Perceptions of the Scope of Practice of Audiology.

PURPOSE: The primary purpose of this study was to determine which scope of practice roles and responsibilities are attributed to the profession of audiology (AUD) relative to other health care disciplines by a group of health and human services faculty and students. METHOD: An online survey inquiring about participant knowledge of different health professions' scopes of practice, and experience with and attitude toward the profession of AUD, was sent to faculty and students in the Western Michigan University College of Health and Human Services. Students also completed two subscales of the Interprofessional Attitudes Scale. Descriptive statistics and chi-square and Kruskal-Wallis analyses evaluating response differences between groups are presented. RESULTS: Thirty-six faculty and 118 students (48 graduate and 70 undergraduate) completed the survey. AUD was the profession most often associated with all hearing-related scope of practice activities. Speech-language pathology was often associated with hearing-related scope of practice activities. Audiologists were less commonly associated with vestibular, balance, and mobility scope of practice activities. Group was significant for four scope of practice activities. About half of respondents indicated they knew nothing or a little about AUD, and a majority had no or rare interactions with audiologists in class or clinic. Only about half of participants responded they were likely or very likely to refer patients to an audiologist. CONCLUSION: Increased knowledge of the scope of practice and exposure to the profession of AUD may benefit other health care professionals and patients, possibly leading to increased interprofessional practice and an increased number of appropriate referrals.

Screening for Falls: A Prospective Pilot Study for the Audiology Clinic.

PURPOSE: The purpose of this study was to determine if clinical measures that audiologists may already be using or are able to collect on a routine basis are useful in screening for future falls. METHOD: This prospective cohort study protocol included 20 community-dwelling participants aged 60 years or older who completed case history questions, pure-tone and speech audiometry, common questionnaires, the Timed Up and Go test, and a prospective 6-month falls diary to determine which measures were correlated with the number of prospective 6-month falls. RESULTS: Five participants (25%) fell in the 6 months after the research session. Significant correlations were noted between prospective falls and age, home safety modifications, engagement in fall prevention activities, and history of falls in the last 12 months. CONCLUSION: Straightforward case history questions that could be part of a routine audiologic evaluation, such as fall history in the previous year, are significantly correlated with prospective number of falls in 6 months. These questions could help to identify audiology patients who may benefit from further fall risk assessment.

Subjective Hearing Difficulty and Fall Risk.

Purpose Hearing loss is a risk factor for falls. The purpose of this study was to investigate the relation between subjective hearing difficulty and risk of falls. Method Community-dwelling older adults, aged 60 years and older, completed a case history; three questionnaires, including the Hearing Handicap Inventory for the Elderly (HHIE), Dizziness Handicap Inventory (DHI), Activities-Specific Balance Confidence Scale (ABC); and one functional balance measure, the Timed Up and Go (TUG) test. Pearson and Spearman correlations were calculated, and average scores were plotted according to group and HHIE score category for DHI, ABC, TUG, the number of medications, and the number of recent falls. Results Seventy-four participants were included in this analysis: 28 nonaudiology patients, 18 audiology patients with hearing aids, and 28 audiology patients without hearing aids. Significant positive correlations were noted between HHIE and DHI scores for audiology patients without hearing aids and between HHIE score and number of recent falls for audiology patients with hearing aids. When average scores were plotted for DHI, ABC, TUG, the number of medications, and the number of recent falls according to group and category, there were clear trends toward increased fall risk as HHIE score categories increased (i.e., mild to moderate to severe) based on previously used criteria. Conclusions Overall, a trend was noticed such that, for increasing HHIE score categories, fall risk increased. Significant correlations existed between HHIE score and some of the measures used to indicate fall risk (i.e., DHI score, number of recent falls). Future fall risk research should investigate subjective hearing difficulty as a risk factor, as well as pure-tone audiometric thresholds.

Fall risk screening protocol for older hearing clinic patients.

OBJECTIVE: The primary purposes of this study were (1) to describe measures that may contrast audiology patients who fall from those who do not fall and (2) to evaluate the clinical performance of measures that could be easily used for fall risk screening in a mainstream audiology hearing clinic. DESIGN: Cross-sectional study Study sample: Thirty-six community-dwelling audiology patient participants and 27 community-dwelling non-audiology patients over 60 years of age. RESULTS: The Hearing Handicap Inventory for the Elderly (HHIE) most accurately identified patients with a recent fall (sensitivity: 76.0%), while the Dizziness Handicap Inventory (DHI) most accurately identified patients without a recent fall (specificity: 90.9%). A combination of measures used in a protocol-including HHIE, DHI, number of medications, and the Timed Up and Go test-resulted in good, accurate identification of patients with or without a recent history of falls (92.0% sensitivity, 100% specificity). CONCLUSIONS: This study reports good sensitivity and excellent specificity for identifying patients with and without a recent history of falls when measures were combined into a screening protocol. Despite previously reported barriers, effective fall risk screenings may be performed in hearing clinic settings with measures often readily accessible to audiologists.

Audiology patient fall statistics and risk factors compared to non-audiology patients.

OBJECTIVE: To compare fall statistics (e.g. incidence, prevalence), fall risks, and characteristics of patients who seek hearing healthcare from an audiologist to individuals who have not sought such services. DESIGN: Case-control study. STUDY SAMPLE: Two groups of community-dwelling older adult patients: 25 audiology patients aged 60 years or older (M age: 69.2 years, SD: 4.5, range: 61-77) and a control group (gender- and age-matched ±2 years) of 25 non-audiology patients (M age: 69.6, SD: 4.7, range: 60-77). RESULTS: Annual incidence of falls (most recent 12 months) was higher in audiology patients (68.0%) than non-audiology patients (28.0%; p = .005). Audiology patients reported a higher incidence of multiple recent falls (p =.025) and more chronic health conditions (p = .028) than non-audiology patients. CONCLUSIONS: Significantly more audiology patients fall on an annual basis than non-audiology patients, suggesting that falls are a pervasive issue in general hearing clinics. Further action on the part of healthcare professionals providing audiologic services may be necessary to identify individuals at risk for falling.

Identifying Balance Measures Most Likely to Identify Recent Falls.

BACKGROUND AND PURPOSE: Falls sustained by older adults are an increasing health care issue. Early identification of those at risk for falling can lead to successful prevention of falls. Balance complaints are common among individuals who fall or are at risk for falling. The purpose of this study was to evaluate the clinical utility of a multifaceted balance protocol used for fall risk screening, with the hypothesis that this protocol would successfully identify individuals who had a recent fall (within the previous 12 months). METHODS: This is a retrospective review of 30 individuals who self-referred for a free fall risk screening. Measures included case history, Activities-Specific Balance Confidence Scale, modified Clinical Test of Sensory Interaction on Balance, Timed Up and Go test, and Dynamic Visual Acuity. Statistical analyses were focused on the ability of the test protocol to identify a fall within the past 12 months and included descriptive statistics, clinical utility indices, logistic regression, receiver operating characteristic curve, area under the curve analysis, effect size (Cohen d), and Spearman correlation coefficients. RESULTS AND DISCUSSION: All individuals who self-referred for this free screening had current imbalance complaints, and were typically women (70%), had a mean age of 77.2 years, and had a fear of falling (70%). Almost half (46.7%) reported at least 1 lifetime fall and 40.0% within the past 12 months. Regression analysis suggested that the Timed Up and Go test was the most important indicator of a recent fall. A cutoff score of 12 or more seconds was optimal (sensitivity: 83.3%; specificity: 61.1%). CONCLUSIONS: Older adults with current complaints of imbalance have a higher rate of falls, fall-related injury, and fear of falling than the general community-dwelling public. The Timed Up and Go test is useful for determining recent fall history in individuals with imbalance.

Test-retest reliability of the vestibular sensory-evoked potential (VsEP) in C57BL/6J mice.

BACKGROUND: The vestibular sensory-evoked potential (VsEP) is an electrical potential that provides a direct test of vestibular function in animals. VsEP recordings are carried out using subcutaneous stainless steel electrodes placed over the nuchal crest (noninverting), behind either the left or right pinna (inverting), and at the hip (ground). A noninvasive head clip is used to secure the head to a mechanical shaker for delivery of a linear vestibular stimulus measured in units of jerk (g/msec). Frequent repositioning of the noninvasive head clip and skin electrodes may be necessary during recording for particular protocols; however, the test-retest reliability of the VsEP response (latency, amplitude, and threshold) has not been determined. PURPOSE: The purpose of this study was to determine the possible effects of frequent repositioning of the noninvasive head clip and skin electrodes on VsEP response parameters (latencies, amplitudes, and thresholds). We hypothesize that the VsEP response will remain stable and reliable with such repeated measurements in a given animal across time. RESEARCH DESIGN: Linear VsEP responses were recorded from ten C57 mice (ages: 2.45 mo ±0.20; weights: 17.94 g ±1.51). Two standard threshold protocols and four repeated VsEP measurements at +6 dB re: 1.0 g/msec were performed, with four selected time points of head clip repositioning. In addition, three novice investigators performed measurements of noninverting electrode placement and head clip positioning. RESULTS: VsEP response latency, amplitude, and threshold means did not significantly change with frequent repositioning of the head clip and skin electrodes; however, increased variability was observed. CONCLUSIONS: The findings demonstrate that repositioning does not introduce significant changes in mean parameter values of the recorded VsEP response waveform; however, mean absolute difference calculations demonstrated that frequent repositioning increased response variance. For VsEP protocols requiring frequent repositioning, standardized electrode montage, optimal placement of the noninverting electrode at the nuchal crest, and increased sample size are suggested.

Gaze Stabilization Test Asymmetry Score as an Indicator of Previous Concussion in a Cohort of Collegiate Football Players.

OBJECTIVE: Vestibular dysfunction may lead to decreased visual acuity with head movements, which may impede athletic performance and result in injury. The purpose of this study was to test the hypothesis that athletes with history of concussion would have differences in gaze stabilization test (GST) as compared with those without a history of concussion. DESIGN: Cross-sectional, descriptive. SETTING: University Athletic Medicine Facility. PARTICIPANTS: Fifteen collegiate football players with a history of concussion, 25 collegiate football players without a history of concussion. INTERVENTION: Participants completed the dizziness handicap inventory (DHI), static visual acuity, perception time test, active yaw plane GST, stability evaluation test (SET), and a bedside oculomotor examination. MAIN OUTCOME MEASURES: Independent samples t test was used to compare GST, SET, and DHI scores per group, with Bonferroni-adjusted alpha at P < 0.01. Receiver operating characteristic curve analysis and area under the curve (AUC) were used to assess the clinical performance of the GST and SET. RESULTS: Athletes with previous concussion had a larger GST asymmetry score [mean (M) = 12.40, SD = 9.09] than those without concussion (M = 4.92, SD = 4.67; t (18.70) = -2.955, P = 0.008, 95% CI, -12.79 to -2.18, d = -1.37). Clinical performance of the GST (AUC = 0.77) was better than the SET (AUC = 0.61). CONCLUSIONS: Results suggest peripheral vestibular or vestibular-visual interaction deficits in collegiate athletes with a history of concussion. The results support further research on the use of GST for sport-related concussion evaluation and monitoring. CLINICAL RELEVANCE: Inclusion of objective vestibular tests in the concussion protocol may reveal the presence of peripheral vestibular or visual-vestibular deficits. Therefore, the GST may add an important perspective on the effects of concussion.

Falls in the audiology clinic: a pilot study.

BACKGROUND: Falls are a common and often preventable cause of injury and death among older adults. Hearing loss, vestibular disorders, dizziness, and imbalance are common risk factors for falls; however, the rate of falls among older audiology patients has never been assessed. PURPOSE: To examine the fall history and risk factors of older adults seen in a university audiology clinic. RESEARCH DESIGN: A descriptive and correlational retrospective chart review of fall history and characteristics of patients seen in a university audiology clinic. STUDY SAMPLE: 88 (51 women, 37 men) patients aged 60 yr and older seen in a university audiology clinic. DATA COLLECTION AND ANALYSIS: At the time of hearing evaluation, clinic patients filled out the Activities-Specific Balance Confidence (ABC) Scale, as well as a history form containing fall-related questions. These measures, as well as demographic information (gender and age) were retrieved during a retrospective chart review. Data were analyzed with independent-samples t-tests, Pearson correlations, and descriptive statistics. RESULTS: Fifty percent of the study sample reported falling within the preceding 12 mo, while 70% reported having fallen at some point in the past. ABC Scale score was negatively correlated with age and number of recent falls. CONCLUSIONS: There appears to be a higher prevalence of falls within a university audiology clinic relative to previously published fall rates in the general population.

Pure-tone hearing asymmetry: a logistic approach modeling age, sex, and noise exposure history.

BACKGROUND: Asymmetric hearing loss (AHL) can be an early sign of vestibular schwannoma (VS). However, recognizing VS-induced AHL is challenging. There is no universally accepted definition of a "medically significant pure-tone hearing asymmetry," in part because AHL is a common feature of medically benign forms of hearing loss (e.g., age- or firearm-related hearing loss). In most cases, the determination that an observed AHL does not come from a benign cause involves subjective clinical judgment. PURPOSE: Our purpose was threefold: (1) to quantify hearing asymmetry distributions in a large group of patients with medically benign forms of hearing loss, stratifying for age, sex, and noise exposure history; (2) to assess how previously proposed hearing asymmetry calculations segregate tumor from nontumor cases; and (3) to present the results of a logistic regression method for defining hearing asymmetry that incorporates age, sex, and noise information. RESEARCH DESIGN: Retrospective chart review. STUDY SAMPLE: Five thousand six hundred and sixty-one patients with idiopathic, age- or noise exposure-related hearing loss and 85 untreated VS patients. DATA COLLECTION AND ANALYSIS: Audiometric, patient history, and clinical impression data were collected from 22,785 consecutive patient visits to the audiology section at Mayo Clinic in Florida from 2006 to 2009 to screen for eligibility. Those eligible were then stratified by VS presence, age, sex, and self-reported noise exposure history. Pure-tone asymmetry distributions were analyzed. Audiometric data from VS diagnoses were used to create four additional audiograms per patient to model the hypothetical development of AHL prior to the actual hearing test. The ability of 11 previously defined hearing asymmetry calculations to distinguish between VS and non-VS cases was described. A logistic regression model was developed that integrated age, sex, and noise exposure history with pure-tone asymmetry data. Regression model performance was then compared to existing asymmetry calculation methods. RESULTS: The 11 existing pure-tone asymmetry calculations varied in tumor detection performance. Age, sex, and noise exposure history helped to predict benign forms of hearing asymmetry. The logistic regression model outperformed existing asymmetry calculations and better accounted for normal age-, sex-, and noise exposure-related asymmetry variability. CONCLUSIONS: Our logistic regression asymmetry method improves the clinician's ability to estimate risk of VS, in part by integrating categorical patient history and numeric test data. This form of modeling can enhance clinical decision making in audiology and otology.