A qualitative study showing that a telecare tool can have benefits before and during the initial hearing assessment appointment.

OBJECTIVE: To examine patient and audiologist experiences and perspectives of using a patient-centred telecare tool, the Ida Institute's Why Improve My Hearing? (WIMH) Tool, before and during the initial hearing assessment appointment. DESIGN: A qualitative study comprising individual semi-structured interviews using a maximum variation sampling strategy. The data were analysed using an established thematic analysis technique. STUDY SAMPLE: Fifteen participants, including ten patients (i.e. adults with hearing loss) and five audiologists, were recruited from Adult Audiology Services within the United Kingdom's publicly-funded National Health Service (NHS). RESULTS: Three themes described the impact of using the WIMH Tool. Theme 1 (i.e. enhanced preparation before the appointment): the Tool helps patients to better understand and accept their hearing difficulties in advance of their first appointment. Theme 2 (i.e. enriched discussion during the appointment): the tool can enhance patient-centred communication, as well as the efficiency of the appointment. Theme 3 (i.e. varied impact on outcomes following the appointment): the Tool can improve patient motivation, readiness, and involvement in decision-making, though it may have limited impact on additional outcomes, such as adherence. CONCLUSION: The WIMH Tool can be successfully implemented in audiological practice, resulting in benefits before and during the initial hearing assessment appointment.

Satisfaction with hearing assessment feedback using the My Hearing Explained tool: client and audiologist perceptions.

OBJECTIVE: To determine the perceived satisfaction and understanding of hearing assessment feedback, using the Ida My Hearing Explained Tool (IMHET), compared to the standard audiogram reported by adult clients and audiologists. DESIGN: This study is a mixed-method design comparing clients and audiologists' perceptions through a single-blinded, randomised control trial and focus group discussions. After using either the audiogram or IMHET for feedback, clients and audiologists completed the adapted Patient Satisfaction Questionnaire (PSQ). STUDY SAMPLE: During client's initial audiological consultations, audiologists provided hearing assessment feedback (Total = 51) using the IMHET or audiogram. Twenty-seven clients and seven audiologists participated in focus groups, and/or open-ended questions. RESULTS: Satisfaction was not significantly different (p > 0.05) between the IMHET (76.18; SD: 2.66) or audiogram (75.63; SD: 4.73) for the overall PSQ scores reported by clients and audiologists. Two shared main themes, understanding and satisfaction, were identified for both tools from the focus groups and open-ended questions. A third main theme, recommendations, was identified only for the IMHET. CONCLUSIONS: The IMHET is a valuable resource for clients during hearing assessment feedback. Audiologists recommend that the audiogram be used as a supplement when using the IMHET to provide feedback.

Experienced hearing aid users' perspectives of assessment and communication within audiology: a qualitative study using digital methods.

OBJECTIVE: To explore experienced hearing aid users' perspectives of audiological assessments and the patient-audiologist communication dynamic during clinical interactions. DESIGN: A qualitative study was implemented incorporating both an online focus group and online semi-structured interviews. Sessions were audio-recorded and transcribed verbatim. Iterative-inductive thematic analysis was carried out to identify themes related to assessment and communication within audiology practice. STUDY SAMPLES: Seven experienced hearing aid users took part in an online focus group and 14 participated in online semi-structured interviews (age range: 22 - 86 years; 9 males, 11 females). RESULTS: Themes related to assessment included the unaided and aided testing procedure and relating tests to real world hearing difficulties. Themes related to communication included the importance of deaf aware communication strategies, explanation of test results and patient centred care in audiology. CONCLUSION: To ensure hearing aid services meet the needs of the service users, we should explore user perspectives and proactively adapt service delivery. This approach should be ongoing, in response to advances in hearing aid technology. Within audiology, experienced hearing aid users' value (1) comprehensive, relatable hearing assessment, (2) deaf aware patient-audiologist communication, (3) accessible services and (4) a personalised approach to recommend suitable technology and address patient specific aspects of hearing loss.

Challenges and opportunities for telehealth assessment during COVID-19: iT-RES, adapting a remote version of the test for rating emotions in speech.

OBJECTIVE: COVID-19 social isolation restrictions have accelerated the need to adapt clinical assessment tools to telemedicine. Remote adaptations are of special importance for populations at risk, e.g. older adults and individuals with chronic medical comorbidities. In response to this urgent clinical and scientific need, we describe a remote adaptation of the T-RES (Oron et al. 2020; IJA), designed to assess the complex processing of spoken emotions, based on identification and integration of the semantics and prosody of spoken sentences. DESIGN: We present iT-RES, an online version of the speech-perception assessment tool, detailing the challenges considered and solution chosen when designing the telehealth tool. We show a preliminary validation of performance against the original lab-based T-RES. STUDY SAMPLE: A between-participants design, within two groups of 78 young adults (T-RES, n = 39; iT-RES, n = 39). RESULTS: i-TRES performance closely followed that of T-RES, with no group differences found in the main trends, identification of emotions, selective attention, and integration. CONCLUSIONS: The design of iT-RES mapped the main challenges for remote auditory assessments, and solutions taken to address them. We hope that this will encourage further efforts for telehealth adaptations of clinical services, to meet the needs of special populations and avoid halting scientific research.

Speech-Language Pathologists' Perceptions of School-Based Services for Children With Hearing Loss.

Purpose School-aged children with hearing loss are best served by a multidisciplinary team of professionals. The purpose of this research was to assess school-based speech-language pathologists' (SLPs) perceptions of their access to, involvement of, and working relationships with educational audiologists in their current work setting. Method An online survey was developed and distributed to school-based SLPs in North Carolina. Results A significant difference in access to and involvement of educational audiologists across the state was found. Conclusions This research contributes to professional knowledge by providing information about current perceptions in the field about interprofessional practice in a school-based setting. Overall, SLPs reported positive feelings about their working relationship with educational audiologists and feel the workload is distributed fairly.

South African hearing conservation programmes in the context of tele-audiology: A scoping review.

BACKGROUND: The limited involvement of audiologists in occupational noise-induced hearing loss (ONIHL) management through hearing conservation programmes (HCPs) is a global issue. In low- and middle-income (LAMI) countries such as South Africa, this is also exacerbated by demand versus capacity challenges. Tele-audiology is an option requiring serious deliberation by the audiology community within HCPs in LAMI contexts. OBJECTIVES: This scoping review explores if tele-audiology has a potential value in HCPs and reviews what has been documented in the literature on the use of tele-audiology in HCPs. METHOD: A scoping review was conducted using the Arksey and O'Malley's framework. A search was conducted in five electronic bibliographic databases including Science Direct, PubMed, Scopus Medline, ProQuest and Google Scholar and the grey literature to identify publications presenting considerations around tele-audiology in the implementation of HCPs. RESULTS: Findings revealed significant dearth of evidence specific to the use or application of tele-audiology in ONIHL and/or HCPs both within the African context and internationally, despite the purported potential benefit of this service delivery model, particularly in resource-constrained contexts such as LAMI countries. Of the publications deemed potentially relevant to this scoping review, none were found that specifically investigated or addressed the use of tele-audiology in ONIHL or HCPs as their main objective. Nuanced analysis of publications revealed that in the last decade, indication for potential growth in the use of tele-audiology within occupational audiology is indicated. CONCLUSION: Because of the significant demand versus capacity challenges in LAMI countries, and because of the need for scaling up audiology professionals' management of HCPs, careful consideration of teleaudiology as a platform to deliver services in these contexts is required.

Infection prevention and control measures in audiology practice within public healthcare facilities in KwaZulu-Natal province, South Africa.

BACKGROUND: Audiologists have a clinical and ethical responsibility to create a working environment, designed to reduce the potential for cross-contamination or transmission of infections. OBJECTIVES: To describe the infection prevention and control (IPC) measures utilised and the opinions of audiologists and speech therapists, and audiologists (A/STAs) towards IPC in public healthcare facilities in KwaZulu-Natal province, South Africa. METHOD: A quantitative, descriptive survey was utilised and entailed completing an online questionnaire. The Cronbach's alpha (0.82) indicated good internal consistency of the tool. Forty-nine A/STAs from 29 public healthcare facilities responded. RESULTS: Most participants (82%) followed a generic Department of Health policy on IPC, while 67% alluded to a discipline-specific policy. Participants had received training in infection control but indicated that further instruction was required for audiology-specific infection control procedures. Only 57% indicated that they 'sometimes' wore gloves with every patient during direct clinical contact. An association between the healthcare facility level and the wearing of gloves was found to be statistically significant (p = 0.025). Participants at regional and tertiary levels contended that gloves should be worn during most procedures versus those at district levels of care. While 96% washed their hands after each patient, only 76% washed their hands before each patient. Twenty-nine per cent indicated that they only 'sometimes' wore masks when in contact with patients with communicable diseases. Approximately one-third disinfected touch surfaces and toys, based on the clinician's discretion. The majority (86%) of participants, however, always followed the correct protocol for medical waste disposal. Despite training and the availability of policies, some practitioners displayed poor IPC practices in terms of universal precautions, personal protective equipment, handwashing and sterilisation. CONCLUSION: Further education, training and awareness related to appropriate IPC measures are recommended for audiologists. It is envisaged that this will lead to more effective IPC measures in audiology practice thereby reducing the risk of infection transmission.

Shifting and transforming the practice of audiology: The inclusion of traditional healing.

BACKGROUND: Societal diversity encompasses an array of cultural, religious and spiritual beliefs that influence an individual's perspective of illness and diseases. Healthcare providers are challenged with the task of considering these diversities in clinical practice. The symbiotic relationship between the healthcare provider and the traditional healer in any healthcare field is rare. OBJECTIVES: The aims were to determine the perspectives of audiologists with regard to traditional healing in South Africa (SA) and to document if and how the audiologist engages with traditional healing in practice. METHOD: A questionnaire containing closed and open-ended questions was utilised. Thematic analysis was conducted on the qualitative data, and the quantitative data were displayed using tables and figures. RESULTS: Forty-one audiologists working at public and private hospitals and clinics in SA were included in this study. The personal experiences of audiologists resulted in varying definitions of a traditional healer. Audiologists reported that patients utilised traditional healing methods such as pouring urine or motor oil into the ear. Strategies of accommodation included being culturally appropriate during conversations, respecting and acknowledging the individual's cultural and religious beliefs. Twenty-seven audiologists were willing to collaborate with traditional healers to support the patient. CONCLUSION: There is a need for an integral holistic model of care in Audiology. There is a lack of communication structures to facilitate the implementation of a collaborative model of care in the current medical model of practice of Audiology. The global trend of holistic and person-centred care is evident, and the field of Audiology cannot negate the role of traditional healers as alternate healthcare providers in SA.

Bayesian Applications in Auditory Research.

Purpose This article presents a basic exploration of Bayesian inference to inform researchers unfamiliar to this type of analysis of the many advantages this readily available approach provides. Method First, we demonstrate the development of Bayes' theorem, the cornerstone of Bayesian statistics, into an iterative process of updating priors. Working with a few assumptions, including normalcy and conjugacy of prior distribution, we express how one would calculate the posterior distribution using the prior distribution and the likelihood of the parameter. Next, we move to an example in auditory research by considering the effect of sound therapy for reducing the perceived loudness of tinnitus. In this case, as well as most real-world settings, we turn to Markov chain simulations because the assumptions allowing for easy calculations no longer hold. Using Markov chain Monte Carlo methods, we can illustrate several analysis solutions given by a straightforward Bayesian approach. Conclusion Bayesian methods are widely applicable and can help scientists overcome analysis problems, including how to include existing information, run interim analysis, achieve consensus through measurement, and, most importantly, interpret results correctly. Supplemental Material https://doi.org/10.23641/asha.7822592.

Relationship Between Objective and Behavioral Audiology for Young Children Being Assessed for Cochlear Implantation: Implications for CI Candidacy Assessment.

OBJECTIVE: This study aimed to evaluate the feasibility of making cochlear implant recommendations based on diagnostic ABR and ASSR results. The goal was to challenge the need for behavioral audiometry as part of the standard cochlear implant assessment battery for infants with profound hearing loss and to reduce the age at which cochlear implant recommendation was made. STUDY DESIGN: A retrospective review of 123 patient files for children referred to the pediatric cochlear implant service before 3 years of age over a 3-year period was undertaken. Results for click-ABR, ASSR, and behavioral audiology at 500, 1k, 2k and 4k Hz, and tympanometry were collected and relationships were investigated for 64 children who met the inclusion criteria. Data were excluded for 59 children due to the presence of auditory neuropathy findings, middle ear pathology at the time of testing, if ASSR was not assessed at intensity levels >85 dB, and/or behavioral testing was judged to be unreliable by two experienced clinicians. SETTING: Primary care pediatric cochlear implant program located within a hospital setting. PATIENTS: Pediatric patients referred for cochlear implant evaluation before 3 years of age. INTERVENTIONS(S): Children were assessed using ABR, ASSR, and behavioral audiometry for identification and confirmation of hearing loss. MAIN OUTCOME MEASURES(S): Correlation between diagnostic click-ABR and ASSR thresholds and subsequently obtained behavioral hearing thresholds. RESULTS: Results for objective measures (click-ABR and ASSR) were significantly correlated with behavioral results. The correlations, however, were poorer than expected with limited predictive value. For 6 of the 64 children click-ABR and/or ASSR suggested profound hearing loss and corresponding behavioral hearing threshold was found to be in the severe hearing loss range. CONCLUSIONS: Findings of this study do not support making cochlear implant recommendations based on the findings of diagnostic click-ABR and ASSR alone. Investigating ways to reduce the average age children with severe-to-profound hearing loss receive a cochlear implant is a priority for the study institution. An alternate evaluation pathway for infants which incorporates a multifaceted assessment is warranted and will be the focus of future work at the study institution.

Amplification and aural rehabilitation in resource-constrained environments.

OBJECTIVES: This article attempts to highlight the challenges and possibilities for hearing healthcare through technology and aural rehabilitation in a resource-constrained setting, using South Africa as an example.Results and conclusionThe authors argue that it is possible to enhance service delivery by using free resources and maximising the limited existing resources. In order to provide a sustainable hearing healthcare service in developing countries, it is pertinent to understand the context where the services are needed, and not just adopt an approach developed for a different context. Audiologists in such settings need to employ strategies to develop context-specific tools, and adapt existing tools to serve the needs of the local population. Some examples, although not exhaustive, are provided in the article.

Stories From the Webcams: Cincinnati Children's Hospital Medical Center Audiology Telehealth and Pediatric Auditory Device Services.

PURPOSE: The purpose of this manuscript is to describe the regulatory, technological, and training considerations for audiologists investigating telehealth and to offer some examples of audiology services provided through telehealth. METHOD: The authors presented the regulatory components, the technology required for audiology staff and patients, and staff training for the audiology telehealth program at Cincinnati Children's Hospital Medical Center. Four case studies highlighting the successful use of telehealth in providing auditory device services to patients were also presented. RESULTS AND CONCLUSION: The described regulatory, technological, and training hierarchy provides a framework for audiologists interested in starting a telehealth program. The cases presented illustrate that telehealth can be used to provide some auditory device services, such as troubleshooting, mapping, and parent consulting.

The use of ecological momentary assessment in hearing research and future clinical applications.

To obtain real-world insights into the hearing difficulties of individuals, the field of hearing research has recently started to adopt ecological momentary assessment. Using this approach, study participants describe their experiences in real time, in their own natural environment. This paper describes the use of ecological momentary assessment in hearing research to date. Several studies have shown the approach is feasible and has good construct validity for use with adults with hearing impairment and/or tinnitus. Two recent studies conducted by the authors are described. The first study investigated the listening experiences of older adults with mild hearing impairment and concluded that ecological momentary assessment provided group and individual data which highlighted the between-subject variability in this clinical population. The second study investigated the difference that the provision of hearing aids could make for older adults with mild hearing impairment. The pilot study indicated that ecological momentary assessment could be successfully used in intervention studies to measure, for example, individual hearing aid benefit, which may extend beyond improved speech understanding. The study also revealed the potential for ecological momentary assessment as a tool for clinical practice and decision-making. Ecological momentary assessment can result in a rich array of research data if specific study design guidelines, presented in this paper, are followed. The development of a clinical ecological momentary assessment tool would provide clinicians an individualized outcome measure and facilitate the adoption of a greater degree of client- and family-centeredness, thereby improving rehabilitation outcomes.

Comorbidities of hearing loss and the implications of multimorbidity for audiological care.

With increasing age, the risk of developing chronic health conditions also increases, and many older people suffer from multiple co-existing health conditions, i.e., multimorbidity. One common health condition at older age is hearing loss (HL). The current article reflects on the implications for audiological care, when HL is one of several health conditions in a multimorbidity. An overview of health conditions often co-existing with HL, so called comorbidities, is provided, including indications for the strength of the associations. The overview is based on a literature study examining cohort studies that were published in the years 2010-2018 and examined associations of hearing loss with other health conditions, namely Visual impairment, Mobility restrictions, Cognitive impairment, Psychosocial health problems, Diabetes, Cardiovascular diseases, Stroke, Arthritis, and Cancer. This selection was based on previous publications on common chronic health conditions at older age and comorbidities of hearing loss. For all of these health conditions, it was found that prevalence is larger in people with a HL and several longitudinal studies also found increased incident rates in people with a HL. The examined publications provide little information on how hearing loss should be managed in the clinical care of its comorbidities and vice versa. The current article discusses several options for adaptations of current care. Nonetheless, solutions for an integrated audiology care model targeting HL in a multimorbidity are still lacking and should be subject to future research.

Cost and outcome of a community-based paediatric hearing screening programme in rural India with application of tele-audiology for follow-up diagnostic hearing assessment.

OBJECTIVE: This study evaluated the cost and outcome of a community-based hearing screening programme in which village health workers (VHWs) screened children in their homes using a two-step DPOAE screening protocol. Children referred in a second screening underwent tele diagnostic ABR testing in a mobile tele-van using satellite connectivity or at local centre using broadband internet at the rural location. DESIGN: Economic analysis was carried out to estimate cost incurred and outcome achieved for hearing screening, follow-up diagnostic assessment and identification of hearing loss. Two-way sensitivity analysis determined the most beneficial cost-outcome. STUDY SAMPLE: 1335 children under 5 years of age underwent screening by VHWs. RESULTS: Nineteen of the 22 children referred completed the tele diagnostic evaluation. Five children were identified with hearing loss. The cost-outcomes were better when using broadband internet for tele-diagnostics. The use of least expensive human resources and equipment yielded the lowest cost per child screened (Rs.1526; $23; €21). When follow-up expenses were thus maximised, the cost per child was reduced considerably for diagnostic hearing assessment (Rs.102,065; $1532; €1368) and for the cost per child identified (Rs.388,237; $5826; €5204). CONCLUSION: Settings with constrained resources can benefit from a community-based programme integrated with tele diagnostics.

Referral rates of postlingually deafened adult hearing aid users for a cochlear implant candidacy assessment.

OBJECTIVE: The aims of this study were: to investigate the referral rates of postlingually deafened adult cochlear implant (CI) candidates from a hearing aid (HA) clinic for a CI candidacy assessment and to gain insight about factors influencing the referral pathways to CI assessments. DESIGN: Two methodologies were used: a retrospective cohort study reviewing clinical files and a questionnaire to clinicians. STUDY SAMPLE: The files of 1249 adult clients from the HA clinic who had average puretone hearing thresholds greater or equal to 65 dB HL in the better hearing ear and unaided phoneme recognition scores of less than 50% in both ears were reviewed. All of the clinicians completed the online questionnaire. RESULTS: Eighteen adults met the CI candidacy criteria, of whom 16 (89%) had a CI discussion with their audiologist, with 11 (61%) being referred for a CI evaluation. Of these 11, four proceeded to implantation. Questionnaire responses revealed the need for better information on candidacy and referral guidelines for HA audiologists, in addition to enhanced communication between HA and CI clinics. CONCLUSIONS: Overall the results indicate that the referral pathway to obtain a CI assessment is a barrier contributing to the low CI penetration rate in adults.

Difficult conversations: talking about cost in audiology consultations with older adults.

OBJECTIVE: Financial cost is a barrier for many older adults in their decision to obtain hearing aids (HAs). This study aimed to examine conversations about the cost of HAs in detail within initial audiology appointments. DESIGN: Sixty-two initial audiology appointments were video-recorded. The data were analysed using conversation analysis. STUDY SAMPLE: Participants included 26 audiologists, 62 older adults and 17 companions. RESULTS: Audiologists and clients displayed interactional difficulty during conversations about cost. Clients often had emotional responses to the cost of HAs, which were not attended to by audiologists. It was typical for audiologists to present one HA cost option at a time, which led to multiple rejections from clients which made the interactions difficult. Alternatively, when audiologists offered multiple cost options at once this led to a smoother interaction. CONCLUSIONS: Audiologists and clients were observed to have difficulty talking about HA costs. Offering clients multiple HA cost options at the same time can engage clients in the decision-making process and lead to a smoother interaction between audiologist and client in the management phase of appointments.

Stages of change in audiology: comparison of three self-assessment measures.

OBJECTIVE: In a clinical setting, theories of health behaviour change could help audiologists and other hearing health care professionals understand the barriers that prevent people with hearing problems to seek audiological help. The transtheoretical (stages of change) model of health behaviour change is one of these theories. It describes a person's journey towards health behaviour change (e.g. seeking help or taking up rehabilitation) in separate stages: precontemplation, contemplation, preparation, action, and, finally, maintenance. A short self-assessment measure of stages of change may guide the clinician and facilitate first appointments. This article describes correlations between three stages of change measures of different lengths, one 24-item and two one-item. DESIGN: Participants were recruited through an online hearing screening study. Adults who failed the speech-in-noise recognition screening test and who had never undergone a hearing aid fitting were invited to complete further questionnaires online, including the three stages of change measures. STUDY SAMPLE: In total, 224 adults completed the three measures. RESULTS: A majority of the participants were categorised as being in one of the information- and help-seeking stage of change (contemplation or preparation). The three stages of change measures were significantly correlated. Conclusions Our results support further investigating the use of a one-item measure to determine stages of change in people with hearing impairment.

Paediatric hearing aid management: a demonstration project for using virtual visits to enhance parent support.

OBJECTIVE: The purpose of this study was to explore the use of virtual visits to monitor hearing aid use with data logging measurements and provide parent support for hearing aid management. DESIGN: A 6-month longitudinal case study design was used. STUDY SAMPLE: Four families and two providers participated. RESULTS: Average hours of daily hearing aid use increased 3.5 h from the beginning to the end of the study period. Prior to receiving virtual visits, the parents and the clinicians generally indicated they were hopeful about the benefits of virtual visits including the frequency and convenience of the appointments but had some concerns about technical difficulties. These concerns diminished at the conclusion of the study. CONCLUSION: Virtual visits provided benefits to families including flexibility and timely access to support. The ability to collect data logging information more frequently was important for effective problem-solving to increase hearing aid use. Both parents and clinicians were accepting of tele-support. Parents and professionals would benefit from technology that allows them to access data logging information more easily and frequently.

A Methodology for the Analysis of Spontaneous Reactions in Automated Hearing Assessment.

Audiology is the science of hearing and auditory processes study. The evaluation of hearing capacity is commonly performed by an audiologist using an audiometer, where the patient is asked to show some kind of sign when he or she recognizes the stimulus. This evaluation becomes much more complicated when the patient suffers some type of cognitive decline that hinders the emission of visible signs of recognition. With this group of patients, a typical question-answer interaction is not applicable, so the audiologist must focus his attention on the patient's spontaneous gestural reactions. This manual evaluation entails a number of problems: it is highly subjective, difficult to determine in real time (since the expert must pay attention simultaneously to the audiological process and the patient's reactions), etc. Considering this, in this paper, we present an automatic methodology for processing video sequences recorded during the performance of the hearing test in order to assist the audiologist in the detection of these spontaneous reactions. This screening method analyzes the movements that occur within the eye area, which has been pointed out by the audiologists as the most representative for these patients. By the analysis of these movements, the system helps the audiologist to determine when a positive gestural reaction has taken place increasing the objectivity and reproducibility.