Publications by Year: 2009

OBJECTIVES: Comparing the effects of different disorders and interventions on health-related quality of life (HRQoL) is important for healthcare policy and accountability. There are two basic approaches to measure HRQoL: questionnaires derived from psychometrics and preference-based measures or utilities derived from econometrics. While disease-specific HRQoL questionnaires, such as the Dizziness Handicap Inventory (DHI), are important because they focus on the impact of a specific problem and its treatments (i.e., vestibular disorders), economic comparisons of the impacts of diseases/disorders and their treatments are typically based on utility assessment. The utility measures for audiology application (UMAA) were developed to measure utilities for various audiologic conditions using a standard computer. The purpose of this study was to determine if the UMAA provides stable, valid, and sensitive utility measures of the effects of benign paroxysmal positional vertigo (BPPV) and its treatment on HRQoL. It was hypothesized that utilities, as measured by the UMAA, would indicate improvement in HRQoL post-treatment for BPPV comparable to a disease-specific health status measure (DHI).

DESIGN: The UMAA incorporates three techniques to measure utility: rating scale, standard gamble, and time tradeoff. A utility is a cardinal measure of strength of preference and is measured on a continuum basis from 0.0 (incapacitating dizziness) to 1.0 (no dizziness). Fifty-two adults with BPPV of the posterior semicircular canal completed the UMAA and DHI before treatment and again post-treatment. A subgroup of 15 participants completed the UMAA on two occasions before treatment to assess test-retest stability and to establish critical difference values.

RESULTS: Results from this investigation demonstrate that utilities as measured through the UMAA are stable, valid, and comparable to the DHI. Post-treatment utilities were also significantly higher than pretreatment utilities, indicating that the utilities, as measured through the UMAA, are sensitive to improvement in HRQoL after BPPV treatment.

CONCLUSIONS: Utilities as measured through the UMAA seem sensitive to changes in HRQoL after treatment of BPPV. Since the UMAA can be used to measure patient preference (i.e., utility), it may be useful for comparison of specific audiologic conditions, such as BPPV, to nonaudiologic conditions, such as cardiovascular disease and kidney disease.

OBJECTIVE: Cochlear implant (CI) users typically report that speech recognition becomes substantially more difficult in the presence of background noise. This perception is consistent with objective measures of speech recognition showing that CI users require more favorable signal-to-noise ratios than normal-hearing (NH) listeners to achieve equivalent speech recognition. However, recent research in hearing aid users suggests that noise tolerance or the "willingness to listen in noise" may also influence perceived communication ability. Therefore, the purpose of this study was to evaluate the extent to which speech recognition in noise and noise tolerance predict perceived communication ability among adult CI users.

DESIGN: Twenty adult CI users were evaluated on an objective test of speech recognition in noise (Bamford-Kowal-Bench Sentences in Noise [BKB-SIN] test) and a measure of noise tolerance (Acceptable Noise Level [ANL] test) and completed a self-report measure of communication difficulty (Abbreviated Profile of Hearing Aid Benefit [APHAB]). Relationships between BKB-SIN scores, ANL scores, and aided APHAB scores for the ease of communication, background noise, reverberation, and Global scales were assessed. In addition, BKB-SIN scores and ANL scores for the CI users were compared with scores for a control group of 23 NH listeners.

RESULTS: CI users demonstrated substantially poorer BKB-SIN scores than NH listeners, as expected; however, their ANL scores were similar to those for NH listeners. BKB-SIN scores and ANL scores were not systematically related to one another. Each measure accounted for more than one third of the variance in CI users' aided APHAB Global scores; together, the two measures accounted for 72% of that variance.

CONCLUSIONS: Both speech recognition in noise and noise tolerance are strongly associated with CI users' self-perceived communication ability. The two measures seem to reflect different factors that influence an individual's communication experience; thus, both may provide useful clinical information. The establishment of formal criteria for BKB-SIN scores and ANL scores that are predictive of excessive communication difficulty may help to identify CI users who could benefit from additional audiologic rehabilitation.

Pregnancy during graduate medical training became a pertinent issue in the United States during the 10-year interval between 1992 and 2002 as the number of female residents trended steadily upward to over 25 per cent. Surgical training programs characteristically present unique challenges and stressors for all trainees, and pregnancy introduces additional physical, professional, and emotional demands for the pregnant woman and her coworkers. A qualitative study was performed using in-person interviews of female otolaryngology residents who had given birth within the previous 12 months. Items addressed included the pregnancy course and its complications, specific stressors during and after pregnancy, and solutions implemented by the resident and her program director. Reactions and level of support from coworkers were also discussed. Five pregnancies were reported among three residents interviewed. One resident experienced preterm delivery, which necessitated a week-long stay in the neonatal intensive care unit for her infant. Another had chorioamnionitis during delivery of two infants. One child had low birth weight. The third resident had a miscarriage during the first trimester of her first pregnancy and sustained a minor head injury after fainting in the operating room during her second pregnancy. Overall, long hours, unpredictable work demands, and guilt over colleagues' increased workloads and altered schedules were noted as significant sources of stress among these residents; the women also described high expectations of themselves, along with misgivings over their ability to balance pregnancy and parenthood with career demands. The most significant postpartum stress indicator was the matter of child care, especially as it related to finding adequate coverage for on-call periods ranging from 3 to 14 days per month. Maintaining breastfeeding was an additional concern in the postpartum period. Pregnancy during surgical residency is a significant source of conflict for the pregnant resident and her colleagues. Our study illustrates how program directors can pre-emptively address challenges this event presents. When policies on maternity leave, call issues during pregnancy, and flexible rotation schedules are in place before pregnancy occurs, the process may be smoother and more rewarding for all involved.

PURPOSE: To use the International Outcome Inventory for Hearing Aids (IOI-HA) with patients having advanced hearing aid technology to assess their satisfaction and benefit focusing on gender and experience effects, compare to norms, and use the IOI-HA and a practice-specific questionnaire to monitor the quality of the services provided by a dispensing practice.

RESEARCH DESIGN: A study of 160 potential participants who had worn their newly purchased multichannel digital hearing aids having directional microphones for at least three months, completed a trial period, and should have had time to acclimatize to them. English-speaking, private or insurance paying, competent, adult patients from a private practice were mailed a 12-item practice-specific questionnaire and the seven-item IOI-HA.

RESULTS: Of the 160 questionnaires mailed, 73 were returned for a 46% return rate. Of those, 64 were useable. Participants included male (34) and female (30), new (30) and previous (34) hearing aid users, who self-selected their participation by returning the questionnaires. The practice-specific questionnaire assessed patients' demographics and the quality of services received. The IOI-HA was analyzed according to an overall score and on two different factor scores. A power analysis revealed that 19 respondents per group were needed for the IOI-HA results to have a statistical power of .80 and probability of a Type II error of .20 for detecting a significant difference at the p < 0.05 level. Similar to earlier studies, no significant differences were observed either for any of the main effects or interactions for gender or user experience for the two IOI-HA factors and overall scores. A significant, but weak, positive correlation (r = .34; df = 63; p < .05) was observed between patients' overall satisfaction as indicated from the IOI-HA and the practice-specific quality assurance satisfaction question. T-tests on IOI-HA items 4 (satisfaction) and 7 (quality of life) revealed that the present participants' responses were significantly higher than for those in the normative study.

CONCLUSIONS: Gender and hearing aid experience did not influence these patients' responses on the IOI-HA, and all respondents were satisfied with their hearing aids and the practice that dispensed them. No major differences were found between these patients' IOI-HA results and normative data suggesting that both sets of respondents were satisfied with their hearing aids. However, limited statistical comparisons for the satisfaction and quality of life items revealed significant differences in favor of these participants' scores over those in the normative study. This suggested that the advanced hearing aid technology used here had a positive effect on patients' ratings and that the IOI-HA norms should be updated periodically to reflect changes in technology.

Simply asking elderly patients whether they have trouble hearing is an effective start to screening for hearing loss. Refer elderly patients with suspected hearing impairment for audiologic diagnosis and nonmedical rehabilitation treatment, including hearing aids. To assess a patient's risk of falling, review gait, balance disorders, weakness, environmental hazards, and medications.