Chronic suppurative otitis media refers to those ears in which the ear drum has a chronic non healing perforation. The perforation may or may not be associated with ossicular fixation or necrosis, middle ear infections, tympanosclerosis or mastoiditis. It is a disease commonly found in lower socio-economic areas and is particularly prevalent worldwide in groups with low living standards.

Chronic suppurative otitis media.

Ordinary families, special children, a systems approach to childhood disability

ObjectiveTo determine the impact of pediatric hearing loss (HL) on quality of life (QOL).Data SourcesA qualified medical librarian conducted a literature search for relevant publications that evaluate QOL in school-aged children with HL.Review MethodsStudies were assessed independently by 2 reviewers for inclusion in the systematic review and meta-analysis.ResultsFrom 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...

/pdf/quality-of-life-in-children-with-hearing-impairment-1zq5k27rri.pdf

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

Objectives: To review evidence regarding the health-related quality of life (HRQoL) and cost-effectiveness of unilateral and bilateral cochlear implantation (CI) among children and adults with severe-to-profound hearing loss. Study Design: Narrative review. Methods: Publications related to quality of life (QoL) and costs of care in CI were acquired through searches in English-language databases. Studies were included if they had identified the HRQoL attainment, cost of care, cost-utility, or cost-effectiveness associated with CI. Results: 57 studies were critically reviewed. The QoL outcome metrics used in these articles were divided into 2 categories - generic and condition specific. In studies investigating children, many reported no significant difference in QoL attainment between CI recipients and normal-hearing peers. In adults, significant improvements in QoL after implantation and higher QoL than in their nonimplanted (hearing-aided) peers were frequently reported. Studies involving an older adult cohort reported significant improvement in QoL after implantation, which was often independent of audiological performance. Overall, the calculated cost-utility ratios consistently met the threshold of cost acceptance, indicating acceptable values for expenditures on CI. Conclusions: Considerable work has been done on the QoL attainment and health economic implications of CI. Unilateral CI across all age groups leads to reported sustained benefits in the recipients' overall and disease-specific QoL. With increased cost associated with bilateral CI, further study is needed to characterize its costs and benefits with respect to the recipients' health, well-being, and contributions to society.

/pdf/quality-of-life-and-cost-effectiveness-of-cochlear-implants-2y2cduqg5z.pdf

Quality of Life and Cost-Effectiveness of Cochlear Implants: A Narrative Review

Purpose of the study Age-related hearing loss negatively affects health outcomes, yet disparities in hearing care, such as hearing aid use, exist based on race/ethnicity and socioeconomic position. Recent national efforts highlight reduction of hearing care disparities as a public health imperative. This study a) describes a community engagement approach to addressing disparities, b) reports preliminary outcomes of a novel intervention, and c) discusses implementation processes and potential for wide-scale testing and use. Design and methods This was a prospective, randomized control pilot, with a 3-month delayed treatment group as a waitlist control, that assessed feasibility, acceptability, and preliminary efficacy of a community-delivered, affordable, and accessible intervention for older adults with hearing loss. Outcomes were assessed at 3 months, comparing immediate and delayed groups, and pooled to compare the cohort's pre- and 3-month post-intervention results. Results All participants completed the study (n = 15). The program was highly acceptable: 93% benefited, 100% would recommend the program, and 67% wanted to serve as future program trainers. At 3 months, the treated group (n = 8) experienced fewer social and emotional effects of hearing loss and fewer depressive symptoms as compared to the delayed treatment group (n = 7). Pooling 3-month post-intervention scores (n = 15), participants reported fewer negative hearing-related effects (effect size = -0.96) and reduced depressive symptoms (effect size = -0.43). Implications The HEARS (Hearing Equality through Accessible Research & Solutions) intervention is feasible, acceptable, low risk, and demonstrates preliminary efficacy. HEARS offers a novel, low-cost, and readily scalable solution to reduce hearing care disparities and highlights how a community-engaged approach to intervention development can address disparities.

The Baltimore HEARS Pilot Study: An Affordable, Accessible, Community-Delivered Hearing Care Intervention.

Health-related quality of life in cochlear implanted patients in Romania.

The impact of hearing loss

Vestibular sensorial input is essential for psychomotor development of the very small children. In consequence, possible vestibular impairment induced by cochlear implantation in deaf children could affect the balance and walking learning process. Some of cochlear implanted children can present congenital vestibular deficit. The anatomical and embryological relation between auditory and vestibular system explains why congenital neurosensorial hearing loss may associate vestibular impairment. The cochlear implant surgery presents a vestibular lesion risk. Bilateral vestibulopathy, as it appears in early childhood, has a poor prognosis for the psychomotor and cognitive development. Even probably rare, bilateral vestibulopathy induced by simultaneous bilateral cochlear implantation can delay the acquisition of motor skills. This pathology can be avoided by an appropriate surgical indication related to the vestibular preoperative status. This study reports the vestibular saccular functional modifications after the cochlear implantation in children. The cervical vestibular evoked myogenic potentials (cVEMPs) were performed in children before and after the cochlear implantation. Since previous studies report different vestibular impairment related to the portelectrode insertion approach, another objective of our study was to assess the saccular postoperative status depending of the insertion by cochleostomy (CO) or through the round window (RW). We performed cVEMPs for 80 patients (135 cochlear implanted ears) before and after cochlear implantation. We have detected preoperative saccular areflexia in 33 (24.4%) ears. In the group of 102 (75.6%) ears with preoperative normal saccular function, 72 (70.6%) ears preserved the cVEMP response after the surgery, while in 30 (29.4%) ears the cVEMP response was lost. Reporting our findings to the portelectrode insertion method, we found normal saccular function in 73.3% of the cochlear implanted ears by RW surgical approach and in 68.42% ears by CO approach. These results suggest that the RW portelectrode insertion is the recommended strategy in order to avoid the saccular vestibular impairment.

Saccular function evolution related to cochlear implantation in hearing impaired children.

The role of cochlear implant in deaf children development is well-known However, the results are highly variable and depend on several factors The most important role belongs to the family, family environment in which the child develops The aim of the study was to evaluate the features of the family environment in which cochlear-implanted children develop The questionnaire “Family Environment Scale” was sent to 108 families who had cochlear-implanted child with more than 6 months of experience One of the parents was asked to fill out the questionnaire which also included general information about the child and the family A total of 58 families responded to the questionnaire and accepted to participate in the study Mean values were higher compared with normal families in the areas of cohesion, expressiveness, intellectual-cultural orientation and organization, but the cohesion and organization score mean value exceeded the normal values (between 40 and 60) The independence and the conflict areas had lower values than normal families but did not exceed the lower limit of normal (40) The relationship between the family and the auditory-verbal development potential of the cochlear-implanted child is obvious However, further studies are needed to establish correlations between the characteristics of the family environment and the level of auditory-verbal and psycho-cognitive development of the cochlear-implanted child so we can act on the family environment through education or therapy, to get maximum benefit with these children

Violeta Necula

Papers

Health-related quality of life in cochlear implanted patients in Romania.

The impact of hearing loss

Saccular function evolution related to cochlear implantation in hearing impaired children.

Effects of family environment features on cochlear-implanted children

Safety and effectiveness of chloral hydrate in outpatient paediatric sedation for objective hearing tests.