Dr. Hashir Aazh has a close working relationship with the researchers at University of London, University of Surrey, and University of Cambridge.

Below are some of the topics and abstracts of the recent studies conducted by Dr. Hashir Aazh:




Am J Audiol. 2017 Sep 18;26(3):226-232.

Incidence of Discomfort During Pure-Tone Audiometry and Measurement of

Uncomfortable Loudness Levels Among People Seeking Help for Tinnitus and/or

Hyperacusis.

Aazh H(1), Moore BCJ(2).

Author information:

(1)Audiology Department, Royal Surrey County Hospital NHS Foundation Trust,

Guildford, United Kingdom.

(2)Department of Psychology, University of Cambridge, United Kingdom.

Purpose: The aim of this study was to assess the proportion of patients seen in a

tinnitus and hyperacusis therapy clinic for whom presentation levels based on the

British Society of Audiology (BSA)-recommended procedures for pure-tone

audiometry and determination of uncomfortable loudness levels (ULLs) exceed ULLs,

leading to discomfort during administration of these procedures.

Method: This was a retrospective cross-sectional study of 362 consecutive

patients who attended a National Health Service audiology clinic for tinnitus

and/or hyperacusis rehabilitation.

Results: For 21% of the patients, presentation levels based on the BSA procedure

for pure-tone audiometry exceeded the ULL for at least 1 of the measured

frequencies (excluding the first frequency tested, 1 kHz): 0.25, 0.5, 2, 3, 4, 6,

and 8 kHz. For 24% of patients, the starting presentation level of 60 dB hearing

level recommended for determination of ULLs exceeded the ULL for at least 1

frequency.

Conclusion: The starting presentation levels used for pure-tone audiometry and

measurement of ULLs should be lower than those recommended by the BSA for people

with tinnitus and hyperacusis.

 

Int J Audiol. 2017 Sep;56(9):677-684.

Factors related to tinnitus and hyperacusis handicap in older people.

Aazh H(1), Lammaing K(1), Moore BCJ(2).

Author information:

(1)a Audiology Department , Royal Surrey County Hospital NHS Foundation Trust ,

Guildford , UK and.

(2)b Department of Experimental Psychology , University of Cambridge , Cambridge

, UK.

OBJECTIVE: The aim was to assess factors related to tinnitus and hyperacusis

handicap in older people.

DESIGN: Retrospective cross-sectional.

STUDY SAMPLE: Data were gathered for 184 patients with an average age of 69

years.

RESULTS: Tinnitus handicap as measured via the Tinnitus Handicap Inventory (THI)

was significantly predicted by tinnitus annoyance as measured via the visual

analogue scale (VAS) (regression coefficient, b = 2.9, p < 0.001) and the effect

of tinnitus on the patient's life as measured via the VAS (b = 3.9, p < 0.001).

Hyperacusis handicap as measured via the Hyperacusis Questionnaire (HQ) was

significantly predicted by the score on the depression subscale of the Hospital

Anxiety and Depression Scale (HADS) (b = 0.8, p < 0.001) and to a small extent by

the THI score (b = 0.07, p = 0.048). Insomnia scores as measured via the Insomnia

Severity Index (ISI) were significantly predicted by scores on the depression

subscale of the HADS (b = 0.46, p = 0.007).

CONCLUSIONS: Since tinnitus annoyance significantly predicts tinnitus handicap,

it is important to explore factors associated with annoyance that may be useful

in designing appropriate rehabilitative interventions aimed at reducing tinnitus

handicap in older people. Future studies should explore whether hyperacusis and

insomnia in older people with tinnitus need to be managed in conjunction with

treatment for depression.

 

 Int J Audiol. 2017 Oct;56(10):793-800

Factors related to uncomfortable loudness levels for patients seen in a tinnitus

and hyperacusis clinic.

Aazh H(1), Moore BCJ(2).

Author information:

(1)a Audiology Department , Royal Surrey County Hospital NHS Foundation Trust ,

Guildford , UK and.

(2)b Department of Experimental Psychology , University of Cambridge , Cambridge

, UK.

OBJECTIVES: The aims were as follows: (1) to explore patterns of uncomfortable

loudness levels (ULLs) across frequency and their associated factors for patients

with tinnitus and hyperacusis, and (2) to re-evaluate the criteria for diagnosing

hyperacusis based on ULLs and scores for the Hyperacusis Questionnaire (HQ).

DESIGN: This was a retrospective cross-sectional study.

STUDY SAMPLE: 573 consecutive patients for whom ULLs had been measured were

included.

RESULTS: A good correspondence between the diagnosis of hyperacusis based on the

across-frequency average ULL for the ear with the lowest ULLs (ULLmin) and

hyperacusis handicap based on HQ scores was obtained with cut-off values of

ULLmin ≤77 dB HL and HQ score ≥ 22. A regression model showed significant

relationships between ULLmin and the score on the HQ and age. The mean HQ score

for patients with a large interaural asymmetry in ULLs was significantly higher

than for the remainder. Hyperacusis handicap was associated with strong

across-frequency variations in ULLs.

CONCLUSIONS: Appropriate cut-off values for diagnosing hyperacusis are ULLmin

≤77 dB HL and HQ score ≥22. Large interaural asymmetry and large across-frequency

variations in ULLs are associated with higher HQ scores.

 

Int J Audiol. 2017 Jul;56(7):489-498.

Usefulness of self-report questionnaires for psychological assessment of patients

with tinnitus and hyperacusis and patients' views of the questionnaires.

Aazh H(1), Moore BCJ(2).

Author information:

(1)a Audiology Department , Royal Surrey County Hospital NHS Foundation Trust ,

Guildford , UK and.

(2)b Department of Experimental Psychology , University of Cambridge , Cambridge

, UK.

OBJECTIVE: The objective was to determine the relevance and applicability of

psychological questionnaires to patients seeking help for tinnitus and/or

hyperacusis.

DESIGN: This was a questionnaire-based survey. The following questionnaires were

administered: Generalised Anxiety Disorder (GAD-7), Short Health Anxiety

Inventory (SHAI), Mini-Social Phobia Inventory (Mini-SPIN), Obsessive Compulsive

Inventory-Revised (OCI-R), Panic Disorder Severity Scale-Self Report (PDSS-SR),

Patient Health Questionnaire (PHQ-9) and Penn State Worry

Questionnaire-Abbreviated version (PSWQ-A). In addition, a patient feedback

questionnaire was completed asking about the extent to which each questionnaire

was relevant to them and how strongly they would recommend its use in the

assessment of patients with tinnitus and hyperacusis.

STUDY SAMPLE: A total of 150/402 consecutive patients seen in a one-year period

completed the questionnaires.

RESULTS: 65% of patients had abnormal scores for one or more of the

questionnaires. All questionnaires except the PDSS-SR were rated as relevant and

recommended for use.

CONCLUSIONS: The GAD-7, SHAI, Mini-SPIN, OCI-R, PSWQ-A and PHQ-9 are recommended

for evaluation of psychological problems for patients seeking help for tinnitus

and/or hyperacusis. Abnormal results on these questionnaires may indicate the

need for referral for possible treatment of psychological problems.

 

J Am Acad Audiol. 2017 Mar;28(3):248-260.

Audiological Rehabilitation for Facilitating Hearing Aid Use: A Review.

Aazh H(1)(2), Moore BC(3).

Author information:

(1)Audiology Department, Royal Surrey County Hospital NHS Foundation Trust,

Guildford, UK.

(2)London School of Hygiene & Tropical Medicine, University of London, London,

UK.

(3)Department of Psychology, University of Cambridge, Cambridge, UK.

 

PURPOSE: This article reviews and critically analyzes the design of studies on

the effect of audiological rehabilitation (AR) programs on hearing aid (HA)

outcomes, in order to guide future research.

RESEARCH DESIGN: The design of this study was a narrative review. Studies were

included in the review if they were randomized controlled trials that

investigated the effects of AR on HA use and outcome between 2000 and 2016.

RESULTS: Seven articles that met the inclusion criteria were included in the

review. Most used educational rather than counseling approaches. Although

educational AR programs seem to be useful in enhancing the use of communication

strategies, there is limited evidence for their effect on HA use and

self-perceived hearing handicap.

CONCLUSIONS: More research is needed in this field. Future studies should (1)

investigate the efficacy of AR interventions based on counseling and empathetic

listening as opposed to or in addition to educational interventions, (2) use

stricter criteria to include only a subpopulation of patients who do not get on

well with their HAs, (3) measure the amount of HA use via data-logging and

self-report questionnaires, and (4) use a matching comparison intervention for

patients in the control group.

 

 

Int J Audiol. 2016 Sep;55(9):514-22

Tinnitus and hyperacusis therapy in a UK National Health Service audiology

department: Patients' evaluations of the effectiveness of treatments.

Aazh H(1), Moore BC(2), Lammaing K(1), Cropley M(3).

Author information:

(1)a Audiology Department , Royal Surrey County Hospital NHS Foundation Trust ,

Guildford , UK .

(2)b Department of Experimental Psychology , University of Cambridge , UK , and.

(3)c School of Psychology , University of Surrey , Guildford , UK.

OBJECTIVE: To assess patients' judgements of the effectiveness of the tinnitus

and hyperacusis therapies offered in a specialist UK National Health Service

audiology department.

DESIGN: Cross-sectional service evaluation questionnaire survey. Patients were

asked to rank the effectiveness of the treatment they received on a scale from 1

to 5 (1 = no effect, 5 = very effective).

STUDY SAMPLE: The questionnaire was sent to all patients who received treatment

between January and March 2014 (n = 200) and 92 questionnaires were returned.

RESULTS: The mean score was greatest for counselling (Mean = 4.7, SD = 0.6),

followed by education (Mean = 4.5, SD = 0.8), cognitive behavioural therapy - CBT

(Mean = 4.4, SD = 0.7), and hearing tests (Mean = 4.4, SD = 0.9). Only 6% of

responders rated counselling as 3 or below. In contrast, bedside sound

generators, hearing aids, and wideband noise generators were rated as 3 or below

by 25%, 36%, and 47% of participants, respectively.

CONCLUSION: The most effective components of the tinnitus and hyperacusis therapy

interventions were judged by the patients to be counselling, education, and CBT.

 

Int J Audiol. 2016;55(3):149-56.

Feasibility of conducting a randomized controlled trial to evaluate the effect of

motivational interviewing on hearing-aid use.

Aazh H(1).

Author information:

(1)a Audiology Department , Royal Surrey County Hospital , Guildford , UK.

OBJECTIVES: The aim of this study was to evaluate the feasibility of conducting a

randomized controlled trial (RCT) on the effect of motivational interviewing (MI)

on hearing-aid use.

DESIGN: This was a pilot single-blind, randomized parallel-group study conducted

in the UK.

STUDY SAMPLE: Thirty-seven adult patients who reported using their hearing aid(s)

less than four hours per day were randomized to MI combined with Standard Care

(MISC) (n = 20), and Standard Care only (SC) (n = 17).

RESULTS: Of 220 patients invited, 37 were enrolled giving the recruitment rate of

17%. One participant withdrew giving the retention rate of 97%. It was feasible

to combine MI with SC for facilitating hearing-aid use and deliver the

intervention with high fidelity in an audiology setting. The measure on

hearing-aid use (data logging) one month after interventions favoured the MISC

group.

CONCLUSIONS: This pilot study suggests that conducting an RCT on using MI for

facilitating hearing-aid use in people who do not use their hearing aids is

feasible, and that MI combined with SC may have more positive effects on

hearing-aid use compared to SC only.

 

Int J Audiol. 2015 Mar;54(3):152-61.

Hearing-aid use and its determinants in the UK National Health Service: a

cross-sectional study at the Royal Surrey County Hospital.

Aazh H(1), Prasher D, Nanchahal K, Moore BC.

Author information:

(1)* Audiology Department, Royal Surrey County Hospital NHS Foundation Trust ,

Guildford , UK.

OBJECTIVES: The aim of this study was to investigate the rate of and factors

contributing to non-adherence to hearing-aid use in the UK National Health

Service.

DESIGN: A cross-sectional postal questionnaire survey.

STUDY SAMPLE: A questionnaire, including the International Outcome Inventory for

Hearing Aids, was sent to all patients fitted with hearing aids at the Royal

Surrey County Hospital between 2011 and 2012 (N = 1874). A total of 1023

questionnaires were completed and returned (response rate of 55%).

RESULTS: A total of 29% of responders did not use their hearing aids on a regular

basis (i.e. used them less than four hours per day). Non-regular use was more

prevalent in new (40%) than in existing patients (11%). Factors that reduced the

risk of non-regular use included bilateral versus unilateral amplification, and

moderate or severe hearing loss in the better ear. 16% of responders fitted with

bilateral amplification used only one of their hearing aids.

CONCLUSIONS: The level of non-regular use of hearing aids in NHS found in this

study was comparable to those for other countries. Additional support might be

needed for patients at a higher risk of non-regular use.

 

 Noise Health. 2014 Mar-Apr;16(69):123-6.

Insights from the First International Conference on Hyperacusis: causes,

evaluation, diagnosis and treatment.

Aazh H(1), McFerran D, Salvi R, Prasher D, Jastreboff M, Jastreboff P.

Author information:

(1)Department of Audiology, Royal Surrey County Hospital, Guildford; Department

of Social and Environmental Health Research, London School of Hygiene & Tropical

Medicine, London, United Kingdom.

 

The First International Conference on Hyperacusis gathered over 100 scientists

and health care professionals in London, UK. Key conclusions from the conference

included: (1) Hyperacusis is characterized by reduced tolerance of sound that has

perceptual, psychological and social dimensions; (2) there is a growing awareness

that children as well as adults experience symptoms of hyperacusis or misophonia;

(3) the exact mechanisms that give rise to hyperacusis are not clear, but the

available evidence suggests that functional changes within the central nervous

system are important and in particular, hyperacusis may be related to increased

gain in the central auditory pathways and to increased anxiety or emotional

response to sound; (4) various counseling and sound therapy approaches seem

beneficial in the management of hyperacusis, but the evidence base for these

remains poor.

 

Am J Audiol. 2012 Dec;21(2):175-80.

The accuracy of matching target insertion gains with open-fit hearing aids.

Aazh H(1), Moore BC, Prasher D.

Author information:

(1)Royal Surrey County Hospital National Health Service Foundation Trust, UK.

hashir.aazh@nhs.net

PURPOSE: To assess the accuracy with which target insertion gains were matched

for a single type of open-fit hearing aid, both on initial fitting and after

adjustment.

METHOD: The hearing aids were fitted using the first-fit setting in the

programming software and the target formula was selected as NAL-NL1. The

difference between the real ear insertion gain (REIG) and the NAL-NL1 target REIG

was recorded. The initial fitting was considered acceptable if the difference was

less than 10 dB at all frequencies. If an initial fitting was not acceptable, the

frequency-gain response was modified. The difference between the final REIG and

the NAL-NL1 target REIG was recorded as final target mismatch.

RESULTS: Of the 51 initial fittings, 36 (71%) failed to achieve a match within

±10 dB of the NAL-NL1 insertion gain target at 1 or more frequencies between 0.25

and 4 kHz. After the authors adjusted the frequency-gain response of the hearing

aids, only 9 fittings (18%) failed to achieve a match.

CONCLUSION: These outcomes suggest that target insertion gains for the open-fit

hearing aids used here are rarely achieved with a first fitting but can usually

be achieved through adjustments based on REIG measurements.

 

Int J Audiol. 2012 Feb;51(2):103-7.

Real ear measurement methods for open fit hearing aids: modified pressure

concurrent equalization (MPCE) versus modified pressure stored equalization

(MPSE).

Aazh H(1), Moore BC, Prasher D.

Author information:

(1)Audiology Department, Royal Surrey County Hospital NHS Foundation Trust,

Guildford, UK. hashir.aazh@nhs.net

OBJECTIVE: The aim of this study was to assess differences between real ear

insertion gains (REIG) measured with the modified pressure concurrent

equalization (MPCE) and modified pressure stored equalization (MPSE) methods for

open fittings in a typical audiology patient population.

DESIGN: REIGs were compared for the two methods using a warble tone sweep at 65

dB SPL. The differences between the two methods at 0.25, 0.5, 1, 2, 3, 4 and 6

kHz were recorded.

STUDY SAMPLE: Eighty-three ears of a consecutive sample of 48 candidates for

open-fit hearing aids were included.

RESULTS: The mean difference between MPSE and MPCE REIGs was less than 1 dB at

all frequencies. Analysis of variance showed that the main effect of method was

not significant, and there was no significant interaction between method and

frequency.

CONCLUSIONS: The results for the MPSE and MPCE methods did not differ

significantly for the patients with mild-to-moderate hearing losses tested here,

for whom REIGs were generally less than 20 dB. Further research is needed to

identify the REIG values at which the differences between MPCE and MPSE methods

become clinically significant.

 

Am J Audiol. 2011 Dec;20(2):151-8.

Gabapentin for tinnitus: a systematic review.

Aazh H(1), El Refaie A, Humphriss R.

Author information:

(1)Royal Surrey County Hospital NHS Foundation Trust, Guildford, United Kingdom.

hashir.aazh@nhs.net

PURPOSE: The main aim of this study was to assess the effect of gabapentin on

tinnitus via a systematic review.

METHOD: An electronic search of literature as well as a hand search were

conducted. Only double-blind randomized controlled trials (RCTs) that met all of

the inclusion criteria were included in this review. The Cochrane Collaboration

tool for risk of bias assessment was used to investigate the validity of the

included studies. Meta-analysis was not appropriate due to inadequate details in

reporting the data in the included studies. Hence, qualitative synthesis and

interpretation of the data were carried out.

RESULTS: Two studies that met the inclusion criteria were included in the review.

Fourteen studies were excluded. There were substantive within-study clinical

heterogeneities with regard to the baseline tinnitus handicap scores, duration of

tinnitus, and severity of hearing loss in the included double-blind RCTs.

CONCLUSION: The authors of both studies reported that gabapentin was not superior

to placebo in their primary outcomes. However, following the assessment of risk

of bias and within-study clinical heterogeneities, this review concludes that

there is insufficient evidence regarding the effect of gabapentin on tinnitus.