Aural Rehabilitation Services Research Articles

Survey of Aural Rehabilitation Services: 2002 to 2022

Survey of Aural Rehabilitation Services: 2002 to 2022

Survey of Auditory Training Awareness for Hearing Professionals and Elderly Individuals Using Hearing Aids

Purpose: The purpose of this study was to identify the demand for auditory training provision and survey beneficiary experience.Methods: A total of 161 participants (80 hearing professionals and 81 elderly hearing aid users) were surveyed online or in-person. Both groups completed 26 questions related to their experience of providing or receiving auditory training, awareness of need, and preference.Results: The hearing professional group was strongly aware of the need to provide auditory training to improve communication problems in elderly individuals using hearing aids, and the absence of a systematic auditory training program was the biggest factor in not providing auditory training. The elderly hearing aid user group also recognized the need for auditory training to improve communication problems, but they responded that the hassle of visiting a clinic for training and lack of training time were factors that made participation in auditory training difficult.Conclusion: Hearing professionals should expand the scope of aural rehabilitation services to provide effective auditory training programs that fit the concept of rehabilitation, rather than simply providing hearing aid fitting management services to improve communication skills. Therefore, hearing professionals should conduct an intervention program after hearing aid fitting for elderly hearing aid users so that hearing rehabilitation can be comprehensively performed according to auditory and cognitive perceptual changes. In addition, efforts are required to solve limitations that make it difficult for elderly individuals who use hearing aids to participate in auditory training, such as the development of a web-based auditory training program.

Audiologists' Perceptions of Hearing Healthcare Resources and Services in South Africa's Public Healthcare System.

Hearing loss poses a significant burden globally. Its prevalence is exceptionally high in countries across the African region, where healthcare resources and services remain inaccessible. This study aimed to describe audiologists' perceptions regarding hearing healthcare resources and services within South Africa's public healthcare system. A national self-developed telephonic survey was conducted with audiologists in public healthcare system hospitals across South Africa, with the final sample comprising 100 audiologists. Most (82%) audiologists indicated that their hospitals did not have adequate hearing healthcare resources to render efficient audiology services to patients. Binaural amplification devices (invasive and non-invasive) for adults with bilateral hearing loss who adhered to the criteria for these devices were perceived to be unavailable in most hospitals. Audiologists also perceived that universal newborn hearing screening services, adult aural rehabilitation services, and follow-up care for all hearing devices post-warranty expiration were limited. Efforts should be made to upsurge hearing healthcare resources, including increasing the financial budgets allocated to audiology resources so that increased diagnostic and screening audiology equipment and hearing devices can be procured where required, and additional audiologists can be employed within the South African public sector hospitals where needed.

Designing and Implementing a Comprehensive Telehealth Aural Rehabilitation Program for Adult Cochlear Implant Recipients

Purpose: A comprehensive aural rehabilitation (AR) program incorporates sensory management, perceptual training, counseling, and instruction. However, the process of designing and implementing such a program is inconsistent across clinical sites, and additional information regarding the use of teleaudiology to implement AR services is needed. The purpose of this clinical focus article is to describe the process of creating and implementing a comprehensive teleaudiology AR program for older adults who use cochlear implants (CIs) at the University of South Alabama (USA) Speech & Hearing Center. Conclusions: A comprehensive teleaudiology AR program may be successfully designed and implemented for older adult populations. Information provided in this clinical focus article may serve as a guide or example for other trained health care professionals looking to create an in-person or telehealth AR program for older adults who use CIs. Supplemental Material: https://doi.org/10.23641/asha.16755289

A Randomized Controlled Trial Using Automated Technology for Improving Ototoxicity Monitoring in VA Oncology Patients

Purpose Determine the efficacy of ototoxicity monitoring (OM) administered as automated protocols with the Oto-ID mobile audiometer (automated ototoxicity monitoring [A-OM]), compared with usual care (UC) OM in cancer patients receiving cisplatin. Method Participants were patients (n = 46, mean age 64.7 years; range: 30-78 years) receiving cisplatin-based chemotherapy at the Department of Veterans Affairs Portland Health Care System. A randomized controlled trial contrasted A-OM and UC at up to three program evaluations (PEs) conducted by the study audiologist who was blinded to arm through PE1. PE1 occurred before randomization or oncology treatment; PE2 and PE3 occurred during and/or after treatment at 35 and 365 days postrandomization. The A-OM group (n = 24) used Oto-ID to screen their hearing before each cisplatin dose. Oto-ID results were sent to the study audiologist for interpretation, follow-up, and care coordination. The UC group (n = 22) received a consult for OM services through the audiology clinic. Outcomes included hearing shift near each patient's high-frequency hearing limit, revised hearing-handicap inventory score, and survival time from the start of treatment. Adherence to OM protocols, patients' use of aural rehabilitation services, and oncologists' treatment decisions were also examined. Results Ototoxicity was identified at a high overall rate (46% and 76% at 35 and 365 days, respectively, postrandomization). Adherence to monitoring prior to each cisplatin dose was 83.3% for those randomized to A-OM compared with 4.5% for UC. Randomization to A-OM was not associated with reduced ototoxic hearing shifts or self-reported hearing handicap relative to UC; neither did it compromise participants' survival. Half of participants in each arm accessed aural rehabilitation services. One in each arm had a documented ototoxicity-related cisplatin dose reduction. Conclusions Auditory impairment was an actionable concern for the participants and their oncology providers. A dedicated surveillance program using the Oto-ID's automated protocols improved adherence to OM recommendations over a traditional UC service delivery model. Supplemental Material https://doi.org/10.23641/asha.16649602.

Qualitative research methods to investigate communication within a group aural rehabilitation intervention

Objective: Aural Rehabilitation (AR) aims to minimise negative effects of hearing loss. However, there has been limited study of the lived experience of clients receiving Aural Rehabilitation services, particularly for disparity populations. The purpose of this study is to demonstrate the use of an innovative qualitative approach to investigating communication in an AR setting among Hispanic/Latino older adult dyads.Design: We developed a qualitative phenomenology approach using observation methods to document and analyse how individuals experience living with acquired hearing loss within group AR. Trained observers collected systematic, detailed notes on observations of participants over the course of a 5-week community-based AR intervention. In partnership with audiologists, Community Health Workers facilitated the intervention, which focussed on decreasing negative communication impacts of hearing loss for families. Audiometric data and subjective hearing disability results, using the HHIE-S Spanish version, are presented as additional context for observation outcomes.Study sample: Participants were older Hispanic/Latino adults with hearing loss and their frequent communication partners (five dyads).Results: Four themes related to the experience of communication emerged among dyads in the intervention: (i) emotions related to hearing loss (ii) communication dynamics, (iii) self-management of hearing loss, and (iv) hearing health advocacy.Conclusions: A mixed methods approach that includes group observation would contribute substantially to comprehensively evaluating group AR interventions.Trial registration: ClinicalTrials.gov identifier: NCT03255161.

Employ Audiology Assistants to Grow Your Practice

Employ Audiology Assistants to Grow Your Practice

Epidemiological and rehabilitation analyses of patients with hearing disabilities of Uyghur and Han Chinese ethnicities in Xinjiang, China: a comparative study

The main objective of this study was to explore the differences in epidemiological characteristics and rehabilitation needs between Uyghur and Han Chinese ethnicities, with a view to providing a foundation for the development of effective hearing-disability rehabilitation policies in Xinjiang, China. We conducted a population-based epidemiological study. The epidemiological characteristics of the aural disabilities were examined and demand for aural rehabilitation services evaluated. We further investigated the demographic characteristics of the hearing-disability populations from different ethnic communities in Xinjiang and the social-environmental support provided. Subjects were randomly selected from individuals aged 2 years and above with a hearing disability who were registered in the Xinjiang Disabled Persons’ Federation. Analyses were performed on two population groups (Uyghur and Han Chinese ethnicities) in Xinjiang, China. Subjects were selected via simple random sampling, and the χ2 test was used for data analysis. Our results disclosed a higher prevalence of hearing disabilities in males than females. Moreover, the recovery service demand rate of patients from Southern Xinjiang was higher than that of individuals from Northern Xinjiang. The collective findings strongly highlight the overall need to focus on meeting the high demand for barrier-free facilities and assistive devices. Rehabilitation services offered by the government are not in line with demand. Comprehensive assessment of the rehabilitation requirements of hearing-disability patients, systematic provision of adequate services and training of technical personnel are important measures that should be adopted to alter the present situation and improve treatment options for hearing disabilities in China.

Practices and views of audiologists regarding aural rehabilitation services for adults with acquired hearing loss.

BackgroundHearing loss in adults is one of the leading disabilities globally. It is managed through aural rehabilitation for which there is a paucity of literature in South Africa. This raises the question of interest, the integrity of holistic service provision amongst audiologists and whether interest and challenges affect current practices.ObjectivesTo describe audiologists’ practices and views on aural rehabilitation services for adults, including interest and challenges experienced.MethodA descriptive online survey was completed by 45 of 1440 invited practicing audiologists who were members of the two national professional associations in South Africa. Each association emailed the questionnaire link to all its members. Data were analysed using the Statistical Package for the Social Sciences version 21, and included the paired samples t-test and chi-squared tests.ResultsThe most provided services were hearing aids (81.4%), communication strategies training (69.8%) and informational counselling (79.8%). A strong interest was reported by most for each service. Challenges included limited client compliance, unaffordability of services, limited undergraduate training, language barriers, unrealistic expectations and individual differences. Statistically significant differences between service provision, interest and challenges indicated that these are influential but not individually significant to service provision.ConclusionImbalanced service provision, high interest and many more challenges are experienced. These factors contribute but are not solely markedly influential in service provision.

Aural Rehabilitation in Private Practice

Aural rehabilitation refers to sensory management, auditory speech perception training, and counseling services provided to those with hearing loss and their communication partners. The goal of aural rehabilitation is to reduce the impact that hearing loss has on communication and daily function. There is ample evidence confirming the effectiveness of aural rehabilitation, however, comprehensive aural rehabilitation services are rarely offered in the private practice setting. Lack of time, compliance, and reimbursement have been suggested as possible reasons for the rare provision of aural rehabilitation services. The purpose of this article is to provide the reader with a simple framework for efficiently incorporating aural rehabilitation services into a busy private practice. It is suggested that both client and clinician compliance will improve when clinicians become proficient with a few select tools in the areas of assessment, education and counseling, auditory training, and follow-up. In today's changing marketplace, it is critical for private practice clinicians to set themselves apart from the commodity options by offering comprehensive aural rehabilitation services.

Listening and Learning: Using Telepractice to Serve Children and Adults with Hearing Loss

Families of children with hearing loss and adults who also have been diagnosed with hearing loss require audiologic management, effective hearing technology, and consistent intervention or rehabilitation to improve their communication. Parents of young children with hearing loss who have chosen a listening and spoken language approach, such as Auditory-Verbal Therapy (AVT), may struggle to find qualified providers who can deliver these services. Similarly, adults with hearing loss also may find it challenging to enroll in aural rehabilitation services due to a lack of availability. The Telepractice and eLearning Laboratory (TeLL) in the School of Speech-Language Pathology and Audiology at the University of Akron has developed a model of telepractice service delivery to provide AVT to families of young children with hearing loss and adult aural rehabilitation services. This paper describes the rationale for establishing these services and a general framework that guides service delivery.

Editorial

Figure: Kenneth E. Smith, PhDFigure: Larry Engelmann, AuDThe Academy of Doctors of Audiology (ADA) should be applauded for developing the “18x18” initiative. It positions audiologists as an entry point into the healthcare system for hearing and balance services, representing a real improvement in public access to audiologic care. The legislation proposed by the ADA would amend Title XVIII of the Social Security Act by 2018. Currently, Medicare requires a written order/referral from a physician or other specialist in order to cover diagnostic audiology services. The order/referral cannot include any statement about evaluating the patient for the purpose of fitting hearing aids. The documentation of medical necessity is the audiologist's responsibility, regardless of the referral source. Several glaring problems are addressed by this initiative: The referral technically can come from any medical specialty, including obstetrics, dermatology, podiatry, optometry, and other disciplines unrelated to hearing and balance issues. The evaluation can be repeated only if a change in hearing and balance is suspected and that change has a high probability of being a medical issue. This latter requirement leads to additional expense for the patient and to Medicare, as well as more appointment time for the physician. Adding audiologists to the list of direct providers would result in more efficient, timely, and cost-effective care to patients from practitioners eminently qualified to diagnose and treat hearing and balance disorders. The result would be a direct savings of time and cost, as well as the implied option to address the Medicare referral and reimbursement requirements. The Academy of Doctors of Audiology has made it clear that “18x18” is not merely an ADA project. Rather, this initiative creates a golden opportunity to unite the profession and include all national organizations representing audiology, as well as state audiology organizations; doctoral programs, including faculty and students; and licensing boards. This initiative combines the American Academy of Audiology's work advocating for direct access to audiologists and the American Speech–-Language–Hearing Association's efforts promoting reimbursement to audiologists for aural rehabilitation and vestibular rehabilitation services, which currently are reimbursable to speech–language pathologists and physical therapists, respectively, but not audiologists. The ADA-proposed legislation would recognize audiologists as limited license physicians under Medicare for reimbursement purposes. There is a risk that this change might diminish the role of primary care physicians. Why is this issue relevant to patient care? Every bit of survey data available to us supports the fact that the primary care physician is the main motivator of patient behavior and action to seek hearing healthcare. The role of the primary care physician assumes even more importance when one considers the impact of hearing loss on quality of life, depression, dementia, Alzheimer's disease, and other critical medical issues. In our opinion, unless audiologists continue and expand their education of primary care physicians, market penetration figures will stay exactly where they are, regardless of the entry point for services. This issue requires more, not less, attention in AuD programs. Change? Yes. The audiologist should be an entry point to hearing and balance care. Change? No. The role of the primary care physician remains critical to the early identification and treatment of hearing and balance problems. More on ‘18X18’ Next Month HJ's cover story explores scope-of-practice issues in hearing healthcare, and how this initiative can help.

Environmental design-An expanding role in hearing rehabilitation for older adults

INTRODUCTION The role of the audiologist in aural rehabilitation services on behalf of older adults with hearing impairment is expanding, just as our knowledge of hearing in aging likewise expands [1]. In the past, audiologists generally found that they could not do as much as they desired to assist their older patients in acoustic design modifications to alleviate or prevent environmental interference in communication. This was, in part, probably a result of a lack of academic preparation in the area of environmental design. Training in that area has, in most instances, not been generally available in the majority of preparatory programs. This lack of information has restricted audiology students from learning about an important service that can improve the communicative efficiency of many older adults with impaired hearing function. Rather than letting colleagues continue to rely on a seat of the pants approach to environmental design, this editorial will introduce the concepts and principles of environmental design that take into account aspects of hearing impairment in older adults, including design concepts and the physiological bases for those design considerations. AUDITORY CHANGES IN AGING The complexities involved in the peripheral and central nervous system (CNS) auditory components of presbycusis, along with the compounding effects of the auditory environment, can negatively influence an older adult's ability to communicate in their frequented listening environments. Many public and private listening environments play havoc with aging peripheral and CNS auditory systems. Adults who, at an earlier age, may have noted only some difficulty in specific degraded listening environments may now be experiencing frustrating difficulty. They may blame the difficulties on the speaker, when the problem might be the reverberant characteristics of the meeting room, the anechoic environment of their home, or auditory distractions. These older adults with hearing impairment might begin to avoid places where they would otherwise like to be, increasing their social isolation. Changes in both the peripheral and CNS auditory systems can occur in conjunction with advancing age. The following classic example presents a concise summary of the insidiousness of those changes: Unlike Dr. Oliver Wendell Holmes' New England Deacon who built the wonderful one-horse shay, the architect of the cochlea did not design it to give perfect service for 'a hundred years to a day,' or even for the traditional three-score-and-ten. Its condition in old age, however, seldom represents the effects of aging alone, but rather the accumulative, combined assaults of noise and drugs, as well as [2, p. 139] Many older adults experience a gradual decline in the CNS auditory system's ability to process the acoustic complexities of speech with the speed and accuracy that they possessed in their younger years. If the slightest decline in speed and precision at the level of the brain stem and/or auditory cortex needed to process the acoustic and linguistic components of speech is noted and if that decline in speed of processing is coupled with a peripheral hearing loss in the higher frequency phonemes of speech, which is typical of older adults, then the difficulties that they can experience in hearing and understanding speech will be compounded. Peripheral Auditory System The peripheral auditory system's functioning declines regularly over time. A person's lifestyle, noise exposure, heredity, diet, state of cardiovascular health, and other variables can result in some degree of negative change within the cochlea, with an accompanying sensorineural hearing loss--a gradually progressive sensorineural hearing loss that typically involves the higher frequencies. Since approximately two-thirds of American English phonemes possess important high-frequency acoustic components, a hearing loss that primarily involves a decline in the higher frequencies can negatively affect speech understanding. …

Self-reported outcomes of aural rehabilitation for adult hearing aid users in a developing South African context

Hearing impairment has far-reaching consequences for affected individuals, in terms of quality of life indicators. In the public health care sector of South Africa the hearing-impaired population is faced with limited aural rehabilitation services. This study evaluated self-reported outcomes of aural rehabilitation in a group of adults in the public health care sector with a standardised outcomes measurement tool (IOI-HA). Sixty-one participants were included (44% male; sample mean age 69.7 years) through face-to-face or telephonic interviews. Results revealed that the average perceived outcome of participants (5 = best outcome; 1 = poorest outcome) was positive across all domains of the inventory including daily use of hearing aids (4.3); benefits provided by hearing aids (4.3); residual activity limitation (3.9); satisfaction with hearing aids (4.5); residual participation restriction (4.0); impact of hearing difficulties on others (4.6); and changes in quality of life (4.5). Statistically significant relationships for daily use of hearing aids, degree of hearing loss, type of hearing aids fitted, and the perceived benefit from hearing aids in difficult listening environments (p<0.05) were evident. Adult aural rehabilitation for hearing loss in a public health care facility, even without optimal hearing aid fittings, was effective in providing positive perceived outcomes comparable to similar studies in developed countries. The findings advocate for the initiation of affordable and sustainable aural rehabilitation services in developing countries despite apparent resource limitations.

The Expanding World of Sigrid Cerf

The Expanding World of Sigrid Cerf

Aural Rehabilitation Telepractice

Aural Rehabilitation Telepractice

Supporting Family Caregivers

Supporting Family Caregivers

Predictors of Hearing Aid Use in an Older, Community-Based, New Zealand Veteran Sample: Implications for Aural Rehabilitation

Hearing loss is the third most prevalent chronic disability among older adults, with older adults the prime users of aural rehabilitation services. Ex-service personnel, in particular, frequently develop hearing-related disorders, and yet research on hearing aid utilisation in this group is sparse. The present study explored predictors of hearing aid use in a randomly selected sample of 1249 New Zealand veterans. Perceived benefit, performance and ease of use of aid(s) were related to increased use. Older veterans were more likely to use their aid(s) and greater overall hearing loss also increased adherence; however, inexperienced wearers were less adherent. Satisfaction with audiological service and overall satisfaction with the performance of the aid(s) was also linked to use. Health related variables were unrelated to frequency of aid use. These results highlight the need to provide ongoing support for all veterans, but in particular novice users, who become engaged in ongoing aural rehabilitation processes.

Longitudinal changes in children's speech and voice physiology after cochlear implantation.

The purposes of this investigation were 1) to describe speech/voice physiological characteristics of prelingually deafened children before and after cochlear implantation and determine whether they fall into a range that would be considered deviant, 2) to determine whether selected deviant articulatory and phonatory behaviors of children with cochlear implants persist despite long-term cochlear implant use and continued participation in aural rehabilitation services, and 3) to determine whether further development of deviant articulatory and phonatory behaviors occurs postimplantation. Seven prelingually deafened children who received cochlear implants after 5 yr of age were followed from shortly before implantation until 5 to 6 yr postimplantation. These children received their early education in a Total Communication environment and used the Nucleus 22-electrode cochlear implant. All of them initially used the MPEAK speech processing strategy, and five of them eventually upgraded to the SPEAK speech processing strategy. Speech/voice physiological measurements that were obtained periodically from the children included intraoral air pressure (P(o)), nasal and phonatory air flow, voice onset time (VOT), and fundamental frequency (F(o)). Data from the deaf children were compared with a database from 56 children with normal hearing to determine when the deaf children exhibited "deviant" speech/voice behaviors. Speech/voice behaviors were considered "deviant" if they never occurred for children with normal hearing or were associated with z-scores that were outside the range of +/-2.0. The deaf children showed a wide range of deviant speech and voice behaviors both pre- and post-cochlear implant. The most frequently occurring atypical behaviors were use of negative P(o), high P(o) for [b, m], long and short VOT for [p], and high F(o). Some deviant behaviors improved post-cochlear implant. However, deviant behaviors often persisted for several years post-cochlear implant. There was considerable evidence of further development of deviant behaviors post-cochlear implant. All of the deaf children demonstrated deviancy on at least two of our measures at the last data collection interval (5 to 6 yr post-cochlear implant). Children who received cochlear implants after 5 yr of age and who were educated in a Total Communication setting showed persistence and further development of deviant speech/voice behaviors for several years post-cochlear implant. Although our findings cannot be generalized to other populations of children with cochlear implants (i.e., those who were implanted earlier, those educated in auditory-oral programs), it seems wisest at the present time not to assume that children's deviant speech/voice behaviors will remit spontaneously with continued cochlear implant use. Our data provide an important comparative database for future investigations of pediatric cochlear implant users who have had shorter periods of auditory deprivation and who have received cochlear implants with more current technological features. Longitudinal Changes in Children's Speech and Voice Physiology after Cochlear Implantation

Hearing and vision loss within residential care facilities ‐the need for improved service delivery

Objective: To assess the level of hearing impairment within residential care facilities and to determine the efficacy of providing aural rehabilitation services within the facility.Method: 178 elderly residents participated in this project. The procedures included case history, pure‐tone screening, otoscopic examination, vision screening, hearing aid assessment and sentence identification.Results: Despite 87.1% of participants having a significant hearing impairment only 43.3% currently wore hearing aids. Linked to poor hearing aid use was the fact that 43.9% of hearing aids required some degree of maintenance. Otoscopic examination revealed 42.1% of ear canals to be occluded with cerumen to a degree that medical intervention was required. Sentence identification revealed the importance of aiding and access to contextual and visual cues (lip‐reading) for this population.Conclusions: This study confirms the high prevalence of hearing impairment amongst the elderly and makes a case for increased rehabilitation services being directed towards this population particularly in the areas of hearing aid maintenance, cerumen removal and delivery of communication skills training to residential care workers.