Telehealth appointments have grown in popularity due to the COVID-19 global pandemic. Three cases presented in this article show several different perspectives where telehealth was utilized. For the first patient, appoin...Telehealth appointments have grown in popularity due to the COVID-19 global pandemic. Three cases presented in this article show several different perspectives where telehealth was utilized. For the first patient, appointments were successfully completed via telehealth; however, the patient's family opted to continue with an unsecure internet connection at a local laundromat. For the second patient, a stable internet connection could not be obtained in his home, thus making telehealth appointments unavailable. The caregiver of this patient ended up driving to the clinic to have adjustments made in person. For the third patient, telehealth appointments were unavailable due to unstable internet connections as well as difficulty setting up video interpreting services. These cases highlight the idea that telehealth can be incredibly beneficial, when used correctly. For some, the option to attend appointments virtually gives them access to specialists that otherwise may not be available. For other patients, aspects such as access to smart devices and steady internet access must be considered to ensure a successful connection. The hope is that this article sheds light on some of the potential setbacks that can come from the use of telehealth appointments in a practice and provides discussion regarding for whom telehealth may be appropriate, even in pediatric patients. After reading this article, readers should be able to discuss ways in which there could be solutions for these barriers that may prevent some patients from utilizing these types of virtual appointments.
Clinic closures across the United States in response to the coronavirus disease 2019 (COVID-19) pandemic meant that many audiology services were reduced to phone calls, video visits, and modified services (e.g., curbside...Clinic closures across the United States in response to the coronavirus disease 2019 (COVID-19) pandemic meant that many audiology services were reduced to phone calls, video visits, and modified services (e.g., curbside, mail-ins, drop offs). Audiologists and other providers needed a way to manage hearing- and ear-related complaints via telehealth. A simple pure tone air conduction threshold test performed at home was used to determine which patients needed to come into the clinic for an in-person appointment. This case will review a 56-year-old male who was being treated for an idiopathic sudden sensorineural hearing loss prior to clinic closure. He had on file a comprehensive audiogram at first onset of symptoms and was treated with oral steroids. Virtual hearing testing was then utilized for a variety of other patients from teenagers to adults to triage hearing- and ear-related complaints while clinics were closed for in-person visits.
Telehealth as a means to deliver health care services has been used by physicians for many years, but the use of telehealth in audiology, specifically in pediatrics, has been minimal. Barriers such as licensure, reimburs...Telehealth as a means to deliver health care services has been used by physicians for many years, but the use of telehealth in audiology, specifically in pediatrics, has been minimal. Barriers such as licensure, reimbursement, technology, and equipment have been cited as reasons for audiologists not participating in telehealth. However, the COVID-19 pandemic created the need for telehealth services to be widely used to safely increase access to healthcare, and emergent orders helped reduce previous barriers so that audiologists could participate in telehealth service delivery. This article details three cases where audiologists delivered telehealth services to children. These case studies demonstrate portions of the Division of Audiology Telehealth Program of the Cincinnati Children's Hospital Medical Center and how they increased access to hearing healthcare in response to the COVID-19 pandemic.
Decreased sound tolerance (DST) is a negative reaction to environmental sounds and is estimated to affect 3.5% of the population. This case report presents the evaluation and management of an adult female with severe, lo...Decreased sound tolerance (DST) is a negative reaction to environmental sounds and is estimated to affect 3.5% of the population. This case report presents the evaluation and management of an adult female with severe, longstanding misophonia. Her evaluation included comprehensive audiometric testing (including uncomfortable loudness levels) and a detailed assessment of the impact of DST on her life. She enrolled in tinnitus retraining therapy and began receiving treatment aiming to facilitate habituation of bothersome environmental sounds. This case was complicated by the advent of the coronavirus disease 2019 (COVID-19) pandemic and a telemedicine hybrid approach was employed to increase access to audiologic care. Using this structure, some appointments occurred in person in the clinic and others occurred via a telemedicine video visit format. Telemedicine video visits facilitated in-depth discussions, afforded the opportunity to answer questions, and provided the option of cloud-based remote programming of on-ear devices. Future care will continue to employ a hybrid approach.
Telehealth, or the delivery of healthcare services from a distance, has historically been used to provide care to underserved populations and to those unable to visit a healthcare center. During the ongoing global COVID-...Telehealth, or the delivery of healthcare services from a distance, has historically been used to provide care to underserved populations and to those unable to visit a healthcare center. During the ongoing global COVID-19 pandemic, some providers of tinnitus healthcare services incorporated telehealth into their clinical protocols to allow for continued care for their patients while adhering to social distancing guidelines and safety measures. Bothersome tinnitus can negatively impact one's quality of life. Telehealth has been instrumental in treating this debilitating problem in a time when in-person care has not been easily available. The case of a patient with tinnitus is examined to demonstrate the use of a hybrid delivery model utilizing telehealth and in-person interactions to assess and manage her bothersome tinnitus. In-person services were used for audiological assessments and fitting of treatment devices, while telehealth was utilized for counseling, education, and remote programming of her treatment devices. This combined approach, which has allowed the patient to continue receiving care safely during the pandemic, can be continued for future care. Telehealth offers several advantages to patients and providers alike. While the COVID-19 pandemic will hopefully come to an end, telehealth services for tinnitus management may be here to stay.
This case study examines the methods used to troubleshoot a cochlear implant processor via video visit with a nonagenarian (90+ years old) with a bimodal cochlear implant system. This article will discuss the evaluation...This case study examines the methods used to troubleshoot a cochlear implant processor via video visit with a nonagenarian (90+ years old) with a bimodal cochlear implant system. This article will discuss the evaluation and management as well as which specific issues could be addressed virtually and how they were resolved. Examples will be provided about how to virtually connect with the patient and how to best facilitate communication during a video visit. Additionally, this article will examine the captioning apps and other hearing assistive technology available for smartphones that can provide further assistance during a cell phone call along with their benefits and limitations.
Difficulty hearing in the presence of background noise is a common complaint heard by audiologists. This can be accompanied by additional difficulty in classrooms and other difficult listening situations. This was recent...Difficulty hearing in the presence of background noise is a common complaint heard by audiologists. This can be accompanied by additional difficulty in classrooms and other difficult listening situations. This was recently exacerbated by the coronavirus disease 2019 (COVID-19) shutdowns and the accompanying mask usage and virtual meetings. This article describes one such patient seen during the recent shutdown. This patient reported difficulty hearing during her college coursework for her music performance major. She was an established otology patient with an extensive middle ear history including multiple surgeries. During the shutdown, she virtually consulted with the auditory processing disorders clinic at the recommendation of her otologist to discuss her college-related difficulty and pursue educational accommodations. Challenges and solutions for seeing this patient and other, similar patients virtually are discussed as well as a review of how this patient proceeded and how the knowledge gained from this patient could apply to others with similar concerns.
Providing same-day hearing aid fitting appointments to patients being seen in an audiology clinic for an audiometric evaluation may help decrease clinic wait times and reduce the need for future in-person appointments. P...Providing same-day hearing aid fitting appointments to patients being seen in an audiology clinic for an audiometric evaluation may help decrease clinic wait times and reduce the need for future in-person appointments. Prior to 2020, the Veterans Administration (VA) Healthcare System did not allow hearing aid manufacturers to provide functional demonstration (demo) hearing aids to VA audiology clinics. Due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID-19) pandemic, this rule was changed to minimize the number of required in-person VA audiology appointments. The audiology clinic at the Pittsburgh VA Healthcare System developed a hearing aid fitting protocol using demo hearing aids to provide same-day hearing aid fitting appointments. This case study pertains to a female Veteran who presented to the clinic with complaints of decreased hearing and bothersome tinnitus. The patient completed a comprehensive audiometric evaluation, auditory processing disorder screening, hearing aid evaluation, and hearing aid fitting in the clinic. All follow-up appointments were scheduled to be completed via telehealth. The initial findings in this case study indicate that same-day hearing aid fittings can be successful for some patients. Future telehealth follow-up appointments will determine this patient's level of success using hearing aid-related outcome measures.
The use of various forms of tele-audiology exploded during the pandemic. This brief article provides tips and considerations for providing tele-audiology as we move beyond the pandemic. Importantly, audiologists need to...The use of various forms of tele-audiology exploded during the pandemic. This brief article provides tips and considerations for providing tele-audiology as we move beyond the pandemic. Importantly, audiologists need to document all forms of remote care including audio/visual, telephone (audio only), and email to support movement toward state licensing boards acknowledging that audiologists are qualified to provide this care and for insurers to support reimbursement for care provided via this mechanism. Educators will need to ensure that classroom and clinical education includes tele-audiology.
With the aging of the population, vision (VL), hearing (HL), and dual-sensory (DSL, concurrent VL and HL) loss will likely constitute important public health challenges. Walking speed is an indicator of functional status...With the aging of the population, vision (VL), hearing (HL), and dual-sensory (DSL, concurrent VL and HL) loss will likely constitute important public health challenges. Walking speed is an indicator of functional status and is associated with mortality. Using the Health and Retirement Study, a nationally representative U.S. cohort, we analyzed the longitudinal relationship between sensory loss and walking speed. In multivariable mixed effects linear models, baseline walking speed was slower by 0.05 m/s (95% confidence interval [CI] = 0.04-0.07) for VL, 0.02 (95% CI = 0.003-0.03) for HL, and 0.07 (95% CI = 0.05-0.08) for DSL compared with those without sensory loss. Similar annual declines in walking speeds occurred in all groups. In time-to-event analyses, the risk of incident slow walking speed (walking speed < 0.6 m/s) was 43% (95% CI = 25-65%), 29% (95% CI = 13-48%), and 35% (95% CI = 13-61%) higher among those with VL, HL, and DSL respectively, relative to those without sensory loss. The risk of incident very slow walking speed (walking speed < 0.4 m/s) was significantly higher among those with HL and DSL relative to those without sensory loss, and significantly higher among those with DSL relative to those with VL or HL alone. Addressing sensory loss and teaching compensatory strategies may help mitigate the effect of sensory loss on walking speed.
This article aims to investigate the association between hearing and nonfatal injury or falls in a nationally representative sample of adults from the National Health Interview Survey (NHIS) utilizing over 20 years of pa...This article aims to investigate the association between hearing and nonfatal injury or falls in a nationally representative sample of adults from the National Health Interview Survey (NHIS) utilizing over 20 years of participant surveys. We conducted a pooled cross-sectional analysis of participant surveys (aged 50 years and older) from 1997 to 2017. Self-report hearing difficulty, history of injury over the last 3 months, reported injury from fall over the last 3 months, and reported reason for fall (including due to balance/dizziness) were collected. Using logistic regression, we investigated the odds of injury, injury from fall, and fall due to balance/dizziness by self-report hearing status. In secondary analysis, we investigated the odds of each outcome by reported hearing aid use. Models were adjusted for demographics, year of study, vision difficulty, diabetes, employment, and cardiovascular disease. Reported moderate or greater difficulty hearing demonstrated a significantly greater odds of injury (odds ratio [OR]: 1.29; 95% confidence interval [CI]: 1.18, 1.42) or fall due to balance/dizziness (OR: 1.26; 95% CI: 1.00, 1.60) compared with reported excellent/good hearing. A dose-response association was seen across levels of reported difficulty hearing for all outcomes. In this nationally representative study of adults aged 50 years and older, greater reported difficulty hearing was significantly associated with increased odds of injury and suggests greater odds of falls or fall due to balance/dizziness compared with reported good hearing. Results suggest hearing loss should be considered as a possible risk factor for both injury and fall prevention studies and programming in older adults.
This article aims to evaluate a hearing loss intervention versus an aging education intervention on activity engagement in the Aging and Cognitive Health Evaluation in Elders pilot (ACHIEVE-P). Forty adults (70-84 years)...This article aims to evaluate a hearing loss intervention versus an aging education intervention on activity engagement in the Aging and Cognitive Health Evaluation in Elders pilot (ACHIEVE-P). Forty adults (70-84 years) with hearing loss recruited from the Atherosclerosis Risk in Communities Study and de novo participated. Participants were randomized 1:1 to a best practices hearing intervention or a successful aging intervention. Hearing was measured with pure-tone audiometry. The Community Healthy Activities Model Program for Seniors questionnaire measured self-reported time engaging in activities at baseline and 6-month follow-up. At baseline, greater hearing loss was associated with reduced time per week on mental activities (-3.0 hours per 10 dB of hearing loss, 95% confidence interval: -5.8, -0.2). Mental activity engagement increased (mean: +1.3 hours, SD = 6.6) for the hearing intervention group but decreased (mean: -1.1 hours, SD = 4.8) for the aging education group (Cohen's : 0.41). Hearing loss may be associated with reduced engagement in mental activities. Whether hearing loss treatment impacts activity will be studied in the full-scale ACHIEVE trial.
Hearing loss (HL) is common among individuals aged 50 and older and is associated with increased healthcare costs. Whether HL is associated with less access to healthcare is unclear. In this study, we examined the associ...Hearing loss (HL) is common among individuals aged 50 and older and is associated with increased healthcare costs. Whether HL is associated with less access to healthcare is unclear. In this study, we examined the association between HL and access to medical care and prescription drugs among individuals 50+ with and without HL. We used nationally representative 2013-2014 Medical Expenditure Panel Survey data, consisting of 1,977 adults with HL and 17,399 without. We applied an inverse propensity score weighting and regression modeling to adjust for any potential differences in health and socioeconomic conditions between the two groups. Adults with HL were more likely to be white, less educated, poorer, and with public insurance ( < 0.001). They were also likely to have hypertension, heart disease, stroke, emphysema, high cholesterol, diabetes, joint pain, and arthritis ( < 0.001). The odds of reporting unmet medical needs (odds ratio [OR] = 1.85; 95% confidence interval [CI] = 1.29-2.66), delay in getting medical needs met (OR = 1.37; 95% CI = 1.00-1.87), and having unfilled prescriptions (OR = 1.81; 95% CI = 1.27-2.59) were higher among individuals with HL compared with their counterparts without HL. Individuals with HL have less access to care and prescription drugs. To ensure equitability in access, public health policies should address specific needs of people with HL.
Hearing loss (HL) can negatively impact patient-provider communication and limit access to health promotion information, which may lead to decreased preventive care utilization. Using data from the 2015 and 2018 National...Hearing loss (HL) can negatively impact patient-provider communication and limit access to health promotion information, which may lead to decreased preventive care utilization. Using data from the 2015 and 2018 National Health Interview Survey, we examined the association between perceived HL with and without hearing aid use with self-reported age-appropriate uptake of breast and colon cancer screening, and influenza and pneumococcal vaccination. In models adjusted for sociodemographic characteristics, access to care, and health status, people with HL had lower odds of receiving breast cancer screening (odds ratio [OR] = 0.83, 95% confidence interval [CI] = 0.72-0.96) and higher odds of receiving pneumococcal vaccination (OR = 1.11, 95% CI = 1.00-1.24) relative to those without HL. There were no differences in their colon cancer or influenza vaccination uptake. Compared with those without HL, people with HL who used hearing aids had increased odds of colon cancer screening and influenza and pneumococcal vaccination, while people with HL who did not use hearing aids were less likely to report cancer screening. Overall, Americans with untreated HL were less likely to report completing cancer screening. Hearing aid use may modify the association between HL and preventive care uptake. Screening for HL in primary care settings and communication trainings for providers may help reduce cancer screening disparities.
Several studies have recently illuminated the relationship between hearing loss and hospitalizations, but little is understood as to why hearing loss is associated with greater risk for hospitalizations. This study exami...Several studies have recently illuminated the relationship between hearing loss and hospitalizations, but little is understood as to why hearing loss is associated with greater risk for hospitalizations. This study examines the role of patient-provider communication as the mechanism by which those with hearing loss are more likely to be hospitalized, using the self-reported data from 12,654 Medicare beneficiaries from the 2016 Medicare Current Beneficiary Survey (MCBS) Cost and Use File. Multivariable logistic regression was used to model the odds of any hospitalization in the past year and negative binomial regression to model the incident rate ratio of hospitalization based on number of hospitalizations in the past year. It was found that Medicare beneficiaries who experience impaired communication with their physician due to trouble hearing have greater odds of hospitalization and a higher rate of all hospitalization over a 1-year period. Understanding the complex relationship between hearing loss, patient-provider communication, and hospitalizations may provide health care professionals with a better rational to address not only hearing loss but also impaired communication in the care of an individual.
Age-related hearing loss (ARHL) has been connected to both cognitive decline and late-life depression. Several mechanisms have been offered to explain both individual links. Causal and common mechanisms have been theoriz...Age-related hearing loss (ARHL) has been connected to both cognitive decline and late-life depression. Several mechanisms have been offered to explain both individual links. Causal and common mechanisms have been theorized for the relationship between ARHL and impaired cognition, including dementia. The causal mechanisms include increased cognitive load, social isolation, and structural brain changes. Common mechanisms include neurovascular disease as well as other known or as-yet undiscovered neuropathologic processes. Behavioral mechanisms have been used to explain the potentially causal association of ARHL with depression. Behavioral mechanisms include social isolation, loneliness, as well as decreased mobility and impairments of activities of daily living, all of which can increase the risk of depression. The mechanisms underlying the associations between hearing loss and impaired cognition, as well as hearing loss and depression, are likely not mutually exclusive. ARHL may contribute to both impaired cognition and depression through overlapping mechanisms. Furthermore, ARHL may contribute to impaired cognition which may, in turn, contribute to depression. Because ARHL is highly prevalent and greatly undertreated, targeting this condition is an appealing and potentially influential strategy to reduce the risk of developing two potentially devastating diseases of later life. However, further studies are necessary to elucidate the mechanistic relationship between ARHL, depression, and impaired cognition.
Epidemiology is the science of public health. The focus of this discussion is to present a brief overview of how epidemiology approaches questions of disease causation, including why it sometimes gets things wrong, and s...Epidemiology is the science of public health. The focus of this discussion is to present a brief overview of how epidemiology approaches questions of disease causation, including why it sometimes gets things wrong, and so to provide a framework for how we consume and use this type of research, particularly when it comes to patient care.
Phone use is a critical communication event in many people's lives. Audiologists have aimed to assist individuals with hearing loss and phone usage through the use of technology and counseling. To counsel effectively, al...Phone use is a critical communication event in many people's lives. Audiologists have aimed to assist individuals with hearing loss and phone usage through the use of technology and counseling. To counsel effectively, all contributions to hearing difficulty on the phone must be considered, including the effects of smartphone cases. The purpose of this study was to evaluate the effects on dB output caused by waterproof smartphone cases that cover the ear-level speaker. One waterproof case was tested with three smartphones, two iPhones, and one Android. A second waterproof case was tested with the two iPhones. Results revealed there was significant attenuation of the audio-signal by both waterproof smartphone cases that was great enough in one case/phone combination to potentially result in a complete lack of intelligibility of the signal.
COVID-19 has challenged most everyone in every facet of life. In the beginning of the pandemic shutdown, schools had to make decisions quickly often with limited planning. For students who were deaf or hard of hearing, c...COVID-19 has challenged most everyone in every facet of life. In the beginning of the pandemic shutdown, schools had to make decisions quickly often with limited planning. For students who were deaf or hard of hearing, communication access during instruction was the urgent focus of teachers of the deaf/hard of hearing and educational audiologists. The move from the classroom to home resulted in both predictable and unpredictable challenges as well as some unexpected benefits. Based on numerous conversations with these professionals as well as parents, the challenges encountered with online learning and solutions that were implemented to support students are reported.