scholarly journals Primary Care Approach to Hearing Loss: The Hidden Disability

2005 ◽  
Vol 84 (1) ◽  
pp. 26-44 ◽  
Author(s):  
Seth M. Cohen ◽  
Robert F. Labadie ◽  
David S. Haynes
Keyword(s):  
Primary Care ◽  
Hearing Loss ◽  
Cochlear Implants ◽  
Hearing Aids ◽  
Primary Care Physicians ◽  
Care Center ◽  
Tertiary Care ◽  
Local Resources ◽  
Academic Center ◽  
Care Approach

We report the results of a survey designed to investigate audiologic referral patterns of primary care physicians and, more specifically, their referral of patients for hearing aids and cochlear implants. Three hundred internal medicine and family medicine physicians were identified from a referral basin of a tertiary care center and chosen randomly to be faxed questionnaires concerning their views about patients with hearing loss, hearing loss screening and referral practices, and availability of local resources. Of the 260 physicians who received a questionnaire, 85 (32.7%) responded. Of their communities (60% of which had populations of fewer than 50,000), 82.4% had an otolaryngologist and 40% had access to an academic center. Although 97.6% of the responding physicians indicated that hearing loss affected patients’ quality of life, only 60% assessed patients for hearing loss. “Lack of time” and “more pressing issues” were the most common reasons given for not evaluating patients for hearing loss. Although 76 physicians (89.4%) said they were aware of cochlear implants, only 22 (25.9%) had referred patients for implant evaluation. Lack of referral most commonly resulted from uncertainties about “where to refer” and “which patients were potential candidates.” The results of this survey suggest that a large percentage of primary care physicians do not routinely test for hearing impairment in adults.

scholarly journals Assessment of Hearing Loss in Patients Receiving Chemoradiotherapy in Adjuvant Setting for Head and Neck Malignancy

2020 ◽  
Vol 3 (01) ◽  
pp. 16-22
Author(s):  
Vani Krishana Gupta ◽  
Mahesh Bhat ◽  
Vinay Vaidyanathan Rao ◽  
Vishak Surendra
Keyword(s):  
Hearing Loss ◽  
Head And Neck ◽  
Hearing Aids ◽  
Otitis Media With Effusion ◽  
Care Center ◽  
Tertiary Care ◽  
Intensity Modulated Radiotherapy ◽  
Pure Tone Audiometry ◽  
Average Dose ◽  
Head And Neck Malignancies

Abstract Introduction The aim of the study is to assess the hearing loss in patients who receive chemoradiation (chemoradiotherapy or CTRT) for head and neck malignancies. Materials and Methods Prospective study was conducted in the Department of ENT of a tertiary care center from September 2013 to August 2014. Forty patients suffering from head and neck malignancies (histologically proven) were included in the study. Patients with pre-existing hearing loss were excluded. All patients received radiotherapy dose of 66 to 70 Gy given as 2 Gy/d, 5 d/wk and chemotherapy dose of cisplatin 35 mg/m2 once a week for 6 weeks. Hearing was assessed by pure tone audiometry (PTA) and impedance audiometry conducted at regular intervals. Mcnemars chi-square test was used to compare the impedance and paired t-test and Pearson’s correlation were used to compare PTA at various stages. Results Predominantly male patients (28) falling in the age group of 40 to 60 years, suffered from various head and neck cancer, most common being oropharynx (14). Twenty patients developed sensorineural hearing loss (SNHL)—11(55%) had mild, seven (35%) had moderate, and two (10%) had severe grade of SNHL. Majority of these patients, 12 (60%) started developing SNHL mid-therapy, five (25%) at the completion of therapy and three (15%) 3 months post-therapy. Hearing loss was found to be more with two-dimensional radiotherapy (2DRT) and three-dimensional radiotherapy (3DRT) than with intensity-modulated radiotherapy (IMRT) as assessed by serial PTA. The average dose of radiation to right and left ears, respectively were 27.10 and 24.66 Gy. The incidence of otitis media with effusion increased during the treatment accounting for the conductive hearing loss irrespective of the modality of radiation used. Conclusion CTRT causes significant hearing loss in patients suffering from head and neck malignancies leading to further increase in the morbidity. Screening audiological assessment would be helpful to know the pretherapy status of the ear. Using newer modalities like IMRT can reduce hearing loss. Regular audiological screening can catch it at its onset and help in early use of hearing aids.

Plasticity of tonotopic maps in humans: influence of hearing loss, hearing aids and cochlear implants

2009 ◽  
Vol 130 (3) ◽  
pp. 333-337 ◽  
Author(s):  
Hung Thai-Van ◽  
Evelyne Veuillet ◽  
Arnaud Norena ◽  
Jeanne Guiraud ◽  
Lionel Collet
Keyword(s):  
Hearing Loss ◽  
Cochlear Implants ◽  
Hearing Aids

Establishment of Primary Care Continuity Experiences in Community Pediatricians' Offices: Nuts and Bolts

PEDIATRICS ◽  
1993 ◽  
Vol 91 (6) ◽  
pp. 1185-1189
Author(s):  
Janice R. Sargent ◽  
Lucy M. Osborn ◽  
Kenneth B. Roberts ◽  
Thomas G. DeWitt
Keyword(s):  
Primary Care ◽  
Medical Education ◽  
Professional Education ◽  
Primary Care Physicians ◽  
Clinical Training ◽  
Clinical Teaching ◽  
Tertiary Care ◽  
Ambulatory Training ◽  
Lengths Of Stay ◽  
Tertiary Care Centers

During the past 30 years, there has been an increasing awareness of the importance of ambulatory care training in medical education. The discrepancy between education and practice was pointed out in the General Professional Education Panel report that indicated training was based largely in hospital settings even though the vast majority of doctor-patient encounters do not result in hospitalization.1 Perkoff,2 noting changes in hospital care such as shorter lengths of stay, increased outpatient care, and the need for well-trained primary care physicians, stated that programs need to make a major effort to emphasize clinical teaching in outpatient settings. Recognizing the need for these changes, the Accreditation Council on Graduate Medical Education (ACGME) has increased dramatically the requirement in primary care specialties for clinical ambulatory training.3 For pediatrics, these requirements have progressed from the suggestion that clinical training should be obtained in outpatient clinics (1961) to requiring clinical training in primary care clinics weekly for 3 years (1985). The problems in providing good training in ambulatory settings have been well described.2-4 In comparison inpatient teaching, training students and residents in an outpatient clinic is inefficient and costly. One of the methods suggested to address these problems has been to move ambulatory training out of tertiary care centers to community sites.5-9 Many pediatric programs are now using community sites for at least a portion of resident education.10 Alpert et al10 and Greenberg et al,11 although encouraging the use of these sites to reduce the gap between pediatric education and the service delivery system, pointed out that there are no standards for use of community sites.

scholarly journals The Role of the Primary-Care Physician in Treating Relapses in Multiple Sclerosis Patients

2009 ◽  
Vol 11 (3) ◽  
pp. 122-126 ◽  
Author(s):  
Sarah A. Morrow ◽  
Marcelo Kremenchutzky
Keyword(s):  
Multiple Sclerosis ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Tertiary Care ◽  
Care Physician ◽  
Diagnosis And Treatment ◽  
High Prevalence ◽  
Tertiary Care Centers ◽  
Multiple Sclerosis Patients

Multiple sclerosis (MS) is a common disabling neurologic disease with an overall prevalence in Canada of 240 in 100,000. Multiple sclerosis clinics are located at tertiary-care centers that may be difficult for a patient to access during an acute relapse. Many relapses are evaluated by primary-care physicians in private clinics or emergency departments, but these physicians' familiarity with MS is not known. Therefore, a survey was undertaken to determine the knowledge and experience of primary-care physicians regarding the diagnosis and treatment of MS relapses. A total of 1282 licensed primary-care physicians in the catchment area of the London (Ontario, Canada) Multiple Sclerosis Clinic were identified and mailed a two-page anonymous survey. A total of 237 (18.5%) responses were obtained, but only 216 (16.8%) of these respondents were still in active practice. Of these 216 physicians, only 9% reported having no MS patients in their practice, while 70% had one to five patients, 16.7% had six to ten, and 1.9% had more than ten (3.7% did not respond to this question). Corticosteroids were recognized as an MS treatment by 49.5% of the respondents, but only 43.1% identified them as a treatment for acute relapses. In addition, 31% did not know how to diagnose a relapse, and only 37% identified new signs or symptoms of neurologic dysfunction as indicating a potential relapse. Despite the high prevalence of MS in Canada, primary-care physicians require more education and support from specialists in MS care regarding the diagnosis and treatment of MS relapses.

scholarly journals Association of Age-Related Hearing Loss with Cognitive Decline

2020 ◽  
Vol 63 (4) ◽  
pp. 145-153
Author(s):  
Juyong Chung
Keyword(s):  
Hearing Loss ◽  
Cognitive Decline ◽  
Cochlear Implants ◽  
Hearing Aids ◽  
Microvascular Disease ◽  
Single Mechanism ◽  
Hearing Aid Use ◽  
Age Related ◽  
Age Related Hearing Loss

A number of studies have demonstrated a significant association between age-related hearing loss (ARHL) and cognitive decline. However their relationship is not clear. In this review, we focused on the etiological mechanisms between ARHL and cognitive decline to explain the nature of this relationship: 1) causal mechanisms (e.g., cognitive load hypothesis, cascade hypothesis); 2) common cause mechanisms (e.g., microvascular disease); 3) overdiagnosis or harbinger hypothesis. We conclude that no single mechanism is sufficient and hearing and cognition related to each other in several different ways. In addition, we reviewed the effectiveness of hearing intervention (e.g., hearing aids and cochlear implants) on cognition function, and the role of hearing aid use and cochlear implant depends on the relevant mechanism.

scholarly journals Integrated complex care coordination for children with medical complexity: A mixed-methods evaluation of tertiary care-community collaboration

2021 ◽  
Author(s):  
Eyal Cohen ◽  
Ashley Lacombe-Duncan ◽  
Karen Spalding ◽  
Jennifer MacInnis ◽  
David Nicholas ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Care Coordination ◽  
Care Center ◽  
Tertiary Care ◽  
Care Utilization ◽  
Complex Care ◽  
Tertiary Care Center ◽  
Community Based ◽  
Children With Medical Complexity

Background Primary care medical homes may improve health outcomes for children with special healthcare needs (CSHCN), by improving care coordination. However, community-based primary care practices may be challenged to deliver comprehensive care coordination to complex subsets of CSHCN such as children with medical complexity (CMC). Linking a tertiary care center with the community may achieve cost effective and high quality care for CMC. The objective of this study was to evaluate the outcomes of community-based complex care clinics integrated with a tertiary care center. Methods A before- and after-intervention study design with mixed (quantitative/qualitative) methods was utilized. Clinics at two community hospitals distant from tertiary care were staffed by local community pediatricians with the tertiary care center nurse practitioner and linked with primary care providers. Eighty-one children with underlying chronic conditions, fragility, requirement for high intensity care and/or technology assistance, and involvement of multiple providers participated. Main outcome measures included health care utilization and expenditures, parent reports of parent- and child-quality of life [QOL (SF-36®, CPCHILD©, PedsQL™)], and family-centered care (MPOC-20®). Comparisons were made in equal (up to 1 year) pre- and post-periods supplemented by qualitative perspectives of families and pediatricians. Results Total health care system costs decreased from median (IQR) $244 (981) per patient per month (PPPM) pre-enrolment to $131 (355) PPPM post-enrolment (p=.007), driven primarily by fewer inpatient days in the tertiary care center (p=.006). Parents reported decreased out of pocket expenses (p<.0001). Parental QOL did not significantly change over the course of the study. Child QOL improved between baseline and 6 months in two PedsQL™ domains [Social (p=.01); Emotional (p=.003)], and between baseline and 1 year in two CPCHILD© domains [Health Standardization Section (p=.04); Comfort and Emotions (p=.03)], while total CPCHILD© score decreased between baseline and 1 year (p=.003). Parents and providers reported the ability to receive care close to home as a key benefit. Conclusions Complex care can be provided in community-based settings with less direct tertiary care involvement through an integrated clinic. Improvements in health care utilization and family-centeredness of care can be achieved despite minimal changes in parental perceptions of child health.

scholarly journals A study on chronic otitis media in tertiary care center

2018 ◽  
Vol 4 (2) ◽  
pp. 455
Author(s):  
Leena Rajam K. ◽  
Vikram V. J. ◽  
Priyanka C. ◽  
Indumathi R.
Keyword(s):  
Hearing Loss ◽  
Temporal Bone ◽  
Otitis Media ◽  
Care Center ◽  
Tertiary Care ◽  
Disease Process ◽  
Chronic Otitis Media ◽  
Common Finding ◽  
Duration Of Symptoms ◽  
Female Patients

<p class="abstract"><strong>Background:</strong> Chronic otitis media (COM) is a serious healthcare concern worldwide, because of the distress and economic burden to the patient and their family. Temporal bone pneumatization plays an important role in etiology, behaviour, course and outcome of COM. Pneumatisation gets poorer with growing chronicity of the disease<span lang="EN-IN">. </span></p><p class="abstract"><strong>Methods:</strong> A retrospective study was conducted between March 2015-March 2017 on female patients visiting with COM, at ENT department Kasturba Gandhi Hospital, Madras Medical College. The records were analysed of the age, duration of symptoms, associated complaints, pure tone audiogram, computerised tomography of temporal bone, mastoid surgery done according to the disease process affecting the ear<span lang="EN-IN">.  </span></p><p class="abstract"><strong>Results:</strong> 35 female COM patients were analysed, most common age group is between 31-40 years in 14 patients. There hearing loss was mild category in 27. There were 27 cases of mucosal type of chronic otitis media and 8 cases of squamous type. The CT scan with sclerosis of mastoid was the common finding<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> In exclusive study on female patients with COM, the mucosal type of COM is common with mild hearing loss and sclerosed mastoid indicating the chronicity<span lang="EN-IN">.</span></p><p class="abstract"> </p>

The Acquisition of Acoustic Cues to Onset and Coda Voicing Contrasts by Preschoolers With Hearing Loss

2021 ◽  
pp. 1-18
Author(s):  
Laurence Bruggeman ◽  
Julien Millasseau ◽  
Ivan Yuen ◽  
Katherine Demuth
Keyword(s):  
Hearing Loss ◽  
Cochlear Implants ◽  
Hearing Aids ◽  
Self Esteem ◽  
Acoustic Cues ◽  
Elicited Imitation ◽  
Phonological Representations ◽  
Initial Onset ◽  
English Speaking ◽  
Children With Hearing Loss

Purpose Children with hearing loss (HL), including those with hearing aids (HAs) and cochlear implants (CIs), often have difficulties contrasting words like “ b each ” versus “ p each ” and “ do g ” versus “ do ck ” due to challenges producing systematic voicing contrasts. Even when acoustic contrasts are present, these may not be perceived as such by others. This can cause miscommunication, leading to poor self-esteem and social isolation. Acoustic evidence is therefore needed to determine if these children have established distinct voicing categories before entering school and if misperceptions are due to a lack of phonological representations or due to a still-maturing implementation system. The findings should help inform more effective early intervention. Method Participants included 14 children with HL (eight HA users, five CI users, and one bimodal) and 20 with normal hearing, all English-speaking preschoolers. In an elicited imitation task, they produced consonant–vowel–consonant minimal pair words that contrasted voicing in word-initial (onset) or word-final (coda) position at all three places of articulation (PoAs). Results Overall, children with HL showed acoustically distinct voicing categories for both onsets and codas at all three PoAs. Contrasts were less systematic for codas than for onsets, as also confirmed by adults' perceptual ratings. Conclusions Preschoolers with HL produce acoustic differences for voiced versus voiceless onsets and codas, indicating distinct phonological representations for both. Nonetheless, codas were less accurately perceived by adult raters, especially when produced by CI users. This suggests a protracted development of the phonetic implementation of codas, where CI users, in particular, may benefit from targeted intervention.

scholarly journals Aging, Cognitive Decline and Hearing Loss: Effects of Auditory Rehabilitation and Training with Hearing Aids and Cochlear Implants on Cognitive Function and Depression among Older Adults

2016 ◽  
Vol 21 (Suppl. 1) ◽  
pp. 21-28 ◽  
Author(s):  
Alessandro Castiglione ◽  
Alice Benatti ◽  
Carmelita Velardita ◽  
Diego Favaro ◽  
Elisa Padoan ◽  
...  
Keyword(s):  
Older Adults ◽  
Hearing Loss ◽  
Cognitive Decline ◽  
Cochlear Implants ◽  
Hearing Aids ◽  
Digit Span ◽  
Depression Scale ◽  
Cognitive Status ◽  
Long Term Memory ◽  
Auditory Rehabilitation

A growing interest in cognitive effects associated with speech and hearing processes is spreading throughout the scientific community essentially guided by evidence that central and peripheral hearing loss is associated with cognitive decline. For the present research, 125 participants older than 65 years of age (105 with hearing impairment and 20 with normal hearing) were enrolled, divided into 6 groups according to their degree of hearing loss and assessed to determine the effects of the treatment applied. Patients in our research program routinely undergo an extensive audiological and cognitive evaluation protocol providing results from the Digit Span test, Stroop color-word test, Montreal Cognitive Assessment and Geriatric Depression Scale, before and after rehabilitation. Data analysis was performed for a cross-sectional and longitudinal study of the outcomes for the different treatment groups. Each group demonstrated improvement after auditory rehabilitation or training on short- and long-term memory tasks, level of depression and cognitive status scores. Auditory rehabilitation by cochlear implants or hearing aids is effective also among older adults (median age of 74 years) with different degrees of hearing loss, and enables positive improvements in terms of social isolation, depression and cognitive performance.

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