American Journal of Audiology最新文献

Purpose: In 2022, the Food and Drug Administration (FDA) permitted the sale of over-the-counter (OTC) hearing aids nationwide. The impact on audiology practice has not been well characterized. The purpose of this study is to determine if there was a change in the volume of hearing aid evaluations (HAEs) and comprehensive audiologic exams (CAEs) at an academic tertiary care audiology practice following the ruling.

Method: Data were collected from the billing records of patients ≥ 18 years old. HAE and CAE visits, defined by Current Procedural Terminology and Healthcare Common Procedure Coding System codes, were included. The number of visits was totaled for equal time periods (534 days) before and after October 17, 2022, when OTC hearing aid sales began. Sensitivity analysis (365 days before and after the ruling) accounted for seasonality. Change in visits per day over the entire period was calculated from the slope of the line of best fit.

Results: The mean (SD) age was 60.5 (18.3) years. There were 20,300 combined HAE and CAE visits. Compared to before the ruling, over the entire study period (534 days), HAE visits increased by 12.0% (n = 57), CAE visits increased by 7.3% (n = 685), and combined visits (HAE and CAE) increased by 7.6% (n = 744) after the ruling. Over the entire study period (534 days), HAE had an increase of 0.084 visits/day, CAE had an increase of 4.56 visits/day, and combined visits (HAE and CAE) had an increase of 4.95 visits/day.

Conclusions: The FDA OTC hearing aid ruling did not have a meaningful impact on the volume of HAEs and CAEs at an academic audiology practice. We found a small trend toward increased volume. Future studies should investigate visit patterns in other practice models to understand the full impact of the ruling on clinical audiology practice volumes.

Purpose: This study examined maturational differences in basic auditory processing between children and young adults using the Portable Automated Rapid Testing (PART) battery. A secondary aim was to assess whether auditory processing performance was associated with cognitive abilities across development.

Method: Children aged 8-13 years (n = 36) and young adults aged 18-25 years (n = 37) completed a battery of PART subtests measuring temporal fine structure (TFS), spectrotemporal sensitivity (STS), and spatial release from masking (SRM). Participants also completed six subtests from the National Institutes of Health Toolbox Cognition Battery. Group differences in auditory and cognitive performance were analyzed using linear mixed-effects models. Principal components analysis was used to derive a unified index of auditory proficiency, and correlations with cognitive measures were assessed.

Results: Significant maturational differences were observed in TFS and SRM, with children showing elevated thresholds and reduced spatial unmasking compared to adults. No group differences were found in STS. An exploratory subgroup analysis in children (8-10 vs. 11-13 years) revealed significant differences in SRM and STS, suggesting continued development within the pediatric age range. The composite auditory index significantly differentiated children from adults but was largely uncorrelated with cognitive measures in either group.

Conclusions: These findings suggest that core auditory processing abilities, particularly those related to fine temporal cues and spatial hearing, continue to mature into adolescence. Exploratory analyses further highlight developmental changes even within the 8-13 years age range. When assessed using basic auditory processing tasks such as those in the PART battery, auditory performance showed limited association with cognitive abilities. This has important clinical implications, as it supports the use of developmentally appropriate, low-burden tools such PART in pediatric auditory processing evaluations. Ongoing efforts to establish normative data across narrower age bands will further enhance its clinical utility.

Supplemental material: https://doi.org/10.23641/asha.30266848.

Purpose: The aim of this prospective study was to compare the results of the traditional cochlear implant fitting method and the anatomy-based fitting method.

Method: Seventy-two cochlear implant users with congenital (36 participants) and postlingual (36 participants) profound hearing loss and unilateral cochlear implantation were included in the study. After determining the center frequencies according to the actual anatomical location of each electrode contact on the computed tomography records obtained after implantation with OTOPLAN software (Version 1.5.0; CAScination AG), the cochlear implant processor was programmed with MED-EL MAESTRO 9.0 software using an anatomy-based fitting method. The Musical Perception Test (MPT), Spectral-Temporally Modulated Ripple Test (SMRT), free-field pure-tone hearing thresholds, speech recognition, and speech discrimination tests were applied. The results obtained with both methods were compared.

Results: In both groups, the MPT and SMRT scores, free-field pure-tone hearing thresholds with cochlear implants, speech recognition, and speech discrimination test results were significantly higher with the anatomy-based fitting method compared with the traditional fitting method (p < .05).

Conclusions: Cochlear implant users performed better with anatomy-based fitting. Thus, anatomy-based fitting should be incorporated into cochlear implant speech processor fitting methods.

Purpose: In fiscal year 2020 (FY20), the Veterans Health Administration (VHA) initiated a pilot study to determine whether automated audiometry could be used in conjunction with asynchronous telehealth systems to increase access points for audiologic services to Veterans across multiple VHA locations.

Method: Veterans Integrated Service Network (VISN) 19 was provided funding from the Office of Rural Health (ORH) to take on this pilot project to trial a hub-and-spoke model of asynchronous automated audiometry service delivery. With this care model, the patient and trained telepresenter are in one location utilizing the testing equipment, and the results are collected and transmitted to the patient record. The audiologist then reviews the stored results from within the patient record, diagnoses as able based on results, and provides follow-up care to the Veteran via video or telephone visit, at which time a further care plan is developed.

Conclusions: Although there were many challenges with the equipment procurement and supply chain in the postpandemic world, 16 of the initial 20 sites across the region were launched by the end of FY24. As a result of this pilot, asynchronous automated audiometry was approved as an Enterprise-Wide Initiative in the VHA system with 34 additional sites across VHA receiving ORH funding and multiple additional sites beginning their own asynchronous automated audiometry programs.

Purpose: Cochlear implants (CIs) are an effective strategy for managing patients with hearing loss who derive limited benefit from other treatment options. Although the Veterans Health Administration (VHA) has made a strong effort to expand access to CI technology and onboard new CI sites across the country, access to consistent CI services can still be challenging. This is especially true for Veterans who reside in more rural and remote areas. The purpose of this tutorial is to describe various models of care and provide solutions that are replicable throughout the VHA for meeting the needs of our most severely hard of hearing Veterans.

Results: Routine availability of CI programming using telehealth options, such as clinical video telehealth (CVT) or VA video connect (VVC), significantly improve access to CI care. Other benefits of remote programming may include decreased wait times, less travel time and cost, and improved adherence to treatment plans. Additionally, aural rehabilitation for CI recipients can be performed remotely to improve outcomes. This innovative model for delivering audiology services will be described.

Conclusions: Remote care teleaudiology CI services available for Veterans in the VHA have the potential to improve outcomes in a cost-effective manner that is patient-centered and replicable across the enterprise. Implementing these strategies addresses the critical need to standardize telehealth practices for CI programming and rehabilitative interventions across the VHA. This program can give all Veterans access to CI care in an efficient manner, with reduced costs, result in fewer travel barriers, and allow for a more positive outcome for the VHA, its patients, and their families.

Purpose: This exploratory study examined if hearing handicap in older adults affected listening-related fatigue during health care interactions and explored whether different face mask types worn during the coronavirus disease 2019 (COVID-19) pandemic influenced this association.

Method: A cross-sectional observational study among community-dwelling adults aged 60 years and older receiving care at an academic health care system outpatient audiology or otolaryngology clinics was conducted. Eligible participants completed and returned a mail-in self-reported packet including the Hearing Handicap Inventory for the Elderly (Screener Version; HHIE-S) and the 10-item Vanderbilt Fatigue Scale for Adults (VFS-A-10). Face masks were institutionally required during the COVID-19 pandemic, with options including (a) standard surgical face mask, (b) clear face mask, or (c) standard surgical face mask with face shield. General linear models assessed differences in VFS-A-10 by HHIE-S score.

Results: Among the 104 participants, the HHIE-S mean was 15.3 (SD = 10.4); 34.3% experienced no hearing handicap, 45.5% experienced mild to moderate handicap, and 20.2% experienced severe handicap. Higher hearing handicap scores correlated with increased listening-related fatigue (β = 0.66, SE = 0.06, p ≤ .0001). Clear masks were linked to less listening-related fatigue, especially for individuals with higher degrees of hearing handicap, compared to standard surgical masks (β = -0.30, SE = 0.10, p ≤ .01).

Conclusions: Findings from this exploratory study underscore the need for tailored communication strategies and accommodations to enhance the health care experience for individuals with hearing handicap. Future research could explore listening-related fatigue in other health care settings.

Purpose: This clinical focus article provides an overview of essential areas of current teleaudiology practice and goals for future expansion and innovation. It includes descriptions of telehealth models, rural expansion capabilities, access improvement initiatives, pilot programs, remote audiology applications, and overcoming barriers to teleaudiology.

Conclusion: Positive changes within teleaudiology service delivery are accomplished with advancements in technology, connectivity, and software; carefully planned and coordinated approaches; and investment in personnel who contribute their talent and commitment to the process.

Purpose: Effective communication is essential to optimize medical care, but patients and providers are poor at recognizing hearing difficulty. While hearing loss is managed in outpatient clinics at the Veterans Affairs Pittsburgh Healthcare System, audiologic care for inpatients is typically reactive or not provided.

Method: An audiology inpatient management (AIM) program was developed to improve communication between inpatients with hearing loss and their medical providers during a hospitalization. AIM uses chart review to proactively identify inpatients that may have difficulty communicating with medical providers and provides bedside audiologic care. AIM was piloted on one inpatient unit before expanding to the entire medical center.

Results: Fifty-two percent (52%) of the pilot unit's new admissions had previously documented hearing loss. Although 83% of inpatients with hearing loss were fitted with hearing aids before their hospitalization, only 31% brought them to the hospital upon admission. Since expanding AIM to every inpatient unit, 28% of all new hospital admissions received audiologic care at bedside.

Conclusions: This article describes AIM's design, implementation, and evaluation with the intent of serving as a resource for other audiologists creating a similar program. Audiologists must guide recommendations on how to ensure that inpatients with hearing loss can effectively participate in their health care.

Background: Telehealth facilitates access to care via technology and broadband infrastructure, remotely connecting patients and their clinical care teams. This is particularly important for those in rural and medically underserved areas, where there may be a lack of specialty medical care, and terrain, weather, or transportation options may make travel to a health care facility difficult.

Purpose: The purpose of this clinical focus article is to provide an overview of the history, current state, and future direction of telehealth within the Department of Veterans Affairs.

Conclusions: A variety of tools and technology with which telehealth can be delivered exist. This enables health care organizations to leverage their clinical networks to match supply and demand across their enterprise and offer additional choices for how patients receive their care. The COVID-19 pandemic was an opportune time for expansion of telehealth. Postpandemic, in many health care systems, it has become a core part of clinical operations. To realize the full potential of telehealth and to ensure equity across populations, addressing gaps in broadband access and digital skills will be critical.

Purpose: Understanding speech in challenging environments can be fatiguing for individuals with and without hearing loss. Empirical research examining interventions to reduce such fatigue, however, is limited. Our study investigated the effects of imperfect captions, such as those created using automated speech recognition systems, on listening-related fatigue during a challenging speech task.

Method: Twenty-two adults (aged 18-63 years) with essentially normal hearing completed a sustained dual task designed to induce listening-related fatigue. The primary task was audiovisual sentence recognition in quiet, with speech levels individually adjusted for ~70% correct performance (without captions). The secondary task was response time (RT) to topic words presented during the speech task. Participants completed the dual task with or without captions. Subjective fatigue ratings were obtained before, during, and after the dual task. Vigilant attention was measured via the secondary task and before and after the dual task using visual stimuli (RTs to a visual marker presented at random intervals).

Results: Subjective fatigue ratings increased significantly over the course of the dual task. However, this increase was larger for the group who had captions, even though they had better sentence recognition overall. Evidence of behavioral fatigue (slowed RTs over time) was also present but only for those in the Caption group. Anecdotal reports from study participants suggest that the increased fatigue for the Caption group was related to the cognitive challenge of combining information from the time-locked audiovisual cues and the time-delayed, and imperfect, text captions.

Conclusions: Even though they were time-delayed and contained inaccuracies, captions improved speech recognition. However, this benefit was accompanied by greater increases in subjective and behavioral fatigue. Therefore, in some conditions imperfect captions can have negative consequences for listening-related fatigue. Further research is needed to determine whether this pattern holds in different circumstances, such as with audio-only stimuli.

Supplemental material: https://doi.org/10.23641/asha.29646482.