Is a hybrid of online and face-to-face services feasible for audiological rehabilitation post COVID-19? Findings from three public health patients.

BACKGROUND:  The global coronavirus disease 2019 (COVID-19) pandemic has pushed many audiologists to incorporate remote service delivery methods to adhere to mandatory health and safety protocols. The use of tele-audiology for audiological rehabilitation may provide a sustainable, cost-effective modality to suit the existing need, particularly in low-resourced countries. OBJECTIVES:  This study aimed to investigate the feasibility of implementing a hybrid tele-rehabilitation programme in a South African public health context. An online auditory training (AT) programme was used to determine (1) compliance, (2) clinical benefit, (3) participant experience and (4) costs. METHOD:  A convergent mixed methods design with a feasibility approach was utilised. Data collection was done through questionnaires, in-booth assessments, online AT, and face-to-face interviewing. Participants undertook online AT over 4 weeks. For pre- and post-online AT, the Abbreviated Profile of Hearing Aid Benefit (APHAB), QuickSIN, entrance and exit questionnaires, interviews and a system usability scale were administered. RESULTS:  Key findings of this study included (1) a high compliance rate (84.82%) with minimal clinician contact time at 3 h 25 min over 5-6-weeks; (2) improvement in perceived hearing aid (HA) benefit, and improvement in listening skills; (3) reported positive experiences; and (4) minimal programme costs at an average of R1350.00 per participant. CONCLUSION:  The results showed positive indicators that the use of hybrid tele-rehabilitative strategies may provide a viable alternative to the traditional face-to-face modality. The hybrid approach showed clinical benefits, cost-effectiveness, minimal contact time as well as COVID-19 compliance. Further large-scale research is still needed.

Health Behavior and Motivational Engagement Models Can Explain and Modify Teleaudiology Uptake.

PURPOSE: The remote delivery of health care services (i.e., telehealth) has steadily increased across the health care landscape over the past decade with a dramatic increase following the onset of the COVID-19 pandemic. Remote audiology delivery (i.e., teleaudiology), by contrast, has traditionally been characterized by relatively low utilization. While teleaudiology services increased during the COVID-19 lockdown period, most of those services were generally limited to follow-up care and postfitting consultations to existing patients. Furthermore, there is reason to believe that, despite the benefits that remote care provides, the use of teleaudiology services has decreased as in-person care has increased following the lifting of mandatory COVID-related lockdowns. The purpose of this viewpoint article is to posit that existing theories of health behavior, usually applied to patient-specific behaviors (e.g., hearing aid uptake) may explain the reluctance of audiologists to "uptake" a teleaudiology model of care. We also explore the potential of motivational engagement strategies as a means to allow audiologists to examine their sources of ambivalence as they consider adopting a remote service-delivery model. CONCLUSIONS: Health behavior models such as the Health Belief, Transtheoretical, and capability, opportunity, motivation, and behavior (COM-B) models represent theories that may help to explain audiologists' resistance to adopting remote delivery services. Motivational engagement strategies, such as decisional balance, can provide useful tools for audiologists to examine their attitudes toward the adoption of teleaudiology.

Increasing unemployment rate amongst health professionals: Will there be jobs for newly graduated South African audiologists post-COVID-19?

BACKGROUND:  Before the coronavirus disease 2019 (COVID-19) pandemic in early 2020, the unemployment rate in South Africa was at its highest in history at 29.1%. During the COVID-19 pandemic to date, unemployment rose even higher to 35.3%. In this context, there has been an increase in the number of unemployed health professionals in South Africa. OBJECTIVES:  This study aimed to determine the employment rates of newly graduated South African audiologists and identify the challenges in obtaining and maintaining employment for audiologists in South Africa. METHODS:  A descriptive online survey design was used. Participants were recruited online through professional association webpages using the snowball sampling technique. All qualified audiologists registered with the Health Professionals Council of South Africa were eligible to participate. RESULTS:  A total of 132 audiologists completed the survey. In the first-year postgraduation, 16% of the participants were unemployed, and this increased to 19% in the second-year postgraduation. In the majority (81%) of employed participants, almost a fifth (19%) were working within non-audiology/healthcare fields. The most common workplace challenges reported were remuneration (37%) followed by lack of resources (18%), workload (18%), work environment (10%), working hours (9%) and, lastly, interprofessional relationships (8%). CONCLUSION:  Findings from this study are the first to document employment rates amongst South African audiologists. These findings have the potential to influence the critical discourse on hearing healthcare human resource planning, hearing healthcare labour capacity and potential for growth in the South African context post-COVID-19.

Perceptions of Preceptors and Audiology Students on Practicum During the COVID-19 Pandemic.

PURPOSE: The aim of this study was to assess the perceptions of audiology students and preceptors regarding changes in the practicum as a result of COVID-19. METHOD: This study was conducted during two different periods, with Internet questionnaires posted on social media forums. Preceptors and newly graduated clinicians were recruited in 2019 for a study prior to COVID-19, and students and preceptors were recruited for comparison during COVID-19. Four groups participated in this study: (a) 101 students who were enrolled in the second, third, or fourth year of an Israeli communication disorders Bachelor of Arts (BA) program during the pandemic; (b) 94 newly graduated audiologists with a BA degree from an Israeli communication disorders program granted in the last 3 years (before COVID-19); (c) 18 audiologist preceptors who supervised audiology practicum in an Israeli communication disorders BA programs (before COVID-19); and (d) 20 audiologist preceptors who, during COVID-19, were supervising an audiology practicum in Israel. Perceptions of the various groups were compared. RESULTS: Although perceptions of preceptors and students regarding the practicum were revealed to be similar, perceptions of the practicum before COVID-19 underwent changes in the course of the pandemic. In evaluating the COVID-19 experience, both preceptors and students agreed that more hours of practicum were needed, as well as more variety in types of cases and exposure to varied placements. CONCLUSION: Academic programs and employers should consider implications of changes implemented in the practicum due to COVID-19, which can be addressed either in continuing education and/or by additional supervision in the future workplace. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19855639.

[Telerehabilitation of hearing-impaired children during COVID-19 pandemic]. / Distantsionnaya reabilitatsiya detei s tugoukhost'yu v period pandemii COVID-19 v usloviyakh surdologicheskogo tsentra.

OBJECTIVE: To evaluate advantages and effectiveness of remote rehabilitation services for hearing-impaired children at Center of Pediatric Audiology during COVID-19 pandemic. MATERIAL AND METHODS: 181 children with different types and degrees of permanent hearing loss, their parents and 10 hearing care professionals (audiologists, speech-language therapists) were included in the study. 2115 rehabilitation services were provided during 3 months: video- and text consultations, video lessons with child, sending homework to parents, etc. RESULTS: The results of questionnaires showed that, on specialists' and parents' opinion, remote rehabilitation care is effective tool for hearing impaired children during emergency situations. TeleCare allowed to improve parents' abilities to manage with children by themselves, their understanding goals and methods of rehabilitation, improving child's hearing and speech skills. 95% of parents were satisfied by remote rehabilitation. Advantages and problems of remote hearing rehabilitation were analyzed from the sides of professionals and parents. The most challenging activities for professionals during TeleCare were: evaluation of HA/CI effectiveness, diagnosis and developing of hearing and speech. CONCLUSIONS: The experience of remote hearing rehabilitation in emergency situation allows to conclude that this type of care could be useful in clinical practice after pandemic for parents consulting and for children with motor problems.

Internet-Based Audiologist-Guided Cognitive Behavioral Therapy for Tinnitus: Randomized Controlled Trial.

BACKGROUND: Tinnitus is a symptom that can be very distressing owing to hearing sounds not related to any external sound source. Managing tinnitus is notoriously difficult, and access to evidence-based care is limited. Cognitive behavioral therapy (CBT) is a tinnitus management strategy with the most evidence of effectiveness but is rarely offered to those distressed by tinnitus. The provision of internet-based CBT for tinnitus overcomes accessibility barriers; however, it is not currently readily available in the United States. OBJECTIVE: The aim of this study is to investigate the efficacy of internet-based CBT compared with that of weekly monitoring for the management of tinnitus in reducing tinnitus distress; reducing tinnitus-related comorbidities, including tinnitus cognitions, insomnia, anxiety, and depression; and assessing the stability of the intervention effects 2 months after the intervention. METHODS: A 2-arm randomized clinical trial comparing audiologist-guided internet-based CBT (n=79) to a weekly monitoring group (n=79) with a 2-month follow-up assessed the efficacy of internet-based CBT. Eligible participants included adults seeking help for tinnitus. Recruitment was conducted on the web using an open-access website. Participants were randomized via 1:1 allocation, but blinding was not possible. The study was undertaken by English or Spanish speakers on the web. The primary outcome was a change in tinnitus distress as measured using the Tinnitus Functional Index. Secondary outcome measures included anxiety, depression, insomnia, tinnitus cognition, hearing-related difficulties, and quality of life. RESULTS: Internet-based CBT led to a greater reduction in tinnitus distress (mean 36.57, SD 22) compared with that in weekly monitoring (mean 46.31, SD 20.63; effect size: Cohen d=0.46, 95% CI 0.14-0.77) using an intention-to-treat analysis. For the secondary outcomes, there was a greater reduction in negative tinnitus cognition and insomnia. The results remained stable over the 2-month follow-up period. No important adverse events were observed. Further, 16% (10/158) of participants withdrew, with low overall compliance rates for questionnaire completion of 72.3% (107/148) at T1, 61% (91/148) at T2, and 42% (62/148) at T3. CONCLUSIONS: This study is the first to evaluate and indicate the efficacy of audiologist-delivered internet-based CBT in reducing tinnitus distress in a US population. It was also the first study to offer internet-based CBT in Spanish to accommodate the large Hispanic population in the United States. The results have been encouraging, and further work is indicated in view of making such an intervention applicable to a wider population. Further work is required to improve compliance and attract more Spanish speakers. TRIAL REGISTRATION: ClinicalTrials.gov NCT04004260; https://clinicaltrials.gov/ct2/show/NCT04004260.

Analysis of barriers and facilitators to early hearing detection and intervention in KwaZulu-Natal, South Africa.

BACKGROUND: There is slow progress in early hearing detection and intervention (EHDI) services within South Africa. Audiologists are EHDI gatekeepers and can provide valuable insights into the barriers and facilitators that can progressively move EHDI towards best practice in South Africa. OBJECTIVES: The study aimed to determine the barriers and facilitators to EHDI in KwaZulu-Natal as reported by audiologists/speech therapists and audiologists (A/STAs). METHOD: A descriptive qualitative approach was used. Telephonic interviews were conducted with 12 A/STAs working in public and private healthcare facilities, using the strengths, weaknesses, opportunities, threats (SWOT) conceptual framework. Data was analysed using thematic analysis in conjunction with NVivo software. RESULTS: One of the main barriers perceived by A/STAs, affecting EHDI was the lack of resources in healthcare facilities. The participants indicated that although there was a guideline in place to guide practice, it may be more suited to an urban area versus a rural area. Poor knowledge and awareness of EHDI was also identified as a barrier. Information provided from A/STAs at grassroots level, in the various provinces, may benefit in developing a more contextually relevant and practical guideline. Facilitators included; development of task teams specifically for EHDI programmes, creation of improved communication networks for collaboration and communication, training of healthcare professionals and improving data management systems. CONCLUSION: Strategies such as an increase in resources, further education and training, development of contextually relevant, culturally, and linguistically diverse practices and protocols need to be in place to improve EHDI implementation. Further research, clinical implications and limitations are provided emanating from the study.

International survey of audiologists during the COVID-19 pandemic: use of and attitudes to telehealth.

OBJECTIVE: To determine the attitudes of audiologists towards telehealth and use of telehealth for the delivery of ear and hearing services pre-, during- and post- the COVID-19 pandemic, and to identify the perceived effects of telehealth on services and barriers to telehealth. DESIGN: An online survey distributed through the International Society of Audiology and member societies. STUDY SAMPLE: A total of 337 audiologists completing the survey between 23 June and 13 August 2020. RESULTS: There was a significant increase in the perceived importance of telehealth from before (44.3%) to during COVID-19 (87.1%), and the use of telehealth previous (41.3%), current (61.9%) and expected use of telehealth (80.4%). Telehealth was considered adequate for many audiology services, although hearing assessment and device fitting by telehealth received least support. Matters related to timeliness of services and reduction of travel were reported as the main advantages, but relationships between practitioners and clients may suffer with telehealth. Important barriers were technologies related to the client or remote site; clinic-related items were moderate barriers, although more clinician training was a common theme provided through open-ended responses. CONCLUSION: The COVID-19 pandemic has resulted in audiologists having a more positive attitude towards and greater use of telehealth, but with some reservations.

International survey of audiologists during the COVID-19 pandemic: effects on mental well-being of audiologists.

OBJECTIVE: The aim of the study was to examine the mental well-being of audiologists in the midst of the COVID-19 pandemic. DESIGN: A cross-sectional online survey was conducted during the COVID-19 pandemic, between 23 June and 13 August 2020. A self-report survey included screening measures for psychological distress (PHQ-4: anxiety and depression) and loneliness (UCLA-3). STUDY SAMPLE: 239 audiologists from around the world. RESULTS: The prevalence of psychological distress was 12.1% (subscales for anxiety 16.3% and depression 10.4%), and loneliness 32.2%. Depression and loneliness were higher in those participants self-reporting perceived job insecurity, with psychological distress (anxiety and depression) higher in those from South Africa. Accessibility to Employee Assistance Programs (EAPs) appears to be a protective factor. CONCLUSIONS: Well-being interventions, such as EAPS, are needed to support audiologists during challenging times like the COVID-19 pandemic.

International survey of audiologists during the COVID-19 pandemic: effects on the workplace.

OBJECTIVE: This study surveyed the effects of the COVID-19 pandemic on the audiology workplace. DESIGN: The study used a cross-sectional survey design for audiologists across the globe (n = 337) using an online survey (June-August 2020) focussing on changes to the workplace during the pandemic. RESULTS: Participants represented varied work settings and audiology services. Only a third (31.5%) provided psychosocial support, which may be important during the pandemic, as part of their services. Almost all (97%) audiologists reported changes to their workplace, with 76.4% reporting reduced caseloads during the COVID-19 pandemic. When rating their current and anticipated work conditions, 38.7% reported reduced working hours although only 13.8% anticipated reduced working hours in 6-months' time. Audiologists ranked services such as access to hearing assessment, hearing device adjustment and maintenance, and general audiological support as being more important during the pandemic than services such as psychosocial, emotional and tinnitus support. CONCLUSIONS: The COVID-19 pandemic has resulted in significant disruptions to audiological practice that highlights the need to adapt and incorporate new audiological practices including telehealth, to ensure patients have continued access to care and clinics remain sustainable during the ongoing COVID-19 pandemic and recovery phase.

Audiology practice during COVID-19 crisis in Jordan and Arab countries.

OBJECTIVE: This study investigated audiologists' knowledge of COVID-19 characteristics and infection control measures they followed during the COVID-19 pandemic. Moreover, it examined the impact of COVID-19 on audiology practice, and audiologist's knowledge of telehealth as an alternative. DESIGN: A web-based cross-sectional study using a questionnaire consisting of four sections. STUDY SAMPLE: This study engaged 164 audiologists practicing in Jordan and Arab countries. RESULTS: Fever, cough, difficulty in breathing, and fatigue were identified as COVID-19 characteristics by over 80% of the audiologists. Other symptoms were identified by less than half of the audiologists. The audiologists showed limited knowledge regarding measures against COVID-19 transmission. This study revealed the limited availability of infection control measures in many audiologists' workplace. The majority of audiologists stopped working due to the COVID-19 crisis and only 61.6% of the audiologists were familiar with the concepts of tele-audiology and its related aspects. However, most participants were keen to learn more. CONCLUSIONS: This study revealed limited knowledge among audiologists regarding some of the COVID-19 characteristics, and limited compliance with the infection control policies. Limited knowledge in the application of telehealth in audiology practice was also shown.

Opioid-Induced Hearing Loss and Neonatal Abstinence Syndrome: Clinical Considerations for Audiologists and Recommendations for Future Research.

Purpose Over the last two decades, the number of Americans misusing opioids has reached epidemic levels. With such drastic increases in opioid misuse, audiologists are more likely to have patients with opioid-induced hearing loss or neonatal abstinence syndrome (NAS) than in previous years. More attention is needed on how these increases might influence clinical practice and such a discussion could be useful for audiologists. The goal of this article, therefore, is to summarize what is currently known regarding the relationship between opioid misuse and audiology to help guide hearing health care providers (with a particular focus on opioid-induced hearing loss and NAS). This article (a) summarizes the overlap in opioid misuse and hearing loss populations, (b) describes the evidence linking opioid misuse to hearing loss, (c) discusses clinical implications that opioid-induced hearing loss and NAS have for practicing audiologists, and (d) recommends directions for future audiological research on opioid-induced hearing loss and NAS. Conclusions There is considerable overlap between populations at-risk for hearing loss and opioid misuse. Additionally, compelling evidence exists linking opioid misuse to hearing loss, but the specific causal mechanisms remain unclear, indicating a need for additional research. This article attempts to fill a gap in the audiological literature and has the potential to serve as a guide for hearing health care providers to make more informed clinical decisions regarding patients with opioid-induced hearing loss and NAS. Clinicians may wish to consider the concerns raised in this article before intervening with such concerns, especially in the absence of best practice protocols.

Audiology in the time of COVID-19: practices and opinions of audiologists in the UK.

OBJECTIVE: To document changes in audiology practice resulting from COVID-19 restrictions and to assess audiologists' opinions about teleaudiology. DESIGN: A survey consisting of closed-set and open-ended questions that assessed working practices during the COVID-19 restrictions and audiologists' attitudes towards teleaudiology. SAMPLE: About 120 audiologists in the UK recruited via snowball sampling through social media and emails. RESULTS: About 30% of respondents said they had used teleaudiology prior to COVID-19 restrictions; 98% had done at the time of survey completion, and 86% said they would continue to do so even when restrictions are lifted. Reasons for prior non-use of teleaudiology were associated with clinical limitations/needs, available infrastructure and patient preferences. Respondents believe teleaudiology will improve travel, convenience, flexibility and scheduling, that it will have little/no impact on satisfaction and quality of care, but that it will negatively impact personal interactions. Concerns about teleaudiology focussed on communication, inability to conduct some clinical procedures and technology. CONCLUSIONS: Respondents' experience with teleaudiology has generally been positive however improvements to infrastructure and training are necessary, and because many procedures must be conducted in-person, it will always be necessary to have hybrid-care pathways available.