Subjective Handicap Research Articles

Dysphonia in School Teachers: An Occupational Risk Concern?

BackgroundSchool teachers are known to be at risk for dysphonia. However, they do not always get the benefits that are guaranteed to people with occupational diseases. Objective parameters attempting to quantify the condition are a requirement. Based on an earlier smaller study done in a single district of Kerala, a highly literate State in south India, the present study was envisaged as a Statewide survey of the problem. ObjectivesThe aim was to check the possibility of designating voice problem (dysphonia) in school teachers as a distinct occupational health issue. The primary objective was to document the prevalence of subjective dysphonia. Secondarily, the study sought to look for possible associations between known risk factors and dysphonia. MethodsA cross-sectional, questionnaire-based survey was conducted. The tool was developed from an earlier version, with the addition of risk factor questions and subjective handicap scoring. Three categories of dysphonia were obtained. Statistical analyses were done for all variables, with p value < 0.05 considered statistically significant. Odds ratios (OR) with 95% confidence limits were calculated for four of the risk factors. ResultsCompleted responses were obtained from 4014 school teachers. Of these, 1885 (46.96%) had dysphonia at the time of responding, 1922 (47.88%), in the last one year, and 2650 (66.02%), at some point during their career. Most risk factors had statistically significant association with dysphonia. OR calculation showed greater risk for teachers in government managed or aided schools, those teaching in secondary (5th to 12th grade) schools, those in the job for more than 20 years, and teaching social sciences subject. ConclusionsThere is a high prevalence of dysphonia in school teachers in a Statewide survey of Kerala. Several risk factors have been identified; some peculiar to the region. There is enough numerical evidence to designate dysphonia in school teachers as an occupational health issue.

Validity and Reliability Study of the Turkish Version of the Subjective Handicap of Epilepsy

Validity and Reliability Study of the Turkish Version of the Subjective Handicap of Epilepsy

Enhancement of Subjective Quality of Life Following Surgical Intervention in Patients With Drug-Resistant Epilepsy: A Depressive Symptom-Independent Outcome.

To evaluate the impact of depressive symptoms on the subjective perception of quality of life in patients with drug-resistant epilepsy (DRE) after surgical treatment for seizures. Methods: A case-control study with DRE patients who received surgical treatment (n=19) and matched non-operated patients (n=23). We assessed the quality of life using the Subjective Handicap of Epilepsy (SHE) scale, alongside measuring depressive symptoms using the Beck Depression Inventory (BDI). The mean age of the participants was 45 years, with females constituting 52.4% of the patients. A majority (73.8%) had been diagnosed with temporal lobe epilepsy. Those who had undergone surgical intervention showed significantly enhanced performance across all quality-of-life domains on the SHE scale independently of depressive symptoms. The domains of "Work and Activity,""Physical Health,"and "Self-Perception" displayed the greatest improvements, with the surgical group's averages outperforming the control group by factors of 1.87, 2.53, and 2.81, respectively. Influential differences impacting the quality-of-life scores included seizure frequency, the quantity of antiepileptic drugs utilized, and the incidence of convulsive seizures. The findings suggest that surgical control of seizures in drug-resistant focal epilepsy is associated with improvement in quality of life across various domains, independently of the depressive symptoms of the patients.

Singing Voice Concern in Tertiary Laryngology Practice

To determine the prevalence and characteristics of patients who identify singing voice as a primary concern when presenting with general voice complaints to a voice clinic. Data were collected from medical records on demographics, medical history, laryngoscopy exam, diagnosis, and subsequent treatments; and from self-report questionnaires including the Voice Handicap Index-10 (VHI-10) and clinical voice questionnaire. A total of 17% of patients presenting to a voice clinic with general voice problems who completed a VHI-10 identified singing voice as a primary concern. Compared to the reference cohort, patients concerned about singing voice report greater handicap on several questions of the VHI-10, particularly in personal and social life impact, loss of income, unpredictability of vocal clarity, subjective upset, and subjective handicap. Those concerned with singing voice were also more concerned about their vocal problem, and both more likely to be recommended voice therapy and participate in voice therapy despite no statistical differences in categorical diagnoses. When considering both professional and recreational singers, voice concerns occurred in 17% of the cohort under study. Patients with singing voice concerns are accounted for largely by recreational singers, who remain poorly characterized in the literature. We underscore the importance of sensitivity and responsivity to the needs of this group of patients.

(Even Off-Label) Cochlear Implantation in Single-Sided Deafness and Asymmetric Hearing Loss Results in Measurable Objective and Subjective Benefit.

To quantify objective and subjective outcomes in cochlear implant (CI) recipients with asymmetric hearing loss, including single-sided deafness (SSD) whose candidacy was determined on an ear-specific basis when word recognition was 50% or less. Retrospective case review. Tertiary referral center. The effectiveness of CI in cases of SSD and asymmetric hearing loss (AHL) has been described in terms of tinnitus suppression, improved speech recognition in quiet and noise, enhanced localization ability, and improved quality of life. However, CI is not yet routinely offered as a top option or standard of care for these individuals. Recent Food and Drug Administration (FDA) labeling limits aided word recognition in the ear to be implanted to only 5% in cases of AHL/SSD, which is significantly poorer than 40 to 50%, which is often referenced in cases of bilateral hearing loss. Anecdotal experience suggests that patients with much better preoperative word recognition than 5% can benefit from CI. We conducted a retrospective chart review of all adult CI candidates, with one ear exhibiting consonant-nucleus-consonant (CNC) word recognition scores at least 50% and one ear not meeting CI candidacy (i.e., CNC word recognition >50%). Outcome variables of interest included word and sentence recognition and subjective handicap questionnaires (hearing, tinnitus, dizziness) and the Speech Spatial Qualities questionnaire. Statistically and clinically significant improvement in speech understanding (word, sentence, sentence in noise) was noted for both the SSD and AHL groups in the implanted ear. There were statistically and clinically significant subjective improvements noted for both groups on the Hearing Handicap Inventory, the Tinnitus Handicap Inventory, and the Speech Spatial Qualities questionnaire by 1 month after activation. There were no significant differences between the AHL and SSD groups on either objective or subjective measures of the implanted ear. Individual word understanding improved for the majority of recipients across both groups and is not dependent on meeting the FDA criteria of less than 5%. Cochlear implantation is a viable option with measurable objective and perceived benefits for recipients with preoperative aided CNC word scores exceeding current FDA labeling. There is no significant difference between the AHL and SSD groups, suggesting that candidacy and outcome expectations should be set based on the ear to be implanted alone, without regard for the ability of the better hearing ear.

Determining attributed factors of hearing handicap in individuals with auditory sensory and neural pathology

IntroductionThere is a modest relationship between speech perception skills and perceived hearing handicap in individuals with hearing loss. In this study, an attempt is made at linking psychoacoustic results and speech perception skills to understand the subjective handicap and quality of life. ObjectiveTo investigate how speech perception in noise (signal to noise ratio-50), difference limen frequency, temporal modulation transfer function, hearing handicap inventory for adults, and quality of life in auditory neuropathy spectrum disorder differs from sensorineural hearing loss. Further we attempt to discern attributed factors of hearing handicap in auditory neuropathy spectrum disorder and sensorineural hearing loss. MethodsA cross-sectional study with comparative and correlational research designs were utilized. Eighty-four participants were grouped into sensorineural hearing loss (n = 49), and auditory neuropathy spectrum disorder (n = 35) was sub-grouped into mild, moderately severe, and severe. We evaluated signal to noise ratio-50, difference limen frequency, and temporal modulation transfer function. In addition, hearing handicap inventory for adults, and quality of life questionnaires were administered. ResultsMild auditory neuropathy spectrum disorder showed impairment in speech perception and discriminating frequency, which were similar to the severe sensory neural hearing loss. Temporal resolution impairment in auditory neuropathy spectrum disorder mild was significantly higher than in each sub-groups of sensorineural hearing loss. The severity of the hearing handicap in was similar to severe sensorineural hearing loss, quality of life was equally affected in sensorineural hearing loss and auditory neuropathy spectrum disorder. In sensorineural hearing loss, signal to noise ratio-50 was positively related, and quality of life was negatively related to hearing handicap. In auditory neuropathy spectrum disorder, no contributory factors were related to hearing handicap. ConclusionMild auditory neural pathology demonstrates impairment in speech recognition and psychoacoustic skills similar to severe cochlear pathology. In sensorineural hearing loss, hearing handicap is predicted from quality of life and speech perception, but none of the contributory factors predicted hearing handicap in auditory neuropathy spectrum disorder.

Subjective Evaluation of Balance by the Dizziness Handicap Inventory Does Not Predict Fall Risk in Older Adults Visiting Otolaryngology Clinics.

Subjective symptoms of dizziness in older adults are affected not only by objective data such as postural balance, but also by complex psychological factors. Published data analyzing how simultaneous evaluations of both objective and subjective assessments of balance can predict fall risk remain lacking. This study examined how fall risk can be predicted based on both objective data for balance and hearing and subjective symptoms of dizziness among older adults visiting otolaryngology clinics. Medical charts of 76 patients ≥65 years old with dizziness/vertigo who visited the otolaryngology clinic were reviewed. Objective data were evaluated by postural balance (posturographic data with eyes open and closed, and one-leg standing test), spontaneous nystagmus, and mean hearing levels. Subjective handicap associated with dizziness/vertigo was assessed using the Dizziness Handicap Inventory (DHI). Subjective mental status of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Information on history (cardiovascular diseases) and fall accidents within the preceding year was collected using an in-house interview sheet. Objective data on postural balance did not correlate with subjective symptoms on DHI or HADS (P > .05, Pearson's correlation coefficient). Adjusted logistic regression modeling with the outcome of incident falls revealed that poor postural balance significantly predicted fall risk (P < .05; 4.9 [1.4-16.8] per 10-cm2 increment). Nystagmus tended to be associated with fall risk. In contrast, DHI score did not predict fall risk (P = .43; 1.0 [0.9-1.03]). Receiver operating characteristic analysis proposed a cut-off for postural sway with eyes closed >6.1 cm2 as optimal to predict falls in patients with nystagmus (AUC, 0.74; 95% confidence interval, 0.48-0.997). Poor postural balance is associated with increased fall risk after adjusting for subjective symptoms in older adults at otolaryngology clinics. Conversely, the self-perceived dizziness handicap of DHI score is an insufficient tool to evaluate their fall risk.

Association between Intelligence Level and Handicap Degree in Epilepsy Patients

Background:. Epilepsy correlates with high limitation value, disability and function loss which can give negative impact to patient’s quality of life. This negative impact correlates with either epilectic seizures (motoric, sensory and behavior) or effects of anti-epileptic drugs that can cause cognitive impairment, which in this case is intelligence aspect with handicap in epilepsy patients. We determined correlation between intelligence level and handicap degree in epilepsy patients. Methods: The research was conducted in patients of Neurological Department of Dr. Soetomo General Hospital, Surabaya, Indonesia, who met inclusion and exclusion criteria, consecutively from July 2013-December 2013. Intelligence test was conducted using Standard Progressive Matrices (SPM) test, while test on handicap degree was conducted using Subjective Handicap Epilepsy (SHE) test. Results: There were 40 research subjects (19 females and 21 males) with average age of 30.9±9.6. The average score of SHE was 70.08±16/69, while the average score of SPM was 88.53±10.34. There was a weak positive correlation and statistically significant correlation between SPM and SHE scores (r = 0.345 and p = 0.029). Conclusion: There was a correlation between intelligence level and handicap degree in epilepsy patients.

This issue of Acta

This issue of Acta

Correlation between morphological characteristics in spectral‐domain‐optical coherence tomography, different functional tests and a patient's subjective handicap in acute central serous chorioretinopathy

The purpose of this study was to identify quantitatively measurable morphologic optical coherence tomography (OCT) characteristics in patients with an acute episode of central serous chorioretinopathy (CSC) and evaluate their correlation to functional and psychological variables for their use in daily clinical practice. Retinal thickness (RT), the height, area and volume of subretinal fluid (SRF)/pigment epithelium detachments were evaluated using the standardized procedures of the Vienna Reading Center. These morphologic characteristics were compared with functional variables [best-corrected visual acuity (BCVA), contrast sensitivity (CS), retinal sensitivity/microperimetry, fixation stability], and patients' subjective handicap from CSC using the National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ-25). Data from 39 CSC patients were included in this analysis. Three different SRF height measures showed a high negative correlation (r=-0.7) to retinal sensitivity within the central 9°, which was also negatively correlated with SRF area and volume (r=-0.6). The CS score and fixation stability (fixation points within 2°) showed a moderate negative correlation (r=-0.4) with SRF height variables. Comparison of the subjective handicap with morphological characteristics in spectral-domain (SD)-OCT showed SRF height had the highest correlation (r=-0.4) with the subjective problems reported and overall NEI VFQ-25 score. In conclusion, SRF height measured in SD-OCT showed the best correlation with functional variables and patients' subjective handicap caused by the disease and therefore seems to be the best variable to look at in daily clinical routine. Even though area and volume also show a correlation, these cannot be so easily measured as height and are therefore not suggested for daily clinical routine.

The individual with epilepsy: perceptions about the disease and implications on quality of life.

The present study aims to analyze the perceptions of individuals with epilepsy about the disease and its impact in their quality of life (QoL). This is a cross-sectional, qualitative and quantitative study conducted in a tertiary referral hospital associated with the Brazilian National Health System (SUS). Data were collected from 30 individuals with diagnosis of refractory temporal lobe epilepsy (RTLE). The study participants responded to a questionnaire to collect sociodemographic and clinical data, as well as their perceptions about the disease. QoL was assessed by the Subjective Handicap of Epilepsy (SHE) and the Stigma Scale of Epilepsy (SSE). Significant correlation was found between stigma and quality of life and the work and activity and social and personal life domains, as well as between stigma and perceptions about epilepsy. The responses provided by the participants were organized into four categories: definitions and causes, seizures and treatment, family and social impacts, and impact on individuals' lives. The results show that participants have limited knowledge about epilepsy and that there is a negative impact caused by the stigma related to this disease on their QoL. It was possible to verify that QoL and stigma are directly related to the understanding of participants about epilepsy. Therefore, it is important to implement programs and actions that aim to provide patients and their families with more comprehensive knowledge about epilepsy; promote communication between health professionals and patients; and encourage the participation of patients and their families during treatment.

Case Study of Auditory Training for Long-Term Users of Hearing Aids with Poor Word Recognition

Purpose: Auditory training involves active listening to auditory stimuli. Auditory training has been reported to enhance performance in various auditory tasks, supplementing the limitation of hearing aids. The purpose of this case was to determine efficacy of 10-week auditory training for two hearing aids (HA) users even though they have used hearing aids more than 10 years but having little satisfaction on their HAs. Methods: We conducted a 10-week in-laboratory audiotory training (one session per week, about 1 hour per session). Four types of materials (environmental sounds, consonants, sentences, and crossword quiz) were used as training stimuli. Difficulty level for training was adjusted focusing on the use of an adaptive method. To examine the efficacy of the 10-week training, the recognition abilities of environmental sounds, consonants, words, and sentences were compared before and immediately after the training. As a subjective outcome, the Korean Evaluation Scale for Hearing Handicap (KESHH) questionnaire was also conducted before and after training. To examine retention of training effects, we conducted the same evaluations at 10-week, one month and seven months after the completion of training. Results: The recognition scores of all stimuli were improved immediately after 10-week training. The results of the self-reported questionnaire of KESHH demonstrated that auditory training reduced subjective handicap from impaired hearing, indicating that auditory training positively affected individual’s subjective satisfaction of HA. The training efficacy appeared to be maintained even seven months after the completion of training. Conclusion: Auditory training was effective to improve recognition performance as well as the subjective satisfaction of own HA for unsatisfactory HA users.

The Impact of Minimal to Mild Sensorineural Hearing Loss in Adults

The relationship between the pure-tone audiogram and the categorization of normal hearing or a mild hearing loss fails to account for other important non-audiometric factors that impact hearing ability for approximately one-third of adults. In order to obtain a complete hearing profile of our patients who present with normal hearing or a mild hearing loss, it is necessary to consider more than simply the results of the pure-tone audiogram. Both subjective hearing handicap via questionnaire and suprathreshold auditory measures (especially in background noise) have been shown to be sensitive to deficits not captured by the pure-tone audiogram. Viable treatment options with demonstrated benefit, such as mild-gain amplification, should be considered for this population.

The prevalence and subjective handicap of epilepsy in ilie- a rural riverine community in Southwest Nigeria: A door –to- door survey

The prevalence and subjective handicap of epilepsy in ilie- a rural riverine community in Southwest Nigeria: A door –to- door survey

P.1.k.033 Subjective handicap in people with epilepsy in Georgia and Turkey

P.1.k.033 Subjective handicap in people with epilepsy in Georgia and Turkey

The prevalence and subjective handicap of epilepsy in Ilie — A rural riverine community in South West Nigeria: A door-to-door survey

BackgroundThe prevalence of epilepsy is high in tropical countries, particularly in Africa with an estimated mean prevalence of 15 per 1000. There is lack of recent data on epilepsy prevalence in Nigeria. The main objective of this study was to determine the prevalence of epilepsy in Ilie in South West (SW) Nigeria, and the secondary objectives were to determine the clinical characteristics, the seizure types with electroencephalography (EEG) recording, the pattern of treatment, and to evaluate the subjective handicap of people with epilepsy (PWE). Materials and methodsThe study, which was descriptive cross-sectional, was carried out in Ilie, a rural community in South West Nigeria, using a simple random sampling technique. The survey was done in 2 phases from January 2013 to April 2013.Phase 1: Door-to-door screening using the WHO Neuroscience Research Protocol to detect neurological disorders by health workers.Phase 2: Individuals with positive screening had complete neurologic examination by neurologists as well as an EEG recording. The questionnaires for survey of epilepsy in tropical countries and subjective handicap of epilepsy were administered to all PWE. ResultsTwo thousand two hundred twelve individuals from 231 households were screened during the first phase, and 33 cases of neurologic diseases were detected. During the second phase, 10 cases were confirmed to be epilepsy by neurologists, thus giving a crude lifetime prevalence of 10/2212=4.5/1000 population (95% CI=2.30–8.04). ConclusionsThe prevalence of epilepsy in Ilie in South West Nigeria is rather low compared with previous figures from studies in rural Africa.

Cognitive and psychosocial effects of oxcarbazepine monotherapy in newly diagnosed partial epilepsy.

The aim of this study was to assess the effects of oxcarbazepine (OXC) on cognition and psychosocial difficulties in patients with new-onset partial epilepsy. Cognitive and psychosocial assessments were performed before and after 6 to 12 months of OXC monotherapy in 52 drug-naive patients (25 women; mean age, 31.1 years; SD, 12.1 years). Cognitive functions were evaluated with well-structured and validated tools. Mood, psychological distress, subjective handicap, and quality of life were also evaluated. Differences between baseline and after-treatment evaluation were compared and adjusted for possible confounders such as age, sex, seizure control, duration of epilepsy, assessment interval, and epileptogenic region. Mean assessment interval was 231.8 (range, 182-348) days, and mean (SD) OXC dose at retest was 693.8 (208.9) mg. The OXC was found to have no significant adverse effect on cognition. Furthermore, OXC monotherapy was not found to affect psychosocial difficulties, including psychological distress and subjective handicap. The results suggest that OXC monotherapy could be used to treat newly diagnosed partial epilepsy without adversely affecting cognitive and psychosocial functions.

Change of Voice Quality before and after Treatment of Short-Term Therapy with Proton Pump Inhibitor in Laryngopharyngeal Reflux

Received May 19, 2014 Revised July 23, 2014 Accepted July 23, 2014 Address for correspondence Jung Hyun Chang, MD, PhD Department of OtolaryngologyHead and Neck Surgery, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang 410-719, Korea Tel +82-31-900-0346 Fax +82-31-900-0613 E-mail manbang5@naver.com Background and ObjectivesZZThe aim of this study was to verify that voice analysis could be an alternate tool for the evaluation of proton pump inhibitor treatment of laryngopharyngeal reflux (LPR). Subjects and MethodZZTwenty-two patients with LPR symptoms underwent laryngoscopy, stroboscopy and their reflux finding index (RFI) were evaluated. Subjective reflux symptom scores (RSS) and voice handicap index (VHI) were completed at the baseline. All patients underwent voice analysis. Thereafter, patients had short-term proton pump inhibitor therapy for 6 weeks. The RFI, RSS, VHI and voice analysis were repeated during the last week of the treatment. ResultsZZRFI was improved and both RSS and VHI were improved after the treatment. RSS and VHI were significantly correlated. In voice analysis, shimmer significantly improved and harmony to noise ratio (HNR) also improved. ConclusionZZVoice analysis can be indicators of treatment results of laryngopharyngeal reflux disease. Korean J Otorhinolaryngol-Head Neck Surg 2014;57(10):703-6

Adequacy of the Simplified Version of the Tinnitus Handicap Inventory (THI-S) to Measure Tinnitus Handicap and Relevant Distress

Background and ObjectivesThe Tinnitus Handicap Inventory (THI) often requires patients to devote their time to complete the questionnaire than they expect. Given that it limits the effectiveness of THI in a busy clinical practice that desires a quick and easy assessment of tinnitus handicap, this study evaluated clinical usefulness of a Simplified version of Tinnitus Handicap Inventory (THI-S) in measuring the severity of tinnitus handicap as well as predicting the psychological distress associated with tinnitus.Subjects and MethodsA total of 129 outpatients suffering from tinnitus (61 with normal hearing and 68 with hearing loss) participated in this study. The responses of THI-S (10 items) and THI (25 items) were evaluated to quantify the subjective handicap of tinnitus. The self-perceived level of stress, anxiety, and depression of all participants was measured with a series of self-report questionnaires such as Korean version of Brief Encounter Psychosocial Instrument (BEPSI), State Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI), respectively. All the questionnaire responses were analyzed using non-parametric analyses to examine the convergence, comparability, internal consistency reliability and validity of THI-S.ResultsThe severity of tinnitus handicap and the relevant psychological distress greatly varied across individuals. The THI-S responses were comparable to original THI responses, regardless of hearing status of patients. The internal consistency of THI-S responses was found to be good for total score (Cronbach's α=0.83-0.91), with moderately high consistency for the emotional, functional, and catastrophic subscales. Significant (p<0.01) correlations of the THI-S with the THI (rs=0.95) as well as with the BEPSI, STAI, BDI questionnaires (rs=0.40-0.45) suggest that the THI-S questionnaire appeared to be useful to provide objective data of subjective tinnitus handicap as well as predict psychological distress. Three factors were extracted through factor analysis, which explained 73% of the total variance.ConclusionsDespite reducing the length of 25 items of THI to 10 items, the THI-S can be used as s a simple but reliable and valid tool for evaluating severity of tinnitus handicap as well as detecting its negative impact on psychological functioning.

Subjective handicap in people with epilepsy in Georgia and Turkey

Subjective handicap in people with epilepsy in Georgia and Turkey