International survey of audiologists during the COVID-19 pandemic: use of and attitudes to telehealth.

OBJECTIVE: To determine the attitudes of audiologists towards telehealth and use of telehealth for the delivery of ear and hearing services pre-, during- and post- the COVID-19 pandemic, and to identify the perceived effects of telehealth on services and barriers to telehealth. DESIGN: An online survey distributed through the International Society of Audiology and member societies. STUDY SAMPLE: A total of 337 audiologists completing the survey between 23 June and 13 August 2020. RESULTS: There was a significant increase in the perceived importance of telehealth from before (44.3%) to during COVID-19 (87.1%), and the use of telehealth previous (41.3%), current (61.9%) and expected use of telehealth (80.4%). Telehealth was considered adequate for many audiology services, although hearing assessment and device fitting by telehealth received least support. Matters related to timeliness of services and reduction of travel were reported as the main advantages, but relationships between practitioners and clients may suffer with telehealth. Important barriers were technologies related to the client or remote site; clinic-related items were moderate barriers, although more clinician training was a common theme provided through open-ended responses. CONCLUSION: The COVID-19 pandemic has resulted in audiologists having a more positive attitude towards and greater use of telehealth, but with some reservations.

The dynamics of auditory stream segregation: Effects of sudden changes in frequency, level, or modulation.

Three experiments explored the effects of abrupt changes in stimulus properties on streaming dynamics. Listeners monitored 20-s-long low- and high-frequency (LHL-) tone sequences and reported the number of streams heard throughout. Experiments 1 and 2 used pure tones and examined the effects of changing triplet base frequency and level, respectively. Abrupt changes in base frequency (±3-12 semitones) caused significant magnitude-related falls in segregation (resetting), regardless of transition direction, but an asymmetry occurred for changes in level (±12 dB). Rising-level transitions usually decreased segregation significantly, whereas falling-level transitions had little or no effect. Experiment 3 used pure tones (unmodulated) and narrowly spaced (±25 Hz) tone pairs (dyads); the two evoke similar excitation patterns, but dyads are strongly modulated with a distinctive timbre. Dyad-only sequences induced a strongly segregated percept, limiting scope for further build-up. Alternation between groups of pure tones and dyads produced large, asymmetric changes in streaming. Dyad-to-pure transitions caused substantial resetting, but pure-to-dyad transitions sometimes elicited even greater segregation than for the corresponding interval in dyad-only sequences (overshoot). The results indicate that abrupt changes in timbre can strongly affect the likelihood of stream segregation without introducing significant peripheral-channeling cues. These asymmetric effects of transition direction are reminiscent of subtractive adaptation in vision.

Stream biasing by different induction sequences: Evaluating stream capture as an account of the segregation-promoting effects of constant-frequency inducers.

Stream segregation for a test sequence comprising high-frequency (H) and low-frequency (L) pure tones, presented in a galloping rhythm, is much greater when preceded by a constant-frequency induction sequence matching one subset than by an inducer configured like the test sequence; this difference persists for several seconds. It has been proposed that constant-frequency inducers promote stream segregation by capturing the matching subset of test-sequence tones into an on-going, pre-established stream. This explanation was evaluated using 2-s induction sequences followed by longer test sequences (12-20 s). Listeners reported the number of streams heard throughout the test sequence. Experiment 1 used LHL- sequences and one or other subset of inducer tones was attenuated (0-24 dB in 6-dB steps, and ∞). Greater attenuation usually caused a progressive increase in segregation, towards that following the constant-frequency inducer. Experiment 2 used HLH- sequences and the L inducer tones were raised or lowered in frequency relative to their test-sequence counterparts (ΔfI = 0, 0.5, 1.0, or 1.5 × ΔfT ). Either change greatly increased segregation. These results are concordant with the notion of attention switching to new sounds but contradict the stream-capture hypothesis, unless a "proto-object" corresponding to the continuing subset is assumed to form during the induction sequence.

Factors Affecting the Use of Speech Testing in Adult Audiology.

OBJECTIVE: The aim of this study was to evaluate hearing health care professionals' (HHPs) speech testing practices in routine adult audiology services and better understand the facilitators and barriers to speech testing provision. DESIGN: A cross-sectional questionnaire study was conducted. STUDY SAMPLE: A sample (N = 306) of HHPs from the public (64%) and private (36%) sectors in the United Kingdom completed the survey. RESULTS: In the United Kingdom, speech testing practice varied significantly between health sectors. Speech testing was carried out during the audiology assessment by 73.4% of private sector HHPs and 20.4% of those from the public sector. During the hearing aid intervention stage, speech testing was carried out by 56.5% and 26.5% of HHPs from the private and public sectors, respectively. Recognized benefits of speech testing included (a) providing patients with relatable assessment information, (b) guiding hearing aid fitting, and (c) supporting a diagnostic test battery. A lack of clinical time was a key barrier to uptake. CONCLUSIONS: Use of speech testing varies in adult audiology. Results from this study found that the percentage of U.K. HHPs making use of speech tests was low compared to that of other countries. HHPs recognized different benefits of speech testing in audiology practice, but the barriers limiting uptake were often driven by factors derived from decision makers rather than clinical rationale. Privately funded HHPs used speech tests more frequently than those working in the public sector where time and resources are under greater pressure and governed by guidance that does not include a recommendation for speech testing. Therefore, the inclusion of speech testing in national clinical guidelines could increase the consistency of use and facilitate the comparison of practice trends across centers. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20044457.