Mark Krumm

Telehealth in audiology: The need and potential to reach underserved communities

Abstract Permanent hearing loss is a leading global health care burden, with 1 in 10 people affected to a mild or greater degree. A shortage of trained healthcare professionals and associated infrastructure and resource limitations mean that hearing health services are unavailable to the majority of the world population. Utilizing information and communication technology in hearing health care, or tele-audiology, combined with automation offer unique opportunities for improved clinical care, widespread access to services, and more cost-effective and sustainable hearing health care. Tele-audiology demonstrates significant potential in areas such as education and training of hearing health care professionals, paraprofessionals, parents, and adults with hearing disorders; screening for auditory disorders; diagnosis of hearing loss; and intervention services. Global connectivity is rapidly growing with increasingly widespread distribution into underserved communities where audiological services may be facilitated through telehealth models. Although many questions related to aspects such as quality control, licensure, jurisdictional responsibility, certification and reimbursement still need to be addressed; no alternative strategy can currently offer the same potential reach for impacting the global burden of hearing loss in the near and foreseeable future. Sumario La pérdida auditiva permanente es una importante carga para los cuidados de la salud a nivel mundial, con 1 de cada 10 personas afectadas en grado ligero o mayor. La escasez de profesionales entrenados en cuidados de la salud y de infraestructura asociada y la limitación de recursos determina que los servicios de salud auditiva no estén disponibles para la mayoría de la población mundial. La utilización de información y tecnología de la comunicación para los cuidados de la salud auditiva o teleaudiología, combinada con la automatización, ofrece oportunidades únicas para mejorar los cuidados clínicos, ampliar el acceso a los servicios y tener cuidados de salud auditiva costoefectivos y sustentables. La Teleaudiología ha demostrado un potencial significativo en áreas como las de educación y adiestramientio de profesionales de la salud auditiva, profesionales afines, padres y adultos con problemas auditivos; tamiz de problemas auditivos; diagnóstico de pérdidas auditivas y servicios de intervención. La conectividad global está creciendo rápidamente y ha aumentado de manera generalizada su distribución en comunidades con pocos servicios, en donde los servicios audiológicos pueden facilitarse a través de modelos de telesalud. No obstante, existen muchas dudas que deben resolverse y que están relacionadas con aspectos como control de calidad, regulación del ejercicio profesional, responsabilidad jurisdiccional, certificación y reembolso de servicios, pero no existe como alternativa ninguna otra estrategia que pueda ofrecer actualmente el mismo potencial, para impactar el peso global de las pérdidas auditivas en el futuro cercano o previsible.

Providing basic hearing tests using remote computing technology.

We administered pure tone and otoacoustic emissions testing to subjects in a distant community using remote computing technology. Fifteen men and 15 women ranging in age from 18–30 years were tested. An audiometer was used to measure subject pure tone thresholds. In addition, distortion product otoacoustic emissions (DPOAEs) data were recorded using a portable system. Both systems were interfaced to a PC which was connected to the local area network at Minot State University (MSU). An examiner at Utah State University, 1100 km away, could control both the DPOAE and the audiometer equipment at MSU. Overall, the pure tone means for the face-to-face and telemedicine trials were equivalent at each frequency. Moreover, DPOAE recordings exhibited equivalent results at each frequency for telemedicine and face-to-face trials. These results support the use of remote computing as a telemedicine method for providing pure tone audiometry and DPOAE testing to distant communities.

Telemedicine for audiology screening of infants

Summary Distortion product otoacoustic emissions (DPOAE) and automated auditory brainstem response (AABR) screening were conducted in infants at a distant hospital using remote computing. Eighteen males and twelve females ranging in age from 11–45 days were tested. Both DPOAE and AABR data were recorded using an integrated test system which was connected to the computer network at the Utah Valley Regional Medical Center. Using a broadband Internet connection, an examiner at Utah State University, 200 km away, could control the DPOAE and the ABR equipment. Identical hearing screening results were obtained for face-to-face and telemedicine trials with all infants. The DPOAE means for face-to-face and telemedicine trials were not significantly different at any frequency. In an analysis of variance, there was no significant difference for the test method (F = 0.8, P > 0.05). These results indicate that remote computing is a feasible telemedicine method for providing DPOAE and ABR hearing screening services to infants in rural communities.

Improving the access of young urban children to speech, language and hearing screening via telehealth

We studied the feasibility of low-cost videoconferencing (using Skype) in urban community health clinics for speech, language and hearing screening of children up to six years of age. During a two-year study, screening services were provided via videoconferencing at two community clinics in an inner city area of Cleveland, Ohio. In total, 411 screenings were completed. Of these, 358 children (87%) received hearing screenings, 377 (92%) received tympanometry screening and 263 (64%) received speech and language screening only. A total of 151 children were aged three years or under (37%). The reliability of pure tone hearing screening (n = 7), DPOAE screening (n = 51) and speech-language screening (n = 10) was 100%. Typanometry screenings (n = 55) were 84% reliable. Families reported a high level of satisfaction with both the technology and with the videoconferencing. The results indicate that low-cost videoconferencing for screening of speech, language and hearing development in very young children in urban community health clinics is feasible, reliable and strongly supported by the community.

A REVIEW OF CONTEMPORARY TELE-AUDIOLOGY LITERATURE

Tele-audiology has grown considerably since Swanepoel and Hall’s literature review in 2010. Numerous new works on telehealth have appeared in areas of diagnosis, pediatric audiology, rehabilitation, cochlear implants, screening, web portals, and hearing aids. Asynchronous solutions are now more common for screening and diagnostic purposes. In addition, self-assessment and m-health systems are available which offer accessible and valid paradigms. In general, tele-audiology appears to be an increasingly useful method for providing hearing healthcare access to consumers anytime and anywhere.

School-based language screening among primary school children using telepractice: A feasibility study from India

Abstract Purpose: This study explored the feasibility of conducting school-based language screening using telepractice to expand its scope for providing speech-language pathology services in India. Method: Thirty-two primary school children underwent language screenings through in-person and telemethods. Screening through telemethod was conducted by a Speech-Language Pathologist (SLP) using digitised picture stimuli presented through videoconferencing and remote computing with assistance of a facilitator at school site. Technology and child-related factors influencing screening were documented using an inventory. Result: Language outcomes through in-person and telemethods revealed no significant differences in both receptive and expressive domains, suggesting absence of bias due to testing method used. Use of multiple internet options at both sites helped overcome technical challenges related to connectivity during screening through telemethod. The trained facilitator played a crucial role in overcoming child related factors such as poor speech intelligibility, poor audibility of voice, motivation, interaction with SLP and need for frequent breaks. Conclusion: Feasibility of conducting school-based language screening using multiple internet options and help of a facilitator at school demonstrates promise for delivery of services by SLP in resource constrained contexts such as India.