Audiology Practice Research Articles

A Comparison of Face-to-Face Versus Online Instruction in the Correct Pronunciation of Anatomical Terms in Communication Sciences and Disorders. An Initial Investigation

Accurate pronunciation of anatomical terms in the clinical practice of speech-language pathology (SLP) and audiology (AUD) enables a clinician to express and comprehend a conversation with peers and other professionals. It is also an important component of ensuring patient safety and in providing quality, patient-centered care. To date, no studies have explored whether differences may exist between the pronunciation skills of students who elect to complete a human anatomy and physiology course online versus in a face-to-face (FTF) format. This pilot study explored the ability of 98 undergraduate student participants to correctly pronounce 20 identical key terms that were a part of the course Anatomy and Physiology of the Speech and Hearing Mechanism. Students were enrolled in either an online or a FTF format of this course. Student participants were also asked to self-rate their perceived ability to pronounce these terms correctly using a Likert-type rating scale. The results indicated that students enrolled in the FTF format produced a significantly greater percentage of correct terms and rated their pronunciation ability significantly higher compared to those enrolled online. Performance of both groups was positively correlated to the self-ratings of pronunciation accuracy. These results suggest that an Internet-based, multimedia teaching method that incorporates tools for improving the pronunciation skills of students who complete a human anatomy and physiology course is warranted.

Knowledge of the audiological effects, symptoms and practices related to personal listening devices of health sciences students at a South African university.

This study aimed to determine the knowledge of first year health sciences students at a South African university regarding hearing loss and symptoms attributable to personal listening devices and their practices concerning the use of personal listening devices. This was a cross-sectional study carried out using an anonymous self-administered questionnaire. Of 336 students, 269 (80.1 per cent) completed the questionnaire. While most participants could identify symptoms that could be caused by extensive use of personal listening devices, almost 30 per cent did not know that it could cause permanent hearing loss. Personal listening devices were used by 90.7 per cent of participants, with 77.8 per cent having used them for more than five years. Use was at a high volume in 14.9 per cent of participants and for more than 2 hours per day in 52.7 per cent. The findings indicate the need for an educational programme to inform students as to safe listening practices when using personal listening devices.

Audiology Practices in the Preoperative Evaluation and Management of Adult Cochlear Implant Candidates

Currently, no clear guidelines exist regarding clinical testing methods for identifying adult cochlear implant (CI) candidates. Indications provided by the US Food and Drug Administration, Medicare, and private insurers are ambiguous concerning test materials and the level and mode of test presentation. This could lead to wide variability in clinical assessment and, potentially, unequal access to CIs for individuals with clinically significant hearing loss. To examine the preoperative testing methods used by audiologists in evaluating adult CI candidates across the United States. A survey assessing audiology practice patterns was created using a Research Electronic Data Capture system hosted at the University of Miami. A link to a survey (65 questions in multiple-choice or rank-order format was distributed electronically along with a request for completion to members of the American Cochlear Implant Alliance and to the Institute for Cochlear Implant Training forum. Responses were collected from January 17 to June 4, 2018. Participation was limited to audiologists who evaluate adult CI candidates, and respondents who do not provide adult CI care were excluded. Collected demographic information included work setting, years of experience, and highest level of education attained. Percentages, medians, and interquartile ranges were from aggregated responses concerning hearing aid verification methods; testing methods, materials, and practices; nonauditory factors that might affect CI candidacy; audiology practice patterns; and expanded indications for CIs. Anonymized surveys were returned by 99 respondents; because surveys were available electronically, the number of audiologists who viewed the survey but did not respond was not available. Seven respondents identified themselves as pediatric specialists and were excluded, resulting in a total of 92 surveys available for analysis (denominators vary because respondents could complete the survey without answering all questions). Seventy percent of respondents (51 of 72) were doctors of audiology, and nearly 50% (33 of 74) were employed at universities and academic centers performing more than 50 CIs per year. When assessing adult candidacy for implant, most respondents reported using test materials from the Minimum Speech Test Battery: 96% (51 of 53), using AzBio sentences in quiet; 89% (47 of 53), AzBio sentences in noise; and 100% (53 of 53), the consonant-vowel nucleus-consonant, monosyllabic words test. However, these tests were applied inconsistently, with 39 of 53 respondents (74%) reporting use of a sound pressure level scale and the other 14 (26%) a hearing level scale at various decibel levels, and with some using a single signal-to-noise ratio and others using multiple ratios for sound-in-noise tests. Respondents' definitions of the best aided listening condition for assessing implant candidates also varied widely. Among the nonauditory factors ranked most important for assessing CI candidacy were patient's level of cognition and expectations of CI; yet, few respondents reported including cognitive or psychological tests in the assessment protocol. Findings of this study reveal considerable variability in preoperative testing methods and practices across health care professionals assessing adult candidates for CI. This lack of standardization in the delivery of care may increase the risk for health care inequities, specifically in access to care for adults with clinically significant hearing loss.

Infection prevention and control measures in audiology practice within public healthcare facilities in KwaZulu-Natal province, South Africa.

BackgroundAudiologists have a clinical and ethical responsibility to create a working environment, designed to reduce the potential for cross-contamination or transmission of infections.ObjectivesTo describe the infection prevention and control (IPC) measures utilised and the opinions of audiologists and speech therapists, and audiologists (A/STAs) towards IPC in public healthcare facilities in KwaZulu-Natal province, South Africa.MethodA quantitative, descriptive survey was utilised and entailed completing an online questionnaire. The Cronbach’s alpha (0.82) indicated good internal consistency of the tool. Forty-nine A/STAs from 29 public healthcare facilities responded.ResultsMost participants (82%) followed a generic Department of Health policy on IPC, while 67% alluded to a discipline-specific policy. Participants had received training in infection control but indicated that further instruction was required for audiology-specific infection control procedures. Only 57% indicated that they ‘sometimes’ wore gloves with every patient during direct clinical contact. An association between the healthcare facility level and the wearing of gloves was found to be statistically significant (p = 0.025). Participants at regional and tertiary levels contended that gloves should be worn during most procedures versus those at district levels of care. While 96% washed their hands after each patient, only 76% washed their hands before each patient. Twenty-nine per cent indicated that they only ‘sometimes’ wore masks when in contact with patients with communicable diseases. Approximately one-third disinfected touch surfaces and toys, based on the clinician’s discretion. The majority (86%) of participants, however, always followed the correct protocol for medical waste disposal. Despite training and the availability of policies, some practitioners displayed poor IPC practices in terms of universal precautions, personal protective equipment, handwashing and sterilisation.ConclusionFurther education, training and awareness related to appropriate IPC measures are recommended for audiologists. It is envisaged that this will lead to more effective IPC measures in audiology practice thereby reducing the risk of infection transmission.

Developing an intervention to implement an ICF-based e-intake tool in clinical otology and audiology practice

Objective: To develop an intervention for the implementation of an ICF-based e-intake tool in clinical oto-audiology practice.Design: Intervention design study using the eight-stepped Behaviour Change Wheel. Hearing health professionals’ (HHPs) and patients’ barriers to and enablers of the use of the tool were identified in our previous study (steps 1–4). Following these steps, relevant intervention functions and policy categories were selected to address the reported barriers and enablers (steps 5–6); and behaviour change techniques and delivery modes were chosen for the selected intervention functions (steps 7–8).Results: For HHPs, the intervention functions education, training, enablement, modelling, persuasion and environmental restructuring were selected (step 5). Guidelines, service provision, and changes in the environment were identified as appropriate policy categories (step 6). These were linked to nine behaviour change techniques (e.g. information on health consequences), delivered through educational/training materials and workshops, and environmental factors (steps 7–8). For patients, the intervention functions education and enablement were selected, supported through service provision (steps 5–6). These were linked to three behaviour change techniques (e.g. environmental factors), delivered through their incorporation into the tool (steps 7–8).Conclusions: A multifaceted intervention was proposed to support the successful implementation of the intake tool.

Shifting and transforming the practice of audiology: The inclusion of traditional healing.

BackgroundSocietal diversity encompasses an array of cultural, religious and spiritual beliefs that influence an individual’s perspective of illness and diseases. Healthcare providers are challenged with the task of considering these diversities in clinical practice. The symbiotic relationship between the healthcare provider and the traditional healer in any healthcare field is rare.ObjectivesThe aims were to determine the perspectives of audiologists with regard to traditional healing in South Africa (SA) and to document if and how the audiologist engages with traditional healing in practice.MethodA questionnaire containing closed and open-ended questions was utilised. Thematic analysis was conducted on the qualitative data, and the quantitative data were displayed using tables and figures.ResultsForty-one audiologists working at public and private hospitals and clinics in SA were included in this study. The personal experiences of audiologists resulted in varying definitions of a traditional healer. Audiologists reported that patients utilised traditional healing methods such as pouring urine or motor oil into the ear. Strategies of accommodation included being culturally appropriate during conversations, respecting and acknowledging the individual’s cultural and religious beliefs. Twenty-seven audiologists were willing to collaborate with traditional healers to support the patient.ConclusionThere is a need for an integral holistic model of care in Audiology. There is a lack of communication structures to facilitate the implementation of a collaborative model of care in the current medical model of practice of Audiology. The global trend of holistic and person-centred care is evident, and the field of Audiology cannot negate the role of traditional healers as alternate healthcare providers in SA.

Incorporating Tinnitus Management Services into Your Audiology Practice

Incorporating Tinnitus Management Services into Your Audiology Practice

The Role of Audiology in the Care of Persons with Diabetes.

Hearing loss and balance issues contributing to falls are common problems for persons with diabetes (PWD). According to the Centers for Disease Control and Prevention (CDC), hearing loss and risk of falls are under recognized in diabetes care. Audiology should play an important role in the care of PWD, but currently many PWD are not medically monitored and managed for hearing loss and risk of falls. Proper care will require a change in audiological practice and in educational programs preparing students for careers in audiology.

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.

Have You Heard About Audiology?: Spread the Word to Grow Your Practice

Have You Heard About Audiology?: Spread the Word to Grow Your Practice

Adverse Childhood Experiences: Research, Effects, and Tools for Change

Adverse Childhood Experiences: Research, Effects, and Tools for Change

Gaining Greater Adherence from Patients for Amplification.

Every audiology curriculum features coursework and clinical practicum experiences on the knowledge and skills necessary to complete a basic audiological evaluation, diagnose the source of any abnormalities, and a plan for intervention. More advanced coursework typically includes information on balance disorders, newborn infant hearing screening, hearing conservation, amplification, and other electrophysiological tests. In addition, most programs include at least one course on the basic management principles on how to start and maintain a private practice in audiology. However, educational programs rarely include any type of coursework on how to handle common objections to obtaining help in the form of amplification. This is rather surprising considering that more than 90% of patients whom an audiologist evaluates have sensory neural hearing loss where the primary treatment is amplification, except for people with severe hearing losses who are candidates for cochlear implants. This lack of training and experience often leaves clinicians intimidated by common objections to treatment involving purchasing amplification. This article will discuss common objections that patients voice each day to obtaining amplification and will offer possible solutions.

Resale Product and Accessory Opportunities for Audiology Practices.

Patients need and/or want access to any number of products, including consumables and durable goods, and accessories as part of their audiology care. Audiologists have an opportunity to offer products and accessories for resale from their clinical office. Several methods for reselling items to established patients including an overview of an ecommerce approach successfully implemented by several individual audiology private practices will be reviewed. Upon completion, readers will be familiar with the general steps for incorporating an e-shop within an existing business Web site. Additionally, insights as to effective tactics for generating e-shop revenue will be shared.

Reprodutibilidade de testes de resolução temporal em adultos

O uso de testes comportamentais é uma prática clínica frequente na audiologia devido à sua grande contribuição ao diagnóstico e aos processos de intervenção fonoaudiológica. Objetivo: Verificar a reprodutibilidade dos protocolos de avaliação da resolução temporal em adultos. Método: Participaram da amostra 34 sujeitos, 22 do sexo feminino e 12 do masculino, com média de idade de 26,21 anos (20 a 52 anos; dp= 8,92) seguindo os critérios: ausência de histórico otológico e/ou audiológico e queixas escolares; normalidade no padrão audiológico e no teste dicótico de dígitos. Foram utilizados na pesquisa os testes Random Gap Detection Test e Gap in Noise, a 50 dB. Ambos foram aplicados em dois momentos, sendo a segunda aplicação com intervalo de uma semana da primeira. O teste Wilcoxon foi utilizado para análise do desempenho da amostra no teste GIN em função da orelha e Teste de Friedman para análise do RGDT em função da frequência testada nos dois momentos. Foi adotado o nível de significância de 5%. O coeficiente de correlação intraclasse foi utilizado na análise da concordância entre as aplicações teste(T1) e reteste (T2) pelo mesmo avaliador (reprodutibilidade). Resultados: Não houve diferença entre as frequências testadas no RGDT (média) no T1 e T2. Houve diferença no desempenho do GIN entre orelha direita e esquerda no T2. A reprodutibilidade de teste-reteste no RGDT (média) e GIN foi substancial conforme o coeficiente de correlação intraclasse. Conclusão: Há reprodutibilidade no teste RGDT quando comparada a média das frequências e no teste GIN bilateralmente.

Vestibular assessment and management in adults: South African audiologists’ expressed level of confidence and knowledge explored

Background: Vestibular assessment and management is within the scope of practice of audiology, and therefore audiologists are expected and required to assess and manage patients with vestibular disorders. Due to the developing nature of South Africa and the developing nature of audiology as a profession in the country, paucity of evidence-base regarding audiologists’ training and practice confidence in this field exists.Objective: To explore South African audiologists’ level of confidence and training in performing vestibular assessment and management.Methods: A survey research methodology with a cross-sectional research design was adopted, where a 29 item web-based survey was used to survey 32 audiologists from across the country. All audiologists surveyed were qualified and registered with the Health Professions Council of South Africa (HPCSA) independent practitioners. Data were analyzed using descriptive statistics.Results: Just over half of the participants (53.6%) conducting vestibular assessments in their practices. More than half (65.6%) of the audiologists received formal education from the university; while only 40.6% received clinical training. 59.4% of the participants were not confident in performing vestibular assessment; while 65.5% of participants were not confident in performing vestibular management. Over 80% of audiologists who were not confident in performing vestibular assessment and management work in public hospitals where over 70% of the South African population accesses health care.Conclusion: More audiologists are not confident in performing vestibular assessment and management, particularly those who are working in public hospitals. The findings raise implications for training and resource planning and allocation.

Economic Interplay of Medicare and Audiology

Over the past 10 years, numerous efforts have been undertaken to change the standing of audiology within the Medicare program. These efforts have focused on several key factors, including (1) allowing Medicare beneficiaries to access audiology services without a physician referral and (2) having Medicare pay for audiology treatment services such as audiologic rehabilitation or cerumen removal. These proposed changes are often tied to the political perspective of reducing costs to Medicare or more importantly, increasing patient access while reducing co-pays for Medicare beneficiaries and improving patient outcomes. To understand the financial impact of these efforts on clinical practices at the provider and patient levels, we looked into Medicare payments for audiologic procedures (current and previous years’ payments are available on the Medicare website). This information led us to access the Medicare databases that listed each individual audiologist and the specific characteristics of the beneficiaries they served. We discovered that Medicare tracks details such as how many Medicare beneficiaries are served by an audiologist, how many procedure codes are billed, the amount billed per provider, and the amount allowed by Medicare. These same databases include the demographic characteristics of patients served by each provider and, perhaps most interestingly, the percentage of patients with various comorbidities for each provider. For example, on average, nearly 65 percent of patients seen by audiologists in 2017 had hypertension, 55 percent had hyperlipidemia, 29 percent had diabetes, and 25 percent had chronic kidney disease. These data led us to question the relation of these comorbidities to hearing status, as well as the role of audiologists with respect to these comorbidities. The relationship between kidney disease and hearing loss has long been appreciated, and evidence of a more significant relationship between cardiovascular disease and hearing and between cognitive status and hearing loss is emerging. It certainly wouldn't be the role of audiologists to manage diabetes or hypertension, but might audiologists have a role in assessing the general health status of patients even if that assessment is asking the right questions? Or might the audiologist have a role in the early identification of comorbid conditions that helps reduce costs to patients and to payers? By extension, it is time to revisit the current audiology test battery to ensure that processes are sensitive and robust enough in identifying markers not only of hearing loss but also of other medical conditions. The Centers for Medicare and Medicaid Services (CMS) grant audiologists the right to provide reimbursable clinical services that are medically necessary to Medicare beneficiaries and, in return, expect outcomes and recommendations to help manage and treat these patients. By considering patients in the context of their overall health, audiologists may be able to provide further economic benefit to patients and payers, particularly if they can get beyond the pure tone audiogram and the idea that hearing loss exists in isolation from other health conditions. As we undertake this project to examine the financial impact of Medicare on audiology practices, we've come to realize that audiology practices can have a significant financial impact on Medicare and their beneficiaries. One of our key takeaways was that audiologists have the knowledge and skills necessary to identify, manage, and treat Medicare beneficiaries who have a confluence of health-related issues that may be identified early by the audiologist or mitigated by audiology services. Audiologists must proactively offer their full scope of hearing and balance services to these patients and secure our role in the evaluation and management of individuals with hearing and balance disorders. Thoughts on something you read here? Write to us at [email protected]

Examining the Utility of Photovoice as an Audiological Counseling Tool.

Photovoice is a participatory action research method in which people take photographs to represent real-world experiences, so that issues of interest/concern can be documented. There are no published studies in which photovoice has been used in audiological rehabilitation (AR). The purpose of this feasibility study was to examine whether photovoice could have application in audiology. A feasibility study was designed to determine whether photovoice could be adapted for use as a clinical auditory rehabilitation tool (1) to facilitate provision of tailored communication strategy counseling, (2) as a post-hearing aid fitting counseling tool, (3) to enhance communication between partners regarding hearing loss, and (4) to provide an understanding of the emotional impacts of hearing loss. In this combined qualitative and quantitative feasibility study, a photovoice intervention was given to four groups of participants. Twenty-four individuals were recruited from a research subject data repository at the National Center for Rehabilitative Auditory Research. The study involved two visits to the laboratory during which participants received instruction in photovoice methodology (visit 1) and then, one to two weeks later, discussed their photographs during a debriefing session (visit 2). The mean number of photographs taken by participants was 12.6 (range: 4-29); the mean duration of the debriefing sessions was 40:39 min:sec (range: 14:30-66:22 min:sec). Participants reported that participating had made them think more about their hearing problems, appreciate their hearing aids more, and be more aware of the situations in which their hearing aids did and did not help. The taking and discussion of the photographs was also described as a learning tool, and it had facilitated conversations with others about hearing problems. Participants who completed the study with their communication partner (use case 3) said it had assisted with problem-solving and gave insight into the perspective of their partner. The research team noted that photovoice facilitated highly tailored counseling and provision of evidence-based recommendations for hearing assistive technology, enhanced interaction between communication partners, provided insight into participants' lifestyle and communication needs, and seemed to generate rapport and trust. This feasibility study indicated that participants were willing to engage in photovoice and that it could be used to guide selection of rehabilitation recommendations and for postfitting counseling. Its application in audiological practice would seem timely and valuable for improving patient-centered and family-centered AR.

The Circle of Care for Older Adults With Hearing Loss and Comorbidities: A Case Study of a Geriatric Audiology Clinic.

Purpose Older adults seeking audiologic rehabilitation often present with medical comorbidities, yet these realities of practice are poorly understood. Study aims were to examine (a) the frequency of identification of selected comorbidities in clients of a geriatric audiology clinic, (b) the influence of comorbidities on audiology practice, and (c) the effect of comorbidities on rehabilitation outcomes. Method The records of 135 clients ( M age = 86 years) were examined. Information about comorbidities came from audiology charts (physical paper files) and hospital electronic health records (EHRs). Data about rehabilitation recommendations and outcomes came from the charts. Focus groups with audiologists probed their views of how comorbidities influenced their practice. Results The frequency of identification was 68% for visual, 50% for cognitive, and 42% for manual dexterity issues; 84% had more than one comorbidity. Also noted were hypertension (43%), falls (33%), diabetes (13%), and depression (16%). Integrating information from the audiology chart and EHR provided a more complete understanding of comorbidities. Information about hearing in the EHR included logs of outpatient audiology visits (75% of 135 cases), audiologists' care notes for inpatients and long-term care residents (25%), and entries by other health professionals (60%). Modifications to audiology practice were common and varied depending on comorbidity. High rates of success were achieved regardless of comorbidities. Conclusions In this clinic, successful outcomes were achieved by modifying audiology practice for clients with comorbidities. Increased interprofessional communication among clinicians in the circle of care could improve care planning and outcomes for older adults with hearing loss.

5 Steps to Avoid Medical Errors in Audiology Practice

5 Steps to Avoid Medical Errors in Audiology Practice

Graduate training opportunities in the hearing sciences at the University of Louisville

The University of Louisville currently offers two branches of training opportunities for students interested in pursuing graduate training in the hearing sciences: A Ph.D. degree in experimental psychology with concentration in hearing science, and a clinical doctorate in audiology (Au.D.). The Ph.D. degree program offers mentored research training in areas such as psychoacoustics, speech perception, spatial hearing, and multisensory perception, and guarantees students four years of funding (tuition plus stipend). The Au.D. program is a 4-year program designed to provide students with the academic and clinical background necessary to enter audiologic practice. Both programs are affiliated with the Heuser Hearing Institute, which, along with the University of Louisville, provides laboratory facilities and clinical populations for both research and training. An accelerated Au.D./Ph.D. training program that integrates key components of both programs for training of students interested in clinically-based research is under development. Additional information is available at http://louisville.edu/medicine/degrees/audiology and http://louisville.edu/psychology/graduate/vision-hearing.