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Kaisa Bjuresäter,1 Mattias Bergström Andrén,2,3 Elina Mäki-Torkko,4,5 Agneta Anderzén-Carlsson,6 Per-Inge Carlsson2,5 1Institution of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden; 2Department of Audiology, Central Hospital, Region Värmland, Karlstad, Sweden; 3School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; 4Audiological Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; 5School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; 6University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, SwedenCorrespondence: Kaisa Bjuresäter, Email kaisa.bjuresater@kau.seBackground: Hearing loss increases with age and due to increased life expectancy there is an increase in the number of individuals living with hearing loss. Older people with hearing loss residing in nursing homes are often dependent on healthcare professionals to help them with their hearing aids.Objective: The aim of the study was to translate and test the psychometric properties of a Swedish version of a Norwegian questionnaire and to assess healthcare professionals’ self-reported knowledge, experience, skills, competence, and information needs pertaining to residents’ hearing loss and hearing aids in the Swedish context.Materials and Methods: A Norwegian questionnaire was translated and adapted, and thereafter distributed to healthcare professionals in nine nursing homes in mid Sweden between 2020 and 2021, and 313 questionnaires were returned.Results: An exploratory factor analysis demonstrated adequate factorial structure in six factors, satisfying construct validity and internal consistency for the Swedish version. A confirmatory factor analysis showed a satisfactory model fit. Healthcare professionals reported having the skills required for handling hearing aids, but reported lower scores for having received information about hearing aids, taking initiatives to refer residents to hearing healthcare units, and checking for earwax. Registered nurses generally reported lower perceived knowledge and practical skills concerning hearing aids. Seventy-seven percent of the total group reported a need for information regarding hearing aid maintenance.Conclusion: Healthcare professionals reported that the majority of nursing home residents need help with their hearing aids, but only a minority of these professionals had received education on hearing loss and training in hearing aid maintenance. Enrolled nurses and care assistants demonstrated higher levels of competence in handling hearing aids compared to registered nurses. In order to ensure safe and effective care, as well as facilitate communication among older adults with hearing loss, healthcare professionals need appropriate education and training.Keywords: hearing loss, nursing homes, health care professionals, competence, instrument translation, psychometric testing

Objectives: Over 90% of 4--5-year-old children in Sweden spend most of their awake time at preschool. The rooms are acoustically designed for educational purposes and not adapted to the specific preschool requirements. Also, sounds reaching a child's eardrum are not comparable to an adult's, as higher frequencies are affected differently by the torso, head, pinna and ear canal. Studies on children's perception and behavior support a sensitivity for high frequencies and studies of otoacoustic emissions indicative of hearing damage have further highlighted the risk. The intermittent sound characteristics in preschool may also contribute to an increased risk for hearing disorders, recently observed in a cohort study among preschool personnel. There is a great need to develop acoustic criteria that support preschool activities and child-specific hearing and health. To investigate the risk of noise-induced hearing problems for preschool children, our research team carried out two preparatory studies among preschool children. One among 12 children from two departments at a preschool in 2015, and one among 33 preschool children from six preschools in 2017. Material and methods: Noise levels were measured using stationary measurements and personal dosimeters. Hearing function was measured by Distortion Product Otoacoustic Emissions (DPOAE), which detects early changes in the hearing function after exposure to loud sounds. Results: The 2015 study showed a reduced function at 6 kHz (right ear) with a mean reduction of 2.59 dB p<0.05, after a day at preschool. Preliminary data from the 2017 follow-up, show a reduction over the week with similar effects sizes as the previous study but with the clearest and significant effects for 3 and 4 kHz (right ear). Pilot studies have also shown that a child dummy head receives up to 10 dB higher amplitudes around 6 kHz compared to an adult dummy head in a preschool sound environment. Given the child-specific amplification, certain higher frequency sounds may be perceived as painful and distressing by children. Initial support for these reactions was given in a qualitative study of 36, 4--6 years old preschool children. Uncontrollable sounds and distressing sounds i.e. angry, loud and scraping sounds were experienced both physically and emotionally painful. The importance of a child's perspective for acoustic interventions at preschools was further shown in a 2016 study where the reduction of noise levels was significantly associated with a 30% (OR=0.69) reduction of children's perception of scraping and screeching sounds. The study also associated scraping and screeching sounds with a 60% reduction of negative emotional reactions and an 80% reduction of stress-related symptoms. Conclusions: Taken together, current room-acoustic standards do not fully capture the acoustic needs of the preschool environment, nor that children experience the sound environment differently than adults. The current occupational safety regulations of the sound levels may not provide enough safety for children. There is, therefore, a great need to continue to study how we may prevent the risk of noise-induced stress and discomfort and hearing disorders among pre-school children. The pilot studies have formed a base for a current study that will relate detailed sound measurements from 33 preschools to measurements of around 330 children's perception (validated questionnaire), language (validated test) and impact on hearing (repeated measures of otoacoustic emissions). The aim is to identify child relevant acoustic criteria that may contribute to preventing noise-induced discomfort, stress and hearing disorders among pre-school children and adults. The posterpresentation will describe results from previous pilot studies and the plan for the larger study. [ABSTRACT FROM AUTHOR]

This study investigated the impact of bilateral bone conduction (BC) stimulation and sensorineural hearing loss on spatial release from masking, binaural intelligibility level difference, and lateralization. The study involved two groups of adults with mild to moderate sensorineural hearing loss: one group of 21 participants with symmetric hearing loss and another group of nine participants with asymmetric hearing loss. All tests were conducted through BC and air conduction (AC) headsets with non-individualized virtual positions of the sound sources and linear amplification based on individual hearing thresholds. The findings revealed a bilateral benefit for both groups of hearing-impaired individuals, with symmetric hearing loss yielding better results than asymmetric hearing loss. AC stimulation provided approximately twice the benefit in terms of dB compared to BC stimulation. A large part of this benefit originated from a favorable signal-to-noise ratio due to noise reduction from the head shadow. However, binaural processing was present in both hearing-impaired groups with bilateral BC stimulation. The ability to lateralize sounds based on interaural time delays was significantly impaired in participants with both types of hearing loss when stimulation was by BC. Despite these challenges, the study underscores the benefits of bilateral fitting of BC hearing aids, even in individuals with mild to moderate sensorineural hearing loss, whether symmetric or asymmetric., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: The objective of this study is to estimate the prevalence of self-reported hearing difficulties, vision difficulties and combined vision and hearing difficulties in a Swedish adult population that varies according to migration status, sex, age, disability measured by ADL and IADL and educational attainment level., Methods: The study utilised data from the Survey of Health, Ageing and Retirement in Europe, which consisted of 2257 individuals aged 60 and above that were interviewed in Sweden in the 2019/2020, SHARE wave 8. To determine the prevalence of sensory difficulties (hearing, vision and dual-sensory difficulties) among various subgroups of the population, a multinomial logistic regression was used. The results of these analyses are presented in terms of predicted probabilities., Results: The study findings indicate that foreign-born older adults experience a lower prevalence of visual difficulties (6.2% [3.3-11.5] in comparison to their Swedish-born counterparts. Moreover, older adults with higher levels of education tend to report a lower prevalence of sensory difficulties overall. Furthermore, sex differences are apparent, with males reporting a higher prevalence of hearing difficulties (18.9% [15.5-22.8] vs. 12.8% [10.7-15.3]) and females reporting a higher prevalence of vision difficulties (12.7% [10.7-15.1] vs. 8.5%[6.8-10.5])., Conclusion: The findings highlight disparities in the prevalence and type of perceived sensory difficulties experienced by older adults, by factors such as age, sex, education and migration status. It is important to consider these demographic factors in healthcare planning and interventions aimed at mitigating sensory difficulties in the older population., (© 2024. The Author(s).)

Background: An effective newborn hearing screening programme has low referral rate and low loss to follow-up (LTFU) rate after referral from initial screening. This systematic review identified studies evaluating the effect of protocol and programme factors on these two outcomes, including the screening method used and the infant group., Methods: Five databases were searched (latest: April 2021). Included studies reported original data from newborn hearing screening and described the target outcomes against a protocol or programme level factor. Studies were excluded if results were only available for one risk condition, for each ear, or for < 100 infants, or if methodological bias was observed. Included studies were evaluated for quality across three domains: sample, screening and outcome, using modified criteria from the Ottawa-Newcastle and QUADAS-2 scales. Findings from the included studies were synthesised in tables, figures and text., Results: Fifty-eight studies reported on referral rate, 8 on LTFU rate, and 35 on both. Only 15 studies defined LTFU. Substantial diversity in referral and LTFU rate was observed across studies. Twelve of fourteen studies that evaluated screening method showed lower referral rates with aABR compared to TEOAE for well babies (WB). Rescreening before hospital discharge and screening after 3 days of age reduced referral rates. Studies investigating LTFU reported lower rates for programmes that had audiologist involvement, did not require fees for step 2, were embedded in a larger regional or national programme, and scheduled follow-up in a location accessible to the families. In programmes with low overall LTFU, higher LTFU was observed for infants from the NICU compared to WB., Conclusion: Although poor reporting and exclusion of non-English articles may limit the generalisability from this review, key influential factors for referral and LTFU rates were identified. Including aABR in WB screening can effectively reduce referral rates, but it is not the only solution. The reported referral and LTFU rates vary largely across studies, implying the contribution of several parameters identified in this review and the context in which the programme is performed. Extra attention should be paid to infants with higher risk for hearing impairment to ensure their return to follow-up., (© 2022. The Author(s).)

Studies have limitedly considered children with early-identified unilateral hearing impairment (UHI), and clinical practices regarding screening, diagnostics and habilitation in this group are rarely documented. In this study, routines for newborns with UHI from screening to diagnostics and habilitation were explored in Norway, Sweden and Finland. An online survey was sent to hospitals responsible for the hearing diagnostics of children requesting information about their practices regarding congenital UHI. Responses covered 95% of the children born in the three included countries. The results revealed large variations in ways of organising healthcare and in clinical decisions regarding hearing screening, diagnostics and habilitation of children with congenital UHI. Finally, implications for policy making and research are also discussed.

Objectives: Abandonment of vision, hearing or mobility aids suggests common barriers and facilitators to ongoing device use. However, the possible interactive effects of combined hearing and vision disabilities on device use by those living with deafblindness are unclear. Here we summarise existing knowledge on variables influencing assistive technology use from the perspective of persons living with deafblindness. We used the WHO's International Classification of Functioning, Disability and Health (ICF) framework to contextualise the findings, asking 'What is currently known about variables influencing the (non-)use of assistive devices recommended for persons with deafblindness?', Design: A scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Checklist., Data Sources: PubMed; ProQuest: ERIC; ProQuest Dissertation; ProQuest: Sociological Thesaurus; Web of Science; Scientific Electronic Library Online; Bielefeld Academic Search Engine; Pascal & Francis; APA PsycINFO and Ebsco for CINAHL were searched through 9 November 2020., Eligibility Criteria: We included peer-reviewed studies that reported on assistive technology, device abandonment/utilisation and provided data from persons living with deafblindness., Data Extraction and Synthesis: Four team members independently scored 83 studies for eligibility., Results: Ten articles were chosen for data extraction. The emerging variables replicated established categories of barriers and facilitators: personal, device-related, environmental and intervention variables. The use of the ICF highlighted how an intermediate variable (eg, device acceptability) was necessary in order for a variable to become a barrier or a facilitator to device use., Conclusions: The variables influencing device use by persons with deafblindness followed the same categories described for single impairments. Usability was challenged in devices that rely on the 'other' sense. Haptic and tactile aids are rarely studied. The limited available information and the dire need for assistive technologies for people with deafblindness emphasises the urgency of research and technology development for this marginalised population., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The middle ear is a small and hard to reach compartment, limiting the amount of tissue that can be extracted and the possibilities for studying the molecular mechanisms behind diseases like cholesteatoma. In this paper 14 reference gene candidates were evaluated in the middle ear mucosa of cholesteatoma patients and two different control tissues. ACTB and GAPDH were shown to be the optimal genes for the normalisation of target gene expression when investigating middle ear mucosa in multiplex qPCR analysis. Validation of reference genes using c-MYC expression confirmed the suitability of ACTB and GAPDH as reference genes and showed an upregulation of c-MYC in middle ear mucosa during cholesteatoma. The occurrence of participants of the innate immunity, TLR2 and TLR4, were analysed in order to compare healthy middle ear mucosa to cholesteatoma. Analysis of TLR2 and TLR4 showed variable results depending on control tissue used, highlighting the importance of selecting relevant control tissue when investigating causes for disease. It is our belief that a consensus regarding reference genes and control tissue will contribute to the comparability and reproducibility of studies within the field., Competing Interests: The authors have declared that no competing interests exist.

Introduction  Hearing impairment is a common disease worldwide, with a comprehensive impact, and cochlear implantation (CI) is an intervention for profound hearing impairment. Objective  To study the outcome one and three years after unilateral CI on hearing, health-related quality of life and level of depression and anxiety, and the correlation between the outcomes. Second, to study whether age, gender, etiology, operated side, residual hearing or cognitive performance can predict the outcome. Methods  A prospective longitudinal study including adults with profound postlingual hearing impairment, with respect to hearing (speech recognition), health-related quality of life (Health Utilities Index 3) and level of depression and anxiety (Hospital Anxiety and Depression scale), pre-CI, and one and three years post-CI. The total sample was composed of 40 participants (40% of men), with a mean age of 71 years. Results  Speech recognition and the overall health-related quality of life improved one year post-CI ( p  = 0.000), without correlation (ρ= 0.27), and with no difference three years post-CI. The hearing attribute (in the health-related quality of life instrument) improved one and three years post-CI ( p  = 0.000). The level of anxiety did not change one and three years post-CI. The level of depression improved one year post-CI ( p  = 0.036), and deteriorated three years post-CI ( p  = 0.031). Age, etiology, operated side, residual hearing and cognitive performance did not predict the outcome, but the female gender did significantly improve speech recognition compared with men ( p  = 0.009). Conclusion  The CI significantly improved speech recognition, health-related quality of life and level of depression one year post-CI without mutual correlation, and women performed significantly better than men. There were no further improvements three years post-CI, apart from the hearing attribute., Competing Interests: Conflict of Interests The authors have no conflict of interests to declare.

The Saami are the only indigenous population in Europe and their traditional living area is northern Scandinavia. Hearing impairment (HI) among Saami has not been studied before. The objective was to investigate the presence and type of HI among Saami adults, aged 49-77 years (median age 61 years), living in northern Finland. In addition, the presence of self-reported hearing difficulties, difficulties to hear in background noise and tinnitus were studied. An epidemiological, cross-sectional study encompassing a structured interview, otological examination and audiometry was performed. Bilateral HI was present in 42.9% of men and 29.4% of women, when HI was defined as a pure tone average (PTA) of at least 20 dB hearing level (HL) or more at the frequencies of 0.5, 1, 2 and 4 kHz. In one or both ears (worse ear hearing level, WEHL 0.5,1,2,4 ≥20 dB HL) HI was present in 61.8% of men and 42.2% of women. Sensorineural high frequency hearing impairment was found to be most common. Nearly half (46.9%) of the study subjects reported hearing problems and more than half (55.6%) reported difficulties in following conversation in background noise. Measured HI and subjective hearing difficulties are common among the Saami adults. The healthcare personnel working in this area should be aware of the hearing problems of the Saami population., Abbreviations: ARHI, Age-related hearing impairment; PTA, Pure tone average; HI, Hearing impairment; HL, Hearing level; BEHL, Better ear hearing level; WEHL, Worse ear hearing level; CI, Confidence interval.

The understanding of patterns of genetic variation within and among human populations is a prerequisite for successful genetic association mapping studies of complex diseases and traits. Some populations are more favorable for association mapping studies than others. The Saami from northern Scandinavia and the Kola Peninsula represent a population isolate that, among European populations, has been less extensively sampled, despite some early interest for association mapping studies. In this paper, we report the results of a first genome-wide SNP-based study of genetic population structure in the Finnish Saami. Using data from the HapMap and the human genome diversity project (HGDP-CEPH) and recently developed statistical methods, we studied individual genetic ancestry. We quantified genetic differentiation between the Saami population and the HGDP-CEPH populations by calculating pair-wise F(ST) statistics and by characterizing identity-by-state sharing for pair-wise population comparisons. This study affirms an east Asian contribution to the predominantly European-derived Saami gene pool. Using model-based individual ancestry analysis, the median estimated percentage of the genome with east Asian ancestry was 6% (first and third quartiles: 5 and 8%, respectively). We found that genetic similarity between population pairs roughly correlated with geographic distance. Among the European HGDP-CEPH populations, F(ST) was smallest for the comparison with the Russians (F(ST)=0.0098), and estimates for the other population comparisons ranged from 0.0129 to 0.0263. Our analysis also revealed fine-scale substructure within the Finnish Saami and warns against the confounding effects of both hidden population structure and undocumented relatedness in genetic association studies of isolated populations., (© 2011 Macmillan Publishers Limited All rights reserved 1018-4813/11)

This study aimed at contributing to the elucidation of the genetic basis of age-related hearing impairment (ARHI), a common multifactorial disease with an important genetic contribution as demonstrated by heritability studies. We conducted a genome-wide association study (GWAS) in the Finnish Saami, a small, ancient, genetically isolated population without evidence of demographic expansion. The choice of this study population was motivated by its anticipated higher extent of LD, potentially offering a substantial power advantage for association mapping. DNA samples and audiometric measurements were collected from 352 Finnish Saami individuals, aged between 50 and 75 years. To reduce the burden of multiple testing, we applied principal component (PC) analysis to the multivariate audiometric phenotype. The first three PCs captured 80% of the variation in hearing thresholds, while maintaining biologically important audiometric features. All subjects were genotyped with the Affymetrix 100 K chip. To account for multiple levels of relatedness among subjects, as well as for population stratification, association testing was performed using a mixed model. We summarised the top-ranking association signals for the three traits under study. The top-ranked SNP, rs457717 (P-value 3.55 x 10(-7)), was associated with PC3 and was localised in an intron of the IQ motif-containing GTPase-activating-like protein (IQGAP2). Intriguingly, the SNP rs161927 (P-value 0.000149), seventh-ranked for PC1, was positioned immediately downstream from the metabotropic glutamate receptor-7 gene (GRM7). As a previous GWAS of a European and Finnish sample set already suggested a role for GRM7 in ARHI, this study provides further evidence for the involvement of this gene.

The Saami from Fennoscandia are believed to represent an ancient, genetically isolated population with no evidence of population expansion. Theoretical work has indicated that under this demographic scenario, extensive linkage disequilibrium (LD) is generated by genetic drift. Therefore, it has been suggested that the Saami would be particularly suited for genetic association studies, offering a substantial power advantage and allowing more economic study designs. However, no study has yet assessed this claim. As part of a GWAS for a complex trait, we evaluated the relative power for association studies of common variants in the Finnish Saami. LD patterns in the Saami were very similar to those in the non-African HapMap reference panels. Haplotype diversity was reduced and, on average, levels of LD were higher in the Saami as compared with those in the HapMap panels. However, using a 'hidden' SNP approach we show that this does not translate into a power gain in association studies. Contrary to earlier claims, we show that for a given set of common SNPs, genomic coverage attained in the Saami is similar to that in the non-African HapMap panels. Nevertheless, the reduced haplotype diversity could potentially facilitate gene identification, especially if multiple rare variants play a role in disease etiology. Our results further indicate that the HapMap is a useful resource for genetic studies in the Saami.

A multicenter study was set up to elucidate the environmental and medical risk factors contributing to age-related hearing impairment (ARHI). Nine subsamples, collected by nine audiological centers across Europe, added up to a total of 4,083 subjects between 53 and 67 years. Audiometric data (pure-tone average [PTA]) were collected and the participants filled out a questionnaire on environmental risk factors and medical history. People with a history of disease that could affect hearing were excluded. PTAs were adjusted for age and sex and tested for association with exposure to risk factors. Noise exposure was associated with a significant loss of hearing at high sound frequencies (>1 kHz). Smoking significantly increased high-frequency hearing loss, and the effect was dose-dependent. The effect of smoking remained significant when accounting for cardiovascular disease events. Taller people had better hearing on average with a more pronounced effect at low sound frequencies (<2 kHz). A high body mass index (BMI) correlated with hearing loss across the frequency range tested. Moderate alcohol consumption was inversely correlated with hearing loss. Significant associations were found in the high as well as in the low frequencies. The results suggest that a healthy lifestyle can protect against age-related hearing impairment.

Age-related hearing impairment (ARHI), or presbycusis, is a very common multifactorial disorder. Despite the knowledge that genetics play an important role in the etiology of human ARHI as revealed by heritability studies, to date, its precise genetic determinants remain elusive. Here we report the results of a cross-sectional family-based genetic study employing audiometric data. By using principal component analysis, we were able to reduce the dimensionality of this multivariate phenotype while capturing most of the variation and retaining biologically important features of the audiograms. We conducted a genome-wide association as well as a linkage scan with high-density SNP microarrays. Because of the presence of genetic population substructure, association testing was stratified after which evidence was combined by meta-analysis. No association signals reaching genome-wide significance were detected. Linkage analysis identified a linkage peak on 8q24.13-q24.22 for a trait correlated to audiogram shape. The signal reached genome-wide significance, as assessed by simulations. This finding represents the first locus for an ARHI trait.