Assessing the efficacy of asynchronous telehealth-based hearing screening and diagnostic services using automated audiometry in a rural South African school

Breaking Sound Barriers: Exploring Tele-Audiology's Impact on Hearing Healthcare

Hearing impairment is a global issue, affecting billions of people; however, there is a gap between the population affected by hearing loss and those able to access hearing healthcare. Tele-audiology, the application of telemedicine in audiology, serves as a new form of technology which aims to provide synchronous or asynchronous hearing healthcare. In this article, we reviewed some recent studies of tele-audiology-related topics to have a glimpse of the current development, associated challenges, and future advancement. Through the utilization of tele-audiology, patients can conveniently access hearing healthcare, and thus save travel costs and time. Recent studies indicate that remote hearing screening and intervention are non-inferior to the performance of traditional clinical pathways. However, despite its potential benefits, the implementation of tele-audiology faces numerous challenges, and audiologists have varying attitudes on this technology. Overcoming obstacles such as high infrastructure costs, limited reimbursement, and the lack of quality standards calls for concerted efforts to develop effective strategies. Ethical concerns, reimbursement, and patient privacy are all crucial aspects requiring in-depth discussion. Enhancing the education and training of students and healthcare workers, along with providing relevant resources, will contribute to a more efficient, systematic hearing healthcare. Future research will aim to develop integrated models with evidence-based protocols and incorporating AI to enhance the affordability and accessibility of hearing healthcare.

Comparisons of air-conduction hearing thresholds between manual and automated methods in a commercial audiometer

Objective

To investigate the correlation of air-conduction thresholds between automated audiometry in a non-isolated environment and manual audiometry in participants with normal hearing and different degrees of hearing loss.

Methods

Eighty-three participants aged 11-88 years old underwent automated pure-tone audiometry in a non-acoustically isolated environment, and the results were compared with those of manual pure-tone audiometry performed in a standard acoustically isolated booth, with the order of testing randomised. Six frequencies of 250, 500, 1,000, 2000, 4,000 and 8,000 Hz were tested.

Results

All 166 ears were completed and 996 valid hearing threshold data were obtained, with 28 data exceeding the 95% confidence interval in the Bland-Altman plot, accounting for 2.81% of all data. The means and standard deviations of the differences for the six frequencies from 250 to 8,000 Hz were, respectively, 0.63 ± 5.31, 0.69 ± 4.50, 0.45 ± 4.99, 0.3 ± 6.2, -0.15 ± 4.8, and 0.21 ± 4.97 dB. The correlation coefficients of the two test results for normal hearing, mild, moderate, severe and above hearing loss groups were 0.95, 0.92, 0.97, and 0.96, respectively. The correlation coefficient of the automated and manual audiometry thresholds for the age groups under 40 years, 40-60 years, and 60 years above, were 0.98, 0.97 and 0.97, respectively, with all being statistically significant (p < 0.01). The response time of the three age groups were 791 ± 181 ms, 900 ± 190 ms and 1,063 ± 332 ms, respectively, and there was a significant difference between the groups under 40 years and over 60 years.

Conclusion

There was good consistency between automated pure-tone audiometry in a non-acoustically isolated environment and manual pure-tone audiometry in participants with different hearing levels and different age groups.

In pursuit of increasing the application of tele-audiology in South Africa: COVID-19 puts on the alert for patient site facilitator training

BACKGROUND

 The coronavirus disease 2019 (COVID-19) presented and highlighted new and unanticipated challenges to the provision of clinical services, raising an urgency for the application of different models of service delivery, including tele-audiology. In many tele-audiology encounters, a site facilitator is needed at the patient site to help with the hands-on aspects of procedures, and the implications of this requirement are significant for the resource-constrained African context.

OBJECTIVES

 The aim of this scoping review was to investigate published evidence on training provided to patient site facilitators (PSFs) for tele-audiology application to guide the South African audiology community in tele-audiology application initiatives.

METHOD

 Electronic bibliographic databases including Science Direct, PubMed, Scopus MEDLINE and ProQuest were searched to identify peer-reviewed publications, published in English, between 2017 and 2021 related to training of PSFs. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) were followed during the screening process as well as for illustrating the process.

RESULTS

 Findings are discussed under four key themes: (1) type of tele-audiology and the implications thereof, (2) length of training and its implications, (3) diversity in the range of PSFs used and its implications for the training, and (4) heterogeneity in the training.

CONCLUSION

 The findings highlight important considerations for tele-audiology application within the African context, specifically decision-making around who can serve in the role of PSFs, as well as content and nature of training required, with implications for policy and regulations as well as human resource strategy. These findings are important for the COVID-19 pandemic era and beyond.

Telemedicine and Telementoring in Rhinology, Otology, and Laryngology: A Scoping Review

Objective

Telemedicine and telementoring have had a significant boost across all medical and surgical specialties over the last decade and especially during the COVID-19 pandemic. The aim of this scoping review is to synthesize the current use of telemedicine and telementoring in otorhinolaryngology and head and neck surgery.

Data Sources

PubMed and Cochrane Library.

Review Methods

A scoping review search was conducted, which identified 469 articles. Following full-text screening by 2 researchers, 173 articles were eligible for inclusion and further categorized via relevant subdomains.

Conclusions

Virtual encounters and telementoring are the 2 main applications of telemedicine in otolaryngology. These applications can be classified into 7 subdomains. Different ear, nose, and throat subspecialties utilized certain telemedicine applications more than others; for example, almost all articles on patient engagement tools are rhinology based. Overall, telemedicine is feasible, showing similar concordance when compared with traditional methods; it is also cost-effective, with high patient and provider satisfaction.

Implications for Practice

Telemedicine in otorhinolaryngology has been widely employed during the COVID-19 pandemic and has a huge potential, especially with regard to its distributing quality care to rural areas. However, it is important to note that with current exponential use, it is equally crucial to ensure security and privacy and integrate HIPAA-compliant systems (Health Insurance Portability and Accountability Act) in the big data era. It is expected that many more applications developed during the pandemic are here to stay and will be refined in years to come.

An evidence-based synthesis of instructional reading and spelling procedures using telepractice: A rapid review in the context of COVID-19

BACKGROUND

Due to COVID-19, many educators and allied health practitioners are facing the challenge of rapidly transitioning to telepractice delivery of instructional reading and spelling procedures without being fully informed of the evidence.

AIMS

A rapid review was conducted to provide educators, allied health practitioners and policymakers with a synthesis of valid, relevant and actionable evidence relating to telepractice delivery of instructional reading and spelling procedures. The aim was to investigate the nature and outcomes of studies examining instructional reading and spelling procedures delivered via telepractice to school-aged students.

METHODS & PROCEDURES

A rapid review was undertaken in accordance with the eight-step process published by the Cochrane Rapid Reviews Methods Group. Medline (all databases), Embase, Cochrane and ProQuest Central were systematically searched with predefined search terms organized across four key concepts relating to the research questions.

OUTCOMES & RESULTS

Nine studies were included in this rapid review. Reading and spelling instruction and intervention using telepractice can be feasible and engaging. Telepractice assessment for reading and spelling can be equally effective as onsite assessment.

CONCLUSIONS & IMPLICATIONS

The evidence base for telepractice delivery of reading and spelling procedures is in its infancy in terms of both the quantity and the quality of the evidence. Insufficient evidence exists to draw clear conclusions about its efficacy, and therefore practitioners should proceed cautiously. What this paper adds What is already known on the subject For onsite delivery, evidence-based reading and spelling assessment, instruction and interventions delivered by educators and allied health practitioners have been shown to accelerate students' skills; less is known about the efficacy of instructional reading and spelling procedures in a telepractice model, which have rapidly become the new norm in many countries due to the COVID-19 pandemic. The benefits of telepractice include improved access to services, increased service availability, convenience, time efficiency, caseload management efficiency and removal of logistical barriers relating to cost and geographical location. During the COVID-19 pandemic, telepractice has facilitated continued access to services. What this study adds to existing knowledge Reading and spelling instruction and intervention delivered via telepractice can be feasible and engaging. Telepractice is a viable mode to deliver reading and spelling assessments with strong agreement between telepractice and onsite scores. Given their low methodological quality, the studies in this review provide valuable information around the how of telepractice reading and spelling procedures and highlight the factors that may contribute to positive outcomes with this service delivery model. What are the potential or actual clinical implications of this work? Educators and allied health practitioners need a thorough understanding of the student's telepractice environment and require adequate training and support to engage in telepractice service delivery. Educators and allied health practitioners should consider students for telepractice on a case-by-case basis. Practitioners should proceed cautiously with telepractice reading and spelling assessment, intervention and instruction, with the knowledge that the current available evidence is of limited quality.

Comparison of Diagnostic Auditory Processing Test Scores Measured in Clinical and School Settings

Purpose

The study aimed to compare auditory processing and cognitive test scores measured in a clinical setting with that measured in a school setting using a repeated-measures design. This was done on typically developing children and children with auditory processing disorder (APD).

Method

Thirty-two children (16 typically developing and 16 with APD), aged 7 years, were evaluated using three diagnostic auditory processing tests and a cognitive test. The tests included the Speech Perception in Noise Test in Kannada, the Gap Detection Threshold Test, the Dichotic Consonant–Vowel Test, and the Auditory Memory and Sequencing Test in Kannada. All the children were evaluated in an audiological diagnostic setting, as well as in their school.

Results

No significant difference in scores was obtained in the two settings for all the four tests that were administered. This was seen in the typically developing children and the children with APD. Additionally, the pass/fail decision for each test did not alter in the two settings. Moderate to almost perfect agreement was seen between the tests carried out in the two settings in both groups, on a Kappa test of agreement. In both settings, the children with APD performed significantly poorer than the typically developing children on the four diagnostic tests.

Conclusions

The findings of the study indicate that the diagnostic auditory processing tests and the cognitive test can be carried out in school settings as effectively as tests carried out in an audiological diagnostic clinical setting. This will enable carrying out diagnostic tests on children in schools soon after they are referred on screening auditory processing tools, administered in the educational setting. This will prevent missing diagnosis of children who fail to report to a diagnostic audiological center for detailed auditory processing evaluation.

The Role of Patient-Site Facilitators in Teleaudiology: A Scoping Review

Purpose Teleaudiology helps improve access to hearing health care by overcoming the geographic gap between providers and patients. In many teleaudiology encounters, a facilitator is needed at the patient site to help with hands-on aspects of procedures. The aim of this study was to review the scope and nature of research around patient-site facilitators in teleaudiology. We focused on identifying the facilitators' background, training, and responsibilities. Method To conduct this scoping review, we searched PubMed, CINAHL, and Embase. To be included, studies needed to address teleaudiology; be experimental/quasi-experimental, correlational/predictive, or descriptive; be published in English; and include the use of a facilitator at the patient location. Results A total of 82 studies met the inclusion criteria. The available literature described a number of different individuals in the role of the patient-site facilitator, including audiologists, students, and local aides. Fifty-seven unique tasks were identified, including orienting the client to the space, assisting with technology, and assisting with audiology procedures. The largest number of studies (n = 42) did not describe the facilitators' training. When reported, the facilitators' training was heterogenous in terms of who delivered the training, the length of the training, and the training content. Conclusions Across studies, the range of duties performed by patient-site facilitators indicates they may have an important role in teleaudiology. However, details are still needed surrounding their background, responsibilities, and training. Future research is warranted exploring the role of the patient-site facilitator, including their impact on teleaudiology service delivery. Supplemental Material https://doi.org/10.23641/asha.12475796.

"Even though I am alone, I feel that we are many" - An appreciative inquiry study of asynchronous, provider-to-provider teleconsultations in Turkana, Kenya

Non-physician clinicians (NPCs) in low and middle-income countries (LMICs) often have little physical proximity to the resources-equipment, supplies or skills-needed to deliver effective care, forcing them to refer patients to distant sites. Unlike equipment or supplies, which require dedicated supply chains, physician/specialist skills needed to support NPCs can be sourced and delivered through telecommunication technologies. In LMICs however, these skills are scarce and sparsely distributed, making it difficult to implement commonly used real-time (synchronous), hub-and-spoke telemedicine paradigms. An asynchronous teleconsultations service was implemented in Turkana County, Kenya, connecting NPCs with a volunteer network of remote physicians and specialists. In 2017-18, the service supported over 100 teleconsultations and referrals across 20 primary healthcare clinics and two hospitals. This qualitative study aimed to explore the impact of the telemedicine intervention on health system stakeholders, and perceived health-related benefits to patients. Data were collected using Appreciative Inquiry, a strengths-based, positive approach to assessing interventions and informing systems change. We highlight the impact of provider-to-provider asynchronous teleconsultations on multiple stakeholders and healthcare processes. Provider benefits include improved communication and team work, increased confidence and capacity to deliver services in remote sites, and professional satisfaction for both NPCs and remote physicians. Health system benefits include efficiency improvements through improved care coordination and avoiding unnecessary referrals, and increased equity and access to physician/specialist care by reducing geographical, financial and social barriers. Providers and health system managers recognised several non-health benefits to patients including increased trust and care seeking from NPCs, and social benefits of avoiding unnecessary referrals (reduced social disruption, displacement and costs). The findings reveal the wider impact that modern teleconsultation services enabled by mobile technologies and algorithms can have on LMIC communities and health systems. The study highlights the importance of viewing provider-to-provider teleconsultations as complex health service delivery interventions with multiple pathways and processes that can ultimately improve health outcomes.

Applied tele-audiology research in clinical practice during the past decade: a scoping review

OBJECTIVE

The purpose of this scoping review was two-fold, (1) to provide information about the characteristics, type of service delivery, participant information and outcomes related to tele-audiology in clinical popluations, and (2) to describe documented facilitators and barriers to tele-audiology delivery from the perspectives of practitioners and service recipients. Knowledge of these findings can assist audiologists in considering remote service delivery options for their practices.

DESIGN

A scoping review was conducted in November 2019 to identify English-language peer-reviewed journal articles published from 1 January 2010 to 30 October 2019 related to remote clinical service delivery in audiology.

RESULTS

Thirty-six published research articles were included. Research studies were classified into four broad areas with some articles including more than one area within the scope of their article: Screening (n = 5), Diagnostic (n = 5), Intervention (n = 18), and Perspectives (n = 22).

CONCLUSION

Hearing healthcare service delivery is expanding with the changing technological landscape, providing greater opportunities and flexibility for audiologists and patients. There are clear opportunities for interdisciplinary collaboration and for collaboration with on-site local facilitators. Local facilitators, with training, can assist in connecting individuals to follow-up care, provide educational support, and needed hands-on assistance for specialised testing.

Results of hearing screening of school-age children in Bishkek, Kyrgyzstan

Aim:

To gauge the prevalence of hearing loss in school children in Bishkek, Kyrgyzstan, and refer pupils with positive results for further diagnostic testing.

Background:

According to WHO data, hearing disorders are common in school-age children. Screening for hearing loss is an important preventative tool, helping to avoid further complications. Expenditure that supports early child development can reduce future outlay on health care and social services; it can eliminate disability problems, education deficits, and social maladaptation in later adult life.

Methods:

Pure-tone air-conduction hearing thresholds were obtained at 0.5–8 kHz. The results of the hearing screening examination were regarded as positive if pure-tone thresholds were higher than 20 dB HL in one or both ears at one or more of the test frequencies. Data were also obtained from follow-up visits of children who failed the initial screening.

Findings:

This study included 452 children aged 7–13 years old. Based on audiograms, screening showed that 123 (27.2%) of the children had hearing impairment. The study has important implications for clinical practice and health policy. There is a need for systematic monitoring of hearing status among children of this age, and parents and educators need to be made aware of the significance of hearing loss.