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Hundreds more children and adults eligible for cochlear implants on the NHS

NICE| January 2019 | Hundreds more children and adults eligible for cochlear implants on the NHS

Following a review of the definition of severe to profound deafness which is used to identify if a cochlear implant might be appropriate, NICE have updated their eligibility criteria for cochlear implants. 

Meindert Boysen, director of the Centre for Technology Evaluation, said: “The appraisal committee listened to stakeholder concerns regarding the eligibility criteria for cochlear implants being out of date. Upon review it was concluded this needed to be updated.



“The new eligibility criteria for cochlear implants will ensure that they continue to be available on the NHS to those individuals who will benefit from them the most.”

Severe to profound deafness is now recognised as only hearing sounds louder than 80dB HL at 2 or more frequencies without hearing aids, a lowering of the previous threshold (Source: NICE).

NICE [press release]

Cochlear implants for children and adults with severe to profound deafness (part review of TA166)

See also:

Nursing Times  Hundreds more patients to be eligible for cochlear implants

The Independent NHS to offer hundreds more deaf people life-changing  cochlear implant 

Oral steroids do not help hearing for children with glue ear

NIHR | November 2018 | Oral steroids do not help hearing for children with glue ear

An NIHR-funded trial demonstrates that oral steroids do not improve hearing, symptoms, or quality of life in children with glue ear. This NIHR-funded trial compared oral steroids with placebo for 389 children with otitis media with effusion,  and found no significant effect on those outcomes.



The study shows that many children will improve spontaneously, even after three months of glue ear and confirms that steroids are not useful, even though they are well tolerated. Surgery to place ventilation tubes known as grommets is an option for children with persistent glue ear in and hearing loss in both ears. This evidence supports more informed discussions with parents about watchful waiting and the surgical options available.



Background: Children with persistent hearing loss due to otitis media with effusion are commonly managed by surgical intervention. A safe, cheap, and effective medical treatment would enhance treatment options. Underpowered, poor-quality trials have found short-term benefit from oral steroids. We aimed to investigate whether a short course of oral steroids would achieve acceptable hearing in children with persistent otitis media with effusion and hearing loss.

Methods: In this individually randomised, parallel, double-blinded, placebo-controlled trial we recruited children aged 2-8 years with symptoms attributable to otitis media with effusion for at least 3 months and with confirmed bilateral hearing loss. Participants were recruited from 20 ear, nose, and throat (ENT), paediatric audiology, and audiovestibular medicine outpatient departments in England and Wales. Participants were randomly allocated (1:1) to sequentially numbered identical prednisolone (oral steroid) or placebo packs by use of computer-generated random permuted block sizes stratified by site and child’s age. The primary outcome was audiometry-confirmed acceptable hearing at 5 weeks. All analyses were by intention to treat. This trial is registered with the ISRCTN Registry, number ISRCTN49798431.

Findings: Between March 20, 2014, and April 5, 2016, 1018 children were screened, of whom 389 were randomised. 200 were assigned to receive oral steroids and 189 to receive placebo. Hearing at 5 weeks was assessed in 183 children in the oral steroid group and in 180 in the placebo group. Acceptable hearing was observed in 73 (40%) children in the oral steroid group and in 59 (33%) in the placebo group (absolute difference 7% [95% CI -3 to 17], number needed to treat 14; adjusted odds ratio 1.36. There was no evidence of any significant differences in adverse events or quality-of-life measures between the groups.

Interpretation: Otitis media with effusion in children with documented hearing loss and attributable symptoms for at least 3 months has a high rate of spontaneous resolution. A short course of oral prednisolone is not an effective treatment for most children aged 2-8 years with persistent otitis media with effusion, but is well tolerated. One in 14 children might achieve improved hearing but not quality of life. Discussions about watchful waiting and other interventions will be supported by this evidence.

Full reference: Francis, N. A., et al | 2018|  Oral steroids for resolution of otitis media with effusion in children (OSTRICH): a double-blinded, placebo-controlled randomised trial | Lancet | 392 | 10147| 10.3310/signal-000674

Full signal from NIHR 

Is gout associated with a higher risk of hearing loss in adults?

A new cohort study examines whether gout is associated with a higher risk of hearing loss in older adults. 



Objectives To evaluate whether gout is associated with a higher risk of hearing loss in older adults.
Design Retrospective cohort study.
Setting USA.
Participants 5% random sample of US Medicare claims 2006–2012, representative of US adults aged 65 years or older.
Primary and secondary outcomes Incident (new) hearing loss identified by the presence of at least two claims at least 4 weeks apart with an International Classification of Diseases, Ninth Revision, 389.xx, with no respective claim in the baseline 1-year observation period.
Results Among the 1.71 million eligible people, 89 409 developed incident hearing impairment. The crude incidence rates of incident hearing impairment in people with versus without gout were 16.9 vs. 8.7 per 1000 person-years. Using Cox regression analyses adjusted for demographics, medical comorbidity and common cardiovascular and gout medications, we found that gout was associated with a significantly higher HR of incident hearing impairment, HR was 1.44. Findings were confirmed in sensitivity analyses that substituted continuous Charlson-Romano Index with categorical variable or all comorbidities and additionally cardiovascular risk factors, with minimal attenuation of HR.
Conclusions Gout is associated with a higher risk of development of hearing loss in older adults. Future studies need to assess the underlying mechanisms of this association.

The full article is available to read at BMJ Open  

Full reference: Singh, J.A.Cleveland, J.D. | 2018| Gout and hearing impairment in the elderly: a retrospective cohort study using the US Medicare claims data| 

Changing Hearing Performance and Sound Preference With Words and Expectations: Meaning Responses in Audiology

Hodgetts, W. E., Aalto, D., Ostevik, A., & Cummine, J. |2018 | Changing Hearing Performance and Sound Preference With Words and Expectations: Meaning Responses in Audiology| Ear and hearing| Epub ahead of print | Doi: 10.1097/AUD.0000000000000634

A new article, soon to be published in the journal Ear and hearing, adds to the literature on nonauditory factors such as motivation, effort, and task demands that can impact performance in clinics and laboratories. 



In this article, we explore two manipulations of “meaning response,” intended to either “impart” meaning to participants through the manipulation of a few words in the test instructions or to “invite” meaning by making the participant feel involved in the setting of their preferred sound.


In experiment 1, 59 adults with normal hearing were randomly assigned to one of the two groups. Group 1 was told “this hearing in noise test (HINT) you are about to do is really hard,” while the second group was told “this HINT test is really easy.” In experiment 2, 59 normal-hearing adults were randomly assigned to one of two groups. Every participant was played a highly distorted sound file and given 5 mystery sliders on a computer to move as often and as much as they wished until the sound was “best” to them. They were then told we applied their settings to a new file and they needed to rate their sound settings on this new file against either (1) another participant in the study, or (2) an expert audiologist. In fact, we played them the same sound file twice.


In experiment 1, those who were told the test was hard performed significantly better than the easy group. In experiment 2, a significant preference was found in the group when comparing “my setting” to “another participant.” No significant difference was found in the group comparing “my setting” to the “expert.”


Imparting or inviting meaning into the context of audiological outcome measurement can alter outcomes even in the absence of any additional technology or treatment. These findings lend support to a growing body of research about the many nonauditory factors including motivation, effort, and task demands that can impact performance in our clinics and laboratories.

Rotherham NHS staff can request this article here 


Comorbidities of hearing loss and the implications of multimorbidity for audiological care

Besser, J., Stropahl, M., Urry, E., & Launer, S. |2018| Comorbidities of hearing loss and the implications of multimorbidity for audiological care| Hearing Research| https://doi.org/10.1016/j.heares.2018.06.008

Hearing Research has published an article that considers the impact of  multimorbidities in audiological patients, it is available to read in full from Hearing Research. 




With increasing age, the risk of developing chronic health conditions also increases, and many older people suffer from multiple co-existing health conditions, i.e., multimorbidity. One common health condition at older age is hearing loss (HL). The current article reflects on the implications for audiological care, when HL is one of several health conditions in a multimorbidity. An overview of health conditions often co-existing with HL, so called comorbidities, is provided, including indications for the strength of the associations. The overview is based on a literature study examining cohort studies that were published in the years 2010–2018 and examined associations of hearing loss with other health conditions, namely Visual impairment, Mobility restrictions, Cognitive impairment, Psychosocial health problems, Diabetes, Cardiovascular diseases, Stroke, Arthritis, and Cancer. This selection was based on previous publications on common chronic health conditions at older age and comorbidities of hearing loss. For all of these health conditions, it was found that prevalence is larger in people with a HL and several longitudinal studies also found increased incident rates in people with a HL. The examined publications provide little information on how hearing loss should be managed in the clinical care of its comorbidities and vice versa. The current article discusses several options for adaptations of current care. Nonetheless, solutions for an integrated audiology care model targeting HL in a multimorbidity are still lacking and should be subject to future research.

Read the article here 

The Influence of Hearing Aid Gain on Gap-Detection Thresholds for Children and Adults With Hearing Loss

A new article published in the journal Ear and Hearing considers how a hearing aid contributes to the ability to perceive a gap in noise for children and adults with hearing loss.


ObjectivesThe objective of this experiment was to examine the contributions of audibility to the ability to perceive a gap in noise for children and adults. Sensorineural hearing loss (SNHL) in adulthood is associated with a deficit in gap detection. It is well known that reduced audibility in adult listeners with SNHL contributes to this deficit; however, it is unclear the extent to which hearing aid amplification can restore gap-detection thresholds, and the effect of childhood SNHL on gap-detection thresholds have not been described. For adults, it was hypothesized that restoring the dynamic range of hearing for listeners with SNHL would lead to approximately normal gap-detection thresholds. Children with normal hearing (NH) exhibit poorer gap-detection thresholds than adults. Because of their hearing losschildren with SNHL have less auditory experience than their peers with NH. Yet, it is unknown the extent to which auditory experience impacts their ability to perceive gaps in noise. Even with the provision of amplification, it was hypothesized that children with SNHL would show a deficit in gap detection, relative to their peers with normal hearing, because of reduced auditory experience.

DesignThe ability to detect a silent interval in noise was tested by adapting the stimulus level required for detection of gap durations between 3 and 20 ms for adults and children with and without SNHL. Stimulus-level thresholds were measured for participants with SNHL without amplification and with two prescriptive procedures—the adult and child versions of the desired sensation level i/o program—using a hearing aid simulator. The child version better restored the normal dynamic range than the adult version. Adults and children with NH were tested without amplification.

ResultsWhen fitted using the procedure that best restored the dynamic range, adults with SNHL had stimulus-level thresholds similar to those of adults with normal hearing. Compared to the children with NH, the children with SNHL required a higher stimulus level to detect a 5-ms gap, despite having used the procedure that better restored the normal dynamic range of hearing. Otherwise, the two groups of children had similar stimulus-level thresholds.

ConclusionThese findings suggest that apparent deficits in temporal resolution, as measured using stimulus-level thresholds for the detection of gaps, are dependent on age and audibility. These novel results indicate that childhood SNHL may impair temporal resolution as measured by stimulus-level thresholds for the detection of a gap in noise. This work has implications for understanding the effects of amplification on the ability to perceive temporal cues in speech.

Full reference: Brennan, M. A., McCreery, R. W., Buss, E., & Jesteadt, W. |2018| The Influence of Hearing Aid Gain on Gap-Detection Thresholds for Children and Adults With Hearing Loss|Ear and hearing| Vol. 39|(5)| P. 969-979.

This article can be requested by Rotherham NHS staff here 

Sound therapy (using amplification devices and/or sound generators) for tinnitus in adults

Sereda  M, Xia  J, El Refaie  A, Hall  DA, Hoare  DJ| 2018|  Sound therapy (using amplification devices and/or sound generators) for tinnitus in adults. Cochrane Database of Systematic Reviews |Issue 8| Art. No.: CD013094| DOI: 10.1002/14651858.CD013094.

The Cochrane Library has published a  new protocol for an update of two Cochrane Reviews on sound therapy (masking) and on amplification with hearing aids for tinnitus that were first published in the Cochrane Library in Issue 12, 2010 and updated in 2012 (Hobson 2012).


The protocol is available from The Cochrane Library 

protocol for a Cochrane Review (Intervention). The protocol assesses the effect of sound therapy (using amplification devices and/or sound generators) for tinnitus in adults.