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Objectives: While there are several consumer mobile applications for hearing assessment, only a few have been clinically studied. Nevertheless, none of them accounts for underlying hardware differences. Moreover, there is currently no app available to assess the user’s capability of resolving temporal cues (i.e. temporal resolution), which is vital for speech perception and sound localisation. To address these limitations, we developed an Android app that adapts to the frequency response of Bluetooth-enabled headphones and conducts pure-tone audiometry and a temporal masking (TM) test.

Design and Study Sample: 24 normal-hearing and 24 hearing-impaired individuals (mean age = 49.2 and 59.0 years, respectively) were recruited. Clinical audiometry was conducted according to ISO8253-:2010 at 250 to 8000 Hz. The app-based audiometry was conducted at the same frequencies. A TM paradigm was implemented and conducted at gap durations of 5,10,20,40, and 80 ms.

Results: App-based audiometry results closely matched the clinical measurements. Linear mixed models revealed no significant differences between the two methods. The correlation between the two methods was significant (p<.001) and strong (r=.90). Our TM method provided a quick estimate of auditory temporal resolution at 500, 2000, and 4000 Hz.

Conclusion: The app can accurately and quickly estimate the user’s clinical audiogram and temporal resolution.

OBJECTIVES: Bone conduction devices (BCD) have been commercially available since the 1980s for patients with conductive hearing loss (CHL), mixed hearing loss (MHL), or single-sided deafness (SSD). BCDs significantly improve the hearing capacity of patients regardless of age, which has a positive impact on their quality of life, mental health, education, and work performance. BCDs are categorized as percutaneous or transcutaneous solutions based on the attachment method. Selecting the optimal solution for patients requires consideration of audiological outcomes, guidelines, safety, patient preferences, and costs. This study evaluated the cost-effectiveness of an active transcutaneous solution (Osia System, Cochlear Ltd.) compared with percutaneous solutions to treat adult patients in Sweden. MATERIALS AND METHODS: A Markov model was developed to simulate a cohort of adult patients aged 59 years or older receiving Osia or percutaneous BCDs. The model considered 3 health states: patients who have received a BCD, patients without a device due to explantation (without reimplantation) or elective device non-use, and an absorbing state (death). The final state was based on age-dependent mortality, assuming hearing loss does not impact mortality. Probabilities were determined for transition between the health states with 6-month cycles and a lifetime horizon. Utility scores for each health state were derived from published literature using the Health Utilities Index Mark III (HUI3). Complication rates were also sourced from the literature, and the cost of complications and implantation from the National Board of Health and Welfare in Sweden, Socialstyrelsen. The perspective of the model was the Swedish health care system, and the main outcome was incremental cost per quality-adjusted life year (QALY) gained. Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the results. RESULTS: Osia was associated with an increase in cost of 79,293 SEK and an increase in QALYs of 0.73 compared with percutaneous devices, resulting in an incremental cost-effectiveness ratio of 108,318 SEK per QALY gained. The main drivers of cost-effectiveness were baseline age, the cost of surgery, and the difference in utility scores between the two interventions. The differences in HUI3 scores may be linked to the reduced risk of complications, improved cosmetic appearance, and improved hearing with Osia. CONCLUSIONS: Osia is cost-effective compared with percutaneous devices over a lifetime horizon, when applying low to moderate cost per QALY willingness-to-pay thresholds indicated by the Swedish Agency for Health Technology Assessment and Assessment of Social Services. This analysis provides information on the economic impact of different hearing solutions to support decisions on which BCD best meets the needs of patients and health care budgets.

Background: Otitis media (OM) in children is a common infection in primary care, contributing to a significant global health and economic burden. In high-income countries, diagnostic inaccuracy leads to over-diagnosis of acute OM (AOM) and over-prescribing of antibiotics, which may contribute to antibiotic resistance.

Aim: To investigate the diagnostic accuracy and the influence of artificial intelligence (AI) in diagnosing OM among primary care physicians and medical students.

Method: A diagnostic accuracy study in which primary care physicians and medical students diagnosed AOM, OM with effusion (OME), and normal eardrums using 21 high-quality digital images, both without and with a fictitious AI support. We estimated the technological impact of the fictitious AI support.

Results: Overall diagnostic accuracy was 64% without, and 75% with AI support. The most experienced physicians reached 69% without, and 80% with AI; the least experienced 61% without, and 73% with AI; medical students reached 64% without, and 74% with AI. Accuracy for AOM was 77% without and 86% with AI, and for OME 46% without and 66% with AI. Mean diagnostic confidence increased significantly with AI support. The technological impact was 1.4. Automation bias was 1.2 overall, 0.9 for the most experienced and 1.2 for the least experienced physicians.

Conclusion: We report modest diagnostic accuracy for OM among primary care physicians and medical students. The fictitious AI support system improved both accuracy and diagnostic confidence and reduced over-diagnosis. The most experienced physicians achieved the highest accuracy, the less experienced were more often misled by the fictitious AI.

Background: National studies on primary malignant tumours arising from the external auditory canal (EAC) are rare.

Objectives: To investigate the incidence and outcomes of squamous cell carcinoma of the external auditory canal (SCC-EAC) in Sweden.

Materials and methods: The retrospective study included patients diagnosed with SCC-EAC in Sweden from 2007 to 2017.

Results: Forty-six patients with SCC-EAC were identified. The crude annual incidence was 0.043 per 100,000 inhabitants (age-standardised rate (ASR): 0.024 WHO, 0.045 Europe). Among the 40 patients treated with curative intent, 85% achieved remission, and 23% subsequently relapsed. Uncertain or non-radical primary surgery significantly correlated with residual tumour or relapse (p = 0.01) and disease-specific mortality (p = 0.002). Clear margins were achieved in 60% of T1 tumours and 21% of T4 tumours, indicating surgical undertreatment. None of the patients who underwent radical surgery died of SCC-EAC.

Conclusions and significance: The incidence of SCC-EAC in Sweden was lower than international rates. Non-radical surgery drastically increased mortality, and postoperative radiotherapy (PORT) could not fully compensate for incomplete resection. Consequently, a more aggressive surgical approach is justified.

Introduction: Noise trauma may induce auditory symptoms and temporary or permanent shifts in hearing thresholds, assessed with a tone audiogram. Until recently it has been assumed that primary changes after noise trauma exclusively represent damage to the sensory hair cells. Contrary, animal studies have now shown early alterations in auditory brainstem response (ABR) characteristic of auditory neuropathy (AN), as reduction or absence of wave I, following noise trauma. AN involves a variety of disease mechanisms in the cochlea and auditory nerve, affecting the synaptic encoding and/or neural transmission of auditory information. The aim of this study was to evaluate whether patients exposed to noise trauma exhibit click ABR alterations characteristic of AN.

Method: Thirty-one adult patients who attended an ear-nose and throat clinic, after a noise trauma, were included and an age- and gender-matched control group of 31 adults was constructed. To evaluate audiologic hearing impairment pure tone audiometry, speech intelligibility, click ABR and transient evoked otoacoustic emissions (TEOAE)/cochlear microphonics (CM) were performed. A full linear mixed model including the interaction between sex and group was tested.

Results: Our study showed that individuals exposed to sudden and distinct traumatic noise exhibit a statistically significant reduction (81.1 nV, p < 0.001) in the amplitude of wave I in ABR.

Conclusion: We suggest that the hearing investigation after sudden traumatic noise exposure should therefore be expanded with ABR to confirm or exclude AN.

Diagnosing ear diseases from images of the tympanic membrane has emerged as a promising application for deep learning-based classification models. While several studies report high diagnostic accuracy, these models often struggle to generalize to external data that does not match the image characteristics of the training data. This study aims to evaluate methods for enhancing model generalizability. We trained artificial neural networks on tympanic membrane images from five datasets with a large heterogeneity between them. The datasets consisted of images from different countries, captured with different otoscope models, and with different image pre-processing applied at the source (e.g., colour normalization, cropping, and resolution). Artificial neural networks for binary (normal/abnormal) classification were trained on three datasets, and the models were evaluated on two. We explored several strategies to improve generalizability, including image pre-processing, data augmentation, transfer learning, and different network architectures. The effects of each investigated factor and their interactions were determined through a full factorial experimental design and linear mixed-effects model. Our best classification network achieved a mean accuracy of 83% (sensitivity 71%, specificity 91%) on external datasets. In contrast, the baseline trained without an optimized training method and using non-processed datasets yielded an accuracy of 53% (sensitivity 83%, specificity 34%). Our findings highlight how a better choice of network, training and augmentation strategies, and data verification improve model generalizability.

Hearing loss is the third most significant cause of disability globally and is associated with anxiety, depression, loneliness, and cognitive decline. For those unable to utilize conventional hearing aids due to conditions such as ear canal atresia, eczema, recurrent external otitis or extensive ear surgery, implantable hearing aids provide an alternative. This narrative review provides an overview of available bone conduction devices and active middle ear implants. The rapid advancements in implantable hearing aid technology necessitate ongoing education of healthcare professionals to enable informed patient decisions.

Purpose: Chronic rhinosinusitis (CRS) is related to asthma and chronic obstructive pulmonary disease (COPD). However, combined data on CRS, pulmonary function, lower airway symptoms, and cigarette smoking from the general population are lacking. The current study investigates the relationships between CRS and chronic airflow limitation (CAL), lower airway symptoms and COPD in a middle-aged population of ever-smokers and never-smokers.

Patients and Methods: All subjects from the Swedish CArdioPulmonary bioImage Study (SCAPIS) were included. Subjects underwent spirometry after bronchodilation. Chronic airflow limitation was defined as FEV1/FVC ratio <0.7. Computed tomography imaging of the thorax was performed to detect the presence of emphysema, and the subjects answered a comprehensive questionnaire on CRS, lower airway symptoms, asthma, chronic bronchitis, and cigarette smoking habits.

Results: In total, 30,154 adult subjects in the age range of 50–64 years were included. The prevalence of CRS was 5.6%. CRS was more-prevalent among subjects in the following categories: CAL (7.6%), lower airway symptoms (15.7%), current smokers (8.2%), asthma (13.6%), never-smokers and ever-smokers with COPD (17.6% and 15.3%, respectively), emphysema (6.7%), and chronic bronchitis (24.5%). In the adjusted regression model, CRS was significantly associated with CAL (OR 1.40), lower airway symptoms (OR 4.59), chronic bronchitis (OR 6.48), asthma (OR 3.08), and COPD (OR 3.10).

Conclusion: In this national, randomly chosen population sample of more than 30,000 middle-aged men and women, CRS is associated with CAL, lower airway symptoms, chronic bronchitis, asthma, and COPD. In patients with CRS and in patients with lower airway inflammation, it is important to consider the inflammatory status of the entire airway system.

Otitis Media (OM) is a prevalent condition in children that can lead to hearing impairment and significant healthcare costs. Inaccuracy in primary care and equipment cost in developing countries are concerning issues in OM diagnostics. Acoustic Reflectometry (AR) offers a low-cost, non-invasive diagnostic alternative, though it has fallen short on accuracy in previous studies. The primary aim of this study was to establish a computational simulation and an experimental model able to reproduce AR performed on human individuals to enable further research and accuracy improvement. The secondary aim was to perform a sensitivity analysis on AR instrument user error. Simulations and experiments were validated against measurements from human individuals with OM and normal ears, respectively. The results reveal that the simulation sufficiently reproduces human AR measurements and distinguishes an ear with OM from a healthy ear. The experiment delivered satisfying measurements on OM but underperformed in a normal ear scenario. The simulations and experiments overpredicted sound reflection in OM. The sensitivity study showed promising robustness of AR, concluding that computational simulation is a viable tool and complement to an experimental approach in research of AR. Future efforts should focus on paediatric models and partially filled middle ear simulations to promote clinical relevance.

• För att få svensk läkarlegitimation ska läkaren kunna utöva läkaryrket på ett patientsäkert sätt.
• Låga krav på dokumentation av tidigare utbildning för tillträde till kunskapsprovsvägen till svensk legitimation nödvändiggör ett brett kunskaps- och färdighetsprov.
• Kunskapsprovet har samma målbild för säkerställande av kunskaper och färdigheter som svensk legitimationsgrundande läkarutbildning.
• Vägen via kompletterande utbildning till svensk legitimation kommer att förändras för att bli direkt legitimationsgrundande.
• Målbilden för säkerställande av kunskaper och färdigheter vid kompletterande utbildning bör vara densamma som vid svensk legitimationsgrundande läkarutbildning.

There are four paths to a Swedish medical license. A shared agreement exists for those converting from a European license to recognize qualifications granted in the respective countries mutually. Swedish medical graduates and International Medical Graduates (IMGs) trained outside the EU/EES/Schweiz are assessed against the professional qualifications specified in the Higher Education Ordinance (1993:100). This paper discusses the different pathways to a Swedish Medical License, how they are interrelated and changing, and the number of licenses granted via the specific pathways in 2023 and the previous 7 years. In 2023, 2,318 Swedish medical licenses were awarded. The largest group (1,407/2,318) were graduates from a Swedish medical school (with a minimum of 18 months of internship (AT)). The second largest group (704/2,318) were licensed physicians from a country within the EU/EEA. The smallest group (207/2,318) were international medical graduates (IMGs) who had passed the proficiency test (with a 6-month internship) or a complementary medical education (KUL) at one of the Swedish universities (with a minimum of 18 months of internship (AT)). During 2016–2023, 826 IMGs passed the proficiency test, and 533 IMGs completed KUL. During the same period, 10,958 students graduated from Swedish medical programmes, and 6,844 medical licenses were approved based on education in the EU/EEC. The pathway for IMGs starts with applying to the National Board of Health and Welfare to be approved for the tests. The theoretical test is a 180-item exam with single-best answers covering the medical field with basic and clinical sciences. After passing the theoretical test, the practical skills are tested with an Objective Structured Clinical Examination (OSCE) with fourteen 6-minute and four 14-minute stations. After passing the practical test, the IMG is assessed during a 6-month internship and must take an online Swedish law course. When successfully passing these steps, the IMG applies for a Swedish medical license with a certificate of passing a language test in Swedish at the C1 level. The educational pathway consists of a 1- to 2-year-long complementary programme for international medical graduates (KUL) offered at five Swedish universities. The regular Swedish medical programmes are in transition from preparing for an internship to preparing to qualify directly for a medical license without an intermediate internship. Consequently, KUL also needs to develop new curricula, preparing for direct qualification for a medical license, from which the first students will most likely graduate in spring 2027.