Extended scope of practice audiology in the ENT outpatient clinic - a pilot study

Extended scope audiology clinic - a review of its outcomes and re-presentation to the ear nose and throat service

OBJECTIVE

To evaluate the role of Extended Scope (ES) audiologists in managing adult Ear Nose and Throat (ENT)/Otology waitlists and analyse patient re-presentation rate to the ENT service within 12 months of being discharged from the clinic.

DESIGN

A retrospective cohort study assessing the efficacy of ES audiologists, measuring the discharge rate from ENT waitlists, the rate of escalation to ENT care, and the rate and reasons for any re-presentations to care.

STUDY SAMPLE

394 adult patients.

RESULTS

Of the referred patients, 95% (n = 374) were deemed suitable for ES care. Of these, 75% were discharged without further ENT intervention, 20% required escalation to ENT, and 5% were returned to the waitlist. Only one patient re-presented for care within 12 months. The inclusion of patients with CHL/MHL and vestibular symptoms marked an expansion from our previous work. The re-presentation rate was notably lower compared to other allied health ES clinics.

CONCLUSION

The ES Audiology clinic demonstrates a high discharge rate with a low incidence of patient re-presentation, highlighting the ES audiologists' efficiency in managing non-urgent ENT cases. The study supports the continued use and expansion of ES roles to ensuring timely and quality care for patients on ENT waitlists.

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.

Diagnostic and management plan concordance across advanced audiologists, paediatric audiologists and non-specialist ENT doctors

OBJECTIVE

To compare the concordance of advanced audiologists (AA), junior doctors (JD) and paediatric audiologists (PA) with an Ear, Nose and Throat (ENT) specialist on the diagnosis and management of children with middle ear or hearing concerns.

DESIGN

A clinical equivalence (concordance) study.

STUDY SAMPLE

Three AAs, five JDs, three PAs and one ENT specialist asynchronously reported diagnoses and management plans for ten, online paediatric cases consisting of video-otoscopic images and clinical findings.

RESULTS

For medical diagnosis, significant agreement with the ENT specialist was observed at moderate and near-perfect levels for two AAs (k = 0.561 and 0.815), moderate levels for four JDs (k = 0.5 to 0.603) and near-perfect level for one PA (k = 0.815). For management decisions, significant agreement with the ENT specialist was observed at substantial (k = 0.636) and near-perfect (k = 0.818) levels for two AAs, and at a moderate level (k = 0.538) for one PA. Within group inter-rater agreement for management plans was substantial for AAs and JDs, and moderate for PAs.

CONCLUSIONS

For children with middle ear disease or hearing concerns, AAs, JDs and PAs showed similar levels of agreement with an ENT specialist on diagnosis, but AAs were more likely than JDs or PAs to agree with an ENT specialist on management.

Ear Portal: An urban-based ear, nose, and throat, and audiology referral telehealth portal to improve access to specialist ear-health services for children

INTRODUCTION

Shortage of ear, nose, and throat specialists in public hospitals can result in delays in the detection and management of otitis media. This study introduced a new hospital-based telehealth service, named the Ear Portal, and investigated its role in improving access to specialist care.

METHODS

The study included 87 children (aged 6 months to 6 years) referred to a tertiary children's hospital due to otitis media-related concerns. A specialist multidisciplinary team met fortnightly to review pre-recorded data and provide care plans.

RESULTS

The service resulted in a median waiting time of 28 days to receive a diagnosis and care plan by the multidisciplinary team, compared to a mean waiting time of 450 days for a reference group receiving standard healthcare services. Most children (90.3%) received bilateral ear diagnosis. Normal findings were found in 43.9%. However, the majority required further ear, nose, and throat with or without audiology face-to-face follow-up due to a diagnosis of middle-ear disease, unknown hearing status, or concerns not related to ears. The mean time required for clinical assessments completion by research assistants and multidisciplinary team review was 37.6 and 5.1 min per participant, respectively.

DISCUSSION

Children in the Ear Portal service received a diagnosis and care plan in a median of 28 days, which is within the clinically recommended timeframes. With sufficient clinical information, this service can provide faster access to specialist care than the standard healthcare pathway. The service can reduce the time required by the specialist to provide a diagnosis and care plan which may help increase the specialists' capacity.