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Hearing Disorders: HELP
Articles by Debara L. Tucci
Based on 27 articles published since 2009
(Why 27 articles?)
||||

Between 2009 and 2019, Debara Tucci wrote the following 27 articles about Hearing Disorders.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline Clinical practice guideline: sudden hearing loss. 2012

Stachler, Robert J / Chandrasekhar, Sujana S / Archer, Sanford M / Rosenfeld, Richard M / Schwartz, Seth R / Barrs, David M / Brown, Steven R / Fife, Terry D / Ford, Peg / Ganiats, Theodore G / Hollingsworth, Deena B / Lewandowski, Christopher A / Montano, Joseph J / Saunders, James E / Tucci, Debara L / Valente, Michael / Warren, Barbara E / Yaremchuk, Kathleen L / Robertson, Peter J / Anonymous4970719. ·Department of Otolaryngology, Henry Ford Hospital, Detroit, Michigan 48202, USA. rstachl1@hfhs.org ·Otolaryngol Head Neck Surg · Pubmed #22383545.

ABSTRACT: OBJECTIVE: Sudden hearing loss (SHL) is a frightening symptom that often prompts an urgent or emergent visit to a physician. This guideline provides evidence-based recommendations for the diagnosis, management, and follow-up of patients who present with SHL. The guideline primarily focuses on sudden sensorineural hearing loss (SSNHL) in adult patients (aged 18 and older). Prompt recognition and management of SSNHL may improve hearing recovery and patient quality of life (QOL). Sudden sensorineural hearing loss affects 5 to 20 per 100,000 population, with about 4000 new cases per year in the United States. This guideline is intended for all clinicians who diagnose or manage adult patients who present with SHL. PURPOSE: The purpose of this guideline is to provide clinicians with evidence-based recommendations in evaluating patients with SHL, with particular emphasis on managing SSNHL. The panel recognized that patients enter the health care system with SHL as a nonspecific, primary complaint. Therefore, the initial recommendations of the guideline deal with efficiently distinguishing SSNHL from other causes of SHL at the time of presentation. By focusing on opportunities for quality improvement, the guideline should improve diagnostic accuracy, facilitate prompt intervention, decrease variations in management, reduce unnecessary tests and imaging procedures, and improve hearing and rehabilitative outcomes for affected patients. RESULTS: The panel made strong recommendations that clinicians should (1) distinguish sensorineural hearing loss from conductive hearing loss in a patient presenting with SHL; (2) educate patients with idiopathic sudden sensorineural hearing loss (ISSNHL) about the natural history of the condition, the benefits and risks of medical interventions, and the limitations of existing evidence regarding efficacy; and (3) counsel patients with incomplete recovery of hearing about the possible benefits of amplification and hearing-assistive technology and other supportive measures. The panel made recommendations that clinicians should (1) assess patients with presumptive SSNHL for bilateral SHL, recurrent episodes of SHL, or focal neurologic findings; (2) diagnose presumptive ISSNHL if audiometry confirms a 30-dB hearing loss at 3 consecutive frequencies and an underlying condition cannot be identified by history and physical examination; (3) evaluate patients with ISSNHL for retrocochlear pathology by obtaining magnetic resonance imaging, auditory brainstem response, or audiometric follow-up; (4) offer intratympanic steroid perfusion when patients have incomplete recovery from ISSNHL after failure of initial management; and (5) obtain follow-up audiometric evaluation within 6 months of diagnosis for patients with ISSNHL. The panel offered as options that clinicians may offer (1) corticosteroids as initial therapy to patients with ISSNHL and (2) hyperbaric oxygen therapy within 3 months of diagnosis of ISSNHL. The panel made a recommendation against clinicians routinely prescribing antivirals, thrombolytics, vasodilators, vasoactive substances, or antioxidants to patients with ISSNHL. The panel made strong recommendations against clinicians (1) ordering computerized tomography of the head/brain in the initial evaluation of a patient with presumptive SSNHL and (2) obtaining routine laboratory tests in patients with ISSNHL.

2 Review Global Hearing Loss Prevention. 2018

Brown, Clifford Scott / Emmett, Susan D / Robler, Samantha Kleindienst / Tucci, Debara L. ·Department of Surgery, Division of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, 40 Duke Medicine Circle, M150 Green Zone, DUMC 2824, Durham, NC 27710, USA. · Department of Surgery, Division of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Duke Global Health Institute, Box 3805, Durham, NC 27710, USA. · Norton Sound Health Corporation, Norton Sound Health, PO Box 966, Nome, AK 99762, USA. · Department of Surgery, Division of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Box 3805, Durham, NC 27710, USA. Electronic address: debara.tucci@duke.edu. ·Otolaryngol Clin North Am · Pubmed #29525388.

ABSTRACT: Hearing loss is the fourth leading contributor to years lived with a disability worldwide. Most recent estimates indicate that one-half of a billion people suffer from disabling hearing loss worldwide. The social and economic burden is significant. When attributing monetary value to years lived with disability owing to hearing loss, there is greater than $US750 billion lost each year globally. There are numerous contributors to hearing loss, including congenital, infectious, noise exposure, age-related, traumatic, and immune-mediated causes. Understanding the pathophysiology of these factors allows for the development of preventative and treatment strategies specific to the underlying cause.

3 Review Hearing Loss in Adults. 2017

Cunningham, Lisa L / Tucci, Debara L. ·From the Section on Sensory Cell Biology, National Institute on Deafness and Other Communication Disorders, Bethesda, MD (L.L.C.) · and the Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC (D.L.T.). ·N Engl J Med · Pubmed #29262274.

ABSTRACT: -- No abstract --

4 Review Global hearing health care: new findings and perspectives. 2017

Wilson, Blake S / Tucci, Debara L / Merson, Michael H / O'Donoghue, Gerard M. ·Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA; School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA. Electronic address: blake.wilson@duke.edu. · Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA. · Duke Global Health Institute, Duke University, Durham, NC, USA. · National Institute of Health Research, Nottingham Biomedical Research Centre, Nottingham, UK; Nottingham University Hospitals NHS Trust, Nottingham, UK. ·Lancet · Pubmed #28705460.

ABSTRACT: In 2015, approximately half a billion people had disabling hearing loss, about 6·8% of the world's population. These numbers are substantially higher than estimates published before 2013, and point to the growing importance of hearing loss and global hearing health care. In this Review, we describe the burden of hearing loss and offer our and others' recommendations for halting and then reversing the continuing increases in this burden. Low-cost possibilities exist for prevention of hearing loss, as do unprecedented opportunities to reduce the generally high treatment costs. These possibilities and opportunities could and should be exploited. Additionally, a comprehensive worldwide initiative like VISION 2020 but for hearing could provide a focus for support and also enable and facilitate the increased efforts that are needed to reduce the burden. Success would produce major personal and societal gains, including gains that would help to fulfil the "healthy lives" and "disability inclusive" goals in the UN's new 2030 Agenda for Sustainable Development.

5 Review Emerging Therapies for Sensorineural Hearing Loss. 2017

Crowson, Matthew Gordon / Hertzano, Ronna / Tucci, Debara L. ·*Division of Head & Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina †Department of Otorhinolaryngology-Head & Neck Surgery, Anatomy and Neurobiology and Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland. ·Otol Neurotol · Pubmed #28383465.

ABSTRACT: OBJECTIVE: To critically review and evaluate the proposed mechanisms and documented results of the therapeutics currently in active clinical drug trials for the treatment of sensorineural hearing loss. DATA SOURCES: US National Institutes of Health (NIH) Clinical Trials registry, MEDLINE/PubMed. STUDY SELECTION & DATA EXTRACTION: A review of the NIH Clinical Trials registry identified candidate hearing loss therapies, and supporting publications were acquired from MEDLINE/PubMed. Proof-of-concept, therapeutic mechanisms, and clinical outcomes were critically appraised. DATA SYNTHESIS: Twenty-two active clinical drug trials registered in the United States were identified, and six potentially therapeutic molecules were reviewed. Of the six molecules reviewed, four comprised mechanisms pertaining to mitigating oxidative stress pathways that presumably lead to inner ear cell death. One remaining therapy sought to manipulate the cell death cascade, and the last remaining therapy was a novel cell replacement therapy approach to introduce a transcription factor that promotes hair cell regeneration. CONCLUSION: A common theme in recent clinical trials registered in the United States appears to be the targeting of cell death pathways and influence of oxidant stressors on cochlear sensory neuroepithelium. In addition, a virus-delivered cell replacement therapy would be the first of its kind should it prove safe and efficacious. Significant challenges for bringing these bench-to-bedside therapies to market remain. It is never assured that results in non-human animal models translate to effective therapies in the setting of human biology. Moreover, as additional processes are described in association with hearing loss, such as an immune response and loss of synaptic contacts, additional pathways for targeting become available.

6 Review Mini Review of the Cost-Effectiveness of Unilateral Osseointegrated Implants in Adults: Possibly Cost-Effective for the Correct Indication. 2016

Crowson, Matthew G / Tucci, Debara L. ·Division of Otolaryngology - Head and Neck Surgery, Duke University Medical Center, Durham, N.C., USA. ·Audiol Neurootol · Pubmed #26895350.

ABSTRACT: An osseointegrated implant (e.g. bone-anchored hearing aid, BAHA) is a surgically implantable device for unilateral sensorineural and unilateral or bilateral conductive hearing loss in patients who otherwise cannot use or do not prefer a conventional air conduction hearing aid (ACHA). The specific indications for an osseointegrated implant are evolving and dependent upon the country or regulatory body overseeing the provision of these devices. However, there are general groups of patients who would be likely to benefit, one such group being patients with congenital aural atresia. Given the anatomical aberrancies with aural atresia, these subjects cannot wear ACHAs. Another group of patients who may benefit from an osseointegrated implant over an ACHA are patients with chronically draining otological infections. As the provision of an osseointegrated implant requires a surgical procedure, there are inherent direct and indirect costs associated with its use beyond those required for an ACHA. Consideration of outcomes and cost-effectiveness for the osseointegrated implant versus the ACHA is prudent prior to making policy decisions in a setting of limited health care resources. We performed a mini review on all available cost-effectiveness analyses of osseointegrated implants published in Medline. There are only 2 contemporary cost-effectiveness analyses published to date. There is limited quality of life data available for patients living with an osseointegrated implant. As a result, the cost-effectiveness of the osseointegrated implant, specifically the BAHA, compared to conventional hearing aid devices remains unclear. However, there are clear indications for the BAHA when a standard hearing aid cannot be used (e.g. chronic draining ear) or in single-sided severe-to-profound hearing loss with reasonable hearing in the contralateral ear. The BAHA should not be considered interchangeable with the ACHA with regard to cost-effectiveness, but rather considered as an effective option for the patient for the correct indication.

7 Review Cochlear implants matching the prosthesis to the brain and facilitating desired plastic changes in brain function. 2011

Wilson, Blake S / Dorman, Michael F / Woldorff, Marty G / Tucci, Debara L. ·Duke Hearing Center, Duke University Medical Center (DUMC), Durham, NC, USA. blake.wilson@duke.edu ·Prog Brain Res · Pubmed #21867799.

ABSTRACT: The cochlear implant (CI) is one of the great success stories of modern medicine. A high level of function is provided for most patients. However, some patients still do not achieve excellent or even good results using the present-day devices. Accumulating evidence is pointing to differences in the processing abilities of the "auditory brain" among patients as a principal contributor to this remaining and still large variability in outcomes. In this chapter, we describe a new approach to the design of CIs that takes these differences into account and thereby may improve outcomes for patients with compromised auditory brains.

8 Review A summary of the literature on global hearing impairment: current status and priorities for action. 2010

Tucci, Debara / Merson, Michael H / Wilson, Blake S. ·Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA. tucci001@mc.duke.edu ·Otol Neurotol · Pubmed #20050266.

ABSTRACT: BACKGROUND: Hearing loss (HL) and deafness are global issues that affect at least 278 million people worldwide. Two thirds of the people who have HL worldwide live in developing countries. Importantly, it is estimated that 50% of this HL can be prevented. In developing countries, funding for prevention, early detection, and rehabilitative programs is severely limited, and therefore, agencies must compete against priorities to treat life-threatening, pandemic diseases such as human immunodeficiency virus, malaria, and tuberculosis. Delays in diagnosis are common, and social attitudes, local customs, and cultural bias are contributing factors. OBJECTIVE: The purpose of this review is to gain an understanding of the prevalence of HL in the developing world and to focus attention on the growing need for both prevention and effective treatment programs. A second goal is to use this information to suggest priorities and approaches to address these problems worldwide. DATA SOURCES: The data were compiled from a review of the literature on the global impacts of hearing impairment and recently published reports on the prevalence and cause of hearing impairment in developing nations. CONCLUSION: The high prevalence of HL in the developing world is due to a variety of factors, including lack of widespread comprehensive immunization programs and other medical care, and inadequate funds for intervention once HL is identified. International organizations, governments, and nongovernment organizations have many opportunities to prevent and treat HL through cost-effective means.

9 Article A Lancet Commission to address the global burden of hearing loss. 2019

Wilson, Blake S / Tucci, Debara L / O'Donoghue, Gerard M / Merson, Michael H / Frankish, Helen. ·Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA; Duke Global Health Institute, Durham, NC, USA; Departments of Biomedical Engineering and Electrical and Computer Engineering, Duke University, Durham, NC, USA; School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA. Electronic address: blake.wilson@duke.edu. · Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA. · National Institute of Health Research, Nottingham Biomedical Research Centre, Nottingham, UK; Nottingham University Hospitals NHS Trust, Nottingham, UK. · Duke Global Health Institute, Durham, NC, USA; SingHealth Duke-National University of Singapore (NUS) Global Health Institute, Singapore. · The Lancet, London, UK. ·Lancet · Pubmed #30827785.

ABSTRACT: -- No abstract --

10 Article Hearing loss and psychiatric disorders: a review. 2019

Blazer, Dan G / Tucci, Debara L. ·Department of Psychiatry and Behavioral Sciences,Duke University School of Medicine, Duke University Medical Center,Durham, NC 27710 Box 3003,USA. · Division of Head and Neck Surgery and Communication Sciences, Department of Surgery,Duke University School of Medicine,Durham, NC 27710 Box 3003,USA. ·Psychol Med · Pubmed #30457063.

ABSTRACT: Hearing loss is one of the most common yet unrecognized impairments experienced by adults, especially as they age. Mental health investigators and practitioners require better understanding of hearing loss, its association with psychiatric disorders, and the treatment of these disorders in the presence of hearing loss as well as the treatment of hearing loss itself. In this review, the authors briefly explore the global burden of hearing loss. Next we provide an overview of the extant literature on hearing loss associated with cognitive impairment, depression, anxiety disorders, psychoses, and quality of life with attention focused on the strength of the association, possible mechanisms explaining the association, data on treatment options specific to these disorders, and future research opportunities for these disorders. Current approaches to the treatment of hearing loss are presented, including hearing aids, rehabilitation including psychotherapies, surgical procedures (specifically cochlear implants), and induction loops connected to telecoils. Finally, cutting edge research into the pathophysiology and potential biological treatments of hearing loss is described.

11 Article Steroid Use for Sudden Sensorineural Hearing Loss: A CHEER Network Study. 2018

Witsell, David L / Mulder, Hillary / Rauch, Steven / Schulz, Kristine A / Tucci, Debara L. ·1 Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA. · 2 Duke Clinical Research Institute, Durham, North Carolina, USA. · 3 Massachusetts Eye & Ear Institute, Boston, Massachusetts, USA. ·Otolaryngol Head Neck Surg · Pubmed #30084293.

ABSTRACT: OBJECTIVE: The objective of this study was to describe patterns of corticosteroid treatment for sudden sensorineural hearing loss and to evaluate effectiveness based on delivery mode (oral vs intratympanic vs both). STUDY DESIGN: Cross-sectional repeated measures. SETTING: Patients were recruited from practices within the Creating Healthcare Excellence through Education and Research (CHEER) Network. CHEER is a National Institutes of Health-funded nationwide network of 30 community and academic otolaryngology practice sites. SUBJECTS AND METHODS: A subset of 117 patients who had been treated with steroids for sudden sensorineural hearing loss were recruited from within a larger initial CHEER Network study on clinical practice guideline compliance. Outcomes included audiometric and speech scores and patient-perceived improvement. Descriptive analyses, Wilcoxon rank-sum tests, and Fisher exact tests were run. RESULTS: Two categories (oral and simultaneous oral + intratympanic) had adequate sample sizes to support statistical comparison of treatment results. Improvements were seen in both audiometry and speech testing scores; 57% of patients self-reported improvement perceived as either minor or major. There were no significant differences in degree of improvement between these treatment groups. CONCLUSIONS: We observed that a majority of steroid-treated patients demonstrated hearing improvement, but this improvement did not meet criteria for statistical significance. As in other studies on this topic, the relatively small sample size may have prevented differentiation of effectiveness among steroid treatments. We propose that the use of alternative approaches, such as pragmatic clinical trials and multidisciplinary electronic health record systems and megadatabases, may hold the most promise for an approach to best practice development.

12 Article Hearing loss on social media: Who is winning hearts and minds? 2018

Crowson, Matthew G / Tucci, Debara L / Kaylie, David. ·Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A. ·Laryngoscope · Pubmed #28988431.

ABSTRACT: OBJECTIVES/HYPOTHESIS: To analyze specific patterns of Twitter usage using common references to hearing loss, and characterize the virtual public that comprises the hearing loss community to inform hearing loss stakeholders for opportunities for engagement and outreach. STUDY DESIGN: Social media network analysis. METHODS: Twitter tweets were sampled from July 2016 to September 2016 using #hearing, #hearingloss, #deaf, #hearingimpairment, #hardofhearing, #deafness, #hearingmatters, #hearinghealth, and #hearingimpaired tags. User and Twitter social community metrics were examined including temporal trends, tweet content, user activity, tweet reach, and an analysis of the tweets' social network. RESULTS: We identified and analyzed 49,208 tweets from July 2016 to September 2016 with tags relevant to hearing loss. Of the 100 most active Twitter accounts, organizations owned 67% compared to 33% owned by individuals. Commercial/for profit and informational organizations were the most common organization account owners (26% and 16%, respectively). Five unique tweets were identified as each having a reach of over 100,000 Twitter users, with the greatest reach exceeding 250,000 users. Temporal analysis identified marked retweet outliers (>300 retweets per hour) that corresponded with a widely publicized event involving the dismissal of a deaf employee from a fast-food chain store. CONCLUSIONS: Twitter accounts owned by organizations outnumbered individual accounts, and commercial/for profit user accounts were the most frequently active organization account type. Tweets pertaining to hearing loss may have a broad reach to a large community base. Analyses of social media use can be helpful in discovering issues of interest to the hearing loss community, as well as determining which users and organizations are dominating social network conversations. LEVEL OF EVIDENCE: NA. Laryngoscope, 128:1453-1461, 2018.

13 Article The Growing-and Now Alarming-Burden of Hearing Loss Worldwide. 2017

Tucci, Debara L / Wilson, Blake S / O'Donoghue, Gerard M. ·Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina National Institute of Health Research, Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK. ·Otol Neurotol · Pubmed #29065094.

ABSTRACT: -- No abstract --

14 Article Provincial Variation of Cochlear Implantation Surgical Volumes and Cost in Canada. 2017

Crowson, Matthew G / Chen, Joseph M / Tucci, Debara. ·1 Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, USA. · 2 Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Center, Toronto, Canada. ·Otolaryngol Head Neck Surg · Pubmed #27650806.

ABSTRACT: Objectives To investigate provincial cochlear implantation (CI) annual volume and cost trends. Study Design Database analysis. Setting National surgical volume and cost database. Subjects and Methods Aggregate-level provincial CI volumes and cost data for adult and pediatric CI surgery from 2005 to 2014 were obtained from the Canadian Institute for Health Information. Population-level aging forecast estimates were obtained from the Ontario Ministry of Finance and Statistics Canada. Linear fit, analysis of variance, and Tukey's analyses were utilized to compare variances and means. Results The national volume of annual CI procedures is forecasted to increase by <30 per year ( R

15 Article Moving Beyond GDP: Cost Effectiveness of Cochlear Implantation and Deaf Education in Latin America. 2016

Emmett, Susan D / Tucci, Debara L / Bento, Ricardo F / Garcia, Juan M / Juman, Solaiman / Chiossone-Kerdel, Juan A / Liu, Ta J / de Muñoz, Patricia Castellanos / Ullauri, Alejandra / Letort, Jose J / Mansilla, Teresita / Urquijo, Diana P / Aparicio, Maria L / Gong, Wenfeng / Francis, Howard W / Saunders, James E. ·*Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine †Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A. ‡Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A. §Department of Otolaryngology, University of Sao Paulo, Sao Paulo, Brazil ||Section of Otolaryngology, Santa Fe of Bogota Foundation, Bogota ¶Division of Otology and Neurotology, University of Health Sciences Foundation, FUCS, Bogota, Colombia #Division of Otolaryngology, Department of Surgery, University of the West Indies, St. Augustine, Trinidad **Cochlear Implant Department, Venezuelan Foundation of Otology, Caracas, Venezuela ††Department of Otolaryngology, National University of Asuncion, Asuncion ‡‡Catholic University of Asuncion, Asuncion, Paraguay §§CEDAF, Hearing Center, Guatemala City, Guatemala ||||Chicago Hearing Care, Chicago, Illinois, U.S.A. ¶¶Otolaryngology Center, Quito, Ecuador ***Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, U.S.A. ·Otol Neurotol · Pubmed #27518131.

ABSTRACT: HYPOTHESIS: Cochlear implantation (CI) and deaf education are cost effective management strategies of childhood profound sensorineural hearing loss in Latin America. BACKGROUND: CI has been widely established as cost effective in North America and Europe and is considered standard of care in those regions, yet cost effectiveness in other economic environments has not been explored. With 80% of the global hearing loss burden existing in low- and middle-income countries, developing cost effective management strategies in these settings is essential. This analysis represents the continuation of a global assessment of CI and deaf education cost effectiveness. METHODS: Brazil, Colombia, Ecuador, Guatemala, Paraguay, Trinidad and Tobago, and Venezuela participated in the study. A Disability Adjusted Life Years model was applied with 3% discounting and 10-year length of analysis. Experts from each country supplied cost estimates from known costs and published data. Sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost effectiveness was determined using the World Health Organization standard of cost effectiveness ratio/gross domestic product per capita (CER/GDP)<3. RESULTS: Deaf education was very cost effective in all countries (CER/GDP 0.07-0.93). CI was cost effective in all countries (CER/GDP 0.69-2.96), with borderline cost effectiveness in the Guatemalan sensitivity analysis (Max CER/GDP 3.21). CONCLUSION: Both cochlear implantation and deaf education are widely cost effective in Latin America. In the lower-middle income economy of Guatemala, implant cost may have a larger impact. GDP is less influential in the middle- and high-income economies included in this study.

16 Article Access to and Uptake of Cochlear Implantation Among Children in North Carolina. 2016

Alberg, Joni / Crowson, Matthew G / Tucci, Debara L. ·consultant, Yale Alberg & Associates; former executive director (1999-2014), BEGINNINGS, Raleigh, North Carolina. · resident physician in otolaryngology, Head and Neck Surgery Residency Program, Duke University Medical Center, Durham, North Carolina. · director, Duke Cochlear Implant Program, Duke University Medical Center, Durham, North Carolina debara.tucci@duke.edu. ·N C Med J · Pubmed #27422943.

ABSTRACT: BACKGROUND: Cochlear implantation (CI) is a highly effective intervention for children with advanced hearing loss who cannot benefit from amplification. Despite the established benefits of CI, it is likely that not all children who are potential candidates for CI receive this intervention. The purpose of this study was to determine the percentage of North Carolina children who are candidates for and end up undergoing CI, and to detect whether barriers exist that prevent access to care for unimplanted candidates. METHODS: This study was a retrospective analysis of 1,501 children whose families were served by BEGINNINGS from January 1, 2009 through December 31, 2013. All families of children identified as potential CI candidates who were able to participate in the study (n = 141) were contacted by BEGINNINGS parent educators who queried parents about their child's use of technology and any reasons for lack of use of technology. RESULTS: Overall, 60.9% of children diagnosed with profound, severe-profound, severe, moderate-severe, or moderate-profound hearing loss received at least 1 cochlear implant. For children with profound hearing loss, 88.9% had a least 1 cochlear implant. Common reasons for the decision not to perform CI included parental preference and anatomical issues unfavorable to CI. LIMITATIONS: Some information was not included in the database, including socioeconomic status and the child's age at the time of intervention. CONCLUSION: The rate of CI for North Carolina children who have advanced hearing loss is greater than 60% and significantly higher for children with greater degrees of impairment. No significant financial or geographic barriers to CI were identified. We hypothesize that the high rate of CI for appropriate candidates in North Carolina is due in part to parental access to counseling and education provided through BEGINNINGS.

17 Article Evaluation of Compliance for Treatment of Sudden Hearing Loss: A CHEER Network Study. 2016

Witsell, David L / Khoury, Tawfiq / Schulz, Kristine A / Stachler, Robert / Tucci, Debara L / Wojdyla, Daniel. ·Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA David.witsell@duke.edu. · Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA. · Henry Ford Medical Group, Detroit, Michigan, USA. · Duke Clinical Research Institute, Durham, North Carolina, USA. ·Otolaryngol Head Neck Surg · Pubmed #27371626.

ABSTRACT: OBJECTIVE: The objective of this study is to describe the presentation and management of sudden sensorineural hearing loss for patients seen in academic and community-based practices within the context of the American Academy of Otolaryngology-Head and Neck Surgery Foundation's "Clinical Practice Guideline: Sudden Hearing Loss." The intention is to use these findings to guide implementation strategies and quality improvement initiatives and as pilot data for the development of clinical research initiatives. STUDY DESIGN: A cross-sectional study of patients with sudden hearing loss. SETTING: Patients were recruited from practices within the Creating Healthcare Excellence through Education and Research (CHEER) network. The CHEER network is an National Institutes of Health-funded network of 30 otolaryngology sites across the country, half of which are community based and half of which are academic practices. SUBJECTS AND METHODS: A total of 173 patients were recruited. Data were gathered via custom questionnaires collected by study site coordinators and entered into a secure online platform. Descriptive analyses and correlation statistics were run with SAS 9.3.1. RESULTS: Of the 13 guideline statements in the American Academy of Otolaryngology-Head and Neck Surgery Foundation's clinical practice guideline on sudden hearing loss, 11 statements were evaluable through this study. Compliance for otolaryngologists was >95% for key action statements (KASs) 1, 3, and 6; 90% to 95% for KASs 5 and 10; and <90% for KASs 7 and 13. Compliance was <45% for nonotolaryngologists for KASs 3 and 5-7. CONCLUSIONS: There is opportunity for nonotolaryngologists to improve for statements 3 and 5-7. Otolaryngologists are compliant with many of the KASs overall, but there is significant room for improvement.

18 Article GDP Matters: Cost Effectiveness of Cochlear Implantation and Deaf Education in Sub-Saharan Africa. 2015

Emmett, Susan D / Tucci, Debara L / Smith, Magteld / Macharia, Isaac M / Ndegwa, Serah N / Nakku, Doreen / Mukara, Kaitesi B / Ibekwe, Titus S / Mulwafu, Wakisa / Gong, Wenfeng / Francis, Howard W / Saunders, James E. ·*Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine; †Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A.; ‡Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A.; §Department of Otorhinolaryngology-Head and Neck Surgery, University of the Free State, Bloemfontein, South Africa; ∥Department of Surgery, University of Nairobi, Nairobi, Kenya; ¶Mbarara University of Science and Technology, Mbarara, Uganda; **University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda; ††Department of ENT, University of Abuja and the University of Abuja Teaching Hospital, Abuja, Nigeria; ‡‡Department of Surgery, University of Malawi College of Medicine, Blantyre, Malawi; and §§Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, U.S.A. ·Otol Neurotol · Pubmed #26244622.

ABSTRACT: HYPOTHESIS: Cochlear implantation and deaf education are cost effective in Sub-Saharan Africa. BACKGROUND: Cost effectiveness of pediatric cochlear implantation has been well established in developed countries but is unknown in low resource settings, where access to the technology has traditionally been limited. With incidence of severe-to-profound congenital sensorineural hearing loss 5 to 6 times higher in low/middle-income countries than the United States and Europe, developing cost-effective management strategies in these settings is critical. METHODS: Costs were obtained from experts in Nigeria, South Africa, Kenya, Rwanda, Uganda, and Malawi using known costs and published data, with estimation when necessary. A disability adjusted life years (DALY) model was applied using 3% discounting and 10-year length of analysis. Sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost effectiveness was determined using the WHO standard of cost-effectiveness ratio/gross domestic product per capita (CER/GDP) less than 3. RESULTS: Cochlear implantation was cost effective in South Africa and Nigeria, with CER/GDP of 1.03 and 2.05, respectively. Deaf education was cost effective in all countries investigated, with CER/GDP ranging from 0.55 to 1.56. The most influential factor in the sensitivity analysis was device cost, with the cost-effective threshold reached in all countries using discounted device costs that varied directly with GDP. CONCLUSION: Cochlear implantation and deaf education are equally cost effective in lower-middle and upper-middle income economies of Nigeria and South Africa. Device cost may have greater impact in the emerging economies of Kenya, Uganda, Rwanda, and Malawi.

19 Article Cost Effectiveness of Childhood Cochlear Implantation and Deaf Education in Nicaragua: A Disability Adjusted Life Year Model. 2015

Saunders, James E / Barrs, David M / Gong, Wenfeng / Wilson, Blake S / Mojica, Karen / Tucci, Debara L. ·*Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, U.S.A.; †Department of Otolaryngology, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A.; ‡Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A.; §Duke University, Research Triangle Park, Durham, North Carolina, U.S.A.; ∥Department of Otolaryngology, Hospital Central Managua, Managua, Nicaragua; and ¶Duke University Medical Center, Durham, North Carolina, U.S.A. ·Otol Neurotol · Pubmed #26171672.

ABSTRACT: INTRODUCTION: Cochlear implantation (CI) is a common intervention for severe-to-profound hearing loss in high-income countries, but is not commonly available to children in low resource environments. Owing in part to the device costs, CI has been assumed to be less economical than deaf education for low resource countries. The purpose of this study is to compare the cost effectiveness of the two interventions for children with severe-to-profound sensorineural hearing loss (SNHL) in a model using disability adjusted life years (DALYs). METHODS: Cost estimates were derived from published data, expert opinion, and known costs of services in Nicaragua. Individual costs and lifetime DALY estimates with a 3% discounting rate were applied to both two interventions. Sensitivity analysis was implemented to evaluate the effect on the discounted cost of five key components: implant cost, audiology salary, speech therapy salary, number of children implanted per year, and device failure probability. RESULTS: The costs per DALY averted are $5,898 and $5,529 for CI and deaf education, respectively. Using standards set by the WHO, both interventions are cost effective. Sensitivity analysis shows that when all costs set to maximum estimates, CI is still cost effective. CONCLUSION: Using a conservative DALY analysis, both CI and deaf education are cost-effective treatment alternatives for severe-to-profound SNHL. CI intervention costs are not only influenced by the initial surgery and device costs but also by rehabilitation costs and the lifetime maintenance, device replacement, and battery costs. The major CI cost differences in this low resource setting were increased initial training and infrastructure costs, but lower medical personnel and surgery costs.

20 Article Restoring synaptic connections in the inner ear after noise damage. 2015

Cunningham, Lisa L / Tucci, Debara L. · ·N Engl J Med · Pubmed #25564901.

ABSTRACT: -- No abstract --

21 Article Choice of ear for cochlear implantation: implant the better- or worse-hearing ear? 2015

Patki, Aniruddha / Tucci, Debara L. ·Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Duke University, Durham, North Carolina, U.S.A. ·Laryngoscope · Pubmed #25303740.

ABSTRACT: -- No abstract --

22 Article Evaluation of preoperative hearing-in-noise protocol for osseointegrated hearing implants. 2013

Whited, Chad W / Unrein, Sara C / Tucci, Debara L / Kaylie, David M. ·Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Duke University Hospital, Durham, North Carolina 27710, USA. chad.w.whited@gmail.com ·Otol Neurotol · Pubmed #23820797.

ABSTRACT: OBJECTIVE: Evaluate the clinical use of a preoperative protocol using hearing-in-noise improvement as measured by Adaptive HINT and Quick SIN in patients undergoing ossseointegrated hearing implantation for single-sided deafness (SSD). STUDY DESIGN: Prospective cohort. SETTING: Tertiary academic hospital and clinic. PATIENTS: All consecutive English-speaking patients with SSD undergoing osseointegrated hearing implantation whom we have preoperative and postoperative Quick SIN and Adaptive HINT measurements. INTERVENTIONS: Measure preoperative unaided and aided (headband simulator) hearing-in-noise ratio improvement and compare with postoperative results. MAIN OUTCOME MEASURES: The improvement in hearing-in-noise in preoperative unaided to aided and then correlate to postoperative hearing-in-noise results. RESULTS: Total of 12 patients participated in the study. There was a statistically significant improvement from preoperative unaided Quick SIN and Adaptive HINT scores to preoperative aided scores (p = 0.001 and p = 0.004). There was statistically significant improvement from preoperative unaided Quick SIN and adaptive HINT to postoperative implant scores (p = 0.002 and p = 0.003). Comparing preoperative aided with postoperative implant aided, there demonstrated a significant improvement in QuickSIN with -2.7 SNR (p = 0.045) and in HINT with -2.35 dB (p = 0.05). CONCLUSION: This is the first study evaluating a preoperative protocol using both Quick SIN and Adaptive HINT testing for osseointegrated hearing implantation. Postoperatively, there was a statistically significant improvement in both of the hearing-in-noise measures. There was significant correlation between the preoperative simulator and postoperative hearing-in-noise measures signifying the benefit of using Quick SIN and HINT as a predictive preoperative tool to evaluate surgical candidacy and improve patient education and expectations.

23 Article Management of hearing in pediatric NF2. 2012

Shepard, Taylor H / Tucci, Debara L / Grant, Gerald A / Kaylie, David M. ·Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA. ·Otol Neurotol · Pubmed #22710553.

ABSTRACT: OBJECTIVE: This study will demonstrate an individualized approach to hearing preservation and tumor management in pediatric patients with neurofibromatosis type 2 (NF2). The unique nature of each case discussed will provide valuable guiding principles for the treating surgeon. PATIENTS: Pediatric patients under the care of the senior authors presenting with bilateral vestibular schwannoma and NF2. INTERVENTIONS: Interventions used for hearing optimization, in conjunction with surgical interventions, include use of hearing aids, cochlear implants, auditory brainstem implants, radiation therapy, and chemotherapeutic agents such as bevacizumab. RESULTS: Pediatric patients with NF2 present a unique and difficult challenge to the neurotologist. These children are still developing physically, mentally, and socially. They generally have a poorer prognosis and diminished life expectancy. Considerations of utmost importance include management of the tumor with the goal of minimizing outcomes such as significant bilateral hearing loss, facial paralysis, and injury to other cranial nerves, which would be detrimental to the quality of life. These patients are best served by a team of physicians who can provide individualized patient care. The team can proactively develop the treatment strategy before initial tumor resection. MAIN OUTCOME MEASURES: Hearing results, tumor control. CONCLUSION: Each patient with NF2 is unique; methods to preserve hearing must be individually tailored to preserve optimal hearing and avoid disruption of the development of the pediatric patient.

24 Article The Otology Data Collection project: report from the CHEER network. 2011

Witsell, David L / Rauch, Steven D / Tucci, Debara L / Telian, Steven A / Roland, Peter S / Nguyen-Huynh, Anh T / Schulz, Kristine. ·Duke University Medical Center, Durham, North Carolina 27710, USA. david.witsell@duke.edu ·Otolaryngol Head Neck Surg · Pubmed #21771950.

ABSTRACT: OBJECTIVE: To describe and communicate data collected in the CHEER (Creating Healthcare Excellence through Education and Research) infrastructure proof-of-concept study to facilitate understanding of the potential capabilities of practice-based research networks and to present pilot data for development of future research initiatives. STUDY DESIGN: Prospective observational study of CHEER infrastructure operational capacity using a convenience sample of all patients presenting to the practices with tinnitus, dizziness, or a combination of these symptoms. SETTING: The CHEER network of community and academic practice sites. SUBJECTS AND METHODS: The data collection exercise collected demographic, clinical, treatment, and health-related quality-of-life surveys on tinnitus, dizziness, and migraine disorders. Descriptive analysis of the data is presented. RESULTS: Of the sites in the CHEER network, 73% (16/22) successfully enrolled subjects; a total of 1532 patients were enrolled in 8 months. Tinnitus alone, dizziness alone, and both occurred in 28%, 34%, and 29%, respectively. Patients complaining of tinnitus and dizziness had lower quality of life than those sufferers with 1 disorder. Migraine was associated with 27% of patients. The most frequent diagnoses for patients with tinnitus and dizziness were Ménière disease (34%), vertiginous migraine (18%), and benign paroxysmal positional vertigo (16%). CONCLUSION: Descriptive data on patients with common disorders can be rapidly collected within the framework of a practice-based research network. The data in this study provide valuable pilot information on the targeted disorders, providing a baseline for development of future epidemiological data and clinical trials.

25 Article Implementation and testing of research infrastructure for practice-based research in hearing and communication disorders. 2011

Witsell, David L / Schulz, Kristine A / Moore, Kathy / Tucci, Debara L / Anonymous1070695. ·Duke University Medical Center, Durham, North Carolina 27710, USA. david.witsell@duke.edu ·Otolaryngol Head Neck Surg · Pubmed #21593460.

ABSTRACT: OBJECTIVE: To describe site capability and experience of the CHEER network (Creating Healthcare Excellence through Education and Research) to rapidly collect descriptive data on patients with tinnitus and dizziness visiting participating CHEER sites. STUDY DESIGN: Prospective observational data collection study over 6 months. SETTING: Twenty one community otology and otolaryngology practices in the United States. SUBJECTS AND METHODS: As proof of concept, a data collection study was developed for patients with tinnitus and dizziness (presenting with or without associated migraine) through a collaborative effort of the CHEER principal investigator (PI) and co-PIs. The 9-page questionnaire included validated instruments and additional patient- and physician-reported information. Information was captured electronically via REDCap by each site's CHEER research coordinator. Site initiation, data entry rates, and research coordinator feedback were also collected. RESULTS: Of the 21 CHEER sites, 15 participated in the study. Nine sites entered a patient within the first 31 days of study initiation, and all 15 sites were entering patients and corresponding clinical data within 72 days. During the 6-month study, 1044 patients were entered into the REDCap database. Research coordinator engagement was a major driver for success, whereas time and resources were deterrents. Incentives included altruism, professional development, and future financial opportunities. CONCLUSION: The CHEER research network has significant capability and infrastructure to collect prospective data in a practice-based environment. Research coordinator engagement undergirds network success; however, future efforts will cultivate stronger collaboration of the coordinator and site PI. Central coordination of practice-based research through a hub and spoke concept can be successful.

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