Pub Date : 2023-10-30DOI: 10.1097/01.hj.0000995260.15519.9e
Daniel Fink
There’s a new definition of noise: Noise is unwanted and/or harmful sound.1 The new definition replaces the obsolete definition—Noise is unwanted sound. This change was adopted by the International Commission on Biological Effects of Noise at its 14th Congress in June.2Editorial, noiseWhy is a new definition needed? The American National Standards Institute and Acoustical Society of America Standard 2.32 definition is Noise. (a) Undesired sound. By extension, noise is any unwanted disturbance within a useful frequency band, such as undesired electric waves in a transmission channel or device. (b) Erratic, intermittent, or statistically random oscillation.3 (Other organizations and many dictionaries use the definition noise is unwanted sound.) This definition, developed by the Acoustical Society of America almost 100 years ago in the early days of acoustical science, misses two main problems. First, it puts the onus on anyone complaining about noise, implying that we are complainers, weak, neurotic, or perhaps trying to stop the advance of progress. Second, it ignores what is now known about the adverse auditory and non-auditory health effects of noise exposure.4 Noise has been called “the new secondhand smoke.”5 With the old definition of noise, those of us who want a quieter world were in the same place as we were in the 1980s and 1990s, when we wanted smoke-free restaurants, stores, doctors’ waiting rooms, workplaces, planes, and trains. Smoking was seen as a harmless habit, and those who asked that someone refrain from smoking in their presence were viewed as fussy or self-centered, trying to interfere with the smoker’s harmless pleasure. That changed to a certain extent in 1964, when the first Surgeon General’s Report on Smoking and Health was published6, but smoking was still commonplace. Much greater progress was made after 1993, when the Environmental Protection Agency determined that environmental tobacco smoke, commonly called secondhand smoke, was a health hazard causing cancer with no known safe lower level of exposure.7 Our concerns about secondhand smoke suddenly became health concerns. Regulators and legislators started listening to us—despite Big Tobacco’s claims that smokers’ freedom to smoke was being restricted, a sneaky campaign by Big Tobacco raising doubts about the dangers of tobacco smoke and postulating other causes of cancer in smokers8 and those in the hospitality business expressing concerns about decreased revenue if people couldn’t smoke in their establishments. Of course, there were no major causes of lung cancer in smokers other than smoking, and multiple studies show that if smokers didn’t patronize restaurants and bars that didn’t allow smoking, others who didn’t want a side order of secondhand smoke with their meal were glad to return to restaurants.9 The end result, with cigarette taxes increased, cigarette advertising limited, and smoking becoming socially unacceptable, was that millions of smokers quit and the
噪音有一个新的定义:噪音是不需要的和/或有害的声音新的定义取代了过时的定义——噪音是不需要的声音。国际噪音生物效应委员会在6月召开的第14届大会上采纳了这一改变。美国国家标准协会和美国声学学会标准2.32对噪声的定义是。(a)不希望听到的声音。引申开来，噪声是在有用的频带内的任何不需要的干扰，例如在传输信道或设备中不需要的电波。(b)不稳定的、间歇的或统计上随机的振荡(其他组织和许多字典使用的定义噪音是不需要的声音。)这个定义是由美国声学学会(Acoustical Society of America)在大约100年前声学科学的早期提出的，它忽略了两个主要问题。首先，它把抱怨噪音的责任推给了任何抱怨噪音的人，暗示我们是爱抱怨的人、软弱的人、神经质的人，或者是试图阻止进步的人。其次，它忽略了现在所知道的噪音暴露对听觉和非听觉健康的不利影响噪音被称为“新的二手烟”。按照噪音的旧定义，我们这些想要一个更安静的世界的人，就像我们在20世纪80年代和90年代一样，当时我们想要无烟的餐馆、商店、医生候诊室、工作场所、飞机和火车。吸烟被视为一种无害的习惯，那些要求别人在他们面前不要吸烟的人被视为挑剔或以自我为中心，试图干扰吸烟者无害的快乐。1964年，第一份卫生部长关于吸烟与健康的报告发表，这在一定程度上有所改变，但吸烟仍然司空见惯。1993年以后取得了更大的进展，当时环境保护署确定，环境中的烟草烟雾，通常被称为二手烟，是一种会致癌的健康危害，没有已知的安全的较低接触量我们对二手烟的担忧突然变成了对健康的担忧。监管机构和立法者开始倾听我们的声音——尽管烟草巨头声称吸烟者的吸烟自由受到限制，但烟草巨头发起的一场鬼鬼祟祟的运动引发了人们对烟草烟雾危害的怀疑，并假定吸烟者患癌症的其他原因，而酒店业人士则担心，如果人们不能在他们的场所吸烟，他们的收入会减少。当然，除了吸烟，没有其他导致吸烟者患肺癌的主要原因，而且多项研究表明，如果吸烟者不光顾那些不允许吸烟的餐馆和酒吧，那些不想在用餐时再点二手烟的人就会很高兴地回到餐馆最终的结果是，随着香烟税的增加，香烟广告的限制，吸烟在社会上变得不可接受，数以百万计的吸烟者戒烟了，美国基本上实现了无烟。吸烟者和二手烟暴露者因癌症和心脏病住院的人数和死亡人数都大幅下降，儿童因哮喘住院的人数也有所下降。这是20世纪最伟大的公共卫生成就之一，与本世纪初的清洁空气和水以及本世纪中叶的预防传染病的疫苗接种和免疫接种一样，为个人和人口的健康带来了巨大的好处。噪音的新定义有三个重要含义:1)噪音会导致公众听力丧失，而不仅仅是职业性接触噪音的工人想要的噪音，无论是来自摇滚音乐会还是使用电动工具，都会造成听觉损伤。讨厌的噪音会使人产生压力，而压力对人体健康有害。噪音污染，主要来自交通工具的噪音，在工业化社会中被普遍认为是现代生活的一部分，但它危害我们的健康。交通噪音导致心血管疾病和死亡增加。对这些不利健康影响的全面讨论超出了这篇社论的范围，但暴露于交通噪音会激活不自主的生理应激反应，导致血压和心率升高，应激激素水平升高，动脉内膜炎症。尽管我们认为我们已经习惯了家外、学校和工作场所外道路交通的嗡嗡声，以及许多地方来自火车或飞机的噪音，但我们并不习惯这些不自觉的生理反应，这些反应导致心血管疾病和死亡的增加。对每个人的生理影响可能很小，但当超过1亿美国人暴露在交通噪音中时，人口健康影响是巨大的。
{"title":"A New Definition of Noise","authors":"Daniel Fink","doi":"10.1097/01.hj.0000995260.15519.9e","DOIUrl":"https://doi.org/10.1097/01.hj.0000995260.15519.9e","url":null,"abstract":"There’s a new definition of noise: Noise is unwanted and/or harmful sound.1 The new definition replaces the obsolete definition—Noise is unwanted sound. This change was adopted by the International Commission on Biological Effects of Noise at its 14th Congress in June.2Editorial, noiseWhy is a new definition needed? The American National Standards Institute and Acoustical Society of America Standard 2.32 definition is Noise. (a) Undesired sound. By extension, noise is any unwanted disturbance within a useful frequency band, such as undesired electric waves in a transmission channel or device. (b) Erratic, intermittent, or statistically random oscillation.3 (Other organizations and many dictionaries use the definition noise is unwanted sound.) This definition, developed by the Acoustical Society of America almost 100 years ago in the early days of acoustical science, misses two main problems. First, it puts the onus on anyone complaining about noise, implying that we are complainers, weak, neurotic, or perhaps trying to stop the advance of progress. Second, it ignores what is now known about the adverse auditory and non-auditory health effects of noise exposure.4 Noise has been called “the new secondhand smoke.”5 With the old definition of noise, those of us who want a quieter world were in the same place as we were in the 1980s and 1990s, when we wanted smoke-free restaurants, stores, doctors’ waiting rooms, workplaces, planes, and trains. Smoking was seen as a harmless habit, and those who asked that someone refrain from smoking in their presence were viewed as fussy or self-centered, trying to interfere with the smoker’s harmless pleasure. That changed to a certain extent in 1964, when the first Surgeon General’s Report on Smoking and Health was published6, but smoking was still commonplace. Much greater progress was made after 1993, when the Environmental Protection Agency determined that environmental tobacco smoke, commonly called secondhand smoke, was a health hazard causing cancer with no known safe lower level of exposure.7 Our concerns about secondhand smoke suddenly became health concerns. Regulators and legislators started listening to us—despite Big Tobacco’s claims that smokers’ freedom to smoke was being restricted, a sneaky campaign by Big Tobacco raising doubts about the dangers of tobacco smoke and postulating other causes of cancer in smokers8 and those in the hospitality business expressing concerns about decreased revenue if people couldn’t smoke in their establishments. Of course, there were no major causes of lung cancer in smokers other than smoking, and multiple studies show that if smokers didn’t patronize restaurants and bars that didn’t allow smoking, others who didn’t want a side order of secondhand smoke with their meal were glad to return to restaurants.9 The end result, with cigarette taxes increased, cigarette advertising limited, and smoking becoming socially unacceptable, was that millions of smokers quit and the","PeriodicalId":39705,"journal":{"name":"Hearing Journal","volume":"39 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136105399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-30DOI: 10.1097/01.hj.0000995256.76987.1b
Amy Badstubner, Kari Morgenstein Dermer
This three-part series explores different aspects of professional coaching. Catch up with Part 1: Leading With a Coaching Mindset here: https://bit.ly/3tmfhmh.Figure 1: The above image shows the thoughts, feelings, and actions associated with each of the 7 Levels of Energy. Chart adapted from work done by Bruce D. Schneider. Employee engagement, Energy Leadership Index Assessment, practice management, practice management series.The concept of employee engagement has evolved significantly over time. Its multifaceted nature makes it a topic that can be easy to talk about, but hard to implement. Undoubtedly, in today’s landscape, employee engagement holds unparalleled significance, particularly within the health care sector, where its relevance has surged to unprecedented heights.1,2 However, it is possible that conventional strategies to drive engagement have fallen short in meeting contemporary challenges. In our coaching group, both with clients and for our own team, we use the 7 Levels of Energy Framework.3 This system not only offers a fresh perspective, but also a structured methodology that is easy to grasp and has the power to amplify employee engagement. THE 7 LEVELS OF ENERGY FRAMEWORK By leveraging the various energy levels described by Schneider, we can delve deeper into the motivations, attitudes, and behaviors that shape employee engagement. This approach not only enriches our understanding of employees and how employees show up, but also equips organizations with a toolkit capable of driving sustainable change. Let’s clarify what we mean by “energy” for this article. Don’t worry—we are not revisiting your psychoacoustics class or asking you to make any calculations. Here, energy refers to the lens or filters you have that shape your perceptions, attitudes, and actions.4 There are 7 Levels of Energy we have the potential to experience day to day (Figure 1). We often experience several levels of energy in one day or even within an hour. It is important to note that no energy level is good or bad; they all have advantages and disadvantages. All the levels serve a purpose. The objective, however, is to raise our awareness so we can recognize how we are showing up and actively choose if that level is serving our needs at the time. It is through this self-awareness and intentional choice that we can harness our personal power for a more fulfilling and purpose-driven life, both personally and professionally.5 EMPLOYEE ENGAGEMENT EXAMPLES Below are examples of what employee engagement might look like for each level of energy. Level 1: “No one understands me. I get overlooked for every opportunity.” “I have been here for 10 years and have never been given a raise. It’s not fair!” Level 2: “I am livid that Sally gets to leave early. Why can’t I?” “My boss makes me so angry because she doesn’t know how hard I work.” Level 3: “Things are fine at my job; it could always be worse somewhere else.” “My boss seems disappointed with me, but it’s all go
这个由三部分组成的系列探讨了专业教练的不同方面。1:上面的图片显示了与7个能量级别中的每一个相关的思想、感觉和行动。图表改编自Bruce D. Schneider所做的工作。员工敬业度，能源领导指数评估，实践管理，实践管理系列。随着时间的推移，员工敬业度的概念发生了重大变化。它的多面性使它成为一个很容易谈论，但很难实施的话题。毫无疑问，在当今的形势下，员工敬业度具有无与伦比的重要性，特别是在医疗保健行业，其相关性已飙升至前所未有的高度。然而，推动互动的传统策略可能无法满足当前的挑战。在我们的教练团队中，无论是对客户还是对我们自己的团队，我们都使用了7级能量框架。这个系统不仅提供了一个全新的视角，而且是一个易于掌握的结构化方法，并且有能力增强员工的敬业度。通过施耐德描述的各种能量水平，我们可以更深入地研究塑造员工敬业度的动机、态度和行为。这种方法不仅丰富了我们对员工和员工表现的理解，而且还为组织提供了一个能够推动可持续变革的工具包。让我们在本文中澄清一下“能量”的含义。别担心，我们不会重访你的心理声学课，也不会让你做任何计算。在这里，能量指的是塑造你的感知、态度和行为的镜头或滤镜我们每天都有可能体验到七种能量水平(图1)。我们经常在一天甚至一个小时内体验到几种能量水平。重要的是要注意，能量水平没有好坏之分;它们都有优点和缺点。所有关卡都是有目的的。然而，我们的目标是提高我们的意识，这样我们就能认识到我们是如何表现的，并积极地选择那个层次是否符合我们的需要。正是通过这种自我意识和有意识的选择，我们才能驾驭我们的个人力量，获得更充实、更有目标的生活，无论是个人生活还是职业生活以下是不同能量水平下员工敬业度的例子。第一级:“没人理解我。每次机会我都被忽视。”“我在这儿干了10年了，从来没有加薪过。这不公平!”第二层:“我对莎莉提早离开很生气。为什么我不能?“我的老板让我很生气，因为她不知道我工作有多努力。”第三级:“我的工作很好;其他地方的情况可能更糟。“我老板似乎对我很失望，不过没关系，她会过去的。”第四级:“我知道我的老板正经历一段艰难的时期。我去看看她。”“我的同事没有按时交报告。让我看看他是否需要帮助。”第五级:“我对自己的工作很平静，在工作中找到了很多乐趣。“我很高兴我们正在寻找一种新的病人报告系统。”我们刚刚尝试的系统并不适合我们，但谢天谢地，我们现在知道我们不想要什么了。”第六级:“我有很多创意，我迫不及待地想和我的团队分享。“我相信我现在的职位/工作对我来说是正确的。”第7级:“我可以完全专注于工作。“我对我所做的事情和和我一起做的人有着绝对的热情。”作为领导或老板，你能做些什么?在每个能量级别中引导员工敬业度看起来会有所不同。然而，总的来说，这里有一些有用的问题可以确保你的员工感到被关注和被倾听。这样做的目的不是要改变员工表现出来的精力，而是要确保员工感到被关注和被倾听记住，作为领导者，我们的工作是识别员工在7级能量图表中的位置，并确定我们是否有办法支持他们。同样重要的是，领导者要花点时间认识到他们自己表现出的能量水平。领导者必须花时间反思自己每天是如何表现的，在压力下是如何表现的，以及这种能量是如何传递给员工的。 当你的员工表现出不同的精力水平时，你可以问他们以下几个问题:你认为你现在处于什么精力水平?这种能量水平对你有什么好处?你现在想带着什么能量出现?另一种考虑____的方法是什么?你如何重新定义已经发生的事情来帮助你继续前进?你认为主要的挑战是什么?你认为这种想法是从哪里来的?你怎样才能让这种情况对你来说更有成就感呢?如果你可以重来，你会做什么不同?你认为你的盲点在哪里?是什么让你无法完成目标?在这种情况下，你如何给你的同事面子?在这种情况下，你的同事可能需要什么?能量领导指数(ELI)评估我们在教练实践中使用能量领导指数(ELI)。ELI是一种强有力的态度评估——与性格测试非常不同——它衡量的是你在个人生活和职业生活中所投入的能量水平。它能给你提供精力充沛的个人资料，有了这些信息，你就能更好地意识到自己每天是如何表现的，以及在压力下是如何表现的。有了这种意识，你就可以开始识别可能阻碍你实现目标的障碍。总而言之，员工敬业度的7个层次的概念提供了一个独特的框架来理解员工是如何表现的，以及他们的生活过滤器是如何塑造他们的思想、感情和行动的。员工敬业度是一个动态的、多方面的过程，要求领导者和公司也向内看，找出自己的局限性或缺点。最终，在工作场所采用7级能量框架可以带来更有动力和更满意的员工，培养持续改进和成功的文化下个月再来看看《听力杂志》这个系列的第三部分，它将涵盖“(再次)找到你的原因”。我们将探索发现和培养激情，包括当你在生活中或在一份你无法离开或改变的工作中感到困惑时，你可以茁壮成长的方法。
{"title":"Inspiring Success at Your Practice Part 2: The 7 Levels of Energy To Elevate Employee Engagement","authors":"Amy Badstubner, Kari Morgenstein Dermer","doi":"10.1097/01.hj.0000995256.76987.1b","DOIUrl":"https://doi.org/10.1097/01.hj.0000995256.76987.1b","url":null,"abstract":"This three-part series explores different aspects of professional coaching. Catch up with Part 1: Leading With a Coaching Mindset here: https://bit.ly/3tmfhmh.Figure 1: The above image shows the thoughts, feelings, and actions associated with each of the 7 Levels of Energy. Chart adapted from work done by Bruce D. Schneider. Employee engagement, Energy Leadership Index Assessment, practice management, practice management series.The concept of employee engagement has evolved significantly over time. Its multifaceted nature makes it a topic that can be easy to talk about, but hard to implement. Undoubtedly, in today’s landscape, employee engagement holds unparalleled significance, particularly within the health care sector, where its relevance has surged to unprecedented heights.1,2 However, it is possible that conventional strategies to drive engagement have fallen short in meeting contemporary challenges. In our coaching group, both with clients and for our own team, we use the 7 Levels of Energy Framework.3 This system not only offers a fresh perspective, but also a structured methodology that is easy to grasp and has the power to amplify employee engagement. THE 7 LEVELS OF ENERGY FRAMEWORK By leveraging the various energy levels described by Schneider, we can delve deeper into the motivations, attitudes, and behaviors that shape employee engagement. This approach not only enriches our understanding of employees and how employees show up, but also equips organizations with a toolkit capable of driving sustainable change. Let’s clarify what we mean by “energy” for this article. Don’t worry—we are not revisiting your psychoacoustics class or asking you to make any calculations. Here, energy refers to the lens or filters you have that shape your perceptions, attitudes, and actions.4 There are 7 Levels of Energy we have the potential to experience day to day (Figure 1). We often experience several levels of energy in one day or even within an hour. It is important to note that no energy level is good or bad; they all have advantages and disadvantages. All the levels serve a purpose. The objective, however, is to raise our awareness so we can recognize how we are showing up and actively choose if that level is serving our needs at the time. It is through this self-awareness and intentional choice that we can harness our personal power for a more fulfilling and purpose-driven life, both personally and professionally.5 EMPLOYEE ENGAGEMENT EXAMPLES Below are examples of what employee engagement might look like for each level of energy. Level 1: “No one understands me. I get overlooked for every opportunity.” “I have been here for 10 years and have never been given a raise. It’s not fair!” Level 2: “I am livid that Sally gets to leave early. Why can’t I?” “My boss makes me so angry because she doesn’t know how hard I work.” Level 3: “Things are fine at my job; it could always be worse somewhere else.” “My boss seems disappointed with me, but it’s all go","PeriodicalId":39705,"journal":{"name":"Hearing Journal","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136105229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-30DOI: 10.1097/01.hj.0000995248.41694.44
Caitlin Frisby, Karina de Sousa, David R. Moore, De Wet Swanepoel
Millions of individuals worldwide are affected by hearing loss, with a global estimate of 2.5 billion projected by 2050.1 Hearing loss has a profound effect on individuals’ overall quality of life, including communication, social interactions, education, and employment.1–4 However, hearing aid uptake is generally low. In Africa, less than 10% of individuals needing hearing aids acquire them, with some estimates as low as 3%.1,5 The global burden of hearing loss is exacerbated by the limited number of hearing health care services and the lack of trained professionals.1,6 The global shortage of hearing health care professionals, particularly in low- and middle-income settings, is a major challenge to existing service delivery models, which require specialist health care providers. Generally, low- and lower-middle-income regions have one or fewer ENT specialists or audiologists per million population.7 In Africa, 56% and 78% of countries have less than one ENT specialist or audiologist per million population, respectively.7Figure 1: From left: An example of a CHW conducting a hearing assessment; a community member receiving hearing aids; and hearing aids placed in community members’ ears. Hearing aid, service delivery models, low-income communities, telehealth, teleaudiology.Table 1: Important Considerations for Community-Based Hearing Aid Provision Service-Delivery Models.Considering the shortage of services and providers, the World Health Organization (WHO) has identified several key priorities to improve access to hearing health care services. These include community-based care facilitated by minimally trained community health care workers (CHWs) using innovative technologies.1 Task-shifting from professionals to CHWs has been proposed to address the shortage and decentralize access to care.1 This approach could enable CHWs to facilitate screening and assessment of hearing loss, referral of cases requiring medical intervention, fitting low-cost pre-set hearing aids for eligible individuals, and ensuring tailored follow-up care designed for low- and middle-income settings. The WHO has set up a technical working group developing guidelines for hearing aid provision service-delivery models in low-income settings. INNOVATIVE COMMUNITY-BASED HEARING AID PROVISION A recent review8 demonstrated that CHWs can be utilized across a range of hearing health care services and that these services are feasible for community-based hearing care. Services included infant hearing screening in rural areas9 and childhood and adult hearing screening in various decentralized settings.10,11 Studies conducted in Bangladesh and India showcased the effectiveness of community-based hearing aid service provision models facilitated by CHWs.12,13 The Bangladesh study involved CHWs fitting pocket model hearing aids for children, comparing the community-based model to a traditional center-based approach. Both approaches yielded similar outcomes on most items of the International
通过实施训练有素的非专业人员，这些项目有可能惠及更多有需要的人。如表1所示，在低收入地区提供有效的社区助听器服务有几个重要的考虑因素。健康护理中心是否协助推行这些服务，是决定服务能否成功推行及能否继续提供支援的关键。招募和培训合适的助理员——最好是目标社区的成员——是至关重要的，这些助理员接受的培训应该与标准化指南保持一致，并由听力保健专业人员提供帮助。必须提供用户友好、高质量、低成本的评估工具、干预措施和支持，以促进在低收入和中等收入环境中使用。虽然已经对社区助听器提供进行了一些研究，但重要的是要认识到存在重大的知识差距，特别是关于特殊人群，如儿童。必须进行涉及儿童的其他可行性研究，以探索为特殊人群实施服务提供模式的潜力。与成人相比，儿童具有独特的听力特征，他们的听力发育、解剖差异和交流需求增加了本地驱动服务提供的复杂性。早期发现是成功干预的主要因素。随后，及时的干预措施会对儿童的结局和未来的发展产生深远的影响在这一过程中，卫生保健工作者可以发挥关键作用，进行听力筛查，转介未能接受进一步诊断测试的儿童，或在专家监督下使用远程听力学设备和服务促进诊断测试。专门的电生理测试，如听觉脑干反应(ABR)或耳声发射(OAE)，可能由使用远程保健的专家进行和解释，而物理设置可以由卫生保健中心提供便利。用户友好的、自动化的、设置简单的诊断工具可以增强远程听力学促进的测试。保健员将需要更具体的培训，以促进儿童的筛选和听力评估，包括支持远程听力学辅助的ABR和OAE测试。在干预方面，chw可以在最初的互动、助听器安装前、助听器安装后的支持、故障排除和指导方面发挥重要作用。在远程专家的支持下安装助听器可能是一个潜在的选择，但需要具体的技能提升培训。建议采取分阶段但加速的方法向儿童提供听力保健。针对年龄较大的儿童的护理更容易开始。然而，一旦建立起来，就可以而且应该优先考虑扩大对幼儿的服务，因为迫切需要向听力损失儿童提供早期干预。结论需要助听器的人数与实际使用助听器人数之间的巨大差距值得关注，特别是在低收入和中等收入环境中。为了解决导致听力保健服务有限的问题，世卫组织低收入环境助听器服务提供技术工作组制定了一份成人和儿童议定书草案。这一模式目前正在多中心可行性研究中进行评估，包括南非的不同地点和美国的低收入环境。这项多中心研究将对该方案的有效性进行全面评估，并将为2024年发布的最终指南提供信息。创新的以社区为基础的服务提供模式可以在传统环境之外、在服务不足的社区以可扩展的方式提供服务，有可能显著改善全球资源有限环境中的听力保健服务。David R. Moore博士和De Wet Swanepoel博士得到了美国国立卫生研究院(NIH)国家耳聋和沟通障碍研究所的支持(奖励号1R21DC019598)。David R. Moore也得到了英国国立卫生研究院曼彻斯特生物医学研究中心的支持。
{"title":"Prioritizing Hearing Aid Service Delivery Models for Low-Income Communities","authors":"Caitlin Frisby, Karina de Sousa, David R. Moore, De Wet Swanepoel","doi":"10.1097/01.hj.0000995248.41694.44","DOIUrl":"https://doi.org/10.1097/01.hj.0000995248.41694.44","url":null,"abstract":"Millions of individuals worldwide are affected by hearing loss, with a global estimate of 2.5 billion projected by 2050.1 Hearing loss has a profound effect on individuals’ overall quality of life, including communication, social interactions, education, and employment.1–4 However, hearing aid uptake is generally low. In Africa, less than 10% of individuals needing hearing aids acquire them, with some estimates as low as 3%.1,5 The global burden of hearing loss is exacerbated by the limited number of hearing health care services and the lack of trained professionals.1,6 The global shortage of hearing health care professionals, particularly in low- and middle-income settings, is a major challenge to existing service delivery models, which require specialist health care providers. Generally, low- and lower-middle-income regions have one or fewer ENT specialists or audiologists per million population.7 In Africa, 56% and 78% of countries have less than one ENT specialist or audiologist per million population, respectively.7Figure 1: From left: An example of a CHW conducting a hearing assessment; a community member receiving hearing aids; and hearing aids placed in community members’ ears. Hearing aid, service delivery models, low-income communities, telehealth, teleaudiology.Table 1: Important Considerations for Community-Based Hearing Aid Provision Service-Delivery Models.Considering the shortage of services and providers, the World Health Organization (WHO) has identified several key priorities to improve access to hearing health care services. These include community-based care facilitated by minimally trained community health care workers (CHWs) using innovative technologies.1 Task-shifting from professionals to CHWs has been proposed to address the shortage and decentralize access to care.1 This approach could enable CHWs to facilitate screening and assessment of hearing loss, referral of cases requiring medical intervention, fitting low-cost pre-set hearing aids for eligible individuals, and ensuring tailored follow-up care designed for low- and middle-income settings. The WHO has set up a technical working group developing guidelines for hearing aid provision service-delivery models in low-income settings. INNOVATIVE COMMUNITY-BASED HEARING AID PROVISION A recent review8 demonstrated that CHWs can be utilized across a range of hearing health care services and that these services are feasible for community-based hearing care. Services included infant hearing screening in rural areas9 and childhood and adult hearing screening in various decentralized settings.10,11 Studies conducted in Bangladesh and India showcased the effectiveness of community-based hearing aid service provision models facilitated by CHWs.12,13 The Bangladesh study involved CHWs fitting pocket model hearing aids for children, comparing the community-based model to a traditional center-based approach. Both approaches yielded similar outcomes on most items of the International","PeriodicalId":39705,"journal":{"name":"Hearing Journal","volume":"41 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136105223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-30DOI: 10.1097/01.hj.0000995244.44386.bd
Ryan C. Mulligan, Antony R. Joseph
The tensor tympani muscle (TTM) is a long-striated muscle that originates in a bony canal superior to the cartilaginous section of the Eustachian tube. The tendon of the muscle emerges laterally from the opening of the canal, courses through the middle ear cavity, and attaches at the neck of the manubrium. Contraction of the TTM draws the manubrium of the malleus medially, resulting in an inward displacement of the tympanic membrane (TM) and increased middle ear pressure. TTM contraction has been shown to occur simultaneously with the contraction of the tensor veli palatini muscle (TVPM).1,2 The TVPM assists with swallowing and is considered the primary dilator of the Eustachian tube (ET).3 Both the TTM and TVPM are innervated by the mandibular division of the trigeminal nerve and share continuous muscle fibers.4,5Figure 1: (A) Jerger Type A tympanograms obtained with the TTM at rest, which yielded a normal tracing, bilaterally. (B) A tympanogram obtained during extended TTM contraction, which resulted in a tracing with a reduced peak compliance for both ears. (C, left Column) A tympanogram performed following the Toynbee maneuver resulted in negative peak pressure. (C, right Column) Following TM contraction, a second tympanogram was obtained which revealed a return to relative ambient peak pressure.Figure 2: (A) Repetitive TM contractions were recorded over a 15-second window. Each deflection contained four distinct stages: (1) a reduction in compliance (downward tracing) with TTM contraction, (2) an increase in compliance (upward tracing) with the relaxation of the TTM, (3) a further increase or spike in compliance (upward tracing) above baseline, and (4) a near return to baseline compliance (leveling of the tracing). The brief upward spike in compliance above baseline (arrow) is consistent with the breakage of the ET seal. (B) TTM contraction resulted in upward deflections with negative pressure applied to the EAC. The superimposed dotted line highlights the change in baseline compliance between TTM contractions. This appears to reflect a flow of air bolus through the ET with repeated TTM contraction. (C) Extended TTM contraction over a 15-second window.Figure 3: Right ear pure-tone air- and bone-conduction thresholds were obtained with the TTM in a relaxed state (gray) and contracted (red). TTM contraction resulted in mild low-frequency hearing loss.The TTM has been implicated in numerous conditions including middle ear myoclonus, palatal tremor, and Meniere’s disease; albeit its presumed role in these pathologies is speculative.6–8 A previous report theorized that TTM injury may lead to continuous, tonic TTM contraction with secondary otologic symptoms that include tinnitus, aural fullness, vertigo, and otalgia.9 The principal clinical tool that is used for the assessment of TTM contraction is immittance audiometry. TTM contraction has been shown to produce distinct tympanometric findings such as low static compliance and tracings that chang
在环境气压(图2A)和EAC负压(图2B)下，进行15秒的快速耳肌状态(收缩和放松)循环，进行改良声衰减测试。该试验之后是耳肌的延伸收缩(图2C)。在经过认证的声学测试室内，使用GSI AudioStar Pro (Grason-Stadler, Eden Prairie, MN)进行250- 8000hz的纯音听力阈值测试。首先在肌肉松弛状态下获得听力阈值，然后收缩(图3)。在每次阈值测量之前，使用手势来指示耳肌肉收缩的时间。为了避免肌肉疲劳，测试电池的各种元素都是单次进行的。本案例研究的目的是调查个体自我描述的自主收缩TTM肌的能力。使用手持式耳镜无法观察到TTM收缩时的鼓膜运动，尽管有报道称在不同的放大倍率下，可以看到TTM收缩时的鼓膜运动。10,12,13使用探针传声器证实了短时间的客观耳鸣。有报道称，在打开咽鼓管时发生咔嗒声耳鸣，可能是由于管腔粘膜突然破裂引起的。14,15据报道，在TTM收缩期间出现的低频隆隆声可能与几个来源有关，包括肌肉收缩噪音或椭圆窗内内侧镫骨运动引起的内耳水压增加。无论其来源如何，耳鸣可能起到掩蔽器的作用，并与鼓室-听骨系统的强化一起，可能导致自发性颞下颌肌收缩时观察到的轻度低频听力损失。在鼓室测量中，在三个病例中观察到与TTM活动相对应的中耳通气的证据:汤因比操作后获得的鼓室图显示，随着TTM的收缩，中耳压力从负向接近环境的中耳压力转变。这一发现表明气流随着耳咽管的收缩流过耳咽管。改良声学衰减显示每次收缩后中耳顺应性高于基线。这表明由于咽鼓管密封破裂导致的中容积增大，在TTM收缩后依从性出现短期尖峰。在EAC负压下的改良衰减试验中，TTM反复收缩导致中耳顺应性在基线上逐渐降低。随着反复的TTM收缩，这种稳定的变化似乎与向中耳泵入空气以及中耳与EAC之间的压力梯度扩大相一致。据我们所知，自愿TTM收缩后的中耳通气先前未见报道。虽然很新奇，但考虑到耳咽管与耳咽管主扩张器(TVPM)之间的密切关系，这并不奇怪。两块肌肉受三叉神经下颌骨支配，共同收缩，并共享一个局部肌肉连接。利用波义耳定律，可以对TTM帮助TVPM打开咽鼓管的机制进行检验。波义耳定律表明，在封闭系统中，体积和压力成反比。正常情况下，耳咽管是封闭的，中耳是封闭的空气空间。因此，即使是TM轻微的向内运动伴随着TTM的收缩，也会导致中耳容积突然下降，中耳压力相应上升。自发性耳膜收缩引起的中耳超压可能对耳咽管密封施加压力，并帮助TVPM打开耳咽管。这样，中耳可被视为含有促进中耳通气的泵机制。在报告耳鸣的情况下，临床医生询问耳鸣功能障碍并寻求患者对耳鸣感觉的描述是谨慎的。患者可能会报告低频主观性耳鸣，以及在安静的房间里可以听到或使用探针麦克风检测到的滴答声。一个实用的TTM测试电池可能包括125至8,000 Hz的纯音空气和骨传导听力测定，以及耳镜、鼓室测量和无声刺激的声衰减测试。结论:我们提出的病例与以前的文献报道一致，但提供了关于自愿TTM收缩的新的临床见解。一个独特的观察是，TTM收缩似乎与通过咽鼓管的气流有关。 意志性TTM收缩导致客观的咔哒声耳鸣和主观性耳鸣，其形式为隆隆声、轻度低频听力损失和低静态峰顺应性鼓室图。TTM收缩的其他指标包括改良声衰减测试时的高幅度顺应性变化，以及在EAC施加负压时鼓室示踪方向的反转。了解这些诊断结果可以帮助临床医生识别疑似耳科病变(如耳鸣)患者的异常TTM活动。
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Pub Date : 2023-10-30DOI: 10.1097/01.hj.0000995264.80206.87
Prasha Sooful, Andrea Simpson, Mich Thornton, and Bojana Šarkic´
The release of ChatGPT in 2022, a large language model (LLP) trained by Open AI, garnered considerable attention from various sectors, including the technological domain, academic community, and the public.1 In health care settings, the potential for chatbots to enhance patient engagement, facilitate remote care, and improve access to hearing health care services has been increasingly recognized.2 In the realm of higher education, ChatGPT is the subject of extensive research and testing across a range of fields, including law, medicine, and business.3–7 The algorithm has demonstrated impressive adaptability and versatility, positioning itself as a promising tool for teaching and learning, including generating assessments.8Figure 1: Prompts to generate ChatGPT ideas on ways to use it in higher education and specifically Audiology.Table 1: Sample CREATE Prompt for a Specific Audiology Assessment.Table 2: Sample Audiology Assessment Question Co-designed with ChatGPT.Table 3: Example of Assessment Rubric Generated by ChatGPT.Despite the growing recognition of ChatGPT’s potential in higher education, reactions to its use have been mixed due to the increased potential of plagiarism. Institutions have responded to this risk by increasing precautionary measures (i.e., reverting to traditional pen and paper exams and face-to-face oral assessments), prohibition (i.e., banning AI tools with the support of AI detection software), while others have accepted it (i.e., incorporating AI tools into assessment development and design).8–12 Promoting authenticity and academic integrity in assessment continues to present a priority for educational institutions.13–15 Besides providing the foundation for high academic standards and best practice, authentic assessments and academic integrity enrich students with skills that advance their employability, particularly in fields dominated by technological advances, including audiology.16 As a health care profession, most audiology training programs naturally include practical and authentic assessment, such as clinical exams, objective structured clinical exams, simulations, clinical placements, and clinical vivas. These face-to-face assessments reduce the risk of plagiarism, however, they can be time-consuming for staff. In addition, theoretical aspects of the program are usually assessed via written means. It is these written tasks where AI provides both risk and opportunity. CONSIDERATIONS FOR EDUCATORS When creating effective assessment questions using ChatGPT, there are a few key considerations that educators should keep in mind. First, it is important to ensure that the prompts align with the course objectives and the level of complexity appropriate for the intended level of study.15 ChatGPT prompts are a way to enable conversations between users and the AI which can be tailored to specific subjects and can make responses more accurate and efficient. One way to generate a powerful prompt is to use the CREATE model (Cha
{"title":"The AI Revolution: Rethinking Assessment in Audiology Training Programs","authors":"Prasha Sooful, Andrea Simpson, Mich Thornton, and Bojana Šarkic´","doi":"10.1097/01.hj.0000995264.80206.87","DOIUrl":"https://doi.org/10.1097/01.hj.0000995264.80206.87","url":null,"abstract":"The release of ChatGPT in 2022, a large language model (LLP) trained by Open AI, garnered considerable attention from various sectors, including the technological domain, academic community, and the public.1 In health care settings, the potential for chatbots to enhance patient engagement, facilitate remote care, and improve access to hearing health care services has been increasingly recognized.2 In the realm of higher education, ChatGPT is the subject of extensive research and testing across a range of fields, including law, medicine, and business.3–7 The algorithm has demonstrated impressive adaptability and versatility, positioning itself as a promising tool for teaching and learning, including generating assessments.8Figure 1: Prompts to generate ChatGPT ideas on ways to use it in higher education and specifically Audiology.Table 1: Sample CREATE Prompt for a Specific Audiology Assessment.Table 2: Sample Audiology Assessment Question Co-designed with ChatGPT.Table 3: Example of Assessment Rubric Generated by ChatGPT.Despite the growing recognition of ChatGPT’s potential in higher education, reactions to its use have been mixed due to the increased potential of plagiarism. Institutions have responded to this risk by increasing precautionary measures (i.e., reverting to traditional pen and paper exams and face-to-face oral assessments), prohibition (i.e., banning AI tools with the support of AI detection software), while others have accepted it (i.e., incorporating AI tools into assessment development and design).8–12 Promoting authenticity and academic integrity in assessment continues to present a priority for educational institutions.13–15 Besides providing the foundation for high academic standards and best practice, authentic assessments and academic integrity enrich students with skills that advance their employability, particularly in fields dominated by technological advances, including audiology.16 As a health care profession, most audiology training programs naturally include practical and authentic assessment, such as clinical exams, objective structured clinical exams, simulations, clinical placements, and clinical vivas. These face-to-face assessments reduce the risk of plagiarism, however, they can be time-consuming for staff. In addition, theoretical aspects of the program are usually assessed via written means. It is these written tasks where AI provides both risk and opportunity. CONSIDERATIONS FOR EDUCATORS When creating effective assessment questions using ChatGPT, there are a few key considerations that educators should keep in mind. First, it is important to ensure that the prompts align with the course objectives and the level of complexity appropriate for the intended level of study.15 ChatGPT prompts are a way to enable conversations between users and the AI which can be tailored to specific subjects and can make responses more accurate and efficient. One way to generate a powerful prompt is to use the CREATE model (Cha","PeriodicalId":39705,"journal":{"name":"Hearing Journal","volume":"41 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136105224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-30DOI: 10.1097/01.hj.0000995236.30278.bb
Sophie J. Balk
Noise exposures experienced by infants, children, and adolescents can be hazardous. Teens—and even young children—use headphones, ear buds, and other personal listening devices. Young people attend concerts, dances, and celebratory events where music is often painfully loud. Noise experienced at young ages can cause hearing loss; other noise effects can adversely affect learning, quality of life, and life trajectories.www.shutterstock.com. American Academy of Pediatrics, AAP, noise, technical report, policy statement, pediatrics, hearing loss, prevention.Noise exposure is poorly understood as a public health hazard. Despite scientific evidence to the contrary, noise is treated differently than many other environmental hazards. If fact, noisy environments—such as restaurants where holding nearby conversations can be difficult without shouting—are often accepted as a given. Two reports from the American Academy of Pediatrics (AAP) highlight children’s susceptibilities to the effects of noise. The Technical Report (https://bit.ly/3tLk80x) provides a scientific basis for a Policy Statement; the Policy Statement (https://bit.ly/46JL27u) gives key information and recommendations to pediatricians, government, and medical and other organizations. AAP reports inform clinical practice and advocacy efforts for 67,000 AAP members and other pediatric clinicians. This article includes concepts and recommendations from these publications. UPDATED DEFINITION Noise has often been defined as “unpleasant or unwanted sound.” A new definition—noise is “unwanted and/or harmful sound”—was adopted by the International Commission on Biological Effects of Noise (ICBEN) in June 2023.1 This definition is more accurate, since harmful noise levels are frequently sought during leisure activities. NOISE CATEGORIES Occupational noise is experienced in the workplace. Environmental noise usually arises from fossil fuel-powered sources. Outdoor sources include road traffic, railways, airplanes and airports, industrial sites, wind farms, leaf blowers, and lawn mowers. Environmental noise has disproportionate effects on underserved communities. Indoor sources include equipment, infant sleep machines, video games, toys, televisions, and classrooms. Recreational noise (“leisure noise”) sources include personal listening devices; restaurants; music at events; sports venues; and recreational firearm use. Listening to music and attending social and celebratory events are very important to many, yet noise from these sources can be hazardous. OCCUPATIONAL STANDARDS Noise-induced hearing loss in adults resulting from workplace and military exposure has been known for centuries. Standards for workplace safety in the United States are set by the National Institute for Occupational Safety and Health (NIOSH) and the Occupational Safety and Health Administration (OSHA). These standards are designed to protect workers from noise-induced hearing loss over 40-year careers. The Recommended Exposure L
{"title":"New American Academy of Pediatrics Practice Recommendations Address the Hazards of Noise","authors":"Sophie J. Balk","doi":"10.1097/01.hj.0000995236.30278.bb","DOIUrl":"https://doi.org/10.1097/01.hj.0000995236.30278.bb","url":null,"abstract":"Noise exposures experienced by infants, children, and adolescents can be hazardous. Teens—and even young children—use headphones, ear buds, and other personal listening devices. Young people attend concerts, dances, and celebratory events where music is often painfully loud. Noise experienced at young ages can cause hearing loss; other noise effects can adversely affect learning, quality of life, and life trajectories.www.shutterstock.com. American Academy of Pediatrics, AAP, noise, technical report, policy statement, pediatrics, hearing loss, prevention.Noise exposure is poorly understood as a public health hazard. Despite scientific evidence to the contrary, noise is treated differently than many other environmental hazards. If fact, noisy environments—such as restaurants where holding nearby conversations can be difficult without shouting—are often accepted as a given. Two reports from the American Academy of Pediatrics (AAP) highlight children’s susceptibilities to the effects of noise. The Technical Report (https://bit.ly/3tLk80x) provides a scientific basis for a Policy Statement; the Policy Statement (https://bit.ly/46JL27u) gives key information and recommendations to pediatricians, government, and medical and other organizations. AAP reports inform clinical practice and advocacy efforts for 67,000 AAP members and other pediatric clinicians. This article includes concepts and recommendations from these publications. UPDATED DEFINITION Noise has often been defined as “unpleasant or unwanted sound.” A new definition—noise is “unwanted and/or harmful sound”—was adopted by the International Commission on Biological Effects of Noise (ICBEN) in June 2023.1 This definition is more accurate, since harmful noise levels are frequently sought during leisure activities. NOISE CATEGORIES Occupational noise is experienced in the workplace. Environmental noise usually arises from fossil fuel-powered sources. Outdoor sources include road traffic, railways, airplanes and airports, industrial sites, wind farms, leaf blowers, and lawn mowers. Environmental noise has disproportionate effects on underserved communities. Indoor sources include equipment, infant sleep machines, video games, toys, televisions, and classrooms. Recreational noise (“leisure noise”) sources include personal listening devices; restaurants; music at events; sports venues; and recreational firearm use. Listening to music and attending social and celebratory events are very important to many, yet noise from these sources can be hazardous. OCCUPATIONAL STANDARDS Noise-induced hearing loss in adults resulting from workplace and military exposure has been known for centuries. Standards for workplace safety in the United States are set by the National Institute for Occupational Safety and Health (NIOSH) and the Occupational Safety and Health Administration (OSHA). These standards are designed to protect workers from noise-induced hearing loss over 40-year careers. The Recommended Exposure L","PeriodicalId":39705,"journal":{"name":"Hearing Journal","volume":"112 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136105396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-30DOI: 10.1097/01.hj.0000995252.00927.cc
Daim Tabba, Karen Tawk, Mehdi Abouzari, Hamid R. Djalilian
A 69-year-old female presents as a consult regarding right-sided hearing loss and tinnitus. She has had the symptoms since the 1970s and was recommended surgery at that time, although it was not pursued. She is currently presenting because her symptoms have become worse over the past five years. The patient additionally endorses migraine headaches with vertigo. The patient denies any family history of hearing loss or ear surgery. Tympanic membranes are normal on microscopy. Weber test shows lateralization to the right ear and Rinne test shows bone conduction greater than air conduction on the right side. The patient had an audiogram completed (see Figure 1).Figure 1: The patient’s audiogram at presentation. Asymmetric mixed hearing loss, round window obliteration, Clinical Consultation.Figure 2: Axial (horizontal) CT of temporal bones showing the obliterated round window in the axial direction on the right. Asymmetric mixed hearing loss, round window obliteration, Clinical Consultation.Figure 3: Axial (horizontal) CT of temporal bones showing air (black) in a round window niche on the left. Asymmetric mixed hearing loss, round window obliteration, Clinical Consultation.Figure 4: Coronal (parallel to the face) CT of temporal bones showing the obliterated round window in the coronal direction. Asymmetric mixed hearing loss, round window obliteration, Clinical Consultation.Figure 5: Sagittal (vertical parallel to the ear) CT of temporal bones demonstrating the obliterated round window in the sagittal direction. Asymmetric mixed hearing loss, round window obliteration, Clinical Consultation.DIAGNOSIS: ROUND WINDOW OBLITERATION By Daim Tabba, BA, BS; Karen Tawk, MD; Mehdi Abouzari, MD, PhD; and Hamid R. Djalilian, MD Upon examination of the patient’s audiograms, it is evident that the patient primarily has an asymmetric (right-sided) mixed hearing loss. Typically, when a patient presents with a normal physical exam and conductive hearing loss, the most likely diagnosis is otosclerosis. Otosclerosis refers to abnormal bone remodeling in the inner ear such that the normally dense endochondral layer of the bony otic capsule is replaced by one or more foci of vascular bone leading to bony overgrowth. As this overgrowth develops, the stapes can no longer properly function and becomes fixated. As such, conduction gradually worsens.1 Cochlear involvement, as would be the case with round window involvement by the otosclerotic bone, can lead to sensorineural hearing loss and if the round window becomes obliterated, it can lead to conductive hearing loss. leading to a mixed hearing loss overall.2 Other potential pathologies linked to mixed hearing loss include the third-window effect, or an enlarged vestibular aqueduct (EVA). The third-window effect in EVA occurs from the loss of vibrations of the inner ear fluids through an enlarged vestibular aqueduct, which is effectively a third window into the inner ear. This diagnosis seems unlikely because it is rare tha
{"title":"Symptom: Asymmetric Mixed Hearing Loss","authors":"Daim Tabba, Karen Tawk, Mehdi Abouzari, Hamid R. Djalilian","doi":"10.1097/01.hj.0000995252.00927.cc","DOIUrl":"https://doi.org/10.1097/01.hj.0000995252.00927.cc","url":null,"abstract":"A 69-year-old female presents as a consult regarding right-sided hearing loss and tinnitus. She has had the symptoms since the 1970s and was recommended surgery at that time, although it was not pursued. She is currently presenting because her symptoms have become worse over the past five years. The patient additionally endorses migraine headaches with vertigo. The patient denies any family history of hearing loss or ear surgery. Tympanic membranes are normal on microscopy. Weber test shows lateralization to the right ear and Rinne test shows bone conduction greater than air conduction on the right side. The patient had an audiogram completed (see Figure 1).Figure 1: The patient’s audiogram at presentation. Asymmetric mixed hearing loss, round window obliteration, Clinical Consultation.Figure 2: Axial (horizontal) CT of temporal bones showing the obliterated round window in the axial direction on the right. Asymmetric mixed hearing loss, round window obliteration, Clinical Consultation.Figure 3: Axial (horizontal) CT of temporal bones showing air (black) in a round window niche on the left. Asymmetric mixed hearing loss, round window obliteration, Clinical Consultation.Figure 4: Coronal (parallel to the face) CT of temporal bones showing the obliterated round window in the coronal direction. Asymmetric mixed hearing loss, round window obliteration, Clinical Consultation.Figure 5: Sagittal (vertical parallel to the ear) CT of temporal bones demonstrating the obliterated round window in the sagittal direction. Asymmetric mixed hearing loss, round window obliteration, Clinical Consultation.DIAGNOSIS: ROUND WINDOW OBLITERATION By Daim Tabba, BA, BS; Karen Tawk, MD; Mehdi Abouzari, MD, PhD; and Hamid R. Djalilian, MD Upon examination of the patient’s audiograms, it is evident that the patient primarily has an asymmetric (right-sided) mixed hearing loss. Typically, when a patient presents with a normal physical exam and conductive hearing loss, the most likely diagnosis is otosclerosis. Otosclerosis refers to abnormal bone remodeling in the inner ear such that the normally dense endochondral layer of the bony otic capsule is replaced by one or more foci of vascular bone leading to bony overgrowth. As this overgrowth develops, the stapes can no longer properly function and becomes fixated. As such, conduction gradually worsens.1 Cochlear involvement, as would be the case with round window involvement by the otosclerotic bone, can lead to sensorineural hearing loss and if the round window becomes obliterated, it can lead to conductive hearing loss. leading to a mixed hearing loss overall.2 Other potential pathologies linked to mixed hearing loss include the third-window effect, or an enlarged vestibular aqueduct (EVA). The third-window effect in EVA occurs from the loss of vibrations of the inner ear fluids through an enlarged vestibular aqueduct, which is effectively a third window into the inner ear. This diagnosis seems unlikely because it is rare tha","PeriodicalId":39705,"journal":{"name":"Hearing Journal","volume":"113 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136105057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-30DOI: 10.1097/01.hj.0000995232.86614.1a
Douglas L. Beck
Welcome back to The Hearing Journal’s newest column, Perspectives With Dr. Beck. Dr. Beck’s interview with James E. Galvin, MD, MPH, continues with an even deeper look into the nuanced relationship between audiology and cognition. Dr. Galvin is the Alexandria and Bernard Schoninger Endowed Chair in Memory Disorders and Professor of Neurology and Psychiatry & Behavioral Sciences at the University of Miami Miller School of Medicine. He is Founding Director of the Comprehensive Center for Brain Health, Director and Principal Investigator of the Lewy Body Dementia Research Center of Excellence, and Chief of the Division of Cognitive Neurology leading brain health and neurodegenerative disease research and clinical programs. If you missed Part 1 of this interview from the October issue of The Hearing Journal, catch up here: https://bit.ly/46Aps4L.www.shutterstock.com. Perspectives With Dr. Beck, neurology, cognition, cognitive screening, James Galvin.James E. Galvin, MD, MPH. Perspectives With Dr. Beck, neurology, cognition, cognitive screening, James Galvin.Dr. Beck: Good morning, Jim. Thanks for joining me again to discuss pharmaceutical developments and realistic expectations for people with Alzheimer’s Disease and Related Disorders (ADRD). Dr. Galvin: I’m happy to help, Doug. Dr. Beck: To review some of our previous discussion, we had discussed the Lancet’s 2020 article1, which indicated some 60% of dementia risk is due to age and DNA, and perhaps 40% is due to potentially modifiable risk factors, the largest of which was untreated hearing loss (8.2% PAF [population attributable factor]). Dr. Galvin: Yes, and we discussed that some of the potentially modifiable risk factors interact with other listed and unlisted risk factors, too, and so it is not a simple fraction or percentage risk for any individual. Epidemiology provides us with very -important trends and averages for a group, which does not necessarily tell us about the specific risks related to the individual we’re assessing or treating. We really need to consider many different factors beyond those listed in the Lancet article, and all these things must be considered and weighted accordingly. Dr. Beck: Agreed. Further, Nianago and colleagues (2022) reported the most significant potentially modifiable risk factor for dementia was mid-life obesity.2 And so, all of this is evolving rapidly, and it seems we’re left with nature versus nurture, or genetics and/or environmental factors as the primary risk factors. So, all that’s old is new again! Dr. Galvin: Yes, and so it’s important to choose your parents carefully! But seriously, these potentially modifiable risk factors interact with each other, and they interact with your genetic makeup and all your lifestyle choices, factors, and habits. The result of these interactions varies from individual to individual. And so, all these factors are actually dynamically interrelated and focusing on just one factor may miss the forest for the trees. And
{"title":"Neurology, Cognition, Cognitive Screenings and Audiology, Part 2","authors":"Douglas L. Beck","doi":"10.1097/01.hj.0000995232.86614.1a","DOIUrl":"https://doi.org/10.1097/01.hj.0000995232.86614.1a","url":null,"abstract":"Welcome back to The Hearing Journal’s newest column, Perspectives With Dr. Beck. Dr. Beck’s interview with James E. Galvin, MD, MPH, continues with an even deeper look into the nuanced relationship between audiology and cognition. Dr. Galvin is the Alexandria and Bernard Schoninger Endowed Chair in Memory Disorders and Professor of Neurology and Psychiatry & Behavioral Sciences at the University of Miami Miller School of Medicine. He is Founding Director of the Comprehensive Center for Brain Health, Director and Principal Investigator of the Lewy Body Dementia Research Center of Excellence, and Chief of the Division of Cognitive Neurology leading brain health and neurodegenerative disease research and clinical programs. If you missed Part 1 of this interview from the October issue of The Hearing Journal, catch up here: https://bit.ly/46Aps4L.www.shutterstock.com. Perspectives With Dr. Beck, neurology, cognition, cognitive screening, James Galvin.James E. Galvin, MD, MPH. Perspectives With Dr. Beck, neurology, cognition, cognitive screening, James Galvin.Dr. Beck: Good morning, Jim. Thanks for joining me again to discuss pharmaceutical developments and realistic expectations for people with Alzheimer’s Disease and Related Disorders (ADRD). Dr. Galvin: I’m happy to help, Doug. Dr. Beck: To review some of our previous discussion, we had discussed the Lancet’s 2020 article1, which indicated some 60% of dementia risk is due to age and DNA, and perhaps 40% is due to potentially modifiable risk factors, the largest of which was untreated hearing loss (8.2% PAF [population attributable factor]). Dr. Galvin: Yes, and we discussed that some of the potentially modifiable risk factors interact with other listed and unlisted risk factors, too, and so it is not a simple fraction or percentage risk for any individual. Epidemiology provides us with very -important trends and averages for a group, which does not necessarily tell us about the specific risks related to the individual we’re assessing or treating. We really need to consider many different factors beyond those listed in the Lancet article, and all these things must be considered and weighted accordingly. Dr. Beck: Agreed. Further, Nianago and colleagues (2022) reported the most significant potentially modifiable risk factor for dementia was mid-life obesity.2 And so, all of this is evolving rapidly, and it seems we’re left with nature versus nurture, or genetics and/or environmental factors as the primary risk factors. So, all that’s old is new again! Dr. Galvin: Yes, and so it’s important to choose your parents carefully! But seriously, these potentially modifiable risk factors interact with each other, and they interact with your genetic makeup and all your lifestyle choices, factors, and habits. The result of these interactions varies from individual to individual. And so, all these factors are actually dynamically interrelated and focusing on just one factor may miss the forest for the trees. And ","PeriodicalId":39705,"journal":{"name":"Hearing Journal","volume":"20 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136105056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-28DOI: 10.1097/01.hj.0000991292.86677.5f
John Drinkwater
When it comes to accommodation requests under the Americans with Disabilities Act, employee requests have record keeping, oversight, accountability and due process. Customers don’t even have the protection of record keeping, and without that the rest is meaningless. This article proposes similar protections for customers. GOALS AND POLICIES The vast majority of companies are committed to continuously improving diversity and inclusion, and to provide an environment that is safe, welcoming, inclusive, and respectful for all. Under Title III of the ADA, places of public accommodation (private businesses that are open to the public) must give people with disabilities an equal opportunity to participate in and to benefit from their services.1 Businesses are expected to consult with the person with a disability. The Department of Justice notes: “Businesses have formal and informal policies, practices, and procedures. However, sometimes they can make it difficult or impossible for a customer with a disability to access goods and services. That is why the ADA requires businesses to make ‘reasonable modifications’ to their usual ways of doing things when serving people with disabilities. Most modifications involve only minor adjustments in policies.”2 At many businesses, this is handled informally, with a discussion and an acceptable accommodation. Many requests don’t cost anything, such as adjusting the volume of background music for the hearing disabled.3 However, what happens if a request applies to multiple disabled people, or multiple locations in the same city and can’t be addressed by an individual employee, or an employee denies a legitimate accommodation request? The ADA uses the same criteria to evaluate both employee accommodation requests under Title I (regulated by the EEOC) and customer requests under Title III (regulated by the DOJ).4 For employees, there are checks and balances that include oversight by the EEOC with record keeping and reporting requirements. But there are none of those record keeping protections for customers. There are many valid circumstances for treating employees and customers differently under the ADA. However, with regard to procedures for handling accommodation requests, employees versus customers is a distinction without a difference—except for the people the act intends to cover! Without records, well-meaning companies don’t know how many requests they have received, on what subject, on what criteria were they approved or denied, and there is no way for them to evaluate whether they are meeting diversity and inclusion commitments. The DOJ is charged with enforcing the ADA for customer accommodation requests, but without records what can they do? It seems that’s a system that allows for unchecked and undocumented discrimination. REALITY Access for the disabled is grounded in the ADA and company policies, but the reality for many disabled is far different. One would think that if one industry focused on accessibili
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Pub Date : 2023-09-28DOI: 10.1097/01.hj.0000991284.64034.ee
Douglas L. Beck
Welcome to the first installment of our new column, Perspectives With Dr. Beck. With career experience spanning the roles of Audiology program director and adjunct professor, private practice co-founder, Editor-in-Chief, society web content editor, and industry manufacturer consultant, Dr. Douglas L. Beck brings his unique wealth of insight to The Hearing Journal through interviews with leading industry experts and in-depth articles exploring audiology’s most significant challenges and opportunities.www.shutterstock.com. Perspectives With Dr. Beck, neurology, cognition, cognitive screening, James Galvin.James E. Galvin, MD, MPH. Perspectives With Dr. Beck, neurology, cognition, cognitive screening, James Galvin.Results from Johns Hopkins University’s Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study linking the use of hearing aids to a more slowed cognitive decline were recently published in The Lancet, leaving audiologists grappling with how involved they should be in their patients’ cognitive screenings. Dr. Beck speaks with James E. Galvin, MD, MPH, in a two-part interview covering the nuanced topic of audiology’s relationship with cognition. Dr. Galvin is the Alexandria and Bernard Schoninger Endowed Chair in Memory Disorders and Professor of Neurology and Psychiatry & Behavioral Sciences at the University of Miami Miller School of Medicine. He is Founding Director of the Comprehensive Center for Brain Health, Director and Principal Investigator of the Lewy Body Dementia Research Center of Excellence, and Chief of the Division of Cognitive Neurology leading brain health and neurodegenerative disease research and clinical programs. Dr. Beck: Good morning, Jim. Thanks for meeting with me today. Dr. Galvin: Hi, Doug. Thanks for inviting me. Dr. Beck: Entirely my pleasure! By way of disclosure, I want to report that you and I met in 2022, before I retired as VP of Clinical Sciences at Cognivue, Inc. At that time you were an advisor on the Cognivue clinical advisory board, and I was always very interested in your thoughts on contemporary issues. Before we get into the clinical issues, where did you go to medical school? Dr. Galvin: I went to medical school at what is now Rutgers University, but when I attended it was called The University of Medicine and Dentistry of New Jersey – New Jersey Medical School in Newark, NJ. Dr. Beck: And because you’re a professor of both neurology and psychiatry at the University of Miami Miller School of Medicine, it seems I should ask…did you do a fellowship in both disciplines, neurology and psychiatry? How does that work? Dr. Galvin: The way it works is the Board is the American Board of Psychiatry and Neurology is the one board for both disciplines. It can be confusing, but generally, the practitioner becomes Board Certified in one discipline, and for me that’s neurology, although members can do a residency in neurology or psychiatry or they can be “double-boarded” and do both neuro-psychiatry, but
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