Hearing healthcare has always been multidisciplinary and collaborative in nature. The advent of over-the-counter (OTC) hearing aids has introduced a new partnership opportunity between audiologists and pharmacists. This...Hearing healthcare has always been multidisciplinary and collaborative in nature. The advent of over-the-counter (OTC) hearing aids has introduced a new partnership opportunity between audiologists and pharmacists. This article will apply public health aspects of hearing loss in adults to models of interprofessional partnership and healthcare through didactic case examples. Resources specific to building a professional community to support the needs of adults with hearing loss will be highlighted.
Over-the-counter (OTC) hearing aids are designed to be accessible as a self-guided experience, not requiring professional support. However, some individuals may pursue OTC hearing aids and also desire (limited) professio...Over-the-counter (OTC) hearing aids are designed to be accessible as a self-guided experience, not requiring professional support. However, some individuals may pursue OTC hearing aids and also desire (limited) professional support. The purpose of this article was to explore the potential role of audiologists in patients' self-guided journeys with OTC hearing aids by examining four related questions. (1) Why might audiologists want to know about OTCs? (2) What types of patient support for OTC hearing aids might be beneficial for patients? (3) What additional knowledge and skills, outside of those already obtained for current prescription service delivery models, are necessary or useful? (4) What is the evidence base around service delivery as it extends to OTC hearing aids? Several potential professional support approaches are considered. While speculative due to the constraints of the limited current evidence base, potentially important factors, including the impact on patient outcomes and cost-effectiveness, were included when possible. The introduction of OTC hearing aids has changed the hearing aid marketplace; however, the demand for both OTC and prescription hearing aids is only increasing. With these changes, interested audiologists have new and unique opportunities to support more patients by participating in the OTC hearing aid marketplace through the acquisition of new OTC-specific knowledge and through partnerships with other professionals and OTC providers.
Over-the-counter (OTC) hearing aids became available for purchase online, in retail stores, and in pharmacies in October 2022. As trusted sources of healthcare information, audiologists and pharmacists are likely among t...Over-the-counter (OTC) hearing aids became available for purchase online, in retail stores, and in pharmacies in October 2022. As trusted sources of healthcare information, audiologists and pharmacists are likely among the first to field questions about these devices. Therefore, it is essential for them to understand their proper use, identify reliable devices, and know when to refer patients for further evaluation. Understanding the regulatory criteria for OTC hearing aids is especially important. These devices must meet specific conditions for sale, which ensure their safety and effectiveness for the public. Familiarity with these regulations will ensure that audiologists and pharmacists can help patients choose devices that meet established standards, avoiding misrepresented products. Given the visibility and accessibility of OTC hearing aids in pharmacies, pharmacists can offer initial guidance, answer questions, and help patients navigate the available options on their shelves. Audiologists, experts in hearing health, can assess a patient's hearing needs and determine whether an OTC hearing aid is a suitable option, guiding the patient's device selection. This article will summarize a presentation given to audiologists and pharmacists by Julie Cohen, AuD, PhD, an audiologist and scientific reviewer at the Food and Drug Administration (FDA), on the FDA's OTC Hearing Aid Regulations. Audience questions were answered by Dr. Cohen and by FDA lead scientific reviewer, Lindsay Devries, AuD, PhD.
Over-the-counter (OTC) hearing aids have the potential to greatly improve access to hearing health care in the United States. Though intended for self-care, health professionals should be at the forefront of determining...Over-the-counter (OTC) hearing aids have the potential to greatly improve access to hearing health care in the United States. Though intended for self-care, health professionals should be at the forefront of determining service delivery models that will optimize the impact of OTC hearing aids. Collaborations between audiologists and pharmacists could be particularly successful due to pharmacists' high accessibility and audiologists' expertise in hearing health care. The two professions should continue to work together to help achieve optimum outcomes to best serve the public and their health. This will require education of both professions. Pharmacists now have continuing education opportunities to learn about OTC hearing aids.
In recent years, pharmacies have entered the over-the-counter (OTC) hearing aid market, providing an accessible alternative for individuals with hearing loss. This shift is driven by several key factors, including the li...In recent years, pharmacies have entered the over-the-counter (OTC) hearing aid market, providing an accessible alternative for individuals with hearing loss. This shift is driven by several key factors, including the limited availability of audiologists in many areas, particularly in rural or underserved regions. High-cost hearing aids can be a significant barrier for lower-income households. With the rising demand for affordable hearing solutions, pharmacies have emerged as a viable option for offering these devices, often at a fraction of the cost of traditional audiology services. By expanding access to hearing aids, pharmacies aim to address both the scarcity of specialized care and the financial constraints faced by many patients, making hearing health more attainable for a broader population. This article highlights how rural and elderly populations are often underserved in healthcare, with an emphasis on specialty services like audiology. It will demonstrate how a pharmacy recognized a disparity in the market and took action toward providing expanded patient care, unique to the usual pharmacy services we all know.
Tinnitus onset is associated with numerous auditory and psychological correlates in the general population, and are compounded in musicians. With the assistance of patient quotes and a case study, this article explores t...Tinnitus onset is associated with numerous auditory and psychological correlates in the general population, and are compounded in musicians. With the assistance of patient quotes and a case study, this article explores the vocational, emotional, and practical factors which should be considered by clinicians who work with this population. To better serve music-exposed individuals, especially music industry professionals, telehealth has proven to be a viable and advantageous care delivery method due in part to decreased barriers to access.
Tinnitus is distressing and affects the quality of life for many patients. Yet, responses to tinnitus vary. To meet the individual needs of our patients, we developed a service delivery model that served several purposes...Tinnitus is distressing and affects the quality of life for many patients. Yet, responses to tinnitus vary. To meet the individual needs of our patients, we developed a service delivery model that served several purposes: (1) to provide a time- and cost-effective program utilizing a care path, group delivery model, and the use of an interprofessional team approach; and (2) to offer quality, best-practice care to meet the needs of those individuals distressed by tinnitus. This article describes the Cleveland Clinic Tinnitus Management Clinic utilized, for more than 20 years, to provide care to patients with tinnitus.
Tinnitus is the perception of sound without the presence of an external stimulus. The mechanisms associated with tinnitus are not entirely known, making diagnosis and treatment challenging. Although tinnitus mechanisms a...Tinnitus is the perception of sound without the presence of an external stimulus. The mechanisms associated with tinnitus are not entirely known, making diagnosis and treatment challenging. Although tinnitus mechanisms are not entirely known, there is evidence supporting an association between tinnitus with cochlear damage, reduced inhibition, and atypical cortical function. These mechanisms have been studied in animal models and people with tinnitus using a variety of different approaches. One approach that is a possible indicator of tinnitus in humans is sensory or auditory gating, which is a measure of inhibition. The goals of this article are to (1) review the mechanistic evidence associating tinnitus with cochlear damage and reduced inhibition, (2) discuss evidence of inhibitory impairments in people with tinnitus represented by auditory gating, and (3) address potential future directions to improve our ability to evaluate auditory gating mechanisms in people with tinnitus.
This article is the first in a two-part series intended to provide guidance related to the essential components of establishing a tinnitus care pathway in your clinic. Please see Part 2: Implementation for Additional Det...This article is the first in a two-part series intended to provide guidance related to the essential components of establishing a tinnitus care pathway in your clinic. Please see Part 2: Implementation for Additional Details Related to Implementation of the Suggested Protocols.
There is strong evidence that attention plays an important role in tinnitus perception, but less is known about its role in treating tinnitus. This review scoped the literature for evidence of the role attention plays in...There is strong evidence that attention plays an important role in tinnitus perception, but less is known about its role in treating tinnitus. This review scoped the literature for evidence of the role attention plays in tinnitus therapy and catalogued the methods employed, clinical outcomes, and the degree to which interventions for tinnitus were supported. The research question was "what role does attention play in the management or treatment of tinnitus." To identify relevant studies, database searches of Scopus (keywords) PsychArticle (title and abstract), CINAHL complete (title and abstract), and PubMed (title and abstract) were performed in March/April 2024 using the following search terms: [tinnitus] and [attention] and [treatment] or [therapy] or [management]. After the removal of duplicates, 494 articles were identified. After exclusions, and additions from references, 38 articles were included in the review. Treatments were classified into five types: electrical/magnetic stimulation, psychological, sound therapy, music therapy, and perceptual training. Sound therapy and perceptual training were identified as having the most evidence for their benefit via an attention mechanism. A model of sound and perceptual training in alleviating tinnitus through an attention pathway is presented.
This article is the second in a two-part series intended to provide guidance related to the essential components of establishing a comprehensive tinnitus care pathway in your clinic. Please see "Part 1: Essential Compone...This article is the second in a two-part series intended to provide guidance related to the essential components of establishing a comprehensive tinnitus care pathway in your clinic. Please see "Part 1: Essential Components" for relevant background information detailing why each of the components described in this article were included.
The weight of evidence supports hearing aids playing an important role in tinnitus management. Less information is available about the role of auditory rehabilitation (AR) in the hearing aid therapy process. The research...The weight of evidence supports hearing aids playing an important role in tinnitus management. Less information is available about the role of auditory rehabilitation (AR) in the hearing aid therapy process. The research question was "what role has amplification and AR played in the management of tinnitus." To identify relevant studies, database searches of Scopus (keywords), Embase (keywords), and PubMed (title and abstract) were carried out in April/May 2024 using the following search terms [tinnitus] and [amplification] or [hearing aids]. Articles were excluded if not written in English or unavailable in full text. Reviews and protocols were excluded. Once duplicates were removed, 495 articles were screened with 58 articles being included in the review. After cataloguing, articles were divided into those that described use of AR in their methods and those that did not. AR was subcategorized into four categories and described as (1) instruction, (2) counseling, (3) sensory management, (4) perceptual training. Articles published in the last 12 years support the use of hearing aids. The use of AR in addition to amplification was common but its content, application, and contribution to outcomes were ambiguous. Augmentation of amplification benefits for tinnitus through AR presents an opportunity for future research. In future research, each AR component needs to be described in greater detail and the relative merits of different types of AR and their role in personalized therapy needs to be ascertained.
Clinical services for tinnitus have expanded greatly since the "masking" method was introduced by Jack Vernon in the 1970s. According to PubMed, the number of peer-reviewed publications has increased dramatically since t...Clinical services for tinnitus have expanded greatly since the "masking" method was introduced by Jack Vernon in the 1970s. According to PubMed, the number of peer-reviewed publications has increased dramatically since that time (seven with "tinnitus" in the title in 1975; 477 in 2023). With so much research and overall interest, it might be expected that tinnitus services have improved accordingly. In reality, there are many variations of treatment, but no one method has been shown to be more effective than any other. This diversity of methods is evident when researching "tinnitus" on the internet and considering the many different ways clinicians offer tinnitus services. Some offer an evidence-based method but may not have the competency to ensure fidelity. Further is the proliferation of commercial methods that can cost thousands of dollars. In this article, I propose a framework for providing tinnitus clinical services called Tinnitus Stepped-Care. This framework does not promote specific procedures for tinnitus assessment and treatment, but rather suggests guiding principles that are essential in each of six progressive steps of tinnitus clinical care. It is further proposed to test the stepped-care model in the (currently under development) Tinnitus Learning Health Network (TLHN). The TLHN would consist of a network of clinicians, patients, and researchers from around the world who collaborate in establishing "best tinnitus practices." Collaboration would involve using and sharing data for the ongoing monitoring of a large, diverse, well-described patient population, and using quality improvement science to test and monitor outcomes over time, to determine the most effective treatments for different subgroups of tinnitus patients.
Tinnitus exerts negative influences upon the quality of life for more than 50 million people in the United States. Through its mission and resources, the American Tinnitus Association (ATA) offers support and hope for th...Tinnitus exerts negative influences upon the quality of life for more than 50 million people in the United States. Through its mission and resources, the American Tinnitus Association (ATA) offers support and hope for these many individuals who are burdened by this condition. ATA provides patients a range of clinical referral services and informational resources and also funds researchers and clinical scientists whose work supports tinnitus management strategies and potential curative approaches. ATA also provides hearing healthcare practitioners support services that foster a sense of community among providers, intended to enhance accessibility and improve outcomes for patients from all parts of the country.
Probe microphone measurements are an essential step in an individualized hearing aid fitting. These measurements allow audiologists to account for the individual's hearing and ear canal acoustics when programming hearing...Probe microphone measurements are an essential step in an individualized hearing aid fitting. These measurements allow audiologists to account for the individual's hearing and ear canal acoustics when programming hearing aids. An evidence-based hearing aid fitting includes matching the measured output of the hearing aids to targets for each input level and frequency. This allows the audiologist to confidently counsel the patient that the acoustic fitting is accurate, and the next step is for the individual to use the amplification during all waking hours to adapt to the newly amplified sounds. This also avoids mistakes such as overamplification or insufficient gain, which can endanger the patient and/or lead to a compromised fitting.
The test box can be used for fitting hearing aids (verifying audibility for the individual), for setting and fine-tuning specific signal processing (e.g., directional microphones, noise reduction, frequency lowering, tel...The test box can be used for fitting hearing aids (verifying audibility for the individual), for setting and fine-tuning specific signal processing (e.g., directional microphones, noise reduction, frequency lowering, telecoil responses), and for setting the response for specific accessories (e.g., remote microphones). If you have selected these features for your patient, it is important to make sure they are working properly and turned on. In addition, these tests can help you address specific patient complaints. Let us start by using the test box to pre-set a hearing aid and then we will move on to speech tests of signal processing and features.
The real-ear probe microphone system provides a powerful tool to individual hearing aid fittings accounting for your patient's hearing and ear canal characteristics. The primary treatment for hearing loss is audibility,...The real-ear probe microphone system provides a powerful tool to individual hearing aid fittings accounting for your patient's hearing and ear canal characteristics. The primary treatment for hearing loss is audibility, returning an audible signal across frequencies and input levels given the constraints of the hearing loss. This chapter will provide detailed information on the measures needed to individualize the hearing aid fitting and will present various clinical scenarios that will allow you to work with this information and see how you apply this knowledge clinically. You will explore the verification of signal processing and features that allow you to support your patients.