%0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e58197 %T Evaluation of Comparative Efficacy of Polyherbal Steam Inhalation Versus Polyherbal Nasal Fumigation (Dhoopana) in Children With Rhinitis (Pratishyaya): Protocol for an Open-Label Randomized Controlled Trial %A Kakar,Monika %A Rathi,Renu %A Balakrishnan,Deepthi %A Rathi,Bharat %+ Deptartment of Kaumarbhritya, Mahatma Gandhi Ayurveda College Hospital & Research Centre, Salod (H), Wardha, Maharashtra, 442001, India, 91 9711728156, ayurmonika@gmail.com %K pratishyaya %K Ayurveda %K allergic rhinitis %K rhinitis %K dhoopana %K nasal fumigation %K steam inhalation %K polyherbal %K vasa %K nirgundi %K nilgiri %K tulsi %K sneezing %K nasal cavity %K nasal decongestants %K evaluation %K efficacy %K child %K adolescent %K randomized controlled trial %D 2025 %7 21.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Rhinitis is a condition characterized by inflammation of the nasal mucosa. It causes obstruction and congestion in the nasal cavity. Clinically, it resembles pratishyaya (rhinitis) in Ayurveda, which is caused by accumulation and downward movement of the tridoshas (3 elements, named vata, pitta, and kapha) in the nasal cavity. Rhinitis is one of the most common diseases among children. There is no role for antibiotics in rhinitis, and nasal decongestants have also not been found to be effective in its management. In Ayurveda, dhoopana (nasal fumigation) is mentioned in the pratishyaya treatment protocol. However, we have found no previous study regarding its efficacy. The efficacy of tulsi, vasa, nirgundi, and nilgiri is already proven when they are used for steam inhalation in respiratory tract infections. Therefore, in this study, a dhoopana of a polyherbal formulation containing tulsi, vasa, nirgundi, and nilgiri will be compared with the inhalation of steam containing arka (a liquid obtained by distillation) of tulsi, vasa, nirgundi, and nilgiri leaves in children with pratishyaya. Objective: We aim to evaluate the efficacy of polyherbal steam inhalation as a standard control against dhoopana in children aged 7 to 14 years with pratishyaya. Methods: A total of 70 participants fulfilling the inclusion criteria were selected and distributed into 2 groups of 35 each. The intervention group received dhoopana and the control group received polyherbal steam inhalation, both twice daily for 7 days. The primary outcome measure was the change in Total Nasal Symptom Score and a modified cold spatula test. At the same time, the association between prakriti (body constitution) and the prevalence of pratishyaya in children was analyzed as a secondary outcome. Assessments were performed on days 3, 5, and 7, with a follow-up time of 28 days. Appropriate descriptive and inferential statistics will be used for data analysis. Results: As of November 2024, we have completed our enrollment of 70 patients, with 35 patients in each group. Data analysis will be completed by February 2025, and we expect results to be published in March 2025. Conclusions: We anticipate that polyherbal nasal fumigation will be found to be equally as effective as polyherbal steam inhalation in the management of acute rhinitis in the pediatric population. This study may provide a standardized, herbal, safe, and cost-effective treatment for rhinitis in children in the form of dhoopana. International Registered Report Identifier (IRRID): DERR1-10.2196/58197 %M 39983110 %R 10.2196/58197 %U https://www.researchprotocols.org/2025/1/e58197 %U https://doi.org/10.2196/58197 %U http://www.ncbi.nlm.nih.gov/pubmed/39983110 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e67036 %T Device Failures and Adverse Events Associated With Rhinolaryngoscopes: Analysis of the Manufacturer and User Facility Device Experience (MAUDE) Database %A Chang,Shao-Hsuan %A Chen,Daishi %A Chen,Chi-Sheng %A Zhou,Dong %A Yeh,Lung-Kun %K medical device %K device malfunction %K rhinolaryngoscope %K adverse event %K MAUDE %K Manufacturer and User Facility Device Experience %D 2025 %7 5.2.2025 %9 %J JMIR Hum Factors %G English %X Background: Rhinolaryngoscopes are one of the most widely used tools by otolaryngologists and speech-language pathologists in current clinical practice. However, there is limited data on adverse events associated with or caused by the use of rhinolaryngoscopes. Objective: In this study, we used the Manufacturer and User Facility Device Experience (MAUDE) database with the aim of providing insights that may assist otolaryngologists in better understanding the limitations of these devices and selecting appropriate procedures for their specific clinical setting. Methods: We characterized complications associated with the postmarket use of rhinolaryngoscope devices from the US Food and Drug Administration MAUDE database from 2016 through 2023. Results: A total of 2591 reports were identified, including 2534 device malfunctions, 56 injuries, and 1 death, from 2016 through 2023. The most common device problem with rhinolaryngoscopes was breakage (n=1058 reports, 40.8%), followed by fluid leaks (n=632 reports, 24.4%). The third most common problem was poor image quality (n=467 reports, 18%). Other device issues included contamination or device reprocessing problems (n=127 reports, 4.9%), material deformation or wear (n=125 reports, 4.8%), and device detachment (n=73 reports, 2.8%). Of the 63 reported adverse events, the most common patient-related adverse event was hemorrhage or bleeding, accounting for 18 reports, with the root causes including material deformation or wear, breakage, wrinkled rubber, or improper operation. Conclusions: Our study offers valuable insights for endoscopists and manufacturers to recognize potential issues and adverse events associated with the use of rhinolaryngoscopes. It emphasizes the need for improving device reliability, training, and procedural protocols to enhance patient safety during diagnostic procedures. %R 10.2196/67036 %U https://humanfactors.jmir.org/2025/1/e67036 %U https://doi.org/10.2196/67036 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e65142 %T Evaluating the Safety and Usability of an Over-the-Counter Medical Device for Adults With Mild to Moderate Hearing Loss: Formative and Summative Usability Testing %A Salwei,Megan Elizabeth %A Anders,Shilo %A Reale,Carrie %A Slagle,Jason M %A Ricketts,Todd %A Weinger,Matthew B %K usability %K human factors %K patient safety %K over-the-counter hearing aids %K direct-to-consumer hearing aids %K medical device %K hearing loss %K adult %K hearing impairment %K hearing aid use %K hearing care %K formative usability test %K safety %K mobile phone %D 2025 %7 20.1.2025 %9 %J JMIR Hum Factors %G English %X Background: Only 15% of the nearly 30 million Americans with hearing loss use hearing aids, partly due to high cost, stigma, and limited access to professional hearing care. Hearing impairment in adults can lead to social isolation and depression and is associated with an increased risk of falls. Given the persistent barriers to hearing aid use, the Food and Drug Administration issued a final rule to allow over-the-counter hearing aids to be sold directly to adult consumers with perceived mild to moderate hearing loss at pharmacies, stores, and online retailers without seeing a physician or licensed hearing health care professional. Objective: We evaluated the safety and usability of an over-the-counter hearing aid prior to Food and Drug Administration approval and market release. Methods: We first conducted a formative usability test of the device and associated app with 5 intended users to identify outstanding safety and usability issues (testing round 1). Following design modifications, we performed a summative usability test with 15 intended users of the device (testing round 2). We concurrently conducted a test with 21 nonintended users (ie, users with contraindications to use) to ascertain if consumers could determine when they should not use the device, based on the packaging, instructions, and labeling (testing round 3). Participants were asked to complete 2‐5 tasks, as if they were using the hearing aid in real life. After each task, participants rated the task difficulty. At the end of each session, participants completed a 10-question knowledge assessment and the System Usability Scale and then participated in debriefing interviews to gather qualitative feedback. All sessions were video recorded and analyzed to identify use errors and design improvement opportunities. Results: Usability issues were identified in all 3 usability testing rounds. There were minimal safety-related issues with the device. Round 1 testing led to several design modifications which then increased task success in round 2 testing. Participants had the most difficulty with the task of pairing the hearing aids to the cell phone. Participants also had difficulty distinguishing the right and left earbuds. Nonintended users did not always understand device contraindications (eg, tinnitus and severe hearing loss). Overall, test findings informed 9 actionable design modifications (eg, clarifying pairing steps and increasing font size) that improved device usability and safety. Conclusions: This study evaluated the usability and safety of an over-the-counter hearing aid for adults with mild to moderate hearing loss. Human factors engineering methods identified opportunities to improve the safety and usability of this direct-to-consumer medical device for individuals with perceived mild-moderate hearing loss. %R 10.2196/65142 %U https://humanfactors.jmir.org/2025/1/e65142 %U https://doi.org/10.2196/65142 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e51936 %T Oral Cancer Incidence Among Adult Males With Current or Former Use of Cigarettes or Smokeless Tobacco: Population-Based Study %A Noggle,Brendan %A Cheng,Hui %A Sarkar,Mohamadi %K tobacco harm reduction %K oral cancer %K smokeless tobacco %K smoking %K cancer epidemiology %K cancer registry %K population-based study %K oral cancer incidence %K cancer cases %D 2024 %7 6.11.2024 %9 %J JMIR Cancer %G English %X Background: Tobacco use has been identified as a risk factor for oral cancer worldwide. However, relative oral cancer incidence among adults who smoke cigarettes, use smokeless tobacco products (ST), have transitioned from cigarettes to ST, quit cigarettes and/or ST (“quitters”), or never used tobacco has not been well studied. Objective: We aim to present population-based oral cancer incidence rates for adults who smoke cigarettes, use ST, are former smokers who now use ST, or quit. Methods: We estimated cross-sectional incidence rates and incidence rate ratios (IRRs) using data from statewide cancer registries (Colorado, Florida, North Carolina, and Texas) and population counts derived from national surveys using combined data from 2014‐2017. A random-effect meta-analysis approach was used to summarize estimates among these groups, based on multiple imputation-based IRR estimates by state and age group while considering potential heterogeneity. Results: A total of 19,536 oral cancer cases were identified among adult males 35 years and older in the study geographies and period. The oral cancer incidence rate among adults who smoke was significantly higher than the ST group (2.6 times higher, 95% CI 2.0‐3.3, P<.001), 3.6 (95% CI 3.2‐4.1, P<.001) times higher than the never users, and 2.4 (95% CI 1.8‐3.1, P<.001) times higher compared to former smokers who now use ST. The IRR among the ST group relative to never users was 1.4 (95% CI 1.1‐1.9, P=.02). The IRR between former smokers who now use ST and those who quit was 1.4 (95% CI 1.0‐2.1, P=.08). Conclusions: Findings from this population-based study with a large number of oral cancer cases support significantly high oral cancer incidence among adults who smoke and a lower risk of oral cancer incidence among never users, quitters, users of ST, and former smokers who now use ST compared to cigarettes. Future studies with detailed control of tobacco history and other relevant confounders are needed to confirm these findings. %R 10.2196/51936 %U https://cancer.jmir.org/2024/1/e51936 %U https://doi.org/10.2196/51936 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e57199 %T Impact of Patient Personality on Adherence to Oral Anticancer Medications: An Opportunity? %A Jafari,Mahtab %A Shahverdian,Alex %A Sadigh,Gelareh %A Van Etten,Richard A %+ Department of Pharmaceutical Scienes, University of California, Irvine, 856 Health Sciences Quad 5400, Room 4020, Irvine, CA, 92697-3958, United States, 1 949 8240145, mjafari@uci.edu %K cancer %K medication adherence %K medication persistence %K Five-Factor Model %K Type D personality %K oncology %K cancer medications %K oral anticancer therapy %K chemotherapy %D 2024 %7 30.10.2024 %9 Viewpoint %J JMIR Cancer %G English %X Adherence to prescribed oral anticancer therapy is an important determinant of patient outcomes, including progression-free and overall survival. While many factors (eg, medication side effects and out-of-pocket costs, problems with insurance authorization, and timely medication refills) can affect adherence, one that is relatively unexplored is the impact of a patient’s attitude and personality. Patient personality influences medication adherence and persistence in nonmalignant chronic conditions such as cardiovascular disease and diabetes. In breast cancer and chronic myeloid leukemia, studies suggest that personality also affects adherence to oral chemotherapy which can be targeted to improve adherence. In this viewpoint, we highlight the opportunity of incorporating patient personality as interventions to oral cancer therapy adherence and discuss current barriers to implementation. %M 39475848 %R 10.2196/57199 %U https://cancer.jmir.org/2024/1/e57199 %U https://doi.org/10.2196/57199 %U http://www.ncbi.nlm.nih.gov/pubmed/39475848 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59894 %T Over-the-Counter Hearing Aids Versus Traditional Hearing Aids in Patients With Mild-to-Moderate Hearing Loss: Protocol for a Noninferiority Randomized Controlled Trial %A Kim,Ga-Young %A Jo,Mini %A Cho,Young Sang %A Moon,Il Joon %+ Department of Otorhinolaryngology - Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, 81, Irwon-ro, Seoul, 06342, Republic of Korea, 82 3410 3579, moonij@skku.edu %K hearing aids %K over-the-counter hearing aids %K correction of hearing impairment %K randomized controlled trial %K evidence-based medicine %K hearing loss %K aging %K hearing sensitivity %K mobile phone %D 2024 %7 25.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: With the aging of society, the prevalence of hearing loss (HL) is increasing. Currently, approximately 5% of the global population has HL, and this number is projected to reach 7 million by 2050. Although hearing aids (HAs) are the primary treatment for HL, their use is limited by barriers such as high costs and social stigma. To address these limitations, over-the-counter (OTC) HAs have been introduced, but their effectiveness and drawbacks require further investigation. Objective: This study aims to conduct a noninferiority randomized controlled trial comparing OTC HAs with traditional HAs to assess the clinical effectiveness of OTC HAs. Methods: We designed a noninferiority randomized controlled trial comparing OTC HAs and traditional HAs in adults with mild-to-moderate HL. A total of 64 participants (32 per group) will be recruited. Randomization will be performed using block randomization (block sizes of 2 or 4) with an equal allocation ratio. The study will include 2 types of HAs: an OTC HA (Jabra Enhance Pro) and a traditional HA (LiNX Quattro LE561-DRW) by GN ReSound A/S. OTC HAs will be self-fitted using a smartphone app, while traditional HAs will be fitted by a licensed audiologist using the National Acoustics Laboratories–Non-Linear Prescription, second generation. Assessments, including functional gain, real-ear measurement, speech audiometry, and questionnaires, will be conducted at 6-month intervals over the course of 3 visits. Statistical analysis will compare the 2 outcomes, focusing on functional gain, to determine noninferiority. Results: This study is scheduled to begin in August 2024 and has not yet recruited any participants. The study will be conducted over 2 years, from August 2024 to July 2026. Each participant will have 2 follow-up visits at 6-month intervals, making the total follow-up period 1 year. Conclusions: Since 2022, the introduction of OTC HAs has revolutionized access to these devices. Researchers, clinicians, and the general public are keen to evaluate the clinical effectiveness of OTC HAs, as more individuals will likely use them for HL. This increased usage will provide valuable real-world data to understand the benefits and limitations of OTC HAs. Monitoring the outcomes and user feedback will provide insights into their effectiveness and impact on hearing rehabilitation. International Registered Report Identifier (IRRID): PRR1-10.2196/59894 %M 39454188 %R 10.2196/59894 %U https://www.researchprotocols.org/2024/1/e59894 %U https://doi.org/10.2196/59894 %U http://www.ncbi.nlm.nih.gov/pubmed/39454188 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60695 %T Performance of Retrieval-Augmented Large Language Models to Recommend Head and Neck Cancer Clinical Trials %A Hung,Tony K W %A Kuperman,Gilad J %A Sherman,Eric J %A Ho,Alan L %A Weng,Chunhua %A Pfister,David G %A Mao,Jun J %+ Memorial Sloan Kettering Cancer Center, 530 E 74th St, New York, NY, 10021, United States, 1 646 608 4127, hungt@mskcc.org %K large language model %K LLM %K ChatGPT %K GPT-4 %K artificial intelligence %K AI %K clinical trials %K decision support %K LookUpTrials %K cancer care delivery %K head and neck oncology %K head and neck cancer %K retrieval augmented generation %D 2024 %7 15.10.2024 %9 Research Letter %J J Med Internet Res %G English %X %M 39405514 %R 10.2196/60695 %U https://www.jmir.org/2024/1/e60695 %U https://doi.org/10.2196/60695 %U http://www.ncbi.nlm.nih.gov/pubmed/39405514 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56063 %T Ayurveda Management of Allergic Rhinitis: Protocol for a Randomized Controlled Trial %A Mata,Shweta %A Rajput,Shivshankar %A Tuli,Isha Preet %A Mundada,Pallavi %A Gupta,Bharti %A Srikanth,Narayanam %A Acharya,Rabinarayanan %+ Central Ayurveda Research Institute, Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Road no. 66 Punjabi Bagh West, New Delhi, 110026, India, 91 08866014946, drshwetamataccras@gmail.com %K allergic rhinitis %K AR %K Anu Taila Nasya %K fluticasone propionate nasal spray %K Naradiya Laxmivilas Rasa %K randomized controlled trial %K Shrishadi Kwath %D 2024 %7 25.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Allergic rhinitis (AR) is the inflammation of the membranes lining the nose due to allergen exposure and is characterized by sneezing, nasal congestion, itching of the nose, or postnasal discharge. The prevalence varies worldwide, perhaps due to the geographic and aeroallergen differences, with 10% to 30% of the world’s population experiencing AR. In this study, Anu Taila Nasya, Naradiya Laxmivilas Rasa, and Shirishadi Kwath will be compared to a fluticasone nasal spray. Objective: The primary aim is to assess the efficacy of Ayurvedic management for AR (or vataja pratishyaya) by comparing it to a conventional control group. The secondary aims are to determine the mean change in the nasal endoscopy index and the mean change in the laboratory tests. Methods: This ongoing study is an open-label randomized controlled interventional trial, with a sample size of 90 both in the trial and standard control group (including dropouts, 20%), and will be carried out for 24 months. Participants in the trial group will receive Ayurvedic treatment, that is, Anu Taila Nasya (6 drops in each nostril for 7 days for 3 consecutive weeks), Naradiya Laxmivilas Rasa (250 mg twice per day), and Shirishadi Kwath (40 ml twice per day for 45 days). The participants in the control group will receive a fluticasone propionate nasal spray (2 sprays once per day for 45 days). The primary outcome will include the mean change in the Control of Allergic Rhinitis and Asthma Test score, and the secondary outcomes will include the mean change in the nasal endoscopy index (assessment of nasal membrane color, pale or hyperemia; rhinorrhea, watery or yellow; and inferior turbinate swelling, hypertrophy) and the mean change in the laboratory tests. Results: As of May 2024, 72 patients have been enrolled in both groups. Data analysis should be completed by February 2025. The study will be reported following standard guidelines for reporting randomized controlled trials. Clinical results will be disseminated through conferences and peer-reviewed publication in a relevant journal. Conclusions: The Ayurvedic approach could be an evidence-based therapeutic tactic for the management of AR. Trial Registration: Clinical Trials Registry India CTRI/2023/06/053395; https://tinyurl.com/564d2zz8 International Registered Report Identifier (IRRID): DERR1-10.2196/56063 %M 39321461 %R 10.2196/56063 %U https://www.researchprotocols.org/2024/1/e56063 %U https://doi.org/10.2196/56063 %U http://www.ncbi.nlm.nih.gov/pubmed/39321461 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57335 %T The Application of Mask Region-Based Convolutional Neural Networks in the Detection of Nasal Septal Deviation Using Cone Beam Computed Tomography Images: Proof-of-Concept Study %A Shetty,Shishir %A Mubarak,Auwalu Saleh %A R David,Leena %A Al Jouhari,Mhd Omar %A Talaat,Wael %A Al-Rawi,Natheer %A AlKawas,Sausan %A Shetty,Sunaina %A Uzun Ozsahin,Dilber %+ Department of Medical Diagnostic Imaging, College of Health Sciences, University of Sharjah, Building M31, Sharjah, 27272, United Arab Emirates, 971 556491740, dozsahin@sharjah.ac.ae %K convolutional neural networks %K nasal septal deviation %K cone beam computed tomography %K tomographic %K tomography %K nasal %K nose %K face %K facial %K image %K images %K imagery %K artificial intelligence %K CNN %K neural network %K neural networks %K ResNet %D 2024 %7 3.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence (AI) models are being increasingly studied for the detection of variations and pathologies in different imaging modalities. Nasal septal deviation (NSD) is an important anatomical structure with clinical implications. However, AI-based radiographic detection of NSD has not yet been studied. Objective: This research aimed to develop and evaluate a real-time model that can detect probable NSD using cone beam computed tomography (CBCT) images. Methods: Coronal section images were obtained from 204 full-volume CBCT scans. The scans were classified as normal and deviated by 2 maxillofacial radiologists. The images were then used to train and test the AI model. Mask region-based convolutional neural networks (Mask R-CNNs) comprising 3 different backbones—ResNet50, ResNet101, and MobileNet—were used to detect deviated nasal septum in 204 CBCT images. To further improve the detection, an image preprocessing technique (contrast enhancement [CEH]) was added. Results: The best-performing model—CEH-ResNet101—achieved a mean average precision of 0.911, with an area under the curve of 0.921. Conclusions: The performance of the model shows that the model is capable of detecting nasal septal deviation. Future research in this field should focus on additional preprocessing of images and detection of NSD based on multiple planes using 3D images. %M 39226096 %R 10.2196/57335 %U https://formative.jmir.org/2024/1/e57335 %U https://doi.org/10.2196/57335 %U http://www.ncbi.nlm.nih.gov/pubmed/39226096 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55535 %T Evaluation of the Quality and Readability of Web-Based Information Regarding Foreign Bodies of the Ear, Nose, and Throat: Qualitative Content Analysis %A Ko,Tsz Ki %A Tan,Denise Jia Yun %A Fan,Ka Siu %+ Department of Surgery, Royal Stoke Hospital, Newcastle Road, Stoke, United Kingdom, 44 7378977812, tszkiko95@gmail.com %K foreign body %K quality of internet information %K readability of internet information %K EQIP %K Ensuring Quality Information for Patients %K medical informatics %K readability %K readable %K health information %K online information %K information resource %K information resources %K website %K websites %K quality %K evaluation %K evaluations %K reading level %K grade level %D 2024 %7 15.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Foreign body (FB) inhalation, ingestion, and insertion account for 11% of emergency admissions for ear, nose, and throat conditions. Children are disproportionately affected, and urgent intervention may be needed to maintain airway patency and prevent blood vessel occlusion. High-quality, readable online information could help reduce poor outcomes from FBs. Objective: We aim to evaluate the quality and readability of available online health information relating to FBs. Methods: In total, 6 search phrases were queried using the Google search engine. For each search term, the first 30 results were captured. Websites in the English language and displaying health information were included. The provider and country of origin were recorded. The modified 36-item Ensuring Quality Information for Patients tool was used to assess information quality. Readability was assessed using a combination of tools: Flesch Reading Ease score, Flesch-Kincaid Grade Level, Gunning-Fog Index, and Simple Measure of Gobbledygook. Results: After the removal of duplicates, 73 websites were assessed, with the majority originating from the United States (n=46, 63%). Overall, the quality of the content was of moderate quality, with a median Ensuring Quality Information for Patients score of 21 (IQR 18-25, maximum 29) out of a maximum possible score of 36. Precautionary measures were not mentioned on 41% (n=30) of websites and 30% (n=22) did not identify disk batteries as a risky FB. Red flags necessitating urgent care were identified on 95% (n=69) of websites, with 89% (n=65) advising patients to seek medical attention and 38% (n=28) advising on safe FB removal. Readability scores (Flesch Reading Ease score=12.4, Flesch-Kincaid Grade Level=6.2, Gunning-Fog Index=6.5, and Simple Measure of Gobbledygook=5.9 years) showed most websites (56%) were below the recommended sixth-grade level. Conclusions: The current quality and readability of information regarding FBs is inadequate. More than half of the websites were above the recommended sixth-grade reading level, and important information regarding high-risk FBs such as disk batteries and magnets was frequently excluded. Strategies should be developed to improve access to high-quality information that informs patients and parents about risks and when to seek medical help. Strategies to promote high-quality websites in search results also have the potential to improve outcomes. %M 39145998 %R 10.2196/55535 %U https://formative.jmir.org/2024/1/e55535 %U https://doi.org/10.2196/55535 %U http://www.ncbi.nlm.nih.gov/pubmed/39145998 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51706 %T A 3D and Explainable Artificial Intelligence Model for Evaluation of Chronic Otitis Media Based on Temporal Bone Computed Tomography: Model Development, Validation, and Clinical Application %A Chen,Binjun %A Li,Yike %A Sun,Yu %A Sun,Haojie %A Wang,Yanmei %A Lyu,Jihan %A Guo,Jiajie %A Bao,Shunxing %A Cheng,Yushu %A Niu,Xun %A Yang,Lian %A Xu,Jianghong %A Yang,Juanmei %A Huang,Yibo %A Chi,Fanglu %A Liang,Bo %A Ren,Dongdong %+ Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, 1215 Medical Center Drive, Nashville, TN, 37232, United States, 1 6153438146, yike.li.1@vumc.org %K artificial intelligence %K cholesteatoma %K deep learning %K otitis media %K tomography, x-ray computed %K machine learning %K mastoidectomy %K convolutional neural networks %K temporal bone %D 2024 %7 8.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Temporal bone computed tomography (CT) helps diagnose chronic otitis media (COM). However, its interpretation requires training and expertise. Artificial intelligence (AI) can help clinicians evaluate COM through CT scans, but existing models lack transparency and may not fully leverage multidimensional diagnostic information. Objective: We aimed to develop an explainable AI system based on 3D convolutional neural networks (CNNs) for automatic CT-based evaluation of COM. Methods: Temporal bone CT scans were retrospectively obtained from patients operated for COM between December 2015 and July 2021 at 2 independent institutes. A region of interest encompassing the middle ear was automatically segmented, and 3D CNNs were subsequently trained to identify pathological ears and cholesteatoma. An ablation study was performed to refine model architecture. Benchmark tests were conducted against a baseline 2D model and 7 clinical experts. Model performance was measured through cross-validation and external validation. Heat maps, generated using Gradient-Weighted Class Activation Mapping, were used to highlight critical decision-making regions. Finally, the AI system was assessed with a prospective cohort to aid clinicians in preoperative COM assessment. Results: Internal and external data sets contained 1661 and 108 patients (3153 and 211 eligible ears), respectively. The 3D model exhibited decent performance with mean areas under the receiver operating characteristic curves of 0.96 (SD 0.01) and 0.93 (SD 0.01), and mean accuracies of 0.878 (SD 0.017) and 0.843 (SD 0.015), respectively, for detecting pathological ears on the 2 data sets. Similar outcomes were observed for cholesteatoma identification (mean area under the receiver operating characteristic curve 0.85, SD 0.03 and 0.83, SD 0.05; mean accuracies 0.783, SD 0.04 and 0.813, SD 0.033, respectively). The proposed 3D model achieved a commendable balance between performance and network size relative to alternative models. It significantly outperformed the 2D approach in detecting COM (P≤.05) and exhibited a substantial gain in identifying cholesteatoma (P<.001). The model also demonstrated superior diagnostic capabilities over resident fellows and the attending otologist (P<.05), rivaling all senior clinicians in both tasks. The generated heat maps properly highlighted the middle ear and mastoid regions, aligning with human knowledge in interpreting temporal bone CT. The resulting AI system achieved an accuracy of 81.8% in generating preoperative diagnoses for 121 patients and contributed to clinical decision-making in 90.1% cases. Conclusions: We present a 3D CNN model trained to detect pathological changes and identify cholesteatoma via temporal bone CT scans. In both tasks, this model significantly outperforms the baseline 2D approach, achieving levels comparable with or surpassing those of human experts. The model also exhibits decent generalizability and enhanced comprehensibility. This AI system facilitates automatic COM assessment and shows promising viability in real-world clinical settings. These findings underscore AI’s potential as a valuable aid for clinicians in COM evaluation. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000036300; https://www.chictr.org.cn/showprojEN.html?proj=58685 %M 39116439 %R 10.2196/51706 %U https://www.jmir.org/2024/1/e51706 %U https://doi.org/10.2196/51706 %U http://www.ncbi.nlm.nih.gov/pubmed/39116439 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e57678 %T Explainable AI Method for Tinnitus Diagnosis via Neighbor-Augmented Knowledge Graph and Traditional Chinese Medicine: Development and Validation Study %A Yin,Ziming %A Kuang,Zhongling %A Zhang,Haopeng %A Guo,Yu %A Li,Ting %A Wu,Zhengkun %A Wang,Lihua %+ Department of Otolaryngology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 274 Zhijiang Middle Road, Jing'an District, Shanghai, 200071, China, 86 18116013561, lihuahanhan@126.com %K knowledge graph %K syndrome differentiation %K tinnitus %K traditional Chinese medicine %K explainable %K ear %K audiology %K TCM %K algorithm %K diagnosis %K AI %K artificial intelligence %D 2024 %7 10.6.2024 %9 Original Paper %J JMIR Med Inform %G English %X Background: Tinnitus diagnosis poses a challenge in otolaryngology owing to an extremely complex pathogenesis, lack of effective objectification methods, and factor-affected diagnosis. There is currently a lack of explainable auxiliary diagnostic tools for tinnitus in clinical practice. Objective: This study aims to develop a diagnostic model using an explainable artificial intelligence (AI) method to address the issue of low accuracy in tinnitus diagnosis. Methods: In this study, a knowledge graph–based tinnitus diagnostic method was developed by combining clinical medical knowledge with electronic medical records. Electronic medical record data from 1267 patients were integrated with traditional Chinese clinical medical knowledge to construct a tinnitus knowledge graph. Subsequently, weights were introduced, which measured patient similarity in the knowledge graph based on mutual information values. Finally, a collaborative neighbor algorithm was proposed, which scored patient similarity to obtain the recommended diagnosis. We conducted 2 group experiments and 1 case derivation to explore the effectiveness of our models and compared the models with state-of-the-art graph algorithms and other explainable machine learning models. Results: The experimental results indicate that the method achieved 99.4% accuracy, 98.5% sensitivity, 99.6% specificity, 98.7% precision, 98.6% F1-score, and 99% area under the receiver operating characteristic curve for the inference of 5 tinnitus subtypes among 253 test patients. Additionally, it demonstrated good interpretability. The topological structure of knowledge graphs provides transparency that can explain the reasons for the similarity between patients. Conclusions: This method provides doctors with a reliable and explainable diagnostic tool that is expected to improve tinnitus diagnosis accuracy. %M 38857077 %R 10.2196/57678 %U https://medinform.jmir.org/2024/1/e57678 %U https://doi.org/10.2196/57678 %U http://www.ncbi.nlm.nih.gov/pubmed/38857077 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53642 %T Development of a Subjective Visual Vertical Test System Using a Smartphone With Virtual Reality Goggles for Screening of Otolithic Dysfunction: Observational Study %A Umibe,Akiko %A Fushiki,Hiroaki %A Tsunoda,Reiko %A Kuroda,Tatsuaki %A Kuroda,Kazuhiro %A Tanaka,Yasuhiro %+ Department of Otorhinolaryngology, Head and Neck Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minami-Koshigaya, Koshigaya-shi, Saitama, 343-8555, Japan, 81 489651111, aumibe@dokkyomed.ac.jp %K vestibular function tests %K telemedicine %K smartphone %K virtual reality %K otolith dysfunction screening tool %K vestibular evoked myogenic potential %K iPhone %K mobile phone %D 2024 %7 4.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The subjective visual vertical (SVV) test can evaluate otolith function and spatial awareness and is performed in dedicated vertigo centers using specialized equipment; however, it is not otherwise widely used because of the specific equipment and space requirements. An SVV test smartphone app was developed to easily perform assessments in outpatient facilities. Objective: This study aimed to verify whether the SVV test smartphone app with commercially available virtual reality goggles can be used in a clinical setting. Methods: The reference range was calculated for 15 healthy participants. We included 14 adult patients with unilateral vestibular neuritis, sudden sensorineural hearing loss with vertigo, and Meniere disease and investigated the correlation between the SVV test results and vestibular evoked myogenic potential (VEMP) results. Results: The SVV reference range of healthy participants for the sitting front-facing position was small, ranging from –2.6º to 2.3º. Among the 14 patients, 6 (43%) exceeded the reference range for healthy participants. The SVV of patients with vestibular neuritis and sudden sensorineural hearing loss tended to deviate to the affected side. A total of 9 (64%) had abnormal cervical VEMP (cVEMP) values and 6 (43%) had abnormal ocular VEMP (oVEMP) values. No significant difference was found between the presence or absence of abnormal SVV values and the presence or absence of abnormal cVEMP and oVEMP values; however, the odds ratios (ORs) suggested a higher likelihood of abnormal SVV values among those with abnormal cVEMP and oVEMP responses (OR 2.40, 95% CI 0.18-32.88; P>.99; and OR 2, 95% CI 0.90-4.45; P=.46, respectively). Conclusions: The SVV app can be used anywhere and in a short period while reducing directional bias by using virtual reality goggles, thus making it highly versatile and useful as a practical otolith dysfunction screening tool. %M 38833295 %R 10.2196/53642 %U https://formative.jmir.org/2024/1/e53642 %U https://doi.org/10.2196/53642 %U http://www.ncbi.nlm.nih.gov/pubmed/38833295 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54326 %T Exploring the Prevalence of Tinnitus and Ear-Related Symptoms in China After the COVID-19 Pandemic: Online Cross-Sectional Survey %A Wang,Di %A Li,Peifan %A Huang,Xiaoling %A Liu,Yixuan %A Mao,Shihang %A Yin,Haoning %A Wang,Na %A Luo,Yan %A Sun,Shan %+ Research Service Office, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China, 86 18917786102, shansun@fudan.edu.cn %K COVID-19 pandemic %K tinnitus %K ear-related symptoms %K online survey %K prevalence %K ear-related %K China %K cross-sectional %K complex %K heterogeneous %K symptom %K symptoms %K Chinese %K population %K investigate %K health care %K exploratory %K teen %K teens %K teenager %K teenagers %K older adult %K older adults %K elder %K elderly %K older person %K older people %K COVID-19 %K regression analysis %D 2024 %7 24.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Tinnitus is a complex and heterogeneous disease that has been identified as a common manifestation of COVID-19. To gain a comprehensive understanding of tinnitus symptoms in individuals following COVID-19 infection, we conducted an online survey called the China Ear Nose and Throat Symptom Survey in the COVID-19 Pandemic (CENTSS) among the Chinese population. Objective: Our objective was to investigate tinnitus and ear-related symptoms after COVID-19 infection in the Chinese population, with the aim of providing a solid empirical foundation for improved health care. The findings from CENTSS can contribute to the development of enhanced management strategies for tinnitus in the context of long COVID. By gaining a better understanding of the factors contributing to tinnitus in individuals with COVID-19, health care providers can tailor interventions to address the specific needs of affected patients. Furthermore, this study serves as a basis for research on the long-term consequences of COVID-19 infection and its associated tinnitus symptoms. Methods: A quantitative, online, cross-sectional survey study design was used to explore the impact of the COVID-19 pandemic on experiences with tinnitus in China. Data were collected through an online questionnaire designed to identify the presence of tinnitus and its impacts. Descriptive statistics were used to analyze individuals' demographic characteristics, COVID-19 infection–related ear symptoms, and the cognitive and emotional implications of tinnitus. Univariable and multivariable logistic regression analyses were used to model the cross-sectional baseline associations between demographic characteristics, noise exposure, educational level, health and lifestyle factors, and the occurrence of tinnitus. Results: Between December 19, 2022, and February 1, 2023, we obtained responses from 1262 Chinese participants representing 24 regions, with an average age of 37 years. Among them, 540 patients (42.8%) reported experiencing ear-related symptoms after COVID-19 infection. Only 114 (9%) of these patients sought medical attention specifically for their ear symptoms, while 426 (33.8%) did not seek hospital care. Tinnitus emerged as the most prevalent and impactful symptom among all ear-related symptoms experienced after COVID-19 infection. Of the respondents, female participants (688/888, 77.78%), younger individuals (<30 years), individuals with lower education levels, participants residing in western China, and those with a history of otolaryngology diseases were more likely to develop tinnitus following COVID-19 infection. Conclusions: In summary, tinnitus was identified as the most common ear-related symptom during COVID-19 infection. Individuals experiencing tinnitus after COVID-19 infection were found to have poorer cognitive and emotional well-being. Different ear-related symptoms in patients post–COVID-19 infection may suggest viral invasion of various parts of the ear. It is therefore crucial to monitor and manage hearing-related changes resulting from COVID-19 as clinical services resume. %R 10.2196/54326 %U https://formative.jmir.org/2024/1/e54326 %U https://doi.org/10.2196/54326 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39076 %T Effectiveness of Telerehabilitation Interventions for Self-management of Tinnitus: Systematic Review %A Demoen,Sara %A Chalimourdas,Antonios %A Timmermans,Annick %A Van Rompaey,Vincent %A Vanderveken,Olivier M %A Jacquemin,Laure %A Schlee,Winfried %A Marneffe,Wim %A Luyten,Janis %A Gilles,Annick %A Michiels,Sarah %+ Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Martelarenlaan 42, Hasselt, 3500, Belgium, 32 11269244, sara.demoen@uhasselt.be %K tinnitus %K audiology %K systematic review %K telerehabilitation %K self-management %K intervention %K quality of life %K internet %K self-help %K mobile phone %D 2023 %7 9.2.2023 %9 Review %J J Med Internet Res %G English %X Background: Tinnitus is a highly prevalent symptom affecting 10%-20% of the adult population. Most patients with tinnitus have chronic tinnitus, which can directly or indirectly disrupt their daily life and negatively affect the health-related quality of life. Therefore, patients with tinnitus are frequently in need of costly and time-consuming treatments. As an answer, telerehabilitation interventions are on a rise to promote self-management in patients with tinnitus and reduce their dependency on in-person care. Objective: This systematic review aimed to provide an overview of the research concerning the effectiveness of telerehabilitation interventions for self-management of tinnitus. Methods: This systematic review adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were eligible for inclusion if study participants were adult patients with complaints of primary subjective tinnitus and the study intervention comprised any possible telerehabilitation form for the self-management of tinnitus complaints. A search for eligible studies was conducted on PubMed, ScienceDirect, Scopus, Web of Science, and Cochrane Library. The Cochrane Risk of Bias 2 tool was used to the assess risk of bias. Results: In total, 29 articles were found eligible, and of these, 5 (17%) studied multiple telerehabilitation forms. Internet-based cognitive behavioral treatment with guidance by a psychologist or audiologist was examined in 17 studies (n=1767), internet-based cognitive behavioral treatment without guidance was examined in 4 studies (n=940), self-help manuals were examined in 1 study (n=72), technological self-help devices were examined in 2 studies (n=82), smartphone apps were examined in 8 studies (n=284), and other internet-based interventions were examined in 2 studies (n=130). These rehabilitation categories were proven to be effective in decreasing tinnitus severity and relieving tinnitus distress as measured by tinnitus questionnaires such as Tinnitus Functional Index, Tinnitus Handicap Inventory, or Tinnitus Reactions Questionnaire. However, dropout rates were often high (range 4%-71.4%). All studies reported between some concerns and high concerns of risk of bias, resulting in low to moderate certainty levels. Conclusions: Overall, there is low to moderate quality evidence that telerehabilitation interventions effectively reduce tinnitus severity and distress. These interventions form a possible tool to improve the self-management capacities of the patient and the accessibility of tinnitus care as a replacement or an addition to in-person care. Nevertheless, barriers such as lack of time, engagement, motivation, and openness of the patient causing high dropout should be considered. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021285450; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=285450 %M 36757768 %R 10.2196/39076 %U https://www.jmir.org/2023/1/e39076 %U https://doi.org/10.2196/39076 %U http://www.ncbi.nlm.nih.gov/pubmed/36757768 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e39789 %T Wearable Neck Surface Accelerometers for Occupational Vocal Health Monitoring: Instrument and Analysis Validation Study %A Lei,Zhengdong %A Martignetti,Lisa %A Ridgway,Chelsea %A Peacock,Simon %A Sakata,Jon T %A Li-Jessen,Nicole Y K %+ School of Communication Sciences and Disorders, McGill University, 2001 Avenue McGill College, 8th Floor, Montreal, QC, H3A1G1, Canada, 1 514 398 5933, nicole.li@mcgill.ca %K mechano-acoustic sensing %K voice monitoring %K wearable device %K neck surface accelerometer %D 2022 %7 5.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Neck surface accelerometer (NSA) wearable devices have been developed for voice and upper airway health monitoring. As opposed to acoustic sounds, NSA senses mechanical vibrations propagated from the vocal tract to neck skin, which are indicative of a person’s voice and airway conditions. NSA signals do not carry identifiable speech information and a speaker’s privacy is thus protected, which is important and necessary for continuous wearable monitoring. Our device was already tested for its durable endurance and signal processing algorithms in controlled laboratory conditions. Objective: This study aims to further evaluate both instrument and analysis validity in a group of occupational vocal users, namely, voice actors, who use their voices extensively at work in an ecologically valid setting. Methods: A total of 16 professional voice actors (age range 21-50 years; 11 females and 5 males) participated in this study. All participants were mounted with an NSA on their sternal notches during the voice acting and voice assessment sessions. The voice acting session was 4-hour long, directed by a voice director in a professional sound studio. Voice assessment sessions were conducted before, during, and 48 hours after the acting session. The assessment included phonation tasks of passage reading, sustained vowels, maximum vowel phonation, and pitch glides. Clinical acoustic metrics (eg, fundamental frequency, cepstral measures) and a vocal dose measure (ie, accumulated distance dose from acting) were computed from NSA signals. A commonly used online questionnaire (Self-Administered Voice Rating questionnaire) was also implemented to track participants’ perception of vocal fatigue. Results: The NSA wearables stayed in place for all participants despite active body movements during the acting. The ensued body noise did not interfere with the NSA signal quality. All planned acoustic metrics were successfully derived from NSA signals and their numerical values were comparable with literature data. For a 4-hour long voice acting, the averaged distance dose was about 8354 m with no gender differences. Participants perceived vocal fatigue as early as 2 hours after the start of voice acting, with recovery 24-48 hours after the acting session. Among all acoustic metrics across phonation tasks, cepstral peak prominence and spectral tilt from the passage reading most closely mirrored trends in perceived fatigue. Conclusions: The ecological validity of an in-house NSA wearable was vetted in a workplace setting. One key application of this wearable is to prompt occupational voice users when their vocal safety limits are reached for duly protection. Signal processing algorithms can thus be further developed for near real-time estimation of clinically relevant metrics, such as accumulated distance dose, cepstral peak prominence, and spectral tilt. This functionality will enable continuous self-awareness of vocal behavior and protection of vocal safety in occupational voice users. %M 35930317 %R 10.2196/39789 %U https://formative.jmir.org/2022/8/e39789 %U https://doi.org/10.2196/39789 %U http://www.ncbi.nlm.nih.gov/pubmed/35930317 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e34126 %T A Questionnaire-Based Ensemble Learning Model to Predict the Diagnosis of Vertigo: Model Development and Validation Study %A Yu,Fangzhou %A Wu,Peixia %A Deng,Haowen %A Wu,Jingfang %A Sun,Shan %A Yu,Huiqian %A Yang,Jianming %A Luo,Xianyang %A He,Jing %A Ma,Xiulan %A Wen,Junxiong %A Qiu,Danhong %A Nie,Guohui %A Liu,Rizhao %A Hu,Guohua %A Chen,Tao %A Zhang,Cheng %A Li,Huawei %+ Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Room 611, Building 9, No. 83, Fenyang Road, Xuhui District, Shanghai, 200031, China, 86 021 64377134 ext 2669, hwli@shmu.edu.cn %K vestibular disorders %K machine learning %K diagnostic model %K vertigo %K ENT %K questionnaire %D 2022 %7 3.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Questionnaires have been used in the past 2 decades to predict the diagnosis of vertigo and assist clinical decision-making. A questionnaire-based machine learning model is expected to improve the efficiency of diagnosis of vestibular disorders. Objective: This study aims to develop and validate a questionnaire-based machine learning model that predicts the diagnosis of vertigo. Methods: In this multicenter prospective study, patients presenting with vertigo entered a consecutive cohort at their first visit to the ENT and vertigo clinics of 7 tertiary referral centers from August 2019 to March 2021, with a follow-up period of 2 months. All participants completed a diagnostic questionnaire after eligibility screening. Patients who received only 1 final diagnosis by their treating specialists for their primary complaint were included in model development and validation. The data of patients enrolled before February 1, 2021 were used for modeling and cross-validation, while patients enrolled afterward entered external validation. Results: A total of 1693 patients were enrolled, with a response rate of 96.2% (1693/1760). The median age was 51 (IQR 38-61) years, with 991 (58.5%) females; 1041 (61.5%) patients received the final diagnosis during the study period. Among them, 928 (54.8%) patients were included in model development and validation, and 113 (6.7%) patients who enrolled later were used as a test set for external validation. They were classified into 5 diagnostic categories. We compared 9 candidate machine learning methods, and the recalibrated model of light gradient boosting machine achieved the best performance, with an area under the curve of 0.937 (95% CI 0.917-0.962) in cross-validation and 0.954 (95% CI 0.944-0.967) in external validation. Conclusions: The questionnaire-based light gradient boosting machine was able to predict common vestibular disorders and assist decision-making in ENT and vertigo clinics. Further studies with a larger sample size and the participation of neurologists will help assess the generalization and robustness of this machine learning method. %M 35921135 %R 10.2196/34126 %U https://www.jmir.org/2022/8/e34126 %U https://doi.org/10.2196/34126 %U http://www.ncbi.nlm.nih.gov/pubmed/35921135 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e27207 %T Telemedicine for Adults With Cochlear Implants in the United Kingdom (CHOICE): Protocol for a Prospective Interventional Multisite Study %A Cullington,Helen %A Kitterick,Padraig %A Darnton,Philippa %A Finch,Tracy %A Greenwell,Kate %A Riggs,Carol %A Weal,Mark %A Walker,Dawn-Marie %A Sibley,Andrew %+ University of Southampton Auditory Implant Service, University of Southampton, Southampton, SO17 1BJ, United Kingdom, 44 2380593522, h.cullington@soton.ac.uk %K cochlear implants %K hearing %K deafness %K telemedicine %K patient-centered care %D 2022 %7 13.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cochlear implants provide hearing to approximately 750,000 people with deafness worldwide; these patients require lifelong follow-up. Care for adults with implants in the United Kingdom occurs at one of 19 centers, which may be far from the patients’ homes. In a previous randomized controlled trial, we successfully introduced person-centered care. We designed, implemented, and evaluated the following remote care pathway: a personalized web-based support tool, home hearing check, self–device adjustment, and upgrading of sound processors at home rather than in the clinic. The remote care group had a significant increase in empowerment after using the tools, and the patients and clinicians were keen to continue. We would now like to scale up these improvements as an option for >12,000 UK adults using implants; we are commissioning an independent evaluation of this intervention and rollout to establish if it achieves its aims of more empowered and confident patients; more accessible and equitable care; stable hearing; more efficient, person-centered, and scalable service; and more satisfied and engaged patients and clinicians. Objective: This study aims to evaluate the impact and rollout of a person-centered clinical care pathway via telemedicine for adults with cochlear implants in the United Kingdom, using both outcomes and process evaluation. Methods: This project will scale up and evaluate a person-centered long-term follow-up pathway for adults using cochlear implants through a personalized website, including a home hearing check, uploading photos of cochlear implant site, listening in noise and music practice, ordering of spares, questionnaires, and other resources. Both quantitative and qualitative analyses will be conducted, and they will be both an outcome and process evaluation. Results: As of July 2021, the trial is closed, and all data collection is complete. The evaluation report is expected to be published in December 2021, and the research data have not yet been analyzed. Conclusions: This project will present the results of the first scaling up of a remote care pathway for adults with cochlear implants in the United Kingdom. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN51668922; https://www.isrctn.com/ISRCTN51668922 International Registered Report Identifier (IRRID): DERR1-10.2196/27207 %M 35416780 %R 10.2196/27207 %U https://www.researchprotocols.org/2022/4/e27207 %U https://doi.org/10.2196/27207 %U http://www.ncbi.nlm.nih.gov/pubmed/35416780 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e26461 %T REDCap Delivery of a Web-Based Intervention for Patients With Voice Disorders: Usability Study %A Stambler,Danielle Mollie %A Feddema,Erin %A Riggins,Olivia %A Campeau,Kari %A Breuch,Lee-Ann Kastman %A Kessler,Molly M %A Misono,Stephanie %+ Department of Writing Studies, University of Minnesota, Nolte Center, 315 Pillsbury Dr SE, Minneapolis, MN, 55455, United States, 1 612 624 3445, stambler@umn.edu %K web-based intervention %K REDCap %K voice disorders %K usability study %K heuristics %K eHealth %K online %K health %K web-based participation %K patients %K web-based platform %D 2022 %7 25.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Web-based health interventions are increasingly common and are promising for patients with voice disorders because web-based participation does not require voice use. To address needs such as Health Insurance Portability and Accountability Act compliance, unique user access, the ability to send automated reminders, and a limited development budget, we used the Research Electronic Data Capture (REDCap) data management platform to deliver a patient-facing psychological intervention designed for patients with voice disorders. This was a novel use of REDCap. Objective: We aimed to evaluate the usability of the intervention, with this intervention serving as a use case for REDCap-based patient-facing interventions. Methods: We used REDCap survey instruments to develop the web-based voice intervention modules, then conducted usability evaluations using (1) heuristic evaluations by 2 evaluators, and (2) formal usability testing with 7 participants, consisting of predetermined tasks, a think-aloud protocol, ease-of-use measurements, a product reaction card, and a debriefing interview. Results: Heuristic evaluations found strengths in visibility of system status and real-world match, and weaknesses in user control and help documentation. Based on this feedback, changes to the intervention were made before usability testing. Overall, usability testing participants found the intervention useful and easy to use, although testing revealed some concerns with design, content, and terminology. Some concerns were readily addressed, and others required adaptations within REDCap. Conclusions: The REDCap version of a complex web-based patient-facing intervention performed well in heuristic evaluation and formal usability testing. REDCap can effectively be used for patient-facing intervention delivery, particularly if the limitations of the platform are anticipated and mitigated. %M 35333191 %R 10.2196/26461 %U https://humanfactors.jmir.org/2022/1/e26461 %U https://doi.org/10.2196/26461 %U http://www.ncbi.nlm.nih.gov/pubmed/35333191 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e24592 %T Pulmonary Screening Practices of Otolaryngology–Head and Neck Surgeons Across Saudi Arabia in the Posttreatment Surveillance of Squamous Cell Carcinoma: Cross-sectional Survey Study %A Alnefaie,Majed %A Alamri,Abdullah %A Saeedi,Asalh %A Althobaiti,Awwadh %A Alosaimi,Shahad %A Alqurashi,Yousuf %A Marzouki,Hani %A Merdad,Mazin %+ King Fahad Armed Forces Hospital, Medical Services of The Armed Forces, Al Kurnaysh Rd, Al Andalus, Jeddah, 23311, Saudi Arabia, 966 500900450, Majed.n.md@gmail.com %K squamous cell carcinoma of head and neck %K lung neoplasms %K radiography %K otolaryngology %K surgeons %K survey %D 2022 %7 18.3.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: With respect to patients with head and neck squamous cell carcinoma (HNSCC), posttreatment surveillance for distant disease has mostly focused on the lungs, as HNSCC distant metastasis occurs in this organ in 90% of HNSCC cases. Additionally, the incidence rate of primary tumors in the lungs is high due to the field cancerization of the entire upper aerodigestive tract. Objective: Our cross-sectional survey study aims to evaluate the current beliefs and pulmonary screening practices of otolaryngology–head and neck surgeons across Saudi Arabia with respect to the posttreatment surveillance of HNSCC. Methods: This nationwide cross-sectional survey was conducted among head and neck surgeon members of the Saudi Society of Otolaryngology from June 1 to June 30, 2020. A predesigned questionnaire was used for data collection, and a descriptive analysis was carried out. Results: This study included 22 participants and had a 78% (22/28) response rate. This study found that the majority of participants (9/22, 41%) used lung radiography for routine lung screening during posttreatment follow-ups, whereas 32% (7/22) used low-dose computed tomography (CT; 7/22, 32%). With regard to the number of years for which participants perform lung screening during follow-ups, the majority of participants (17/22, 77%) reported 5 years, and only 9% (2/22) have performed lifelong lung screening. With regard to the frequency of lung screening, 77% (17/22) of participants conduct screening annually, 18% (4/22) conduct screening half-yearly, and 5% (1/22) conduct screening biennially. With regard to beliefs about the effectiveness of screening procedures in reducing lung cancer mortality rates during follow-ups, 36% (8/22) of participants believed them to be very effective or somewhat effective, 18% (4/22) did not know, and only 9% (2/22) believed that they were not effective. Conclusions: The participants mainly used lung radiography (9/22, 41%), low-dose CT (7/22, 32%), or positron emission tomography/CT (6/22, 27%) as a routine lung screening method during the posttreatment follow-up of patients with head and neck cancer for 5 years (17/22, 77%) or 10 years (3/22, 14%), and only a small percentage of participants have performed lifelong lung screening (2/22, 9%). Lung screening was mostly conducted annually or half-yearly. Such screening was believed to be very effective or somewhat effective. %M 35302511 %R 10.2196/24592 %U https://www.i-jmr.org/2022/1/e24592 %U https://doi.org/10.2196/24592 %U http://www.ncbi.nlm.nih.gov/pubmed/35302511 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e27584 %T Internet-Based Audiologist-Guided Cognitive Behavioral Therapy for Tinnitus: Randomized Controlled Trial %A W Beukes,Eldré %A Andersson,Gerhard %A Fagelson,Marc %A Manchaiah,Vinaya %+ Vision and Hearing Research Centre, Anglia Ruskin University, East Road, Cambridge, CB1 1TP, United Kingdom, 44 07951113157, eldre.beukes@aru.co.uk %K tinnitus %K cognitive behavioral therapy %K internet intervention %K web-based intervention %K randomized controlled trial %K telehealth %K teleaudiology %K eHealth %D 2022 %7 14.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Tinnitus is a symptom that can be very distressing owing to hearing sounds not related to any external sound source. Managing tinnitus is notoriously difficult, and access to evidence-based care is limited. Cognitive behavioral therapy (CBT) is a tinnitus management strategy with the most evidence of effectiveness but is rarely offered to those distressed by tinnitus. The provision of internet-based CBT for tinnitus overcomes accessibility barriers; however, it is not currently readily available in the United States. Objective: The aim of this study is to investigate the efficacy of internet-based CBT compared with that of weekly monitoring for the management of tinnitus in reducing tinnitus distress; reducing tinnitus-related comorbidities, including tinnitus cognitions, insomnia, anxiety, and depression; and assessing the stability of the intervention effects 2 months after the intervention. Methods: A 2-arm randomized clinical trial comparing audiologist-guided internet-based CBT (n=79) to a weekly monitoring group (n=79) with a 2-month follow-up assessed the efficacy of internet-based CBT. Eligible participants included adults seeking help for tinnitus. Recruitment was conducted on the web using an open-access website. Participants were randomized via 1:1 allocation, but blinding was not possible. The study was undertaken by English or Spanish speakers on the web. The primary outcome was a change in tinnitus distress as measured using the Tinnitus Functional Index. Secondary outcome measures included anxiety, depression, insomnia, tinnitus cognition, hearing-related difficulties, and quality of life. Results: Internet-based CBT led to a greater reduction in tinnitus distress (mean 36.57, SD 22) compared with that in weekly monitoring (mean 46.31, SD 20.63; effect size: Cohen d=0.46, 95% CI 0.14-0.77) using an intention-to-treat analysis. For the secondary outcomes, there was a greater reduction in negative tinnitus cognition and insomnia. The results remained stable over the 2-month follow-up period. No important adverse events were observed. Further, 16% (10/158) of participants withdrew, with low overall compliance rates for questionnaire completion of 72.3% (107/148) at T1, 61% (91/148) at T2, and 42% (62/148) at T3. Conclusions: This study is the first to evaluate and indicate the efficacy of audiologist-delivered internet-based CBT in reducing tinnitus distress in a US population. It was also the first study to offer internet-based CBT in Spanish to accommodate the large Hispanic population in the United States. The results have been encouraging, and further work is indicated in view of making such an intervention applicable to a wider population. Further work is required to improve compliance and attract more Spanish speakers. Trial Registration: ClinicalTrials.gov NCT04004260; https://clinicaltrials.gov/ct2/show/NCT04004260 %M 35156936 %R 10.2196/27584 %U https://www.jmir.org/2022/2/e27584 %U https://doi.org/10.2196/27584 %U http://www.ncbi.nlm.nih.gov/pubmed/35156936 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e32581 %T Digital Approaches to Automated and Machine Learning Assessments of Hearing: Scoping Review %A Wasmann,Jan-Willem %A Pragt,Leontien %A Eikelboom,Robert %A Swanepoel,De Wet %+ Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Philips van Leydenlaan 15, Nijmegen, 6500 HB, Netherlands, 31 024 361 04 2, Jan-Willem.Wasmann@radboudumc.nl %K audiology %K automated audiometry %K automatic audiometry %K automation %K digital health technologies %K digital hearing health care %K machine learning %K remote care %K self-administered audiometry %K self-assessment audiometry %K user-operated audiometry %K digital health %K hearing loss %K digital hearing %K digital devices %K mobile phone %K telehealth %D 2022 %7 2.2.2022 %9 Review %J J Med Internet Res %G English %X Background: Hearing loss affects 1 in 5 people worldwide and is estimated to affect 1 in 4 by 2050. Treatment relies on the accurate diagnosis of hearing loss; however, this first step is out of reach for >80% of those affected. Increasingly automated approaches are being developed for self-administered digital hearing assessments without the direct involvement of professionals. Objective: This study aims to provide an overview of digital approaches in automated and machine learning assessments of hearing using pure-tone audiometry and to focus on the aspects related to accuracy, reliability, and time efficiency. This review is an extension of a 2013 systematic review. Methods: A search across the electronic databases of PubMed, IEEE, and Web of Science was conducted to identify relevant reports from the peer-reviewed literature. Key information about each report’s scope and details was collected to assess the commonalities among the approaches. Results: A total of 56 reports from 2012 to June 2021 were included. From this selection, 27 unique automated approaches were identified. Machine learning approaches require fewer trials than conventional threshold-seeking approaches, and personal digital devices make assessments more affordable and accessible. Validity can be enhanced using digital technologies for quality surveillance, including noise monitoring and detecting inconclusive results. Conclusions: In the past 10 years, an increasing number of automated approaches have reported similar accuracy, reliability, and time efficiency as manual hearing assessments. New developments, including machine learning approaches, offer features, versatility, and cost-effectiveness beyond manual audiometry. Used within identified limitations, automated assessments using digital devices can support task-shifting, self-care, telehealth, and clinical care pathways. %M 34919056 %R 10.2196/32581 %U https://www.jmir.org/2022/2/e32581 %U https://doi.org/10.2196/32581 %U http://www.ncbi.nlm.nih.gov/pubmed/34919056 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e27809 %T Knowledge and Expectations of Hearing Aid Apps Among Smartphone Users and Hearing Professionals: Cross-sectional Survey %A Han,Jae Sang %A Park,Yong-Ho %A Song,Jae-Jun %A Moon,Il Joon %A Lee,Woojoo %A Kim,Yoonjoong %A Cho,Young Sang %A Seo,Jae-Hyun %A Park,Moo Kyun %+ Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea, 82 2 2258 6210, revivalseo@catholic.ac.kr %K smartphone %K hearing aids %K app %K perception %K survey %K hearing loss %K mobile phone %D 2022 %7 7.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the increasing prevalence of hearing loss, the cost and psychological barriers to the use of hearing aids may prevent their use in individuals with hearing loss. Patients with hearing loss can benefit from smartphone-based hearing aid apps (SHAAs), which are smartphone apps that use a mobile device as a sound amplifier. Objective: The aim of this study is to determine how ear, nose, and throat outpatients perceive SHAAs, analyze the factors that affect their perceptions, and estimate the costs of an annual subscription to an app through a self-administered questionnaire survey of smartphone users and hearing specialists. Methods: This study used a cross-sectional, multicenter survey of both ear, nose, and throat outpatients and hearing specialists. The questionnaire was designed to collect personal information about the respondents and their responses to 18 questions concerning SHAAs in five domains: knowledge, needs, cost, expectations, and information. Perception questions were rated on a scale of 1 (strongly disagree) to 5 (strongly agree). Questions about the expected cost of SHAAs were included in the questionnaire distributed to hearing experts. Results: Among the 219 smartphone users and 42 hearing specialists, only 8 (3.7%) respondents recognized SHAAs, whereas 18% (47/261) of respondents reported considering the use of an assistive device to improve their hearing capacity. The average perception score was 2.81 (SD 1.22). Among the factors that shaped perceptions of SHAAs, the needs category received the lowest scores (2.02, SD 1.42), whereas the cost category received the highest scores (3.29, SD 1.14). Age was correlated with the information domain (P<.001), and an increased level of hearing impairment resulted in significantly higher points in the needs category (P<.001). Patients expected the cost of an annual app subscription to an SHAA to be approximately US $86, and the predicted cost was associated with economic status (P=.02) and was higher than the prices expected by hearing specialists (P<.001). Conclusions: Outpatients expected SHAAs to cost more than hearing specialists. However, the perception of the SHAA was relatively low. In this regard, enhanced awareness is required to popularize SHAAs. %M 34994699 %R 10.2196/27809 %U https://mhealth.jmir.org/2022/1/e27809 %U https://doi.org/10.2196/27809 %U http://www.ncbi.nlm.nih.gov/pubmed/34994699 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 12 %P e33049 %T Differential Biases and Variabilities of Deep Learning–Based Artificial Intelligence and Human Experts in Clinical Diagnosis: Retrospective Cohort and Survey Study %A Cha,Dongchul %A Pae,Chongwon %A Lee,Se A %A Na,Gina %A Hur,Young Kyun %A Lee,Ho Young %A Cho,A Ra %A Cho,Young Joon %A Han,Sang Gil %A Kim,Sung Huhn %A Choi,Jae Young %A Park,Hae-Jeong %+ Center for Systems and Translational Brain Sciences, Institute of Human Complexity and Systems Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seoul, 03722, Republic of Korea, 82 2 2228 2363, parkhj@yuhs.ac %K human-machine cooperation %K convolutional neural network %K deep learning, class imbalance problem %K otoscopy %K eardrum %K artificial intelligence %K otology %K computer-aided diagnosis %D 2021 %7 8.12.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Deep learning (DL)–based artificial intelligence may have different diagnostic characteristics than human experts in medical diagnosis. As a data-driven knowledge system, heterogeneous population incidence in the clinical world is considered to cause more bias to DL than clinicians. Conversely, by experiencing limited numbers of cases, human experts may exhibit large interindividual variability. Thus, understanding how the 2 groups classify given data differently is an essential step for the cooperative usage of DL in clinical application. Objective: This study aimed to evaluate and compare the differential effects of clinical experience in otoendoscopic image diagnosis in both computers and physicians exemplified by the class imbalance problem and guide clinicians when utilizing decision support systems. Methods: We used digital otoendoscopic images of patients who visited the outpatient clinic in the Department of Otorhinolaryngology at Severance Hospital, Seoul, South Korea, from January 2013 to June 2019, for a total of 22,707 otoendoscopic images. We excluded similar images, and 7500 otoendoscopic images were selected for labeling. We built a DL-based image classification model to classify the given image into 6 disease categories. Two test sets of 300 images were populated: balanced and imbalanced test sets. We included 14 clinicians (otolaryngologists and nonotolaryngology specialists including general practitioners) and 13 DL-based models. We used accuracy (overall and per-class) and kappa statistics to compare the results of individual physicians and the ML models. Results: Our ML models had consistently high accuracies (balanced test set: mean 77.14%, SD 1.83%; imbalanced test set: mean 82.03%, SD 3.06%), equivalent to those of otolaryngologists (balanced: mean 71.17%, SD 3.37%; imbalanced: mean 72.84%, SD 6.41%) and far better than those of nonotolaryngologists (balanced: mean 45.63%, SD 7.89%; imbalanced: mean 44.08%, SD 15.83%). However, ML models suffered from class imbalance problems (balanced test set: mean 77.14%, SD 1.83%; imbalanced test set: mean 82.03%, SD 3.06%). This was mitigated by data augmentation, particularly for low incidence classes, but rare disease classes still had low per-class accuracies. Human physicians, despite being less affected by prevalence, showed high interphysician variability (ML models: kappa=0.83, SD 0.02; otolaryngologists: kappa=0.60, SD 0.07). Conclusions: Even though ML models deliver excellent performance in classifying ear disease, physicians and ML models have their own strengths. ML models have consistent and high accuracy while considering only the given image and show bias toward prevalence, whereas human physicians have varying performance but do not show bias toward prevalence and may also consider extra information that is not images. To deliver the best patient care in the shortage of otolaryngologists, our ML model can serve a cooperative role for clinicians with diverse expertise, as long as it is kept in mind that models consider only images and could be biased toward prevalent diseases even after data augmentation. %M 34889764 %R 10.2196/33049 %U https://medinform.jmir.org/2021/12/e33049 %U https://doi.org/10.2196/33049 %U http://www.ncbi.nlm.nih.gov/pubmed/34889764 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 4 %P e25654 %T Audience of Academic Otolaryngology on Twitter: Cross-sectional Study %A Xie,Deborah X %A Boss,Emily F %A Stewart,C Matthew %+ Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, 601 N Caroline Street, Baltimore, MD, 21231, United States, 1 410 955 3492, cstewa16@jhmi.edu %K Twitter %K otolaryngology %K residency %K medical education %K social media %K internet %D 2021 %7 8.12.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: Despite the ubiquity of social media, the utilization and audience reach of this communication method by otolaryngology-head and neck surgery (OHNS) residency programs has not been investigated. Objective: The purpose of this study was to evaluate the content posted to a popular social media platform (Twitter) by OHNS residency programs. Methods: In this cross-sectional study, we identified Twitter accounts for accredited academic OHNS residency programs. Tweets published over a 6-month period (March to August 2019) were extracted. Tweets were categorized and analyzed for source (original versus retweet) and target audience (medical versus layman). A random sample of 100 tweets was used to identify patterns of content, which were then used to categorize additional tweets. We quantified the total number of likes or retweets by health care professionals. Results: Of the 121 accredited programs, 35 (28.9%) had Twitter accounts. Of the 2526 tweets in the 6-month period, 1695 (67.10%) were original-content tweets. The majority of tweets (1283/1695, 75.69%) were targeted toward health care workers, most of which did not directly contain medical information (954/1283, 74.36%). These tweets contained information about the department’s trainees and education (349/954, 36.6%), participation at conferences (263/954, 27.6%), and research publications (112/954, 11.7%). Two-thirds of all tweets did not contain medical information. Medical professionals accounted for 1249/1362 (91.70%) of retweets and 5616/6372 (88.14%) of likes on original-content tweets. Conclusions: The majority of Twitter usage by OHNS residency programs is for intra and interprofessional communication, and only a minority of tweets contain information geared toward the public. Communication and information sharing with patients is not the focus of OHNS departments on Twitter. %M 34889748 %R 10.2196/25654 %U https://mededu.jmir.org/2021/4/e25654 %U https://doi.org/10.2196/25654 %U http://www.ncbi.nlm.nih.gov/pubmed/34889748 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e25460 %T Improved Environment-Aware–Based Noise Reduction System for Cochlear Implant Users Based on a Knowledge Transfer Approach: Development and Usability Study %A Li,Lieber Po-Hung %A Han,Ji-Yan %A Zheng,Wei-Zhong %A Huang,Ren-Jie %A Lai,Ying-Hui %+ Department of Biomedical Engineering, National Yang Ming Chiao Tung University, No 155, Sec 2, Linong Street, Taipei, 112, Taiwan, 886 228267021, yh.lai@nycu.edu.tw %K cochlear implants %K noise reduction %K deep learning %K noise classification %K hearing %K deaf %K sound %K audio %K cochlear %D 2021 %7 28.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Cochlear implant technology is a well-known approach to help deaf individuals hear speech again and can improve speech intelligibility in quiet conditions; however, it still has room for improvement in noisy conditions. More recently, it has been proven that deep learning–based noise reduction, such as noise classification and deep denoising autoencoder (NC+DDAE), can benefit the intelligibility performance of patients with cochlear implants compared to classical noise reduction algorithms. Objective: Following the successful implementation of the NC+DDAE model in our previous study, this study aimed to propose an advanced noise reduction system using knowledge transfer technology, called NC+DDAE_T; examine the proposed NC+DDAE_T noise reduction system using objective evaluations and subjective listening tests; and investigate which layer substitution of the knowledge transfer technology in the NC+DDAE_T noise reduction system provides the best outcome. Methods: The knowledge transfer technology was adopted to reduce the number of parameters of the NC+DDAE_T compared with the NC+DDAE. We investigated which layer should be substituted using short-time objective intelligibility and perceptual evaluation of speech quality scores as well as t-distributed stochastic neighbor embedding to visualize the features in each model layer. Moreover, we enrolled 10 cochlear implant users for listening tests to evaluate the benefits of the newly developed NC+DDAE_T. Results: The experimental results showed that substituting the middle layer (ie, the second layer in this study) of the noise-independent DDAE (NI-DDAE) model achieved the best performance gain regarding short-time objective intelligibility and perceptual evaluation of speech quality scores. Therefore, the parameters of layer 3 in the NI-DDAE were chosen to be replaced, thereby establishing the NC+DDAE_T. Both objective and listening test results showed that the proposed NC+DDAE_T noise reduction system achieved similar performances compared with the previous NC+DDAE in several noisy test conditions. However, the proposed NC+DDAE_T only required a quarter of the number of parameters compared to the NC+DDAE. Conclusions: This study demonstrated that knowledge transfer technology can help reduce the number of parameters in an NC+DDAE while keeping similar performance rates. This suggests that the proposed NC+DDAE_T model may reduce the implementation costs of this noise reduction system and provide more benefits for cochlear implant users. %M 34709193 %R 10.2196/25460 %U https://www.jmir.org/2021/10/e25460 %U https://doi.org/10.2196/25460 %U http://www.ncbi.nlm.nih.gov/pubmed/34709193 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29678 %T A Fully Automated Analytic System for Measuring Endolymphatic Hydrops Ratios in Patients With Ménière Disease via Magnetic Resonance Imaging: Deep Learning Model Development Study %A Park,Chae Jung %A Cho,Young Sang %A Chung,Myung Jin %A Kim,Yi-Kyung %A Kim,Hyung-Jin %A Kim,Kyunga %A Ko,Jae-Wook %A Chung,Won-Ho %A Cho,Baek Hwan %+ Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 06355, Republic of Korea, 82 234100885, baekhwan.cho@samsung.com %K deep learning %K magnetic resonance imaging %K medical image segmentation %K Ménière disease %K inner ear %K endolymphatic hydrops %K artificial intelligence %K machine learning %K multi-class segmentation %K convolutional neural network %K end-to-end system %K clinician support %K clinical decision support system %K image selection %K clinical usability %K automation %D 2021 %7 21.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Recently, the analysis of endolymphatic hydropses (EHs) via inner ear magnetic resonance imaging (MRI) for patients with Ménière disease has been attempted in various studies. In addition, artificial intelligence has rapidly been incorporated into the medical field. In our previous studies, an automated algorithm for EH analysis was developed by using a convolutional neural network. However, several limitations existed, and further studies were conducted to compensate for these limitations. Objective: The aim of this study is to develop a fully automated analytic system for measuring EH ratios that enhances EH analysis accuracy and clinical usability when studying Ménière disease via MRI. Methods: We proposed the 3into3Inception and 3intoUNet networks. Their network architectures were based on those of the Inception-v3 and U-Net networks, respectively. The developed networks were trained for inner ear segmentation by using the magnetic resonance images of 124 people and were embedded in a new, automated EH analysis system—inner-ear hydrops estimation via artificial intelligence (INHEARIT)-version 2 (INHEARIT-v2). After fivefold cross-validation, an additional test was performed by using 60 new, unseen magnetic resonance images to evaluate the performance of our system. The INHEARIT-v2 system has a new function that automatically selects representative images from a full MRI stack. Results: The average segmentation performance of the fivefold cross-validation was measured via the intersection of union method, resulting in performance values of 0.743 (SD 0.030) for the 3into3Inception network and 0.811 (SD 0.032) for the 3intoUNet network. The representative magnetic resonance slices (ie, from a data set of unseen magnetic resonance images) that were automatically selected by the INHEARIT-v2 system only differed from a maximum of 2 expert-selected slices. After comparing the ratios calculated by experienced physicians and those calculated by the INHEARIT-v2 system, we found that the average intraclass correlation coefficient for all cases was 0.941; the average intraclass correlation coefficient of the vestibules was 0.968, and that of the cochleae was 0.914. The time required for the fully automated system to accurately analyze EH ratios based on a patient's MRI stack was approximately 3.5 seconds. Conclusions: In this study, a fully automated full-stack magnetic resonance analysis system for measuring EH ratios was developed (named INHEARIT-v2), and the results showed that there was a high correlation between the expert-calculated EH ratio values and those calculated by the INHEARIT-v2 system. The system is an upgraded version of the INHEARIT system; it has higher segmentation performance and automatically selects representative images from an MRI stack. The new model can help clinicians by providing objective analysis results and reducing the workload for interpreting magnetic resonance images. %M 34546181 %R 10.2196/29678 %U https://www.jmir.org/2021/9/e29678 %U https://doi.org/10.2196/29678 %U http://www.ncbi.nlm.nih.gov/pubmed/34546181 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e28328 %T Biannual Differences in Interest Peaks for Web Inquiries Into Ear Pain and Ear Drops: Infodemiology Study %A Brkic,Faris F %A Besser,Gerold %A Schally,Martin %A Schmid,Elisabeth M %A Parzefall,Thomas %A Riss,Dominik %A Liu,David T %+ Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria, 43 1 404 002 0820, david.liu@meduniwien.ac.at %K otitis media %K otitis externa %K otalgia %K Google Trends %K infodemiology %K infoveillance %K infodemic %K social listening %D 2021 %7 20.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The data retrieved with the online search engine, Google Trends, can summarize internet inquiries into specified search terms. This engine may be used for analyzing inquiry peaks for different medical conditions and symptoms. Objective: The aim of this study was to analyze World Wide Web interest peaks for “ear pain,” “ear infection,” and “ear drops.” Methods: We used Google Trends to assess the public online interest for search terms “ear pain,” “ear infection,” and “ear drops” in 5 English and non–English-speaking countries from both hemispheres based on time series data. We performed our analysis for the time frame between January 1, 2004, and December 31, 2019. First, we assessed whether our search terms were most relevant to the topics of ear pain, ear infection, and ear drops. We then tested the reliability of Google Trends time series data using the intraclass correlation coefficient. In a second step, we computed univariate time series plots to depict peaks in web-based interest. In the last step, we used the cosinor analysis to test the statistical significance of seasonal interest peaks. Results: In the first part of the study, it was revealed that “ear infection,” “ear pain,” and “ear drops” were the most relevant search terms in the noted time frame. Next, the intraclass correlation analysis showed a moderate to excellent reliability for all 5 countries’ 3 primary search terms. The subsequent analysis revealed winter interest peaks for “ear infection” and “ear pain”. On the other hand, the World Wide Web search for “ear drops” peaked annually during the summer months. All peaks were statistically significant as revealed by the cosinor model (all P values <.001). Conclusions: It can be concluded that individuals affected by otitis media or externa, possibly the majority, look for medical information online. Therefore, there is a need for accurate and easily accessible information on these conditions in the World Wide Web, particularly on differentiating signs and therapy options. Meeting this need may facilitate timely diagnosis, proper therapy, and eventual circumvention of potentially life-threatening complications. %M 34185016 %R 10.2196/28328 %U https://www.jmir.org/2021/6/e28328/ %U https://doi.org/10.2196/28328 %U http://www.ncbi.nlm.nih.gov/pubmed/34185016 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 9 %N 4 %P e14640 %T Prevalence of and Factors Associated With Eustachian Tube Dysfunction Among the Public in Jeddah, Saudi Arabia: Cross-Sectional Survey-Based Study %A Alshehri,Khalid A %A Saggaf,Omar M %A Alshamrani,Hussein M %A Alnefaie,Abdulrahman Mutlaq %A Alghamdi,Khalid B %+ Otorhinolaryngology and Head and Neck Surgery, King Abdulaziz University, PO box 80200, Jeddah, 21589, Saudi Arabia, 966 567033721, khalid.edu95@gmail.com %K Eustachian tube %K Eustachian tube dysfunction %K chronic otitis media %K hearing loss %K electronic survey %K cholesteatoma %K 7-item Eustachian Tube Dysfunction Questionnaire %D 2020 %7 19.11.2020 %9 Original Paper %J Interact J Med Res %G English %X Background: Obstruction of the Eustachian tube is a common condition that is unpleasant and might lead to various middle ear disorders. Objective: This study aimed to estimate the prevalence of Eustachian tube dysfunction (ETD) among the public in Jeddah, Saudi Arabia. Methods: This cross-sectional survey-based study was conducted in Jeddah during August 2018 by distributing an electronic survey form to participants from different districts of the city. All male and female residents of Jeddah aged 10 years and above had the chance to participate in this study. Results: A total of 2372 participants (female, 1535/2372, 64.71%; male, 837/2372, 35.28%; mean age 31.31 years, SD 11.85 years) agreed to contribute to our study. Upon analysis of their answers to the questionnaire, the overall prevalence of ETD in our sample was found to be 42.49% (1008/2372). The prevalence was higher among participants who reported a previous diagnosis of ETD and hearing loss (1897/2372, 80.00% and 1902/2372, 80.21%, respectively). Additionally, participants with a family history of hearing loss had a significantly higher prevalence (1136/2372, 47.92%) of ETD than those with no family history of hearing loss. Our analysis also showed that females were at a greater risk of developing ETD than males (P=.01). Conclusions: As per our prevalence data, ETD is a common disease in Jeddah, pointing to the need for more attention, awareness, and research. %M 33211016 %R 10.2196/14640 %U https://www.i-jmr.org/2020/4/e14640 %U https://doi.org/10.2196/14640 %U http://www.ncbi.nlm.nih.gov/pubmed/33211016 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 9 %N 1 %P e14446 %T Defining Symptom Concepts in Chronic Subjective Tinnitus: Web-Based Discussion Forum Study %A Hibbert,Alice %A Vesala,Markku %A Kerr,Micky %A Fackrell,Kathryn %A Harrison,Stephen %A Smith,Harriet %A Hall,Deborah Ann %+ National Institute for Health Research Nottingham Biomedical Research Centre, The Ropewalk, Nottingham, , United Kingdom, 44 8232600, deborah.hall@nottingham.ac.uk %K patient outcome assessment %K treatment outcome %K concept formation %K qualitative research %K patient participation %K community participation %K stakeholder participation %K Web social networking %D 2020 %7 7.1.2020 %9 Original Paper %J Interact J Med Res %G English %X Background: A minimum standard based upon consensus decision making recommends a core set of tinnitus-specific health complaints (outcome domains) that should be assessed and reported in all clinical trials as this enables comparisons to be made across studies as well as data pooling for meta-analysis. Objective: This study aimed to further clarify how the outcome domain concepts should be defined for 5 of the core set: tinnitus intrusiveness, sense of control, acceptance of tinnitus, concentration, and ability to ignore. This step requires a clear and fully elaborated definition for each outcome domain, moving from an abstract or a vague concept to an operationalized and measurable health-related construct, so that a suitable measurement instrument can then be identified. Methods: A series of 5 focus group–style semistructured discussions were conducted via a Web-based discussion forum, each open for 2 weeks and ending with a vote. The participants included 148 tinnitus experts who completed a preceding e-Delphi survey that had generated the original set of minimum standards. The participants were health care users living with tinnitus, health care professionals, clinical researchers, commercial representatives, and funders. Results: The Web discussions led to a revision of all 5 original plain language definitions that had been used in the preceding e-Delphi survey. Each revised definition was voted by 8 to 53 participants and reached the prespecified threshold of 70% consensus for all except tinnitus intrusiveness. Although a single definition was not agreed upon for tinnitus intrusiveness, the majority of participants shared the view that the concept should be sufficiently broad to encapsulate a range of subdomains. The examples included tinnitus awareness, unpleasantness, and impact on different aspects of everyday life. Thematic analysis of the 5 Web-based discussion threads gave important insights into expert interpretations of each core outcome domain, generating an operationalized and measurable health construct in each case. Conclusions: The qualitative data gathered during the Web-based discussion forum provided an important in-depth understanding of the health concepts that had raised a debate during earlier face-to-face meetings. The descriptive summaries and definitions provide sufficient operationalization of those concepts to proceed to the second stage of core outcome set development that is to identify and evaluate suitable measurement instruments. This study supports the use of Web-based peer discussion forums in defining health concepts. %M 31909716 %R 10.2196/14446 %U https://www.i-jmr.org/2020/1/e14446 %U https://doi.org/10.2196/14446 %U http://www.ncbi.nlm.nih.gov/pubmed/31909716 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 3 %P e14519 %T The Presence of Physical Symptoms in Patients With Tinnitus: International Web-Based Survey %A Michiels,Sarah %A Harrison,Stephen %A Vesala,Markku %A Schlee,Winfried %+ Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610, Belgium, 32 485840758, sarah.michiels@uantwerpen.be %K tinnitus %K self report %K surveys %D 2019 %7 30.07.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Tinnitus, or ringing in the ears, is a phantom perception of sound in the absence of overt acoustic stimulation. Many patients indicate that the perception of their tinnitus is not constant and can vary from moment to moment. This tinnitus fluctuation is one of the diagnostic criteria for somatosensory tinnitus (ST), a tinnitus subtype that is influenced by cervical spine or temporomandibular dysfunctions, although various factors have been reported to cause fluctuations in tinnitus, such as stress, anxiety, and physical activity. Objective: The aim of this study was twofold: (1) to investigate the presence of physical symptoms in a large group of participants with tinnitus and (2) to investigate if these physical symptoms are more frequently present in a subgroup of participants with ST. Methods: A Web-based survey, questioning the presence of physical symptoms in a convenience sample of participants with tinnitus, was launched on the online forum, Tinnitus Talk, managed by Tinnitus Hub. After a general analysis of the physical symptoms present in our survey population, we further analyzed the group of participants who were diagnosed by a physician (n=1262). This subgroup was divided into 2 groups, one group diagnosed with ST and another group diagnosed with other types of tinnitus. Results: In total, 6115 participants with a mean age of 54.08 years (SD 13.8) completed the survey. Physical symptoms were frequently present in our sample of participants with tinnitus: 4221 participants (69.02%) reported some form of neck pain, 429 (7.01%) were diagnosed with temporomandibular disorders, 2730 (44.64%) indicated they have bruxism, and between 858 and 1419 (14.03%-23.20%) participants were able to modulate their tinnitus by voluntary movements. ST was diagnosed in 154 out of 1262 (12.20%) participants whose tinnitus cause was diagnosed by a physician. Symptoms referring to the known diagnostic criteria were evidently more present in the ST group than in the non-ST group. Additionally, participants with ST more often indicated a negative effect of a bad night’s sleep (P=.01) and light intensity exercise (P=.01). Conclusions: Physical activity and movement (disorders) frequently affect tinnitus severity. Head-neck related symptoms are more frequently reported in the ST group, as is the ability to modulate the tinnitus by head or jaw movements. Additionally, participants with ST more often report fluctuations of their tinnitus and reaction to sleeping difficulties and low intensity exercise. %M 31364603 %R 10.2196/14519 %U http://www.i-jmr.org/2019/3/e14519/ %U https://doi.org/10.2196/14519 %U http://www.ncbi.nlm.nih.gov/pubmed/31364603 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 1 %P e9 %T Representation of Tinnitus in the US Newspaper Media and in Facebook Pages: Cross-Sectional Analysis of Secondary Data %A Manchaiah,Vinaya %A Ratinaud,Pierre %A Andersson,Gerhard %+ Department of Speech and Hearing Sciences, Lamar University, PO Box 10076, Beaumont, TX, 77710, United States, 1 4098808927, vinaya.manchaiah@lamar.edu %K tinnitus %K chronic condition %K health communication %K health information %K media %K news media %K social media %D 2018 %7 08.05.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: When people with health conditions begin to manage their health issues, one important issue that emerges is the question as to what exactly do they do with the information that they have obtained through various sources (eg, news media, social media, health professionals, friends, and family). The information they gather helps form their opinions and, to some degree, influences their attitudes toward managing their condition. Objective: This study aimed to understand how tinnitus is represented in the US newspaper media and in Facebook pages (ie, social media) using text pattern analysis. Methods: This was a cross-sectional study based upon secondary analyses of publicly available data. The 2 datasets (ie, text corpuses) analyzed in this study were generated from US newspaper media during 1980-2017 (downloaded from the database US Major Dailies by ProQuest) and Facebook pages during 2010-2016. The text corpuses were analyzed using the Iramuteq software using cluster analysis and chi-square tests. Results: The newspaper dataset had 432 articles. The cluster analysis resulted in 5 clusters, which were named as follows: (1) brain stimulation (26.2%), (2) symptoms (13.5%), (3) coping (19.8%), (4) social support (24.2%), and (5) treatment innovation (16.4%). A time series analysis of clusters indicated a change in the pattern of information presented in newspaper media during 1980-2017 (eg, more emphasis on cluster 5, focusing on treatment inventions). The Facebook dataset had 1569 texts. The cluster analysis resulted in 7 clusters, which were named as: (1) diagnosis (21.9%), (2) cause (4.1%), (3) research and development (13.6%), (4) social support (18.8%), (5) challenges (11.1%), (6) symptoms (21.4%), and (7) coping (9.2%). A time series analysis of clusters indicated no change in information presented in Facebook pages on tinnitus during 2011-2016. Conclusions: The study highlights the specific aspects about tinnitus that the US newspaper media and Facebook pages focus on, as well as how these aspects change over time. These findings can help health care providers better understand the presuppositions that tinnitus patients may have. More importantly, the findings can help public health experts and health communication experts in tailoring health information about tinnitus to promote self-management, as well as assisting in appropriate choices of treatment for those living with tinnitus. %M 29739734 %R 10.2196/ijmr.9065 %U http://www.i-jmr.org/2018/1/e9/ %U https://doi.org/10.2196/ijmr.9065 %U http://www.ncbi.nlm.nih.gov/pubmed/29739734