Hearing Aid Services Research Articles

"Close to My Community": A Qualitative Study of Community Health Worker-Supported Teleaudiology Hearing Aid Services.

Given well-documented disparities in rural and minority communities, alternative service delivery models that help improve access to hearing care are needed. This article reports on a study of older Latino adults with hearing loss who received hearing aid services with Community Health Workers (CHWs) providing support via teleaudiology. The present study used qualitative data to explore perceptions of this novel service delivery model. Participants completed semistructured interviews related to their experiences in the intervention approximately 17 weeks after the hearing aid fitting appointment. Two coders independently coded the data, using an iterative deductive and inductive thematic analysis approach. Inter-rater reliability was good (κ = 0.80). Of the 28 participants, 19 were interviewed (CHW group: n = 9, 8 females; non-CHW group: n = 10, 9 females). Both groups of participants reported experiencing barriers in access to care and reported positive experiences with teleaudiology and with hearing aids as part of the trial. CHW group participants reported interactions with patient-site facilitators that were indicative of patient-centeredness. Results demonstrate the feasibility and potential effectiveness of trained CHWs as patient-site facilitators in teleaudiology-delivered hearing aid services for adults.

Systematic review of patient and service outcome measures of remote digital technologies for cochlear implant and hearing aid users

IntroductionThe use of telehealth for cochlear implant (CI) and hearing aid service provision has the potential to provide efficient, effective, and equitable services to users. However, clinicians require evidence that remote technologies provide care that is equal, or superior to, standard delivery. There are many outcome measures used across audiology, however there is little consensus for a standardized approach to assessment. This systematic review aims to identify the outcome measures to assess remote technologies for CI and hearing aid users, as a first step in a larger project to develop a core outcome set for remote technologies in CI users.MethodsA systematic search of seven electronic databases was conducted using a search strategy defined by PICOTS for the research question. Eligible studies were in English and published in 2012 onwards. Search strategy, selection, and data collection followed PRISMA 2020 guidelines.ResultsThis systematic literature review of 49 articles revealed over 250 discrete outcomes. Outcome measures were grouped into core areas, outcome domains, and outcome sub-domains. Studies assessing remote technology for CI users assessed significantly more outcomes in the ear and labyrinth domain (43% vs. 10%) and studies assessing remote technology in hearing aid users assessed significantly more outcomes in the cognitive (28% vs. 5%) and emotional (35% vs. 10%) functioning domains. Outcome measures within the auditory functioning domain were also significantly different, with CI studies utilizing more speech perception measures (95% vs. 21%) and hearing aid studies utilizing significantly more self-reported outcome measures (73% vs. 19%).DiscussionThe inclusion of hearing aid studies was to ensure that all key outcome domains used within remote hearing rehabilitation were captured, as well as to compare differences in outcome domains between the two user groups. There were significant differences between studies of remote technologies for CI and hearing aid users. These results will inform the ongoing development of a core outcome set for remote technologies in CI users.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=370171, identifier: CRD42022370171.

Amplifying Access: Progress After 1 Year of Over-the-Counter Hearing Aids

Purpose: A number of barriers exist that limit access to hearing aids and services, including high cost, limited number of providers, and patients' perceived lack of need. The traditional model of hearing aid service delivery requires patients to undergo a hearing test, receive a medical evaluation or waiver, and receive a hearing aid fitting from qualified providers, such as a licensed audiologist. In an effort to improve access and affordability, the U.S. Food and Drug Administration recently established a new category of over-the-counter (OTC) hearing aids for adults with perceived mild–moderate hearing loss that can be purchased without the involvement of a professional. The purpose of this Viewpoint article is to reflect on the progress that has been accomplished in the inaugural year of OTC hearing aids. Conclusions: In the last year, hearing aids have become more readily available to consumers online and in stores. A number of companies have entered the OTC hearing aid market, leading to innovative designs and a variety of options for consumers. The regulations governing OTC hearing aids have also spurred increased attention on hearing care and created new opportunities for interprofessional collaboration. In addition, research has illustrated the real-world effectiveness of OTC hearing aids. Still, in some respects, the first year of OTC hearing aids has not met expectations. Evidence points to low adoption as well as misconceptions, including regarding the distinction between OTC and prescription hearing aids. Audiologists can play an important role in addressing misconceptions by increasing their own knowledge of the devices and talking about them with patients and in outreach activities. There are a number of outstanding needs, including to investigate U.S. consumers' satisfaction when using these devices long term and to evaluate the impact of OTC hearing aids in countries outside of the United States.

Service delivery approaches related to hearing aids in low- and middle-income countries or resource-limited settings: A systematic scoping review.

Hearing loss is an important global public health issue which can be alleviated through treatment with hearing aids. However, most people who would benefit from hearing aids do not receive them, in part due to challenges in accessing hearing aids and related services, which are most salient in low- and middle-income countries (LMIC) and other resource-limited settings. Innovative approaches for hearing aid service delivery can overcome many of the challenges related to access, including that of limited human resources trained to provide ear and hearing care. The purpose of this systematic scoping review is to synthesize evidence on service delivery approaches for hearing aid provision in LMIC and resource-limited settings. We searched 3 databases (PubMed, Scopus, Ovid MEDLINE) for peer-reviewed articles from 2000 to 2022 that focused on service delivery approaches related to hearing aids in LMIC or resource-limited settings. Fifteen peer-reviewed articles were included, which described hospital-based (3 studies), large-scale donation program (1 studies), community-based (7 studies), and remote (telehealth; 4 studies) service delivery approaches. Key findings are that hearing aid services can be successfully delivered in hospital- and community-based settings, and remotely, and that both qualified hearing care providers and trained non-specialists can provide quality hearing aid services. Service delivery approaches focused on community-based and remote care, and task sharing among qualified hearing care providers and trained non-specialists can likely improve access to hearing aids worldwide, thereby reducing the burden of untreated hearing loss.

Prioritizing Hearing Aid Service Delivery Models for Low-Income Communities

Prioritizing Hearing Aid Service Delivery Models for Low-Income Communities

Exploring Factors Enabling Hearing Aid Usage: Perspectives of Hearing Aid Users and Audiologists.

To explore the aspects favoring hearing aid usage among individuals with hearing impairment based on hearing aid users' and audiologists' perspectives. The present study used inductive thematic analysis. The participants were 12 hearing aid users and 12 Audiologists. The study was conducted in interview mode either face-to-face or telephonic mode. The verbatim of the participants was transcribed and different codes were assigned. The codes were used to derive the subthemes and themes. Four major themes were obtained. The first and second themes were Client-centred and Clinician-centred aspects respectively. The third theme focussed on Hearing aid trial and service delivery aspects. The fourth theme discussed mainly Hearing aid-associated benefits and drawbacks. Audiologist should effectively address the challenges posted by hearing aid users, this in turn can favor the hearing adoption among the adults with hearing loss.

Research on Customer Relationship Management Strategy of "Hearing Aid Fitting" Based on Refined Data Analysis

Wearing hearing aids can help hearing impaired patients enter the sound world, so as to improve their quality of life. Hearing aid fitting is highly professional and requires long-term after-sales service. This paper takes 300 impaired patients and 50 hearing aid fitters of Siemens hearing aid fitting Engineer as the research object to analyze the main influencing factors of hearing impaired patients' purchase of hearing aids and the key factors to improve long-term satisfaction. Hearing aid effect, wearing comfort and service quality significantly affect the long-term satisfaction of hearing-impaired patients. Brand, price, refined customer relationship maintenance and technical personification have a positive impact on customer repeat purchase and recommendation.

Hearing Aid User Perspectives: Reasons and Recommendations for Prescription and Over-The-Counter Device Uptake

Hearing Aid User Perspectives: Reasons and Recommendations for Prescription and Over-The-Counter Device Uptake

Deaf signers and hearing aids: motivations, access, competency and service effectiveness

Objectives This study concerns culturally Deaf signers in the UK who use hearing aids and (i) explores motivations for hearing aid use (ii) identifies barriers and facilitators to accessing NHS hearing aid services, (iii) examines cultural competency of hearing aid clinics and (iv) identifies factors influencing effective adult hearing aid service provision. Design Online survey in British Sign Language and English that was informed by Deaf service users. Study sample 75 Deaf adult BSL users who wear hearing aids and use NHS hearing aid clinics. Results No specific reason emerged as outstandingly important for hearing aid use; however, assisting with lipreading (57%) and listening to music (52%) were rated as very/extremely important. Access issues reported were contacting clinics, poor communication with staff and lack of Deaf awareness. To be an effective and culturally competent hearing aid clinic for Deaf signers, a good understanding of Deaf culture and language was most rated as important (87%). Conclusion The study is the first that explores hearing aid use and experiences of accessing hearing aid clinics from Deaf signers’ perspectives. Enhancements to clinical practice are required to consider culturally Deaf people’s motivations for hearing aid use and make services more BSL-friendly.

A Scoping Review of Technology and Infrastructure Needs in the Delivery of Virtual Hearing Aid Services.

The digital health revolution has brought forward integral technological advancements enabling virtual care as a readily accessible delivery model. Despite this forward momentum, the field of audiology still faces barriers that impede the uptake of virtual services into routine clinical practice. The aim of this study was to gather, synthesize, and summarize the literature around virtual hearing aid intervention studies and the related technology and infrastructure requirements. A scoping review was conducted using MEDLINE, CINAHL, Scopus, Nursing and Allied Health, and Web of Science databases. Objectives, inclusion criteria, and scoping review methods were specified in advance and documented in a protocol. The 11 studies identified through this review related to virtual hearing aid services delivered by a licensed health care provider and/or facilitator(s) specific to hearing aid management, programming, verification, and validation services. Service delivery models varied according to patient population, technology experience, type(s) and time course of care, type of remote location, and technology/support requirements. Barriers and facilitators to implementation-related themes including technology access and function, client sociotechnical, convenience, education and training, interaction quality, service delivery, and technology innovation. This scoping review provides evidence around the technology and infrastructure required for full integration of virtual hearing aid services into practice and according to care type. Low-tech versus high-tech requirements may be used to guide virtual service delivery triaging efforts. Research and development efforts in the areas of pediatrics, clinical support tools, and hearing aid/app-based solutions will support further uptake of virtual service delivery in audiology.

Approaches to Measuring Productivity in Audiology Clinics

Approaches to Measuring Productivity in Audiology Clinics

Moderators and predictors in a parent hearing aid management eHealth program

Objective Consistent hearing aid use is essential for spoken language development of children who are hard of hearing. A recent randomised controlled trial of an eHealth hearing aid management education program found the intervention increased knowledge, perceptions, confidence, and device monitoring among parents of young children. Yet, it is not known which variables can be a point of emphasis to improve treatment outcomes. The purpose of this study was to investigate potential moderators and predictors in the eHealth program. Design Randomised controlled trial Study Sample Parents (N = 78) of children (42 months or younger) were randomised to the intervention or treatment-as-usual (TAU) group. Results Results revealed that high psychological inflexibility, low parent activation, and low hours of hearing aid use may moderate device monitoring frequency and knowledge; parents in the intervention improved over time compared to the TAU group. Psychological inflexibility and parent activation also predicted treatment outcomes. Conclusion The findings suggest the need to address parent psychological inflexibility related to hearing loss management, parents’ role in their child’s hearing aid management, and reported hours of hearing aid use as part of hearing aid service delivery. Identification of barriers to hearing aid management can assist audiologists in adjusting support to improve outcomes.

Experienced hearing aid users’ perspectives of assessment and communication within audiology: a qualitative study using digital methods

Objective To explore experienced hearing aid users’ perspectives of audiological assessments and the patient–audiologist communication dynamic during clinical interactions. Design A qualitative study was implemented incorporating both an online focus group and online semi-structured interviews. Sessions were audio-recorded and transcribed verbatim. Iterative-inductive thematic analysis was carried out to identify themes related to assessment and communication within audiology practice. Study samples Seven experienced hearing aid users took part in an online focus group and 14 participated in online semi-structured interviews (age range: 22 − 86 years; 9 males, 11 females). Results Themes related to assessment included the unaided and aided testing procedure and relating tests to real world hearing difficulties. Themes related to communication included the importance of deaf aware communication strategies, explanation of test results and patient centred care in audiology. Conclusion To ensure hearing aid services meet the needs of the service users, we should explore user perspectives and proactively adapt service delivery. This approach should be ongoing, in response to advances in hearing aid technology. Within audiology, experienced hearing aid users’ value (1) comprehensive, relatable hearing assessment, (2) deaf aware patient–audiologist communication, (3) accessible services and (4) a personalised approach to recommend suitable technology and address patient specific aspects of hearing loss.

Exploring the lived experiences of British Sign Language (BSL) users who access NHS adult hearing aid clinics: an interpretative phenomenological analysis

Objective To explore the lived experiences of culturally Deaf British Sign Language (BSL) users who access adult hearing aid services. Design Semi-structured qualitative interviews were conducted in BSL by the Deaf researcher and analysed using an Interpretative Phenomenological Analysis (IPA) approach. Study sample Eight Deaf BSL expert informants who were experienced users of NHS adult hearing aid clinics. Results Participants expressed dissatisfaction about audiology staff's lack of Deaf awareness and did not feel valued as Deaf signers. Participants' motivations for hearing aid use primarily concerned audibility rather than speech. Mismatch of perspectives on ‘hearing’ between audiologists and Deaf patients are discussed in the context of culturally sensitive services. Inadequate or uncertain linguistic access during appointments is considered in light of patient agency. Conclusion This is the first study to explore culturally Deaf signers' specific experiences of adult hearing aid services in the UK and their experiences of hearing aids. There are numerous reasons why Deaf signers wear hearing aids, but access to spoken language is not a priority. Limited Deaf awareness and cultural competence in adult hearing aid services can result in patient frustration and disempowerment. Suggestions for improvement in the Deaf signing patient experience are offered.

Feasibility of community health workers as teleaudiology patient-site facilitators: a multilevel training study

Objective We evaluated the feasibility of a multi-level teleaudiology patient-site facilitator training program for Community Health Workers (CHWs) at a partnering health centre in southern Arizona. Design Three levels were offered: Introductory, with basic information on hearing loss and teleaudiology; Intermediate, on technology, team roles, and access issues; and Facilitator, on further knowledge and hands-on skills to serve as patient-site facilitators in synchronous hearing aid service delivery. Six domains of feasibility were addressed using a mixed-methods design. Quantitative data included survey responses and observation of hands-on skills. Qualitative data included field notes from group discussion and open-ended survey questions, and were analysed using CHW core competencies. Study sample Twelve CHWs participated in the introductory training, ten moved on to intermediate, and three continued to the facilitator. Results Quantitative outcomes indicated that the trainings were feasible according to each of the six domains. CHWs in the facilitator training passed the practical hands-on skill assessment. Qualitative analyses revealed CHWs comments addressed eight of the ten possible CHW core competencies, and focussed on service coordination/navigation, and capacity building. Conclusions Teleaudiology trainings for CHWs were feasible, increasing service capacity for a potential pathway to improve access to hearing health care in low-resource areas.

Use of Diagnostic Testing and Intervention for Sensorineural Hearing Loss in US Children From 2008 to 2018

Early detection and intervention of pediatric hearing loss is critical for language development and academic achievement. However, variations in the diagnostic workup and management of pediatric sensorineural hearing loss (SNHL) exist. To identify patient and clinician factors that are associated with variation in practice on a national level. This cross-sectional study used the Optum claims database to identify 53 711 unique children with SNHL between January 1, 2008, and December 31, 2018. National use rates and mean costs for diagnostic modalities (electrocardiogram, cytomegalovirus testing, magnetic resonance imaging, computed tomography, and genetic testing) and interventions (speech-language pathology, billed hearing aid services, and cochlear implant surgery) were reported. The associations of age, sex, SNHL laterality, clinician type, race/ethnicity, and household income with diagnostic workup and intervention use were measured in multivariable analyses. Of 53 711 patients, 23 735 (44.2%) were girls, 2934 (5.5%) were Asian, 3797 (7.1%) were Black, 5626 (10.5%) were Hispanic, 33 441 (62.3%) were White, and the mean (SD) age was 7.3 (5.3) years. Of all patients, 32 200 (60.0%) were seen by general otolaryngologists, while 7573 (14.10%) were seen by pediatric otolaryngologists. Diagnostic workup was received by 14 647 patients (27.3%), while 13 482 (25.1%) received intervention. Use of genetic testing increased (odds ratio, 1.22 per year; 95% CI, 1.20-1.24), whereas use of computed tomography decreased (odds ratio, 0.93 per year; 95% CI, 0.92-0.94) during the study period. After adjusting for relevant covariables, children who were seen by pediatric otolaryngologists and geneticists had the highest odds of receiving workup and intervention. Additionally, racial/ethnic and economic disparities were observed in the use of most modalities of diagnostic workup and intervention for pediatric SNHL. This cross-sectional study identified factors associated with disparities in the diagnostic workup and intervention of pediatric SNHL, thus highlighting the need for increased education and standardization in the management of this common sensory disorder.

Geographic Distribution of the Hearing Aid Dispensing Workforce: A Teleaudiology Planning Assessment for Arizona.

Teleaudiology helps connect patients in rural and underresourced areas to hearing health care providers, minimizing the barrier of geography (Swanepoel et al., 2010). In the United States, teleaudiology is at the initial stages of implementation (Bush, Thompson, Irungu, & Ayugi, 2016). Telehealth researchers recommend conducting a comprehensive planning assessment to optimize implementation and adoption (AlDossary, Martin-Khan, Bradford, Armfield, & Smith, 2017; Alverson et al., 2008; Krupinski, 2015). A geographic analysis of the hearing aid dispensing workforce served as the initial stage of a teleaudiology planning assessment in Arizona. The analysis used publically available data sets from the U.S. Census, Arizona Department of Health Services, and the U.S. Veterans Administration. Geographic information system tools were used to analyze and visually represent population, potential teleaudiology site data, and hearing aid dispensing workforce (defined as audiologists and hearing instrument specialists licensed to dispense hearing aids in Arizona). ArcGIS was used to generate road networks and travel distance estimations. The number of audiologists per county ranged from 0 to 216 (average 22.1). Six out of Arizona's 15 counties lacked a single audiologist, and 2 counties lacked a hearing instrument specialist. Potential expansion sites for teleaudiology were located in areas of the state that lacked practice locations for hearing aid services. There are geographic areas of Arizona that lack licensed hearing aid locations yet are populated by individuals who may need services. Resource availability data inform teleaudiology program expansion. Future research will include data from providers and community members on their perceived needs for services.

Interplay between efficiency and quality in contracting: a case of responses to policy changes in public hearing-aid service

ABSTRACTThis article provides a study of supply-side responses to contracting out hearing aid services and products in the Danish public sector. Drawing on the theory of social mechanisms, we show how service quality is reconfigured as a response to the contracting changes and argue that efficiency and quality concerns are always interrelated. We conclude that micro level action-formation components will likely transform the effects of the situational policy changes at the macro level. Therefore, simultaneous management of efficiency and quality is an essential and ongoing effort that requires responsiveness to the non-contractible dimensions of quality.

Teleaudiology Services for Rehabilitation With Hearing Aids in Adults: A Systematic Review

This review examined (a) the current evidence from studies on teleaudiology applications for rehabilitation of adults with hearing impairment with hearing aids and (b) whether it is sufficient to support the translation into routine clinical practice. A search strategy and eligibility criteria were utilized to include articles specifically related to hearing aid fitting and follow-up procedures that are involved in consultations for the rehabilitation of adults, where the service was provided by the clinician by teleaudiology. A search using key words and Medical Subject Headings (MeSH) was conducted on the main electronic databases that index health-related studies. The included studies were assessed using validated evaluation tools for methodological quality, level of evidence, and grade recommendations for application into practice. Fourteen studies were identified as being within the scope of this review. The evaluation tools showed that none of these studies demonstrated either a strong methodological quality or high level of evidence. Analysis of evidence identified 19 activities, which were classified into service outcomes categories of feasibility, barriers, efficiency, quality, and effectiveness. Recommendations could be made regarding the (a) feasibility, (b) barriers, and (c) efficiency of teleaudiology for the rehabilitation of hearing loss with hearing aids. This review provides up-to-date evidence for teleaudiology hearing aid services in new and experienced hearing aid users in different practice settings. Findings direct future research priorities to strengthen evidence-based practice. There is a need for further studies of many aspects of teleaudiology services for rehabilitation with hearing aids to support their implementation into clinical practice. https://doi.org/10.23641/asha.6534473.

Contemporary analysis of practicing otolaryngologists

To investigate contemporary issues facing practicing otolaryngologists including workforce dynamics, ancillary service modeling, otolaryngic allergy integration, ambulatory surgery center utilization, and relevant certificate of need legislation. A cross-sectional survey analysis of academic and private practicing otolaryngologists in North and South Carolina in 2016. A cross-sectional survey was e-mailed to 510 practicing otolaryngologists in North and South Carolina. A 21.3% survey response rate was achieved. Otolaryngology workforce was defined by horizontal aggregation of otolaryngologists into larger group models, with fewer solo practitioners being replaced by younger otolaryngologists or employing otolaryngology extenders. Excluding academic practice, few otolaryngologists have chosen direct hospital employment as a career option, although otolaryngologists with fewer years of practice are pursuing that option with greater frequency. Ancillary services showed audiology and hearing aid services being the most common, followed by otolaryngic allergy, point-of-service computed tomography, and ultrasound. Although otolaryngologists tend to avoid vertical integration, ambulatory surgery center (ASC) ownership trends favor a joint venture model with a hospital system partner. Most otolaryngologists favor changes to certificate of need legislation to improve patient access to these lower-cost facilities, regardless of whether they currently utilize or have access to an ASC. Otolaryngology is uniquely positioned to adapt and respond to current paradigm shifts within ambulatory medicine. Further analysis is needed to prepare current and future otolaryngologists for the demands and opportunities these challenges pose as patient-centered care models and consumer dynamics shape future patient expectations and utilization of healthcare. 5. Laryngoscope, 2490-2499, 2018.