Bone conduction hearing kit for children with glue ear
IF 1.4
Q3 HEALTH CARE SCIENCES & SERVICES
Tamsin Mary Holland Brown, I. Fitzgerald O’Connor, J. Bewick, Colin Morley
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Abstract
© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Background Hearing loss is one of the most common disabilities in childhood. One in 10 children starting school in UK or Europe have hearing loss secondary to glue ear (Otitis Media with Effusion (OME)). 2 This is much higher in lower income countries. Eighty per cent of children have at least one episode of glue ear, where fluid builds up behind their eardrum after a cough, cold or ear infection. OME often selfresolves or children can be offered grommets (also known as ‘tympanostomy tubes’) if persistent. Grommets ‘only offer short term hearing improvement’ of ~12 dB, diminishing to ~4 dB 6–9 months later, therefore grommets improve a child’s symptoms for about 6 months while ‘natural resolution continues’. Grommet insertion is common, requiring a general anaesthetic, and risks include opening the middle ear to infection (requiring treatment in approximately a third of patients), perforation (1% of cases) and variable scarring the eardrum (tympanosclerosis). Hearing aids are not an easy solution, since glue ear fluctuates and multiple audiology appointments are needed to avoid overamplification or underamplification. Children need to hear to learn. Poor hearing can affect speech, language, social skills, listening, attention and learning. While some children catch up learning after an episode of glue ear, others do not. Glue ear mostly affects those under 8 years old, which is a critical time for development, speech acquisition, learning, writing, spelling and phonics. Deafness at this time interferes with speech development, language, communication, auditory processing, selfesteem, socialisation, listening and learning. Operational aims and objectives Bone conduction hearing aids work well in OME because they send sound as a vibration through the bones of the skull directly to the cochlea (bypassing the eardrum and middle ear bones where the fluid, mucus or ‘glue’ accumulates) but they are often prohibitively expensive, costing up to £3000. Bone conduction headphones are marketed at cyclists, allowing sound from mobile phones to be directed straight to the cochlea while sound from traffic noises still accessible through the ear canals. These headphones cost ~£100 commercially (figure 1) . An initial study in 2016–2018 trialled these simple bone conduction headphones paired to a microphone for the first time in children with OME. The Hear Glue Ear app was trialled in 2019. It was codesigned with a patient Summary box
胶耳儿童骨传导助听器
©作者(或其雇主)2021。禁止商业重用。请参阅权利和权限。英国医学杂志出版。背景听力损失是儿童时期最常见的残疾之一。在英国或欧洲,每10个刚入学的孩子中就有1个听力损失继发于胶耳(渗出性中耳炎)。这一比例在低收入国家要高得多。80%的儿童至少有过一次胶耳,即在咳嗽、感冒或耳部感染后,鼓膜后积液。OME通常会自行消退,如果持续存在,可以给儿童提供套管(也称为“鼓室造瘘管”)。耳套“只能提供~12分贝的短期听力改善”,6 - 9个月后会下降到~4分贝,因此,耳套可以在大约6个月的时间内改善儿童的症状,而“自然消退会继续”。植入护圈是常见的,需要全身麻醉,风险包括打开中耳导致感染(约三分之一的患者需要治疗)、穿孔(1%的病例)和鼓膜可变疤痕(鼓膜硬化)。助听器不是一个简单的解决方案,因为胶耳波动,需要多次听力学预约以避免过度放大或放大不足。孩子们需要听才能学习。听力不好会影响说话、语言、社交技能、听力、注意力和学习。虽然有些孩子在胶耳发作后能赶上学习进度,但有些孩子却不能。胶水耳主要影响8岁以下的儿童,这是发育、语言习得、学习、写作、拼写和语音的关键时期。此时的耳聋会干扰言语发育、语言、交流、听觉处理、自尊、社交、倾听和学习。骨传导助听器在OME中效果很好,因为它们通过颅骨将声音以振动的形式直接传递到耳蜗(绕过鼓膜和中耳骨,因为那里会积聚液体、粘液或“胶”),但它们通常非常昂贵,价格高达3000英镑。骨传导耳机是针对骑自行车的人销售的,它可以让手机发出的声音直接传到耳蜗,而来自交通噪音的声音仍然可以通过耳道进入。这些耳机的商业售价约为100英镑(图1)。2016-2018年的一项初步研究首次在OME患儿身上试用了这些简单的骨传导耳机与麦克风配对。这款名为Hear Glue Ear的应用程序于2019年试用。它与患者总结箱共同设计
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来源期刊
期刊介绍:
Healthcare is undergoing a revolution and novel medical technologies are being developed to treat patients in better and faster ways. Mobile revolution has put a handheld computer in pockets of billions and we are ushering in an era of mHealth. In developed and developing world alike healthcare costs are a concern and frugal innovations are being promoted for bringing down the costs of healthcare. BMJ Innovations aims to promote innovative research which creates new, cost-effective medical devices, technologies, processes and systems that improve patient care, with particular focus on the needs of patients, physicians, and the health care industry as a whole and act as a platform to catalyse and seed more innovations. Submissions to BMJ Innovations will be considered from all clinical areas of medicine along with business and process innovations that make healthcare accessible and affordable. Submissions from groups of investigators engaged in international collaborations are especially encouraged. The broad areas of innovations that this journal aims to chronicle include but are not limited to: Medical devices, mHealth and wearable health technologies, Assistive technologies, Diagnostics, Health IT, systems and process innovation.