203 lines
109 KiB
Text
203 lines
109 KiB
Text
<!DOCTYPE html>
|
|
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" class="no-js no-jr">
|
|
<head>
|
|
<!-- For pinger, set start time and add meta elements. -->
|
|
<script type="text/javascript">var ncbi_startTime = new Date();</script>
|
|
|
|
<!-- Logger begin -->
|
|
<meta name="ncbi_db" content="books">
|
|
<meta name="ncbi_pdid" content="book-toc">
|
|
<meta name="ncbi_acc" content="NBK600102">
|
|
<meta name="ncbi_domain" content="niceng236er7">
|
|
<meta name="ncbi_report" content="reader">
|
|
<meta name="ncbi_type" content="fulltext">
|
|
<meta name="ncbi_objectid" content="">
|
|
<meta name="ncbi_pcid" content="/NBK600102/?report=reader">
|
|
<meta name="ncbi_pagename" content="Evidence reviews for the optimal tool for hearing assessment - NCBI Bookshelf">
|
|
<meta name="ncbi_bookparttype" content="toc">
|
|
<meta name="ncbi_app" content="bookshelf">
|
|
<!-- Logger end -->
|
|
|
|
<!--component id="Page" label="meta"/-->
|
|
<script type="text/javascript" src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.boots.min.js"> </script><title>Evidence reviews for the optimal tool for hearing assessment - NCBI Bookshelf</title>
|
|
<meta charset="utf-8">
|
|
<meta name="apple-mobile-web-app-capable" content="no">
|
|
<meta name="viewport" content="initial-scale=1,minimum-scale=1,maximum-scale=1,user-scalable=no">
|
|
<meta name="jr-col-layout" content="1">
|
|
<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE,NOIMAGEINDEX">
|
|
<meta name="citation_title" content="Evidence reviews for the optimal tool for hearing assessment">
|
|
<meta name="citation_publisher" content="National Institute for Health and Care Excellence (NICE)">
|
|
<meta name="citation_date" content="2023/10">
|
|
<meta name="citation_pmid" content="38330156">
|
|
<meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK600102/">
|
|
<meta name="citation_keywords" content="Stroke Rehabilitation">
|
|
<meta name="citation_keywords" content="Stroke">
|
|
<meta name="citation_keywords" content="Subarachnoid Hemorrhage">
|
|
<meta name="citation_keywords" content="Diagnostic Techniques, Otological">
|
|
<meta name="citation_keywords" content="Hearing Tests">
|
|
<meta name="citation_keywords" content="Hearing Loss">
|
|
<meta name="citation_keywords" content="Treatment Outcome">
|
|
<meta name="citation_keywords" content="Cost-Benefit Analysis">
|
|
<meta name="citation_keywords" content="Adolescent">
|
|
<meta name="citation_keywords" content="Young Adult">
|
|
<meta name="citation_keywords" content="Adult">
|
|
<meta name="citation_keywords" content="Middle Aged">
|
|
<meta name="citation_keywords" content="Aged">
|
|
<meta name="citation_keywords" content="Aged, 80 and over">
|
|
<meta name="citation_keywords" content="Humans">
|
|
<meta name="citation_keywords" content="Review">
|
|
<link rel="schema.DC" href="http://purl.org/DC/elements/1.0/">
|
|
<meta name="DC.Title" content="Evidence reviews for the optimal tool for hearing assessment">
|
|
<meta name="DC.Type" content="Text">
|
|
<meta name="DC.Publisher" content="National Institute for Health and Care Excellence (NICE)">
|
|
<meta name="DC.Date" content="2023/10">
|
|
<meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK600102/">
|
|
<meta name="og:title" content="Evidence reviews for the optimal tool for hearing assessment">
|
|
<meta name="og:type" content="book">
|
|
<meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK600102/">
|
|
<meta name="og:site_name" content="NCBI Bookshelf">
|
|
<meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng236er7-lrg.png">
|
|
<meta name="twitter:card" content="summary">
|
|
<meta name="twitter:site" content="@ncbibooks">
|
|
<meta name="bk-non-canon-loc" content="/books/n/niceng236er7/toc/?report=reader">
|
|
<link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK600102/">
|
|
<link href="https://fonts.googleapis.com/css?family=Archivo+Narrow:400,700,400italic,700italic&subset=latin" rel="stylesheet" type="text/css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/jatsreader/ptpmc_3.22/css/libs.min.css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/jatsreader/ptpmc_3.22/css/jr.min.css">
|
|
<meta name="format-detection" content="telephone=no">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css//books_print.min.css" type="text/css" media="print">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_reader.min.css" type="text/css">
|
|
<style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style>
|
|
|
|
<link rel="shortcut icon" href="//www.ncbi.nlm.nih.gov/favicon.ico">
|
|
<meta name="ncbi_phid" content="CE8DE03D7D6B760100000000010D00E1.m_5">
|
|
<meta name='referrer' content='origin-when-cross-origin'/><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3852956/3849091.css"></head>
|
|
<body>
|
|
<!-- Book content! -->
|
|
|
|
|
|
<div id="jr" data-jr-path="/corehtml/pmc/jatsreader/ptpmc_3.22/"><div class="jr-unsupported"><table class="modal"><tr><td><span class="attn inline-block"></span><br />Your browser does not support the NLM PubReader view.<br />Go to <a href="/pmc/about/pr-browsers/">this page</a> to see a list of supported browsers<br />or return to the <br /><a href="/books/NBK600102/?report=classic">regular view</a>.</td></tr></table></div><div id="jr-ui" class="hidden"><nav id="jr-head"><div class="flexh tb"><div id="jr-tb1"><a id="jr-links-sw" class="hidden" title="Links"><svg xmlns="http://www.w3.org/2000/svg" version="1.1" x="0px" y="0px" viewBox="0 0 70.6 85.3" style="enable-background:new 0 0 70.6 85.3;vertical-align:middle" xml:space="preserve" width="24" height="24">
|
|
<style type="text/css">.st0{fill:#939598;}</style>
|
|
<g>
|
|
<path class="st0" d="M36,0C12.8,2.2-22.4,14.6,19.6,32.5C40.7,41.4-30.6,14,35.9,9.8"></path>
|
|
<path class="st0" d="M34.5,85.3c23.2-2.2,58.4-14.6,16.4-32.5c-21.1-8.9,50.2,18.5-16.3,22.7"></path>
|
|
<path class="st0" d="M34.7,37.1c66.5-4.2-4.8-31.6,16.3-22.7c42.1,17.9,6.9,30.3-16.4,32.5h1.7c-66.2,4.4,4.8,31.6-16.3,22.7 c-42.1-17.9-6.9-30.3,16.4-32.5"></path>
|
|
</g>
|
|
</svg> Books</a></div><div class="jr-rhead f1 flexh"></div><div id="jr-tb2"><a id="jr-bkhelp-sw" class="btn wsprkl hidden" title="Help with NLM PubReader">?</a><a id="jr-help-sw" class="btn wsprkl hidden" title="Settings and typography in NLM PubReader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512" preserveAspectRatio="none"><path d="M462,283.742v-55.485l-29.981-10.662c-11.431-4.065-20.628-12.794-25.274-24.001 c-0.002-0.004-0.004-0.009-0.006-0.013c-4.659-11.235-4.333-23.918,0.889-34.903l13.653-28.724l-39.234-39.234l-28.72,13.652 c-10.979,5.219-23.68,5.546-34.908,0.889c-0.005-0.002-0.01-0.003-0.014-0.005c-11.215-4.65-19.933-13.834-24-25.273L283.741,50 h-55.484l-10.662,29.981c-4.065,11.431-12.794,20.627-24.001,25.274c-0.005,0.002-0.009,0.004-0.014,0.005 c-11.235,4.66-23.919,4.333-34.905-0.889l-28.723-13.653l-39.234,39.234l13.653,28.721c5.219,10.979,5.545,23.681,0.889,34.91 c-0.002,0.004-0.004,0.009-0.006,0.013c-4.649,11.214-13.834,19.931-25.271,23.998L50,228.257v55.485l29.98,10.661 c11.431,4.065,20.627,12.794,25.274,24c0.002,0.005,0.003,0.01,0.005,0.014c4.66,11.236,4.334,23.921-0.888,34.906l-13.654,28.723 l39.234,39.234l28.721-13.652c10.979-5.219,23.681-5.546,34.909-0.889c0.005,0.002,0.01,0.004,0.014,0.006 c11.214,4.649,19.93,13.833,23.998,25.271L228.257,462h55.484l10.595-29.79c4.103-11.538,12.908-20.824,24.216-25.525 c0.005-0.002,0.009-0.004,0.014-0.006c11.127-4.628,23.694-4.311,34.578,0.863l28.902,13.738l39.234-39.234l-13.66-28.737 c-5.214-10.969-5.539-23.659-0.886-34.877c0.002-0.005,0.004-0.009,0.006-0.014c4.654-11.225,13.848-19.949,25.297-24.021 L462,283.742z M256,331.546c-41.724,0-75.548-33.823-75.548-75.546s33.824-75.547,75.548-75.547 c41.723,0,75.546,33.824,75.546,75.547S297.723,331.546,256,331.546z"></path></svg></a><a id="jr-fip-sw" class="btn wsprkl hidden" title="Find"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-cmap-sw" class="btn wsprkl hidden" title="Table of Contents"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M20,20h10v8H20V20zM36,20h44v8H36V20zM20,37.33h10v8H20V37.33zM36,37.33h44v8H36V37.33zM20,54.66h10v8H20V54.66zM36,54.66h44v8H36V54.66zM20,72h10v8 H20V72zM36,72h44v8H36V72z"></path></svg></a></div></div></nav><nav id="jr-dash" class="noselect"><nav id="jr-dash" class="noselect"><div id="jr-pi" class="hidden"><a id="jr-pi-prev" class="hidden" title="Previous page"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a><div class="pginfo">Page <i class="jr-pg-pn">0</i> of <i class="jr-pg-lp">0</i></div><a id="jr-pi-next" class="hidden" title="Next page"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div><div id="jr-is-tb"><a id="jr-is-sw" class="btn wsprkl hidden" title="Switch between Figures/Tables strip and Progress bar"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><rect x="10" y="40" width="20" height="20"></rect><rect x="40" y="40" width="20" height="20"></rect><rect x="70" y="40" width="20" height="20"></rect></svg></a></div><nav id="jr-istrip" class="istrip hidden"><a id="jr-is-prev" href="#" class="hidden" title="Previous"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M80,40 60,65 80,90 70,90 50,65 70,40z M50,40 30,65 50,90 40,90 20,65 40,40z"></path><text x="35" y="25" textLength="60" style="font-size:25px">Prev</text></svg></a><a id="jr-is-next" href="#" class="hidden" title="Next"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M20,40 40,65 20,90 30,90 50,65 30,40z M50,40 70,65 50,90 60,90 80,65 60,40z"></path><text x="15" y="25" textLength="60" style="font-size:25px">Next</text></svg></a></nav><nav id="jr-progress"></nav></nav></nav><aside id="jr-links-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">NCBI Bookshelf</div></div><div class="cnt lol f1"><a href="/books/">Home</a><a href="/books/browse/">Browse All Titles</a><a class="btn share" target="_blank" rel="noopener noreferrer" href="https://www.facebook.com/sharer/sharer.php?u=https://www.ncbi.nlm.nih.gov/books/NBK600102/"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 33 33" style="vertical-align:middle" width="24" height="24" preserveAspectRatio="none"><g><path d="M 17.996,32L 12,32 L 12,16 l-4,0 l0-5.514 l 4-0.002l-0.006-3.248C 11.993,2.737, 13.213,0, 18.512,0l 4.412,0 l0,5.515 l-2.757,0 c-2.063,0-2.163,0.77-2.163,2.209l-0.008,2.76l 4.959,0 l-0.585,5.514L 18,16L 17.996,32z"></path></g></svg> Share on Facebook</a><a class="btn share" target="_blank" rel="noopener noreferrer" href="https://twitter.com/intent/tweet?url=https://www.ncbi.nlm.nih.gov/books/NBK600102/&text=Evidence%20reviews%20for%20the%20optimal%20tool%20for%20hearing%20assessment"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 33 33" style="vertical-align:middle" width="24" height="24"><g><path d="M 32,6.076c-1.177,0.522-2.443,0.875-3.771,1.034c 1.355-0.813, 2.396-2.099, 2.887-3.632 c-1.269,0.752-2.674,1.299-4.169,1.593c-1.198-1.276-2.904-2.073-4.792-2.073c-3.626,0-6.565,2.939-6.565,6.565 c0,0.515, 0.058,1.016, 0.17,1.496c-5.456-0.274-10.294-2.888-13.532-6.86c-0.565,0.97-0.889,2.097-0.889,3.301 c0,2.278, 1.159,4.287, 2.921,5.465c-1.076-0.034-2.088-0.329-2.974-0.821c-0.001,0.027-0.001,0.055-0.001,0.083 c0,3.181, 2.263,5.834, 5.266,6.438c-0.551,0.15-1.131,0.23-1.73,0.23c-0.423,0-0.834-0.041-1.235-0.118 c 0.836,2.608, 3.26,4.506, 6.133,4.559c-2.247,1.761-5.078,2.81-8.154,2.81c-0.53,0-1.052-0.031-1.566-0.092 c 2.905,1.863, 6.356,2.95, 10.064,2.95c 12.076,0, 18.679-10.004, 18.679-18.68c0-0.285-0.006-0.568-0.019-0.849 C 30.007,8.548, 31.12,7.392, 32,6.076z"></path></g></svg> Share on Twitter</a></div></aside><aside id="jr-cmap-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">In Page Navigation</div></div><div class="cnt lol f1"><a href="/books/n/niceercollect/?report=reader">NICE Evidence Reviews Collection</a><a class="current">Title Information</a></div></aside><aside id="jr-help-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Settings</div></div><div class="cnt f1"><div id="jr-typo-p" class="typo"><div><a class="sf btn wsprkl">A-</a><a class="lf btn wsprkl">A+</a></div><div><a class="bcol-auto btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 200 100" preserveAspectRatio="none"><text x="10" y="70" style="font-size:60px;font-family: Trebuchet MS, ArialMT, Arial, sans-serif" textLength="180">AUTO</text></svg></a><a class="bcol-1 btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M15,25 85,25zM15,40 85,40zM15,55 85,55zM15,70 85,70z"></path></svg></a><a class="bcol-2 btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M5,25 45,25z M55,25 95,25zM5,40 45,40z M55,40 95,40zM5,55 45,55z M55,55 95,55zM5,70 45,70z M55,70 95,70z"></path></svg></a></div></div><div class="lol"><a class="" href="/books/NBK600102/?report=classic">Switch to classic view</a><a href="/books/n/niceng236er7/pdf/">PDF (799K)</a><a href="/books/n/niceng236er7/toc/?report=printable">Print View</a></div></div></aside><aside id="jr-bkhelp-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Help</div></div><div class="cnt f1 lol"><a id="jr-helpobj-sw" data-path="/corehtml/pmc/jatsreader/ptpmc_3.22/" data-href="/corehtml/pmc/jatsreader/ptpmc_3.22/img/bookshelf/help.xml" href="">Help</a><a href="mailto:info@ncbi.nlm.nih.gov?subject=PubReader%20feedback%20%2F%20NBK600102%20%2F%20sid%3ACE8B5AF87C7FFCB1_0191SID%20%2F%20phid%3ACE8DE03D7D6B760100000000010D00E1.4">Send us feedback</a><a id="jr-about-sw" data-path="/corehtml/pmc/jatsreader/ptpmc_3.22/" data-href="/corehtml/pmc/jatsreader/ptpmc_3.22/img/bookshelf/about.xml" href="">About PubReader</a></div></aside><aside id="jr-objectbox" class="thidden hidden"><div class="jr-objectbox-close wsprkl">✘</div><div class="jr-objectbox-inner cnt"><div class="jr-objectbox-drawer"></div></div></aside><nav id="jr-pm-left" class="hidden"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 40 800" preserveAspectRatio="none"><text font-stretch="ultra-condensed" x="800" y="-15" text-anchor="end" transform="rotate(90)" font-size="18" letter-spacing=".1em">Previous Page</text></svg></nav><nav id="jr-pm-right" class="hidden"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 40 800" preserveAspectRatio="none"><text font-stretch="ultra-condensed" x="800" y="-15" text-anchor="end" transform="rotate(90)" font-size="18" letter-spacing=".1em">Next Page</text></svg></nav><nav id="jr-fip" class="hidden"><nav id="jr-fip-term-p"><input type="search" placeholder="search this page" id="jr-fip-term" autocorrect="off" autocomplete="off" /><a id="jr-fip-mg" class="wsprkl btn" title="Find"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style"><div class="fm-sec bkr_bottom_sep"><div class="bkr_thumb"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng236er7-lrg.png" alt="Cover of Evidence reviews for the optimal tool for hearing assessment" /></a></div><div class="bkr_bib"><h1 id="_NBK600102_"><span itemprop="name">Evidence reviews for the optimal tool for hearing assessment</span></h1><div class="subtitle">Stroke rehabilitation in adults (update)</div><p><b>Evidence review D</b></p><p><i>NICE Guideline, No. 236</i></p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2023 Oct</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-5450-6</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2023.</div></div><div class="bkr_clear"></div></div><div id="niceng236er7.s1"><h2 id="_niceng236er7_s1_">1. Optimal tool for hearing assessment</h2><div id="niceng236er7.s1.1"><h3>1.1. Review question</h3><p>In people after stroke, what is the optimal tool for assessment of hearing?</p><div id="niceng236er7.s1.1.1"><h4>1.1.1. Introduction</h4><p>A stroke can affect hearing at several levels from simple perception of sounds to the processing of these. In addition, people who have a stroke may already have a hearing deficit since both problems occur more frequently with increasing age. It is therefore unsurprising that a degree of hearing loss is common after a stroke. This is important both for its effect on quality of life in its own right and because it can hinder communication and cause difficulties in participating in rehabilitation.</p><p>There is no widely agreed process for assessment of hearing impairment during stroke rehabilitation. The purpose of this review was to evaluate the evidence for the clinical and cost effectiveness of tools which would contribute to an objective assessment of hearing loss after a stroke.</p></div><div id="niceng236er7.s1.1.2"><h4>1.1.2. Summary of the protocol</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng236er7tab1"><a href="/books/NBK600102/table/niceng236er7.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng236er7tab1" rid-ob="figobniceng236er7tab1"><img class="small-thumb" src="/books/NBK600102/table/niceng236er7.tab1/?report=thumb" src-large="/books/NBK600102/table/niceng236er7.tab1/?report=previmg" alt="Table 1. PICO characteristics of review question." /></a><div class="icnblk_cntnt"><h4 id="niceng236er7.tab1"><a href="/books/NBK600102/table/niceng236er7.tab1/?report=objectonly" target="object" rid-ob="figobniceng236er7tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of review question. </p></div></div><p>For full details see the review protocol in <a href="#niceng236er7.appa">Appendix A</a>.</p></div><div id="niceng236er7.s1.1.3"><h4>1.1.3. Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng236er7.appa">Appendix A</a> and the <a href="/books/NBK600102/bin/supp_NG236_Methods_20231018.pdf">methods</a> document.</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="niceng236er7.s1.1.4"><h4>1.1.4. Diagnostic evidence</h4><div id="niceng236er7.s1.1.4.1"><h5>1.1.4.1. Included studies</h5><p>One cross-sectional study assessing the diagnostic accuracy of various index tests was included in the review;<a class="bibr" href="#niceng236er7.s1.1.ref2" rid="niceng236er7.s1.1.ref2"><sup>2</sup></a> this is summarised in <a class="figpopup" href="/books/NBK600102/table/niceng236er7.tab2/?report=objectonly" target="object" rid-figpopup="figniceng236er7tab2" rid-ob="figobniceng236er7tab2">Table 2</a>. This study investigated the following index tests:
|
|
<ul><li class="half_rhythm"><div>Handheld hearing screener</div></li><li class="half_rhythm"><div>Handicap Hearing Inventory in the Elderly</div></li><li class="half_rhythm"><div>Amsterdam Inventory Auditory of Disability</div></li><li class="half_rhythm"><div>Combined handheld hearing screener and Amsterdam Inventory Auditory of Disability</div></li></ul></p><p>Evidence from this study is summarised in the clinical evidence summary below in <a class="figpopup" href="/books/NBK600102/table/niceng236er7.tab3/?report=objectonly" target="object" rid-figpopup="figniceng236er7tab3" rid-ob="figobniceng236er7tab3">Table 3</a> and references in 1.1.14 References. The assessment of the evidence quality was conducted with emphasis on test sensitivity and specificity as this was identified by the committee as the primary measure in guiding decision-making. The committee set clinical decision thresholds as sensitivity/specificity 0.9 and 0.75 above which a test would be recommended and 0.6 and 0.5 below which a test is of no clinical use.</p><p>No relevant diagnostic test accuracy studies of index test bedside clinical tests in people under investigation for hearing problems after stroke were identified.</p><p>See also the study selection flow chart in <a href="#niceng236er7.appc">Appendix C</a>, sensitivity and specificity forest plots in <a href="#niceng236er7.appe">Appendix E</a>, and study evidence tables in <a href="#niceng236er7.appd">Appendix D</a>.</p></div><div id="niceng236er7.s1.1.4.2"><h5>1.1.4.2. Excluded studies</h5><p>See the excluded studies list in <a href="#niceng236er7.appi">Appendix I</a>.</p></div></div><div id="niceng236er7.s1.1.5"><h4>1.1.5. Summary of studies included in the diagnostic evidence</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng236er7tab2"><a href="/books/NBK600102/table/niceng236er7.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figniceng236er7tab2" rid-ob="figobniceng236er7tab2"><img class="small-thumb" src="/books/NBK600102/table/niceng236er7.tab2/?report=thumb" src-large="/books/NBK600102/table/niceng236er7.tab2/?report=previmg" alt="Table 2. Summary of studies included in the evidence review." /></a><div class="icnblk_cntnt"><h4 id="niceng236er7.tab2"><a href="/books/NBK600102/table/niceng236er7.tab2/?report=objectonly" target="object" rid-ob="figobniceng236er7tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of studies included in the evidence review. </p></div></div><p>See <a href="#niceng236er7.appd">Appendix D</a> for full evidence tables.</p></div><div id="niceng236er7.s1.1.6"><h4>1.1.6. Summary of the diagnostic evidence</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng236er7tab3"><a href="/books/NBK600102/table/niceng236er7.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figniceng236er7tab3" rid-ob="figobniceng236er7tab3"><img class="small-thumb" src="/books/NBK600102/table/niceng236er7.tab3/?report=thumb" src-large="/books/NBK600102/table/niceng236er7.tab3/?report=previmg" alt="Table 3. Clinical evidence summary: diagnostic test accuracy for handheld hearing screener." /></a><div class="icnblk_cntnt"><h4 id="niceng236er7.tab3"><a href="/books/NBK600102/table/niceng236er7.tab3/?report=objectonly" target="object" rid-ob="figobniceng236er7tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: diagnostic test accuracy for handheld hearing screener. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng236er7tab4"><a href="/books/NBK600102/table/niceng236er7.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img figpopup" rid-figpopup="figniceng236er7tab4" rid-ob="figobniceng236er7tab4"><img class="small-thumb" src="/books/NBK600102/table/niceng236er7.tab4/?report=thumb" src-large="/books/NBK600102/table/niceng236er7.tab4/?report=previmg" alt="Table 4. Clinical evidence summary: diagnostic test accuracy for the Handicap Hearing Inventory in the Elderly questionnaire." /></a><div class="icnblk_cntnt"><h4 id="niceng236er7.tab4"><a href="/books/NBK600102/table/niceng236er7.tab4/?report=objectonly" target="object" rid-ob="figobniceng236er7tab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: diagnostic test accuracy for the Handicap Hearing Inventory in the Elderly questionnaire. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng236er7tab5"><a href="/books/NBK600102/table/niceng236er7.tab5/?report=objectonly" target="object" title="Table 5" class="img_link icnblk_img figpopup" rid-figpopup="figniceng236er7tab5" rid-ob="figobniceng236er7tab5"><img class="small-thumb" src="/books/NBK600102/table/niceng236er7.tab5/?report=thumb" src-large="/books/NBK600102/table/niceng236er7.tab5/?report=previmg" alt="Table 5. Clinical evidence summary: diagnostic test accuracy for the Amsterdam Inventory Auditory of Disability questionnaire." /></a><div class="icnblk_cntnt"><h4 id="niceng236er7.tab5"><a href="/books/NBK600102/table/niceng236er7.tab5/?report=objectonly" target="object" rid-ob="figobniceng236er7tab5">Table 5</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: diagnostic test accuracy for the Amsterdam Inventory Auditory of Disability questionnaire. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng236er7tab6"><a href="/books/NBK600102/table/niceng236er7.tab6/?report=objectonly" target="object" title="Table 6" class="img_link icnblk_img figpopup" rid-figpopup="figniceng236er7tab6" rid-ob="figobniceng236er7tab6"><img class="small-thumb" src="/books/NBK600102/table/niceng236er7.tab6/?report=thumb" src-large="/books/NBK600102/table/niceng236er7.tab6/?report=previmg" alt="Table 6. Clinical evidence summary: diagnostic test accuracy for the combination of the handheld hearing screener and the Amsterdam Inventory Auditory of Disability questionnaire." /></a><div class="icnblk_cntnt"><h4 id="niceng236er7.tab6"><a href="/books/NBK600102/table/niceng236er7.tab6/?report=objectonly" target="object" rid-ob="figobniceng236er7tab6">Table 6</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: diagnostic test accuracy for the combination of the handheld hearing screener and the Amsterdam Inventory Auditory of Disability questionnaire. </p></div></div></div><div id="niceng236er7.s1.1.7"><h4>1.1.7. Economic evidence</h4><div id="niceng236er7.s1.1.7.1"><h5>1.1.7.1. Included studies</h5><p>No health economic studies were included.</p></div><div id="niceng236er7.s1.1.7.2"><h5>1.1.7.2. Excluded studies</h5><p>No relevant health economic studies were excluded due to assessment of limited applicability or methodological limitations.</p><p>See also the health economic study selection flow chart in <a href="#niceng236er7.appf">Appendix F</a>.</p></div></div><div id="niceng236er7.s1.1.8"><h4>1.1.8. Summary of included economic evidence</h4><p>There are no included health economic studies in this review.</p></div><div id="niceng236er7.s1.1.9"><h4>1.1.9. Economic model</h4><p>This area was not prioritised for new cost-effectiveness analysis.</p></div><div id="niceng236er7.s1.1.10"><h4>1.1.10. Unit costs</h4><p>The Koohi 2019<a class="bibr" href="#niceng236er7.s1.1.ref2" rid="niceng236er7.s1.1.ref2"><sup>2</sup></a> study included in the clinical review considered hearing assessment using two different questionnaires, a handheld hearing screener and a combination of a questionnaire and the handheld screener.</p><p>Resource use associated with use of a handheld screener will relate to the staff time doing the assessment and the cost of the device. The clinical study stated that doing an assessment using the handheld screener took 5 minutes (including a discussion about instructions for the test). The handheld hearing screener used in this study was ROTO by Otovation. However, this is not currently listed in the NHS supply chain catalogue and could not be identified on other websites. Other hearing screeners from the same manufacturer were found in the catalogue and costs ranged from £2,034 to £2,754<a class="bibr" href="#niceng236er7.s1.1.ref5" rid="niceng236er7.s1.1.ref5"><sup>5</sup></a> but these were not specified as handheld screeners and so costs may be higher. An Interacoustic single handed use paediatric screening audiometer was listed at £804. Other ongoing costs would include maintenance costs and batteries.</p><p>The cost per use is expected to be low considering that the screener would be used for a number of patients. Example costs per use based on the costs above and assumptions about lifetime and usage are shown in <a class="figpopup" href="/books/NBK600102/table/niceng236er7.tab7/?report=objectonly" target="object" rid-figpopup="figniceng236er7tab7" rid-ob="figobniceng236er7tab7">Table 7</a> below.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng236er7tab7"><a href="/books/NBK600102/table/niceng236er7.tab7/?report=objectonly" target="object" title="Table 7" class="img_link icnblk_img figpopup" rid-figpopup="figniceng236er7tab7" rid-ob="figobniceng236er7tab7"><img class="small-thumb" src="/books/NBK600102/table/niceng236er7.tab7/?report=thumb" src-large="/books/NBK600102/table/niceng236er7.tab7/?report=previmg" alt="Table 7. Example hearing screener costs per use." /></a><div class="icnblk_cntnt"><h4 id="niceng236er7.tab7"><a href="/books/NBK600102/table/niceng236er7.tab7/?report=objectonly" target="object" rid-ob="figobniceng236er7tab7">Table 7</a></h4><p class="float-caption no_bottom_margin">Example hearing screener costs per use. </p></div></div><p>The clinical study included in this review also assessed two validated questionnaires. The authors noted that the questionnaires took under 10 minutes to complete. The questionnaires are defined as self-reported and so may be completed by the person who has had a stroke. However, in some cases people may to require assistance to do this from staff and there will be staff time required to review the questionnaire. The amount of staff time required is not stated in the clinical study. There do not appear to be charges for using the assessment questionnaires identified in the clinical review. There will be some costs associated with printing questionnaires.</p><p>If hearing problems are identified from screening, then people will be referred to either audiology or an ENT for an audiology assessment. This would include people who were both accurately diagnosed (which is dependent on the sensitivity of the screening tools) and misdiagnosed as having a hearing problem (which is dependent on the specificity of the screening tools).</p><p>Relevant example unit costs are provided in <a class="figpopup" href="/books/NBK600102/table/niceng236er7.tab8/?report=objectonly" target="object" rid-figpopup="figniceng236er7tab8" rid-ob="figobniceng236er7tab8">Table 8</a> below to aid consideration of cost effectiveness.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng236er7tab8"><a href="/books/NBK600102/table/niceng236er7.tab8/?report=objectonly" target="object" title="Table 8" class="img_link icnblk_img figpopup" rid-figpopup="figniceng236er7tab8" rid-ob="figobniceng236er7tab8"><img class="small-thumb" src="/books/NBK600102/table/niceng236er7.tab8/?report=thumb" src-large="/books/NBK600102/table/niceng236er7.tab8/?report=previmg" alt="Table 8. Unit costs of health care professionals who may be involved in providing hearing assessments." /></a><div class="icnblk_cntnt"><h4 id="niceng236er7.tab8"><a href="/books/NBK600102/table/niceng236er7.tab8/?report=objectonly" target="object" rid-ob="figobniceng236er7tab8">Table 8</a></h4><p class="float-caption no_bottom_margin">Unit costs of health care professionals who may be involved in providing hearing assessments. </p></div></div></div><div id="niceng236er7.s1.1.11"><h4>1.1.11. Evidence statements</h4><div id="niceng236er7.s1.1.11.1"><h5>Clinical evidence statements</h5><div id="niceng236er7.s1.1.11.1.1"><h5>Economic</h5><p>No relevant economic evaluations were identified.</p></div></div></div><div id="niceng236er7.s1.1.12"><h4>1.1.12. The committee’s discussion and interpretation of the evidence</h4><div id="niceng236er7.s1.1.12.1"><h5>1.1.12.1. The outcomes that matter most</h5><p>This review included outcomes for a test and treat review and a diagnostic accuracy review. The test and treat review outcomes were person/participant generic health-related quality of life, carer generic health-related quality of life, activities of daily living, participation in leisure activities/social groups scores, psychological distress (depression, anxiety and distress), stroke-related scales of cognition, speech perception, functional communication, stroke-specific Patient-Reported Outcome Measures and withdrawal due to adverse events. For the diagnostic accuracy review sensitivity was considered the most important measure by the committee because determining the presence of hearing problems without any tests is difficult and having a test that can correctly identify a problem would be of significant benefit. The consequences of missing a hearing problem can be that people can have a reduced quality of life and that they do not engage with their rehabilitation effectively. These problems can be exacerbated for people with communication difficulties, where this can be a significant barrier to engaging with speech and language therapy.</p><p>There was no evidence for the test and treat review. For the diagnostic accuracy review, evidence was identified for sensitivity, specificity and positive and negative predictive values.</p></div><div id="niceng236er7.s1.1.12.2"><h5>1.1.12.2. The quality of the evidence</h5><p>One study was identified for inclusion in this review. The committee acknowledged the limited number of studies and the limited number of participants in the study (42 people). The evidence included the index tests of a handheld hearing screening device; questionnaires including the Handicap Hearing Inventory in the Elderly, Amsterdam Inventory Auditory of Disability; and a combination of the handheld hearing screener and Amsterdam Inventory Auditory of Disability.</p><p>The risk of bias for the outcomes was graded as having no major problems. However, the quality of the outcomes were downgraded for population indirectness, as people with communication and cognitive difficulties were excluded from the studies. Due to the significant impact that hearing problems could have on people with these difficulties, the outcomes were deemed to be limited in this capacity. Due to the small sample size, there were often wide confidence intervals in the outcomes leading to imprecision being identified. Therefore, the quality of the evidence ranged from moderate to very low, with outcomes for sensitivity being of moderate quality (due to the sensitivity and confidence intervals all being below that agreed in the decision threshold) and for specificity being of very low quality (due to the confidence intervals crossing both decision thresholds).</p></div><div id="niceng236er7.s1.1.12.3"><h5>1.1.12.3. Benefits and harms</h5><p>The committee compared the different index tests to each other. When comparing their effectiveness for people with all types of hearing loss, none of the tests had sufficient sensitivity to meet the decision threshold, while all had sufficient specificity to achieve this. In order, the sensitivity was best for the handheld hearing screener (at 0.69) while it was worse for the combination of the handheld hearing screener and Amsterdam Inventory Auditory of Disability questionnaire (0.50), Handicap Hearing Inventory in the Elderly (0.44) and Amsterdam Inventory Auditory of Disability (0.33) questionnaires respectively. The specificity was 1 for the individual tests, while the combination of the handheld hearing screener and Amsterdam Inventory Auditory of Disability questionnaire was lower (0.8889). This was due to the rule to determine if people had a hearing problem with the combination looking at a subscale of the Amsterdam Inventory Auditory of Disability questionnaire rather than the entire questionnaire.</p><p>The study also reported the sensitivity and specificity for the handheld hearing screener if considering only peripheral hearing loss, as the handheld hearing screener was designed to investigate the presence of peripheral hearing loss rather than central or mixed hearing loss. In this scenario, the sensitivity was higher achieving the decision threshold (92.59, 95% confidence interval: 75.71-99.09). While the committee was interested in all types of hearing loss, they acknowledged this result when making their decision.</p><p>Testing by all of these methods was unlikely to cause harms to the person. The economic considerations and resource use is considered in section 1.1.12.4 Cost effectiveness and resource use. The usual clinical practice would require a person to be referred to an audiologist if a hearing problem is suspected. Hearing problems may not be apparent using routine assessment techniques and so having additional methods for identifying problems is important. Weighing up the limited evidence available, the committee recommended that all people should have their hearing assessed and that a questionnaire could be considered to help identify people with hearing problems as while there was limited sensitivity, the benefits were likely greater than not using any tools. The committee highlighted that anyone using the tool should be aware of the limitations of the questionnaires and should take into account the views of the person and their family about their hearing. If they have any suspicion about hearing problems, whether from subjective concerns or from screening using hearing questionnaire, these should then be further investigated by audiology services.</p><p>Due to the limited evidence available the committee made research recommendations to gather more information with a larger number of participants to investigate the effectiveness of different tools to assess hearing in people after stroke and to gain information about the prevalence of hearing problems, as evidence for this was very limited and could help to provide a better understanding of how likely hearing problems are after a stroke.</p></div><div id="niceng236er7.s1.1.12.4"><h5>1.1.12.4. Cost effectiveness and resource use</h5><p>No economic evidence was identified for this review. Therefore, the hearing assessment tools included in the only clinical study for this review were evaluated in terms of costs and resource use. The clinical study assessed the diagnostic accuracy of two validated questionnaires (The Amsterdam Inventory Auditory for Disability (AIAD) and the Hearing Handicap Inventory for Elderly (HHIE) questionnaires) for the determination of peripheral hearing loss and/or central auditory processing disorder (CAPD), and a handheld hearing screener (ROTO by Otovation) for the determination of peripheral audiometric hearing loss. The study also compared the diagnostic accuracy of the handheld screener in combination with either questionnaire.</p><p>The committee agreed the questionnaires would incur lower resource use compared to the handheld screener, as the authors noted that the questionnaires took under 10 minutes to complete and there does not appear to be charges for using either questionnaire, however there will be some costs associated with printing the questionnaires. The questionnaires are defined as self-reported, which will reduce staff time as it can completed by the person who has had a stroke. However, in some cases people may to require assistance to do this from staff, and there will be staff time required to review the questionnaire. The amount of staff time required is not stated in the clinical study.</p><p>Resource use associated with use of a handheld screener will relate to the staff time doing the assessment and the cost of the device. The clinical study stated that doing an assessment using the handheld screener took 5 minutes (including a discussion about instructions for the test), which suggests that using a combination of the screener and either of the questionnaires would therefore take around 15 minutes to complete. The cost of the ROTO handheld screener is not currently listed in the NHS supply chain catalogue and could not be identified on other websites. Other hearing screeners from the same manufacturer were found in the catalogue ranged from £2,034 to £2,754 but these were not specified as handheld screeners and have more sophisticated features such as data management and wireless printing and are also described as being designed to be used by hearing specialists. A single-handed screening audiometer was listed on the NHS supply chain catalogue at £804, however this was designed for paediatric use. Other ongoing costs include maintenance costs and batteries. Given this information, simple cost-calculations were presented to the committee to inform the discussion. Using two of the hearing screeners listed in the catalogue (one handheld and one wireless) and data from 2019/2020 SSNAP data on the number of stroke cases per year, the calculations suggest that the average cost per use is expected to be low (£0.61 for the £804 screener and £.156 for the £2,034 screener), assuming that both devices would last for 3 years.</p><p>The committee stated that in terms of the assessment pathway in current practice, after people are given the hearing assessment, those who are identified as having hearing problems are typically referred on to either audiology or an ENT for an audiology assessment. This would include people who were both accurately diagnosed (which is dependent on the sensitivity of the screening tools) and misdiagnosed as having a hearing problem (which is dependent on the specificity of the screening tools). The results of the clinical study found that the handheld screener and the questionnaires all had 100% specificity in detecting mild or greater hearing loss in stroke patients. The handheld screener had the highest sensitivity in detecting mild or greater hearing loss in stroke patients, however, the combined intervention was both less sensitive and less specific than the handheld screener alone. The co-optee audiologist for this review stated that the hearing questionnaires assessed in the clinical study are widely used in current practice but are not used in isolation, while hearing screeners are not routinely used in audiology as there can be few different factors which impact their reliability (for example, test environments, user error and variability in the results obtained) which need to be considered when selecting the best option and typically they are not as sensitive as manual audiometry. The committee were unsure if the hearing assessment tools being considered would sufficiently assess post-stroke hearing problems, as the audiologist noted that hearing loss following stroke may cause damage of the inner ear (cochlear) but can also cause disruption or damage along the whole hearing pathway including the auditory nerve, which causes more auditory processing type hearing difficulties. Hearing screeners such as the ROTO would not detect this as they are a measure of cochlear function only, therefore hearing screeners alone may not show the entirety of hearing dysfunction caused by stroke and it can be possible to have normal hearing thresholds with abnormal auditory nerve function. However, the clinical study did recommend the use of questionnaires (AIAD and HHIE) as an assessment of the central auditory dysfunction which can be experienced by stroke patient, which may be an issue that needs to be considered as part of the hearing screening program.</p><p>The committee highlighted that post-stroke hearing problems are not always currently being routinely assessed, with some estimating that the assessments occur approximately 10% of the time, despite existing recommendations. The committee felt that this was due uncertainty surrounding which assessment tool to use and the staff responsible for providing a hearing assessment. It was noted that new recommendations about the optimal tool to use may have the indirect effect of increasing the number of people being assessed and identified as having hearing problems (and therefore increasing the number referred to audiology or ENT). However, the committee view was that inadequate provision hearing assessments and subsequent lack of treatment for hearing problems can impact quality of life and an individuals’ ability to fully engage in rehabilitation. Despite the lack of published economic evidence available, the committee consensus was that improved identification of hearing problems could increase QALYs.</p><p>Given the lack of economic evidence and limited clinical evidence, an ‘offer’ recommendation was made for the assessment of hearing to all people within the first 6 weeks following stroke, and ‘consider’ recommendations were made for the use of the two hearing questionnaires, as this is anticipated to encourage rehabilitation teams to provide assessments and to improve current practice which currently lacks clarity on how hearing assessments should be provided.</p></div><div id="niceng236er7.s1.1.12.5"><h5>1.1.12.5. Other factors the committee took into account</h5><p>The committee acknowledged and cross refer to other relevant NICE guidance including NG98 Hearing loss in adults: assessment and management.</p><p>The lay representatives on the committee highlighted the importance of early consideration of hearing problems. In their experience when this has not been considered quickly in the past this has led to worsening of symptoms and the worsening of cognitive impairment. Earlier referral for audiology could improve the person’s ability to engage with rehabilitation and reduce the chance of adverse events such as cognitive impairment.</p></div></div><div id="niceng236er7.s1.1.13"><h4>1.1.13. Recommendations supported by this evidence review</h4><p>This evidence review supports recommendations 1.9.1 to 1.9.4 and the research recommendations on handheld hearing screeners and prevalence of hearing problems in <a href="#niceng236er7.appj">Appendix J</a>.</p></div><div id="niceng236er7.s1.1.rl.r1"><h4>1.1.14. References</h4><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="niceng236er7.s1.1.ref1">Beecham
|
|
J, Curtis
|
|
L. Unit costs of health and social care 2020. Canterbury. Personal Social Services Research Unit University of Kent, 2020. Available from: <a href="https://www.pssru.ac.uk/project-pages/unit-costs/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.pssru.ac<wbr style="display:inline-block"></wbr>​.uk/project-pages/unit-costs/</a></div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="niceng236er7.s1.1.ref2">Koohi
|
|
N, Vickers
|
|
DA, Utoomprurkporn
|
|
N, Werring
|
|
DJ, Bamiou
|
|
DE. A Hearing Screening Protocol for Stroke Patients: An Exploratory Study. Frontiers in neurology [electronic resource]. 2019; 10:842
|
|
[<a href="/pmc/articles/PMC6691813/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6691813</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31447763" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31447763</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>3.</dt><dd><div class="bk_ref" id="niceng236er7.s1.1.ref3">National Institute for Health and Care Excellence. Developing NICE guidelines: the manual [updated January
|
|
2022]. London. National Institute for Health and Care Excellence, 2014. Available from: <a href="https://www.nice.org.uk/process/pmg20" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.nice.org.uk/process/pmg20</a></div></dd></dl><dl class="bkr_refwrap"><dt>4.</dt><dd><div class="bk_ref" id="niceng236er7.s1.1.ref4">NHS England and NHS Improvement. 2019/20
|
|
National Cost Collection Data Publication. 2022. Available from: <a href="https://www.england.nhs.uk/publication/2019-20-national-cost-collection-data-publication" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.england.nhs<wbr style="display:inline-block"></wbr>​.uk/publication/2019-20-national-cost-collection-data-publication</a> Last accessed: 01/02/2023.</div></dd></dl><dl class="bkr_refwrap"><dt>5.</dt><dd><div class="bk_ref" id="niceng236er7.s1.1.ref5">NHS Supply Chain. NHS Supply Chain Catalogue. 2022. Available from: <a href="https://my.supplychain.nhs.uk/catalogue" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://my<wbr style="display:inline-block"></wbr>​.supplychain.nhs.uk/catalogue</a> Last accessed: 01/02/2023.</div></dd></dl></dl></div></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng236er7.appa"><h3>Appendix A. Review protocols</h3><p id="niceng236er7.appa.et1"><a href="/books/NBK600102/bin/niceng236er7-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for the optimal tool for the assessment of hearing in people after stroke</a><span class="small"> (PDF, 257K)</span></p><p id="niceng236er7.appa.et2"><a href="/books/NBK600102/bin/niceng236er7-appa-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for health economic literature review</a><span class="small"> (PDF, 178K)</span></p></div><div id="niceng236er7.appb"><h3>Appendix B. Literature search strategies</h3><p id="niceng236er7.appb.et1"><a href="/books/NBK600102/bin/niceng236er7-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">B.1. Clinical search literature search strategy</a><span class="small"> (PDF, 203K)</span></p><p id="niceng236er7.appb.et2"><a href="/books/NBK600102/bin/niceng236er7-appb-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">B.2. Health Economics literature search strategy</a><span class="small"> (PDF, 227K)</span></p></div><div id="niceng236er7.appc"><h3>Appendix C. Diagnostic evidence study selection</h3><p id="niceng236er7.appc.et1"><a href="/books/NBK600102/bin/niceng236er7-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Figure 1. Flow chart of clinical study selection for the review of the optimal tool for the assessment of hearing</a><span class="small"> (PDF, 189K)</span></p></div><div id="niceng236er7.appd"><h3>Appendix D. Diagnostic evidence</h3><p id="niceng236er7.appd.et1"><a href="/books/NBK600102/bin/niceng236er7-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (168K)</span></p></div><div id="niceng236er7.appe"><h3>Appendix E. Forest plots</h3><div id="niceng236er7.appe.s1"><h4>E.1. Coupled sensitivity and specificity forest plots</h4><p id="niceng236er7.appe.et1"><a href="/books/NBK600102/bin/niceng236er7-appe-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (95K)</span></p></div><div id="niceng236er7.appe.s2"><h4>E.2. ROC curves</h4><p>Meta-analysis was not possible due to insufficient data. Therefore, ROC curves have not been produced.</p></div><div id="niceng236er7.appe.s3"><h4>E.3. Area under the curve</h4><p>No additional data reported.</p></div></div><div id="niceng236er7.appf"><h3>Appendix F. Economic evidence study selection</h3><p id="niceng236er7.appf.et1"><a href="/books/NBK600102/bin/niceng236er7-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Figure 5. Flow chart of health economic study selection for the guideline</a><span class="small"> (PDF, 194K)</span></p></div><div id="niceng236er7.appg"><h3>Appendix G. Economic evidence tables</h3><p>There are no included health economic studies in this review.</p></div><div id="niceng236er7.apph"><h3>Appendix H. Health economic model</h3><p>New cost-effectiveness analysis was not conducted in this area.</p></div><div id="niceng236er7.appi"><h3>Appendix I. Excluded studies</h3><div id="niceng236er7.appi.s1"><h4>Clinical studies</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng236er7appitab1"><a href="/books/NBK600102/table/niceng236er7.appi.tab1/?report=objectonly" target="object" title="Table 11" class="img_link icnblk_img figpopup" rid-figpopup="figniceng236er7appitab1" rid-ob="figobniceng236er7appitab1"><img class="small-thumb" src="/books/NBK600102/table/niceng236er7.appi.tab1/?report=thumb" src-large="/books/NBK600102/table/niceng236er7.appi.tab1/?report=previmg" alt="Table 11. Studies excluded from the clinical review." /></a><div class="icnblk_cntnt"><h4 id="niceng236er7.appi.tab1"><a href="/books/NBK600102/table/niceng236er7.appi.tab1/?report=objectonly" target="object" rid-ob="figobniceng236er7appitab1">Table 11</a></h4><p class="float-caption no_bottom_margin">Studies excluded from the clinical review. </p></div></div></div><div id="niceng236er7.appi.s2"><h4>Health Economic studies</h4><p>Published health economic studies that met the inclusion criteria (relevant population, comparators, economic study design, published 2006 or later and not from non-OECD country or USA) but that were excluded following appraisal of applicability and methodological quality are listed below. See the health economic protocol for more details.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng236er7appitab2"><a href="/books/NBK600102/table/niceng236er7.appi.tab2/?report=objectonly" target="object" title="Table 12" class="img_link icnblk_img figpopup" rid-figpopup="figniceng236er7appitab2" rid-ob="figobniceng236er7appitab2"><img class="small-thumb" src="/books/NBK600102/table/niceng236er7.appi.tab2/?report=thumb" src-large="/books/NBK600102/table/niceng236er7.appi.tab2/?report=previmg" alt="Table 12. Studies excluded from the health economic review." /></a><div class="icnblk_cntnt"><h4 id="niceng236er7.appi.tab2"><a href="/books/NBK600102/table/niceng236er7.appi.tab2/?report=objectonly" target="object" rid-ob="figobniceng236er7appitab2">Table 12</a></h4><p class="float-caption no_bottom_margin">Studies excluded from the health economic review. </p></div></div></div></div><div id="niceng236er7.appj"><h3>Appendix J. Research recommendations – full details</h3><div id="niceng236er7.appj.s1"><h4>J.1. Research recommendation</h4><p>What is the clinical and cost-effectiveness, and the diagnostic test accuracy, of using handheld hearing screeners to assess hearing in people after stroke?</p><div id="niceng236er7.appj.s1.1"><h5>J.1.1. Why this is important</h5><p>Hearing problems are thought to be a common occurrence after stroke. These problems may be identified by the person, their family members and/or carers and healthcare professionals. However, some problems may not be identified for an extended period of time and may have effects on the person’s ability to engage with rehabilitation. Hearing problems may be factors contributing to problems with communication and cognition and so identifying problems in these populations is of particular importance. Currently there is limited evidence discussing the use of different hearing screening tools, with the study identified in this review being conducted in a limited population of people who were already believed to be at high risk of hearing problems. Handheld hearing screeners were investigated and showed positive results but given the potential costs of the intervention and the limitations identified, further evidence was required before the committee could recommend their use. A study investigating the use of handheld hearing screeners for people after stroke would be useful to know what the most effective tool is to identify hearing problems and the clinical and costeffectiveness of these strategies.</p></div><div id="niceng236er7.appj.s1.2"><h5>J.1.2. Rationale for research recommendation</h5><p id="niceng236er7.appj.et1"><a href="/books/NBK600102/bin/niceng236er7-appj-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (98K)</span></p></div><div id="niceng236er7.appj.s1.3"><h5>J.1.3. Rationale for research recommendation</h5><p id="niceng236er7.appj.et2"><a href="/books/NBK600102/bin/niceng236er7-appj-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (161K)</span></p></div></div><div id="niceng236er7.appj.s2"><h4>J.2. Research recommendation</h4><p>What is the prevalence of hearing problems after stroke?</p></div><div id="niceng236er7.appj.s2.1"><h4>J.2.1. Why this is important</h4><p>Hearing problems are thought to be a common occurrence after stroke. When completing this review, limited information was available discussing the prevalence of hearing problems after stroke. In addition, information available indicated that hearing problems may be present early after stroke but may resolve spontaneously and be less common in the chronic period after stroke. Given the limited information available in this area, it is difficult to understand the effect hearing problems have after stroke. Additional prevalence information at different time periods after stroke would be useful for gaining a greater understanding of the problem, allowing for more accurate recommendations in the future.</p></div><div id="niceng236er7.appj.s2.2"><h4>J.2.2. Rationale for research recommendation</h4><p id="niceng236er7.appj.et3"><a href="/books/NBK600102/bin/niceng236er7-appj-et3.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (95K)</span></p></div><div id="niceng236er7.appj.s2.3"><h4>J.2.3. Rationale for research recommendation</h4><p id="niceng236er7.appj.et4"><a href="/books/NBK600102/bin/niceng236er7-appj-et4.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (140K)</span></p></div></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Evidence reviews underpinning recommendations 1.9.1 to 1.9.4 and research recommendations in the NICE guideline</p><p>These evidence reviews were developed by NICE</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2023.</div><div class="small"><span class="label">Bookshelf ID: NBK600102</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/38330156" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">38330156</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng236er7tab1"><div id="niceng236er7.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO characteristics of review question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK600102/table/niceng236er7.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng236er7.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng236er7.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng236er7.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inclusion:
|
|
<ul><li class="half_rhythm"><div>Adults (age ≥16 years) who have had a first or recurrent stroke (including people after a subarachnoid haemorrhage)</div></li></ul>
|
|
Exclusion:
|
|
<ul><li class="half_rhythm"><div>Children (age <16 years)</div></li><li class="half_rhythm"><div>People who had a transient ischaemic attack</div></li><li class="half_rhythm"><div>People with other conditions that cause hearing problems</div></li></ul>
|
|
</td></tr><tr><th id="hd_b_niceng236er7.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Target condition</th><td headers="hd_b_niceng236er7.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hearing loss after stroke</td></tr><tr><th id="hd_b_niceng236er7.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Index tests (comparators)</th><td headers="hd_b_niceng236er7.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Tools for assessment of hearing after a stroke:
|
|
<ul class="circle"><li class="half_rhythm"><div>Handheld hearing screener
|
|
<dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>–</dt><dd><p class="no_top_margin">Cut off:
|
|
<ul><li class="half_rhythm"><div>Problem detected</div></li><li class="half_rhythm"><div>Problem not detected</div></li></ul></p></dd></dl></dl></div></li><li class="half_rhythm"><div>Hearing specific questionnaires
|
|
<dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>–</dt><dd><p class="no_top_margin">Hearing Handicap inventory Screening Version (HHIE)
|
|
<ul><li class="half_rhythm"><div>Cut off:
|
|
<ul class="circle"><li class="half_rhythm"><div>≤16</div></li><li class="half_rhythm"><div>>16</div></li></ul></div></li></ul></p></dd></dl><dl class="bkr_refwrap"><dt>–</dt><dd><p class="no_top_margin">The Amsterdam Inventory Auditory for Disability (AIAD)
|
|
<ul><li class="half_rhythm"><div>Cut off:
|
|
<ul class="circle"><li class="half_rhythm"><div><64</div></li><li class="half_rhythm"><div>64-84 (no problem)</div></li></ul></div></li></ul></p></dd></dl></dl></div></li><li class="half_rhythm"><div>Bedside clinical tests (any test will be accepted, including those within a comprehensive neurological examination)
|
|
<dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>–</dt><dd><p class="no_top_margin">Cut off:
|
|
<ul class="simple-list"><li class="half_rhythm"><div>Problem detected</div></li><li class="half_rhythm"><div>Problem not detected</div></li></ul></p></dd></dl></dl></div></li><li class="half_rhythm"><div>Combinations of the above</div></li></ul></div></li></ul>
|
|
<p>For the test-and-treat portion of the review, studies comparing any of the above interventions to each other were considered. The following key confounders were considered for these studies:
|
|
<ul><li class="half_rhythm"><div>Presence of communication difficulties</div></li><li class="half_rhythm"><div>Cognitive impairment at baseline</div></li><li class="half_rhythm"><div>Age</div></li></ul></p>
|
|
</td></tr><tr><th id="hd_b_niceng236er7.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standards</th><td headers="hd_b_niceng236er7.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Audiometry [assessment by an audiologist]</div></li></ul>
|
|
</td></tr><tr><th id="hd_b_niceng236er7.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Statistical measures and Outcomes</th><td headers="hd_b_niceng236er7.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Clinical effectiveness (test and treat) outcomes:</p><p>At time period
|
|
<ul><li class="half_rhythm"><div><1 year</div></li><li class="half_rhythm"><div>≥1 year</div></li><li class="half_rhythm"><div>Person/participant generic health-related quality of life (continuous outcomes will be prioritised)</div></li><li class="half_rhythm"><div>Carer generic health-related quality of life (continuous outcomes will be prioritised)</div></li><li class="half_rhythm"><div>Activities of daily living (continuous outcomes will be prioritised)</div></li><li class="half_rhythm"><div>Participation in leisure activities/social groups scores (continuous outcomes will be prioritised)</div></li><li class="half_rhythm"><div>Psychological distress (continuous outcomes will be prioritised)
|
|
<ul class="circle"><li class="half_rhythm"><div>Depression</div></li><li class="half_rhythm"><div>Anxiety</div></li><li class="half_rhythm"><div>Distress</div></li></ul></div></li><li class="half_rhythm"><div>Stroke-related scales of cognition (continuous outcomes will be prioritised) (including non-spatial attention and working memory, spatial attention, memory and executive function scores)</div></li><li class="half_rhythm"><div>Speech perception (continuous outcomes will be prioritised)</div></li><li class="half_rhythm"><div>Functional communication (continuous outcomes will be prioritised)</div></li><li class="half_rhythm"><div>Stroke-specific Patient-Reported Outcome Measures (continuous outcomes will be prioritised)</div></li><li class="half_rhythm"><div>Withdrawal due to adverse events (dichotomous outcome)</div></li></ul></p>
|
|
<p>If not mentioned above, other validated scores will be considered and discussed with the committee to deliberate on their inclusion.</p>
|
|
<p>Diagnostic accuracy outcomes:
|
|
<ul><li class="half_rhythm"><div>Sensitivity</div></li><li class="half_rhythm"><div>Specificity</div></li><li class="half_rhythm"><div>Raw data to calculate 2x2 tables to calculate sensitivity and specificity</div></li><li class="half_rhythm"><div>Area under the curve</div></li><li class="half_rhythm"><div>Likelihood ratios</div></li><li class="half_rhythm"><div>Positive predictive values</div></li><li class="half_rhythm"><div>Negative predictive values</div></li><li class="half_rhythm"><div>Intra-test and inter-test reliability</div></li></ul></p>
|
|
</td></tr><tr><th id="hd_b_niceng236er7.tab1_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_niceng236er7.tab1_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Clinical effectiveness (test and treat)
|
|
<ul><li class="half_rhythm"><div>Systematic reviews of RCTs</div></li><li class="half_rhythm"><div>Parallel RCTs</div></li><li class="half_rhythm"><div>Non-randomised studies (if insufficient evidence from parallel RCTs)
|
|
<ul class="circle"><li class="half_rhythm"><div>Prospective cohort study</div></li><li class="half_rhythm"><div>Retrospective cohort study</div></li></ul></div></li></ul></p>
|
|
<p>Published NMAs and IPDs will be considered for inclusion.</p>
|
|
<p>Diagnostic test accuracy:</p><p>Cross sectional studies and cohort studies will be included.</p></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng236er7tab2"><div id="niceng236er7.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of studies included in the evidence review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK600102/table/niceng236er7.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng236er7.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng236er7.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng236er7.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_niceng236er7.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Target condition</th><th id="hd_h_niceng236er7.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Index test</th><th id="hd_h_niceng236er7.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard</th><th id="hd_h_niceng236er7.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng236er7.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Koohi 2019<a class="bibr" href="#niceng236er7.s1.1.ref2" rid="niceng236er7.s1.1.ref2"><sup>2</sup></a></td><td headers="hd_h_niceng236er7.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>People after stroke (including ischaemic and haemorrhagic stroke)</p>
|
|
<p>Side of stroke:</p>
|
|
<p>Right = 22</p>
|
|
<p>Left = 18</p>
|
|
<p>Both = 2</p>
|
|
<p>Days since stroke (mean [SD]): 171.9 (76.4) days</p>
|
|
</td><td headers="hd_h_niceng236er7.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Central and peripheral hearing loss</td><td headers="hd_h_niceng236er7.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1)</dt><dd><p class="no_top_margin">Handheld hearing screener using the ASHA protocol</p></dd></dl><dl class="bkr_refwrap"><dt>2)</dt><dd><p class="no_top_margin">Handicap Hearing Inventory in the Elderly (HHIE)</p></dd></dl><dl class="bkr_refwrap"><dt>3)</dt><dd><p class="no_top_margin">Amsterdam Inventory Auditory of Disability (AIAD)</p></dd></dl><dl class="bkr_refwrap"><dt>4)</dt><dd><p class="no_top_margin">Combination of handheld hearing screener and Amsterdam Inventory Auditory of Disability</p></dd></dl></dl>
|
|
</td><td headers="hd_h_niceng236er7.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Audiometry (including a range of audiometric techniques to measure pure-tone average, otoacoustic emissions, acoustic reflex thresholds and brainstem responses)</td><td headers="hd_h_niceng236er7.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Setting: Outpatient follow up, United Kingdom</p>
|
|
<p>Funding: This study was funded by the British Medical Association Helen Lawson grant.</p>
|
|
<p>Note: The study reported data that could be used to calculate sensitivity and specificity and reported these calculated parameters. Where possible a 2×2 table was constructed and sensitivity and specificity were calculated. This was not possible for index test 4.</p>
|
|
<p>For index test 1, the study reports sensitivity and specificity for the use of the test in people with peripheral hearing loss only. To maintain consistent with the protocol, this review calculates sensitivity and specificity for all types of hearing loss.</p>
|
|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng236er7tab3"><div id="niceng236er7.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Clinical evidence summary: diagnostic test accuracy for handheld hearing screener</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK600102/table/niceng236er7.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng236er7.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng236er7.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Studies</th><th id="hd_h_niceng236er7.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">N</th><th id="hd_h_niceng236er7.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk of bias</th><th id="hd_h_niceng236er7.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Inconsistency</th><th id="hd_h_niceng236er7.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Indirectness</th><th id="hd_h_niceng236er7.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Imprecision</th><th id="hd_h_niceng236er7.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect size (95%CI)</th><th id="hd_h_niceng236er7.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_niceng236er7.tab3_1_1_1_1 hd_h_niceng236er7.tab3_1_1_1_2 hd_h_niceng236er7.tab3_1_1_1_3 hd_h_niceng236er7.tab3_1_1_1_4 hd_h_niceng236er7.tab3_1_1_1_5 hd_h_niceng236er7.tab3_1_1_1_6 hd_h_niceng236er7.tab3_1_1_1_7 hd_h_niceng236er7.tab3_1_1_1_8" id="hd_b_niceng236er7.tab3_1_1_1_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Handheld hearing screener to detect hearing loss (all types) in people after stroke</th></tr><tr><td headers="hd_h_niceng236er7.tab3_1_1_1_1 hd_b_niceng236er7.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 prospective cohort study</td><td headers="hd_h_niceng236er7.tab3_1_1_1_2 hd_b_niceng236er7.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">42</td><td headers="hd_h_niceng236er7.tab3_1_1_1_3 hd_b_niceng236er7.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng236er7.tab3_1_1_1_4 hd_b_niceng236er7.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng236er7.tab3_1_1_1_5 hd_b_niceng236er7.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>1</sup></td><td headers="hd_h_niceng236er7.tab3_1_1_1_6 hd_b_niceng236er7.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>2</sup></td><td headers="hd_h_niceng236er7.tab3_1_1_1_7 hd_b_niceng236er7.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity=0.69 (0.52-0.84)</td><td headers="hd_h_niceng236er7.tab3_1_1_1_8 hd_b_niceng236er7.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><td headers="hd_h_niceng236er7.tab3_1_1_1_3 hd_b_niceng236er7.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng236er7.tab3_1_1_1_4 hd_b_niceng236er7.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng236er7.tab3_1_1_1_5 hd_b_niceng236er7.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>1</sup></td><td headers="hd_h_niceng236er7.tab3_1_1_1_6 hd_b_niceng236er7.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>2</sup></td><td headers="hd_h_niceng236er7.tab3_1_1_1_7 hd_b_niceng236er7.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity=1.00 (0.54-1.00)</td><td headers="hd_h_niceng236er7.tab3_1_1_1_8 hd_b_niceng236er7.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng236er7.tab3_1"><p class="no_margin">Indirectness was assessed using the QUADAS-2 checklist. The evidence was downgraded by 1 increment due to population indirectness (people with communication and cognitive difficulties were excluded from the study).</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng236er7.tab3_2"><p class="no_margin">Confidence interval crossed the decision threshold corresponding to ‘high sensitivity/specificity’ (90%) and/or ‘low sensitivity/specificity’ (75%).</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng236er7tab4"><div id="niceng236er7.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Clinical evidence summary: diagnostic test accuracy for the Handicap Hearing Inventory in the Elderly questionnaire</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK600102/table/niceng236er7.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng236er7.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng236er7.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Studies</th><th id="hd_h_niceng236er7.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">N</th><th id="hd_h_niceng236er7.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk of bias</th><th id="hd_h_niceng236er7.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Inconsistency</th><th id="hd_h_niceng236er7.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Indirectness</th><th id="hd_h_niceng236er7.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Imprecision</th><th id="hd_h_niceng236er7.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect size (95%CI)</th><th id="hd_h_niceng236er7.tab4_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_niceng236er7.tab4_1_1_1_1 hd_h_niceng236er7.tab4_1_1_1_2 hd_h_niceng236er7.tab4_1_1_1_3 hd_h_niceng236er7.tab4_1_1_1_4 hd_h_niceng236er7.tab4_1_1_1_5 hd_h_niceng236er7.tab4_1_1_1_6 hd_h_niceng236er7.tab4_1_1_1_7 hd_h_niceng236er7.tab4_1_1_1_8" id="hd_b_niceng236er7.tab4_1_1_1_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Handicap Hearing Inventory in the Elderly questionnaire to detect hearing loss (all types) in people after stroke</th></tr><tr><td headers="hd_h_niceng236er7.tab4_1_1_1_1 hd_b_niceng236er7.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 prospective cohort study</td><td headers="hd_h_niceng236er7.tab4_1_1_1_2 hd_b_niceng236er7.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">42</td><td headers="hd_h_niceng236er7.tab4_1_1_1_3 hd_b_niceng236er7.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng236er7.tab4_1_1_1_4 hd_b_niceng236er7.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng236er7.tab4_1_1_1_5 hd_b_niceng236er7.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>1</sup></td><td headers="hd_h_niceng236er7.tab4_1_1_1_6 hd_b_niceng236er7.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng236er7.tab4_1_1_1_7 hd_b_niceng236er7.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity=0.44 (0.28-0.62)</td><td headers="hd_h_niceng236er7.tab4_1_1_1_8 hd_b_niceng236er7.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE</td></tr><tr><td headers="hd_h_niceng236er7.tab4_1_1_1_3 hd_b_niceng236er7.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng236er7.tab4_1_1_1_4 hd_b_niceng236er7.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng236er7.tab4_1_1_1_5 hd_b_niceng236er7.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>1</sup></td><td headers="hd_h_niceng236er7.tab4_1_1_1_6 hd_b_niceng236er7.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>2</sup></td><td headers="hd_h_niceng236er7.tab4_1_1_1_7 hd_b_niceng236er7.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity=1.00 (0.54-1.00)</td><td headers="hd_h_niceng236er7.tab4_1_1_1_8 hd_b_niceng236er7.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng236er7.tab4_1"><p class="no_margin">Indirectness was assessed using the QUADAS-2 checklist. The evidence was downgraded by 1 increment due to population indirectness (people with communication and cognitive difficulties were excluded from the study).</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng236er7.tab4_2"><p class="no_margin">Confidence interval crossed the decision threshold corresponding to ‘high sensitivity/specificity’ (90%) and/or ‘low sensitivity/specificity’ (75%).</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng236er7tab5"><div id="niceng236er7.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">Clinical evidence summary: diagnostic test accuracy for the Amsterdam Inventory Auditory of Disability questionnaire</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK600102/table/niceng236er7.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng236er7.tab5_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng236er7.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Studies</th><th id="hd_h_niceng236er7.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">N</th><th id="hd_h_niceng236er7.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk of bias</th><th id="hd_h_niceng236er7.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Inconsistency</th><th id="hd_h_niceng236er7.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Indirectness</th><th id="hd_h_niceng236er7.tab5_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Imprecision</th><th id="hd_h_niceng236er7.tab5_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect size (95%CI)</th><th id="hd_h_niceng236er7.tab5_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_niceng236er7.tab5_1_1_1_1 hd_h_niceng236er7.tab5_1_1_1_2 hd_h_niceng236er7.tab5_1_1_1_3 hd_h_niceng236er7.tab5_1_1_1_4 hd_h_niceng236er7.tab5_1_1_1_5 hd_h_niceng236er7.tab5_1_1_1_6 hd_h_niceng236er7.tab5_1_1_1_7 hd_h_niceng236er7.tab5_1_1_1_8" id="hd_b_niceng236er7.tab5_1_1_1_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Amsterdam Inventory Auditory of Disability questionnaire to detect hearing loss (all types) in people after stroke</th></tr><tr><td headers="hd_h_niceng236er7.tab5_1_1_1_1 hd_b_niceng236er7.tab5_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 prospective cohort study</td><td headers="hd_h_niceng236er7.tab5_1_1_1_2 hd_b_niceng236er7.tab5_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">42</td><td headers="hd_h_niceng236er7.tab5_1_1_1_3 hd_b_niceng236er7.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng236er7.tab5_1_1_1_4 hd_b_niceng236er7.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng236er7.tab5_1_1_1_5 hd_b_niceng236er7.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>1</sup></td><td headers="hd_h_niceng236er7.tab5_1_1_1_6 hd_b_niceng236er7.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng236er7.tab5_1_1_1_7 hd_b_niceng236er7.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity=0.33 (0.19-0.51)</td><td headers="hd_h_niceng236er7.tab5_1_1_1_8 hd_b_niceng236er7.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE</td></tr><tr><td headers="hd_h_niceng236er7.tab5_1_1_1_3 hd_b_niceng236er7.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng236er7.tab5_1_1_1_4 hd_b_niceng236er7.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng236er7.tab5_1_1_1_5 hd_b_niceng236er7.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>1</sup></td><td headers="hd_h_niceng236er7.tab5_1_1_1_6 hd_b_niceng236er7.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>2</sup></td><td headers="hd_h_niceng236er7.tab5_1_1_1_7 hd_b_niceng236er7.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity=1.00 (0.54-1.00)</td><td headers="hd_h_niceng236er7.tab5_1_1_1_8 hd_b_niceng236er7.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng236er7.tab5_1"><p class="no_margin">Indirectness was assessed using the QUADAS-2 checklist. The evidence was downgraded by 1 increment due to population indirectness (people with communication and cognitive difficulties were excluded from the study).</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng236er7.tab5_2"><p class="no_margin">Confidence interval crossed the decision threshold corresponding to ‘high sensitivity/specificity’ (90%) and/or ‘low sensitivity/specificity’ (75%).</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng236er7tab6"><div id="niceng236er7.tab6" class="table"><h3><span class="label">Table 6</span><span class="title">Clinical evidence summary: diagnostic test accuracy for the combination of the handheld hearing screener and the Amsterdam Inventory Auditory of Disability questionnaire</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK600102/table/niceng236er7.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng236er7.tab6_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng236er7.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Studies</th><th id="hd_h_niceng236er7.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">N</th><th id="hd_h_niceng236er7.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk of bias</th><th id="hd_h_niceng236er7.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Inconsistency</th><th id="hd_h_niceng236er7.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Indirectness</th><th id="hd_h_niceng236er7.tab6_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Imprecision</th><th id="hd_h_niceng236er7.tab6_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect size (95%CI)</th><th id="hd_h_niceng236er7.tab6_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_niceng236er7.tab6_1_1_1_1 hd_h_niceng236er7.tab6_1_1_1_2 hd_h_niceng236er7.tab6_1_1_1_3 hd_h_niceng236er7.tab6_1_1_1_4 hd_h_niceng236er7.tab6_1_1_1_5 hd_h_niceng236er7.tab6_1_1_1_6 hd_h_niceng236er7.tab6_1_1_1_7 hd_h_niceng236er7.tab6_1_1_1_8" id="hd_b_niceng236er7.tab6_1_1_1_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Combination of the handheld hearing screener and the Amsterdam Inventory Auditory of Disability questionnaire to detect hearing loss (all types) in people after stroke</th></tr><tr><td headers="hd_h_niceng236er7.tab6_1_1_1_1 hd_b_niceng236er7.tab6_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 prospective cohort study</td><td headers="hd_h_niceng236er7.tab6_1_1_1_2 hd_b_niceng236er7.tab6_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">42</td><td headers="hd_h_niceng236er7.tab6_1_1_1_3 hd_b_niceng236er7.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng236er7.tab6_1_1_1_4 hd_b_niceng236er7.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng236er7.tab6_1_1_1_5 hd_b_niceng236er7.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>1</sup></td><td headers="hd_h_niceng236er7.tab6_1_1_1_6 hd_b_niceng236er7.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng236er7.tab6_1_1_1_7 hd_b_niceng236er7.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity=0.5000 (0.1570-0.8430)<sup>3</sup></td><td headers="hd_h_niceng236er7.tab6_1_1_1_8 hd_b_niceng236er7.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE</td></tr><tr><td headers="hd_h_niceng236er7.tab6_1_1_1_3 hd_b_niceng236er7.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng236er7.tab6_1_1_1_4 hd_b_niceng236er7.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng236er7.tab6_1_1_1_5 hd_b_niceng236er7.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>1</sup></td><td headers="hd_h_niceng236er7.tab6_1_1_1_6 hd_b_niceng236er7.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>2</sup></td><td headers="hd_h_niceng236er7.tab6_1_1_1_7 hd_b_niceng236er7.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity=0.8889 (0.5175-0.9972)<sup>3</sup></td><td headers="hd_h_niceng236er7.tab6_1_1_1_8 hd_b_niceng236er7.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng236er7.tab6_1"><p class="no_margin">Indirectness was assessed using the QUADAS-2 checklist. The evidence was downgraded by 1 increment due to population indirectness (people with communication and cognitive difficulties were excluded from the study).</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng236er7.tab6_2"><p class="no_margin">Confidence interval crossed the decision threshold corresponding to ‘high sensitivity/specificity’ (90%) and/or ‘low sensitivity/specificity’ (75%).</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng236er7.tab6_3"><p class="no_margin">Values taken directly from the study and so are not reported in a forest plot. Please see the evidence table in <a href="#niceng236er7.appd">Appendix D</a> for further information.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng236er7tab7"><div id="niceng236er7.tab7" class="table"><h3><span class="label">Table 7</span><span class="title">Example hearing screener costs per use</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK600102/table/niceng236er7.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng236er7.tab7_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng236er7.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;"></th><th id="hd_h_niceng236er7.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Example 1</th><th id="hd_h_niceng236er7.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Example 2</th></tr></thead><tbody><tr><td headers="hd_h_niceng236er7.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Device cost<sup>(a)</sup></td><td headers="hd_h_niceng236er7.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£804</td><td headers="hd_h_niceng236er7.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£2034</td></tr><tr><td headers="hd_h_niceng236er7.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Years of use<sup>(b)</sup></td><td headers="hd_h_niceng236er7.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_h_niceng236er7.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td></tr><tr><td headers="hd_h_niceng236er7.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Uses per year<sup>(c)</sup></td><td headers="hd_h_niceng236er7.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">436</td><td headers="hd_h_niceng236er7.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">436</td></tr><tr><td headers="hd_h_niceng236er7.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Average cost per use</td><td headers="hd_h_niceng236er7.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.61</td><td headers="hd_h_niceng236er7.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£1.56</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="niceng236er7.tab7_1"><p class="no_margin">Example audiometer costs available in NHS supply chain catalogue:<a class="bibr" href="#niceng236er7.s1.1.ref5" rid="niceng236er7.s1.1.ref5"><sup>5</sup></a> Example 1 Otovation amplitude wireless audiometer T3; Example 2 Interacoustic single handed use paediatric screening audiometer.</p></div></dd></dl><dl class="bkr_refwrap"><dt>(b)</dt><dd><div id="niceng236er7.tab7_2"><p class="no_margin">Assumption</p></div></dd></dl><dl class="bkr_refwrap"><dt>(c)</dt><dd><div id="niceng236er7.tab7_3"><p class="no_margin">Average stroke cases per year per stroke unit from SSNAP 2019/2020</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng236er7tab8"><div id="niceng236er7.tab8" class="table"><h3><span class="label">Table 8</span><span class="title">Unit costs of health care professionals who may be involved in providing hearing assessments</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK600102/table/niceng236er7.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng236er7.tab8_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng236er7.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Resource</th><th id="hd_h_niceng236er7.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Cost per working hour (hospital-based only)<sup>(a)</sup></th><th id="hd_h_niceng236er7.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Example cost to administer hearing assessment (5 minutes)</th><th id="hd_h_niceng236er7.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Source</th></tr></thead><tbody><tr><td headers="hd_h_niceng236er7.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Band 6 PT/OT</td><td headers="hd_h_niceng236er7.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£52</td><td headers="hd_h_niceng236er7.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£4.34</td><td headers="hd_h_niceng236er7.tab8_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">PSSRU 2020<a class="bibr" href="#niceng236er7.s1.1.ref1" rid="niceng236er7.s1.1.ref1"><sup>1</sup></a></td></tr><tr><td headers="hd_h_niceng236er7.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Band 7 PT/OT</td><td headers="hd_h_niceng236er7.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£62</td><td headers="hd_h_niceng236er7.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£5.17</td></tr><tr><td headers="hd_h_niceng236er7.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(Audiology) Outpatient Audiometry or Hearing Assessment, 19 years and over</td><td headers="hd_h_niceng236er7.tab8_1_1_1_2 hd_h_niceng236er7.tab8_1_1_1_3" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">£68.64 per appointment</td><td headers="hd_h_niceng236er7.tab8_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">NHS reference costs 2019/2020<a class="bibr" href="#niceng236er7.s1.1.ref4" rid="niceng236er7.s1.1.ref4"><sup>4</sup></a></td></tr><tr><td headers="hd_h_niceng236er7.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(ENT) Outpatient Audiometry or Hearing Assessment, 19 years and over</td><td headers="hd_h_niceng236er7.tab8_1_1_1_2 hd_h_niceng236er7.tab8_1_1_1_3" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">£137.46 per appointment</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="niceng236er7.tab8_1"><p class="no_margin">Note: Costs per working hour include salary, salary oncosts, overheads (management and other non-care staff costs including administration and estates staff), capital overheads and qualification costs.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng236er7appitab1"><div id="niceng236er7.appi.tab1" class="table"><h3><span class="label">Table 11</span><span class="title">Studies excluded from the clinical review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK600102/table/niceng236er7.appi.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng236er7.appi.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_niceng236er7.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng236er7.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Code [Reason]</th></tr></thead><tbody><tr><td headers="hd_h_niceng236er7.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Bamiou, D. E., Werring, D., Cox, K.
|
|
et al. (2012) Patient-reported auditory functions after stroke of the central auditory pathway. Stroke
|
|
435: 1285–9
|
|
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/22382162" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22382162</span></a>]
|
|
</td><td headers="hd_h_niceng236er7.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Population not relevant to this review protocol</td></tr><tr><td headers="hd_h_niceng236er7.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Campbell, P.; Pollock, A.; Brady, M. (2014) Should hearing be screened in the first 30 days after an acute stroke? A systematic review. International Journal of Stroke 9(campbellppollockabradymnmahpresearchunitglasgowcaledonianuniversityglasgow unitedkingdom): 38
|
|
</td><td headers="hd_h_niceng236er7.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng236er7.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Formby, C.; Phillips, D. E.; Thomas, R. G. (1987) Hearing loss among stroke patients. Ear & Hearing
|
|
86: 326–32
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/3428485" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3428485</span></a>]
|
|
</td><td headers="hd_h_niceng236er7.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Noncomparative study investigating the use of pure tone audiometry only</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng236er7.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Graves, D. (1995) Is hearing screening needed for all admissions to a stroke rehabilitation unit?. Perspectives
|
|
192: 9–14 [<a href="https://pubmed.ncbi.nlm.nih.gov/7793176" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7793176</span></a>]
|
|
</td><td headers="hd_h_niceng236er7.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Retrospecti ve analysis of people who passed and failed hearing tests identifying the types of hearing loss, not investigating diagnostic accuracy</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng236er7.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Koohi, N., Vickers, D. A., Lakshmanan, R.
|
|
et al. (2017) Hearing Characteristics of Stroke Patients: Prevalence and Characteristics of Hearing Impairment and Auditory Processing Disorders in Stroke Patients. Journal of the American Academy of Audiology
|
|
286: 491–505
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/28590894" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28590894</span></a>]
|
|
</td><td headers="hd_h_niceng236er7.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Comparator in study does not match that specified in this review protocol</td></tr><tr><td headers="hd_h_niceng236er7.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Koohi, N., Vickers, D., Chandrashekar, H.
|
|
et al. (2017) Auditory rehabilitation after stroke: treatment of auditory processing disorders in stroke patients with personal frequency-modulated (FM) systems. Disability & Rehabilitation
|
|
396: 586–593
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/27008578" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27008578</span></a>]
|
|
</td><td headers="hd_h_niceng236er7.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Comparator in study does not match that specified in this review protocol</td></tr><tr><td headers="hd_h_niceng236er7.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Nosrati-Zarenoe, R.; Hansson, M.; Hultcrantz, E. (2010) Assessment of diagnostic approaches to idiopathic sudden sensorineural hearing loss and their influence on treatment and outcome. Acta Oto-Laryngologica
|
|
1303: 384–91
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/19688620" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19688620</span></a>]
|
|
</td><td headers="hd_h_niceng236er7.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Population not relevant to this review protocol</td></tr><tr><td headers="hd_h_niceng236er7.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Onoue, S. S., Ortiz, K. Z., Minett, T. S.
|
|
et al. (2014) Audiological findings in aphasic patients after stroke. Einstein
|
|
124: 433–9
|
|
[<a href="/pmc/articles/PMC4879908/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4879908</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25628193" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25628193</span></a>]
|
|
</td><td headers="hd_h_niceng236er7.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Comparator in study does not match that specified in this review protocol</td></tr><tr><td headers="hd_h_niceng236er7.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Wall, K. J.; Cumming, T. B.; Copland, D. A. (2017) Determining the Association between Language and Cognitive Tests in Poststroke Aphasia. Frontiers in neurology [electronic resource]. 8: 149
|
|
[<a href="/pmc/articles/PMC5418218/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5418218</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28529495" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28529495</span></a>]
|
|
</td><td headers="hd_h_niceng236er7.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Population not relevant to this review protocol</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng236er7appitab2"><div id="niceng236er7.appi.tab2" class="table"><h3><span class="label">Table 12</span><span class="title">Studies excluded from the health economic review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK600102/table/niceng236er7.appi.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng236er7.appi.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng236er7.appi.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference</th><th id="hd_h_niceng236er7.appi.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reason for exclusion</th></tr></thead><tbody><tr><td headers="hd_h_niceng236er7.appi.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None.</td><td headers="hd_h_niceng236er7.appi.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr></tbody></table></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
|
|
|
|
|
|
|
|
|
|
<!-- Book content -->
|
|
|
|
<script type="text/javascript" src="/portal/portal3rc.fcgi/rlib/js/InstrumentNCBIBaseJS/InstrumentPageStarterJS.js"> </script>
|
|
|
|
|
|
<!-- CE8B5AF87C7FFCB1_0191SID /projects/books/PBooks@9.11 portal106 v4.1.r689238 Tue, Oct 22 2024 16:10:51 -->
|
|
<span id="portal-csrf-token" style="display:none" data-token="CE8B5AF87C7FFCB1_0191SID"></span>
|
|
|
|
<script type="text/javascript" src="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/js/3968615.js" snapshot="books"></script></body>
|
|
</html>
|