Assessment of e-Audiology for Providing Clinical Services and Support
Condition: Hearing Loss, Age-Related; Presbycusis, Bilateral; Hearing Disability
MeSH terms: Hearing Loss; Deafness; Presbycusis
Study type: Interventional

Summary: 
      Technological advances in hearing aids and telecommunications, including the widespread
      availability of telehealth (referred to in this proposal as "e-Audiology") applications, have
      the potential to expand both access and affordability of hearing aids for those with
      age-related hearing loss (ARHL). E-Audiology is used by clinicians in a variety of settings,
      including private practice, university clinics, and the Veterans Administration. The American
      Speech-Language-Hearing Association recently updated the Scope of Practice guidelines for
      audiology to include telehealth as "an alternative method of service delivery that
      en-compasses both diagnostics and intervention services.", including all aspects of hearing
      aid selection, fitting, and follow-up counseling and rehabilitation. However, given the
      paucity of evidence of comparative efficacy between office-based service delivery and
      e-Audiology in real-world settings, patients and relevant stakeholders are faced with a major
      decisional dilemma when determining which mode of service delivery would be optimal for
      addressing the needs, preferences, and lifestyles of those with ARHL. Thus, the purpose of
      this study is to determine the benefits, drawbacks, and patient satisfaction associated with
      e-Audiology delivery of hearing aid fitting, services, and supports for older adults with
      mild to moderate ARHL. We plan to use data collected in this pilot study for a future R01
      submission to the NIH.
    

Detailed description: 
      Hearing loss is a chronic disability and a major public health concern. As the U.S.
      population ages, hearing loss prevalence rates are expected to nearly double by 2060 (Goman,
      Reed et al. 2017). Given this projection and the negative, costly impacts of untreated
      hearing loss on health outcomes, there is a national emphasis on increasing access and
      affordability of hearing healthcare (HHC) (President's Council of Advisors on Science and
      Technology 2015, National Academies of Sciences 2016). Two significant factors hinder the
      achievement of successful HHC outcomes: First, US adults face structural barriers to
      accessing HHC including high cost, and limited, inflexible points of entry into the system
      (National Academies of Sciences 2016). Second, hearing aids are often the sole intervention
      offered. While hearing aids improve speech understanding in quiet, difficulties understanding
      speech in challenging listening environments remain. Many of these difficulties can be
      addressed by including hearing assistive technology [HAT] options in the intervention plan.
      Unfortunately, hearing aid uptake is low for adults with hearing loss, and HAT usage is
      reported among only a fraction of those who use hearing aids (Southall, Gagné et al. 2009,
      Hartley, Rochtchina et al. 2010, Chien and Lin 2012, Bainbridge and Ramachandran 2014).
      Technological advances in hearing aids and telecommunications, including the widespread
      availability of "e-Audiology" applications, have the potential to expand both access and
      affordability of HHC by allowing for greater flexibility, lower costs, and personalized
      intervention plans that take into account the listening and lifestyle needs of the
      individual. There is a lack of evidence, however, as to how e-Audiology and patient
      acceptance for e-Audiology impact HHC outcomes. There is an urgent need to understand the
      efficacy of accessible, patient-centered, and comprehensive HHC alternative delivery models,
      like e-Audiology, without which the critical public health problem of untreated hearing loss
      in adults will likely worsen.

      With the long-term goal of enhancing decision-making by patients and providers and improving
      outcomes, the pilot data collected in this proposal will be used for an upcoming R01
      submission which will be responsive to the NIDCD's call for research comparing different HHC
      delivery models and the utilization of new technologies to improve care. The overall
      objectives of this work are twofold. First, we will evaluate outcomes from an e-Audiology
      service delivery model. Second, we will determine the impact of patient preferences for
      delivery model on outcomes. The rationale of the proposed study is that the results will
      enhance the evidence-base for the use of e-Audiology as a mechanism for increasing HHC access
      for diverse adult populations. Results obtained will be submitted as pilot data in an
      upcoming R01 grant application.
    

Intervention name(s): Delivery of hearing healthcare through eAudiology application
Intervention type(s): Device
Intervention description(s): Participants will receive bilateral, behind-the-ear hearing aids as part of this study. The intervention will involve e-Audiology sessions following the initial hearing aid fitting and orientation. E-Audiology sessions will consist of hearing aid follow-up programming, troubleshooting, HAT assistance, and general help with hearing devices. E-Audiology sessions will take place over the course of approximately 6 weeks.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: telehealth; eAudiology; accessibility; Age-related hearing loss