Sarah Y. Bessen

Purpose: Hearing aids are the primary treatment for age-related hearing loss but are vastly underutilized. We explored cross-sectional associations between predisposing, enabling, and need factors and hours of daily hearing aid use. Method: In the Atherosclerosis Risk in Communities (ARIC) Study, 764 participants at Visit 6 (2016–2017) reported hearing aid use. Self-reported hours of daily hearing aid use were modeled continuously (hours) and categorically (< 6, 6–12, and > 12 hr). Covariates included predisposing (age, sex, race–center), enabling (education, marital status, years of prior hearing aid use, global cognitive factor score, depressive symptoms, access to health care, health literacy), and need factors (pure-tone average [PTA], Quick Speech-in-Noise Test [QuickSIN] score). Multivariable-adjusted linear and ordinal logistic models were used to examine associations between these factors and daily hearing aid use. Results: Every 1-year increase in prior hearing aid use was associated with 0.08-hr increase in daily hearing aid use (95% confidence interval [CI] [0.04, 0.13]); every 10-dB increase in PTA was associated with 0.63-hr increase in daily hearing aid use (95% CI [0.18, 1.08]); every 5-point increase in QuickSIN score was associated with 0.53-hr decrease in daily hearing aid use (95% CI [−0.99, −0.06]). Longer duration of prior hearing aid use and poor PTA and QuickSIN performance were associated with higher odds of being in a higher hearing aid use category. Conclusions: Hours of daily hearing aid use is driven primarily by audiometric hearing, SIN performance, and years of prior hearing aid use. Further research into determinants of hours of use can improve precision of hearing care. Supplemental Material: https://doi.org/10.23641/asha.30192826

Objectives: Electronic health record (EHR) work may differently affect women and men physicians. Identifying gender discrepancies in EHR work across different specialties may inform strategies to reduce EHR burdens. Materials and Methods: We retrospectively evaluated EHR use by ambulatory physicians in 4 specialties (2 procedural [cardiology and gastroenterology] and 2 nonprocedural [internal medicine and rheumatology]) during 1 year at a large academic medical institution. Gender differences in EHR and clinical workload across specialties were evaluated by analysis of variance. Mixed-effects linear regression models analyzed gender differences in EHR workload controlling for specialty. Significant differences were additionally examined by stratifying procedural and nonprocedural specialties. Results: Clinical and EHR workload varied across specialties (P <.05), though scheduled clinical workload did not differ by gender. Controlling for specialty, women physicians spent more time per appointment on In Basket messages (P =.001), sent more Secure Chat messages per appointment (P =.003), and spent more time in the EHR outside 7:00 AM-7:00 PM (P <.001) than men. Gender differences in messaging were concentrated among the procedural physicians. Women procedural physicians spent more time on In Basket messages (P <.001) and sent more Secure Chat messages (P =.007) than men, whereas these differences did not occur among nonprocedural physicians. Discussion: Women physicians had greater EHR burdens despite similar scheduled clinical workloads as men. The greater messaging workload predominantly affected women procedural physicians. Conclusion: Gender disparities in EHR burden in ambulatory specialties vary between procedural and nonprocedural fields. Future research is needed to mitigate gender inequity in EHR workloads.

Background: Hearing loss affects nearly two‐thirds of adults over the age of 70 years, and is associated with lower satisfaction with health care, which may be mediated by patient‐provider communication barriers. Accompaniment, the presence and support of a companion during health care interactions, may modify the association between hearing and satisfaction with care by providing an intermediary to assist with communication. Methods: Cross‐sectional study of 9698 Medicare beneficiaries from the 2016 Medicare Current Beneficiaries Survey. We used regression models to estimate the association between self‐reported trouble hearing and satisfaction with care, which was measured through reported satisfaction with overall quality of care, satisfaction with information provided, and satisfaction with provider's concern. Interaction terms and stratification by being accompanied to healthcare visits were used to assess if accompaniment modified the association between hearing loss and satisfaction with care. Results: Nearly 45% of Medicare beneficiaries reported at least a little trouble hearing. Adults with a little trouble hearing (Odds Ratio [OR] = 1.168; 95% Confidence Interval [CI] = 1.047–1.302) and a lot of trouble hearing (OR = 1.293; 95% CI = 1.043–1.603) had higher odds of being dissatisfied with the quality of their health care over the previous year compared to those with no trouble hearing. Among accompanied participants, no association was found between level of hearing trouble and dissatisfaction with care. Among unaccompanied adults, trouble with hearing was associated with higher odds of dissatisfaction. The associations were consistent across the three dissatisfaction outcomes. Conclusions: Medicare beneficiaries with hearing loss had higher odds of dissatisfaction with health care over the past year compared to those without functional hearing loss. Stratified models suggest that accompaniment may modify the association between hearing and dissatisfaction with care. Future research should consider interventions to support unaccompanied adults with hearing loss during health care interactions.

Purpose: Experiencing difficulty with activities of daily living (ADLs) and instrumental ADLs (IADLs) and/or the consequences of unmet ADL/IADL-related needs is associated with adverse health-related outcomes. The association of hearing loss (HL) with experiencing the consequences of unmet ADL/IADL-related needs is not well understood. We investigated the associations of HL with experiencing ADL/IADL difficulties and the consequences of unmet ADL/IADL-related needs in older adults. Method: We investigated cross-sectional associations between audiometric HL, the number of ADL and IADL difficulties, and the number of consequences of unmet ADL/IADL-related needs among adults aged 65 years and older in the National Health and Aging Trends Study. Results: In 4,724 older adults, 30.5% ( n = 1,736) and 30.9% ( n = 1,727) had self-reported difficulty with ADLs and IADLs, respectively. Of the 2,289 participants who reported difficulty with at least one ADL/IADL, 14.0% ( n = 741) reported experience of at least one consequence of an unmet ADL/IADL-related need. In multivariable ordinal regression analyses, mild ( OR = 1.38, 95% CI [1.1, 1.73]) and moderate or greater ( OR = 1.57, 95% CI [1.17, 2.1]) HL were associated with higher odds of difficulties with additional ADLs. Moderate or greater HL was associated with higher odds of reporting difficulties with additional IADLs ( OR = 1.59, 95% CI [1.19, 2.12]). There was no significant association between HL and higher odds of having additional consequences of unmet needs. Conclusions: Our results show an association between HL and a higher number of ADL and IADL difficulties. Adults with HL may require increased support to address difficulties with daily activities and prevent experiencing related consequences. Supplemental Material: https://doi.org/10.23641/asha.28300049

Background: Hearing loss is highly prevalent and associated with increased health care utilization. Recognition of hearing loss may play an important role in self-advocacy in difficult communication situations and prevent negative outcomes. Objectives: To investigate the associations between self-recognition of hearing loss and hospitalization outcomes. Research Design and Subjects: This is a cross-sectional analysis of 1766 participants from the National Health and Aging Trends Study. Exposures and Outcomes: The exposure, recognition of hearing loss, was constructed using participants’ self-reported functional hearing difficulty, audiometric hearing loss, and self-reported hearing aid use. Primary outcomes included self-reported hospital stay occurrence and number of hospital stays within the last year. Regression models were adjusted for demographic, socioeconomic, and health characteristics and further stratified by severity of hearing loss. Results: Among 1766 participants with hearing loss, those with unrecognized hearing loss [60.1% (n=1062)] had higher but statistically insignificant odds of any hospitalization [odds ratio (OR)=1.32; 95% CI: 0.96, 1.81] or higher count of hospitalizations [incident rate ratio (IRR)=1.13; 95% CI: 0.85, 1.51] compared with those with recognized hearing loss (39.9%, n=704). Among participants with mild hearing loss, those with unrecognized hearing loss demonstrated significantly higher odds of any hospitalization occurrence (OR=2.50; 95% CI: 1.26–4.97) and a higher count of hospitalizations (IRR=2.00, 95% CI: 1.00–4.01) than those with recognized hearing loss. There were no significant differences in hospitalization outcomes among participants with moderate or greater hearing loss. Conclusions: In a nationally representative sample of older adults, individuals with unrecognized hearing loss compared with those with self-recognized hearing loss may be at increased odds of adverse hospitalization outcomes.

Automated threshold audiometry (ATA) could increase access to paediatric hearing assessment in low- and middle-income countries, but few studies have evaluated test-retest repeatability of ATA in c...

Image‐guided surgery (IGS) has become a widely adopted technology in otolaryngology. Since its introduction nearly three decades ago, IGS technology has developed rapidly and improved real‐time intraoperative visualization for a diverse array of clinical indications. As usability, accessibility, and clinical experiences with IGS increase, its potential applications as an adjunct in many surgical procedures continue to expand. Here, we describe the basic components of IGS and review both the current state and future directions of IGS in otolaryngology, with attention to current challenges to its application in surgery of the nonrigid upper aerodigestive tract.

Background: Prescription opioid (PO) use is common among adolescents in the United States. Despite recent declines from unprecedented peaks in adolescent PO use (eg, in 2012-2013), there is seemingly paradoxical evidence that PO-related consequences (eg, opioid use disorder and overdoses) are increasing. These trends and their possible consequences emphasize the importance of prevention efforts targeting PO misuse. To our knowledge, we have developed the first interactive web-based program (POP4Teens [P4T]) focused specifically on the prevention of PO misuse among adolescents. Objective: This study aimed to evaluate the effectiveness of P4T, a web-based program designed to prevent adolescent PO misuse, in comparison with JustThinkTwice (JTT), an active control website, on PO-related attitudes, knowledge, risk perception, and intentions to use. Methods: We conducted a web-based randomized controlled trial in 2018. A total of 406 adolescents (aged 12-17 years) were randomly assigned to either P4T or JTT. The outcome variables were attitudes, knowledge, and risk perceptions associated with PO misuse, intentions to use POs, and program feedback. Data were collected at baseline and at 1, 3, and 6 months. Results: Both programs resulted in significant and sustained improvements in intention to use POs, increased perceived risk, impacted expectancies consistent with prevention, and improved PO refusal skills. P4T produced significantly greater increases in PO-related knowledge than JTT did, and it was reportedly easier to use and more liked. Baseline scores for youth reporting past-year medical use of POs, friends who engage in nonmedical use of POs, and/or poor mental health underscored their at-risk status compared with youth from the other groups. Conclusions: P4T positively impacted all study variables that are known to prevent PO misuse among teens. Moreover, its web-based nature simplifies the dissemination and implementation of this novel tool designed to help meet the challenges of the evolving national opioid crisis. Trial Registration: ClinicalTrials.gov NCT02737696; https://clinicaltrials.gov/ct2/show/NCT02737696

Objective: To analyze surgical outcomes of a novel alloplastic reconstruction technique for partial external auditory canal (EAC) defects in tympanomastoidectomy.Methods: Retrospective study of 51 patients with cholesteatoma who underwent repair of partial EAC defects during tympanomastoidectomy at a tertiary referral center over 8 years. Nineteen patients were treated with a novel alloplastic graft technique using hydroxyapatite cement and bone pâté for EAC repair. Thirty‐two patients treated with traditional cartilage repair of the EAC served as a control group. The primary outcomes measured were postoperative cholesteatoma recurrence rates, infection rates, and mean air‐bone gap (ABG).Results: Twenty of the 51 cases (39.2%) were revision surgeries for cholesteatoma recidivism, with a greater proportion of revision surgeries in the alloplastic group (57.9% vs 28.1%, P = .04). There was no significant difference in postoperative cholesteatoma recurrence (P = 1.00) or infection rates (P = .64) between the two techniques, with the alloplastic group experiencing slightly lower rates of recurrence (36.8%) and infection (5.3%) than cartilage repair (37.5% recurrence, 12.5% infection). Mean postoperative ABGs were comparable between the alloplastic (21.5 dB) and cartilage group (26.0 dB, P = .10).Conclusions: Composite alloplastic and bone pâté reconstruction is an effective technique to repair partial EAC defects in tympanomastoidectomy, with comparable postoperative hearing outcomes and no increased risk of cholesteatoma recurrence or infection compared to traditional cartilage repair. Recidivism rates were relatively high in both groups, likely due to the high rate of revision surgeries and aggressive nature of cholesteatoma within the cohort.Level of Evidence: Level 3B.