Objective/Hypothesis Hearing loss is a public health concern yet hearing healthcare disparities exist and influence utilization of rehabilitation services. The objective of this review was to systematically analyze the published literature on motivators, barriers, and compliance factors affecting adult patient access and utilization of hearing rehabilitation healthcare. Data Sources and Study Eligibility Criteria Pubmed, PsychINFO, CINAHL, Web of Science were searched for relevant articles. Eligible studies were those containing original, peer-reviewed research in English pertaining to factors affecting adult hearing healthcare access and utilization of hearing aids and cochlear implantation. The search encompassed 1990-2015. Study Appraisal and Synthesis Methods Two investigators independently reviewed all articles and extracted data. Specific variables regarding access to care and compliance to recommended care were extracted from each study. Results Thirty articles were reviewed. The factors affecting access and utilization of hearing rehabilitation could be classified into motivators, barriers, and compliance in treatment or device use. The key motivators to seek care include degree of hearing loss, self-efficacy, family support, and self-recognition of hearing loss. The primary barriers to care were financial limitations, stigma of hearing devices, inconvenience, competing chronic health problems, and unrealistic expectations. Compliance is most affected by self-efficacy, education level, and engagement in the rehabilition process. Conclusion Accessing hearing healthcare is complicated by multiple factors. Considering the current climate in healthcare policy and legislation towards improved access of care, a deeper understanding of motivators, barriers and compliance factors can aid in delivery of effective and efficient hearing healthcare.

Objective-The purpose of this study is to compare the timing and impact of hearing healthcare of rural and urban adults with severe hearing loss who use cochlear implants (CI).Study Design-Cross-sectional questionnaire study Setting-Tertiary referral center Patients-Adult cochlear implant recipients.Main Outcome Measures-Data collected included county of residence, socioeconomic information, impact of hearing loss on education/employment, and timing of hearing loss treatment. The benefits obtained from cochlear implantation were also evaluated.

Objectives/Hypothesis Sinonasal respiratory epithelial mucociliary clearance (MCC) is dependent on the transepithelial transport of ions such as Cl−. The objectives of the present study were to investigate the role of oxygen restriction in 1) Cl− transport across primary sinonasal epithelial monolayers, 2) expression of the apical Cl− channels CFTR and TMEM16A, and 3) the pathogenesis of chronic rhinosinusitis (CRS). Study Design In vitro investigation. Methods Murine nasal septal epithelial (MNSE, wild type) and human sinonasal epithelial (HSNE) cultures were incubated under hypoxic conditions (1% O2, 5% CO2). Cultures were mounted in Ussing chambers for ion transport measurements. CFTR and TMEM16A expression were measured using quantitative RT-PCR. Results The change in short-circuit current (ΔISC (µA/cm2) attributable to CFTR (forskolin-stimulated) was significantly decreased due to a 12 hour hypoxia exposure in both MNSE (13.55+/− 0.46 vs. 19.23+/−0.18) and HSNE (19.55+/−0.56 vs. 25.49+/−1.48 (control); p<0.05. TMEM16A (UTP-stimulated transport) was inhibited by 48 hours of hypoxic exposure in MNSE (15.92+/−2.87 vs. 51.44+/−3.71(control) p<0.05] and by 12 hours of hypoxic exposure in HSNE (16.75+/−0.68 vs. 24.15+/−1.35 (control). Quantitative RT-PCR (reported as relative mRNA levels+/−S.D.) demonstrated significant reductions in both CFTR and TMEM16A mRNA expression in MNSE and HSNE due to airway epithelial hypoxia. Conclusions Sinonasal epithelial CFTR and TMEM16A-mediated Cl− transport and mRNA expression were robustly decreased in an oxygen restricted environment. The findings in the present study indicate persistent hypoxia may lead to acquired defects in sinonasal Cl− transport in a fashion likely to confer mucociliary dysfunction in CRS. Level of Evidence 1b

Objective The objective of this study was to compare the timing of hearing aid (HA) acquisition between adult in rural and urban communities. We hypothesized that time of acquisition of HA after onset of hearing loss is greater in rural adults compared with urban adults. Secondary objectives included assessment of socioeconomic/educational status and impact of hearing loss and hearing rehabilitation of urban and rural HA recipients. Study Design Cross-sectional questionnaire survey Methods We assessed demographics, timing of HA fitting from onset of hearing loss, and impact of hearing impairment in 336 adult HA recipients (273 urban, 63 rural) from a tertiary referral center. Amplification benefit was assessed using the International Outcome Inventory for Hearing Aids (IOI). Results The time to HA acquisition was greater for rural participants compared to urban participants (19.1 versus 25.7 years, p=0.024) for those with untreated hearing loss for at least 8 years. Age at hearing loss onset was correlated with time to HA acquisition (ρ=−0.54, p<0.001). Rural HA participants experienced longer commutes to hearing specialists (68 versus 32 minutes, p<0.001), were less likely to achieve a degree beyond high school (p<0.001), and were more likely to possess Medicaid coverage (p=0.012) compared to urban participants. Hearing impairment caused job performance difficulty in 60% of all participants. Conclusions Rural adults are at risk for delayed HA acquisition, which may be related to distance to hearing specialists. Further research is indicated to investigate barriers to care and expand access for vulnerable populations. Level of Evidence 4

Introduction:African-Americans are more likely than Caucasians to access healthcare through the emergency department (ED); however, the reasons behind this pattern are unclear. The objective is to investigate the effect of race, insurance, socioeconomic status, and perceived health on the preference for ED use.Methods:This is a prospective study at a tertiary care ED from June to July 2009. Patients were surveyed to capture demographics, healthcare utilization, and baseline health status. The primary outcome of interest was patient-reported routine place of healthcare. Other outcomes included frequency of ED visits in the previous 6 months, barriers to primary care and patient perception of health using select questions from the Medical Outcomes Study Short Form 36 (SF-36).Results:Two hundred and ninety-two patients completed the survey of whom 58% were African-American and 44% were uninsured. African-Americans were equally likely to report 3 or more visits to the ED, but more likely to state a preference for the ED for their usual place of care (24% vs. 13%, p < 0.01). No significant differences between groups were found for barriers to primary care, including insurance. African-Americans less often reported comorbidities or hospitalization within the previous 6 months (23% vs. 34%, p = 0.04). On logistic regression modeling, African-Americans were more than 2 times as likely to select the ED as their usual place of healthcare (OR 2.24, 95% CI 1.22 – 4.08).Conclusion:African-Americans, independent of health insurance, are more likely than Caucasians to designate the ED as their routine place of healthcare.