Hearing loss affects over 360 million people worldwide and has become a major public health and e... more Hearing loss affects over 360 million people worldwide and has become a major public health and economic problem. 1 The negative impact of untreated hearing loss on communication, education, employment is profound leading to an annual economic burden of disease of over 750 billion dollars. 1 The effective and efficient treatment of hearing loss is complicated by a global disparity in hearing healthcare providers, especially in rural regions of high income countries and throughout low income countries. 2 Changes in policy related to hearing healthcare have mandated improved access to care, enhanced quality of care, and focus on value in healthcare. Shifting practice patterns are influencing how and where hearing healthcare is delivered. Telemedicine, which is defined as the use of communications technology to get the right care to the right people at the right time in the right place for the right price, has great potential to meet the demand and improve delivery of hearing healthcare.
There is underutilization of cochlear implants with delays in implantation linked to distance fro... more There is underutilization of cochlear implants with delays in implantation linked to distance from implant centers. Telemedicine could connect cochlear implant specialists with patients in rural locations. We piloted telemedicine cochlear implant testing in a small study, largely composed of normal‐hearing volunteers to trial this new application of teleaudiology technology. Thirteen subjects (8 with normal hearing and 5 with hearing loss ranging from mild to profound) underwent a traditional cochlear implant evaluation in person and then via telemedicine technology. Routine audiometry, word recognition testing, and Arizona Biological Test (AzBio) and consonant‐nucleus‐consonant (CNC) testing were performed. Mean (SD) percent difference in AzBio between in‐person and remote testing was 1.7% (2.06%). Pure tone average (PTA), speech reception threshold (SRT), and word recognition were similar between methods. CNC testing showed a mean (SD) difference of 6.8% (10.2%) between methods. T...
Objectives-To assess the efficacy of a patient navigator intervention to decrease non-adherence t... more Objectives-To assess the efficacy of a patient navigator intervention to decrease non-adherence to obtain audiological testing following failed screening, compared to those receiving the standard of care. Methods-Using a randomized controlled design, guardian-infant dyads, in which the infants had abnormal newborn hearing screening, were recruited within the first week after birth. All participants were referred for definitive audiological diagnostic testing. Dyads were randomized into a patient navigator study arm or standard of care arm. The primary outcome was the percentage of patients with follow-up non-adherence to obtain diagnostic testing. Secondary outcomes were parental knowledge of infant hearing testing recommendations and barriers in obtaining follow-up testing. Results-Sixty-one dyads were enrolled in the study (patient navigator arm=27, standard of care arm=34). The percentage of participants non-adherent to diagnostic follow-up during the first 6 months after birth was significantly lower in the patient navigator arm compared with the standard of care arm (7.4% versus 38.2%) (p=0.005). The timing of initial follow-up was significantly
Objective-To compare the prevalence of disruptive behavior problems between preschool-aged childr... more Objective-To compare the prevalence of disruptive behavior problems between preschool-aged children with hearing loss and normal hearing. Study design-Cross-sectional study Setting-Tertiary academic center Patients-Caregivers of children (2-5 years old) with normal hearing (NH) (n=39), hearing loss using hearing aid(s) (HA) (n=29), or cochlear implant(s) (CI) (n=21). Intervention(s)-Demographic information and a mental health history were obtained. Child behavior and language development were assessed. Main outcome measure(s)-The Young Child-Diagnostic Interview Schedule for Children-IV (YC-DISC-IV) and the MacArthur-Bates Communication Development Inventory (CDI-III) Results-Distributions of race, socioeconomic status, insurance status, and parental home situation (single vs. two parent family) were similar across all groups. Parents of children with hearing loss were significantly more likely to report behavior problems (HA=41%, CI=38%) than parents of NH children (10%; p=0.002). Children with hearing loss were significantly more likely to meet diagnostic criteria for oppositional defiant disorder (HA=48%, CI=48%) than NH children (23%; p=0.02). More NH children (8%) than hearing impaired children (0%) had accessed mental health services (p=0.08). NH children were found to have more advanced language development *
Objective-To examine the incidence of pediatric congenital hearing loss and the timing of diagnos... more Objective-To examine the incidence of pediatric congenital hearing loss and the timing of diagnosis in a rural region of hearing healthcare disparity. Study design-Data from the Kentucky newborn hearing-screening program was accessed to determine the incidence of congenital hearing loss in Kentucky, both in the extremely rural region of Appalachia and non-Appalachian region of Kentucky. We also performed a retrospective review of records of children with congenital hearing loss at our institution to determine the timing of diagnostic testing. Results-In Kentucky, during 2009-2011, there were 6,970 newborns who failed hearing screening; the incidence of newborn hearing loss was 1.71 per 1000 births (1.28/1000 in Appalachia and 1.87/1000 in non-Appalachia). 23.8% of Appalachian newborns compared with 17.3% of non-Appalachian children failed to obtain follow-up diagnostic testing. Children from Appalachia were significantly delayed in obtaining a final diagnosis of hearing loss compared with children from non-Appalachian regions (p=0.04). Conclusion-Congenital hearing loss in children from rural regions with hearing healthcare disparities is a common problem and these children are at risk for a delay in the timing of diagnosis, which has the potential to limit language and social development. It is important to further assess the causative factors and develop interventions that can address this hearing healthcare disparity issue. With an incidence of approximately 1.4 per 1000 newborns screened 1 , hearing loss is the most common neonatal sensory disorder in the United States. The sense of hearing is important during the early years of life for the development of speech, language, and
Objective-The purpose of this study is to assess regional parental barriers in the diagnostic and... more 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.
International Journal of Pediatric Otorhinolaryngology, 2021
This article has been Temporarily withdrawn at the request of the author(s) and/or editor. The Pu... more This article has been Temporarily withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal
ObjectiveMénière’s disease (MD) is a clinical condition defined by spontaneous vertigo attacks (e... more ObjectiveMénière’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 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. 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 appro...
Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 2018
The purpose of this study was to assess barriers to rehabilitation care for pediatric cochlear im... more The purpose of this study was to assess barriers to rehabilitation care for pediatric cochlear implant (CI) recipients. Cross-sectional questionnaire study. Tertiary medical center. Parents of children who received a CI from October 1996 to June 2013. Factors related to access to and barriers in audiology and speech therapy services, factors related to CI use, and performance with CI using the Parents' Evaluation of Aural/Oral Performance of Children (PEACH). Thirty-five parents participated in the study (21 rural residents and 14 urban residents). Distance was a significant barrier to audiology services for rural participants compared with urban participants (p = 0.01). Consistent CI use was complicated by mechanical complications or malfunction in 70% of rural children compared with 33% of urban children (p = 0.05). Only 10% of rural children were able to access speech therapy services at diagnosis compared with 42% of urban children (p = 0.04). Low socioeconomic (SES) status ...
Objective To compare 3-D segmented volumetric analysis of vestibular schwannomas (VS) with tradit... more Objective To compare 3-D segmented volumetric analysis of vestibular schwannomas (VS) with traditional linear tumor measurement on serial magnetic resonance imaging (MRI) studies to assess volume and growth rates. Study Design Case series with retrospective chart review. Setting Tertiary care medical center. Methods This analysis identified 24 VS patients clinically followed with serial gadolinium enhanced images. Maximum linear dimensions (MLD) were obtained from gadolinium-contrasted T1 sequences from 3 serial MRI scans per RECIST guidelines. MLD was cubed (MLD3) and orthogonal analysis (OA) was carried out to provide volumetric estimates for comparison with segmented data. Segmented volumetric analysis (SVA) was performed with semi-automated 3-D conformal procedure. Tumor volume, percentage change in volume, and interval percentage change were compared using paired 2-tailed t tests. Results The average interval between MRIs was 2.6 years. Volume estimates differed significantly b...
Introduction As the most common neonatal sensory disorder in the USA, infant hearing loss has an ... more Introduction As the most common neonatal sensory disorder in the USA, infant hearing loss has an incidence of 1.7 per 1000 births. The consequences of delayed diagnosis and failure to obtain timely intervention include significant communication impairment and negative socioeconomic effects. Early Hearing Detection and Intervention (EHDI) national standards dictate that all infants should be screened and diagnosed by 3 months of age and there is a need for interventions that promote adherence to timely diagnosis. Patient navigation (PN) has been shown to be efficacious to decrease non-adherence with infant hearing diagnostic care; however, PN has yet to be tested in diverse communities or implemented into real-world settings. Methods and analysis The proposed research is a community-engaged, type 1 hybrid effectivenessimplementation trial of a PN intervention aimed at decreasing infant hearing diagnosis non-adherence after failed newborn hearing screening, delivered in statefunded EHDI clinics. Guided by our community advisory board and partners, we aim to (1) test the effectiveness of PN to decrease non-adherence to receipt of infant hearing diagnosis within 3 months after birth using a stepped-wedge trial design, (2) investigate implementation outcomes and factors influencing implementation and (3) determine the cost-effectiveness of PN from the perspective of third-party payers. The study will be conducted from April 2019 until March 2024. Ethics and dissemination This protocol was approved by the University of Kentucky Institutional Review Board. Although all research involving human subjects contains some risk, there are no known serious risks anticipated from participating in this study. We will seek to disseminate our results in a systematic fashion to patients, key stakeholder, policymakers and the scientific community. Our results will impact the field by partnering with communities to inform the scale-up of this innovative patient supportive intervention to create efficient and effective EHDI programmes and maximise public health impact. Trial registration number Clinicaltrials. gov (Pre-results phase): NCT03875339.
IntroductionAs the most common neonatal sensory disorder in the USA, infant hearing loss has an i... more IntroductionAs the most common neonatal sensory disorder in the USA, infant hearing loss has an incidence of 1.7 per 1000 births. The consequences of delayed diagnosis and failure to obtain timely intervention include significant communication impairment and negative socioeconomic effects. Early Hearing Detection and Intervention (EHDI) national standards dictate that all infants should be screened and diagnosed by 3 months of age and there is a need for interventions that promote adherence to timely diagnosis. Patient navigation (PN) has been shown to be efficacious to decrease non-adherence with infant hearing diagnostic care; however, PN has yet to be tested in diverse communities or implemented into real-world settings.Methods and analysisThe proposed research is a community-engaged, type 1 hybrid effectiveness-implementation trial of a PN intervention aimed at decreasing infant hearing diagnosis non-adherence after failed newborn hearing screening, delivered in state-funded EHD...
Hearing loss is a global public health issue with disproportionate negative impacts on those who ... more Hearing loss is a global public health issue with disproportionate negative impacts on those who live in rural regions, such as Appalachia. This commentary provides an overview of hearing health and healthcare disparities in rural regions along with discussion of the significance of recent research findings which highlight the incidence of hearing loss and the shortage of hearing specialists in Appalachia.
Supplemental Digital Content is available in the text Objective: Adults with hearing loss are at ... more Supplemental Digital Content is available in the text Objective: Adults with hearing loss are at risk of negative impacts of the pandemic. Specific factors, such as hearing loss severity and location of residence, may disproportionately impact patients during the pandemic. The objective of this study was to assess the relative impact of the COVID-19 pandemic on hearing loss patients, based on hearing device type and location of residence. Study Design: Prospective cross-sectional questionnaire study. Setting: Tertiary referral center. Patients: Adults with hearing loss. Main Outcome Measures: Data included sociodemographic data, communication challenges, pandemic preparedness, access to healthcare, and mental and emotional health. Results: A total of 614 patients responded (27.8% response rate). Compared with hearing aid users, cochlear implant users reported more difficulty communicating with family/friends (53% versus 41%, p = 0.017), obtaining pandemic information (10% versus 3%, p = 0.002), and understanding live broadcasts (47% versus 17%, p = 0.001) during the pandemic. CI users were less likely than hearing aid users to seek general (52% versus 69%, p = 0.001) and hearing healthcare services (20% versus 34%, p = 0.002). Rural residents reported greater difficulty than urban residents communicating with friends/family (53% versus 39%, p = 0.001), obtaining food/supplies (41% versus 20%, p = 0.004), understanding live broadcasts (31% versus 20%, p = 0.001) during the pandemic. Compared with urban residents, rural residents reported greater difficulty accessing general (57% versus 42%, p = 0.004) and hearing healthcare (49% versus 34%, p = 0.043). Rural residents reported poorer mental/emotional health than urban residents. Conclusions: Among adults with hearing loss, cochlear implant users and rural residents experience greater challenges in communication, pandemic preparedness, and access to healthcare during the COVID-19 pandemic.
OBJECTIVES/HYPOTHESIS A no-show to the operating room date negatively impacts a hospital and can ... more OBJECTIVES/HYPOTHESIS A no-show to the operating room date negatively impacts a hospital and can lead to increased costs for an institution in terms of time, materials, and manpower. Our objectives are to identify the factors associated with operating room no-shows in order to increase clinical efficiency, reduce hospital costs, and increase patient access to care. STUDY DESIGN Single institution retrospective chart review. METHODS A retrospective review was performed of all surgeries within the Otolaryngology department performed at a single tertiary academic center between 2006 and 2019. Demographic and surgical data were collected from the charts. Descriptive, univariate, and multivariate statistics were performed on the data. RESULTS There were a total of 1,752 no-shows and 46,440 patients who did show with an overall no-show rate of 3.63%. A multivariate logistic regression analysis was performed to compare patients who did not show for surgery to those who did. Analysis found multiple risk factors for not showing to surgery that were statistically significant (P < .05) and included decreasing age, planned outpatient case, head and neck oncology subspecialty, increasing distance from the facility, higher number of clinic no-shows, and not having private insurance. African-American race was more likely to show for surgery as scheduled. CONCLUSIONS Numerous factors may play a role on whether or not a patient attends a scheduled surgical date. Some of these factors may be preventable or modifiable to mitigate increased hospital costs associated with no-show to surgery and increase access to care. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
OF DISSERTATION PROMOTION OF EARLY PEDIATRIC HEARING DETECTION THROUGH PATIENT NAVIGATION Congeni... more OF DISSERTATION PROMOTION OF EARLY PEDIATRIC HEARING DETECTION THROUGH PATIENT NAVIGATION Congenital hearing loss is the most common neonatal sensory disorder and it is crucial to diagnose hearing loss as soon as possible after birth in order to facilitate rapid treatment. Universal standards of infant hearing healthcare dictate that infant hearing screening should be completed by one month of age and abnormal screening tests should be followed with definitive audiological testing by three months of age. Obtaining diagnostic testing can be complicated by limited access to care in rural areas, breakdowns in communication, lack of parental support, and poor coordination of care. There is no established method to address appointment non-adherence in newborn hearing testing. Patient navigation (PN), which uses trained healthcare workers to educate patients and facilitate adherence to healthcare, is an evidence-based approach that has had widespread success in facilitating timely care in...
Hearing loss is a global public health problem with high prevalence and profound impacts on healt... more Hearing loss is a global public health problem with high prevalence and profound impacts on health. Cochlear implantation (CI) is a well-established evidence-based treatment for hearing loss; however, there are significant disparities in utilization, access, and clinical outcomes among different populations. While variations in CI outcomes are influenced by innate biological differences, a wide array of social, environmental, and economic factors significantly impact optimal outcomes. These differences in hearing health are rooted in inequities of health-related socioeconomic resources. To define disparities and advance equity in CI, there is a pressing need to understand and target these social factors that influence equitable outcomes, access, and utilization. These factors can be categorized according to the widely accepted framework of social determinants of health, which include the following domains: healthcare access/quality, education access/quality, social and community con...
Hearing loss affects over 360 million people worldwide and has become a major public health and e... more Hearing loss affects over 360 million people worldwide and has become a major public health and economic problem. 1 The negative impact of untreated hearing loss on communication, education, employment is profound leading to an annual economic burden of disease of over 750 billion dollars. 1 The effective and efficient treatment of hearing loss is complicated by a global disparity in hearing healthcare providers, especially in rural regions of high income countries and throughout low income countries. 2 Changes in policy related to hearing healthcare have mandated improved access to care, enhanced quality of care, and focus on value in healthcare. Shifting practice patterns are influencing how and where hearing healthcare is delivered. Telemedicine, which is defined as the use of communications technology to get the right care to the right people at the right time in the right place for the right price, has great potential to meet the demand and improve delivery of hearing healthcare.
There is underutilization of cochlear implants with delays in implantation linked to distance fro... more There is underutilization of cochlear implants with delays in implantation linked to distance from implant centers. Telemedicine could connect cochlear implant specialists with patients in rural locations. We piloted telemedicine cochlear implant testing in a small study, largely composed of normal‐hearing volunteers to trial this new application of teleaudiology technology. Thirteen subjects (8 with normal hearing and 5 with hearing loss ranging from mild to profound) underwent a traditional cochlear implant evaluation in person and then via telemedicine technology. Routine audiometry, word recognition testing, and Arizona Biological Test (AzBio) and consonant‐nucleus‐consonant (CNC) testing were performed. Mean (SD) percent difference in AzBio between in‐person and remote testing was 1.7% (2.06%). Pure tone average (PTA), speech reception threshold (SRT), and word recognition were similar between methods. CNC testing showed a mean (SD) difference of 6.8% (10.2%) between methods. T...
Objectives-To assess the efficacy of a patient navigator intervention to decrease non-adherence t... more Objectives-To assess the efficacy of a patient navigator intervention to decrease non-adherence to obtain audiological testing following failed screening, compared to those receiving the standard of care. Methods-Using a randomized controlled design, guardian-infant dyads, in which the infants had abnormal newborn hearing screening, were recruited within the first week after birth. All participants were referred for definitive audiological diagnostic testing. Dyads were randomized into a patient navigator study arm or standard of care arm. The primary outcome was the percentage of patients with follow-up non-adherence to obtain diagnostic testing. Secondary outcomes were parental knowledge of infant hearing testing recommendations and barriers in obtaining follow-up testing. Results-Sixty-one dyads were enrolled in the study (patient navigator arm=27, standard of care arm=34). The percentage of participants non-adherent to diagnostic follow-up during the first 6 months after birth was significantly lower in the patient navigator arm compared with the standard of care arm (7.4% versus 38.2%) (p=0.005). The timing of initial follow-up was significantly
Objective-To compare the prevalence of disruptive behavior problems between preschool-aged childr... more Objective-To compare the prevalence of disruptive behavior problems between preschool-aged children with hearing loss and normal hearing. Study design-Cross-sectional study Setting-Tertiary academic center Patients-Caregivers of children (2-5 years old) with normal hearing (NH) (n=39), hearing loss using hearing aid(s) (HA) (n=29), or cochlear implant(s) (CI) (n=21). Intervention(s)-Demographic information and a mental health history were obtained. Child behavior and language development were assessed. Main outcome measure(s)-The Young Child-Diagnostic Interview Schedule for Children-IV (YC-DISC-IV) and the MacArthur-Bates Communication Development Inventory (CDI-III) Results-Distributions of race, socioeconomic status, insurance status, and parental home situation (single vs. two parent family) were similar across all groups. Parents of children with hearing loss were significantly more likely to report behavior problems (HA=41%, CI=38%) than parents of NH children (10%; p=0.002). Children with hearing loss were significantly more likely to meet diagnostic criteria for oppositional defiant disorder (HA=48%, CI=48%) than NH children (23%; p=0.02). More NH children (8%) than hearing impaired children (0%) had accessed mental health services (p=0.08). NH children were found to have more advanced language development *
Objective-To examine the incidence of pediatric congenital hearing loss and the timing of diagnos... more Objective-To examine the incidence of pediatric congenital hearing loss and the timing of diagnosis in a rural region of hearing healthcare disparity. Study design-Data from the Kentucky newborn hearing-screening program was accessed to determine the incidence of congenital hearing loss in Kentucky, both in the extremely rural region of Appalachia and non-Appalachian region of Kentucky. We also performed a retrospective review of records of children with congenital hearing loss at our institution to determine the timing of diagnostic testing. Results-In Kentucky, during 2009-2011, there were 6,970 newborns who failed hearing screening; the incidence of newborn hearing loss was 1.71 per 1000 births (1.28/1000 in Appalachia and 1.87/1000 in non-Appalachia). 23.8% of Appalachian newborns compared with 17.3% of non-Appalachian children failed to obtain follow-up diagnostic testing. Children from Appalachia were significantly delayed in obtaining a final diagnosis of hearing loss compared with children from non-Appalachian regions (p=0.04). Conclusion-Congenital hearing loss in children from rural regions with hearing healthcare disparities is a common problem and these children are at risk for a delay in the timing of diagnosis, which has the potential to limit language and social development. It is important to further assess the causative factors and develop interventions that can address this hearing healthcare disparity issue. With an incidence of approximately 1.4 per 1000 newborns screened 1 , hearing loss is the most common neonatal sensory disorder in the United States. The sense of hearing is important during the early years of life for the development of speech, language, and
Objective-The purpose of this study is to assess regional parental barriers in the diagnostic and... more 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.
International Journal of Pediatric Otorhinolaryngology, 2021
This article has been Temporarily withdrawn at the request of the author(s) and/or editor. The Pu... more This article has been Temporarily withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal
ObjectiveMénière’s disease (MD) is a clinical condition defined by spontaneous vertigo attacks (e... more ObjectiveMénière’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 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. 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 appro...
Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 2018
The purpose of this study was to assess barriers to rehabilitation care for pediatric cochlear im... more The purpose of this study was to assess barriers to rehabilitation care for pediatric cochlear implant (CI) recipients. Cross-sectional questionnaire study. Tertiary medical center. Parents of children who received a CI from October 1996 to June 2013. Factors related to access to and barriers in audiology and speech therapy services, factors related to CI use, and performance with CI using the Parents' Evaluation of Aural/Oral Performance of Children (PEACH). Thirty-five parents participated in the study (21 rural residents and 14 urban residents). Distance was a significant barrier to audiology services for rural participants compared with urban participants (p = 0.01). Consistent CI use was complicated by mechanical complications or malfunction in 70% of rural children compared with 33% of urban children (p = 0.05). Only 10% of rural children were able to access speech therapy services at diagnosis compared with 42% of urban children (p = 0.04). Low socioeconomic (SES) status ...
Objective To compare 3-D segmented volumetric analysis of vestibular schwannomas (VS) with tradit... more Objective To compare 3-D segmented volumetric analysis of vestibular schwannomas (VS) with traditional linear tumor measurement on serial magnetic resonance imaging (MRI) studies to assess volume and growth rates. Study Design Case series with retrospective chart review. Setting Tertiary care medical center. Methods This analysis identified 24 VS patients clinically followed with serial gadolinium enhanced images. Maximum linear dimensions (MLD) were obtained from gadolinium-contrasted T1 sequences from 3 serial MRI scans per RECIST guidelines. MLD was cubed (MLD3) and orthogonal analysis (OA) was carried out to provide volumetric estimates for comparison with segmented data. Segmented volumetric analysis (SVA) was performed with semi-automated 3-D conformal procedure. Tumor volume, percentage change in volume, and interval percentage change were compared using paired 2-tailed t tests. Results The average interval between MRIs was 2.6 years. Volume estimates differed significantly b...
Introduction As the most common neonatal sensory disorder in the USA, infant hearing loss has an ... more Introduction As the most common neonatal sensory disorder in the USA, infant hearing loss has an incidence of 1.7 per 1000 births. The consequences of delayed diagnosis and failure to obtain timely intervention include significant communication impairment and negative socioeconomic effects. Early Hearing Detection and Intervention (EHDI) national standards dictate that all infants should be screened and diagnosed by 3 months of age and there is a need for interventions that promote adherence to timely diagnosis. Patient navigation (PN) has been shown to be efficacious to decrease non-adherence with infant hearing diagnostic care; however, PN has yet to be tested in diverse communities or implemented into real-world settings. Methods and analysis The proposed research is a community-engaged, type 1 hybrid effectivenessimplementation trial of a PN intervention aimed at decreasing infant hearing diagnosis non-adherence after failed newborn hearing screening, delivered in statefunded EHDI clinics. Guided by our community advisory board and partners, we aim to (1) test the effectiveness of PN to decrease non-adherence to receipt of infant hearing diagnosis within 3 months after birth using a stepped-wedge trial design, (2) investigate implementation outcomes and factors influencing implementation and (3) determine the cost-effectiveness of PN from the perspective of third-party payers. The study will be conducted from April 2019 until March 2024. Ethics and dissemination This protocol was approved by the University of Kentucky Institutional Review Board. Although all research involving human subjects contains some risk, there are no known serious risks anticipated from participating in this study. We will seek to disseminate our results in a systematic fashion to patients, key stakeholder, policymakers and the scientific community. Our results will impact the field by partnering with communities to inform the scale-up of this innovative patient supportive intervention to create efficient and effective EHDI programmes and maximise public health impact. Trial registration number Clinicaltrials. gov (Pre-results phase): NCT03875339.
IntroductionAs the most common neonatal sensory disorder in the USA, infant hearing loss has an i... more IntroductionAs the most common neonatal sensory disorder in the USA, infant hearing loss has an incidence of 1.7 per 1000 births. The consequences of delayed diagnosis and failure to obtain timely intervention include significant communication impairment and negative socioeconomic effects. Early Hearing Detection and Intervention (EHDI) national standards dictate that all infants should be screened and diagnosed by 3 months of age and there is a need for interventions that promote adherence to timely diagnosis. Patient navigation (PN) has been shown to be efficacious to decrease non-adherence with infant hearing diagnostic care; however, PN has yet to be tested in diverse communities or implemented into real-world settings.Methods and analysisThe proposed research is a community-engaged, type 1 hybrid effectiveness-implementation trial of a PN intervention aimed at decreasing infant hearing diagnosis non-adherence after failed newborn hearing screening, delivered in state-funded EHD...
Hearing loss is a global public health issue with disproportionate negative impacts on those who ... more Hearing loss is a global public health issue with disproportionate negative impacts on those who live in rural regions, such as Appalachia. This commentary provides an overview of hearing health and healthcare disparities in rural regions along with discussion of the significance of recent research findings which highlight the incidence of hearing loss and the shortage of hearing specialists in Appalachia.
Supplemental Digital Content is available in the text Objective: Adults with hearing loss are at ... more Supplemental Digital Content is available in the text Objective: Adults with hearing loss are at risk of negative impacts of the pandemic. Specific factors, such as hearing loss severity and location of residence, may disproportionately impact patients during the pandemic. The objective of this study was to assess the relative impact of the COVID-19 pandemic on hearing loss patients, based on hearing device type and location of residence. Study Design: Prospective cross-sectional questionnaire study. Setting: Tertiary referral center. Patients: Adults with hearing loss. Main Outcome Measures: Data included sociodemographic data, communication challenges, pandemic preparedness, access to healthcare, and mental and emotional health. Results: A total of 614 patients responded (27.8% response rate). Compared with hearing aid users, cochlear implant users reported more difficulty communicating with family/friends (53% versus 41%, p = 0.017), obtaining pandemic information (10% versus 3%, p = 0.002), and understanding live broadcasts (47% versus 17%, p = 0.001) during the pandemic. CI users were less likely than hearing aid users to seek general (52% versus 69%, p = 0.001) and hearing healthcare services (20% versus 34%, p = 0.002). Rural residents reported greater difficulty than urban residents communicating with friends/family (53% versus 39%, p = 0.001), obtaining food/supplies (41% versus 20%, p = 0.004), understanding live broadcasts (31% versus 20%, p = 0.001) during the pandemic. Compared with urban residents, rural residents reported greater difficulty accessing general (57% versus 42%, p = 0.004) and hearing healthcare (49% versus 34%, p = 0.043). Rural residents reported poorer mental/emotional health than urban residents. Conclusions: Among adults with hearing loss, cochlear implant users and rural residents experience greater challenges in communication, pandemic preparedness, and access to healthcare during the COVID-19 pandemic.
OBJECTIVES/HYPOTHESIS A no-show to the operating room date negatively impacts a hospital and can ... more OBJECTIVES/HYPOTHESIS A no-show to the operating room date negatively impacts a hospital and can lead to increased costs for an institution in terms of time, materials, and manpower. Our objectives are to identify the factors associated with operating room no-shows in order to increase clinical efficiency, reduce hospital costs, and increase patient access to care. STUDY DESIGN Single institution retrospective chart review. METHODS A retrospective review was performed of all surgeries within the Otolaryngology department performed at a single tertiary academic center between 2006 and 2019. Demographic and surgical data were collected from the charts. Descriptive, univariate, and multivariate statistics were performed on the data. RESULTS There were a total of 1,752 no-shows and 46,440 patients who did show with an overall no-show rate of 3.63%. A multivariate logistic regression analysis was performed to compare patients who did not show for surgery to those who did. Analysis found multiple risk factors for not showing to surgery that were statistically significant (P < .05) and included decreasing age, planned outpatient case, head and neck oncology subspecialty, increasing distance from the facility, higher number of clinic no-shows, and not having private insurance. African-American race was more likely to show for surgery as scheduled. CONCLUSIONS Numerous factors may play a role on whether or not a patient attends a scheduled surgical date. Some of these factors may be preventable or modifiable to mitigate increased hospital costs associated with no-show to surgery and increase access to care. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
OF DISSERTATION PROMOTION OF EARLY PEDIATRIC HEARING DETECTION THROUGH PATIENT NAVIGATION Congeni... more OF DISSERTATION PROMOTION OF EARLY PEDIATRIC HEARING DETECTION THROUGH PATIENT NAVIGATION Congenital hearing loss is the most common neonatal sensory disorder and it is crucial to diagnose hearing loss as soon as possible after birth in order to facilitate rapid treatment. Universal standards of infant hearing healthcare dictate that infant hearing screening should be completed by one month of age and abnormal screening tests should be followed with definitive audiological testing by three months of age. Obtaining diagnostic testing can be complicated by limited access to care in rural areas, breakdowns in communication, lack of parental support, and poor coordination of care. There is no established method to address appointment non-adherence in newborn hearing testing. Patient navigation (PN), which uses trained healthcare workers to educate patients and facilitate adherence to healthcare, is an evidence-based approach that has had widespread success in facilitating timely care in...
Hearing loss is a global public health problem with high prevalence and profound impacts on healt... more Hearing loss is a global public health problem with high prevalence and profound impacts on health. Cochlear implantation (CI) is a well-established evidence-based treatment for hearing loss; however, there are significant disparities in utilization, access, and clinical outcomes among different populations. While variations in CI outcomes are influenced by innate biological differences, a wide array of social, environmental, and economic factors significantly impact optimal outcomes. These differences in hearing health are rooted in inequities of health-related socioeconomic resources. To define disparities and advance equity in CI, there is a pressing need to understand and target these social factors that influence equitable outcomes, access, and utilization. These factors can be categorized according to the widely accepted framework of social determinants of health, which include the following domains: healthcare access/quality, education access/quality, social and community con...
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Papers by Matthew Bush