Objective Ménière’s disease (MD) is a clinical condition defined by spontaneous vertigo attacks (each lasting 20 minutes to 12 hours) with documented low- to midfrequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo. It also presents with fluctuating aural symptoms (hearing loss, tinnitus, or ear fullness) in the affected ear. The underlying etiology of MD is not completely clear, yet it has been associated with inner ear fluid (endolymph) volume increases, culminating in episodic ear symptoms (vertigo, fluctuating hearing loss, tinnitus, and aural fullness). Physical examination findings are often unremarkable, and audiometric testing may or may not show low- to midfrequency sensorineural hearing loss. Conventional imaging, if performed, is also typically normal. The goals of MD treatment are to prevent or reduce vertigo severity and frequency; relieve or prevent hearing loss, tinnitus, and aural fullness; and improve quality of life. Treatment approaches to MD are many and typically include modifications of lifestyle factors (eg, diet) and medical, surgical, or a combination of therapies. Purpose The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of MD. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.

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.

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4. Laryngoscope, 128:626-631, 2018.

Objective The purpose of this study is to assess regional parental barriers in the diagnostic and therapeutic process following abnormal newborn hearing screening (NHS) testing. Study Design Cross-sectional questionnaire study Setting Tertiary medical center Patients Parents of infants who failed NHS in Kentucky from January 2009 – February 2012 Main Outcome Measure Demographic information, county of origin, and attitudes and perceptions regarding NHS and barriers in the NHS diagnostic process. Results There were 460 participants in the study, which included25.4% of parents were from the Appalachian region. 21% of Appalachian parents found the process on newborn hearing testing difficult. Appalachian parents were more likely to have no more than 12 years of education (OR 1.7, p=0.02) and Medicaid insurance (OR 2.3, p<0.001) compared with non-Appalachian parents. A higher percentage of Appalachian parents were unaware of the NHS results at the time of hospital discharge than non-Appalachians (14% v. 7%, p=0.03). Distance from the diagnostic/therapeutic center represented was a significant barrier for Appalachian parents (OR 2.8, p=0.001). Compared with urban parents, a greater percentage of rural parents had never heard of a cochlear implant (p=0.01). Appalachian parents expressed a strong interest in telemedicine and a desire for closer services. Conclusion Multiple barriers including education, distance, accessibility, socioeconomic factors can affect timely diagnosis and treatment of congenital hearing loss for children residing in rural areas. Educational and telemedicine programs may benefit parents in Appalachia, as well as parents in other rural areas.