Vestibular Assessment and Rehabilitation: Ten-Year Survey Trends of Audiologists’ Opinions and Practice

Nelson, M. et al. JJournal of the American Academy of Audiology, Volume 27, Number 2, February 2016, pp. 126-140(15)

Image shows section through the vestibular organ.

Background: The past decade has yielded changes in the education and training of audiologists and technological advancements that have become widely available for clinical balance function testing. It is unclear if recent advancements in vestibular instrumentation or the transition to an AuD degree have affected audiologists’ vestibular clinical practice or opinions.

Purpose: The purpose of this study was to examine predominant opinions and practices for vestibular assessment (VA) and vestibular rehabilitation (VR) over the past decade and between master’s- and AuD-level audiologists.

Method: A 31-question survey was administered to audiologists via U.S. mail in 2003 (N = 7,500) and electronically in 2014 (N = 9,984) with a response rate of 12% and 10%, respectively.

Results: There was an increase in the number of audiologists providing vestibular services in the past decade. Most respondents agreed that audiologists were the most qualified professionals to conduct VA. Less than half of the surveyed audiologists felt that graduate training was adequate for VA. AuD-level audiologists were more satisfied with graduate training and felt more comfortable performing VA compared to master’s-level audiologists. Few respondents agreed that audiologists were the most qualified professionals to conduct VR or that graduate training prepared them to conduct VR. The basic vestibular test battery was unchanged across surveys and included: calorics, smooth pursuit, saccades, search for spontaneous, positional, gaze and optokinetic nystagmus, Dix‐Hallpike, case history, and hearing evaluation. There was a trend toward greater use of air (versus water) calorics, videonystagmography (versus electronystagmography), and additional tests of vestibular and balance function.

Conclusions: VA is a growing specialty area in the field of audiology. Better training opportunities are needed to increase audiologists’ knowledge and skills for providing vestibular services. The basic tests performed during VA have remained relatively unchanged over the past 10 yr.

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Motivational engagement in first-time hearing aid users: A feasibility study

Ferguson, M. et al. International Journal of Audiology. Published online: 26 Feb 2016.

Objective: To assess (1) the feasibility of incorporating the Ida Institute’s Motivation Tools into a UK audiology service, (2) the potential benefits of motivational engagement in first-time hearing aid users, and (3) predictors of hearing aid and general health outcome measures.

Design: A feasibility study using a single-centre, prospective, quasi-randomized controlled design with two arms. The Ida Institute’s Motivation Tools formed the basis for motivational engagement.

Study sample: First-time hearing aid users were recruited at the initial hearing assessment appointment. The intervention arm underwent motivational engagement (M+, n = 32), and a control arm (M-, n = 36) received standard care only.

Results: The M+ group showed greater self-efficacy, reduced anxiety, and greater engagement with the audiologist at assessment and fitting appointments. However, there were no significant between-group differences 10-weeks post-fitting. Hearing-related communication scores predicted anxiety, and social isolation scores predicted depression for the M+ group. Readiness to address hearing difficulties predicted hearing aid outcomes for the M- group. Hearing sensitivity was not a predictor of outcomes.

Conclusions: There were some positive results from motivational engagement early in the patient journey. Future research should consider using qualitative methods to explore whether there are longer-term benefits of motivational engagement in hearing aid users.

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Factors influencing pursuit of hearing evaluation: Enhancing the health belief model with perceived burden from hearing loss on communication partners

Schulz, K. A. et al. International Journal of Audiology. Published online: 15 Feb 2016.

Objective: There is limited application of health behavior-based theoretical models in hearing healthcare, yet other fields utilizing these models have shown their value in affecting behavior change. The health belief model (HBM) has demonstrated appropriateness for hearing research. This study assessed factors that influence an individual with suspected hearing loss to pursue clinical evaluation, with a focus on perceived burden of hearing loss on communication partners, using the HBM as a framework.

Design: Cross-sectional design collecting demographics along with three validated hearing-loss related questionnaires.

Study sample: Patients from Duke University Medical Center Otolaryngology Clinic aged 55–75 years who indicated a communication partner had expressed concern about their hearing. A final sample of 413 completed questionnaire sets was achieved.

Results: The HBM model construct ‘cues to action’ was a significant (p <0.001) predictor of pursuing hearing evaluation. Perceived burden of hearing loss on communication partners was a significant (p <0.001) predictor of pursuing hearing evaluation and improves the model fit when added to the HBM: 72.0% correct prediction when burden is added versus 66.6% when not (p <0.0001).

Conclusions: Hearing healthcare initiatives that incorporate these factors may improve hearing help-seeking behavior. More research using sound theoretical models in hearing healthcare is warranted.

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Predictors of Psychosocial Outcomes in Hard of Hearing Preschool Children

Laugen, N. et al. J. Deaf Stud. Deaf Educ. (2016) 

Children with hearing loss are at risk for developing psychosocial problems. Children with mild to severe hearing loss are less frequently subject to research, in particular in preschool, and we therefore know less about the risk in this particular group. To address this, we compared psychosocial functioning in thirty-five 4–5-year olds with hearing aids to that of 180 typically hearing children. Parent ratings of psychosocial functioning and social skills, as well as scores of receptive vocabulary, were obtained. Children with hearing loss evidenced more psychosocial problems than hearing agemates. Female gender and early detection of hearing loss predicted better psychosocial functioning among children with hearing loss, whereas vocabulary and degree of hearing loss did not. Early intervention addressing psychosocial functioning is warranted for children with all degrees of hearing loss, including mild and moderate. Gender differences should be investigated in future research.

Children who are deaf and hard of hearing (DHH) are at risk for psychosocial problems (Fellinger, Holzinger, Sattel, & Laucht, 2008;Moeller, 2007). Identifying the prevalence of psychosocial problems and their potential causes are vital to prevent and ameliorate these. Research has often addressed children with cochlear implants (Hogan, Shipley, Strazdins, Purcell, & Baker, 2011), but we know comparatively less about the psychosocial development of hard of hearing (HH) children; that is, children with mild to severe hearing loss (25–89 dB) who often use spoken language as their main language and who benefit from hearing aids rather than cochlear implants. By many, this group has been described as “historically underserved” (Holte et al., 2012, p. 163). This lack of knowledge even concerns basic information such as gender differences in psychosocial problems, as outcomes about this particular group are rarely reported separately in DHH research.

Psychosocial adjustment includes emotional, social, and behavioral aspects. Development within these areas is associated with one’s mental health, which is defined by WHO as “a state of well-being in which every individual realizes his or her own potential” (WHO, 2014). There is a substantial continuity in psychosocial difficulties from preschool years to middle childhood and adolescence (Luby, Gaffrey, Tillman, April, & Belden, 2014), thus emphasizing the importance of early intervention in this area. Even so, most research has been directed towards middle childhood and adolescence. It is therefore especially important to study preschoolers to provide a knowledge base to build early interventions upon. Specifically, there is a considerable lack of knowledge about (a) the prevalence of psychosocial problems and (b) its relation to degree of hearing loss, gender, and other potential risk and protective factors in HH preschool children. The overarching aim of this study is therefore to provide such information.

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Latest developments in Tinitus

Nicola George. Action on Hearing Loss.

Auris Medical also has another experimental drug called AM-101 in late-stage clinical testing for the treatment of acute tinnitus. When the sensory cells in the ear are exposed to trauma such as loud noise or toxins, they can send abnormal signals to the auditory nerve. These damaging signals are thought to be the start of some types of tinnitus.  AM-101 works by blocking these damaging signals and the clinical researchers hope that by treating this early stage of tinnitus, longer term tinnitus will be prevented. People who have had tinnitus for less than 6 months can take part in the clinical trial in certain hospitals and ENT clinics across the UK. More information about the trial and how to take part can be found at the Tinnitus Study website.

In an earlier stage clinical trial in America, the biotech company Otonomy have begun testing their new drug OTO-311 for the treatment of tinnitus. Because this is the first time OTO-311 has been given to people (a “Phase 1” clinical trial), this study will be carried out in healthy volunteers first so that researchers can be sure that the treatment is safe.  During 2016 they will test different doses of OTO-311 and if all goes well with this Phase 1 study, the company hopes to begin testing in people with tinnitus in the second half of the year.

Medicines to help improve cochlear implants

Nicola George. Action on Hearing Loss.

Cochlear implants allow profoundly deaf people, for whom hearing aids provide lArtist's impression of synapses connecting between neurons.ittle benefit, to hear by electrically stimulating the auditory nerve. For some people who receive a cochlear implant, the level of improvement in their hearing is not as great as expected. The biotech company Autifony Therapeutics are planning a clinical trial to test their experimental drug, AUT00063, in people with cochlear implants who are not gaining the expected benefit from their device. AUT00063 acts on nerves that carry sound signals from the ear to the brain and the researchers hope that this treatment will improve the transmission of nerve signals from the implant to the brain and increase the benefit that people get from a cochlear implant, especially in the perception of speech.

Over recent years, improvements in cochlear implant technology and surgical techniques have meant that cochlear implants can be given to people who have some residual natural hearing in the implanted ear. This allows people to benefit from “artificial” hearing through the implant while still being able to use any natural hearing that remains in the same ear (usually a degree of low frequency hearing). However there is a risk that this residual natural hearing will deteriorate over time due to the effects of the implant on the remaining sensory cells of the inner ear. In a clinical trial planned to start in the middle of 2016, the biotech company Auris Medical will test if administering their experimental medicine AM-111 during cochlear implant surgery will reduce the risk of progressive loss of residual natural hearing by blocking one of the biological pathways that causes sensory cells in the ear to die.

Attentional Bias in Patients with Decompensated Tinnitus: Prima Facie Evidence from Event-Related Potentials

Li, Z. et al. Audiology & Neurotology 2016;21:38-44

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Image source: Jen Collins

Tinnitus refers to the auditory perception of sound in the absence of external sound or electric stimuli. The influence of tinnitus on cognitive processing is at the cutting edge of ongoing tinnitus research.

In this study, we adopted an objective indicator of attentional processing, i.e. the mismatch negativity (MMN), to assess the attentional bias in patients with decompensated tinnitus. Three kinds of pure tones, D1 (8,000 Hz), S (8,500 Hz) and D2 (9,000 Hz), were used to induce event-related potentials (ERPs) in the normal ear. Employing the oddball paradigm, the task was divided into two blocks in which D1 and D2 were set as deviation stimuli, respectively. Only D2 induced a significant MMN in the tinnitus group, while neither D1 nor D2 was able to induce MMN in the control group. In addition, the ERPs in the left hemisphere, which were recorded within the time window of 90-150 ms (ERP90-150 ms), were significantly higher than those in the right hemisphere in the tinnitus group, while no significant difference was observed in the control group. Lastly, the amplitude of ERP90-150 ms in the tinnitus group was significantly higher than that in the control group.

These findings suggest that patients with decompensated tinnitus showed automatic processing of acoustic stimuli, thereby indicating that these patients allocated more cognitive resources to acoustic stimulus processing. We suggest that the difficulty in disengaging or facilitated attention of patients might underlie this phenomenon. The limitations of the current study are discussed.

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