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REFERENCES 1. WHO. Deafness and hearing loss. WHO. 2013:1-‐5. Available at: hkp://www.who.int/mediacentre/factsheets/fs300/en/index.html. Accessed April 27, 2013. 2. Sindhusake D, Mitchell P, Smith W, et al. Valida?on of self-‐reported hearing loss. The Blue Mountains Hearing Study. Int J Epidemiol. 2001;30:1371-‐1378. doi:10.1093/ije/30.6.1371. 3. Zhu W, Zeng N, Wang N. Sensi?vity , Specificity , Accuracy , Associated Confidence Interval and ROC Analysis with Prac?cal SAS ® Implementa?ons K & L consul?ng services , Inc , Fort Washington , PA Octagon Research Solu?ons , Wayne. NESUG Heal Care Life Sci. 2010:1-‐9. 4. MedCalc. Diagnos?c test evalua?on. :1-‐2. Available at: hkp://www.medcalc.org/calc/diagnos?c_test.php. 5. Marini a. LS, Halpern R, Aerts D. Sensibilidade, especificidade e valor predi?vo da queixa audi?va. Rev Saude Publica. 2005;39(6):982-‐984. doi:10.1590/S0034-‐89102005000600017. 6. Torre P, Moyer CJ, Haro NR. The accuracy of self-‐reported hearing loss in older La?no-‐American adults. Int J Audiol. 2006;45:559-‐562. doi:10.1080/14992020600860935. 7. Nondahl DM, Cruickshanks KJ, Wiley TL, Tweed TS, Klein R, Klein BEK. Accuracy of Self-‐reported Hearing Loss. 1998:295-‐301. 8. Valete-‐Rosalino CM, Rozenfeld S. Triagem audi?va em idosos: comparação entre auto-‐relato e audiometria. Rev Bras Otorrinolaringol. 2005;71(2):193-‐200. doi:10.1590/S0034-‐72992005000200013.
n
Prevalence Diference
SensiHvity Specificity PPV NPV Accuracy Self-‐report HL(PSR)
HL(PHL) PHL-‐PSR
Right ear 573 47,0% 46,7% -‐0,3% 74,2% 76,7% 73,6
% 77,2% 75,5%
LeM ear 573 50,5% 44,6% -‐5,9% 79,9% 73,1% 70,5
% 81,9% 76,1%
n
Prevalence Diference
SensiHvity Specificity PPV NPV Accuracy Self-‐report HL(PSR)
HL(PHL) PHL-‐PSR
TOTAL 573 34,6% 37,9% +3,3% 65,0% 84% 71,2% 79,7% 76,8%
SensiHvity and specificity of self-‐reported hearing loss
Cris?na Caroça, MD1,2; Paula Campelo, MD2; João Paço, MD, PhD1,2
1Nova Medical School – Faculty of Medical Sciences, Lisbon, Portugal; 2Hospital CUF Infante Santo, Lisbon, Portugal
INTRODUCTION
DISCUSSION
RESULTS
Chart 1. Label in 24pt Arial.
Graph & Table 1. Distribu?on by age.
Figure 1. Child during PTA. Figure 2. Child during ABR.
ABSTRACT
METHODS AND MATERIALS
CONCLUSIONS
IntroducHon: The ques?on about hearing status is common and oAen placed in epidemiological studies. In this work we compare the prevalence of self-‐reported hearing loss with the prevalence of hearing loss obtained from audiometric tes?ng in a sample of the popula?on of São Tomé and Príncipe. Material and methods: We analyzed the data collected through a ques?onnaire on the percep?on of hearing applied in a clinical audiology assessment of pa?ents in São Tomé and Príncipe. All pa?ents were asked about their hearing status for each ear with the ques?on: “Do you feel you have a hearing loss?”. We considered two classifica?ons of hearing disability. We assessed the sensi?vity, specificity and predic?ve value of complaints, based on audiometric tests carried out -‐ tone pure audiogram and auditory brainstem response. Results: From 721 queries performed, only 573 pa?ents answered the ques?on: “Do you feel you have a hearing loss?”. We obtained, according to the classifica?on in the best ear, a sensi?vity of 65% and specificity of 84%, with a posi?ve and nega?ve predic?ve value of 71.2% and 79.7% respec?vely, compared to the full range of audiometric tests. The prevalence of individuals with hearing complaints was 34.5% and of those who actually had hearing loss on audiometric tests was 37.9%. Conclusions: Although audiometric evalua?on remains the gold standard for hearing screening, the subjec?ve percep?on of hearing loss con?nues to be a form of deafness iden?fica?on and may be useful in epidemiological studies, especially in poor countries like São Tomé and Príncipe.
• Total of 573 individuals were analyzed • Aged 1 to 83 years, mean age of 20.79 years, median age of 16 and mode of 7 years
• Audiological test valida?on: • Pure Tone Audiogram (PTA) – 81.2% • Auditory Brainstem Response (ABR) – 18.8%
■ Retrospec?ve study of medical charts, from individuals that have been observed at the audiology appointment within the Humanitarian Missions in São Tomé and Príncipe
■ Only individuals or caretakers who answered a self-‐reported ques?on “Do you think you have hearing loss?” and had record of the hearing or electrophysiological threshold, were included
■ Classifica?on adopted was the classifica?on of World Health Organiza?on (WHO)1
■ Hearing loss is a hearing threshold (mean value of 500, 1000, 2000 and 4000Hz air conduc?on thresholds) higher than 25 dB in the beker ear. • According to the WHO classifica?on, the ques?on “Do you think you have hearing loss?” has demonstrated to be
efficient in iden?fying hearing loss but mainly normal hearing individuals within the popula?on of São Tomé and Príncipe, becoming a useful ques?on on hearing loss screening in this popula?on.
• Although audiometric tes?ng s?ll remains as the gold standard, the subjec?ve percep?on of hearing loss con?nues to be an important way of iden?fying hearing loss, especially in epidemiologic studies.
• In younger ages, where the tutor mostly gives the answer to the ques?on, the self-‐report presents a high specificity despite the low sensi?vity.
§ About 5% of the world’s popula?on has hearing loss (HL)1
§ HL is responsible for: § Social isola?on § Depression § Low educa?on § Low social produc?vity § Low quality of life
§ Ques?ons about one’s hearing are seldom included in ques?onnaires on large-‐scale epidemiological studies2
§ Pure tone audiogram is the gold standard exam to es?mate the prevalence of HL
■ Applica?on of a ques?on: “Do you think you have a hearing loss?” in a clinical inquiry during the audiology appointment within the Humanitarian Mission in São Tomé and Príncipe (“Health for All -‐ specialiFes” project from a NGDO -‐ IMVF)
■ Valida?on of self reported ques?on by audiometric exams: § Pure tone audiogram (PTA) § Auditory brainstem response (ABR)
■ Study the sensi?vity, specificity, posi?ve predic?ve value (PPV), nega?ve predic?ve value (NPV) and accuracy of the self-‐reported ques?on3,4
Cris?na Caroça Hospital CUF Infante Santo Email: [email protected] Phone: +351 917507165
CONTACT
PURPOSE
n
Prevalence Diference
SensiHvity Specificity PPV NPV Accuracy Self-‐report HL(PSR)
HL(PHL) PHL-‐PSR
Male 277 48% 33,2% 37,2% +4% 61,2% 83,3% 68,5
% 78,4% 75,1%
Female 296 52%
35,8% 38,5% +2,7% 68,4% 84,6% 73,6%
81,0% 78,4%
§ The female group revealed a higher sensi?vity (68.72%) and specificity (84.62%) than the male group; the results from this study were similar to the one’s considering the best ear5. Probably because male underes?mate HL
§ In children, the answer to the ques?on about hearing loss, based on the best ear is some?mes complicated5, resul?ng in a lower sensi?vity (67.7%) but with a high specificity of 85.5%.
§ As age increases, when evalua?ng the best ear, the sensi?vity decreases and the specificity rises. § The self-‐report of hearing loss in the older group was lower because it was hard to recognize one’s hearing loss as
it is seen as a sign of ageing or, on the other hand, as the loss is gradual, there is no percep?on of the hearing loss6,7,8.
n
Prevalence Diference
SensiHvity Specificity PPV NPV Accuracy Self-‐report HL(PSR)
HL(PHL) PHL-‐PSR
<7 Y 100 18% 31,0% 31,0% 0% 67,7% 85,5% 67,7
% 85,5% 80%
≥7 <20 Y
218 38% 41,3% 39,9% -‐1,4% 75,9% 81,7% 73,3
% 83,6% 79,3%
≥20 Y 254 44%
27,8% 38,6% +10,8% 55,1% 85,3% 70,1%
75,1% 73,6%
48%
52%
Male Female
Graph & Table 2. Distribu?on by gender.
Graph & Table 3. Distribu?on by ear.
Table 4. Results in global sample.
‘HEALTHFOR ALL’
Sao Tome and PrincipeINFORMATIVE DOCUMENT
1988!2014