Heightening our vigilance towards patient well-being.

OBJECTIVE: Audiology patients frequently experience psychosocial difficulties created by their hearing loss or exacerbated by the loss. Clinicians are not always attuned to the unstated emotional undercurrents which may signal a need for further discussion or referral. This article aims to heighten audiologists' vigilance towards patient well-being. DESIGN: A series of case vignettes with sample dialogue demonstrate the need for heightened clinical awareness of confounding consequences patients may grapple with and possible responses to these issues. CONCLUSIONS: Beyond hearing loss, contributing detractors to patient well-being can be difficult to recognise for clinicians, and exploration and discussions may feel challenging to broach. A heightened vigilance within patient care calls upon audiologists to be alert for concerns or conditions beyond hearing loss that may be threatening our patients or further decreasing the quality of their lives and that of their families.

Satisfaction and Technology Evaluation of a Telehealth Robotic Program to Optimize Healthy Independent Living for Older Adults.

BACKGROUND AND PURPOSE: With the growth in the aging population, and shortage of primary care providers, telehealth programs are needed to optimize healthy independent living for older adults. The purpose of this study was to evaluate a nurse-led intervention program delivered through a telepresence robot to promote healthy lifestyles and address chronic illness management among older adults living independently in a retirement community. Telepresence robots provide two-way video-mediated communication with remote in-home navigation. DESIGN AND METHODS: Satisfaction and technology evaluation ratings of the Telehealth Community Health Assistance Team (T-CHAT) program, as well as qualitative data from open-ended questions, were obtained from 26 older adults and 7 nurse practitioner students. FINDINGS: On a scale from 1 = strongly disagree to 5 = strongly agree, satisfaction ratings were positive for usefulness (M = 3.90), ease of use (M = 4.16), and acceptability (M = 4.06). Technology evaluation ratings were high for all sessions (M = 4.35). Older adults and nurse practitioner students were highly complementary of the program. Areas for improvement were identified. CONCLUSIONS: The T-CHAT program demonstrated high ratings for satisfaction (usefulness, ease of use, acceptability) and for evaluation of the telepresence robot technology. Further refinement of the T-CHAT program is warranted, as is testing outcomes of this potentially viable mode of healthcare delivery. CLINICAL RELEVANCE: Robotics is the wave of the future and provides an innovative mode of delivery to address health promotion and chronic illness management in older adults. Satisfaction and technology evaluation of robotic technology is paramount prior to implementation of such programs into practice.

Using telehealth to optimize healthy independent living for older adults: A feasibility study.

The purpose of this study was to test feasibility of the Telehealth Community Health Assistance Team (T-CHAT), a nurse-led intervention delivered through a telepresence robot designed to promote healthy independent living among older adults. Using a quasi-experimental design, 21 older adults were divided into a T-CHAT group (n = 11) or a waitlist control group (n = 10). The T-CHAT group received 3 weekly health coaching sessions from a nurse practitioner student through the telepresence robot. Data trends were analyzed using two-way repeated measures analysis of covariance (ANCOVA) with baseline values as co-variates; effect sizes using partial eta squared (η2). Medium to large improvements in unhealthy days, depressive symptoms, sleep, quality of life, and confidence/self-efficacy were found favoring the T-CHAT group. Recruitment and retention strategies were successful, with lessons learned for future studies. Further research is warranted to refine and test efficacy of the T-CHAT program to promote healthy independent living among older adults.

Use of noise cancellation earphones in out-of-booth audiometric evaluations.

OBJECTIVE: To assess the utility of noise cancelation earphones (NCE) in audiometric evaluations. DESIGN: Degree of noise reduction of Bose QuietComfort 15 NCE was assessed through probe-microphone measures and sound-field audiometry. Occlusion effects from NCE were assessed for potential effects on bone-conduction thresholds. STUDY SAMPLE: Twenty participants were tested to determine average occlusion effect values during bone-conduction testing with and without NCE. Noise reduction values of the NCE were assessed on a single subject through probe-microphone measures and sound-field testing. RESULTS: NCE sufficiently reduced ambient noise to levels acceptable for air-conduction testing as well as for bone-conduction testing for most patients when adding minimal adjustment to acceptable levels as outlined by the ANSI S3.1-1999 standard. In addition, NCE did not create a clinically significant change in the occlusion effect for bone-conduction testing. CONCLUSION: NCE placed over insert earphones provide a sound pressure level at the tympanic membrane that is below ANSI standards for routine air-conduction testing and result in sufficient ambient noise reduction for bone-conduction testing with most patients. There is no clinically significant occlusion effect from NCE during routine bone-conduction audiometry. These findings support the utility of using NCE for offsite audiometric testing.

Visual discrimination predicts naming and semantic association accuracy in Alzheimer disease.

OBJECTIVE: Language impairment is a common symptom of Alzheimer disease (AD), and is thought to be related to semantic processing. This study examines the contribution of another process, namely visual perception, on measures of confrontation naming and semantic association abilities in persons with probable AD. METHODS: Twenty individuals with probable mild-moderate Alzheimer disease and 20 age-matched controls completed a battery of neuropsychologic measures assessing visual perception, naming, and semantic association ability. Visual discrimination tasks that varied in the degree to which they likely accessed stored structural representations were used to gauge whether structural processing deficits could account for deficits in naming and in semantic association in AD. RESULTS: Visual discrimination abilities of nameable objects in AD strongly predicted performance on both picture naming and semantic association ability, but lacked the same predictive value for controls. Although impaired, performance on visual discrimination tests of abstract shapes and novel faces showed no significant relationship with picture naming and semantic association. These results provide additional evidence to support that structural processing deficits exist in AD, and may contribute to object recognition and naming deficits. CONCLUSIONS: Our findings suggest that there is a common deficit in discrimination of pictures using nameable objects, picture naming, and semantic association of pictures in AD. Disturbances in structural processing of pictured items may be associated with lexical-semantic impairment in AD, owing to degraded internal storage of structural knowledge.

Canine brainstem auditory evoked responses are not clinically impacted by head size or breed.

Accurate assessment of canine hearing is essential to decrease the incidence of hereditary deafness in predisposed breeds and to substantiate hearing acuity. The Brainstem Auditory Evoked Response (BAER) is a widely accepted, objective test used in humans and animals for estimation of hearing thresholds and deafness diagnosis. In contrast to humans, testing and recording parameters for determination of normal values for canine hearing are not available. Conflicting information concerning breed and head size effects on canine BAER tests are major contributors preventing this normalization. The present study utilized standard head measurement techniques coupled with BAER testing and recording parameters modeled from humans to examine the effect canine head size and breed have on BAER results. Forty-three adult dogs from fourteen different breeds had head size measurements and BAER tests performed. The mean latencies compared by breed for waves I, II, III, IV, and V were as follows: 1.46±0.49 ms, 2.52±0.54 ms, 3.45±0.41 ms, 4.53±0.83 ms and 5.53±0.43 ms, respectively. The mean wave I-V latency interval for all breeds was 3.69 ms. All dogs showed similar waveform morphology, structures, including the presence of five waves occurring within 11 ms after stimulus presentation and a significant trough occurring after Wave V. All of the waveform morphology for our subjects occurred with consistent interpeak latencies as shown by statistical testing. All animals had diagnostic results within the expected ranges for each wave latency and interwave interval allowing diagnostic evaluation. Our results establish that neither differences in head size nor breed impact determination of canine BAER waveform morphology, latency, or hearing sensitivity for diagnostic purposes. The differences in canine head size do not have a relevant impact on canine BAERs and are not clinically pertinent to management or diagnostic decisions.

Electrodiagnostic evaluation of auditory function in the dog.

Given the high incidence of deafness within several breeds of dogs, accurate hearing screening and assessment is essential. In addition to brainstem auditory evoked response (BAER) testing, 2 other electrophysiologic tests are now being examined as audiologic tools for use in veterinary medicine: otoacoustic emissions and the auditory steady state response (ASSR). To improve BAER testing of animals and ensure an accurate interpretation of test findings from one test site to another, the establishment of and adherence to clear protocols is essential. The ASSR holds promise as an objective test for rapid testing of multiple frequencies in both ears simultaneously.

Canine hearing loss management.

Dog owners and handlers are naturally concerned when suspicion of hearing loss arises for their dogs. Questions frequently asked of the veterinarian center on warning signs of canine hearing loss and what can be done for the dog if hearing loss is confirmed. This article addresses warning signs of canine hearing loss, communication training and safety awareness issues, and the feasibility of hearing aid amplification for dogs.

Effect of kennel noise on hearing in dogs.

OBJECTIVE: To evaluate the degree of noise to which kenneled dogs were exposed in 2 typical kennels and to determine whether a measurable change in hearing might have developed as a result of exposure to this noise. ANIMALS: 14 dogs temporarily housed in 2 kennel environments. PROCEDURES: Noise levels were measured for a 6-month period in one environment (veterinary technical college kennel) and for 3 months in another (animal shelter). Auditory brainstem response testing was performed on dogs in the veterinary kennel 48 hours and 3 and 6 months after arrival. Temporal changes in the lowest detectable response levels for wave V were analyzed. RESULTS: Acoustic analysis of the kennel environments revealed equivalent sound level values ranging between 100 and 108 dB sound pressure level for the 2 kennels. At the end of 6 months, all 14 dogs that underwent hearing tests had a measured change in hearing. CONCLUSIONS AND CLINICAL RELEVANCE: Results of the noise assessments indicated levels that are damaging to the human auditory system. Such levels could be considered dangerous for kenneled dogs as well, particularly given the demonstrated hearing loss in dogs housed in the veterinary kennel for a prolonged period. Noise abatement strategies should be a standard part of kennel design and operation when such kennels are intended for long-term housing of dogs.