FD is a rare disease, enhanced education for both patients and GPs about FD and about the benefits of specialized care and patient organizations is crucial. Additionally, comprehensive counselling services should be developed to address the various needs of FD patients. Future research should investigate the overall care situations also in other countries to provide a broader understanding and to improve global health care standards for FD patients.

A cross-sectional study of how high-frequency hearing loss impacts cognitive functions in middle-aged-to-older adults

Purpose

Research on the association between hearing loss and cognition has primarily focused on speech-range hearing frequencies (i.e., 0.5-4 kHz), as these frequencies are most relevant to everyday functioning. However, age-related hearing loss (ARHL) tends to impact higher-frequency hearing first, and more severely. Despite this, limited research has investigated the relationship between high-frequency (i.e., >4 kHz) hearing loss and cognitive impairment. In the current study, we aimed to assess whether high-frequency hearing loss predicts non-verbal cognitive functions (i.e., visuospatial executive function, learning, and memory tasks) above and beyond speech-frequency hearing loss.

Materials and methods

Participants were 241 English-speaking adults, aged 40-88 years, with hearing loss. Audiometrically assessed better-ear, speech-frequency (0.5, 1, 2 & 4 kHz; BE4PTA) and high-frequency (6 & 8 kHz; BE2PTA) hearing loss were compared to cognitive functions measured using non-verbal tests from the Cambridge Neuropsychological Test Automated Battery; covariates included hearing-loss asymmetry, age, sex, premorbid IQ, and mental health measured with the short-form Depression Anxiety Stress Scales.

Results

While correlation analyses demonstrated that all measured cognitive faculties were associated with both BE4PTA and BE2PTA, hierarchical linear regression analyses demonstrated that only BE4PTA predicted cognitive flexibility and working-memory ability after controlling for covariates; age primarily accounted for BE2PTA's cognitive effects.

Conclusion

While both speech and higher-frequency hearing loss were associated with poorer cognition, only the former demonstrated effects beyond those of ageing. However, the present study only investigated two frequencies in the higher range, encouraging broader investigation of higher-frequency hearing's cognitive effects in the future.

Evaluating the Effectiveness of Community-Delivered Hearing Rehabilitation and Health Education Intervention on Social Isolation and Functioning Among Chinese Adults With Hearing Impairment: Protocol for Randomized Controlled Trial

BACKGROUND

Hearing impairment (HI) is a common sensory deficit with considerable impacts on social well-being (SWB) in adults. Evidence on the effectiveness of auditory rehabilitation and hearing health education in the social domain of health for individuals with HI is scarce.

OBJECTIVE

This study aims to test the feasibility and efficacy of providing free hearing aids or a combined offline and online hearing health education intervention on social isolation and functioning among Chinese adults with HI.

METHODS

This study is a 3-arm, single-blinded, randomized controlled trial (RCT) with a follow-up at 24 months after the baseline study. A total of 435 participants aged 18 years and older with some degree of HI will be recruited and randomly assigned to 2 intervention groups and 1 control group. Free hearing-aid provision, as well as a hearing health education program that is combined with online and offline lessons, will be implemented in 2 intervention groups, respectively. The control group will not receive any intervention. The primary outcomes include social isolation and functioning in society. The secondary outcomes include social engagement, a sense of mastery, self-efficacy, psychological resilience, chronic diseases, life satisfaction, hearing health literacy, and hearing care usage.

RESULTS

Participants were recruited for hearing tests in September 2022, during which baseline results were collected through in-person interviews. Follow-up interviews were conducted in September 2024. The primary analysis will use ANOVA, linear mixed-effects modeling, structural equation modeling, and cost-effectiveness analysis.

CONCLUSIONS

The findings of this study will provide evidence for the impact and cost-effectiveness of a community-based auditory or hearing health education intervention on SWB among Chinese adults with HI, which may contribute to promoting hearing health and reducing adverse health consequences in an aging society.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2200062148; https://www.chictr.org.cn/showproj.html?proj=174741.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/64115.

Experimental validation and identification of ferroptosis-associated biomarkers for diagnostic and therapeutic targeting in hearing loss

Objectives

Ferroptosis, a regulated form of cell death, has attracted significant attention in hearing loss research; however, the role of ferroptosis-related genes remains unclear. This study aimed to clarify diagnostic and therapeutic targeting of ferroptosis-related genes in hearing loss.

Methods

Differentially expressed genes related to hearing loss from the GEO database were intersected with ferroptosis-related genes. The Lasso and SVM-RFE models were applied to reduce the gene set, identifying model genes. Biological functions, pathways, and gene-drug associations related to these model genes were analyzed. Age-related hearing loss (ARHL) genes within the model genes were obtained from a genome-wide association study (GWAS) dataset. Further validation was conducted in HEI-OC1 cells and the cochleae of C57BL/6J mice, including auditory brainstem response (ABR) testing, qRT-PCR, Western blotting, Fe2+ detection, and immunofluorescence analysis.

Results

The study identified 20 ferroptosis-related genes associated with hearing loss. Using Lasso and SVM-RFE models, a novel model was constructed, consisting of nine genes (SCD, ENPP2, PANX2, NEDD4, MEF2C, ABCC5, KLHDC3, CYP4F8 and IFNA2). Among these, MEF2C and NEDD4 were found to be associated with ARHL.

Conclusion

Ferroptosis is a potential pathological mechanism in hearing loss research, and the nine ferroptosis-related genes identified provide promising targets for exploring new diagnostics and treatments for hearing loss. Notably, MEF2C and NEDD4 are associated with ARHL.

Global Barriers to Otolaryngology Care

Importance

Understanding the global barriers to otolaryngology-head and neck surgery (OHNS) care is crucial in addressing disparities in access to care, particularly in low-income and middle-income countries (LMICs).

Objective

To characterize barriers to comprehensive otolaryngology care across World Bank income groups.

Design, Setting, and Participants

Using an online cross-sectional survey that was administered by the Global OHNS Initiative via international and national professional societies, personal contacts, and social media, this study captured the perceptions of otolaryngologists regarding barriers to OHNS care at the levels of the country, health sector, clinician, and patient. Participants included otolaryngologists from the 194 World Health Organization member states and Taiwan. Eligibility criteria included a medical degree and specialized training in managing conditions of the ear, nose, and throat. The nonresponse rate was not recorded. The data collection period spanned from October 2022 to June 2023.

Exposures

Exposures included World Bank income group classification.

Main Outcomes and Measures

The primary outcomes were Likert scale responses regarding frequency of barriers to OHNS care. The a priori hypothesis was that LMICs would report more frequent barriers to OHNS care.

Results

The study involved 146 otolaryngologists (47 female individuals [32%]), with 69 (47%) from high-income countries and 77 (53%) from LMICs. Male individuals represented 45 high-income country respondents (65%) and 54 LMIC respondents (70%). Barriers were reported across income groups at all levels of the health system, with a higher frequency in LMICs. Several barriers were reported to be more substantial in LMICs, such as the national volume and distribution of otolaryngologists, financial compensation for clinicians, and patient stigma, and others were common across income settings, such as the availability of operating rooms and inflexible working hours. Common concerns included national and health sector barriers: OHNS workforce, referral networks, government support; clinician barriers: excessive clinician workloads, understaffing, poor administration support; patient barriers: distance to health care facilities, financial burdens such as medical costs and foregone wages, stigma, and health literacy.

Conclusions and Relevance

The results of this cross-sectional study suggest that there are barriers to otolaryngology care globally that affected all levels of the health care system. This work may inform prioritization of otolaryngology within research and policy, and it emphasizes the need for effective strategies to expand access to otolaryngology care, particularly in lower-income settings.

Obesity affects the association between Serum Klotho and age-related hearing loss: A cross-sectional study

OBJECTIVE

The influence of obesity on the interplay between Klotho and age-related hearing loss (ARHL) requires further exploration. This study investigates the impact of obesity on the correlation between Serum Klotho levels and ARHL prevalence in a large cohort.

METHODS

The present study analyzed data from the National Health and Nutrition Examination Survey (NHANES) involving 3355 participants. Participants were stratified based on body mass index (BMI) into non-obese (BMI < 30 kg/m²) and obese (BMI ≥ 30 kg/m²) groups. We then assessed the interaction between serum Klotho levels and the risk of ARHL using multivariable logistic regression. Restricted cubic splines were employed to evaluate the dose-response relationship between serum Klotho and ARHL in both non-obese and obese groups.

RESULTS

In non-obese participants, serum Klotho levels were significantly associated with ARHL in both univariate (OR = 0.84, 95 % CI 0.77-0.93, p < 0.001) and multivariable analyses (OR = 0.88, 95 % CI 0.79-0.99, p = 0.034). A restricted cubic spline model confirmed a linear relationship between serum Klotho and ARHL in this group (p for non-linearity = 0.969). Conversely, no significant association was found in obese participants. These findings underscore a persistent association between serum Klotho and ARHL in non-obese individuals after adjusting for confounding factors.

CONCLUSION

Obesity appears to modulate the association between serum Klotho levels and age-related hearing loss, offering potential insights for improving prevention and management strategies for hearing impairment.

Heavy metal biomarkers and their impact on hearing loss risk: a machine learning framework analysis

Background

Exposure to heavy metals has been implicated in adverse auditory health outcomes, yet the precise relationships between heavy metal biomarkers and hearing status remain underexplored. This study leverages a machine learning framework to investigate these associations, offering a novel approach to understanding the interplay between environmental exposures and hearing loss.

Methods

We conducted a retrospective cross-sectional analysis using data from the 2012-2018 National Health and Nutrition Examination Survey (NHANES), encompassing 2,772 participants after applying exclusion criteria. Demographic, clinical, and heavy metal biomarker data (e.g., blood lead and cadmium levels) were analyzed as features, with hearing loss status-defined as a pure-tone average threshold exceeding 25 dB HL across 500, 1,000, 2000, and 4,000 Hz in the better ear-serving as the binary outcome. Multiple machine learning algorithms, including Random Forest, XGBoost, Gradient Boosting, Logistic Regression, CatBoost, and MLP, were optimized and evaluated. Model performance was assessed using accuracy, area under the curve (AUC), sensitivity, and specificity, while SHAP (SHapley Additive exPlanations) elucidated feature contributions.

Results

The CatBoost model demonstrated the strongest performance, achieving an accuracy of 74.9% and an AUC of 0.792 on test data. Age, education level, gender, and blood levels of lead and cadmium emerged as the most significant features associated with hearing loss, as determined by SHAP analysis. These findings highlight key correlates of hearing impairment within the study population.

Conclusion

This study underscores the utility of a machine learning framework in identifying associations between heavy metal biomarkers and hearing loss in a nationally representative sample. While not designed to forecast hearing loss over time, our findings suggest potential clinical relevance for identifying individuals with elevated heavy metal exposure who may warrant further audiometric evaluation. This work lays a foundation for future longitudinal studies to explore these relationships more comprehensively.

Caregiver Challenges and Opportunities for Accessing Early Hearing Detection and Intervention: A Narrative Inquiry from South Africa

BACKGROUND

Early Hearing Detection and Intervention (EHDI) is essential for minimising the negative impact of childhood hearing loss on speech, language, and cognitive development. However, in low- and middle-income countries such as South Africa, various challenges hinder the implementation of EHDI services, leading to delayed diagnosis and intervention.

AIM

This study explores caregivers' experiences with EHDI services, identifying key challenges and facilitators affecting access and timely intervention.

METHODS

A narrative inquiry approach was used as part of a broader research initiative on family-centred EHDI. Nine caregivers of children who are deaf or hard of hearing (DHH) were purposively sampled, and data were collected through semi-structured interviews.

RESULTS

Thematic analysis revealed systemic and structural challenges, logistical and financial constraints, and caregiver-related factors that hindered access to EHDI services. Key facilitators included caregiver knowledge and advocacy, family support services such as counselling and South African Sign Language training, and high-quality audiological and educational services.

CONCLUSIONS

Findings emphasise the need for policy-driven reforms, including expanding newborn hearing screening programmes, improving financial assistance mechanisms, and increasing public awareness. Addressing these challenges and leveraging facilitators can help South Africa align with global EHDI benchmarks and improve outcomes for DHH children.

Impact of Preschool Hearing Screening in Low-Income Communities: Program Outcomes and Caregiver Perspectives

PURPOSE

This study aimed to describe the impact of a preschool hearing screening program in a low- and middle-income country (LMIC) in terms of referral outcomes and caregiver perspectives.

METHOD

This study included two components. First, a review of outcomes from a large-scale community-based hearing screening program, facilitated by community health workers (CHWs), for preschool children who failed their hearing screening. Second, telephonic surveys were conducted with (a) 25 caregivers whose children attended follow-up appointments and were diagnosed with hearing loss and (b) 33 caregivers whose children did not attend follow-up appointments.

RESULTS

Over 21 months, 13,322 children underwent hearing screening, with an initial referral rate of 6% (809). Follow-up tests at preschools covered 86.2% (697) of children who failed the initial hearing screening, of whom 47.8% (387) presented with hearing loss and were referred for further evaluation. Among the 190 attending follow-up appointments, 54.8% (104) were diagnosed with hearing loss. Of these, 71.1% (74) had conductive hearing loss, 12.5% (13) had sensorineural hearing loss, and 13.5% (14) had mixed hearing loss. Caregivers strongly supported (96%) community-based hearing screening for preschool-aged children. Notably, attendance varied significantly between preschool rescreenings (86.2%) and health care facility follow-up appointments (49.1%). Caregivers highlighted barriers to attend hearing services including work commitments, long waiting times at health care facilities, miscommunication about referrals and appointments, relocations, and COVID-19 appointment cancellations.

CONCLUSIONS

This study highlights the effectiveness of community-based hearing screenings in LMICs, led by CHWs. It emphasizes strong caregiver support and the importance of culturally relevant communication. Challenges in follow-up attendance persist, emphasizing the need for improved accessibility and communication within health care systems. Prioritizing caregiver concerns and promoting culturally sensitive education are essential for improving outcomes.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28462613.

The global prevalence of complete hearing loss in 204 countries and territories from 1992 to 2021: a systematic analysis for the global burden of disease study 2021

Background

Complete hearing loss, especially the age-related type, poses a significant public health challenge globally. This study aims to assess the global burden on the prevalence of complete hearing loss from 1992 to 2021 and forecast trends up to 2036.

Methods

Using data from the Global Burden of Disease (GBD) Study 2021, we assessed the global burden of complete hearing loss across 204 countries and territories. We analyzed temporal trends in ASPR using Joinpoint regression, evaluated the contributions of age, period, and cohort effects through Age-Period-Cohort modeling, and performed decomposition analysis to determine the impact of demographic and epidemiological changes on prevalence trends. Predictions of future ASPR trends were made using Bayesian Age-Period-Cohort (BAPC) and Autoregressive Integrated Moving Average (ARIMA) models.

Results

By 2021, the global prevalence of complete hearing loss had reached 9.9 million cases, with the ASPR declining from 134.35 to 117.79 per 100,000. The overall Estimated Annual Percentage Change (EAPC) was-0.45. The most significant reductions were observed in low-SDI regions, particularly Sub-Saharan Africa (EAPC: -0.74). In contrast, high-SDI regions, including North America and Western Europe, showed more modest declines (EAPC: -0.18). Notably, East Asia exhibited a 62.3% increase in prevalence, with high-income Asia Pacific showing the highest relative rise at 83.97%. Age-related hearing loss remained the dominant cause, especially among individuals aged 60 and above. Males were more affected than females. Population aging and growth were the major drivers of the increased prevalence in high-SDI regions, while population growth was the primary factor in low-SDI areas.

Conclusion

The burden of complete hearing loss remains high in prevalence, particularly in aging populations within high-SDI regions, despite overall reductions in ASPR. Significant regional disparities remain, highlighting the need for targeted interventions to improve access to hearing care and affordable technologies in low-SDI regions.

Global Trends in the Incidence, Prevalence and Disability-Adjusted Life Years of Leprosy from 1990 to 2019: An Age-Period-Cohort Analysis Using the Global Burden of Disease Study 2019

Background

Leprosy is a neglected tropical disease, with approximately 200,000 new cases reported worldwide every year. Although there are numerous studies on the epidemiology of leprosy, the age, period, and cohort effects remain poorly understood.

Objective

We present an overview of trends in leprosy incidence, prevalence and disability-adjusted life years worldwide from 1990 to 2019 and associations with age, period, and birth cohort. Data for analysis were obtained from the Global Burden of Disease Study 2019.

Methods

We described incident case, prevalent case, age-standardised incidence, prevalence and disability-adjusted life years rates of leprosy from 1990 to 2019. Subsequently, we calculated overall annual percentage changes, annual percentage changes, and the relative risks of period and cohort using an age-period-cohort model.

Results

From 1990 to 2019, the global age-standardized incidence rate of leprosy decreased from 1.48 per 100,000 to 0.65 per 100,000. Additionally, countries with low Socio-Demographic Index (SDI) demonstrated higher age-standardised incidence, prevalence and disability-adjusted life years rate. The age-standardised incidence, prevalence and disability-adjusted life years rate were significantly higher in males compared to females. Furthermore, the impact of age on leprosy increased with age, peaking at 25-35 years, with the highest prevalence rates observed in the 35-40 age group. Notably, the peak age of leprosy onset increases with SDI. Both the period and cohort effects on leprosy incidence and prevalence showed decreasing trend in middle SDI, low-middle SDI and low SDI countries in recent 30 years and birth cohort later than 1905. However, unfavorable period and cohort effects were noted in high SDI regions.

Conclusion

Leprosy incidence, prevalence and disability-adjusted life years have significantly decreased globally, but remain high in areas with lower SDI. Developing regions should increase public awareness of leprosy risk factors, develop effective control policies to better manage and prevent the disease.

Bi-Allelic MARVELD2 Variant Identified with Exome Sequencing in a Consanguineous Multiplex Ghanaian Family Segregating Non-Syndromic Hearing Loss

Genetic studies and phenotypic expansion of hearing loss (HL) for people living in Africa are greatly needed. We evaluated the clinical phenotypes of three affected siblings presenting non-syndromic (NS) HL and five unaffected members of a consanguineous Ghanaian family. Analysis of exome sequence data was performed for all affected and one unaffected family members. In-depth genetic and cellular characterization studies were performed to investigate biological significance of the implicated variant using bioinformatic tools and cell-based experimentation. Audiological examinations showed severe-to-profound, bilateral, symmetrical, and post-lingual onset. The whole-exome sequencing (WES) identified a homozygous frameshift variant: MARVEL domain containing 2 (MARVELD2):c.1058dup;p.(Val354Serfs*5) in all affected siblings. This frameshift variant leads to an early stop codon insertion and predicted to be targeted by nonsense medicated decay (mutant protein predicted to lack conserved C-terminal domain if translated). Cell immunofluorescence and immunocytochemistry studies exposed the functional impact of the mutant protein's expression, stability, localization, protein-protein binding, barrier function, and actin cytoskeleton architecture. The identified variant segregates with NSHL in the index Ghanaian family. The data support this nonsense variant as pathogenic, likely to impact the homeostasis of ions, solutes, and other molecules, compromising membrane barrier and signaling in the inner ear spaces.

The Locally Driven Temporal Bone Dissection Laboratory: A Sustainable Tool for Otologic Development in Sub-Saharan Africa

Objective

To evaluate the feasibility of a temporal bone dissection laboratory in Tanzania to support otologic surgical training for otolaryngologists in the region.

Study Design

This prospective cohort study evaluates six temporal bone laboratory training sessions over the course of 11 months. Pretraining and posttraining surveys were distributed during the first year of implementation in 2023. Postsurveys were distributed both immediately and 6 months posttraining.

Setting

Single tertiary care academic medical center in Dar es Salaam, Tanzania.

Methods

Participant data for 47 attendees including country/region of practice, otologic procedures completed, and number of trainees/audiologists in their clinical practice were collected in the pretraining survey. A 5-point Likert scale was used to assess pretraining and posttraining comfort with completing common otologic procedures. Study outcomes included comfort level, barriers to implementing acquired knowledge, and overall training quality.

Results

The results highlight that participants did not have pretraining comfort with, exposure to, and training with many otologic surgeries. These limitations were largely attributed to barriers identified by participants including limited access to training, learning opportunities, and equipment for otologic procedures. Findings also indicate statistically significant increases in comfort level for the majority of common otologic procedures evaluated.

Conclusion

This study highlights that the training has been both feasible for and desired by participants, and has addressed critical needs in continued surgical training. Temporal bone dissection labs are a feasible and highly desired model to increase the otologic capacity of practicing otolaryngologists regionally and offer a promising approach for addressing the lack of training opportunities in the region.

Refinement and Validation of a New Patient-Reported Experience Measure for Hearing Loss (My Hearing PREM)

CONTEXT

Patient-reported experience measures (PREMs) generate insights into daily challenges experienced when living with a chronic condition and experiences of care. There are no validated PREMs to measure the experience of hearing loss.

OBJECTIVE

The aim of this study was to evaluate the psychometric properties of a newly developed tool, 'My Hearing PREM', designed to assess the experience of living with hearing loss and receiving audiology care.

SETTING AND PARTICIPANTS

Adults with hearing loss (n = 401) were recruited from audiology clinics in Scotland and England, and non-clinical routes such as lip-reading classes, clinical research networks, national charity links and social media.

DESIGN

Participants completed a 27-item PREM alongside validated scales to measure communication difficulties, loneliness, quality of life, decisional conflict and health literacy. Modern (Rasch) and traditional psychometric analysis techniques (internal consistency and construct validity) were used to assess the psychometric properties of the My Hearing PREM.

RESULTS

Factor analysis of the initial 27 items produced 3 subscales: Emotional Burden, Support and Communication, after 4 items were removed due to poor fit. Rasch analysis was carried out on each of these subscales and a further 7 items with poor fit to the Rasch model were removed. This resulted in a long-form 16-item (My Hearing PREM-16) demonstrating good internal reliability (Cronbach's α = 0.91). Each subscale showed good internal reliability (0.91, 0.85 and 0.71). A short-form (My Hearing PREM-9) version was developed for use in clinical practice (α = 0.79). Both forms of the PREM demonstrated medium to strong significant correlations with the validated measures.

CONCLUSION

Both the My Hearing PREM-16 and My Hearing PREM-9 are reliable measures with good construct validity. They provide a way for healthcare professionals to understand how hearing loss is affecting an individual's emotional well-being, social interactions and communication. Ongoing research is exploring the feasibility of My Hearing PREM in routine audiology practice.

PATIENT OR PUBLIC CONTRIBUTION

We developed the project in collaboration with members of the public who have lived experience of hearing loss, recruited through Aston University and volunteer networks connected to audiology services. Additionally, we engaged with individuals more likely to be impacted by hearing loss, including adults with learning disabilities, older adults in residential care, and members of South Asian communities (Bangladeshi, Indian and Pakistani). These stakeholders provided valuable feedback on the study's aims, the content and format of the My Hearing PREM items, the survey design and recruitment strategies.

Review of Ototoxic Drugs Using Health Insurance Data: A Data-Driven Management System

Objective

With more than 1.57 billion people affected by hearing loss worldwide, this study investigates the association between ototoxic drug use and hearing loss, utilizing South Korean national health data. The goal is to inform clinical prevention and management guidelines by identifying ototoxic drugs and assessing their risks.

Study Design

This study is a retrospective observational study using the Health Insurance Review and Assessment Service (HIRA) to analyze the association between suspected ototoxic drug use and hearing loss.

Setting

Data were obtained from the National Patient Samples (NPS) of HIRA in South Korea, covering 2009 to 2016. The study included all National Health Insurance (NHI) enrollees with at least one hospital visit.

Methods

Patients diagnosed with suspected ototoxicity hearing loss (SOHL) were identified, and ototoxic drugs were reviewed using national data. Of 491 reviewed ingredients, 151 were suspected ototoxic. Logistic regression and Cox proportional hazards models assessed associations between drug prescriptions and SOHL, analyzed with SAS 9.4.

Results

SOHL patients were older, with higher rates of underlying conditions and medication use compared to controls. The odds ratio (OR) for SOHL was significantly elevated in patients aged ≥65, increasing from 3.007 to 3.366. Proton pump inhibitors (PPIs) and antibiotics presented elevated risks, especially in older adults, with hazard ratios (HRs) for PPIs rising from 1.85 to 2.90. Notably, PPIs posed higher risks for patients <65.

Conclusion

The study confirms that factors like age, gender, underlying diseases, and specific medications increase SOHL risk, emphasizing the need for cautious medication use tailored to age.