Publications by authors named "Vinaya Manchaiah"

118 Publications

International survey of audiologists during the COVID-19 pandemic: effects on the workplace.

Int J Audiol 2021 Jun 17:1-8. Epub 2021 Jun 17.

Ear Science Institute Australia, Subiaco, Western Australia, Australia.

Objective: This study surveyed the effects of the COVID-19 pandemic on the audiology workplace.

Design: The study used a cross-sectional survey design for audiologists across the globe ( = 337) using an online survey (June-August 2020) focussing on changes to the workplace during the pandemic.

Results: Participants represented varied work settings and audiology services. Only a third (31.5%) provided psychosocial support, which may be important during the pandemic, as part of their services. Almost all (97%) audiologists reported changes to their workplace, with 76.4% reporting reduced caseloads during the COVID-19 pandemic. When rating their current and anticipated work conditions, 38.7% reported reduced working hours although only 13.8% anticipated reduced working hours in 6-months' time. Audiologists ranked services such as access to hearing assessment, hearing device adjustment and maintenance, and general audiological support as being more important during the pandemic than services such as psychosocial, emotional and tinnitus support.

Conclusions: The COVID-19 pandemic has resulted in significant disruptions to audiological practice that highlights the need to adapt and incorporate new audiological practices including telehealth, to ensure patients have continued access to care and clinics remain sustainable during the ongoing COVID-19 pandemic and recovery phase.
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http://dx.doi.org/10.1080/14992027.2021.1937348DOI Listing
June 2021

Hearing aid acquisition and ownership: what can we learn from online consumer reviews?

Int J Audiol 2021 Jun 13:1-10. Epub 2021 Jun 13.

Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA.

Objective: To explore the publicised opinions of consumers actively participating in online hearing aid reviews.

Design: A retrospective design examining data generated from an online consumer review website (www.HearingTracker.com). Qualitative data (open text responses) were analysed using the open source automated topic modelling software IRaMuTeQ (http://www.iramuteq.org/) to identify themes. Outputs were compared with quantitative data from the consumer reviews (short response questions exploring hearing aid performance and benefit, and some meta-data such as hearing aid brand and years of hearing aid ownership).

Study Sample: 1378 online consumer hearing aid reviews.

Results: Six clusters within two domains were identified. The domain Device Acquisition included three clusters: The domain Device Use included three clusters: ; and .

Conclusions: Although online hearing aid consumers indicate positive performance on multiple-choice questions relating to hearing aid performance and benefit, their online reviews describe a number of barriers limiting their success. Hearing healthcare clinicians must employ a personalised approach to audiological rehabilitation to ensure individual clients' needs are met.
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http://dx.doi.org/10.1080/14992027.2021.1931487DOI Listing
June 2021

Dismantling internet-based cognitive behavioral therapy for tinnitus. The contribution of applied relaxation: A randomized controlled trial.

Internet Interv 2021 Sep 12;25:100402. Epub 2021 May 12.

Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA.

Background: Internet-based cognitive behavioral therapy (ICBT) for tinnitus is an evidence-based intervention. The components of ICBT for tinnitus have, however, not been dismantled and thus the effectiveness of the different therapeutic components is unknown. It is, furthermore, not known if heterogeneous tinnitus subgroups respond differently to ICBT.

Aims: This dismantling study aimed to explore the contribution of applied relaxation within ICBT for reducing tinnitus distress and comorbidities associated with tinnitus. A secondary aim was to assess whether outcomes varied for three tinnitus subgroups, namely those with significant tinnitus severity, those with low tinnitus severity, and those with significant depression.

Methods: A parallel randomized controlled trial design ( = 126) was used to compare audiologist-guided applied relaxation with the full ICBT intervention. Recruitment was online and via the intervention platform. Assessments were completed at four-time points including a 2-month follow-up period. The primary outcome was tinnitus severity as measured by the Tinnitus Functional Index. Secondary outcomes were included for anxiety, depression, insomnia, negative tinnitus cognitions, health-related quality of life, hearing disability, and hyperacusis. Treatment engagement variables including the number of logins, number of modules opened, and the number of messages sent. Both an intention-to-treat analysis and completer's only analysis were undertaken.

Results: Engagement was low which compromised results as the full intervention was undertaken by few participants. Both the ICBT and applied relaxation resulted in large reduction of tinnitus severity (within-group effect sizes  = 0.87 and 0.68, respectively for completers only analysis), which were maintained, or further improved at follow-up. These reductions in tinnitus distress were greater for the ICBT group, with a small effect size differences (between-group  = 0.15 in favor of ICBT for completers only analysis). Tinnitus distress decreased the most at post-intervention for those with significant depression at baseline. Both ICBT and applied relaxation contributed to significant reductions on most secondary outcome measures, with no group differences, except for a greater reduction of hyperacusis in the ICBT group.

Conclusion: Due to poor compliance partly attributed to the COVID-19 pandemic results were compromised. Further studies employing strategies to improve compliance and engagement are required. The intervention's effectiveness increased with initial level of tinnitus distress; those with the highest scores at intake experienced the most substantial changes on the outcome measures. This may suggest tailoring of interventions according to tinnitus severity. Larger samples are needed to confirm this.
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http://dx.doi.org/10.1016/j.invent.2021.100402DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141772PMC
September 2021

Development and Preliminary Evaluation of the Tinnitus Severity Short Form.

Am J Audiol 2021 Jun 24;30(2):404-415. Epub 2021 May 24.

Department of Psychological & Brain Sciences, Washington University in St. Louis, MO.

Purpose Tinnitus, or the perception of sounds that occur without an external sound source, is a prevalent condition worldwide. For a subset of adults, tinnitus causes significant distress and impairment. Several patient-reported outcome measures have been developed to assess severity of tinnitus distress. However, at present, the field lacks a brief measure that is sensitive to treatment change. The purpose of the current study was to develop and preliminarily validate a brief questionnaire for tinnitus severity from two existing measures of tinnitus-related distress, the Tinnitus Handicap Inventory (THI) and Tinnitus Functional Index (TFI). Method Using data from nine study samples in the United States and United Kingdom, we conducted exploratory and confirmatory factor analyses to identify a short measure with good psychometric properties. We also assessed sensitivity to treatment-related change by examining associations with change in the TFI and THI. Finally, we conducted a confirmatory factor analysis of the final short questionnaire in a new sample of adults seeking treatment for tinnitus-related distress. Results We identified 10 items from the THI and TFI that exhibited limited loadings on secondary factors. The resulting Tinnitus Severity Short Form achieved good to excellent fit, including in a unique sample of individuals seeking online treatment for tinnitus, and appeared sensitive to treatment-related change. Conclusions The Tinnitus Severity Short Form developed in the current study may be a useful tool for the assessment of subjective severity and distress associated with tinnitus, especially when patient burden is a concern. Further research is necessary to fully validate the questionnaire for the assessment of treatment-related change.
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http://dx.doi.org/10.1044/2021_AJA-20-00164DOI Listing
June 2021

Coping With Tinnitus During the COVID-19 Pandemic.

Am J Audiol 2021 Jun 12;30(2):385-393. Epub 2021 May 12.

Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX.

Purpose The COVID-19 pandemic disrupted normal operations of health care services, broad sectors of the economy, and the ability to socialize freely. For those with tinnitus, such changes can be factors in exacerbating tinnitus. The purpose of this study was to determine tinnitus help-seeking behavior, which resources individuals utilized to cope during the pandemic, and what additional support is desired. Method An exploratory cross-sectional study design including 1,522 adults with tinnitus living in North America (Canada and the United States) was used. Data were collected through an online survey distributed by the American Tinnitus Association via e-mail. Free text from open-ended questions was analyzed using the automated content analysis. The responses to the structured questionnaire were analyzed using descriptive and nonparametric statistics. Results Significantly less tinnitus support was sought during the pandemic, and very few respondents utilized tinnitus support networks during the pandemic at the time the survey was conducted. Nonetheless, seeking support during the pandemic was significantly associated with significantly less tinnitus distress. The most frequently utilized resources for coping during the pandemic were contacting family and friends, spending time outdoors or in nature, relaxation, and exercise. Such tools for coping were associated with significantly less tinnitus distress. The support requested and advice provided by participants to health care services had overlap. The main support needs related to managing tinnitus included addressing hearing loss, providing peer support, finding cures, and accessing trained and understanding health care providers to help. The advice for professionals related to tinnitus management included the need for cures, personalized support, addressing hearing loss, targeting the tinnitus percept, and providing more information about the condition. Conclusions These findings provide suggestions on how to better support those with tinnitus at a time when health care is undergoing rapid changes. Findings can be used by stakeholders, clinical practitioners, and tinnitus support services to devise ways to work more effectively together to improve access to patient-driven, suitable, accessible, and evidence-based support. Supplemental Material https://doi.org/10.23641/asha.14558514.
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http://dx.doi.org/10.1044/2021_AJA-20-00188DOI Listing
June 2021

Sound-level Monitoring Earphones With Smartphone Feedback as an Intervention to Promote Healthy Listening Behaviors in Young Adults.

Ear Hear 2021 Mar 29. Epub 2021 Mar 29.

1Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa 2Department of Speech and Hearing Sciences, Lamar University, Beaumont, Texas, United States of America 3Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Karnataka, India 4Ear Sciences Centre, School of Surgery, University of Western Australia, Nedlands, WA, Australia 5Ear Sciences Institute Australia, Subiaco, Australia.

Objectives: More than a billion adolescents and youngsters are estimated to be at risk of acquiring recreational noise-induced hearing loss (RNIHL) due to the unsafe use of personal audio systems. RNIHL is preventable; therefore, the present study aimed to determine (i) the accuracy and reliability of dbTrack (Westone) sound-level monitoring earphones and (ii) the effect of sound-level monitoring earphones with smartphone feedback and hearing-health information as an intervention to promote healthy listening behaviors in young adults.

Design: The study consisted of two phases: the first phase investigated the accuracy and reliability of dbTrack sound-level monitoring earphones. Accuracy was determined by comparing earphone measurements to sound level meter measurements. Intradevice reliability was determined by comparing earphone measurements during test-retest conditions. Nineteen participants were recruited through convenience sampling to determine within-subject reliability by comparing in-ear sound levels measured by the earphones during test-retest conditions. For the second phase of the study, a single-group pretest-posttest design was utilized. Forty participants, recruited through snowball sampling, utilized the sound-level monitoring earphones with the accompanying dbTrack smartphone application for 4 weeks. The application's smartphone feedback was disabled during the first 2 weeks (pretest condition) and enabled during the last 2 weeks (posttest condition). Average daily intensities, durations, and sound dosages measured during pre- and posttest conditions were compared.

Results: Phase 1 dbTrack earphone measurements were within 1 dB when compared with sound level meter measurements. Earphones were also within 1 dB in repeated measures across earphones and across participants. Phase 2 posttest average daily intensity decreased by 8.7 dB (18.3 SD), duration decreased by 7.6 minutes (46.6 SD), and sound dose decreased by 4128.4% (24965.5% SD). Differences in intensity and sound dose were significantly lower with a small and medium effect size, respectively.

Conclusions: This study's preliminary data indicate that dbTrack (Westone) sound-level monitoring earphones with a calibrated in-ear microphone can reliably and accurately measure personal audio systems sound exposure. Preliminary results also suggest that feedback on sound exposure using the accurate sound-level monitoring earphones with the accompanying dbTrack application can potentially promote safe listening behavior in young adults and reduce the risk of acquiring an RNIHL.
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http://dx.doi.org/10.1097/AUD.0000000000001029DOI Listing
March 2021

Vestibular drop attacks in Ménière's disease: A systematic review and meta-analysis of frequency, correlates and consequences.

J Vestib Res 2021 Apr 28. Epub 2021 Apr 28.

Hearing and Balance Research Unit, Field of Otolaryngology, School of Medicine, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.

Background: Vestibular drop attacks (VDA), also called Tumarkin otolith crises as a complication of Ménière's disease (MD) were first described in 1936. Nevertheless, a clearer understanding of their prevalence and manifestations is needed.

The Objective: of this review is to determine the frequency, correlates and consequences of VDA in MD.

Method: Three databases were searched (i.e., MEDLINE, PubMed and Google Academia). A total of 1,791 references were identified, of which 18 studies were considered eligible. There was a large variation in the definition of VDA used in the studies.

Results: The frequency of VDA in MD leading to a fall to the ground varied from 3 to 19% in 9 hospital-based studies. In studies where a less restrictive definition of VDA included attacks with postural perturbation, tripping and near-to-fall situations was used the prevalence ranged from 50 to 72%. The pooled frequency of VDA leading to fall to the ground was 8% (95% CI 4 to 12%) in hospital-based studies. In these studies, VDA often occurred in severe and advanced MD whereas in cohort studies such connection was not found. Co-morbidity with migraine increased the likelihood of VDA occurrence in MD. In 3 studies syncope was recorded in connection to VDA with falls. In terms of clinical manifestation, audiometry, MRI, vestibular evoked muscle response measures indicated endolymphatic hydrops with involvement of the otolith system. The hearing loss was more pronounced, and balance was worse in MD patients with VDA than in those without. Injury associated with VDA was reported in only one study.

Conclusions: VDA is a common phenomenon in MD, occurring even in mild MD and complicated with syncope. Some preliminary evidence suggests that VDA may lead to severe injuries.
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http://dx.doi.org/10.3233/VES-201514DOI Listing
April 2021

Suggestions for shaping tinnitus service provision in Western Europe: Lessons from the COVID-19 pandemic.

Int J Clin Pract 2021 Apr 10:e14196. Epub 2021 Apr 10.

Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.

Background: Tinnitus severity has been exacerbated because of the COVID-19 pandemic and those with tinnitus require additional support. Such support should be informed by patient preferences and needs. The objective of this study was to gather information from individuals with tinnitus living in Europe to inform stakeholders of the (a) support they needed in relation to changes associated with the COVID-19 pandemic and (b) suggestions regarding tinnitus care for the future.

Methods: A cross-sectional mixed method study design was used using closed and open-ended questions via an online survey. Data were gathered from 710 adults experiencing tinnitus in Western Europe, with the majority living in The Netherlands, Belgium and Sweden. Data were analysed using qualitative content analysis and descriptive statistics.

Results: Those with tinnitus indicated the following support needs during the pandemic (a) support for tinnitus, (b) support for hearing-related difficulties, (c) social support and (d) pandemic-related support. Five directions for future tinnitus care were provided, namely, (a) need for understanding professional support and access to multidisciplinary experts, (b) greater range of therapies and resources, (c) access to more information about tinnitus, (d) prioritising tinnitus research and (e) more support for hearing protection and hearing loss prevention.

Conclusions: The findings point to the need for accessible (remote), patient-centred, suitable and evidence-based tinnitus care. Insights from the current study can be used by various stakeholders including clinical practitioners and tinnitus support services to ensure those with tinnitus have access to the help and support required in order to reduce service provision insufficiencies.
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http://dx.doi.org/10.1111/ijcp.14196DOI Listing
April 2021

Psychometric properties of the Kannada version of the International Outcome Inventory for Hearing Aids (IOI-HA).

Int J Audiol 2021 Mar 11:1-7. Epub 2021 Mar 11.

Audiology India, Mysore, India.

Objective: This study aimed to validate the translated Kannada version of the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire for hearing aid users.

Design: The original (English) and the translated versions of the IOI-HA questionnaire along with the Self-Assessment of Communication (SAC) were self-administered by hearing aid users. To examine test-retest reliability, 50% of the study participants completed the Kannada IOI-HA for a second time approximately 15 days later. The data analyses examined various psychometric properties using a predetermined quality criterion.

Study Sample: 105 Kannada-English bilingual adults using hearing aids.

Results: Factor analysis indicated a two-factor structure that explained a 61.8% variance in the IOI-HA. A Cronbach's alpha coefficient of 0.7 indicated acceptable internal consistency. Good test-retest reliability (Interclass Correlation Coefficient > 0.9) was obtained for both conditions (i.e. between the original English and translated Kannada versions and also between two different administrations of the Kannada IOI-HA questionnaire). Divergent validity test results were acceptable, and no ceiling or floor effects were noted. Convergent validity testing of the SAC, however, was poor with small correlation, although the direction of correlation (i.e. negative) was as expected.

Conclusion: Results suggest acceptable psychometric properties of the Kannada version of the IOI-HA questionnaire.
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http://dx.doi.org/10.1080/14992027.2021.1884910DOI Listing
March 2021

Social representation of hearing aids among people with hearing loss: an exploratory study.

Int J Audiol 2021 Mar 2:1-15. Epub 2021 Mar 2.

Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA.

Objective: The aim of the current study was to examine the social representation (SR) of hearing aids in people with hearing loss (PHL) in India, the Republic of Korea (ROK), the United Kingdom (UK), and the United States of America (US).

Design: The study used a cross-sectional survey design. The data collected by using a free association task were analysed qualitatively (i.e. content analysis) and quantitatively (i.e. chi-square analysis, similarities analysis, prototypical analysis).

Study Sample: 424 participants with hearing loss.

Results: The most commonly reported categories across all countries were "beneficial," "cost and time," and "appearance and design." Approximately 50% of the associations reported were negative. There were variations in terms of the categories that were predominant in the SR of each country. "Others actions and attitude" category was predominantly reported by PHL in India. "Disturbance" and "dissatisfaction" of hearing aids and the "repairs and maintenance of hearing aids" categories were mainly reported from the ROK and the US, respectively.

Conclusions: The current results highlight the main aspects that PHL report spontaneously when they think about hearing aids. The findings will help to further inform public health campaigns and will contribute to develop culturally appropriate media materials regarding hearing aids.
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http://dx.doi.org/10.1080/14992027.2021.1886349DOI Listing
March 2021

Vestibular drop attacks in Ménière's disease.

J Vestib Res 2021 Feb 26. Epub 2021 Feb 26.

Department of Speech and Hearing Sciences, Lamar University, Beaumont, Texas, USA.

The aim of the present study was to evaluate the severity of vestibular drop attack (VDA) in Ménière's disease (MD) and to examine the association between VDA severity and other MD-related complaints. The study used a cross-sectional survey design using an electronic questionnaire. The mean age of participants was 56.7 years, and the mean duration of MD was 12.4 years. Four categories of VDA were identified based on level of severity. VDA occurred in 305 (50.7%) of the 602 patients. Of these, 133 patients (22%) experienced mild VDA (i.e., associated with tripping); 80 (13%) experienced moderate VDA (i.e., associated with fall threat unless they had been able to grab support); and 92 (15%) experienced severe VDA (i.e., patients fell to the ground, as in a classical Tumarkin attack). In 70%of participants, VDA occurred less than once a week. VDA lasted for only a few seconds in 90%of participants. 87%reported single attacks, whereas 13%experienced VDA in clusters. VDA was associated with visual auras, reduced quality of life, poor postural control, and fatigue. Approximately half of MD patients experience VDA with varying degrees of severity. If VDA causes falls or near-falls, the attacks should be appropriately treated.
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http://dx.doi.org/10.3233/VES-201502DOI Listing
February 2021

Exploring tinnitus heterogeneity.

Prog Brain Res 2021 24;260:79-99. Epub 2020 Jul 24.

National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Ropewalk House, Nottingham, United Kingdom; Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Nottingham Audiology Services, Nottingham University Hospitals, Nottingham, United Kingdom.

Introduction: Tinnitus experiences differ widely. A greater understanding of the core processes underlying these variations is needed. Moreover, meaningful definitions for different subgroups are required to better manage this heterogeneous population. The objective of the present research was to contribute toward the understanding of tinnitus heterogeneity by identifying factors that can predict tinnitus severity and to ascertain if distinct subgroups of tinnitus presentation can be identified.

Methods: This cross-sectional study consisted of 326 adults subdivided into subgroups of those with mild tinnitus (n=32; 10%), significant tinnitus (n=99; 30%) and severe tinnitus (n=195; 60%) according to their scores from the Tinnitus Functional Index. Multiple regression was used to identify factors associated with tinnitus severity. These factors included personal traits, tinnitus-related traits, treatment modalities and clinical comorbidities.

Results: Insomnia, hearing distress, and anxiety were the best predictors of tinnitus severity (explaining 53% of the variability). These comorbidities were stronger predictors than any demographical factors (that explained 11% of the variability). Distinct subgroups based on tinnitus severity (mild, significant, and severe) and anxiety levels were evident. Those with severe tinnitus had significantly more severe comorbidities compared with the mild and significant groups.

Conclusions: This study highlights that people with tinnitus could initially be grouped according to tinnitus severity to direct further management. Those with higher tinnitus severity should receive more immediate and intensive care. Due to the strong associations between tinnitus severity and tinnitus-related comorbidities (e.g., insomnia, hearing disability, and anxiety), tinnitus assessment and interventions should focus on these comorbidities.
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http://dx.doi.org/10.1016/bs.pbr.2020.05.022DOI Listing
July 2020

A Comparison of Intervention Intensity and Service Delivery Models With School-Age Children With Speech Sound Disorders in a School Setting.

Lang Speech Hear Serv Sch 2021 04 26;52(2):529-541. Epub 2021 Jan 26.

University of Texas Rio Grande Valley, Edinburg.

Purpose This study examined intervention intensity and service delivery with school-age children with mild or mild-moderate speech sound disorders. The commonly used business-as-usual (BAU) service delivery model and a shorter, more frequent, individual model (experimental [EXP]) were compared. Method A between-subjects group design was selected. In BAU, 11 children received group sessions, 2 times per week, 30 min per session for 6 weeks. In EXP, 11 children received individual session, 3 times per week, 5 min per session for 6 weeks. Group differences on measures of dose (i.e., therapeutic input and production trials) and cumulative treatment intensity were examined. The extent to which children, across both conditions, demonstrated gains in speech sound accuracy and the extent to which gains differed between BAU and EXP were examined. Results There was a significant group difference on dose. Children in BAU received more therapeutic input and production trials than children in EXP. Cumulative treatment intensity was not statistically different between groups when dose was calculated as therapeutic input or production trials. Results from both conditions indicated statistically significant differences on measures of speech sound accuracy with large effect sizes. No group differences on gains were noted. Conclusions Dose calculated as therapeutic input and production trials plays an important role in understanding the impact of cumulative intervention intensity. Children with mild or mild-moderate speech sound disorders may benefit more from a shorter, frequent, individual service delivery model than a BAU model.
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http://dx.doi.org/10.1044/2020_LSHSS-20-00057DOI Listing
April 2021

Social Representation of "Hearing Loss" Among People with Hearing Loss: An Exploratory Cross-Cultural Study.

J Am Acad Audiol 2020 11 15;31(10):725-739. Epub 2020 Dec 15.

Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, United Kingdom.

Background: Hearing loss can have an effect on the physical, psychosocial, and cognitive wellbeing of an individual. Despite the research on attitudes and stigma associated with hearing loss, people with hearing loss (PHL) continue to delay seeking help. Thus, it is vital to look at alternative theories which have been successfully used in disability research to better understand how PHL perceive hearing loss.

Purpose: The aim of the current exploratory study was to examine the social representation (SR) of "hearing loss" in PHL in India, Republic of Korea (ROK), United Kingdom (UK), and the United States (US).

Research Design: The study used a cross-sectional survey design.

Study Sample: In this study, 424 participants were recruited using a consecutive sampling method in four countries (India, Republic of Korea, United Kingdom, and United States).

Data Collection And Analysis: Data collection was conducted using a questionnaire. Data were analyzed using content analysis, similarities analysis, prototypical analysis, and chi-square analysis.

Results: The free associations of the PHL were grouped into 37 categories. The most commonly reported categories were and . Similarities analysis and prototypical analysis highlighted two main negative categories () which form the central elements of SR of hearing loss. PHL associated hearing loss mainly as a negative phenomenon, but with some positive and neutral aspects. Respondents from ROK reported a greater number of neutral associations compared with other countries. There were cross-cultural similarities and differences in terms of PHL's SR of hearing loss, but there were more similarities than differences.

Conclusion: The study provides an insight into how PHL collectively view their "hearing loss" and helps to develop our understanding of the influence of culture on the SR of "hearing loss." The results will aid the development of culturally appropriate public education campaigns, marketing material, and appropriate rehabilitation for PHL.
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http://dx.doi.org/10.1055/s-0040-1719127DOI Listing
November 2020

Quality and readability of internet information about stuttering.

J Fluency Disord 2021 Mar 8;67:105824. Epub 2020 Dec 8.

Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA; Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, Karnataka, India.

Purpose: We examined the quality and readability of English-language Internet information about stuttering and evaluated the results considering recommendations by experts in health literacy.

Method: A search of Internet websites containing information about stuttering was conducted. Three key words (i.e., stuttering, stammering, speech disfluency) were entered into five country-specific versions of the most commonly used Internet search engine. A total of 79 websites were assessed. Their origin (commercial, non-profit, government, personal or university), quality [Health On the Net (HON) certification and DISCERN scores], and readability [Flesch Reading Ease (FRE) score, Flesch-Kincaid Grade Level Formula (F-KGL), and Simple Measure of Gobbledygook (SMOG)] were assessed.

Results: Of the 79 websites, 38 % were of commercial, 42 % were of nonprofit organization, 15 % were of government and 5% were of university origins, respectively. Only 13 % had obtained HON certification and the mean DISCERN scores was 3.10 in a 5-point scale. The mean reading grade levels were at 13th and 14th grade and 100 % of the websites exceeded the recommended 5th to 6th reading grade level for health information.

Conclusions: The quality of Internet-based health information about the treatment of stuttering is generally adequate, but actual usability of the sites examined in this study may be limited due to poor readability levels. This is problematic in persons with poor literacy skills. Since the Internet can be readily accessed as a valuable consumer information resource, speech-language pathologists and other healthcare professionals have an opportunity to direct consumers to websites that provide readable information of good quality.
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http://dx.doi.org/10.1016/j.jfludis.2020.105824DOI Listing
March 2021

Changes in Tinnitus Experiences During the COVID-19 Pandemic.

Front Public Health 2020 5;8:592878. Epub 2020 Nov 5.

Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, United States.

The COVID-19 pandemic has disrupted delivery of healthcare, economic activity, and affected social interactions. Identifying and supporting those most affected by the pandemic is required. The purpose of this study was to determine the impact of the pandemic on individuals with tinnitus and to identify mediating factors. This is a mixed-methods exploratory cross-sectional study, using data collected via an online survey from 3,103 individuals with tinnitus from 48 countries. The greatest representation was from North America (49%) and Europe (47%) and other countries were only marginally represented. Although the study was aimed at those with pre-existing tinnitus, 7 individuals reported having COVID-19 initiated tinnitus. Having COVID-19 symptoms exacerbated tinnitus in 40% of respondents, made no change in 54%, and improved tinnitus in 6%. Other mediating factors such as the social and emotional consequences of the pandemic made pre-existing tinnitus more bothersome for 32% of the respondents, particularly for females and younger adults, better for 1%, and caused no change to tinnitus for 67%. Pre-existing tinnitus was significantly exacerbated for those self-isolating, experiencing loneliness, sleeping poorly, and with reduced levels of exercise. Increased depression, anxiety, irritability, and financial worries further significantly contributed to tinnitus being more bothersome during the pandemic period. These findings have implications for tinnitus management, because they highlight the diverse response both internal and external factors have on tinnitus levels. Clinical services should be mindful that tinnitus may be caused by contracting COVID-19 and pre-existing tinnitus may be exacerbated, although in the majority of respondents there was no change. Additional support should be offered where tinnitus severity has increased due to the health, social, and/or emotional effects of the COVID-19 pandemic. Tinnitus may be more bothersome for those experiencing loneliness, having fewer social interactions, and who are more anxious or worried.
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http://dx.doi.org/10.3389/fpubh.2020.592878DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7676491PMC
May 2021

A Content Analysis of YouTube Videos Related to Hearing Aids.

J Am Acad Audiol 2020 10 20;31(9):636-645. Epub 2020 Nov 20.

Department of Speech and Hearing Sciences, Lamar University, Beaumont, Texas.

Background: Increasingly, people access Internet-based health information about various chronic conditions including hearing loss and hearing aids. YouTube is one media source that has gained much popularity in recent years.

Purpose: The current study examines the source, content, understandability, and actionability of YouTube videos related to hearing aids.

Research Design: Cross-sectional design by analyzing the videos at single point in time.

Study Sample: One hundred most frequently viewed videos in YouTube.

Intervention: Not applicable.

Data Collection And Analysis: The 100 most-viewed English language videos targeting individuals seeking information regarding hearing aids were identified and manually coded. Data collection included general information about the video (e.g., source, title, authorship, date of upload, duration of video), popularity-driven measures (e.g., number of views, likes, dislikes), and the video source (consumer, professional, or media). The video content was analyzed to examine what pertinent information they contained in relation to a predetermined fact sheet. Understandability and actionability of the videos were examined using the Patient Education Material Assessment Tool for Audiovisual Materials.

Results: Of the 100 most-viewed videos, 11 were consumer-based, 80 were created by professionals, and the remaining 9 were media-based. General information about hearing aids, hearing aid types, and handling and maintenance of hearing aids were the most frequently discussed content categories with over 50% of all videos commenting on these areas. Differences were noted between source types in several content categories. The overall understandability scores for videos from all sources were 74%, which was considered adequate; however, the actionability scores for all the videos were 68%, which is considered inadequate.

Conclusion: YouTube videos about hearing aids focused on a range of issues and some differences were found between source types. The poor actionability of these videos may result in incongruous consumer actions. Content and quality of the information in hearing aid YouTube videos needs to be improved with input from professionals.
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http://dx.doi.org/10.1055/s-0040-1717123DOI Listing
October 2020

Validation of the Brief International Classification of Functioning, Disability and Health (ICF) core set for hearing loss: an international multicentre study.

Int J Audiol 2021 Jun 18;60(6):412-420. Epub 2020 Nov 18.

Faculty of Medicine and Health, Audiological Research Centre, Örebro University, Örebro, Sweden.

Objective: Hearing loss (HL) affects the everyday functioning of millions of people worldwide. The Brief International Classification of Functioning Disability and Health (ICF) core sets for HL was developed to meet the complex health care needs of adults with HL. Because the brief core set for HL has not yet been validated internationally, this study aimed to investigate its validity from an international perspective.

Design: A cross-sectional validation study based on data from structured interviews with adults with HL.

Study Sample: Participants ( = 571) from India, South Africa, Sweden and the US were included.

Results: A six-factor solution explained 71% of the variance, focussing on issues related to ( = 0.915). Three ICF categories demonstrated low reliability - and .

Conclusion: The Brief ICF core set for HL is valid for adults with HL internationally. However, to further increase its international validity, we recommend adding the categories and replacing with the more inclusive block,
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http://dx.doi.org/10.1080/14992027.2020.1846088DOI Listing
June 2021

Use of Videos and Digital Media in Parent-implemented Interventions for Parents of Children with Primary Speech Sound And/or Language Disorders: A Scoping Review.

J Child Fam Stud 2020 Oct 1:1-13. Epub 2020 Oct 1.

Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX USA.

No review to date has focused on evaluating the use of videos and digital media in parent-implemented interventions for parents of children with primary language or speech sound disorder (LD/SSD). Research objectives guiding this scoping review included an evaluation of (a) use of videos and/or other digital media in parent-implemented interventions; (b) use of videos and/or other digital media in asynchronous content; (c) the role of the parent as learner; and (d) the program impact on parents and children. This review followed a five-stage framework: (a) identify research questions; (b) identify relevant studies; (c) select studies; (d) chart the data; and (e) collate, summarize and report the results. Ten studies were included. No program included parents of children with speech disorders. One fully asynchronous program was identified, though many programs included videos concurrent with direct instruction. No study described the parent as learner and only four studies examined parent satisfaction and perceptions. These four studies directly measured specific parent behavior and results indicated that the programs had a positive impact on parents' interactions. Nine of the ten studies included child outcomes. This low volume of studies suggests limited work in this area. The review describes research gaps and future directions.
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http://dx.doi.org/10.1007/s10826-020-01842-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529088PMC
October 2020

LoCHAid: An ultra-low-cost hearing aid for age-related hearing loss.

PLoS One 2020 23;15(9):e0238922. Epub 2020 Sep 23.

School of Chemical & Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA, United States of America.

Hearing aids are the primary tool in non-medical rehabilitation for individuals with hearing loss. While the costs of the electronic components have reduced substantially, the cost of a hearing aid has risen steadily to the point that it has become unaffordable for the majority of the population with Age-Related Hearing Loss (ARHL) especially for those residing in low- and middle-income countries. Here, we present an ultra-low-cost, affordable and accessible hearing aid device ('LoCHAid'), specifically targeted towards treating ARHL in elderly patients. The LoCHAid components cost 98 cents (< $1) when purchased in bulk for 10,000 units and can be personalized for each user through a 3D-printable case. It is designed to be an over-the-counter (OTC) self-serviceable solution for elderly individuals with ARHL. Electroacoustic measurements show that the device meets most of the targets set out by the WHO Preferred Product Profile and Consumer Technology Association for hearing aids. The frequency response of the hearing aid shows selectable gain in the range of 4-8 kHz, and mild to moderate gain between 200-1000 Hz, and shows very limited total distortion (1%). Simulated gain measurements show that the LoCHAid is well fitted to a range of ARHL profiles for males and females between the ages of 60-79 years. Overall, the measurements show that the device offers the potential to benefit individuals with ARHL. Thus, our proposed design has the potential to address the challenge of affordable and accessible hearing technology for hearing impaired elderly individuals especially in low- and middle-income countries.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238922PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7510997PMC
October 2020

Features, Functionality, and Acceptability of Internet-Based Cognitive Behavioral Therapy for Tinnitus in the United States.

Am J Audiol 2020 Sep 28;29(3):476-490. Epub 2020 Jul 28.

Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX.

Objective Although tinnitus is one of the most commonly reported symptoms in the general population, patients with bothersome tinnitus are challenged by issues related to accessibility of care and intervention options that lack strong evidence to support their use. Therefore, creative ways of delivering evidence-based interventions are necessary. Internet-based cognitive behavioral therapy (ICBT) demonstrates potential as a means of delivering this support but is not currently available in the United States. This article discusses the adaptation of an ICBT intervention, originally used in Sweden, Germany, and the United Kingdom, for delivery in the United States. The aim of this study was to (a) modify the web platform's features to suit a U.S. population, (b) adapt its functionality to comply with regulatory aspects, and (c) evaluate the credibility and acceptability of the ICBT intervention from the perspective of health care professionals and patients with bothersome tinnitus. Materials/Method Initially, the iTerapi ePlatform developed in Sweden was adopted for use in the United States. Functional adaptations followed to ensure that the platform's functional and security features complied with both institutional and governmental regulations and that it was suitable for a U.S. population. Following these adaptations, credibility and acceptance of the materials were evaluated by both health care professionals ( = 11) and patients with bothersome tinnitus ( = 8). Results Software safety and compliance regulatory assessments were met. Health care professionals and patients reported favorable acceptance and satisfaction ratings regarding the content, suitability, presentation, usability, and exercises provided in the ICBT platform. Modifications to the features and functionality of the platform were made according to user feedback. Conclusions Ensuring that the ePlatform employed the appropriate features and functionalities for the intended population was essential to developing the Internet-based interventions. The favorable user evaluations indicated that the intervention materials were appropriate for the tinnitus population in the United States.
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http://dx.doi.org/10.1044/2020_AJA-20-00002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7842846PMC
September 2020

Portrayal of Hearing Loss in YouTube Videos: An Exploratory Cross-Sectional Analysis.

Am J Audiol 2020 Sep 13;29(3):450-459. Epub 2020 Jul 13.

Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.

Objective The objective of the current study was to examine the source, content, understandability, and actionability of hearing loss information on YouTube videos. Method The study used a cross-sectional design. One hundred of the most frequently viewed YouTube videos were identified, and various data were manually coded (i.e., video source, video content, popularity measures such as number of views, likes, and dislikes). In addition, the understandability and actionability of each video were evaluated using the Patient Education Materials Assessment Tool for Audiovisual Materials rating scale. Results Of the 100 most viewed videos, 16 were created by consumers, 62 were professional created, and 22 were media based. Symptoms, causes, and treatment or management of hearing loss were the most frequently discussed content categories, with over 60% of all videos commenting on these areas. The overall understandability and actionability scores for the 100 videos included were 77% and 31%, respectively, indicating adequate understandability and poor actionability. Conclusions The YouTube videos on hearing loss focus on a range of issues. The poor actionability of these videos was a concern, as these videos may not lead to appropriate consumer actions in addressing their hearing loss. Efforts are needed to improve the quality and content of these videos to promote appropriate behavior change.
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http://dx.doi.org/10.1044/2020_AJA-19-00121DOI Listing
September 2020

Quality, Readability, and Suitability of Hearing Health-Related Materials: A Descriptive Review.

Am J Audiol 2020 Sep 18;29(3):513-527. Epub 2020 Jun 18.

Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX.

Objectives The objective of this descriptive review was to determine the quality, readability, and suitability of ear and hearing health information and materials for patients and their significant others. Method A literature search was conducted between August 2018 and April 2019 in the databases CINAHL Complete, MEDLINE, and PsychInfo. Inclusion and exclusion criteria were used to shortlist studies. Data regarding quality, suitability, and readability were extracted from the included studies. Data were assessed qualitatively. Results There were 34 studies included in this review. Of those, eight examined quality, 33 assessed readability, and four investigated the suitability of materials. The range of materials assessed included diagnostic reports, patient education materials (PEMs), patient-reported outcome measures, and websites. Quality elements were examined in studies focusing on website information. Findings indicated that most websites were of poor quality. Suitability was examined in studies focusing on PEMs such as hearing aid user guides. Findings indicated that most of the existing materials were not suitable for the intended populations. The reading grade level of information across all four categories was found to be higher than the recommended fifth or sixth reading grade level for health-related materials. Revisions of some diagnostic reports and PEMs showed that improvements are possible. Conclusions This review suggests that ear- and hearing-related materials generally have lower quality and suitability with higher readability (more difficult to read). Development of materials that are suitable, of high quality, and at the appropriate readability levels is required to improve accessibility of ear- and hearing-related materials.
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http://dx.doi.org/10.1044/2020_AJA-19-00040DOI Listing
September 2020

A cross-sectional study of the portrayal of childhood speech and language disorders in YouTube videos.

Digit Health 2020 Jan-Dec;6:2055207620929785. Epub 2020 Jun 2.

Department of Speech and Hearing, Manipal Academy of Higher Education, India.

Purpose: This study examined meta-data, source, type of informational content, understandability, and actionability of YouTube content related to speech and/or language disorders.

Method: The 100 most widely viewed videos related to children with speech and/or language disorders were obtained. Meta-data and sources of each upload were identified. Type of informational content within the videos was analyzed. The Patient Education Material Assessment Tool for Audiovisual Materials was used to assess understandability and actionability.

Results: A significant difference between video source groups was found for length of video, thumbs-up, and thumbs-down, but not for number of views. The YouTube videos related to speech and/or language disorders covered a range of issues, although a majority of the content focused on signs/symptoms and treatment. Videos had close-to-adequate understandability (i.e. 68%), although poor actionability scores (i.e. 32%) were noted. Videos uploaded by professionals were superior to other upload sources in understandability, but no difference was noted between video source for actionability.

Conclusions: Study insights about meta-data, source, type of informational content, understandability, and actionability of YouTube videos may help professionals understand the nature of online content related to speech and/or language disorders. Study implications and recommendations for further research are discussed.
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http://dx.doi.org/10.1177/2055207620929785DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7271267PMC
June 2020

Twitter usage about autism spectrum disorder.

Autism 2020 10 6;24(7):1805-1816. Epub 2020 Jun 6.

Lamar University, USA.

Stakeholders within autism spectrum disorder communities use Twitter for specific purposes. The goal of this study was to characterize patterns and themes of tweet content and sentiment and intercommunications between users sending and retweeting content to their respective user networks. The study used cross-sectional analysis of data generated from Twitter. Twitter content, sentiment, users, and community networks were examined from a sample of tweets with the highest Twitter reach and the lowest Twitter reach. Results indicate that Twitter content from both samples was primarily related to empowerment and support. Differences between the number of tweets originating from an individual in the lowest reach sample (i.e. 41%) as compared to the individuals in the highest reach sample (i.e. 18%) were noted. The number of users belonging to an advocacy subcommunity was substantially larger than a clinical and research subcommunity. Results provide insight into the presuppositions of individuals with autism spectrum disorder, their families and significant others, and other stakeholders.
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http://dx.doi.org/10.1177/1362361320923173DOI Listing
October 2020

The Use of the Internet and Social Media by Individuals with Ménière's Disease: An Exploratory Survey of Finnish Ménière Federation Members.

J Int Adv Otol 2020 Apr;16(1):13-17

University of Tartu School of Medicine, Tartu, Estonia.

Objectives: The present study explored the use of the Internet and social media by individuals with Ménière's disease (MD).

Materials And Methods: This study utilized a retrospective design and included the data of 465 individuals with MD from the Finnish Ménière Federation (FMF) database. Moreover, the participants included 346 females (i.e., approximately 75% of the sample), with roughly 95% of which middle-aged or older adults. An Internet-based survey was used to collect the demographic information and determine the use of the Internet and social media by individuals with MD in order to establish a computer-based peer support program.

Results: Based on the findings, more than 90% of the respondents reported using the Internet, 70% used the Internet to gather information about MD, and 47% stated that they trusted the information on the Internet.

Conclusion: The Internet and social media are frequently used by individuals with MD to gather information about their health conditions. Therefore, it is essential to ensure that appropriate and accurate information is available via Internet websites and social media platforms.
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http://dx.doi.org/10.5152/iao.2020.7563DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7224418PMC
April 2020

Media Use by Older Adults With Hearing Loss: An Exploratory Survey.

Am J Audiol 2020 Jun 29;29(2):218-225. Epub 2020 Apr 29.

Department of Otolaryngology, Hearing and Balance Research Unit, University of Tampere, Finland.

Objectives There has been a substantial increase in people with health conditions seeking health-related information online. The aim of this study was to examine the media usage by older adults with hearing loss. Method The study used a cross-sectional survey design. A total of 556 older adults with hearing loss (Hearing Tracker website users) completed the survey that was focused on (a) demographic information, (b) general electronic media usage, (c) sources of hearing health information, and (d) social media use for hearing health information. Data were analyzed using descriptive statistics and chi-square tests. Results When seeking hearing health care information, the majority of the participants turned to the Internet (54%) followed by health professionals (34%) as the first response to their symptoms. Both sources were also rated as the easiest means of obtaining hearing health information. The information from health care providers was rated as more reliable and important for decision making than that from the Internet. Facebook and YouTube were the most frequently used social media platforms with over 40% of the respondents using them "most of the time" or "sometimes." All the social media platforms were rated less favorably than other sources for ease of finding information, reliability, and importance in decision making. Conclusion Older adults with hearing loss use various forms of electronic media for seeking hearing health information. They place the most trust on the information obtained from hearing health care professionals. These professionals need to be aware of the quality of information available on the Internet and social media sources in order to direct patients to credible sources. Supplemental Material https://doi.org/10.23641/asha.12170397.
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http://dx.doi.org/10.1044/2020_AJA-19-00039DOI Listing
June 2020

Quality and readability of English-language Internet information for vestibular disorders.

J Vestib Res 2020 ;30(2):63-72

Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA.

Background: The Internet has become a powerful, accessible resource for many patients to use for their own medical management and knowledge. Vestibular disorders are prevalent, especially in the elderly. As the Internet is increasingly a major source of health-related information to the general public, it is often used to search for information regarding dizziness and vertigo. Ensuring that the information is accessible, unbiased, and appropriate can aid informed decision-making.

Objective: To evaluate the quality and readability of English-language Internet information related to vestibular disorders.

Methods: A cross-sectional website search using three keywords (nausea, dizziness, and vertigo) in five country-specific versions of the most commonly used Internet search engine was conducted in March 2018. The language was limited to English for all websites. Quality was assessed by presence of Health on the Net (HON) certification and DISCERN scores. Readability was assessed using the Flesch Reading Ease (FRE) score, Flesch-Kincaid Grade Level Formula (F-KGL), and Simple Measure of Gobbledygook (SMOG).

Results: In total, 112 websites were included and analyzed. The majority were commercial (61%) websites. A total of 42% had obtained HON certification. No association was found between the presence of HON certification and the resource of the website. The DISCERN scores had a mean of 2.52 (SD 1.1). Readability measures indicated that an average of 14-18 years of education was required to read and understand the Internet information provided regarding vestibular disorders.

Conclusions: To ensure the accessible to the general population, it is necessary to improve the quality and readability of Internet-based information regarding vestibular disorders.
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http://dx.doi.org/10.3233/VES-200698DOI Listing
January 2020

Twitter Usage Using Common Reference to Tinnitus.

Am J Audiol 2020 Jun 21;29(2):206-217. Epub 2020 Apr 21.

Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX.

Objective The objective of the study was to examine specific patterns of Twitter usage using common reference to tinnitus. Method The study used cross-sectional analysis of data generated from Twitter data. Twitter content, language, reach, users, accounts, temporal trends, and social networks were examined. Results Around 70,000 tweets were identified and analyzed from May to October 2018. Of the 100 most active Twitter accounts, organizations owned 52%, individuals owned 44%, and 4% of the accounts were unknown. Commercial/for-profit and nonprofit organizations were the most common organization account owners (i.e., 26% and 16%, respectively). Seven unique tweets were identified with a reach of over 400 Twitter users. The greatest reach exceeded 2,000 users. Temporal analysis identified retweet outliers (> 200 retweets per hour) that corresponded to a widely publicized event involving the response of a Twitter user to another user's joke. Content analysis indicated that Twitter is a platform that primarily functions to advocate, share personal experiences, or share information about management of tinnitus rather than to provide social support and build relationships. Conclusions Twitter accounts owned by organizations outnumbered individual accounts, and commercial/for-profit user accounts were the most frequently active organization account type. Analyses of social media use can be helpful in discovering issues of interest to the tinnitus community as well as determining which users and organizations are dominating social network conversations.
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http://dx.doi.org/10.1044/2020_AJA-19-00055DOI Listing
June 2020

Vestibular drop attacks in Ménière's disease and its association with migraine.

Eur Arch Otorhinolaryngol 2020 Jul 17;277(7):1907-1916. Epub 2020 Mar 17.

Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA.

Purpose: We explored the association of vestibular drop attacks (VDA) with or without migraine in patients with Ménière's disease (MD) and compared with patients classified as vestibular migraine (VM).

Method: The study involved a cross-sectional survey design. Data were collected from 401 members of Finnish Ménière Federation who experienced VDA.

Results: In the sample of 401 patients with VDA who did not experience headache, VM was diagnosed among 16.4% participants and migraine not associated with vertigo was experienced among 25.2% of the participants. Severity of postural instability, ability to move, and ability to stand up from chair differed among VDA baseline, VDA migraine and VM patient groups. Syncope associated with VDA was noticed more frequently in VM group. In terms of neurological complaints, except for visual problems, all other symptoms differed significantly between three patient groups. The health-related quality of life also differed between groups with VM group having the worse scores.

Conclusions: The current study suggests that migraine is common in MD patients who experience VDA. We observed no definite complaint that could be ascertained to VM. The coexistence of migraine increased the impact of complaints associated with VDA.
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http://dx.doi.org/10.1007/s00405-020-05890-3DOI Listing
July 2020