Objectives
To systematically review evidence on the prevalence and characteristics of hearing impairment among children and adults living with HIV in low‐ and middle‐income countries (LMIC).
Methods
...Articles were identified up to January 2016 through searching four electronic databases. Epidemiological studies conducted in LMIC that explored the association between HIV status and hearing loss, with or without an HIV‐uninfected comparison group, were eligible for inclusion. Results were screened and assessed for eligibility, and data were extracted by two reviewers, with discussion in the case of disagreement. Findings were narratively synthesised.
Results
The search identified 638 unique references, of which 21 studies were included in the review, including 3491 people with HIV from 13 LMIC. There was lack of consistency in the definition used for hearing loss, making comparability across studies difficult. Among children with HIV, across the three studies that used a cut‐off of >15 dB in either ear, the prevalence of hearing loss ranged from 22 to 37%. Among the three studies that used >25 dB in either ear, the prevalence ranged from 32 to 39%. Among adults with HIV, for the five studies that used a threshold of >25 dB for either ear, the prevalence ranged from 10 to 43%. The prevalence of hearing impairment was significantly higher among people with HIV than in controls in eight of the ten studies that assessed this comparison. Conductive hearing loss was the most common type of hearing loss in children with HIV, while sensorineural hearing loss was more common in adults with HIV. There was a lack of evidence for an association between ART use and hearing loss, although there was some suggestion that late stage of HIV disease or low CD4 count was related to hearing loss. There were concerns about the quality of the studies included in the review.
Conclusions
The current evidence is suggestive of a high prevalence of hearing loss among people living with HIV compared to people without HIV, or to WHO estimates for the general population. More research is needed to better understand the aetiology of hearing loss in relation to HIV, and whether screening for and treatment of hearing loss can be effectively integrated into HIV treatment services needs further research.
Objectifs
Analyser systématiquement les données sur la prévalence et les caractéristiques de la déficience auditive chez les enfants et les adultes infectés par le VIH dans les pays à revenu faible et intermédiaire (PFR‐PRI).
Méthodes
Les articles ont été identifiés jusqu’à janvier 2016 via la recherche dans quatre bases de données électroniques. Les études épidémiologiques menées dans les PFR‐PRI qui exploraient l'association entre le statut VIH et la perte auditive, avec ou sans groupe de comparaison de patients VIH négatifs, étaient éligibles pour inclusion. Les résultats ont été examinés et évalués pour l’éligibilité et les données ont été extraites par deux examinateurs, avec une discussion dans les cas de discordance. Les conclusions ont été synthétisées de manière narrative.
Résultats
La recherche a identifié 638 références uniques, dont 21 études ont été incluses dans l'analyse, comprenant 3491 personnes vivant avec le VIH dans 13 PFR‐PRI. Il y avait un manque de cohérence dans la définition utilisée pour la perte auditive, rendant difficile la comparabilité entre les études. Chez les enfants infectés par le VIH, dans les trois études qui ont utilisé un seuil de > 15 dB dans chaque oreille, la prévalence de la perte auditive variait de 22 à 37%. Parmi les trois études qui ont utilisé un seuil de > 25 dB dans chaque oreille, la prévalence variait de 32 à 39%. Chez les adultes infectés par le VIH, pour les cinq études qui ont utilisé un seuil > 25 dB pour chaque oreille, la prévalence variait de 10 à 43%. La prévalence de la déficience auditive était significativement plus élevée chez les personnes avec le VIH que chez les témoins dans huit des dix études qui ont analysé cette comparaison. La perte auditive conductive était le type de perte auditive le plus courant chez les enfants infectés par le VIH, tandis que la perte auditive neurosensorielle était plus fréquente chez les adultes infectés par le VIH. Il n'y avait pas de preuves d'une association entre l'utilisation de l’ART et la perte d'audition, bien qu'il ait été suggéré que le stade tardif de la maladie VIH ou le faible nombre de CD4 était lié à une perte auditive. Il y avait des incertitudes quant à la qualité des études incluses dans l'analyse.
Conclusions
Les données actuelles suggèrent une forte prévalence de perte auditive chez les personnes vivant avec le VIH par rapport à celles sans VIH, ou aux estimations de l’OMS pour la population générale. Des recherches supplémentaires sont nécessaires pour mieux comprendre l’étiologie de la perte auditive en relation avec le VIH, et si le dépistage et le traitement de la perte auditive peut être efficacement intégrée dans les services de traitement du VIH.
Full text
Available for:
FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Objective
To determine whether a non‐specialist health worker can accurately undertake audiometry and otoscopy, the essential clinical examinations in a survey of hearing loss, instead of a highly ...skilled specialist (i.e. ENT or audiologist).
Methods
A clinic‐based diagnostic accuracy study was conducted in Malawi. Consecutively sampled participants ≥ 18 years had their hearing tested using a validated tablet‐based audiometer (hearTest) by an audiologist (gold standard), an audiology officer, a nurse and a community health worker (CHW). Otoscopy for diagnosis of ear pathologies was conducted by an ENT specialist (gold standard), an ENT clinical officer, a CHW, an ENT nurse and a general nurse. Sensitivity, specificity and kappa (κ) were calculated. 80% sensitivity, 70% specificity and kappa of 0.6 were considered adequate.
Results
Six hundred and seventeen participants were included. High sensitivity (>90%) and specificity (>85%) in detecting bilateral hearing loss was obtained by all non‐specialists. For otoscopy, sensitivity and specificity were >80% for all non‐specialists in diagnosing any pathology except for the ENT nurse. Agreement in diagnoses for the ENT clinical officer was good (κ = 0.7) in both ears. For other assessors, moderate agreement was found (κ = 0.5).
Conclusion
A non‐specialist can be trained to accurately assess hearing using mobile‐based audiometry. However, accurate diagnosis of ear conditions requires at least an ENT clinical officer (or equivalent). Conducting surveys of hearing loss with non‐specialists could lower costs and increase data collection, particularly in low‐ and middle‐income countries, where ENT specialists are scarce.
Objectif
Déterminer si un agent de santé non spécialisé peut effectuer avec précision une audiométrie et une otoscopie, examens cliniques essentiels dans une évaluation sur la perte auditive, à la place d'un spécialiste hautement qualifié (ORL ou audiologiste).
Méthodes
Etude de la précision du diagnostic en clinique menée au Malawi. Les participants de l’échantillonnage consécutif âgés de 18 ans et plus ont été testés pour l'audition à l'aide d'un audiomètre sur tablette (HearTest) validé par un audiologiste (référence standard), un agent d'audiologie, une infirmière et un agent de santé communautaire (ASC). L'otoscopie pour le diagnostic des pathologies de l'oreille a été réalisée par un spécialiste ORL (référence‐standard), un agent clinique ORL, un ASC, un infirmier ORL et un infirmier général. La sensibilité, la spécificité et kappa (k) ont été calculés. Une sensibilité de 80%, une spécificité de 70% et un kappa de 0,6 ont été jugés adéquats.
Résultats
617 participants ont été inclus. Tous les non‐spécialistes ont obtenu une sensibilité (> 90%) et une spécificité (> 85%) élevées dans la détection de la perte auditive bilatérale. Pour l'otoscopie, la sensibilité et la spécificité étaient > 80% pour tous les non‐spécialistes dans le diagnostic de toute pathologie à l'exception des infirmiers ORL. La concordance des diagnostics pour l'agent clinique ORL était bonne (k = 0,7) pour les deux oreilles. Pour les autres évaluateurs, une concordance modérée a été trouvée (k = 0,5).
Conclusion
Un non spécialiste peut être formé pour évaluer avec précision l'audition à l'aide d'une audiométrie mobile. Cependant, un diagnostic précis des problèmes d'oreille nécessite au moins un agent clinique ORL (ou son équivalent). Mener des évaluations sur la perte auditive par des non‐spécialistes pourrait réduire les coûts et augmenter la collecte de données, en particulier dans les pays à revenu faible ou intermédiaire, où les spécialistes en ORL sont rares.
Full text
Available for:
FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background: A 2009 survey of ENT, audiology, and speech therapy services and training opportunities in 18 Sub-Saharan African countries reported that the availability of services was extremely poor, ...the distribution of services was very inequitable, and training opportunities were limited.
Objective: We conducted a new survey to determine the current status of ear, nose, and throat (ENT), audiology, and speech therapy services in sub-Saharan Africa.
Method: This study is a cross-sectional study. A questionnaire was distributed by email to an ad hoc group of ENT surgeons and audiologists in 30 sub-Saharan African countries. Data from the current survey were compared to those of a 2009 survey. The numbers of ENT surgeons, audiologists, and speech therapists/100,000 people were compared to the ratios in the United Kingdom.
Results: A total of 22 countries responded to the questionnaire. When data of the 15 countries that responded in both 2009 and 2015 are compared, the number of ENT surgeons had increased by 43%, audiologists had increased by 2.5%, and speech therapists by 30%. When the 23% population growth is taken into account, the numbers of ENT surgeons, audiologists, and speech therapists per 100,000 people had declined in four countries, and there remains a severe shortfall of ENT surgeons, audiologists, and speech therapists when compared to the UK Respondents cited lack of availability of basic equipment as the most frequent limitation in providing ENT services. Other important factors causing limitations in daily practice were: lack of ENT training facilities and audiological rehabilitation, low awareness of the burden of ENT pathology, as well as poor human resources management.
Conclusions: There has been a lack of progress in ENT, audiology, and speech therapy services and training opportunities in sub-Saharan Africa between 2009 and 2015. There is a need to look at increased collaboration with developed countries and non-governmental organisations, establishing new and improving existing training centres in Africa, and task-shifting of some ENT services to primary health workers.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Abstract Objectives The prevalence of hearing loss (HL) in children infected with HIV/AIDS is not well studied. Even fewer studies focus on stable HIV-infected children treated with high-effective ...antiretroviral therapy (HAART). We aim to compare the prevalence of ear disease and HL in HAART-treated, HIV + children in Addis Ababa, Ethiopia with a well, similarly-aged elementary school population with unknown HIV status (HIVU). Methods Children underwent standard head and neck examination and cerumen removal by board certified otolaryngologists. Next, certified audiologists performed hearing screening with pure-tone audiometry using a circumaural headset but without an ambient noise reducing environment. Children failing audiometric screening underwent full behavioral audiometry including air and bone testing. The primary outcome parameter was HL > 25 dB with the audiologist accounting for background noise. A second endpoint was PTA >40 dB (500, 1000, 2000 Hz) without assessment of background noise. Results 107 HIV+ and 147 HIVU children met inclusion criteria. In the HIV + cohort 17.8% had evidence of TM perforations and 8.4% had otorrhea. In the HIVU group 2.7% had a TM perforation and 0% had otorrhea. Hearing was significantly worse in HIV + children. (Audiologist determination: 38.3% HL HIV+, 12.2% HIVU, Fisher's-Exact-Test OR: 4.5, 95% CI 2.4–8.3, p-value <0.0001; Worse-hearing-ear PTA > 40 dB: 19.6% HL HIV+, 6.1% HIVU, OR: 3.7, 95% CI 1.7–8.4, p-value <0.001). Conclusions Chronic OM, conductive and mixed hearing losses are significantly more common in HAART-treated HIV + children than in well, similarly-aged controls. Rates of SNHL are similar.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
To determine the prevalence of chronic ear disease in HIV+, highly active anti-retroviral therapy (HAART)-treated children and compare this to the prevalence in healthy children of similar age living ...in a similar setting.
From previous clinical work in Ethiopia, we suspected that chronic middle ear disease was common both in the general pediatric population and especially among children with HIV/AIDS. Few studies have examined the prevalence of chronic ear disease in HIV + children, particularly in those treated with HAART.
Full examination of the head and neck was performed by otolaryngologists. This including cleaning of cerumen, otoscopy and microscopic otoscopy when needed. Patient's medical records were reviewed. Presence or absence of tympanic membrane (TM) perforation (unilateral or bilateral), tympanosclerosis, TM atrophy, otorrhea and/or cholesteatoma was documented.
112 HIV+ and 162 healthy (HIVU) children were included. Prevalence of TM perforations was 17% in the HIV + infected versus 3% in the HIVU (Fisher's-Exact-Test; OR: 7.2, 95% CI 2.5–20, p-value <0.0001). Presence of unilateral TM perforations was 12% in the HIV + population and 2% in the HIVU population (Fisher's-Exact-Test; OR: 6.8, 95% CI 2.0–22, p-value 0.002). The presence of bilateral perforations was 4% in the HIV + population and 1% in the HIVU population (Fisher's-Exact-Test; OR: 6.8, 95% CI 1.1–42, p-value 0.088).
In the HIV + cohort, 2% were diagnosed with cholesteatoma compared to 0% in the HIVU population (95% CI HIV+ 0.002–0.06; HIVU 0.0–0.02) and 8% of HIV + subjects had active middle ear discharge, compared to 0% in the HIVU population (95% CI HIV+ 0.04–0.1; HIVU 0.0–0.02). Neither tympanosclerosis nor tympanic membrane atrophy was more frequent in the HIV + population compared to the HIVU population. Persistent or recurrent TM perforation was not more frequent in children with prior tympanoplasty in the HIV + population compared to the HIVU population.
TM perforations are significantly more common in HAART-treated HIV + children than in healthy, age-matched HIVU population. Otorrhea and cholesteatoma were found only in the HIV + cohort.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
The Rapid Assessment of Hearing Loss (RAHL) survey protocol aims to measure the prevalence and causes of hearing loss in a low cost and rapid manner, to inform planning of ear and hearing services. ...This paper reports on the first field-test of the RAHL in Gao'an County, Jiangxi Province, China. This study aimed to 1) To report on the feasibility of RAHL; 2) report on the estimated prevalence and causes of hearing loss in Gao'an.
A cross-sectional population-based survey was conducted in September-October 2018. Forty-seven clusters in Gao'an County were selected using probability-proportionate-to-size sampling. Within clusters, compact segment sampling was conducted to select 30 people aged 50+. A questionnaire was completed covering sociodemographics, hearing health, and risk factors. Automated pure-tone audiometry was completed for all participants, using smartphone-based audiometry (hearTest), at 0.5, 1, 2, 4 kHz (kHz). All participants had their ears examined by an Ear Nose and Throat (ENT) doctor, using otoscopy, and probable causes of hearing loss assigned. Prevalence estimates were age and sex standardised to the Jiangxi population. Feasibility of a cluster size of 30 was examined by assessing the response rate, and the proportion of clusters completed in 1 day.
1344 of 1421 eligible participants completed the survey (94.6%). 100% of clusters were completed in 1 day. The survey was completed in 4.5 weeks. The prevalence of moderate or greater hearing loss (pure-tone average of 0.5, 1, 2, 4 kHz of > = 41dBHL in the better ear) was 16.3% (95% CI = 14.3, 18.5) and for any level of hearing loss (pure-tone average of > = 26dBHL in the better ear) the prevalence was 53.2% (95% CI = 49.2, 57.1). The majority of hearing loss was due to acquired sensorineural causes (91.7% left; 92.1% right). Overall 54.0% of the population aged 50+ (108,000 people) are in need of diagnostic audiology services, 3.4% were in need of wax removal (7000 people), and 4.8% were in need of surgical services (9500 people). Hearing aid coverage was 0.4%.
The RAHL survey protocol is feasible, demonstrated through the number of people examined per day, and the high response rate. The survey was completed in a much shorter period than previous all-age surveys in China. Some remaining challenges included assignment of causes of probable sensorineural loss. The data obtained from this survey can be used to scale-up hearing services in Gao'an.
We have previously found linkage to chromosome 1p34 in five large families with autosomal dominant non-syndromic hearing impairment (DFNA2). In all five families, the connexin31 gene (GJB3), located ...at 1p34 and responsible for non-syndromic autosomal dominant hearing loss in two small Chinese families, has been excluded as the responsible gene. Recently, a fourth member of the KCNQ branch of the K+ channel family, KCNQ4, has been cloned. KCNQ4 was mapped to chromosome 1 p34 and a single mutation was found in three patients from a small French family with non-syndromic autosomal dominant hearing loss. In this study, we have analysed the KCNQ4 gene for mutations in our five DFNA2 families. Missense mutations altering conserved amino acids were found in three families and an inactivating deletion was present in a fourth family. No KCNQ4 mutation could be found in a single DFNA2 family of Indonesian origin. These results indicate that at least two and possibly three genes responsible for hearing impairment are located close together on chromosome 1p34 and suggest that KCNQ4 mutations may be a relatively frequent cause of autosomal dominant hearing loss.
Surgical blocking of the eustachian tube is presented as an ultimate treatment option in a 11-year-old suicidal boy with a therapy-resistant, persistent clicking tinnitus caused by myoclonus of the ...levator veli palatini.
An 11-year-old boy decompensated psychologically as a result of loud and objective tinnitus. The tinnitus could be heard easily by an examiner by bringing his own ear at a distance of approximately 20 to 30 cm to the left ear of the patient. No neurologic etiology for the tinnitus could be traced. Pediatric psychiatric evaluation resulted in a recommendation to perform, as a last resort, an experimental surgical option like blockage of the eustachian tube.
Treatment with Tegretol (Novartis, The Netherlands) had no effect. Treatment with Dysport (Ipsen) botulin toxin with 30 to 60 U was temporarily effective. Finally, 60 U were not effective anymore. As last refugium, a surgical blockage of the eustachian tube has been performed, first with bone cement and later by a more conventional surgical blockage of that bony tube.
After surgical blockage of the bony part of the eustachian tube, the objective tinnitus disappeared. Blockage of the protympanum by bone cement resulted in only 1 year of successful blocking. After recurrence of the tinnitus combined with aeration of the middle ear, a second surgical transcanal approach was successful in blocking the eustachian tube. With a grommet, the hearing level remained within 10 dB for 0.5 to 8.0 kHz.
Hereditary hearing impairment shows extreme genetic heterogeneity and more than 40 different loci have been reported. One of these, DFNA2, was localized to chromosome 1p34 on the basis of linkage ...analysis in two large families with autosomal dominant nonsyndromic hearing loss originating from Indonesia and the United States. Subsequently, hearing loss in three additional large families from Belgium and the Netherlands was found to map to the same region. Two different genes are now reported to be the `DFNA2' gene. In December's issue of Nature Genetics, Jia-Hui Xia and colleagues described two small Chinese families with nonsyndromic autosomal dominant hearing loss in which they found a missense and a nonsense mutation in GJB3, which encodes connexin 31 (ref. 3). As GJB3 is located on chromosome 1p34, it was proposed, in an accompanying News & Views that GJB3 is a good candidate for involvement in DFNA2 families. Extensive sequence analysis of the coding region and the 5 theta UTR of GJB3 in all 5 DFNA2 families revealed no mutations, however (data not shown). A recent report in Cell reports the identification of a novel member (KCNQ4) of the potassium channel family KCNQ, also located on chromosome 1p34. Its authors found its mutation to segregate with hearing loss in a small French family, and claimed the identification of the DFNA2 gene.
Full text
Available for:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
PDF
