Publications by authors named "Judith E C Lieu"

58 Publications

Fatigue in Children With Unilateral and Bilateral Hearing Loss.

Otol Neurotol 2021 Jun 18. Epub 2021 Jun 18.

Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, California Department of Otolaryngology-Head and Neck Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.

Objective: To determine whether children with unilateral hearing loss (UHL) experience similar levels fatigue as children with bilateral hearing loss (BHL) or normal-hearing (NH).

Design: Cross-sectional study.

Setting: Two tertiary care otolaryngology practices.

Participants: Children, 5 to 18 years old, with UHL or BHL and their parents.

Main Outcome Measures: PedsQL Multidimensional Fatigue Scale (MFS) survey.

Results: Overall response rate was 90/384 (23%). Mean age of child participants was 10.7 years old (standard deviations [SD] 3.1); 38 (42%) were men and 52 (58%) were women. Sixty-nine (77%) children had UHL, 21 (23%) had BHL. Children with BHL (mean 65, SD 21) and UHL (mean 75, SD 17) reported greater levels of fatigue than children with NH (BHL difference -15, 95% confidence interval [CI] -25 to -5; UHL difference -6, 95% CI -13-1.2). Parent-proxy reports for children with BHL (mean 67, SD 20) and UHL (mean 76, SD 20) reported more fatigue than NH (BHL difference -22, 95% CI -33 to -12; UHL difference -14; 95% CI -20 to -8). Sub-section scores for general, sleep, and cognitive fatigue were higher for children with BHL and UHL than NH.

Conclusion And Relevance: Children with UHL and BHL reported significantly more fatigue than children with NH, and children with BHL reported more fatigue than UHL. These findings underscore the need to increase auditory rehabilitation and educational resources for children with UHL and support the use of the PedsQL MFS questionnaire as a measure to follow disability experienced by children with HL as they undergo hearing rehabilitation.
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http://dx.doi.org/10.1097/MAO.0000000000003225DOI Listing
June 2021

Review of Hearing Loss in Children-Reply.

JAMA 2021 03;325(12):1224-1225

Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio.

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http://dx.doi.org/10.1001/jama.2021.0390DOI Listing
March 2021

Speech and language outcomes in mild-moderate unilateral sensorineural hearing loss.

Int J Pediatr Otorhinolaryngol 2021 Feb 14;141:110558. Epub 2020 Dec 14.

Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address:

Objective: The impact of mild-moderate unilateral sensorineural hearing loss (USNHL) on speech and language delay (SLD) is not well established. Objectives included (1) determining SLD prevalence in patients with mild-moderate USNHL in comparison to prevalence in the general population and severe-profound USNHL patients and (2) examining speech, language, and auditory function testing (SLAT) results in USNHL patients.

Methods: A retrospective chart review of pediatric patients with USNHL, classified using pure tone averages (PTA) into mild-moderate (PTA 21-60) and severe-profound (PTA ≥ 61) USNHL groups was conducted. Abnormal SLAT values defined SLD. Prevalence and association of SLD based on USNHL severity was calculated. Onesample binomial tests compared observed frequencies of SLD to reported values.

Results: Forty-nine patients were identified with USNHL; 34 patients underwent SLAT. SLD frequency for mild-moderate USNHL was 25% (95% CI, 9-49%), higher than the general population rate (5.95%). No statistically significant difference was noted between SLD frequency in mild-moderate versus severe-profound USNHL. There were no significant correlations between SLAT measures and PTA thresholds.

Conclusion: There was a statistically significant increase in SLD in mild-moderate USNHL compared to the general population. There were no correlations between SLAT measures and PTA thresholds. Children with USNHL need close monitoring of speech, language and auditory development and functioning. Studies with larger sample sizes will help delineate if these findings truly reflect results in children with USNHL.
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http://dx.doi.org/10.1016/j.ijporl.2020.110558DOI Listing
February 2021

Predictors of Occurrence and Timing of Post-Tonsillectomy Hemorrhage: A Case-Control Study.

Ann Otol Rhinol Laryngol 2021 Jul 8;130(7):825-832. Epub 2020 Dec 8.

Department of Otolaryngology, Washington University School of Medicine, Saint Louis, MO, USA.

Objective: To describe cases and timing of pediatric post-tonsillectomy hemorrhage (PTH), to evaluate predictors of PTH, and to determine the optimal amount of postoperative care unit (PACU) monitoring time.

Study Design: Using the Pediatric Health Information System (PHIS) database and electronic medical records, a matched case-control study from 2005 to 2015 was performed.

Setting: A single, tertiary-care institution.

Subjects And Methods: Each case of PTH was matched with 1 to 4 controls for the following factors: age, sex, surgeon, and time of year. A total of 124 cases of PTH and 479 tonsillectomy controls were included. The rate and timing of postoperative bleeding were assessed, and matched pair analysis was performed using conditional logistic regression.

Results: Our institutional PTH rate of 1.9% (130 of 6949) included 124 patients; 15% (19) were primary (≤24 hours), with 50% (9) occurring within 5 hours. Twenty-one percent (4 of 19) of primary PTH patients received operative intervention. Eighty-five percent (105 of 124) of all cases were secondary PTH, and 47% (49) of those patients received operative intervention. Cold steel (OR 1.9, 95% CI 1.1-3.3) and Coblation (OR 1.9, 95% CI 1.2-3.1) techniques and tonsillectomy alone (OR 3.7, 95% CI 1.9-7.2) increased odds of PTH. Patients who developed PTH had 4 times the odds of having a preceding postoperative respiratory event than controls (OR 4.0, 95% CI 1.6-10.0).

Conclusion: We conducted a rigorous case-control study for PTH, finding that PTH was associated with use of cold steel and Coblation techniques and with tonsillectomy alone. Patients with a postoperative respiratory event may be more likely to develop a PTH and should be counseled accordingly. A PACU monitoring time of 4 hours is sufficient for outpatient tonsillectomy.
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http://dx.doi.org/10.1177/0003489420978010DOI Listing
July 2021

Hearing Loss in Children: A Review.

JAMA 2020 Dec;324(21):2195-2205

Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri.

Importance: Hearing loss in children is common and by age 18 years, affects nearly 1 of every 5 children. Without hearing rehabilitation, hearing loss can cause detrimental effects on speech, language, developmental, educational, and cognitive outcomes in children.

Observations: Consequences of hearing loss in children include worse outcomes in speech, language, education, social functioning, cognitive abilities, and quality of life. Hearing loss can be congenital, delayed onset, or acquired with possible etiologies including congenital infections, genetic causes including syndromic and nonsyndromic etiologies, and trauma, among others. Evaluation of hearing loss must be based on suspected diagnosis, type, laterality and degree of hearing loss, age of onset, and additional variables such as exposure to cranial irradiation. Hearing rehabilitation for children with hearing loss may include use of hearing aids, cochlear implants, bone anchored devices, or use of assistive devices such as frequency modulating systems.

Conclusions And Relevance: Hearing loss in children is common, and there has been substantial progress in diagnosis and management of these cases. Early identification of hearing loss and understanding its etiology can assist with prognosis and counseling of families. In addition, awareness of treatment strategies including the many hearing device options, cochlear implant, and assistive devices can help direct management of the patient to optimize outcomes.
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http://dx.doi.org/10.1001/jama.2020.17647DOI Listing
December 2020

Hearing Loss-Related Issues Affecting Quality of Life in Preschool Children.

Otolaryngol Head Neck Surg 2021 06 20;164(6):1322-1329. Epub 2020 Oct 20.

Washington University Department of Otolaryngology-Head and Neck Surgery, St Louis, Missouri, USA.

Objective: The impact of hearing loss (HL) on quality of life (QOL) in young children has not been examined systematically. The objective of this study was to examine patient, parent, and professional perspectives on experiences and situations that affect the QOL in young children with HL and to identify themes that emerged from coded data to develop a parent-proxy QOL measure for young children with HL.

Study Design: Qualitative study with 6 focus groups followed by semistructured interviews with other parents and professionals as stakeholder checks.

Setting: Academic medical center and local schools for the deaf.

Methods: Audiology department clinic lists were used to identify eligible participants, who included 5- to 7-year-old children with permanent HL and parents of 2- to 7-year-old children with permanent HL. A sample of 6 children and 12 parents participated in focus groups. An audiology department and multiple schools for the deaf in the area were contacted to recruit for professional participants, resulting in a sample of 10 professionals who participated in focus groups. Focus groups and interviews were audiotaped and transcribed verbatim. Inductive thematic analysis of focus group transcripts identified key concepts and emerging themes of how HL affects young children.

Results: Six themes emerged from the data: behavior, feelings, environments, social/activities, family, and hearing equipment. Child, parent, and professional focus group themes overlapped well, and data saturation was reached.

Conclusion: These qualitative data provided insight into HL-related issues affecting young children's QOL and were used to create items for a new parent-proxy QOL questionnaire.
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http://dx.doi.org/10.1177/0194599820962475DOI Listing
June 2021

Physical Therapy for Iatrogenic Facial Paralysis: A Systematic Review.

JAMA Otolaryngol Head Neck Surg 2020 11;146(11):1065-1072

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri.

Importance: Facial paralysis (FP) after surgery has substantial functional, emotional, and financial consequences. Most iatrogenic FP is managed by watchful waiting, with the expectation of facial function recovery. A potential treatment is physical therapy (PT).

Objective: To investigate whether noninvasive PT compared with no PT or other intervention improves facial nerve outcomes in adults with iatrogenic FP.

Evidence Review: Patients with noniatrogenic FP, facial reanimation surgery, and invasive adjunctive treatments (acupuncture or botulinum toxin injection) were excluded. A systematic review was conducted for records discussing iatrogenic FP and PT; a search for these records was performed using Ovid MEDLINE (1946-2019), Embase (1947-2019), Scopus (1823-2019), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform (2004-2019), and ClinicalTrials.gov (1997-2019). The references of all the included articles were also assessed for eligible studies. All human participant, English-language study designs with at least 2 cases were included. Quality assessment was performed using the Methodological Index for Non-randomized Studies (MINORS) and the revised Cochrane Risk of Bias 2 (RoB 2) tool for randomized controlled trials. All search strategies were completed on May 16, 2019, and again on October 1, 2019.

Findings: Fifteen studies (7 of which were retrospective cohort studies) and 313 patients with iatrogenic FP were included in the systematic review. Most iatrogenic FP (166 patients [53%]) was associated with parotidectomy; traditional PT (ie, facial massage) was the most common intervention (196 patients [63%]). The use of various facial grading systems and inconsistent reporting of outcomes prevented direct comparison of PT types.

Conclusions And Relevance: Because of heterogeneity in reported outcomes of facial nerve recovery, definitive conclusions were unable to be made regarding the association between PT and outcomes of iatrogenic FP. Physical therapy probably has benefit and is associated with no harm in patients with iatrogenic FP.
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http://dx.doi.org/10.1001/jamaoto.2020.3049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8048107PMC
November 2020

Regionalization of ORL Boot Camps: Report of the Society of University Otolaryngologists Task Force.

Laryngoscope 2021 04 28;131(4):737-743. Epub 2020 Aug 28.

Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, U.S.A.

Objectives: Simulation-based boot camps have emerged as timely vehicles to help novice residents develop the skills needed to manage medical emergencies. Geographically regional boot camps provide opportunities for interaction between residents and faculty from multiple otolaryngology programs. The Society of University Otolaryngologists (SUO) Boot Camp Task Force investigated the concept of regional access to otolaryngology boot camps with the goal of making more regional boot camps available for otolaryngology residents across the United States.

Study Design: Interviews.

Methods: The SUO Boot Camp Task Force assessed regional access to otolaryngology boot camps with a focus on geographic distribution, curricular content, and finances. Boot camp directors were contacted by email and telephone and interviewed to elicit information on all these areas.

Results: Data were available from 10 known regional simulation-based boot camps designed for novice residents. Individual boot camps included from 12 to 30 residents and 10 to 50 faculty members. Curricula included both technical (ie, procedural) and non-technical (eg, communication, leadership) skills for individuals and teams. Content was heavily weighted toward a variety of airway problems and management techniques, although various conditions involving hemorrhage, and airway fires were also addressed. Funding and expense structures had the greatest variability.

Conclusions: Considerable variability was identified among the known regional boot camps in terms of numbers of participants and finances, but fewer differences in curriculum. Geographic opportunity for 9 to 10 new boot camps was identified. The SUO Task Force recommends that a consensus be developed for several individual skill and teamwork scenario objectives to be included in each boot camp. Laryngoscope, 131:737-743, 2021.
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http://dx.doi.org/10.1002/lary.29052DOI Listing
April 2021

Validation of a Parent Proxy Quality-of-Life Measure for Young Children With Hearing Loss.

Laryngoscope 2021 03 15;131(3):663-670. Epub 2020 Jul 15.

Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A.

Objectives: No hearing-related quality of life (QL) questionnaire currently exists for children < 7 years. This study aimed to develop and evaluate the construct validity and reliability of a new parent-proxy Preschool Hearing Environments and Reflection on Quality of Life (HEAR-QL) questionnaire.

Methods: Parents of children 2 to 6 years old with any hearing loss (HL) were recruited from multiple sites. To evaluate the new measure's construct validity, participants completed a 70-item preschool HEAR-QL and validated questionnaires measuring hearing and communication functioning (Parents' Evaluation of Aural/Oral Performance of Children), generic pediatric QL (Pediatric Quality of Life Inventory Parent Report, PedsQL), family functioning (PedsQL Family Impact Module), and parent well-being (Patient Reported Outcomes Measurement Information System Adult Global Report). Participants completed the preschool HEAR-QL 2 weeks later to measure test-retest reliability. Exploratory principal components analysis was used to reduce the number of items and determine the underlying HEAR-QL factor structure. Analysis of variance examined HEAR-QL differences by HL.

Results: Among 205 parents, 144 had children with bilateral HL, 50 had children with unilateral HL, 10 had children with normal hearing (NH), and one child's hearing status was unspecified. The 70-item questionnaire was reduced to 23 items with five underlying factors: Behavior and Attention, Hearing Environments, New Social Situations, Social Interactions, and Communication. Cronbach's alpha for each factor ranged from 0.80 to 0.91. Test-retest reliability was 0.93. Moderate-to-strong correlations (r > .300) were observed between each Preschool HEAR-QL factor and previously validated measures. Hearing Environments scores differed significantly between children with NH and any HL.

Conclusion: Preschool HEAR-QL correlations with other measures supported its construct validity. Discriminant validity testing requires a larger sample of children with NH.

Level Of Evidence: NA Laryngoscope, 131:663-670, 2021.
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http://dx.doi.org/10.1002/lary.28891DOI Listing
March 2021

Panel 5: Impact of otitis media on quality of life and development.

Int J Pediatr Otorhinolaryngol 2020 Mar 20;130 Suppl 1:109837. Epub 2019 Dec 20.

Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands.

Objective: To summarize recent advances in knowledge on otitis media (OM) and quality of life (QoL) and development by synthesizing relevant research in this field published between June 1., 2015 until June 1., 2019.

Data Sources: Systematic searches of PubMed, Embase and the Cochrane Library using predefined database-specific syntaxes.

Review Methods: Articles selected were randomized controlled trials and observational studies with an adequate control group estimating treatment effects of OM including acute OM (AOM), recurrent AOM (RAOM), OM with effusion (OME), chronic OM (COM) and chronic suppurative OM (CSOM). Items included were Health Status, Health Status Indicators, Quality of Life, Functional Status, Specific Learning Disorder, Developmental Disabilities, Language Development Disorders, and Problem Behavior.

Results: The electronic database searches yielded a total of 699 records. After screening titles and abstracts, we identified 34 potentially eligible articles. Of these, 18 were excluded. This left 15 articles suitable for inclusion.

Conclusions: Although evidence is accumulating that OM may significantly impair children's QoL and development as well as caregiver's QoL, studies on this topic are relatively scarce and vary substantially in terms of methodological quality and outcome measurement instruments (OMI) used. In this review, studies have used 10 different OMIs capturing a wide range of OM symptoms as well as generic and disease-specific QoL outcomes. OM was associated with negative effects on auditory processing, language and speech development, school readiness, social competence, psychosocial wellbeing, and sleep. We found only four relevant randomized controlled trials, which mostly failed to demonstrate superiority of interventions in terms of QoL improvement and reports on reversibility are lacking. This underpins the urgent need for high quality studies in this field using validated and uniform OMIs. To facilitate interpretation and harmonization of study findings, we suggest and support the development of a core outcome set for the various OM entities that should include the most reliable and meaningful QoL and developmental OMIs.
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http://dx.doi.org/10.1016/j.ijporl.2019.109837DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197055PMC
March 2020

Between Current Implications and Future Perspectives-Reply.

JAMA Otolaryngol Head Neck Surg 2019 Nov;145(11):1082

Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri.

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http://dx.doi.org/10.1001/jamaoto.2019.2792DOI Listing
November 2019

Vestibular Screening in Pediatric Patients with Otitis Media.

J Am Acad Audiol 2020 03 9;31(3):209-216. Epub 2019 Jul 9.

Washington University School of Medicine Program in Audiology and Communication Sciences, St. Louis, MO and Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO.

Background: Otitis media with effusion (OME) is a common cause of vestibular disturbances in children. However, young children often lack the language to express their symptoms, and it is uncommon to screen children for vestibular impairments.

Purpose: The purpose of this study was to develop a screening protocol for children presenting with OME to determine if diagnostic vestibular testing is necessary.

Research Design: Children with normal hearing (NH), sensorineural hearing loss (SNHL), and conductive hearing loss (CHL) due to OME participated in a vestibular screening.

Study Sample: There were 30 participants, ages four to eight years, ranging from 48 to 101 months included in the study: 10 with NH, 11 with CHL due to OME, and 9 with SNHL.

Data Collection And Analysis: The vestibular screening consists of patient and parent questionnaires and a functional evaluation. The tests examined coordination, balance, oculomotor function, and nystagmus.

Results: Those with CHL were significantly more likely to display abnormal smoothness of pursuit, as measured with observations for rapid tracking, absence of or delayed saccades, and overshoot, than those with NH or SNHL (p = 0.012). Parents of children with CHL due to OME were more likely to report their child experiencing middle ear pressure than the parents of children with NH or SNHL (p = 0.010). In addition, children with CHL were less likely to report hearing loss than those with NH or SNHL. Parent and patient report were not found to be reliable indicators of vestibular disturbances.

Conclusions: This pilot study suggests that children with CHL due to OME present with more oculomotor abnormalities than their peers with NH. Further research is necessary to determine validity and reliability of the findings for this present study.
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http://dx.doi.org/10.3766/jaaa.18101DOI Listing
March 2020

Benefits of Imaging in Children for Unilateral Sensorineural Hearing Loss and the Eye of the Beholder.

JAMA Otolaryngol Head Neck Surg 2019 05;145(5):443-444

Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri.

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http://dx.doi.org/10.1001/jamaoto.2019.0160DOI Listing
May 2019

Intranasal Corticosteroids Do Not Lead to Ocular Changes: A Systematic Review and Meta-analysis.

Laryngoscope 2019 01 19;129(1):6-12. Epub 2018 Sep 19.

Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, U.S.A.

Objectives: The safety and efficacy of intranasal corticosteroids (INCS) are well established, but there remains apprehension that INCS could lead to systemic side effects, as with oral steroids. The objective of this systematic review was to assess whether the use of INCS lead to increased intraocular pressure (IOP) above 20 mm Hg, glaucoma, or formation of posterior subcapsular cataracts in adult patients with rhinitis.

Methods: Two medical librarians searched the published literature for records discussing the use of "nasal steroids" in "rhinitis" and their effect on "intraocular pressure," "cataracts," or "glaucoma."

Results: A total of 484 studies were identified, and 10 randomized controlled trials met our inclusion criteria. Meta-analysis of 2,226 patients revealed that the relative risk of elevated IOP in those who received INCS was 2.24 (95% confidence interval [CI]: 0.68 to 7.34) compared to placebo. The absolute increased incidence of elevated IOP in patients using INCS compared to placebo was 0.8% (95% CI: 0% to 1.6%). There were zero cases of glaucoma in both placebo and INCS groups at 12 months. The absolute increased incidence of developing a posterior subcapsular cataract was 0.02% (95% CI: -0.3% to 0.4%).

Conclusions: Use of INCS is not associated with a significant risk of elevating IOP or developing a posterior subcapsular cataract in patients with allergic rhinitis. Presence of glaucoma, however, is the real clinical adverse event of concern. There were zero reported cases of glaucoma at 12 months. Future studies should formally evaluate for glaucoma rather than use IOP measures as a surrogate. Laryngoscope, 129:6-12, 2019.
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http://dx.doi.org/10.1002/lary.27209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6320292PMC
January 2019

Longitudinal hearing loss in Wolfram syndrome.

Orphanet J Rare Dis 2018 06 27;13(1):102. Epub 2018 Jun 27.

Department of Psychiatry, Washington University in St. Louis School of Medicine, 4525 Scott Avenue, Campus Box 8134, St. Louis, MO, 63110, USA.

Background: Wolfram syndrome (WFS) is a rare autosomal recessive disease with clinical manifestations of diabetes mellitus (DM), diabetes insipidus (DI), optic nerve atrophy (OA) and sensorineural hearing loss (SNHL). Although SNHL is a key symptom of WFS, there is limited information on its natural history using standardized measures. Such information is important for clinical care and determining its use as an outcome measure in clinical trials.

Methods: Standardized audiologic measures, including pure-tone testing, tympanometry, speech perception, and the unaided Speech Intelligibility Index (SII) were assessed in patients with confirmed WFS annually. Mixed model analyses were used to examine main effects of age, time or interactions for pure tone average (PTA), high frequency average (HFA) and SII.

Results: Forty WFS patients were evaluated between 1 and 6 times. Mean age at initial enrollment was 13.5 years (SD = 5.6). Patients were classified as having normal hearing (n = 10), mild-to-severe (n = 24) or profound SNHL (n = 6). Mean age of diagnosis for SNHL was 8.3 years (SD = 5.1) with 75% prevalence. HFA worsened over time for both ears, and SII worsened over time in the worse ear, with greater decline in both measures in younger patients. Average estimated change over 1 year for all measures was in the subclinical range and power analyses suggest that 100 patients would be needed per group (treatment vs. placebo) to detect a 60% reduction in annual change of HFA over 3 years. If trials focused on just those patients with SNHL, power estimates suggest 55 patients per group would be sufficient.

Conclusions: Most patients had a slow progressive SNHL emerging in late childhood. Change over time with standard audiologic tests (HFA, SII) was small and would not be detectable for at least 2 years in an individual. Relatively large sample sizes would be necessary to detect significant impact on hearing progression in a clinical trial. Hearing function should be monitored clinically in WFS to provide appropriate intervention. Because SNHL can occur very early in WFS, audiologists and otolaryngologists should be aware of and refer for later emerging symptoms.
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http://dx.doi.org/10.1186/s13023-018-0852-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020390PMC
June 2018

Permanent Unilateral Hearing Loss (UHL) and Childhood Development.

Authors:
Judith E C Lieu

Curr Otorhinolaryngol Rep 2018 15;6(1):74-81. Epub 2018 Feb 15.

Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8115, St. Louis, MO 63110 USA.

Purpose Of Review: The aim of this study is to summarize the consequences of permanent unilateral hearing loss (UHL) on the development of children as documented in the recent literature.

Recent Findings: Congenital and early-identified UHL places young children at risk for delays in speech-language development. School-aged children with UHL score lower on standardized tests of language and cognition and need increased assistance in school for educational and behavioral issues than siblings with normal hearing, and report lower hearing-related quality of life, similar to children with bilateral hearing loss (HL). Early intervention, including use of hearing amplification devices, might ameliorate some of those affects. For a child with mild to severe UHL at presentation, the risk of progression of HL in the worse-hearing ear may be as high as 40%, and the risk of progression to bilateral HL approaches 20%.

Summary: Although UHL can adversely affect the development of children, how to mitigate those effects requires investigation.
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http://dx.doi.org/10.1007/s40136-018-0185-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5884900PMC
February 2018

Validations of the OM-6 Parent-Proxy Survey for Infants/Toddlers with Otitis Media.

Otolaryngol Head Neck Surg 2018 05 9;158(5):934-941. Epub 2018 Jan 9.

1 Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA.

Objective To validate the Otitis Media-6 (OM-6), a parent-proxy quality-of-life (QOL) questionnaire for infants/young children with OM, against other previously validated generic QOL questionnaires. Study Design Multi-institutional cross-sectional study. Setting Twenty-three otolaryngology, pediatric, and family practices across the United States. Subjects and Methods Caregivers of 6- to 24-month-old children with a history of OM completed the OM-6, OM History Form, and Pediatric Quality of Life (PedsQL) Infant Scales survey. Principal components analysis (PCA) examined the underlying factor structure of items on the OM-6, and Cronbach's α measured the internal consistency of items on each factor. Discriminant validity was assessed with receiver operating curves (ROCs). Results Surveys from 1045 patients were analyzed. The overall OM-6 was strongly to moderately correlated with the PedsQL Infant Scales scores (Pearson r = -0.649 for ages 6-12 months and -0.566 for ages 13-24 months). Two underlying constructs, "Behavior and Symptoms" and "Hearing and Speech," emerged from the PCA. Each factor and the overall OM-6 showed excellent internal consistency reliability (each Cronbach's α >0.75). The areas under the curve on the ROC analyses were <0.65 for recurrent and chronic OM using a variety of frequency and chronicity cut-points and definitions. Conclusion The OM-6 measures 2 underlying QOL constructs, Behavior and Symptoms and Hearing/Speech. The overall OM-6 showed acceptably high internal consistency reliability and good construct validity. However, the ability of the OM-6 to identify children who have more severe clinical recurrent or chronic OM vs milder disease was not supported by our analysis.
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http://dx.doi.org/10.1177/0194599817750372DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6265042PMC
May 2018

Auditory Outcomes with Hearing Rehabilitation in Children with Unilateral Hearing Loss: A Systematic Review.

Otolaryngol Head Neck Surg 2017 10 29;157(4):565-571. Epub 2017 Aug 29.

1 Cleveland Clinic, Cleveland, Ohio, USA.

Objective Options for management of unilateral hearing loss (UHL) in children include conventional hearing aids, bone-conduction hearing devices, contralateral routing of signal (CROS) aids, and frequency-modulating (FM) systems. The objective of this study was to systematically review the current literature to characterize auditory outcomes of hearing rehabilitation options in UHL. Data Sources PubMed, EMBASE, Medline, CINAHL, and Cochrane Library were searched from inception to January 2016. Manual searches of bibliographies were also performed. Review Methods Studies analyzing auditory outcomes of hearing amplification in children with UHL were included. Outcome measures included functional and objective auditory results. Two independent reviewers evaluated each abstract and article. Results Of the 249 articles identified, 12 met inclusion criteria. Seven articles solely focused on outcomes with bone-conduction hearing devices. Outcomes favored improved pure-tone averages, speech recognition thresholds, and sound localization in implanted patients. Five studies focused on FM systems, conventional hearing aids, or CROS hearing aids. Limited data are available but suggest a trend toward improvement in speech perception with hearing aids. FM systems were shown to have the most benefit for speech recognition in noise. Studies evaluating CROS hearing aids demonstrated variable outcomes. Conclusions Data evaluating functional and objective auditory measures following hearing amplification in children with UHL are limited. Most studies do suggest improvement in speech perception, speech recognition in noise, and sound localization with a hearing rehabilitation device.
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http://dx.doi.org/10.1177/0194599817726757DOI Listing
October 2017

Speech and Language Consequences of Unilateral Hearing Loss: A Systematic Review.

Otolaryngol Head Neck Surg 2017 10 22;157(4):572-579. Epub 2017 Aug 22.

3 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.

Objective Unilateral hearing loss has been shown to have negative consequences for speech and language development in children. The objective of this study was to systematically review the current literature to quantify the impact of unilateral hearing loss on children, with the use of objective measures of speech and language. Data Sources PubMed, EMBASE, Medline, CINAHL, and Cochrane Library were searched from inception to March 2015. Manual searches of references were also completed. Review Methods All studies that described speech and language outcomes for children with unilateral hearing loss were included. Outcome measures included results from any test of speech and language that evaluated or had age-standardized norms. Due to heterogeneity of the data, quantitative analysis could not be completed. Qualitative analysis was performed on the included studies. Two independent evaluators reviewed each abstract and article. Results A total of 429 studies were identified; 13 met inclusion criteria and were reviewed. Overall, 7 studies showed poorer scores on various speech and language tests, with effects more pronounced for children with severe to profound hearing loss. Four studies did not demonstrate any difference in testing results between patients with unilateral hearing loss and those with normal hearing. Two studies that evaluated effects on speech and language longitudinally showed initial speech problems, with improvement in scores over time. Conclusions There are inconsistent data regarding effects of unilateral hearing loss on speech and language outcomes for children. The majority of recent studies suggest poorer speech and language testing results, especially for patients with severe to profound unilateral hearing loss.
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http://dx.doi.org/10.1177/0194599817726326DOI Listing
October 2017

Macrolide-associated sensorineural hearing loss: A systematic review.

Laryngoscope 2018 01 3;128(1):228-236. Epub 2017 Aug 3.

Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.

Objectives: To investigate the potential association of macrolide antibiotics with sensorineural hearing loss (SNHL) and which agents and dosage may be related. To evaluate whether an optimal treatment exists for reversing SNHL that occurs after macrolide therapy.

Study Design: Systematic review of the literature.

Methods: Computerized (PubMed, EMBASE, Cochrane Library) and manual searches were performed to identify human studies of all ages (patients) who received macrolides (intervention, with or without control) and documented SNHL (outcome). All study designs were assessed. Extracted data included macrolide regimen details, as well as the timing, severity, and reversibility of SNHL with drug cessation alone or with additional medical intervention. Study designs and the associated risk of bias were assessed.

Results: The 44 publications (3 prospective, 41 retrospective) that met these criteria described 78 cases of audiometrically confirmed SNHL. SNHL was associated with oral and intravenous macrolide administration at standard and elevated doses. SNHL was irreversible in six cases, despite macrolide cessation (n = 5) and oral steroid treatment (n = 1). Irreversible SNHL was observed following 2 to 3 days of exposure. SNHL was reversible with macrolide cessation alone in 70 cases. In two cases, macrolide cessation coupled with oral steroid administration restored hearing. Reversible cases improved within hours to days. Nine studies also described 42 cases of subjective patient-reported hearing loss. Limitations in the data arose from study design, related comorbidities, and concomitant drug administration.

Conclusion: SNHL may follow macrolide exposure, even at standard oral doses. Further research is needed to understand the incidence, prevalence, and biological mechanism of its ototoxicity. Laryngoscope, 128:228-236, 2018.
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http://dx.doi.org/10.1002/lary.26799DOI Listing
January 2018

Variations in the Prevalence of Hearing Loss in Children: Truth or Artifact?

Authors:
Judith E C Lieu

JAMA Otolaryngol Head Neck Surg 2017 09;143(9):935-936

Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri.

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http://dx.doi.org/10.1001/jamaoto.2017.1172DOI Listing
September 2017

Differences in interregional brain connectivity in children with unilateral hearing loss.

Laryngoscope 2017 11 20;127(11):2636-2645. Epub 2017 Apr 20.

Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A.

Objectives: To identify functional network architecture differences in the brains of children with unilateral hearing loss (UHL) using resting-state functional-connectivity magnetic resonance imaging (rs-fcMRI).

Study Design: Prospective observational study.

Methods: Children (7 to 17 years of age) with severe to profound hearing loss in one ear, along with their normal hearing (NH) siblings, were recruited and imaged using rs-fcMRI. Eleven children had right UHL; nine had left UHL; and 13 had normal hearing. Forty-one brain regions of interest culled from established brain networks such as the default mode (DMN); cingulo-opercular (CON); and frontoparietal networks (FPN); as well as regions for language, phonological, and visual processing, were analyzed using regionwise correlations and conjunction analysis to determine differences in functional connectivity between the UHL and normal hearing children.

Results: When compared to the NH group, children with UHL showed increased connectivity patterns between multiple networks, such as between the CON and visual processing centers. However, there were decreased, as well as aberrant connectivity patterns with the coactivation of the DMN and FPN, a relationship that usually is negatively correlated.

Conclusion: Children with UHL demonstrate multiple functional connectivity differences between brain networks involved with executive function, cognition, and language comprehension that may represent adaptive as well as maladaptive changes. These findings suggest that possible interventions or habilitation, beyond amplification, might be able to affect some children's requirement for additional help at school.

Level Of Evidence: 3b. Laryngoscope, 127:2636-2645, 2017.
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http://dx.doi.org/10.1002/lary.26587DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5650569PMC
November 2017

Role of Qualitative Research in Shared Decision Making for Treatment of Sleep-Disordered Breathing: Patients, Preferences, and Personal Factors.

Authors:
Judith E C Lieu

JAMA Otolaryngol Head Neck Surg 2017 03;143(3):213-214

Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri.

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http://dx.doi.org/10.1001/jamaoto.2016.3364DOI Listing
March 2017

Developing Quality Measures for Adult Cochlear Implant Centers: Preliminary Findings.

Otolaryngol Head Neck Surg 2016 11 23;155(5):748-752. Epub 2016 Aug 23.

Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA.

The study objective was to develop quality measures for adult cochlear implant centers. A modified Delphi design beginning with focus groups of surgeons and audiologists was used, as adapted from the American College of Cardiology / American Heart Association method for creating quality measures. Two academic cochlear implant programs and 1 private program participated. Qualitative focus group analysis yielded 58 candidate measures. An additional 5 candidate measures were added from a systematic review of the literature. After exclusion of pediatric measures, structure measures, and process measures and discussion of details and implications of each measure, 8 measures remained as the preliminary Adult Cochlear Implant Outcome (CI-OUTCOME) Measure Set. This study provides a preliminary set of measures for evaluating the quality of adult cochlear implant centers, based on input from implant surgeons and audiologists. The next step will be to gather feedback from implant patients.
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http://dx.doi.org/10.1177/0194599816665583DOI Listing
November 2016

Quality of Life in Children with Hearing Impairment: Systematic Review and Meta-analysis.

Otolaryngol Head Neck Surg 2016 08 26;155(2):208-19. Epub 2016 Apr 26.

Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA.

Objective: To determine the impact of pediatric hearing loss (HL) on quality of life (QOL).

Data Sources: A qualified medical librarian conducted a literature search for relevant publications that evaluate QOL in school-aged children with HL.

Review Methods: Studies were assessed independently by 2 reviewers for inclusion in the systematic review and meta-analysis.

Results: From 979 abstracts, 69 were identified as relevant; ultimately, 40 articles were included in the systematic review. This review revealed that children with HL generally report a lower QOL than their normal-hearing peers and that QOL improves after interventions. The extent of these differences is variable among studies and depends on the QOL measure. Four studies using the Pediatric Quality of Life Inventory (PedsQL) had sufficient data for inclusion in a meta-analysis. After studies were pooled, statistically and clinically significant differences in PedsQL scores were found between children with normal hearing and those with HL, specifically in the social and school domains. Statistically significant differences were also noted in total scores for children with unilateral HL and in the physical domain for children with bilateral HL as compared with those having normal hearing; however, these differences were not clinically meaningful.

Conclusions: Our analysis reveals that decreased QOL in children with HL is detected in distinct domains of the PedsQL. These domains-school activities and social interactions-are especially important for development and learning. Future work should focus on these aspects of QOL when assessing HL in the pediatric population.
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http://dx.doi.org/10.1177/0194599816640485DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293136PMC
August 2016

Analysis of Outcome Domains in Adult Cochlear Implantation: A Systematic Review.

Otolaryngol Head Neck Surg 2016 08 5;155(2):238-45. Epub 2016 Apr 5.

Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA.

Objectives: To determine the breadth of outcome domains used in the reporting of adult cochlear implant surgery for the purpose of registry and quality measure development.

Data Sources: Systematic review of randomized controlled trials.

Review Methods: In consultation with a medical librarian, search strategies were constructed to identify randomized controlled trials studying adults undergoing cochlear implantation. MEDLINE, EMBASE, Scopus, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and the Database of Abstracts of Reviews of Effects were searched from database inception to July 2015. Studies were evaluated for level of evidence and risk of bias with the Cochrane Collaboration's Risk of Bias Tool, and outcome domains were extracted from each study.

Results: Of 4473 unique citations found, 8 studies were included in this review. All 8 trials were evidence level 1B. Risk of bias was low in 2 trials and high in the other 6. Reported outcome domains included speech perception in quiet and noise, speech tracking, quality of life, timbre perception, hearing preservation, vestibular function, electrode insertion technique, functional measures, functional imaging, fitting time, and tinnitus.

Conclusions: An analysis of randomized controlled trials studying cochlear implantation in adults yielded a wide spectrum of outcome domains. This is the first study to comprehensively describe the breadth of outcome domains in adult cochlear implantation. Validated instruments from these domains could be considered for potential inclusion as quality measures and registry use.
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http://dx.doi.org/10.1177/0194599816641382DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422673PMC
August 2016

Efficacy of earphones for 12- to 24-month-old children during visual reinforcement audiometry.

Int J Audiol 2016 ;55(4):248-53

b Department of Otolaryngology - Head and Neck Surgery , Washington University School of Medicine , St. Louis , Missouri , USA , and.

Objective: Efficacy of insert and supra-aural earphones during visual reinforcement audiometry (VRA) was investigated for 12- to 24-month-old children.

Design: VRA testing began in the soundfield and transitioned to either insert or supra-aural earphones. Audiologists recorded threshold estimates, participant behaviors, and an overall subjective rating of earphone acceptance.

Study Sample: One hundred and eighty-six 12- to 24-month-old children referred to the Department of Audiology at St. Louis Children's Hospital for a variety of reasons.

Results: Subjective ratings indicated high acceptance of insert earphones (84%) and supra-aural earphones (80%) despite negative behaviors. There was no significant difference in the number of threshold estimates based on earphone type for 12- to 17-month-old participants. Participants in the 18- to 24-month-old age group provided significantly more threshold estimates with insert earphones (mean = 5.3 threshold estimates, SD = 3.5) than with supra-aural earphones (mean = 2.9 threshold estimates, SD = 2.9). All seven participants who rejected earphone placement were successfully reconditioned for soundfield testing.

Conclusions: Data support the use of insert earphones during VRA, especially with 18-to 24-month-old children, to obtain ear-specific information.
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http://dx.doi.org/10.3109/14992027.2015.1122236DOI Listing
December 2016

Understanding Quality Measures in Otolaryngology-Head and Neck Surgery.

JAMA Otolaryngol Head Neck Surg 2016 Jan;142(1):86-90

Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri.

As health care reimbursements based on pay-for-performance models become more common, there is an unprecedented demand for ways to measure health care quality and demonstrate value. Performance measures, a type of quality measure, are unique tools in a health care delivery system that allow objective monitoring of adherence to specific goals and tracking of outcomes. We sought to provide information on the development of quality measures in otolaryngology-head and neck surgery, as well as the goals of performance measurement at a national level and for our specialty. The historical development, various types, and approach to creating effective performance measures are discussed. The primary methods of developing performance measures (using clinical practice guidelines, clinical registries, and alternative methods) are also discussed. Performance measures are an important tool that can aid otolaryngologists in achieving effective, efficient, equitable, timely, safe, and patient-centered care as outlined by the Institute of Medicine.
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http://dx.doi.org/10.1001/jamaoto.2015.2687DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5514290PMC
January 2016

Management of Children with Unilateral Hearing Loss.

Authors:
Judith E C Lieu

Otolaryngol Clin North Am 2015 Dec 9;48(6):1011-26. Epub 2015 Oct 9.

Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St Louis, MO 63110, USA. Electronic address:

Children with impaired hearing in one ear (unilateral hearing loss [UHL]) and normal hearing in the other ear experience challenges in understanding speech in noisy backgrounds and localizing the source of sounds in 3-dimensional space. They are at a high risk for speech and language delay and need educational help in school. However, definitive evidence of benefit from amplification is currently lacking to recommend placement of hearing aids or cochlear implants in all young children with UHL. Management of UHL in children should be guided by the child's development, performance in school, and personal/family values and preferences.
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http://dx.doi.org/10.1016/j.otc.2015.07.006DOI Listing
December 2015

Asymmetric and unilateral hearing loss in children.

Cell Tissue Res 2015 Jul 26;361(1):271-8. Epub 2015 May 26.

Department of Otolaryngology - Head & Neck Surgery, Washington University School of Medicine, St. Louis, Mo., USA,

Asymmetric and unilateral hearing losses in children have traditionally been underappreciated, but health care practitioners are now beginning to understand their effect on development and the underlying pathophysiologic mechanisms. The common wisdom among medical and educational professionals has been that at least one normal-hearing or near-normal-hearing ear was sufficient for typical speech and language development in children. The objective of this review is to illustrate, to the non-otolaryngologist, the consequences of asymmetric and unilateral hearing loss in children on developmental and educational outcomes. Etiology, detection, and management are also discussed. Lastly, implications for further research are considered.
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http://dx.doi.org/10.1007/s00441-015-2208-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4490007PMC
July 2015