Category: Audiology

What did you say? Excuse me? Pardon Me? What?

If your patients have uttered these words recently, they are not alone.

The World Health Organization estimates that over 1 billion young adults are at risk for hearing loss[1] and there are an estimated 37.5 million adults in the USA who report some trouble hearing.[2] Additionally, with the majority of people in America wearing masks/face coverings due to COVID-19, it has created communications challenges even for those without hearing loss.

New hearing challenges in a pandemic

The face coverings worn throughout the pandemic, as well as plexiglass partitions and social distancing, have made it difficult to hear others. It is estimated that different types of facemasks attenuate everyday speech sounds by as much as 10-15 decibels.[3] This is like having a mild hearing loss, meaning people realized very quickly what it was like to suddenly have difficulty communicating each day.

Indeed, throughout the pandemic your patients likely noticed that listening was no longer easy.  Sorting out words and filling in the “missing” parts of a sentence from a loved one, colleague, or friend became difficult and tiring. Even those with otherwise normal hearing levels likely understood what it was like to have hearing loss, finding it more difficult to understand others than before. 

Discussing hearing loss

Given the widespread hearing challenges, now is the perfect time to have a conversation with your patients about their hearing. How can you begin? Try asking about their experiences during the pandemic, and if they can recognize instances before the pandemic when they had difficulty hearing or understanding conversations. And as face mask restrictions continue to ease up, you can ask them if they have any challenges when communicating even when speaking to people who aren’t wearing masks.

You can also bring up the following example, which illustrates how simple misunderstandings can be an early sign of hearing loss. For instance, your spouse or significant other may say “Please go and get my keys,” but you might hear “Please go and get some bees.” This demonstrates how quickly communications can break down by mis-hearing just one word. Given the many conversations that happen throughout the day – at home, in work meetings, at the grocery store, and even when watching TV – these simple misunderstandings can add up and cause a great deal of frustration. If left untreated, hearing loss can lead to more serious conditions, such as social isolation and even increase your risk for dementia. Unfortunately, many people with hearing loss

choose to avoid social situations out of fear of embarrassment or frustration by not being able to participate in a conversation. 

New technology delivers an enhanced hearing experience

What can patients do to address their hearing loss? The first step is to get their hearing baseline checked by an Audiologist. You’ll also want to let them know that hearing loss shouldn’t stop or limit them from going out and enjoying life again – especially as life gets back to normal! We were stuck inside for too long to miss out on any more fun, and with proper hearing treatment, they can hear all the sounds around them like never before.

Of course, some patients may be nervous about wearing hearing aids and even getting a hearing test. You can help calm their nerves by explaining the process and the wonders of today’s hearing technology.

Make sure to let them know that today’s audiology consultation involves a lot of cool tech and listening experiences that are NOT anything like the hearing aids of the past. Today’s technology like that from Widex, a 60+ year old Danish tech company, includes the WIDEX MOMENT, the smallest rechargeable receiver-in-the canal device with Artificial Intelligence and machine learning. The WIDEX MOMENT hearing device is fully automatic and can learn how wearers like to hear/listen and adapt to their unique preferences over time with My Sound. 

The sound quality from WIDEX MOMENT is one of the most coveted natural sound experiences, thanks to ZeroDelay technology that delivers the fastest processing time in the industry and eliminates the artificial sound experienced with other devices. No matter how they like to spend their time,  wearers can enjoy it with their individual listening preferences, from listening to their favorite music to enjoying social activities. 

If they still aren’t convinced about the benefits for checking and treating their hearing loss, you may want to mention how 91% of the adults who tried the new WIDEX MOMENT could now participate in life once again![4]  

The time to act is now

To help your patients hear like they used to and live life to the fullest, be sure to refer any patients with hearing loss to your practice’s Audiologists. To learn more about Widex, visit: https://www.widexpro.com/en-us/

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[1] World Health Organization. (2021, April 1). Deafness and hearing loss. https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss

[2] National Institute on Deafness and Other Communication Disorders. (2021, March 25). Quick Statistics About Hearing. https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing

[3] Corey RM, Jones U, Singer AC. Acoustic effects of medical, cloth, and transparent face masks on speech signals. The Journal of the Acoustical Society of America 148, 2371 (2020).

[4]Balling LW, Townend O, Helmink D. Sound quality in real life–Not just for experts. Hearing Review. 2021;28(2):27-30.(2):27-30.

The work clinicians do to contribute to breakthrough science

Clinical trials have been used in the world of medicine for years, but now we are seeing an increase in trials that are more ENT-Audiology based.  An analysis of trial registration data downloaded from Clinical Trials.gov and utilizing administrative data from the Duke University Medical Center from October 1, 2007 to September 27, 2010 revealed a total of 1115 registered interventional trials assigned to otolaryngology.  Of these, head and neck cancer trials predominated.  But what is happening in this space in 2021 is nothing short of an explosion. At the time of this article, there are 797 current clinical trials in the hearing loss space as listed on Clinicaltrials.gov.  Although head and neck cancer trials are still leading in number, there is a significant uptick in trials for new pharmacological treatments & medications for sensorineural hearing loss, age-related hearing loss, tinnitus, and dizziness just to mention a few. There are also a number of ongoing FDA studies related to different devices used in treating hearing loss.

Our practice is currently involved in 14 clinical trials ranging from procedure trials to medication trials.  We have a clinical trial team that finds trials that may interest our physicians and providers, presents them as opportunities for the practice and then applies to the study. There are several steps from the time of application to when a site is accepted for participation in the trial. Each step of the process builds on the other until subject recruitment can begin. Look for our upcoming article on the Business of Clinical Trials.

As an audiologist, I believe some of the most exciting trials today are the studies investigating restoring the cochlear synapse.  It is more recently believed that when the cochlear synapse is impaired, it directly impacts a person’s ability to understand in noise.  This is supported in research on hidden hearing loss. This article discusses hidden hearing loss at length; the authors suggest this type of selective neural loss may be the physiological basis for many of the cases of hearing disability with a normal audiogram.

If you have been performing audiological testing on patients for any period of time, you most likely have come across a patient with a similar story. A patient presents with a concern about their hearing, you perform a hearing test, and everything appears to be within normal limits.  If we weren’t performing speech in noise testing at the time, did we tell them they had normal hearing? did we miss them altogether? I think about early in my career where we assured patients, as did our physicians, that their hearing was “within normal limits”, but was it really hidden hearing loss that went undiagnosed because the current research hadn’t suggested it existed yet, we weren’t performing an expanded standard battery on all patients, or we simply weren’t asking the right questions?

As we know, speech-in-noise testing is often not standardly performed, unless it is tied to a larger work-up like a cochlear implant assessment, an auditory processing disorder battery or part of hearing aid verification. Today, providers have the opportunity to dig a little deeper when the patient’s primary complaint is specifically related to difficulty understanding in noise, and their hearing is within normal limits.   In this situation, hidden hearing loss could still be missed without pushing beyond the basic audiometric testing. Now that the clinical trials and research are focused more than ever on hearing loss and other audiologically related symptoms, we need to become even more vigilant by consistently managing patients with robust patient history and expanded standard diagnostic practices.

Within our clinical guidelines at ENTAAF, the Quick Sin is included as part of our standard audiological battery, and still there are times where it isn’t done.  It is true that it takes slightly more time, and sometimes that makes it difficult to keep schedules on time. We find that performing the QuickSin or the Words in Noise (WIN) test adds about 3 minutes to the testing battery.

As audiologists, one of the most important things that we can do is to take the lead in educating the other medical providers that are involved in managing our patients with hearing loss.  When we provide them with peer reviewed articles that support the benefits of adding this into our regular battery, it better aligns our recommendations.  The audiogram has been thought by many to be the picture of what is happening with our patients hearing, but the truth is, we are finding that the basic audiologic battery used in most practices may not be robust enough to tell the whole story.

Listed below are a few things discovered in this journey to gain a better picture of our patient’s hearing health. By adding speech in noise testing to our clinical battery we have seen a number of benefits. 

The additional test:

1. Assists patients in understanding the complexity of hearing speech in a noisy background.
2. Allows us to quantify the degree of difficulty that patients are experiencing when listening in noisy environments and compared against normative data
3. Presents a testing environment that mimics where our patients complain they have the most difficulty, in noise.
4. Provides insight into those that end up having thresholds within normal limits but still feel they have significant difficult with speech in noise environments.
5. Gives us a baseline of performance to assess the benefit and project outcomes for the recommended aural rehabilitation programs.
6. Provides a robust group of patients to access information on speech in noise performance, allowing us to participate in clinical trials surrounding cochlear synaptopathy as well as opens up other clinical trials that involve hearing loss & audiological testing.  

If your practice location has been involved in clinical trials, then you know that there are several considerations before adding this service into your practice. Look for our upcoming series on the Business of Clinical Trials.

If you are like most, the word “curbside” brings visions of food being delivered to your car window, maybe even on roller skates. Prior to 2019, most people would likely not have thought about the term “curbside” when discussing health care services.  And as providers, most of us didn’t think that we would provide patient care at the curb outside the office front door. Today, it is not uncommon to drive through medical building parking lots and see that there are assigned Curbside Care designated parking spots.   Some practices have handmade signs that are stuck in the ground (that is how we started), and others have embraced the new way to deliver care, for now and the future, assigning permanent parking spots for curbside care.

As we think back to the first days of the pandemic lock down, it brings back vivid memories of uncertainty; fear for ourselves and our patients and wondering how we could continue to serve our patients who were already predisposed for isolation by the pure nature of hearing loss.  Never in our lifetime had we been asked, or in some cases told, to shelter-in-place due to a medical threat. The healthcare world was managing difficult questions of how we keep people safe while still being able to serve their medical needs.  The discussions were swirling in the media, in phone conversations with colleagues and within practices on what is considered “essential healthcare services” when a community is faced with a global pandemic?  Some classified “essential” as anything required to save a patient’s life; others considered anything that negatively impacts a patient’s quality of life as “essential care”.  As a medical provider that witnesses the impact on the overall health and wellness that even an untreated mild hearing loss can bring, knows that for most, untreated hearing loss has substantial consequences when the world is managing normal circumstances. Now to be isolated at home, without support systems like family and friends, created an environment where a patient’s only contact with the world is through a video or phone call, television, radio, and social media.  We argued that hearing care services were even more essential in everyday life, now more than ever, hearing was a person’s primary lifeline.

At that point, we started asking ourselves, how can our physicians and providers meet patients where they are: in the community, at their homes, and on their connected devices. Although some of these changes will reverse as the world feels safer and more comfortable, we believe that there has been a fundamental shift in the delivery care.  We already had digitally enabled care in some ways, through apps and our patient portal, we needed to expand our care delivery and inform our patients.  We ultimately learned to connect to our patients in new ways, through: telemedicine appointments, remote-programming schedules, drop-off services and curbside care; and we are not looking back. 

To make patients feel as safe as possible and meet the social distancing guidelines, medical professions were able to start providing telehealth visits to meet their healthcare needs in a time that being in an exam room with a patient was not “safe”.  In audiology, we can provide a vast number of services via telehealth, however, we must have our patients positioned to move to this type of care.  What do I mean by this?  Remote programming has been available in hearing instruments for quite some time, but not widely adopted due to licensing concerns as it relates to telemedicine and audiology.  But once again, COVID 19 created a window where prior telehealth regulations by insurers were loosened so patients could be provided healthcare as it was needed, and providers could receive payment.

In hearing care, we had the answer – remote programming.  Thankfully, the hearing instrument manufacturers had been incorporating remote programming capabilities for quite some time. That said, many of us did not wholly appreciate the effort until COVID hit unexpectedly. And even then, many of us were not fully prepared to deliver it to the bulk of our patients. Our practice had written hearing aid delivery guidelines that include activating any remote programming capabilities in the hearing instrument. So, in theory, as part of our clinical protocol, all instruments are to be set up for remote care services.  Guess what happened when the pandemic started?  We quickly discovered that for whatever reason, many providers had not initiated the remote capability.   As I investigated the reasons why it had not been done, the first reason was time, they didn’t have enough of it during the delivery of the technology to add another feature and counsel on it.  However, the biggest reason was they didn’t think the patient would use it.  And for the most part, at that time, they weren’t wrong.  Most of our patients set in-person appointments for their follow-up and on-going hearing care.  When we look back now, we just weren’t planning for a pandemic-like environment.  We had been delivering care one way, for a very long time; and only for extreme cases, like illness or distance, did we ever really use any type of phone consult, telemedicine visit or remote programming capability as a practice.  Wow.  We were wrong about adaptation when there are extenuating circumstances and other available care channels to receive help. 

This is where the Curbside Care Channel journey began for ENT and Allergy Associates of Florida.  To service our patient’s hearing instrument needs, we first had to have all hearing aids prepared for remote programming, which for most patients meant we needed their instruments in the clinic. However, at this time during the pandemic, we couldn’t have the patients physically in the hearing aid clinic, and thus, Curbside Care was born.  While servicing the patient this way, we could wear proper personal protective equipment, do the proper patient attestation, take temperatures, and mostly stay at the required social distance. Best of all, we could take the patients hearing instruments from them and prepare them for remote programming while they sat in the safety of their own car.

The next hurdle was figuring out how to inform our patients about the new way to visit the office. We wanted them to know that we were here for them.  The fastest way to engage with them was on our social media of course.  We went “Live on Facebook” on ENTAAF’s Hearing Clinic social channel and talked about the new way to visit the office, how the Curbside Care would allow us to assist them safely, what remote programming meant and communicated that they did not have to be our patient to get help. 

As providers, we focused on how we could manage the situation within the government guidelines and still find solutions that would meet the needs of our patients while protecting the staff.  Even though what we came up with may even seem outside-of-the-box, we simply focused on how to meet the needs of the patient by managing them “where they were”; and in this case, they were in their car. After all, some practices still utilize the care channel of ‘at-home’ care, and take care of patients where they live, we surely could be creative enough to manage care if they would drive to us.

Considerations when adding or maintaining this modern delivery channel:

1. Put a clinical guideline in place that requires that if remote programming features are available, they are activated at time of fitting.  Next, add this feature to your chart review process to monitor provider compliance.
2. Assess the parking spaces around the practice to determine best parking spots to assign as Curbside Services.
3. Assure you have adequate signage designated for the curbside area and that you have communicated to the patient how to notify the office when they arrive.
4. Familiarize and train support staff on services that can be provided curbside and how to triage patients between face-to-face care, drop-off service, remote programming appointment and curbside care.
5. Become familiar with all manufacturers remote capabilities allowing your team to manage patients that may have purchased from other locations. Understanding what is available also allows the practice to determine if there are other products that may meet the needs of current patients.  
6. Develop manufacturer specific checklists listing the required steps the provider must execute to enable remote programming capabilities in products.
7. Regroup with your providers and staff to discuss benchmarks around different care channels, talk about how they are doing, and what they are seeing with patient outcomes.  Remember, there is always a way to improve the experience for both your patients and the team that is providing the care.

Hopefully, we are turning the corner on this pandemic.  With that, many patients are still not comfortable being in the office, and for many, having to come into the office is a burden. We believe that Curbside Care and Remote Programming Appointments are here to stay in the world of hearing care.  Moving forward, we will continue to deliver hearing care in these newer channels.