A Hearing Screening Protocol for Stroke Patients: An Exploratory Study.

Nehzat Koohi,Deborah A Vickers,Doris-Eva Bamiou,David J Werring,Nattawan Utoomprurkporn

doi:10.3389/fneur.2019.00842

Abstract

Background: Auditory impairment post stroke is common and may be due to both peripheral hearing loss and or central auditory processing disorder (CAPD). When auditory impairment remains untreated, it may impact on patient communication and rehabilitation after stroke. Offering a comprehensive audiological assessment to all stroke patients would be both costly and time-consuming. A brief hearing screening is thus required.Objective: The aim of this study was to determine whether a two-tiered hearing screening approach, with use of a handheld hearing screener and two validated hearing questionnaires could be used as a hearing screening for peripheral hearing loss and CAPD in stroke survivors. The sensitivity and specificity of the screening method was analyzed.Methods: This was a prospective study conducted in a tertiary neurology hospital. Forty-two consecutive stroke patients were recruited and tested within 3–12 months post-onset of their stroke. Three screening tools for the identification of hearing impairment were evaluated in this study: A handheld hearing screener for determination of peripheral audiometric hearing loss and two validated questionnaires (The Amsterdam Inventory Auditory for Disability (AIAD) and the Hearing Handicap Inventory for Elderly (HHIE) questionnaires) for determination of peripheral hearing loss and/or CAPD.Results: The hearing screener had a sensitivity of 92. 59% detecting a hearing loss and specificity of 100%. The greatest test accuracy in identifying a central auditory processing type hearing impairment in stroke patients was found when the handheld hearing screener and the AIAD questionnaire were combined.Conclusion: This study is a first step toward addressing the complex auditory needs of stroke survivors in a systematic manner, with the ultimate aim to support their communication needs and long-term recovery and wellbeing.Registration: Project Identification number 11/0469 and REC ref 11/LO/1675.

Highlights

Stroke can affect all levels of the auditory pathway from the hearing organ to the cortex and manifest with deficits in audiometric thresholds and/or more complex central auditory processing disorder (CAPD) with perceptual difficulties in speech, sound recognition, and localization [1,2,3]
Data from 42 stroke patients were obtained for all screening protocols
Accuracy of Self-Reported Hearing Handicap Inventory for Elderly (HHIE) Questionnaire The HHIE questionnaire had a low sensitivity of 44.44% and specificity of 100% for peripheral hearing loss, positive predictive value (PPV) of 100% but negative predictive value (NPV) of 23.08% (Table 3)

Summary

Introduction

Stroke can affect all levels of the auditory pathway from the hearing organ to the cortex and manifest with deficits in audiometric thresholds and/or more complex central auditory processing disorder (CAPD) with perceptual difficulties in speech, sound recognition, and localization [1,2,3]. Identification and remediation of auditory impairments and deficits in stroke survivors may help improve speech perception [9], communication and overall social engagement [10] but may potentially preserve their cognitive function long term [11]. Auditory impairment post stroke is common and may be due to both peripheral hearing loss and or central auditory processing disorder (CAPD). When auditory impairment remains untreated, it may impact on patient communication and rehabilitation after stroke.

Methods

Results

Conclusion