Browsing by Author "Der, Carolina"
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Item Active transcutaneous bone conduction implant: audiological results in paediatric patients with bilateral microtia associated with external auditory canal atresia(Taylor & Francis Online, 2017) Bravo, Sofia; Der, Carolina; Fuentes, EduardoOBJECTIVE: To describe, in terms of functional gain and word recognition, the audiological results of patients under 18 years of age implanted with the active bone conduction implant, Bonebridge™. DESIGN: Retrospective case studies conducted by reviewing the medical records of patients receiving implants between 2014 and 2016 in the public health sector in Chile. STUDY SAMPLE: All patients implanted with the Bonebridge were included (N = 15). Individuals who had bilateral conductive hearing loss, secondary to external ear malformations, were considered as candidates. RESULTS: The average hearing threshold one month after switch on was 25.2 dB (95%CI 23.5-26.9). Hearing thresholds between 0.5 and 4 kHz were better when compared with bone conduction hearing aids. Best performance was observed at 4 kHz, where improvements to hearing were observed throughout the adaptation process. There was evidence of a significant increase in the recognition of monosyllables. CONCLUSIONS: The Bonebridge implant showed improvements to hearing thresholds and word recognition in paediatric patients with congenital conductive hearing loss.Publication Development and validation of DeciBHAL-US: A novel microsimulation model of hearing loss across the lifespan in the United States(2022) Borre, Ethan; Myers, Evan; Dubno, Judy; O’Donoghue, Gerard; Diab, Mohamed; Emmett, Susan; Saunders, James; Der, Carolina; McMahon, Catherine; Younis, Danah; Francis, Howard; Tucci, Debara; Wilson, Blake; Ogbuoji, Osondu; Sanders, GillianBackground: Hearing loss affects over 50% of people in the US across their lifespan and there is a lack of decision modeling frameworks to inform optimal hearing healthcare delivery. Our objective was to develop and validate a microsimulation model of hearing loss across the lifespan in the US. Methods: We collaborated with the Lancet Commission on Hearing Loss to outline model structure, identify input data sources, and calibrate/validate DeciBHAL-US (Decision model of the Burden of Hearing loss Across the Lifespan). We populated the model with literature-based estimates and validated the conceptual model with key informants. We validated key model endpoints to the published literature, including: 1) natural history of sensorineural hearing loss (SNHL), 2) natural history of conductive hearing loss (CHL), and 3) the hearing loss cascade of care. We reported the coefficient of variance root mean square error (CV-RMSE), considering values ≤15% to indicate adequate fit. Findings: For SNHL prevalence, the CV-RMSE for model projected male and female age-specific prevalence compared to sex-adjusted National Health and Nutrition Examination Survey (NHANES) data was 4.9 and 5.7%, respectively. Incorporating literature-based age-related decline in SNHL, we validated mean four-frequency average hearing loss in the better ear (dB) among all persons to longitudinal data (CV-RMSE=11.3%). We validated the age-stratified prevalence of CHL to adjusted NHANES data (CV-RMSE=10.9%). We incorporated age- and severity-stratified time to first hearing aid (HA) use data and HA discontinuation data (adjusted for time-period of use) and validated to NHANES estimates on the prevalence of adult HA use (CV-RMSE=10.3%). Interpretation: Our results indicate adequate model fit to internal and external validation data. Future incorporation of cost and severity-stratified utility data will allow for cost-effectiveness analysis of US hearing healthcare interventions across the lifespan. Further research might expand the modeling framework to international settings.Item Inequality in the distribution of ear, nose and throat specialists in 15 Latin American countries: an ecological study(2019) Bright, Tess; Mújica, .Oscar J.; Ramke, Jacqueline; Moreno, Claudia M.; Der, Carolina; Melendez, Amarilis; Lara Ovares, Ericka; Sandoval Domingues, Edgar Ivan; Santana Hernandez, Diego Jose; Chadha, Shelly; Silva, Juan Carlos; Peñaranda, AugustoObjective: To explore sociogeographical inequalities in the availability and distribution of ear, nose and throat specialists (ENTs) in 15 Latin American (LA) countries. Design: Ecological. Setting: Spanish and Portuguese-speaking countries of LA.The number of registered ENTs in 2017 was obtained from the National ENT Society in each country. Outcome measures: The ENT rate/million population was calculated at the national and subnational (eg, state) level. Three measures were calculated to assess subnational distributive inequality of ENTs: (1) absolute and (2) relative index of dissimilarity; and (3) concentration index (using the Human Development Index as the equity stratifier). Finally, the ratio of ENTs/million population in the capital area compared with the rest of the country was calculated. Results: There was more than a 30-fold difference in the number of ENTs/million population across the included countries-from 61.0 in Argentina (95% CI 58.7 to 63.4) to 2.8 in Guatemala (95% CI 2.1 to 3.8). In all countries, ENTs were more prevalent in advantaged areas and in capital areas. To attain distributive equality, Paraguay would need to redistribute the greatest proportion of its ENT workforce (67.3%; 95% CI 57.8% to 75.6%) and Brazil the least (18.5%; 95% CI 17.6% to 19.5%). Conclusions: There is high inequality in the number and distribution of ENTs between and within the 15 studied countries in LA. This evidence can be used to inform policies that improve access to ear and hearing services in the region, such as scale-up of training of ENTs and incentives to distribute specialists equally. These actions to reduce inequities, alongside addressing the social determinants of ear and hearing health, are essential to realise Universal Health Coverage.Item National linguistic validation of the Tinnitus Handicap Inventory (THI). Assessment of disability caused by tinnitus in chilean spanish-speaking population(2012) Der, Carolina; Alzérreca, Eugenio; San Martín, José Tomás; Román, Liliana; Zamorano, Isabel; Malhue, Jorge; Aliaga, Paola; Coronelli, Linda; Sarda, SoledadIntroduction: The psycho-emotional assessment is of utmost importance for evaluation of patients with tinnitus. The Tinnitus Handicap Inventory (THI), is the most known and validated test for this purpose. Objectives: We propose a linguistic validation of the THI, in order to obtain reliable answers in our country. Materials and Methods: We performed a translation of the original English questionnaire and assessed its feasibility by applying it in a group of patients with tinnitus. Statistical analysis included internal validity (Cronbach’s alpha) and linear correlation tests (Pearson coefficient). Results: We evaluated 60 patients with a mean age of 59 years. We obtained a Cronbach’s alpha index of 0.97 for the whole questionnaire. Conclusions: The adapted version of the THI shows satisfactory levels of internal consistency for the assessment of disability caused by tinnitus.Item Research Equity in Otolaryngology–Head and Neck Surgery(2021) Harlan Patterson, Rolvix; Jue Xu, Mary; Okerosi, Samuel; Bhutta, Mahmood F.; Der, Carolina; Alkire, Blake; Njogu, Rose; Vendra, Varun; Tamir, Sharon Ovnat; Fagan, Johannes J.Equitable research collaborations benefit the quality and rele- vance of global otolaryngology–head and neck surgery research. However, analyses of existing global health literature have shown disproportionate representation by foreign authors. To avert this inequity and improve global otolaryngology–head and neck sur- gery research, we propose a framework that emphasizes local representation and capacity building in research.Publication The Global Otolaryngology-Head and Neck Surgery Workforce(2023) Petrucci, Beatriz; Okerosi, Samuel; Patterson, Rolvix; Hobday, Sara; Salano, Valerie; Waterworth, Christopher; Brody, Robert; Sprow, Holly; Alkire, Blake; Fagan, Johannes; Ovnat Tamir, Sharon; Der, Carolina; Bhutta, Mahmood; Maina, Ivy; Pang, Jonathan; Daudu, Davina; Mukuzi, Allan; Srinivasan, Tarika; Pietrobon, Carolina; Hao, Sheng-Po; Nakku, Doreen; Seguya, Amina; Din, Taseer; Djoutsop Mbougo, Olga; Mokoh, Lilian; Jashek-Ahmed, Farizeh; Law, Tyler; Holt, Elizabeth; Haider, Ali; Zemene, Yilkal; Ibekwe, Titus; Raphiou, Oumar; Alvarado, Jaqueline; Mulwafu, Wakisa; Fenton, John; Agius, Adrian; Doležal, Pavel; Amani, Édouard; Mojica, Karen; Silva, RicardoImportance: A core component of delivering care of head and neck diseases is an adequate workforce. The World Health Organization report, Multi-Country Assessment of National Capacity to Provide Hearing Care, captured primary workforce estimates from 68 member states in 2012, noting that response rates were a limitation and that updated more comprehensive data are needed. Objective: To establish comprehensive workforce metrics for global otolaryngology-head and neck surgery (OHNS) with updated data from more countries/territories. Design, setting, and participants: A cross-sectional electronic survey characterizing the OHNS workforce was disseminated from February 10 to June 22, 2022, to professional society leaders, medical licensing boards, public health officials, and practicing OHNS clinicians. Main outcome: The OHNS workforce per capita, stratified by income and region. Results: Responses were collected from 121 of 195 countries/territories (62%). Survey responses specifically reported on OHNS workforce from 114 countries/territories representing 84% of the world's population. The global OHNS clinician density was 2.19 (range, 0-61.7) OHNS clinicians per 100 000 population. The OHNS clinician density varied by World Bank income group with higher-income countries associated with a higher density of clinicians. Regionally, Europe had the highest clinician density (5.70 clinicians per 100 000 population) whereas Africa (0.18 clinicians per 100 000 population) and Southeast Asia (1.12 clinicians per 100 000 population) had the lowest. The OHNS clinicians deliver most of the surgical management of ear diseases and hearing care, rhinologic and sinus diseases, laryngeal disorders, and upper aerodigestive mucosal cancer globally. Conclusion and relevance: This cross-sectional survey study provides a comprehensive assessment of the global OHNS workforce. These results can guide focused investment in training and policy development to address disparities in the availability of OHNS clinicians.Publication Validation of the Decision model of the Burden of Hearing loss Across the Lifespan (DeciBHAL) in Chile, India, and Nigeria(2022) Borre, Ethan; Ayer, Austin; Der, Carolina; Ibekwe, Titus; Emmett, Susan; Dixit, Siddharth; Shahid, Minahil; Olusanya, Bolajoko; Garg, Suneela; Johri, Mohini; Saunders, James; Tucci, Debara; Wilson, Blake; Ogbuoji, Osondu; Sanders, GillianBackground: There is no published decision model for informing hearing health care resource allocation across the lifespan in low- and middle-income countries. We sought to validate the Decision model of the Burden of Hearing loss Across the Lifespan International (DeciBHAL-I) in Chile, India, and Nigeria. Methods: DeciBHAL-I simulates bilateral sensorineural hearing loss (SNHL) and conductive hearing loss (CHL) acquisition, SNHL progression, and hearing loss treatment. To inform model inputs, we identified setting-specific estimates including SNHL prevalence from the Global Burden of Disease (GBD) studies, acute otitis media (AOM) incidence and prevalence of otitis-media related CHL from a systematic review, and setting-specific pediatric and adult hearing aid use prevalence. We considered a coefficient of variance root mean square error (CV-RMSE) of ≤15% to indicate good model fit. Findings: The model-estimated prevalence of bilateral SNHL closely matched GBD estimates, (CV-RMSEs: 3.2-7.4%). Age-specific AOM incidences from DeciBHAL-I also achieved good fit (CV-RMSEs=5.0-7.5%). Model-projected chronic suppurative otitis media prevalence (1.5% in Chile, 4.9% in India, and 3.4% in Nigeria) was consistent with setting-specific estimates, and the incidence of otitis media-related CHL was calibrated to attain adequate model fit. DeciBHAL-projected adult hearing aid use in Chile (3.2-19.7% ages 65-85 years) was within the 95% confidence intervals of published estimates. Adult hearing aid prevalence from the model in India was 1.4-2.3%, and 1.1-1.3% in Nigeria, consistent with literature-based and expert estimates. Interpretation: DeciBHAL-I reasonably simulates hearing loss natural history, detection, and treatment in Chile, India, and Nigeria. Future cost-effectiveness analyses might use DeciBHAL-I to inform global hearing health policy.