Background The impact of COVID-19 on physical and mental health and employment after hospitalisation with acute disease is not well understood. The aim of this study was to determine the effects of COVID-19-related hospitalisation on health and employment, to identify factors associated with recovery, and to describe recovery phenotypes. MethodsThe Post-hospitalisation COVID-19 study (PHOSP-COVID) is a multicentre, long-term follow-up study of adults (aged ≥18 years) discharged from hospital in the UK with a clinical diagnosis of COVID-19, involving an assessment between 2 and 7 months after discharge, including detailed recording of symptoms, and physiological and biochemical testing. Multivariable logistic regression was done for the primary outcome of patient-perceived recovery, with age, sex, ethnicity, body-mass index, comorbidities, and severity of acute illness as covariates. A posthoc cluster analysis of outcomes for breathlessness, fatigue, mental health, cognitive impairment, and physical performance was done using the clustering large applications k-medoids approach. The study is registered on the ISRCTN Registry (ISRCTN10980107). Findings We report findings for 1077 patients discharged from hospital between March 5 and Nov 30, 2020, who underwent assessment at a median of 5•9 months (IQR 4•9-6•5) after discharge. Participants had a mean age of 58 years (SD 13); 384 (36%) were female, 710 (69%) were of white ethnicity, 288 (27%) had received mechanical ventilation, and 540 (50%) had at least two comorbidities. At follow-up, only 239 (29%) of 830 participants felt fully recovered, 158 (20%) of 806 had a new disability (assessed by the Washington Group Short Set on Functioning), and 124 (19%) of 641 experienced a health-related change in occupation. Factors associated with not recovering were female sex, middle age (40-59 years), two or more comorbidities, and more severe acute illness. The magnitude of the persistent health burden was substantial but only weakly associated with the severity of acute illness. Four clusters were identified with different severities of mental and physical health impairment (n=767): very severe (131 patients, 17%), severe (159, 21%), moderate along with cognitive impairment (127, 17%), and mild (350, 46%). Of the outcomes used in the cluster analysis, all were closely related except for cognitive impairment. Three (3%) of 113 patients in the very severe cluster, nine (7%) of 129 in the severe cluster, 36 (36%) of 99 in the moderate cluster, and 114 (43%) of 267 in the mild cluster reported feeling fully recovered. Persistently elevated serum C-reactive protein was positively associated with cluster severity.Interpretation We identified factors related to not recovering after hospital admission with COVID-19 at 6 months after discharge (eg, female sex, middle age, two or more comorbidities, and more acute severe illness), and four different recovery phenotypes. The severity of physical and mental health impairments were closely related, whereas cognitive health impairments w...

It has been suggested that visual language is maladaptive for hearing restoration with a cochlear implant (CI) due to cross-modal recruitment of auditory brain regions. Rehabilitative guidelines therefore discourage the use of visual language. However, neuroscientific understanding of cross-modal plasticity following cochlear implantation has been restricted due to incompatibility between established neuroimaging techniques and the surgically implanted electronic and magnetic components of the CI. As a solution to this problem, here we used functional near-infrared spectroscopy (fNIRS), a noninvasive optical neuroimaging method that is fully compatible with a CI and safe for repeated testing. The aim of this study was to examine cross-modal activation of auditory brain regions by visual speech from before to after implantation and its relation to CI success. Using fNIRS, we examined activation of superior temporal cortex to visual speech in the same profoundly deaf adults both before and 6 mo after implantation. Patients' ability to understand auditory speech with their CI was also measured following 6 mo of CI use. Contrary to existing theory, the results demonstrate that increased cross-modal activation of auditory brain regions by visual speech from before to after implantation is associated with better speech understanding with a CI. Furthermore, activation of auditory cortex by visual and auditory speech developed in synchrony after implantation. Together these findings suggest that cross-modal plasticity by visual speech does not exert previously assumed maladaptive effects on CI success, but instead provides adaptive benefits to the restoration of hearing after implantation through an audiovisual mechanism. cochlear implantation | cross-modal plasticity | functional near-infrared spectroscopy | superior temporal cortex | visual speech

Compared with unilateral cochlear implantation, bilateral implantation is associated with better listening skills in severely-profoundly deaf children.

A note on versions:The version presented here may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the repository url above for details on accessing the published version and note that access may require a subscription. T A B L E O F C O N T E N T S A B S T R A C TThis is the protocol for a review and there is no abstract. The objectives are as follows:To evaluate the effectiveness of hearing aids for mild to moderate hearing loss in adults who have been prescribed at least one hearing aid. B A C K G R O U N D Description of the conditionHearing loss is the most prevalent sensory deficit (Mathers 2000); it represents a major public health issue with substantial economical and societal costs. Untreated, adult hearing loss results in communication difficulties that can lead to social isolation and withdrawal, depression and reduced quality of life (Davis 2007). Hearing loss is also associated with an increased risk of dementia (Lin 2011). According to the World Health Organization hearing loss is the 13th most common global disease burden and the third leading cause of years living with disease (WHO 2008). Disabling hearing loss is estimated to affect 360 million persons globally (5.3% of the world's population) (WHO 2012a). The prevalence of hearing loss increases with age (Akeroyd 2014), and given the ageing society it is predicted that by 2030 adult-onset hearing loss will be the seventh largest disease burden, above diabetes and human immunodeficiency virus (HIV) (WHO 2008). Epidemiological data suggest that the majority of cases of hearing loss in adults are sensorineural (92%) and bilateral (94.8%) (Cruickshanks 1998). There are numerous definitions of hearing loss across different countries and organisations (Timmer 2015). In this review, hearing loss is defined according to pure-tone thresholds averaged across 0.5 kHz, 1.0 kHz, 2.0 kHz and 4.0 kHz in the better-hearing ear, consistent with the World Health Organization grades of hearing impairment (Mathers 2000). The majority of hearing losses (92%) are those that are defined as mild or moderate (AoHL 2015). Mild (or slight) hearing loss is indicated as 26 to 40 dB hearing level (HL) and described as the ability to hear and repeat words spoken in a normal voice at one metre. Moderate hearing loss is indicated as 41 to 60 dB HL and described as the ability to hear and repeat words using a raised voice at one metre (Mathers 2000). In addition to a loss of hearing sensitivity, there may be additional sensory deficits of temporal and spectral pro-

No abstract

Objectives:A systematic review of the literature and meta-analysis was conducted to assess the nature and quality of the evidence for the use of hearing instruments in adults with a unilateral severe to profound sensorineural hearing loss.Design:The PubMed, EMBASE, MEDLINE, Cochrane, CINAHL, and DARE databases were searched with no restrictions on language. The search included articles from the start of each database until February 11, 2015. Studies were included that (a) assessed the impact of any form of hearing instrument, including devices that reroute signals between the ears or restore aspects of hearing to a deaf ear, in adults with a sensorineural severe to profound loss in one ear and normal or near-normal hearing in the other ear; (b) compared different devices or compared a device with placebo or the unaided condition; (c) measured outcomes in terms of speech perception, spatial listening, or quality of life; (d) were prospective controlled or observational studies. Studies that met prospectively defined criteria were subjected to random effects meta-analyses.Results:Twenty-seven studies reported in 30 articles were included. The evidence was graded as low-to-moderate quality having been obtained primarily from observational before-after comparisons. The meta-analysis identified statistically significant benefits to speech perception in noise for devices that rerouted the speech signals of interest from the worse ear to the better ear using either air or bone conduction (mean benefit, 2.5 dB). However, these devices also degraded speech understanding significantly and to a similar extent (mean deficit, 3.1 dB) when noise was rerouted to the better ear. Data on the effects of cochlear implantation on speech perception could not be pooled as the prospectively defined criteria for meta-analysis were not met. Inconsistency in the assessment of outcomes relating to sound localization also precluded the synthesis of evidence across studies. Evidence for the relative efficacy of different devices was sparse but a statistically significant advantage was observed for rerouting speech signals using abutment-mounted bone conduction devices when compared with outcomes after preoperative trials of air conduction devices when speech and noise were colocated (mean benefit, 1.5 dB). Patients reported significant improvements in hearing-related quality of life with both rerouting devices and following cochlear implantation. Only two studies measured health-related quality of life and findings were inconclusive.Conclusions:Devices that reroute sounds from an ear with a severe to profound hearing loss to an ear with minimal hearing loss may improve speech perception in noise when signals of interest are located toward the impaired ear. However, the same device may also degrade speech perception as all signals are rerouted indiscriminately, including noise. Although the restoration of functional hearing in both ears through cochlear implantation could be expected to provide benefits to speech perception, the inability to ...

A note on versions:The version presented here may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the repository url above for details on accessing the published version and note that access may require a subscription. T A B L E O F C O N T E N T S A B S T R A C TThis is the protocol for a review and there is no abstract. The objectives are as follows:To evaluate the effectiveness of hearing aids for mild to moderate hearing loss in adults who have been prescribed at least one hearing aid. B A C K G R O U N D Description of the conditionHearing loss is the most prevalent sensory deficit (Mathers 2000); it represents a major public health issue with substantial economical and societal costs. Untreated, adult hearing loss results in communication difficulties that can lead to social isolation and withdrawal, depression and reduced quality of life (Davis 2007). Hearing loss is also associated with an increased risk of dementia (Lin 2011). According to the World Health Organization hearing loss is the 13th most common global disease burden and the third leading cause of years living with disease (WHO 2008). Disabling hearing loss is estimated to affect 360 million persons globally (5.3% of the world's population) (WHO 2012a). The prevalence of hearing loss increases with age (Akeroyd 2014), and given the ageing society it is predicted that by 2030 adult-onset hearing loss will be the seventh largest disease burden, above diabetes and human immunodeficiency virus (HIV) (WHO 2008). Epidemiological data suggest that the majority of cases of hearing loss in adults are sensorineural (92%) and bilateral (94.8%) (Cruickshanks 1998). There are numerous definitions of hearing loss across different countries and organisations (Timmer 2015). In this review, hearing loss is defined according to pure-tone thresholds averaged across 0.5 kHz, 1.0 kHz, 2.0 kHz and 4.0 kHz in the better-hearing ear, consistent with the World Health Organization grades of hearing impairment (Mathers 2000). The majority of hearing losses (92%) are those that are defined as mild or moderate (AoHL 2015). Mild (or slight) hearing loss is indicated as 26 to 40 dB hearing level (HL) and described as the ability to hear and repeat words spoken in a normal voice at one metre. Moderate hearing loss is indicated as 41 to 60 dB HL and described as the ability to hear and repeat words using a raised voice at one metre (Mathers 2000). In addition to a loss of hearing sensitivity, there may be additional sensory deficits of temporal and spectral pro-

The benefits of prior information about who would speak, where they would be located, and when they would speak were measured in a multi-talker spatial-listening task. On each trial, a target phrase and several masker phrases were allocated to 13 loudspeakers in a 180 degrees arc, and to 13 overlapping time slots, which started every 800 ms. Speech-reception thresholds (SRTs) were measured as the level of target relative to masker phrases at which listeners reported key words at 71% correct. When phases started in pairs all three cues were beneficial ("who" 3.2 dB, "where" 5.1 dB, and "when" 0.3 dB). Over a range of onset asynchronies, SRTs corresponded consistently to a signal-to-noise ratio (SNR) of -2 dB at the start of the target phrase. When phrases started one at a time, SRTs fell to a SNR of -8 dB and were improved significantly, but only marginally, by constraining "who" (1.9 dB), and not by constraining "where" (1.0 dB) or "when" (0.01 dB). Thus, prior information about "who," "where," and "when" was beneficial, but only when talkers started speaking in pairs. Low SRTs may arise when talkers start speaking one at a time because of automatic orienting to phrase onsets and/or the use of loudness differences to distinguish target from masker phrases.