%0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e47150 %T The Design and Evaluation of a Simulation Tool for Audiology Screening Education: Design Science Approach %A Gerdes,John %A Schooley,Benjamin %A Sharp,Dakota %A Miller,Juliana %+ Department of Integrated Information Technology, University of South Carolina, Bert Storey Innovation Center, Suite 1300, 550 Assembly Street, Columbia, SC, 29208, United States, 1 803 777 8529, jgerdes@sc.edu %K design science %K audiology %K simulation %K hearing screening %K framework %K speech pathology %K training %D 2025 %7 20.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The early identification of hearing loss and ear disorders is important. Regular screening is recommended for all age groups to determine whether a full hearing assessment is necessary and allow for timely treatment of hearing problems. Procedural training is needed for new speech-language pathology students as well as continuing education for those trained to perform this screening procedure. Limited availability and access to physical training locations can make it difficult to receive the needed training. Objective: The aims of this study were to (1) develop a new hearing screening simulation software platform and (2) assess its effectiveness in training a group of graduate-level speech-language pathology students in hearing screening procedures. Methods: An audiology simulator modeled after the commercial Grason-Stadler GSI39 combination audiometer and tympanometer device was developed to serve as a precursor to traditional face-to-face clinical instruction. A description of the simulator development process, guided by a design science approach, is presented. The initiation phase established the initial criteria for the simulator design. This was followed by an iterative process involving prototype development, review, and critique by the clinical faculty. This feedback served as input for the subsequent iteration. The evaluation of the final prototype involved 33 speech-language pathology graduate students as part of an introductory audiology class. These students were randomly assigned to control (receiving in-person instruction) and test (in-person instruction and simulation tool use) groups. Students in both groups were subsequently evaluated as they performed audiology screenings on human participants and completed a 25-item pretest and posttest survey. Nonparametric Mann-Whitney U tests were conducted on the mean differences between pretest and posttest ordinal survey response data to compare the control and intervention groups. Results: The results indicated that the students who used the simulation tool demonstrated greater confidence in their ability to (1) explain hearing screening procedures to a child (P=.02), (2) determine whether otoscopy results are normal (P=.02), and (3) determine whether otoscopy results are abnormal (P=.03). Open-ended responses indicated that the students found that the hands-on experience provided by the simulator resulted in an easy-to-use and useful learning experience with the audiometer, which increased their confidence in their ability to perform hearing screenings. Conclusions: Software-based education simulation tools for audiology screening may provide a beneficial approach to educating students and professionals in hearing screening training. The tool tested in this study supports individualized, self-paced learning with context-sensitive feedback and performance assessment, incorporating an extensible approach to supporting simulated subjects. %M 39977027 %R 10.2196/47150 %U https://formative.jmir.org/2025/1/e47150 %U https://doi.org/10.2196/47150 %U http://www.ncbi.nlm.nih.gov/pubmed/39977027 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59575 %T Continuous Improvement of Chronic Tinnitus Through a 9-Month Smartphone-Based Cognitive Behavioral Therapy: Randomized Controlled Trial %A Walter,Uso %A Pennig,Stefan %A Bleckmann,Lothar %A Röschmann-Doose,Kristina %A Wittig,Thomas %A Thomsen,Jörn %A Schlee,Winfried %+ G Pohl-Boskamp GmbH & Co KG, Kieler Straße 11, Hohenlockstedt, 25551, Germany, 49 4826 59 457, j.thomsen@pohl-boskamp.de %K tinnitus %K chronic tinnitus %K mobile health app %K mHealth %K mobile app %K application %K smartphone %K digital health %K digital technology %K digital intervention %K cognitive behavioral therapy %K randomized controlled trial %K statistical analysis %D 2025 %7 18.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Tinnitus is the perception of sound without an external auditive stimulus and can be a severe burden for affected patients. Medical guidelines recommend cognitive behavioral therapy (CBT) for tinnitus treatment, which effectively improves tinnitus-related distress and anxiety. Objective: This study investigates the outcome of a 9-month smartphone-based CBT for patients with tinnitus. Methods: The randomized controlled clinical trial in this study investigates the efficacy of a smartphone-based CBT for 187 patients with chronic tinnitus over a 9-month treatment period. In the initial 3 months, a waiting list design was applied, and in the subsequent study phase, the data of both treatment groups were collectively analyzed. The scores on the Tinnitus Questionnaire (TQ); 9-item Patient Health Questionnaire (PHQ-9); 9-item Self-Efficacy, Optimism, Pessimism (SWOP-K9) questionnaire; and 20-item Perceived Stress Questionnaire (PSQ-20) were assessed as endpoints after 3 and 9 months of treatment. Results: We observed a statistically significant reduction in the tinnitus burden in patients who received the smartphone-based CBT intervention. Although no changes were observed initially in the TQ sum scores in the waiting control group (baseline mean, 37.8, SD 4.7; 3 months mean 37.5, SD 4.8; analysis of covariance [ANCOVA] P=.52), the scores significantly decreased once the app-based CBT had commenced. Data pooled from both groups revealed significant reduction in the TQ sum score by 12.49 (SD 1.44) (ANCOVA, P<.001) and 18.48 (SD 1.85) (ANCOVA, P<.001) points after 3 and 9 months, respectively, which was also clinically important. The calculated Cohen d was 1.38. Similarly, the scores on PSQ-20 (–9.14 points; ANCOVA, P<.001), PHQ-9 (–2.47 points; ANCOVA, P<.001), and SWOP-K9 (0.17 points; ANCOVA, P<.001) were significantly improved at the end of the therapy, with corresponding intermediate effect sizes after 9 months. Conclusions: The data in our study provide evidence of statistically significant, clinically relevant, and continuous benefits of an app-based CBT intervention in patients with chronic tinnitus. Trial Registration: Deutsches Register Klinischer Studien DRKS00022973; https://drks.de/search/de/trial/DRKS00022973 %M 39965780 %R 10.2196/59575 %U https://www.jmir.org/2025/1/e59575 %U https://doi.org/10.2196/59575 %U http://www.ncbi.nlm.nih.gov/pubmed/39965780 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e55427 %T Sign Language Recognition System for Deaf Patients: Protocol for a Systematic Review %A Marcolino,Milena Soriano %A Oliveira,Lucca Fagundes Ramos %A Valle,Lucas Rocha %A Rosa,Luiza Marinho Motta Santa %A Reis,Zilma Silveira Nogueira %A Soares,Thiago Barbabela de Castro %A Bernardino,Elidéa Lúcia Almeida %A Cordeiro,Raniere Alislan Almeida %A Prates,Raquel Oliveira %A Campos,Mario Fernando Montenegro %+ Medical School, Universidade Federal de Ouro Preto, Rua Professor Paulo Magalhães, 122, Ouro Preto, 35400000, Brazil, 55 31998688135, fagundes.lucca8@gmail.com %K computer neural networks %K artificial intelligence %K biomedical technology %K communication aids for disabled %K computer vision %K sign language %K hearing loss %K deaf people %K communication barriers %K gestures %D 2025 %7 23.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Individuals with hearing impairments may face hindrances in health care assistance, which may significantly impact the prognosis and the incidence of complications and iatrogenic events. Therefore, the development of automatic communication systems to assist the interaction between this population and health care workers is paramount. Objective: This study aims to systematically review the evidence on communication systems using human-computer interaction techniques developed for deaf people who communicate through sign language that are already in use or proposed for use in health care contexts and have been tested with human users or videos of human users. Methods: A systematic review will be performed based on a literature search in MEDLINE, Web of Science, ACM, and IEEE Xplore as well as top-tiered conferences in the area to identify relevant studies. The inclusion criteria are the description of the development of a sign language recognition system in a health care context and the testing with human users. Independent investigators (LFRO, LRV, and LMMSR) will screen eligible studies, and disagreements will be solved by a senior researcher (MSM). The included papers will undergo full-text screening. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flow diagram will be presented to visually summarize the screening process, ensuring clarity and transparency in presenting the results. Additionally, a comprehensive chart table will be constructed to consolidate essential data related to the key variables extracted from the studies. These results will be meticulously analyzed and presented descriptively, offering insightful interpretations of the information encapsulated within the table. Results: A preliminary search was performed in April 2024. Researchers concluded the study selection by July 2024. Data extraction, synthesis, report, and recommendations are expected to be finished by February 2025. Conclusions: This systematic review will identify human-machine systems that enable communication in health services involving deaf patients, presenting the framework that includes usability and application in human contexts. We will present a comprehensive panel of findings, highlighting systems used to tackle communication barriers and offer a narrative comparison of current implementation practices. International Registered Report Identifier (IRRID): PRR1-10.2196/55427 %M 39847417 %R 10.2196/55427 %U https://www.researchprotocols.org/2025/1/e55427 %U https://doi.org/10.2196/55427 %U http://www.ncbi.nlm.nih.gov/pubmed/39847417 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e65142 %T Evaluating the Safety and Usability of an Over-the-Counter Medical Device for Adults With Mild to Moderate Hearing Loss: Formative and Summative Usability Testing %A Salwei,Megan Elizabeth %A Anders,Shilo %A Reale,Carrie %A Slagle,Jason M %A Ricketts,Todd %A Weinger,Matthew B %K usability %K human factors %K patient safety %K over-the-counter hearing aids %K direct-to-consumer hearing aids %K medical device %K hearing loss %K adult %K hearing impairment %K hearing aid use %K hearing care %K formative usability test %K safety %K mobile phone %D 2025 %7 20.1.2025 %9 %J JMIR Hum Factors %G English %X Background: Only 15% of the nearly 30 million Americans with hearing loss use hearing aids, partly due to high cost, stigma, and limited access to professional hearing care. Hearing impairment in adults can lead to social isolation and depression and is associated with an increased risk of falls. Given the persistent barriers to hearing aid use, the Food and Drug Administration issued a final rule to allow over-the-counter hearing aids to be sold directly to adult consumers with perceived mild to moderate hearing loss at pharmacies, stores, and online retailers without seeing a physician or licensed hearing health care professional. Objective: We evaluated the safety and usability of an over-the-counter hearing aid prior to Food and Drug Administration approval and market release. Methods: We first conducted a formative usability test of the device and associated app with 5 intended users to identify outstanding safety and usability issues (testing round 1). Following design modifications, we performed a summative usability test with 15 intended users of the device (testing round 2). We concurrently conducted a test with 21 nonintended users (ie, users with contraindications to use) to ascertain if consumers could determine when they should not use the device, based on the packaging, instructions, and labeling (testing round 3). Participants were asked to complete 2‐5 tasks, as if they were using the hearing aid in real life. After each task, participants rated the task difficulty. At the end of each session, participants completed a 10-question knowledge assessment and the System Usability Scale and then participated in debriefing interviews to gather qualitative feedback. All sessions were video recorded and analyzed to identify use errors and design improvement opportunities. Results: Usability issues were identified in all 3 usability testing rounds. There were minimal safety-related issues with the device. Round 1 testing led to several design modifications which then increased task success in round 2 testing. Participants had the most difficulty with the task of pairing the hearing aids to the cell phone. Participants also had difficulty distinguishing the right and left earbuds. Nonintended users did not always understand device contraindications (eg, tinnitus and severe hearing loss). Overall, test findings informed 9 actionable design modifications (eg, clarifying pairing steps and increasing font size) that improved device usability and safety. Conclusions: This study evaluated the usability and safety of an over-the-counter hearing aid for adults with mild to moderate hearing loss. Human factors engineering methods identified opportunities to improve the safety and usability of this direct-to-consumer medical device for individuals with perceived mild-moderate hearing loss. %R 10.2196/65142 %U https://humanfactors.jmir.org/2025/1/e65142 %U https://doi.org/10.2196/65142 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60150 %T Digital Frequency Customized Relieving Sound for Chronic Subjective Tinnitus Management: Prospective Controlled Study %A Tang,Dongmei %A Peng,Yuzhu %A Gu,Dantong %A Wu,Yongzhen %A Li,Huawei %+ ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China, 86 13023299189, tang.dongm@163.com %K tinnitus %K digital frequency customized relieving sound %K unmodified music %K sound therapy %K prospective study %K mobile phone %D 2025 %7 17.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Tinnitus is a major health issue, but currently no tinnitus elimination treatments exist for chronic subjective tinnitus. Acoustic therapy, especially personalized acoustic therapy, plays an increasingly important role in tinnitus treatment. With the application of smartphones, personalized acoustic stimulation combined with smartphone apps will be more conducive to the individualized treatment and management of patients with tinnitus. Objective: The aim of this study was to evaluate the efficacy of a new personalized approach known as the digital frequency customized relieving sound (DFCRS) for tinnitus treatment and to explore the factors that may influence its therapeutic effect. Methods: Patients with subjective tinnitus were enrolled in this study from July 14, 2020, to May 24, 2021, in the tinnitus specialist clinic of Eye and ENT Hospital, Fudan University, Shanghai, China. In this nonrandomized concurrent controlled trial, a total of 107 participants were assigned to listen to personalized DFCRS through our developed app, while the other 77 participants who did not want to download and use the app were assigned to listen to unmodified music (UM). All the recruits were instructed to listen to DFCRS or UM for at least 2 hours a day and complete follow-up assessments at baseline, 1, 2, and 3 months. Multidimensional assessment scales, that is, Tinnitus Handicapped Inventory (THI), Hospital Anxiety and Depression Scale (HADS), Athens Insomnia Scale (AIS), Fear of Tinnitus Questionnaire (FTQ), and Tinnitus Catastrophizing Scale (TCS) were used to evaluate the severity of tinnitus and the quality of life. Linear mixed models were used to test for changes in the THI scores across 3 months of acoustic treatment between group (DFCRS or UM treatment) and time. A multiclass logistic model was built with a stepwise function to determine the influence of the different covariates on the effects of acoustic treatment. Results: The results of the multidimensional assessment scales after 3 months of treatment showed that DFCRS-treated patients had significant tinnitus relief compared to those in the UM group. Linear mixed models revealed a significant reduction in the THI scores over time (P<.001), with the DFCRS group showing significantly greater improvement than the UM group (P<.001). At 3 months, 92.5% (99/107) of the patients undergoing DFCRS reported tinnitus relief or disappearance, and longer daily treatment time was associated with better outcomes (P=.007). Multiclass logistic regression confirmed that longer treatment time (odds ratio [OR] 13.07-64.78; P<.001) and more severe tinnitus at baseline (OR 10.46-83.71; P<.001) predicted better treatment response. All secondary outcomes (HADS, AIS, FTQ, TCS) showed significant improvements over time (P<.001). Conclusions: Our study suggests that DFCRS is a new promising and noninvasive therapy for chronic tinnitus, and it can be delivered through a mobile app to bring more convenience to patients with tinnitus. %M 39823588 %R 10.2196/60150 %U https://www.jmir.org/2025/1/e60150 %U https://doi.org/10.2196/60150 %U http://www.ncbi.nlm.nih.gov/pubmed/39823588 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e53460 %T Development and Beta Validation of an mHealth-Based Hearing Screener (SRESHT) for Young Children in Resource-Limited Countries: Pilot Validation Study %A Ramkumar,Vidya %A Joshi B,Deepashree %A Prabhakar,Anil %A Hall,James W %A Vaidyanath,Ramya %+ Faculty of Audiology and Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research, Sri Ramachandra Nagar, Porur, Chennai, 600116, India, 91 9894170609, deepasrijoshi25@sriramachandra.edu.in %K audiometry %K mHealth %K devices %K wireless %K tablet-based screening %K childhood hearing loss %K early hearing detection and intervention %K tablets %K children %K neonates %K hearing loss %K infants %K development %K validation %K mobile phones %D 2025 %7 13.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of hearing loss in infants in India varies between 4 and 5 per 1000. Objective-based otoacoustic emissions and auditory brainstem response have been used in high-income countries for establishing early hearing screening and intervention programs. Nevertheless, the use of objective screening tests in low- and middle-income countries (LMICs) such as India is not feasible. Mobile health (mHealth) solutions have been demonstrated to be a viable option for hearing screening in LMICs. Objective: This study aims to develop and beta-validate an affordable hearing screener for children younger than 6 years of age to identify moderately severe or higher degrees of hearing loss. Methods: In phase 1, a mHealth-based hearing screener (SRESHT) was developed using a single board computer with wireless commercial headphones and speakers as transducers, which were calibrated according to the standard procedure. Three subjective hearing screening modules were conceptualized and developed for different age groups: (1) behavioral observation audiometry–screening for infants aged from 0 to 1 year; (2) speech spectrum awareness task–screening for children 1 to 3 years old; and (3) speech recognition task–screening for children 3 to 6 years old. Different auditory stimuli for the screening modules were generated and suitability was assessed: (1) noisemakers, animal sounds, and environmental sounds for infants (birth to 1 year old); (2) animal sounds and nonsense syllables for children (1 to 3 years old); and (3) eighteen picturable spondee words for children (3 to 6 years old). In phase 2, the SRESHT screener was beta-validated in children aged below 6 years to establish the agreement between SRESHT modules and the gold-standard procedure in identifying moderately severe and higher degrees of hearing loss. Results: Off-the-shelf commercial speakers and headphones were selected and calibrated. On comparison of stimuli for behavioral observation audiometry on 15 children, Noisemaker stimuli were found suitable based on the average minimum response levels. On comparison of different stimuli for speech spectrum awareness task on 15 children, animal sounds were found to be suitable. On familiarity check of 18 spondee words for speech recognition task among 20 children, 12 spondee words had the eligibility cutoff (85%) and a presentation level of 5 dB SL (re-pure tone threshold) was sufficient to achieve 80% psychometric function. In phase 2, a total of 55 children aged 0 to 6 years (31 normal hearing and 24 hearing impairment) underwent SRESHT screening for beta validation. Cohen κ indicated that the overall SRESHT screener had a very good agreement (κ=0.82) with gold-standard audiometric screening for identifying moderately severe and higher degrees of hearing loss. Conclusions: The development and beta validation of the SRESHT screener using the selected auditory stimuli showed that the stimuli were suitable for screening children. %M 39805111 %R 10.2196/53460 %U https://formative.jmir.org/2025/1/e53460 %U https://doi.org/10.2196/53460 %U http://www.ncbi.nlm.nih.gov/pubmed/39805111 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58444 %T Reliable Web-Based Auditory Cognitive Testing: Observational Study %A Lad,Meher %A Taylor,John-Paul %A Griffiths,Timothy David %+ Translational and Clinical Research Institute, Newcastle University, Auditory Laboratory, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom, 44 0191 208 6000, meher.lad@newcastle.ac.uk %K auditory testing %K hearing loss %K cognitive testing %K auditory %K observational study %K older adult %K hearing %K questionnaire %K auditory cognitive testing %K in person %K web-based setting %K auditory memory %K Pearson %K female %K women %K audiology %D 2024 %7 9.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based experimentation, accelerated by the COVID-19 pandemic, has enabled large-scale participant recruitment and data collection. Auditory testing on the web has shown promise but faces challenges such as uncontrolled environments and verifying headphone use. Prior studies have successfully replicated auditory experiments but often involved younger participants, limiting the generalizability to older adults with varying hearing abilities. This study explores the feasibility of conducting reliable auditory cognitive testing using a web-based platform, especially among older adults. Objective: This study aims to determine whether demographic factors such as age and hearing status influence participation in web-based auditory cognitive experiments and to assess the reproducibility of auditory cognitive measures—specifically speech-in-noise perception and auditory memory (AuM)—between in-person and web-based settings. Additionally, this study aims to examine the relationship between musical sophistication, measured by the Goldsmiths Musical Sophistication Index (GMSI), and auditory cognitive measures across different testing environments. Methods: A total of 153 participants aged 50 to 86 years were recruited from local registries and memory clinics; 58 of these returned for web-based, follow-up assessments. An additional 89 participants from the PREVENT cohort were included in the web-based study, forming a combined sample. Participants completed speech-in-noise perception tasks (Digits-in-Noise and Speech-in-Babble), AuM tests for frequency and amplitude modulation rate, and the GMSI questionnaire. In-person testing was conducted in a soundproof room with standardized equipment, while web-based tests required participants to use headphones in a quiet room via a web-based app. The reproducibility of auditory measures was evaluated using Pearson and intraclass correlation coefficients, and statistical analyses assessed relationships between variables across settings. Results: Older participants and those with severe hearing loss were underrepresented in the web-based follow-up. The GMSI questionnaire demonstrated the highest reproducibility (r=0.82), while auditory cognitive tasks showed moderate reproducibility (Digits-in-Noise and Speech-in-Babble r=0.55 AuM tests for frequency r=0.75 and amplitude modulation rate r=0.44). There were no significant differences in the correlation between age and auditory measures across in-person and web-based settings (all P>.05). The study replicated previously reported associations between AuM and GMSI scores, as well as sentence-in-noise perception, indicating consistency across testing environments. Conclusions: Web-based auditory cognitive testing is feasible and yields results comparable to in-person testing, especially for questionnaire-based measures like the GMSI. While auditory tasks demonstrated moderate reproducibility, the consistent replication of key associations suggests that web-based testing is a viable alternative for auditory cognition research. However, the underrepresentation of older adults and those with severe hearing loss highlights a need to address barriers to web-based participation. Future work should explore methods to enhance inclusivity, such as remote guided testing, and address factors like digital literacy and equipment standards to improve the representativeness and quality of web-based auditory research. %M 39652871 %R 10.2196/58444 %U https://www.jmir.org/2024/1/e58444 %U https://doi.org/10.2196/58444 %U http://www.ncbi.nlm.nih.gov/pubmed/39652871 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e55231 %T Incorporating an Intelligent Tutoring System Into a Game-Based Auditory Rehabilitation Training for Adult Cochlear Implant Recipients: Algorithm Development and Validation %A Gnadlinger,Florian %A Werminghaus,Maika %A Selmanagić,André %A Filla,Tim %A Richter,Jutta G %A Kriglstein,Simone %A Klenzner,Thomas %+ Faculty of Informatics, Masaryk University, Botanická 68a, Brno, 602 00, Czech Republic, 420 549 49 ext 4382, florian.gnadlinger@mail.muni.cz %K cochlear implant %K eHealth %K evidence-centered design %K hearing rehabilitation %K adaptive learning %K intelligent tutoring system %K game-based learning %D 2024 %7 3.12.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Cochlear implants are implanted hearing devices; instead of amplifying sounds like common hearing aids, this technology delivers preprocessed sound information directly to the hearing (ie, auditory) nerves. After surgery and the first cochlear implant activation, patients must practice interpreting the new auditory sensations, especially for language comprehension. This rehabilitation process is accompanied by hearing therapy through face-to-face training with a therapist, self-directed training, and computer-based auditory training. Objective: In general, self-directed, computer-based auditory training tasks have already shown advantages. However, compliance of cochlear implant recipients is still a major factor, especially for self-directed training at home. Hence, we aimed to explore the combination of 2 techniques to enhance learner motivation in this context: adaptive learning (in the form of an intelligent tutoring system) and game-based learning (in the form of a serious game). Methods: Following the suggestions of the evidence-centered design framework, a domain analysis of hearing therapy was conducted, allowing us to partially describe human hearing skill as a probabilistic competence model (Bayesian network). We developed an algorithm that uses such a model to estimate the current competence level of a patient and create training recommendations. For training, our developed task system was based on 7 language comprehension task types that act as a blueprint for generating tasks of diverse difficulty automatically. To achieve this, 1053 audio assets with meta-information labels were created. We embedded the adaptive task system into a graphic novel–like mobile serious game. German-speaking cochlear implant recipients used the system during a feasibility study for 4 weeks. Results: The 23 adult participants (20 women; 3 men) fulfilled 2259 tasks. In total, 2004 (90.5%) tasks were solved correctly, and 255 (9.5%) tasks were solved incorrectly. A generalized additive model analysis of these tasks indicated that the system adapted to the estimated competency levels of the cochlear implant recipients more quickly in the beginning than at the end. Compared with a uniform distribution of all task types, the recommended task types differed (χ²6=86.713; P<.001), indicating that the system selected specific task types for each patient. This is underlined by the identified categories for the error proportions of the task types. Conclusions: This contribution demonstrates the feasibility of combining an intelligent tutoring system with a serious game in cochlear implant rehabilitation therapies. The findings presented here could lead to further advances in cochlear implant care and aural rehabilitation in general. Trial Registration: German Clinical Trials Register (DRKS) DRKS00022860; https://drks.de/search/en/trial/DRKS00022860 %M 39626219 %R 10.2196/55231 %U https://games.jmir.org/2024/1/e55231 %U https://doi.org/10.2196/55231 %U http://www.ncbi.nlm.nih.gov/pubmed/39626219 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e64590 %T Video Remote Sign Language Interpreting in Health Communication for Deaf People: Protocol for a Randomized Controlled Trial %A Rivas Velarde,Minerva %A Izquierdo Martinez,Laura Catalina %A Dalal,Jyoti %A Martinez-R,Angela %A Cruz Reyes,Danna Lesley %A Cuculick,Jess %A Vallejo-Silva,Alexie %A Irreño-Sotomonte,Jonathan %A Groce,Nora %+ School Of Health Science, University of Applied Sciences and Arts Western, Avenue de Champel 47, 1206 Geneva, 27, Geneva, 1206, Switzerland, 41 0774562383, minerva.rivas@hesge.ch %K assistive technology %K video remote interpretation %K deaf %K disability %K communication %K healthcare %D 2024 %7 2.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The current standard of interpretation provision is not efficacious or not acceptable to Deaf patients who communicate using sign language. In-person or video relay interpretation (VRI) sign language interpretation is largely unavailable. There are no clear data on the availability of VRI or in-person interpretation. Given the limited number of available sign language interpreters and the cost, VRI may be more available than in-person. Existing evidence tends to focus on assessing personal preferences of Deaf users regarding interpretation and interpreters’ preferences. Although respecting preferences is essential, there is a vacuum of knowledge on how the format of access to interpretation impacts the quality of communication between Deaf persons and health personnel. Objective: This study aims to look at the effectiveness of the VRI system in improving communication outcomes between Deaf patients and doctors versus the available standard of care of the usual communication tools, including informal interpretation, lip- or note-reading, and using their mobile phones to contact a formal or informal interpreter, for Deaf patients aged 18 years and older in Bogota, Colombia. Methods: This is a randomized controlled trial with a total sample size of 216 participants, divided into 2 groups: an intervention group, which receives a medical appointment using VRI, and a control group, which receives a medical appointment using standard communication. Both the Deaf participants and the health care professionals will be blinded to the allocation, as they will not know whether the appointment will involve VRI or standard communication until they arrive at the office. The primary outcome measure will be an assessment of communication using a Doctor-Patient Communication Scale. This scale was translated into Colombian Sign Language following a rigorous cultural adaptation and translation procedure. Furthermore, the database contains key clinical variables and recommendations provided by the doctor during a general medicine appointment. We will compute associations. Results: Recruitment opened on August 24, 2023. As of July 2024, 180 participants had been enrolled. The intervention and data collection were finalized in October 2024. The findings of this study are expected to be submitted for publication in early 2025. Conclusions: This study will provide rigorous evidence regarding information and communications technology intervention in health care, addressing empirical challenges in using inclusive research designs in public health. In addition, effective VRI models that address the challenges faced by Deaf people will be tested, implemented, and maintained in low- and middle-income countries. A disability-inclusive evaluative tool for quality communication mediated by VRI in health care is also tested. Ultimately, this will lead to evidence-based recommendations for implementing the Convention on the Rights of Persons with Disabilities (CRPD) in mobile health contexts. Trial Registration: ClinicalTrials.gov NCT05966623; https://clinicaltrials.gov/study/NCT05966623 International Registered Report Identifier (IRRID): DERR1-10.2196/64590 %R 10.2196/64590 %U https://www.researchprotocols.org/2024/1/e64590 %U https://doi.org/10.2196/64590 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57851 %T Epidemiological Characteristics and Spatiotemporal Analysis of Occupational Noise–Induced Deafness From 2006 to 2022 in Guangdong, China: Surveillance Study %A Zhou,Shanyu %A Huang,Yongshun %A Chen,Lin %A Wen,Xianzhong %A Wang,Shu %A Huang,Lang %A Li,Xudong %K occupational noise-induced deafness %K epidemiological characteristics %K joinpoint regression %K spatial autocorrelation %K Guangdong %K noise-induced %K deafness %K hearing loss %K hearing impairment %K occupational noise %K noise %K ONID %K China %K epidemiology %K spatiotemporal analysis %K comprehensive analysis %K occupational diseases %K policy formulation %K health resource %K surveillance %K Moran's I %K spatial %K clustering %K public health %K teleaudiology %K audiology %D 2024 %7 29.11.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Occupational noise–induced deafness (ONID) has replaced occupational poisoning as the second most common occupational disease in China since 2015. However, there is a limited number of articles on epidemiological characteristics of legally diagnosed ONID. Objective: We conducted a comprehensive analysis of the epidemiological and spatiotemporal characteristics of ONID in Guangdong Province from 2006 to 2022, with the aim of providing a scientific foundation for policy formulation and health resource allocation. Methods: Surveillance data of ONID cases in Guangdong Province from 2006 to 2022 were obtained from the “Occupational Diseases and Health Hazard Factors Monitoring Information System.” Joinpoint regression analysis was applied to assess the long-term trends in cases of ONID from 2006 to 2022. Global spatial autocorrelation analysis was performed to measure the overall degree of similarity of the attribute values of spatially adjacent or neighboring regional units. The local indicators of spatial autocorrelation (LISA) plots were then used to identify the local clusters of ONID in Guangdong. Results: There were 3761 ONID cases in Guangdong Province from 2006 to 2022, showing a significantly increased trend in cases across the entire study period (average annual percentage change 21.9, 95% CI 18.7-35.1). The Moran’s I values for the period of 2006 to 2022 ranged from 0.202 to 0.649 (all P<.001), indicating a positive spatial correlation of ONID across regions each year in Guangdong Province. A total of 15 high-high clusters were notably concentrated in specific counties within the Pearl River Delta. Conclusions: Significant spatiotemporal patterns of ONID in Guangdong Province from 2006 to 2022 were identified, characterized by a dramatic increase followed by stabilization in case numbers. ONID predominantly occur in manufacturing industries, domestically funded enterprises, among males, individuals aged 40‐49 years, and those with 5+ years of occupational noise exposure. Spatial analysis demonstrated significant clustering in the Pearl River Delta region, with consistent positive spatial autocorrelation across years. These results could help prioritize the allocation of resources for targeted prevention and control measures for ONID. %R 10.2196/57851 %U https://publichealth.jmir.org/2024/1/e57851 %U https://doi.org/10.2196/57851 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e60373 %T Optimizing a Classification Model to Evaluate Individual Susceptibility in Noise-Induced Hearing Loss: Cross-Sectional Study %A Li,Shiyuan %A Yu,Xiao %A Ma,Xinrong %A Wang,Ying %A Guo,Junjie %A Wang,Jiping %A Shen,Wenxin %A Dong,Hongyu %A Salvi,Richard %A Wang,Hui %A Yin,Shankai %K noise-induced hearing loss %K susceptible %K resistance %K machine learning algorithms %K linear regression %K extended high frequencies %K phenotypic characteristics %K genetic heterogeneity %D 2024 %7 14.11.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Noise-induced hearing loss (NIHL), one of the leading causes of hearing loss in young adults, is a major health care problem that has negative social and economic consequences. It is commonly recognized that individual susceptibility largely varies among individuals who are exposed to similar noise. An objective method is, therefore, needed to identify those who are extremely sensitive to noise-exposed jobs to prevent them from developing severe NIHL. Objective: This study aims to determine an optimal model for detecting individuals susceptible or resistant to NIHL and further explore phenotypic traits uniquely associated with their susceptibility profiles. Methods: Cross-sectional data on hearing loss caused by occupational noise were collected from 2015 to 2021 at shipyards in Shanghai, China. Six methods were summarized from the literature review and applied to evaluate their classification performance for susceptibility and resistance of participants to NIHL. A machine learning (ML)–based diagnostic model using frequencies from 0.25 to 12 kHz was developed to determine the most reliable frequencies, considering accuracy and area under the curve. An optimal method with the most reliable frequencies was then constructed to detect individuals who were susceptible versus resistant to NIHL. Phenotypic characteristics such as age, exposure time, cumulative noise exposure, and hearing thresholds (HTs) were explored to identify these groups. Results: A total of 6276 participants (median age 41, IQR 33‐47 years; n=5372, 85.6% men) were included in the analysis. The ML-based NIHL diagnostic model with misclassified subjects showed the best performance for identifying workers in the NIHL-susceptible group (NIHL-SG) and NIHL-resistant group (NIHL-RG). The mean HTs at 4 and 12.5 kHz showed the highest predictive value for detecting those in the NIHL-SG and NIHL-RG (accuracy=0.78 and area under the curve=0.81). Individuals in the NIHL-SG selected by the optimized model were younger than those in the NIHL-RG (median 28, IQR 25‐31 years vs median 35, IQR 32‐39 years; P<.001), with a shorter duration of noise exposure (median 5, IQR 2‐8 years vs median 8, IQR 4‐12 years; P<.001) and lower cumulative noise exposure (median 90, IQR 86‐92 dBA-years vs median 92.2, IQR 89.2‐94.7 dBA-years; P<.001) but greater HTs (4 and 12.5 kHz; median 58.8, IQR 53.8‐63.8 dB HL vs median 8.8, IQR 7.5‐11.3 dB HL; P<.001). Conclusions: An ML-based NIHL diagnostic model with misclassified subjects using the mean HTs of 4 and 12.5 kHz was the most reliable method for identifying individuals susceptible or resistant to NIHL. However, further studies are needed to determine the genetic factors that govern NIHL susceptibility. Trial Registration: Chinese Clinical Trial Registry ChiCTR-RPC-17012580; https://www.chictr.org.cn/showprojEN.html?proj=21399 %R 10.2196/60373 %U https://publichealth.jmir.org/2024/1/e60373 %U https://doi.org/10.2196/60373 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59894 %T Over-the-Counter Hearing Aids Versus Traditional Hearing Aids in Patients With Mild-to-Moderate Hearing Loss: Protocol for a Noninferiority Randomized Controlled Trial %A Kim,Ga-Young %A Jo,Mini %A Cho,Young Sang %A Moon,Il Joon %+ Department of Otorhinolaryngology - Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, 81, Irwon-ro, Seoul, 06342, Republic of Korea, 82 3410 3579, moonij@skku.edu %K hearing aids %K over-the-counter hearing aids %K correction of hearing impairment %K randomized controlled trial %K evidence-based medicine %K hearing loss %K aging %K hearing sensitivity %K mobile phone %D 2024 %7 25.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: With the aging of society, the prevalence of hearing loss (HL) is increasing. Currently, approximately 5% of the global population has HL, and this number is projected to reach 7 million by 2050. Although hearing aids (HAs) are the primary treatment for HL, their use is limited by barriers such as high costs and social stigma. To address these limitations, over-the-counter (OTC) HAs have been introduced, but their effectiveness and drawbacks require further investigation. Objective: This study aims to conduct a noninferiority randomized controlled trial comparing OTC HAs with traditional HAs to assess the clinical effectiveness of OTC HAs. Methods: We designed a noninferiority randomized controlled trial comparing OTC HAs and traditional HAs in adults with mild-to-moderate HL. A total of 64 participants (32 per group) will be recruited. Randomization will be performed using block randomization (block sizes of 2 or 4) with an equal allocation ratio. The study will include 2 types of HAs: an OTC HA (Jabra Enhance Pro) and a traditional HA (LiNX Quattro LE561-DRW) by GN ReSound A/S. OTC HAs will be self-fitted using a smartphone app, while traditional HAs will be fitted by a licensed audiologist using the National Acoustics Laboratories–Non-Linear Prescription, second generation. Assessments, including functional gain, real-ear measurement, speech audiometry, and questionnaires, will be conducted at 6-month intervals over the course of 3 visits. Statistical analysis will compare the 2 outcomes, focusing on functional gain, to determine noninferiority. Results: This study is scheduled to begin in August 2024 and has not yet recruited any participants. The study will be conducted over 2 years, from August 2024 to July 2026. Each participant will have 2 follow-up visits at 6-month intervals, making the total follow-up period 1 year. Conclusions: Since 2022, the introduction of OTC HAs has revolutionized access to these devices. Researchers, clinicians, and the general public are keen to evaluate the clinical effectiveness of OTC HAs, as more individuals will likely use them for HL. This increased usage will provide valuable real-world data to understand the benefits and limitations of OTC HAs. Monitoring the outcomes and user feedback will provide insights into their effectiveness and impact on hearing rehabilitation. International Registered Report Identifier (IRRID): PRR1-10.2196/59894 %M 39454188 %R 10.2196/59894 %U https://www.researchprotocols.org/2024/1/e59894 %U https://doi.org/10.2196/59894 %U http://www.ncbi.nlm.nih.gov/pubmed/39454188 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55089 %T Ayurvedic Management of Presbycusis (Project TOPMAC): Protocol for an Exploratory Randomized Controlled Trial %A V,Krishna Kumar %A Thomas,Sanjeev V %A C Nair,Murugan %A Nair,Parvathy G %A L,Nisha M %A S,Anuradha %A Tripathi,Arunabh %A Mundada,Pallavi %A Yadav,Babita %A Rao,B C S %A D,Sudhakar %A N,Srikanth %+ Central Council for Research in Ayurvedic Sciences, D Block, Janakpuri Institutional Area, New Delhi, 110058, India, 91 7306892140, drkkempran@gmail.com %K presbycusis %K Karnapurana %K Kshirabala Taila %K Rasayana %K Withania somnifera (L.) Dunal %K age-related hearing loss %K hearing loss %K sensorineural %K auditory information %K older adults %K older adult %K geriatrics %K tinnitus %K population-based %K cognitive deterioration %K topical oil pooling %K efficacy %K TOPMAC %K intervention %K hearing status %K effectiveness %K Ayurveda %D 2024 %7 23.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Presbycusis is characterized by sensorineural hearing loss in both ears at high frequencies, which affects more than half of the older adults by the age of 75 years and is often accompanied by tinnitus and cognitive deterioration. Unfortunately, there are no treatments available to restore hearing loss. Treatment mainly focuses on improving the quality of life and communication with hearing aids. Traditional medicine like Ayurveda also explains ailments of a similar nature as Badhirya and advises using drugs with antiaging and neuroprotective activity for treatment. In Ayurveda, Badhirya and Karnanada (senile deafness with tinnitus) are due to vitiation of Vata Dosha. Treatments such as topical oil pooling (Karnapurana) are usually advised to counter Vata, improve hearing capacity, and reduce tinnitus. Kshirabala Taila, a medicated oil formulation prepared with Sida cordifolia Linnaeus, is one of the most preferred oils for topical oil pooling in such conditions, as it has a definitive indication for sensory dysfunctions. Drugs like Withania somnifera (L.) Dunal (Ashwagandha) are also used, as they ameliorate neurodegeneration and help to improve cognitive dysfunction. Objective: We propose an exploratory randomized controlled trial study for evaluating the efficacy of TOPMAC (Topical Oil Pooling with Kshirabala Taila and Supplementation of Ashwagandha Churna) in tinnitus suppression and hearing and cognitive function protection in patients aged 60-75 years with mild to moderate presbycusis. Methods: A parallel, 2-group, exploratory randomized controlled trial will be conducted in an Indian Ayurvedic research center at its outpatient service. Participants (N=60) with mild to moderate presbycusis will be recruited by screening. Participants will be randomized (computer-generated 1:1) to receive either basic treatment and health education (BTHE) or BTHE+TOPMAC for 24 weeks. The primary objective is to compare the efficacy of TOPMAC with that of BTHE in the protection of hearing function. The secondary objective is to compare the efficacy of TOPMAC with that of BTHE in tinnitus suppression and cognitive function protection. Results: This project was funded in January 2023. The institutional ethics committees at National Ayurveda Research Institute for Panchakarma (3/1/2020/NARIP/Tech/2036) and Institute for Communicative and Cognitive Neuro Sciences (IEC006) approved this study. The first patient was enrolled in September 2023; 22 participants were enrolled as of August 2024. The data analysis is yet to start, and the results are expected to be published by January 2025. Conclusions: If this exploratory trial is proven effective, it will steer the setting of a definitive randomized controlled trial to test whether the TOPMAC intervention can be incorporated as a cost-effective integrative approach for managing presbycusis. The Indian government has already launched a National Program for Prevention and Control of Deafness to benefit the deaf population. TOPMAC may later be considered for integration with the national program. Trial Registration: Clinical Trials Registry India CTRI/2023/04/051485; https://tinyurl.com/2h2hry3n International Registered Report Identifier (IRRID): DERR1-10.2196/55089 %M 39312772 %R 10.2196/55089 %U https://www.researchprotocols.org/2024/1/e55089 %U https://doi.org/10.2196/55089 %U http://www.ncbi.nlm.nih.gov/pubmed/39312772 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e59315 %T Enabling People With Intellectual and Sensory Disabilities to Trigger a Tablet’s Delivery of Task Instructions by Walking to the Tablet: Proof-of-Concept Study %A Lancioni,Giulio E %A Singh,Nirbhay N %A O’Reilly,Mark F %A Sigafoos,Jeff %A Alberti,Gloria %A Orlando,Isabella %A Chiariello,Valeria %A Desideri,Lorenzo %+ Lega F D’Oro Research Center, Via Linguetta 3, Osimo, 60027, Italy, 39 3408323465, giulio.lancioni@uniba.it %K technology %K tablet %K task %K instructions %K intellectual disability, visual impairment, hearing impairment %D 2024 %7 12.6.2024 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: People with intellectual and sensory or sensory-motor disabilities tend to have problems performing multistep tasks. To alleviate their problems, technological solutions have been developed that provide task-step instructions. Instructions are generally delivered at people’s request (eg, as they touch an area of a computer or tablet screen) or automatically, at preset intervals. Objective: This study carried out a preliminary assessment of a new tablet-based technology system that presented task-step instructions when participants with intellectual and sensory disabilities walked close to the tablet (ie, did not require participants to perform fine motor responses on the tablet screen). Methods: The system entailed a tablet and a wireless camera and was programmed to present instructions when participants approached the tablet, that is, when the camera positioned in front of the tablet detected them. Two instructions were available for each task step. One instruction concerned the object(s) that the participants were to collect, and the other instruction concerned the “where” and “how” the object(s) collected would need to be used. For 3 of the six participants, the two instructions were presented in succession, with the second instruction presented once the required object(s) had been collected. For the other 3 participants, the two instructions were presented simultaneously. Instructions consisted of pictorial representations combined with brief verbal phrases. The impact of the system was assessed for each of the 2 groups of participants using a nonconcurrent multiple baseline design across individuals. Results: All participants were successful in using the system. Their mean frequency of correct task steps was close to or above 11.5 for tasks including 12 steps. Their level of correct performance tended to be much lower during the baseline phase when they were to receive the task-step instructions from a regular tablet through scrolling responses. Conclusions: The findings, which need to be interpreted with caution given the preliminary nature of the study, suggest that the new tablet-based technology system might be useful for helping people with intellectual and sensory disabilities perform multistep tasks. %M 38865701 %R 10.2196/59315 %U https://rehab.jmir.org/2024/1/e59315 %U https://doi.org/10.2196/59315 %U http://www.ncbi.nlm.nih.gov/pubmed/38865701 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51770 %T An Initial Validation of Community-Based Air-Conduction Audiometry in Adults With Simulated Hearing Impairment Using a New Web App, DigiBel: Validation Study %A Sienko,Anna %A Thirunavukarasu,Arun James %A Kuzmich,Tanya %A Allen,Louise %+ School of Clinical Medicine, University of Cambridge, Hills Road, Cambridge, CB2 0SP, United Kingdom, 44 1223 336700, as2866@cam.ac.uk %K audiology %K audiometry %K hearing test %K eHealth %K mobile application %K automated audiometry %K hearing loss %K hearing impairment %K web-app %K web-apps %K web-application %K digital health %K hearing %K adult %K adults %K mobile health %K mhealth %K community-based %K home-based %K assistive technology %K screening %K usability %K ears %K ear %D 2024 %7 25.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 80% of primary school children in the United States and Europe experience glue ear, which may impair hearing at a critical time for speech acquisition and social development. A web-based app, DigiBel, has been developed primarily to identify individuals with conductive hearing impairment who may benefit from the temporary use of bone-conduction assistive technology in the community. Objective: This preliminary study aims to determine the screening accuracy and usability of DigiBel self-assessed air-conduction (AC) pure tone audiometry in adult volunteers with simulated hearing impairment prior to formal clinical validation. Methods: Healthy adults, each with 1 ear plugged, underwent automated AC pure tone audiometry (reference test) and DigiBel audiometry in quiet community settings. Threshold measurements were compared across 6 tone frequencies and DigiBel test-retest reliability was calculated. The accuracy of DigiBel for detecting more than 20 dB of hearing impairment was assessed. A total of 30 adults (30 unplugged ears and 30 plugged ears) completed both audiometry tests. Results: DigiBel had 100% sensitivity (95% CI 87.23-100) and 72.73% (95% CI 54.48-86.70) specificity in detecting hearing impairment. Threshold mean bias was insignificant except at 4000 and 8000 Hz where a small but significant overestimation of threshold measurement was identified. All 24 participants completing feedback rated the DigiBel test as good or excellent and 21 (88%) participants agreed or strongly agreed that they would be able to do the test at home without help. Conclusions: This study supports the potential use of DigiBel as a screening tool for hearing impairment. The findings will be used to improve the software further prior to undertaking a formal clinical trial of AC and bone-conduction audiometry in individuals with suspected conductive hearing impairment. %M 38271088 %R 10.2196/51770 %U https://formative.jmir.org/2024/1/e51770 %U https://doi.org/10.2196/51770 %U http://www.ncbi.nlm.nih.gov/pubmed/38271088 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46043 %T Mobile Health Hearing Aid Acclimatization and Support Program in Low-Income Communities: Feasibility Study %A Frisby,Caitlin %A Eikelboom,Robert H %A Mahomed-Asmail,Faheema %A Kuper,Hannah %A Moore,David R %A de Kock,Tersia %A Manchaiah,Vinaya %A Swanepoel,De Wet %+ Department of Speech-Language Pathology and Audiology, University of Pretoria, cnr Lynnwood Road and Roper Street, Pretoria, 0028, South Africa, 27 012 420 2357, dewet.swanepoel@up.ac.za %K community-based rehabilitation %K community health care worker %K text message %K messaging %K motivational %K reminder %K acclimatization %K technology use %K hearing aid acclimatization %K hearing aid %K hearing loss %K low- and middle-income countries %K LMIC %K low income %K developing country %K low resource %K hearing %K audiology %K mobile health %K mHealth %K health care workers %K usability %D 2023 %7 23.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The most common management option for hearing loss is hearing aids. In addition to devices, patients require information and support, including maintenance and troubleshooting. Mobile health (mHealth) technologies can support hearing aid management, acclimatization, and use. This study developed an mHealth acclimatization and support program for first-time hearing aid users and subsequently implemented and pilot-tested the feasibility of the program. The program was facilitated by community health workers (CHWs) in low-income communities in South Africa. Objective: This study aimed to evaluate the feasibility of an mHealth acclimatization and support program supported by CHWs in low-income communities. Methods: An application-based acclimatization and support was adapted and translated for use in low- and middle-income countries. This program was delivered in the form of 20 different voice notes accompanied by graphical illustrations via WhatsApp or 20 different SMS text messages. The program was provided to first-time hearing aid users immediately after a community-based hearing aid fitting in March 2021 in 2 low-income communities in the Western Cape, South Africa. The 20 messages were sent over a period of 45 days. Participants were contacted telephonically on days 8, 20, and 43 of the program and via open-ended paper-based questionnaires translated to isiXhosa 45 days and 6 months after the program started to obtain information on their experiences, perceptions, and accessibility of the program. Their responses were analyzed using inductive thematic analysis. Results: A total of 19 participants fitted with hearing aids received the mHealth acclimatization and support program. Most participants (15/19, 79%) received the program via WhatsApp, with 21% (4/19) of them receiving it via SMS text message. Participants described the program as helpful, supportive, informative, sufficient, and clear at both follow-ups. A total of 14 participants reported that they were still using their hearing aids at the 6-month follow-up. Three participants indicated that not all their questions about hearing aids were answered, and 5 others had minor hearing aid issues. This included feedback (n=1), battery performance (n=1), physical fit (n=2), and issues with hearing aid accessories (n=1). However, CHWs successfully addressed all these issues. There were no notable differences in responses between the participants who received the program via WhatsApp compared with those who received it through SMS text message. Most participants receiving WhatsApp messages reported that the voice notes were easier to understand, but the graphical illustrations supplemented the voice notes well. Conclusions: An mHealth acclimatization and support program is feasible and potentially assists hearing aid acclimatization and use for first-time users in low-income communities. Scalable mHealth support options can facilitate increased access and improve outcomes of hearing care. %M 37610802 %R 10.2196/46043 %U https://formative.jmir.org/2023/1/e46043 %U https://doi.org/10.2196/46043 %U http://www.ncbi.nlm.nih.gov/pubmed/37610802 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e40561 %T Improving Knowledge About Pregnancy for Deaf South African Women of Reproductive Age Through a Text Messaging–Based Information Campaign: Mixed Methods Study %A Haricharan,Hanne Jensen %A Hacking,Damian %A Lau,Yan Kwan %A Heap,Marion %+ School of Public Health, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa, 27 829656103, hanne.haricharan@uct.ac.za %K SMS text messages %K cell phones %K mobile health %K mHealth %K health information %K health literacy %K healthy behavior %K maternal health %K antenatal care %K Deaf %K South Africa %D 2023 %7 22.5.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Signing Deaf South Africans have limited access to health information and, consequently, limited knowledge about health. Maternal and neonatal mortality rates are high. Cell phone use is high, making it a potentially effective way of communicating about maternal and child health. Objective: The primary aim of this study was to assess whether an SMS text messaging–based health information campaign could improve knowledge about pregnancy, antenatal care, and healthy living during pregnancy for signing Deaf South African women of reproductive age. The secondary aim was to evaluate the acceptability of such an intervention. Methods: This study was designed as a pretest-posttest study. A baseline questionnaire assessed participants’ knowledge about pregnancy, antenatal care, and healthy living during pregnancy before an SMS text messaging–based information campaign was conducted. After the campaign, an exit questionnaire was administered containing the same questions as the baseline questionnaire with additional questions on general acceptability and communication preferences. The results were compared between baseline and exit using the McNemar and Wilcoxon signed rank tests. A focus group aimed to obtain further information on the impact and acceptability of SMS text messages. The focus group was analyzed inductively. Results: The study showed a statistically significant improvement in overall health knowledge among participants. Despite this, some participants found the medical terminology challenging to understand. Several ways of improving SMS text messaging campaigns for the Deaf were identified, including using Multimedia Messaging Services with a person signing messages and linking information campaigns to a communication service that would enable Deaf people to pose questions. The focus group also suggested that SMS text messages might play a role in motivating healthy behaviors during pregnancy. Conclusions: The SMS text messaging campaign effectively improved Deaf women’s knowledge about pregnancy, antenatal care, and healthy living during pregnancy and has the potential to affect health behavior. This contrasts with a similar study on hearing pregnant women. This suggests that SMS text messages may be particularly effective in improving Deaf people’s health knowledge. However, attention should be paid to Deaf participants’ specific needs and communication preferences to optimize impact. The potential of using SMS text messaging campaigns to affect behavior should be studied. Trial Registration: Pan-African Clinical Trials Registry (PACTR) PACTR201512001352180; https://tinyurl.com/3rxvsrbe %M 37213174 %R 10.2196/40561 %U https://pediatrics.jmir.org/2023/1/e40561 %U https://doi.org/10.2196/40561 %U http://www.ncbi.nlm.nih.gov/pubmed/37213174 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e39314 %T Dual Sensory Impairment as a Predictor of Loneliness and Isolation in Older Adults: National Cohort Study %A Wang,Qiong %A Zhang,Shimin %A Wang,Yi %A Zhao,Dan %A Zhou,Chengchao %+ Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Number 44, Wen-hua-xi Road, Jinan, 250012, China, 86 0531 8838 1567, zhouchengchao@sdu.edu.cn %K loneliness %K social isolation %K dual sensory impairment %K vision impairment %K hearing impairment %K mental health %D 2022 %7 14.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Loneliness and social isolation are global public health challenges. Sensory impairments (SIs) are highly prevalent among older adults but are often ignored as a part of normal aging. Identifying the role of SIs in loneliness and social isolation could provide insight into strategies for improving public health among older adults. Objective: This study aims to analyze the effects of SIs on loneliness and social isolation among older adults in rural and urban China. Methods: This cohort study of 3069 older adults (aged 60+) used data from 4 waves (2011, 2013, 2015, and 2018) of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey of adults aged 45 years or older. SIs include hearing impairment (HI), vision impairment (VI), and dual sensory impairment (DSI). DSI is defined as the co-occurrence of VI and HI. Participants with complete data on hearing, vision, social isolation, and loneliness were included in the analysis. Generalized estimating equation models adjusted for covariates were used to examine the relationships of DSI with loneliness and social isolation among older adults. Results: Older adults in rural areas have higher prevalence of DSI, loneliness, and social isolation than their urban counterparts. In rural areas, participants with VI only (odds ratio [OR] 1.34, 95% CI 1.12-1.62; P=.002), HI only (OR 1.32, 95% CI 1.02-1.71; P=.03), and DSI (OR 1.84, 95% CI 1.56-2.18; P<.001) were more likely to experience loneliness compared with participants without SIs. DSI showed a statistically significant association with loneliness compared with VI only (OR 1.37, 95% CI 1.22-1.54; P<.001) and HI only (OR 1.39, 95% CI 1.13-1.72; P=.002). In urban areas, participants with VI only (OR 2.44, 95% CI 1.57-3.80; P<.001), HI only (OR 2.47, 95% CI 1.41-4.32; P=.002), and DSI (OR 1.88, 95% CI 1.24-2.85; P=.003) were more likely to experience loneliness compared with participants without SIs. DSI was not associated with the increased likelihood of loneliness compared with HI only or VI only. SIs were not associated with social isolation among older adults in urban and rural areas. Until 2018, 86.97% (2669/3069) reported VI, but only 27.11% (832/3069) and 9.45% (290/3069) were treated with glasses and cataract surgery, respectively; besides, 75 individuals received both glasses and cataract surgery treatment. The prevalence of HI was 74.39% (2283/3069) in 2018, but only 0.72% (22/3069) were treated with a hearing aid. Conclusions: SIs are associated with an increased risk of loneliness rather than social isolation. A compounded risk of DSI on loneliness exists in rural areas rather than in urban areas. These findings expand our knowledge about the effects of SIs on loneliness and social isolation in non-Western populations. Interventions targeting HI only and DSI might be particularly effective for mitigating loneliness of older adults in urban and rural areas, respectively. Considering the high prevalence and low treatment rate of SIs, measures should be taken to make treatment more accessible. %M 36374533 %R 10.2196/39314 %U https://publichealth.jmir.org/2022/11/e39314 %U https://doi.org/10.2196/39314 %U http://www.ncbi.nlm.nih.gov/pubmed/36374533 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e36671 %T Investigating the Provision and Context of Use of Hearing Aid Listening Programs From Real-world Data: Observational Study %A Pasta,Alessandro %A Szatmari,Tiberiu-Ioan %A Christensen,Jeppe Høy %A Jensen,Kasper Juul %A Pontoppidan,Niels Henrik %A Sun,Kang %A Larsen,Jakob Eg %+ Department of Applied Mathematics and Computer Science, Technical University of Denmark, Richard Petersens Plads, Building 324, Kongens Lyngby, 2800, Denmark, 45 4525 3031, alpas@dtu.dk %K personalized medicine %K hearing aids %K data logging %K listening programs %K sound environment %K mobile phone %D 2022 %7 17.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Listening programs enable hearing aid (HA) users to change device settings for specific listening situations and thereby personalize their listening experience. However, investigations into real-world use of such listening programs to support clinical decisions and evaluate the success of HA treatment are lacking. Objective: We aimed to investigate the provision of listening programs among a large group of in-market HA users and the context in which the programs are typically used. Methods: First, we analyzed how many and which programs were provided to 32,336 in-market HA users. Second, we explored 332,271 program selections from 1312 selected users to investigate the sound environments in which specific programs were used and whether such environments reflect the listening intent conveyed by the name of the used program. Our analysis was based on real-world longitudinal data logged by smartphone-connected HAs. Results: In our sample, 57.71% (18,663/32,336) of the HA users had programs for specific listening situations, which is a higher proportion than previously reported, most likely because of the inclusion criteria. On the basis of association rule mining, we identified a primary additional listening program, Speech in Noise, which is frequent among users and often provided when other additional programs are also provided. We also identified 2 secondary additional programs (Comfort and Music), which are frequent among users who get ≥3 programs and usually provided in combination with Speech in Noise. In addition, 2 programs (TV and Remote Mic) were related to the use of external accessories and not found to be associated with other programs. On average, users selected Speech in Noise, Comfort, and Music in louder, noisier, and less-modulated (all P<.01) environments compared with the environment in which they selected the default program, General. The difference from the sound environment in which they selected General was significantly larger in the minutes following program selection than in the minutes preceding it. Conclusions: This study provides a deeper insight into the provision of listening programs on a large scale and demonstrates that additional listening programs are used as intended and according to the sound environment conveyed by the program name. %M 36251349 %R 10.2196/36671 %U https://www.jmir.org/2022/10/e36671 %U https://doi.org/10.2196/36671 %U http://www.ncbi.nlm.nih.gov/pubmed/36251349 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e24903 %T Encouraging Hearing Loss Prevention in Music Listeners Using Personalized Technology: Questionnaire Study %A Zhu,Dylan Tianyu %+ Blair Academy, 2 Park St., Blairstown, NJ, 07825, United States, 1 9089777453, dylan.zhu.research@gmail.com %K mHealth %K mobile health %K prevention %K NIHL %K noise induced hearing loss %K MIHL %K music induced hearing loss %K intervention %K wearable device %D 2022 %7 27.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Noise-induced hearing loss (NIHL) affects millions of people despite being almost completely preventable. For recreational music listening through personal listening equipment (such as earbuds), it seems that listeners do not yet have a way to accurately assess their risk of developing hearing loss and prevent it accordingly. Objective: The aim of this study is to analyze the perceived utility of a hypothetical device that encourages NIHL prevention based on listeners’ exposure to noise and to determine the most effective methods of such encouragement. Here, we describe 3 different potential NIHL risk notification method types, as follows: auditory, external visual, and visual. Methods: An open, web-based survey was created on Google Forms, and the link was posted to Amazon’s Mechanical Turk as well as music-related Reddit communities. The survey was designed to gauge each respondent’s self-assessed NIHL awareness, willingness to lower their audio if reminded, and NIHL risk notification type preference. The likelihood of a specific notification type to encourage NIHL prevention among its users was based on the average of each user’s responses to 2 survey questions. Data collection started on July 13, 2020, and ended on July 17, 2020. Results: Of the 116 respondents, 92 (79.3%) reported having prior awareness about NIHL; however, 60 (51.7%) described doing nothing to prevent it despite 96 (82.8%) feeling a moderate, high, or extreme risk of developing NIHL. Of those who already prevented NIHL, 96% (53.5/56) described using estimates to guide their prevention instead of using data. A Kruskal-Wallis test corrected for ties showed that despite the visual NIHL risk notification type being selected by the highest number of participants (84/116, 72.4%), the auditory type had a significantly higher (H1=6.848; P=.03) average percentage likelihood of encouraging NIHL prevention (62%, SD 24%) among the 40 respondents who chose it, with a median likelihood of 56% (95% CI 50%-75%). The visual type’s average likelihood was 50% (SD 28.1%), with a median of 50% (95% CI 37.5%-56.3%). Regardless of the NIHL risk notification type, 69% (80/116) of respondents were not opposed to using NIHL risk notifications and lowering their audio volume accordingly. Conclusions: The hypothetical device detailed here was thought to be useful because most respondents (82.8%, 96/116) felt an extreme to moderate risk of developing NIHL and such a device could provide accurate data to those who currently use estimates to prevent NIHL, and most respondents were willing to act on NIHL risk notifications. The most effective NIHL risk notification type seemed to be the auditory type, but many aspects of this study need further research to determine which implementation method should reach the public. %M 35759318 %R 10.2196/24903 %U https://formative.jmir.org/2022/6/e24903 %U https://doi.org/10.2196/24903 %U http://www.ncbi.nlm.nih.gov/pubmed/35759318 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 6 %P e32986 %T Hearing Loss in Patients With Morquio Syndrome: Protocol for a Scoping Review %A Diaz-Ordoñez,Lorena %A Candelo,Estephania %A Silva-Cuero,Katherine %A Saldarriaga,Wilmar %A Murgašová,Lenka %A Magner,Martin %A Pachajoa,Harry %+ Department of Basic Medical Sciences, Center for Research on Congenital Anomalies and Rare Diseases (CIACER), Universidad Icesi, St 18 122-135, Cali, 760031, Colombia, 57 5552334 ext 8542, lldiaz@icesi.edu.co %K Morquio syndrome %K hearing loss %K rare diseases %K scoping review %D 2022 %7 7.6.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mild to moderate hearing loss is common in patients with mucopolysaccharidosis (MPS) IVA. The hearing loss can be conductive, sensorineural, or mixed. However, in these patients, the mixed form is frequent, attributed to the combination of conductive and neurosensory elements, with slowly progressive evolution. Conductive hearing loss may be secondary to recurrent upper respiratory tract infections, serous otitis media, and deformities of the ear ossicles due to the accumulation of glycosaminoglycans (GAGs). Meanwhile, the sensorineural form is mainly attributed to the accumulation of GAGs in the auditory system. Objective: The aim of this scoping review is to understand the extent and type of evidence in relation to the physiopathology, classification, epidemiology, and clinical management of hearing loss and the effect of therapy for hearing loss in patients with MPS IVA. Methods: This scoping review includes participants across all genders and of no particular age group who are diagnosed with MPS IVA and develop hearing loss as a comorbidity. No exclusion criteria (country, language, or document type) will be applicable. The information sources will include experimental and quasi-experimental, analytical observational, observational, and qualitative studies. Unpublished literature will not be covered. Grey literature will be covered. A total of 2 independent reviewers will participate in the process of screening the literature, paper selection, and data extraction, and this process will be performed blindly. When all manuscripts have been selected, disagreements that arise between the 2 reviewers at each stage of the selection process will be resolved through discussion or with an additional reviewer. Results will be reported with descriptive statistics and information will be displayed in a diagrammatic or tabular manner, as explained in the JBI guidelines. Results: The literature search was performed in November 2021 in MEDLINE, LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde), the Cochrane Library, ScienceDirect, Google Scholar, and OpenGrey; a total of 780 results were retrieved. Completion of the review is expected in mid-2022. Conclusions: This scoping review will be the first to describe the extent of the information regarding the development of hearing loss in the MPS IVA population. The data gathered by this review may lead to an understanding of the grade of hearing loss in this population and allow for the assessment of possible interventions according to the disease pattern. International Registered Report Identifier (IRRID): PRR1-10.2196/32986 %M 35671071 %R 10.2196/32986 %U https://www.researchprotocols.org/2022/6/e32986 %U https://doi.org/10.2196/32986 %U http://www.ncbi.nlm.nih.gov/pubmed/35671071 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e25086 %T The Sign 4 Big Feelings Intervention to Improve Early Years Outcomes in Preschool Children: Outcome Evaluation %A Davidson,Rosemary %A Randhawa,Gurch %+ Institute for Health Research, University of Bedfordshire, University Square, Luton, LU1 3JU, United Kingdom, 44 1582 743797, rosemary.davidson@beds.ac.uk %K language development %K sign language %K early years outcomes %K well-being %D 2022 %7 20.5.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Any delays in language development may affect learning, profoundly influencing personal, social, and professional trajectories. The effectiveness of the Sign 4 Big Feelings (S4BF) intervention was investigated by measuring changes in early years outcomes (EYOs) after a 3-month period. Objective: This study aims to determine whether children’s well-being and EYOs significantly improve (beyond typical, expected development) after the S4BF intervention period and whether there are differences between boys and girls in progress achieved. Methods: An evaluation of the S4BF intervention was conducted with 111 preschool-age children in early years settings in Luton, United Kingdom. Listening, speaking, understanding, and managing feelings and behavior, in addition to the Leuven well-being scale, were assessed in a quasi-experimental study design to measure pre- and postintervention outcomes. Results: Statistically and clinically significant differences were found for each of the 7 pre- and postmeasures evaluated: words understood and spoken, well-being scores, and the 4 EYO domains. Gender differences were negligible in all analyses. Conclusions: Children of all abilities may benefit considerably from S4BF, but a language-based intervention of this nature may be transformational for children who are behind developmentally, with English as an additional language, or of lower socioeconomic status. Trial Registration: ISRCTN Registry ISRCTN42025531; https://doi.org/10.1186/ISRCTN42025531 %M 35594062 %R 10.2196/25086 %U https://pediatrics.jmir.org/2022/2/e25086 %U https://doi.org/10.2196/25086 %U http://www.ncbi.nlm.nih.gov/pubmed/35594062 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e27207 %T Telemedicine for Adults With Cochlear Implants in the United Kingdom (CHOICE): Protocol for a Prospective Interventional Multisite Study %A Cullington,Helen %A Kitterick,Padraig %A Darnton,Philippa %A Finch,Tracy %A Greenwell,Kate %A Riggs,Carol %A Weal,Mark %A Walker,Dawn-Marie %A Sibley,Andrew %+ University of Southampton Auditory Implant Service, University of Southampton, Southampton, SO17 1BJ, United Kingdom, 44 2380593522, h.cullington@soton.ac.uk %K cochlear implants %K hearing %K deafness %K telemedicine %K patient-centered care %D 2022 %7 13.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cochlear implants provide hearing to approximately 750,000 people with deafness worldwide; these patients require lifelong follow-up. Care for adults with implants in the United Kingdom occurs at one of 19 centers, which may be far from the patients’ homes. In a previous randomized controlled trial, we successfully introduced person-centered care. We designed, implemented, and evaluated the following remote care pathway: a personalized web-based support tool, home hearing check, self–device adjustment, and upgrading of sound processors at home rather than in the clinic. The remote care group had a significant increase in empowerment after using the tools, and the patients and clinicians were keen to continue. We would now like to scale up these improvements as an option for >12,000 UK adults using implants; we are commissioning an independent evaluation of this intervention and rollout to establish if it achieves its aims of more empowered and confident patients; more accessible and equitable care; stable hearing; more efficient, person-centered, and scalable service; and more satisfied and engaged patients and clinicians. Objective: This study aims to evaluate the impact and rollout of a person-centered clinical care pathway via telemedicine for adults with cochlear implants in the United Kingdom, using both outcomes and process evaluation. Methods: This project will scale up and evaluate a person-centered long-term follow-up pathway for adults using cochlear implants through a personalized website, including a home hearing check, uploading photos of cochlear implant site, listening in noise and music practice, ordering of spares, questionnaires, and other resources. Both quantitative and qualitative analyses will be conducted, and they will be both an outcome and process evaluation. Results: As of July 2021, the trial is closed, and all data collection is complete. The evaluation report is expected to be published in December 2021, and the research data have not yet been analyzed. Conclusions: This project will present the results of the first scaling up of a remote care pathway for adults with cochlear implants in the United Kingdom. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN51668922; https://www.isrctn.com/ISRCTN51668922 International Registered Report Identifier (IRRID): DERR1-10.2196/27207 %M 35416780 %R 10.2196/27207 %U https://www.researchprotocols.org/2022/4/e27207 %U https://doi.org/10.2196/27207 %U http://www.ncbi.nlm.nih.gov/pubmed/35416780 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35641 %T Understanding the Potential of Mental Health Apps to Address Mental Health Needs of the Deaf and Hard of Hearing Community: Mixed Methods Study %A Borghouts,Judith %A Neary,Martha %A Palomares,Kristina %A De Leon,Cinthia %A Schueller,Stephen M %A Schneider,Margaret %A Stadnick,Nicole %A Mukamel,Dana B %A Sorkin,Dara H %A Brown,Dakota %A McCleerey-Hooper,Shannon %A Moriarty,Gloria %A Eikey,Elizabeth V %+ Department of Medicine, University of California, Irvine, 100 Theory, Irvine, CA, 92617, United States, 1 9498240246, jborghou@uci.edu %K mental health %K deaf and hard of hearing community %K mHealth %K digital health %K needs assessment %K deaf %K hard of hearing %K hearing %K focus group %K survey %K mixed methods %K intervention %K health app %K user needs %D 2022 %7 11.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mental health concerns are a significant issue among the deaf and hard of hearing (D/HH) community, but community members can face several unique challenges to accessing appropriate resources. Objective: The aim of this study was to investigate the mental health needs of the D/HH community and how mental health apps may be able to support these needs. Methods: A total of 10 members of the D/HH community participated in a focus group and survey to provide their perspectives and experiences. Participants were members of the Center on Deafness Inland Empire team, which comprises people with lived experience as members of and advocates for the D/HH community. Results: Findings identified a spectrum of needs for mental health apps, including offering American Sign Language and English support, increased education of mental health to reduce stigma around mental health, direct communication with a Deaf worker, and apps that are accessible to a range of community members in terms of culture, resources required, and location. Conclusions: These findings can inform the development of digital mental health resources and outreach strategies that are appropriate for the D/HH community. %M 35404259 %R 10.2196/35641 %U https://humanfactors.jmir.org/2022/2/e35641 %U https://doi.org/10.2196/35641 %U http://www.ncbi.nlm.nih.gov/pubmed/35404259 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e33476 %T Real-World Effectiveness of Wearable Augmented Reality Device for Patients With Hearing Loss: Prospective Study %A Han,Ul Gyu %A Lee,Jung-Yup %A Kim,Ga-Young %A Jo,Mini %A Lee,Jaeseong %A Bang,Kyoung Ho %A Cho,Young Sang %A Hong,Sung Hwa %A Moon,Il Joon %+ Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea, 82 10 3789 7505, moon.iljoon@gmail.com %K hearing loss %K hearing aids %K personal sound amplification product %K wearable augmented reality device %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hearing loss limits communication and social activity, and hearing aids (HAs) are an efficient rehabilitative option for improving oral communication and speech comprehension, as well as the psychosocial comfort of people with hearing loss. To overcome this problem, over-the-counter amplification devices including personal sound amplification products and wearable augmented reality devices (WARDs) have been introduced. Objective: This study aimed to evaluate the clinical effectiveness of WARDs for patients with mild to moderate hearing loss. Methods: A total of 40 patients (18 men and 22 women) with mild to moderate hearing loss were enrolled prospectively in this study. All participants were instructed to wear a WARD, Galaxy Buds Pro (Samsung Electronics), at least 4 hours a day for 2 weeks, for amplifying ambient sounds. Questionnaires including the Korean version of the abbreviated profile of hearing aid benefit (K-APHAB) and the Korean adaptation of the international outcome inventory for hearing aids (K-IOI-HA) were used to assess personal satisfaction in all participants. Audiologic tests, including sound field audiometry, sound field word recognition score (WRS), and the Korean version of hearing in noise test (K-HINT), were administered to 14 of 40 patients. The tests were performed under two conditions: unaided and aided with WARDs. Results: The mean age of the participants was 55.4 (SD 10.7) years. After 2 weeks of the field trial, participants demonstrated a benefit of WARDs on the K-APHAB. Scores of 3 subscales of ease of communication, reverberation, and background noise were improved significantly (P<.001). However, scores regarding aversiveness were worse under the aided condition (P<.001). K-IOI-HA findings indicated high user satisfaction after the 2-week field trial. On audiologic evaluation, the K-HINT did not show significant differences between unaided and aided conditions (P=.97). However, the hearing threshold on sound field audiometry (P=.001) and the WRS (P=.002) showed significant improvements under the aided condition. Conclusions: WARDs can be beneficial for patients with mild to moderate hearing loss as a cost-effective alternative to conventional hearing aids. %M 35320113 %R 10.2196/33476 %U https://mhealth.jmir.org/2022/3/e33476 %U https://doi.org/10.2196/33476 %U http://www.ncbi.nlm.nih.gov/pubmed/35320113 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e32581 %T Digital Approaches to Automated and Machine Learning Assessments of Hearing: Scoping Review %A Wasmann,Jan-Willem %A Pragt,Leontien %A Eikelboom,Robert %A Swanepoel,De Wet %+ Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Philips van Leydenlaan 15, Nijmegen, 6500 HB, Netherlands, 31 024 361 04 2, Jan-Willem.Wasmann@radboudumc.nl %K audiology %K automated audiometry %K automatic audiometry %K automation %K digital health technologies %K digital hearing health care %K machine learning %K remote care %K self-administered audiometry %K self-assessment audiometry %K user-operated audiometry %K digital health %K hearing loss %K digital hearing %K digital devices %K mobile phone %K telehealth %D 2022 %7 2.2.2022 %9 Review %J J Med Internet Res %G English %X Background: Hearing loss affects 1 in 5 people worldwide and is estimated to affect 1 in 4 by 2050. Treatment relies on the accurate diagnosis of hearing loss; however, this first step is out of reach for >80% of those affected. Increasingly automated approaches are being developed for self-administered digital hearing assessments without the direct involvement of professionals. Objective: This study aims to provide an overview of digital approaches in automated and machine learning assessments of hearing using pure-tone audiometry and to focus on the aspects related to accuracy, reliability, and time efficiency. This review is an extension of a 2013 systematic review. Methods: A search across the electronic databases of PubMed, IEEE, and Web of Science was conducted to identify relevant reports from the peer-reviewed literature. Key information about each report’s scope and details was collected to assess the commonalities among the approaches. Results: A total of 56 reports from 2012 to June 2021 were included. From this selection, 27 unique automated approaches were identified. Machine learning approaches require fewer trials than conventional threshold-seeking approaches, and personal digital devices make assessments more affordable and accessible. Validity can be enhanced using digital technologies for quality surveillance, including noise monitoring and detecting inconclusive results. Conclusions: In the past 10 years, an increasing number of automated approaches have reported similar accuracy, reliability, and time efficiency as manual hearing assessments. New developments, including machine learning approaches, offer features, versatility, and cost-effectiveness beyond manual audiometry. Used within identified limitations, automated assessments using digital devices can support task-shifting, self-care, telehealth, and clinical care pathways. %M 34919056 %R 10.2196/32581 %U https://www.jmir.org/2022/2/e32581 %U https://doi.org/10.2196/32581 %U http://www.ncbi.nlm.nih.gov/pubmed/34919056 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e27809 %T Knowledge and Expectations of Hearing Aid Apps Among Smartphone Users and Hearing Professionals: Cross-sectional Survey %A Han,Jae Sang %A Park,Yong-Ho %A Song,Jae-Jun %A Moon,Il Joon %A Lee,Woojoo %A Kim,Yoonjoong %A Cho,Young Sang %A Seo,Jae-Hyun %A Park,Moo Kyun %+ Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea, 82 2 2258 6210, revivalseo@catholic.ac.kr %K smartphone %K hearing aids %K app %K perception %K survey %K hearing loss %K mobile phone %D 2022 %7 7.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the increasing prevalence of hearing loss, the cost and psychological barriers to the use of hearing aids may prevent their use in individuals with hearing loss. Patients with hearing loss can benefit from smartphone-based hearing aid apps (SHAAs), which are smartphone apps that use a mobile device as a sound amplifier. Objective: The aim of this study is to determine how ear, nose, and throat outpatients perceive SHAAs, analyze the factors that affect their perceptions, and estimate the costs of an annual subscription to an app through a self-administered questionnaire survey of smartphone users and hearing specialists. Methods: This study used a cross-sectional, multicenter survey of both ear, nose, and throat outpatients and hearing specialists. The questionnaire was designed to collect personal information about the respondents and their responses to 18 questions concerning SHAAs in five domains: knowledge, needs, cost, expectations, and information. Perception questions were rated on a scale of 1 (strongly disagree) to 5 (strongly agree). Questions about the expected cost of SHAAs were included in the questionnaire distributed to hearing experts. Results: Among the 219 smartphone users and 42 hearing specialists, only 8 (3.7%) respondents recognized SHAAs, whereas 18% (47/261) of respondents reported considering the use of an assistive device to improve their hearing capacity. The average perception score was 2.81 (SD 1.22). Among the factors that shaped perceptions of SHAAs, the needs category received the lowest scores (2.02, SD 1.42), whereas the cost category received the highest scores (3.29, SD 1.14). Age was correlated with the information domain (P<.001), and an increased level of hearing impairment resulted in significantly higher points in the needs category (P<.001). Patients expected the cost of an annual app subscription to an SHAA to be approximately US $86, and the predicted cost was associated with economic status (P=.02) and was higher than the prices expected by hearing specialists (P<.001). Conclusions: Outpatients expected SHAAs to cost more than hearing specialists. However, the perception of the SHAA was relatively low. In this regard, enhanced awareness is required to popularize SHAAs. %M 34994699 %R 10.2196/27809 %U https://mhealth.jmir.org/2022/1/e27809 %U https://doi.org/10.2196/27809 %U http://www.ncbi.nlm.nih.gov/pubmed/34994699 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e27599 %T A Comparison of the Use of Smart Devices, Apps, and Social Media Between Adults With and Without Hearing Impairment: Cross-sectional Web-Based Study %A van Wier,Marieke F %A Urry,Emily %A Lissenberg-Witte,Birgit I %A Kramer,Sophia E %+ Ear & Hearing, Otolaryngology-Head and Neck Surgery, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, Netherlands, 31 20 4440952, m.vanwier1@amsterdamumc.nl %K hearing impairment %K social media use %K app use %K benefits from social media %K eHealth %K mobile phone %D 2021 %7 20.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth and social media could be of particular benefit to adults with hearing impairment, but it is unknown whether their use of smart devices, apps, and social media is similar to that of the general population. Objective: Our aim is to study whether adults with normal hearing and those with impaired hearing differ in their weekly use of smart devices, apps, and social media; reasons for using social media; and benefits from using social media. Methods: We used data from a Dutch cohort, the National Longitudinal Study on Hearing. Data were collected from September 2016 to April 2020 using a web-based questionnaire and speech-in-noise test. The results from this test were used to categorize normal hearing and hearing impairment. Outcomes were compared using (multiple) logistic regression models. Results: Adults with impaired hearing (n=384) did not differ from normal hearing adults (n=341) in their use of a smartphone or tablet. They were less likely to make use of social media apps on a smartphone, tablet, or smartwatch (age-adjusted odds ratio [OR] 0.67, 95% CI 0.48-0.92; P=.02). Use of social media on all devices and use of other apps did not differ. Adults with hearing impairment were more likely to agree with using social media to stay in touch with family members (OR 1.54, 95% CI 1.16-2.07; P=.003) and friends (age-adjusted OR 1.35, 95% CI 1.01-1.81; P=.046). Furthermore, they were more likely to agree with using social media to perform their work (age-adjusted OR 1.51, 95% CI 1.04-2.18; P=.03). There were no differences in the experienced benefits from social media. Conclusions: The potential for eHealth is confirmed because adults with hearing impairment are not less likely to use smart devices than their normal hearing peers. Adults with hearing impairment are less likely to use social media apps on a smart device but not less likely to use social media on all types of internet-connected devices. This warrants further research on the types of social media platforms that adults with hearing impairment use and on the type of device on which they prefer to use social media. Given that participants with hearing impairment are more likely than their normal hearing peers to use social media to perform their work, use of social media may be seen as an opportunity to enhance vocational rehabilitation services for persons with hearing impairment. %M 34932013 %R 10.2196/27599 %U https://www.jmir.org/2021/12/e27599 %U https://doi.org/10.2196/27599 %U http://www.ncbi.nlm.nih.gov/pubmed/34932013 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e28999 %T Exploratory Data Mining Techniques (Decision Tree Models) for Examining the Impact of Internet-Based Cognitive Behavioral Therapy for Tinnitus: Machine Learning Approach %A Rodrigo,Hansapani %A Beukes,Eldré W %A Andersson,Gerhard %A Manchaiah,Vinaya %+ School of Mathematical and Statistical Sciences, University of Texas Rio Grande Valley, 1201 W University Drive, Edinburgh, TX, 78539, United States, 1 9566652313, hansapani.rodrigo@utrgv.edu %K tinnitus %K internet interventions %K digital therapeutics %K cognitive behavioral therapy %K artificial intelligence %K machine learning %K data mining %K decision tree %K random forest %D 2021 %7 2.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: There is huge variability in the way that individuals with tinnitus respond to interventions. These experiential variations, together with a range of associated etiologies, contribute to tinnitus being a highly heterogeneous condition. Despite this heterogeneity, a “one size fits all” approach is taken when making management recommendations. Although there are various management approaches, not all are equally effective. Psychological approaches such as cognitive behavioral therapy have the most evidence base. Managing tinnitus is challenging due to the significant variations in tinnitus experiences and treatment successes. Tailored interventions based on individual tinnitus profiles may improve outcomes. Predictive models of treatment success are, however, lacking. Objective: This study aimed to use exploratory data mining techniques (ie, decision tree models) to identify the variables associated with the treatment success of internet-based cognitive behavioral therapy (ICBT) for tinnitus. Methods: Individuals (N=228) who underwent ICBT in 3 separate clinical trials were included in this analysis. The primary outcome variable was a reduction of 13 points in tinnitus severity, which was measured by using the Tinnitus Functional Index following the intervention. The predictor variables included demographic characteristics, tinnitus and hearing-related variables, and clinical factors (ie, anxiety, depression, insomnia, hyperacusis, hearing disability, cognitive function, and life satisfaction). Analyses were undertaken by using various exploratory machine learning algorithms to identify the most influencing variables. In total, 6 decision tree models were implemented, namely the classification and regression tree (CART), C5.0, GB, XGBoost, AdaBoost algorithm and random forest models. The Shapley additive explanations framework was applied to the two optimal decision tree models to determine relative predictor importance. Results: Among the six decision tree models, the CART (accuracy: mean 70.7%, SD 2.4%; sensitivity: mean 74%, SD 5.5%; specificity: mean 64%, SD 3.7%; area under the receiver operating characteristic curve [AUC]: mean 0.69, SD 0.001) and gradient boosting (accuracy: mean 71.8%, SD 1.5%; sensitivity: mean 78.3%, SD 2.8%; specificity: 58.7%, SD 4.2%; AUC: mean 0.68, SD 0.02) models were found to be the best predictive models. Although the other models had acceptable accuracy (range 56.3%-66.7%) and sensitivity (range 68.6%-77.9%), they all had relatively weak specificity (range 31.1%-50%) and AUCs (range 0.52-0.62). A higher education level was the most influencing factor for ICBT outcomes. The CART decision tree model identified 3 participant groups who had at least an 85% success probability following the undertaking of ICBT. Conclusions: Decision tree models, especially the CART and gradient boosting models, appeared to be promising in predicting ICBT outcomes. Their predictive power may be improved by using larger sample sizes and including a wider range of predictive factors in future studies. %M 34726612 %R 10.2196/28999 %U https://www.jmir.org/2021/11/e28999 %U https://doi.org/10.2196/28999 %U http://www.ncbi.nlm.nih.gov/pubmed/34726612 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e28378 %T Diagnostic Accuracy of Smartphone-Based Audiometry for Hearing Loss Detection: Meta-analysis %A Chen,Chih-Hao %A Lin,Heng-Yu Haley %A Wang,Mao-Che %A Chu,Yuan-Chia %A Chang,Chun-Yu %A Huang,Chii-Yuan %A Cheng,Yen-Fu %+ Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taiwan, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 11217, Taiwan, 886 2 2871 2121 ext 1292, yfcheng2@vghtpe.gov.tw %K audiometry %K hearing loss %K hearing test %K mhealth %K mobile health %K digital health %K meta-analysis %K mobile phone %K smartphone diagnostic test accuracy %D 2021 %7 10.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hearing loss is one of the most common disabilities worldwide and affects both individual and public health. Pure tone audiometry (PTA) is the gold standard for hearing assessment, but it is often not available in many settings, given its high cost and demand for human resources. Smartphone-based audiometry may be equally effective and can improve access to adequate hearing evaluations. Objective: The aim of this systematic review is to synthesize the current evidence of the role of smartphone-based audiometry in hearing assessments and further explore the factors that influence its diagnostic accuracy. Methods: Five databases—PubMed, Embase, Cochrane Library, Web of Science, and Scopus—were queried to identify original studies that examined the diagnostic accuracy of hearing loss measurement using smartphone-based devices with conventional PTA as a reference test. A bivariate random-effects meta-analysis was performed to estimate the pooled sensitivity and specificity. The factors associated with diagnostic accuracy were identified using a bivariate meta-regression model. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Results: In all, 25 studies with a total of 4470 patients were included in the meta-analysis. The overall sensitivity, specificity, and area under the receiver operating characteristic curve for smartphone-based audiometry were 89% (95% CI 83%-93%), 93% (95% CI 87%-97%), and 0.96 (95% CI 0.93-0.97), respectively; the corresponding values for the smartphone-based speech recognition test were 91% (95% CI 86%-94%), 88% (95% CI 75%-94%), and 0.93 (95% CI 0.90-0.95), respectively. Meta-regression analysis revealed that patient age, equipment used, and the presence of soundproof booths were significantly related to diagnostic accuracy. Conclusions: We have presented comprehensive evidence regarding the effectiveness of smartphone-based tests in diagnosing hearing loss. Smartphone-based audiometry may serve as an accurate and accessible approach to hearing evaluations, especially in settings where conventional PTA is unavailable. %M 34515644 %R 10.2196/28378 %U https://mhealth.jmir.org/2021/9/e28378/ %U https://doi.org/10.2196/28378 %U http://www.ncbi.nlm.nih.gov/pubmed/34515644 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e26708 %T Using Gaze Tracking as a Research Tool in the Deaf Health Literacy and Access to Health Information Project: Protocol for a Multisite Mixed Methods Study and Preliminary Results %A Champlin,Sara %A Cuculick,Jessica %A Hauser,Peter C %A Wyse,Kelley %A McKee,Michael M %+ Mayborn School of Journalism, The University of North Texas, 1155 Union Circle #310499, Denton, TX, 76205, United States, 1 9403697851, sara.champlin@unt.edu %K gaze tracking %K deaf %K disabilities %K accessibility %K online health information %K health information seeking %K mobile phone %D 2021 %7 7.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Previous studies have identified the internet as a major source of health information. Reliable and accessible sources of web-based health information are critical for cultivating patient-centered care. However, the accessibility and use of web-based health information remains largely unknown for deaf individuals. We used gaze-tracking technology to understand the navigation and use of web-based health information by deaf adults who communicate with sign language and by hearing adults. Objective: This paper discusses our protocol for implementing gaze-tracking technology in a study that included both deaf and hearing participants. We report the preliminary results and lessons learned from the implementation of the protocol. Methods: We conducted gaze-tracking sessions with 450 deaf signers and 450 hearing participants as a part of a larger, multisite mixed methods research study. Then, we conducted qualitative elicitation interviews with a subsample of 21 deaf and 13 hearing participants, who engaged in a search task and reviewed their gaze recordings. To our knowledge, no study has implemented a similar research protocol to better understand the experiences of deaf adults. As such, we also examined research staff notes and observations from team meetings regarding the conduct of gaze-tracking data to delineate lessons learned and best practices for research protocols in this area. Results: Findings from the implementation of this study protocol highlight the use of gaze technology with deaf participants. We developed additional protocol steps to minimize gaze disruption from either lipreading or communicating in sign language. For example, research assistants were often unable to maintain eye contact with participants while signing because of the need to simultaneously point at the computer monitor to provide instructions related to gaze study components, such as the calibration process. In addition to developing ways to effectively provide instructions in American Sign Language, a practice exercise was included in the gaze tracker session to familiarize participants with the computer and technology. The use of the playback feature permitted a deeper dialogue between researchers and participants, which we found vital for understanding the experiences of deaf participants. Conclusions: On the basis of our experience using the study protocol through a large research project, incorporating gaze-tracking technology offers beneficial avenues for better understanding how individuals interact with health information. Gaze tracking can determine the type and placement of visual content that attracts attention from the viewers of diverse backgrounds, including deaf individuals. The lessons learned through this study will help future researchers in determining ideal study designs, such as suitable protocols and participant characteristics (eg, deaf signers), while including gaze trackers in their projects. This approach explored how different ways of presenting health information can affect or enable visual learners to engage and use health information effectively. International Registered Report Identifier (IRRID): RR1-10.2196/26708 %M 34491211 %R 10.2196/26708 %U https://www.researchprotocols.org/2021/9/e26708 %U https://doi.org/10.2196/26708 %U http://www.ncbi.nlm.nih.gov/pubmed/34491211 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 3 %P e26976 %T Feasibility of Virtual Reality Audiological Testing: Prospective Study %A Seol,Hye Yoon %A Kang,Soojin %A Lim,Jihyun %A Hong,Sung Hwa %A Moon,Il Joon %+ Department of Otolaryngology-Head & Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea, 82 2 3410 3579, moonij@skku.edu %K hearing loss %K virtual reality %K speech performance %K real-world performance %K hearing %K audiology %D 2021 %7 31.8.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: It has been noted in the literature that there is a gap between clinical assessment and real-world performance. Real-world conversations entail visual and audio information, yet there are not any audiological assessment tools that include visual information. Virtual reality (VR) technology has been applied to various areas, including audiology. However, the use of VR in speech-in-noise perception has not yet been investigated. Objective: The purpose of this study was to investigate the impact of virtual space (VS) on speech performance and its feasibility to be used as a speech test instrument. We hypothesized that individuals’ ability to recognize speech would improve when visual cues were provided. Methods: A total of 30 individuals with normal hearing and 25 individuals with hearing loss completed pure-tone audiometry and the Korean version of the Hearing in Noise Test (K-HINT) under three conditions—conventional K-HINT (cK-HINT), VS on PC (VSPC), and VS head-mounted display (VSHMD)—at –10 dB, –5 dB, 0 dB, and +5 dB signal-to-noise ratios (SNRs). Participants listened to target speech and repeated it back to the tester for all conditions. Hearing aid users in the hearing loss group completed testing under unaided and aided conditions. A questionnaire was administered after testing to gather subjective opinions on the headset, the VSHMD condition, and test preference. Results: Provision of visual information had a significant impact on speech performance between the normal hearing and hearing impaired groups. The Mann-Whitney U test showed statistical significance (P<.05) between the two groups under all test conditions. Hearing aid use led to better integration of audio and visual cues. Statistical significance through the Mann-Whitney U test was observed for –5 dB (P=.04) and 0 dB (P=.02) SNRs under the cK-HINT condition, as well as for –10 dB (P=.007) and 0 dB (P=.04) SNRs under the VSPC condition, between hearing aid and non–hearing aid users. Participants reported positive responses across almost all items on the questionnaire except for the weight of the headset. Participants preferred a test method with visual imagery, but found the headset to be heavy. Conclusions: Findings are in line with previous literature that showed that visual cues were beneficial for communication. This is the first study to include hearing aid users with a more naturalistic stimulus and a relatively simple test environment, suggesting the feasibility of VR audiological testing in clinical practice. %M 34463624 %R 10.2196/26976 %U https://games.jmir.org/2021/3/e26976 %U https://doi.org/10.2196/26976 %U http://www.ncbi.nlm.nih.gov/pubmed/34463624 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e28878 %T Redesigning a Web-Based Stakeholder Consensus Meeting About Core Outcomes for Clinical Trials: Formative Feedback Study %A Katiri,Roulla %A Hall,Deborah A %A Hoare,Derek J %A Fackrell,Kathryn %A Horobin,Adele %A Buggy,Nóra %A Hogan,Nicholas %A Kitterick,Pádraig T %A , %+ National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Ropewalk House, 113 The Ropewalk, Nottingham, NG1 5DU, United Kingdom, 44 1158232626, padraig.kitterick@nottingham.ac.uk %K COVID-19 %K nominal group technique %K formative research %K patient participation %K persons with hearing impairments %K mobile phone %D 2021 %7 19.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Clinical trials that assess the benefits and harms of an intervention do so by measuring and reporting outcomes. Inconsistent selection and diversity in the choice of outcomes make it challenging to directly compare interventions. To achieve an agreed core set of outcomes, a consensus methodology is recommended, comprising a web-based Delphi survey and a face-to-face consensus meeting. However, UK government regulations to control the pandemic prohibited plans for a face-to-face consensus meeting as part of the Core Rehabilitation Outcome Set for Single-Sided Deafness (CROSSSD) study. Objective: This study aims to evaluate the modifications made by the CROSSSD study team to achieve consensus using web-based methods, but with minimal deviation from the original study protocol. Methods: The study team worked with health care users and professionals to translate the planned face-to-face consensus meeting in a web-based format, preserving the key elements of the nominal group technique. A follow-up survey gathered evaluation feedback on the experiences of the 22 participating members. Feedback covered premeeting preparation, the process of facilitated discussions and voting, ability to contribute, and perceived fairness of the outcome. Results: Overall, 98% (53/54) of feedback responses agreed or strongly agreed with the statements given, indicating that the web-based meeting achieved its original goals of open discussion, debate, and voting to agree with a core outcome set for single-sided deafness. Hearing-impaired participants were fully engaged, but there were some methodological challenges. For the participants, challenges included building rapport, understanding, and delivering the tasks in hand. For the study team, challenges included the need for thorough preparation and management of the unpredictability of tasks on the day. Conclusions: Sharing our experiences and lessons learned can benefit future core outcome set developers. Overcoming the challenges of delivering a web-based consensus exercise in the face of the pandemic can be applied more generally to maximize inclusiveness, enhance geographical access, and reduce research costs. %M 34420915 %R 10.2196/28878 %U https://formative.jmir.org/2021/8/e28878 %U https://doi.org/10.2196/28878 %U http://www.ncbi.nlm.nih.gov/pubmed/34420915 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e21444 %T Reasons for Discontinuing Active Participation on the Internet Forum Tinnitus Talk: Mixed Methods Citizen Science Study %A Budimir,Sanja %A Kuska,Martin %A Spiliopoulou,Myra %A Schlee,Winfried %A Pryss,Rüdiger %A Andersson,Gerhard %A Goedhart,Hazel %A Harrison,Stephen %A Vesala,Markku %A Hegde,Gourish %A Langguth,Berthold %A Pieh,Christoph %A Probst,Thomas %+ Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Dr.-Karl-Dorrek-Strasse 30, Krems an der Donau, 3500, Austria, 43 27328932531, sanja.budimir@donau-uni.ac.at %K tinnitus %K Tinnitus Talk %K Internet forum %K dropout %K reasons for discontinuation %D 2021 %7 8.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Tinnitus Talk is a nonprofit online self-help forum. Asking inactive users about their reasons for discontinued usage of health-related online platforms such as Tinnitus Talk is important for quality assurance. Objective: The aim of this study was to explore reasons for discontinued use of Tinnitus Talk, and their associations to the perceptions of Tinnitus Talk and the age of users who ceased logging on to the platform. Methods: Initially, 13,745 users that did not use Tinnitus Talk within the previous 2 months were contacted and the response rate was 20.47% (n=2814). After dataset filtering, a total of 2172 past members of Tinnitus Talk were included in the analyses. Nine predefined reasons for discontinued usage of Tinnitus Talk were included in the survey as well as one open question. Moreover, there were 14 predefined questions focusing on perception of Tinnitus Talk (usefulness, content, community, and quality of members’ posts). Mixed methods analyses were performed. Frequencies and correlation coefficients were calculated for quantitative data, and grounded theory methodology was utilized for exploration of the qualitative data. Results: Quantitative analysis revealed reasons for discontinued use of Tinnitus Talk as well as associations of these reasons with perceptions of Tinnitus Talk and age. Among the eight predefined reasons for discontinued use of Tinnitus Talk, the most frequently reported was not finding the information they were looking for (451/2695, 16.7%). Overall, the highest rated perception of Tinnitus Talk was content-related ease of understanding (mean 3.9, SD 0.64). A high number (nearly 40%) of participants provided additional free text explaining why they discontinued use. Qualitative analyses identified a total of 1654 specific reasons, more than 93% of which (n=1544) could be inductively coded. The coding system consisted of 33 thematically labeled codes clustered into 10 categories. The most frequent additional reason for discontinuing use was thinking that there is no cure or help for tinnitus symptoms (375/1544, 24.3%). Significant correlations (P<.001) were observed between reasons for discontinued usage and perception of Tinnitus Talk. Several reasons for discontinued usage were associated with the examined dimensions of perception of Tinnitus Talk (usefulness, content, community, as well as quality of members’ posts). Moreover, significant correlations (P<.001) between age and reasons for discontinued use were found. Older age was associated with no longer using Tinnitus Talk because of not finding what they were looking for. In addition, older participants had a generally less positive perception of Tinnitus Talk than younger participants (P<.001). Conclusions: This study contributes to understanding the reasons for discontinued usage of online self-help platforms, which are typically only reported according to the dropout rates. Furthermore, specific groups of users who did not benefit from Tinnitus Talk were identified, and several practical implications for improvement of the structure, content, and goals of Tinnitus Talk were suggested. %M 33830060 %R 10.2196/21444 %U https://formative.jmir.org/2021/4/e21444 %U https://doi.org/10.2196/21444 %U http://www.ncbi.nlm.nih.gov/pubmed/33830060 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e20890 %T An mHealth App (Speech Banana) for Auditory Training: App Design and Development Study %A Ratnanather,J Tilak %A Bhattacharya,Rohit %A Heston,Margo B %A Song,Joanne %A Fernandez,Lindsey R %A Lim,Hong Seo %A Lee,Seung-Wook %A Tam,Edric %A Yoo,Sungho %A Bae,Seung-Ho %A Lam,Inez %A Jeon,Hyoung Won %A Chang,Son A %A Koo,Ja-Won %+ Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173, Bundang-gu, Seongnam-si, 13620, Republic of Korea, 82 31 787 7402, speechbanana@jhu.edu %K speech therapy %K mobile phone %K computers, handheld %K cochlear implants %K hearing aids %D 2021 %7 15.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the growing adult population using electronic hearing devices such as cochlear implants or hearing aids, there is an increasing worldwide need for auditory training (AT) to promote optimal device use. However, financial resources and scheduling conflicts make clinical AT infeasible. Objective: To address this gap between need and accessibility, we primarily aimed to develop a mobile health (mHealth) app called Speech Banana for AT. The app would be substantially more affordable and portable than clinical AT; would deliver a validated training model that is reflective of modern techniques; and would track users’ progress in speech comprehension, providing greater continuity between periodic in-person visits. To improve international availability, our secondary aim was to implement the English language training model into Korean as a proof of concept for worldwide usability. Methods: A problem- and objective-centered Design Science Research Methodology approach was adopted to develop the Speech Banana app. A review of previous literature and computer-based learning programs outlined current AT gaps, whereas interviews with speech pathologists and users clarified the features that were addressed in the app. Past and present users were invited to evaluate the app via community forums and the System Usability Scale. Results: Speech Banana has been implemented in English and Korean languages for iPad and web use. The app comprises 38 lessons, which include analytic exercises pairing visual and auditory stimuli, and synthetic quizzes presenting auditory stimuli only. During quizzes, users type the sentence heard, and the app provides visual feedback on performance. Users may select a male or female speaker and the volume of background noise, allowing for training with a range of frequencies and signal-to-noise ratios. There were more than 3200 downloads of the English iPad app and almost 100 downloads of the Korean app; more than 100 users registered for the web apps. The English app received a System Usability Scale rating of “good” from 6 users, and the Korean app received a rating of “OK” from 16 users. Conclusions: Speech Banana offers AT accessibility with a validated curriculum, allowing users to develop speech comprehension skills with the aid of a mobile device. This mHealth app holds potential as a supplement to clinical AT, particularly in this era of global telemedicine. %M 33720025 %R 10.2196/20890 %U https://mhealth.jmir.org/2021/3/e20890 %U https://doi.org/10.2196/20890 %U http://www.ncbi.nlm.nih.gov/pubmed/33720025 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 1 %P e20405 %T Tablet-Based Telerehabilitation Versus Conventional Face-to-Face Rehabilitation After Cochlear Implantation: Prospective Intervention Pilot Study %A Völter,Christiane %A Stöckmann,Carolin %A Schirmer,Christiane %A Dazert,Stefan %+ Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr University Bochum, St Elisabeth Hospital, Bleichstraße 15, Bochum, 44787, Germany, 49 2345098390, christiane.voelter@rub.de %K computer-based auditory training %K correction of hearing impairment %K cochlear implant %K effectivity %K intervention study %K telerehabilitation %K pandemic %D 2021 %7 12.3.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Technologies allowing home-based rehabilitation may be a key means of saving financial resources while also facilitating people’s access to treatment. After cochlear implantation, auditory training is necessary for the brain to adapt to new auditory signals transmitted by the cochlear implant (CI). To date, auditory training is conducted in a face-to-face setting at a specialized center. However, because of the COVID-19 pandemic’s impact on health care, the need for new therapeutic settings has intensified. Objective: The aims of this study are to assess the feasibility of a novel teletherapeutic auditory rehabilitation platform in adult CI recipients and compare the clinical outcomes and economic benefits of this platform with those derived from conventional face-to-face rehabilitation settings in a clinic. Methods: In total, 20 experienced adult CI users with a mean age of 59.4 (SD 16.3) years participated in the study. They completed 3 weeks of standard (face-to-face) therapy, followed by 3 weeks of computer-based auditory training (CBAT) at home. Participants were assessed at three intervals: before face-to-face therapy, after face-to-face therapy, and after CBAT. The primary outcomes were speech understanding in quiet and noisy conditions. The secondary outcomes were the usability of the CBAT system, the participants’ subjective rating of their own listening abilities, and the time required for completing face-to-face and CBAT sessions for CI users and therapists. Results: Greater benefits were observed after CBAT than after standard therapy in nearly all speech outcome measures. Significant improvements were found in sentence comprehension in noise (P=.004), speech tracking (P=.004) and phoneme differentiation (vowels: P=.001; consonants: P=.02) after CBAT. Only speech tracking improved significantly after conventional therapy (P=.007). The program’s usability was judged to be high: only 2 of 20 participants could not imagine using the program without support. The different features of the training platform were rated as high. Cost analysis showed a cost difference in favor of CBAT: therapists spent 120 minutes per week face-to-face and 30 minutes per week on computer-based sessions. For CI users, attending standard therapy required an average of approximately 78 (SD 58.6) minutes of travel time per appointment. Conclusions: The proposed teletherapeutic approach for hearing rehabilitation enables good clinical outcomes while saving time for CI users and clinicians. The promising speech understanding results might be due to the high satisfaction of users with the CBAT program. Teletherapy might offer a cost-effective solution to address the lack of human resources in health care as well as the global challenge of current or future pandemics. %M 33709934 %R 10.2196/20405 %U https://rehab.jmir.org/2021/1/e20405 %U https://doi.org/10.2196/20405 %U http://www.ncbi.nlm.nih.gov/pubmed/33709934 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e21103 %T Perception of COVID-19 Physical Distancing Effectiveness and Contagiousness of Asymptomatic Individuals: Cross-sectional Survey of Deaf and Hard of Hearing Adults in the United States %A Paludneviciene,Raylene %A Knight,Tracy %A Firl,Gideon %A Luttrell,Kaela %A Takayama,Kota %A Kushalnagar,Poorna %+ Department of Psychology, Gallaudet University, 800 Florida Ave NE, Washington, DC, 20002, United States, 1 585 666 0818, poorna.kushalnagar@gallaudet.edu %K COVID-19 %K coronavirus %K physical distancing %K asymptomatic individual %K social media %K deaf %K hard of hearing %K sign language %K perception %K misinformation %D 2021 %7 25.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, there has been a rapid increase in the amount of information about the disease and SARS-CoV-2 on the internet. If the language used in video messages is not clear or understandable to deaf and hard of hearing (DHH) people with a high school degree or less, this can cause confusion and result in information gaps among DHH people during a health emergency. Objective: The aim of this study is to investigate the relationship between DHH people's perception of the effectiveness of physical distancing and contagiousness of an asymptomatic person. Methods: This is a cross-sectional survey study on DHH people's perceptions about COVID-19 (N=475). Items pertaining to COVID-19 knowledge were administered to US deaf adults from April 17, 2020, to May 1, 2020, via a bilingual American Sign Language/English online survey platform. Results: The sample consisted of 475 DHH adults aged 18-88 years old, with 74% (n=352) identifying as White and 54% (n=256) as female. About 88% (n=418) of the sample felt they knew most things or a lot about physical distancing. This figure dropped to 72% (n=342) for the question about the effectiveness of physical distancing in reducing the spread of COVID-19 and 70% (n=333) for the question about the contagiousness of an infected person without symptoms. Education and a knowledge of the effectiveness of physical distancing significantly predicted knowledge about the contagiousness of an asymptomatic individual. Race, gender, and age did not emerge as significant predictors. Conclusions: This results of this study point to the strong connection between education and coronavirus-related knowledge. Education-related disparities can be remedied by making information fully accessible and easily understood during emergencies and pandemics. %M 33560996 %R 10.2196/21103 %U https://www.jmir.org/2021/2/e21103 %U https://doi.org/10.2196/21103 %U http://www.ncbi.nlm.nih.gov/pubmed/33560996 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e26406 %T Central Auditory Tests to Track Cognitive Function in People With HIV: Longitudinal Cohort Study %A Niemczak,Christopher %A Fellows,Abigail %A Lichtenstein,Jonathan %A White-Schwoch,Travis %A Magohe,Albert %A Gui,Jiang %A Wilbur,Jed %A Clavier,Odile %A Massawe,Enica %A Moshi,Ndeserua %A Boivin,Michael %A Kraus,Nina %A Buckey,Jay %+ Geisel School of Medicine at Dartmouth, Dartmouth College, One Medical Center Drive, Lebanon, NH, 03755, United States, 1 603 650 6012, christopher.e.niemczak@dartmouth.edu %K HIV %K central auditory function %K auditory perception %K cognitive dysfunction %K testing %K cognition %K cognitive function %K neurocognitive deficit %K longitudinal %K auditory %K nervous system %K screening %K monitoring %K surveillance %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The development of neurocognitive deficits in people infected with HIV is a significant public health problem. Previous cross-sectional studies have shown that performance on central auditory tests (CATs) correlates with cognitive test results in those with HIV, but no longitudinal data exist for confirmation. We have been performing longitudinal assessments of central auditory and cognitive function on a cohort of HIV-positive and HIV-negative individuals in Dar es Salaam, Tanzania to understand how the central auditory system could be used to study and track the progress of central nervous system dysfunction. Objective: The goal of the project was to determine if CATs can track the trajectory of cognitive function over time in people diagnosed with HIV. Methods: Tests of peripheral and central auditory function as well as cognitive performance were performed on 382 individuals over the course of 3.5 years. Visits were scheduled every 6 months. CATs included tests of auditory temporal processing (gap detection) and speech perception in noise (Hearing in Noise Test and Triple Digit Test). Cognitive tests included the Montreal Cognitive Assessment (MoCA), Test of Variables of Attention (TOVA), and subtests from the Cogstate battery. HIV-positive subjects were divided into groups based on their CAT results at their final visit (bottom 20%, top 20%, middle 60%). Primary analyses focused on the comparison between HIV-positive individuals that performed worse on CATs (bottom 20%) and the overall HIV-positive group (middle 60%). Data were analyzed using linear mixed-effect models with time as the main fixed effect. Results: The group with the worst (bottom 20%) CAT performance showed a difference in trajectory for the MoCA (P=.003), TOVA (P<.048), and Cogstate (P<.046) over the course of the study period compared to the overall HIV-positive group. A battery of three CATs showed a significant difference in cognitive trajectory over a relatively short study period of 3.5 years independent of age (bottom 20% vs HIV-positive group). Conclusions: The results of this study support the ability for CATs to track cognitive function over time, suggesting that central auditory processing can provide a window into central nervous system performance. CATs can be simple to perform, and are relatively insensitive to education and socioeconomic status because they only require repeating sentences, numbers, or detecting gaps in noise. These tests could potentially provide a time-efficient, low-cost method to screen for and monitor cognitive decline in patients with HIV, making them a useful surveillance tool for this major public health problem. %M 33470933 %R 10.2196/26406 %U http://formative.jmir.org/2021/2/e26406/ %U https://doi.org/10.2196/26406 %U http://www.ncbi.nlm.nih.gov/pubmed/33470933 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e13908 %T Cultural Adaptation of Digital Knowledge Translation Tools for Acute Otitis Media in Low- to Middle-Income Countries: Mixed Methods Usability Study %A Meherali,Salima %A Hartling,Lisa %A Scott,Shannon D %+ Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada, 1 7804921037, shannon.scott@ualberta.ca %K acute otitis media %K knowledge translation %K pediatric %K parent’s experiences %K information needs %K global health %D 2021 %7 20.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Acute otitis media (AOM) is the most common pediatric bacterial ear infection. AOM presents challenges to parents who lack accurate information. Digital knowledge translation tools offer a promising approach to communicating complex health information. We developed AOM knowledge translation tools for Canadian parents and augmented them for Pakistani parent end users. Objective: This pilot study aimed to (1) develop AOM knowledge translation tools for Canadian parents, (2) adapt the knowledge translation tools across cultural contexts, and (3) evaluate the usability of the adapted knowledge translation tools. Methods: Parents’ perceptions of the translated knowledge translation tools’ usability were explored using a mixed-methods design. We recruited parent participants from a hospital in Pakistan to complete usability surveys (n=47) and focus group interviews (n=21). Descriptive statistics and content analysis were used to analyze data. Results: Usability results showed the usefulness and effectiveness of both adapted knowledge translation tools. Parents reported preferring a digital media narrative format in their own language. Findings revealed that culturally adapted knowledge translation tools are effective in transferring health information to parents. Conclusions: Digital knowledge translation tools offer a promising approach to improving health literacy and communicating complex health information to parents of children with AOM. Culturally adapting the tools generated important knowledge that will contribute to knowledge translation advancements. Evaluation of the tool effectiveness is a critical next step to exploring the impact of knowledge translation tools on child health outcomes. %M 33470942 %R 10.2196/13908 %U http://formative.jmir.org/2021/1/e13908/ %U https://doi.org/10.2196/13908 %U http://www.ncbi.nlm.nih.gov/pubmed/33470942 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e23047 %T A Smartphone-Based Approach to Screening for Sudden Sensorineural Hearing Loss: Cross-Sectional Validity Study %A Lin,Heng-Yu Haley %A Chu,Yuan-Chia %A Lai,Ying-Hui %A Cheng,Hsiu-Lien %A Lai,Feipei %A Cheng,Yen-Fu %A Liao,Wen-Huei %+ Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, Taiwan, 886 2 2875 7808 ext 7264, whliaovictor@gmail.com %K sudden sensorineural hearing loss %K hearing test %K telemedicine %K mobile apps %K pure tone %K audiometry %D 2020 %7 11.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Sudden sensorineural hearing loss (SSNHL) is an otologic emergency that warrants urgent management. Pure-tone audiometry remains the gold standard for definitively diagnosing SSNHL. However, in clinical settings such as primary care practices and urgent care facilities, conventional pure-tone audiometry is often unavailable. Objective: This study aimed to determine the correlation between hearing outcomes measured by conventional pure-tone audiometry and those measured by the proposed smartphone-based Ear Scale app and determine the diagnostic validity of the hearing scale differences between the two ears as obtained by the Ear Scale app for SSNHL. Methods: This cross-sectional study included a cohort of 88 participants with possible SSNHL who were referred to an otolaryngology clinic or emergency department at a tertiary medical center in Taipei, Taiwan, between January 2018 and June 2019. All participants underwent hearing assessments with conventional pure-tone audiometry and the proposed smartphone-based Ear Scale app consecutively. The gold standard for diagnosing SSNHL was defined as the pure-tone average (PTA) difference between the two ears being ≥30 dB HL. The hearing results measured by the Ear Scale app were presented as 20 stratified hearing scales. The hearing scale difference between the two ears was estimated to detect SSNHL. Results: The study sample comprised 88 adults with a mean age of 46 years, and 50% (44/88) were females. PTA measured by conventional pure-tone audiometry was strongly correlated with the hearing scale assessed by the Ear Scale app, with a Pearson correlation coefficient of .88 (95% CI .82-.92). The sensitivity of the 5–hearing scale difference (25 dB HL difference) between the impaired ear and the contralateral ear in diagnosing SSNHL was 95.5% (95% CI 87.5%-99.1%), with a specificity of 66.7% (95% CI 43.0%-85.4%). Conclusions: Our findings suggest that the proposed smartphone-based Ear Scale app can be useful in the evaluation of SSNHL in clinical settings where conventional pure-tone audiometry is not available. %M 33174845 %R 10.2196/23047 %U http://mhealth.jmir.org/2020/11/e23047/ %U https://doi.org/10.2196/23047 %U http://www.ncbi.nlm.nih.gov/pubmed/33174845 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e17213 %T Screening for Hearing Impairment in Older Adults by Smartphone-Based Audiometry, Self-Perception, HHIE Screening Questionnaire, and Free-Field Voice Test: Comparative Evaluation of the Screening Accuracy With Standard Pure-Tone Audiometry %A Li,Lok Yee Joyce %A Wang,Shin-Yi %A Wu,Cheng-Jung %A Tsai,Cheng-Yu %A Wu,Te-Fang %A Lin,Yaoh-Shiang %+ Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd, Zhonghe District, New Taipei City, 23561, Taiwan, 886 22490088, b101090126@tmu.edu.tw %K hearing impairment %K self-perception %K HHIE-S questionnaire %K free-field voice test %K mobile phone %K audiometry %K mobile health %D 2020 %7 27.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hearing impairment is the most frequent sensory deficit in humans, affecting more than 360 million people worldwide. In fact, hearing impairment is not merely a health problem, but it also has a great impact on the educational performance, economic income, and quality of life. Hearing impairment is therefore an important social concern. Objective: We aimed to evaluate and compare the accuracy of self-perception, Hearing Handicap Inventory for the Elderly-Screening (HHIE-S) questionnaire, free-field voice test, and smartphone-based audiometry as tests for screening moderate hearing impairment in older adults in China. Methods: In this study, 41 patients were recruited through a single otology practice. All patients were older than 65 years. Patients with otorrhea and cognitive impairment were excluded. Moderate hearing impairment was defined as mean hearing thresholds at 500, 1000, 2000, and 4000 Hz >40 dB hearing loss (pure-tone average > 40 dB hearing loss). All patients completed 5 hearing tests, namely, the self-perception test, HHIE-S questionnaire test, free-field voice test, smartphone-based audiometry test, and standard pure-tone audiometry by the same audiologist. We compared the results of these tests to the standard audiogram in the better-hearing ear. Results: The sensitivity and the specificity of the self-perception test were 0.58 (95% CI 0.29-0.84) and 0.34 (95% CI 0.19-0.54), respectively. The sensitivity and the specificity of the HHIE-S questionnaire test were 0.67 (95% CI 0.35-0.89) and 0.31 (95% CI 0.316-0.51), respectively. The sensitivity and the specificity of the free-field voice test were 0.83 (95% CI 0.51-0.97) and 0.41 (95% CI 0.24-0.61), respectively. The sensitivity and the specificity of the smartphone-based audiometry test were 0.92 (95% CI 0.60-0.99) and 0.76 (95% CI 0.56-0.89), respectively. Smartphone-based audiometry correctly diagnosed the presence of hearing loss with high sensitivity and high specificity. Conclusions: Smartphone-based audiometry may be a dependable screening test to rule out moderate hearing impairment in the older population. %M 33107828 %R 10.2196/17213 %U http://mhealth.jmir.org/2020/10/e17213/ %U https://doi.org/10.2196/17213 %U http://www.ncbi.nlm.nih.gov/pubmed/33107828 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 3 %P e19880 %T A Novel Auditory-Cognitive Training App for Delaying or Preventing the Onset of Dementia: Participatory Design With Stakeholders %A Frost,Emily %A Porat,Talya %A Malhotra,Paresh %A Picinali,Lorenzo %+ Dyson School of Design Engineering, Imperial College London, Dyson Building, Imperial College Road, London, SW7 2DB, United Kingdom, 44 2075948158, e.frost@imperial.ac.uk %K cognitive decline %K mobile phone %K hearing loss %D 2020 %7 30.9.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Multiple gaming apps exist under the dementia umbrella for skills such as navigation; however, an app to specifically investigate the role of hearing loss in the process of cognitive decline is yet to be designed. There is a demonstrable gap in the utilization of games to further the knowledge of the potential relationship between hearing loss and dementia. Objective: This study aims to identify the needs, facilitators, and barriers in designing a novel auditory-cognitive training gaming app. Methods: A participatory design approach was used to engage key stakeholders across audiology and cognitive disorder specialties. Two rounds, including paired semistructured interviews and focus groups, were completed and thematically analyzed. Results: A total of 18 stakeholders participated, and 6 themes were identified to inform the next stage of app development. These included congruence with hobbies, life getting in the way, motivational challenge, accessibility, addictive competition, and realism. Conclusions: The findings can now be implemented in the development of the app. The app will be evaluated against outcome measures of speech listening in noise, cognitive and attentional tasks, quality of life, and usability. %M 32996884 %R 10.2196/19880 %U http://humanfactors.jmir.org/2020/3/e19880/ %U https://doi.org/10.2196/19880 %U http://www.ncbi.nlm.nih.gov/pubmed/32996884 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e17927 %T Effectiveness of a Web-Based SUpport PRogram (SUPR) for Hearing Aid Users Aged 50+: Two-Arm, Cluster Randomized Controlled Trial %A Meijerink,Janine FJ %A Pronk,Marieke %A Lissenberg-Witte,Birgit I %A Jansen,Vera %A Kramer,Sophia E %+ Otolaryngology—Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands, 1 +31 020 444 905, m.pronk@amsterdamumc.nl %K hearing loss %K hearing aids %K auditory rehabilitation %K self-management %K communication programs %K internet %K hearing aid dispensing practice %K randomized controlled trial %D 2020 %7 22.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Hearing aid (HA) use is known to improve health outcomes for people with hearing loss. Despite that, HA use is suboptimal, and communication issues and hearing-related activity limitations and participation restrictions often remain. Web-based self-management communication programs may support people with hearing loss to effectively self-manage the impact of hearing loss in their daily lives. Objective: The goal of the research is to examine the short- and long-term effects of a web-based self-management SUpport PRogram (SUPR) on communication strategy use (primary outcome) and a range of secondary outcomes for HA users aged 50 years and older. Methods: Clients of 36 HA dispensing practices were randomized to SUPR (SUPR recipients; n=180 HA users) and 34 to care as usual (controls; n=163 HA users). SUPR recipients received a practical support booklet and online materials delivered via email over the course of their 6-month HA rehabilitation trajectory. They were encouraged to appoint a communication partner and were offered optional email contact with the HA dispensing practice. The online materials included 3 instruction videos on HA handling, 5 videos on communication strategies, and 3 testimonial videos. Care as usual included a HA fitting rehabilitation trajectory only. Measurements were carried out at baseline, immediately postintervention, 6 months postintervention, and 12 months postintervention. The primary outcome measure was self-reported use of communication strategies (3 subscales of the Communication Profile for the Hearing Impaired [CPHI]). Secondary outcome measures included self-reported personal adjustment to hearing loss (CPHI); use, satisfaction and benefit of HAs and SUPR (use questionnaire; International Outcome Inventory for Hearing Aids [IOI-HA], Alternative Interventions [IOI-AI]); recommendation of HA dispensing services; self-efficacy for HA handling (Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids [MARS-HA]); readiness to act on hearing loss (University of Rhode Island Change Assessment adapted for hearing loss [URICA-HL]); and hearing disability (Amsterdam Inventory for Auditory Disability and Handicap [AIADH]). Results: Linear mixed model analyses (intention to treat) showed no significant differences between the SUPR and control group in the course of communication strategy use (CPHI). Immediately postintervention, SUPR recipients showed significantly higher self-efficacy for advanced HA handling than the controls, which was sustained at 12 months (MARS-HA; mean difference immediately postintervention: 5.3, 95% CI 0.3 to 10.4; P=.04). Also, SUPR recipients showed significantly greater HA satisfaction than controls immediately postintervention (IOI-HA; 0.3, 95% CI 0.09 to 0.5; P=.006), which was sustained at 12 months, and significantly greater HA use than the controls immediately postintervention (IOI-HA; 0.3, 95% CI 0.02 to 0.5; P=.03), which was not sustained at 12 months. Conclusions: This study provides ground to recommend adding SUPR to standard HA dispensing care, as long-term, modest improvements in HA outcomes were observed. Further research is needed to evaluate what adjustments to SUPR are needed to establish long-term effectiveness on outcomes in the psychosocial domain. Trial Registration: ISRCTN77340339; http://www.isrctn.com/ISRCTN77340339 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2016-015012 %M 32960175 %R 10.2196/17927 %U http://www.jmir.org/2020/9/e17927/ %U https://doi.org/10.2196/17927 %U http://www.ncbi.nlm.nih.gov/pubmed/32960175 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e17193 %T Evaluating a Theoretically Informed and Cocreated Mobile Health Educational Intervention for First-Time Hearing Aid Users: Qualitative Interview Study %A Maidment,David W %A Heyes,Rachel %A Gomez,Rachel %A Coulson,Neil S %A Wharrad,Heather %A Ferguson,Melanie A %+ School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, United Kingdom, 44 1509225439, D.W.Maidment@lboro.ac.uk %K hearing loss %K hearing aids %K telemedicine %K behavioral medicine %K qualitative research %K mobile phone %D 2020 %7 5.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adults living with hearing loss have highly variable knowledge of hearing aids, resulting in suboptimal use or nonuse. This issue can be addressed by the provision of high-quality educational resources. Objective: This study aims to assess the everyday experiences of first-time hearing aid users when using a newly developed, theoretically informed cocreated mobile health (mHealth) educational intervention called m2Hear. This intervention aims to deliver greater opportunities for individualization and interactivity compared with our previously developed multimedia intervention, C2Hear. Methods: A total of 16 first-time hearing aid users trialed m2Hear for a period of 10-weeks in their everyday lives, after which individual semistructured interviews were completed. The data were analyzed using an established deductive thematic analysis procedure underpinned by the Capability, Opportunity, Motivation-Behavior model. The model stipulates that to engage in a target behavior, an individual must have physical and psychological capability, physical and social opportunity, and automatic and reflective motivation. Results: Capability—m2Hear was viewed as a concise and comprehensive resource, suitable for a range of digital literacy skills. It was stated that m2Hear could be conveniently reused to provide useful reminders that facilitate knowledge of hearing aids and communication. Opportunity—m2Hear was simple and straightforward to use, enabling greater individualization and independence. The availability of m2Hear via mobile technologies also improved accessibility. Motivation—m2Hear provided greater support and reassurance, improving confidence and empowering users to self-manage their hearing loss. Conclusions: Overall, this qualitative study suggests that m2Hear supports first-time hearing aid users to successfully self-manage their hearing loss postfitting. Furthermore, this study demonstrates the utility of employing a combined theoretical and ecologically valid approach in the development of mHealth educational resources to meet the individual self-management needs of adults living with hearing loss. Trial Registration: ClinicalTrials.gov NCT03136718; https://clinicaltrials.gov/ct2/show/NCT03136718 %M 32755885 %R 10.2196/17193 %U https://mhealth.jmir.org/2020/8/e17193 %U https://doi.org/10.2196/17193 %U http://www.ncbi.nlm.nih.gov/pubmed/32755885 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17238 %T Worldwide Prevalence of Hearing Loss Among Smartphone Users: Cross-Sectional Study Using a Mobile-Based App %A Masalski,Marcin %A Morawski,Krzysztof %+ Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Wroclaw Medical University, Wybrzeze Ludwika Pasteura 1, Wroclaw, 50-367, Poland, 48 515086252, marcin.masalski@pwr.edu.pl %K hearing loss %K epidemiology %K mobile-based %K hearing test %K pure-tone audiometry %D 2020 %7 23.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In addition to the aging process, risk factors for hearing loss in adults include, among others, exposure to noise, use of ototoxic drugs, genetics, and limited access to medical care. Differences in exposure to these factors are bound to be reflected in the prevalence of hearing loss. Assessment of hearing loss can easily be carried out on a large scale and at low cost using mobile apps. Objective: This study aimed to conduct a worldwide assessment of the differences in hearing loss prevalence between countries in a group of mobile device users. Methods: Hearing tests were conducted using the open-access Android-based mobile app Hearing Test. The app is available free of charge in the Google Play store, provided that consent to the use of the results for scientific purposes is given. This study included hearing tests carried out on device models supported by the app with bundled headphones in the set. Calibration factors for supported models were determined using the biological method. The tests consisted of self-determining the quietest audible tone in the frequency range from 250 Hz to 8 kHz by adjusting its intensity using the buttons. The ambient noise level was optionally monitored using a built-in microphone. Following the test, the user could compare his hearing threshold against age norms by providing his or her age. The user's location was identified based on the phone’s IP address. Results: From November 23, 2016 to November 22, 2019, 733,716 hearing tests were conducted on 236,716 mobile devices across 212 countries. After rejecting the tests that were incomplete, performed with disconnected headphones, not meeting the time criterion, repeated by the same user, or carried out regularly on one device, 116,733 of 733,716 tests (15.9%) were qualified for further analysis. The prevalence of hearing loss, defined as the average threshold at frequencies 0.5 kHz, 1 kHz, 2 kHz, and 4 kHz above 25 dB HL in the better ear, was calculated at 15.6% (95% CI 15.4-15.8). Statistically significant differences were found between countries (P<.001), with the highest prevalences for Bangladesh, Pakistan, and India (>28%) and the lowest prevalences for Taiwan, Finland, and South Korea (<11%). Conclusions: Hearing thresholds measured by means of mobile devices were congruent with the literature data on worldwide hearing loss prevalence. Uniform recruitment criteria simplify the comparison of the hearing loss prevalence across countries. Hearing testing on mobile devices may be a valid tool in epidemiological studies carried out on a large scale. %M 32706700 %R 10.2196/17238 %U http://www.jmir.org/2020/7/e17238/ %U https://doi.org/10.2196/17238 %U http://www.ncbi.nlm.nih.gov/pubmed/32706700 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e15547 %T Applying Machine Learning to Daily-Life Data From the TrackYourTinnitus Mobile Health Crowdsensing Platform to Predict the Mobile Operating System Used With High Accuracy: Longitudinal Observational Study %A Pryss,Rüdiger %A Schlee,Winfried %A Hoppenstedt,Burkhard %A Reichert,Manfred %A Spiliopoulou,Myra %A Langguth,Berthold %A Breitmayer,Marius %A Probst,Thomas %+ Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str 2, Würzburg, 97080, Germany, 49 931 20146471, ruediger.pryss@uni-wuerzburg.de %K mHealth %K crowdsensing %K tinnitus %K machine learning %K mobile operating system differences %K ecological momentary assessment %K mobile phone %D 2020 %7 30.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Tinnitus is often described as the phantom perception of a sound and is experienced by 5.1% to 42.7% of the population worldwide, at least once during their lifetime. The symptoms often reduce the patient’s quality of life. The TrackYourTinnitus (TYT) mobile health (mHealth) crowdsensing platform was developed for two operating systems (OS)—Android and iOS—to help patients demystify the daily moment-to-moment variations of their tinnitus symptoms. In all platforms developed for more than one OS, it is important to investigate whether the crowdsensed data predicts the OS that was used in order to understand the degree to which the OS is a confounder that is necessary to consider. Objective: In this study, we explored whether the mobile OS—Android and iOS—used during user assessments can be predicted by the dynamic daily-life TYT data. Methods: TYT mainly applies the paradigms ecological momentary assessment (EMA) and mobile crowdsensing to collect dynamic EMA (EMA-D) daily-life data. The dynamic daily-life TYT data that were analyzed included eight questions as part of the EMA-D questionnaire. In this study, 518 TYT users were analyzed, who each completed at least 11 EMA-D questionnaires. Out of these, 221 were iOS users and 297 were Android users. The iOS users completed, in total, 14,708 EMA-D questionnaires; the number of EMA-D questionnaires completed by the Android users was randomly reduced to the same number to properly address the research question of the study. Machine learning methods—a feedforward neural network, a decision tree, a random forest classifier, and a support vector machine—were applied to address the research question. Results: Machine learning was able to predict the mobile OS used with an accuracy up to 78.94% based on the provided EMA-D questionnaires on the assessment level. In this context, the daily measurements regarding how users concentrate on the actual activity were particularly suitable for the prediction of the mobile OS used. Conclusions: In the work at hand, two particular aspects have been revealed. First, machine learning can contribute to EMA-D data in the medical context. Second, based on the EMA-D data of TYT, we found that the accuracy in predicting the mobile OS used has several implications. Particularly, in clinical studies using mobile devices, the OS should be assessed as a covariate, as it might be a confounder. %M 32602842 %R 10.2196/15547 %U http://www.jmir.org/2020/6/e15547/ %U https://doi.org/10.2196/15547 %U http://www.ncbi.nlm.nih.gov/pubmed/32602842 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 1 %P e15348 %T The Sign 4 Little Talkers Intervention to Improve Listening, Understanding, Speaking, and Behavior in Hearing Preschool Children: Outcome Evaluation %A Davidson,Rosemary %A Randhawa,Gurch %+ Institute for Health Research, University of Bedfordshire, University Square, Luton, LU1 3JU, United Kingdom, 44 1234 400 ext 400, rosemary.davidson@beds.ac.uk %K sign language %K early years %K intervention %K disadvantage %D 2020 %7 30.6.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Gaining age-appropriate proficiency in speech and language in the early years is crucial to later life chances; however, a significant proportion of children fail to meet the expected standards in these early years outcomes when they start school. Factors influencing the development of language and communication include low income, gender, and having English as an additional language (EAL). Objective: This study aimed to determine whether the Sign 4 Little Talkers (S4LT) program improves key developmental outcomes in hearing preschool children. S4LT was developed to address gaps in the attainment of vocabulary and communication skills in preschool children, identified through routine monitoring of outcomes in early years. Signs were adapted and incorporated into storybooks to improve vocabulary, communication, and behavior in hearing children. Methods: An evaluation of S4LT was conducted to measure key outcomes pre- and postintervention in 8 early years settings in Luton, United Kingdom. A total of 118 preschool children were tested in 4 early years outcomes domains—listening, speaking, understanding, and managing feelings and behavior—as well as Leuven well-being scales and the number of key words understood and spoken. Results: Statistically significant results were found for all measures tested: words spoken (P<.001) and understood (P<.001), speaking (P<.001), managing feelings and behavior (P<.001), understanding (P<.001), listening and attention (P<.001), and well-being (P<.001). Approximately two-thirds of the children made expected or good progress, often progressing multiple steps in educational attainment after being assessed as developmentally behind at baseline. Conclusions: The findings reported here suggest that S4LT may help children to catch up with their peers at a crucial stage in development and become school ready by improving their command of language and communication as well as learning social skills. Our analysis also highlights specific groups of children who are not responding as well as expected, namely boys with EAL, and who require additional, tailored support. %M 32452813 %R 10.2196/15348 %U https://pediatrics.jmir.org/2020/1/e15348 %U https://doi.org/10.2196/15348 %U http://www.ncbi.nlm.nih.gov/pubmed/32452813 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 2 %P e16310 %T Usability of a Mobile App for Improving Literacy in Children With Hearing Impairment: Focus Group Study %A DeForte,Shelly %A Sezgin,Emre %A Huefner,Janelle %A Lucius,Shana %A Luna,John %A Satyapriya,Anand A %A Malhotra,Prashant %+ Research Information Solutions and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, United States, 1 6143556814, emre.sezgin@nationwidechildrens.org %K hearing aids %K focus groups %K cochlear implants %K literacy %K reading %K hearing loss %K hearing impairment %K mobile applications %K qualitative study %K usability %K aural rehabilitation %D 2020 %7 28.5.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Children with hearing loss, even those identified early and who use hearing aids or cochlear implants, may face challenges in developing spoken language and literacy. This can lead to academic, behavioral, and social difficulties. There are apps for healthy children to improve their spoken language and literacy and apps that focus on sign language proficiency for children with hearing loss, but these apps are limited for children with hearing loss. Therefore, we have developed an app called Hear Me Read, which uses enhanced digital stories as therapy tools for speech, language, and literacy for children with hearing loss. The platform has therapist and parent/child modes that allow (1) the selection of high-quality, illustrated digital stories by a speech-language pathologist, parent, or child; (2) the modification of digital stories for a multitude of speech and language targets; and (3) the assignment of stories by a therapist to facilitate individualized speech and language goals. In addition, Hear Me Read makes the caregiver a core partner in engagement through functionality, whereby the caregiver can record video and audio of themselves to be played back by the child. Objective: This study aimed to evaluate the user experience of the Hear Me Read app through a focus group study with caregivers and their children. Methods: We recruited 16 participants (8 children with and without hearing loss and 8 caregivers) to participate in 1-hour focus groups. Caregivers and children interacted with the app and discussed their experiences through a semistructured group interview. We employed thematic analysis methods and analyzed the data. We used feedback from the focus group to improve the elements of the app for a larger clinical trial assessing the impact of the app on outcomes. Results: We identified three themes: default needs, specific needs, and family needs. Participants found the app to be esthetically pleasing and easy to use. The findings of this study helped us to identify usability attributes and to amend app functionalities to best fit user needs. Caregivers and children appreciated the enhancements, such as highlighting of parts of speech and caregiver reading of video playback, which were made possible by the digital format. Participants expressed that the app could be used to enhance family reading sessions and family interaction. Conclusions: The findings from this focus group study are promising for the use of educational apps designed specifically for those with hearing loss who are pursuing listening and spoken language as a communication outcome. Further investigation is needed with larger sample sizes to understand the clinical impact on relevant language and literacy outcomes in this population. %M 32205305 %R 10.2196/16310 %U http://humanfactors.jmir.org/2020/2/e16310/ %U https://doi.org/10.2196/16310 %U http://www.ncbi.nlm.nih.gov/pubmed/32205305 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 7 %N 1 %P e15843 %T Therapist-Guided Telerehabilitation for Adult Cochlear Implant Users: Developmental and Feasibility Study %A Völter,Christiane %A Schirmer,Christiane %A Hinsen,Dorothee %A Roeber,Marieke %A Dazert,Stefan %A Bilda,Kerstin %+ Department of Otorhinolaryngology, Head and Neck Surgery, St. Elisabeth Hospital, Ruhr University Bochum, Bleichstraße 15, Bochum, 44787, Germany, 49 2345098390, christiane.voelter@rub.de %K telerehabilitation %K cochlear implantation %K computer-based auditory training %K multimodal platform system %D 2020 %7 28.5.2020 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Cochlear implants can provide auditory perception to many people with hearing impairment who derive insufficient benefits from hearing aid use. For optimal speech perception with a cochlear implant, postoperative auditory training is necessary to adapt the brain to the new sound transmitted by the implant. Currently, this training is usually conducted via face-to-face sessions in rehabilitation centers. With the aging of society, the prevalence of age-related hearing loss and the number of adults with cochlear implants are expected to increase. Therefore, augmenting face-to-face rehabilitation with alternative forms of auditory training may be highly valuable. Objective: The purpose of this multidisciplinary study was to evaluate the newly developed internet-based teletherapeutic multimodal system Train2hear, which enables adult cochlear implant users to perform well-structured and therapist-guided hearing rehabilitation sessions on their own. Methods: The study was conducted in 3 phases: (1) we searched databases from January 2005 to October 2018 for auditory training programs suitable for adult cochlear implant users; (2) we developed a prototype of Train2hear based on speech and language development theories; (3) 18 cochlear implant users (mean age 61, SD 15.4 years) and 10 speech and language therapists (mean age 34, SD 10.9 years) assessed the usability and the feasibility of the prototype. This was achieved via questionnaires, including the System Usability Scale (SUS) and a short version of the intrinsic motivation inventory (KIM) questionnaires. Results: The key components of the Train2hear training program are an initial analysis according to the International Classification of Functioning, Disability and Health; a range of different hierarchically based exercises; and an automatic and dynamic adaptation of the different tasks according to the cochlear implant user’s progress. In addition to motivational mechanisms (such as supportive feedback), the cochlear implant user and therapist receive feedback in the form of comprehensive statistical analysis. In general, cochlear implant users enjoyed their training as assessed by KIM scores (mean 19, SD 2.9, maximum 21). In terms of usability (scale 0-100), the majority of users rated the Train2hear program as excellent (mean 88, SD 10.5). Age (P=.007) and sex (P=.01) had a significant impact on the SUS score with regard to usability of the program. The therapists (SUS score mean 93, SD 9.2) provided slightly more positive feedback than the cochlear implant users (mean 85, SD 10.3). Conclusions: Based on this first evaluation, Train2hear was well accepted by both cochlear implant users and therapists. Computer-based auditory training might be a promising cost-effective option that can provide a highly personalized rehabilitation program suited to individual cochlear implant user characteristics. %M 32255434 %R 10.2196/15843 %U http://rehab.jmir.org/2020/1/e15843/ %U https://doi.org/10.2196/15843 %U http://www.ncbi.nlm.nih.gov/pubmed/32255434 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 4 %P e15452 %T Effectiveness and Cost-Effectiveness of Receiving a Hearing Dog on Mental Well-Being and Health in People With Hearing Loss: Protocol for a Randomized Controlled Trial %A Stuttard,Lucy %A Hewitt,Catherine %A Fairhurst,Caroline %A Weatherly,Helen %A Walker,Simon %A Longo,Francesco %A Maddison,Jane %A Boyle,Philip %A Beresford,Bryony %+ Social Policy Research Unit, Department of Social Policy and Social Work, Alcuin B Block, University of York, Heslington, York, YO10 5DD, United Kingdom, 44 01904321965, lucy.stuttard@york.ac.uk %K randomized controlled trial %K hearing loss %K qualitative research %K economics %K assistance dog %D 2020 %7 17.4.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: People with hearing loss, particularly those who lose their hearing in adulthood, are at an increased risk of social isolation, mental health difficulties, unemployment, loss of independence, risk of accidents, and impaired quality of life. In the United Kingdom, a single third-sector organization provides hearing dogs, a specific type of assistance dog trained to provide sound support to people with hearing loss. These dogs may also deliver numerous psychosocial benefits to recipients. This has not previously been fully investigated. Objective: The study aims to evaluate the impact of a hearing dog partnership on the lives of individuals with severe or profound hearing loss. Methods: A 2-arm, randomized controlled trial will be conducted within the United Kingdom with 162 hearing dog applicants, aged 18 years and older. Participants will be randomized 1:1 using a matched-pairs design to receive a hearing dog sooner than usual (intervention arm: arm B) or to receive a hearing dog within the usual timeframe (comparator arm: arm A). In the effectiveness analysis, the primary outcome is a comparison of mental well-being 6 months after participants in arm B have received a hearing dog (arm A have not yet received a hearing dog), measured using the Short Warwick Edinburgh Mental Well-Being Scale. Secondary outcome measures include the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Work and Social Adjustments Scale. An economic evaluation will assess the cost-effectiveness, including health-related quality-adjusted life years using the EuroQol 5 Dimensions and social care–related quality-adjusted life years. Participants will be followed up for up to 2 years. A nested qualitative study will investigate the impacts of having a hearing dog and how these impacts occur. Results: The study is funded by the National Institute for Health Research’s School for Social Care Research. Recruitment commenced in March 2017 and is now complete. A total of 165 participants were randomized. Data collection will continue until January 2020. Results will be published in peer-reviewed journals and at conferences. A summary of the findings will be made available to participants. Ethical approval was received from the University of York’s Department of Social Policy and Social Work Research Ethics Committee (reference SPSW/S/17/1). Conclusions: The findings from this study will provide, for the first time, strong and reliable evidence on the impact of having a hearing dog on people’s lives in terms of their quality of life, well-being, and mental health. Trial Registration: International Standard Randomised Controlled Trial Number Registry ISRCTN36452009; http://www.isrctn.com/ISRCTN36452009 International Registered Report Identifier (IRRID): DERR1-10.2196/15452 %M 32301737 %R 10.2196/15452 %U https://www.researchprotocols.org/2020/4/e15452 %U https://doi.org/10.2196/15452 %U http://www.ncbi.nlm.nih.gov/pubmed/32301737 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e15875 %T Patient Uptake, Experience, and Satisfaction Using Web-Based and Face-to-Face Hearing Health Services: Process Evaluation Study %A Ratanjee-Vanmali,Husmita %A Swanepoel,De Wet %A Laplante-Lévesque,Ariane %+ Department of Speech-Language Pathology & Audiology, University of Pretoria, Lynnwood Rd & Roper Street, Pretoria, 0001, South Africa, 27 124204280, dewet.swanepoel@up.ac.za %K audiology %K hearing loss %K internet-based intervention %K patient outcome assessment %K patient satisfaction %K telemedicine %K text messaging %K eHealth %K mHealth %K social media %K patient-centered care %D 2020 %7 20.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Globally, access to hearing health care is a growing concern with 900 million people estimated to suffer from disabling hearing loss by 2050. Hearing loss is one of the most common chronic health conditions, yet access to hearing health care is limited. Incorporating Web-based (voice calling, messaging, or emailing) service delivery into current treatment pathways could improve access and allow for better scalability of services. Current electronic health studies in audiology have focused on technical feasibility, sensitivity, and specificity of diagnostic hearing testing and not on patient satisfaction, experiences, and sustainable models along the entire patient journey. Objective: This study aimed to investigate a hybrid (Web-based and face-to-face) hearing health service in terms of uptake, experience, and satisfaction in adult patients with hearing loss. Methods: A nonprofit hearing research clinic using online and face-to-face services was implemented in Durban, South Africa, using online recruitment from the clinic’s Facebook page and Google AdWords, which directed persons to an online Web-based hearing screening test. Web-based and face-to-face care pathways included assessment, treatment, and rehabilitation. To evaluate the service, an online survey comprising (1) a validated satisfaction measurement tool (Short Assessment of Patient Satisfaction), (2) a process evaluation of all the 5 steps completed, and (3) personal preferences of communication methods used vs methods preferred was conducted, which was sent to 46 patients who used clinic services. Results: Of the patients invited, 67% (31/46) completed the survey with mean age 66 years, (SD 16). Almost all patients, 92% (30/31) reported that the online screening test assisted them in seeking hearing health care. Approximately 60% (18/31) of the patients accessed the online hearing screening test from an Android device. Patients stayed in contact with the audiologist mostly through WhatsApp instant messaging (27/31, 87%), and most patients (25/31, 81%) preferred to use this method of communication. The patients continuing with hearing health care were significantly older and had significantly poorer speech recognition abilities compared with the patients who discontinued seeking hearing health care. A statistically significant positive result (P=.007) was found between age and the number of appointments per patient. Around 61% (19/31) of patients previously completed diagnostic testing at other practices, with 95% (18/19) rating the services at the hybrid clinic as better. The net promoter score was 87, indicating that patients were highly likely to recommend the hybrid clinic to friends and family. Conclusions: This study applied Web-based and face-to-face components into a hybrid clinic and measured an overall positive experience with high patient satisfaction through a process evaluation. The findings support the potential of a hybrid clinic with synchronous and asynchronous modes of communication to be a scalable hearing health care model, addressing the needs of adults with hearing loss globally. %M 32196459 %R 10.2196/15875 %U http://www.jmir.org/2020/3/e15875/ %U https://doi.org/10.2196/15875 %U http://www.ncbi.nlm.nih.gov/pubmed/32196459 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 1 %P e15464 %T The Impact of Hearing Impairment on the Life Trajectories of Aboriginal Children in Remote Australia: Protocol for the Hearing Loss in Kids Project %A Su,Jiunn-Yih %A He,Vincent Yaofeng %A Guthridge,Steven %A Silburn,Sven %+ Centre for Child Development and Education, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, 0811, Australia, 61 415563523, jiunn-yih.su2@menzies.edu.au %K data linkage %K hearing impairment %K indigenous population %K child development %K primary schools %K academic achievement %K child maltreatment %K juvenile delinquency %D 2020 %7 15.1.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Previous studies have reported a high prevalence of chronic otitis media (OM) and hearing impairment (HI) in Aboriginal children in the Northern Territory (NT) of Australia. Children affected by these disorders are believed to be at increased risk for adverse outcomes in early childhood development, school attendance, academic performance, and child maltreatment and youth offending. However, to date, there have been no studies quantifying the association between HI and these outcomes in this population. Objective: This study will investigate the association between HI and the 5 outcomes in Aboriginal children living in remote NT communities. Methods: Individual-level information linked across multiple administrative datasets will be used to conduct a series of retrospective observational studies on selected developmental and school outcomes. The predictor variables for all studies are the results from audiometric hearing assessments. The outcome measures are as follows: Australian Early Development Census results, representing developmental readiness for school, assessed around 5 years of age; Year 1 school attendance rates; Year 3 school-based academic performance, assessed in the National Assessment Program—Literacy and Numeracy; incidence of child maltreatment events (including both notifications and substantiated cases); and incidence of a first guilty verdict for youth offenders. Confounding and moderating factors available for the analysis include both community-level factors (including school fixed effects, socioeconomic status, level of remoteness, and housing crowdedness) and individual-level factors (including maternal and perinatal health and hospital admissions in early childhood). Results: The study commenced in 2018, with ethics and data custodian approvals for data access and linkage. This has enabled the completion of data linkage and the commencement of data analysis for individual component studies, with findings expected to be published in 2019 and 2020. Conclusions: This study will provide first evidence of the impact of OM-related HI on the developmental, educational, and social outcomes of Australian Aboriginal children. The findings are expected to have significant implications for policy development, service design, and resource allocation. International Registered Report Identifier (IRRID): RR1-10.2196/15464 %M 31939348 %R 10.2196/15464 %U https://www.researchprotocols.org/2020/1/e15464 %U https://doi.org/10.2196/15464 %U http://www.ncbi.nlm.nih.gov/pubmed/31939348 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e14036 %T An Ototoxicity Grading System Within a Mobile App (OtoCalc) for a Resource-Limited Setting to Guide Grading and Management of Drug-Induced Hearing Loss in Patients With Drug-Resistant Tuberculosis: Prospective, Cross-Sectional Case Series %A Hollander,Cara %A Joubert,Karin %A Schellack,Natalie %+ School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi St, Ga-Rankuwa Zone 1, Ga-Rankuwa, 0208, South Africa, 27 828158878, carahollander6@gmail.com %K drug-resistant tuberculosis %K ototoxicity %K grading system %K eHealth %K OtoCalc %D 2020 %7 14.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Tuberculosis (TB) affects millions of people worldwide and is treated with medication including aminoglycosides and polypeptides. Individuals respond differently to medications as a result of their genetic inheritance. These differences in genetic inheritance can result in the underdosing or overdosing of medication, which may affect the efficacy or, in the case of aminoglycosides and polypeptides used in the treatment of all forms of TB, result in ototoxicity. When ototoxicity is detected, physicians should adjust dosages to minimize further ototoxicity and hearing loss; however, there are no suitable grading systems to define significant hearing loss. Objective: The aim of this study was to develop a standardized grading system by making use of an electronic health (eHealth) platform to ensure that a user-friendly method was available to interpret hearing test results, calculate significant hearing loss, and provide recommendations with regard to dosage adjustments and management. It further aimed to establish the sensitivity of the newly developed grading scale. Methods: This grading system was developed in South Africa based on data that were obtained from an audiology and pharmacokinetic study on patients with drug-resistant TB (DR-TB) at two DR-TB units at state-run hospitals. This feasibility study employed a prospective, cross-sectional, exploratory, descriptive case series research design, with a total of 22 participants. Participants underwent audiological and pharmacological assessments at baseline and every 2 weeks for the first 3 months of treatment. Various professionals (8 in total) were subsequently involved in the development of the eHealth system, including a software engineer, four audiologists, a pharmacist, a medical doctor, and a nurse. The app underwent 14 modifications that involved aspects of data storage, ease of usability, grades, and the risk factor checklist. Results: An ototoxicity grading system within a mobile app for use by doctors, nurses, and audiologists was developed for patients with DR-TB. The purpose of this user-friendly ototoxicity calculator, OtoCalc, is to (1) assist health professionals in assessing patients for ototoxicity, (2) establish the clinical significance of ototoxicity by calculating the grade of hearing loss, (3) monitor the progression of hearing loss, and (4) enable systematic referral and management of patients according to their needs. Conclusions: This newly developed system is more sensitive than the existing grading methods for determining ototoxicity in patients with DR-TB. This app needs to be trialed in a larger sample to establish data security, ease of use, and suitability within this population. %M 31934875 %R 10.2196/14036 %U https://mhealth.jmir.org/2020/1/e14036 %U https://doi.org/10.2196/14036 %U http://www.ncbi.nlm.nih.gov/pubmed/31934875 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e14198 %T Quality of Deaf and Hard-of-Hearing Mobile Apps: Evaluation Using the Mobile App Rating Scale (MARS) With Additional Criteria From a Content Expert %A Romero,Ryan Lee %A Kates,Frederick %A Hart,Mark %A Ojeda,Amanda %A Meirom,Itai %A Hardy,Stephen %+ College of Public Health and Health Professions, University of Florida, 1225 Center Drive, Gainesville, FL, United States, 1 (352) 273 6060, ryan.romero1000@ufl.edu %K eHealth %K mobile health %K mHealth %K mobile app %K hearing %K deaf persons %K sign language %D 2019 %7 30.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The spread of technology and dissemination of knowledge across the World Wide Web has prompted the development of apps for American Sign Language (ASL) translation, interpretation, and syntax recognition. There is limited literature regarding the quality, effectiveness, and appropriateness of mobile health (mHealth) apps for the deaf and hard-of-hearing (DHOH) that pose to aid the DHOH in their everyday communication and activities. Other than the star-rating system with minimal comments regarding quality, the evaluation metrics used to rate mobile apps are commonly subjective. Objective: This study aimed to evaluate the quality and effectiveness of DHOH apps using a standardized scale. In addition, it also aimed to identify content-specific criteria to improve the evaluation process by using a content expert, and to use the content expert to more accurately evaluate apps and features supporting the DHOH. Methods: A list of potential apps for evaluation was generated after a preliminary screening for apps related to the DHOH. Inclusion and exclusion criteria were developed to refine the master list of apps. The study modified a standardized rating scale with additional content-specific criteria applicable to the DHOH population for app evaluation. This was accomplished by including a DHOH content expert in the design of content-specific criteria. Results: The results indicate a clear distinction in Mobile App Rating Scale (MARS) scores among apps within the study’s three app categories: ASL translators (highest score=3.72), speech-to-text (highest score=3.6), and hard-of-hearing assistants (highest score=3.90). Of the 217 apps obtained from the search criteria, 21 apps met the inclusion and exclusion criteria. Furthermore, the limited consideration for measures specific to the target population along with a high app turnover rate suggests opportunities for improved app effectiveness and evaluation. Conclusions: As more mHealth apps enter the market for the DHOH population, more criteria-based evaluation is needed to ensure the safety and appropriateness of the apps for the intended users. Evaluation of population-specific mHealth apps can benefit from content-specific measurement criteria developed by a content expert in the field. %M 31670695 %R 10.2196/14198 %U http://mhealth.jmir.org/2019/10/e14198/ %U https://doi.org/10.2196/14198 %U http://www.ncbi.nlm.nih.gov/pubmed/31670695 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 10 %P e14889 %T Deaf Adults’ Health Literacy and Access to Health Information: Protocol for a Multicenter Mixed Methods Study %A McKee,Michael M %A Hauser,Peter C %A Champlin,Sara %A Paasche-Orlow,Michael %A Wyse,Kelley %A Cuculick,Jessica %A Buis,Lorraine R %A Plegue,Melissa %A Sen,Ananda %A Fetters,Michael D %+ Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104, United States, 1 734 998 7335, mmmckee@umich.edu %K deaf %K hearing loss %K consumer health information %K health literacy %D 2019 %7 9.10.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Deaf American Sign Language (ASL) users often struggle with limited health literacy compared with their hearing peers. However, the mechanisms driving limited health literacy and how this may impact access to and understanding of health information for Deaf individuals have not been determined. Deaf individuals are more likely than hearing individuals to use the internet, yet they continue to report significant barriers to health information. This study presents an opportunity to identify key targets that impact information access for a largely marginalized population. Objective: This study aims to elucidate the role of information marginalization on health literacy in Deaf ASL users and to better understand the mechanisms of health literacy in this population for the purpose of identifying viable targets for future health literacy interventions. Methods: This is an exploratory mixed methods study to identify predictors and moderators of health literacy in the Deaf population. These predictors of health literacy will be used to inform the second step that qualitatively explains the findings, including how Deaf individuals access and understand Web-based health information. Multiple interviewer- and computer-based instruments underwent translation and adaptation, from English to ASL, to make them accessible for the Deaf participants in our study. A planned sample of 450 Deaf ASL users and 450 hearing native English speakers, aged 18 to 70 years, will be recruited from 3 partnering sites: Rochester, NY; Flint, MI; and Chicago, IL. These individuals will participate in a single data collection visit. A subset of participants (approximately 30) with key characteristics of interest will be invited for a second data collection visit to observe and inquire more about their ability to directly access, navigate, and comprehend Web-based health information. The study will help assess how the ways health literacy and information are visualized may differ between Deaf individuals and hearing individuals. The study will also survey participants’ ownership and use of computer and mobile devices and their level of Web-based information use, including health information. Results: Adaptation and translation of protocols and instruments have been completed and are now in use for the study. Recruitment is underway and will continue until late 2020. Results from this study will be used to provide a guide on how to structure Web-based health information in a way that maximizes accessibility and improves health literacy for Deaf individuals. Conclusions: The results from this mixed methods proposal will advance what is known about health literacy and health information accessibility for Deaf individuals. This innovative study will generate rich data on how to formulate health information and health literacy interventions more accurately to take advantage of visual learning skills. International Registered Report Identifier (IRRID): PRR1-10.2196/14889 %M 31599730 %R 10.2196/14889 %U https://www.researchprotocols.org/2019/10/e14889 %U https://doi.org/10.2196/14889 %U http://www.ncbi.nlm.nih.gov/pubmed/31599730 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e13658 %T Social Media Use and HIV Screening Uptake Among Deaf Adults in the United States: Cross-Sectional Survey Study %A Argenyi,Michael %A Kushalnagar,Poorna %+ Gallaudet University, 800 Florida Ave, NE, Deaf Health Communication and Quality of Life Center, Washington, DC, 20002, United States, 1 2027502257, poorna.kushalnagar@gallaudet.edu %K HIV %K sexually transmitted disease %K sexually transmitted infection %K deaf %K sign language %K social media %K internet %D 2019 %7 2.10.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: About 46% of US adults obtain recommended HIV screening at least once during their lifetime. There is little knowledge of screening rates among deaf and hard-of-hearing adults who primarily use American Sign Language (ASL), or of social media as a potentially efficacious route for HIV prevention outreach, despite lower HIV/AIDS-specific health literacy and potentially higher HIV seropositivity rates than hearing peers. Objective: We investigated both the likelihood of HIV screening uptake among deaf adults in the past year and over one year ago, and the relationship between social media use and HIV screening uptake among deaf adult ASL users. Methods: The Health Information National Trends Survey in ASL was administered to 1340 deaf US adults between 2015-2018. Modified Poisson with robust standard errors was used to assess the relationship between social media usage as a predictor and HIV screening as an outcome (screened more than one year ago, screened within the past year, and never been screened), after adjusting for sociodemographics and sexually transmitted disease (STD) covariates. Results: The estimated lifetime prevalence of HIV screening uptake among our sample was 54% (719/1340), with 32% (429/1340) in the past year. Being of younger age, male gender, black, lesbian, gay, bisexual, or queer, or having some college education or a prior STD were associated with HIV screening uptake. Adjusting for correlates, social media use was significantly associated with HIV screening in the past year, compared to either lifetime or never. Conclusions: Screening falls well short of universal screening targets, with gaps among heterosexual, female, Caucasian, or older deaf adults. HIV screening outreach may not be effective because of technological or linguistic inaccessibility, rendering ASL users an underrecognized minority group. However, social media is still a powerful tool, particularly among younger deaf adults at risk for HIV. %M 31579021 %R 10.2196/13658 %U https://publichealth.jmir.org/2019/4/e13658 %U https://doi.org/10.2196/13658 %U http://www.ncbi.nlm.nih.gov/pubmed/31579021 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e12033 %T A Mobile Phone–Based Approach for Hearing Screening of School-Age Children: Cross-Sectional Validation Study %A Chu,Yuan-Chia %A Cheng,Yen-Fu %A Lai,Ying-Hui %A Tsao,Yu %A Tu,Tzong-Yang %A Young,Shuenn Tsong %A Chen,Tzer-Shyong %A Chung,Yu-Fang %A Lai,Feipei %A Liao,Wen-Huei %+ Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, No 201, Sec 2, Shipai Rd, Beitou District, Taipei, 11217, Taiwan, 886 938102333, whliaovictor@gmail.com %K hearing tests %K telemedicine %K mobile apps %K audiometry, pure-tone %D 2019 %7 01.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pure-tone screening (PTS) is considered as the gold standard for hearing screening programs in school-age children. Mobile devices, such as mobile phones, have the potential for audiometric testing. Objective: This study aimed to demonstrate a new approach to rapidly screen hearing status and provide stratified test values, using a smartphone-based hearing screening app, for each screened ear of school-age children. Method: This was a prospective cohort study design. The proposed smartphone-based screening method and a standard sound-treated booth with PTS were used to assess 85 school-age children (170 ears). Sound-treated PTS involved applying 4 test tones to each tested ear: 500 Hz at 25 dB and 1000 Hz, 2000 Hz, and 4000 Hz at 20 dB. The results were classified as pass (normal hearing in the ear) or fail (possible hearing impairment). The proposed smartphone-based screening employs 20 stratified hearing scales. Thresholds were compared with those of pure-tone average (PTA). Results: A total of 85 subjects (170 ears), including 38 males and 47 females, aged between 11 and 12 years with a mean (SD) of 11 (0.5) years, participated in the trial. Both screening methods produced comparable pass and fail results (pass in 168 ears and fail in 2 ears). The smartphone-based screening detected moderate or worse hearing loss (average PTA>25 dB) accurately. Both the sensitivity and specificity of the smartphone-based screening method were calculated at 100%. Conclusions: The results of the proposed smartphone-based self-hearing test demonstrated high concordance with conventional PTS in a sound-treated booth. Our results suggested the potential use of the proposed smartphone-based hearing screening in a school-age population. %M 30932870 %R 10.2196/12033 %U https://mhealth.jmir.org/2019/4/e12033/ %U https://doi.org/10.2196/12033 %U http://www.ncbi.nlm.nih.gov/pubmed/30932870 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 6 %N 1 %P e13233 %T Video Remote Interpreting Technology in Health Care: Cross-Sectional Study of Deaf Patients’ Experiences %A Kushalnagar,Poorna %A Paludneviciene,Raylene %A Kushalnagar,Raja %+ Department of Psychology, Gallaudet University, 800 Florida Ave, NE, Washington, DC, 20002, United States, 1 5856660818, poorna.kushalnagar@gallaudet.edu %K video remote interpreting %K deaf %K sign language %K assistive technology %K accessibility %K communication %D 2019 %7 11.03.2019 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: The advent of new rehabilitation and assistive technologies has led to the creation of video remote interpreting (VRI) as an accessible communication technology for deaf patients. Although there has been a rapid growth in the use of VRI technology by health care providers, there is scant published information on VRI users and their satisfaction. Current, timely data are needed to understand deaf patients’ use and satisfaction with the quality of VRI technology in health care settings. Objective: This study aimed to investigate the national trends of deaf patients’ satisfaction with the quality of video remote interpreting (VRI) in health settings and recommend actions to improve VRI quality and deaf patients’ satisfaction with VRI in health care settings. Methods: Secondary data related to deaf adults’ experiences of using VRI service in a medical setting were obtained from the Health Information National Trends Survey in American Sign Language, which was administered to a US sample of deaf adults between 2016 and 2018. Results: Among our VRI users (N=555, all in the United States) who answered questions about VRI usage in health between 2016 and 2018, only 41% were satisfied with the quality of the VRI technology service. Respondents with fewer years of education or those who were male were more likely to rate the VRI quality as acceptable. After adjusting for covariates in a binary regression analysis, deaf patients’ self-reported interference (ie, VRI interpreter’s interference with disclosure of health information) increased patient dissatisfaction with the quality of VRI technology service by three-fold. Conclusions: To increase satisfaction with VRI technology service in health care and rehabilitation settings among deaf patients, special attention needs to be given to video technology, as the use of sign language requires high-fidelity video for optimal communication between the interpreter and patient. To promote the willingness to disclose medical information through VRI among deaf patients, the interpreter must be highly skilled in both expressive and receptive communication and have the requisite background in medicine and rehabilitation. %M 30855233 %R 10.2196/13233 %U http://rehab.jmir.org/2019/1/e13233/ %U https://doi.org/10.2196/13233 %U http://www.ncbi.nlm.nih.gov/pubmed/30855233 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 10 %P e174 %T Hearing Aid Use in Older Adults With Postlingual Sensorineural Hearing Loss: Protocol for a Prospective Cohort Study %A Hughes,Matthew E %A Nkyekyer,Joanna %A Innes-Brown,Hamish %A Rossell,Susan L %A Sly,David %A Bhar,Sunil %A Pipingas,Andrew %A Hennessy,Alison %A Meyer,Denny %+ Centre for Mental Health, School of Health Sciences, Swinburne University of Technology, John Street, Hawthorn, 3181, Australia, 61 3 9214 8674, matthewhughes@swin.edu.au %K sensorineural hearing loss %K hearing aids %K cognition %K psychosocial function %K speech processing %K fMRI %D 2018 %7 26.10.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older adults with postlingual sensorineural hearing loss (SNHL) exhibit a poor prognosis that not only includes impaired auditory function but also rapid cognitive decline, especially speech-related cognition, in addition to psychosocial dysfunction and an increased risk of dementia. Consistent with this prognosis, individuals with SNHL exhibit global atrophic brain alteration as well as altered neural function and regional brain organization within the cortical substrates that underlie auditory and speech processing. Recent evidence suggests that the use of hearing aids might ameliorate this prognosis. Objective: The objective was to study the effects of a hearing aid use intervention on neurocognitive and psychosocial functioning in individuals with SNHL aged ≥55 years. Methods: All aspects of this study will be conducted at Swinburne University of Technology (Hawthorn, Victoria, Australia). We will recruit 2 groups (n=30 per group) of individuals with mild to moderate SNHL from both the community and audiology health clinics (Alison Hennessy Audiology, Chelsea Hearing Pty Ltd). These groups will include individuals who have worn a hearing aid for, at least, 12 months or never worn a hearing aid. All participants would be asked to complete, at 2 time points (t) including baseline (t=0) and follow-up (t=6 months), tests of hearing and psychosocial and cognitive function and attend a magnetic resonance imaging (MRI) session. The MRI session will include both structural and functional MRI (sMRI and fMRI) scans, the latter involving the performance of a novel speech processing task. Results: This research is funded by the Barbara Dicker Brain Sciences Foundation Grants, the Australian Research Council, Alison Hennessy Audiology, and Chelsea Hearing Pty Ltd under the Industry Transformation Training Centre Scheme (ARC Project #IC140100023). We obtained the ethics approval on November 18, 2017 (Swinburne University Human Research Ethics Committee protocol number SHR Project 2017/266). The recruitment began in December 2017 and will be completed by December 2020. Conclusions: This is the first study to assess the effect hearing aid use has on neural, cognitive, and psychosocial factors in individuals with SNHL who have never used hearing aids. Furthermore, this study is expected to clarify the relationships among altered brain structure and function, psychosocial factors, and cognition in response to the hearing aid use. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12617001616369; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12617001616369 (Accessed by WebCite at http://www.webcitation.org/70yatZ9ze) International Registered Report Identifier (IRRID): RR1-10.2196/9916 %M 30368434 %R 10.2196/resprot.9916 %U https://www.researchprotocols.org/2018/10/e174/ %U https://doi.org/10.2196/resprot.9916 %U http://www.ncbi.nlm.nih.gov/pubmed/30368434 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e186 %T A Tablet-Based Mobile Hearing Screening System for Preschoolers: Design and Validation Study %A Yimtae,Kwanchanok %A Israsena,Pasin %A Thanawirattananit,Panida %A Seesutas,Sangvorn %A Saibua,Siwat %A Kasemsiri,Pornthep %A Noymai,Anukool %A Soonrach,Tharapong %+ National Electronics and Computer Technology Center, National Science and Technology Development Agency, 112 Thailand Science Park, Klong Luang, Pathumthani, Thailand, 66 5646900, pasin.israsena@nectec.or.th %K hearing screening %K mobile health %K speech audiometry %K hearing loss %D 2018 %7 23.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hearing ability is important for children to develop speech and language skills as they grow. After a mandatory newborn hearing screening, group or mass screening of children at later ages, such as at preschool age, is often practiced. For this practice to be effective and accessible in low-resource countries such as Thailand, innovative enabling tools that make use of pervasive mobile and smartphone technology should be considered. Objective: This study aims to develop a cost-effective, tablet-based hearing screening system that can perform a rapid minimal speech recognition level test. Methods: An Android-based screening app was developed. The screening protocol involved asking children to choose pictures corresponding to a set of predefined words heard at various sound levels offered in a specifically designed sequence. For the app, the set of words was validated, and their corresponding speech power levels were calibrated. We recruited 122 children, aged 4-5 years, during the development phase. Another 63 children of the same age were screened for their hearing abilities using the app in version 2. The results in terms of the sensitivity and specificity were compared with those measured using the conventional audiometric equipment. Results: For screening purposes, the sensitivity of the developed screening system version 2 was 76.67% (95% CI 59.07-88.21), and the specificity was 95.83% (95% CI 89.77-98.37) for screening children with mild hearing loss (pure-tone average threshold at 1, 2, and 4 kHz, >20 dB). The time taken for the screening of each child was 150.52 (SD 19.07) seconds (95% CI 145.71-155.32 seconds). The average time used for conventional play audiometry was 11.79 (SD 3.66) minutes (95% CI 10.85-12.71 minutes). Conclusions: This study shows the potential use of a tablet-based system for rapid and mobile hearing screening. The system was shown to have good overall sensitivity and specificity. Overall, the idea can be easily adopted for systems based on other languages. %M 30355558 %R 10.2196/mhealth.9560 %U http://mhealth.jmir.org/2018/10/e186/ %U https://doi.org/10.2196/mhealth.9560 %U http://www.ncbi.nlm.nih.gov/pubmed/30355558 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 3 %P e85 %T Investigating the Impact of Hearing Aid Use and Auditory Training on Cognition, Depressive Symptoms, and Social Interaction in Adults With Hearing Loss: Protocol for a Crossover Trial %A Nkyekyer,Joanna %A Meyer,Denny %A Blamey,Peter J %A Pipingas,Andrew %A Bhar,Sunil %+ Australian Research Council Training Centre in Biodevices, Faculty of Science, Engineering and Technology, Swinburne University of Technology, John Street Hawthorn, Mail H11, P O Box 218, Hawthorn Victoria, 3122, Australia, 61 422733157, jnkyekyer@swin.edu.au %K sensorineural hearing loss %K hearing aids %K crossover design %D 2018 %7 23.03.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sensorineural hearing loss is the most common sensory deficit among older adults. Some of the psychosocial consequences of this condition include difficulty in understanding speech, depression, and social isolation. Studies have shown that older adults with hearing loss show some age-related cognitive decline. Hearing aids have been proven as successful interventions to alleviate sensorineural hearing loss. In addition to hearing aid use, the positive effects of auditory training—formal listening activities designed to optimize speech perception—are now being documented among adults with hearing loss who use hearing aids, especially new hearing aid users. Auditory training has also been shown to produce prolonged cognitive performance improvements. However, there is still little evidence to support the benefits of simultaneous hearing aid use and individualized face-to-face auditory training on cognitive performance in adults with hearing loss. Objective: This study will investigate whether using hearing aids for the first time will improve the impact of individualized face-to-face auditory training on cognition, depression, and social interaction for adults with sensorineural hearing loss. The rationale for this study is based on the hypothesis that, in adults with sensorineural hearing loss, using hearing aids for the first time in combination with individualized face-to-face auditory training will be more effective for improving cognition, depressive symptoms, and social interaction rather than auditory training on its own. Methods: This is a crossover trial targeting 40 men and women between 50 and 90 years of age with either mild or moderate symmetric sensorineural hearing loss. Consented, willing participants will be recruited from either an independent living accommodation or via a community database to undergo a 6-month intensive face-to-face auditory training program (active control). Participants will be assigned in random order to receive hearing aid (intervention) for either the first 3 or last 3 months of the 6-month auditory training program. Each participant will be tested at baseline, 3, and 6 months using a neuropsychological battery of computer-based cognitive assessments, together with a depression symptom instrument and a social interaction measure. The primary outcome will be cognitive performance with regard to spatial working memory. Secondary outcome measures include other cognition performance measures, depressive symptoms, social interaction, and hearing satisfaction. Results: Data analysis is currently under way and the first results are expected to be submitted for publication in June 2018. Conclusions: Results from the study will inform strategies for aural rehabilitation, hearing aid delivery, and future hearing loss intervention trials. Trial Registration: ClinicalTrials.gov NCT03112850; https://clinicaltrials.gov/ct2/show/NCT03112850 (Archived by WebCite at http://www.webcitation.org/6xz12fD0B). %M 29572201 %R 10.2196/resprot.8936 %U http://www.researchprotocols.org/2018/3/e85/ %U https://doi.org/10.2196/resprot.8936 %U http://www.ncbi.nlm.nih.gov/pubmed/29572201 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 3 %P e79 %T The Physiological Bases of Hidden Noise-Induced Hearing Loss: Protocol for a Functional Neuroimaging Study %A Dewey,Rebecca Susan %A Hall,Deborah A %A Guest,Hannah %A Prendergast,Garreth %A Plack,Christopher J %A Francis,Susan T %+ National Institute for Health Research Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham, NG1 5DU, United Kingdom, 44 1158232638, rebecca.dewey@nottingham.ac.uk %K functional magnetic resonance imaging %K auditory pathways %K auditory brain stem response %D 2018 %7 09.03.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Rodent studies indicate that noise exposure can cause permanent damage to synapses between inner hair cells and high-threshold auditory nerve fibers, without permanently altering threshold sensitivity. These demonstrations of what is commonly known as hidden hearing loss have been confirmed in several rodent species, but the implications for human hearing are unclear. Objective: Our Medical Research Council–funded program aims to address this unanswered question, by investigating functional consequences of the damage to the human peripheral and central auditory nervous system that results from cumulative lifetime noise exposure. Behavioral and neuroimaging techniques are being used in a series of parallel studies aimed at detecting hidden hearing loss in humans. The planned neuroimaging study aims to (1) identify central auditory biomarkers associated with hidden hearing loss; (2) investigate whether there are any additive contributions from tinnitus or diminished sound tolerance, which are often comorbid with hearing problems; and (3) explore the relation between subcortical functional magnetic resonance imaging (fMRI) measures and the auditory brainstem response (ABR). Methods: Individuals aged 25 to 40 years with pure tone hearing thresholds ≤20 dB hearing level over the range 500 Hz to 8 kHz and no contraindications for MRI or signs of ear disease will be recruited into the study. Lifetime noise exposure will be estimated using an in-depth structured interview. Auditory responses throughout the central auditory system will be recorded using ABR and fMRI. Analyses will focus predominantly on correlations between lifetime noise exposure and auditory response characteristics. Results: This paper reports the study protocol. The funding was awarded in July 2013. Enrollment for the study described in this protocol commenced in February 2017 and was completed in December 2017. Results are expected in 2018. Conclusions: This challenging and comprehensive study will have the potential to impact diagnostic procedures for hidden hearing loss, enabling early identification of noise-induced auditory damage via the detection of changes in central auditory processing. Consequently, this will generate the opportunity to give personalized advice regarding provision of ear defense and monitoring of further damage, thus reducing the incidence of noise-induced hearing loss. %M 29523503 %R 10.2196/resprot.9095 %U http://www.researchprotocols.org/2018/3/e79/ %U https://doi.org/10.2196/resprot.9095 %U http://www.ncbi.nlm.nih.gov/pubmed/29523503 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e10 %T Hearing Tests Based on Biologically Calibrated Mobile Devices: Comparison With Pure-Tone Audiometry %A Masalski,Marcin %A Grysiński,Tomasz %A Kręcicki,Tomasz %+ Department and Clinic of Otolaryngology, Head and Neck Surgery, Faculty of Postgraduate Medical Training, Wroclaw Medical University, Borowska 213, Wrocław, 50-556, Poland, 48 515086252, marcin.masalski@pwr.edu.pl %K hearing test %K mobile health %K mobile apps %K pure-tone audiometry %D 2018 %7 10.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hearing screening tests based on pure-tone audiometry may be conducted on mobile devices, provided that the devices are specially calibrated for the purpose. Calibration consists of determining the reference sound level and can be performed in relation to the hearing threshold of normal-hearing persons. In the case of devices provided by the manufacturer, together with bundled headphones, the reference sound level can be calculated once for all devices of the same model. Objective: This study aimed to compare the hearing threshold measured by a mobile device that was calibrated using a model-specific, biologically determined reference sound level with the hearing threshold obtained in pure-tone audiometry. Methods: Trial participants were recruited offline using face-to-face prompting from among Otolaryngology Clinic patients, who own Android-based mobile devices with bundled headphones. The hearing threshold was obtained on a mobile device by means of an open access app, Hearing Test, with incorporated model-specific reference sound levels. These reference sound levels were previously determined in uncontrolled conditions in relation to the hearing threshold of normal-hearing persons. An audiologist-assisted self-measurement was conducted by the participants in a sound booth, and it involved determining the lowest audible sound generated by the device within the frequency range of 250 Hz to 8 kHz. The results were compared with pure-tone audiometry. Results: A total of 70 subjects, 34 men and 36 women, aged 18-71 years (mean 36, standard deviation [SD] 11) participated in the trial. The hearing threshold obtained on mobile devices was significantly different from the one determined by pure-tone audiometry with a mean difference of 2.6 dB (95% CI 2.0-3.1) and SD of 8.3 dB (95% CI 7.9-8.7). The number of differences not greater than 10 dB reached 89% (95% CI 88-91), whereas the mean absolute difference was obtained at 6.5 dB (95% CI 6.2-6.9). Sensitivity and specificity for a mobile-based screening method were calculated at 98% (95% CI 93-100.0) and 79% (95% CI 71-87), respectively. Conclusions: The method of hearing self-test carried out on mobile devices with bundled headphones demonstrates high compatibility with pure-tone audiometry, which confirms its potential application in hearing monitoring, screening tests, or epidemiological examinations on a large scale. %M 29321124 %R 10.2196/mhealth.7800 %U https://mhealth.jmir.org/2018/1/e10/ %U https://doi.org/10.2196/mhealth.7800 %U http://www.ncbi.nlm.nih.gov/pubmed/29321124 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 3 %N 2 %P e13 %T Validated Smartphone-Based Apps for Ear and Hearing Assessments: A Review %A Bright,Tess %A Pallawela,Danuk %+ London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom, 44 (0)20 7636 8636, tess.bright1@lshtm.ac.uk %K hearing %K testing %K mobile %K audiometry %K smartphone %K applications %K app %K hearing loss %K hearing impairment %K surveys %K prevalence %D 2016 %7 23.12.2016 %9 Review %J JMIR Rehabil Assist Technol %G English %X Background: An estimated 360 million people have a disabling hearing impairment globally, the vast majority of whom live in low- and middle-income countries (LMICs). Early identification through screening is important to negate the negative effects of untreated hearing impairment. Substantial barriers exist in screening for hearing impairment in LMICs, such as the requirement for skilled hearing health care professionals and prohibitively expensive specialist equipment to measure hearing. These challenges may be overcome through utilization of increasingly available smartphone app technologies for ear and hearing assessments that are easy to use by unskilled professionals. Objective: Our objective was to identify and compare available apps for ear and hearing assessments and consider the incorporation of such apps into hearing screening programs Methods: In July 2015, the commercial app stores Google Play and Apple App Store were searched to identify apps for ear and hearing assessments. Thereafter, six databases (EMBASE, MEDLINE, Global Health, Web of Science, CINAHL, and mHealth Evidence) were searched to assess which of the apps identified in the commercial review had been validated against gold standard measures. A comparison was made between validated apps. Results: App store search queries returned 30 apps that could be used for ear and hearing assessments, the majority of which are for performing audiometry. The literature search identified 11 eligible validity studies that examined 6 different apps. uHear, an app for self-administered audiometry, was validated in the highest number of peer reviewed studies against gold standard pure tone audiometry (n=5). However, the accuracy of uHear varied across these studies. Conclusions: Very few of the available apps have been validated in peer-reviewed studies. Of the apps that have been validated, further independent research is required to fully understand their accuracy at detecting ear and hearing conditions. %M 28582261 %R 10.2196/rehab.6074 %U http://rehab.jmir.org/2016/2/e13/ %U https://doi.org/10.2196/rehab.6074 %U http://www.ncbi.nlm.nih.gov/pubmed/28582261 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 3 %N 2 %P e28 %T Exploration of Deaf People’s Health Information Sources and Techniques for Information Delivery in Cape Town: A Qualitative Study for the Design and Development of a Mobile Health App %A Chininthorn,Prangnat %A Glaser,Meryl %A Tucker,William David %A Diehl,Jan Carel %+ Section of Design for Sustainability, Department of Design Engineering, Delft University of Technology, Landbergstraat 15, Delft, 2628 CE, Netherlands, 31 1 15 27 87658, p.chininthorn@tudelft.nl %K Deafness %K sign language %K South Africa %K mHealth %K health %K qualitative research %K co-creation %K community-based co-design %D 2016 %7 11.11.2016 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Many cultural and linguistic Deaf people in South Africa face disparity when accessing health information because of social and language barriers. The number of certified South African Sign Language interpreters (SASLIs) is also insufficient to meet the demand of the Deaf population in the country. Our research team, in collaboration with the Deaf communities in Cape Town, devised a mobile health app called SignSupport to bridge the communication gaps in health care contexts. We consequently plan to extend our work with a Health Knowledge Transfer System (HKTS) to provide Deaf people with accessible, understandable, and accurate health information. We conducted an explorative study to prepare the groundwork for the design and development of the system. Objectives: To investigate the current modes of health information distributed to Deaf people in Cape Town, identify the health information sources Deaf people prefer and their reasons, and define effective techniques for delivering understandable information to generate the groundwork for the mobile health app development with and for Deaf people. Methods: A qualitative methodology using semistructured interviews with sensitizing tools was used in a community-based codesign setting. A total of 23 Deaf people and 10 health professionals participated in this study. Inductive and deductive coding was used for the analysis. Results: Deaf people currently have access to 4 modes of health information distribution through: Deaf and other relevant organizations, hearing health professionals, personal interactions, and the mass media. Their preferred and accessible sources are those delivering information in signed language and with communication techniques that match Deaf people’s communication needs. Accessible and accurate health information can be delivered to Deaf people by 3 effective techniques: using signed language including its dialects, through health drama with its combined techniques, and accompanying the information with pictures in combination with simple text descriptions. Conclusions: We can apply the knowledge gained from this exploration to build the groundwork of the mobile health information system. We see an opportunity to design an HKTS to assist the information delivery during the patient-health professional interactions in primary health care settings. Deaf people want to understand the information relevant to their diagnosed disease and its self-management. The 3 identified effective techniques will be applied to deliver health information through the mobile health app. %M 27836819 %R 10.2196/humanfactors.6653 %U http://humanfactors.jmir.org/2016/2/e28/ %U https://doi.org/10.2196/humanfactors.6653 %U http://www.ncbi.nlm.nih.gov/pubmed/27836819 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 5 %P e130 %T Hearing Tests on Mobile Devices: Evaluation of the Reference Sound Level by Means of Biological Calibration %A Masalski,Marcin %A Kipiński,Lech %A Grysiński,Tomasz %A Kręcicki,Tomasz %+ Department and Clinic of Otolaryngology, Head and Neck Surgery, Wroclaw Medical University, Borowska 213, Wrocław, 50-556, Poland, 48 515086252, marcin.masalski@pwr.edu.pl %K hearing test, mobile device, calibration %D 2016 %7 30.05.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Hearing tests carried out in home setting by means of mobile devices require previous calibration of the reference sound level. Mobile devices with bundled headphones create a possibility of applying the predefined level for a particular model as an alternative to calibrating each device separately. Objective: The objective of this study was to determine the reference sound level for sets composed of a mobile device and bundled headphones. Methods: Reference sound levels for Android-based mobile devices were determined using an open access mobile phone app by means of biological calibration, that is, in relation to the normal-hearing threshold. The examinations were conducted in 2 groups: an uncontrolled and a controlled one. In the uncontrolled group, the fully automated self-measurements were carried out in home conditions by 18- to 35-year-old subjects, without prior hearing problems, recruited online. Calibration was conducted as a preliminary step in preparation for further examination. In the controlled group, audiologist-assisted examinations were performed in a sound booth, on normal-hearing subjects verified through pure-tone audiometry, recruited offline from among the workers and patients of the clinic. In both the groups, the reference sound levels were determined on a subject’s mobile device using the Bekesy audiometry. The reference sound levels were compared between the groups. Intramodel and intermodel analyses were carried out as well. Results: In the uncontrolled group, 8988 calibrations were conducted on 8620 different devices representing 2040 models. In the controlled group, 158 calibrations (test and retest) were conducted on 79 devices representing 50 models. Result analysis was performed for 10 most frequently used models in both the groups. The difference in reference sound levels between uncontrolled and controlled groups was 1.50 dB (SD 4.42). The mean SD of the reference sound level determined for devices within the same model was 4.03 dB (95% CI 3.93-4.11). Statistically significant differences were found across models. Conclusions: Reference sound levels determined in the uncontrolled group are comparable to the values obtained in the controlled group. This validates the use of biological calibration in the uncontrolled group for determining the predefined reference sound level for new devices. Moreover, due to a relatively small deviation of the reference sound level for devices of the same model, it is feasible to conduct hearing screening on devices calibrated with the predefined reference sound level. %M 27241793 %R 10.2196/jmir.4987 %U http://www.jmir.org/2016/5/e130/ %U https://doi.org/10.2196/jmir.4987 %U http://www.ncbi.nlm.nih.gov/pubmed/27241793 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 2 %N 2 %P e18 %T Use of the Satisfaction With Amplification in Daily Life Questionnaire to Assess Patient Satisfaction Following Remote Hearing Aid Adjustments (Telefitting) %A Penteado,Silvio Pires %A Bento,Ricardo Ferreira %A Battistella,Linamara Rizzo %A Silva,Sara Manami %A Sooful,Prasha %+ Medical School, Otorhinolaryngology Department, University of Sao Paulo, Av Dr Eneas Carvalho de Aguiar 255, Suite 6167, Sao Paulo, 05403-000, Brazil, 55 11 30689855, penteadosp@gmail.com %K audiology %K hearing aids %K hearing loss %K telemedicine %K correction of hearing impairment %K public policy %K prosthesis fitting %K telemedicine %K questionnairies %K quality improvement %D 2014 %7 02.09.2014 %9 Original Paper %J JMIR Med Inform %G English %X Background: Hearing loss can affect approximately 15% of the pediatric population and up to 40% of the adult population. The gold standard of treatment for hearing loss is amplification of hearing thresholds by means of a hearing aid instrument. A hearing aid is an electronic device equipped with a topology of only three major components of aggregate cost. The gold standard of hearing aid fittings is face-to-face appointments in hearing aid centers, clinics, or hospitals. Telefitting encompasses the programming and adjustments of hearing aid settings remotely. Fitting hearing aids remotely is a relatively simple procedure, using minimal computer hardware and Internet access. Objective: This project aimed to examine the feasibility and outcomes of remote hearing aid adjustments (telefitting) by assessing patient satisfaction via the Portuguese version of the Satisfaction With Amplification in Daily Life (SADL) questionnaire. Methods: The Brazilian Portuguese version of the SADL was used in this experimental research design. Participants were randomly selected through the Rehabilitation Clinical (Espaco Reouvir) of the Otorhinolaryngology Department Medical School University of Sao Paulo. Of the 8 participants in the study, 5 were female and 3 were male, with a mean age of 71.5 years. The design consisted of two face-to-face sessions performed within 15 working days of each other. The remote assistance took place 15 days later. Results: The average scores from this study are above the mean scores from the original SADL normative data. These indicate a high level of satisfaction in participants who were fitted remotely. Conclusions: The use of an evaluation questionnaire is a simple yet effective method to objectively assess the success of a remote fitting. Questionnaire outcomes can help hearing stakeholders improve the National Policy on Hearing Health Care in Brazil. The results of this project indicated that patient satisfaction levels of those fitted remotely were comparable to those fitted in the conventional manner, that is, face-to-face. %M 25599909 %R 10.2196/medinform.2769 %U http://medinform.jmir.org/2014/2/e18/ %U https://doi.org/10.2196/medinform.2769 %U http://www.ncbi.nlm.nih.gov/pubmed/25599909 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e11 %T Biological Calibration for Web-Based Hearing Tests: Evaluation of the Methods %A Masalski,Marcin %A Grysiński,Tomasz %A Kręcicki,Tomasz %+ Department and Clinic of Otolaryngology, Head and Neck Surgery, Wroclaw Medical University, Wybrzeże L Pasteura 1, Wrocław, 50-367, Poland, 48 71 734 37 00, marcin.masalski@pwr.wroc.pl %K pure-tone audiometry %K computer-assisted instruction %K self-examination %D 2014 %7 15.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Online hearing tests conducted in home settings on a personal computer (PC) require prior calibration. Biological calibration consists of approximating the reference sound level via the hearing threshold of a person with normal hearing. Objective: The objective of this study was to identify the error of the proposed methods of biological calibration, their duration, and the subjective difficulty in conducting these tests via PC. Methods: Seven methods have been proposed for measuring the calibration coefficients. All measurements were performed in reference to the hearing threshold of a normal-hearing person. Three methods were proposed for determining the reference sound level on the basis of these calibration coefficients. Methods were compared for the estimated error, duration, and difficulty of the calibration. Web-based self-assessed measurements of the calibration coefficients were carried out in 3 series: (1) at a otolaryngology clinic, (2) at the participant’s home, and (3) again at the clinic. Additionally, in series 1 and 3, pure-tone audiometry was conducted and series 3 was followed by an offline questionnaire concerning the difficulty of the calibration. Participants were recruited offline from coworkers of the Department and Clinic of Otolaryngology, Wroclaw Medical University, Poland. Results: All 25 participants, aged 22-35 years (median 27) completed all tests and filled in the questionnaire. The smallest standard deviation of the calibration coefficient in the test-retest measurement was obtained at the level of 3.87 dB (95% CI 3.52-4.29) for the modulated signal presented in accordance with the rules of Bekesy’s audiometry. The method is characterized by moderate duration time and a relatively simple procedure. The simplest and shortest method was the method of self-adjustment of the sound volume to the barely audible level. In the test-retest measurement, the deviation of this method equaled 4.97 dB (95% CI 4.53-5.51). Among methods determining the reference sound level, the levels determined independently for each frequency revealed the smallest error. The estimated standard deviations of the difference in the hearing threshold between the examination conducted on a biologically calibrated PC and pure-tone audiometry varied from 7.27 dB (95% CI 6.71-7.93) to 10.38 dB (95% CI 9.11-12.03), depending on the calibration method. Conclusions: In this study, an analysis of biological calibration was performed and the presented results included calibration error, calibration time, and calibration difficulty. These values determine potential applications of Web-based hearing tests conducted in home settings and are decisive factors when selecting the calibration method. If there are no substantial time limitations, it is advisable to use Bekesy method and determine the reference sound level independently at each frequency because this approach is characterized by the lowest error. %M 24429353 %R 10.2196/jmir.2798 %U http://www.jmir.org/2014/1/e11/ %U https://doi.org/10.2196/jmir.2798 %U http://www.ncbi.nlm.nih.gov/pubmed/24429353 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 5 %P e91 %T Internet Access and Use in Adults With Hearing Loss %A Thorén,Elisabet Sundewall %A Öberg,Marie %A Wänström,Gunilla %A Andersson,Gerhard %A Lunner,Thomas %+ Division of Technical Audiology, Department of Clinical and Experimental Medicine, Linköping University, Sandbäcksgatan 7, Linköping, 581 85, Sweden, 46 10 103 28 57, elisabet.thoren@liu.se %K hearing loss %K hearing rehabilitation %K Internet %K trends %D 2013 %7 09.05.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: The future rehabilitation of adults with hearing loss is likely to involve online tools used by individuals at home. Online tools could also be useful for people who are not seeking professional help for their hearing problems. Hearing impairment is a disability that increases with age, and increased age is still associated with reduced use of the Internet. Therefore, to continue the research on online audiological rehabilitative tools for people with hearing loss, it is important to determine if and to what extent adults with hearing loss use the Internet. Objective: To evaluate the use of the Internet and email in a group of adults with hearing loss and to investigate if their use of Internet and email differed between genders, among different age groups, and how it compared with the general population in Sweden. Methods: Questionnaires containing multiple-choice questions about Internet access, email use, and educational level were mailed to individuals with hearing loss, who were registered as patients at a hearing aid clinic. Out of the 269 invited participants, 158 returned a completed questionnaire, which was a response rate of 58.7%. Results: The results showed that 60% (94/158) of the participants with hearing loss used computers and the Internet. The degree of hearing loss in the group of participants did not explain the level of Internet usage, while factors of age, gender, and education did (P<.001). More men than women used the Internet (OR 2.54, 95% CI 1.32-4.91, P<.001). Use of the Internet was higher in the youngest age group (25-64 years) compared to the oldest age group (75-96 years, P=.001). A higher usage of the Internet was observed in the participants with hearing loss, especially the elderly, when compared with the general population of Sweden (OR 1.74, 95% CI 1.23-3.17, P=.04). Conclusions: We conclude that the use of computers and the Internet overall is at least at the same level for people with hearing loss as for the general age-matched population in Sweden, but that this use is even higher in specific age groups. These results are important for the future work in developing and evaluating rehabilitative educational online tools for adults with hearing loss. %M 23659867 %R 10.2196/jmir.2221 %U http://www.jmir.org/2013/5/e91/ %U https://doi.org/10.2196/jmir.2221 %U http://www.ncbi.nlm.nih.gov/pubmed/23659867 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 4 %P e113 %T Computer Skills and Internet Use in Adults Aged 50-74 Years: Influence of Hearing Difficulties %A Henshaw,Helen %A Clark,Daniel P A %A Kang,Sujin %A Ferguson,Melanie A %+ NIHR National Biomedical Research Unit in Hearing, School of Clinical Sciences, University of Nottingham, Ropewalk House, 113 The Ropewalk, Nottingham, NG1 5DU, United Kingdom, 44 (0)115 8232600, helen.henshaw@nottingham.ac.uk %K hearing loss %K hearing difficulties %K screening %K intervention %K hearing health care %K eHealth %K personal computer %K Internet use. %D 2012 %7 24.08.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of personal computers (PCs) and the Internet to provide health care information and interventions has increased substantially over the past decade. Yet the effectiveness of such an approach is highly dependent upon whether the target population has both access and the skill set required to use this technology. This is particularly relevant in the delivery of hearing health care because most people with hearing loss are over 50 years (average age for initial hearing aid fitting is 74 years). Although PC skill and Internet use by demographic factors have been examined previously, data do not currently exist that examine the effects of hearing difficulties on PC skill or Internet use in older adults. Objective: To explore the effect that hearing difficulty has on PC skill and Internet use in an opportunistic sample of adults aged 50-74 years. Methods: Postal questionnaires about hearing difficulty, PC skill, and Internet use (n=3629) were distributed to adults aged 50-74 years through three family physician practices in Nottingham, United Kingdom. A subsample of 84 respondents completed a second detailed questionnaire on confidence in using a keyboard, mouse, and track pad. Summed scores were termed the “PC confidence index.” The PC confidence index was used to verify the PC skill categories in the postal questionnaire (ie, never used a computer, beginner, and competent). Results: The postal questionnaire response rate was 36.78% (1298/3529) and 95.15% (1235/1298) of these contained complete information. There was a significant between-category difference for PC skill by PC confidence index (P<.001), thus verifying the three-category PC skill scale. PC and Internet use was greater in the younger respondents (50-62 years) than in the older respondents (63-74 years). The younger group’s PC and Internet use was 81.0% and 60.9%, respectively; the older group’s PC and Internet use was 54.0% and 29.8%, respectively. Those with slight hearing difficulties in the older group had significantly greater odds of PC use compared to those with no hearing difficulties (odds ratio [OR]=1.57, 95% confidence interval [CI] 1.06-2.30, P=.02). Those with moderate+ hearing difficulties had lower odds of PC use compared with those with no hearing difficulties, both overall (OR=0.58, 95% CI 0.39-0.87, P=.008) and in the younger group (OR=0.49, 95% CI 0.26-0.86, P=.008). Similar results were demonstrated for Internet use by age group (older: OR=1.57, 95% CI 0.99-2.47, P=.05; younger: OR=0.32, 95% CI 0.16-0.62, P=.001). Conclusions: Hearing health care is of particular relevance to older adults because of the prevalence of age-related hearing loss. Our data show that older adults experiencing slight hearing difficulty have increased odds of greater PC skill and Internet use than those reporting no difficulty. These findings suggest that PC and Internet delivery of hearing screening, information, and intervention is feasible for people between 50-74 years who have hearing loss, but who would not typically present to an audiologist. %M 22954484 %R 10.2196/jmir.2036 %U http://www.jmir.org/2012/4/e113/ %U https://doi.org/10.2196/jmir.2036 %U http://www.ncbi.nlm.nih.gov/pubmed/22954484 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 4 %P e102 %T Speech Perception Benefits of Internet Versus Conventional Telephony for Hearing-Impaired Individuals %A Mantokoudis,Georgios %A Dubach,Patrick %A Pfiffner,Flurin %A Kompis,Martin %A Caversaccio,Marco %A Senn,Pascal %+ Cochlear Implant Division, Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, University of Bern, Inselspital, Freiburgstrasse, Bern, 3010, Switzerland, 41 31 632 3347, pascal.senn@insel.ch %K VoIP %K Internet telephony %K hearing impaired %K communication %D 2012 %7 16.07.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Telephone communication is a challenge for many hearing-impaired individuals. One important technical reason for this difficulty is the restricted frequency range (0.3–3.4 kHz) of conventional landline telephones. Internet telephony (voice over Internet protocol [VoIP]) is transmitted with a larger frequency range (0.1–8 kHz) and therefore includes more frequencies relevant to speech perception. According to a recently published, laboratory-based study, the theoretical advantage of ideal VoIP conditions over conventional telephone quality has translated into improved speech perception by hearing-impaired individuals. However, the speech perception benefits of nonideal VoIP network conditions, which may occur in daily life, have not been explored. VoIP use cannot be recommended to hearing-impaired individuals before its potential under more realistic conditions has been examined. Objective: To compare realistic VoIP network conditions, under which digital data packets may be lost, with ideal conventional telephone quality with respect to their impact on speech perception by hearing-impaired individuals. Methods: We assessed speech perception using standardized test material presented under simulated VoIP conditions with increasing digital data packet loss (from 0% to 20%) and compared with simulated ideal conventional telephone quality. We monaurally tested 10 adult users of cochlear implants, 10 adult users of hearing aids, and 10 normal-hearing adults in the free sound field, both in quiet and with background noise. Results: Across all participant groups, mean speech perception scores using VoIP with 0%, 5%, and 10% packet loss were 15.2% (range 0%–53%), 10.6% (4%–46%), and 8.8% (7%–33%) higher, respectively, than with ideal conventional telephone quality. Speech perception did not differ between VoIP with 20% packet loss and conventional telephone quality. The maximum benefits were observed under ideal VoIP conditions without packet loss and were 36% (P = .001) for cochlear implant users, 18% (P = .002) for hearing aid users, and 53% (P = .001) for normal-hearing adults. With a packet loss of 10%, the maximum benefits were 30% (P = .002) for cochlear implant users, 6% (P = .38) for hearing aid users, and 33% (P = .002) for normal-hearing adults. Conclusions: VoIP offers a speech perception benefit over conventional telephone quality, even when mild or moderate packet loss scenarios are created in the laboratory. VoIP, therefore, has the potential to significantly improve telecommunication abilities for the large community of hearing-impaired individuals. %M 22805169 %R 10.2196/jmir.1818 %U http://www.jmir.org/2012/4/e102/ %U https://doi.org/10.2196/jmir.1818 %U http://www.ncbi.nlm.nih.gov/pubmed/22805169