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Scientific Reports Jun 2024Hearing problems are commonly diagnosed with the use of tonal audiometry, which measures a patient's hearing threshold in both air and bone conduction at various...
Hearing problems are commonly diagnosed with the use of tonal audiometry, which measures a patient's hearing threshold in both air and bone conduction at various frequencies. Results of audiometry tests, usually represented graphically in the form of an audiogram, need to be interpreted by a professional audiologist in order to determine the exact type of hearing loss and administer proper treatment. However, the small number of professionals in the field can severely delay proper diagnosis. The presented work proposes a neural network solution for classification of tonal audiometry data. The solution, based on the Bidirectional Long Short-Term Memory architecture, has been devised and evaluated for classifying audiometry results into four classes, representing normal hearing, conductive hearing loss, mixed hearing loss, and sensorineural hearing loss. The network was trained using 15,046 test results analysed and categorised by professional audiologists. The proposed model achieves 99.33% classification accuracy on datasets outside of training. In clinical application, the model allows general practitioners to independently classify tonal audiometry results for patient referral. In addition, the proposed solution provides audiologists and otolaryngologists with access to an AI decision support system that has the potential to reduce their burden, improve diagnostic accuracy, and minimise human error.
Topics: Humans; Audiometry, Pure-Tone; Neural Networks, Computer; Female; Male; Hearing Loss; Adult; Middle Aged; Hearing Loss, Sensorineural; Hearing Loss, Conductive
PubMed: 38902305
DOI: 10.1038/s41598-024-64310-2 -
Clinical Otolaryngology : Official... Jun 2024Pathway innovation using smartphone otoscopy and tablet-based audiometry technologies to deliver ear and hearing services via trained audiologists may improve efficiency...
INTRODUCTION
Pathway innovation using smartphone otoscopy and tablet-based audiometry technologies to deliver ear and hearing services via trained audiologists may improve efficiency of the service. An ENT-integrated-community-ear service (ENTICES-combining community audiology management, remote ENT review and novel technologies) was piloted. We aimed to assess the efficiency and safety of ENTICES.
METHOD
ENTICES was a community-based and audiologist-led pathway. Patients with otological symptoms were self-referred to this service. Smartphone otoscopy and tablet-based audiograms were performed. Two otologists reviewed all decisions made in the community by audiologists based on video-otoscopy, hearing tests and chart reviews. Data on the first 50 consecutive new patients attending either consultant-led hospital otology clinics (HOC), audiologist-led hospital advanced audiology diagnostics (AAD) or ENTICES clinics were collected between 1 August 2021 and 31 December 2021. Data were collected through chart reviews and questionnaires to compare the three pathways with respect to efficiency, patient satisfaction, technology utility and safety.
RESULTS
No audiology-led ENTICES decisions were amended by hospital otologists following remote review. Remote review of video-otoscopy with history was sufficient for a diagnosis in 80% of cases. Adding hearing tests and standardised history increased the diagnostic yield to 98%. Patient satisfaction scores showed 100% service recommendation. The cost per patient, per visit, was £83.36, £99.07 and £69.72 for AAD, HOC or ENTICES, respectively.
CONCLUSION
ENTICES provides a safe ear and hearing service that patients rated highly. Thirty-two per cent of hospital otology patients were eligible for this service. For those patients, ENTICES is 20% more cost-effective and can reduce the number of clinic visits by up to 60% compared with HOC.
PubMed: 38899484
DOI: 10.1111/coa.14192 -
Indian Journal of Otolaryngology and... Jun 2024Auditory neuropathy spectrum disorder (ANSD) is a distinct type of SNHL that is characterized by the presence of otoacoustic emissions and/or cochlear microphonics....
INTRODUCTION
Auditory neuropathy spectrum disorder (ANSD) is a distinct type of SNHL that is characterized by the presence of otoacoustic emissions and/or cochlear microphonics. Cochlear implantation was initially not recommended for ANSD children, later studies showed variable outcomes among ANSD. CI is currently the intervention option of choice for many children with ANSD who are unable to obtain benefit from conventional amplification.
AIM AND OBJECTIVES
To review experiences with some of the preoperative and postoperative findings in a child who was diagnosed with auditory neuropathy and provided with cochlear implant. To describe changes in auditory function, which enabled to have significant improvement in hearing and communication skills through auditory verbal therapy (AVT) and regular follow ups.
STUDY DESIGN
Pre and postoperative, findings in cochlear implant recipient who was diagnosed with ANSD. Child received complete medical examinations, including related consultations in audiology, otorhinolaryngology, paediatrics, neurology, psychology, speech language pathology, and radiology.
METHODOLOGY/CASE REPORT
A 3-year-old-female have brought to the hospital with a C/o not responding to sounds, name call and unable to speak. Medical and Audiological evaluations were initiated. The hearing assessments of the child included appropriate behavioural audiometric techniques, objective measures of middle ear function, acoustic reflex studies, transient evoked (TEOAE), distortion product (DPOAE) otoacoustic emissions and auditory brainstem responses (ABR). Implanted with (HiRes Ultra CI HiFocus SlimJ Electrode), and objective measures were recorded intraoperatively electrode impedances and neural response telemetry (NRT) to assess the outcomes technically. These intraoperative objective measures were used to help program the speech processor for the child. Postoperatively, child has had regular follow-up with otorhinolaryngologist to assure complete healing of the surgical incision, to assess their general medical conditions, and audiologist for switch-on (speech processor) followed by mapping. The hearing and communication skills have been assessed, also continued Auditory Verbal Therapy (AVT) on a regular basis. Postoperatively, objective measures were recorded in regular intervals and monitored with therapy outcomes.
RESULTS
The child has shown significant improvement in sound detection, speech perception abilities, communication skills and shown evidence of progression of good NRT results, which were recorded and had no postoperative complications.
CONCLUSION
Experience with cochlear implantation for child diagnosed with ANSD that effectively received and benefited from CI. A detailed and careful evaluations, audiological follow-ups and tailored rehabilitation plans, can be considered as a beneficial management approach for CI, especially who diagnosed with ANSD. The regular use of cochlear implant in this diagnosis can lead to a clear increase in speech comprehension, development and overall progress in quality of life. Success or lack of success with a CI appears to be somewhat dependent on the specific site of lesion (pre- or post-synaptic). Currently there are no clinical measures available to diagnose the specific site of lesion. Indeed, CI appears to be an effective rehabilitation modality for ANSD patients. This may be explained by the fact that the implanted electrode delivers synchronized electrical impulses directly to the auditory nerve, bypassing the presynaptic IHCs and its synapse involved in the unsynchronized firing of the auditory nerve described in ANSD. However, genetic studies that have proven to be essential in the knowledge of underlying mechanisms of ANSD represent a promising therapeutic approach in the management of ANSD.
PubMed: 38883447
DOI: 10.1007/s12070-023-04448-z -
Seminars in Hearing May 2024Probe microphone measurements are an essential step in an individualized hearing aid fitting. These measurements allow audiologists to account for the individual's... (Review)
Review
Probe microphone measurements are an essential step in an individualized hearing aid fitting. These measurements allow audiologists to account for the individual's hearing and ear canal acoustics when programming hearing aids. An evidence-based hearing aid fitting includes matching the measured output of the hearing aids to targets for each input level and frequency. This allows the audiologist to confidently counsel the patient that the acoustic fitting is accurate, and the next step is for the individual to use the amplification during all waking hours to adapt to the newly amplified sounds. This also avoids mistakes such as overamplification or insufficient gain, which can endanger the patient and/or lead to a compromised fitting.
PubMed: 38855348
DOI: 10.1055/s-0044-1786505 -
Disability and Rehabilitation Jun 2024Older adults with communication disabilities (CDs) experience barriers to receiving care and face a paucity of accommodations for their disability. Utilizing someone...
PURPOSE
Older adults with communication disabilities (CDs) experience barriers to receiving care and face a paucity of accommodations for their disability. Utilizing someone that supports communication with healthcare providers (communication support persons) may be a way that this group self-supports their disability. We examined if this utilization was independently associated with CDs among older adults. We also sought to understand if socioeconomic factors were associated with utilization.
METHODS
We used the 2015 National Health and Aging Trends Survey (NHATS) to conduct a cross-sectional analysis of Medicare beneficiaries ( = 5954) with functional hearing, expressive, or cognitive difficulties. We calculated a weighted, population prevalence and an adjusted prevalence ratio (APR) controlling for sociodemographic, health and other disability factors.
RESULTS
Among community dwelling older adults, having CDs was associated with higher utilization of a communication support person at medical visits (APR: 1.41 [CI: 1.27 - 1.57]). Among adults with CDs, Black adults and women had lower levels of utilization as compared to White adults and men, respectively.
CONCLUSION
Communication support persons may be a way that older adults with CDs self-support their disability. However, not all older adults with CDs bring someone and variation by social factors could suggest that unmet support needs exist.
PubMed: 38826064
DOI: 10.1080/09638288.2024.2351155 -
International Journal of Audiology Jun 2024Explore the impact of Ida's "My Hearing Explained" (MHE) tool on audiologists' language and patients' understanding/interpretation of hearing test results.
The impact of using the Ida "My Hearing Explained" tool on audiologists' language and patient understanding of hearing test results: a comparison with standard audiogram explanations.
OBJECTIVE
Explore the impact of Ida's "My Hearing Explained" (MHE) tool on audiologists' language and patients' understanding/interpretation of hearing test results.
DESIGN
Audiologists were video-recorded in two sequential conditions: 1) giving standard audiogram explanations to 13 patients and, 2) following discretionary self-training, giving explanations using the MHE tool (nine patients). Outcomes of interest were audiologists' language complexity, use of jargon, and audiologist-patient interactivity. Semi-structured patient interviews, conducted 1-7 days after appointments, were analysed using inductive qualitative content analysis. Patient recall was verified.
STUDY SAMPLE
Four audiologists from one United Kingdom audiology service, and 22 patients (mean age 63.5 yrs) participated.
RESULTS
In comparison to standard audiogram explanations, audiologists' language was simpler and audiologist-patient interactivity greater with the MHE tool. Interview data analysis revealed differences between explanation types within the themes of "Understanding" and "Interpretation." 54% (standard audiogram) and 22% (MHE tool) of patients expressed a desire for takeaway information. 31% (standard audiogram) and 67% (MHE tool) of patients reported their explanation helped them relay their results to others. Four patients (one receiving the MHE tool) incorrectly recalled information, suggesting inadequate understanding in these cases.
CONCLUSIONS
The MHE tool has potential for improving the accessibility and comprehensibility of hearing test results.
PubMed: 38824465
DOI: 10.1080/14992027.2024.2358432 -
Audiology Research Apr 2024Cognitive behavioural therapy (CBT) for tinnitus management is effective and widely recommended by national and international practice guidelines. However, all the... (Review)
Review
BACKGROUND
Cognitive behavioural therapy (CBT) for tinnitus management is effective and widely recommended by national and international practice guidelines. However, all the evidence for CBT so far has come from Psychologist-led programs, and the potential role of Audiologists in providing CBT for tinnitus remains an important consideration.
OBJECTIVES
This study sets out to systematically map the body of literature relating to Audiologist-provided CBT for tinnitus, in order to summarise the current state of evidence and determine directions for future research.
ELIGIBILITY CRITERIA
Sources were eligible for inclusion if they addressed the concept of Audiologist-provided CBT. No restrictions were imposed on the date of publication. Only sources published in English were included.
SOURCES OF EVIDENCE
A wide range of primary and secondary literature sources were sought.
CHARTING METHODS
Data from included sources were charted systematically using a pre-designed data charting form.
RESULTS
Of the 267 identified sources, 30 were included in this review. This included both primary and secondary literature sources. Primary sources were compared and showed variation across Audiologist-provided CBT programs both in terms of procedural details and from a research standpoint.
CONCLUSIONS
A growing body of evidence has addressed the concept of Audiologist-provided CBT. Directions for future research include further primary research with an increased focus on face-to-face Audiologist-provided CBT, and a comparison of the outcomes of Audiologist-provided vs. Psychologist-provided CBT.
PubMed: 38804459
DOI: 10.3390/audiolres14030035 -
The Science of Diabetes Self-management... Jun 2024The purpose of this study was to assess the knowledge, attitudes, and practices among providers and patients regarding hearing impairment and screening referrals in...
PURPOSE
The purpose of this study was to assess the knowledge, attitudes, and practices among providers and patients regarding hearing impairment and screening referrals in people with diabetes.
METHODS
A cross-sectional survey design among health care providers and patients at an academic medical center in Oklahoma was used to gather knowledge, attitudes, and practices data.
RESULTS
Only 25.6% of providers selected hearing impairment as a complication of diabetes, whereas 96.7% selected retinopathy, kidney dysfunction, and foot infection. Reported barriers to referring patients for hearing impairment screenings were being unfamiliar with recommended screening frequency (57.3%) and existence of higher priorities (35.4%). When asked to select parts of the body affected by diabetes, 21.0% of patients surveyed selected ears, 88.0% selected feet, and 85.0% selected eyes and kidneys. Fewer patients reported being told hearing impairment is a complication of diabetes compared to retinopathy (8.1% vs 85.9%). Additionally, 24.2% of patients reported having a hearing impairment screening, and 96.0% reported having a dilated eye exam.
CONCLUSIONS
Most providers and patients at an academic medical center are unaware of the relationship between diabetes and hearing impairment. Providers reported there are several barriers that need to be overcome to refer patients to audiologists.
Topics: Humans; Cross-Sectional Studies; Health Knowledge, Attitudes, Practice; Male; Female; Hearing Loss; Middle Aged; Adult; Aged; Health Personnel; Diabetes Complications; Diabetes Mellitus; Oklahoma; Referral and Consultation; Mass Screening
PubMed: 38804076
DOI: 10.1177/26350106241250291 -
Technology and Health Care : Official... 2024The speech reception threshold (SRT), synonymous with the speech recognition threshold, denotes the minimum hearing level required for an individual to discern 50% of...
BACKGROUND
The speech reception threshold (SRT), synonymous with the speech recognition threshold, denotes the minimum hearing level required for an individual to discern 50% of presented speech material. This threshold is measured independently in each ear with a repetitive up-down adjustment of stimulus level starting from the initial SRT value derived from pure tone thresholds (PTTs), measured via pure-tone audiometry (PTA). However, repetitive adjustments in the test contributes to increased fatigue for both patients and audiologists, compromising the reliability of the hearing tests.
OBJECTIVE
Determining the first (initial) sound level closer to the finally determined SRT value, is important to reduce the number of repetitions. The existing method to determine the initial sound level is to average the PTTs called pure tone average (PTAv).
METHODS
We propose a novel method using a machine learning approach to estimate a more optimal initial sound level for the SRT test. Specifically, a convolutional neural network with 1-dimensional filters (1D CNN) was implemented to predict a superior initial level than the conventional methods.
RESULTS
Our approach produced a reduction of 37.92% in the difference between the initial stimulus level and the final SRT value.
CONCLUSIONS
This outcome substantiates that our approach can reduce the repetitions for finding the final SRT, and, as the result, the hearing test time can be reduced.
Topics: Humans; Speech Reception Threshold Test; Audiometry, Pure-Tone; Adult; Male; Female; Machine Learning; Reproducibility of Results; Auditory Threshold; Neural Networks, Computer; Speech Perception
PubMed: 38759049
DOI: 10.3233/THC-248017 -
American Journal of Audiology May 2024Audiological services are underused, possibly because patients need to drive long distances to see a provider. In this study, we measured the association of drive times...
PURPOSE
Audiological services are underused, possibly because patients need to drive long distances to see a provider. In this study, we measured the association of drive times to the nearest audiologist with population density, income, ethnicity, race, and distance to the nearest audiology graduate program.
METHOD
Drive times for each census block group to the nearest audiologist were measured using census data, the National Provider Identifier Registry, and a geographic analyzing tool called ArcGIS for all block groups within the United States. The association between drive times and population density, income, ethnicity, race, and audiology program distance was evaluated with a population density-matched case-control study and multiple linear regression analyses.
RESULTS
Approximately 5.29 million Americans need to drive at least 1 hr to visit their closest audiologist. The 10% most rural-dwelling Americans drive an average of 33.8 min. The population density-matched case-control study demonstrated that percent below poverty, percent identifying as Hispanic, and travel times to the nearest audiology program were all significantly higher in census block groups with high drive times to the nearest audiologist. An average of 7.96% of individuals in census block groups with low drive times identified as Hispanic, but 18.8% identified as Hispanic in high drive time groups. The multiple linear regression showed that the effect of demographics and distance to the nearest audiology program was highest in rural areas. In both analyses, adjusting for poverty did not drastically change the effect of percent identifying as Hispanic on drive times.
CONCLUSIONS
Long drive times restrict access to audiological care for those who live in rural areas. This restriction disproportionately affects those in rural areas who identify as Hispanic or have low income.
PubMed: 38758682
DOI: 10.1044/2024_AJA-23-00279