Adult Audiology Research Articles

Evaluation of the Ask-Inform-Manage-Encourage-Refer Intervention and Its Implementation Targeting the Provision of Mental Wellbeing Support Within the Audiology Setting.

The ask, inform, manage, encourage, refer (AIMER) program is a behavior change intervention designed to increase the frequency with which hearing healthcare clinicians (HHCs) ask about and provide information regarding mental wellbeing within adult audiology services. The objective of this study was to systematically evaluate the first iteration of the AIMER program to determine whether the intervention achieved the changes in HHC behaviors anticipated and to evaluate feasibility of implementing the AIMER program based on the implementation protocol. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide this evaluation. Data were collected from October 2020 to February 2022 and included both quantitative and qualitative measures (i.e., observation reports, staff surveys, clinical diaries, clinical file audits, and interviews). Comparison between pre- and post-implementation data showed that the AIMER intervention successfully increased: (i) HHC's skills and confidence for discussing mental wellbeing; (ii) how often HHCs ask about mental wellbeing within audiology consultations; (iii) how often HHCs provide personalized information and support regarding mental wellbeing within audiology consultations; and (iv) how often HHCs use mental wellbeing terms within clinical case notes and general practitioner reports. The factors affecting feasibility of implementing the AIMER program within the clinical setting could be classified into three major categories: (i) the AIMER program itself and its way of delivery to clinical staff; (ii) people working with the AIMER program; and (iii) contextual factors. Key recommendations to improve future implementation of the AIMER program were provided by the participants. The AIMER program was shown to be effective at increasing the frequency with which HHCs ask about and provide information regarding mental wellbeing within routine audiological service delivery. Implementation of the AIMER program was feasible but leaves room for improvement. Use of the reach, effectiveness, adoption, implementation, and maintenance framework facilitated systematic evaluation of multiple indicators providing a broad evaluation of the AIMER program. Our analysis helps to better understand the optimal levels of training and facilitation and provides recommendations to improve future scale-up of the AIMER program. The findings of this study will be used to further adapt and improve the AIMER program and to enhance program implementation strategies before its further dissemination.

Original Research Clinical attendance rate at a tertiary adult audiological service in South Africa.

Clinical non-attendance to audiological appointments may negatively affect early diagnosis and intervention as well as treatment outcomes for adults with hearing impairments. This study aimed to explore the attendance rate and factors influencing attendance and non-attendance at an adult audiology diagnostic clinic at a tertiary hospital in Gauteng, South Africa. A mixed-methods research design, utilising structured questionnaires and a retrospective record review was adopted. A total of 31 adult patients at a diagnostic audiology clinic were interviewed. Findings revealed an attendance rate of 47.62%, with 52.38% rate failure to return for follow-up appointments. Key reasons for attendance included understanding the need for appointments (57%), staff attitudes (42%) and appointment reminders (17%), and those for non-attendance included multiple appointments (33%), work commitments (28%), transport (8%) and forgetting about the appointment (8%). Six reasons for non-attendance were prominent in the current study: having multiple appointments (33%), work commitments (28%), forgetting the appointment (8%), transport difficulties (8%), attitudes and/or perceptions of the healthcare system (4%) and sequelae of hearing impairment (8%). This study reinforces previous research findings while highlighting that health literacy and Batho Pele (people first) ethos by staff positively influence attendance.Contribution:Current findings contribute towards contextually relevant evidence on the attendance rate in this sector for ear and hearing care, as well as additional insights into factors influencing this within the South African context. This information is crucial for clinical services provision planning as well as for policy formulation around resource allocation in the public healthcare sector.

Use of the Behaviour Change Wheel to design an intervention to improve the provision of mental wellbeing support within the audiology setting

ObjectiveThis study describes the development of an intervention to increase the frequency of audiologists’ asking about and providing information regarding mental wellbeing within adult audiology services.DesignThe Behaviour Change Wheel (BCW), an eight-step systematic process, was followed to develop the intervention. Reports describing the first four steps are published elsewhere. This report describes the final four steps and details the intervention developed.ResultsA multifaceted intervention was developed to change audiologists’ behaviours relating to providing mental wellbeing support to adults with hearing loss. Specifically, three behaviours were targeted: (1) asking clients about their mental wellbeing, (2) providing general information on the mental wellbeing impacts of hearing loss, and (3) providing personalised information on managing the mental wellbeing impacts of hearing loss. A variety of intervention functions and behaviour change techniques were incorporated into the intervention, including instruction and demonstration, information about others approval, adding objects to the environment, use of prompts/cues, and endorsement from credible sources.ConclusionThis study is the first to use the Behaviour Change Wheel to develop an intervention targeting mental wellbeing support behaviours in audiologists and confirms the usability and usefulness of the approach in a complex area of clinical care. The systematic development of the Ask, Inform, Manage, Encourage, Refer (AIMER) intervention will facilitate a thorough evaluation of its effectiveness in the next phase of this work.

Managing comorbid cognitive impairment and hearing loss in older adults: a UK survey of audiology and memory services.

midlife hearing loss is a potentially modifiable risk factor for dementia. Addressing comorbid hearing loss and cognitive impairment in services for older adults may offer opportunities to reduce dementia risk. to explore current practice and views amongst UK professionals regarding hearing assessment and care in memory clinics and cognitive assessment and care in hearing aid clinics. national survey study. Between July 2021 and March 2022, we distributed the online survey link via email and via QR codes at conferences to professionals working in National Health Service (NHS) memory services and audiologists working in NHS and private adult audiology services. We present descriptive statistics. 135 professionals working in NHS memory services and 156 audiologists (68% NHS, 32% private sector) responded. Of those working in memory services, 79% estimate that >25% of their patients have significant hearing difficulties; 98% think it useful to ask about hearing difficulties and 91% do so; 56% think it useful to perform a hearing test in clinic but only 4% do so. Of audiologists, 36% estimate that >25% of their older adult patients have significant memory problems; 90% think it useful to perform cognitive assessments, but only 4% do so. Main barriers cited are lack of training, time and resources. although professionals working in memory and audiology services felt addressing this comorbidity would be useful, current practice varies and does not generally address it. These results inform future research into operational solutions to integrating memory and audiology services.

Patient perceptions of cognitive screening in adult audiology services: A qualitative exploration.

Both hearing loss and dementia are extremely pervasive, especially amongst older adults. As hearing loss and dementia have common symptoms, misdiagnosis can be common, and failure to address hearing loss for people with dementia could accelerate cognitive decline. The timely detection of cognitive impairment is clinically important, however the use of cognitive assessments in adult audiology services is a hotly debated topic. Although the early detection of cognitive impairment may improve patient care and quality of life, patients attending audiology services for hearing assessment might not expect to be asked questions about their cognition. The aim of this study was to qualitatively explore patient and public perspectives and preferences on the use of cognitive screening within adult audiology services. Quantitative and qualitative data were gathered from an online survey and a workshop. Descriptive statistics were applied to quantitative data and an inductive thematic analysis was performed on free-text responses. In total, 90 respondents completed the online survey. Overall, cognitive screening in audiology was reported to be acceptable to participants (92%). A reflexive thematic analysis of the qualitative data reported four themes: i) knowledge of cognitive impairment and screening, ii) implementation of cognitive screening, iii) impact of screening on patient and iv) contributions to future care and research. A workshop was held with five participants to discuss and reflect on the findings in more detail. Participants found cognitive screening to be acceptable within adult audiology services providing audiologists had suitable training, and sufficient explanation and justification were provided. However, implications such as additional time and staff resource and supplementary training for audiologists would be required to address participants concerns.

Improving the implementation of family-centred care in adult audiology appointments: a feasibility intervention study

Objective There is mounting evidence for implementing family-centred care (FCC) in adult audiology services, however FCC is not typically observed in adult clinical practice. This study implemented an intervention to increase family member attendance and involvement within adult audiology appointments. Design The study involved a mixed method design over three key phases: Standard Care, Intervention I (increasing family member attendance), and Intervention II (increasing family member involvement). Study Sample Staff from four private audiology clinics within one organisation participated in the intervention. Data was collected from different clients in each phase (n = 27 Standard Care, n = 30 Intervention I, and n = 23 Intervention II). Results Family member attendance increased from 26% of appointments in Standard Care to 40% at Intervention I, and 48% at Intervention II. Family member involvement also showed improvement on some measures (video analysis) although talk time did not significantly increase. Significant improvements in client satisfaction with services were found (Net Promoter Score and Measure of Processes of Care). Conclusion The implementation of FCC in audiology clinics needs to be an ongoing, whole-of-clinic approach, including staff in all roles. Increasing family member attendance at adult audiology appointments can lead to benefits to client satisfaction with services.

Factors Affecting the Use of Speech Testing in Adult Audiology.

ObjectiveTo evaluate hearing healthcare professionals’ (HHPs) speech testing practices in routine adult audiology services, and better understand the facilitators and barriers to speech testing provision.DesignA cross-sectional questionnaire studyStudy SampleA sample (n=306) of HHPs from the public (64%) and private sector (36%), in the United Kingdom (UK), completed the surveyResultsIn the UK, 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 sector, respectively. Recognised benefits of speech testing included: 1) providing patients with relatable assessment information, 2) guiding hearing aid fitting, 3) supporting a diagnostic test battery. A lack of clinical time was a key barrier to uptake.ConclusionUse of speech testing varies in adult audiology. Results from the present study found the percentage of UK HHPs making use of speech tests was low compared to other countries. HHPs recognised 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 centres.

A qualitative study showing that a telecare tool can have benefits before and during the initial hearing assessment appointment

Objective To examine patient and audiologist experiences and perspectives of using a patient-centred telecare tool, the Ida Institute’s Why Improve My Hearing? (WIMH) Tool, before and during the initial hearing assessment appointment. Design A qualitative study comprising individual semi-structured interviews using a maximum variation sampling strategy. The data were analysed using an established thematic analysis technique. Study sample Fifteen participants, including ten patients (i.e. adults with hearing loss) and five audiologists, were recruited from Adult Audiology Services within the United Kingdom’s publicly-funded National Health Service (NHS). Results Three themes described the impact of using the WIMH Tool. Theme 1 (i.e. enhanced preparation before the appointment): the Tool helps patients to better understand and accept their hearing difficulties in advance of their first appointment. Theme 2 (i.e. enriched discussion during the appointment): the tool can enhance patient-centred communication, as well as the efficiency of the appointment. Theme 3 (i.e. varied impact on outcomes following the appointment): the Tool can improve patient motivation, readiness, and involvement in decision-making, though it may have limited impact on additional outcomes, such as adherence. Conclusion The WIMH Tool can be successfully implemented in audiological practice, resulting in benefits before and during the initial hearing assessment appointment.

Use of the Behaviour Change Wheel to design an intervention to improve the implementation of family-centred care in adult audiology services

Objective This study describes the development of an intervention to improve family-centred care in adult audiology services. Design The Behaviour Change Wheel (BCW) was followed to develop the intervention. The BCW involves eight steps across three stages: (1) understanding the behaviour, (2) identifying intervention options, and (3) identifying content and implementation options. Study Sample The data in Stage 1 comprised of 13 interviews with clinic staff. The research team drew on their own expertise and empirical research to complete Stages 2 and 3. Results A two-phase, face-to-face intervention was developed to change clinic staff’ behaviours to address two problem behaviours: (1) increase family member attendance to adult audiology appointments; and (2) increase family member involvement within appointments. Three target behaviours were chosen for the intervention to address the two problem behaviours. A variety of intervention functions and behaviour change techniques were incorporated into the intervention. Conclusion The BCW provided a useful framework for developing a whole-of-clinic intervention to increase family member attendance and involvement in adult audiology appointments. Recent research in social psychology has suggested that this type of family involvement and support in healthcare is a strong predictor of well-being for adult clients and their families.

Predicting Hearing Loss for Cancer Patients Before Treatment

Most of us will have a loved one hear the devastating words, “You have cancer.” As he or she processes this news, quick treatment decisions must be made. Cancer treatment side effects, such as hearing loss, often come with uncertainties. Our team sought to provide clarity to patients with head and neck cancer on their expected hearing loss before treatment.shutterstock/Iurii Motov, Health care, hearing loss, cancer.Figure 1: The standard model (post-treatment data) is as accurate as the predictive model (pretreatment data). Health care, hearing loss, cancer.Figure 2: Screenshot of the web-based app. Health care, hearing loss, cancer.Each year, more than half a million people develop head and neck cancer, and more than a quarter million die from it.1 Treatment options include surgery, radiation therapy, and chemotherapy (cisplatin). These therapies can cause permanent hearing loss and other side effects, including kidney damage (nephropathy), extreme dry mouth (xerostomia), and loss of healthy tissue (radiation necrosis).2-8 Despite the negative impact of hearing loss on patients’ quality of life, it can be overlooked.9 In 2014, our division of adult audiology at Washington University School of Medicine in St. Louis began providing care for head and neck cancer patients in collaboration with otolaryngology physicians. One of our team members attended a weekly multidisciplinary tumor board to better understand a patient's treatment journey and their challenges in streamlining the process for our patients. We were able to provide audiological care within existing structures to avoid disruptions by reaching out to our multidisciplinary partners. Working with the radiation oncology department, we built standard referral patterns to increase patient follow-up while reducing patient burden through same-day appointments. Baseline audiological testing was incorporated into our department's Head & Neck Cancer Multi-Disciplinary Clinic launched in 2016. The clinic allowed patients to see multiple medical professionals—a radiation oncologist, a medical oncologist, a head and neck cancer surgeon, a speech therapist, and an audiologist—all on the same day. This was appreciated by patients since they could complete their pre-treatment cancer appointments in one morning instead of a month. At these appointments, many patients often asked about what to expect of their hearing after treatment, which made us realize a gap: We could only provide general information about the effects of ototoxic medications, but couldn't address our patients’ needs. As a result, our team decided to explore options for how we could predict post-treatment hearing loss before treatment to provide better counseling. PREDICTING HEARING LOSS A literature review only revealed options that could predict hearing loss after treatment because they relied on final treatment doses. After identifying this gap in information, our team decided to create a new resource for patients. We studied 242 patients using an internal database and data from Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, the Washington University Oncology Data Services Cancer Registry, Varian (a radiation oncology treatment planning software), and AudBase (a clinical audiometric database). We collected demographic information, tobacco and alcohol use, tumor characteristics (stage, histology, and proximity to the cochlea), and treatment methods (surgery, surgery with clean margins, cisplatin treatment regimen, total cumulative cisplatin dose, and mean cochlear radiotherapy dose) for each patient. Next, we analyzed the data to determine if they could be used to predict post-treatment hearing (pure-tone average [PTA] of 1, 2, 4 kHz) and help counsel patients on their hearing before treatment. We built two key models: one that used proxy measures available before treatment (location of the tumor and planned chemotherapy treatment regimen) and another that relied on final treatment doses. The results were identical: Using pre-treatment measures was as accurate as using post-treatment measures (Fig. 1). The pretreatment factors that we found predicted hearing loss were age, pre-treatment hearing, location of the tumor, and planned treatment chemotherapy dose. Using these factors, our model explained 80 percent of a patient's post-treatment hearing (1, 2, 4 kHz PTA), had a sensitivity of 80 percent and a specificity of 75 percent for predicting post-treatment hearing loss greater or less than 35 dB HL. To our knowledge, we created the first model capable of accurately predicting post-treatment hearing loss before treatment. Our team converted the model into a user-friendly internet-based tool. To use the tool, an audiologist inputs the predictive factors into a web-based application at the baseline hearing test (Fig. 2). The audiologist can then use this information to counsel his or her patient on realistic expectations regarding the patient's post-treatment hearing; however, the model is not yet ready for widespread implementation. We are working to validate it in a new cohort of patients with head and neck cancer.10 Once completed, we plan to publish the data and share our findings to support patients across the country. Each patient we see is someone's loved one. We hope our tool makes their journey a little easier.

Identifying barriers and facilitators to implementing family-centred care in adult audiology practices: a COM-B interview study exploring staff perspectives

Objective: This study explored staff perspectives of the barriers and facilitators to improving the implementation of family-centred care (FCC) in audiology practice.Design: Semi-structured interviews, informed by the COM-B (Capability–Opportunity–Motivation–Behaviour) model, were conducted with staff members at a private hearing care company in Australia.Study Sample: Thirteen participants were interviewed including managers, clinicians, and front-of-house staff.Results: Staff with different roles had different perspectives on barriers; however, the main barriers included: (1) insufficient knowledge regarding the principles of FCC and its benefits; (2) insufficient knowledge regarding the reasons why a family member should attend the appointment; (3) inadequate skills in how to ask for family member attendance; (4) experiencing discomfort when asking clients to bring a family member to their appointment; (5) inconsistent training and tools to support the implementation of FCC; (6) organisational culture not supporting FCC; and (7) a lack of confidence in abilities to manage conflict between clients and family members within appointments.Conclusions: The study indicated that there were numerous barriers to be overcome for staff to further implement FCC into their current practice. The interview findings will be used to develop an intervention to improve the implementation of FCC in audiology practice.

Family Involvement in Adult Audiology Appointments

Family Involvement in Adult Audiology Appointments

Family Involvement in Adult Hearing Evaluation Appointments: Patient Perspectives.

Background Many adults suffer from an array of consequences due to their hearing loss (e.g., self-efficacy, mastery, psychosocial challenges). Family involvement can help improve their outcomes. Purpose This study aimed to determine audiology adult patients hearing experiences and inquired about their perspectives on family involvement in appointments. Research Design A cross-sectional survey was completed. Descriptive statistics, item analyses, and quantitative analyses were used to examine patient's characteristics and perspectives. Study Sample Three hundred eighty-two adult audiology patients participated in the study. Data Collection and Analysis A 15-item survey was created with 4 sections, including patient demographic information, general hearing questions, hearing experiences, and family interactions and involvement. Descriptive statistics were used to examine patient's characteristics and perspectives on family involvement in audiology appointments. Chronbach's alpha was used to reveal good internal consistency of difficult feelings related to hearing and perceived negative family member reactions. Quantitative analyses were used to determine patient perspectives on family involvement. Results Though patients reported difficulties due to their hearing loss, more than half reported that they did not want family involvement or they were unsure of the benefit that the involvement would provide. Patients who were interested in having family involved reported benefits such as educational opportunities and support. Few barriers of family involvement were reported by patients. Conclusions Patients had a mixed desire about family involvement in their adult audiology appointments. Education of patients about the benefits of family involvement may need to happen for this shift in audiologic practice.

A qualitative investigation of decision making during help-seeking for adult hearing loss

Objective: The Any Qualified Provider framework in the National Health Service has changed the way adult audiology services are offered in England. Under the new rules, patients are being offered a choice in geographical location and audiology provider. This study aimed to explore how choices in treatment are presented and to identify what information patients need when they are seeking help with hearing loss. Design: This study adopted qualitative methods of ethnographic observations and focus group interviews to identify information needed prior to, and during, help-seeking. Observational data and focus group data were analysed using the constant comparison method of grounded theory. Study sample: Participants were recruited from a community Health and Social Care Trust in the west of England. This service incorporates both an Audiology and a Hearing Therapy service. Twenty seven participants were involved in focus groups or interviews. Results: Participants receive little information beyond the detail of hearing aids. Participants report little information that was not directly related to uptake of hearing aids. Conclusions: Participant preferences were not explored and limited information resulted in decisions that were clinician-led. The gaps in information reflect previous data on clinician communication and highlight the need for consistent information on a range of interventions to manage hearing loss.

Adult Audiology Casebook

In Brief One book, Adult Audiology Casebook by Michael Valente and L. Maureen Valente, is reviewed in this issue. Aparna Rao describes the compilation of case studies as extensive and diverse with many audiologists contributing to the content. Additionally, Dr. Rao notes that the content of this book is a valuable resource for experienced clinicians as well as students who are learning about the profession.

Atresia and Sudden Sensorineural Hearing Loss

This case study summarizes findings in an adult male, aged 57, who presented to the Adult Audiology Clinic with aural atresia in the right ear resulting in a conductive hearing loss and a sudden sensorineural hearing loss in the left ear. Treatment options included reconstruction surgery in the right ear, bone anchored hearing aid in the right ear to overcome the conductive hearing loss, bone anchored hearing aid in the left ear for single sided deafness, and intratympanic steroid injections in the left ear to salvage hearing. This case study highlights that when a patient is educated on all available options the patient is then able to make a decision comfortable to him and to help improve his hearing.

Otoakustische Emissionen – Schallaussendungen des Ohres: Entstehung, Registriermethode, Eigenschaften und klinische Bedeutung

Since the discovery of otoacoustic emissions from the human ear in 1978 by Kemp several researchers have investigated this phenomenon as a possible basis for a clinical test of the cochlear function. The aim of this paper is to review the properties and the clinical significance of spontaneous otoacoustic Emissions (SOAE), transiently evoked otoacoustic emissions (TEOAE) and distortion product otoacoustic emissions (DPOAE). Because of the low incidence, SOAE have no clinical significance in adult and pediatric audiology. In adult audiology TEOAEs are limited by three facts: TEOAEs are not more sensitive than conventional audiometry, TEOAEs reflect only midfrequency activity (I-5kHz), TEOAEs cannot be recorded from ears where the main hearing loss is 30 dB HL or higher. As many case studies have demonstrated there is no doubt about the usefulness of TEOAEs for screening auditory dysfunction in neonates and infants. Recording TEOAEs is a simple and noninvasive test. It is time-saving, compared with auditory brainstem response audiometry, and more sensitive and more precise than behavioural audiometry. DPOAE can be recorded in ears having considerably more hearing loss than can TEOAEs. The capability of fully examining the frequency pattern of outer hair cell loss would clearly complement the „yes or no” information concerning hearing capacity provided by TEOAEs. At present, DPOAE-testing instrumentation is yet based upon laboratory equipment.

Staffing and structure for paediatric audiology services in hospital and community units.

The component functions of a paediatric audiology service are outlined on the basis of the main broad categories of patient and their requirements, as seen from a 'good practice' standpoint; a service structure is offered in terms of patient flow. This leads to a distinction between the small, specifically medical requirement, and the large, specifically audiological testing requirement. Indications are given of the scale of audiology requiring to be done by community staff not specializing in audiology. Notional incidence figures (and acceptable screen failure rates) allow the number of audiological posts or sessions required for screening and related community paediatric audiology work to be estimated per million population served. This totals about 9.75 FTE professional posts of varying grades per million population plus 1.5 FTE support, but in nearly all circumstances there will be many more incumbents than this, each with diverse other duties. The recommended staffing of audiologists doing hospital-based assessment and rehabilitation work and requiring specialized audiology training totals about 7.0 full-time equivalent (FTE) audiology posts and 2.5 support posts in a hospital paediatric audiology department, per million population; this is above the currently prevailing level of provision. The resource requirements would be raised by the widespread introduction of a non-standard screen (other than for the standard 6 to 9 month screen and the school-entry screen) by about 40% for community services and 15% for consequential increases in hospital services. In hospital units, the staffing will usually be interleaved with that of adult audiology, even where the served population may be large enough (e.g. 0.5 million, three to four paediatric audiology staff) to make a separate section worthwhile. In community units, there does not appear to be a particularly good rationale for community doctors specializing full-time in audiology, although some medical staff time is needed to undertake the specifically medical components. A partial degree of specialization among health visitors (or at least greater audiological training and experience) would probably achieve better performance of screens and simplify the attainment and maintenance of testing standards. Activities in hospital and community units have strong mutual implications: adding an intermediate-age screen to the established first-year and school-entry screens, and adding an at-risk neonatal screen would together increase consequent demands upon hospital paediatric audiology about 35%, although in neither case would the screening activity itself be undertaken in the hospital audiology unit.(ABSTRACT TRUNCATED AT 400 WORDS)