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Biomedical subjects

A Parving

Publications and source records attributed to A Parving.

At least 19 recordsLinked to original sources
PubMed1996

[Hearing problems--what do general practitioners do?].

Surveys have shown that the overall prevalence of hearing problems in the adult population is approximately 20% with an increasing prevalence as a function of age, i.e. a prevalence of 40-70% in the population at an age of 70+ years. This survey describes the role of general practitioners (GP) in audiology based on questionnaire evaluations mailed to all GPs in the Copenhagen City and to GPs offering services to persons > or = 80 years of age in the Valby health authority subdistrict. Additionally, an evaluation of hearing-impaired persons referred to the Audiological Department has been performed. Only 10% of GPs indicated that they knew the structure and organization of the hearing health services, resulting in a delay in rehabilitation. Forty-five percent of GPs always refer their elderly patients > or = 80 years of age with hearing problems to otologists in the primary health care sector, which represents unnecessary and additional costs within the local health authority. Among the hearing-impaired only 29% had gone to their GP due to hearing problems. The attitude to hearing aids among the GPs is positive, and 95% consider a hearing aid capable of improving the quality of life. It is suggested that GPs receive training and education within the audiological field before entering general practice, and that postgraduate courses directed towards GPs are established.

Adult↗
PubMed1996

Epidemiology of permanent hearing impairment in children in relation to costs of a hearing health surveillance program.

The objective of this investigation was to estimate the prevalence of any permanent hearing impairment (PHI) in the right and or left ear based on children included into a surveillance program in the local pediatric hearing health services (PHHS), and to analyze the costs, generated by the children. The study is a cross-sectional study, which is part of a major prospective study directed towards delineation of all aspects of pediatric audiology. The present sample comprises 228 children, 115 males and 113 females, at a median age of 13 years, range 0-24, and involves all children living in the health district of the City of Copenhagen, who are or have been included in a local surveillance program with one (school children) or two (pre-school children) annual visits for children with PHI > 20 dB HL at any frequency in either the left or the right ear. The prevalence of PHI increases with increasing age, reaching its peak in the age band 10-14 years exhibiting a rate of 5.32 1000 (95% confidence intervals: 4.27 to 6.64 per 1000). The estimated incidence of PHI in a ten year cohort born 1977-1986 is 325 100 000 children born (95% confidence intervals: 277 to 382 per 100 000). The most frequent factor causing PHI is inheritance, showing an increase from 20% in 1977-1981 cohorts, to 37% in 1982-1986 cohorts. The costs involved in the PHHS concerning PHI varies considerably from approximately 345 000 to 990 000 DKr.. depending on the model used for the economical analysis. No data on cost-benefit or cost-effectiveness can be given in this context, and it is concluded that the documented changes in the prevalence and causes of PHI in children emphasize the need for a continuous monitoring and evaluation of the epidemiological figures.

Adolescent↗
PubMed1996

A syndrome with retinitis pigmentosa, progressive hearing impairment, vestibular dysfunction, and congenital cataract.

A family with an unusual association of retinitis pigmentosa, progressive and severe hearing impairment, vestibular dysfunction, and congenital zonular cataract is described. The disease had a rather uniform appearance in five affected individuals. Parental consanguinity was documented in all cases and a common ancestor born in 1702 was identified. Consequently, autosomal recessive inheritance seems to be the most likely mode of transmission. This disorder possibly represents a new clinical entity among combined retinal dystrophy and hearing impairment syndromes.

Adult↗
PubMed1995

Regional cerebral activation during auditory stimulation in patients with cochlear implants.

OBJECTIVE: To evaluate a possible change in the regional cerebral blood flow (rCBF) in the language-related cortical areas of the brain during stimulation of a cochlear implant. METHODS: The rCBF was measured by single-photon emission tomography and inhalation of Xenon Xe 133, providing information on the regional functional level of the brain. A supplementary single-photon emission tomographic scan was also performed, using technetium Tc 99m hexamethylpropyleneamineoxime as a flow marker. The rCBF was measured during rest (baseline) and during auditory stimulation by presenting white noise and running speech to the ear with the implant. PATIENTS: Five deaf patients who had undergone intracochlear or extracochlear implantation surgery. RESULTS: As in subjects with normal hearing, notable activation was not found in the relevant primary auditory cortex on stimulation with white noise. Two of the patients with implants had an increase in the rCBF in the relevant contralateral hemisphere on stimulation with running speech, but in the other three patients, a notable increase was not detected. This lack of increase in the rCBF on speech stimulation was consistent with the lack of speech recognition experienced by the subjects when using the implant. In one subject, the implant had a beneficial effect on speech understanding that was associated with a significant increase in the cerebral blood flow in the Broca's speech area and Wernicke's second speech area. CONCLUSIONS: Although the results are preliminary, the single-photon emission tomographic technique may be useful when evaluating the function of a cochlear implant. The method may also help select patients and/or ears for cochlear implantation. Four of five patients had functional defects of auditory relevant cortical areas, suggesting that their deafness might be associated with central impairment in addition to their cochlear defects.

Acoustic Stimulation↗
PubMed1995

An audit of hearing rehabilitation within the health service--past and present.

The present contribution can be considered as an audit of the hearing aid rehabilitation programme as performed in Copenhagen, based on an ongoing quality assurance. A comparative analysis was performed in outcome measures between two 3-month periods in which the only change had been a transfer of the preliminary instruction in manipulation and management of hearing aid (HA) from the educational to the health sector. The data analysis was based on a questionnaire including three samples (sample A, n = 800 evaluated before the change; sample B,n = 779 after the change; and sample C, n = 73 with no change, acting as a reference). The comparison demonstrated no significant differences in the ability to manage or manipulate HA between samples A and B, and no changes were found in the reference sample, C. A significant decrease in the frequency of hearing-impaired subjects needing additional appointments in the health sector was found in sample B. Those subjects who at the HA fitting had made no request for additional educational services demonstrated a significantly higher frequency of 97% capability to manage HA at the follow-up in comparison to only 84% among those who had requested services compatible with the distribution of experienced/unexperienced HA users. The additional data analyses render no support for any effect of the educational services on the ability to manipulate and manage HA.

Adult↗
PubMed1995

A clinical comparative investigation of a non-linear versus linear hearing aid.

The objective of this study was to compare the effect and performance of a hearing aid (HA) having a non-linear amplification below 1600 Hz (test HA) with a linear amplifying HA (control HA), aiming towards identical target groups of hearing-disabled people. The investigation was designed as a single-blind crossover interview study, i.e. the interviewer was blind. Thirty-two experienced HA users at a median age of 74 years participated. The observation period was 6-8 weeks for both HAs. For several evaluation parameters the participants found the test HA superior to the control HA, and a significantly better effect of the test HA was indicated in person-to-person conversation in quiet surroundings. Also, quality of sound was significantly better in the test HA, and thus these parameters support the test HA, being preferred by 75%. No significant differences were found in the objectively evaluated parameter, i.e. speech recognition score in background noise (SRSN: S/N = 0) between the two aids. A one-year follow-up examination of those preferring the test HA demonstrated continuously frequent use and satisfaction with the automatic volume control. It is concluded that skilled HA users with a wide range of hearing impairment at an age of 60-80 years prefer a non-linear HA to their current linear HA when fitted monaurally--however, a certain bias in the unblinded test subjects cannot be excluded.

Aged↗
PubMed1995

Factors causing hearing impairment: some perspectives from Europe.

This review concentrates on factors causing permanent hearing impairment in childhood, described in some European studies. The emphasis is on comparative studies, based on strict criteria and terminology upon which longitudinal changes in the pattern of factors causing hearing impairment can be demonstrated in well-defined cohorts of children. The high proportion of 20-39 percent of unknown causes of permanent hearing impairment in childhood reflects a general lack of knowledge about causative factors and systematic etiologic evaluation within pediatric audiology. Future surveillance programs, including examination procedures directed towards causative factors, may see a reduction of the "unknown" category and ultimately may result in prevention of permanent hearing impairment in childhood. Some factors causing hearing impairment in adults are mentioned, including recent studies that show organic toxic solvents as a factor. As well, some controversial findings concerning the relationship between hearing impairment and endocrine disorders such as hypothyroidism and diabetes mellitus are briefly reported. It is concluded that future developments and research in the etiologic field within pediatric and adult audiology may contribute to the delineation of yet unknown damaging factors or reduction of the effect of factors causing hearing impairment--a disorder that ultimately results in adverse effects on the quality of life in all age groups.

Adult↗
PubMed1994

Is there a relationship between the acoustic occlusion effect and the sensation of occlusion?

The objective of the present investigation was to examine the relationship between the acoustic occlusion effect and the subjective occlusion sensation when using ear moulds. The material comprises 45 subjects (19M and 26F, at a median age of 76 years, range 38-88 years) subgrouped according to the classification of their hearing disorder into two group: N = 22 subjects with conductive hearing loss (1); N = 21 subjects with sensorineural hearing loss (2). The side effects caused by an ear mould were evaluated at an interview, based on a structured questionnaire, two months after the hearing aid fitting. The comparative investigation showed that when the outer ear canal was occluded with an ear mould there were no significant differences between the two groups of subjects in the frequency of sensation of occlusion, in the sound quality of environmental sound or own voice, in hearing problems when chewing, or in ventilation problems. Neither were significant differences in the magnitude of the acoustic occlusion effect present between those answering yes and those answering yes and those answering no to a change in the sound quality of own voice in the group with sensorineural hearing loss. Although the number of subjects is limited, it is concluded that no relationship exists between the acoustic occlusion effect and the perceived sound quality, thus leaving no physical basis for the claim that this side effect is caused by an ear mould.

Adult↗
PubMed1994

The causes of profound hearing impairment in a school for the deaf--a longitudinal study.

The study was aimed towards an evaluation of the causes of hearing loss in children attending the School for the 'Deaf' in Copenhagen in 1993-4 in comparison to causes evaluated 10 and 40 years previously (Arnvig, 1953; Holten and Parving, 1985). The 124 children attending the school in 1993 represent 0.04% of the age-matched target population of 312,715. A more detailed evaluation of two comparable cohorts born in 1969-77 and 1979-87 demonstrates a significant increase of children attending this type of school from 0.03% to 0.05% within a 10-year period, while a comparison between 1953 and 1993 demonstrates a reduction from 0.07% to 0.04%. The longitudinal evaluation of the causes of hearing loss showed a significant increase in the frequency of congenital inherited hearing impairment from 29% (1953) through 33% (1983) to 43% (1993), whereas a significant reduction of about 17% in the frequency of acquired deafness due to chronic otitis media was found. Between 1953 and 1993 a minor reduction (2%) in post-meningitic acquired hearing impairment was found, between 1953 and 1983 there was a significant increase in prenatal infections, compared with a decrease of 6% between 1983 and 1993. It is concluded that significant changes are found both in the prevalence of children referred to the school and in the factors causing severe to profound hearing impairment in children. Continuous recording of, and improvement in, diagnostic classification is necessary to obtain preventive measures.

Adolescent↗
PubMed1994

An audit of hearing aid quality in Denmark. II: Type of defects.

In this investigation the type of defects in hearing aids (HAs) is described, and the stability of HAs is evaluated, based on prospective longitudinal data over an observation period of 2 years. An exchange of information between the Danish national hearing health service and hearing aid manufacturers, representing the private sector, demonstrates that overall external components to which the HA-user has access, are frequently defective. However, with time, internal components, to which the HA-user has no access, are frequently defective within the first year of use, whereas external components malfunction significantly more frequently after 3 years of use. Among the dispensed hearing aids, 11% were defective at the fitting, indicating insufficient quality control by the manufacturers. A prospective longitudinal investigation of 1141 defective HAs revealed that 12% of behind-the-ear HAs become defective within the first year of use, exhibiting the greatest stability. After 2 years of use, all in-the-canal HAs are defective, while only 33% of the in-the-ear HAs remain intact. It is concluded that the established exchange of information between the public and private sectors offers valid information on the quality of HAs; that the quality and stability of HAs is insufficient; and that the quality should be improved, (based on international criteria).

Correction of Hearing Impairment↗
PubMed1993

[Congenital hearing disability among children in Copenhagen].

The survey describes the detection, identification and aetiology of congenital/early acquired (i.e. neonatal period) hearing disability in a well-defined cohort of children, living in the Copenhagen area (Copenhagen City and County). The effect of intervention programmes is also mentioned. The children's age at identification can be considered as an evaluation of the quality of hearing screening aimed towards the detection of children with congenital/early acquired hearing disability, while the results of the aetiological evaluation reflects the quality of the diagnostic evaluations performed within paediatric audiology. The prevalence rate of 1.5/1000 of congenital/early acquired hearing disability for children born during 1980-1990 is unchanged in comparison to the period 1970-1980. An improvement in the detection of children with congenital/early acquired hearing disability is found, the identification is, however, still delayed in both children at risk and not-at-risk of hearing disability. The parents are most frequently the first to raise suspicion of their child's hearing disability, but very seldom apply to the audiological department without a referral from the primary health care sector. A change in the aetiology of congenital/early acquired hearing disability has taken place within 1980-1990, which can be ascribed to the reduced frequency of foetal rubella infection, while the frequency of inherited hearing disability has increased. The outcome of intervention programmes, evaluated by means of type of school, education, and employment situation is briefly described in relation to the social consequences of a hearing disability.

Child, Preschool↗
PubMed1993

Congenital hearing disability--epidemiology and identification: a comparison between two health authority districts.

The objective of the present study was to describe some epidemiological aspects of congenital/early acquired (i.e. in the neonatal period) hearing disability (CEHD) in children born between 1980 and 1990, living in two separate health authority districts, i.e. the Copenhagen City/County; in addition, to evaluate the age at identification of the children, the persons raising suspicion of the hearing loss and the pattern of referral; finally, to compare some epidemiological aspects and the age at identification of similarly defined cohorts of children, born 1970-80. Thus the evaluation can be considered as an audit of the primary health care sector concerning children with CEHD. An identical prevalence rate of CEHD was demonstrated, i.e. 1.5/1000 with a better ear hearing level average at 0.5-4 kHz > or = 25 dB (BEHL 0.5-4 kHz) in both regions and unchanged from 1970-80. The median age at identification in the total cohort was 16/18 months in the City/County, respectively, demonstrating a significantly earlier identification of at-risk children in the County with the opposite pattern in the City. The parents were the first to raise suspicion of their child's hearing disability in 50%/57% in the City/County and only minor differences in the pattern of referral was found in the two regions. The frequency of at-risk children among parents/professionals who first suspected the CEHD showed no significant differences; however, the BEHL 0.5-4 kHz in the children was poorer in the group of parents who first raised the suspicion when compared with the group of professionals. Thus the BEHL 0.5-4 kHz is of significance for the age at identification and for the person raising the suspicion of CEHD. Although an improvement in the early identification of CEHD has taken place, when comparing the 1970-80 cohort and 1980-90 cohort, it is concluded that children with CEHD are identified with a substantial delay and that the line of information both concerning high-risk criteria and general information should be continued and intensified towards both parents and professionals.

Age Factors↗
PubMed1993

Hearing disability in childhood--a cross-sectional and longitudinal investigation of causative factors.

This contribution describes and compares the causes of hearing disability in a cohort of children, born 1980-90, provided with hearing aids and included into the longitudinal surveillance programs of hearing-disabled children performed in two pediatric audiological units within the Copenhagen area. In addition the causes of hearing disability in childhood are compared with the causes found in a cohort born 1970-80, within the same geographical area, using the same criteria for hearing disability and diagnostic classification. No significant differences in the etiology of hearing disability were present in the two districts, and in the combined area prenatal causes accounted for 55% with inheritance (46%) being the most prominent cause of hearing disability. A significant increase in the incidence of inherited hearing disability among the prenatal causes from 69% in the 1970-80 cohort to 85% in the 1980-90 cohort was demonstrated, while a significant decrease in the incidence of foetal infection (i.e. rubella) from 27% to 9% within the two decades was demonstrated. No significant changes in the perinatal and postnatal causes were found from the 1970-80 to 1980-90 cohort, and although an improvement in the diagnostic procedures was found--i.e. a reduction from 26% to 20% in the incidence of unknown cause--the difference in the incidence of unknown cause is insignificant between the two decades. The investigation supports the need for continuous monitoring of the causes of hearing disability in childhood and supports the potential value of worldwide accepted criteria for etiological categories.

Child↗
PubMed1993

Observer variations in the evaluation of facial nerve function after acoustic neuroma surgery.

This investigation was performed in order to evaluate the observer variations in facial nerve function after surgery for an acoustic neuroma. From 1976-90, 507 patients were operated on by the same surgical team (M.T. and J.T.) using a translabyrinthine approach. One hundred and forty-four patients living in Copenhagen City and County were invited for interview and objective examination. Only 128 patients attended the interview and examination which were carried out by the same ENT physician. Data concerning observation of the facial nerve function only is presented. Its function was clinically evaluated (using the House and Brackmann (1985) grading scale) by two different observers i.e. the ENT physician and one of the surgeons. The patients were asked face-to-face with the ENT physician to estimate the degree of facial nerve function according to a 0-100 per cent scale. Comparing normal and abolished facial nerve function the judgments of the ENT physician and the surgeon agreed with the patient's own evaluation.

Adult↗
PubMed1993

Mixed solvent exposure and hearing impairment: an epidemiological study of 3284 men. The Copenhagen male study.

Animal experiments and human studies have indicated an effect on auditory functions from exposure to organic solvents. In this study the relationship between self-assessed hearing problems and occupational exposure to solvents was investigated in a cross-sectional design with 3284 participating men aged 53-74 years. Exposure to solvents for five years or more resulted in an adjusted relative risk (RR) for hearing impairment of 1.4 (95 per cent CI: 1.1-1.9) in men without occupational exposure to noise. Factors adjusted for were age, noise traumas, chronic middle ear infection and family history of hearing impairment. The prevalence of hearing impairment in men not exposed to organic solvents was 24 per cent and the attributable risk from solvent exposure was 9.6 per cent. Exposure for less than five years had no effect on hearing capacity. Occupational exposure to noise for five years or more had an effect twice that of solvents, RR: 1.9 (95 per cent CI: 1.7-2.1). In men exposed to both solvents and noise the effect of the latter dominated and no additional effect from solvents was found. A subsample of 51 men was examined with pure tone audiometry and 20 of 21 men who reported abnormal hearing also fulfilled an audiometric criterion for hearing impairment. In conclusion a damaging effect on hearing ability from long-term solvent exposure was found in the present study. The relative effect was moderate but with a high background frequency of hearing problems in the unexposed sample the absolute effect, ie attributable risk, was considerable and of both clinical and preventive importance.

Aged↗
PubMed1993

Epidemiology of hearing disorders. Some factors affecting hearing. The Copenhagen Male Study.

This epidemiological investigation reports on the results from a 10-year follow-up examination concerning hearing and factors known to cause hearing problems. In addition, an evaluation concerning the possible association between hearing impairment and factors affecting the state of health is reported. The original sample comprised 5,050 subjects, and at the present examination 3,387 (67%) males at a median age of 63 years (range 53-75) participated. An increasing prevalence of 30-40% of hearing problems was demonstrated with increasing age. A prevalence of 17% of tinnitus of more than 5 min duration was found; 3% indicated that their tinnitus was so annoying that it interfered with sleep, reading and/or concentration. The prevalence of tinnitus increased up to the age of 70, and seemed to remain constant thereafter. A significant correlation between experienced hearing problems and environmental factors causing damage to the hearing organ was found. Furthermore, a correlation between hearing problems and C3-S complement was found, but no correlations could be established between hearing problems and other blood groups. No correlation was found between cardiovascular disease and hearing problems except for minor circulatory problems, nor between hearing problems and hormonal diseases. It is concluded that the present study supports previous epidemiological investigations concerning the prevalence of hearing problems and factors affecting hearing. The association between hearing problems and C3-S complement, which to the authors' knowledge has not previously been reported, should be further evaluated. No association was found between hearing problems and other blood groups.

Age Factors↗