American Journal of Audiology最新文献

Purpose: In the United States, final-year externs in clinical audiology play an important role in clinical practices, yet many are unpaid for their work. This article evaluates cross-discipline research to place the high prevalence of unpaid externships in a larger trend toward precarious work arrangements that shift risk from employers to workers. Concerns about the cost of paying externs are understandable, and this article discusses how the benefits outweigh the challenges. Audiology program directors and precepting audiologists have a responsibility to challenge this status quo that undervalues audiology externs and advocate for paid externships. Compelling reasons to compensate externs include attracting higher quality trainees, reducing medical errors, improving extern learning outcomes and health, and addressing the shortage of audiologists to meet rising demands for audiologic services. Establishing paid externships as the expected standard will require changes at both the organizational and individual practice levels. Precepting audiologists are ideally positioned to model equitable labor practices and invest in the future of the profession.

Conclusions: This article argues that fair monetary compensation for the work that externs perform is essential for the well-being of trainees and for the quality of the clinical services they provide. By fairly compensating externs for their important work, audiologists can create a fairer, more equitable pipeline of diverse audiologists to meet rising hearing health care needs. It is time to recognize the value of audiology externs' work and commit to providing them the compensation they deserve.

Purpose: The objective of this study was to evaluate anxiety, depression, dizziness disability, sleep, and quality of life in individuals diagnosed with Ménière's disease (MD) and vestibular migraine (VM). Additionally, the study sought to examine the impact of anxiety and depression levels, as well as dizziness disability, on sleep and quality of life.

Method: The present study included a total of 51 individuals, with 25 subjects in the MD group and 26 subjects in the VM group. The Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI), the Dizziness Handicap Inventory (DHI), the 36-Item Short Form Health Survey (SF-36) for quality of life, and the Pittsburgh Sleep Quality Index (PSQI) were administered face-to-face to all subjects.

Results: A statistically significant difference was not observed between the two groups in terms of BDI, BAI, DHI total, and subcategories (Emotional, Physical, and Functional; p > .05). Among the subdimensions of SF-36, only Vitality and Mental Health scores were found to be statistically significantly higher in the MD group compared to the VM group (p = .039 and p = .030, respectively). Conversely, the PSQI score exhibited a statistically significant difference, with higher values observed in the VM group compared to the MD group (p = .023).

Conclusions: VM and MD significantly impact psychological and physiological outcomes, including anxiety, depression, dizziness, quality of life, and sleep. Psychiatric comorbidities and reduced quality of life profoundly affect daily life. Therefore, a multidisciplinary approach, including psychiatric support, is essential for effective management.

Purpose: High rates of hearing loss are observed for individuals with Down syndrome, and regular hearing assessment is recommended for children and adults. Unknown variability of threshold estimates for repeated auditory assessments for individuals with diverse intellectual abilities, such as individuals with Down syndrome, confounds the ability to determine true threshold changes between assessments. This study evaluated variability of pure-tone thresholds measured within and across test sessions for individuals with Down syndrome.

Method: Participants included 27 individuals with Down syndrome, ages 5.1-46.5 years (average = 22.7, SD = 11.8). A group of 11 neurotypical individuals, ages 15.9-48.6 years (average = 24.5, SD = 10.3) was included in intrasession variability assessment. Pure-tone thresholds in quiet were measured at 1, 4, 8, and 11.2 kHz during a single session or during repeated audiograms separated by 2.7-11.2 months (average = 5.8, SD = 2.4) and 3.0-3.9 years (average = 3.4, SD = 0.4).

Results: Intrasession variability was ≤ 10 dB for 94.3%-100% of thresholds for participants with Down syndrome, with similar variability observed for neurotypical participants. Threshold differences were ≤ 10 dB for 63.2%-85% of responses from audiograms separated by an average of 5.8 months and 37.5%-62.5% of responses separated by an average of 3.4 years.

Conclusions: Intrasession variability for participants with Down syndrome aligns with current clinical standards accepting variability of ≤ 10 dB between repeated threshold estimates. Differences in repeated audiometric thresholds greater than 10 dB likely reflect true changes in hearing sensitivity.

Supplemental material: https://doi.org/10.23641/asha.30052885.

Purpose: This study aimed to evaluate the impact of different hearing devices on sound localization and speech perception in individuals with single-sided deafness (SSD). Specifically, the study sought to assess the performance of softband bone-anchored hearing aids (BAHAs) and contralateral routing of signals hearing aids (CROS HA) in various conditions to determine their effectiveness in improving auditory outcomes for SSD patients.

Method: Eighteen participants (aged between 20 and 50 years) with SSD underwent tests using softband BAHA, CROS HA, and unaided conditions in a counterbalanced design. Sound localization tests, speech perception in noise assessments, and subjective satisfaction ratings were conducted to measure the effectiveness of the hearing devices. The study employed a single-subject, repeated-measures experimental design to compare the performance of the different devices.

Results: The results revealed that softband BAHA significantly improved sound localization, particularly in low-frequency stimulus localization, compared to CROS HA and unaided conditions (p = .03). Subjective satisfaction scores aligned with objective test outcomes, indicating a preference for softband BAHA. Speech perception in noise performance varied across conditions, with both hearing devices showing benefits in certain scenarios.

Conclusions: The findings of this study have important clinical implications for selecting appropriate hearing device options for SSD patients. Softband BAHA demonstrated superior performance in sound localization tasks, as evidenced by the significant improvement observed in the Azimuth Localization Test results. This test measures a central auditory skill-sound localization-by evaluating participants' ability to accurately identify the direction of sound sources. The enhanced performance with softband BAHA in this task suggests that the BAHA device provides the brain with more robust cues for localization when compared with the CROS device. Using suitable hearing devices during rehabilitation for SSD patients is crucial for enhancing auditory outcomes and quality of life in this population. Further research is warranted to address the limitations identified and optimize rehabilitation strategies for individuals with SSD.

Purpose: The purpose of this clinical focus article is to summarize the processes used at the San Francisco Veterans Affairs Health Care System (SFVAHCS) for cart-based synchronous audiology. This system involves a provider located at a main facility where they use a web-based teleconferencing platform to work with a patient at a community-based outpatient clinic with the help of a telehealth technician using a Clinical Access Station (CAS; GlobalMed) cart.

Method: The components of a successful cart-based synchronous audiology service are presented. These include a description of the problem of serving patients who live at great distances from Veterans Affairs (VA) hospitals, how to arrange the facility for use with the CAS cart to achieve maximum organization, and technician roles and training.

Results: Veterans may live in cities 15 to over 250 mi from the SFVAHCS in their California network. The SFVAHCS also serves Veterans outside their California network. Cart-based synchronous audiology offers an opportunity to provide services originating from San Francisco. Arranging the technician's workspace with the CAS cart is critical for efficient patient care, and examples of organizational tools are provided. Finally, a key to success is the capability of the telehealth technician. Suggestions are provided for technician training and skill assessment defined by the VA central office to promote nationally standardized, evidence-based practice with this modality of care.

Conclusions: The goal of cart-based synchronous audiology at the SFVAHCS is to provide the Veterans with the same quality of care that they would receive in a face-to-face appointment. This goal is being met by the SFVAHCS audiology service well outside of its defined catchment region or the designated area or areas from which a health care facility can expect to receive patients needing their services.

Purpose: This clinical focus article examines the history and evolution of telehealth, emphasizing its technological advancements, integration into health care systems, and the transformative impact of the COVID-19 pandemic on telehealth utilization in the United States, within the private sector and the Veterans Health Administration (VHA). Particular attention is given to the integration of audiology within telehealth, highlighting how the growth and use of teleaudiology services within the VHA have expanded access to this specialized care for Veterans. It aims to clarify how telehealth, including teleaudiology, has been established as a critical modality for enhancing health care access and delivery to Veterans.

Conclusions: The historical context reveals that, while telehealth has roots tracing back to the American Civil War or earlier, the COVID-19 pandemic catalyzed an unprecedented surge in adoption and integration of telehealth services in both the private sector and the VHA. The data indicate a significant increase in telehealth encounters and patient satisfaction before, during, and after the COVID-19 pandemic, reinforcing its role as a complementary modality alongside traditional in-person care. Challenges such as regulatory barriers and digital access disparities continue to exist, yet ongoing efforts to embed telehealth training in health care education and to foster technological innovation signal a promising future for telehealth. As the health care landscape evolves, telehealth is poised to remain an integral component of patient-centered care.

Purpose: This clinical study aimed to discuss the delivery and outcome of virtual group care for Veterans receiving progressive tinnitus management (PTM) services in the Bay Pines Veterans Affairs (VA) Healthcare System.

Method: Virtual group PTM was provided to Veterans during fiscal years (FYs) 2022-2024 using the VA Video Connect (VVC) platform. Outcome measures were obtained via the Tinnitus Workshop Follow-Up form after completion of the virtual workshops.

Results: Outcome data collected for FYs 2022-2024 showed that 80% of the respondents used all four strategies instructed in the workshops (using sound, relaxation, planning activities, changing unhelpful thoughts about tinnitus). Specifically, 94% reported using sound, 94% used relaxation strategies, 92% reported planning activities, and 88% reported changing unhelpful thoughts about tinnitus. The majority of respondents reported an improved sense of control of tinnitus (68%), improved ability to cope with tinnitus (68%), improved overall quality of life (QOL; 67%), and less bothersome tinnitus (60%) after participating in the workshops. Ninety-three percent of respondents recommended the workshops for other Veterans with bothersome tinnitus. Sixty percent requested text messages to support their tinnitus plan of care.

Conclusions: Clinical outcomes of care delivered to Veterans with bothersome tinnitus showed use of the PTM coping strategies and improved QOL indicators after completion of care, with 93% of the respondents recommending virtual group PTM care to other Veterans with bothersome tinnitus. Veterans were receptive to receiving text messages to supplement their tinnitus plan of care. Clinical tele-audiology services for group participants in the VA can be successfully delivered via the VVC platform for a variety of audiologic needs including bothersome tinnitus.

Purpose: Individual older adults with hearing loss often have unique communication needs that vary across different listening conditions. The current study examined whether user-directed fine-tuning of hearing aid programs specifically for different sound scenes would improve perceived speech quality.

Method: Thirty older adult participants were recruited based on self-reported hearing challenges or pure-tone audiometry indicating a hearing loss. Participants self-tuned the hearing aid frequency-gain characteristics while listening to continuous speech embedded in background noise, presented as simulated real-world sound scenes. The self-tuning procedure was conducted in two sound scenes, "Noisy Indoor" and "Noisy Outdoor," with an average speech level at 60 dB(A) and signal-to-noise ratios of +5 dB and +10 dB, respectively. Speech quality ratings were collected for each scene using an interface inspired by the Multiple Stimuli with Hidden Reference and Anchor method. In each sound scene, participants rated four programs: two self-tuned, one standard prescription based, and one poor-quality anchor. The order of presentation was randomized and blinded.

Results: Results showed that participants rated their self-tuned programs tailored to specific scenes significantly higher compared to both the prescription-based program and their self-tuned program for the other scene.

Conclusion: User-driven self-tuning procedures can be useful to capture scene-specific preferences for hearing aid settings and improve the perceived speech quality.

Supplemental material: https://doi.org/10.23641/asha.30359560.

Purpose: Hearing aids are the primary treatment for age-related hearing loss but are vastly underutilized. We explored cross-sectional associations between predisposing, enabling, and need factors and hours of daily hearing aid use.

Method: In the Atherosclerosis Risk in Communities (ARIC) Study, 764 participants at Visit 6 (2016-2017) reported hearing aid use. Self-reported hours of daily hearing aid use were modeled continuously (hours) and categorically (< 6, 6-12, and > 12 hr). Covariates included predisposing (age, sex, race-center), enabling (education, marital status, years of prior hearing aid use, global cognitive factor score, depressive symptoms, access to health care, health literacy), and need factors (pure-tone average [PTA], Quick Speech-in-Noise Test [QuickSIN] score). Multivariable-adjusted linear and ordinal logistic models were used to examine associations between these factors and daily hearing aid use.

Results: Every 1-year increase in prior hearing aid use was associated with 0.08-hr increase in daily hearing aid use (95% confidence interval [CI] [0.04, 0.13]); every 10-dB increase in PTA was associated with 0.63-hr increase in daily hearing aid use (95% CI [0.18, 1.08]); every 5-point increase in QuickSIN score was associated with 0.53-hr decrease in daily hearing aid use (95% CI [-0.99, -0.06]). Longer duration of prior hearing aid use and poor PTA and QuickSIN performance were associated with higher odds of being in a higher hearing aid use category.

Conclusions: Hours of daily hearing aid use is driven primarily by audiometric hearing, SIN performance, and years of prior hearing aid use. Further research into determinants of hours of use can improve precision of hearing care.

Supplemental material: https://doi.org/10.23641/asha.30192826.