Audiology in the time of COVID-19: practices and opinions of audiologists in the UK.

OBJECTIVE: To document changes in audiology practice resulting from COVID-19 restrictions and to assess audiologists' opinions about teleaudiology. DESIGN: A survey consisting of closed-set and open-ended questions that assessed working practices during the COVID-19 restrictions and audiologists' attitudes towards teleaudiology. SAMPLE: About 120 audiologists in the UK recruited via snowball sampling through social media and emails. RESULTS: About 30% of respondents said they had used teleaudiology prior to COVID-19 restrictions; 98% had done at the time of survey completion, and 86% said they would continue to do so even when restrictions are lifted. Reasons for prior non-use of teleaudiology were associated with clinical limitations/needs, available infrastructure and patient preferences. Respondents believe teleaudiology will improve travel, convenience, flexibility and scheduling, that it will have little/no impact on satisfaction and quality of care, but that it will negatively impact personal interactions. Concerns about teleaudiology focussed on communication, inability to conduct some clinical procedures and technology. CONCLUSIONS: Respondents' experience with teleaudiology has generally been positive however improvements to infrastructure and training are necessary, and because many procedures must be conducted in-person, it will always be necessary to have hybrid-care pathways available.

ManCAD100: 100 Years of Audiology and Deaf Education at Manchester.

In 2019, the Manchester Centre for Audiology and Deafness celebrates its 100th anniversary. To mark the centenary, this special issue is a collection of papers that showcases current research in Manchester Centre for Audiology and Deafness. The Editorial provides a brief history and description of the Centre and an overview of the special issue.

Association of Speech Processor Technology and Speech Recognition Outcomes in Adult Cochlear Implant Users.

OBJECTIVE: Determine association of advancements in speech processor technology with improvements in speech recognition outcomes. STUDY DESIGN: Retrospective cohort. SETTING: Tertiary referral center. PATIENTS: Adult unilateral cochlear implant (CI) recipients. INTERVENTION: Increasing novelty of speech processor defined by year of market availability. MAIN OUTCOME MEASURES: Consonant-Nucleus-Consonant (CNC) and Hearing in Noise Test (HINT) in quiet. RESULTS: From 1991 to 2016, 1,111 CNC scores and 1,121 HINT scores were collected from 351 patients who had complete data. Mean post-implantation CNC score was 53.8% and increased with more recent era of implantation (p < 0.001, analysis of variance [ANOVA]). Median HINT score was 87.0% and did not significantly vary with implantation era (p = 0.06, ANOVA). Multivariable generalized linear models were fitted to estimate the effect of speech processor novelty on CNC and HINT scores, each accounting for clustering of scores within patients and characteristics known to influence speech recognition outcomes. Each 5-year increment in speech processor novelty was independently associated with an increase in CNC score by 2.85% (95% confidence limits [CL] 0.26, 5.44%) and was not associated with change in HINT scores (p = 0.30). CONCLUSION: Newer speech processors are associated with improved CNC scores independent of the year of device implantation and expanding candidacy criteria. The lack of association with HINT scores can be attributed to a ceiling effect, suggesting that HINT in quiet may not be an informative test of speech recognition in the modern CI recipient. The implications of these findings with respect to appropriate interval of speech processor upgrades are discussed.

Audiology Telemedicine Evaluations: Potential Expanded Applications.

There is underutilization of cochlear implants with delays in implantation linked to distance from implant centers. Telemedicine could connect cochlear implant specialists with patients in rural locations. We piloted telemedicine cochlear implant testing in a small study, largely composed of normal-hearing volunteers to trial this new application of teleaudiology technology. Thirteen subjects (8 with normal hearing and 5 with hearing loss ranging from mild to profound) underwent a traditional cochlear implant evaluation in person and then via telemedicine technology. Routine audiometry, word recognition testing, and Arizona Biological Test (AzBio) and consonant-nucleus-consonant (CNC) testing were performed. Mean (SD) percent difference in AzBio between in-person and remote testing was 1.7% (2.06%). Pure tone average (PTA), speech reception threshold (SRT), and word recognition were similar between methods. CNC testing showed a mean (SD) difference of 6.8% (10.2%) between methods. Testing conditions were acceptable to audiologists and subjects. Further study to validate this method in cochlear implant candidates and a larger population is warranted.

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.

Current practice of ototoxicity management across the United Kingdom (UK).

OBJECTIVE: Effective management of patients diagnosed with ototoxicity is needed to reduce hearing and balance damage which affects communication and life quality. Despite widespread recommendations to monitor and manage ototoxicity in an early and effective manner, there is limited evidence to support the actual implementation of these recommendations for affected patient groups in healthcare services across the UK with limited publications available. In this study, an online questionnaire analysed the current practice of ototoxicity management and patient pathways across the UK once the diagnosis of ototoxicity was confirmed, targeting Audiologists, ENTs/AVPs and GPs. DESIGN: Qualitative Survey Study. STUDY SAMPLE: A randomised sample of hearing services in the UK, including audiology departments; GP practices and local health settings were targeted with a total of 134 completed surveys. RESULTS: About 72% reported the absence of ototoxicity management protocols within their centre. Results depicted great inconsistency and variation across the UK in ototoxicity management services provided, treatment modification, monitoring and referral pathways. CONCLUSION: Developing and advocating national guidelines are intended not only to inform clinical decision making but to provide minimum standards of care in ototoxicity management and offer greater awareness and education to improve patients' quality of life.

Hearing and Balance Disorders in the State of Hawai'i: Demographics and Demand for Services.

Hearing and balance disorders affect people of all ages. Among children, hearing loss affects speech and language development, academic performance, and psychosocial development. Hearing loss in adults negatively impacts work productivity, cognitive function, and psychosocial status. Prevalence of hearing loss in children in Hawai'i is higher than the national average. Research indicates that hearing loss is a prevalent condition among veterans and advanced age adults. This is of particular concern in Hawai'i as the state is home to many military training facilities and has a large elderly population. In contrast to the higher than average prevalence of hearing loss in Hawai'i, there is a relatively small number of practicing audiologists in the state. Audiologists are independent doctoral level professionals responsible for the assessment and non-medical management of hearing impairment, vestibular disorders, auditory processing disorder, auditory neuropathy, tinnitus, and related disorders. Currently, there is no formal audiology training program in Hawai'i to meet the needs for current or future hearing health professionals. The Department of Communication Sciences and Disorders at the University of Hawai'i at Manoa is developing a proposal for a Doctor of Audiology (Au.D.) program to provide a comprehensive doctoral-level audiology curriculum and clinical training in order to graduate audiologists with knowledge and skills needed to serve people with hearing and balance disorders in Hawai'i. This review article describes the current status of hearing and balance disorders and services in Hawai'i and stresses the importance of early identification and intervention in remediating their effects in all ages, with a focus on the need for expanding hearing health services in Hawai'i.

Audiological management of adults with hearing impairment in Malaysia.

OBJECTIVE: This study explored the nature of audiological services for adults with hearing impairment in Malaysia, with an emphasis on whether current services address clients' overall functioning as described by the World Health Organisation's International Classification of Functioning, Disability, and Health (ICF) framework. DESIGN: An online survey exploring current practice, skills and confidence of audiologists, and the infrastructure and facilities available in their workplaces, was distributed to audiologists in Malaysia via professional associations and social media. STUDY SAMPLE: A total of 111 audiologists, 84.7% female and 15.3% male (range = 23-44 years), participated in the study. RESULTS: Although audiologists in Malaysia reported addressing all of the ICF domains, less than 26% of them assessed the patients' speech perception, carried out real-ear measurements, or used outcome measures routinely. The majority of the audiologists reported feeling confident in managing adult patients. However, 83% of the audiologists indicated they wanted to improve their skills related to management of adult patients, particularly in the areas of counselling and auditory training. CONCLUSIONS: Inadequate infrastructure, resources and facilities in the workplace may have contributed to the gaps in service provision and influenced the current practice of audiological management for adult patients in Malaysia.

[The current state and prospects of the development of cochlear implantation].

This paper reports the literature data summarizing the recent achievements in the field of rehabilitation of the patients suffering from deafness and serious impairment of hearing with the use of cochlear implantation. Much attention is given to the limitations of the modern strategies of signal processing and the prospects for the further development of scientific research in this area. Special emphasis is laid on recent progress in audiology including the binaural cochlear implant technology and the electroacoustic stimulation facilitating significant improvement in the outcomes of rehabilitation of the patients. Also, the prospects for the further developments in the field of construction of the new cochlear implantations systems, the novel algorithms for information processing, and the original therapeutic modalities designed to stimulated the growth of axonal processed of the spiral ganglion and their outgrowths into the electrode system.

Technology for hearing loss--as We Know it, and as We Dream it.

PURPOSE: Worldwide demand for accessible hearing health technology continues to increase while the numbers of hearing healthcare specialists are grossly inadequate to meet this demand. Proliferation of innovative technology and the advent of greater access to global connectivity are providing an opportunity to identify and harness new resources that may change current audiological service delivery methods to maximize access, efficiency and impact. METHODS: By searching through the most current literature and engaging in discussions with industry experts, it is possible to identify avenues that could increase services to those who have hearing loss with innovative healthcare technology. This article aims to review the current state as well as future trends of hearing health technology by addressing: Technology as We Know it; and Technology as We Dream it. RESULTS: Some of the newer technologies we have recently witnessed include: micro processors; personalized computing devices (e.g. smartphones); web-based applications; an expanding clinical repertoire with integrated test equipment; and globalization of telecommunications that opens the door to telehealth; and self-fitting of hearing aids. Yet, innovation continues scaffolding on recent successes with innovations for hearing healthcare expected to increase into the future. CONCLUSION: As technology and connectivity continue to evolve so should the practice of audiology adapt to the global needs by capitalizing on these advances to optimize service delivery access and sustainability. IMPLICATIONS FOR REHABILITATION: Capital investment in equipment will be dramatically reduced with smaller, lighter, less costly and more portable equipment. Individuals who live in remote regions with little or no hearing healthcare access can undergo valid assessments by a professional via telehealth. Web-based applications allow clinicians to expand their repertoire and reach of services.

Audiologists' knowledge of cochlear implants and their related referrals to the cochlear implant centre: Pilot study findings from UK.

OBJECTIVE: The guidelines for cochlear implantation are well defined and have changed over time with the improvement in technology. The ease with which audiologists can make a referral to a cochlear implant (CI) centre may affect the time it takes before a candidate can gain benefit from a CI. The current service evaluation explores audiologists' awareness of CIs, and whether this could influence referrals for cochlear implantation in the UK. METHOD: A 31-item questionnaire was developed by the authors, to be completed in about 10 minutes. It was designed to elicit information about the training, experience, and practice of audiologists. The questionnaire was designed based on National Institute for Health and Clinical Excellence guidelines and questions used in the previous studies reported in the literature. RESULTS: The majority of the respondents (97%) agreed that CIs can provide more than just environmental awareness. Almost half of the respondents were confident in determining whether a particular patient meets the guidelines of cochlear implantation in the UK, and in discussing CIs with patients and their families. Audiologists who responded felt that more and regular training in referral criteria, benefits, and outcomes would be beneficial. DISCUSSION: The results show a trend that clinical scientists (audiology)/audiologists support cochlear implantation, but due to a lack of training and familiarity, not all are confident in discussing CIs with patients and making an appropriate referral.