Telemedicine in Audiology. Best practice recommendations from the French Society of Audiology (SFA) and the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL)

ObjectivesAccess to diagnosis and treatments for auditory disorders and related pathologies has regressed in France during the COVID-19 pandemic, posing a risk to the patient's chance of recovery. This best practice recommendations guide aims to list the existing technological solutions for the remote examination of a patient with hearing complaint, and to outline their benefits and, where applicable, their limitations.MethodsThe recommendations were developed both from the clinical experience of the medical experts who drafted the guide, and from an extensive review of the literature dealing with clinical practice recommendations for tele-audiology. Tele-audiometry solutions were identified on the basis of a search engine query carried out in April 2020, prior to verification of their availability on the European market.ResultsVideo otoscopy solutions allow for the teletransmission of images compatible with a high-quality diagnosis, either by connecting via internet to a tele-health platform or using a smartphone or a tablet with an iOS or Android operating system. Using the same telecommunication methods, it is possible to remotely conduct a pure-tone audiometry test in accordance with standard practice, a speech-in-quiet or a speech-in-noise audiometry test, as well as objective measures of hearing. Clinical and paraclinical examinations can be accessed by the physician to be interpreted on a deferred basis (asynchronous tele-audiology). Examinations can also be conducted in real time in a patient, at any age of life, as long as a caregiver can be present during the installation of the transducers or the acoumetry. Tele-audiology solutions also find application in the remote training of future healthcare professionals involved in the management of deafness and hearing impairment.ConclusionUnder French law, tele-otoscopy is a medical procedure that is either a tele-expertise (asynchronous adive) or a teleconsultation act (synchronous advice). Subjective and objective evaluation of the patient's hearing functions can be done remotely provided that the listed precautions are respected.     

Sentence recognition in noise: Variables in compilation and interpretation of tests

Abstract

Tests of sentence recognition in noise constitute an essential tool for the assessment of auditory abilities that are representative of everyday listening experiences. A number of recent articles have reported on the development of such tests, documenting different approaches and methods. However, both the development and interpretation of these tests require careful consideration of many variables. This article reviews and categorizes the stimulus, presentation, subject, response, and performance variables influencing the development and interpretation of tests of sentence recognition in noise. A systematic framework is utilized to document published findings on these variables. Recommendations and guidelines, based on test performance requirements and test objectives, are provided concerning the interpretation of results and the development of new test materials.

Sumario

La ECoG ha mostrado desde hace mucho que complementa el diagnóstico de la MD, primariamente por la medición de la tasa de amplitud SP/AP. Aunque se reporta en la literatura como una prueba de alta especificidad para este trastorno, la sensibilidad de la ECoG, en la población general de MD, se mantiene relativamente baja (rango de 20-65%), El presente estudio evaluó la sensibilidad y la especificidad del protocolo de ECoG que empleamos para pacientes con sospecha de MD, que incluyó la medición de la amplitud y las áreas de los SP y AP ante clicks (para derivar las tasas de amplitud y de área de SP/AP) y la amplitud del SP ante bursts tonales de 1000 y 2000 Hz. Se condujo un cuadro de revisión retrospectivo para comparar los resultados de de la ECoG de 178 pacientes sospechosos de MD, con su diagnóstico eventual. Las medidas de la mayor sensibilidad y especificidad (determinadas utilizando un análisis logístico de regresión) incluyeron: amplitud del PS, área del PS, tasa de área SP/AP y área total de SP-AP. Los valores de sensibilidad y especificidad asociados con esas medidas fueron de 92% y 84%, respectivamente. El valor de sensibilidad fue considerablemente mayor que el previamente reportado y esto es atribuible a la inclusión de mediciones de área en nuestro protocolo.     

Guidelines (short version) of the French Society of Otorhinolaryngology (SFORL) on pediatric cochlear implant indications

ObjectivesThe authors present the guidelines of the French Society of Otorhinolaryngology – Head and Neck Surgery (Société française d’oto-rhino-laryngologie et de chirurgie de la face et du cou – SFORL) on the indications for cochlear implantation in children.MethodsA multidisciplinary work group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members’ individual experience. They were then read over by an editorial group independent of the work group. The guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence.ResultsThe SFORL recommends that children with bilateral severe/profound hearing loss be offered bilateral cochlear implantation, with surgery before 12 months of age. In sequential bilateral cochlear implantation in children with severe/profound hearing loss, it is recommended to reduce the interval between the two implants, preferably to less than 18 months. The SFORL recommends encouraging children with unilateral cochlear implants to wear contralateral hearing aids when residual hearing is present, and recommends assessing perception with hearing-in-noise tests. It is recommended that the surgical technique should try to preserve the residual functional structures of the inner ear as much as possible.     

Adaptation of the HINT (hearing in noise test) for adult Canadian Francophone populations

The HINT provides an efficient and reliable method of assessing speech intelligibility in quiet and in noise by using an adaptive strategy to measure speech reception thresholds for sentences, thus avoiding ceiling and floor effects that plague traditional measures performed at fixed presentation levels. A strong need for such a test within the Canadian Francophone population, led us to develop a French version of the HINT. Here we describe the development of this test. The Canadian French version is composed of 240-recorded sentences, equated for intelligibility, and cast into 12 phonemically balanced 20-sentence lists. Average headphone SRTs, measured with 36 adult Canadian Francophone native speakers with normal hearing, were 16.4?dBA in quiet, ?3.0?dBA SNR in a 65?dBA noise front condition and ?11.4?dBA SNR in a 65?dBA noise side condition. Reliability was established by means of within-subjects standard deviation of repeated SRT measurements over different lists and yielded values of 2.2 and 1.1?dB for the quiet and noise conditions, respectively.     

Management of somatic pain induced by head-and-neck cancer treatment: Definition and assessment. Guidelines of the French Oto-Rhino-Laryngology- Head and Neck Surgery Society (SFORL)

ObjectivesThe authors present the guidelines of the French Oto-Rhino-Laryngology- Head and Neck Surgery Society (Société française d’oto-rhino-laryngologie et de chirurgie de la face et du cou [SFORL]) for the management of somatic pain induced by head-and-neck cancer treatment, and in particular the instruments needed for the definition and initial assessment of the various types of pain.MethodsA multidisciplinary work group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members’ individual experience. They were then read over by an editorial group independent of the work group. The final version was established in a coordination meeting. The guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence.ResultsThe priority is to eliminate tumoral recurrence when pain reappears or changes following head-and-neck cancer treatment. Neuropathic pain screening instruments and pain assessment scales should be used to assess pain intensity and treatment efficacy. Functional rehabilitation sessions should be prescribed to reduce musculoskeletal pain and prevent ankylosis and postural disorder. Psychotherapy and mind-body therapy, when available, should be provided in case of chronic pain. In case of recalcitrant complex pain, referral should be made to a multidisciplinary pain structure.ConclusionThe management of somatic pain induced by head-and-neck cancer treatment above all requires identifying and assessing the intensity of the various types of pain involved, their functional impact and their emotional component.     

French Otorhinolaryngology Society (SFORL) good practice guidelines for dental implant surgery close to the maxillary sinus

ObjectivesTo draw up guidelines for ENT management associated with dental implant surgery with or without sinus lift.Materials and methodsThe methodology followed the rules of laid down by the French Health Authority (HAS): “Methodological bases for drawing up professional recommendations by formalized consensus”. The chosen method was the RAND/UCLA “RAND appropriateness method” (short version).ResultsIn the pre-implantation check-up, it is recommended to systematically screen for sinonasal pathology on medical interview and to favor 3D CT or cone-beam imaging. It is recommended that imaging include the entire maxillary sinus when the patient does not have sinonasal history or functional signs on interview. Otherwise, examination of all sinonasal cavities is recommended. This attitude enables simultaneous analysis of maxillary infrastructure for pre-implantation work-up and assessment of sinonasal cavity status. Sinus mucosal incidentalomas are very common in the healthy population and must be assessed with reference to the clinical, endoscopic and radiological context.ConclusionThis formalized expert consensus establishes a common base of knowledge, to clarify the issues and clinical situations and to standardize practices.     

Guidelines of the French Society of Otorhinolaryngology (SFORL). Epistaxis and high blood pressure

Objectives

The authors present the guidelines of the French Oto-Rhino-Laryngology – Head and Neck Surgery Society (Société Française d’Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou: SFORL) on epistaxis in high blood pressure.

Management of somatic pain induced by head and neck cancer treatment: Pain following radiation therapy and chemotherapy. Guidelines of the French Otorhinolaryngology Head and Neck Surgery Society (SFORL)

ObjectivesThe authors present the section of the guidelines of the French Otorhinolaryngology Head and Neck Surgery Society (SFORL) for the management of somatic pain induced by head and neck cancer treatment concerning management of pain following radiation therapy and chemotherapy.MethodsA multidisciplinary work group was entrusted with a literature review. Guidelines were drawn up based on the articles retrieved and the group members’ experience. They were read over by an editorial group independent of the work group. A coordination meeting drew up the final version. Guidelines were graded A, B or C or as expert opinion in decreasing order of level of evidence.ResultsParticular care should be given to detection and early adapted treatment of pain induced by radiation therapy and/or chemotherapy, to improve quality of life in head and neck cancer patients.     

Guidelines of the French Society of Otorhinolaryngology (SFORL). Second-line treatment of epistaxis in adults

Objectives

The authors present the guidelines of the French Oto-Rhino-Laryngology – Head and Neck Surgery Society (Société Française d’Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou: SFORL) on second-line treatment of epistaxis in adults, after failure of anterior and/or anterior–posterior nasal packing.

Guidelines of the French Society of Otorhinolaryngology (SFORL). First-line treatment of epistaxis in adults

Objectives

The authors present the guidelines of the French Otorhinolaryngology-Head and Neck Surgery Society (SFORL) on first-line treatment of epistaxis in adults.

Guidelines of the French Society of Otorhinolaryngology (SFORL) for teleconsultation in patients with vertigo during the COVID-19 pandemic

ObjectivesIn the context of the SARS-CoV-2 pandemic, patients may have been dissuaded from seeking consultation, thus exposing themselves to a risk of loss of chance. This guide aims to define how teleconsultation can assist in assessing vertiginous adults or children, and to gather the information needed to provide quick medical care.MethodsThese recommendations rely on the authors’ experience as well as on literature. A survey on otoneurologic approach via telemedicine has been conducted based on a literature search until March 2020.ResultsThe first clinical assessment of the vertiginous patient via teleconsultation can only be successful if the following conditions are met: initial contact to verify the feasibility of the assessment at a distance, the presence of a caregiver in order to assist the patient, the possibility of making video recordings. Medical history via telemedicine, as in a face-to-face assessment, allows to assess the characteristics, duration, frequency, and potential triggering factors of the vertigo, in both children and adults. During teleconsultation, the following tests can be carried out: oculomotricity evaluation, assessment of balance, simple neurological tests, checking for positional vertigo/nystagmus and, eventually to perform canalith-repositioning procedures. In children, the following should be searched for: history of hearing or visual impairment, a context of fever or trauma, otorrhea, signs of meningeal irritation.ConclusionThe neurotologic telemedicine relies on the accuracy of the clinical assessment, which is based on history taking and a few simple tests, encouraging the development of a decision-making algorithm adapted for teleconsultation. However, the latter has its limitations during an emergency examination of a new patient presenting vertigo, and, at least in some cases, cannot replace a face-to-face consultation. Teleconsultation is often adapted for follow-up consultations of previously selected vertiginous patients during face-to-face assessment.     

Guidelines of the French Society of Otorhinolaryngology (SFORL) (short version). Specific treatment of epistaxis in Rendu-Osler-Weber disease

Objectives

The authors present the guidelines of the French Oto-Rhino-Laryngology – Head and Neck Surgery Society (Société Française d’Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou: SFORL) concerning specific treatment of epistaxis in Rendu-Osler-Weber disease.

人工耳蜗植入者噪声环境下普通话言语测听测试方案的优化研究

目的探讨适宜临床应用的人工耳蜗植入者噪声环境下普通话言语测听(mandarin hearing in noisetest,MHINT)方案。方法对10名母语为普通话的语后聋人工耳蜗植入者进行MHINT测试。测试方案1:由易到难的顺序进行安静环境言语识别率测试(speech recognition scores,SRS)→固定信噪比SRS测试→言语识别阈测试(reception threshold of sentences,RTS);测试方案2:由难到易的顺序进行RTS测试→固定信噪比SRS测试→安静环境SRS测试。优化测试方案:预测试→对象以言语识别率得分高低分级→正式测试。结果①测试方案1:全体受试者安静环境SRS测试的完成率100%(10/10),固定信噪比SRS测试的完成率50%(5/10);4名可完成固定信噪比SRS测试的受试者接受RTS测试,2名完成测试(50%,2/4);②测试方案2:全体受试者依次接受RTS测试(完成率20%,2/10)、噪声环境SRS测试(完成率50%,5/10)和安静环境SRS测试(完成率为100%,10/10);③优化测试方案:10名对象根据预测试SRS得分分级后,5名受试者接受并完成安静环境SRS测试(完成率100%,5/5);5名受试者接受并完成噪声环境SRS测试(完成率100%,5/5),其中4名进一步接受自适应RTS测试,2名完成测试(完成率50%,2/4)。结论根据预测试结果对受试者的言语能力进行分级,选取难度适中的测试方案进行测试,可提高言语测试的效率。根据助听装置使用者的言语能力为其制定个性化的测试参数和合理的评估流程,将有利于MHINT测试在临床言语识别评估工作的推广使用。     

Guidelines of the French Society of ENT (SFORL): Drug-induced sleep endoscopy in adult obstructive sleep apnea syndrome

ObjectivesTo determine the indications, anesthesiological and surgical procedure and interest of drug-induced sleep endoscopy in the treatment of adult obstructive sleep apnea syndrome.DesignA redactional committee of 17 experts was set up. Conflicts of interest were disclosed and followed up throughout the process of drawing up the guidelines. The work received no funding from any firm dealing in health products (drugs or devices). The GRADE (Grading of Recommendations Assessment, Development and Evaluation) method was applied to assess the quality of the data on which the guidelines were founded. It was stressed that strong recommendations should not be made on the basis of poor-quality or insufficient data.MethodsThe committee studied 29 questions on 5 topics: indications and contraindications, anesthetic technique, surgical technique, interpretation and reporting of results, and management guided by results.ResultsExpert review and application of the GRADE method led to 30 guidelines: 10 with high level of evidence (Grade 1+ or 1?), 19 with low level (GRADE 2+ or 2?) and 1 expert opinion.ConclusionExperts fully agreed on the strong guidelines formalizing the indications and modalities of drug-induced sleep endoscopy for adult obstructive sleep apnea syndrome.     

Guidelines (short version) of the French Society of Otorhinolaryngology (SFORL) on cervical lymphatic malformation in adults and children: Diagnosis

Objectives

The authors present the guidelines of the French Society of Otorhinolaryngology (SFORL) for the diagnosis of cervical lymphatic malformation in adults and children.

Development of the Listening Self-Efficacy Questionnaire (LSEQ)

Abstract

Objective: Listening self-efficacy refers to the beliefs, or confidence, that listeners have in their capability to successfully listen in specific situations, which may influence audiologic rehabilitation outcomes. The objective of this study was to develop and validate the Listening Self-Efficacy Questionnaire (LSEQ), which quantifies listening self-efficacy in a variety of situations where the goal of the listener is to understand speech. Study Sample: Older listeners with hearing loss (N = 169) participated in the study. Design: A factor analysis showed that the LSEQ has three subscales, with beliefs about listening capabilities relating to the following situations: (1) dialogue in quiet, (2) focusing attention on a single source, and (3) complex auditory scenes. Internal consistency reliability was excellent (Chronbach's α > .80). Results: The validity of the LSEQ was demonstrated by comparing the LSEQ scores to audiologic measures, responses on questionnaires, and to the scores for reference groups of younger and older listeners with normal hearing. Conclusion: The findings indicate that the LSEQ is a valid and reliable measure of listening self-efficacy with good potential for use in clinical and research settings.

Sumario

Objetivo: La auto-eficacia para escuchar se refiere a la convicción o confianza que el sujeto tenga sobre su capacidad de escuchar exitosamente en situaciones específicas, las cuáles pueden influir los resultados de una rehabilitación audiológica. El propósito de este estudio fue desarrollar y validar un cuestionario de auto-eficacia para escuchar (LSEQ), que cuantifica la auto-eficacia para escuchar en una variedad de situaciones, donde la meta es entender lenguaje. Muestra del Estudio: Participaron en el estudio sujetos mayores con hipoacusia (n = 169). Diseño: Un análisis factorial mostró que el LSEQ tiene tres sub-escalas, con relación a capacidades para escuchar en la siguientes situaciones: (1) diálogo en silencio, (2) concentrando la atención en un fuente única, y (3) escenarios auditivos complejos. La confiabilidad y la consistencia interna fue excelente (Chronbach α > .80). Resultados: La validez del LSEQ fue demostrada comparando las puntuaciones con las mediciones audiológicas, con las respuestas de cuestionarios, y con las puntuaciones para grupos de referencia de personas jóvenes y viejas con audición normal. Conclusión: Los hallazgos indican que el LSEQ es una medida válida y confiable de auto-eficacia para escuchar con un buen potencial para utilizarse en el contexto clínico y de investigación.     

French Society of ENT (SFORL) guidelines. Indications for cochlear implantation in adults

The authors present the guidelines of the French Society of ENT and Head and Neck Surgery (SFORL) regarding indications for cochlear implantation in adults. After a literature review by a multidisciplinary workgroup, guidelines were drawn up based on retrieved articles and group-members’ experience, then read over by an independent reading group to edit the final version. Guidelines were graded A, B, C or “expert opinion” according to decreasing level of evidence. There is no upper age limit to cochlear implantation in the absence of proven dementia and if autonomy is at least partial. Bilateral implantation may be proposed if unilateral implantation fails to provide sufficiently good spatial localization, speech perception in noise and quality of life, and should be preceded by binaural hearing assessment. Rehabilitation by acoustic and electrical stimulation may be proposed when low-frequency hearing persists. Quality of life should be assessed before and after implantation.     

Guidelines of the French Society of Otorhinolaryngology (SFORL): Nonsteroidal anti-inflammatory drugs (NSAIDs) and pediatric ENT infections. Short version

ObjectivesTo present the guidelines of the French Society of Otolaryngology-Head and Neck Surgery concerning the use of non-steroidal anti-inflammatory drugs (NSAIDs) in pediatric ENT infections.MethodsBased on a critical analysis of the medical literature up to November 2016, a multidisciplinary workgroup of 11 practitioners wrote clinical practice guidelines. Levels of evidence were classified according to the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) system: GRADE A, B, C or “expert opinion”. The first version of the text was reworked by the workgroup following comments by the 22 members of the reading group.ResultsThe main recommendations are: NSAIDs are indicated at analgesic doses (e.g. 20–30 mg/kg/day for ibuprofen) in combination with paracetamol (acetaminophen) in uncomplicated pediatric ENT infections (acute otitis media, tonsillitis, upper respiratory infections, and maxillary sinusitis) if: o pain is of medium intensity (visual analogue scale (VAS) score 3–5 or “Evaluation Enfant Douleur” (EVENDOL) child pain score 4–7) and insufficiently relieved by first-line paracetamol (residual VAS ≥ 3 or EVENDOL ≥ 4); o pain is moderate to intense (VAS 5–7 or EVENDOL 7–10). When combined, paracetamol and ibuprofen are ideally taken simultaneously every 6 h. It is recommended: (1) o not to prescribe NSAIDs in severe or complicated pediatric ENT infections; (2) o to suspend NSAIDs treatment in case of unusual clinical presentation of the infection (duration or symptoms); (3) o not to prescribe NSAIDs for more than 72 h.     

社区老年人群纯音听阈测试结果分析

目的获得社区老年人群纯音听阈的正常值，为选取敏感频率测试老年人听阈提供参考依据。方法采用整群随机抽样方法，选取60岁以上社区老年人845例，按平均听阈（0．5、1、2和4kHz听阈平均值）≤40dBHL为正常或轻微损失，筛选205人，按60～65岁、66～70岁、71～75岁和76岁以上分组，计算各年龄组在0．5、1、2、3、4和8kHz的听阈及听阈检出率，采用SPSSl3．0软件进行）x^x检验和方差分析。结果听力正常老年人群不同年龄组听阈值存在显著差异（P〈0．01），随着年龄增长，听阈值呈增高趋势；不同频率听力测试显示不同频率组听阈值存在显著差异（P〈0．01）。各年龄组的听阈随频率的增高而增高，随频率、年龄增高，听阈检出率呈下降趋势。结论高频较低频测听能够早诊断老年人听力损失，可作为检测老年人早期听力损失的客观手段。