Hearing Assistive Technology Research Articles

A Physiologically Inspired Model for Solving the Cocktail Party Problem

At a cocktail party, we can broadly monitor the entire acoustic scene to detect important cues (e.g., our names being called, or the fire alarm going off), or selectively listen to a target sound source (e.g., a conversation partner). It has recently been observed that individual neurons in the avian field L (analog to the mammalian auditory cortex) can display broad spatial tuning to single targets and selective tuning to a target embedded in spatially distributed sound mixtures. Here, we describe a model inspired by these experimental observations and apply it to process mixtures of human speech sentences. This processing is realized in the neural spiking domain. It converts binaural acoustic inputs into cortical spike trains using a multi-stage model composed of a cochlear filter-bank, a midbrain spatial-localization network, and a cortical network. The output spike trains of the cortical network are then converted back into an acoustic waveform, using a stimulus reconstruction technique. The intelligibility of the reconstructed output is quantified using an objective measure of speech intelligibility. We apply the algorithm to single and multi-talker speech to demonstrate that the physiologically inspired algorithm is able to achieve intelligible reconstruction of an “attended” target sentence embedded in two other non-attended masker sentences. The algorithm is also robust to masker level and displays performance trends comparable to humans. The ideas from this work may help improve the performance of hearing assistive devices (e.g., hearing aids and cochlear implants), speech-recognition technology, and computational algorithms for processing natural scenes cluttered with spatially distributed acoustic objects.

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.

One Tool in the Toolkit Is Not Enough: Making the Case for Using Multisensory Approaches in Aural Habilitation of Children With Reduced Hearing

PurposeThis article proposes modifications to current rehabilitation methods for infants and children who are deaf or have reduced hearing. The widespread implementation of newborn hearing screening has resulted in numerous benefits to infants with reduced hearing and their families. Collectively, despite the enormous audiologic benefit that many children receive from both hearing assistive technologies and the provision of direct services aimed to support their development, numerous children with reduced hearing continue to perform below the levels of their counterparts with typical hearing in their ability to demonstrate age-appropriate functional use of language skills.ConclusionsStudies suggest that the brains of all infants and children (including those who are deaf, who have reduced hearing, and/or who utilize hearing assistance technology) benefit from the input of multiple senses. Cognitive neuroscience and hearing science suggest a significant benefit to engaging multiple modalities for communication and increasing the amount of information that is accessible to infants and young children who are deaf or hard of hearing.By using brain science to inform the rehabilitation of children with reduced hearing, this article concludes that therapy should be multimodal while minimizing use of discrete skills, thinking of language and communication opportunities as a continuum. Further recommendations for rehabilitation are provided.

Today's Hearing Technologies: Definitions, Regulations, Overlaps

Today's Hearing Technologies: Definitions, Regulations, Overlaps

The Characteristics of Adults with Severe Hearing Loss.

Severe hearing loss impairs communication in a wide range of listening environments. However, we lack data as to the specific objective and subjective abilities of listeners with severe hearing loss. Insight into those abilities may inform treatment choices. The primary goal was to describe the audiometric profiles, spectral resolution ability, and objective and subjective speech perception of a sample of adult listeners with severe hearing loss, and to consider the relationships among those measures. We also considered the typical fitting received by individuals with severe loss, in terms of hearing aid style, electroacoustic characteristics, and features, as well as supplementary device use. A within-subjects design was used. Participants included 36 adults aged 54-93 yr with unilateral or bilateral severe hearing loss. Testing included a full hearing and hearing aid history; audiometric evaluation; loudness growth and dynamic range; spectral resolution; assessment of cochlear dead regions; objective and subjective assessment of speech recognition; and electroacoustic evaluation of current hearing aids. Regression models were used to analyze relationships between hearing loss, spectral resolution, and speech recognition. For speech in quiet, 60% of the variance was approximately equally accounted for by amount of hearing loss, spectral resolution, and number of dead regions. For speech in noise, only a modest proportion of performance variance was explained by amount of hearing loss. In general, participants were wearing amplification of appropriate style and technology for their hearing loss, but the extent of assistive technology use was low. Subjective communication ratings depended on the listening situation, but in general, were similar to previously published data for adults with mild-to-moderate loss who did not wear hearing aids. The present data suggest that the range of abilities of an individual can be more fully captured with comprehensive testing. Such testing also offers an opportunity for informed counseling regarding realistic expectations for hearing aid use and the availability of hearing assistive technology.

Factors Affecting Speech Reception in Background Noise with a Vocoder Implementation of the FAST Algorithm.

Speech segregation in background noise remains a difficult task for individuals with hearing loss. Several signal processing strategies have been developed to improve the efficacy of hearing assistive technologies in complex listening environments. The present study measured speech reception thresholds in normal-hearing listeners attending to a vocoder based on the Fundamental Asynchronous Stimulus Timing algorithm (FAST: Smith et al. 2014), which triggers pulses based on the amplitudes of channel magnitudes in order to preserve envelope timing cues, with two different reconstruction bandwidths (narrowband and broadband) to control the degree of spectrotemporal resolution. Five types of background noise were used including same male talker, female talker, time-reversed male talker, time-reversed female talker, and speech-shaped noise to probe the contributions of different types of speech segregation cues and to elucidate how degradation affects speech reception across these conditions. Maskers were spatialized using head-related transfer functions in order to create co-located and spatially separated conditions. Results indicate that benefits arising from voicing and spatial cues can be preserved using the FAST algorithm but are reduced with a reduction in spectral resolution.

A comparative examination of healthcare use related to hearing impairment in Europe

Introduction: The economic burden of hearing impairment is an area of increased interest. In this paper we examine the relationship between hearing impairment and service use in 14 European countries. Methods: Based on the Survey of Health Ageing and Retirement in Europe (SHARE) undertaken in 2013, Poisson regression models are used to analyse the relationship between the number of visits/number of nights in hospital, and hearing impairment controlling for a number of covariates. Results: We find that hearing impairment is generally associated with increased use of primary and secondary healthcare services when other aspects of health have been controlled. Comparative analysis revealed that where access to hearing assistive technology was greatest the additional use of services was least. Conclusions: The comparative analysis suggests that variations exist across countries in respect of the additional healthcare use occasioned by hearing impairment. They may also provide valuable insights into how the burden of illness might be reduced.

App Helps Users Find Ear-Friendly Places

You have accessThe ASHA LeaderApp-titude1 Jun 2017App Helps Users Find Ear-Friendly PlacesUsers of the iHEARu app help one another locate quieter spaces and hearing technology access through sound ratings and reviews. Kelly TremblayPhD, CCC-A Kelly Tremblay Google Scholar More articles by this author , PhD, CCC-A https://doi.org/10.1044/leader.APP.22062017.np SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In The statistics on Americans’ concerns about noise exposure are telling: 41 percent of adults age 18 and older in a recent ASHA-commissioned survey were concerned that past noise exposure in loud leisure settings might have harmed their hearing. Just over 50 percent expressed concern that future exposure could be harmful. A newly launched app, iHEARu, addresses and seeks to alleviate such concern by helping people in the United States and across the globe find ear-friendly places to hear and be heard. The app, available for free at the iTunes App Store and at Google Play, allows people to report sound levels and share them with others. Through crowdsourcing, people can choose to avoid the noisiest times at restaurants and other places. Protection and access Those who simply want a quiet eatery, bar or café can turn to the app’s GPS for guidance. Users note which places are ear-friendly—if, for example, the business offers customers the option of sitting in a quieter area or is open to turning down the volume on music. And those who like it loud can use iHEARu to see whether a venue’s noise levels warrant the use of hearing protection. iHEARu is also an accessibility tool. People can use it to let others know if hearing assistive technology is available onsite in a particular public or commercial spaces. The app then guides users to those sites. iHEARu can also provide useful guidance to clinicians. Audiologists, for example, can tell their patients about quiet places as well as where they can find hearing-looped venues. They can also tell their patients to look for the iHEARu signs in the windows of participating restaurants and establishments. The app’s origins As a university professor, audiologist and hearing advocate working to enhance social and communication opportunities for over 30 years, I originally developed the app as a passion project. It is entirely self-funded, with support from volunteers. My father had multiple sclerosis, so during my childhood my family always had to identify places that were wheelchair-accessible. Developing this app was a way for me to combine my passion for accessibility and hearing protection with the power of mobile technology. To help get it started, iHEARu recently launched the San Diego Sound Project, through which San Diego State University and California State University San Marcos students volunteered to record sound levels at public establishments around San Diego’s lively Gaslamp Quarter and other tourist areas. These and other efforts to increase the number of user-generated reviews on the iHEARu app will help everyone make sound decisions about where to meet others so they can hear and be heard. To join these efforts, you can use the app and write hearing-friendliness reviews about the places near you. Author Notes Kelly Tremblay, PhD, CCC-A, is a professor in the Department of Speech and Hearing Sciences at the University of Washington. She serves on the Boards of the American Auditory Society and the Hearing Loss Association of America. [email protected] Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 22Issue 6June 2017 Get Permissions Add to your Mendeley library History Published in print: Jun 1, 2017 Metrics Current downloads: 142 Topicsleader_do_tagasha-article-typesleader-topicsCopyright & Permissions© 2017 American Speech-Language-Hearing AssociationLoading ...

Improving Art Museum Accessibility for Adults With Acquired Hearing Loss.

Adults with hearing loss rated the accessibility of guided or docent-led art museum tours with and without hearing assistive technology (HAT). Nineteen individuals (average age 64 years, range 35-87 years) with acquired hearing loss participated. All participants had a bilateral hearing loss (mild to profound) using hearing aids (n = 12), cochlear implants (n = 5), or no technology (n = 2). Two docents who were previously trained to modify their presentations and use clear speech led the tours. Participants experienced a tour with and without the museum's HAT and rated its effectiveness using a rating scale. The study used a pre-post test design. The docent-led tours with HAT were rated significantly higher (p = .003) than the tours without HAT. Participants made several suggestions on improving museum accessibility for individuals with hearing loss. The use of HAT during a museum tour was beneficial for individuals with hearing loss. Training docents to modify their presentations, use clear speech, and HAT improved the accessibility of docent-led tours for individuals with hearing loss.

TELEGRAM: contribution in assistive technology indication for individuals with hearing impairment.

The objective of the study was to translate and culturally adapt to Portuguese the TELEGRAM instrument and to evaluate its effectiveness in adults with hearing impairment using hearing aids. The TELEGRAM was translated into the Portuguese language, reviewed for grammatical and idiomatic equivalences (reverse translations) and linguistic and cultural adaptations. After translation, the TELEGRAM was applied to 20 individuals with hearing impairment. A descriptive analysis of the results was performed. After the grammatical and idiomatic equivalence, the replacement of one term/item was suggested, which was modified and adapted to the Brazilian context. In general, the questions of the instrument were considered easy to understand. Among the categories assessed, individuals with hearing loss had greater difficulty using the telephone and in activities such as attending church gatherings, parties, or in situations of noisy environments, distance and reverberation. The TELEGRAM translated into Brazilian Portuguese proved to be an easily applicable tool in population studies and effective to assess which are the main situations where individuals with hearing impairment have greater difficulty in communication, reinforcing the importance of hearing rehabilitation and assistive technology to minimize these difficulties.

Cost implications for changing candidacy or access to service within a publicly funded healthcare system?

Introduction: Undue attention in the allocation of healthcare resources can be given to expenditures as opposed to expenditures avoided. This can be particularly apparent when expenditures avoided fall across different budget holders and budgetary pressures are strained.Methods: The paper presents estimates of the potential savings attributable to the adoption of new hearing assistive technologies in Britain between 1992 and 2014 based on multivariate analyses of survey data.Results: The reduction in service use among the hearing impaired between 1992 and 2014 is estimated to amount to between £53 and £92 million per annum.Conclusion: Issues in estimating the impact of widening candidature for cochlear implants on costs exist related to potential savings. This research begins to lay a firmer evidence base for such work as well as identifying some of the challenges.

Evaluation of a wireless audio streaming accessory to improve mobile telephone performance of cochlear implant users

Objective: The objective of this study was to evaluate the potential improvement in word recognition in quiet and in noise obtained with use of a Bluetooth-compatible wireless hearing assistance technology (HAT) relative to the acoustic mobile telephone condition (e.g. the mobile telephone receiver held to the microphone of the sound processor). Design: A two-way repeated measures design was used to evaluate differences in telephone word recognition obtained in quiet and in competing noise in the acoustic mobile telephone condition compared to performance obtained with use of the CI sound processor and a telephone HAT. Study sample: Sixteen adult users of Nucleus cochlear implants and the Nucleus 6 sound processor were included in this study. Results: Word recognition over the mobile telephone in quiet and in noise was significantly better with use of the wireless HAT compared to performance in the acoustic mobile telephone condition. Word recognition over the mobile telephone was better in quiet when compared to performance in noise. Conclusions: The results of this study indicate that use of a wireless HAT improves word recognition over the mobile telephone in quiet and in noise relative to performance in the acoustic mobile telephone condition for a group of adult cochlear implant recipients.

Impact of Aging and Cognition on Hearing Assistive Technology Use.

Many factors go into appropriate recommendation and use of hearing assistive technology (HAT). The aging auditory system presents with its own complications and intricacies; there are many types of age-related hearing loss, and it is possible that the underlying cause of hearing loss can significantly impact the recommendations and performance with HATs. The audiologist should take into consideration peripheral and central auditory function when selecting HATs for the aging adult population as well as when selecting appropriate types of technology including personal sound amplification products, hearing aids, cochlear implants, and other assistive technology. The cognitive ability of the patient plays a central role in the recommendations of HAT. It is possible that the use of HATs could mitigate some of the effects of cognitive decline and thus should be considered as early as possible. Assessment of ability and appropriate recommendations are crucial to consistent use of HAT devices.

High-Frequency Audibility: The Effects of Audiometric Configuration, Stimulus Type, and Device

For the last decade, the importance of providing amplification up to 9-10 kHz has been supported by multiple studies involving children and adults. The extent to which a listener with hearing loss can benefit from bandwidth expansion is dependent on the audibility of high-frequency cues. The American National Standards Institute (ANSI) devised a standard method for measuring and reporting hearing aid bandwidth for quality-control purposes. However, ANSI bandwidth measurements were never intended to reflect the true frequency range that is audible for a speech stimulus for a person with hearing loss. The purpose of this study was to (1) determine the maximum audible frequency of conventional hearing aids using a speech signal as the input through the hearing aid microphone for different degrees of hearing loss, (2) examine how the maximum audible frequency changes when the input stimulus is presented through hearing assistance technology (HAT) systems with cross-coupling of manufacturers' transmitters and receivers, and (3) evaluate how the maximum audible frequency compares with the upper limit of the ANSI bandwidth measure. Eight behind-the-ear hearing aids from five hearing aid manufacturers were selected based on a range of ANSI bandwidth upper frequency limits. Three audiometric configurations with varied degrees of high-frequency hearing loss were programmed into each hearing aid. Hearing aid responses were measured with the International Speech Test Signal (ISTS), broadband noise, and a short speech token (/asa/) as stimuli presented through a loudspeaker. HAT devices from three manufacturers were used to create five HAT scenarios. These instruments were coupled to the hearing aid programmed for the audiogram that provided the highest maximum audible frequency in the hearing aid analysis. The response from each HAT scenario was obtained using the same three stimuli as during the hearing aid analysis. All measurements were collected in an audiometric sound booth on a Knowles Electronic Manikin for Acoustic Research (KEMAR). A custom computer program was used to record responses from KEMAR. Maximum audible frequency was defined as the highest point where the Long-Term Average Speech Spectrum (LTASS) intersected the audiogram. The average maximum audible frequency measured through KEMAR ranged from 3.5 kHz to beyond 8 kHz and varied significantly across devices, audiograms, and stimuli. The specified upper limit of the ANSI bandwidth was not predictive of the maximum audible frequency across conditions. For most HAT systems, the maximum audible frequency for the hearing aid plus HAT condition was equivalent to the hearing aid for the same measurement configuration. In some cases, however, the HAT system imposed a lower maximum audible frequency than the hearing aid-only condition. The maximum audible frequency of behind-the-ear hearing aids is dependent on the degree of hearing loss, amplification device, and stimulus input. Estimating the maximum audible frequency by estimating the frequency where the speech spectrum intersects the audiogram in the high frequencies can assist clinicians in making decisions about which device or configuration of devices provides the greatest access to high-frequency information, as well as whether frequency-lowering technology should be used.

Hearing aid and hearing assistance technology use in Aotearoa/New Zealand

Objective: The purpose of this study was to describe factors that are related to hearing aid and hearing assistance technology ownership and use in Aotearoa/New Zealand. Design: Adults with hearing impairment living in New Zealand were surveyed regarding health-related quality of life and device usage. Audiometric data (hearing sensitivity and speech in noise) were collected. Study sample: Data were obtained from 123 adults with hearing impairment: 73 reported current hearing-aid use, 81 reported current hearing assistance technology use. Results: In both analyses, device users had more difficulty understanding speech in background noise, had poor hearing in both their better and worse hearing ears, and perceived more consequences of hearing impairment in their everyday lives (both emotionally and socially) than non-hearing-aid users. Discriminant analyses showed that the social consequences of hearing impairment and the better ear hearing best classified hearing aid users from non-users but social consequences and worse ear hearing best classified hearing assistance technology users from non-users. Conclusions: Quality of life measurements and speech-in-noise assessments provide useful clinical information. Hearing-impaired adults in New Zealand who use hearing aids also tend to use hearing assistance technology, which has important clinical implications.

Keeping Up with Wireless Hearing Assistive Technology

Keeping Up with Wireless Hearing Assistive Technology

Hearing Assistance Technology: Collaborating with Teens to Get It Right

The benefits of hearing assistance technology (HAT) to enhance speech and other desired auditory inputs for listeners with compromised auditory and listening skills are known. However, the best designed and fitted technology is only as effective as its utilization. Benefit is realized when the HAT device is used as prescribed, is used consistently, is working properly, and achieves the desired listening goals for the individual. Therefore, proper selection and management of HAT is critical to achieving the desired outcomes associated with HAT use. Even when benefit is demonstrated, and the HAT is well managed, there are other reasons why users opt not to use the devices. For teens, social identity and the desire to be like their peers complicate the use of HAT. Audiologists should do their part by collaborating with the HAT candidate to assure appropriate selection, fitting, counseling, and orientation and training procedures have occurred.

Cochlear Implants and Remote Microphone Technology

Advances in cochlear implant (CI) technology have allowed for impressive outcomes for implant recipients. In fact, many CI recipients achieve ceiling-level scores (i.e., near 100%) on sentence-recognition tests in quiet used in clinical settings. It is, however, well known that CI users often continue to experience difficulty with speech understanding in noisy and reverberant environments (e.g., classroom, restaurant, etc.). Recent research has indicated that performance in these difficult situations may be improved through the use of wireless remote microphone technology. In this article, a review will be provided of several studies that have explored the use of wireless remote microphones for CI users. Specifically, this review will focus on studies that have addressed both induction neckloop and directly coupled radiofrequency (RF) systems, fixed receiver gain settings, audio mixing ratio, adaptive frequency-modulated (FM) systems, cochlear implant signal processing, and digital RF systems. The effect of each of these items on a CI recipient's performance will be discussed. Additionally, clinical tips to optimize hearing assistance technology benefit for CI users will be provided as well as a protocol for fitting and verifying the appropriateness of wireless remote microphone technology for CI users and for optimizing user benefit.

Comparison of Speech Recognition With Adaptive Digital and FM Remote Microphone Hearing Assistance Technology by Listeners Who Use Hearing Aids

The purpose of this study was to compare the benefits of 3 types of remote microphone hearing assistance technology (HAT), adaptive digital broadband, adaptive frequency modulation (FM), and fixed FM, through objective and subjective measures of speech recognition in clinical and real-world settings. Participants included 11 adults, ages 16 to 78 years, with primarily moderate-to-severe bilateral hearing impairment (HI), who wore binaural behind-the-ear hearing aids; and 15 adults, ages 18 to 30 years, with normal hearing. Sentence recognition in quiet and in noise and subjective ratings were obtained in 3 conditions of wireless signal processing. Performance by the listeners with HI when using the adaptive digital technology was significantly better than that obtained with the FM technology, with the greatest benefits at the highest noise levels. The majority of listeners also preferred the digital technology when listening in a real-world noisy environment. The wireless technology allowed persons with HI to surpass persons with normal hearing in speech recognition in noise, with the greatest benefit occurring with adaptive digital technology. The use of adaptive digital technology combined with speechreading cues would allow persons with HI to engage in communication in environments that would have otherwise not been possible with traditional wireless technology.

New opportunities and challenges for teleaudiology within Department of Veterans Affairs

INTRODUCTION Teleaudiology is the delivery of audiology services and information via telecommunications technologies. In recent years, technological advances have resulted in a dramatic increase in the possibilities offered by teleaudiology--from diagnostic audiology and remote hearing aid fittings to downloadable hearing aid applications and real-time rehabilitation interventions. Teleaudiology has the capacity to provide access to audiological services to individuals living in rural locations, to those in inner urban populations who cannot afford or access the services of a professional, and to others who choose to self-manage their hearing impairment. With broader access and new models of service delivery come vast possibilities but also new challenges and questions for patients and professionals alike. Teleaudiology can be conducted using at least four models of telemedicine practice: 1.Synchronous/real-time data collection, referred to by the Department of Veterans Affairs (VA) as clinical video telehealth, in which face-to-face video-conferencing between patients and providers takes place. Synchronous/real-time data collection can be used to conduct hearing tests, hearing aid fittings, and audiologist-directed real-ear measures, and for hearing-aid counseling and tinnitus management. 2. Store and forward telehealth, in which data are acquired and stored by a technician at a remote facility and later forwarded to a specialist for interpretation and diagnosis. This form of telemedicine can be used to interpret video otoscopy, audiometry, immittence, otoacoustic emissions, and auditorybrainstem response readings. 3. Remote monitoring, referred to by VA as home telehealth, in which mobile devices are used to collect data that can be monitored by healthcare providers. Remote monitoring can be used to monitor hearing aid use or changes in hearing over time. 4. Mobile health, in which smartphone applications (apps) or other software is used for self-management of health conditions independent of a practitioner. Mobile health apps for hearing testing, auditory training, tinnitus management, and hearing aid counseling are readily available, as are apps that can turn a smartphone into a sophisticated amplification device. Without question, teleaudiology has effectively overcome barriers such as distance, cost, and the lack of specialist providers in remote locations, to increase access to audiological services. Data from the World Health Organization (WHO) illustrate this considerable need. According to WHO, there are almost 300 million people with moderate-to-profound hearing loss, but of these only about 10% use any form of hearing assistive technology. This number drops to 2.5 percent for developing countries [1]. Several countries have well-established teleaudiology programs, including Brazil, South Africa, and Australia. In the United States, teleaudiology services are becoming available through programs implemented by the VA and other organizations, such as the Alaska Federal Health Care Access Network (AFHCAN). These programs are driven by need. An estimated 37 percent of enrolled Veterans live in rural areas and 2 percent live in highly rural areas, * with 47 percent of rural and 95 percent of highly rural Veterans living 2 or more hours travel time from a VA clinic [2]. Likewise, 75 percent of Alaskan communities are unconnected by road to a hospital, 25 percent of communities have no airport, and 59 percent of the Alaskan population live in medically underserved areas. Furthermore, 60 percent of the state's physicians live and practice in Anchorage, while only 40 percent of the population resides there, with many locations having few or no specialist practitioners [3]. VA TELEAUDIOLOGY The VA teleaudiology pilot program began in 2009 as a joint effort between VA Telehealth Services, Office of Rehabilitation Services, and the Audiology and Speech Pathology National Program Office. …