Till Örebro universitet

PURPOSE: The study investigated which hearing-related patient-related outcome measures (PROMs) are available for use within the Swedish hearing health care system. The study also investigated the translation process and psychometric evaluation of the identified PROMs.

METHOD: A two-step method, including a literature review and an online survey, was used. The respondents of the online survey represented public and private hearing-related health care systems in Sweden. Thirty-three hearing health care clinics participated, representing 20 of 21 counties in Sweden.

RESULTS: Within Swedish hearing-related health care, a variation in the applicable PROMs was found. Usually, PROMs were used for adult patients but also can be applied to children. PROMs were primarily used for post-rehabilitation evaluations or prior hearing rehabilitation for diagnostics and/or hearing need assessment. Most PROMs measured hearing aid benefit and tinnitus-related issues. Overall, the study identified 29 PROMs available in Swedish for which all but two were validated with the translation process described in 12 studies.

CONCLUSIONS: In Sweden, 29 hearing-related PROMs are available. Differences in PROM use between the hearing health care units were found, indicating a need for consensus and national guidelines.

Bakgrund: Inom området för audiologi och hörselrehabilitering finns det många olika frågeformulär framtagna och översiktsstudier har påvisat att många av dessa frågeformulär; inte används kliniskt, enbart använts i en enstaka studie och att många frågeformulär inte utvärderats gällande psykometriska aspekter såsom validitet och reliabilitet. I en kartläggning genomförd av Socialstyrelsen 2012 visade resultatet att det varierar mycket mellan Sveriges regioner gällande vilka frågeformulär som används. Inom vissa regioner används flera frågeformulär och inom andra används inte några frågeformulär alls, det varierar även mycket gällande vilka frågeformulär som används.     Internationellt har fokus på frågeformulär, översättningsprocesser och psykometrisk utvärdering fått allt mer fokus under senare år och flera studier har publicerats inom ämnet. Av denna anledning är det även av stor vikt att undersöka vilka frågeformulär som används inom svensk hörselvård idag, vilka evidens frågeformulären bygger på, vilken kvalitet översättningarna har och om de utvärderats psykometrisk. Studiens resultat kommer att vara till hjälp vid val av frågeformulär och att jobba evidensbaserat inom svensk hörselvård. 

Syfte: Syftet med studien är att kartlägga vilka frågeformulär som används inom hörselvården i Sverige och hur dessa frågeformulär är översatta och psykometriskt utvärderade.

Metod: Studien består av två delar, en webbenkät och en litteraturstudie. Webbenkäten riktar sig till privat och regional hörselvård i Sverige och omfattar bland annat frågor om vilka frågeformulär som används, i vilket syfte dessa används samt för vilken patientgrupp. Studiens andra del är en litteratursökning baserat på resultatet av webbenkäten. Syftet med litteratursökningen är att sammanställa vilka frågeformulär som finns översatta till svenska och hur de utvärderats psykometriskt.

Preliminära resultat: Datainsamling pågår under våren 2023, hittills har svar inkommit från både privat och regional hörselvård, från hela Sverige. Preliminära resultat visar på en variation gällande vilka frågeformulär som används inom olika regioner och verksamheter. Variation finns även gällande vilka patientgrupper och i vilket syfte frågeformulären används.     Resultatet kommer färdigställas under våren/sommaren 2023 och innehålla en översikt över vilka frågeformulär som används kliniskt i Sverige, hur de används, vilka evidens de har, och hur de utvärderats psykometrisk. Målet är att denna översikt ska kunna vara till hjälp för personal inom hörselvården i att kunna jobba evidensbaserat och välja och använda lämpliga frågeformulär som verktyg i sitt kliniska arbete. 

Health care interventions that are intended to improve hearing should be based on the results of individual patient assessments. To improve these assessments, the feasibility of an International Classification of Functioning, Disability, and Health (ICF)-based interview tool was tested in a single clinical setting in Sweden. Audiologists participating in the study used the interview tool during a four-week testing period and provided written reflections after each session. The use of this tool was also evaluated in a focus group interview that took place after the completion of the project. The results of this study identified both process-related and structure-related factors that were highly relevant to the implementation of this interview tool. Overall, the findings revealed that the use of this interview tool promoted person-centered care in encounters focused on clinical audiological rehabilitation. Specifically, the ICF-based holistic approach permitted the audiologists to acquire more comprehensive patient narratives. The use of the ICF interview tool facilitated patient participation and permitted the audiologist to collect more substantial and meaningful information from each patient.

Background: The prevalence of disabling hearing loss is increasing worldwide. However, previous studies on hearing loss prevalence have enrolled small populations or only provided estimates.

Aim: To establish the prevalence of severe-to-profound hearing loss (STPHL) in the adult Swedish population and compare it with the cochlear implantation rate in Sweden.

Material and methods: We established a database containing over 15 million audiograms obtained from regions covering > 99% of the Swedish population by extracting audiogram data from the computer software application, Auditbase. We used this database to calculate the percentage of adult patients with bilateral hearing levels >= 70 dB. We collected data regarding cochlear implantations in Sweden from the National Board of Welfare and Health.

Results: The prevalence of STPHL in the adult Swedish population was 0.28%. There were regional variations in the prevalence and rate of cochlear implantation; however, there was no association between both parameters.

Conclusions: This study presents an updated and reliable prevalence figure for STPHL in Sweden.

Significance: Patients with STPHL have extensive rehabilitation requirements; accordingly, it is important to determine the accurate prevalence of STPHL to inform the allocation of adequate resources.

Severe-to-profound hearing loss (STPHL) can affect a person negatively in many ways. Audiological rehabilitation is important for these patients. Patients receiving cochlear implants make up less than 10% of this group but have been studied extensively. In 2005, a national registry for adult patients with STPHL was introduced in Sweden. Its purpose was to evaluate and improve rehabilitation for all patients with STPHL. Data from the Swedish registry for adult patients with STPHL were used to evaluate variables affecting the audiological rehabilitation. Previous published data from the registry were reviewed, and new data from the follow-up questionnaire were presented. More than 90% of patients rehabilitated with hearing aids experienced a good or very good benefit of audiological rehabilitation. Tinnitus and vertigo affected quality of life negatively and were reported by many patients with STPHL (41% and 31%) at follow-up. To maintain the high number of patients who find audiological rehabilitation beneficial, individualized treatment plans and timely re-evaluations are crucial. Tinnitus and vertigo need to be addressed repeatedly in the rehabilitation process.

The present thesis concerns the daily sound environment and the human perception of the same. The sound environment affects the possibility to be active in a communication. With background noise, it may be harder to hear desired signals, and when suffering from a hearing loss, negative effects of the background noise increase. Previous research has explored, that persons with hearing loss benefit from hearing aid usage, but there is a risk of non-usage due to low sound quality. The non-usage of hearing aids has furthermore been described as a cause of isolation and social withdrawal for persons with hearing loss.

The general aim of the present thesis is to explore the concept of disturbing sounds in a daily sound environment and to examine the influence of hearing loss and hearing aid usage. Disturbing sounds were investigated in means of perception of loudness and annoyance, where loudness concerned the acoustical properties, mainly sound level, whereas annoyance concerned the psychological phenomenon, defined as an individual adverse reaction to noise. The results of studies I and II showed, that hearing aid users experience disturbing sounds more or less daily, and that those sounds resulted in a decreased usage of hearing aids. The effect of disturbing sounds seemed to rely on several factors, acoustical as well as psychological, and there was not one single factor providing a full explanation of disturbance. In study III and IV, the perception of sounds in normal hearing and hearing impaired persons were thoroughly examined and revealed that hearing thresholds affect the perceived loudness and annoyance. Furthermore, the effect of hearing aids on loudness and annoyance perception was investigated. The results showed that hearing aids restored the loudness and annoyance to levels comparable to people with normal hearing function. The results of the studies stress that additional research should focus on the implementation of knowledge of disturbing sounds in audiological rehabilitation, in order to increase the benefit of hearing aid usage.

OBJECTIVE: Sounds in the daily environment may cause loudness and annoyance. The present study investigated the perception of loudness and annoyance for eight different sounds present in a daily sound environment and at nine different levels varying by ±20 dB around the recorded level. The outcomes were related to tests of participants' auditory and cognitive abilities.

DESIGN: The participants undertook auditory and working memory (WM) tests prior to ratings of everyday sounds previously shown to be disturbing for persons with hearing impairment (hearing aid users).

STUDY SAMPLE: Twenty-one participants aged between 24 and 71 years, with normal hearing threshold levels.

RESULTS: Both perceived loudness and annoyance were primarily driven by the sound level. Sounds emitted from paper were rated as having greater loudness and being more annoying than the other sound sources at the same sound level. Auditory and cognitive abilities did not influence the perception of loudness and annoyance.

CONCLUSIONS: Loudness and annoyance ratings were mainly driven by sound level. Expectations of a sound seemed to influence the assessment of loudness and annoyance while auditory performance and WM capacity showed no influence on the ratings.