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گايدلاين اديولوژي آمريكا در خصوص بيماران دچار كم شنوايي حسي عصبي شديد تا عميق
Adult Patients with Severe-to-Profound Unilateral Sensorineural Hearing Loss
سال ارائه مقاله : 2015// سال پذيرش : 2015// نوع مقاله : Guide Line دسته بندي :
This practice guideline was prepared by the American Academy of Audiology (the Academy) task force on Adult Patients
with Severe-to-Profound Unilateral Sensorineural Hearing Loss (USNHL). The specific goal of this guideline is to provide
a set of statements, recommendations, and strategies for best practice in the provision of a comprehensive treatment
plan for the audiological management of adults with severe-to-profound USNHL. Specific statements and recommendations
were made by initially reviewing the existing scientific evidence published in peer-reviewed and non-peer-reviewed
journals. When direct evidence (i.e., evidence directly relating clinical procedures to the principal health outcomes) was
not available, both indirect evidence, which involves examining two or more bodies of evidence to relate the clinical procedures
to the principal health outcomes,1 and consensus practice were considered in making recommendations.
This guideline addresses the technical aspects of hearing device selection, fitting, verification, validation, and counseling
within the context of a comprehensive treatment plan. In the process of making specific statements, recommendations,
and strategies, careful consideration was given to the elements of care that optimize patient outcomes.
The primary effects of hearing loss are addressed by the World Health Organization International Classification of Functioning,
Disability, and Health (WHO-ICF) Classification b230, which relates to hearing function, specifically the function
of sensing the presence of sounds and discriminating the location, pitch, loudness, and quality of sounds.2 Thus, the
primary objective outcome measure for hearing device use is to assess the effects of the treatment in terms of improving
hearing function, a process often referred to by audiologists as “verification.” Examples of verification might include
real ear measures, measures of speech recognition in quiet and noise, measures of loudness discomfort or aided sound
The presence of a hearing loss can result in activity limitations and participation restrictions as described in the ICF
classification scheme.2 For example, a patient with hearing loss may have difficulties in receiving spoken messages (ICF
Classification d310), engaging effectively in conversations (ICF Classification d350), learning through listening (ICF Classification
d115), remunerative employment (ICF Classification d850), engaging in some forms of recreation and leisure (ICF
Classification d920), attending religious services (ICF Classification d320), and so forth. Both environmental (i.e., external)
factors that include the physical, social, and attitudinal environment in which patients live and patient (i.e., internal) factors,
or those features of the patient that are not part of a particular health condition or state, will influence the effect of
the impairment, activity limitations, and participation restrictions on the health-related quality of life (QOL) of a patient who
has a hearing loss.3
If a hearing device or devices and other hearing assistive technology (HAT) are successful in reducing a hearing loss,
activity limitations and participation restrictions related to communication also should be alleviated. Improvements in
QOL occur when activity limitations and participation restrictions are reduced. When the audiological management
of hearing loss is placed within a comprehensive rehabilitative approach, outcomes of a hearing device are also measured
in terms of activity, participation, and QOL. Audiologists often refer to the outcome measured in these domains
as “validation” of treatment. Measures of validation are typically in the form of questionnaires, interviews, and/or profiles.
Examples might include measures of benefit and/or satisfaction, expectations, changes in activity limitations, changes in
handicap, ease of use, and subjective changes in the ability to localize.