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AbstractObjectiveDesignStudy sampleResultsConclusionTo evaluate the role of Extended Scope (ES) audiologists in managing adult Ear Nose and Throat (ENT)/Otology waitlists and analyse patient re-presentation rate to the ENT service within 12 months of being discharged from the clinic.A retrospective cohort study assessing the efficacy of ES audiologists, measuring the discharge rate from ENT waitlists, the rate of escalation to ENT care, and the rate and reasons for any re-presentations to care.394 adult patients.Of the referred patients, 95% (n = 374) were deemed suitable for ES care. Of these, 75% were discharged without further ENT intervention, 20% required escalation to ENT, and 5% were returned to the waitlist. Only one patient re-presented for care within 12 months. The inclusion of patients with CHL/MHL and vestibular symptoms marked an expansion from our previous work. The re-presentation rate was notably lower compared to other allied health ES clinics.The ES Audiology clinic demonstrates a high discharge rate with a low incidence of patient re-presentation, highlighting the ES audiologists’ efficiency in managing non-urgent ENT cases. The study supports the continued use and expansion of ES roles to ensuring timely and quality care for patients on ENT waitlists. [ABSTRACT FROM AUTHOR]

To review the decision-making paradigm in the recommendations of BCI and aMEI overlapping candidacy for patients with conductive or mixed HL, and to determine if there are differences in hearing and quality of life outcomes between these implantable hearing devices. Retrospective data from patients receiving BCI or aMEI in the past decade were analysed. Patients were grouped into: 1. BCI candidates, 2. BCI or aMEI candidates, and 3. aMEI candidates. We compared outcomes and examined the impact of BC threshold, age at implantation, and duration of hearing loss on candidacy. 89 participants were included: 30 BCI, 37 aMEI, and 22 BCI or aMEI candidates. All groups performed similarly in aided sound field threshold testing. BCI group had lower speech scores in quiet compared to 'BCI or aMEI.' No significant differences were found in APHAB global scores. BC threshold, duration of hearing loss, and age at implantation had no significant effects. Outcomes were generally similar across groups, except for higher effective gain in the aMEI group. Our proposed patient pathway and decision-making approach facilitate candidate selection for aMEI and BCI, aiming to optimise outcomes. [ABSTRACT FROM AUTHOR]

To investigate the feasibility of using an extended scope (ES) audiology service to provide care to non-urgent adult patients waiting for an Ear Nose and Throat (ENT) appointment. Based on suitability criteria developed by the Audiology and ENT departments, an internal review of the ENT wait list identified patients who would be suitable for an ES audiology clinic. 220 non-urgent patients on the ENT wait list with hearing loss and/or tinnitus. A total of 220 patients were transferred from the ENT wait list to the ES audiology clinic: 200 (90.9%) were seen by the ES Audiologist and 20 (9.1%) patients self-discharged or did not attend the appointment. Out of the 200 patients seen, 175 (87.5%) were assessed, managed and discharged without the need for input from an Otologist. The remaining 25 (12.5%) patients needed an Otologist's input. This study has demonstrated the feasibility of an ES audiology clinic in a tertiary teaching hospital. Of those seen by ES audiologist, 87.5% were discharged from the ENT wait list without medical intervention. This model may represent an effective alternative pathway for lengthy outpatient waiting list management whilst providing patients with timely access to care. [ABSTRACT FROM AUTHOR]

Objective: This retrospective study investigates the incidence of elective cochlear implant (CI) non-use amongst a cohort of adult CI recipients with single-sided deafness (SSD), identifies the causes that led to non-use, and assesses how non-use could be prevented. Methods: All adults with SSD who received a CI between 2008 and 2018 and who became elective CI non-users were included. Elective non-users were defined as CI recipients who decided to stop using their CI or, if explantation was necessary, refused reimplantation. Results: 5/114 (4.4%) adults with SSD who received a CI became elective non-users. The 5 non-users were a mean 44.2 years old (range 33-70 years) at implantation, had a mean duration of deafness of 7.1 years (range 0.5-20 years) at implantation, and used their CI for a mean 11.5 months (range 1.5-60 months) before (fully) discontinuing use. The primary cause of elective non-use was postoperative discouragement due to unrealistic expectations (4 participants) regarding sound perception with the CI or about the greater than expected level of commitment necessary for rehabilitation. Conclusions: Elective non-use among adult CI recipients with single-sided deafness was very rare and could be further prevented by comprehensive counselling to ensure that candidates have realistic expectations about the rehabilitation requirements and the outcomes with the CI. [ABSTRACT FROM AUTHOR]

Objective: While cochlear implant (CI) provision for adults with single-sided deafness (SSD) is now an accepted treatment option, auditory training programs specific to this group of CI users have not been described. This paper details the auditory training protocol and critical factors required to rehabilitate CI users with post-lingual SSD. Outcomes and Results: Several key factors are integral to the success of the rehabilitation program; these include 1) CI users with SSD require a map that is balanced as closely as possible to their normal hearing ear and has optimal mapping levels; 2) the auditory training program needs to be stimulating, rewarding, and directly stimulate the implanted ear via Direct Auditory Input (DAI); 3) CI users need to achieve some success in the early post-implantation stages to maintain or increase their motivation; 3) CI users need to be fully committed to the auditory training; and 5) a well-defined structured auditory training program with immediate feedback and markers of success helps ensure optimal communication outcomes. As an indication of success, from the foundation of the program in 2008 until the present all adults with SSD who have received a CI at our clinic (N = 114) only 5 have elected to stop using their device. Conclusion: The auditory training program described herein has been developed to optimize hearing and quality of life outcomes for adult CI users with SSD. [ABSTRACT FROM AUTHOR]

Objectives: Cochlear implantation is becoming widely used outside the tertiary research centers for treatment of unilateral deafness (UD). No consensus exists, however, on the most suitable assessment/evaluation protocols for this group of adult patients. This paper aims to review the assessment and evaluation protocols used by various research groups and to propose a protocol for the use in the clinical setting. Methods: The PubMed, Embase, and Cochrane Library databases were searched with the keywords ‘cochlear’, ‘implant’, ‘single-sided’, ‘deafness’, ‘adults’, ‘unilateral’, and ‘deafness’. The words were either used individually, combined in pairs, or in groups of 5. All articles reporting on prospective studies, retrospective studies, or case studies were included. Results: Sixteen published studies met the inclusion criteria. Measures of hearing performance, tinnitus, subjective quality of hearing, and quality of life varied greatly among studies. Discussion: Adaptive speech in noise testing, localization, tinnitus measurement questionnaires, and self-rated hearing improvement are widely used among the research groups. These tools in conjunction assess and evaluate the main issues associated with UD. Conclusion: The test battery most commonly used to assess and evaluate adult cochlea implant users with UD consists of (a) a subjective self-rating of hearing performance, (b) localization testing, and (c) the adaptive speech in noise testing conducted in at least the following three spatial configurations: speech and noise presented from the front (S0/N0), speech presented from the front and noise presented to the good hearing ear (S0/Nhe), and speech presented to the implanted ear and noise presented to the hearing ear (Sci/Nhe). [ABSTRACT FROM PUBLISHER]

OBJECTIVE AND IMPORTANCE: This case report illustrates the ongoing extending criteria for cochlear implantation (CI). It reinforces the statement that patients who do not fulfill the standard criteria for CI should be carefully considered on an individual basis. Clinical presentation: The patient on this report presented with a ski-slope high-frequency hearing loss and chronic external ear canal infections. The latter precluded the consistent use of hearing aids with moulds. His speech discrimination in quiet and in noise was poor and his hearing loss was interfering with his ability to work. INTERVENTION: After years of frustration, this patient decided to risk losing his low-frequency residual hearing and was implanted with the new Nucleus((R)) CI422 (Cochlear Ltd). CONCLUSION: Hearing preservation was achieved and he gained a remarkable improvement in his hearing performance. It is thought that his outcomes are the result of the combination of hearing presentation surgery, electrode design, and intensive auditory training. [ABSTRACT FROM AUTHOR]

Objective and importance This case report illustrates the ongoing extending criteria for cochlear implantation (CI). It reinforces the statement that patients who do not fulfill the standard criteria for CI should be carefully considered on an individual basis. Clinical presentation The patient on this report presented with a ski-slope high-frequency hearing loss and chronic external ear canal infections. The latter precluded the consistent use of hearing aids with moulds. His speech discrimination in quiet and in noise was poor and his hearing loss was interfering with his ability to work. Intervention After years of frustration, this patient decided to risk losing his low-frequency residual hearing and was implanted with the new Nucleus® CI422 (Cochlear Ltd). Conclusion Hearing preservation was achieved and he gained a remarkable improvement in his hearing performance. It is thought that his outcomes are the result of the combination of hearing presentation surgery, electrode design, and intensive auditory training. [ABSTRACT FROM AUTHOR]

Objective: To assess the benefits of hearing aids on tinnitus according to the tinnitus reaction questionnaire (TRQ; Wilson et al, 1991), to verify whether the degree of masking provided by the hearing aid influenced the TRQ score, to examine whether the matched tinnitus pitch predicted the effectiveness of hearing aids in masking tinnitus, and to determine whether prescription of high-frequency amplification might be desirable in tinnitus management when tinnitus pitch is high. Design and study sample: A retrospective evaluation of the clinical outcomes of 70 tinnitus patients fitted with hearing aids was undertaken. The primary outcome measure was the TRQ, with a secondary subjective measure of tinnitus masking. Results: Participants who achieved masking with their hearing aids had greater reduction in TRQ scores. Masking was more likely to be achieved when participants had good low-frequency hearing and tinnitus pitch fell into the frequency range of the hearing aids. Conclusions: The results support the use of hearing aids for tinnitus management, and suggest that masking may be a significant contributor to hearing aid success, implying that high-frequency amplification may be effective in high-pitch tinnitus. [ABSTRACT FROM AUTHOR]

Abstract Objective: In this study, we aimed to explore a variation of the NTT standard protocol that would be more beneficial for those patients with hearing loss >50 dB HL in the worst ear (average hearing thresholds at 0.5, 1, 2, and 4 KHz). Study sample: This study involved 26 subjects who had previously undergone NTT at a single private practice. Design: Patients with high level of hearing loss were divided into two groups: Standard protocol group (SP) concluded the treatment following the standard NTT protocol proposed by the treatment's developers and Neuromonics guidelines. Extended protocol group (EP) was treated using a variation of the standard protocol, in which patients continued in stage 1 of the treatment for a prolonged time. Consistent with previously reported studies of the NTT, the tinnitus reaction questionnaire was used to assess tinnitus distress. Clinical outcomes for the two groups were analysed. Results: Both groups achieved statistically significant improvement of their tinnitus distress. EP group achieved quicker clinical benefits when compared to the SP group. Conclusions: Extension of high stimulation period from two to four months may be beneficial for patients with higher level of hearing loss undergoing NTT. Sumario Objetivo: En este estudio nuestro objetivo fue explorar la variación del protocolo estándar del NTT que puede ser más benéfica para los pacientes con una hipoacusia >50 dB HL en el peor oído (promedio de umbrales de audición a 0.5, 1, 2 y 4 KHz). Muestra: Este estudio incluyó a 26 sujetos que previamente habían recibido NTT en una sola clínica privada. Diseño: Los pacientes con una hipoacusia importante fueron divididos en dos grupos: el grupo del protocolo estándar (SP) concluyó el tratamiento siguiendo el protocolo NTT estándar propuesto por quienes desarrollaron las guías de Neuronomics. El grupo del protocolo extendido (EP) fue tratado utilizando una variación del protocolo estándar en el que los pacientes continuaron en el estadio 1 del tratamiento durante un tiempo prolongado. En concordancia con los resultados previamente reportados del NTT, se aplicó el cuestionario de reacción al acúfeno para evaluar la angustia por el mismo. Se analizaron los resultados clínicos de los dos grupos. Resultados: Ambos grupos alcanzaron una mejoría estadísticamente significativa del la angustia por el acúfeno. El grupo EP alcanzó el beneficio clínico más rápidamente comparado con el grupo SP. Conclusiones: La extensión del periodo de alta estimulación de dos a cuatro meses puede beneficiar a los pacientes con un nivel alto de hipoacusia que reciben NTT. [ABSTRACT FROM AUTHOR]

Objective and importance Herpes simplex virus (HSV) is reported to be the most common cause of viral encephalitis. Although extremely rare, reactivation of the virus has been reported following central nervous system surgery. To the best of our knowledge, there is no report in the literature that describes HSV encephalitis following cochlear implantation. Clinical presentation We report a case of meningo-encephalitis occurring 17 days after cochlear implantation using an electro-acoustic stimulation device, with oerioperative steroid medication. Intensive anti-viral therapy was given and the patient recovered from the acute illness over 2 weeks. Agitation and anxiety followed the encephalitis and subsequent progress with the cochlear implant was slow. Twelve months after cochlear implantation this patient shows a gradual and steady progress with her hearing rehabilitation. Conclusion Cochlear implantation surgery was either coincidental or was the trigger factor for reactivation of the HSV. Surgeons must be vigilant to post-surgical meningism symptoms particularly if patients have a history of herpes infections. [ABSTRACT FROM AUTHOR]