Teleaudiology Services in Australia: A National Survey of Hearing Health Care Consumers Amid the COVID-19 Pandemic.

PURPOSE: The aim of this study was to investigate the perspectives of Australia-based hearing health care consumers regarding the (a) provision and utilization of teleaudiology services, (b) experiences with teleaudiology, and (c) barriers and enablers to future teleaudiology use. METHOD: A national prospective self-report online survey was completed between April and October 2020, amid COVID-19. Data were analyzed using descriptive statistics (closed-answer items) and content analysis (open-text responses). A total of 381 participants (Mage = 72.07 years ± 10.08, 142 females) were recruited from different states and territories of Australia. RESULTS: Despite positive outcomes reported by those who undertook teleaudiology appointments during COVID-19, results indicate low-consumer teleaudiology uptake. It can be inferred that consumers were not aware of teleaudiology as an appointment option, clinicians/clinic staff had not informed and/or supported teleaudiology as an option, and biases existed that prevented teleaudiology being more widely adopted. It is unclear whether consumers who were eligible for government subsidies understood that teleaudiology appointments were reimbursed through government funding. Barriers to future teleaudiology uptake were largely related to concerns regarding confidentiality and privacy. CONCLUSION: Low consumer uptake of teleaudiology appointments appears to be driven by consumer preference for in-person services, which appears to be driven by lack of knowledge regarding the availability and effectiveness of teleaudiology. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25619808.

Vestibular function and balance performance in children with sensorineural hearing loss.

OBJECTIVE: Balance difficulties are common in children with sensorineural hearing loss (SNHL). For some of these children, concomitant vestibular deficits may impact postural control. This study aimed to explore vestibular function, functional balance and postural control, and the relationship between these measures in children with SNHL. DESIGN: Cross-sectional study quantifying peripheral vestibular function (vestibular evoked myogenic potentials [VEMP], video head impulse test), functional balance (Bruininks-Oseretsky Test of Motor Proficiency [BOT]) and postural control (static posturography with modified sensory inputs). The relationship between the degree of vestibular impairment, functional balance and postural control was explored. STUDY SAMPLE: Eleven with SNHL, and 11 with normal sound detection (NSD) between 5 and 12 years of age. RESULTS: Children with SNHL had varying degrees of vestibular dysfunction and differences in overall balance performance. Across all children, greater degrees of vestibular impairment were associated with significantly poorer functional balance and postural control performance for complex standing conditions (BOT percentile rank p = 0.001; compliant surface eyes open [EO]: p = 0.027; compliant surface eyes closed: p = 0.048). CONCLUSIONS: Vestibular dysfunction in children with SNHL was variable. Vestibular impairment predicted poorer functional balance performance and postural control abilities, including differences in postural sway patterns.

Utilisation of tele-audiology practices in Australia during the COVID-19 pandemic: Perspectives of audiology clinic owners, managers and reception staff.

OBJECTIVE: To canvas the views of Australia-based hearing healthcare clinic owners/managers and reception staff regarding the utilisation, experiences and perspectives of providing tele-audiology services during the COVID-19 pandemic. DESIGN: A national prospective self-report survey was completed online. Data were analysed using descriptive statistics. STUDY SAMPLE: Twenty-one clinic owners/managers (Mage 54.43 years, 15 female) and 58 reception staff (Mage 42.88 years, 49 female) from Australia-based hearing clinics. RESULTS: Clinic owners/managers reported an increase in use of tele-audiology services as compared to pre-COVID-19. Reception staff reported providing more advice and support to clients over the phone. Both clinic owners/managers and reception staff indicated key barriers to providing tele-audiology services to include concerns about their clients' digital and technological literacy and the perception that in-the-clinic appointments deliver better client outcomes than tele-audiology appointments. CONCLUSIONS: The increased utilisation of tele-audiology services observed appears to be largely influenced by COVID-19 related factors (e.g. maintaining client and staff safety and increased funding). It is therefore possible that utilisation of tele-audiology service may drop once the threat of the pandemic has subsided. Perceived barriers relating to clients' digital literacy and the effectiveness of tele-audiology services require attention to safeguard the future of tele-audiology service delivery in Australia.

Barriers and facilitators to tele-audiology service delivery in Australia during the COVID-19 pandemic: perspectives of hearing healthcare clinicians.

OBJECTIVE: To explore the utilisation, safety, cost, and patient outcomes of delivering tele-audiology services during the COVID-19 pandemic. DESIGN: A national cross-sectional self-report online survey asking participants to reflect on interactions with hearing services between April and October 2020. Data were analysed using descriptive statistics. The COM-B model of behaviour change guided survey creation and the presentation of a subset of the results. STUDY SAMPLE: 249 Australia-based hearing healthcare clinicians (age range 23-74 years; 162 female). RESULTS: Clinicians reported an increase in the use of tele-audiology services, with key drivers relating to keeping their patients safe and keeping businesses running. Clinicians generally viewed the provision of tele-audiology services as successful and resulting in improved patient outcomes. Overall, clinicians were highly motivated to provide tele-audiology services, and they expressed being confident in their knowledge and understanding of tele-audiology service delivery. Barriers to providing tele-audiology services included concerns about the reliability of the results obtained from remote assessments, as well as concerns around information security and privacy issues. CONCLUSIONS: Clinicians' motivations to use tele-audiology services appeared to be driven by their desire to maintain COVID-safe practices during the pandemic and by the COVID-driven increase in availability of funding for tele-audiology services.

COVID-19 and tinnitus: an initiative to improve tinnitus care.

OBJECTIVE: To investigate the effects of COVID-19 on individuals with tinnitus and their views to guide future tinnitus care. DESIGN: A mixed-methods cross-sectional research design. STUDY SAMPLE: An online survey was completed by 365 individuals with tinnitus from Australia and other countries. RESULTS: Tinnitus was reported to be more bothersome during the pandemic by 36% of respondents, whereas 59% reported no change and 5% reported less bothersome tinnitus. Nearly half of the respondents had received COVID-19 vaccination(s) and 12% of them reported more bothersome tinnitus while 2% developed tinnitus post-vaccination. Australian respondents spent less time in self-isolation or quarantine and saw fewer change in in-person social contact than respondents from other countries. More than 70% of respondents thought that tinnitus care services were insufficient both before and during the pandemic. Regarding their opinions on how to improve tinnitus care in the future, five themes including alleviation of condition, government policies, reduced barriers, self- and public-awareness, and hearing devices were identified. CONCLUSIONS: A majority of respondents did not perceive any change in tinnitus perception and one-third of respondents had worsened tinnitus during the pandemic. To improve tinnitus care, better awareness and more accessible resources and management are crucial.

Promoting hearing loss support in general practice: a qualitative concept-mapping study.

Objectives and importance of study: Interventions are needed to help general practitioners (GPs) better support clients living with age-related hearing loss. This project canvassed stakeholder views regarding how GPs might better support people with hearing loss. STUDY TYPE: A group concept-mapping approach was used to identify enablers to improving the way in which GPs could support people with age-related hearing loss. METHODS: Concept-mapping techniques were used to gather the perspectives of GPs (n = 7), adults with hearing loss (n = 21), and professionals working with GPs (n = 4) in Australia. Participants generated statements in response to the question, "What would enable GPs to better support people with hearing loss?" Participants then grouped and ranked these statements via an online portal. RESULTS: Five concepts were identified: 1) making hearing assessment part of routine care; 2) asking questions and raising concerns; 3) listening with empathy and respect; 4) having knowledge and understanding; 5) being connected to expert hearing professional networks. Statements contained within all five concepts were deemed to be highly beneficial in this context, with no individual concept identified to be more or less beneficial than any of the other four concepts. CONCLUSIONS: A wide range of hearing-specific and general communication approaches were identified that could potentially help GPs to better support their adult patients with age-related hearing loss.

Third-party disability in ongoing vestibular disorders through the lens of the ICF framework.

OBJECTIVE: To identify presence and nature of Third-Party Disability experienced by Significant Others (SOs) of people with ongoing vestibular symptoms using the World Health Organisation International Classification of Functioning, Disability and Health (WHO-ICF) framework. DESIGN: Qualitative semi-structured interviews were conducted and analysed by mapping transcripts to the WHO-ICF framework. STUDY SAMPLE: Ten SOs of people with ongoing vestibular symptoms were interviewed. Maximum variation sampling was used. RESULTS: Data mapped to 5 codes in the body functions component of the ICF, highlighting psychological impact on the SO and a broad range of negative emotions; 28 codes in the activities and participations component, showing impaired ability across several areas of the SO's life including social life, communication, general tasks and maintaining domestic balance; and 19 codes in the environmental factors component, highlighting the importance of supportive relationships and functioning health systems. CONCLUSIONS: Third-Party Disability was identified, including psychological impacts on the SO, interruption to their daily lives and increased domestic responsibility. Health professionals may lessen disability by encouraging support networks and practicing family-centred care.

An exploration of significant others' experience with ongoing vestibular disorders.

Objective: To understand the lived experiences of Significant Others (SOs) of people with ongoing vestibular symptoms.Design: Qualitative semi-structured interviews were conducted and analysed using thematic analysis.Study sample: Ten SOs of people with ongoing vestibular symptoms were interviewed. Maximum variation sampling was used.Results: Four predominant themes were identified from the data: (1) Journey The progression of learning to understand, cope and adapt with a family member's vestibular condition is a unique journey; (2) Ownership Participants reported varying levels of ownership of their family member's vestibular condition. Those who considered the vestibular condition as a joint problem were often more burdened by feelings of guilt and redundancy; (3) Intangibility Participants reported inconsistent advice from healthcare professionals, struggles with understanding, and challenges obtaining a shared understanding with their own support networks; (4) Disempowerment SOs were left feeling powerless due to not knowing what to do for a family member when they experienced vestibular symptoms, and not having a comprehensive understanding of the vestibular condition.Conclusions: Ongoing vestibular symptoms have significant and diverse impacts on SOs. This study reveals a need for tailored support of SOs and supports the practice of family-centred care in this population.

The Contribution of Hearing and Hearing Loss to Balance Control.

This study investigated the hypothesis that a hearing 'map' of our surroundings is used to maintain balance control. We investigated the effects of sound on postural sway using centre of pressure analysis in 50 subjects with normal hearing, 28 with hearing loss and 19 with vestibular dysfunction. The acoustic environments utilized sound cues that were either present or absent. It was found that auditory cues are utilized by subjects with normal hearing to improve postural sway. The ability to utilize sound for postural control is diminished when there is a hearing loss, but this appears to be overcome by the use of a hearing aid. Patients with additional vestibular deficits exploit auditory cues to a greater degree, suggesting that sensory weighting to enhance the use of auditory cues may be applied when there is diminished sensory redundancy.

Vestibular rehabilitation outcomes in patients with and without vestibular migraine.

Vestibular rehabilitation programs do appear to play a beneficial role in the treatment of dizziness in patients with vestibular migraine. Anecdotally, however, patients with vestibular migraine may report persistent significant symptoms at the end of a standard treatment period where other non-migrainous patients are accomplishing their treatment goals. Therefore, the objective of this study was to assess the efficacy of vestibular rehabilitation in patients with vestibular migraine compared to patients with vestibular symptoms without migraine. Thirty-six patients (vestibular migraine = 20, vestibular impairment = 16) with significant daily vestibular symptoms received a nine week customized vestibular rehabilitation program. Each subject attended five therapy appointments occurring at initial, two, five, nine and six months. A range of subjective and physical performance outcome measures were taken at baseline, nine weeks and six months. The vestibular migraine group showed poorer subjective performance at the onset of therapy, which was not reflected in the difference in physical performance between the groups. Both groups benefitted equally from rehabilitation. The same degree of improvement was observed in the migraine group regardless of medication regime. This study has validated vestibular rehabilitation as an effective treatment in dizzy patients both with and without vestibular migraine where the use of medication did not preclude benefit from therapy. However, further research is required to clarify the role of specific vestibular suppressant medications and the scheduling of their use in relation to physical therapy.

Neuro-otological findings in patients with migraine- and nonmigraine-related dizziness.

This study presents the neuro-otological findings of 523 patients attending a tertiary vestibular clinic with migraine- and nonmigraine-related dizziness. Subjects were categorized into one of 4 groups, definite migrainous vertigo, probable migrainous vertigo, vestibular disorder coexisting with migraine and nonmigraine-related dizziness. No notable relationship was found between the numbers of abnormal findings between the groups for the majority of the neuro-otological tests. However, there was a significant trend in emetic response to caloric testing. The definite migrainous vertigo group were at least 4 times more likely to be nauseous to caloric testing than any other migraine category. This difference was independent of the magnitude of caloric responses between the emetic migraine groups. While further investigation is required, this study has potentially identified that nauseous/emetic response to caloric stimulation may be a distinguishing factor between migrainous vertigo and other vestibular disorders including those with a coexisting history of migraine.

Effects of age and sleeping position on arousal from sleep in preterm infants.

STUDY OBJECTIVES: Preterm infants are at increased risk of sudden infant death syndrome (SIDS). We investigated whether the prone sleeping position impaired arousal from sleep in healthy preterm infants and whether this impairment was related to cardiorespiratory variables, temperature or postnatal age. DESIGN: Longitudinal SETTING/PARTICIPANTS: 14 healthy preterm infants (mean 32 +/- 0.4 weeks) were studied using daytime polysomnography on 4 occasions: 36-38 weeks postconception age, 2 to 3 weeks postterm, 2 to 3 months postterm, and 5 to 6 months postterm. INTERVENTIONS: N/A. MEASUREMENTS: Multiple measurements of arousal threshold (cm H2O) in response to air-jet stimulation applied alternately to the nares were made in both active sleep and quiet sleep when infants slept both prone and supine. RESULTS: Arousal thresholds were significantly higher in both AS and QS when infants slept prone at 36 to 38 weeks postconception age and 2 to 3 months postterm but not at 2 to 3 weeks or 5 to 6 months postterm. These increases were independent of any sleep position-related changes in either rectal or abdominal skin temperature, respiratory rate, oxygen saturation or heart rate. CONCLUSIONS: At the age when the risk of SIDS is highest, the prone position significantly impairs arousal from both active sleep and quiet sleep in healthy infants born prematurely. This impairment in arousability occurred with no clinically significant changes in cardiorespiratory parameters or body temperature. Decreased arousability from sleep in the prone position may explain its role as a risk factor for SIDS.

Arousal from sleep in infants is impaired following an infection.

Numerous studies have postulated a link between recent infection and Sudden Infant Death Syndrome (SIDS). In this study we contrasted arousal responses from sleep in infants on the day of discharge from hospital following an infection with those when fully recovered and also with well age-matched control infants. Thirteen term infants comprised the infection group and nine well infants acted as age-matched controls. All infants were studied using daytime polysomnography and multiple measurements of arousal threshold (cm H(2)O) in response to air-jet stimulation applied alternately to the nares were made in both active sleep (AS) and quiet sleep (QS). All infants were studied on two occasions: firstly, immediately before discharge from the Paediatric ward, and secondly, 10-15 days later when they were completely well in the case of the infection group.Arousal thresholds in QS in the infection group were significantly elevated on the day of discharge (262 +/- 48 cm H(2)O) compared with 10-15 days later (205 +/- 31 cm H(2)O, p<0.05). Thresholds in the control group were not different between studies. This study provides evidence that arousability from QS is impaired following an infection and we postulate that this may explain the increased risk for SIDS following infection observed in previous studies.