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Background: Hearing loss is highly prevalent in older adults, particularly among those living with dementia and residing in long-term care homes (LTCHs). Sensory declines can have deleterious effects on functioning and contribute to frailty, but the hearing needs of residents are often unrecognized or unaddressed. Objective: To identify valid and reliable screening measures that are effective for the identification of hearing loss and are suitable for use by nursing staff providing care to residents with dementia in LTCHs. Methods: Electronic databases (Embase, Medline, PsycINFO, CENTRAL, and CINAHL) were searched using comprehensive search strategies, and a stepwise approach based on Arksey & O’Malley’s scoping review and appraisal process was followed. Results: There were 193 scientific papers included in the review. Pure-tone audiometry was the most frequently reported measure to test hearing in older adults living with dementia. However, measures including self- or other-reports and questionnaires, review of medical records, otoscopy, and the whisper test were found to be most suitable for use by nurses working with older adults living with dementia in LTCHs. Conclusion: Although frequently used, the suitability of pure-tone audiometry for use by nursing staff in LTCHs is limited, as standardized audiometry presents challenges for many residents, and specific training is needed to successfully adapt test administration procedures and interpret results. The whisper test was considered to be more suitable for use by staff in LTCH; however, it yields a limited characterization of hearing loss. There remains an urgent need to develop new approaches to screen hearing in LTCHs.

Vision and hearing impairments are highly prevalent in adults 65 years of age and older. There is a need to understand their association with multiple health-related outcomes. We analyzed data from the Resident Assessment Instrument for Home Care (RAI-HC). Home care clients were followed for up to 5 years and categorized into seven unique cohorts based on whether or not they developed new vision and/or hearing impairments. An absolute standardized difference (stdiff) of at least 0.2 was considered statistically meaningful. Most clients (at least 60%) were female and 34.9 per cent developed a new sensory impairment. Those with a new concurrent vison and hearing impairment were more likely than those with no sensory impairments to experience a deterioration in receptive communication (stdiff = 0.68) and in cognitive performance (stdiff = 0.49). After multivariate adjustment, they had a twofold increased odds (adjusted odds ratio [OR] = 2.1; 95% confidence interval [CI]:1,87, 2.35) of deterioration in cognitive performance. Changes in sensory functioning are common and have important effects on multiple health-related outcomes.

Objectives Our objectives were to (1) determine the prevalence of self-reported hearing, vision, and dual sensory (both vision and hearing) difficulties in older Canadian adults; (2) examine the association between self-report and behavioral sensory measures; and (3) controlling for behavioral sensory measures, examine variables that might explain the self-reported sensory difficulty, including age, sex, cultural background, socioeconomic status, nonsensory comorbidities, cognitive function, and social factors. Design We used baseline data collected from the 30,097 participants of the comprehensive cohort of the Canadian Longitudinal Study on Aging. Participants who were 45 to 85 years of age (mean age = 63 years, SD = ± 10.25) were recruited using provincial health registries and random-digit dialing. Analyses were conducted for the sample as a whole or stratified by age. Behavioral sensory data for hearing (pure-tone audiometry) and vision (pinhole-corrected visual acuity) were collected at 11 data collection sites. Self-reported sensory and personal data were obtained through in-person interviews. "Difficulty" was defined as a response of "fair" or "poor" (versus "excellent," "very good" or "good") to questions about hearing ability (using a hearing aid if used) and vision (using glasses or corrective lenses if used). Individuals with both hearing and vision difficulties were defined as having dual sensory difficulties. Variables associated with self-reported sensory difficulties were analyzed with multiple regression models. Results Objective 1. The prevalence of impairments based on behavioral measures was higher than the prevalence of difficulties based on self-report measures. The prevalence based on both types of measures increased with age, but the increase was steeper for behavioral measures. Objective 2. In addition to the expected positive associations between self-report and behavioral measures of hearing [odds ratio (OR) = 2.299)] and vision (OR = 15.247), self-reported sensory difficulty was also explained by other within-modality sensory variables, such as the symmetry of impairment and the use of aids. Objective 3. Controlling for behavioral measures of hearing (better-ear pure-tone average) or vision (better-eye visual acuity), older participants were significantly less likely than younger participants to self-report sensory difficulty. Sensory difficulties were reported more often by males and by those with more comorbid health conditions. Compared to those who did not report vision difficulties, those who did report them were more likely to also report hearing difficulties (OR = 2.921) and vice versa (OR = 2.720). There were modality-specific associations with variables relevant to social participation; for example, independent life space was associated with hearing difficulties, and perceived availability of social support and loneliness with vision difficulties. Conclusions The low prevalence of self-reported sensory difficulties relative to the behavioral measures of sensory impairments indicates that (a) a simple screening question about sensory ability may not be sufficient to identify older adults who are in the early stages of sensory decline, and (b) self-reported sensory ability is associated with sensory and nonsensory factors. Age, gender, and comorbidities are the most notable nonsensory predictors for both self-reported hearing and vision. These findings shed light on how the self-reported sensory difficulties of older adults may reflect clinical measures of sensory impairment as well as nonsensory factors.

Objective Meniere's disease (MD) is a clinical disorder that often provides challenges in diagnosis and management. High-quality evidence to guide care providers is sparse, which can result in significant practice variations. Quality indicators (QIs) are one method that can be used to standardize and measure accepted care practices to improve healthcare quality and patient outcomes. Here, we developed practical, high-yield QIs that serve to measure and inform the quality of care provided to patients with MD. Study design Modified RAND Corporation University of California, Los Angeles appropriateness methodology for QI development. Setting Multicenter nine-member expert panel. Patients NA. Interventions NA. Main outcome measure Final QIs deemed appropriate measures of quality care with agreement by the expert panel. Results Twenty-seven candidate indicators were identified after literature review. After the first round of evaluations, the panel agreed on three candidate indicators as appropriate QIs. A subsequent expert panel meeting provided a platform to discuss disagreements. Two agreed-upon QIs were revised during this discussion before final evaluations. The expert panel ultimately agreed upon five QIs as appropriate measures of high-quality care after completing final evaluations and reviewing updated literature. The five quality indicators measure audiometric documentation, minimization of electrocochleography, use of intratympanic dexamethasone, use of intratympanic gentamycin, and rate of labyrinthectomy/vestibular neurectomy in refractory MD patient. Conclusions This study proposes five QIs that cover key aspects of care for MD, such as accurate diagnosis and management options including initial destructive therapies. These QIs can serve multiple purposes, the most important of which is to galvanize quality improvement initiatives.

Supraspinatus (SSP) tendon tears represent a common indication for shoulder surgery. Yet, prediction of postoperative function and tendon retear remains challenging and primarily relies on morphologic magnetic resonance imaging (MRI)-based parameters, supported by patients' demographic data like age, gender, and comorbidities. Considering continuously high retear rates, especially in patients with larger tears and negative prognostic factors, improved outcome prediction could be of high clinical value. Contrast-enhanced ultrasound (CEUS) enables an assessment of dynamic perfusion of the SSP muscle. As a potential surrogate for muscle vitality, CEUS might reflect functional properties of the SSP and support improved outcome prediction after tendon repair. Fifty patients with isolated SSP tendon tears were prospectively enrolled. Preoperatively, SSP muscle perfusion was quantified by CEUS and conventional morphologic parameters like tear size, fatty infiltration, and tendon retraction were assessed by MRI. At six months follow-up, shoulder function, tendon integrity, and muscle perfusion were reassessed. The predictive value of preoperative CEUS for postoperative shoulder function and tendon integrity was evaluated. 35 patients entered the statistical analysis. Preoperative CEUS-based assessment of SSP perfusion significantly correlated with early postoperative shoulder function (Constant, r = 0.48, p < 0.018) and tendon retear (r = 0.67, p < 0.001). CEUS-based subgroup analysis identified patients with exceptionally high, respectively low risk for tendon retear. CEUS-based assessment of the SSP seemed to predict early shoulder function and tendon retear after SSP repair and allowed to identify patient subgroups with exceptionally high or low risk for tendon retear. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 38:1150-1158, 2020.

The purpose of this study was to describe the prevalence of hearing loss (HL), vision loss (VL), and dual sensory loss (DSL) in Canadians 45–85 years of age. Audiometry and visual acuity were measured. Various levels of impairment severity were described. Results were extrapolated to the 2016 Canadian population. In 2016, 1,500,000 Canadian males 45–85 years of age had at least mild HL, 1,800,000 had at least mild VL, and 570,000 had DSL. Among females, 1,200,000 had at least mild HL, 2,200,000 had at least mild VL, and 450,000 had DSL. Among Canadians 45–85 years of age, mild, moderate, and severe HL was prevalent among 13.4 per cent, 3.7 per cent, and 0.4 per cent of males, and among 11.3 per cent, 2.3 per cent, and 0.2 per cent of females, respectively. Mild and moderate, or severe VL was prevalent among 19.8 per cent and 2.4 per cent of males, and among 23.9 per cent and 2.6 per cent of females, respectively. At least mild DSL was prevalent among 6.4 per cent of males and 6.1 per cent of females.

BackgroundAdequate personal protective equipment is needed to reduce the rate of transmission of COVID-19 to health care workers. Otolaryngology groups are recommending a higher level of personal protective equipment for aerosol-generating procedures than public health agencies. The objective of the review was to provide evidence that a.) demonstrates which otolaryngology procedures are aerosol-generating, and that b.) clarifies whether the higher level of PPE advocated by otolaryngology groups is justified.Main bodyHealth care workers in China who performed tracheotomy during the SARS-CoV-1 epidemic had 4.15 times greater odds of contracting the virus than controls who did not perform tracheotomy (95% CI 2.75–7.54). No other studies provide direct epidemiological evidence of increased aerosolized transmission of viruses during otolaryngology procedures. Experimental evidence has shown that electrocautery, advanced energy devices, open suctioning, and drilling can create aerosolized biological particles. The viral load of COVID-19 is highest in the upper aerodigestive tract, increasing the likelihood that aerosols generated during procedures of the upper aerodigestive tract of infected patients would carry viral material. Cough and normal breathing create aerosols which may increase the risk of transmission during outpatient procedures. A significant proportion of individuals infected with COVID-19 may not have symptoms, raising the likelihood of transmission of the disease to inadequately protected health care workers from patients who do not have probable or confirmed infection. Powered air purifying respirators, if used properly, provide a greater level of filtration than N95 masks and thus may reduce the risk of transmission.ConclusionDirect and indirect evidence suggests that a large number of otolaryngology-head and neck surgery procedures are aerosol generating. Otolaryngologists are likely at high risk of contracting COVID-19 during aerosol generating procedures because they are likely exposed to high viral loads in patients infected with the virus. Based on the precautionary principle, even though the evidence is not definitive, adopting enhanced personal protective equipment protocols is reasonable based on the evidence. Further research is needed to clarify the risk associated with performing various procedures during the COVID-19 pandemic, and the degree to which various personal protective equipment reduces the risk.

OBJECTIVE Injuries are responsible for 11% of global disability-adjusted life years. Hearing difficulty may be a modifiable risk factor for injury. The primary aim was to determine whether subjective hearing difficulty is associated with increased incidence of injuries (all-type, workplace, and nonworkplace) serious enough to require health care among Americans aged 18 years and older. The secondary aim was to determine whether hearing difficulty is associated with increased use of health care for injuries. DESIGN The analysis was performed using data from the 1999 to 2012 Medical Expenditure Panel Surveys-Household Component (MEPS-HC). Multivariable estimates are generalizable to the American noninstitutionalized adult population in 2006. Hearing difficulty was determined by computer-assisted personal interview. The primary outcome was number of separate injuries requiring health care (emergency department visits, hospital inpatient admissions, or medical office visits) during the follow-up period. Crude injury incidence rates were calculated with 95% confidence intervals (CIs). Multivariable negative binomial regression was performed to determine the relative incidence rate of injuries among the group reporting hearing difficulties relative to the group reporting no difficulty in hearing, adjusting for relevant confounders. Variance estimates were adjusted to take into account the complex sample design. Results were stratified by sex. RESULTS Of the 121,453 participants in MEPS-HC panels 6-16, 107,352 (88.4%) had complete data and were included in the analysis. The average follow-up was 1.27 years. Seven thousand six hundred and twenty-four participants (7.1%) reported hearing difficulty at baseline. During the follow-up period, 10,727 participants (10.0%) had one or more injuries. In multivariable analyses, hearing difficulty was significantly associated with increased incidence of all-type (males: incidence rate ratio [IRR] 1.31, 95% CI 1.18-1.45, p value < 0.001; females: IRR 1.21, 95% CI 1.07-1.36, p value < 0.001), workplace (males: IRR 1.42, 95% CI 1.16-1.75, p value 0.001; females: IRR 1.61, 95% CI 1.12-2.31, p value 0.010), and nonworkplace injuries (males: IRR 1.24, 95% CI 1.09-1.42, p value 0.001; females: IRR 1.17, 95% CI, 1.02-1.34, p value 0.023). In multivariable analyses, hearing difficulty was associated with increased incidence of emergency department use in males (IRR 1.36, 95% CI 1.13-1.62, p value 0.001) and medical office visits in females (IRR 1.52, 95% CI 1.12-2.05, p value 0.007). CONCLUSIONS The study results suggest the need to investigate the mechanisms underlying the measured associations so that efforts may be directed toward reducing the risk of injury for individuals with hearing difficulties.

Objective: Explore the acceptability of a socialisation, health education and falls prevention programme (Walk and Talk for Your Life: WTL) as an adjunct to group auditory rehabilitation (GAR) and how it might be adapted for older adults with hearing loss (HL). Design: Content theme analysis (CTA) of guided interviews explored the experience of HL, the acceptability of a WTL programme and suggestions on how to adapt the WTL programme to better suit the needs of older adults with HL. Study sample: Twenty-eight (20 women, 8 men) adults (>55 years of age) with HL were interviewed. Seventeen had participated in past WTL programmes and eleven were sampled from the community. Results: Interviewees reported difficulty socialising and a tendency to withdraw from social interactions. Addition of GAR to a WTL programme was found to be highly acceptable. Interviewees suggested that to best suit their needs, sessions should take place in a location with optimal acoustics; include small groups integrating hearing-impaired and hearing-intact participants; include appropriate speaking ground rules; and include an option for partner involvement. Conclusions: The adapted WTL programme provides a holistic and unique approach to the treatment of HL that has the potential to positively impact the hearing-impaired elderly.

The Choosing Wisely Canada Campaign aims to raise awareness amongst physicians and patients regarding unnecessary tests and treatment. The otology/neurotology subspecialty group within the Canadian Society of Otolaryngology – Head & Neck Society developed a list of five common otologic presentations to help physicians deliver high quality effective care: (1) Don’t order specialized audiometric and vestibular testing to screen for peripheral vestibular disease, (2) Don’t perform computed tomography or blood work in the evaluation of sudden sensorineural hearing loss, (3) Don’t perform auditory brain responses (ABR) in patients with asymmetrical hearing loss, (4) Don’t prescribe oral antibiotics as first line treatment for patients with painless otorrhea associated with tympanic membrane perforation or tympanostomy tube, and (5) Don’t perform particle repositioning maneuvers without a clinical diagnosis of posterior canal benign paroxysmal positional vertigo.

In epidemiology studies, researchers may choose to use summary scores of hearing or vision based on self-report or clinical measures. Self-report and clinical measures may yield different classifications. Of the possible clinical measures, there is no consensus regarding which puretone threshold average (PTA) or visual acuity (VA) measures are optimal. We aimed to determine how well different PTAs and VA measures predicted self-reported measures of sensory function. A cross-sectional analysis of 30,097 Canadians aged 45-85 years participating in wave 1 of the Canadian Longitudinal Study on Aging in 2012-2015 was performed. We calculated the area under the receiver operating characteristic curves (AUC) for 9 different PTAs and 6 different VA measures. In the analysis of the PTAs, the classifiers used as comparators included self-reports of hearing and hearing aid use. In the analysis of the VA measures, comparators were self-reports of vision, and corrective lens use. The top-ranked PTA was the binaural mid-frequency PTA (i.e., the average of hearing thresholds at 1000, 2000, 3000 and 4000 Hz in both ears). The top-ranked VA measure was the average pinhole-corrected VA in both eyes. These measures are not commonly used, but should be considered for epidemiological research.

Background and Objectives The objective of the study was to understand how sensory impairments, alone or in combination with cognitive impairment (CI), relate to long-term care (LTC) admissions. Research Design and Methods This retrospective cohort study used existing information from two interRAI assessments; the Resident Assessment Instrument for Home Care (RAI-HC) and the Minimum Data Set 2.0 (MDS 2.0), which were linked at the individual level for 371,696 unique individuals aged 65+ years. The exposure variables of interest included hearing impairment (HI), vision impairment (VI) and dual sensory impairment (DSI) ascertained at participants’ most recent RAI-HC assessment. The main outcome was admission to LTC. Survival analysis, using Cox proportional hazards regression models and Kaplan–Meier curves, was used to identify risk factors associated with LTC admissions. Observations were censored if they remained in home care, died or were discharged somewhere other than to LTC. Results In this sample, 12.7% of clients were admitted to LTC, with a mean time to admission of 49.6 months (SE = 0.20). The main risk factor for LTC admission was a diagnosis of Alzheimer’s dementia (HR = 1.87; CI: 1.83, 1.90). A significant interaction between HI and CI was found, whereby individuals with HI but no CI had a slightly faster time to admission (40.5 months; HR = 1.14) versus clients with both HI and CI (44.9 months; HR = 2.11). Discussion and Implications Although CI increases the risk of LTC admission, HI is also important, making it is imperative to continue to screen for sensory issues among older home care clients.

BackgroundAge-related hearing loss (HL) is a prevalent disability associated with loneliness, isolation, declines in cognitive and physical function and premature mortality. Group audiological rehabilitation (GAR) and hearing technologies address communication and cognitive decline. However, the relationship between loneliness, physical function and GAR among older adults with HL has not been studied.ObjectivesExplore the impact of a group exercise and socialisation/health education intervention and GAR on physical function and loneliness among older adults with HL.Trial designA Young Men’s Christian Association (YMCA)-based, 10-week, single-blind, pilot randomised controlled trial (RCT).ParticipantsAmbulatory adults aged 65 years or older with self-reported HL.InterventionsSeventy-one participants were screened. Thirty-five were randomised to intervention (strength and resistance exercise, socialisation/health education) and GAR (hearing education, communication strategies, psychosocial support) or control (n=31): GAR only.OutcomesNinety-five per cent of eligible participants were randomised. GAR and exercise adherence rates were 80% and 85%, respectively. 88% of participants completed the study. Intervention group functional fitness improved significantly (gait speed: effect size: 0.57, 30 s Sit to Stand Test: effect size: 0.53). Significant improvements in emotional and social loneliness (effect size: 1.16) and hearing-related quality of life (effect size: 0.76) were related to GAR attendance and poorer baseline hearing-related quality of life. Forty-two per cent of participants increased social contacts outside the study.DiscussionWalk, Talk and Listen was feasible and acceptable. Exercise and socialisation/health education improved loneliness and key fitness measures but provided no additional benefit to GAR only for loneliness. This is the first preliminary evidence about the benefits of exercise on fitness and GAR on loneliness among older adults with HL.ImplicationsThis pilot trial provides key information on the sample size required for a larger, longer term RCT to determine the enduring effects of this holistic intervention addressing the negative psychosocial and musculoskeletal downstream effects of HL among older adults.

Sensory and cognitive function both tend to decline with increasing age. Sensory impairments are risk factors for age-related cognitive decline and dementia. One hypothesis about sensory-cognitive associations is that sensory loss results in social isolation which, in turn, is a risk factor for cognitive decline. We tested whether social factors are associated with cognitive and sensory function, and whether sensory-cognitive associations are mediated or moderated by social factors. We used cross-sectional data from 30,029 participants in the Canadian Longitudinal Study of Aging, aged 45–85 years, who had no reported cognitive impairment or diagnosis of dementia. We found strong independent associations of self-reported social variables with hearing (pure-tone audiometry), vision (pinhole-corrected visual acuity), and executive function and weaker associations with memory. The moderating and mediating effects of social variables on sensory-cognitive associations were weak and mostly non-significant, but social factors could be slightly more important for females and older people. Partial retirement (relative to full retirement or not being retired) may have protective effects on cognition in the presence of hearing loss. These findings confirm the association between social factors and sensory and cognitive measures. However, support is weak for the hypothesis that social factors shape sensory-cognitive associations.

BACKGROUND: Acute otitis media (AOM) is one of the most common childhood illnesses. While many children experience sporadic AOM episodes, an important group suffer from recurrent AOM (rAOM), defined as three or more episodes in six months, or four or more in one year. In this subset of children AOM poses a true burden through frequent episodes of ear pain, general illness, sleepless nights and time lost from nursery or school. Grommets, also called ventilation or tympanostomy tubes, can be offered for rAOM. OBJECTIVES: To assess the benefits and harms of bilateral grommet insertion with or without concurrent adenoidectomy in children with rAOM. SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane ENT Trials Register; CENTRAL; MEDLINE; EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 4 December 2017. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing bilateral grommet insertion with or without concurrent adenoidectomy and no ear surgery in children up to age 16 years with rAOM. We planned to apply two main scenarios: grommets as a single surgical intervention and grommets as concurrent treatment with adenoidectomy (i.e. children in both the intervention and comparator groups underwent adenoidectomy). The comparators included active monitoring, antibiotic prophylaxis and placebo medication. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. Primary outcomes were: proportion of children who have no AOM recurrences at three to six months follow-up (intermediate-term) and persistent tympanic membrane perforation (significant adverse event). Secondary outcomes were: proportion of children who have no AOM recurrences at six to 12 months follow-up (long-term); total number of AOM recurrences, disease-specific and generic health-related quality of life, presence of middle ear effusion and other adverse events at short-term, intermediate-term and long-term follow-up. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. MAIN RESULTS: Five RCTs (805 children) with unclear or high risk of bias were included. All studies were conducted prior to the introduction of pneumococcal vaccination in the countries' national immunisation programmes. In none of the trials was adenoidectomy performed concurrently in both groups. Grommets versus active monitoring Grommets were more effective than active monitoring in terms of: - proportion of children who had no AOM recurrence at six months (one study, 95 children, 46% versus 5%; risk ratio (RR) 9.49, 95% confidence interval (CI) 2.38 to 37.80, number needed to treat to benefit (NNTB) 3; low-quality evidence); - proportion of children who had no AOM recurrence at 12 months (one study, 200 children, 48% versus 34%; RR 1.41, 95% CI 1.00 to 1.99, NNTB 8; low-quality evidence); - number of AOM recurrences at six months (one study, 95 children, mean number of AOM recurrences per child: 0.67 versus 2.17, mean difference (MD) -1.50, 95% CI -1.99 to -1.01; low-quality evidence); - number of AOM recurrences at 12 months (one study, 200 children, one-year AOM incidence rate: 1.15 versus 1.70, incidence rate difference -0.55, 95% -0.17 to -0.93; low-quality evidence). Children receiving grommets did not have better disease-specific health-related quality of life (Otitis Media-6 questionnaire) at four (one study, 85 children) or 12 months (one study, 81 children) than those managed by active monitoring (low-quality evidence). One study reported no persistent tympanic membrane perforations among 54 children receiving grommets (low-quality evidence). Grommets versus antibiotic prophylaxis It is uncertain whether or not grommets are more effective than antibiotic prophylaxis in terms of: - proportion of children who had no AOM recurrence at six months (two studies, 96 children, 60% versus 35%; RR 1.68, 95% CI 1.07 to 2.65, I2 = 0%, fixed-effect model, NNTB 5; very low-quality evidence); - number of AOM recurrences at six months (one study, 43 children, mean number of AOM recurrences per child: 0.86 versus 1.38, MD -0.52, 95% CI -1.37 to 0.33; very low-quality evidence). Grommets versus placebo medication Grommets were more effective than placebo medication in terms of: - proportion of children who had no AOM recurrence at six months (one study, 42 children, 55% versus 15%; RR 3.64, 95% CI 1.20 to 11.04, NNTB 3; very low-quality evidence); - number of AOM recurrences at six months (one study, 42 children, mean number of AOM recurrences per child: 0.86 versus 2.0, MD -1.14, 95% CI -2.06 to -0.22; very low-quality evidence). One study reported persistent tympanic membrane perforations in 3 of 76 children (4%) receiving grommets (low-quality evidence). Subgroup analysis There were insufficient data to determine whether presence of middle ear effusion at randomisation, type of grommet or age modified the effectiveness of grommets. AUTHORS' CONCLUSIONS: Current evidence on the effectiveness of grommets in children with rAOM is limited to five RCTs with unclear or high risk of bias, which were conducted prior to the introduction of pneumococcal vaccination. Low to very low-quality evidence suggests that children receiving grommets are less likely to have AOM recurrences compared to those managed by active monitoring and placebo medication, but the magnitude of the effect is modest with around one fewer episode at six months and a less noticeable effect by 12 months. The low to very low quality of the evidence means that these numbers need to be interpreted with caution since the true effects may be substantially different. It is uncertain whether or not grommets are more effective than antibiotic prophylaxis. The risk of persistent tympanic membrane perforation after grommet insertion was low. Widespread use of pneumococcal vaccination has changed the bacteriology and epidemiology of AOM, and how this might impact the results of prior trials is unknown. New and high-quality RCTs of grommet insertion in children with rAOM are therefore needed. These trials should not only focus on the frequency of AOM recurrences, but also collect data on the severity of AOM episodes, antibiotic consumption and adverse effects of both surgery and antibiotics. This is particularly important since grommets may reduce the severity of AOM recurrences and allow for topical rather than oral antibiotic treatment.

Objectives The objective of the current study was to understand the added effects of having a sensory impairment (vision and/or hearing impairment) in combination with cognitive impairment with respect to health-related outcomes among older adults (65+ years old) receiving home care or residing in a long-term care (LTC) facility in Ontario, Canada. Methods Cross-sectional analyses were conducted using existing data collected with one of two interRAI assessments, one for home care (n = 291,824) and one for LTC (n = 110,578). Items in the assessments were used to identify clients with single sensory impairments (e.g., vision only [VI], hearing only [HI]), dual sensory impairment (DSI; i.e., vision and hearing) and those with cognitive impairment (CI). We defined seven mutually exclusive groups based on the presence of single or combined impairments. Results The rate of people having all three impairments (i.e., CI+DSI) was 21.3% in home care and 29.2% in LTC. Across the seven groups, individuals with all three impairments were the most likely to report loneliness, to have a reduction in social engagement, and to experience reduced independence in their activities of daily living (ADLs) and instrumental ADLs (IADLs). Communication challenges were highly prevalent in this group, at 38.0% in home care and 49.2% in LTC. In both care settings, communication difficulties were more common in the CI+DSI group versus the CI-alone group. Conclusions The presence of combined sensory and cognitive impairments is high among older adults in these two care settings and having all three impairments is associated with higher rates of negative outcomes than the rates for those having CI alone. There is a rising imperative for all health care professionals to recognize the potential presence of hearing, vision and cognitive impairments in those for whom they provide care, to ensure that basic screening occurs and to use those results to inform care plans.

Sensory input provides the signals used by the brain when listeners understand speech and participate in social activities with other people in a range of everyday situations. When sensory inputs are diminished, there can be short-term consequences to brain functioning, and long-term deprivation can affect brain neuroplasticity. Indeed, the association between hearing loss and cognitive declines in older adults is supported by experimental and epidemiologic evidence, although the causal mechanisms remain unknown. These interactions of auditory and cognitive aging play out in the challenges confronted by people with age-related hearing problems when understanding speech and engaging in social interactions. In the present article, we use the World Health Organization's International Classification of Functioning, Disability and Health and the Selective Optimization with Compensation models to highlight the importance of adopting a healthy aging perspective that focuses on facilitating active social participation by older adults. First, we examine epidemiologic evidence linking ARHL to cognitive declines and other health issues. Next, we examine how social factors influence and are influenced by auditory and cognitive aging and if they may provide a possible explanation for the association between ARHL and cognitive decline. Finally, we outline how audiologists could reposition hearing health care within the broader context of healthy aging.

Background: Hearing loss (HL) is a disability associated with poorer health-related quality of life including an increased risk for loneliness, isolation, functional fitness declines, falls, hospitalization and premature mortality. The purpose of this pilot trial is to determine the feasibility and acceptability of a novel intervention to reduce loneliness, improve functional fitness, social connectedness, hearing and health-related quality of life in older adults with HL. Methods: This 10-week, single-blind, pilot randomized control trial (RCT) will include a convenience sample of ambulatory adults aged 65 years or older with self-reported HL. Following baseline assessments, participants will be randomized to either intervention (exercise, health education, socialization and group auditory rehabilitation (GAR)) or control (GAR only) groups. The intervention group will attend a local YMCA twice a week and the control group once a week. Intervention sessions will include 45 min of strengthening, balance and resistance exercises, 30 min of group walking at a self-selected pace and 60 min of interactive health education or GAR. The control group will attend 60-min GAR sessions. GAR sessions will include education about hearing, hearing technologies, enhancing communication skills, and psychosocial support. Pre-post trial data collection and measures will include: functional fitness (gait speed, 30-s Sit to Stand Test), hearing and health-related quality of life, loneliness, depression, social participation and social support. At trial end, feasibility (recruitment, randomization, retention, acceptability) and GAR will be evaluated. Discussion: Despite evidence suggesting that HL is associated with declines in functional fitness, there are no studies aimed at addressing functional fitness declines associated with the disability of HL. This pilot trial will provide knowledge about the physical, mental and social impacts on health related to HL as a disability. This will inform the feasibility of a larger RCT and preliminary evidence about the initial effects of a novel, community-based, holistic intervention addressing both the negative psychosocial and functional physical effects of HL among older adults. Trial registration ClinicalTrials.gov, NCT02662192 . Registered on 14 January 2016

OBJECTIVES Hearing preservation (HP) in the context of cochlear implantation (CI) is indicative of an atraumatic insertion, which could potentially offer a clinical advantage to performance, whether such preservation was intended for the application of electoacoustic stimulation (EAS). Our goal was to determine the degree of HP after the implantation of a full-length electrode array (MedEl FLEXsoft). STUDY DESIGN Prospective, within-subject repeated measure design. METHODS Adult patients with residual low-frequency hearing who received a 31.5-mm FlexSoft electrode array were included. Implantation using soft surgery techniques occurred at a single tertiary referral center between 2008 and 2011. Preoperative and postoperative audiometric data were compared. RESULTS In 36 consecutive patients at 1 year postimplantation, 6 (21%) maintained complete HP (an increase of low-frequency pure-tone average (PTA) ≤10 dB from the preoperative value), and 19 (65%) maintained partial HP (an increase in low-frequency PTA ≤40 dB from the preoperative values) throughout the follow-up period (average, 368 d). Higher preoperative hearing threshold levels (HTLs) at 1,000 Hz were associated with HP. CONCLUSION Low-frequency HP is possible in patients implanted with the full-length FlexSoft electrode. Longer follow-up is required to determine if results are maintained over time and if such preservation is in fact advantageous to clinical outcomes. LEVEL OF EVIDENCE 4.

This study's main objective was to assess the sensitivity and specificity of the interRAI Community Health Assessment (CHA) for detecting the presence of vision loss (VL), hearing loss (HL) or both (Dual Sensory Loss, DSL) when compared against performance-based measures of vision and hearing. The interRAI CHA and the Montreal Cognitive Assessment (MoCA) were administered to 200 adults (61+ years of age) who had VL, HL or DSL. We calculated the sensitivity and specificity of the interRAI CHA for detecting sensory impairments using as the gold standard performance based measurements of hearing (pure-tone audiogram) and vision (distance acuity) as determined from the rehabilitation centre record. Results were divided according to participants' cognitive status, as measured by the MoCA and the Cognitive Performance Scale (CPS, embedded within the interRAI CHA). Overall, sensitivity was 100% for VL, 97.1% for HL, and 96.9% for DSL. Specificity was at least 93% in all three groups. In participants who failed the MoCA (i.e., at risk of mild cognitive impairment), the sensitivity was 100% for VL, 96.8% for HL and 96.2% for DSL; in those who were not at risk, the sensitivity was 100% for VL, and 97.4% for HL and DSL. In participants classified by the CPS as borderline intact or mild cognitively impaired, sensitivity was 100% in all groups; in those classified as cognitively intact, sensitivity was 100% for VL, 97.0% for HL, and 96.8% for DSL. These results suggest that the interRAI CHA detects VL, HL, and DSL in high agreement with performance-based measurements of vision and hearing. The interRAI CHA shows high accuracy even in participants with mild cognitive difficulties. Since results were found in a specific population of older rehabilitation clients who all had sensory difficulties, further research is needed to understand its role in screening in other more diverse groups.

OBJECTIVES: Hearing screening programs may benefit adults with unacknowledged or unaddressed hearing loss, but there is limited evidence regarding whether such programs are effective at improving health outcomes. The objective was to determine if poorer audiometric hearing thresholds are associated with poorer cognition, social isolation, burden of physical or mental health, inactivity due to poor physical or mental health, depression, and overnight hospitalizations among older American adults with unacknowledged or unaddressed hearing loss. DESIGN: The authors performed a cross-sectional population-based analysis of older American adults with normal hearing or unacknowledged or unaddressed hearing loss. Data was obtained from the 1999 to 2010 cycles of the National Health and Nutrition Examination Survey. Participants with a pure-tone average (PTA in the better hearing ear of thresholds at 0.5, 1, 2, and 4 kHz) > 25 dB HL who self-reported their hearing ability to be "good" or "excellent" were categorized as having "unacknowledged" hearing loss. Those who had a PTA > 25 dB HL and who self-reported hearing problems but had never had a hearing test or worn a hearing aid were categorized as having "unaddressed" hearing loss. Multivariate regression was performed to account for confounding due to demographic and health variables. RESULTS: A 10 dB increase in PTA was associated with a 52% increased odds of social isolation among 60- to 69-year-olds in multivariate analyses (p = 0.001). The average Digit Symbol Substitution Test score dropped by 2.14 points per 10 dB increase in PTA (p = 0.03), a magnitude equivalent to the drop expected for 3.9 years of chronological aging. PTA was not associated significantly with falls, hospitalizations, burden of physical or mental health, or depression, or social isolation among those aged 70 years or older in these samples. CONCLUSION: Unacknowledged or unaddressed hearing loss was associated with a significantly increased risk of social isolation among 60- to 69-year-olds but not those 70 years or older. It was also associated with lower cognitive scores on the Digit Symbol Substitution Test among 60- to 69-year-olds. This study differs from prior studies by focusing specifically on older adults who have unacknowledged or unaddressed hearing loss because they are the most likely to benefit from pure-tone hearing screening. The finding of associations between hearing loss and measures of social isolation and cognition in these specific samples extends previous findings on unrestricted samples of older adults including those who had already acknowledged hearing problems. Future randomized controlled trials measuring the effectiveness of adult hearing screening programs should measure whether interventions have an effect on these measures in those who have unacknowledged or unaddressed pure-tone hearing loss. Language: en

Older adults with hearing loss (HL), visual loss (VL), and/or cognitive impairment (CI) have poorer health outcomes. There is a strong relationship between HL, VL, CI, and incident dementia. Potential mechanisms include common biological substrates, exhaustion of cognitive reserve, and/or increased social isolation from communication difficulties. Our team examines co-relationships between HL/VL and CI in persons with dementia in the Canadian Consortium for Neurodegeneration in Aging (CCNA). We will review our recent work which has: 1) examined the relationship between CI and sensory loss on quality of care in home care; 2) examined the relationship between HL, VL, social network diversity, social participation, social support, and loneliness in the Canadian Longitudinal Study of Aging (CLSA); and 3) examines the incidence of HL and VL and their relationship with CI in CCNA participants. We will discuss the implications of our findings using these unique datasets for function and well-being.

Objectives/Hypothesis: Cochlear implantation is now the standard of care in patients with significant sensorineural hearing loss. It is well known that patients with severe hearing loss also experience disabling tinnitus. The purpose of this study was to assess the effects of cochlear implants on the perception of tinnitus using the Tinnitus Handicap Inventory (THI). Study Design: Prospective, longitudinal study of 142 cochlear implant patients. Methods: The THI was administered to 142 patients pre- and postimplantation. Outcome measures were obtained 12 months after the implantation. Secondary analyses to examine the correlation between changes in THI scores and outcome measures such as Hearing Handicap Inventory, Hearing in Noise Test (HINT), and short-form 36 (SF-36) quality-of-life scores were performed. Results: Patients demonstrated statistically significant reduction of the THI scores including its subscales (P < .001). Prior to implantation, 37% of patients described their tinnitus as moderate to severe. Postoperatively, this percentage decreased to 10%. Cochlear implantation resulted in complete tinnitus suppression in 37% and tinnitus reduction in another 29% of patients. THI scores significantly correlated with three domains of the SF-36 quality-of-life questionnaire, namely social, emotional, and general health domains. Conclusions: Cochlear implants have a significant suppressive effect on tinnitus in 66% of implant users. Although the reduction in the subjectively perceived tinnitus was statistically significant, it did not correlate with HINT; however, it did correlate with three quality-of-life domains, more significantly for those whose pretreatment conditions were moderate or worse.

OBJECTIVE To assess the lateral growth pattern in adult patients with growing sporadic vestibular schwannomas (VSs) and to decide if repeat imaging is always necessary immediately preoperatively when determining the route of access for microsurgical excision. PATIENTS Adults identified as having VS growth from serial scanning (3 scans per patient) between 1994 and 2007 in a single referral center. Neurofibromatosis Type 2 patients and those with tumor growth already to the fundus of the internal auditory canal were excluded. INTERVENTION Retrospective review of serial imaging. MAIN OUTCOME MEASURES Lateral growth (in millimeters) in the internal auditory canal. RESULTS Thirty subjects were identified who had continued serial imaging after documented growth, of whom 26 (87%)showed no lateral growth and 4 (13%) showed growth of 1 mm.This was determined over a median time period of 26 months(interquartile range, 20Y36.5 mo). The time frame between the second and third scans looked at the period of continued observation in this group of subjects in whom known previous tumor growth had occurred, which was 13 months (interquartile range, 9.25Y16.75 mo), and this is the most reliable time frame upon which a practice-changing decision regarding repeat scanning can be made from these data. CONCLUSION Sporadic VSs that are documented to be growing on serial imaging do not seem to grow to any significant degree in a lateral direction within the internal auditory canal.The results imply that scans performed within a year of any surgical intervention need not be repeated to assess concerns of any further lateral growth while accepting that repeat imaging may be required for other clinical reasons. Key Words:Internal auditory canal

Background Hypermethylation of CpG islands in the promoter region of death-associated protein kinase (DAP-kinase) coupled with the loss of γ-interferon-induced apoptosis have been reported in B-cell malignancies suggesting a role in pathogenesis or prognosis. Along with B-cell malignancies, pediatric lymphomas also include T-cell non-Hodgkin lymphoma (NHL), anaplastic large cell lymphoma, and Hodgkin disease, each with unique prognoses. The purpose of this study was to elucidate epigenetic changes in the DAP-kinase promoter region of pediatric cases to determine associations with aberrant hypermethylation. Procedures Thirty-nine cases of different lymphoid pathology [10 Burkitt lymphoma, 1 B-cell NHL; 7 T-cell lymphoblastic lymphoma; 4 anaplastic large cell lymphoma (LCL); 2 B-cell LCL; 14 nodular sclerosing Hodgkin disease (NSHD); and 1 B-cell acute lymphoblastic leukemia (ALL)] had methylation-specific polymerase chain reaction performed on bisulfite-treated DNA, which distinguishes the methylation status of the promoter region, and DAP-kinase mRNA expression assays performed on available specimens. Results In normal lymphocytes, the CpG islands in the promoter region were unmethylated, as were the T-cell lymphoblastic lymphoma and anaplastic LCL. In contrast, 100% of the Burkitt lymphoma (10/10) and B-cell ALL (1/1) were hypermethylated. Of the specimens with mRNA available, 7/8 Burkitt lymphoma had no DAP-kinase mRNA expression compared to normal expression in 3/3 and 4/4 T-cell lymphoblastic lymphoma and NSHD, respectively. Conclusions In these pediatric lymphoid tumors, hypermethylation of the DAP-kinase promoter region with associated loss of DAP-kinase gene expression was associated with B-cell malignancies and thus may be important in the development and/or provide a prognostic tool in B- cell lymphomas. Med Pediatr Oncol 2003;41:527–531. © 2003 Wiley-Liss, Inc.

The effects of sensory loss on social structure and function in different age and sex groups are poorly understood. We analyzed a population based sample of 21,241 Canadian adults to determine if hearing loss (HL), vision loss (VL) or dual sensory loss (DL) were associated with social network size, social participation, availability of social support, and loneliness, respectively, and whether age or sex modified the associations. VL was associated with reduced social network size in males and low social participation in all age/sex groups. DL was associated with reduced network size and participation in 65–85 year olds. All forms of sensory loss were associated with reduced social support and loneliness. The results might be explained by mobility challenges resulting from VL and DL, and communication problems arising from HL, VL and DL. Individuals with sensory impairments should be targeted for interventions that increase social engagement and support and reduce loneliness.

Objective To describe our experience with stereotactic radiosurgery and its efficacy on growing tumors, and then to compare this result with the natural history of a similar cohort of non-radiation-treated lesions. Study Design A retrospective chart review and cohort comparison. Methods The long-term control rates of patients having undergone radiosurgery were collected and calculated, and this population was then compared with a group of untreated patients from the same period of time with growing lesions. Results A total of 61 patients with growing vestibular schwannomas treated with radiosurgery were included. After a mean of 160 months, we observed a control rate of 85.2%. When compared with a group of 36 patients with growing tumors who were yet to receive treatment (previously published), we found a corrected control rate or relative risk reduction of only 76.8%. Conclusion Radiosurgery for growing vestibular schwannomas is less effective than previously reported in unselected series. Although radiosurgery still has a role in managing this disease, consideration should be given to the actual efficacy that may be calculated when the natural history is known. We hope other centers will similarly report their experience on this cohort of patients.

Objectives Our objective was to systematically identify and evaluate prospective studies providing evidence for and against the use of prokinetic agents in the treatment of laryngopharyngeal reflux (LPR) disease. Data Sources Our data sources were PubMed, Embase, BIOSIS, and Web of Science databases. Review Methods A systematic literature review was conducted to identify studies prospectively evaluating the effectiveness of prokinetic agents in the treatment of LPR. Data from eligible studies were independently extracted from each study by two authors. The primary outcome of interest was the improvement of LPR symptoms among study participants. Secondary outcomes included resolution of LPR physical signs and the development of side effects from therapy. Results Among 724 unique articles identified, four studies met inclusion criteria. These four investigations provided mixed evidence about the effectiveness of prokinetic agents in the treatment of LPR. The studies included in the review were deemed to be at high risk of bias. Three of the four investigations demonstrated a statistically significant difference in patient symptoms that favored the use of prokinetics in the management of LPR. The investigations were mixed in their report of improvement in physical examination findings among patients receiving and those not receiving prokinetic medical therapy. No significant adverse effects were described in any of these trials. Conclusions Prokinetic agents may be a viable treatment option for LPR. The current body of literature is inadequate to make a recommendation for their use in this disease process. Further research should be conducted to assess the use of prokinetic medications in the management of LPR. Level of Evidence NA Laryngoscope 124:2375–2379, 2014

To determine if age-related hearing loss is associated with social isolation and whether factors such as age, gender, income, race, or hearing aid use moderated the association.Cross-sectional.Randomly sampled United States communities.Cross-sectional data on adults 60 to 84 years old from the 1999 to 2006 cycles of the National Health and Nutrition Examination Survey were analyzed. The dependent variable was social isolation, which was defined using the social isolation score (SIS), a 4-point composite index consisting of items pertaining to strength of social network and support. SIS scores ≥2 were considered indicative of social isolation. The independent (predictor) variable was the pure tone average of speech frequency (0.5-4 kHz) hearing thresholds in the better-hearing ear. Covariates included potential medical, demographic, and otologic confounders. We used multivariate logistic regression to evaluate the association between hearing loss and the odds of having social isolation. An exploratory analysis was performed to assess the strength of associations between hearing loss and individual items of the SIS scale.Greater hearing loss was associated with increased odds of social isolation in women aged 60 to 69 years (odds ratio [OR], 3.49 per 25-dB of hearing loss; 95% confidence interval, 1.91, 6.39; P.001). Effect modification by gender was significant in this age group (P = .003). Hearing loss was not significantly associated with social isolation in other age and gender groups.Greater hearing loss is associated with increased odds of being social isolated in a nationally representative sample of women aged 60 to 69 years.

Background/objectives Meniere's disease (MD) that results in bilateral severe to profound sensorineural hearing loss is a rare indication for cochlear implantation; only a few studies exist documenting performance in these patients. The primary objective was to compare the difference in preoperative to 12-month postoperative speech perception scores among subjects with MD and controls. Groupwise comparisons of secondary postoperative outcomes (Tinnitus Handicap Inventory [THI] scores, 36-Item Short Form [SF-36] scores, and postoperative dizziness) were also performed. Methods A retrospective cohort study was conducted. Subjects with MD and controls matched by age, device manufacturer and model, preoperative sentence score, and sentence test used for preimplantation and postimplantation performance assessments were identified from 1,130 patients in the prospectively maintained cochlear implant database at our center. Speech perception, THI, and SF-36 scores and demographic variables were obtained from the database. Vestibular outcomes were obtained by retrospective chart review. Statistical comparisons were performed to compare preoperative to postoperative change between groups. Results Twenty patients with MD were identified. At 1 year after CI, improvements in sentence and word understanding did not differ in magnitude from the controls. Tinnitus was reduced significantly in patients with MD, whereas there was a trend for improvement in the controls. Quality of life as measured by the SF-36 improved in both groups. Patients with MD had significant improvements in 1 domain compared with 5 domains for the controls. Subjects with MD had significantly more chronic dizziness in the postoperative period than did controls. Conclusions Patients with MD who have bilateral severe to profound sensorineural hearing loss benefit significantly from CI. Ongoing dizziness in some patients with MD may result in quality of life improvements that are slightly less than seen for the average adult patient with CI. Larger studies are needed to corroborate the results.

Objectives:By the end of the presentation the participant should better understand 1) the association between social isolation and hearing loss in the elderly; and 2) the consequences of social iso...

HYPOTHESIS Using the rapid prototype (RP) technology, a physical construct of a human temporal bone was developed based on cadaveric tissue to permit simulated surgical training. The objective of the study was to test the face validity of the model. BACKGROUND The cost and access to human cadaveric temporal bones is becoming increasingly challenging, particularly if there are religious and regulatory restrictions. There is a need to develop alternative strategies to improve accessibility. METHODS Ultra high-resolution computed tomography (CT) images (0.15-mm resolution) were obtained from a cadaver temporal bone. Manual segmentation and conversion into a stereolithography file format permitted printing on a RP stereolithography printer. A 3-dimensional physical model was hardened to achieve the desired consistency. Eight practicing otologists were recruited to evaluate this model. Respondents were asked to drill the artificial bone and complete a rating survey upon completion. RESULTS In using a Likert scale between 1 and 5, results for anatomic accuracy were favorable, with the best scores for overall morphology (4.63) and for lateral structures within the bone (4.5). The poorest scores were for the semicircular canals (3.75) and chorda tympani (3.25). Scores for haptic realism were good as well. The average score for the question "overall, how valuable is the model as a surgical simulator" was 4.1. The experts felt that junior residents (PGY 1-3) would benefit most from this surgical education model. CONCLUSION The outer structures of the RP artificial temporal bone can be considered to have face validity. Improvements will continue to be made to address some of the deficiencies in the anatomic and haptic realism of this model.

Objectives/Hypothesis To evaluate percent maximum as an intraoperative facial nerve measurement for the long-term prognostication of vestibular schwannoma surgery. Study Design Prospective cohort study. Methods Evoked amplitude responses to varying levels of stimulus intensity at the nerve root were compared to their supramaximal responses (Mmax) as a percentage, that is, percent maximum. Response charts were constructed for each of the levels of stimulus intensity between 0.05 to 0.3 mA, vis-a-vis facial nerve outcome at 1 year, to establish sensitivities, specificities, and positive predictive values. Logistic regression analyses were used to determine the impact of sex, age, tumor size, and historically defined response parameter on outcomes. Results Seventy-eight patients who underwent vestibular schwannoma surgeries between 2005 and 2010 were studied. The positive predictive value (PPV) of a good facial nerve outcome, defined as House-Brackmann (HB) I-II, increases with percent maximum responses. A 90% PPV could be established when the response amplitude was 50% or greater compared to Mmax. Long-term prognostication appeared best at a higher stimulus level of 0.3 mA. Age and sex did not have an impact on outcome, but tumor size did; with each centimeter increase in tumor size, patients were 105% more likely to have a poor outcome (HB III-VI). If the response parameter “≥240 μV at 0.05 mA” was not present, there was a trend toward poor outcome. Conclusions Percent maximum is a valid intraoperative monitoring measure to prognosticate long-term facial nerve outcome. It should be considered a complementary method of monitoring when evoked responses do not conform to conventional predictors. Level of Evidence 4. Laryngoscope, 123:2533–2538, 2013

Objectives The primary purpose of this study was to evaluate a group of postlingually deafened adults, whose aided speech recognition exceeded commonly accepted candidacy criteria for implantation. The study aimed to define performance and qualitative outcomes of cochlear implants in these individuals compared with their optimally fitted hearing aid(s). Study design Retrospective case series. Setting Tertiary referral center. Patients All postlingually deafened subjects (N = 27), who were unsuccessful hearing aid users implanted between 2000 and 2010 with a preimplantation Hearing in Noise Test (HINT) score of 60% or more were included. Intervention We compared patients' preoperative performance (HINT score) with hearing aids to postoperative performance with the cochlear implant after 12 months of device use. In addition, the Hearing Handicap Inventory questionnaire was used to quantify the hearing-related handicap change perceived after the implantation. Results The study group demonstrated significant postoperative improvement on all outcome measures; most notably, the mean HINT score improved from 68.4% (standard deviation, 8.3) to 91.9% (standard deviation, 9.7). Additionally, there was a significant improvement in hearing-related handicap perceived by all patients. Conclusion The envelope of implantation candidacy criteria continues to expand as shown by this study's cohort. Patient satisfaction and speech recognition results are very encouraging in support of treating those who currently perform at a level above the conventional candidacy threshold but struggle with optimally fitted hearing aids.

To determine the subsequent growth patterns in vestibular schwannomas shown to be growing on serial imaging.Retrospective review.Tertiary academic referral center.Patients with tumors that demonstrated growth of greater than 1 mm/yr between 2 consecutive scans (magnetic resonance or computed tomography) and had at least 1 follow-up scan were included. Patients with neurofibromatosis were excluded.Review of radiographic images (magnetic resonance imaging scans) or neuroradiologists' reports when the images were unavailable.Maximum dimension along the axis of the internal auditory canal was measured for intracanalicular tumors, whereas for extracanalicular tumors, maximal dimension along any orientation was used. A significant difference in dimension was defined to be greater than 1 mm/yr, positive or negative.Thirty-six patients were included in the study; 47% were women and with an average age of 60.2 years. The average follow-up period after growth was identified was 2.1 years. Of the growing tumors, 63.9% continued to grow, 30.6% stayed the same size, and 5.6% regressed in size.Most vestibular schwannomas identified to be growing are likely to continue to grow on subsequent serial imaging. These results are useful in clinical decision making and counseling patients with growing vestibular schwannomas.

BACKGROUND: This is an update of a Cochrane review first published in The Cochrane Library in Issue 4, 2008 and previously updated in 2011. Acute suppurative otitis media is one of the most common infectious diseases in childhood. Recurrent acute otitis media is defined for the purposes of this review as either three or more acute infections of the middle ear cleft in a six‐month period, or at least four episodes in a year. Strategies for managing the condition include the assessment and modification of risk factors where possible, repeated courses of antibiotics for each new infection, antibiotic prophylaxis and the insertion of ventilation tubes (grommets). OBJECTIVES: To establish whether grommet insertion reduces the frequency of episodes of recurrent acute otitis media and the proportion of symptomatic children. SEARCH METHODS: The Cochrane Ear, Nose and Throat Disorders Group (CENTDG) Trials Search Co‐ordinator searched the CENTDG Trials Register; Central Register of Controlled Trials (CENTRAL 2014, Issue 10); PubMed; EMBASE; CINAHL; Web of Science; Clinicaltrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 6 November 2014. SELECTION CRITERIA: Randomised controlled trials comparing grommet insertion versus control (antibiotics/other treatments/no treatment) for recurrent acute otitis media in children aged from 0 to 16 years. DATA COLLECTION AND ANALYSIS: Two authors independently selected studies. Three authors independently assessed study quality and extracted data. We synthesised data descriptively. MAIN RESULTS: Two randomised controlled trials with a total of 148 participants are included in this review. The overall risk of bias in the studies is unclear. The first study randomised 95 children to grommets or control (antibiotic treatment of acute otitis media episodes). For the primary outcome, this study showed that grommet insertion leads to a mean reduction of 1.5 episodes of acute otitis media in the first six months after treatment. In six months of follow‐up significantly more children in the grommet group had no episodes of acute otitis media (P value < 0.001). Complications of surgery included grommet blockage with acute otitis media requiring re‐operation within six months in 3/54 children who underwent grommet insertion. Adverse effects were not documented in the control group. The following pre‐defined secondary outcomes were not reported: change in symptom scores for otalgia or otorrhoea, alteration in the frequency of otalgia or otorrhoea, and number of days at nursery or school lost secondary to acute otitis media. The second study reported on 53 of 68 children who were randomised to grommet insertion or six months of once a day sulfamethoxazole and trimethoprim antibiotic prophylaxis. There was no significant difference in the primary outcome, number of episodes of acute otitis media, during the six‐month follow‐up between grommet insertion and antibiotic treatment groups (64.5% in the surgical group versus 45.4% in the antibiotic group had no recurrence, P value = 0.4). Two participants underwent grommet re‐insertion to replace extruded tubes during the follow‐up period. The only other adverse effect reported was the development of a skin rash in two patients in the medical group. Other pre‐defined secondary outcome measures were not reported. The study has a high risk of bias and the results should be interpreted cautiously. AUTHORS' CONCLUSIONS: Grommets significantly increase the number of acute otitis media‐free children in the first six months after insertion compared to children who receive no treatment. Grommet insertion maybe of equivalent efficacy to once a day antibiotic prophylaxis. Further research is required to confirm the advantage of grommets over no treatment, investigate the effect beyond six months, compare grommet effectiveness against alternative active treatments and confirm the low risk of adverse effects compared to no treatment and all active treatments in recurrent acute otitis media. In the interim clinicians should consider the possible adverse effects of grommet insertion and alternative treatments before recommending surgery.

Background Hearing loss as a possible side effect of azithromycin has been recognized since 1994. Most reports suggesting a link between sensorineural hearing loss (SNHL) and this drug have been in association with prolonged doses for treatment of Mycobacterium lung disease. Mild-moderate, gradual, and reversible SNHL in the speech frequencies has been most often reported. Materials and methods We describe irreversible SNHL in a patient in association with low-dose oral azithromycin prescribed for acute otitis media. We summarize the available evidence, including a systematic literature review, in support of a possible causal association between SNHL and low-dose azithromycin therapy. Interpretation/discussion Physicians should be aware of the potential for even low-dose, oral azithromycin to cause irreversible SNHL as a serious adverse drug reaction in some patients.

Background/objective: Hearing Preservation(HP) in the context of cochlear implantation(CI) is indicative of atraumatic insertion and could potentially offer a clinical advantage to performance. However, if residual hearing is lost due to surgical trauma or from natural deterioration, HP that was achieved from the insertion of a short electrode would then compromise any future performance that would have been obtained through a full length implant. Our goal was to determine the degree of HP after implantation with a full-length electrode (the FLEXsoft).

Figure 3. SF-36 SCORES (%). Average quality of life scores improved for both groups. Significant Improvement was seen in fewer domains for the MD group, however. (Blue = preop; Purple = postop). * Denotes p < 0.05; N=21 per group Figure 2. PATIENTS WITH TINNITUS (%). The number of patients reporting tinnitus decreased in both groups following CI. Significance was reached in the control group. (Blue = preop; Purple = Postop) * Denotes p