Uncomfortable loudness levels among children and adolescents seeking help for tinnitus and/or hyperacusis

Objective: To assess the prevalence of hyperacusis and severe hyperacusis among children and adolescents seen at an audiology outpatient tinnitus and hyperacusis service.

Design: This was a retrospective study. Hyperacusis was considered as present if the average uncomfortable loudness level (ULL) at 0.25, 0.5, 1, 2, 4 and 8?kHz for the ear with the lower average ULL, which is denoted as ULLmin, was ≤77?dB HL. Severe hyperacusis was considered as present if the ULL was 30?dB HL or less for at least one of the measured frequencies for at least one ear.

Study sample: There were 62 young patients with an average age of 12?years (SD?=?4.1?years, range 4–18?years).

Results: Eighty-five percent of patients had hyperacusis and 17% had severe hyperacusis. On average, ULLs at 8?kHz were 9.3?dB lower than ULLs at 0.25?kHz. For 33% of patients, ULLs were at least 20?dB lower at 8 than at 0.25?kHz.

Conclusions: Among children and adolescents seen at an audiology outpatient clinic for tinnitus and hyperacusis, hyperacusis diagnosed on the basis of ULLs is very prevalent and it is often characterised by lower ULLs at 8 than at 0.25?kHz.     

Factors related to uncomfortable loudness levels for patients seen in a tinnitus and hyperacusis clinic

Objectives: The aims were as follows: (1) to explore patterns of uncomfortable loudness levels (ULLs) across frequency and their associated factors for patients with tinnitus and hyperacusis, and (2) to re-evaluate the criteria for diagnosing hyperacusis based on ULLs and scores for the Hyperacusis Questionnaire (HQ). Design: This was a retrospective cross-sectional study. Study sample: 573 consecutive patients for whom ULLs had been measured were included. Results: A good correspondence between the diagnosis of hyperacusis based on the across-frequency average ULL for the ear with the lowest ULLs (ULLmin) and hyperacusis handicap based on HQ scores was obtained with cut-off values of ULLmin ≤77?dB HL and HQ score ≥?22. A regression model showed significant relationships between ULLmin and the score on the HQ and age. The mean HQ score for patients with a large interaural asymmetry in ULLs was significantly higher than for the remainder. Hyperacusis handicap was associated with strong across-frequency variations in ULLs. Conclusions: Appropriate cut-off values for diagnosing hyperacusis are ULLmin ≤77?dB HL and HQ score ≥22. Large interaural asymmetry and large across-frequency variations in ULLs are associated with higher HQ scores.     

Dead regions in the cochlea at 4 kHz in elderly adults: relation to absolute threshold, steepness of audiogram, and pure-tone average

The aims of this study were (1) to investigate the prevalence of dead regions (DRs) at 4 kHz in elderly people with hearing loss and (2) to determine the extent to which the presence/absence of a DR can be predicted from the absolute threshold, the slope of the audiogram, or the pure-tone average (PTA) hearing loss at 0.5, 1, and 2 kHz. DRs were assessed for 98 ears with absolute thresholds between 60 and 85 dB HL at 4 kHz using the threshold equalizing noise test. Thirty-six ears had a DR at 4 kHz. There was no statistically significant difference in the slope of the audiogram or PTA between ears with and without DRs. However, the mean absolute threshold at 4 kHz was significantly higher for the group with DRs than for the group without DRs. The prevalence of DRs exceeded 50% for hearing losses greater than 70 dB.     

Financial burden of heart failure in a developing country: cost analysis from Manipal Heart Failure Registry,India

Aim

To estimate the comprehensive healthcare costs of heart failure (HF) and determine the utilization of healthcare resources (HRU) for 2 years following index hospitalization.

Subjects and methods

The Manipal Heart Failure Registry (MHFR) is a prospective registry analyzing the financial burden and HRU in 610 patients with HF. Costs incurred by patients during 2 years following index hospitalization were estimated, and their association with socio-demographic and clinical factors were calculated. After 54 (8.8%) in-hospital mortalities, 556 patients were followed up for 2 years.

Results

The mean age of the study cohort was 65.08?±?13.6 years, and 245 (40.2%) were females. Based on the ejection fraction (EF), 506 (82.9%) patients were diagnosed as having HF with reduced EF. Average hospital stay during index admission was 5.3?±?2.9 days. Total expenditure during index hospitalization was INR 36.3 million and during 2-year follow-up was INR 45.2 million. Average total expenditure per patient was INR 133,663. The average out-of-pocket expense was INR 82,766 and average health insurance coverage was INR 50,896. Difference in expenditure was significant (P?<?0.05) between specific groups, i.e., etiologies, genders, HF phenotypes, age groups, and healthcare insurance types.

Conclusion

Healthcare expenditure of patients with HF in India is much lower than for the western counterparts. Higher utilization of healthcare resources in HF patients with ischemic etiology, non-compliant to medications, and elderly (age?>?60 years) was associated with increased expenses. Interventional procedures and implantations account for the bulk of the expenses in ischemic HF patients.

Trial registration number

Clinical Trial Registry of India: CTRI/2017/11/010395; National Institute of Health (NIH) clinical trial no.: NCT03157219.

     

Simplified form of tinnitus retraining therapy in adults: a retrospective study

Background

To evaluate the long-term surgical outcome(s) in patients who have undergone canal-wall-down operation with mastoid and epitympanic obliteration using autologous cortical bone chips, bone pate and meatally-based musculoperiosteal flap technique.

Method

Retrospective evaluation of seventy patients operated during 1986–1991 due to a cholesteatoma. An otomicroscopy was performed to evaluate the postoperative outer ear canal configuration with a modified Likert scale (1 – 4). The outer ear canal physical volume was assessed by tympanometry. The hearing outcome and a patient-filled questionnaire were also analyzed.

Results

The posterior wall results were 1.8 (± 0.9 SD) and the attic region 1.8 (± 0.9 SD) (ns., p > 0.05). These values show either no cavity formation or minor formation of a cavity, with a good functional result. The mean volume of the operated ear canal was 1.7 (± 0.5 SD) ml. The volume of the contralateral ear canal was 1.2 (± 0.3 SD) ml (*** p < 0.0001). A comparison of the current mean ABG to the preoperative mean ABG and to the ABG at one-year postoperatively, 5-years postoperatively or 10-years postoperatively showed no statistical significance (p > 0.05).

Conclusion

ABG does not significantly change in the long-term. The configuration of the cavity tends to change, however, the obliteration material is stable in the long-term and clinically significant cavitation rarely occurs.     

Feasibility of conducting a randomized controlled trial to evaluate the effect of motivational interviewing on hearing-aid use

Objectives: The aim of this study was to evaluate the feasibility of conducting a randomized controlled trial (RCT) on the effect of motivational interviewing (MI) on hearing-aid use. Design: This was a pilot single-blind, randomized parallel-group study conducted in the UK. Study sample: Thirty-seven adult patients who reported using their hearing aid(s) less than four hours per day were randomized to MI combined with Standard Care (MISC) (n?=?20), and Standard Care only (SC) (n?=?17). Results: Of 220 patients invited, 37 were enrolled giving the recruitment rate of 17%. One participant withdrew giving the retention rate of 97%. It was feasible to combine MI with SC for facilitating hearing-aid use and deliver the intervention with high fidelity in an audiology setting. The measure on hearing-aid use (data logging) one month after interventions favoured the MISC group. Conclusions: This pilot study suggests that conducting an RCT on using MI for facilitating hearing-aid use in people who do not use their hearing aids is feasible, and that MI combined with SC may have more positive effects on hearing-aid use compared to SC only.     

Tinnitus and hyperacusis therapy in a UK National Health Service audiology department: Patients’ evaluations of the effectiveness of treatments

Objective: To assess patients’ judgements of the effectiveness of the tinnitus and hyperacusis therapies offered in a specialist UK National Health Service audiology department. Design: Cross-sectional service evaluation questionnaire survey. Patients were asked to rank the effectiveness of the treatment they received on a scale from 1 to 5 (1?=?no effect, 5?=?very effective). Study sample: The questionnaire was sent to all patients who received treatment between January and March 2014 (n?=?200) and 92 questionnaires were returned. Results: The mean score was greatest for counselling (Mean?=?4.7, SD?=?0.6), followed by education (Mean?=?4.5, SD?=?0.8), cognitive behavioural therapy - CBT (Mean?=?4.4, SD?=?0.7), and hearing tests (Mean?=?4.4, SD?=?0.9). Only 6% of responders rated counselling as 3 or below. In contrast, bedside sound generators, hearing aids, and wideband noise generators were rated as 3 or below by 25%, 36%, and 47% of participants, respectively. Conclusion: The most effective components of the tinnitus and hyperacusis therapy interventions were judged by the patients to be counselling, education, and CBT.     

Influence of ear canal occlusion and static pressure difference on bone conduction thresholds: Implications for mechanisms of bone conduction

The effect of air pressure change on bone conduction (BC) hearing thresholds in the occluded ear was investigated. The pump manometer system of an impedance bridge was used to change the air pressure in the ear canal of twenty-two normally hearing subjects. BC thresholds were measured with: (1) open ear; (2) the ear canal occluded with a probe tube and application of 0 daPa air pressure; and (3) the ear canal occluded with a probe tube and application of ?350 daPa air pressure. Thresholds were lower in condition 2 than in condition 1, the difference decreasing from 27 dB at 2500 Hz to 4.5 dB at 2000 Hz. Thresholds were higher in condition 3 than in condition 2. The results are interpreted in terms of changes in the relative contribution of the three routes of transmission for BC sound produced by occlusion and by a static pressure difference.     

Influence of gender on continuous positive airway pressure requirements in patients with obstructive sleep apnea syndrome

Introduction  

Gender differences have been noted in key aspects of upper airway physiology and pathophysiology of obstructive sleep apnea (OSA). We postulate that these will lead to disparities in pharyngeal collapsibility and, consequently, positive airway pressure requirements of patients with OSA.