Mimmi Werner

Introduction: Noise trauma may induce auditory symptoms and temporary or permanent shifts in hearing thresholds, assessed with a tone audiogram. Until recently it has been assumed that primary changes after noise trauma exclusively represent damage to the sensory hair cells. Contrary, animal studies have now shown early alterations in auditory brainstem response (ABR) characteristic of auditory neuropathy (AN), as reduction or absence of wave I, following noise trauma. AN involves a variety of disease mechanisms in the cochlea and auditory nerve, affecting the synaptic encoding and/or neural transmission of auditory information. The aim of this study was to evaluate whether patients exposed to noise trauma exhibit click ABR alterations characteristic of AN. Method: Thirty-one adult patients who attended an ear-nose and throat clinic, after a noise trauma, were included and an age- and gender-matched control group of 31 adults was constructed. To evaluate audiologic hearing impairment pure tone audiometry, click ABR and transient evoked otoacoustic emissions (TEOAE)/cochlear microphonics (CM) were performed. A full linear mixed model including the interaction between sex and group was tested. Results: Our study showed that individuals exposed to sudden and distinct traumatic noise exhibit a statistically significant reduction (81.1 nV, p < 0.001) in the amplitude of wave I in ABR. Conclusion: We suggest that the hearing investigation after sudden traumatic noise exposure should therefore be expanded with ABR to confirm or exclude AN.

Objectives: Bone conduction devices (BCD) have been commercially available since the 1980s for patients with conductive hearing loss (CHL), mixed hearing loss (MHL), or single-sided deafness (SSD). BCDs significantly improve the hearing capacity of patients regardless of age, which has a positive impact on their quality of life, mental health, education, and work performance. BCDs are categorized as percutaneous or transcutaneous solutions based on the attachment method. Selecting the optimal solution for patients requires consideration of audiological outcomes, guidelines, safety, patient preferences, and costs. This study evaluated the cost-effectiveness of an active transcutaneous solution (Osia System, Cochlear Ltd.) compared with percutaneous solutions to treat adult patients in Sweden. Materials and methods: A Markov model was developed to simulate a cohort of adult patients aged 59 years or older receiving Osia or percutaneous BCDs. The model considered 3 health states: patients who have received a BCD, patients without a device due to explantation (without reimplantation) or elective device non-use, and an absorbing state (death). The final state was based on age-dependent mortality, assuming hearing loss does not impact mortality. Probabilities were determined for transition between the health states with 6-month cycles and a lifetime horizon. Utility scores for each health state were derived from published literature using the Health Utilities Index Mark III (HUI3). Complication rates were also sourced from the literature, and the cost of complications and implantation from the National Board of Health and Welfare in Sweden, Socialstyrelsen. The perspective of the model was the Swedish health care system, and the main outcome was incremental cost per quality-adjusted life year (QALY) gained. Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the results. Results: Osia was associated with an increase in cost of 79,293 SEK and an increase in QALYs of 0.73 compared with percutaneous devices, resulting in an incremental cost-effectiveness ratio of 108,318 SEK per QALY gained. The main drivers of cost-effectiveness were baseline age, the cost of surgery, and the difference in utility scores between the two interventions. The differences in HUI3 scores may be linked to the reduced risk of complications, improved cosmetic appearance, and improved hearing with Osia. Conclusions: Osia is cost-effective compared with percutaneous devices over a lifetime horizon, when applying low to moderate cost per QALY willingness-to-pay thresholds indicated by the Swedish Agency for Health Technology Assessment and Assessment of Social Services. This analysis provides information on the economic impact of different hearing solutions to support decisions on which BCD best meets the needs of patients and health care budgets.

Otitis Media (OM) is a prevalent condition in children that can lead to hearing impairment and significant healthcare costs. Inaccuracy in primary care and equipment cost in developing countries are concerning issues in OM diagnostics. Acoustic Reflectometry (AR) offers a low-cost, non-invasive diagnostic alternative, though it has fallen short on accuracy in previous studies. The primary aim of this study was to establish a computational simulation and an experimental model able to reproduce AR performed on human individuals to enable further research and accuracy improvement. The secondary aim was to perform a sensitivity analysis on AR instrument user error. Simulations and experiments were validated against measurements from human individuals with OM and normal ears, respectively. The results reveal that the simulation sufficiently reproduces human AR measurements and distinguishes an ear with OM from a healthy ear. The experiment delivered satisfying measurements on OM but underperformed in a normal ear scenario. The simulations and experiments overpredicted sound reflection in OM. The sensitivity study showed promising robustness of AR, concluding that computational simulation is a viable tool and complement to an experimental approach in research of AR. Future efforts should focus on paediatric models and partially filled middle ear simulations to promote clinical relevance.

Otitis media (OM) in children is a common infection in primary care, contributing to a significant global health and economic burden. In high-income countries, diagnostic inaccuracy leads to over-diagnosis of acute OM (AOM) and over-prescribing of antibiotics, which may contribute to antibiotic resistance. To investigate the diagnostic accuracy and the influence of artificial intelligence (AI) in diagnosing OM among primary care physicians and medical students. A diagnostic accuracy study in which primary care physicians and medical students diagnosed AOM, OM with effusion (OME), and normal eardrums using 21 high-quality digital images, both without and with a fictitious AI support. We estimated the technological impact of the fictitious AI support. Overall diagnostic accuracy was 64% without, and 75% with AI support. The most experienced physicians reached 69% without, and 80% with AI; the least experienced 61% without, and 73% with AI; medical students reached 64% without, and 74% with AI. Accuracy for AOM was 77% without and 86% with AI, and for OME 46% without and 66% with AI. Mean diagnostic confidence increased significantly with AI support. The technological impact was 1.4. Automation bias was 1.2 overall, 0.9 for the most experienced and 1.2 for the least experienced physicians. We report modest diagnostic accuracy for OM among primary care physicians and medical students. The fictitious AI support system improved both accuracy and diagnostic confidence and reduced over-diagnosis. The most experienced physicians achieved the highest accuracy, the less experienced were more often misled by the fictitious AI.

Purpose: Chronic rhinosinusitis (CRS) is related to asthma and chronic obstructive pulmonary disease (COPD). However, combined data on CRS, pulmonary function, lower airway symptoms, and cigarette smoking from the general population are lacking. The current study investigates the relationships between CRS and chronic airflow limitation (CAL), lower airway symptoms and COPD in a middle-aged population of ever-smokers and never-smokers. Patients and Methods: All subjects from the Swedish CArdioPulmonary bioImage Study (SCAPIS) were included. Subjects underwent spirometry after bronchodilation. Chronic airflow limitation was defined as FEV₁/FVC ratio < 0.7. Computed tomography imaging of the thorax was performed to detect the presence of emphysema, and the subjects answered a comprehensive questionnaire on CRS, lower airway symptoms, asthma, chronic bronchitis, and cigarette smoking habits. Results: In total, 30,154 adult subjects in the age range of 50– 64 years were included. The prevalence of CRS was 5.6%. CRS was more-prevalent among subjects in the following categories: CAL (7.6%), lower airway symptoms (15.7%), current smokers (8.2%), asthma (13.6%), never-smokers and ever-smokers with COPD (17.6% and 15.3%, respectively), emphysema (6.7%), and chronic bronchitis (24.5%). In the adjusted regression model, CRS was significantly associated with CAL (OR 1.40), lower airway symptoms (OR 4.59), chronic bronchitis (OR 6.48), asthma (OR 3.08), and COPD (OR 3.10). Conclusion: In this national, randomly chosen population sample of more than 30,000 middle-aged men and women, CRS is associated with CAL, lower airway symptoms, chronic bronchitis, asthma, and COPD. In patients with CRS and in patients with lower airway inflammation, it is important to consider the inflammatory status of the entire airway system.

Hearing loss is the third most significant cause of disability globally and is associated with anxiety, depression, loneliness, and cognitive decline. For those unable to utilize conventional hearing aids due to conditions such as ear canal atresia, eczema, recurrent external otitis or extensive ear surgery, implantable hearing aids provide an alternative. This narrative review provides an overview of available bone conduction devices and active middle ear implants. The rapid advancements in implantable hearing aid technology necessitate ongoing education of healthcare professionals to enable informed patient decisions.