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National Guideline Centre (UK). Hearing loss in adults: assessment and management. London: National Institute for Health and Care Excellence (NICE); 2018 Jun. (NICE Guideline, No. 98.)

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Hearing loss in adults: assessment and management.

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Appendix LExcluded clinical studies

L.1. Urgent and routine referral

L.1.1. Urgent referral

Table 70Studies excluded from the clinical review

ReferenceReason for exclusion
Aarnisalo 20041No multivariable analysis
Abuzeid 20086No multivariable analysis
Ahsan 201510Not relevant to review question (patients already undergoing MRI for asymmetric sensorineural hearing loss)
Aimoni 201011Not relevant to review question (cardiovascular risk factors as risk factors for ISSNHL)
Al-Mutairi 201112Not relevant to review question (association of audiological abnormalities with onset vitiligo)
No multivariable analysis
Amiridavan 200622Not relevant to review question (otoacoustic emissions test for outcome of SSNHL)
No multivariable analysis
Ashoor 199830Not relevant to review question (clinical presentation of patients with nasopharyngeal carcinoma)
No multivariable analysis
Aslan 199731Not relevant to review question (initial symptoms in patients with vestibular schwannoma)
No multivariable analysis
Baguley 200636Not relevant to review question (symptoms and signs of vestibular schwannoma)
No multivariable analysis
Bakker 201239Not relevant to review question (systematic review with different protocol)
Bakthavachalam 200440No multivariable analysis
Ballester 200242Not relevant to review question (symptoms and treatment for Ménière’s disease)
No multivariable analysis
Ballesteros 200943No multivariable analysis
Barrett 199547No multivariable analysis
Bathla 201650No multivariable analysis
Berjis 201660Not relevant to review question (flow-mediated dilatation, as measure for endothelial function and total cholesterol as risk factors for SSNHL)
Bovo 200969Incorrect study design (narrative review)
Braun 201371No multivariable analysis
Braun 201370No multivariable analysis
Cadoni 200783Not relevant to review question (risk factors for SSNHL)
Cadoni 201084Not relevant to review question (risk factors for SSNHL)
Chaimoff 199987No multivariable analysis
Chang 201389Not relevant to review question (ISSNHL as risk factor for stroke; bilateral ISSNHL was not significant in the univariable analysis, and not included in the multivariable analysis)
Chang 201590Not relevant to review question (systematic review on serum lipids as risk factors for SSNHL)
Chau 201094Not relevant to review question (systematic review on diagnostic methods for SSNHL)
Chung 2016103Not relevant to review question (risk factors for chronic suppurative otitis media)
Ciccone 2012104Not relevant to review question (endothelial function as risk factor for ISSNHL)
Ciorba 2015106Not relevant to review question
No multivariable analysis
Corona 2012121Not relevant to review question (risk factors for vestibular schwannomas; different symptoms and signs, and confounding factors, from the protocol)
Del Pero 2013138Not relevant to review question (assessment of disease activity and/or infection in the ear nose and throat in people with granulomatosis with polyangiitis, Wegener’s)
Dubach 2010150Not relevant to review question (systematic review on canal cholesteatoma: etiologic factors, clinical evaluation and therapy)
Durmus 2016153Not relevant to review question (to investigate the effects of routine haematological parameters on the development and prognosis of ISSNHL)
No multivariable analysis
Eleftheriadou 2009158Not relevant to review question (to evaluate the presence of vestibular evoked myogenic potentials in patients with multiple sclerosis)
No multivariable analysis
Emamifar 2016160Incorrect study design (narrative review)
Ferrari 2016171Not relevant to review question (incidence of asymptomatic sensorineural hearing loss in patients with systemic lupus erythematosus with no hearing complaints)
Friedland 2009180Not relevant to review question presbycusis (gradual loss of hearing that occurs with ageing) as risk factor for cardiovascular disease; development of a model for assessment of cardiovascular risk based on audiogram pattern and low-frequency hearing loss)
Fusconi 2012182Not relevant to review question (to determine whether thrombophilic factors have a pathogenic role in SSNHL CRVO and SSVD)
Gates 2011187Not relevant to review question (hazard ration for Alzheimer dementia in relation to hearing tests)
Gates 1993188Not relevant to review question (hearing level as predictors of cardiovascular disease; patients received hearing test as part of screening, not because of sudden/recent onset)
Gerganov 2003190No multivariable analysis
Gimsing 2010191No multivariable analysis
Gluth 2006192No multivariable analysis
Gomides 2007197No multivariable analysis
Gopinath 2009199Not relevant to review question (risk factors for stroke)
Harun 2012223Not relevant to review question (age, gender and tumour size as risk factors for hearing loss)
Hasso 2000224Unable to obtain paper
Hentschel 2016226Not relevant to review question (systematic review on diagnostic accuracy of different non-imaging screening protocols that can be used to diagnose vestibular schwannoma in patients with asymmetrical sensorineural hearing loss and/or unilateral audiovestibular dysfunction, considered at risk of vestibular schwannoma)
Hsiao 2015240Not relevant to review question (tension type headaches as risk factor for SSNHL)
Hsu 2016241Not relevant to review question (risk of developing vertebrobasilar insufficiency in patients with SSNHL)
Jeong 2016254Not relevant to review question (risk factors for hearing impairment in patients with rheumatoid arthritis)
Kaminsky 2013264Not relevant to review question (risk factors for cardiac disease, kidney involvement and brain complication in patients with Fabry’s disease)
Keller 2013267Not relevant to review question (risk factors for acute myocardial infarction)
Kentala 1996269No multivariable analysis
Kentala 2000270Not relevant to review question (diagnosis of otologic diseases in patients with vertigo. No multivariable analysis)
Kim 2016276No multivariable analysis
Koo 2015287Not relevant to review question (risk of SSNHL in patients with common sensorineural hearing impairment)
Koo 2016286Not relevant to review question (risk factors for peripheral artery occlusive disease)
Kornblut 1982290Incorrect study design (case report study for 4 patients)
Kuhn 2011297Not relevant to review question (review on causes and treatment of SSNHL)
No multivariable analysis
Kuo 2016301Not relevant to review question (risk of SSNHL post-stroke)
Kwan 2004302No multivariable analysis
Lee 2005316Not relevant to review question (risk factors for sudden deafness in patients with vertebrobasilar ischemia)
No multivariable analysis
Lee 2002317No multivariable analysis
Lee 2015323Not relevant to review question (lipid profiles as risk factor for SSNHL)
Lee 2017320Not relevant to review question (prognostic factors on outcomes of various treatment modalities for ISSNHL)
Lee 2014322No multivariable analysis
Lee 2015319Not relevant to review question (risk factors for tinnitus in patients with ISSNHL and prognostic factors associated with full recovery)
No multivariable analysis
Lee 2010324Not relevant to review question (benign paroxysmal positional vertigo as prognostic factor for hearing outcome)
Lee 2015325No multivariable analysis
Lin 2008342Not relevant to review question (risk factors for stroke)
Lin 2012343Not relevant to review question (systematic review on risk factors for SSNHL)
Lin 2012344Not relevant to review question (diabetes as risk factor for SSNHL)
Lin 2013337Not relevant to review question (risk factors for acute myocardial infarction)
Lionello 2015346Not relevant to review question (prognostic factors to predict recovery in patients treated for ISSNHL)
Lionello 2014347Not relevant to review question (prognostic factors to predict recovery in patients treated for ISSNHL)
Lorenzi 2003352No multivariable analysis
Luntz 2013354Not relevant to review question (to assess the severity of SNHL in patients with unilateral chronic otitis media)
No multivariable analysis
MacAndie 1999357No multivariable analysis
Malucelli 2012362Non-English language publication
Marcucci 2005366Not relevant to review question (risk factors for ISSNHL)
Megighian 1986375Not relevant to review question (frequency of sudden hearing loss by sex, age and presence of previous pathology at onset)
No multivariable analysis
Mosnier 2011393Not relevant to review question (cardiovascular events as risk factors for ISSNHL)
No multivariable analysis
Mozaffari 2010394Not relevant to review question (sensorineural hearing loss as risk factor for diabetes)
No multivariable analysis
Nagaoka 2010399Non-English language publication
Niu 2016426No multivariable analysis
Nouraei 2007428No multivariable analysis
Noury 1989429Not relevant to review question (risk factors for unilateral sensorineural hearing loss and prognostic factors for recovery)
No multivariable analysis
Peltomaa 2000447Not relevant to review question (incidence of Lyme borreliosis in people with SNHL)
No multivariable analysis
Penido 2009449Not relevant to review question (clinical aspects, hearing evolution and efficacy of treatment for SSNHL)
No multivariable analysis
Powell 2010461Not relevant to review question (MRI scan to determine cause of hearing loss, tinnitus and vertigo)
No multivariable analysis
Przewozny 2015472No multivariable analysis
Raber 1997476Not relevant to review question (diagnostic accuracy for asymmetric hearing loss)
No multivariable analysis
Rajati 2016479Unable to obtain paper
Ramos 2005481Non-English language publication
Rassin 2005482Not relevant to review question (characteristics of people with sudden hearing loss)
Rosito 2016492Not relevant to review question (prevalence of cholesteatoma in patients with chronic otitis media)
No multivariable analysis
Saunders 1995501Not relevant to review question (prevalence of acoustic neuroma in sudden hearing loss)
No multivariable analysis
Sauvaget 2005502No multivariable analysis
Sheahan 2001507No multivariable analysis
Sheu 2012511Not relevant to review question (obstructive sleep apnoea as risk factor for SSNHL)
Soheilipour 2013522Not relevant to review question (symptoms of people diagnosed with necrotising external otitis)
No multivariable analysis
Stranden 2016537Not relevant to review question (fibromyalgia as risk factor for hearing loss)
Suckfull 2002539No multivariable analysis
Tanaka 2016551No multivariable analysis
Torre 2005560Not relevant to review question (CVD variables as risk factors for cochlear function)
Tyrrell 2014564Not relevant to review question (Meniere’s disease as risk factor for hearing difficulty)
Vilayur 2010575Not relevant to review question (chronic kidney disease as risk factor for hearing loss)
Vos 2017577Not relevant to review question (risk factors for hearing impairment after subarachnoid haemorrhage)
Wallis 2015579Incorrect study design (narrative review)
Webb 2008583Incorrect study design (narrative review)
Wengrower 2016588Not relevant to review question (inflammatory bowel disease as risk factor for hearing loss)
No multivariable analysis
Wu 2013602Not relevant to review question (chronic periodontitis as risk factor for SSNHL)
Xenellis 2006604Not relevant to review question (prognostic factors linked to recovery from ISSNHL)
No multivariable analysis
Yeh 2015608Not relevant to review question (osteoporosis as risk factor for SSNHL)
Yen 2015610Not relevant to review question (risk of sudden sensorineural hearing loss in patients with psoriasis and other comorbidities)
Yen 2015609Not relevant to review question (chronic otitis media as risk factor for SSNHL)
Yew 2014611Not relevant to review question (diagnostic test accuracy for evaluating tinnitus)
No multivariable analysis
Zhang 2015618No multivariable analysis

L.1.2. Routine referral

Table 71Studies excluded from the clinical review

ReferenceReason for exclusion
Abdelkader 20044Not relevant to review question
Direct referral by the GP to the audiology technician, without first having to be seen by an otolaryngologist.
Results: % of people:
  • who received hearing aids
  • referred to ENT clinic
  • no treatment as hearing is normal or near normal
Becerril-Ramirez 201353Non-English language publication
Dobie 1981147Not relevant to review question
Assess a set of empirical chosen criteria (baseline and periodic audiograms) for otologic referral in an industrial hearing conservation program
Results: % of people with a specific diagnosis and intervention (no data on sensitivity and specificity)
Dobie 1981148Not relevant to review question
Same data published in Dobie 1981147
Dobie 1982146Incorrect study design (narrative paper)
Fetterman 1996172Not relevant to review question
Results: “a multivariate regression analysis was used to examine the combined predictive value of clinical parameters on hearing outcomes (as measured by the change in PTA). The initial SDS contributed the most to prediction, followed by age at treatment, and number of treatment given, for an overall multiple correlation coefficient of 0.44. The initial discrimination score and age had a negative correlation, while the number of treatments had a positive correlation.”
Koay 1996282Not relevant to review question
Direct referral by the GP for hearing aids.
Results: % of people appropriately referred for hearing aid fitting
Lionello 2015346Not relevant to review question
Prognostic value of clinical symptoms and signs, comorbidities in relation to hearing recovery. All patients received steroids treatment.
Prince 2002465Not relevant to review question
Hearing loss due to occupational noise (occupational noise and hearing survey)
Results: age-adjusted OR for hearing impairment associated with noise exposure, medical history and otological abnormalities
Simpson 1995517Not relevant to review question
Audiometric referral criteria for industrial conservation programs
Results: % of people referred for different audiologic criteria (left >25 dB; right>25 dB; low-frequency shift >15 dB; high-frequency shift >30 dB)
Swan 1994547Not relevant to review question
Direct referral by the GP to the audiology department.
Results: % of people who:
  • passed the audiometric, tympanometric and simple otoscopy screen and were prescribed hearing aids by technician
  • failed the three tier screen and were referred to an otologist.

Re-analysis if data using other pass/fail criteria:
  • tone and otoscopic criteria without tympanometry
  • Revised Technicians, Therapists and Scientists in Audiology (TTSA) criteria
van den Berg 1999570Not relevant to review question
Effectiveness of first and repeated audiometric screen in terms of % of hearing-impaired subjects:
  • who had discussed their hearing loss withy GP,
  • who had been referred to an ENT specialist subsequently and
  • who had been prescribed a hearing aid
Yueh 2010614Not relevant to review question
Rating of hearing aid use in 4 screening strategies (no screening/control; otoscope-only; questionnaire-only; dual screening)
Results: % of people for the following events:
  • patient screened positive for HL
  • patient contacted audiology
  • patient kept audiology appointment
  • audiogram show correctable HL
  • patient fit with hearing aid
  • hearing aid use at 1 year

L.2. MRI

Table 72Studies excluded from the clinical review

ReferenceReason for exclusion
Aarnisalo 20041Incorrect study design: not diagnostic accuracy and no index tools
Ahsan 201510Incorrect study design: prognostic not diagnostic
Baker 200338Incorrect study design: not diagnostic accuracy
Carrier 199786Incorrect study design: not diagnostic accuracy and no index tools
Chatrath 200893Incorrect study design: case–control study
Gimsing 2010191Incorrect study design: case–control study
Hentschel 2016226Systematic review: references checked
Kwan, 2004302Incorrect study design: not diagnostic accuracy and no index tools
Metselaar, 2015379Results only presented graphically
Obholzer 2004430Incorrect study design: case–control study
Raber 1997476Flawed study design: not all had MRI (28% of referrals and criteria for MRI not stated); not all had index tests; and indirect population: not all had hearing loss
Saeed 1995497Incorrect study design: not diagnostic accuracy
Sheppard 1996509Incorrect study design: not diagnostic accuracy
Vandervelde571Incorrect index tests

L.3. Subgroups

Table 73Studies excluded from the clinical review

ReferenceReason for exclusion
Albers 201214Inappropriate study design
Allan 200620Inappropriate study design
Bade 199135Inappropriate study design
Bernabei 201462Inappropriate study design
Boi 201268Inappropriate indicators
Cooke 1988116Survey of people with mental handicap in a long-stay hospital. Questionnaire used to diagnosis hearing loss.
Cooke 1989117Survey of people with mental handicap in a long-stay hospital. Questionnaire used to diagnosis hearing loss.
Cooper 2007118Inappropriate indicators. Logistic regression looking at association of intellectual disabilities with DC-LD depression. Hearing impairment is a covariate in the logistic regression, independently associated. Indicator is presence or no presence of depression, gives percentage of people with hearing impairment in either depression or no depression
Cruickshanks 2012124Inappropriate study design (literature review). Scanned for relevant references.
De Silva 2008135Inappropriate outcomes. Study looking at elderly people with a range of cognitive functions and hearing impairment and looked at the performance of a written MMSE rather than a verbal version.
Deal 2017136Inappropriate outcomes. Logistic regression looking at the association of hearing loss and incident dementia.
Deal 2015137Inappropriate outcomes. Logistic regression looking at the association of hearing impairment and cognitive tests.
Evenhuis 1995164Inappropriate presence or absence of indicators. No comparator group.
Gallacher 2004183Inappropriate study design (review). Scanned for relevant references.
Gold 1996195Inappropriate study design. Reports pass and fail rates for 2 different tests, No comparator
Golub 2017196Inappropriate outcomes. Looked at hazard ratios, outcome dementia at follow-up in people with hearing loss, looked at association.
Granick 1976205Inappropriate indicators. Two samples of elderly people, correlation between hearing loss and cognitive decline.
Gurgel 2014212Inappropriate indicators. Cohort of elderly, dementia excluded, looked at incident dementia during follow-up compared in groups with and without hearing loss
Gussekloo 2005213Inappropriate outcomes. Linear regression looking at the association of hearing impairment and cognitive function.
Heine 2014225Inappropriate indicators. Studies included looked at dual loss of hearing and sight and effect on quality of life.
Heywood 2017227Inappropriate presence or absence of indicators. Prevalence of MCI and dementia in a baseline cohort of people with and without hearing loss. Odds ratios for association, then incidence of dementia or MCI during follow-up in people with and without hearing loss.
Hong 2016236Inappropriate outcomes. Logistic regression looking at the association of hearing loss and decline in MMSE.
Hook 1979237Inappropriate study design
Hopper 2016238Inappropriate indicators. Study looked at cohort of people with dementia and mild to moderate hearing loss, looked at the relationship between hearing loss diagnosis in people when using PTA and a different tool RAI-MDS.
Hung 2015244Inappropriate study design (case–control).
Jupiter 2012262Inappropriate presence or absence of indicators. Reports distribution of subjects as a function of categories of hearing loss and MMSE scores.
Kalayam 1995263Inappropriate outcomes/inappropriate indicators. Logistic regression, association of depression and hearing loss.
Kiani 2010273Inappropriate study design. Scanned for relevant references.
Koh 2015284Inappropriate indicators. Study had population of elderly people attending a senior welfare centre, looked at correlation of MMSE with hearing loss.
Kropka 1980296Inappropriate outcomes
Lin 2011338Inappropriate outcomes. Logistic regression, looking at association of hearing loss with cognitive impairment.
Lin 2011339Inappropriate indicators. Logistic regression, no presence of indicators population has no dementia or cognitive impairment.
Lin 2011340Inappropriate outcomes. Cox proportional hazard looking at the association of hearing impairment and various covariates, gives number of people with hearing loss in incident dementia and no dementia group. All patients with dementia at baseline were excluded.
Lin 2013341Inappropriate outcomes. Cox proportional hazard looking at the association of hearing impairment and cognitive impairment.
Lindenberger 2009345Inappropriate indicators. Hearing loss as a predictor for dementia in elderly population.
Malloy 1991361Unable to obtain paper
Matteson 1993370Inappropriate indicators. Diagnosis rate, no comparator
Meister 2017377Inappropriate study design
Meusy 2016381Inappropriate study design (conference abstract)
Meuwese-Jongejeugd 2008382Inappropriate presence or absence of indicators Reports prevalence of combined sensorineural deficit in adults with intellectual disability, reports diagnosis rate prior to the study for combined, visual and hearing loss only, no comparator.
Meuwese-Jongejeugd 2006383Inappropriate presence or absence of indicators. Prevalence of hearing loss in people with ID and a subgroup with Down’s syndrome, no comparator, compares prevalences with population of people without ID but they are from separate published studies.
Mitoku 2016388Inappropriate indicators/outcomes. Logistic regression looking at the association between sensory impairment and cognitive impairment, reports prevalence of cognitive impairment in people with hearing loss.
Naik 2011400Inappropriate study design (conference abstract)
Nirmalasari 2017425Inappropriate outcomes. Paper reports overall prevalence of hearing loss.
Panza 2015439Inappropriate study design. Scanned for relevant references.
Panza 2015440Inappropriate study design. Scanned for relevant references.
Peracino 2014451Inappropriate study design
Peracino 2016452Inappropriate study design. Scanned for relevant references
Peters 1988455Inappropriate presence or absence of indicators. Cohort of dementia patients no comparator.
Pichora-Fuller 2015456Inappropriate study design. Scanned for relevant references.
Piotrowicz 2016457Inappropriate indicators. Cohort of elderly people, tested for hearing impairment and cognitive impairment, reports prevalence odds ratios, used to assess the strength of relation between 2 chosen deficits in the population.
Prasher 1995462Inappropriate presence or absence of indicators. Population with downs syndrome, no comparator.
Prince 2011464Inappropriate method of determining hearing loss. Hearing impairment in people with dementia versus no dementia. Hearing impairment was self reported
Reichman 1983486Inappropriate study design. Scanned for relevant references.
Reynolds 1979488Inappropriate outcomes/indicators. Study of mentally retarded adults in residential facilities, grouped by level of impairment (none to severe), prevalence of hearing impairment reported, unclear how hearing impairment has been evaluated, no comparator.
Schneider 2005503Inappropriate indicators. A group of elderly and young patients tested with sentences at different speeds.
Schubert 2017504Inappropriate outcomes (linear regression)
Sheft 2015508Inappropriate indicators/outcomes (linear regression)
Smith 2000521Inappropriate presence or absence of indicators. A group of people with learning difficulties, no comparator.
Stahl 2017529Inappropriate study design. Scanned for relevant references.
Stein 1992530Inappropriate study design. Scanned for relevant references.
Stewart 1978535Inappropriate study design. Scanned for relevant references.
Su 2017538Inappropriate outcomes. Logistic regression, has incidence rates of dementia in people with age-related hearing loss and control.
Sugawara 2011540Inappropriate outcomes. Multiple linear regressions looking at the association of hearing loss and MMSE, reports overall prevalence of hearing loss for the study, population is people over 50 years.
Taljaard 2016550Inappropriate indicators/outcomes. Scanned for relevant references. Meta-analysis comparing cognition in people with treated or untreated hearing loss and normal hearing.
Uhlmann 1986565Inappropriate presence or absence of indicators. People with Alzheimer’s, no comparator group.
Uhlmann 1989566Inappropriate study design (case–control)
Umeda-Kameyama 2014567Inappropriate study design. Letter to the editor, all patients have some form of Alzheimer’s, other dementia or cognitive impairment, then the number with or without hearing loss is reported.
Webb 1966582Inappropriate study design. Scanned for relevant references.
Weinstein 1986586Inappropriate study design
Woll 2013599Inappropriate study design
Yamada 2014606Inappropriate study design. Gives prevalence of hearing ability in people living in a care home, reported per country as multicentre
Yamada 2014607Inappropriate outcomes
Zheng 2017620Inappropriate outcomes

L.4. Early versus delayed management of hearing loss

Table 74Studies excluded from the clinical review

StudyExclusion reason
Ahn 20088Not review population
Alexander 201516Not review population
Aronzon 200328Inappropriate comparison
Atay 201632Not review population
Battista 200552Not review population
Bogaz 201467Not review population
Bogaz 201566Not review population
Chen 201596Not review population
Chou 2011101Narrative review
Clary 2011109Not review population
Dauman 1985131Not English language
Davis 1992134Non-comparative study
Dispenza 2011145Inappropriate comparison. Not review population
Edizer 2015154Not review population
Egli Gallo 2013157Not review population
Enache 2008161Not review population
Ferguson 2014168Inappropriate comparison
Ferguson 2015169Protocol only
Fitzgerald 2007175Not review population
Gao 2016185Systematic review: references checked
Gordin 2002200Not review population
Gunel 2015210Inappropriate comparison
Gupta 2016211Not review population
Hixon 2016232Inappropriate comparison
Ho 2004233Not review population
Huy 2005245Not review population
Ito 2002249Not review population
Jung 2016260Not review population
Jung Da 2016261Inappropriate comparison. Not review population
Kim 2012277Inappropriate comparison. Not review population
Lasak 2006311Not guideline condition
Liebau 2016334Not review population
Lionello 2015346Not review population
Magnano 2015358Not review population
Martin 2010368Duration of deafness comparison uncontrolled
Michiels 2016384Not guideline condition
Muhlmeier 2016395Inappropriate comparison
Murphy-Lavoie 2012397Narrative review
Mushi 2016398Not guideline condition. Not review population
Nakagawa 2016401Inappropriate comparison
Narozny 2004403Incorrect interventions
Narozny 2006402Incorrect treatments
Rafique 2013478Unadjusted cohort data
Rassin 2005482Not review population
Redleaf 1995484Not review population
Salahaldin 2004498Inappropriate comparison
Salihoglu 2015500Inappropriate comparison
Sherlock 2016510Incorrect treatments. Not review population
Smith 2005520Systematic review: references checked
Summerfield 2000541Not guideline condition
Suzuki 2006544Incorrect interventions
Terzi 2016553Not review population
Tiong 2007557Not review population
Tsai 2011561Not review population
Tschopp 1989562Incorrect interventions
Vijayendra 2012574Not review population
Vlastarakos 2012576Systematic review: references checked
Yildirim 2015612Not review population
Zhang 2004617Incorrect interventions
Zhou 2013622Incorrect interventions

L.5. Communication difficulties and limitations in function

Table 75Studies excluded from the clinical review

ReferenceReason for exclusion
Ferguson 2016167Not relevant to review question (Motivational engagement (ME) versus standard care before and after (10 weeks) hearing aid fitting. Outcomes are not compared with PTA) [note: paper included in the decision tool review]
Ferguson 2016170Not relevant to review question (predictor and outcome measures before and after hearing aid fitting. No intervention given; no comparison with PTA)
Fredriksson 2016179Not relevant to review question (diagnostic performance of DPOAE (distortion product otoacoustic emission) and HINT (hearing in noise test) compared with audiometry, in people with and without hearing loss symptoms, exposed to occupational noise. No intervention for hearing loss is given)
Gopinath 2012198Not relevant to review question (changes in SF-36 between baseline and 10 year follow-up in patients with/without hearing loss at baseline; with/without hearing handicap at baseline; with/without incident hearing loss at baseline; hearing aid users/non-hearing aid users at baseline)
Granberg 2014203Not relevant to review question (systematic review to identify outcome measures used in research conducted in adults with HL as part of the developmental process of the ICF (International Classification of Functioning, Disability and Health)score sets for HL project)
Hickson 2003229Not relevant to review question (HHIE (hearing handicap inventory for the elderly) before and after an ‘Keep on talking’ and ‘Active Communication Programme’ in elderly people; case-control study where control group does not receive the intervention; no PTA measured)
Hickson 2014228Not relevant to review question (No intervention given; no comparison with PTA)
John 2012256Not relevant to review question (calculation of binaural impairment (%BI) using six different arithmetic calculations of hearing impairment and their correlation with HHIA (hearing handicap inventory for adults) and HHIE (hearing handicap inventory for the elderly) in patients with sensorineural hearing loss. No intervention for hearing loss is given)
Knudsen 2010281Not relevant to review question (Systematic review focusing on the crucial steps in the journey separately (help seeking, uptake, use, satisfaction). The “journey”=the sequence of (psychological) events experienced by the hearing impaired person in his or her process of seeking and obtaining help)
Leensen 2011326Not relevant to review question (diagnostic accuracy and Speech in noise test versus PTA in people with noise induced hearing loss. Patients do not receive any intervention, test is applied to a normal hearing group and a hearing impaired group)
Leensen 2011327Not relevant to review question (diagnostic accuracy and Speech in noise test versus PTA in people with noise induced hearing loss. Patients do not receive any intervention, test is applied to a normal hearing group and a hearing impaired group)
Leensen 2013328Not relevant to review question (diagnostic accuracy and Speech in noise test versus PTA in people with noise induced hearing loss. Patients do not receive any intervention, test is applied to a normal hearing group and a hearing impaired group)
Mahmoud 2014359Not relevant to review question (correlation between CNC (consonant nucleus consonant) and AzBio and age at implantation post-cochlear implant. CNC and AzBio were not performed before cochlear implantation)
Spyridakou 2015526Incorrect study design: non-systematic review (how older adults perform in speech in noise tests and what are the key factors that affect such performance)
Tannahill 1979552Not relevant to review question (measure of Speech reception threshold, Word identification and Hearing handicap scale before and after (4 weeks) hearing aid fitting)
Wiley 2000594Not relevant to review question (correlation between HHIE (hearing handicap inventory for the elderly) and age. Logistic regression model based on data collected at baseline examination of the population-based study of hearing loss in older adults; no intervention for hearing loss is considered)

L.6. Management of earwax

L.6.1. Treatment

Table 76Studies excluded from the clinical review

StudyExclusion reason
Amjad 197523Incorrect interventions. TPO (not available in UK) and carbamide peroxide (not available in UK) ear drops
Anonymous 200325Comment
Baker 196937Incorrect study design. Before and after design. TPO ear drops (not available in the UK)
Browning 200275Has been updated
Burgess 196677Incorrect interventions. Investigates Docusate-in-oil ear drops, which are not currently available in UK (Docusate in glycerine is available)
Burton 200979Systematic review: does not fit our protocol. All papers within the review have been considered
Burton 201678Protocol only
Caballero 200581Conference abstract
Chaput de Saintonge 197392Incorrect interventions. Investigated TPO ear drops (not available in the UK) against olive oil. Age group not stated
Clegg 2010110Systematic review: all papers considered
Dummer 1992152Incorrect interventions. Investigates Audax ear drops (not available in UK) against Cerumol (composition not stated)
Fahmy 1982165Insufficient information on study designs. Four studies presented in one paper, and not enough information to determine if any were RCT
General Practitioner Research Group 1967189Incorrect interventions. Atypical ear drops for UK (Cerumol preparation has changed since 1967)
Hand 2004220Systematic review: methods are not adequate/unclear
Harris 1968222Comment paper
Iranian Registry of Clinical Trials 2007248Protocol only
Jaffe 1978250Incorrect interventions. Investigation of Otocerol ear drops (a mixture of oils, not available in UK) and Cerumol (composition not given)
Leong 2005329Incorrect study design. Incorrect interventions
Loveman 2011353Summary article
Lyndon 1992356Incorrect interventions. Investigates Auduax ear drops (not available in UK) and Earex ear drops (Peroxide, available in UK)
Masterson 2000369Comment paper
McCarter 2007373Non-systematic review
NCT 2008415Protocol only
Pothier 2006460Incorrect interventions. Comparison of two specialist ENT procedures. Cannot be sure that our search was optimised to find similar studies, so may not be representative of this section of literature
Proudfoot 1968468Incorrect study design. No comparison arm
Robinson 2001490Comment paper
Silverstein 2011515Long-term outcomes only. Uses isopropyl alcohol irrigations to prevent cerumen impaction. Not sure whether this is a treatment used in UK
Silverstein 2012516Long-term outcomes only. Uses isopropyl alcohol irrigations to prevent cerumen impaction. Not sure whether this is a treatment used in UK
Singer 2000518Incorrect interventions. Children. Investigates TPO ear drops (not available in UK) against Colace ear drops (Docusate sodium, available in UK under another brand name)
Somerville 2002523Systematic review: all papers considered
Soy 2015524Children
Spiro 1997525No results could be extracted. Arms were merged and summary statistics were inadequate.
Williams 2005595Systematic review: study designs inappropriate
Wright 2015601Comment paper

L.6.2. Settings

Table 77Studies excluded from the clinical review

ReferenceReason for exclusion
Almeyda 200721Inappropriate study design
Morgan 1991390Inappropriate study design
Morgan 1992391Inappropriate study design
Ballachanda 199241Inappropriate study design
Bunnag 200276Inappropriate intervention and comparator
Chen 201795Inappropriate population
Clegg 2010110Inappropriate intervention and comparator
Hand 2004220Inappropriate intervention and comparator
Loveman 2011353Summary of HTA, of which full text was obtained
Martin 2000367Inappropriate study design

L.7. Sudden sensorineural hearing loss

L.7.1. Treatment

Table 78Studies excluded from the clinical review

StudyExclusion reason
ACTRN 201333Study not yet recruiting, protocol only
Alimoglu 201119Incorrect study design
Al-Shehri 201613Routes of administration [later question]
Anonymous 2013251Unavailable: unable to locate as cited
Arastou 201327Inappropriate comparison. Route of administration [later question]
Arslan 201129Inappropriate study design: quasi-RCT
Awad 201234Systematic review: references checked
Barreto 201646Systematic review: study designs inappropriate
Berjis 201661Insufficient reporting: Unclear intervention frequency, no detail on doses of failed standard therapy, no time given for length of standard treatment just onset to start of second-line treatment
Chan 200988Abstract
Chang 201091Not in English language
Choi 2011100Incorrect comparison
Choung 2005102Not in English language
Cinamon 2001105Inappropriate study design: quasi-RCT
Conlin 2007114Systematic review: quality assessment is inadequate
Conlin 2007115Systematic review: quality assessment is inadequate
Crane 2015123Systematic review: references checked
Dispenza 2011145Inappropriate comparison. Route of steroid administration [later question]
Drks 2016143Trial, recruiting planned
Eftekharian 2016156Inappropriate comparison. Route of steroid administration [later question]
Euctr 2005163Trial still recruiting
Filipo 2014173Incorrect study design
Fu 2011181Incorrect study design
Gao 2016185Systematic review: study designs inappropriate
Garavello 2012186Systematic review: quality assessment is inadequate
Gundogan 2013209Inappropriate comparison. Route of steroid administration [later question]
Gunel 2015 210Incorrect study design
Halpin 2012217Route of steroid administration [later question]. Inappropriate comparison
Han 2008219Not in English language
Han 2009218Incorrect study design
Ho 2004233Incorrect intervention
Hong 2009235Incorrect comparison
Hultcrantz 2015242Not in English language
Iranian Registry of Clinical Trials 2012247Clinical trial reference. No data
Kesornukhon 2011271Unclear time points for outcomes. Unclear if randomisation broken for preference of treatment
Khorsandi Ashtiani 2012272Inappropriate comparison. Route of steroid administration [later question]
Koltsidopoulos 2013285Systematic review: study designs inappropriate
Kosyakov 2007292Abstract
Kosyakov 2011Inappropriate comparison. Route of steroid administration [later question]
Labus 2010303Systematic review: quality assessment is inadequate
Lavigne 2016314Systematic review
Lawrence 2015315Systematic review: literature search not sufficiently rigorous
Lee 2008318Incorrect study design
Li 2013332Incorrect study design
Li 2015331Systematic review: References checked
Lim 2013336Inappropriate comparison. Route of steroid administration [later question]
Lim 2013335Inappropriate comparison. Route of steroid administration [later question]
Liuh 2011348Not in English language
Liyi 2007349Not in English language
Meine Jansen 2005376Incorrect age group
Min 2011386Abstract
Moon 2011389Incorrect study design
NCT 2003413Letter to the Editor
NCT 2014416Trial not open yet for participant recruitment
Ng 2015417Systematic review: quality assessment is inadequate. Systematic review: methods are not adequate/unclear
Ocak 2014431Incorrect study design
Ochi 1998432Not in English language
Ovet 2015437Incorrect study design
Oyoun 2014438Incorrect study design
Park 2009441Not in English language
Park 2011443Systematic review: methods are not adequate/unclear
Park 2012442Incorrect interventions
Peng 2009448Not in English language
Plontke 2009458Letter to the Editor
Qiang 2017473Systematic review
Qu 2015474Not in English language
Racic 2003477Incorrect interventions
Rauch 2011483Route of steroid administration [later question]. Inappropriate comparison
Seggas 2011505Systematic review: study designs inappropriate
Shin 2002514Not in English language
Stachler 2012527Systematic review: references checked
Swachia 2016545Inappropriate comparison. Route of steroid administration [later question]
Vlastarakos 2012576Systematic review: study designs inappropriate
Wei 2013584Systematic review: references checked
Wen 2005587Not in English language
Westerlaken 2003590Insufficient reporting
Wijck 2007593Incorrect study design
Wilson 1980596Unclear methodology, mixed treatment doses
Yoo 2017613Incorrect intervention: simultaneous versus sequential administration
Zhao 2016619Systematic review: quality assessment is inadequate
Zhou 2011623Inappropriate comparison. Route of steroid administration [later question]
Zhou 2015621Not in English language

L.7.2. Routes of administration

Table 79Studies excluded from the clinical review

StudyExclusion reason
ACTRN 201333Study not yet recruiting, protocol only
Alimoglu 201119Incorrect study design
JPRN 2013251Unavailable: unable to locate as cited
Arslan 201129Inappropriate study design: quasi-RCT
Awad 201234Systematic review: references checked
Barreto 201646Systematic review: study designs inappropriate
Berjis 201661Insufficient reporting: Unclear intervention frequency, no detail on doses of failed standard therapy, no time given for length of standard treatment just onset to start of second-line treatment
Chan 200988Abstract
Chang 201091Not in English language
Choi 2011100Incorrect comparison
Choung 2005102Not in English language
Cinamon 2001105Inappropriate study design: quasi-RCT
Conlin 2007114Systematic review: quality assessment is inadequate
Conlin 2007115Systematic review: quality assessment is inadequate
Crane 2015123Systematic review: quality assessment is inadequate
Deutsches Register Klinischer Studien 2016143Trial, recruiting planned
EU Clinical Trials Register 2005163Trial still recruiting
Filipo 2014173Incorrect study design
Fu 2011181Incorrect study design
Gao 2016185Systematic review: study designs inappropriate
Garavello 2012186Systematic review: quality assessment is inadequate
Gunel 2015 210Incorrect study design
Han 2008219Not in English language
Han 2009218Incorrect study design
Ho 2004233Incorrect intervention
Hong 2009235Incorrect comparison
Hultcrantz 2015242Not in English language
Iranian Registry of Clinical Trials 2012247Unobtainable
Kesornukhon 2011271Unclear time points for outcomes. Unclear if randomisation broken for preference of treatment
Koltsidopoulos 2013285Systematic review: study designs inappropriate
Kosyakov 2007292Abstract
Kosyakov 2011 291Incorrect interventions: dosing regimen not applicable to UK practice
Labus 2010303Systematic review: quality assessment is inadequate
Lawrence 2015315Systematic review: literature search not sufficiently rigorous
Lee 2008318Incorrect study design
Li 2013332Incorrect study design
Li 2015331Systematic review: References checked
Liuh 2011348Not in English language
Liyi 2007349Not in English language
Meine Jansen 2005376Incorrect age group
Min 2011386Abstract
Moon 2011389Incorrect study design
NCT 2003413Letter to the Editor
NCT 2014416Trial not open yet for participant recruitment
Ng 2015417Systematic review: quality assessment is inadequate. Systematic review: methods are not adequate/unclear
Ocak 2014431Incorrect study design
Ochi 1998432Not in English language
Ovet 2015437Incorrect study design
Oyoun 2014438Incorrect study design
Park 2009441Not in English language
Park 2011443Systematic review: methods are not adequate/unclear
Park 2012442Incorrect interventions
Peng 2009448Not in English language
Plontke 2009458Letter to the Editor
Qu 2015474Not in English language
Racic 2003477Incorrect interventions
Seggas 2011505Systematic review: study designs inappropriate
Shin 2002514Not in English language
Stachler 2012527Systematic review: references checked
Vlastarakos 2012576Systematic review: study designs inappropriate
Wei 2013584Systematic review: references checked
Wen 2005587Not in English language
Westerlaken 2003590Insufficient reporting
Wijck 2007593Incorrect study design
Wilson 1980596Unclear methodology, mixed treatment doses
Zhao 2016619Systematic review: quality assessment is inadequate
Zhou 2011623Inappropriate study design: quasi-RCT
Zhou 2015621Not in English language

L.8. Information and support

Table 80Studies excluded from the qualitative review

ReferenceReason for exclusion
Dahl 1998130Incorrect study design: quantitative study
Cardoso 200685Non English language publication
Ferguson 2015166Does not meet protocol criteria (includes people with childhood presentation of deafness)
Graham 2005202Does not meet protocol criteria (includes people with childhood presentation of deafness)
Granberg 2014204Includes data from a developing country
Grutters 2007208Incorrect study design: quantitative study
Halberg 1993216Does not meet protocol (no information/support/advice)
Hallam 2008215Does not meet protocol (no information/support/advice)
Harkins 1988221Incorrect study design: quantitative study
Holliday 2015234Does not meet protocol criteria
Howe 1993239Incorrect study design: review
Iezzoni 2004246Does not meet protocol criteria (includes people with childhood presentation of deafness)
Jennings 2008253Low quality study
Karras265Non English language publication
Knudsen 2013280Sub-analysis of Laplante 2012 study, no additional information
Kritzinger 2014295Includes data from a developing country
Lane 2016305Incorrect study design: quantitative intervention study
Laplante 2010306Does not meet protocol criteria (compares interventions)
Laroche 2000310Does not meet protocol criteria (includes people with childhood presentation of deafness)
Lockey 2010350Does not meet protocol (no information/support/advice)
Manchaiah 2011364Does not meet protocol (no information/support/advice)
Manchaiah 2012363Does not meet protocol (no information/support/advice)
Pereira 2010453Includes data from a developing country
Prior 2008466Does not meet protocol criteria (includes people with childhood presentation of deafness)
Reeves 2005485Does not meet protocol criteria (includes people with childhood presentation of deafness)
Jones 2005257Does not meet protocol criteria (Health education priorities)
Rekkedal 2012487Does not meet protocol criteria (population is children)
Sadler 2001496Unclear methodology
Steinberg 1998532Does not meet protocol criteria (includes people with childhood presentation of deafness)
Steinberg 2002533Does not meet protocol criteria (includes people with childhood presentation of deafness)
Steinberg 2006531Does not meet protocol criteria (includes people with childhood presentation of deafness)
Topp 2013559Incorrect study design: quantitative study and an abstract
Wanstrom 2014 580Does not meet protocol (no information/support/advice)
Witte 2000597Does not meet protocol criteria (includes people with childhood presentation of deafness)
Woll 2013599Conference abstract
Wood 1983600Incorrect study design: quantitative study

L.9. Decision tools

Table 81Studies excluded from the clinical review

StudyExclusion reason
Cobelli 2014111Incorrect study design (non-randomised trial)
Ferguson 2016167Incorrect intervention (included in chapter X)
Joore 2002258Incorrect study design (uncontrolled prospective study)
Weineland 2015585Protocol
Zarenoe 2016616Incorrect intervention (included in chapter X)

L.10. Assistive listening devices

Table 82Studies excluded from the clinical review

StudyExclusion reason
Aldaz 201615Incorrect interventions
Alfakir 201517Incorrect study design
Ali 200818Incorrect study design. Abstract of a systematic review
Anttila 201226Not guideline condition. Systematic review is not relevant to review question or unclear PICO
Bertachini 201563Incorrect age group
Clark 2016108Incorrect study design
Drennan 2005149Incorrect interventions
Galvin 1999184Incorrect study design
Gordon-Salant 2009201Incorrect study design
Jerger 1996255Incorrect study design
Kim 2014275Incorrect study design
Kitterick 2015279Systematic review. Inappropriate comparison
Kreisman 2010293Incorrect interventions
Lewis 2005330Incorrect study design
Maidment 2016360Protocol
Yueh 2001615Incorrect interventions

L.11. Hearing aids

L.11.1. Hearing aids versus no hearing aids

Table 83Studies excluded from the clinical review

ReferenceReason for exclusion
Abrams 20025Inappropriate study design
Jerger 1992255Inappropriate study design
Lavie 2015313Inappropriate study design
Tolson 2002558Inappropriate definition of hearing loss
Yueh 2001615Inappropriate study design

L.11.2. 1 hearing aid versus 2 hearing aids

Table 84Studies excluded from the clinical review

ReferenceReason for exclusion
Formby 2015177Intervention - 2×2 design comparing sound generators versus control and counselling versus no counselling
Kreisman 2010293Intervention - All participants had binaural aids; compared different types of hearing aid designs
Metselaar 2009380Intervention - Compared ‘comparative’ versus ‘prescriptive’ approach for fitting hearing aids
Lavie 2014312Intervention - compared 3 strategies for fitting binaural aids (simultaneous versus sequential (starting with right ear) versus sequential (starting with right ear)
Yueh 2001615Intervention - compared 3 different types of hearing aids against no amplification

L.12. Hearing aid microphones and noise reduction algorithms

L.12.1. Microphones

Table 85Studies excluded from the clinical review

StudyExclusion reason
Amlani 200124Systematic review: references checked
Bentler 200459Incorrect interventions
Bentler 200558Systematic review. Checked included papers
Brimijoin 201474Pre-crossover data unavailable
Desjardins 2016141Incorrect study design
Gnewikow 2009193Pre-crossover data unavailable
Korhonen 2015289Incorrect interventions
Luts 2004355Incorrect study design
Nielsen 1973424Incorrect study design
Oeding 2013433Inappropriate comparison. Incorrect study design
Peeters 2009446Incorrect study design
Preves 1999463Incorrect study design
Quintino 2010475Incorrect study design
Ricketts 2003489Incorrect study design
Shields 2001513Incorrect interventions
Surr 2002542Incorrect study design
Valente 2015569Pre-crossover data unavailable
Wolframm 2012598Incorrect study design
Yueh 2001615Incorrect interventions

L.12.2. Noise reduction algorithms

Table 86Studies excluded from the clinical review

StudyExclusion reason
Bentler 200856Paper does not provide enough data for critical analysis. Contacted author for raw data but she was unable to provide it.
Bentler 199357Method of group allocation uncertain
Digiovanni 2011144Incorrect study design
Kim 2014274Incorrect study design
Korhonen 2013288Incorrect study design
Kuk 2011299Incorrect study design
Kuk 2015298Incorrect study design
Miller 2017 385Incorrect study design
NCT 2005414Clinical trial reference. No data
Oeding 2013433Incorrect study design
Peeters 2009446Incorrect study design
Prosser 2009467Not guideline condition

L.13. Monitoring and follow-up

Table 87Studies excluded from the clinical review

StudyExclusion reason
Chisolm 201399Incorrect study design
Cullington 2016126Protocol
Elkayam 2003159Children
Ferguson 2016167Incorrect interventions
Gussenhoven 2012214Protocol
Hickson 2007230Incorrect interventions
Laplante-Lévesque 2006308Incorrect study design
Lonka 1995351Protocol
Miranda 2008387Incorrect interventions
Penteado 2014450Incorrect interventions
Ramos 2009480Cochlea implants
Selmi 1985506Children
Swanepoel de 2010548Systematic review checked for references
Swanepoel de 2010549Not review population. Not guideline condition
Wasowski 2010581Incorrect interventions
Whitton 2016592Incorrect interventions

L.14. Interventions to support the use of hearing aids

Table 88Studies excluded from the clinical review

StudyExclusion reason
Colucci 2016112Incorrect study design: article describing assistance to family caregivers
Hickson 2003229Incorrect study design: non-RCT
Hickson 2007230population: not all hearing aid users and cannot extract data for hearing aid users only
Hickson 2014228Incorrect study design: logistic regression
Jennings 1994252Incorrect study design: article describing a rehabilitation programme
Kricos 2011294Incorrect study design: opinion piece
Ng 2015418Systematic review
Pryce 2015471Incorrect study design and method: qualitative review
Singh 2016519Systematic review
Thoren 2011554Already included in Barker 2016
Thoren 2014556Already included in Barker 2016
Thoren 2015555Incorrect study design: forum article summarising Thoren 2007 and Thoren 2011
Anonymous 199464Unobtainable
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