Audiology Services Research Articles

Availability of rehabilitation services for communication disorders in Sri Lanka: a cross-sectional survey

ObjectivesTo describe the rehabilitation services available for communication disorders in Sri Lanka and to estimate the adequacy of the services in provinces and districts of the country.SettingThe study considered government...

Integrating services

Andrew McClean explores the benefits of introducing audiology services in-house or via a third party

Hearing healthcare utilisation among older adults with self-reported hearing loss during the COVID-19 pandemic in the United States

Objective To ascertain the prevalence, causes, and risk factors of hearing healthcare delays in older people with self-reported hearing loss in the United States. Design This cross-sectional study used data from the National Health and Ageing Trends Study (NHATS), a nationally representative survey of Medicare beneficiaries. A supplemental COVID-19 survey was mailed to the participants from June to October 2020. Study sample By January 2021, 3257 participants had returned completed COVID-19 questionnaires, with the majority having been self-administered between July and August 2020. Results The participants in the study represented 32.7 million older adults in the US, with 29.1% reporting hearing loss. Among over 12.4 million older adults who put off needed or planned medical care, 19.6% of those with self-reported hearing loss and 24.5% of hearing aid or device users stated they delayed hearing appointments. Approximately 629,911 older adults with hearing devices were impacted by the COVID-19 outbreak for audiological services. The top three reasons were deciding to wait, service cancellation, and fear of going. Education and race/ethnicity were associated with delaying hearing healthcare. Conclusions The COVID-19 pandemic impacted hearing healthcare utilisation among older adults with self-reported hearing loss in 2020, with both patient- and provider- initiated delays.

Opportunities and Challenges for Audiology and Speech-Language Pathology Services in Arabic-Speaking Middle East Countries

Purpose:This article outlines opportunities and challenges pertaining to service delivery faced by audiologists and speech-language pathologists/therapists working in Arabic-speaking Middle Eastern nations. Among the most diverse regions in the world, the Middle East is a region characterized by rapid development in a number of sectors relevant to audiology and speech-language pathology, including education and health care. Despite these developments, there remains a number of challenges, including growing service demands, awareness of the scope of practice of audiologists and speech-language pathologists/therapists, regulation of clinical practice, and shortages of clinicians and evidence-based clinical resources.Conclusion:Developments to address these challenges, as well as strategies that may enhance service delivery, will be presented.

Challenges Faced by Individuals with Hearing Impairment during COVID-19 Pandemic Lockdown in India - A Pilot Study.

COVID - 19 (Corona Virus Infectious Disease) situations reported in 2019, declared by World Health Organization (WHO) as a pandemic is still a prevailing global crisis. Common regulations were implemented such as lockdown, wearing face masks as mandatory, face shields, gloves and maintaining physical and social distance in public places to reduce the spread of the virus. These pandemic induced challenges affected social communication, technical and behavioral aspects in lifestyle of people with hearing impairment. Along with medical, paramedical services, the crisis had challenged hearing, speech language pathology and therapy services too. The study aimed to explore the challenges that adults with hearing impairment had experienced during the pandemic and to suggest some practical solutions that can be implemented by audiologists. It is a questionnaire-based study with purposive sampling method employed in data collection. The questionnaire was administered on adult hearing aid users (mean age: 18 years) recruited for participation from different parts/ clinical setups across India. The outcome of the questionnaire did support the assumption that availing audiological services was difficult or impossible for most of the hearing aid users. Accessing batteries was reported to be the most frequent issue. Adequate level of hearing though hearing aid was important to them and clinical services could not be availed for long period of time due to travel related issues and closure of audiological services. Also, social isolation impacted on their quality of life and effective communication. As a possible solution most of the users chose tele services as a better solution.

Education Intervention on 'Hearing Impairment - Its Assessment and Management' among Medical Practitioners in Sikkim, India.

Health care providers must be aware of the choices in aural rehabilitation methods and assessment procedures available presently to those with hearing impairment in order to facilitate early identification and intervention and ensure quality of care to those hearing impaired individuals. The referrals from the medical fraternities for the audiological services are not uniform across India. Part of reason may be that awareness about the roles of and responsibilities of audiologist's is poor among medical practitioners. In some regions of India medical practitioners may be only grossly be aware of audiologists per se. They may not know enough to refer all individuals with hearing or balance disorders for the required audiological services. To evaluate changes in pre survey and post survey after education intervention specifically planned for medical practitioners in the state of Sikkim, India. Education intervention included awareness about hearing impairment and its assessment and management by audiologists. A pre and post survey comparison research design with purposive convenient sampling technique was applied. Participants were medical practitioners working in geographical area of Sikkim at the time of the study. Inspection of demographic data of respondents showed that they were in their age range of 24 and 60 years and with work experience ranging 1-40 years. Participants were invited for an awareness talk which included, information about hearing loss, early identification and early intervention, tests and management of hearing loss in different age groups, need for hearing aids/cochlear implants, auditory training, and the role of an audiologist in the management of hearing loss and ways to prevent hearing loss. A pre and post awareness program responses were collected from all the participants using a customized questionnaire tool. Respondents exhibited, in the pre-survey questionnaire, lack of awareness in many aspects of audiology, including assessing hearing impairment, diagnosing hearing loss, and the role of an audiologist. There was an overall, statistically significant difference in the level of performance on the pre-awareness and post-awareness responses. Following an awareness campaign among the medical professionals in Sikkim, there was a considerable change in their level of awareness of hearing impairment, its assessment, and management by audiologists. The reach of the awareness campaign was significant as around 70% of subjects showed significant change in their knowledge and attitude towards hearing impairment, its management.

Survey on Knowledge and Attitudes toward Hearing Loss and Assistive Listening Technology among Educational Professionals

Abstract Introduction: Based on review of the literature, the academic difficulties secondary to hearing loss have been well documented, as have been the effectiveness of assistive technology (hearing aids, cochlear implants, and FM systems) and efficacy of additional classroom modifications to decrease the degradation of auditory stimuli for listeners with hearing loss. This is an important issue due to the number of school aged children with hearing loss. Aims and Study: The purpose of this study was to determine classroom teachers’ knowledge of and experience with students with hearing loss. Methodology: Subjects were teachers who were recruited via email addresses obtained through websites . Schools were selected based on their districts being contracted for educational audiology services. Recruitment emails were sent to 300 teachers with different grades were selected. A 35-item questionnaire was created through Google form, a survey generating website. This questionnaire was used to obtain information about teachers ’opinions, experience, and familiarity about the impact of hearing loss in the classroom. Questions regarding willingness to work with students with hearing loss were also included. Results: Were based on Experience/Knowledge of Hearing Loss, Willingness to Work with Children with Hearing Loss & familiarity about the hearing loss in children. Conclusion: The study indicated that teachers do not generally receive specific education regarding working with children with hearing loss. The majority of teachers who did have education obtained it from schooling or continuing education/seminars.

アンケート調査からみた聴覚領域の業務に携わる言語聴覚士の実態について

要旨: 令和2年度に行った「聴覚領域の業務に携わる言語聴覚士の実態調査」の結果にクロス集計及びテキストマイニングを行い, 言語聴覚士の実態を検討した。 教育施設では医療・福祉施設に比べ, 補聴器・人工内耳関連業務が少ない傾向が認められ, 医療施設内でも所属する科により業務内容に差があることが分かった。 一方で常勤・非常勤の違いによる勤務状況には差が少ないことが推測された。 聴覚関連検査のうち電気生理学的検査を実施している割合は少なく, 検査技師などとの分業が推測された。 各職種連携では医療施設勤務で言語小児難聴にかかわっている場合, 学校教諭や保育士との連携が取れない例が目立った。 卒後教育については, 指導者不足の状況が明らかとなり, 成人領域では今後増加する人工内耳装用者へ対応するため教育・雇用機会の増大が望まれ, 小児領域では臨床経験の機会提供や, 地域教育施設との連携のノウハウ提供が望まれるという意見が多かった。

Impact of COVID-19 Pandemic on Older Adults Using Hearing aid/s: Indian Scenario.

The online version contains supplementary material available at 10.1007/s12070-022-03209-8.

Reflexiones frente al acceso a los serviciosde audiología en el sistema de salud colombiano: una mirada desde los determinantes sociales de la salud

La Comisión de los Determinantes Sociales de la Salud corrobora con suficiente evidencia que las condiciones en las que las personas viven y se realizan en sus proyectos de vida determinan la salud o la enfermedad de individuos y colectivos en sus diferentes territorios. En este sentido, el acceso y uso a los servicios de salud es uno de los tantos determinantes sociales que afecta la salud de la gente, puesto que no todos acceden de la misma manera, ya sea por régimen de afiliación, por zona geográfica, barreras administrativas, culturales, etc, que hacen que grupos poblacionales por raza, género, etnia, etc. tengan serias limitaciones en el acceso al sistema. En audiología se han hecho aproximaciones a algunos determinantes sociales de la salud pero no con suficiente contundencia que establezcan relaciones entre dichos determinantes, los servicios de audiología y el sistema de salud que opera bajo la lógica de mercado regulado y le da amplia participación al sector privado por encima del sector público. En esta medida, la reflexión con este artículo motiva a la importancia de abrir nuevas oportunidades en investigaciones para los profesionales en Fonoaudiología, especialistas en audiología, que se ocupen del sistema de salud y allí lo que ocurre con los servicios de audiología.

Impact of the COVID-19 Pandemic on Individuals With Hearing Loss and Audiology Practice in a Developing Country.

This study aimed to determine the challenges faced by individuals with hearing loss at a time when many nations were attempting to move from the COVID-19 pandemic to endemic. A cross-sectional survey was conducted on Malaysian adults with hearing loss to determine the impact of the COVID-19 crisis on hearing aid management, communication difficulties, psychosocial challenges, and access to audiological services. One hundred forty-six individuals aged 18 years old and above with hearing loss were recruited from hearing health care centers to participate in the survey. Many of the participants (54.2%) reported significant difficulties communicating with people wearing face masks. For hearing aid management, repairing (36.3%) and fine-tuning devices (30.2%) were considered more challenging than obtaining a battery (21.3%). The COVID-19 pandemic had a serious psychosocial impact on a small portion of the individuals surveyed. Remote services were rarely offered by the audiologists, and most participants preferred in-person treatment. However, the majority perceived that creating awareness and training on telehealth was important. Effective management for people with hearing loss needs to consider the challenges faced by them, as the world prepares to live with the coronavirus. Clinical protocols should consider providing a service that is helpful for the clients as well as safe and sustainable in future pandemics.

The development of a Self-Rated ICF-based questionnaire (HEAR-COMMAND Tool) to evaluate Hearing, Communication, and Conversation disability: Multinational experts' and patients' perspectives.

An instrument that facilitates the advancement of hearing healthcare delivery from a biomedical model to a biopsychosocial one that underpins the International Classification of Functioning, Disability, and Health framework (ICF) brief and comprehensive Core Sets for Hearing Loss (CSHL) is currently unavailable. The objective is to describe the process of developing and validating a new questionnaire named the HEAR-COMMAND Tool created by transferring the ICF CSHL into a theory-supported, practically manageable concept. A team from Germany, the USA, the Netherlands, and Egypt collaborated on development. The following ICF domains were considered; "Body Functions" (BF), "Activities and Participation" (AP), and "Environmental Factors" (EF). The development yielded English, German, and Arabic versions. A pilot validation study with a total of 109 respondents across three countries, Germany, Egypt, and the USA was conducted to revise the item terminology according to the feedback provided by the respondents. The questionnaire included a total of 120 items. Ninety items were designed to collect information on the functioning and 30 items inquiring about demographic information, hearing status, and Personal Factors. Except for the "Body Structures" (BS) domain, all the categories of the brief ICF CSHL were covered (a total of 85% of the categories). Moreover, the items covered 44% of the comprehensive ICF CSHL categories including 73% of BF, 55% of AP, and 27% of EF domains. Overall, the terminology of 24 ICF-based items was revised based on the qualitative analysis of the respondents' feedback to further clarify the items that were found tod be unclear or misleading. The tool highlighted the broad connection of HL with bodily health and contextual factors. The HEAR-COMMAND Tool was developed based on the ICF CSHL and from multinational experts' and patients' perspectives with the aim to improve the execution of audiological services, treatment, and rehabilitation for adult patients with HL. Additional validation of the tool is ongoing. The next step would be to pair the tool with BS categories since it was excluded from the tool and determine its effectiveness in guiding hearing health care practitioners to holistically classify categories influencing hearing, communication, and conversation disability.

The Credibility of a Smartphone-Based Application for use as a Hearing Screening Tool in Underserved Areas

Context: Hearing loss has been rightly regarded as “invisible disability.” Globally, it is the third largest cause for years lived with disability. It is imperative to detect it early to initiate remedial measures. We intended to find a cheaper, quick, and reliable alternative to the traditional audiological services. Aims: The aim of this study was to assess the hearing levels using a self-administered smartphone hearing application and compare these results with pure-tone audiograms performed by an audiologist. Settings and Design: This diagnostic study was conducted at a tertiary care hospital in the State of Puducherry, between 2019 and 2021. Subjects and Methods: One hundred and nineteen participants were recruited; hearing screening was done using the smartphone application “Hearing Test” followed by pure-tone audiometry. Statistical Analysis Used: The results were analyzed for validity and reliability using SPSS software. Results: The mean age was 34.23 ± 9.39 years, and 57.1% had ear complaints at presentation. At the level of statistical significance of P = 0.05, no difference was found between the tests. An absolute difference of <6.712 for each frequency was observed with the average difference being 5.18 dB (95% confidence interval 5.65–4.73) with standard deviation of 3.56. The smartphone application demonstrated a sensitivity of 76.26% and a specificity of 98.99%. Conclusions: We did not find any significant difference between the application and pure-tone thresholds in any frequency. Thus, the Hearing Test application is a valid screening tool to assess hearing loss early.

Outcomes from 7years of a direct to audiology referral pathway.

BackgroundThe direct to audiology via ENT referral pathway was designed to enhance patient access to audiology services. The pathway is recommended in the Otolaryngology Head & Neck Surgery: a model of care for Ireland report, published in 2019.AimsThis study aimed to review the outcomes of all patients that attended our institution over the last seven years.MethodsA retrospective review of the direct to audiology referral service from March 2014 to December 2021 was conducted. Outcomes were defined by the pathway each patient took following attendance at the audiology clinic. Patients were either (i) discharged, (ii) referred for hearing aid(s) or (iii) identified as candidates for further diagnostic assessments, including a follow-up at the ENT outpatient clinic.ResultsDuring the time frame, 419 patients were triaged to the pathway. The average wait time was 13 days. The average age was 53 years (range 16–96 years, SD = 6.1). Approximately 34% (n = 143) of all patients referred were discharged back to the GP by the audiologist, but 66% (n = 276) presented with ‘red flags’ and needed further investigation in the ENT clinic, with 30% (n = 73) ultimately requiring imaging studies. Over half (n = 254, 61%) were referred for hearing aids.ConclusionThe direct to audiology initiative has proven effective at reducing waiting times for ENT patients solely in need of audiological intervention. Approximately one-third of these referrals to the ENT service can be assessed comprehensively in the audiology clinic, thereby reducing the demand for ENT clinics, enhancing service provision and expediting onwards referral for amplification.

How the Past Shapes the Future and What to Do About It: A Discussion at CI 2021 Virtual With Panelists: Teresa Caraway, Ph.D., C.C.C.-S.L.P.; Cliff Megerian, M.D.; Debara Tucci, M.D., M.S., M.B.A.; Peter Thomas, J.D.; Jason Wigand, Au.D.

This report summarizes the highlights of a lively discussion between leaders in the cochlear implant (CI) field who also bring significant leadership experience at the practice and health system levels, as well as policy and research perspectives. The discussion revealed several areas in which established patterns of practice should be reconsidered to facilitate wider acceptance of the CI as part of an integrated continuum of hearing healthcare. The importance of continued innovation to advance outcomes, lower cost, and increase access was emphasized. Trends in healthcare funding, which increasingly reward quality at lower cost, will also challenge longstanding assumptions that have influenced program design. Proactive efforts that pursue consistent value in the episode of surgical care while establishing innovative delivery models for audiological and rehabilitation services are the best hope for a future of equitable access and expanding impact.

'All of a sudden, you know, you can't go to these services, because of the risk of infection': Audiological service considerations at residential care homes for older persons during COVID-19.

BackgroundResidential care homes for older persons were especially affected during the coronavirus disease 2019 (COVID-19) pandemic lockdowns which resulted in limited social interactions and service provision. Communication became challenging due to the prophylactic use of masks and social distancing.ObjectivesThis qualitative research study set out to explore audiological service considerations in residential care homes for older persons during the COVID-19 restrictions.MethodThrough purposive sampling, nine managers from residential care homes for older persons in Johannesburg participated in semi-structured, online interviews. The transcriptions of these recorded interviews underwent thematic analysis.ResultsManagers employed various strategies to attend to residents’ audiological needs, audiological health, hearing aid use, and hearing aid provision. Furthermore, it transpired that other health related services were prioritised over audiological services in general, but especially during the pandemic lockdowns. Managers reported that staff had to use various communication strategies due to COVID-19 precautions and that masks and social distancing made communication more challenging for residents with hearing loss. Moreover, isolation and modified service provision were extremely taxing on residents.ConclusionThis study highlights the need for continued audiological services at residential care homes, but also the need to balance audiological needs with other health needs because these seem to be prioritised over hearing loss, especially in this population who may have limited agency and choice in the health care options available to them. Furthermore, adapted strategies need to be considered to support communication considering COVID-19 precautions so that communicative difficulties do not exacerbate lockdown isolation.

How to Improve Audiology Services: The Patient Perspective

How to Improve Audiology Services: The Patient Perspective

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.

Establishing the reliability and the validity of the Arabic translated versions of the Effort Assessment Scale and the Fatigue Assessment Scale

Objective The aim was to establish the reliability and the validity of Arabic translated versions of the Fatigue Assessment Scale (FAS) and the Effort Assessment Scale (EAS). Design The FAS and the EAS were translated from the original English following a recommended six-step approach for translating hearing-related questionnaires for different languages. The reliability of the scales was investigated using Cronbach’s alpha, item-total correlation, and inter-item correlation. Construct validity was investigated using factor analysis and the hypothesis testing method. Study sample The translated scales were completed by 146 participants from Jordan and Saudi Arabia (age range 19–86 years old, 39% male). Participants’ hearing level ranged from normal to profound. Results Item 3 in the translated FAS was removed to improve the scale’s construct validity. The translated version of the EAS was found to be as reliable and valid as the original EAS. Conclusions The availability of standardised versions of the FAS and the EAS provides a quick and easy method for improving hearing rehabilitation in Arabic-speaking countries where audiology services can often be costly and not necessarily accessible to all individuals.

Clinicians' and Managers' Views and Experiences of Audiology and Speech-Language Pathology Service Provision for Culturally and Linguistically Diverse Families of Young Children With Hearing Loss.

This study aimed to gather the views and experiences of clinicians and managers on early intervention audiology and speech-language pathology services for culturally and linguistically diverse (CALD) families of children with hearing loss. This qualitative descriptive study involved 27 semistructured interviews with audiologists, speech-language pathologists, and managers working with CALD families of young children with hearing loss. Purposeful sampling was used to recruit participants from three hearing centers working with these families. Interviews were analyzed using thematic analysis. Analysis of the data resulted in five themes: (a) There were perceived added complexities for CALD families in accessing and being involved in services and receiving information; (b) there were perceived family-provider relationship complexities, cultural differences, and service delivery challenges in working with CALD families; (c) clinicians and managers used various strategies for service provision of CALD families; (d) involving interpreters benefited service provision but was challenging at times; and (e) looking to the future and recommendations for clinical practice. Current practices reflect some principles of family-centered care for CALD families of young children with hearing loss. Families and services may benefit from more support regarding family-provider partnerships, information materials and child assessments, working with interpreters, and center support for time and resources. https://doi.org/10.23641/asha.20044427.