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Hearing Evaluation and Auditory Rehabilitation after Stroke

Koohi, N; (2017) Hearing Evaluation and Auditory Rehabilitation after Stroke. Doctoral thesis , UCL (University College London). Green open access

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Abstract

Stroke can affect all levels of the auditory system (from the inner ear to the central tracts), and may result in various types of auditory dysfunctions, such as peripheral hearing loss (cochlea to auditory nerve), disordered auditory processing (brainstem to cortex), and cortical deafness. Hearing-impaired stroke survivors have an increased risk of physical decline after discharge to the community. This may be attributed to restricted participation in post-acute rehabilitation programs due to the hearing impairment. Furthermore, hearing impairment may have a significant impact on listening, linguistic skills and the overall communication of the affected stroke patient. To date, no studies have sought to systematically characterise the auditory function of stroke patients in detail in order to establish the different types of hearing impairments in this cohort of patients. Such information would be clinically useful for understanding and addressing the hearing needs of stroke survivors so that appropriate management could be given to these patients in order to improve their quality of life. One of the main aims of this research was to characterise and classify the hearing impairments of stroke patients using a detailed audiological assessment test battery in order to determine the level of clinical need and inform appropriate rehabilitation for this patient population. We found that the most common type of hearing impairment in stroke subjects was the combination type, ‘peripheral hearing loss and central auditory processing disorders’, in the older subgroup (in 55%), and auditory processing deficits in the younger subgroup (in 40%). Both types of impairment were significantly higher in these groups than in controls. Offering a comprehensive audiological assessment to all stroke patients would be a costly and time-consuming process. Therefore, a preliminary screening program for such patients needs to be identified, e.g. by means of a questionnaire, so that the full audiological assessment could be reserved for those who fail the initial screening. We aimed to determine whether a handheld hearing screener together with two validated hearing questionnaires could be used as a hearing screening tool to facilitate early identification and appropriate referral of hearing impaired stroke patients in the subacute stage. The highest test accuracy was achieved when results of the handheld hearing screener and hearing questionnaires were combined. Nehzat Koohi PhD Thesis vi Auditory disability due to impaired auditory processing (AP), despite normal puretone thresholds, is common after stroke. However, there are currently no proven remedial interventions for AP deficits in stroke patients. Our study is first to investigate the benefits of personal frequency-modulated (FM) systems in stroke patients with disordered AP. Our results demonstrated that FM systems may substantially improve speech-in-noise deficits in stroke patients who are not eligible for conventional hearing aids. We also evaluated the long term benefits for speech reception in noise, after daily ten-week use of personal FMs, in non-aphasic stroke patients with auditory processing deficits. We found that ten weeks of using FM systems by adult stroke patients may lead to benefits in unaided speech in noise perception. Our findings may indicate auditory plasticity type changes.

Type: Thesis (Doctoral)
Title: Hearing Evaluation and Auditory Rehabilitation after Stroke
Event: University College London
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Third party copyright material has been removed from ethesis.
URI: http://discovery.ucl.ac.uk/id/eprint/1541214
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