Audiological Care Research Articles

Hearing Healthcare Professionals' Views about Over-The-Counter (OTC) Hearing Aids: Analysis of Retrospective Survey Data.

Over-the-counter hearing aids have been available to consumers in the US since 17 October 2022 following a ruling by the Food and Drug Administration. However, their reception by hearing healthcare professionals (HHP) has been mixed, and concerns have been expressed by many HHPs. The aim of this study was to examine the concerns that HHPs have towards over-the-counter (OTC) hearing aids. The study used a retrospective survey design. The survey data of HHPs (n = 730) was obtained from Hearing Tracker. A 22-item structured questionnaire was administered using a Question Scout platform. Descriptive analyses examined reported areas of concern and a Fisher's exact test examined the relationship between demographics and responses. A cluster analysis with partitioning around medoids (PAM) was used to identify a sub-group of participants based on responses. Nearly half of HHPs who participated reported that they will support patients with OTC hearing aids purchased elsewhere, whereas a quarter reported that they will sell OTC hearing aids in their clinic or website. HHPs expressed over 70% agreement in 'concern' statements in 14 of the 17 items. Issues about safety, counseling, and audiological care were the key concerns expressed by HHPs about OTC hearing aids. Some demographics (i.e., profession, primary position) were associated with responses to some statements. Two groups were identified based on the responses to concern statements. The HHPs in the first cluster 'OTC averse' (51%) agreed on all the 17 concern statements, whereas the second cluster 'OTC apprehensive' (49%) had some items rated as disagree (i.e., consumers will give up on amplification) and neither agree nor disagree (i.e., do not provide good value, warranties and return periods will be worse), and remaining items were rated as agree. OTC hearing aids were initiated to improve affordability, accessibility, and hearing aid uptake and are currently a rapidly emerging category of hearing devices. Overall, the results of the current study indicate that HHPs have serious concerns about OTC hearing aids. HHP concerns cited in this study provide useful feedback to stakeholders (e.g., HHP professional agencies, FDA, industry, and insurance payers) involved in improving OTC hearing aid implementation.

Using an Online Tool to Apply a Person-Centred Approach in Audiological Rehabilitation: A Pilot Study.

This study aimed to explore the experiences of adult clients with hearing loss and their audiologists in using an online tool, the Living Well Tool (LWT), during initial audiology appointments. The LWT is designed to help clients identify when and where it is most important for them to communicate effectively and live well with hearing loss. A total of 24 adult clients with hearing loss and two audiologists participated in this study. Clients were invited to complete the LWT prior to their next audiology appointment, however, most clients chose to use the LWT in-session with their audiologist. Following the appointment, clients and audiologists participated in individual qualitative semi-structured interviews to explore their experiences of using the LWT, and the extent to which the LWT facilitated person-centred care. Qualitative analysis five key themes which reflected participants' experiences and perceptions of using the LWT: (1) the LWT enhances audiological care; (2) the LWT supports person-centred audiological care; (3) the use of the LWT should be individualised; (4) users value comprehensiveness; and (5) users value accessibility. This study demonstrated that the LWT supported the provision of person-centred audiological care, providing a flexible, comprehensive and accessible means for audiologists to gain an understanding of their clients' needs and preferences. However, it was also noted that the use of a tool must be individualised and accessible for all.

Comparison of Hearing Abnormalities in Non-Diabetic and Diabetic End-Stage Renal Disease Patients Undergoing Hemodialysis

Background and Aim: Hearing loss is a highly prevalent symptom in patients with chronic kidney diseases (CKD). Comorbidities such as Diabetes Mellitus is known as the most common cause of CKD and a significant risk factor for sensorineural hearing loss (SNHL). The aim of this study was to compare SNHL among diabetic with non-diabetic hemodialysis patients.
 Methods: In this study, 33 diabetic patients on hemodialysis were selected from Hami center, Arak, Iran. Non-diabetic subjects were 31 hemodialysis patients without diabetes were matched for age, duration of CKD and hemodialysis. Data were obtained via questionnaire, patients’ files, physical examination, otoscopy and tympanometry. Hearing was analyzed using pure-tone audiometry for both groups.
 Results: In the study, 66.2% of diabetic patients and 52.1% of non-diabetic subjects had SNHL. Results showed that diabetic patient has 1.3 times more likely to have hearing impairment. This difference was not statistically significant. Bilateral mild SNHL was the most prevalent in both groups. No significant difference was reported in SNHL prevalence, mean thresholds of hearing and ear laterality between the groups. Gender and age had a significant effect on hearing loss after adjusting covariables. No significant association was found between diabetes and hearing loss.
 Conclusion: SNHL was more common in hemodialysis patients with diabetes. Patients with diabetes had poorer hearing thresholds compared to non-diabetic group, with no significant difference between groups. The periodical assessment of hearing and extending audiological care in this high-risk population is recommended due to long-term irreversible symptoms of the disease.
 Keywords: Diabetes mellitus; hearing loss; end-stage renal disease

Pediatric Amplification: A Proposed Protocol for In-Person Hearing Aid Fittings and Virtual Follow-Ups.

Children with hearing loss and their families face many financial and logistical barriers to accessing audiological care. At Rush University's Student Community Outreach Program of Excellence (SCOPE), a pediatric hearing loss outreach program is under development to address and overcome those barriers through in-person hearing aid fittings and virtual follow-up appointments. The goal of this clinical focus article was to develop a proposed protocol for SCOPE's pediatric hearing loss outreach program that would detail the use of a bimodal model of service delivery for pediatric amplification services. This clinical focus article provides a general description of the proposed protocol. The proposed protocol was developed as a guideline for future service delivery within SCOPE's pediatric hearing loss outreach program. Categories and details within the protocol were derived from previously published protocols and clinically relevant research. The final protocol is composed of six sections, which detail the rationale and target population, necessary equipment, procedures for in-person hearing aid fittings, procedures for virtual follow-ups, outcome measures, and schedule of appointments. On the national level, access to audiological care for pediatric patients and their families is restricted by both financial and logistical barriers. A telehealth model of service delivery has been shown to be effective in providing high-quality patient care while addressing these barriers. A clinical program using a bimodal model of service delivery will be implemented to address these barriers in Chicago, Illinois. Future investigation is required to monitor the efficacy of the program and develop program-specific materials.

Healthcare consumption among subjects with otitis media undergoing middle ear surgery—analysis of cost drivers

PurposeTo map healthcare utilized by subjects with chronic otitis media, with or without cholesteatoma and perform a cost analysis to determine key drivers of healthcare expenditure.MethodsA registry study of 656 adult subjects with chronic otitis media that underwent a middle ear surgery between 2014 and 2018. Healthcare contacts related to all publicly funded specialist ENT care, audiological care and primary care for a disease of the ear and mastoid process were extracted. The data are extracted from the Swedish National Patient Registry on subjects that reside in western Sweden.ResultsSubjects made 13,782 healthcare contacts at a total cost 61.1 million SEK (6.0 million EUR) between 2014 and 2018. The mean cost per subject was 93,075 SEK (9071 EUR) and ranged between 3971 SEK (387 EUR) and 468,711 SEK (45,683 EUR) per individual. In the most expensive quartile of subjects, mean cost was 192,353 SEK (18,747 EUR) over the 5-year period. These subjects made 3227 ENT contacts (roughly four each year) and 60% of total costs were associated with in-patient ENT care.ConclusionPatients with chronic otitis media are associated with high ENT resource utilization that does not diminish after surgical intervention and the disease places a long-term burden on healthcare systems. Significant costs are attributed to revision surgeries, indicating that these patients could be managed more effectively. In many such cases, reoperation cannot be avoided, especially due to recurrence of cholesteatoma. However, in some patients, when the indication for subsequent surgery is only hearing improvement, alternative options, such as hearing aids or implants, should also be considered. This is especially true in difficult cases, where revision ossiculoplasty is likely.

Is Teleaudiology Achieving Person-Centered Care: A Review.

Digital health and person-centered care are unquestionably linked in today’s Australian healthcare landscape. Teleaudiology is the application of digital health in the field of audiology, and it has become a popular component of standard audiological care. Behavior modification is essential in audiology intervention. Guidance on achieving behavior change, which is dependent on digitally enabled intervention, is a valuable resource when used in tandem to achieve person-centered care. The aim of this review is to determine whether teleaudiology achieves person-centered care. A qualitative review was conducted, followed by mapping and analysis. Analysis identified evidence of teleaudiology use, and ascertained guiding principles are appropriate to behavior change dependent digital intervention supported or enabled person-centered care. In conclusion, teleaudiology will continue to be a promising technology for promoting relatedness, a positive user experience, confidence and capability, and appropriate levels of autonomy for the user to choose from among the person-centered care options available.

Relationships of health-related quality of life with subjective noise sensitivity in the subjects with normal hearing

Objective Our aim was to look for the association of health-related quality of life (HRQoL) with subjective noise sensitivity (SNS) in the audiologically and perceptually normal hearing subjects since HRQoL was suggested as a tool during the intervention of the hearing impaired people. Methods The audiological evaluation was first done in the subjects who were enrolled from the previous study in which Weinstein Noise Sensitivity Scale (WNSS) was adapted to Turkish. Then, the Short Form-36 (SF-36) scores were determined and the relationships of WNSS score with the SF-36 scores were analysed in respect to gender, age, audiological variables. Results Of 210, 124 subjects (M:44; F:80) were taken to the study. WNSS score presented no gender difference and correlation with age and audiological variables. It was found that WNSS score was significantly correlated with emotional and mental domains of HRQoL in women and physical and social functioning in men. Role limitations due to physical health, mental health, role limitations due to emotional problems, social functioning, vitality and mental composite scores were significantly lower in the upper SNS subgroup. Conclusion It was revealed that SNS was strongly associated with HRQoL in perceptionally and audiologically normal hearing males and females via different domains. Therefore, in case of using HRQoL in audiological care, our data suggest that SNS should be taken into account.

Technological and Rehabilitative Concerns: Perspectives of Cochlear Implant Recipients Who Are Musicians.

In these perspectives, we share the experiences of eight cochlear implant (CI) recipients who are musicians, and their efforts within and outside of audiological appointments to achieve satisfying music experiences. Their experiences were previously shared in a panel discussion as part of the 3rd Music and Cochlear Implant Symposium hosted at The University of Cambridge, United Kingdom. Following the symposium, the panel members and moderator developed and completed a follow-up questionnaire to facilitate a formal analysis of the following questions: (a) What forms of support for optimizing music exist within clinical CI appointments, including counseling, mapping, assessment, and rehabilitation? (b) What forms of support do CI users who are interested in music desire? (c) What self-initiated approaches can be used to improve music perception, enjoyment, and participation? Using qualitative methodology, the questionnaire data were coded, aggregated into themes, and then into core categories. The primary themes that emerged from the data were (a) limited levels of support for optimizing music outcomes within normal clinical appointments, (b) difficulties in current mapping and assessment in relation to music perception, and (c) limited availability of clinically sponsored training/rehabilitation for music. These CI recipients then recommended clinical protocol changes and described self-initiated rehabilitation. These findings were examined in relation to literature on clinical practices for CI users, auditory rehabilitation, and patient-centered care, emphasizing best practices and barriers to audiological care. The data as related to healthcare trends were conceptualized and developed into a proposed Reciprocal Model for Music Rehabilitation (RMMR).

Feasibility of treating hearing loss to prevent dementia in MCI: Results of the face to face and remote interventions in the Treating Auditory impairment and Cognition Trial (TACT)

AbstractBackgroundAge‐related hearing loss is an independent and potent risk factor for dementia. There is observational evidence that hearing aid use may mitigate deterioration in cognitive performance and could prevent dementia, but experimental evidence is lacking. A trial on whether treating hearing loss reduces the risk of dementia may not be feasible because people often do not access or use hearing aids even when prescribed. We designed the Treating Auditory impairment and Cognition Trial (TACT) as a manual‐based preventative intervention, promoting and supporting hearing aid use in those with Mild Cognitive Impairment. We studied the feasibility of a full‐scale randomized controlled trial.MethodWe conducted a pilot trial of a new intervention designed to increase uptake and adherence to hearing aid treatment. Pre COVID‐19, we randomized MCI participants to face‐to‐face interventions: the active arm is a home‐based hearing assessment and hearing aid fitting, with study audiologist and research assistant delivering motivational and practical support in 4 visits over 3 months. Participants in the control arm were referred to standard audiological care through their general practitioner without additional hearing support, and given a healthy ageing educational intervention on dementia risk factors, matched in contact with the study team. Follow‐up for both interventions was at 6 months. After the onset of COVID‐19, additional MCI participants, who had not received hearing aids, were allocated to active remote hearing support. This did not involve any face‐to‐face contact with the study team but provided hearing support remotely, with outcomes collected after 1 month.ResultPre COVID‐19, N=36 MCI participants were randomized to the original face‐to‐face study interventions, with follow‐up measures collected at 6 months, also in a face‐to‐face session. After the onset of COVID‐19, a further N=11 received the remote hearing intervention. We will present results from these samples. The pre‐specified outcomes of the pilot include recruitment, randomization, retention, and acceptability of the interventions, with secondary outcomes including difference in usage of hearing aids between active and control arms, and cognition, mood, and social function.ConclusionThe results of this study may influence hearing care in all settings as well as dementia prevention.

Hearing healthcare for workers with hearing loss: audiologists’ experiences and views

Purpose This study explored audiologists’ perspectives regarding their interactions with workers with hearing loss (WHL). Materials and methods Semi-structured interviews were conducted with twenty-five audiologists working in the National Health Service (NHS) and independent companies (IC) in the UK and were thematically analysed. Results The developed themes and sub-themes (shown in parenthesis) are (1) Current practices and routines (Same approach for most patients; Variations between hearing care services; Audiologists’ personal experience of hearing loss) (2) Perceived challenges (Non-routine and challenging cases; The role of hearing technology; Concerns about lack of awareness and knowledge; Communication difficulties between services, Limited funding and resources) (3) Scope for better support (Would like to be informed; Other potential service improvements). Conclusions This study revealed that audiologists’ perceived deficiencies in the hearing rehabilitation for WHL and identified ways to improve it. Key priorities for improvement were found to include addressing audiologists’ informational and training needs, facilitating WHLs’ access to appointments, improving communication between services, raising awareness in the workplace, developing relevant resources and extending funding for provision of longer appointments and hearing technologies. This is the first time this information has been reported in the literature. Opportunities for conducting further research in this area are suggested. Implications for rehabilitation Workers with hearing loss face many challenges in work life and have the option of audiologic rehabilitation to alleviate their difficulties and improve their wellbeing; however, this study suggests that workers' audiological care needs improvements. Audiologists should assess and consider patients' work needs and psychosocial concerns in consultations to provide personalised care. Audiology educational programmes, services, and the healthcare system can assist audiologists in helping workers with hearing loss by providing updated knowledge, continuous training and improved interprofessional communication and patients’ access to useful resources.

Incorporating Patient Narratives to Enhance Audiological Care and Clinical Research Outcomes.

Purpose The engagement of patients as key stakeholders in their experience of care processes is a critical component of quality improvement efforts for both clinical care and translational research. Increasingly, health care systems are soliciting input from patients on care processes and experiences through surveys, patient interviews, and patient video narratives. The purpose of this viewpoint article is twofold: (a) to describe the increasing role of patient narratives about their experiences with adverse health conditions to inform patient-centered research and quality improvement efforts and (b) to present three patient narratives that highlight the real-world impacts of hearing loss and tinnitus, the life enhancing impacts of aural rehabilitation, and the importance of prospective ototoxicity monitoring in individuals with complex health conditions. Conclusion Patient narratives provide individual patient perspectives that can be used to build awareness of the range of experiences and impact of hearing disorders, and to explore patient preferences for when and how to implement hearing-related clinical services.

4 Key Post-pandemic Trends for Marketing Hearing Care to Baby Boomers

4 Key Post-pandemic Trends for Marketing Hearing Care to Baby Boomers

A local rehabilitation service for children with hearing loss

Objectives to discuss the issues of inter-disciplinary cooperation for improvement the pediatric audiological care using modern technologies for hearing restoration.
 Material and methods. An epidemiological study of hearing impairments in 3098 children registered in the Center of Pediatric Audiology (St. Petersburg) and analysis of the city pediatric audiological services were carried out.
 Results. The introduction of the universal newborn hearing screening helped to diagnose hearing loss in children under 1 year of age in 47% of cases. Before the screening implementation, it was diagnosed in 22% of cases. The hearing screening results testify that 26% of children meet modern requirements of early diagnosis (under 3 months) of congenital hearing loss. 54% of children registered in the Audiology Center are using hearing aids or cochlear implants. The mean age of initial amplification is 3 years 8 months. 5.4% of children got amplification under 6 months of age, 20% of children - under 1 year and 58% - under 3 years. The mean interval between diagnosis and amplification was 15.7 months, only 24% of children got amplification within 3 months after being diagnosed.
 A system of family-centered medical, psychological and pedagogical rehabilitation of children with hearing impairments was developed at the Center of Pediatric Audiology.

Telehealth in audiology: an integrative review

We performed an integrative review on the scientific literature about the use of telehealth in audiology care. Through high criteria search of published studies on the "Biblioteca Virtual em Saúde" - Virtual Health Library, PubMed, and Scientific Electronic Library Online databases, nine articles were selected. It was possible to verify that the use of telehealth in audiology is feasible and efficient, because it could promote audiological care for patients from away places. This process reaches more patients and communities by breaking down geographic barriers, and it offers a specific service not available with less cost and more quickly when compared with traditional speech therapy care.

A novel approach to initial hearing assessment

Objective: justifying the possibility of using frequency-based hearing research via the web application ‘Automated System for Initial Hearing Assessment’. Materials and methods. The study was carried out at the Department of Otorhinolaryngology of the Samara State Medical University clinics in October 2019. It involved 91 patients 17 to 73 years old (average age 48±14.6 years). All study participants were divided into two age groups: Group I 17-59 years old), and Group II (over 60 years old). Patients were required to undergo two hearing assessment tests: using the Interacoustics AC-40 clinical audiometer and using our web application ‘Automated System for Initial Hearing Assessment’ (patent No. 2019664671). Results. The maximum difference in average hearing thresholds between pure-tone threshold audiometry and the web application in Group I was 3.3 dB at a frequency of 2 kHz on the right and 3.2 dB at frequencies of 2 and 4 kHz on the left; in Group II, it constituted 4.7 and 3.5 dB at 1 and 2 kHz, on the right, correspondingly, and 7.2 dB at 4 kHz on the left. The presented data were evaluated using the Cohen’s kappa coefficient, which confirmed high level of agreement between the results obtained using the clinical audiometer vs. our original web application. Conclusion. Based on the obtained results, a conclusion was made about the possibility of using the original web application for the initial hearing express assessment in general practice in conditions of limited availability of audiological care.

The Role of Sound Therapies in Tinnitus Care

The Role of Sound Therapies in Tinnitus Care

The Feasibility and Reliability of a Digits-in-Noise Test in the Clinical Follow-Up of Children With Mild to Profound Hearing Loss.

Speech perception in noise is an important aspect of the rehabilitation of children with hearing loss. We aimed to evaluate the feasibility and reliability of the Dutch digits-in-noise (DIN) test in the clinical follow-up of children with hearing aids (HAs) and/or cochlear implants (CIs). A second aim of the study was to gain insight in the speech perception in noise performance of children with different degrees of hearing loss. We retrospectively analyzed DIN test data of Dutch-speaking children with hearing loss (N = 188; 5 to 18 years old). A free-field version of the DIN-test was used. Children with open-set phoneme recognition in quiet of >70% at 65 dB SPL (best aided condition) were included. Ages ranged from 5 to 18 years old. All were experienced HA or CI users and had used their device(s) for at least 1 year before the measurement in the study. The DIN-test was performed in the framework of a clinical rehabilitation program. During testing, children wore their own devices with normal daily programs. The average speech reception threshold (SRT) was -3.6 dB (SD 3.6) for the first list and significantly improved to -4.0 dB (SD 3.1) for the second list. HA users had a 4-dB better SRT compared with CI users. The larger the child's hearing loss, the worse the SRT is. However, 15% of the children who completed a first list of 24 trials were unable to complete a second list. Mean adaptive staircase trajectories across trials suggested that learning occurred throughout the first list, and that loss of sustained attention contributed to response variability during the second list. The DIN test can be used to assess speech perception in noise abilities for children with different degrees of hearing loss and using HAs or CIs. The children with hearing loss required a higher signal-to-noise ratio (SNR) than did normal-hearing children and the required SNR is larger as the hearing loss increases. However, the current measurement procedure should be optimized for use in standard pediatric audiological care, as 15% of the children were unable to conduct a second list after the first list to reach a more stable SNR.

Нарушения слуха у детей – региональные эпидемиологические исследования

The aim of the study is a comparative analysis of medical and social indicators of audiological care for children with hearing impairments in two regions of the Russian Federation and the development of recommendations for its improvement. Methodology. The study was carried out on the basis of children’s audiology centers in St. Petersburg and Novosibirsk. At the first stage, the organization of audiological care for children in the region and the results of audiological screening were analyzed: coverage, frequency of detection of hearing loss. At the second stage, we analyzed the data from outpatient records of children with hearing impairments registered in audiology centers. The age at which the diagnosis was made, the age of primary hearing aid, the type of hearing aid, and the type of educational organization attended by the child were assessed. At the third stage, a screening examination of hearing was carried out in primary school students of a comprehensive school using otoscopy, tympanometry, registration of otoacoustic emission, and tone threshold audiometry. Results. The analysis showed that all components of medical care in the regions comply with international recommendations. Despite this, less than 10% of children with hearing impairment receive it in accordance with the time standard for early care «1-3-6», which involves the detection of hearing impairment at the age of 1 month, diagnosis of hearing impairment at 3 months, at 6 months - hearing aids and psychological and pedagogical assistance to a child and his family. The main reasons for the late diagnosis of hearing impairments in children and, as a consequence, the late start of their rehabilitation have been established: not all children go through the 1st stage of universal audiological screening of newborns, some children with a positive result of the 1st stage of screening do not enter the 2nd stage for diagnostic examination of hearing; children with auditory neuropathy and hearing loss of various etiologies that occur after birth «drop out» from the current audiological screening procedure. Conclusion. A system of measures is proposed to solve the problem of early detection of hearing impairments in children: 1) control of the 1st stage of audiological screening of newborns and the transfer of information about children to be examined at the 2nd stage to the audiology center; 2) the introduction of additional audiological screenings for children at the age of 1 year and upon admission to school; 3) increasing the awareness of pediatricians, neurologists and the population about the causes, diagnosis and rehabilitation of hearing impairment in children; 4) actions aimed at preventing the occurrence of hearing impairment in children (vaccination, treatment of otitis media, hearing hygiene, etc.).

Пространственный кластерный анализ в моделировании доступности медицинской помощи пожилым пациентам с нарушениями слуха

The availability and quality of medical care is ensured by the organization of medical care according to the principle of proximity to the place of residence. The increase in the number of medical institutions will definitely increase the availability of medical care, but it will also increase the cost of providing it, thus reducing the overall efficiency of the health care system. The article discusses the solution to the problem of optimizing the provision of audiological care to elderly patients with hearing impairment and deafness by finding the optimal number of medical institutions providing this assistance and their geographical location within the Chelyabinsk region. The problem was solved on the basis of minimizing the distance and time spent by patients to travel to the place of medical care, using spatial cluster analysis. The possibilities of spatial clustering to create reasonable prerequisites for the optimal solution of the problems of increasing the availability of medical infrastructure for the population are demonstrated.

Hearing impairment screening in adults with chronic general somatic pathology in the republic of Adygeya

Background. The steadily growing number of hearing-impaired patients incited epidemiological research into the etiopathogenesis of sensorineural hearing loss.Objectives. To conduct a screening survey of hearing-impaired adults to identify early sensorineural hearing loss in patients with chronic general somatic pathology in the Republic of Adygea.Мethods. We used a screening method for auditory function disorder diagnosis based on surveying patients with no primary hearing complaints. A total of 6,346 patients with variant chronic general somatic pathology were surveyed anonymously. Statistical analysis and interpretation were performed with Statistica 10.0 and MS Excel 2010.Results. A point–based assessment survey of the patient’s psycho-emotional state in various classroom settings identifi ed the sensorineural disorder risk groups among the visitors of district and municipal outpatient units. Subclinical auditory function disorders were revealed in 16.5% (1045 of 6346), and putative hearing loss of various degree — in 36.2% (2295 of 6346) of the patients. In 47.3% (3006 of 6346), no evidence of hearing loss was observed in the survey. Accentuated analysis revealed early and severe hearing disorders among patients with cardiovascular, endocrine, nervous, excretory, respiratory and other diseases.Conclusion. We show the applicability of screening surveys for detecting early sensorineural hearing loss in patients with chronic general somatic pathology. Acceptance of adapted surveying by family physicians, neurologists and adult endocrinologists will facilitate preclinical identifi cation of risk groups among patients requiring specialised audiological care.