Management Of Hearing Impairment Research Articles

An Effect of Amplification on Hearing Ability, Cognition, and Depression among Middle and Late Adulthood

Background: Age-related hearing loss in middle adulthood (MA) and late adulthood (LA) is a highly prevalent health condition. It will negatively impact on an individual’s cognitive, social, and psychological functions. An effect of amplification on hearing ability, cognition, and depression among MA and LA are sparse. Objective: The aim of the study was to investigate an effect of amplification on hearing ability, cognition, and depression among middle and LA. Methods: A cohort study where 18 MA and 20 LA with hearing impairment aged 50–75 years was selected. Pure tone audiometry, Mini Mental State Examination, and geriatric depression scale were assessed pre and post 6 weeks of amplification. Parameters such as hearing thresholds, cognitive score, and depression level were measured. The statistical tests were used for analyzing the parameters within and across groups. Results: The result shows a significant difference (P < 0.05) with respect to hearing thresholds and cognitive scores within both the groups. A significant difference (P < 0.05) was observed in right ear between both the groups. No significant difference (P > 0.05) was noted in the level of depression between both the groups. Conclusion: An evident difference in the hearing thresholds and cognitive scores were noted with respect to amplification in both the groups. Thus, it can be concluded that the amplification has a significant impact on an individual’s quality of life. It should be considered as an important factor during the management of hearing impairment among middle and late-adulthood.

Association of Age-Related Hearing Impairment With Physical Functioning Among Community-Dwelling Older Adults in the US

Hearing impairment, a common treatable condition, may contribute to poorer physical function with aging. To assess whether hearing impairment is associated with poorer physical function, reduced walking endurance, and faster decline in physical function. In this cohort study, cross-sectional and longitudinal analyses were performed using data from the 2011 to 2019 period of the Atherosclerosis Risk in Communities study, a population-based study of community-dwelling adults at 4 sites in the US. Hearing thresholds (per 10 dB) assessed with pure tone audiometry and categorized as normal hearing or mild, moderate, or severe hearing impairment. Physical function was assessed using the short physical performance battery (SPPB), with composite scores ranging from 0 to 12. A composite score of 6 or less and a score for each component (balance, gait speed, and chair stands) of 2 or less indicated poor performance. Walking endurance was assessed using a 2-minute fast-paced walk test. Tobit regression models adjusted for sociodemographic factors and medical history were used to calculate the mean differences in SPPB composite scores; logistic regression models, to estimate the odds ratios (ORs) of low SPPB composite and component scores; and linear mixed-effects models, to estimate the mean rate of change in SPPB composite scores over time. Of the 2956 participants (mean [SD] age, 79 [4.6] years) who attended study visit 6 between 2016 and 2017, 1722 (58.3%) were women, and 2356 (79.7%) were White. As determined by pure tone audiometry, 973 (33%) participants had normal hearing, 1170 (40%) had mild hearing impairment, 692 (23%) had moderate hearing impairment, and 121 (4%) had severe hearing impairment. In the Tobit regression model, severe hearing impairment was associated with a lower mean SPPB score (β, -0.82; 95% CI, -0.34 to -1.30) compared with normal hearing. In fully adjusted logistic regression models, hearing impairment was associated with higher odds of low physical performance scores (severe impairment vs normal hearing: OR for composite physical performance, 2.51 [95% CI, 1.47-4.27]; OR for balance, 2.58 [95% CI, 1.62-4.12]; OR for gait speed, 2.11 [95% CI, 1.03-4.33]). Over time (2 to 3 visits; maximum, 8.9 years), participants with hearing impairment had faster declines in SPPB compared with those with normal hearing (moderate hearing impairment × time interaction, -0.34 [-0.52 to -0.16]). In adjusted models for walking endurance, participants with moderate or severe hearing impairment walked a mean distance of -2.81 m (95% CI, -5.45 to -0.17 m) and -5.31 m (95% CI, -10.20 to -0.36 m) than those with normal hearing, respectively, during the 2-minute walk test. In this cohort study, hearing impairment was associated with poorer performance, faster decline in physical function, and reduced walking endurance. The results of the longitudinal analysis suggest that hearing impairment may be associated with poorer physical function with aging. Whether management of hearing impairment could delay decline in physical function requires further investigation.

Speech discrimination impairment of the worse-hearing ear in asymmetric hearing loss

Objective This study aimed to compare the difference in maximum speech discrimination score (SDSmax) of the worse-hearing ear in asymmetric hearing loss (ASHL) patients with that in symmetric hearing loss (SHL) patients. Design We retrospectively reviewed medical records of patients with suspected hearing loss (HL) who underwent audiometric examinations. Patients were divided into two groups according to the difference in air conduction (AC) threshold between the right and left ears: the SHL group and the ASHL group. Study sample Of the 102 patients (204 ears), 74 (148 ears) had SHL, and 28 had ASHL. Results The worse-hearing ear of ASHL patients exhibited a statistically significantly higher AC threshold and lower SDSmax, compared with ears of SHL patients and better-hearing ears of ASHL patients, and SDSmax exhibited a statistically significant negative correlation with AC threshold. The SDSmax was statistically significantly lower in the worse-hearing ear of the ASHL group than in moderate to severe HL ears of the SHL group, even though these groups had comparable AC thresholds. Conclusions ASHL patients’ worse-hearing ear exhibited a lower SDSmax than SHL patients’ ears, despite a comparable AC threshold. Management of hearing impairment in ASHL patients should receive more attention.

Assessment of Knowledge and Attitudes of Caregivers Regarding Hearing Impairment among Children at Minia City

Background: Hearing impairment is a partial or total inability to hear. A deaf person has little to no hearing. Hearing loss may occur in one or both ears, it can affect the ability of children to learn spoken language. Aim: The study aimed to assess of knowledge and attitudes of caregivers regarding hearing impairment among children at Minia City. Study design: A cross sectional descriptive design used to conduct in this study. Subject: Random cluster sample of 268 caregivers. Setting: This study was carried out at Alamel School for the Deaf and Hearing impairment at Minia city. Tools: Two tools was utilized in this study, first tool was an interviewing structured questionnaires sheet was contained two parts: Part 1: Socio-demographic characteristics about caregivers and such as age, sex and residence. Part II: Assess caregivers‟ knowledge, about hearing impairment that includes definition, causes, symptoms, consequences and management of hearing impairment and second tool was attitude scale. Results: The results show that 86.5% of children suffer from hearing problem less than one year. Regarding knowledge about symptoms & signs, 58% of caregivers didn't know about screen test for early detection hearing loss. There is highly statistically significant difference as regard the level of caregiver‟s knowledge in relation to residence. There is positive attitude of caregiver regarding hearing impaired child can be manageable if helped and supported. Conclusion: More than half of caregiver didn't have enough knowledge about hearing impairment. There is highly statistically significant difference as regard the level of knowledge of caregiver‟s relation to residence, also there is positive attitude of caregiver regarding hearing impaired children. Recommendations: The study recommended providing health education for caregivers about hearing impairment among children at Minia city and investigating the effect of caregivers‟ knowledge about hearing impairment among children

Pattern of Hearing Impairment in a Tertiary Institution in Ado Ekiti, Nigeria

Background: Hearing impairment is a common sensory impairment affecting all age group worldwide. Aims: This study aimed at determining the prevalence, sociodemographic features, aetiology, audiometry findings, impact on quality of life and management of hearing impairment in a tertiary health institution in Ado-Ekiti, Nigeria. Materials and Methods: This was a prevalence hospital-based study of patients with complaints of hearing impairment in the ear, nose and throat department of Ekiti state university teaching hospital, Ado Ekiti. The study was carried out from May 2017 to April 2018. Consent was obtained from the patients/parents/guardian.Data were obtained by using pretested interviewers assisted questionnaire. All the data obtained were collated, documented and analyzed using SPSS version 18. Results: Prevalence of hearing impairment was 21.2%. There were 36.5% males and 63.5% female with a male to female ratio of 1:1.5. Bilateral hearing impairment was predominant and accounted for 51.9%. Common aetiologic factors of hearing impairment among the patients were; 20.2% earwax impaction, 13.5% ototoxicity, 12.5% otitis media, 11.5% presbyacusis, 11.1% otitis externa and 10.1% febrile illnesses. Common clinical features were earwax, earache, hard of hearing/ear blockage, ear discharge and tinnitus in 49.5%, 45.2%, 40.4%, 36.5% and 29.8% respectively. The most Common type of hearing impairment was a sensorineural hearing loss in 46.2%. Type A tympanometry (normal) was the commonest findings in 47.1%. Pure tone audiometry revealed mild, moderate and moderate-severe hearing impairment to be 44.7%, 27.9%, and 20.2% respectively. Common effect on quality of life was the embarrassment, aggressiveness, social dysfunction and poor academic performance of 13.9%, 11.5%, 10.1% and 6.7%. Majority of the patients in 63.5% had prehospital treatment. Conservative treatment was done in 26.9%. The surgery/procedure were done in 47.6%. Amplification and speech therapy in 13.5% and 6.7% respectively. Conclusion: Hearing impairment is a hidden and common otologic disease with significant associated negative effect on quality of life in Ado- Ekiti, Nigeria

Preschool Children Hearing Impairment: Prevalence, Diagnosis and Management in a Developing Country.

Preschool children hearing impairment is a common otologic diseases worldwide. The burdens of this preventable condition can be reduced in developing country. This study was carried out to determine the prevalence, diagnosis and management of hearing impairment among children less than 5 years seen in our center. This was a prospective hospital based study of preschool children with complaints of hearing impairment in Ekiti state university teaching hospital, Nigeria. This study was conducted over a period of two years (February 2016 to January 2018). Data was obtained from consented patients by using pretested interviewers assisted questionnaire. Data obtained was collated and analyzed by using SPSS software version 18.0. D escriptive statistics was used to present and expressed the data as simple tables and charts. The prevalence of hearing impairment in this study was 5.9% with peak value of 37.6% at preschool age 3 years. There were 42.6% males and 57.4% females. Majority (51.5%) of the patients were urban dwellers. The aetiologic factors of hearing impairment include; 15.8% neonatal jaundice, 13.9% febrile illness, 12.9% otitis media and 11.9% birth asphyxia. Prelingual presentation was commonest in 57.4%. Common clinical features includes yet to speak, restlessness/stubborn and not responding to command in 60.4%, 48.5% and 46.5% respectively. Commonest type of hearing impairment was sensorineural hearing loss is 61.4%. Type A tympanometry (normal) was the commonest findings in 82.2%. Preschool children hearing impairment with late presentation is a common otologic diseases burden to parent and otorhinolaryngologist in our center. The common causes were preventable with resulting permanent auditory damage.

Understanding Hearing Impairment in Individuals from a Perspective of Social and Emotional Functioning

Purpose: Hearing Impairment is one of the most neglected forms of disability. It accounts for the loss of thousands of disability adjusted life years (DALYs) worldwide (WHO, 2005). Developed countries have made some progress in the measuring and management of hearing impairment (HI), but this is still in the initial stages in developing countries such as India. The International Classification of Functioning disability and Health (ICF) has shifted the approach towards a holistic perspective in defining and measuring disability. This paper tries to measure HI from the perspective of social and emotional functioning of individuals. Method: The sample population consisted of 1160 individuals, selected by systematic random sampling from among those who complied with inclusion criteria. 51.7% of the total respondents were females, and 48.3% were males. The participants were administered a questionnaire (Standardised) and their responses were quantified. The data was analysed using Statistical Package for Social Sciences (SPSS) version 20. Results: Prevalence of HI was found more among males than females. 84.6% of the total population had no hearing impairment, whereas 13.7% had mild to moderate impairment, and 1.7% had significant hearing impairment. The Total Impairment score obtained by the individuals was divided into Social Impairment score and Emotional Impairment score. Correlation and Multivariate regression analysis were used. Correlation - Age and Social Dimension Score r= 0.609, p≤0.01, n=1160, R2= 0.370; Age and Emotional Dimension score: r= 0.622, p≤0.01, n=1160, R2= 0.386; Regression- Gender and Social Dimension score b= 0.703, t (1160) = 2.988, p Conclusion: Measuring HI in terms of social and emotional functioning is more holistic and cost-effective, and could be used in resource-poor settings, and for initial screening in large-scale studies.

Management of Hearing Impairment in Children

Hearing loss in children is often a silent and hidden handicap. Children with hearing loss frequently appear to be normal, and often their handicaps are not apparent. Hearing loss that is undetected and untreated can result in speech, language, and cognitive delays. Early identification and intervention with hearing inquired child improve language, communication, and cognitive skills. Sudden or progressive sensorineural hearing loss accompanied by dizziness following barotrauma should prompt consideration of traumatic perilymph fistula. Early surgical exploration is recommended to improve hearing and vestibular symptoms.

The Potential Role of the cABR in Assessment and Management of Hearing Impairment

Hearing aid technology has improved dramatically in the last decade, especially in the ability to adaptively respond to dynamic aspects of background noise. Despite these advancements, however, hearing aid users continue to report difficulty hearing in background noise and having trouble adjusting to amplified sound quality. These difficulties may arise in part from current approaches to hearing aid fittings, which largely focus on increased audibility and management of environmental noise. These approaches do not take into account the fact that sound is processed all along the auditory system from the cochlea to the auditory cortex. Older adults represent the largest group of hearing aid wearers; yet older adults are known to have deficits in temporal resolution in the central auditory system. Here we review evidence that supports the use of the auditory brainstem response to complex sounds (cABR) in the assessment of hearing-in-noise difficulties and auditory training efficacy in older adults.

Practices in habilitation of pediatric recipients of cochlear implants in India: A survey

IntroductionCochlear implant (CI) (re)habilitation programs are long-term processes, with many factors contributing to the overall success. The clinics in India that are working toward pediatric CI habilitation vary in their team philosophy, clinical practices, and service delivery. It is important to explore their clinical perspectives and practices to appreciate their current state and suggest directions for improvement in the future.ObjectiveThe objective of the study was to characterize the current status and clinical practices of the pediatric CI programs in India.MethodsTwenty-two clinics involved in the pediatric CI habilitation program across India participated in the survey. The heads of the CI teams of the participant clinics completed a validated survey questionnaire containing multiple-choice and open-ended questions on the details of the CI habilitation team, assessment and therapy protocols used, and other related clinical services. The categorical data obtained were analyzed using descriptive statistical measures.Results and discussionThe interpretation of results indicated a need to focus future discussions on early identification and management of hearing impairment, funding for CIs, continuing education programs for professionals, decision processes for providing CIs for children with multiple concerns, choice of language(s) of instruction, assessment protocols used, and outreach/consultation services.

Inner ear infections as cause of perinatal deafness

Objective: To assess the role of infective agents as cause of sensorineural hearing loss (SNHL) in children. Setting: Tertiary care center actively involved in management of hearing impairment through cochlear implant program and other rehabilitation program. Materials and Methods: Retrospective chart review of 213 patients who underwent cochlear implantation at our center from 2007 to 2011 was carried out. Out of these, 185 were children. We have done the data analysis with regard to etiology of hearing loss in these 185 children. An etiology for SNHL could be established in 100 out of these 185 cases. Out of these 100 cases, we have further segregated cases where an infectious etiology was implicated. Results: Out of 185 prelingual cochlear implantees, etiology could be determined in 100 cases. Etiology was of infective origin in 26 of these 100 cases. Infective agents implicated in congenital acquired hearing loss were Toxoplasma, Rubella, Cytomegalovirus, and Herpes (TORCH) infections ( n = 9) including Rubella ( n = 7) and Cytomegalovirus (CMV) ( n = 2). Meningitis ( n = 11) and other infections ( n = 6) were responsible for secondary acquired hearing loss. Conclusions: Results showed that among the identified causes, infective agents were responsible in one-fourth cases of profound SNHL. Building awareness about such existence and their major role in causing SNHL among the otolaryngologists, pediatricians, obstetricians, physicians, audiologists and public is considered essential so that such preventable and controllable maladies are reduced by combined efforts from all these stakeholders.

Newborn Genetic Screening for Hearing Impairment: A Preliminary Study at a Tertiary Center

Universal newborn hearing screening (UNHS) is of paramount importance for early identification and management of hearing impairment in children. However, infants with slight/mild, progressive, or late-onset hearing impairment might be missed in conventional UNHS. To investigate whether genetic screening for common deafness-associated mutations could assist in identifying these infants, 1017 consecutive newborns in a tertiary hospital were subjected to both newborn hearing screening using a two-step distortion-product otoacoustic emissions (DPOAE) screening and newborn genetic screening (NGS) for deafness. The NGS targeted 4 deafness-associated mutations commonly found in the Taiwanese population, including p.V37I (c.109G>A) and c.235delC of the GJB2 gene, c.919-2A>G of the SLC26A4 gene, and mitochondrial m.1555A>G of the 12S rRNA gene. The results of the NGS were then correlated to the results of the NHS. Of the 1017 newborns, 16 (1.6%) had unilateral DPOAE screening failure, and 22 (2.2%) had bilateral DPOAE screening failure. A total of 199 (19.6%) babies were found to have at least 1 mutated allele on the NGS for deafness, 11 (1.1%) of whom were homozygous for GJB2 p.V37I, 6 (0.6%) compound heterozygous for GJB2 p.V37I and c.235delC, and 1 (0.1%) homoplasmic for m.1555A>G, who may potentially have hearing loss. Among them, 3 babies, 5 babies, and 1 baby, respectively, passed the NHS at birth. Comprehensive audiological assessments in the 9 babies at 3 months identified 1 with slight hearing loss and 2 with mild hearing loss. NGS for common deafness-associated mutations may identify infants with slight/mild or potentially progressive hearing impairment, thus compensating for the inherent limitations of the conventional UNHS.

Inter‐relationships between hearing impairment, learning disability services and mental health: are learning disability services ‘deaf’ to hearing impairments?

Prevalence of hearing impairment is quite common in people with learning disabilities (double jeopardy). However, this debilitating co‐morbidity remains largely undetected by carers and professionals due to presence of additional disabilities and complex clinical presentation in this population on the one hand, and lack of specialist hearing impairment service provision and difficulty in accessing generic audiology services on the other hand. This article aims to provide practical guidance on assessment and management of hearing impairment in people with learning disabilities by offering a narrative review of available literature on gaps in service delivery.

Congenital hearing impairment

Establishing the etiology of congenital hearing impairment can significantly improve treatment for certain causes of hearing loss and facilitates genetic counseling. High-resolution CT and MRI have contributed to the evaluation and management of hearing impairment. In addition, with the identification of innumerable genetic loci and genetic defects involved in hearing loss, genetic testing has emerged as an invaluable tool in the assessment of hearing impairment. Some of the common forms of congenital hearing loss are reviewed and their imaging features illustrated.

Evaluation of Hearing Loss in Infants and Young Children

The identification, assessment, and management of hearing impairment in the pediatric population can be a challenging endeavor. Nevertheless, newer technology, improved techniques, and the cooperative efforts of various professional organizations and their constituencies have made significant strides toward achieving this goal. As more precise objective technologies are introduced, there will be a tendency to rely more heavily on their application. Both IA and OAEs have already made significant impact in pediatric practices because of their ease and simplicity. Within a short period of time, trained technical staff can become proficient in their usage and test interpretation. Their application in conjunction with basic audiometry can provide a global picture of auditory status (Table 2). However, it is critical to recall that the basic building block of auditory assessment is the audiogram, a true measure of behavioral threshold sensitivity. Therefore, when test results suggest hearing impairment, appropriate audiological referral to the will ensure continuity of services and provision of rehabilitative measures. It is equally essential for primary care providers to understand the therapeutic needs of their patients and to manage and coordinate the medical aspects of the infant or child when hearing loss is suspected.

Distortion product otoacoustic emissions in term infants after hypoxia-ischaemia

Distortion product otoacoustic emissions (DPOAEs) were recorded in 46 term infants who suffered perinatal hypoxia-ischaemia to identify which frequencies in the cochlear audiogram are susceptible to perinatal hypoxia-ischaemia. On days 3-5 after birth, the pass rates across the frequencies of the f(2 )primary tone between 1 and 10 kHz, particularly 1-5 kHz, were all lower than those in normal term controls (X(2 )= 7.27-32.30, all P <0.01). Of the 92 ears, 15 (16.3%) failed the DPOAE test, which was significantly higher than in the controls (4.3%, X(2) = 5.81, P <0.05). At 1 month, 80 ears with a type A tympanogram were re-tested. The pass rates at most frequencies, mainly 1 and 2 kHz, were slightly further decreased. Thirteen ears (16.2%) failed the DPOAE test. These results suggest that the neonatal cochlea, mainly at the frequencies 1-5 kHz, is impaired shortly after perinatal hypoxia-ischaemia and the impairment remains at 1 month. Perinatal hypoxia-ischaemia impairs the neonatal cochlea mainly at the frequencies 1-5 kHz and the impairment detected on days 3-5 after birth is unlikely to improve in the later neonatal period. These findings may have implications for the management of hearing impairment in infants after perinatal hypoxia-ischaemia.

Hearing impairment in children with impacted cerumen.

The aim of this study was to determine whether children in whom impacted cerumen had been removed were at greater risk of hearing impairment than those without a history of impacted cerumen. A retrospective study was conducted in 113 subjects and their pair-matched controls taken from a population of 359 randomly selected school entrants who received otoscopic, audiometric and tympanometric evaluations. It was found that children from whom impacted cerumen had been removed were more likely to have hearing loss (p = 0.0001), and of a more permanent nature (p = 0.002). They were also likely to have more otitis media with effusion (OME) (p = 0.045). Children with a history of impacted cerumen are therefore at greater risk of subsequent hearing problems and of a more permanent nature than those without, notwithstanding the removal of such impacted cerumen. The prevention of cerumen impaction should be of significant public health concern in the management of hearing impairment in children, especially where there is no routine and systematic screening for hearing disorders.

Ballantyne's Deafness

The past twenty years have seen considerable changes in the management of hearing impairment. Cochlear implantation has transformed the outlook for the profoundly deaf, and the way in which the outcomes have been monitored in the UK is a model for evidence-based practice. Hearing aid technology is changing, although there is so far no clear information on which patients will benefit from digital processing of sound. Important developments in screening of infants for hearing loss are currently being implemented. A new edition of Deafness, previously edited by John Ballantyne, is therefore welcome. The book is aimed at a wide readership including various professionals who encounter hearing-impaired people, individuals with hearing impairment and those who have a hearing-impaired relative. Topics include the structure and function of the ear, causes of hearing impairment and its assessment, its impact on mental wellbeing and the role of hearing aids of various sorts. The chapters are concise, well laid out and illustrated with clear line diagrams. This type of book is much more difficult to write than one aimed at the authors' peers, since even basic concepts must be adequately explained and jargon studiously avoided. Most of the authors have succeeded but an exception is the chapter on acquired sensorineural hearing loss, which does not seem to have been written with a lay readership in mind. The opposite pitfall, of simplifying the content so much that it is of no value to professionals in related disciplines, does seem to have been avoided. In the chapter on the management of deafness in childhood the abbreviation SPL (sound pressure level) is used without explanation. Certain areas could have been covered better. The section on middle ear implants is somewhat out of date and not very informative. An account of the potential advantages of implantable hearing aids and the limitations of those currently available would have been more useful than the description of individual devices. These devices are not as yet part of the mainstream management of hearing loss, but patients and healthcare professionals will read about them in the press; a more authoritative account of their present status would have been helpful. Overall my feeling is that this book will be of considerable use to a range of healthcare professionals and to deaf individuals and their relatives. It is therefore a worthy successor to previous editions.

Ballantyne's Deafness, 6th edition

The past twenty years have seen considerable changes in the management of hearing impairment. Cochlear implantation has transformed the outlook for the profoundly deaf, and the way in which the outcomes have been monitored in the UK is a model for evidence-based practice. Hearing aid technology is changing, although there is so far no clear information on which patients will benefit from digital processing of sound. Important developments in screening of infants for hearing loss are currently being implemented. A new edition of Deafness, previously edited by John Ballantyne, is therefore welcome. The book is aimed at a wide readership including various professionals who encounter hearing-impaired people, individuals with hearing impairment and those who have a hearing-impaired relative. Topics include the structure and function of the ear, causes of hearing impairment and its assessment, its impact on mental wellbeing and the role of hearing aids of various sorts. The chapters are concise, well laid out and illustrated with clear line diagrams. This type of book is much more difficult to write than one aimed at the authors' peers, since even basic concepts must be adequately explained and jargon studiously avoided. Most of the authors have succeeded but an exception is the chapter on acquired sensorineural hearing loss, which does not seem to have been written with a lay readership in mind. The opposite pitfall, of simplifying the content so much that it is of no value to professionals in related disciplines, does seem to have been avoided. In the chapter on the management of deafness in childhood the abbreviation SPL (sound pressure level) is used without explanation. Certain areas could have been covered better. The section on middle ear implants is somewhat out of date and not very informative. An account of the potential advantages of implantable hearing aids and the limitations of those currently available would have been more useful than the description of individual devices. These devices are not as yet part of the mainstream management of hearing loss, but patients and healthcare professionals will read about them in the press; a more authoritative account of their present status would have been helpful. Overall my feeling is that this book will be of considerable use to a range of healthcare professionals and to deaf individuals and their relatives. It is therefore a worthy successor to previous editions.

Assessment: scientific foundation.

Assessment: scientific foundation.