Demographic Disparities in Drive Times to the Nearest Audiologist in the United States.

PURPOSE: Audiological services are underused, possibly because patients need to drive long distances to see a provider. In this study, we measured the association of drive times to the nearest audiologist with population density, income, ethnicity, race, and distance to the nearest audiology graduate program. METHOD: Drive times for each census block group to the nearest audiologist were measured using census data, the National Provider Identifier Registry, and a geographic analyzing tool called ArcGIS for all block groups within the United States. The association between drive times and population density, income, ethnicity, race, and audiology program distance was evaluated with a population density-matched case-control study and multiple linear regression analyses. RESULTS: Approximately 5.29 million Americans need to drive at least 1 hr to visit their closest audiologist. The 10% most rural-dwelling Americans drive an average of 33.8 min. The population density-matched case-control study demonstrated that percent below poverty, percent identifying as Hispanic, and travel times to the nearest audiology program were all significantly higher in census block groups with high drive times to the nearest audiologist. An average of 7.96% of individuals in census block groups with low drive times identified as Hispanic, but 18.8% identified as Hispanic in high drive time groups. The multiple linear regression showed that the effect of demographics and distance to the nearest audiology program was highest in rural areas. In both analyses, adjusting for poverty did not drastically change the effect of percent identifying as Hispanic on drive times. CONCLUSIONS: Long drive times restrict access to audiological care for those who live in rural areas. This restriction disproportionately affects those in rural areas who identify as Hispanic or have low income.

Student Perceptions of Learning Clinical Masking in Audiology: An Exploratory Survey Study.

PURPOSE: The audiology literature is rich with work in the area of clinical masking, yet there is a perception that learning how to mask is difficult. The purpose of this study was to explore the experiences of audiology doctoral students and recent graduates in learning clinical masking. METHOD: This exploratory study used a cross-sectional survey design, sampling doctor of audiology (AuD) students and recent graduates to probe the perceived effort required and challenges experienced in learning clinical masking. A total of 424 survey responses were included in the analysis. RESULTS: A large majority of respondents rated learning clinical masking as being challenging and effortful. Responses suggested that it took more than 6 months for confidence to develop. Qualitative analysis of the open-ended question uncovered four themes: "negative experience in the classroom"; "lack of consensus or variation in teaching"; "focus on content/rules"; and "positives, internal and external." CONCLUSIONS: Survey responses shed light on the perception that clinical masking is difficult to learn and highlight teaching and learning strategies that affect the development of this skill. Students reported a negative experience when significant emphasis was placed on formulas and theories and when encountering multiple masking methods in the clinic. On the other hand, students found clinic, simulations, lab-based classes, and some classroom instruction beneficial to learning. Students reported that their learning process included use of cheat sheets, practicing independently, and conceptualizing the process of masking to support their learning.

Development of the Teaching Interpersonal Skills for Telehealth Checklist.

While interpersonal skills in telehealth may positively impact clinical practice, patient engagement and outcomes, assessment strategies are lacking. We conducted a multi-stage iterative approach to develop and test validity and reliability of the Teaching Interpersonal Skills in Telehealth checklist (TIPS-TC). First, we identified observable communication behaviors from the literature. Second, we surveyed telehealth managers and researchers (N = 11) to rate appropriateness of potential checklist items. Level of agreement (35%-91%) and Kappa statistic (0.18-0.89) confirmed items to be retained and identified items to modify. Based on response patterns and comments, we reduced 44 items to 12 critical checklist behaviors. Third, student clinicians used the checklist with video telehealth consultations and provided feedback. Fourth, we conducted reliability testing with practitioners and administrators (N = 68) who completed the TIPS-TC for two versions of a telehealth scenario. Strong interrater reliability intraclass correlation coefficient (ICC) and test-retest reliability ICC (both p < .001), along with non-significant findings of order effects supported the checklist as an acceptable instrument to differentiate high skill from low skill telehealth sessions. The TIPS-TC offers an evidence-based approach to assessing interpersonal skills in telehealth to help evaluate clinician competence and tailor learning activities across disciplinary roles.

Detailed Analysis of High Frequency Auditory Brainstem Response in Patients with Tinnitus: A Preliminary Study.

ABSTRACT: Increased spontaneous activity and aberrant neural synchrony is thought to be the underlying cause of tinnitus. The perceived pitch of tinnitus may be dictated by frequency specific neural fibers of the subcortical pathway, or the projection of altered cortical activity by-way-of tonotopic reorganizations. Subcortical neural activity in relation to tinnitus was characterized using ABR measurements. In the present study, 11 patients (21 ears) with constant tonal tinnitus underwent a two-part experiment. Experiment 1 involved click ABR measurements and included two experimental groups: tinnitus with normal hearing from 2000-4000 Hz (GI) and tinnitus with hearing loss within the range of 2000-4000 Hz (GII). Experiment 2 utilized tone burst ABRs matched to each participant's perceived tinnitus pitch and included two experimental groups: tinnitus with normal hearing at the tinnitus pitch (GIa) and tinnitus with hearing loss at the tinnitus pitch (GIIa). These groups were compared to a control group (GIII) of ten monaurally tested (10 ears) participants with normal hearing thresholds at 250-20000 Hz and no tinnitus. Click ABR results indicate significantly prolonged V-III IPLs for GI and GII and a significantly extended absolute V latency for GII only. Tone burst ABRs matched to tinnitus pitch revealed significantly prolonged absolute latencies and IPLs at three of the seven frequencies for GIIa. ABR threshold seeking was completed and revealed negative eHL values for two of the four different stimuli for GI and GIa and four of the eight stimuli for GII and GIIa. Click ABRs results are suggestive of upper brainstem abnormalities for both groups. While GI demonstrated prolonged V-III IPLs, no significant differences were found for GIa. This suggests that there is no frequency specific subcortical characteristic associated with tinnitus with normal hearing. Frequency specific properties for subcortical activity could not be characterized due to varying results of GIIa.