Social-emotional well-being and adult hearing loss: clinical recommendations.

Aim: Best-practice in audiological rehabilitation takes a holistic client- and family-centred approach and considers hearing care in the context of personal well-being. Hearing loss not only impairs the ability to hear, but can also compromise the ability to communicate, thus negatively impacting both social and emotional well-being. Hearing care professionals play a key role in fostering their client's well-being. This paper aims to provide evidence-based recommendations to ensure inclusion of social-emotional well-being in audiologic rehabilitation clinical practice.Methods: A review of current research and expert opinion.Results: This guide proposes a 5-step plan which includes: identifying the client's social-emotional well-being; including family members in audiological rehabilitation; incorporating social-emotional needs and goals in an individualized management plan; relating identified hearing needs and goals to rehabilitation recommendations; and using counselling skills and techniques to explore and monitor social-emotional well-being. Each component of the 5-step plan is discussed and clinical considerations are presented.Conclusion: These comprehensive recommendations provide guidance to hearing care professionals looking to ensure clients' social-emotional well-being are considered throughout the rehabilitation journey.

Audiological approaches to address the psychosocial needs of adults with hearing loss: perceived benefit and likelihood of use.

OBJECTIVE: To explore the perceived benefit and likely implementation of approaches used by audiologists to address their adult clients' psychosocial needs related to hearing loss. DESIGN: Adults with hearing loss and audiologists completed separate, but related, surveys to rate their perceived benefit and also their likely use of 66 clinical approaches (divided over seven themes) that aim to address psychosocial needs related to hearing loss. STUDY SAMPLE: A sample of 52 Australian adults with hearing loss, and an international sample of 19 audiologists. RESULTS: Overall, participants rated all of the approaches highly on both benefit and likelihood of use; the highest ranked theme was Providing Emotional Support. Cohort comparisons showed that audiologists ranked the approaches significantly higher than did adults with hearing loss. Overall, participants ranked the themes higher on benefit than on the likelihood to use scales. CONCLUSIONS: Adults with hearing loss and audiologists recognise the importance of approaches that address the psychosocial impacts of hearing loss in audiological rehabilitation. However, both groups placed slightly greater value on the internal-based approaches (the clients own emotional response, empowerment, and responsibility), and slightly less emphasis on the external-based approaches (being supported by communication partners, support groups or other health professionals).

Identifying the approaches used by audiologists to address the psychosocial needs of their adult clients.

OBJECTIVE: To identify the approaches taken by audiologists to address their adult clients' psychosocial needs related to hearing loss. DESIGN: A participatory mixed methods design. Participants generated statements describing the ways in which the psychosocial needs of their adult clients with hearing loss are addressed, and then grouped the statements into themes. Data were obtained using face-to-face and online structured questions. Concept mapping techniques were used to identify key concepts and to map each of the concepts relative to each other. STUDY SAMPLE: An international sample of 65 audiologists. RESULTS: Ninety-three statements were generated and grouped into seven conceptual clusters: Client Empowerment; Use of Strategies and Training to Personalise the Rehabilitation Program; Facilitating Peer and Other Professional Support; Providing Emotional Support; Improving Social Engagement with Technology; Including Communication Partners; and Promoting Client Responsibility. CONCLUSIONS: Audiologists employ a wide range of approaches in their attempt to address the psychosocial needs associated with hearing loss experienced by their adult clients. The approaches described were mostly informal and provided in a non-standardised way. The majority of approaches described were not evidence-based, despite the availability of several options that are evidence-based, thus highlighting the implementation gap between research and clinical practice.

Establishing an Office-Based Framework for Resuming Otolaryngology Care in Academic Practice During the COVID-19 Pandemic.

OBJECTIVE: The COVID-19 health crisis abruptly disrupted the practice of otolaryngology. This article aims to define the changes needed to operate an academic otolaryngology practice safely and efficiently from within the epicenter of the pandemic. We define the areas of normal patient workflow that have been affected by COVID-19, and we offer mitigation strategies with attention paid to the specific needs of subspecialties. DATA SOURCES: The article includes data specific to the office practice metrics of the Weill Cornell Medicine Department of Otolaryngology-Head and Neck Surgery, as well as publically available data from New York Presbyterian Hospital system and the New York Times. REVIEW METHODS: Expert opinion. CONCLUSIONS: Through careful planning and execution, it is possible to reestablish safe otolaryngologic patient care during the COVID-19 pandemic. It will require a significant change from prior practice models for successful implementation. Additionally, telemedicine can be positively integrated into the treatment of otolaryngology diseases for new and established patients. IMPLICATIONS FOR PRACTICE: The information conveyed in this review can be used as a guide by large and small otolaryngology groups to identify aspects of the patient visit that are "at risk" due to COVID-19, and it suggests sensible responses that can be made without a significant disruption to normal practice. The methods used to identify vulnerabilities with the patient visit process can be applied to future unforeseen crises, such as a resurgence of COVID-19 or a novel pandemic.

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.

Adult Children's Perspectives on Their Role in Their Parent's Hearing Healthcare Processes.

BACKGROUND: Communication partners play an important role in the hearing healthcare (HHC) process of the person with hearing impairment (HI). However, present research focuses mainly on the role of the spouse; the role of the adult child is often overlooked or understated. PURPOSE: The aim of the study was to describe the role of the adult child in the HHC process of a parent with HI. RESEARCH DESIGN: Using a qualitative study design, participants described their role in their parents' HHC process and the impact of a parent's HI on their relationship and communication in individual semi-structured interviews. STUDY SAMPLE: Twelve adult children of ten parents with HI participated; two sets of siblings were included to gain different perspectives on the HHC process within the same family. DATA COLLECTION AND ANALYSIS: Thematic analysis, a qualitative method to explore participant's perceptions and viewpoints, was used as the method of analysis. RESULTS: The superordinate theme discussed most frequently by participants, communication management, was bolstered by three ideas or pillars: facilitating HHC, communication strategies, and encouraging hearing aid use. Adult children saw themselves as advocates or supporters of their parent's HHC by taking an ongoing and active role in promoting successful communication rather than a role in directing their parent's HHC actions. Within each pillar of communication management, participants' perceptions and actions were modulated by the varying levels of effort and a desire to ask questions to better understand how to help their parent, which in turn influenced their awareness of the HI and HHC options, often resulting in the adult child putting forth new effort. CONCLUSIONS: Whereas the patient journey is often presented to the patient as a linear process, the adult children instead viewed the process of communication management as an ongoing and continuous cycle. The audiologist should be encouraged to involve adult children in the HHC process, as adult children play an important role in everyday communication management.

Adult-children's perspectives on a parent's hearing impairment and its impact on their relationship and communication.

OBJECTIVE: The aim of the study was to describe third-party disability experienced by adult-children as a result of hearing impairment (HI) in a parent. DESIGN: Using semi-structured interviews, participants were asked to describe the impact of a parent's HI on their relationship and communication. Interpretative phenomenological analysis, a qualitative method to explore participant's perceptions and viewpoints, was used as the method of analysis. STUDY SAMPLE: Twelve participants between the ages of 22 and 58 who each had a parent with confirmed HI who owned hearing aids. RESULTS: Within the contextual factors of family relationships, communication situations, and the parent's personality, adult-children considered their coping strategies and feelings that arose as a result of the HI. Coping strategies included putting forth effort in communication, yelling as an ineffective communication strategy, and providing support to the parent with HI. The described feelings included frustration, uncertainty, and loss surrounding their communication and relationship with their parent with HI. These feelings arose as a result of implementing coping strategies, plus these feelings drove the employment of coping strategies. CONCLUSIONS: Adult-children of parents with HI experience third-party disability, however, the participation restrictions and activity limitations experienced by children appear less than experienced by spouses.

A new web-based tool for group audiologic rehabilitation.

PURPOSE: The Group Rehabilitation Online Utility Pack (GROUP) was developed to encourage hearing health care professionals to offer group audiologic rehabilitation (GAR) as an integral part of adult hearing rehabilitation and to provide these professionals with the necessary tools to develop and offer GAR in their clinical practice. METHOD: The GROUP is a dynamic interactive web-based program that allows visitors to craft and create GAR for their professional use. The tool includes the evidence for implementing GAR, content for preparation and planning, instruction for facilitating groups, and actual GAR activities. Each section includes ethnographic videos, allowing professionals to observe GAR in action. CONCLUSION: The GROUP program available on the Ida Institute website was developed with the intent to provide clinicians, academicians, researchers, and students a resource to facilitate the development and implementation of GAR programs throughout the world.

Clinical practice guideline: sudden hearing loss.

OBJECTIVE: Sudden hearing loss (SHL) is a frightening symptom that often prompts an urgent or emergent visit to a physician. This guideline provides evidence-based recommendations for the diagnosis, management, and follow-up of patients who present with SHL. The guideline primarily focuses on sudden sensorineural hearing loss (SSNHL) in adult patients (aged 18 and older). Prompt recognition and management of SSNHL may improve hearing recovery and patient quality of life (QOL). Sudden sensorineural hearing loss affects 5 to 20 per 100,000 population, with about 4000 new cases per year in the United States. This guideline is intended for all clinicians who diagnose or manage adult patients who present with SHL. PURPOSE: The purpose of this guideline is to provide clinicians with evidence-based recommendations in evaluating patients with SHL, with particular emphasis on managing SSNHL. The panel recognized that patients enter the health care system with SHL as a nonspecific, primary complaint. Therefore, the initial recommendations of the guideline deal with efficiently distinguishing SSNHL from other causes of SHL at the time of presentation. By focusing on opportunities for quality improvement, the guideline should improve diagnostic accuracy, facilitate prompt intervention, decrease variations in management, reduce unnecessary tests and imaging procedures, and improve hearing and rehabilitative outcomes for affected patients. RESULTS: The panel made strong recommendations that clinicians should (1) distinguish sensorineural hearing loss from conductive hearing loss in a patient presenting with SHL; (2) educate patients with idiopathic sudden sensorineural hearing loss (ISSNHL) about the natural history of the condition, the benefits and risks of medical interventions, and the limitations of existing evidence regarding efficacy; and (3) counsel patients with incomplete recovery of hearing about the possible benefits of amplification and hearing-assistive technology and other supportive measures. The panel made recommendations that clinicians should (1) assess patients with presumptive SSNHL for bilateral SHL, recurrent episodes of SHL, or focal neurologic findings; (2) diagnose presumptive ISSNHL if audiometry confirms a 30-dB hearing loss at 3 consecutive frequencies and an underlying condition cannot be identified by history and physical examination; (3) evaluate patients with ISSNHL for retrocochlear pathology by obtaining magnetic resonance imaging, auditory brainstem response, or audiometric follow-up; (4) offer intratympanic steroid perfusion when patients have incomplete recovery from ISSNHL after failure of initial management; and (5) obtain follow-up audiometric evaluation within 6 months of diagnosis for patients with ISSNHL. The panel offered as options that clinicians may offer (1) corticosteroids as initial therapy to patients with ISSNHL and (2) hyperbaric oxygen therapy within 3 months of diagnosis of ISSNHL. The panel made a recommendation against clinicians routinely prescribing antivirals, thrombolytics, vasodilators, vasoactive substances, or antioxidants to patients with ISSNHL. The panel made strong recommendations against clinicians (1) ordering computerized tomography of the head/brain in the initial evaluation of a patient with presumptive SSNHL and (2) obtaining routine laboratory tests in patients with ISSNHL.