Explore the vast range of titles available.

Background While 60% of older adults have hearing loss (HL), the majority have never had their hearing tested. Objective We sought to estimate long-term clinical and economic effects of alternative adult hearing screening schedules in the USA. Design Model-based cost-effectiveness analysis simulating Current Detection (CD) and linkage of persons with HL to hearing healthcare, compared to alternative screening schedules varying by age at first screen (45 to 75 years) and screening frequency (every 1 or 5 years). Simulated persons experience yearly age- and sex-specific probabilities of acquiring HL, and subsequent hearing aid uptake (0.5–8%/year) and discontinuation (13–4%). Quality-adjusted life-years (QALYs) were estimated according to hearing level and treatment status. Costs from a health system perspective include screening ($30–120; 2020 USD), HL diagnosis ($300), and hearing aid devices ($3690 year 1, $910/subsequent year). Data sources were published estimates from NHANES and clinical trials of adult hearing screening. Participants Forty-year-old persons in US primary care across their lifetime. Intervention Alternative screening schedules that increase baseline probabilities of hearing aid uptake (base-case 1.62-fold; range 1.05–2.25-fold). Main Measures Lifetime undiscounted and discounted (3%/year) costs and QALYs and incremental cost-effectiveness ratios (ICERs). Key Results CD resulted in 1.20 average person-years of hearing aid use compared to 1.27–1.68 with the screening schedules. Lifetime total per-person undiscounted costs were $3300 for CD and ranged from $3630 for 5-yearly screening beginning at age 75 to $6490 for yearly screening beginning at age 45. In cost-effectiveness analysis, yearly screening beginning at ages 75, 65, and 55 years had ICERs of $39,100/QALY, $48,900/QALY, and $96,900/QALY, respectively. Results were most sensitive to variations in hearing aid utility benefit and screening effectiveness. Limitation Input uncertainty around screening effectiveness. Conclusions We project that yearly hearing screening beginning at age 55+ is cost-effective by US standards.

Background Childhood hearing loss has well-known profound implications for language development, school achievement, and future employment opportunities. School-based health programs can provide hearing screening, but access to specialists for follow-up care is limited in rural areas. This is especially problematic for children in rural Alaska who experience a disproportionately high burden of preventable childhood hearing loss. The purpose of this study will be to develop and test the effectiveness and implementation of school-based specialty telehealth follow-up to improve timely access to specialty care after school hearing screening in rural Alaska. Methods This will be a hybrid type 1 effectiveness-implementation stepped wedge, cluster-randomized trial in three representative regions of Alaska. The trial will evaluate the STAR model, which consists of three core components: (1) enhanced school hearing screening, (2) school-based specialty telehealth follow-up, and (3) streamlined communication between schools, healthcare providers, and parents/caregivers. The trial will begin with a formative phase in the first 2 years, when qualitative data on community preferences and perspectives will be gathered to systematically adapt the STAR model and develop an implementation plan for participating regions. The adapted STAR model will be evaluated with a stepped wedge, cluster-randomized design in approximately 25 schools in three regions of rural Alaska. The primary effectiveness outcome will be the proportion of referrals resulting in specialty follow-up within 60 days of school hearing screening, measured using queries of electronic health records from the healthcare systems serving each region. Generalized estimating equations (GEE) will be used to model these cluster-period school-level proportions to obtain population-averaged intervention effects that are of public health relevance and therefore of interest in implementation trials. Secondary implementation outcomes will include fidelity, reach, acceptability, feasibility, and appropriateness. Sustainability of the STAR model will be evaluated through iterative meetings with state leaders and policymakers. Discussion This trial will evaluate school-based specialty telehealth follow-up in diverse regions of Alaska, addressing preventable childhood hearing loss with a model that could be translated to other rural and underserved groups to bring high-value services into rural schools and alter the paradigm of prevention nationwide. Trial registration NCT05593484. Registered on October 20, 2022.

Objective School hearing screening may mitigate the effects of childhood hearing loss through early identification and intervention. This study provides an overview of existing school hearing screening programs around the world, identifies gaps in the literature, and develops priorities for future research. Data Sources A structured search of the PubMed, Embase, and Cochrane Library databases. Review Methods A total of 65 articles were included according to predefined inclusion criteria. Parameters of interest included age groups screened, audiometric protocols, referral criteria, use of adjunct screening tests, rescreening procedures, hearing loss prevalence, screening test sensitivity and specificity, and loss to follow-up. Conclusions School hearing screening is mandated in few regions worldwide, and there is little accountability regarding whether testing is performed. Screening protocols differ in terms of screening tests included and thresholds used. The most common protocols included a mix of pure tone screening (0.5, 1, 2, and 4 kHz), otoscopy, and tympanometry. Estimates of region-specific disease prevalence were methodologically inaccurate, and rescreening was poorly addressed. Loss to follow-up was also a ubiquitous concern. Implications for Practice There is an urgent need for standardized school hearing screening protocol guidelines globally, which will facilitate more accurate studies of hearing loss prevalence and determination of screening test sensitivity and specificity. In turn, these steps will increase the robustness with which we can study the effects of screening and treatment interventions, and they will support the development of guidelines on the screening, diagnostic, and rehabilitation services needed to reduce the impact of childhood hearing loss.

Background Globally, hearing loss is the second leading cause of disability, affecting approximately 18.7% of the world’s population. However, the burden of hearing loss is unequally distributed, with the majority of affected individuals located in Asia or Sub-Saharan Africa. Following the 2014 West African Ebola Outbreak, disease survivors began to describe hearing loss as part of the constellation of symptoms known as Post-Ebola Syndrome. The goal of this study was to more fully characterize hearing loss among Ebola Virus Disease (EVD) survivors. Methodology and principal findings EVD survivors and their household contacts were recruited (n = 1,12) from Eastern Sierra Leone. Each individual completed a symptom questionnaire, physical exam, and a two-step audiometry process measuring both air and bone conduction thresholds. In comparison to contacts, EVD survivors were more likely to have complaints or abnormal findings affecting every organ system. A significantly greater percentage of EVD survivors were found to have hearing loss in comparison to contacts (23% vs. 9%, p < 0.001). Additionally, survivors were more likely to have bilateral hearing loss of a mixed etiology. Logistic regression revealed that the presence of any symptoms of middle or inner ear (p < 0.001), eye (p = 0.005), psychiatric (p = 0.019), and nervous system (p = 0.037) increased the odds of developing hearing loss. Conclusions and significance This study is the first to use an objective and standardized measurement to report hearing loss among EVD survivors in a clinically meaningful manner. In this study it was found that greater than 1/5th of EVD survivors develop hearing loss. The association between hearing impairment and symptoms affecting the eye and nervous system may indicate a similar mechanism of pathogenesis, which should be investigated further. Due to the quality of life and socioeconomic detriments associated with untreated hearing loss, a greater emphasis must be placed on understanding and mitigating hearing loss following survival to aid in economic recovery following infectious disease epidemics.

Objective This study evaluated the Hearing Environments and Reflection on Quality of Life (HEAR‐QL) questionnaire in rural Alaska, including an addendum crafted through community feedback to reflect the local context. The objectives were to assess whether HEAR‐QL score was inversely correlated with hearing loss and middle ear disease in an Alaska Native population. Methods The HEAR‐QL questionnaires for children and adolescents were administered as part of a cluster randomized trial in rural Alaska from 2017 to 2019. Enrolled students completed an audiometric evaluation and HEAR‐QL questionnaire on the same day. A cross‐sectional evaluation of questionnaire data was utilized. Results A total of 733 children (ages 7–12 years) and 440 adolescents (ages ≥13 years) completed the questionnaire. Median HEAR‐QL scores were similar among children with and without hearing loss (Kruskal–Wallis, p = .39); however, adolescent HEAR‐QL scores significantly decreased with increasing hearing loss (p < .001). Median HEAR‐QL scores were significantly lower in both children (p = .02) and adolescents (p < .001) with middle ear disease compared with those without. In both children and adolescents, the addendum scores were strongly correlated with total HEAR‐QL score (ρSpearman = 0.72 and 0.69, respectively). Conclusions The expected negative association between hearing loss and HEAR‐QL score was observed in adolescents. However, there was significant variability that could not be explained by hearing loss, and further investigation is warranted. The expected negative association was not observed in children. HEAR‐QL scores were associated with middle ear disease in both children and adolescents, making it potentially valuable in populations where the prevalence of ear infections is high. Level of Evidence Level 2 Clinicaltrials.gov registration numbers: NCT03309553 This research presents new evidence on hearing‐related quality of life in a large, representative sample of Alaska Native school‐aged children and adolescents in rural Northwest Alaska. Utilizing the Hearing Environments and Reflection on Quality of Life (HEAR‐QL) questionnaire, we found an expected negative association between hearing loss and HEAR‐QL score in adolescents. We did not see the same expected association for children. We evaluated HEAR‐QL scores and middle ear disease for the first time and found an association for both adolescents and children.

Plain English summary Community involvement is important in good research practice. We led a community-based study to improve early detection and treatment of childhood hearing loss in rural Alaska. This study evaluated a cell phone-based hearing screening process and compared a new telemedicine specialty referral pathway to the standard primary care referral pathway. The study included community involvement, engagement, and participation from the very beginning to inform how to best design the trial. We obtained insight and feedback from community members through involvement of a core stakeholder team and through community engagement and participation in focus groups and community events. Feedback received through community involvement and participation influenced the design of the trial at key decision points. Community member guidance shaped the research question, the outcomes to be measured, and the procedures for completing the project, such as participant recruitment. This study offers an example of community involvement, engagement and participation that could be mirrored in future research to maintain the interests of participating communities. Background Effective systems for early identification and treatment of childhood hearing loss are essential in rural Alaska, where data indicate a high prevalence of childhood ear infections and hearing loss. However, loss to follow-up from school hearing screening programs is pervasive. The Hearing Norton Sound study was a mixed methods community randomized controlled trial that was developed to address this gap. The study engaged community members and participants in the design of the trial, including involvement of stakeholders as collaborators. Methods Community engagement and participation in research design occurred through focus groups and through the integration of stakeholders into the study team. Representation was cross-sectoral, involving individuals from multiple levels of the school and health system, as well as community members from each of the 15 communities. Feedback obtained between April 2017 and August 2017 informed the final design of the randomized trial, which began enrollment of children in October 2017 and concluded in March 2019. Results Stakeholder involvement and community participation shaped the design of specific trial elements (research question; comparators; outcomes and measures; telemedicine protocols; and recruitment and retention). Community involvement was strengthened by the use of multiple modalities of involvement and by the positionality of lead stakeholders on the study team. Conclusions This study highlights the effectiveness of multifaceted stakeholder involvement and participation in the design of health research conducted within Alaska Native communities. It offers an example of involvement and reporting that could be mirrored in future research in order to protect and further the interests of the participating community. Trial registration ClinicalTrials.gov, NCT03309553 , First registered 10/9/2017

Of the 1.6 billion people with hearing loss worldwide, over 1.2 billion live in underserved communities with the least access to hearing care. This includes preventable hearing loss in an estimated 42 million children who, without early identification and treatment, are at increased risk of significant detrimental effects that can last a lifetime. These immense hearing health disparities provide a clear and compelling call to action. The new Center for Hearing Health Equity at the University of Arkansas for Medical Sciences is the first of its kind in the world, established to deliver the critical mission of fostering hearing health equity both globally and locally. This article describes the Center's approach, which is built on inclusive, multidisciplinary collaboration guiding a research-driven, public-health oriented agenda to develop evidence that is directly translatable to policy change. The end goal is to generate momentum towards sustained solutions that will create a new future with hearing care accessible to all.

Background Hearing loss significantly impacts health-related quality of life (QoL), yet the effects of current treatments on QoL utility remain uncertain. Our objective was to describe the impact of untreated and treated hearing loss on QoL utility to inform hearing healthcare policy. Methods We searched databases for articles published through 02/01/2021. Two independent reviewers screened for articles that reported elicitation of general QoL utility values for untreated and treated hearing loss health states. We extracted data and quality indicators from 62 studies that met the inclusion criteria. Results Included studies predominately used observational pre/post designs (61%), evaluated unilateral cochlear implantation (65%), administered the Health Utilities Index 3 (HUI3; 71%), and were conducted in Europe and North America (84%). In general, treatment of hearing loss improved post-treatment QoL utility when measured by most methods except the Euro-QoL 5 dimension (EQ-5D). In meta-analysis, hearing aids for adult mild-to-moderate hearing loss compared to no treatment significantly improved HUI3-estimated QoL utility (3 studies; mean change=0.11; 95% confidence interval (CI): 0.07 to 0.14) but did not impact EQ-5D-estimated QoL (3 studies; mean change=0.0; 95% CI: −0.03 to 0.04). Cochlear implants improved adult QoL utility 1-year post-implantation when measured by the HUI3 (7 studies; mean change=0.17; 95% CI: 0.11 to 0.23); however, pediatric VAS-estimated QoL utility was non-significant (4 studies; mean change=0.12; 95% CI: −0.02 to 0.25). The quality of included studies was limited by failure to report missingness of data and low survey response rates. Our study was limited by heterogeneous study populations and designs. Findings Treatment of hearing loss significantly improves QoL utility, and the HUI3 and VAS were most sensitive to improvements in hearing. Improved access to hearing healthcare should be prioritized. Systematic Review Registration PROSPERO: CRD42021253314

Untreated hearing loss is recognized as a growing global health priority because of its prevalence and harmful effects on health and well-being. Until recently, little progress had been made in expanding hearing care beyond traditional clinic-based models to incorporate public health approaches that increase accessibility to and affordability of hearing care. As demonstrated in numerous countries and for many health conditions, sharing health-care tasks with community health workers (CHWs) offers advantages as a complementary approach to expand health-service delivery and improve public health. This paper explores the possibilities of task shifting to provide hearing care across the life course by reviewing several ongoing projects in a variety of settings - Bangladesh, India, South Africa and the United States of America. The selected programmes train CHWs to provide a range of hearing-care services, from childhood hearing screening to management of age-related hearing loss. We discuss lessons learnt from these examples to inform best practices for task shifting within community-delivered hearing care. Preliminary evidence supports the feasibility, acceptability and effectiveness of hearing care delivered by CHWs in these varied settings. To make further progress, community-delivered hearing care must build on established models of CHWs and ensure adequate training and supervision, delineation of the scope of practice, supportive local and national legislation, incorporation of appropriate technology and analysis of programme costs and cost-effectiveness. In view of the growing evidence, community-delivered hearing care may now be a way forward to improve hearing health equity.

Uncorrected refractive error is the leading cause of vision impairment in children globally, and studies have demonstrated that spectacle correction addresses the large majority of childhood vision impairment. Furthermore, trial evidence illustrates the beneficial impact of spectacles on learning, with effect sizes exceeding that of other school health interventions. While it is established that good vision is important for learning and optimising childhood development and quality of life, many countries lack healthcare systems that provide vision screening or universal access to eyecare for all citizens. This review examined school vision screening across several regions/countries, focusing on conditions that should be targeted and the corresponding interventions. The range of international models, the status of global refractive service coverage and measures needed for improvement are discussed. Vision screening protocols need to effectively detect vision impairment, seamlessly connect with intervention services to deliver spectacles and signpost for future access to eyecare. Conditions which may not be treatable with spectacles alone, including amblyopia, strabismus and other ocular diseases, also warrant signposting for treatment. The vision community must unite to urge governments to invest in building service capacity; allocating the necessary resources and effectively developing public health systems to support vision screening and access to eyecare. Schools play a crucial role in enabling population-based vision screening and need to be supported with eyecare interventions and resources. This will ensure optimised approaches to correct avoidable vision loss and provide children with the educational and health outcomes they deserve.