Search

Objective: Investigating the impact of early childhood ventilation tube insertion (VTI) on long‐term language outcomes. Design: Longitudinal cohort study. Setting: A total of 2900 pregnant women participated in the Raine Study between 1989 and 1991 in Western Australia, and 2868 children have been followed up. Participants: Based on parental reports, 314 children had a history of recurrent otitis media but did not undergo VTI (rOM group); another 94 received VTI (VTI group); while 1735 had no history of rOM (reference group) in the first 3 years of childhood. Children with data on outcomes and confounders were included in analyses of PPVT‐R at ages 6 (n = 1567) and 10 years (n = 1313) and CELF‐III at 10 years (n = 1410) (approximately 5% in the VTI group and 15% in the rOM group). Main Outcome Measures: Peabody Picture Vocabulary Test‐Revised edition and Clinical Evaluation of Language Fundamentals® Preschool‐3. Results: At 6 years, mean PPVT‐R scores were significantly lower in the VTI group than the reference group (β = −3.3; 95% CI [−6.5 to −0.04], p =.047). At 10 years, while the difference between the VTI and reference groups was less pronounced for PPVT‐R scores, there was a small but consistent trend of lower measures, on average, across CELF‐III scores (expressive: β = −3.4 [−7.1 to 0.27], p =.069; receptive: β = −4.1 [−7.9 to −0.34], p =.033; total: β = −3.9 [−7.5 to −0.21], p =.038). There was no evidence to suggest that language outcomes in the rOM group differed from the reference group. Conclusion: Lower scores of language outcomes in school‐aged children who received VTI in early childhood may suggest a long‐term risk which should be considered alongside the potential benefits of VTI. [ABSTRACT FROM AUTHOR]

To explore the barriers and facilitators faced by hearing healthcare clinicians (HHCs) with respect to asking adults with hearing loss (HL) about their emotional well-being. This qualitative study was conducted using semi-structured individual interviews and focus groups. The interview topic guide was developed based on the COM-B model. Fifteen HHCs of a single hearing services organisation in Western Australia across 13 clinic locations participated. Barriers and facilitators that may influence HHCs' behaviour of routinely asking adults about their emotional well-being include having the knowledge and skills to ask about emotional well-being, forgetting to ask, awareness of the emotional impacts of HL, time and tools for asking, clients' reactions to being asked, supportive peers, normalisation of discussions relating to emotional well-being, presence of significant others, emotions associated with asking, being in the habit of asking, reminders, beliefs about consequences and confidence or capabilities, and scope of audiology practice. Application of the COM-B model identified barriers in capabilities (e.g. knowledge), opportunities (e.g. tools), and motivation (e.g. beliefs about benefits of asking about emotions) that need to be addressed for HHCs to ask their clients about their emotional well-being. [ABSTRACT FROM AUTHOR]

The aim of this study was to estimate the prevalence and distress of tinnitus pre- and post-cochlear implantation in patients with bilateral severe to profound hearing loss. In this retrospective study, we included patients from a cochlear implant clinic in Perth, Western Australia. Pre- and post-cochlear implantation data from 300 implant recipients were collected on self-reported presence of tinnitus, tinnitus distress using the Tinnitus Reaction Questionnaire (TRQ), hearing-related quality of life using the Abbreviated Profile of Hearing Aid Benefit (APHAB), and consonant-nucleus vowel-consonant (CNC) word recognition test scores. Retrospectively, patients were grouped into those with or without tinnitus, and the grade of tinnitus distress. The potential factors associated with post-implantation changes in the presence of tinnitus and its distress were evaluated. Tinnitus prevalence was 55.8% pre-operatively and 44.3% post-implantation with a median TRQ score respectively of 12.0 (IQR: 1.0–28.0) and 3.5 (IQR: 0.0–16.2) points. Among the 96 patients experiencing tinnitus pre-implantation, 14.6% patients experienced moderate to catastrophic tinnitus distress pre-implantation compared to 6.3% post-implantation. To conclude, the pre- and post-implantation median TRQ score for the cohort population showed that tinnitus was a "slight" handicap. Tinnitus prevalence and its associated tinnitus distress decreased post-implantation. Patients with tinnitus post-implantation were significantly younger and had less severe pre-implantation hearing loss in the non-implanted ear than patients without tinnitus. Further research is needed to understand the factors influencing changes in tinnitus. [ABSTRACT FROM AUTHOR]

Objective: To investigate hearing aid owners' decisions to attend or not to attend an annual hearing aid review (HAR) appointment. To investigate the possible factors associated with appointment attendance, including age, gender, transportation, travel time, and hearing aid outcomes. Design: A prospective cohort study. Potential participants were notified of their annual HAR appointment in the usual process employed by their clinic. Two months later, potential participants were identified as those who had attended and those who had not attended an appointment. Study sample: One hundred and twenty adult hearing aid users ranging in age from 26 to 100 (M=74, SD=11) years recruited from a single hearing clinic in Perth, Western Australia. Results: Factors found to be significantly associated with attendance at an annual HAR appointment included hearing aid funding source (government subsidised), participants valuing the importance and benefit of the appointment, and superior hearing aid outcomes. Conclusions: Within a controlled practice setting, appointment attendance is influenced by some factors modifiable by the clinician, including providing better education about the process and purpose of the HAR appointment. The value of the HAR appointment was emphasised by the positive association between better hearing aid outcomes HAR appointment attendance. [ABSTRACT FROM AUTHOR]

Objective: Although clinician administered surveys evaluating hearing aid handling skills exist, the development of a self-administered version may reduce clinical load, save consultation time, and facilitate more frequent use than face-to-face consultations allow. However, there is currently no evidence to support whether hearing aid owners can accurately self-report hearing aid handling skills via self-report survey that systematically evaluates the ability to accurately perform the individual aspects of hearing aid handling required for effective hearing aid management.Design: An explorative pilot study using a prospective research design.Study sample: Nineteen adult hearing aid owners, aged between 65 and 93 years.Results: The self-administered survey demonstrated high sensitivity when compared with clinician evaluation of skills, with 93% of participants accurately self-identifying and reporting whether hearing aid handling skill training was required.Conclusions: Hearing aid owners are able to accurately self-report hearing aid handling difficulties when provided with an itemised list of skills. [ABSTRACT FROM AUTHOR]

Objective To examine whether self-reported hearing difficulty is an accurate measure of hearing loss compared with standard hearing screening with pure tone audiometry in rural and urban communities. Design Convenience sampling. Setting Urban and rural areas of Western Australia. Participants A total of 2090 participants (923 men; 1165 women; 2 unknown) aged 20-100 years presenting for community-based hearing screening in urban (982) and rural (1090) areas. Interventions Self-reported hearing difficulty assessed with the Hearing Handicap Inventory for the Elderly - Screening questionnaire. Hearing loss defined as average hearing thresholds >25 dB in the better ear using screening audiometry conducted at 500, 1000, 2000 and 4000 Hz. Main outcome measures Nil. Results The Hearing Handicap Inventory for the Elderly - Screening was sensitive (≥60 years = 76.69%; <60 years = 71.67%) but not specific (≥60 years = 45.15%; <60 years = 49.63%) for identifying hearing loss. The <60 age group had a hearing loss prevalence of 25.6%, and a false-positive rate of 67.12% compared with a prevalence of 69.12% and false-positive rate of 29.77% for the ≥60 age group. For all ages, rural participants were more likely to have a disabling hearing loss (odds ratio 2.04 (95% confidence interval, 1.55-2.67); χ2(1) = 27.28; P < 0.001), but there were no significant differences in hearing aid uptake. Conclusions Patients in rural areas presenting for hearing screenings are more likely to suffer hearing loss than adults in urban areas. We suggest rural health practitioners incorporate a self-reported hearing loss questionnaire into health check-ups for adults, particularly patients aged ≥60 years due to the high prevalence of hearing loss in this group. [ABSTRACT FROM AUTHOR]

Background: Despite its value as a diagnostic measure of middle-ear function, recommendations for tympanometry as a screening test for middle-ear disorders have been tentative. This is primarily due to concerns related to over-referrals, cost-effectiveness, variability in referral criteria and protocols, variable reported screen performance, and influence of demographic and environmental factors. Purpose: The current study assessed tympanometry in a large population of children between 5-7 yr old in terms of normative ranges, performance of current recommended referral criteria, and associations with independent demographic and environmental variables. Research Design: Retrospective cohort study. Study Sample: A total of 2868 children and their families were originally enrolled in the Raine Cohort Study in Western Australia, Of these, 1469 children between 5-7 yr old (average age = 5.97 yr, SD = 0.17 yr) were evaluated with tympanometry and pure-tone audiometry screening. Data Collection and Analysis: Tympanometry was conducted using a 226 Hz probe tone with screening ipsilateral acoustic reflexes recorded using a 1000 Hz stimulus. Hearing screening was conducted using pure tones at 20 dB HL for 1000,2000, and 4000 Hz. Relationships among normative ranges (90% and 95% ranges) for tympanometric indices, age, gender, and month of test were determined. Associations were also explored between tympanometry referrals and month of test, gender, and absence of acoustic reflexes. Results: Normative 90% ranges for tympanometric peak pressure was-275 to 15 daPa, 60-150 daPa for peak compensated tympanometric width, 0.2 and 1.0 mmho for peak compensated static admittance, and 0.7-1.3 cm3 for ear canal volume. Current screening guidelines result in high referral rates for children 5-7 yr old (13.3% and 11.5% using the American Speech-Language-Hearing Association [ASHA] and American Academy of Audiology [AAA] guidelines, respectively). The subgroup of children 6-7 yr old had referral rates (for ears tested) of only 3.3% and 2.7%, respectively, according to ASHA and AAA guidelines. The prevalence of middle-ear effusion (admittance <0.1 mmho) was significantly different across seasons, with the highest (13.5%) in September and lowest (3.8%) in January. Month of test was associated with a general decrease in tympanometric peak pressure across the population. Conclusions: An 80% reduction in tympanometry referrals for children ages 6 and 7 yr compared with children age 5 yr argues for tympanometry as a first-tier screening method in older children only. The impact of regional seasonal influences, representing an increase in referrals as high as 3.5 times from one month to another, should also inform and direct pediatric screening programs for middle-ear functioning and/or hearing loss. [ABSTRACT FROM AUTHOR]

Background: The baby boomer population will become high users of the health-care system in coming years. Self-report of hearing loss at a primary health-care visit may offer timely referrals to audiological services, but there has been no population-based study of self-reported hearing loss in the baby boomer generation. Purpose: To determine the clinical value and audiometric correspondence of self-reported hearing loss as a screening tool for the baby boomer population. Research Design: A population-based study, Busselton Healthy Ageing Study (BHAS), surveying baby boomers born between 1946 and 1964 from the shire of Busselton, Western Australia. Study Sample: A randomized sample of noninstitutionalized baby-boomers listed on the electoral roll (n = 6690) and resident in the shire are eligible to participate. This study reports on data from the first 1004 attendees (53.5% female) with a mean age of 56.23 (SD = 5.43). Data Collection and Analysis: Data from a self-report question on hearing loss and diagnostic pure tone audiometry was utilized for this study. Analysis included screening performance measures of self-report compared to audiometric cut-offs, receiver operator curve (ROC) to determine optimal level, analysis of variance to compare hearing status to self-report, and binary logistic regression to determine best audiometric predictors. Results: Of the sample, 16% self-reported hearing loss (72.1% males). Logistic regression indicated 4000 Hz as the most important individual frequency related to self-report while the four-frequency average (500, 1000, 2000, and 4000 Hz) >25 dB in the worse ear was the most significant averaged cutoff with 68% sensitivity and 87% specificity. Of those who self-reported a hearing loss, 80% had either a four- frequency average hearing loss >25 dB in the worse ear or a high-frequency average (4000 and 8000 Hz) hearing loss greater than 35 dB in the worse ear. Conclusions: Baby boomer adults who self-report hearing impairment on direct inquiry are most likely to have-a hearing loss. A simple question at a primary health care visit may facilitate a timely referral for audiological services in a baby boomer adult, who may be more amenable to rehabilitation. [ABSTRACT FROM AUTHOR]

The view of the tympanic membrane of the ear provides the specialist with important information for the assessment of ear disease and for treatment planning. In rural and remote areas, the incidence of ear disease is high but access to ear specialists is limited. As part of a project to deliver tele-otoscopy services to remote Western Australia, we have investigated various aspects of a tele-otoscopy system. We found that the MedRX video-otoscope is relatively safe to use and produces images of very good quality. A confident diagnosis could be made from still images compressed to 20 kByte. Video sequences could be compressed to a ratio of 1:300. Furthermore, a software package has been developed, and we are developing a training course for health-care workers in remote areas. [ABSTRACT FROM AUTHOR]

Assesses the utilization of ear, nose and throat services by patients in rural and remote areas in Western Australia. Role played by telemedicine in overcoming poor access to specialist services; Investigation of the reason for the consultation or procedure; Costs involved in attending Perth hospital clinics.

Objective: Examine the accuracy of automated audiometry in a clinically heterogeneous population of adults using the KUDUwave automated audiometer., Design: Prospective accuracy study. Manual audiometry was performed in a sound-treated room and automated audiometry was not conducted in a sound-treated environment., Study Sample: 42 consecutively recruited participants from a tertiary otolaryngology department in Western Australia., Results: Absolute mean differences ranged between 5.12-9.68 dB (air-conduction) and 8.26-15 dB (bone-conduction). A total of 86.5% of manual and automated 4FAs were within 10 dB (i.e. ±5 dB); 94.8% were within 15 dB. However, there were significant (p < 0.05) differences between automated and manual audiometry at 250, 500, 1000, and 2000 Hz (air-conduction) and 500 and 1000 Hz (bone-conduction). The effect of age (≥55 years) on accuracy (p = 0.014) was not significant on linear regression (p > 0.05; R(2) =( ) 0.11). The presence of a hearing loss (better ear ≥26 dB) did not significantly affect accuracy (p = 0.604; air-conduction), (p = 0.218; bone-conduction)., Conclusions: This study provides clinical validation of automated audiometry using the KUDUwave in a clinically heterogeneous population, without the use of a sound-treated environment. Whilst threshold variations were statistically significant, future research is needed to ascertain the clinical significance of such variation.

Aim: To describe the prevalence and risk factors of recurrent otitis media (rOM) in an urban Australian population at 3 years of age., Methods: Cross-sectional examination of prevalence and risk factors of rOM in 2280 participants from the Raine Study enrolled from public and private hospitals in Perth, Western Australia, between 1989 and 1991. Parental report questionnaires at 3 years of age were used for rOM identification, with secondary confirmation by otoscopic examination at 1, 2 or 3 years of age., Results: The prevalence of parent-reported rOM was 26.8% (611/2280) and 5.5% (125/2280) for severe rOM in the Study. Independent associations were found between rOM and the presence of older siblings, attendance at day care and the introduction of other milk products at ≤4 months of age. Independent associations for severe rOM were the presence of allergies and attendance at day care., Conclusions: Prevalence rates of rOM within the Raine Study children are similar to a number of other known cohorts. Parity, presence of allergies, attendance at day care and introduction of other milk products at ≤4 months are highlighted as specific risk factors for rOM in this population and presence of allergies and attendance at day care being risk factors for severe rOM. Diagnosis of rOM by parent report and the delay between data collection and reporting are limitations of this study. However, as there is very limited data on OM in urban, non-Indigenous Australian children, this study improves our understanding of OM for this group., (© 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).)

The shortage of otolaryngologists and the high incidence of ear disease in remote areas are major problems in Australia. We have developed a multimedia course for primary care providers that incorporates material about ear anatomy and physiology, ear disease, video-otoscopy and telemedicine software. The computer-based course was followed by a practical one-day course. A multiple-choice test was given to participants before and at the end of the course and a form was used to record feedback. The course was conducted with 30 aboriginal health workers. The participants were able to obtain images of reasonable to good quality after a short period of training. There was an average improvement of about 25% in the test scores, and the feedback regarding the course was extremely positive. The CD-ROM and the Website provide a valuable resource to assist primary care providers in their care of patients with ear disorders.