Publications by authors named "Jennifer Shinn"

40 Publications

Behavioral and Hemodynamic Changes Following Dichotic Training in Patients with Neurological Deficits of the Auditory Nervous System: A Case Series.

J Am Acad Audiol 2021 Mar 4. Epub 2021 Mar 4.

Department of Otolaryngology - Head and Neck Surgery, University of Kentucky, Lexington, Kentucky.

Background:  Dichotic listening occurs when one attends to different acoustical messages presented simultaneously to both ears. This is important for understanding speech in compromised listening situations, such as background noise. Deficits in dichotic listening can be remediated by participating in auditory training. We present two patients with binaural integration deficits who underwent dichotic interaural intensity difference (DIID) training.

Purpose:  The purpose of this investigation is to demonstrate improvement of dichotic listening deficits following DIID training in neurological patients seen clinically for hearing issues.

Research Design:  This was a case series utilizing a pre- and posttreatment design.

Study Sample:  This case series utilized two female participants who demonstrated binaural integration deficits during an auditory processing evaluation.

Intervention:  The participants underwent a pretraining auditory processing evaluation and functional magnetic resonance imaging (fMRI). Participants then underwent 12, 30-minute DIID training sessions followed by posttreatment auditory processing evaluations and fMRI.

Data Collection And Analysis:  Data was collected at the pretreatment appointment and then immediately following the completion of the training.

Results:  Each patient demonstrated varying degrees of improvement on the posttreatment assessment. Case 1 showed significant improvement on the Speech-in-Noise-Revised (SPIN-R) test. fMRI showed changes in activation patterns following training. Case 2 demonstrated improved scores on the Dichotic Digits Test and SPIN-R and increased activation of the calcarine sulcus following training.

Conclusion:  Dichotic training can be an efficacious treatment for binaural integration deficits and may show evidence of improving speech understanding in noise. This case series demonstrates a promising therapy to help patients improve auditory function by improving dichotic listening skills.
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http://dx.doi.org/10.1055/s-0040-1719095DOI Listing
March 2021

Does Adherence to Early Infant Hearing Detection and Intervention Guidelines Positively Impact Pediatric Speech Outcomes?

Laryngoscope 2020 Aug 4. Epub 2020 Aug 4.

Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, U.S.A.

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http://dx.doi.org/10.1002/lary.28994DOI Listing
August 2020

Opioid Prescribing Patterns and Usage Following Cochlear Implantation.

Otol Neurotol 2020 08;41(7):922-928

Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky.

Objective: To evaluate opioid prescribing patterns following cochlear implantation (CI) and assess factors associated with recurrent opioid use.

Study Design: Retrospective cohort study.

Setting: National pharmaceutical database recording opioid fulfillment (Truven Health Marketscan Commercial Claims and Encounters and Medicare Claims and Encounters database) PARTICIPANTS:: CI recipients who filled opioid prescriptions between January 2011 and December 2016. All patients had no previous opioid prescriptions filled 60 days before implantation and filled at least one opioid prescription within 1 week after surgery. Cohort 1 filled only one prescription and cohort 2 filled more than one prescription in the 12 months following CI. Univariate/multivariate analysis was performed to assess for associations with recurrent opioid use.

Main Outcome Measure(s): Opioid prescription details and recurrent opioid use.

Results: The study included 98 patients (cohort 1 = 57, cohort 2 (recurrent opioid use) = 41). Hydrocodone 5 mg was most frequently used. The average duration opioids were prescribed was 5.49 days with an average quantity of tablets of 36.1. Recurrent opioid use in cohort 2 was associated with both total morphine milligram equivalents (MME) prescribed/day in the first postoperative week (OR = 1.03, p = 0.01) and use of stronger MME opioids (OR = 7.20, p = 0.05).

Conclusion: Prescribing patterns following CI can influence recurrent opioid use in patients. Each additional tablet of hydrocodone 5 mg beyond 8 tablets/d or oxycodone 5 mg beyond 5.33 tablets/d, increases the likelihood of recurrent opioid use by 15 or 22.5%, respectively. Limiting opioids prescribed per day to no more than 40 MME could lower the likelihood of patients becoming recurrent opioid users postoperatively.
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http://dx.doi.org/10.1097/MAO.0000000000002674DOI Listing
August 2020

Trends in Opioid Usage Following Tympanoplasty and Mastoidectomy.

Otol Neurotol 2020 09;41(8):e1035-e1040

Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky.

Objective: Evaluate opioid prescribing patterns following tympanoplasty/mastoidectomy and assess factors associated to recurrent opioid use.

Study Design: Retrospective cohort study.

Setting: National pharmaceutical database recording opioid fulfillment (Truven Health Marketscan Commercial Claims/Encounters and Medicare Claims/Encounters database).

Participants: Patients who 1) underwent tympanoplasty and/or mastoidectomy, 2) filled postoperative opioid prescriptions between 2011 and 2016, and 3) had no opioid prescriptions filled 60 days before surgery. Cohort 1 filled only one prescription and cohort 2 filled more than one prescription in the 12 months following surgery. Univariate/multivariate analysis was performed to assess for associations with recurrent opioid use.

Main Outcome Measure(s): Opioid prescription details and recurrent opioid use.

Results: The study included 398 patients (cohort 1 = 233, cohort 2 [recurrent opioid user] = 165). Hydrocodone 5 mg was most frequently used. The average duration opioids were prescribed was 5.8 days with an average quantity of tablets of 36.51. Recurrent opioid use in cohort 2 was associated with total morphine milligram equivalents prescribed/d in the first postoperative week (odds ratio [OR] = 1.02, p < 0.001), post-op chronic pain disorder (OR = 2.00, p = 0.04), post-op substance abuse (OR = 2.12, p = 0.05), and post-op anxiety (OR = 1.96, p = 0.02).

Conclusion: Recurrent opioid use following tympanoplasty/mastoidectomy is associated with the amount prescribed per day but not opioid type or duration of treatment. Postoperative diagnoses such as chronic pain disorder, substance abuse, or anxiety could be predictive of or coexistent with recurrent opioid use. Limiting opioids prescribed per day and use of anti-inflammatory medications could decrease the risk of recurrent opioid use.
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http://dx.doi.org/10.1097/MAO.0000000000002709DOI Listing
September 2020

Audiology Telemedicine Evaluations: Potential Expanded Applications.

Otolaryngol Head Neck Surg 2019 07 5;161(1):63-66. Epub 2019 Mar 5.

1 Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA.

There is underutilization of cochlear implants with delays in implantation linked to distance from implant centers. Telemedicine could connect cochlear implant specialists with patients in rural locations. We piloted telemedicine cochlear implant testing in a small study, largely composed of normal-hearing volunteers to trial this new application of teleaudiology technology. Thirteen subjects (8 with normal hearing and 5 with hearing loss ranging from mild to profound) underwent a traditional cochlear implant evaluation in person and then via telemedicine technology. Routine audiometry, word recognition testing, and Arizona Biological Test (AzBio) and consonant-nucleus-consonant (CNC) testing were performed. Mean (SD) percent difference in AzBio between in-person and remote testing was 1.7% (2.06%). Pure tone average (PTA), speech reception threshold (SRT), and word recognition were similar between methods. CNC testing showed a mean (SD) difference of 6.8% (10.2%) between methods. Testing conditions were acceptable to audiologists and subjects. Further study to validate this method in cochlear implant candidates and a larger population is warranted.
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http://dx.doi.org/10.1177/0194599819835541DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6602851PMC
July 2019

Auditory P300 in Noise in Younger and Older Adults.

J Am Acad Audiol 2018 Nov/Dec;29(10):909-916

University of Kentucky Medical Center, Lexington, KY.

Background: Older adults often report difficulty hearing in background noise which is not completely attributable to peripheral hearing loss. Although age-related declines in cognition and hearing in background noise occur, the underlying age-related changes in processing of auditory stimuli in background noise has yet to be fully understood. The auditory P300 has the potential to elucidate the effects of age on auditory and cognitive processing of stimuli in background noise, but additional research is warranted.

Purpose: The purpose of this study was to investigate age-related differences in cognitive processing of auditory stimuli by evoking the auditory P300 at multiple signal-to-noise ratios (SNRs).

Research Design: A two-group, repeated measures study design was used.

Study Sample: A convenience sample of 35 participants, 15 older adults (mean age of 66.4 yr) and 20 younger adults (mean age of 21.1 yr), participated in the study. All participants had negative otologic and neurological histories.

Data Collection And Analysis: The auditory P300 was evoked using an oddball paradigm with 500 (frequent) and 1000 Hz (target) tonal stimuli in quiet and in the presence of background noise at +20, +10, and 0 SNRs. P300 amplitudes and latencies were measured in each condition for every participant. Repeated measures analyses of variance were conducted for the amplitude and latency measures of the P300 for each group.

Results: Results from this study demonstrated P300 latencies were significantly longer in older adults in noise at the most challenging condition (0 SNR) compared with the quiet condition and between the +10 SNR and 0 SNR conditions. Although older adults had significantly longer P300 latencies compared with younger adults, no significant group by listening condition interaction existed. No significant P300 amplitude differences were found for group, noise, or group × listening condition interactions.

Conclusions: Results provide evidence that auditory cortical processing, regardless of age, is poorer at more difficult SNRs. However, results also demonstrate that older adults perform significantly poorer than younger adults. This supports the notion that some degree of age-related decline in synchronous firing and rate of transmission of the auditory cortical neurons contributing to the auditory P300 exists. Studies are needed to further understand the impact of noise on auditory cortical processing across populations.
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http://dx.doi.org/10.3766/jaaa.17077DOI Listing
October 2019

Hormones and Hearing: Central Auditory Processing in Women.

J Am Acad Audiol 2019 06 25;30(6):493-501. Epub 2018 Sep 25.

Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, KY.

Background: Estrogen has been identified as playing a key role in many organ systems. Recently, estrogen has been found to be produced in the human brain and is believed contribute to central auditory processing. After menopause, a low estrogen state, many women report hearing loss but demonstrate no deficits in peripheral hearing sensitivity, which support the notion that estrogen plays an effect on central auditory processing. Although animal research on estrogen and hearing loss is extensive, there is little in the literature on the human model.

Purpose: The aim of this study was to evaluate relationships between hormonal changes and hearing as it relates to higher auditory function in pre- and postmenopausal (Post-M) females.

Research Design: A prospective, group comparison study.

Study Sample: Twenty eight women between the ages of 18 and 70 at the University of Kentucky were recruited.

Data Collection And Analysis: Participants were separated into premenopausal and peri-/Post-M groups. Participants had normal peripheral hearing sensitivity and underwent a behavioral auditory processing battery and electrophysiological evaluation. An analysis of variance was performed to address the aims of the study.

Results: Results from the study demonstrated statistically significant difference between groups, where Post-M females had difficulties in spatial hearing abilities as reflected on the Listening in Spatialized Noise Test-Sentences test. In addition, measures on the auditory brainstem response and the middle latency response reflected statistically significant differences between groups with Post-M females having longer latencies.

Conclusions: Results from the present study demonstrated significant differences between groups, particularly listening in noise. Females who present with auditory complaints in spite of normal hearing thresholds should have a more extensive audiological evaluation to further evaluate possible central deficits.
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http://dx.doi.org/10.3766/jaaa.17123DOI Listing
June 2019

Promotion of early pediatric hearing detection through patient navigation: A randomized controlled clinical trial.

Laryngoscope 2017 11 20;127 Suppl 7:S1-S13. Epub 2017 Sep 20.

Department of Health, Behavior and Society, University of Kentucky College of Public Health, Lexington, Kentucky, U.S.A.

Objectives/hypothesis: To assess the efficacy of a patient navigator intervention to decrease nonadherence to obtain audiological testing following failed screening, compared to those receiving the standard of care.

Methods: Using a randomized controlled design, guardian-infant dyads, in which the infants had abnormal newborn hearing screening, were recruited within the first week after birth. All participants were referred for definitive audiological diagnostic testing. Dyads were randomized into a patient navigator study arm or standard of care arm. The primary outcome was the percentage of patients with follow-up nonadherence to obtain diagnostic testing. Secondary outcomes were parental knowledge of infant hearing testing recommendations and barriers in obtaining follow-up testing.

Results: Sixty-one dyads were enrolled in the study (patient navigator arm = 27, standard of care arm = 34). The percentage of participants nonadherent to diagnostic follow-up during the first 6 months after birth was significantly lower in the patient navigator arm compared with the standard of care arm (7.4% vs. 38.2%) (P = .005). The timing of initial follow-up was significantly lower in the navigator arm compared with the standard of care arm (67.9 days after birth vs. 105.9 days, P = .010). Patient navigation increased baseline knowledge regarding infant hearing loss diagnosis recommendations compared with the standard of care (P = .004).

Conclusions: Patient navigation decreases nonadherence rates following abnormal infant hearing screening and improves knowledge of follow-up recommendations. This intervention has the potential to improve the timeliness of delivery of infant hearing healthcare; future research is needed to assess the cost and feasibility of larger scale implementation.

Level Of Evidence: 1b. Laryngoscope, 127:S1-S13, 2017.
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http://dx.doi.org/10.1002/lary.26822DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5669046PMC
November 2017

Perspectives on the Pure-Tone Audiogram.

J Am Acad Audiol 2017 Jul/Aug;28(7):655-671

University College London Hospitals, London, UK.

Background: The pure-tone audiogram, though fundamental to audiology, presents limitations, especially in the case of central auditory involvement. Advances in auditory neuroscience underscore the considerably larger role of the central auditory nervous system (CANS) in hearing and related disorders. Given the availability of behavioral audiological tests and electrophysiological procedures that can provide better insights as to the function of the various components of the auditory system, this perspective piece reviews the limitations of the pure-tone audiogram and notes some of the advantages of other tests and procedures used in tandem with the pure-tone threshold measurement.

Purpose: To review and synthesize the literature regarding the utility and limitations of the pure-tone audiogram in determining dysfunction of peripheral sensory and neural systems, as well as the CANS, and to identify other tests and procedures that can supplement pure-tone thresholds and provide enhanced diagnostic insight, especially regarding problems of the central auditory system.

Research Design: A systematic review and synthesis of the literature.

Data Collection And Analysis: The authors independently searched and reviewed literature (journal articles, book chapters) pertaining to the limitations of the pure-tone audiogram.

Results: The pure-tone audiogram provides information as to hearing sensitivity across a selected frequency range. Normal or near-normal pure-tone thresholds sometimes are observed despite cochlear damage. There are a surprising number of patients with acoustic neuromas who have essentially normal pure-tone thresholds. In cases of central deafness, depressed pure-tone thresholds may not accurately reflect the status of the peripheral auditory system. Listening difficulties are seen in the presence of normal pure-tone thresholds. Suprathreshold procedures and a variety of other tests can provide information regarding other and often more central functions of the auditory system.

Conclusions: The audiogram is a primary tool for determining type, degree, and configuration of hearing loss; however, it provides the clinician with information regarding only hearing sensitivity, and no information about central auditory processing or the auditory processing of real-world signals (i.e., speech, music). The pure-tone audiogram offers limited insight into functional hearing and should be viewed only as a test of hearing sensitivity. Given the limitations of the pure-tone audiogram, a brief overview is provided of available behavioral tests and electrophysiological procedures that are sensitive to the function and integrity of the central auditory system, which provide better diagnostic and rehabilitative information to the clinician and patient.
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http://dx.doi.org/10.3766/jaaa.16061DOI Listing
May 2018

Rurality and determinants of hearing healthcare in adult hearing aid recipients.

Laryngoscope 2017 10 31;127(10):2362-2367. Epub 2017 Jan 31.

Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A.

Objective: The objective of this study was to compare the timing of hearing aid (HA) acquisition between adults in rural and urban communities. We hypothesized that time of acquisition of HA after onset of hearing loss is greater in rural adults compared with urban adults. Secondary objectives included assessment of socioeconomic/educational status and impact of hearing loss and hearing rehabilitation of urban and rural HA recipients.

Study Design: Cross-sectional questionnaire survey.

Methods: We assessed demographics, timing of HA fitting from onset of hearing loss, and impact of hearing impairment in 336 adult HA recipients (273 urban, 63 rural) from a tertiary referral center. Amplification benefit was assessed using the International Outcome Inventory for Hearing Aids (IOI).

Results: The time to HA acquisition was greater for rural participants compared to urban participants (19.1 vs. 25.7 years, P = 0.024) for those with untreated hearing loss for at least 8 years. Age at hearing loss onset was correlated with time to HA acquisition (P = -0.54, P < 0.001). Rural HA participants experienced longer commutes to hearing specialists (68 vs. 32 minutes, P < 0.001), were less likely to achieve a degree beyond high school (P < 0.001), and were more likely to possess Medicaid coverage (P = 0.012) compared to urban participants. Hearing impairment caused job performance difficulty in 60% of all participants.

Conclusion: Rural adults are at risk for delayed HA acquisition, which may be related to distance to hearing specialists. Further research is indicated to investigate barriers to care and expand access for vulnerable populations.

Level Of Evidence: 4. Laryngoscope, 127:2362-2367, 2017.
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http://dx.doi.org/10.1002/lary.26490DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537053PMC
October 2017

The Academy Research Grants in Hearing and Balance.

J Am Acad Audiol 2016 Nov/Dec;27(10):788-789

Deputy Editor-in-Chief.

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http://dx.doi.org/10.3766/jaaa.27.10.1DOI Listing
September 2018

Timing and Impact of Hearing Healthcare in Adult Cochlear Implant Recipients: A Rural-Urban Comparison.

Otol Neurotol 2016 10;37(9):1320-4

*Department of Otolaryngology-Head and Neck Surgery†College of Medicine, University of Kentucky, Lexington, Kentucky.

Objective: The purpose of this study is to compare the timing and impact of hearing healthcare of rural and urban adults with severe hearing loss who use cochlear implants (CI).

Study Design: Cross-sectional questionnaire study.

Setting: Tertiary referral center.

Patients: Adult cochlear implant recipients.

Main Outcome Measures: Data collected included county of residence, socioeconomic information, impact of hearing loss on education/employment, and timing of hearing loss treatment. The benefits obtained from cochlear implantation were also evaluated.

Results: There were 91 participants (32 from urban counties, 26 from moderately rural counties, and 33 for extremely rural counties). Rural participants have a longer commute time to the CI center (p < 0.001), lower income (p < 0.001), and higher percentage of Medicaid coverage (p = 0.004). Compared with urban-metro participants, rural participants with gradually progressive hearing loss had a greater time interval from the onset of hearing loss to obtaining hearing aid amplification (10 yr versus 5 yr, p = 0.04). There was also a greater time interval from onset of hearing loss to the time of cochlear implantation in rural participants (p = 0.04). Reported job loss was higher in rural participants than in urban participants (p = 0.05). Both groups reported comparable benefit from cochlear implantation.

Conclusion: Rural CI recipients differ from urban residents in socioeconomic characteristics and may be delayed in timely treatment of hearing loss. Further efforts to expand access to hearing healthcare services may benefit rural adult patients.
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http://dx.doi.org/10.1097/MAO.0000000000001197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027983PMC
October 2016

Factors involved in access and utilization of adult hearing healthcare: A systematic review.

Laryngoscope 2017 05 22;127(5):1187-1194. Epub 2016 Aug 22.

Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A.

Objective/hypothesis: Hearing loss is a public health concern, yet hearing healthcare disparities exist and influence utilization of rehabilitation services. The objective of this review was to systematically analyze the published literature on motivators, barriers, and compliance factors affecting adult patient access and utilization of hearing rehabilitation healthcare.

Data Sources: Pubmed, PsychINFO, CINAHL, and Web of Science were searched for relevant articles. Eligible studies were those containing original, peer-reviewed research in English pertaining to factors affecting adult hearing healthcare access and utilization of hearing aids and cochlear implantation. The search encompassed 1990 to 2015.

Methods: Two investigators independently reviewed all articles and extracted data. Specific variables regarding access to care and compliance to recommended care were extracted from each study.

Results: Thirty articles were reviewed. The factors affecting access and utilization of hearing rehabilitation could be classified into motivators, barriers, and compliance in treatment or device use. The key motivators to seek care include degree of hearing loss, self-efficacy, family support, and self-recognition of hearing loss. The primary barriers to care were financial limitations, stigma of hearing devices, inconvenience, competing chronic health problems, and unrealistic expectations. Compliance is most affected by self-efficacy, education level, and engagement in the rehabilitation process.

Conclusion: Accessing hearing healthcare is complicated by multiple factors. Considering the current climate in healthcare policy and legislation toward improved access of care, a deeper understanding of motivators, barriers, and compliance factors can aid in delivery of effective and efficient hearing healthcare. Laryngoscope, 127:1187-1194, 2017.
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http://dx.doi.org/10.1002/lary.26234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5322257PMC
May 2017

Rural Family Perspectives and Experiences with Early Infant Hearing Detection and Intervention: A Qualitative Study.

J Community Health 2016 Apr;41(2):226-33

Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, 800 Rose Street, Suite C-236, Lexington, KY, 40536-0293, USA.

Infant hearing loss has the potential to cause significant communication impairment. Timely diagnosis and intervention is essential to preventing permanent deficits. Many infants from rural regions are delayed in diagnosis and treatment of hearing loss. The purpose of this study is to characterize the barriers in timely infant hearing healthcare for rural families following newborn newborn hearing screening (NHS) testing. Using stratified purposeful sampling, the study design involved semi-structured phone interviews with parents/guardians of children who failed NHS testing in the Appalachian region of Kentucky between 2012 and 2014 to describe their experiences with early hearing detection and intervention program. Thematic qualitative analysis was performed on interview transcripts to identify common recurring themes in content. 40 parents/guardians participated in the study and consisted primarily of mothers. Demographic data revealed limited educational levels of the participants and 70 % had state-funded insurance coverage. Participants reported barriers in timely infant hearing healthcare that included poor communication of hearing screening results, difficulty in obtaining outpatient testing, inconsistencies in healthcare information from primary care providers, lack of local resources, insurance-related healthcare delays, and conflict with family and work responsibilities. Most participants expressed a great desire to obtain timely hearing healthcare for their children and expressed a willingness to use resources such as telemedicine to obtain that care. There are multiple barriers to timely rural infant hearing healthcare. Minimizing misinformation and improving access to care are priorities to prevent delayed diagnosis and treatment of hearing loss.
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http://dx.doi.org/10.1007/s10900-015-0086-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4769967PMC
April 2016

Pediatric Hearing Healthcare in Kentucky's Appalachian Primary Care Setting.

J Community Health 2015 Aug;40(4):762-8

Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, 800 Rose Street, Suite C-236, Lexington, KY, 40536-0293, USA,

Diagnosis and intervention for infant hearing loss is often delayed in areas of healthcare disparity, such as rural Appalachia. Primary care providers play a key role in timely hearing healthcare. The purpose of this study was to assess the practice patterns of rural primary care providers (PCPs) regarding newborn hearing screening (NHS) and experiences with rural early hearing diagnosis and intervention programs in an area of known hearing healthcare disparity. Cross sectional questionnaire study. Appalachian PCP's in Kentucky were surveyed regarding practice patterns and experiences regarding the diagnosis and treatment of congenital hearing loss. 93 Appalachian primary care practitioners responded and 85% reported that NHS is valuable for pediatric health. Family practitioners were less likely to receive infant NHS results than pediatricians (54.5 versus 95.2%, p < 0.01). A knowledge gap was identified in the goal ages for diagnosis and treatment of congenital hearing loss. Pediatrician providers were more likely to utilize diagnostic testing compared with family practice providers (p < 0.001). Very rural practices (Beale code 7-9) were less likely to perform hearing evaluations in their practices compared with rural practices (Beale code 4-6) (p < 0.001). Family practitioners reported less confidence than pediatricians in counseling and directing care of children who fail newborn hearing screening. 46% felt inadequately prepared or completely unprepared to manage children who fail the NHS. Rural primary care providers face challenges in receiving communication regarding infant hearing screening and may lack confidence in directing and providing rural hearing healthcare for children.
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http://dx.doi.org/10.1007/s10900-015-9997-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4490996PMC
August 2015

Rural barriers to early diagnosis and treatment of infant hearing loss in Appalachia.

Otol Neurotol 2015 Jan;36(1):93-8

*Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington †University of Kentucky College of Medicine, Lexington; ‡Cabinet for Health and Family Services Commission for Children With Special Health Care Needs, Louisville; and §Department of Health Behavior, College of Public Health, University of Kentucky, Lexington, Kentucky, U.S.A.

Objective: The purpose of this study was to assess regional parental barriers in the diagnostic and therapeutic process after abnormal newborn hearing screening (NHS) testing.

Study Design: Cross-sectional questionnaire study.

Setting: Tertiary medical center.

Patients: Parents of infants who failed NHS in Kentucky from January 2009 to February 2012.

Main Outcome Measure: Demographic information, county of origin, attitudes and perceptions regarding NHS, and barriers in the NHS diagnostic process.

Results: There were 460 participants in the study, which included 25.4% of parents from the Appalachian region. Twenty-one percent of Appalachian parents found the process on newborn hearing testing difficult. Appalachian parents were more likely to have no more than 12 years of education (odds ratio [OR], 1.7; p = 0.02) and Medicaid insurance (OR, 2.3; p < 0.001) compared with non-Appalachian parents. A higher percentage of Appalachian parents were unaware of the NHS results at the time of hospital discharge than non-Appalachians (14% versus 7%, p = 0.03). Distance from the diagnostic/therapeutic center represented was a significant barrier for Appalachian parents (OR, 2.8; p = 0.001). Compared with urban parents, a greater percentage of rural parents had never heard of a cochlear implant (p = 0.01). Appalachian parents expressed a strong interest in telemedicine and a desire for closer services.

Conclusion: Multiple barriers including education, distance, accessibility, and socioeconomic factors can affect timely diagnosis and treatment of congenital hearing loss for children residing in rural areas. Educational and telemedicine programs may benefit parents in Appalachia as well as parents in other rural areas.
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http://dx.doi.org/10.1097/MAO.0000000000000636DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4268139PMC
January 2015

Assessment of Appalachian region pediatric hearing healthcare disparities and delays.

Laryngoscope 2014 Jul 10;124(7):1713-7. Epub 2014 Feb 10.

Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A.

Objectives/hypothesis: The purpose of this study was to examine the timing of diagnostic and therapeutic services in cochlear implant recipients from a rural Appalachian region with healthcare disparity.

Study Design: Retrospective analysis.

Methods: Cochlear implant recipients from a tertiary referral center born with severe congenital sensorineural hearing loss were examined. Rural status and Appalachian status of their county of origin were recorded. A log-rank test was used to examine differences in the distributions of time to definitive diagnosis of hearing loss, initial amplification fitting, and cochlear implantation in these children. Correlation analysis of the rural status of each county and the timing of services was assessed.

Results: A total of 53 children born with congenital hearing loss were included in the study (36 from rural counties and 17 from urban/suburban counties). The distribution of weeks after birth to diagnosis (P=.006), amplification (P=.030), and cochlear implantation (P=.002) was delayed in rural children compared with urban children. An analysis factoring in the effect of implementation of mandatory infant hearing screening in 2000 demonstrated a similar delay in rural children for weeks to diagnosis (P=.028), amplification (P=.087), and cochlear implantation (P<.0001).

Conclusions: Children with severe hearing loss in very rural areas, such as Appalachia, may have significant delays in diagnostic and rehabilitative services. Further investigation is warranted to assess causative factors in delays of cochlear implantation and to develop interventions to promote timely diagnosis and care.

Level Of Evidence: 3b.
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http://dx.doi.org/10.1002/lary.24588DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4069222PMC
July 2014

Middle Ear Disease and Cochlear Implant Function: A Case Study.

Hearing Balance Commun 2014;12(3):155-158. Epub 2014 Jun 11.

Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, KY USA.

Objectives And Methods: It has been our clinical observation that active middle ear disease (MED) temporally corresponds to a transient decrease in cochlear implant (CI) function, specifically at the apical electrodes. This is non-intuitive as CI function is thought to be independent of middle ear aeration and inflammation. The purpose of this case study is to demonstrate how active MED negatively affects both subjective hearing complaints and objective impedance measures in a CI patient.

Results: Subjective hearing decreased and impedances levels increased significantly when the patient was experiencing active MED. No significant changes in these measures occurred when there was no active MED.

Conclusions: MED may affect CI function in some patients requiring adjustments in programing at times of involvement.
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http://dx.doi.org/10.3109/21695717.2014.918757DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4676574PMC
June 2014

Delays in diagnosis of congenital hearing loss in rural children.

J Pediatr 2014 Feb 30;164(2):393-7. Epub 2013 Oct 30.

Department of Behavioral Science, University of Kentucky, Lexington, KY.

Objective: To examine the incidence of pediatric congenital hearing loss and the timing of diagnosis in a rural region of hearing healthcare disparity.

Study Design: Data from the Kentucky newborn hearing-screening program was accessed to determine the incidence of congenital hearing loss in Kentucky, both in the extremely rural region of Appalachia and non-Appalachian region of Kentucky. We also performed a retrospective review of records of children with congenital hearing loss at our institution to determine the timing of diagnostic testing.

Results: In Kentucky, during 2009-2011, there were 6970 newborns who failed hearing screening; the incidence of newborn hearing loss was 1.71 per 1000 births (1.28/1000 in Appalachia and 1.87/1000 in non-Appalachia); 23.8% of Appalachian newborns compared with 17.3% of non-Appalachian children failed to obtain follow-up diagnostic testing. Children from Appalachia were significantly delayed in obtaining a final diagnosis of hearing loss compared with children from non-Appalachian regions (P = .04).

Conclusion: Congenital hearing loss in children from rural regions with hearing healthcare disparities is a common problem, and these children are at risk for a delay in the timing of diagnosis, which has the potential to limit language and social development. It is important to further assess the causative factors and develop interventions that can address this hearing healthcare disparity issue.
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http://dx.doi.org/10.1016/j.jpeds.2013.09.047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946850PMC
February 2014

Timing discrepancies of early intervention hearing services in urban and rural cochlear implant recipients.

Otol Neurotol 2013 Dec;34(9):1630-5

*Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington; †Heuser Hearing Institute, Louisville; and ‡University of Kentucky College of Medicine, Lexington, Kentucky, U.S.A.

Objective: The purpose of this study was to examine the timing of early intervention diagnostic and therapeutic services in cochlear implant recipients from rural and urban areas.

Study Design: Retrospective case series review.

Setting: Tertiary referral center.

Patients: Cochlear implant recipients from a single comprehensive hearing institute born with severe congenital sensorineural hearing loss were examined. Timing of diagnostic and therapeutic services was examined.

Intervention(s): Diagnosis, amplification, and eventual cochlear implantation for all patients in the study.

Main Outcome Measure(s): Time points of definitive diagnosis, amplification, and cochlear implantation for children from urban and rural regions were examined. Correlation analysis of distance to testing center and timing of services was also assessed.

Results: Forty children born with congenital hearing loss were included in the study and were diagnosed at a median age of 13 weeks after birth. Children from rural regions obtained amplification at a median age of 47.7 weeks after birth, whereas urban children were amplified at 26 weeks after birth. Cochlear implantation was performed at a median age of 182 weeks after birth in those from rural areas and at 104 weeks after birth in urban-dwelling patients. A linear relationship was identified between distance to the implant center and timing of hearing aid amplification (r = 0.5, p = 0.033) and cochlear implantation (r = 0.5, p = 0.016).

Conclusion: Children residing outside of metro areas may be at higher risk of delayed rehabilitative services and cochlear implantation than those residing in urban areas that may be closer to tertiary care centers.
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http://dx.doi.org/10.1097/MAO.0b013e31829e83adDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3830638PMC
December 2013

Hot or cold? Is monothermal caloric testing useful and cost-effective?

Ann Otol Rhinol Laryngol 2013 Jun;122(6):412-6

Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA.

Objectives: Videonystagmography (VNG) is used widely in the assessment of balance dysfunction. The full test battery can be time-consuming and can induce patient discomfort. The purpose of this study was to examine the value of monothermal caloric testing in predicting unilateral caloric weakness, as well as abnormal VNG vestibular and nonvestibular eye movement, while considering the time and reimbursement associated with these tests.

Methods: In a retrospective review of 645 patients who completed a comprehensive VNG test battery with bithermal caloric testing, we calculated the specificity, sensitivity, and predictive values of monothermal caloric testing in relation to bithermal caloric results and noncaloric VNG results.

Results: With unilateral vestibular weakness (UVW) defined as a 25% interear difference, warm-air monothermal caloric testing yielded a sensitivity of 87% and a negative predictive value of 90% for predicting UVW. With a 10% UVW definition, the warm-air caloric testing sensitivity increased to 95% and the negative predictive value to 92%. Warm-air monothermal caloric testing had a positive predictive value of 85% and a negative predictive value of 18% for predicting noncaloric VNG findings; cold-air monothermal and bithermal testing displayed similar results.

Conclusions: Isolated monothermal testing is a sensitive screening tool for detecting UVW, but is not adequate for predicting noncaloric VNG results.
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http://dx.doi.org/10.1177/000348941312200611DOI Listing
June 2013

The effects and outcomes of electrolyte disturbances and asphyxia on newborns hearing.

Int J Pediatr Otorhinolaryngol 2013 Jul 4;77(7):1072-6. Epub 2013 May 4.

Maternal and Child Health Care Hospital of Baoan, Shenzhen 518133, PR China.

Objective: To determine the effect of electrolyte disturbances (ED) and asphyxia on infant hearing and hearing outcomes.

Study Design: We conducted newborn hearing screening with transient evoked otoacoustic emission (TEOAE) test on a large scale (>5000 infants). The effects of ED and asphyxia on infant hearing and hearing outcomes were evaluated.

Result: The pass rate of TEOAE test was significantly reduced in preterm infants with ED (83.1%, multiple logistic regression analysis: P<0.01) but not in full-term infants with ED (93.6%, P=0.41). However, there was no significant reduction in the pass rate in infants with asphyxia (P=0.85). We further found that hypocalcaemia significantly reduced the pass rate of TEOAE test (86.8%, P<0.01). In the follow-up recheck at 3 months of age, the pass rate remained low (44.4%, P<0.01).

Conclusion: ED is a high-risk factor for preterm infant hearing. Hypocalcaemia can produce more significant impairment with a low recovery rate.
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http://dx.doi.org/10.1016/j.ijporl.2013.03.031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3738180PMC
July 2013

Effect of noise on auditory processing in the operating room.

J Am Coll Surg 2013 May 18;216(5):933-8. Epub 2013 Mar 18.

Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, KY 40536, USA.

Background: Effective communication is a critical component of patient care in the operative room (OR). However, the presence of loud equipment, a large number of staff members, and music can contribute to high levels of background noise. In a setting in which crucial tasks are performed continuously, distractions and barriers to communication can result in harm to both patients and OR personnel. The purpose of this investigation was to simulate OR listening conditions and evaluate the effect of operating noise on auditory function.

Study Design: This is a prospective investigation of 15 subjects ranging from 1 to 30 years of operative experience. All surgeons had normal peripheral hearing sensitivity. The surgeons' ability to understand and repeat words were tested using the Speech in Noise Test-Revised in 4 different conditions chosen to simulate typical OR environments. These included quiet, filtered noise through a mask and background noise both with and without music. They were tested in both a tasked and in an untasked situation.

Results: It was found that the impact of noise is considerably greater when the participant is tasked. Surgeons demonstrated substantially poorer auditory performance in music than in quiet or OR noise. Performance in both conditions was poorer when the sentences were low in predictability.

Conclusions: Operating room noise can cause a decrease in auditory processing function, particularly in the presence of music. This becomes even more difficult when the communication involves conversations that carry critical information that is unpredictable. To avoid possible miscommunication in the OR, attempts should be made to reduce ambient noise levels.
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http://dx.doi.org/10.1016/j.jamcollsurg.2012.12.048DOI Listing
May 2013

The effect of LACE DVD training in new and experienced hearing aid users.

J Am Acad Audiol 2013 Mar;24(3):214-30

Department of Rehabilitation Sciences, University of Kentucky, KY, USA.

Background: Numerous studies have demonstrated that improving the ability to understand speech in noise can be a difficult task for adults with hearing aids (HAs). If HA users want to improve their speech understanding ability, specific training may be needed. Auditory training (AT) is one type of intervention that may enhance speech recognition abilities for adult HA users.

Purpose: The purpose of this study was to examine the behavioral effects of an AT program called Listening and Communication Enhancement (LACE) in the DVD format in new and experienced HA users. While some research has been conducted using the computer version of this program, no research to date has been conducted on the efficacy of the DVD version of the LACE training program in both new and experienced HA users.

Research Design: An experimental, prospective repeated measures group design, with random assignment.

Study Sample: Twenty-nine adults with hearing loss were assigned to one of three groups: new HA plus training, experienced HA plus training, or control (new HA users with no training during the study but provided with training afterward). New HA aid users were randomly assigned to either the training or control group.

Intervention: Participants in the training groups completed twenty 30 min training lessons from the LACE DVD program at home over a period of 4 wk.

Data Collection: Participants in both training groups were evaluated at baseline, after 2 wk of training and again after 4 wk of training. Participants in the control group were evaluated at baseline and after 4 wk of HA use. Several objective listening measures were administered including speech in noise, rapid speech, and competing sentences tasks. Subjective measures included evaluating the participants' perception of the intervention as well as their perceptions of functional listening abilities.

Results: Findings indicate that both new and experienced users improved their understanding of speech in noise, understanding of competing sentences, and communication function after training in comparison to a control group. Effect size calculations suggested that a larger training effect was observed for new HA users compared to experienced HA users. New HA users also reported greater benefit from training compared to experienced users. AT with the LACE DVD format should be encouraged, particularly among new HA users, to improve understanding in difficult listening conditions.
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http://dx.doi.org/10.3766/jaaa.24.3.7DOI Listing
March 2013

Current epidemiology and management trends in acoustic neuroma.

Otolaryngol Head Neck Surg 2010 May;142(5):677-81

Division of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, KY 40536, USA.

Objective: The objective of this study was to assess the epidemiology of acoustic neuroma and determine current trends in therapy using tumor registry techniques.

Study Design: Analysis of a national database.

Subjects And Methods: The Surveillance Epidemiology and End Results (SEER) database is a national tumor registry that began to identify and abstract benign and borderline tumors of the brain and central nervous system in the year 2004. Coding for International Classification of Diseases for Oncology (ICD-O-3) codes for schwannoma (9560/0) with collaborative staging (CS) coding for acoustic nerve (72.4) was used to identify acoustic neuromas. Demographic data, tumor size, and treatment data were analyzed.

Results: A total of 1621 patients with acoustic neuroma were identified, for an incidence rate of 1.1/100,000. Mean age was 53.1 years. Tumors were equally distributed across gender and tumor laterality, with the majority (84%) occurring in Caucasians. Nine hundred sixty-four patients (59.5%) were treated with surgery, whereas 341 (21.0%) were treated with radiation. A total of 1.6 percent received combined therapy over the study period, with the remaining patients receiving either no treatment or unknown therapy. Of tumors less than 2 cm, 27.2 percent were treated with radiotherapy. Statistically significant associations were observed with the increased use of radiotherapy for small (< 2 cm) tumors (P = 0.0001).

Conclusion: Unlike data from single series, which usually represent individual treatment preferences and techniques, use of SEER data allows for the assessment of demographics and treatment trends at the national level. The results and potential applications are discussed.
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http://dx.doi.org/10.1016/j.otohns.2010.01.037DOI Listing
May 2010

The clinical reliability of vestibular evoked myogenic potentials.

Ear Nose Throat J 2010 Apr;89(4):170-6

Division of Otolaryngology, Department of Surgery, University of Kentucky College of Medicine, 800 Rose St., Suite C-236, Lexington, KY 40536-0293, USA.

Vestibular evoked myogenic potential (VEMP) testing has gained popularity as a diagnostic modality in otolaryngology and audiology. To maximize the utility of this test, examiners need the availability of ideal test settings and reliable norms. We conducted a prospective study of 8 subjects with no history of neurotologic symptoms to examine the test-retest consistency of VEMP testing and to analyze the impact of stimulus type and muscle tension monitoring. All subjects underwent VEMP testing with two stimuli: a 500-Hz tone and a click. With each stimulus, testing was completed with and without monitoring of sternocleidomastoid muscle tension. All subjects participated in an initial testing session and then returned for a repeat testing session 2 to 4 weeks later. We measured the amplitude of primary waveforms P13 (first positive peak) and N23 (first negative peak) and analyzed the reliability and reproducibility of the mean amplitude asymmetry of these VEMP peaks. The P13 component of the VEMP (specificity: 86.25%) demonstrated a more stable amplitude than did the N23 component (specificity: 70.50%). Therefore, our statistical analysis of the effect of stimulus type and muscle tension monitoring on test-retest reliability was limited to the P13 waveform. We found that neither the type of stimulus nor the presence or absence of muscle tension monitoring had any statistically significant effect on amplitude asymmetry. We concluded that in VEMP testing, the P13 component was more specific than the N23 component in identifying normal subjects and that the P13 component provided consistent results across test sessions, regardless of the type of stimulus or the presence or absence of muscle tension monitoring.
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April 2010

GIN (Gaps-In-Noise) performance in the pediatric population.

J Am Acad Audiol 2009 Apr;20(4):229-38

Division of Otolaryngology, Department of Surgery, University of Kentucky College of Medicine, Chandler Medical Center, B317 Kentucky Clinic, Lexington, KY, 40536-0284, USA.

Background: The recently developed Gaps-In-Noise (GIN) test has provided a new diagnostic tool for the detection of temporal resolution deficits. Previous reports indicate that the GIN is a relatively sensitive tool for the diagnosis of central auditory processing disorder ([C]APD) in adult populations.

Purpose: The purpose of the present study was to determine the feasibility of the GIN test in the pediatric population.

Research Design: This was a prospective pseudorandomized investigation.

Study Sample: This investigation involved administration of the GIN to 72 participants divided into six groups of normal children ranging from 7 through 18 years of age.

Data Collection And Analysis: The approximate GIN threshold (the shortest gap duration for which at least four of six gaps were correctly identified) served as the dependent variable. Results were analyzed using an ANOVA to examine between- and within-group differences.

Results: No statistically significant differences were seen in GIN thresholds among age groups. In addition, within group analysis yielded no statistically significant differences between ears within each age group. No developmental effect was seen in GIN thresholds between the ages of 7 and 18 years. Children as young as age 7 are able to complete the GIN with no significant difficulty and perform at levels commensurate with normal adults. The absence of ear differences suggests that temporal resolution as measured by the GIN is an auditory process that develops relatively early and symmetrically (i.e., no laterality or ear dominance effects).

Conclusions: The GIN procedure appears to be a feasible measure of temporal resolution in both pediatric and adult populations.
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http://dx.doi.org/10.3766/jaaa.20.4.3DOI Listing
April 2009

Correlation of central auditory processing deficits and vascular loop syndrome.

Ear Nose Throat J 2009 Oct;88(10):E34-7

Department of Surgery (Otolaryngology), University of Kentucky College of Medicine, Lexington, Ky, USA.

We report a case involving a 49-year-old woman with vascular loop syndrome. The patient was evaluated because of complaints of decreased hearing sensitivity in her right ear. Central auditory tests were performed. The patient was found to have an asymmetry on pure-tone audiometry and an auditory processing deficit, suggesting central pathology. Magnetic resonance imaging confirmed central involvement, revealing a vascular loop extending into the right internal auditory canal. This case report demonstrates that auditory deficits may result from vascular loop compression and that these deficits may benefit from a battery of tests to help identify and localize the pathology.
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October 2009

A systematic review to determine the effectiveness of using amplification in conjunction with cochlear implantation.

J Am Acad Audiol 2008 Oct;19(9):657-71; quiz 735

Department of Rehabilitation Sciences, University of Kentucky, Lexington, KY 40536, USA.

Background: The question regarding the use of amplification with implantation is timely and relevant in today's clinical settings where an increased number of adults with measurable hearing are receiving cochlear implants due to the expanding implant criteria, especially among individuals seeking bilateral implantation.

Purpose: To review the evidence available to answer the clinical question: "Does amplification in the ear opposite of a cochlear implant provide improved communication function for adult users?"

Research Design: A systematic review of the evidence that met the search criteria related to the use of amplification in adult implant users. All types of experiments were included with the exception of expert opinion. This systematic review ranked the levels of evidence related to these studies and distinguished the levels of evidence from judgments about the grade and strength of recommendations for the stated clinical question.

Study Sample: Fifty-two articles were initially reviewed with a final 11 articles meeting the search criteria and identified for in-depth analysis.

Data Collection And Analysis: Several electronic databases and textbooks were searched to locate the evidence related to bimodal stimulation. Each article was reviewed using a check sheet and assigned a ranking for level of evidence (Levels 1-6) based on the type of research design that was used and a grade of evidence (A-D) based on the quality, relevance, and extensiveness of the study. Finally the level and grade were collapsed into only three categories to indicating the strength of the recommendations coming from each study and were classified as either strong (I), moderate (II), or weak (III).

Results: Several trends about bimodal stimulation were observed, which include (1) significantly better speech understanding in the bimodal condition for many participants; (2) in noise, the largest bimodal benefits in speech recognition; (3) variable findings on localization tasks; and (4) overall significant improvement in functional ability based on self-assessments. The preponderance of evidence received grades of B or C.

Conclusions: The evidence available indicates "moderate" (II) strength in support of bimodal stimulation for adult implant users. Clinicians should encourage their clients to consider bimodal fittings. Additional research is needed about optimal time frame for introducing bimodal fittings as well as establishing a clinical profile of patients who may benefit most from this intervention compared to bilateral implantation.
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http://dx.doi.org/10.3766/jaaa.19.9.2DOI Listing
October 2008