Audiology Department Research Articles

Hearing Outcomes in the Audiology Department of a Children Hospital.

The incidence of sensorineural hearing loss is between 1 and 3 per 1000 in healthy neonates and 2-4 per 100 in high-risk infants. In this study, we assessed the incidence of hearing impairment in normal term (≥ 37 wga) infants (control group), in children with suspicion and/or risk factors of hearing loss, included premature infants (< 37weeks gestational age (wga) and/or low birth weight < 2,5 Kgr), in children diagnosed with a specific syndrome and in children with speech disorder, candidate for speech therapy. Hearing impairment is a severe consequence of prematurity and its prevalence is inversely related to the maturity of the baby based on gestation age and /or birth weight. Both above parameters are of particular importance and it has not been found that one factor prevails over the other. Premature infants have many concomitant risk factors for hearing impairment. The most important other risk factors were ototoxic medications, very low birth weight and "treatment in the intensive care unit '' (low Apgar score and mechanical ventilation). Frequent risk factors such as congenital infections and family history of hearing loss, although frequently recorded, does not seem to be very significant. Children with speech disorder do not seem to suffer from hearing impairment more frequently than children in general population.

Effects of Receiving Hearing Aids on Health-Related Quality of Life in Adults With Mild Hearing Loss.

Hearing aid (HA) use is a common rehabilitation method for people with hearing loss. This study aimed to investigate whether the use of HA will advance the health-related quality of life (HRQoL). Subjects and. Patients referred to a public audiological department in Norway were invited to participate in this pre-post interventional study. The RAND-SF-36, a generic HRQoL questionnaire, was administered to the participants before and three months after HA fitting. Changes in HRQoL dimensions were analyzed for the whole group and for subgroups based on sex, age, and presence of tinnitus. A total of 202 adults (109 men; mean age, 66.68 years [SD=10.92]) were included in the study. After a mean observation time of 91.63 days (SD=45.61), pain and general health significantly improved. Women aged ≥70 years without tinnitus improved in social functioning, while men aged <70 years with tinnitus improved in general health. Adults with mild hearing loss reported better general health and less bodily pain three months after HA fitting than before. The patient subgroups reported improved general health and social functioning. However, causation remains uncertain because of methodological limitations. A randomized, controlled trial with a longer follow-up time could clarify such issues.

A Retrospective Study on Tinnitus Prevalence and Disease Associations in the Hospital-Based Population

Background: Tinnitus is the perception of sound, which is not generated by external stimulus. Due to its clinical heterogeneity, lack of objective measurements and accompanying symptoms, a gold standard treatment, i.e., effective for every patient has not been established yet. The aim of the present study was to assess the prevalence and characteristics of tinnitus, disease, and lifestyle factors associated with tinnitus. Materials and Methods: Data were obtained from a total of 224 patients (mean age 46.21 ± 12.65), 141 men and 83 women, who attended the audiology department between 2015 and 2021. Results: We found that the tinnitus pitch perception (PP) of males was significantly higher than females (P &lt; 0.001). In addition, we observed a significant positive correlation between tinnitus PP and tinnitus loudness perception (P &lt; 0,005). 12.1% (27 patients) of the individuals included in the study had metabolic disorders (Vitamin D deficiency, diabetes, and cholesterol). Fifty-four percent (121 patients) of the individuals included in the study had normal hearing. Conclusions: Metabolic and cardiovascular diseases should be taken into account for tinnitus anamnesis. The amount of tinnitus patients with normal hearing is also notable.

Bridging the Access Gap: The Telepractice Experience of Speech Therapists and Audiologists at a Public Health Care Facility in South Africa.

South Africa is a low to middle income country (LMIC) with a population of 60 million people. The public health sector serves more than 80% of the population. Chris Hani Baragwanath Academic Hospital is a central level public health care facility situated in Gauteng. The Speech Therapy and Audiology Department provides insight into their telepractice services through a qualitative approach. The onset of the COVID-19 pandemic resulted in therapists exploring telepractice as a sustainable model of service delivery. Therapists and patients encountered many challenges to the implementation of telepractice, however, the commitment of therapists ensured that creative solutions were developed. A comprehensive needs analysis at public health institutions is required to ensure the sustainability of telepractice. A hybrid model (telepractice and in-person consults) holds the potential to reduce the financial burden on patients and increase access to quality patient-centered care.

Psychometric evaluation of the 4C tinnitus management questionnaire for patients with tinnitus alone or tinnitus combined with hyperacusis

Objective To assess the psychometric properties of a new questionnaire evaluating patients’ confidence in managing their tinnitus, the 4C tinnitus management questionnaire (4C), which was designed to be used in the process of cognitive behavioural therapy. Design Retrospective cross-sectional based on patient records. Study samples 99 consecutive patients who sought help for tinnitus (with or without hyperacusis) from an audiology clinic in the UK. Pure tone average (PTA) hearing thresholds, Uncomfortable Loudness Levels (ULLs), and responses to the 4C questionnaire, Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (HQ), and Screening for Anxiety and Depression in Tinnitus (SAD-T) questionnaire were gathered from the records of patients held at the audiology department. Results Cronbach’s alpha for the 4C was 0.91, indicating high internal consistency. Exploratory factor analysis suggested a one-factor solution. Discriminant validity was supported by weak correlations between 4C scores and PTA across ears and ULLmin (the across-frequency average ULL for the ear with lower average ULL). Convergent validity was supported by moderate correlations between 4C scores and scores for the THI, HQ, and SAD-T. Conclusions The 4C is an internally consistent questionnaire with high convergent and discriminant validity, which can be used to assess patients’ confidence in managing their tinnitus.

Rethinking the Audiogram for Hearing Aid Selection

Rethinking the Audiogram for Hearing Aid Selection

MEASUREMENT OF CORRELATION BETWEEN DIZZINESS HANDICAPPED INVENTORY AND PURE TONE AUDIOMETRY FOR EARLY DIAGNOSIS OF MENIERES DISEASE

Background: Menieres Disease (MD) is a chronic, non-life threatening inner ear disease, with attacks of disabling vertigo, progressive hearing loss, and tinnitus as the major symptoms. All three symptoms, separately or in combination, cause great distress and have a considerable impact on the quality of life of the patients. Objective: Aim of this study was to find out whether subjective assessment or objective assessment will be significant towards diagnosis of early Menieres disease and to find out early diagnosis of Menieres disease by comparision between Dizziness Handicapped Inventory (DHI) &amp; Pure tone audiometry. Materials and Methods: This hospital-based retrospective study was carried out at Al Ameen Medical College Hospital, Vijayapur, Karnataka, India. The study population was composed of 93 subjects referred to the audiology department of the ENT Hospital in 01 year period, between May 2021 to April 2022. All 93 subjects underwent the following diagnostic procedures: Collecting detailed clinical history, complete neuro-otological bedside examination and pure-tone audiometry. The inclusion criteria are the presence of complete symptoms compatible with MD (tinnitus, hearing loss and vertigo) associated by documented unilateral sensorineural hearing loss. The exclusion criteria are: incomplete presentation complete presentation associated to conductive, mixed or retrocochlear hearing loss complete presentation, characterized by vertigo syndromes that are not compatible for clinical features and duration for MD. Other clinical exclusion criteria are tympanic perforations, active infections, inflammatory and non-inflammatory stenosis (exostoses, osteomas). Dizziness handicapped inventory was utilized for subjective assessment of Menieres disease whereas Pure tone audiometry was utilized for objective assessment of Menieres disease. In the DHI questionnaire, the patient answered yes, sometimes or no to each question and the strength of the responses were designated with numeric values of 0, 2, and 4. The questionnaire had 25 items, such that the total score ranges from 0 to 100, with a higher score indicating a higher handicap. The relevant data was collected using a pre-tested pro-forma and after collection it was entered in Microsoft Excel to maintain the quality of data. Result:In our study, Forty-five (48.4%) patients were male, 48 (51.6%) were female and the mean age was 48.9±12.1 years. The mean duration of MD was 5.6±4.7 (min: 10 months max: 14 years) years.The means of 0.5-2 kHz air conduction thresholds (dB HL) for unilateral MD in Pathological ear and Healthy ear were 46.8±21.4 and 15.6±13.9, respectively. Speech discrimination scores (%) for unilateral MD in Pathological ear and Healthy ear were 71.5±23.6 and 93.7±6.3, respectively. The mean scores for Physical subscore, Emotional subscore and Functional subscore as per Dizziness Handicap Inventory among the study population was 15.93±8.91, 7.3±4.78 and 16.62±8.85, respectively. The total mean score for all 25 items of DHI was 38.8±19.5. Conclusion: In our study, There was a significant relationship between pure tone audiometry and DHI for some variables. As a part of a clinical follow-up tool for patients with MD, the DHI is a valid, early and reliable health-related, disease-specific QoL scale.

Hearing Technologies and Practices of Care in a Jordanian Audiology Department

Based on five months of ethnographic fieldwork at an audiology department in Amman, Jordan, this paper anthropologically examines the provision of hearing technologies to deaf Jordanians as forms and practices of care (Livingston, 2012; McKay, 2018; Stevenson, 2014). Aside from hearing aids, the department also provides cochlear implants—medical devices implanted via surgery that aim to provide people with hearing loss with some electronic access to sound—to deaf Jordanians, in partnership with a state-affiliated initiative that has distributed more than 1,170 cochlear implants since its establishment in 2010. I ask: how do deaf Jordanians engage with the cochlear implant and other medical technologies, and the biomedical imaginaries in which they are embedded, within and outside the clinical encounter? The cochlear implant and, to a lesser degree, the hearing aid (Edwards, 2010), was controversial when it was first introduced in North America, where some deaf people saw cochlear implantation as a form of cultural “genocide” (Ladd, 2003; Lane et al., 1996; Padden &amp; Humphries, 1988). The cochlear implant has not only become increasingly normalized in the U.S. (Mauldin, 2016) but has also spread transnationally as a medical technology for deaf people in Japan (Nakamura, 2006), India (Friedner, 2018), Mexico (Pfister, 2019), and elsewhere. As cochlear implants have become more prevalent in Jordan, they have become linked not only to debates about language—as I found during preliminary research in 2019 (Loh, 2022)—but also to broader questions about development (cf. Sargent, 2019b) and political economy in a materially under-resourced context where unemployment rates are high. Based on participant observation at the hospital and interviews with clinicians and patients, I argue that care is a useful analytic tool to understand the ambivalence with which many deaf Jordanians view these technologies, in its doublehanded recognition of how such technologies can be useful developmentally—in potentially providing access to speech and presumably better integration into society—but also problematic socio-politically—in diminishing their sense of belonging to broader deaf collectivities. I draw upon medical anthropology, science and technology studies, and “a disability-centered anthropology of the Middle East” (Sargent, 2019a) to ethnographically demonstrate the social life of these hearing technologies in Jordan.

Cochlear implant outcomes in patients with Meniere’s disease: a large case series

Objective To perform a matched cohort study to assess whether patients with Meniere's Disease (MD) require more intensive auditory rehabilitation following cochlear implantation (CI) and identify factors that may affect outcomes in patients with MD. Methods A retrospective case review was performed. MD and control patients were matched for age, biological sex, implant manufacturer and electrode design. Outcomes measured were speech scores, number of visits to audiology department following switch-on, and post-operative active MD. Results Forty consecutive implanted MD patients were identified between May 1993 and May 2019. Patients with active MD following CI required significantly more visits to the audiology department compared to controls (P < 0.01) and patients who had inactive MD post-operatively (P < 0.01). However, in MD patients, active MD was less likely following CI (P = 0.03). In patients who continued to experience active MD post-operatively, further medical and surgical ablative intervention was required to control ongoing Meniere's attacks. Conclusion We present the largest case series of performance outcomes in CI patients with MD. Although speech outcomes in MD patients are comparable to controls, patients with active MD pre-operatively are more likely to experience variation in CI performance requiring a prolonged period of auditory rehabilitation compared to inactive preoperative MD.

When uncertainty becomes the norm: The Chris Hani Baragwanath Academic Hospital's Speech Therapy and Audiology Department's response to the COVID-19 pandemic.

BackgroundIn March 2020 the World Health Organization declared the coronavirus disease 2019 (COVID-19) a pandemic. Management of this pandemic had significant implications for clinical departments across the world. Healthcare systems were urgently required to reorganise and redesign patient care as well as repurpose staff.ObjectivesWe will share the lived experience of our response as speech therapy and audiology (STA) clinicians to the COVID-19 pandemic.MethodThis study adopted an autoethnographic approach within Bronfenbrenner’s bioecological model to describe STA clinicians’ response to the COVID-19 pandemic.ResultsAdaptations to practice were made to continue service provision whilst adhering to COVID-19 regulations. We assisted in other areas to meet the immediate needs of the hospital. Service delivery strategies consisted of a review of clinical and quality assurance protocols. We developed a telehealth service package which included a hybrid approach, within a context of digital poverty. We created resources to ensure continuity of care. Collaboration within our systems facilitated innovative solutions. Mental health and well-being of staff members were key to the response developed.ConclusionSouth African healthcare systems’ inequalities were highlighted by the pandemic. The response showed that the needs of vulnerable populations were not accounted for when developing this public health response. Lessons learnt included the importance of adaptability, becoming comfortable with uncertainty and maintaining open and transparent communication. Consultation and collaboration within various levels of our healthcare system were critical in responding to the needs of patients. Commitment to compassionate leadership and staff well-being were crucial.

Relationship between risk factors of hearing loss and the results of otoacoustic emission in newborns

Objective Congenital hearing loss is a disabling and multi-factorial disease that affects on newborn and children. This study aims to demonstrate the relationship between risk factors for hearing loss and the results of Otoacoustic emission in Iranian newborns. Methods We have retrospectively considered 536 newborns admitted to the Audiology Department of a Children’s Hospital in the north of Iran. Transient Evoked Otoacoustic Emissions (TEOAEs) was recorded during the first week of birth, and the risk factors of hearing loss were collected. Results We found that parent relatives and family history were significantly correlated with OAEs refer results. Moreover, hyper-bilirubinemia indicated a significant correlation only with first right OAEs. There was a significant correlation between gender and first left and right OAEs. Other risk factors such as seizure, transient tachypnoea of the newborn (TTN) and respiratory distress syndrome (RDS), and lip cleft had a significant correlation with first left and right OAEs results; however, these correlations were not relatively highlighted. Conclusions Generally, our data confirm that hearing screening is an absolute necessity in the greater number of newborns. People who got consanguineous marriages should be aware of high incidence of the congenital hearing loss due to parent relatives and family history.

Extended genetic diagnostics for children with profound sensorineural hearing loss by implementing massive parallel sequencing. Diagnostic outcome, family experience and clinical implementation

ObjectivesThe aim of this study was to investigate genetic outcomes, analyze the family experience, and describe the process of implementing genetic sequencing for children with profound sensorineural hearing loss (SNHL) at a tertial audiological center in southern Sweden. DesignThis is a prospective pilot study including eleven children with profound bilateral SNHL who underwent cochlear implant surgery. Genetic diagnostic investigation was performed with whole exome sequencing (WES) complemented with XON-array to identify copy number variants, using a manually curated gene panel incorporating 179 genes associated with non-syndromic and syndromic SNHL. Mitochondrial DNA (mtDNA) from blood was examined separately. A patient reported experience measures (PREM) questionnaire was used to evaluate parental experience. We also describe here the process of implementing WES in an audiology department. ResultsSix female and five male children (mean 3.4 years, SD 3.5 years), with profound bilateral SNHL were included. Genetic variants of interest were found in six subjects (55%), where three (27%) could be classified as pathogenic or likely pathogenic. Among the six cases, one child was found to have a homozygous pathogenic variant in MYO7A and two children had homozygous likely pathogenic variants in SLC26A4 and PCDH15, respectively. One was carrying a compound heterozygote frameshift variant of uncertain significance (VUS) on one allele and in trans, a likely pathogenic deletion on the other allele in PCDH15. Two subjects had homozygous VUS in PCDH15 and ADGRV1, respectively. In five of the cases the variants were in genes associated with Usher syndrome. For one of the likely pathogenic variants, the finding was related to Pendred syndrome. No mtDNA variants related to SNHL were found. The PREM questionnaire revealed that the families had difficulty in fully understanding the results of the genetic analysis. However, the parents of all eleven (100%) subjects still recommended that other families with children with SNHL should undergo genetic testing. Specifically addressed referrals for prompt complementary clinical examination and more individualized care were possible, based on the genetic results. Close clinical collaboration between different specialists, including physicians of audiology, audiologists, clinical geneticists, ophthalmologists, pediatricians, otoneurologists, physiotherapists and hearing habilitation teams was initiated during the implementation of the new regime. For all professionals involved, a better knowledge of the diversity of the genetic background of hearing loss was achieved. ConclusionsWhole exome sequencing and XON-array using a panel of genes associated with SNHL had a high diagnostic yield, added value to the families, and provided guidance for further examinations and habilitation for the child. Great care should be taken to thoroughly inform parents about the genetic test result. Collaborations between departments were intensified and knowledge of hearing genomics was increased among the staff.

Acute Rhinosinusitis in Children with Inhalant Allergies.

Rhinosinusitis is an essential medical problem in pediatric populations. Due to a lack of studies considering allergy impact on pediatric rhinosinusitis, it seems legitimate to investigate this subject. The aim of this paper was to assess the influence of inhalant allergy on acute rhinosinusitis in children. The study involved 100 pediatric patients aged between 3 and 17 years who were admitted to the Chair and Department of Pediatric Otolaryngology, Phoniatrics and Audiology of the Medical University of Lublin due to acute rhinosinusitis. The control group consisted of 50 children without allergy, and the study group consisted of 50 children suffering from inhalant allergy. The methodology employed in this study involved medical history and laryngological examination, as well as laboratory and radiological testing. Dust mite allergy was the most common allergy among patients in the study group. Patients with allergies presented at the hospital later than patients without allergy, and their hospitalization lasted longer due to more severe sinus disease, higher inflammatory parameters, multiple sinus involvement, more frequent fever or rhinosinusitis complications, especially orbital occurrence. Most children in the control group required only pharmacological treatment. Inhalant allergy, especially dust mite allergy, contributes to more severe acute rhinosinusitis in children.

Psychometric Evaluation of the Hyperacusis Impact Questionnaire (HIQ) and Sound Sensitivity Symptoms Questionnaire (SSSQ) Using a Clinical Population of Adult Patients with Tinnitus Alone or Combined with Hyperacusis.

Hyperacusis can be defined as an intolerance of certain everyday sounds, which are perceived as too loud or uncomfortable and which cause significant distress and impairment in the individual's day-to-day activities. It is important to assess symptoms of sound intolerance and their impact on the patient's life, so as to evaluate the need for treatment and to assess the effectiveness of treatments. The aim was to evaluate the psychometric properties of the Hyperacusis Impact Questionnaire (HIQ), and the Sound Sensitivity Symptoms Questionnaire (SSSQ). The 8-item HIQ focuses on assessing the impact of hyperacusis on the patient, while the 5-item SSSQ is designed to assess the type and severity of sound intolerance symptoms. This was a retrospective cross-sectional study. In total, 266 consecutive patients who attended a Tinnitus and Hyperacusis Therapy Clinic in the United Kingdom within a 6-month period. Fifty-five percent were female. The average age was 54 years (standard deviation = 16 years). Data were collected retrospectively from the records of patients held at the audiology department. Audiological measures were pure-tone audiometry and Uncomfortable Loudness Levels (ULLs). Questionnaires administered in addition to the HIQ and SSSQ were: Tinnitus Handicap Inventory, Hyperacusis Questionnaire (HQ), and Screening for Anxiety and Depression in Tinnitus. Exploratory factor analysis suggested one-factor solutions for both the HIQ and SSSQ. Multiple-causes multiple-indicators (MIMIC) models showed some small influences of gender but negligible effects of age for both the HIQ and SSSQ. Receiver Operating Characteristic (ROC) analysis showed no significant effects of covariates on the ROC curves. Cronbach's α was 0.93 for the HIQ, and 0.87 for the SSSQ, indicating high internal consistency. Convergent validity was supported by moderate correlations between HQ and HIQ scores and between SSSQ scores and ULLs. The HIQ and SSSQ are internally consistent questionnaires that can be used in clinical and research settings.

Ototoxic hearing loss in the multi-drug resistant tuberculosis era

Objective: To determine the prevalence of hearing loss in tuberculosis patients using Ototoxic medicines and association with demographic and clinical variables.&#x0D; Methods: This cross sectional study recruited a sample of n= 65 diagnosed cases of tuberculosis on ototoxic chemotherapy, of both genders, aged 12 to 70 years, using non-probability convenience sampling. Study was conducted at Audiology Department of Civil Hospital Bahawalpur, over a period of 6 months from 1st May, 2019 to 31st October 2019. Screening was performed using medical history sheet, otoscopy and hearing assessment. Data collected was analyzed using SPSS- Version 21.0.&#x0D; Results: Results revealed a gender proportion of 43 (66.2%) males and 22(33.8%) females with mean age of 35.87+9.35 years. The prevalence of hearing loss was 23.1% (n=15) with mild hearing loss in 73.33% cases and moderate hearing loss 26.67%. Hearing loss was associated with drug, its duration and associated symptoms of tinnitus and vertigo with p=0.000.&#x0D; Discussion: It is concluded that hearing loss is quite prevalent (23.1%) with multidrug resistant tuberculosis treatment in this region and is significantly associated with the drug used, its duration and associated symptoms.

A study of the hearing status in the contralateral healthy ear of patients with chronic otitis media following mastoidectomy surgery in a tertiary care hospital, Kerala, India

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Bone drilling and suction during surgeries, exposes cochleae to noise of markedly high levels, temporal bone vibrations to high speeds of drill bits. Variations in burr type and drilling duration can determine extent of noise generated. These may affect cochlea and hearing status of a patient. This study tries to identify hearing loss if any, in the apparently healthy contralateral ear and, the effect of various drill parameters on hearing status in patients with chronic otitis media following mastoidectomy surgery.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Study done using proforma, clinical examination data from operation theatre during surgery and audiology department. Pure Tone Audiometry of apparently healthy contralateral and diseased ears in patients done before surgery, within 24 hrs and 72 hrs after surgery.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 161 patients ,12 patients (7.45%) developed hearing loss post operatively. The mean duration of drilling with cutting burr in the 12 patients with hearing loss was 28 minutes 20 seconds (SD: 1.72) and for diamond burr was 25 minutes and 26 seconds (SD: 2.06). Among the patients with hearing loss, four had multiple frequencies affected (33.3%). There was a statistically significant relation in type of drills used in surgery and hearing loss (p&amp;lt;0.001). In 10 Out of 12 patients, the hearing loss post-surgery, (83.3%) reverted to normal within 72 hrs.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;A positive correlation exists between, transient sensorineural hearing loss that develops post-surgery with the various type of drills used for surgery, which reverted to pre-operative hearing levels within 3 days.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Psychometric Evaluation of a Patient Experience Questionnaire (PEQ) for Outpatient Appointments: Analysis Using Data from a U.K. National Health Service Audiology Department.

The Audiology Department at the Royal Surrey NHS Foundation Trust (RSFT), United Kingdom, developed a patient experience questionnaire (PEQ) to assess and compare patients' experiences of attending a wide range of appointments (e.g., hearing assessment, hearing aid fitting, hearing aid review, tinnitus therapy, balance assessment, and balance rehabilitation). The aim of this study was to assess the psychometric properties of the PEQ. The PEQ is a unidimensional instrument with four items that assess a patient's experience of an outpatient appointment. Retrospective cross-sectional study. Patients attending appointments for audiology services at RSFT between January and March 2020. All patients (n = 656) attending appointments for audiology services at RSFT during randomly selected days between January and March 2020 were given the questionnaire to complete themselves (PEQ-self) or to complete on their child's behalf (PEQ-parent). The factor structures for the PEQ-self and PEQ-parent were assessed separately, using confirmatory factor analysis. A multiple-causes, multiple-indicators (MIMIC) model was fitted to explore potential bias due to gender and age. Internal consistency was assessed using Cronbach's α. The bivariate correlations between PEQ scores and other variables were evaluated using the nonparametric Spearman correlation coefficient. Floor and ceiling effects were assessed using the distribution of total scores. Confirmatory factor analysis revealed that a one-factor model gave a close fit to the data for both the self and parent versions. Cronbach's α for the total score was 0.77 for the PEQ-self and 0.86 for the PEQ-parent. The MIMIC model showed no significant direct effects of age or gender for either version. Both the PEQ-self and PEQ-parent questionnaire can be reliably used to measure patients' experiences of outpatient audiology appointments. Future studies should aim to assess the psychometric properties of the PEQ-self and PEQ-parent for a range of outpatient appointments other than audiology.

Complications during Fiberoptic Endoscopic Evaluation of Swallowing in 5,680 Examinations

Objective: To evaluate retrospectively the incidence of complications during fiberoptic endoscopic evaluation of swallowing (FEES) in 5,680 examinations. Patients and Methods: 5,680 patients were evaluated at the Department of Otorhinolaryngology, Audiology and Phoniatrics of Pisa University Hospital between January 2014 and December 2018, involving both inpatients and outpatients. Most common comorbidities included neurological pathologies such as stroke (11.8%), neurodegenerative diseases (28.9%) and a history of previous head and neck surgery (24.6%). The evaluation was conducted by clinicians with experience in swallowing for a minimum of 10 years with the assistance of one or more speech-language pathologists. Results: In all patients studied the endoscope insertion was tolerated, and it was possible to visualize the pharyngolaryngeal structures. Three subjects refused to undergo the procedure after being informed regarding the protocol and were therefore not included in this study. Most patients reported discomfort (70.1%) and gagging (20.8%). In a minority of patients complications were recorded, such as anterior epistaxis (0.1%), posterior epistaxis (0.02%), vasovagal crises (0.08%) and laryngospasm (0.04%). Especially laryngospasm was recorded in patients affected by amyotrophic lateral sclerosis. Multivariate binary logistic regression showed that discomfort (OR 9.944; CI 7.643−12.937), chronic gastrointestinal diseases (OR 2.003; CI 1.518−2.644), neurodegenerative diseases (OR 1.550; CI 1.302−1.846) and brain tumors (OR 1.577; CI 1.179−2.111) were risk factors associated with minor complications. Conclusions: FEES proved to be easy to perform, well tolerated by the patients and cost-effective. It can be performed at the patient’s bedside, and it is characterized by a low rate of complications. As a matter of fact, normally only discomfort, gagging and/or vomiting are reported. Complications occurred only rarely, such as anterior or posterior epistaxis episodes or vasovagal crises, but these are still easily managed. Exceptionally, more severe complications are reported: adverse drug reactions to substances such as blue dye (methylene blue) and local anesthetics (not used in our protocol), and laryngospasm.

Language in Medical Worlds: Hearing Technology for Deaf Jordanian Children

ABSTRACT Bringing together medical and linguistic anthropology, I examine the provision of hearing technology, such as cochlear implants, to deaf Jordanian children, a project animated by an imperative to make deaf children speak. Drawing upon ethnographic fieldwork at a cochlear implantation initiative and an audiology department in Amman, I argue that this imperative must be understood in relation to anxieties about the status of Arabic in Jordan and the historical value of orality in the Middle East. This case shows that more attention must be paid to the role of language ideologies in co-constituting medical encounters between clinicians, parents, and patients.

Communicating Across Cultures and Languages in the Health Care Setting. Claire Penn &amp; Jennifer Watermeyer. Palgrave Macmillan, UK. 368 Pp. ISBN 978-1-137-58100-6

The book under review presents the challenging and creative research endeavours concerning some peculiar characteristics of multicultural and multilingual communication in South African healthcare settings. The authors of this work – Claire Penn, a professor and director of the Health Communication Research Unit, and Jennifer Watermeyer, an associate professor in the Department of Speech Pathology and Audiology at the University of the Witwatersrand, South Africa, – focus on bridging the gap between the voices of the lifeworld and the voices of medicine via communication characterized by the complexities and pitfalls within culturally and linguistically diverse health care contexts. The research under review is aimed at analyzing the cognitive space of professional medical communication in healthcare settings for applying the results in practice. Research of the cross-language interactions in healthcare facilities (using the evidence from South African medical settings) certainly contributes a lot to establishing an adequate cultural brokers’ role in the professional communication and to describing methods aimed at modifying interactions between a healthcare professional and a patient, which taken together lead to the improvement of medical communication in general. This book is a reasonably valuable source of essential knowledge for both healthcare professionals, linguists, discourse analysis researchers, medical educators and practitioners, and for those people who are interested in the specificities of communication research projects in terms of professional medical discourse on the global scale.