Use Of Hearing Devices Research Articles

Speech Comprehension by Cochlear Implant Users Assessed with Evoked Potentials and Response Times

Introduction: Cochlear implant (CI) users differ greatly in their rehabilitation outcomes, including speech understanding in noise. This variability may be related to brain changes associated with intact senses recruiting cortical areas from stimulation-deprived senses. Numerous studies have demonstrated such cross-modal reorganization in individuals with untreated hearing loss. How it is affected by regular use of hearing devices remains unclear, however. To shed light on this, the current study measured cortical responses reflecting comprehension abilities in experienced CI users and normal-hearing controls. Methods: Using multichannel electroencephalography, we tested CI users who had used their devices for at least 12 months and closely matched controls (N = 2 × 13). Cortical responses reflecting comprehension abilities – the N400 and late positive complex (LPC) components – were evoked using congruent and incongruent digit-triplet stimuli. The participants’ task was to assess digit-triplet congruency by means of timed button presses. All measurements were performed in speech-shaped noise 15 dB above individually measured speech recognition thresholds. Three stimulus presentation modes were used: auditory-only, visual-only, and visual-then-auditory. Results: The analyses revealed no group differences in the N400 and LPC responses. In terms of response times, the CI users were slower and differentially affected by the three stimulus presentation modes relative to the controls. Conclusion: Compared to normal-hearing controls, experienced CI users may need more time to comprehend speech in noise. Response times can serve as a proxy for speech comprehension by CI users.

The Impact of Bimodal Hearing on Speech Acoustics of Vowel Production in Adult Cochlear Implant Users.

This study aimed to investigate the acoustic changes in vowel production with different forms of auditory feedback via cochlear implant (CI), hearing aid (HA), and bimodal hearing (CI + HA). Ten post-lingually deaf adult bimodal CI users (aged 50-78 years) produced English vowels /i/, /ɛ/, /æ/, /ɑ/, /ʊ/, and /u/ in the context of /hVd/ during short-term use of no device (ND), HA, CI, and CI + HA. Segmental features (first formant frequency [F 1], second formant frequency [F 2], and vowel space area) and suprasegmental features (duration, intensity, and fundamental frequency [f o]) of vowel production were analyzed. Participants also categorized a vowel continuum synthesized from their own productions of /ɛ/ and /æ/ using HA, CI, and CI + HA. F 1s of all vowels decreased; F 2s of front vowels but not back vowels increased; vowel space areas increased; and vowel durations, intensities, and f os decreased with statistical significance in the HA, CI, and CI + HA conditions relative to the ND condition. Only f os were lower, and vowel space areas were larger with CI and CI + HA than with HA. Average changes in f o, intensity, and F 1 from the ND condition to the HA, CI, and CI + HA conditions were positively correlated. Most participants did not show a typical psychometric function for vowel categorization, and thus, the relationship between vowel categorization and production was not tested. The results suggest that acoustic, electric, and bimodal hearing have a measurable impact on vowel acoustics of post-lingually deaf adults when their hearing devices are turned on and off temporarily. Also, changes in f o and F 1 with the use of hearing devices may be largely driven by changes in intensity.

Age-related Hearing Loss and Aldosterone Treatment

Hearing loss is a common cause of disability in the global population. The prevalence of hearing loss is estimated to dramatically increase in the next decades with an increase in the number of older people. The fact that hearing loss correlates with aging suggests that age-related hearing loss (presbycusis) will be a critical issue and hearing care will be required. Untreated hearing loss has negative effects at multiple levels, such as hearing loss affecting the quality of life of hearing-impaired individuals, deteriorating family relationships, and interfering with economic growth. Unfortunately, treatments for hearing loss are limited to the use of hearing devices. Studies have shown that the number of hearing aid users is approximately 20% of all hearing-impaired individuals. Therefore, having alternative treatments is critical to reduce the number of people with hearing loss and to prevent a dramatic increase in the number of hearing-impaired individuals. In the future, a potential medication may be aldosterone (ALD). Studies have reported positive effects of ALD treatments on hearing loss in aged mice. ALD treatment in aged mice shows an improvement in hearing sensitivity and a healthier cochlear structure. Although higher ALD concentrations are associated with better hearing sensitivity and hearing in noise ability than lower concentrations, there is no clinical trial in ALD treatment in human has been reported.

Prevalence of Cochlear Nerve Deficiency and Hearing Device Use in Children With Single-Sided Deafness.

This study aimed to assess the prevalence of cochlear nerve deficiency (CND) in a cohort of pediatric patients with single-sided deafness (SSD). A secondary objective was to investigate trends in intervention and hearing device use in these children. Case series with chart review. Pediatric tertiary care center. Children ages 0 to 21 years with SSD (N = 190) who underwent computerized tomography (CT) and/or magnetic resonance imaging (MRI) were included. Diagnostic criteria for SSD included unilateral severe-to-profound sensorineural hearing loss with normal hearing sensitivity in the contralateral ear. Diagnostic criteria for CND included neuroradiologist report of an "aplastic or hypoplastic nerve" on MRI or a "stenotic cochlear aperture" on CT. The prevalence of CND was 42% for children with CT only, 76% for children with MRI only, and 63% for children with both MRI and CT. Of the children with MRI and CT, there was a 90% concordance across imaging modalities. About 36% of children with SSD had hearing devices that routed sound to the normal hearing ear (ie, bone conduction hearing device/contralateral routing of signal), while only 3% received a cochlear implant. Approximately 40% did not have a hearing device. Hearing device wear time averaged 2.9hours per day and did not differ based on cochlear nerve status. There is a high prevalence of CND in children with SSD. Cochlear nerve status should be confirmed via MRI in children with SSD. The limited implementation and use of hearing devices observed for children with SSD reinforce the need for increased support for early and continuous intervention.

Hearing outcomes in children with congenital cytomegalovirus infection: From management controversies to lack of parents' knowledge.

Congenital cytomegalovirus (cCMV) is the leading nongenetic cause of sensorineural hearing loss (HL). However, there are no universally accepted approaches to diagnosis, follow-up and treatment. The aim of this study was to evaluate the main characteristics of cCMV-infected children, focusing on their management and long-term hearing outcomes. This retrospective study included all children with cCMV infection who were referred to a third-level referral audiologic center for a 6-year hearing follow-up. The main information collected from the medical records included gestational age, birth weight, trimester of maternal seroconversion, hearing status at birth and after 6 years, hearing fluctuations, treatment with oral valganciclovir (within the first month of life and for 6 months), use of hearing devices, presence of speech-language delay, motor delay, cognitive delay and balance disorders, awareness of cCMV among parents, and parents' engagement in behaviors that could increase the risk of CMV infection during pregnancy. A total of 141 children with cCMV infection (72 males and 69 females; mean gestational age: 37+3 weeks; mean birth weight: 2893g) were assessed. Overall, 48 children (34.0%) had a diagnosis of speech-language delay, 32 (22.7%) of sensorineural HL (59.4% bilaterally; 50% of profound degree), 18 (12.8%) of motor delay, 16 (11.3%) of balance disorders, and 6 (4.3%) of cognitive delay. Among children with HL, 8 (25.0%) were fitted with hearing aids (5 unilaterally and 3 bilaterally), and 5 (15.6%) had undergone cochlear implantation (1 unilaterally and 4 bilaterally), while a bimodal hearing solution was adopted for 2 (6.3%) patients. Compared to children with asymptomatic cCMV infection, symptomatic children had a higher prevalence of neurological and auditory sequelae (P<0.01) and bilateral (P=0.003) and severe-to-profound HL (P=0.004). Overall, 23 children (16.3%) received oral valganciclovir, and only one of them experienced hearing deterioration. Only 14.9% of mothers and 5% of fathers were aware that cCMV could cause progressive or late-onset HL, and 87.9% of parents (248/282) had engaged in behaviors that increased the risk of CMV infection during pregnancy. This study confirmed the importance of performing a long audiological follow-up in children diagnosed with cCMV infection due to the possible late-onset, progressive and fluctuating nature of HL. Moreover, the study highlighted many current controversies in preventive (poor prenatal education), diagnostic (routine maternal serological screening) and therapeutic (valganciclovir administered to asymptomatic children) approaches to cCMV infection. More efforts should be made to improve prevention strategies and raise awareness of cCMV infection risks among the population.

U.S. Population Data on Hearing Loss, Trouble Hearing, and Hearing-Device Use in Adults: National Health and Nutrition Examination Survey, 2011-12, 2015-16, and 2017-20.

The National Health and Nutrition Examination Survey (NHANES) data on audiometric hearing loss, self-reported trouble hearing, and the use of hearing aids and assistive listening devices (ALDs) for the three most recent surveys (2011-12, 2015-16, and 2017-20) were analyzed for adults ranging in age from 20 to 80-plus years. Complete audiograms were available for a total of 8,795 adults. The prevalence of hearing loss, measured audiometrically and self-reported, is provided for males and females by age decade. Logistic-regression analyses identified variables affecting the odds of having an audiometrically defined hearing loss or self-reported trouble hearing. As in previous reports, males were more likely than females to have audiometric hearing loss and the prevalence of hearing loss increased steadily with advancing age. The same trends were observed for self-reported hearing difficulty, although the effects of age and sex were smaller for self-reported trouble hearing compared to audiometric hearing loss. The agreement between the audiometric classification of hearing loss severity and the amount of trouble reported on the self-report measure was moderate (r = 0.61). The prevalence of hearing-aid and ALD use differed for males and females of the same age, females generally using these devices less frequently than males, but both showing increased prevalence of device use with advancing age. Unmet hearing-healthcare need, defined as the percentage of those with identified hearing loss or trouble hearing who were not current hearing-aid users or had never tried hearing aids or ALDs, was about 85%.

Effect of Hearing Device Use on Speech-in-Noise Performance in Children with Severe-to-Profound Unilateral Hearing Loss.

Limited evidence exists for the use of rerouting devices in children with severe-to-profound unilateral sensorineural hearing loss. Many laboratory studies to date have evaluated hearing-in-noise performance in specific target-masker spatial configurations within a small group of participants and with only a subset of available hearing devices. In the present study, the efficacy of all major types of nonsurgical devices was evaluated within a larger group of pediatric subjects on a challenging speech-in-noise recognition task. Children (7-18 years) with unaided severe-to-profound unilateral hearing loss (UHL' n = 36) or bilateral normal hearing (NH, n = 36) participated in the present study. The signal-to-noise ratio (SNR) required for 50% speech understanding (SNR-50) was measured using BKB sentences in the presence of proprietary restaurant noise (R-SPACE BSIN-R) in the R-SPACE Sound System. Subjects listened under 2 target/masker spatial configurations. The target signal was directed toward subjects' NH or hearing-impaired ear (45º azimuth), while the interfering restaurant noise masker was presented from the remaining 7 loudspeakers encircling the subject, spaced every 45º. Head position was fixed during testing. The presentation level of target sentences and masking noise varied over time to estimate the SNR-50 (dB). The following devices were tested in all participants with severe-to-profound UHL: air conduction (AC) contralateral routing of signal (CROS), bone conduction (BC) CROS fitted on a headband with and without the use of remote microphone (RM), and an ear-level RM hearing assistance technology (HAT) system. As a group, participants with severe-to-profound UHL performed best when the target signal was directed toward their NH ear. Across listening conditions, there was an average 8.5 dB improvement in SNR-50 by simply orienting the NH ear toward the target signal. When unaided, participants with severe-to-profound UHL performed as well as participants with NH when the target signal was directed toward the NH ear. Performance was negatively affected by AC CROS when the target signal was directed toward the NH ear, whereas no statistically significant change in performance was observed when using BC CROS. When the target signal was directed toward participants' hearing-impaired ear, all tested devices improved SNR-50 compared with the unaided condition, with small improvements (1-2 dB) observed with CROS devices and the largest improvement (9 dB) gained with the personal ear-level RM HAT system. No added benefit nor decrement was observed when RM was added to BC CROS using a 50/50 mixing ratio when the target was directed toward the impaired ear. In a challenging listening environment with diffuse restaurant noise, SNR-50 was most improved in the study sample when using a personal ear-level RM HAT system. Although tested rerouting devices offered measurable improvement in performance (1-2 dB in SNR-50) when the target was directed to the impaired ear, benefit may be offset by a detriment in performance in the opposing condition. Findings continue to support use of RM HAT for children with severe-to-profound UHL in adverse listening environments, when there is one primary talker of interest, to ensure advantageous SNRs.

801 EFFECTIVENESS OF HEARING REHABILITATION FOR CARE HOME RESIDENTS WITH DEMENTIA: A SYSTEMATIC REVIEW

Abstract Introduction Hearing loss is common among people with dementia living in long-term care homes, leading to poorer quality of life, communication difficulties and exacerbated dementia-related symptoms. Hearing rehabilitation may improve outcomes; however, evidence suggests hearing is poorly managed in care homes. Methods A systematic review reporting on the effectiveness of, and barriers and facilitators to, hearing rehabilitation for residents with dementia was conducted. No restrictions on publication date or language were set and grey literature was considered. Eligible studies were critically appraised and presented via a narrative review. Results Sixteen studies, most of low-to-moderate quality, were identified. Hearing rehabilitation, including hearing devices, communication techniques and visual aids (e.g. flashcards), were reported to improve residents’ communication, quality of life and reduce agitation, with improvements in staff knowledge of hearing loss and job satisfaction. Residents’ symptoms of dementia presented barriers, e.g. losing or not tolerating hearing aids. Low staff prioritization of hearing loss due to time-pressures and lack of hearing-related training for staff were further barriers, particularly for residents who required assistance with hearing devices. Adopting a person-centered approach based on residents’ capabilities and preferences and involving family members facilitated hearing device use. Conclusions Residents with dementia can benefit from hearing rehabilitation. Identifying and implementing efficient, individualized hearing rehabilitation is necessary for those with complex cognitive needs. Increased funding and support for the social care sector is required to address systemic issues that pose barriers to hearing rehabilitation, including time-pressures, lack of training for staff and access to audiology services for residents.

Use of hearing devices and fluency in Brazilian Sign Language and oral language in deaf students

RESUMO Objetivo: avaliar a relação entre fluência na Libras, fluência na língua oral e o uso de dispositivos auxiliares para audição de estudantes surdos. Métodos: participaram 112 profissionais tradutores, intérpretes ou instrutores de Libras que informaram as características auditivas, fluência na Libras e língua oral dos estudantes acompanhados por eles, matriculados na rede municipal de uma cidade brasileira. A análise da associação entre fluência na Libras, fluência na língua oral, grau da perda auditiva e uso de dispositivo foi realizada por meio do teste qui-quadrado ou teste exato de Fisher, consideraram-se significantes valores de p&lt;0,05. Resultados: as respostas dos profissionais referiram-se a 88% (n=126) do total de estudantes surdos matriculados na rede municipal. A média de idade dos estudantes foi de 13 anos, sendo 72 (57%) meninos, 98 (78%) com perda auditiva severa ou profunda, 57 (45%) usuários de dispositivos eletrônicos auxiliares para audição, 83 (66%) fluentes somente na Libras, 12 (10%) fluentes apenas na língua oral e 18 (14%) fluentes na Libras e língua oral. Estudantes que utilizavam dispositivo auxiliar para audição apresentaram melhor fluência oral (p&lt;0,001). Dos estudantes que apresentavam fluência oral (n=30), 18 (60%) eram fluentes em Libras (p&lt;0,001). Conclusão: a Libras foi a modalidade comunicativa utilizada majoritariamente pelos estudantes surdos, mesmo por aqueles que utilizavam também a língua oral e dispositivos eletrônicos, o que pode indicar mudança de percepção social em relação ao surdo, à sua língua e cultura.

Uso de dispositivos auxiliares da audição e fluência na Libras e na língua oral de estudantes surdos

ABSTRACT Purpose: to assess the relationship between deaf students’ fluency in Brazilian Sign Language (BSL) and oral language and hearing aid use. Method: the sample comprised 112 professional BSL translators, interpreters, and instructors. They answered a questionnaire on hearing characteristics and BSL and oral language fluency of students accompanied by them, who attended municipal schools in a Brazilian city. Association analysis between oral language fluency, BSL fluency, the degree of hearing loss, and device use was made with the chi-square test or Fisher’s Exact test. The significance level was set at p&lt;0.05. Results: the professionals’ responses referred to 88% (n = 126) of all deaf students enrolled in municipal schools. The students’ mean age was 13 years; 72 (57%) were males, 98 (78%) had severe or profound hearing loss, 57 (45%) used electronic hearing devices, 83 (66%) were fluent only in BSL, 12 (10%) were fluent only in oral language, and 18 (14%) were fluent in both BSL and oral language. Hearing device use was statistically associated with oral fluency (p &lt; 0.001). Of all students fluent in oral language (n = 30), 18 (60%) were also fluent in BSL (p &lt; 0.001). Conclusion: BSL was the communication modality most used by students, including those who also used oral language and electronic hearing devices. This may indicate a change in the social perception of deaf people, their language, and their culture.

Acoustic voice parameters in hearing-impaired, school-aged children. Research study outcomes

Aim/Background: Individuals deprived of full hearing ability suffer from many problems in their social, professional, and personal lives. Prolonged hearing deprivation, particularly in children, results in many consequences including loss of control of one’s voice. Impaired hearing control of the voice leads to dysphonia of different degrees. The aim of this study was to analyse acoustic voice parameters in hearing-impaired, school-aged children (7–12 years) and the influence of treatment type on voice quality. Material and method: The subjects in this study were a group of 83 Polish school children, aged 7–12 years. ENT and phoniatric examination were performed on each subject prior to inclusion. Acoustic voice analysis was performed for each individual. The linguistic material was a prolonged [a] vowel. The acoustic analysis was performed with a digital spectrograph KAY 4300B for multidimensional voice analysis MDVP (Multi-Dimensional Voice Profile). The criterion to include patients in the study group was a profound prelingual, sensorineural hypoacusis. Within the study group, four subgroups were categorised according to the use of hearing devices: 20 children without any type of hearing device (HL), 20 children with hearing aids (HA), and 20 children with cochlear implants (CI). The children using hearing aids and cochlear implants were included in the study 6 months after the hearing rehabilitation was implemented. The control group (NH) consisted of 23 normal-hearing children, in the same age group, without any co-existing voice disorders. The statistical level of significance p &lt; 0.05 was used. Results: The selected, clinically significant voice parameters were analysed for the groups of children in the study.

Eyes Open, Ears On: Supporting Hearing Technology Use in Children with Hearing Loss

Eyes Open, Ears On: Supporting Hearing Technology Use in Children with Hearing Loss

Improvements and Degradation to Spatial Tactile Acuity Among Blind and Deaf Individuals

Cross-modal reorganization takes place for sensory cortices when there is no more primary input. For instance, the visual cortex in blind individuals which receives no visual input starts responding to auditory and tactile stimuli. Reorganization may improve or degrade processing of other modality inputs, via bottom-up compensational processes and top-down updating. In two experiments, we measured the spatial tactile response in a large sample of early- (N = 49) and late-blind (N = 51) individuals with varying levels of Braille proficiencies, and early-deaf (N = 69) with varying levels of hearing devices against separate hearing and sighted controls. Spatial tactile responses were measured using a standard gradient orientation task on two locations, the finger and tongue. Experiments show limited to no advantage in passive tactile response for blind individuals and degradation for deaf individuals at the finger. However, the use of hearing devices decreased the tactile impairment in early-deaf individuals. Also, no differences in age-related decline in both sensory-impaired groups were shown. Results show less tactile acuity differences between blind and sighted than previously reported, but supports recent reports of tactile impairment among the early-deaf.

Cochlear implant in Kearns-Sayre syndrome: A case study of twin sisters

&lt;p&gt;Hearing loss may be related to several factors, including hearing loss resulting from certain genetic syndromes. Kearns-Sayre syndrome is characterized by mutations in mitochondrial DNA (deoxyribonucleic acid), responsible for the production of energy (adenosine triphosphate-ATP), which is extremely important for the development of structures that require it, such as the cochlea. The case was followed up at the hospital since 2000, due to the progressive characteristic of hearing loss found in audiological tests and findings in cases related to the syndrome. The intervention with individual sound amplification devices proved to be of little benefit for good oral communication of one of the patients, who was diagnosed with bilateral profound hearing loss. Thus, after discussions in clinical meetings, the team opted for the indication of the cochlear implant for the patient, according to the current criteria for indication of this surgery, and with which it obtained good results. His twin sister, who presented good results with hearing aids, will continue in audiological follow-up, to verify the evolution of the case and discuss a new approach, if necessary. Patients with suspected or diagnosed Kearns-Sayre syndrome should seek audiological diagnosis, because it is a possible progressive hearing loss, requiring rehabilitation with the use of hearing devices. Maintaining oral communication is extremely important because, in these cases, other functions will be impaired, such as muscle tone and vision.&lt;/p&gt;

Nursing Management of Hearing Impairment in Nursing Facility Residents.

Hearing impairment (also known as hearing loss) is highly prevalent in residents of nursing facilities and its impacts are far-reaching. Hearing impairment has negative consequences for an individual's quality of life, psychosocial health, physical health, and mortality; these impacts are also exacerbated when hearing impairment cooccurs with other conditions, such as visual or cognitive impairment. These guidelines summarize the extensive evidence about the impacts of hearing impairment, the factors that are associated with increased risk of hearing impairment, assessment criteria for measuring impairment, and the management of residents' hearing impairment. Nursing interventions should focus on (a) cerumen management to reduce hearing impairment and allow for the use of hearing devices; (b) hearing device support so that residents can use hearing aids and/or other assistive listening devices; and (c) communication strategies so that conversations with residents can be facilitated. [Journal of Gerontological Nursing, 46(7), 15-25.].

Beliefs and Self-Efficacy of Parents of Young Children with Hearing Loss.

The purpose of this study was to learn more about the beliefs and self-efficacy of parents of young children with hearing loss. Seventy-two parents completed the Scale of Parental Involvement and Self-Efficacy-Revised (SPISE-R), which queries parents about their child's hearing device use and their perceptions of their own beliefs, knowledge, confidence, and actions pertaining to supporting their child's auditory access and spoken language development. Two beliefs were identified that related to parents' action scores and one belief was identified that related to children's hearing device use. Knowledge and confidence scores were significantly correlated with action scores and children's hearing device use, whereas only confidence scores were related to scores on a measure of children's spoken language abilities. Results indicate the SPISE-R is a promising tool for use in early intervention to better understand parents' strengths and needs pertaining to supporting their young child's auditory access and spoken language development.

Using Technology to Monitor Hearing Device Use and Linguistic Environments: Early Intervention Providers' Perspectives.

To improve outcomes for children with hearing loss, early intervention professionals must work with families to optimize children's hearing device use and the linguistic and auditory features of children's environments. Two technologies with potential use in monitoring these domains are data logging and Language Environment Analysis (LENA) technology. This study, which surveyed early intervention providers, had two objectives: (a) to determine whether providers' experiences, perspectives, and current practices indicated there was a need for tools to better monitor these domains, and (b) to gain a better understanding of providers' experiences with and perspectives on use of the two technologies. Most providers reported that they used informal, subjective methods to monitor functioning in the two domains and felt confident that their methods allowed them to know how consistently children on their caseloads were wearing their hearing devices and what their environments were like between intervention visits. Although most providers reported limited personal experience with accessing data logging information and with LENA technology, many reported receiving data logging information from children's audiologists. Providers generally believed access to the technologies could be beneficial, but only if coupled with proper funding for the technology, appropriate training, and supportive administrative policies.

Exploring the recruitment, ethical considerations, conduct and information dissemination of an audiology trial: a pretrial qualitative study (q-COACH)

IntroductionRandomised controlled trials (RCTs), while still considered the gold standard approach in medical research, can encounter impediments to their successful conduct and the dissemination of results. Pretrial qualitative research can usefully address some of these impediments, including recruitment and retention, ethical conduct, and preferred methods of dissemination. However, pretrial qualitative work is rarely undertaken in audiology. The Comparison of outcomes with hearing aids and cochlear implants in adults with moderately severe-to-profound bilateral sensorineural hearing loss (COACH) is a proposed RCT aiming to clarify when hearing aids (HAs) or cochlear implants (CIs) are the most suitable for different degrees of hearing loss and for which kinds of patients. q-COACH is a pretrial, qualitative study examining stakeholders’ experiences of HAs and CIs, current clinical practices and stakeholders’ perspectives of the design, conduct and dissemination plans for the proposed COACH study.MethodsTwenty-four participants including general practitioners, audiologists, adult HA users, and adult support networks undertook either semi-structured individual or paired interviews and completed demographic questionnaires. Data were analysed thematically.ResultsFour key themes arose from this study: 1) rethinking sampling and recruitment strategies, 2) ethical considerations, 3) refining trial conduct, and 4) interconnected, appropriate and accessible methods of results dissemination.ConclusionsThis qualitative investigation identified key considerations for the proposed RCT design, conduct and dissemination to help with successful implementation of COACH, and to indicate a plan of action at all RCT stages that would be acceptable to potential participants. By drawing on the perspectives of multiple key stakeholders and including a more general discussion of their experience and opinions of hearing loss, hearing device use and service availability, the study revealed experiential and ethical paradigms in which stakeholders operate. In so doing, q-COACH has exposed the benefits of preliminary qualitative investigations that enable detailed and rich understandings of the phenomenon at stake, forestalling problems and improving the quality of trial design, conduct and dissemination, while informing future RCT development discussions.

Effects of an Intervention Designed to Increase Toddlers' Hearing Aid Use.

The purpose of this study was to examine the effectiveness of Ears On, an intervention designed to increase toddlers' use of hearing devices. A single-case, multiple-baseline design across participants was used with three parent-child dyads who demonstrated low hearing aid use despite enrollment in traditional early intervention services. Data logging technology was used to objectively measure hearing aid use. A functional relationship was identified between participation in the intervention and the number of hours children utilized their hearing aids. Two dyads met the criterion set for completing the intervention: an average of 8hr of daily hearing aid use. One dyad did not reach this criterion but did meet the parent's goal of full-time use in the child's educational setting. For all dyads, increases in use were maintained 1 month after completion of the intervention. Findings support use of this short-term, intensive, individualized intervention to improve hearing aid use for toddlers with hearing loss.

Ear measurement of temperature is only useful for screening for fever in an adult emergency department

BackgroundA new generation of ear thermometers with preheated tips and several measurements points should allow a more precise temperature measurement. The aim of the study was to evaluate if the ear temperature measured by this ear thermometer can be used to screen for fever and whether the thermometer is in agreement with the rectal temperature and if age, use of hearing devices or time after admission influences the temperature measurements.MethodsOpen cross-sectional clinical single site study patients, > 18 years old, who were acutely admitted to the short stay unit at the ED. A sample size of 99 patient per subgroup was recruited as random convenience series. As ear thermometer Braun Thermoscan Pro 4000® and as rectal thermometer Omron Flex Temp Smart ® was used. For different cut off of temperature the AUC was calculated and Bland-Altman analysis for calculation of 95% limits of agreement with rectal temperature, with subgroup analysis concerning age, time span from admission time and use of hearing aid.ResultsAmong 599 patients the sensitivity to detect fever with an ear thermometer varied between 68 and 70% with AUC from 0.88–0.97. If the ear temperature was ≥37.5 oC, the sensitivity to detect patients with ≥38.0 oC rectally was 95% which raised to 100% for a rectal temperature of ≥38.3 oC. For the ear thermometer’s ability to determine the exact temperature the 95% limits of agreement were +/− 0.8 oC. with no influence from age, duration of hospital stay or hearing aids.ConclusionThe examined ear thermometer is able to detect fever, defined as ≥38 oC rectally in an adult ED population by using an ear cut-point of 37.5 oC, but not to measure the exact temperature. Used in this way around a fifth of the patients will still be in need of a rectal temperature measurement, but less than 5% with fever ≥38.0 oC will remain undetected and none with fever ≥38.3 oC. Age, admission time and use of hearing aid did not influence the temperature measurements.Trial registrationClinical Trials: ID NCT02977481, date 11/18/2016.