Need an audiologist but can't travel? Telehealth may be an option
You've likely heard of telemedicine, which allows people to remotely video chat with a healthcare provider. But did you know that audiologists can often offer similar services?
What are teleaudiology services?
Teleaudiology is defined as a healthcare service delivery model that allows people to remotely access audiologists, who are licensed professionals that specialize in helping people with hearing loss. The patient may be at home or visit a satellite office that's closer to their home.
Teleaudiology during COVID-19
During the pandemic, telehealth services soared, according to a McKinsey report. For people who are struggling with hearing loss during this time, teleaudiology can be an important way to access care that avoids or limits traditional face-to-face interaction. As a result, many states have relaxed telehealth regulations to make it easier for people to receive remote care.
The way this care can be given varies, according to audiologist Suzanne Younker, former director of TeleHealth at Your Hearing Network (YHN). In some cases, a patient may not need to leave their house, especially if they already have an established relationship with an audiologist who offers telehealth. But, for now, the more common option is to visit a clinic that's only staffed by one front-office person.
"For diagnostic evaluations, some practices are staffed with one front office staffer and the provider (audiologist) is either home or located at another clinic. The provider can interact with the patient through audio-visual conferencing, and complete an assessment appointment in a 1-manned office," she said. "By having only one staff member in a clinic with one patient at a time—and practicing infection control before and after a patient visits—protection is provided to both patient and staff."
How to ensure your telehearing appointment goes well
Chicago-area audiologists Mark Christian and Sheri Gostomelsky put together a handy list of tips to make sure both your in-person and teleaudiology appointments go well. One nice bonus of telehealth offered at home is the ability to skip wearing a face mask.
"It’s great to communicate without having to wear a mask. However, video technology can present new challenges for someone with hearing loss," they point out. "Take charge and advocate for yourself. Getting it right the first time will make for better outcomes with your health."
States that allow teleaudiology
The laws are changing rapidly, Younker said, but in general most states allow licensed audiologists to implement teleaudiology, a few states also allow hearing instrument specialists (HIS) to do so.
Here is a list of states that allow complete services, partial services or very limited services. By clicking the state name, you'll be taken to Healthy Hearing's directory of hearing care professionals in that state, but please note not all of them will offer teleaudiology programs. You'll need to contact your preferred clinic and ask if they offer any remote care.
Telehealthcare with complete services (subject to change)
Telehealthcare with some restrictions
Telehealthcare with limitations/vague rules
Rural areas lack audiologists
Even before the coronavirus, telehealth was expanding to meet a growing need. As Baby Boomers age, more seniors mean more demand for audiology services. But the number of audiologists hasn’t kept up, and especially in rural areas, the nearest audiologist may be far away.
Telehealth could be a key solution. While still a new idea, Younker said it could be available for audiology across the country in the next three to five years. "My feeling is that most states will adopt these relaxed regulations since they have not caused negative outcomes," she said.
While remote care may seem impersonal, people often like it. “We find that when patients are talking about their problems to a screen they give you more detail,” Younker says. “They seem much chattier.”
Programming hearing aids via your phone
Many hearing aid brands come with accompanying smartphone apps. The remarkable thing about these apps? A hearing care provider can remotely program a person's hearing aids via the app, permitting programming to occur without having the patient come into an office. This can be very useful if a person needs their hearing aid settings customized, adjusted or changed.
Wondering if your hearing aids can be programmed this way? Younker recommends that patients contact their provider to inquire if they have the type of hearing aids that can work with a remote programming app.
"If yes, the provider or clinic staff member can walk the patient through the steps of downloading the app on the patient’s cell phone," she said.
If not, touching base with a hearing care provider via another audio-visual method—such as FaceTime or Zoom—can still be useful, although not all problems can be solved this way.
Helpful for patients with limited mobility
Even in cities and suburbs, telehealth audiology could be attractive, particularly for older adults with hearing loss who are homebound or in a nursing home. On average, a new hearing aid user needs to see an audiologist about three times. For patients with dementia, the adjustment may be slower—but caregivers may not have the time to bring patients in for multiple fine-tuning visits.
Because nursing homes don’t tend to have on-site audiologists, it's the caregivers who have to bring patients back and forth to appointments. The trip itself could be stressful for someone with a disability.
Veterans and teleaudiology
The U.S. Veterans Health Administration, which has embraced remote technologies for rural health care, is a major hearing aids supplier, as hearing loss and tinnitus disproportionately affect veterans. More than a third of the veterans it serves live in rural areas and the agency now routinely has eye, skin and radiology specialists reviewing images sent to them electronically. In a pilot program, about 400 veterans have had their hearing tested by audiologists at other locations. Eleven facilities have requested hardware setups to expand their own services, Chad Gladden, an audiology telehealth coordinator for the agency, noted in a July 2019 blog post Audiology telehealth: Helping rural Veterans access hearing evaluations.
Emerging research looks promising
There’s early research to back up Younker’s observation that people tend to like the results of telehealth for audiology. The University of South Dakota is located in Vermillion, a small university town 39 miles from Sioux City by car and more than 130 from Omaha, Nebraska.
For a recent audiology study, researchers recruited 20 study participants with hearing loss, all people with mild dementia who needed hearing aids but didn’t have them. They also lived far from the clinic.
For the study, participants were fitted at the university clinic with hearing aids, which were paired to a smartphone app, managed by their caregivers. The research staff checked the app portal through the work week for messages from a caregiver. They provided advice, and when needed, could make fine-tuning adjustments to the hearing aids.
Researchers monitored wearing time, program use, and the patient’s satisfaction in different real-world listening conditions. The staff could remotely change noise reduction and other algorithms and communicate through real-time video calls, as well as text and voice chat services.
All the volunteers came to the clinic at the beginning and end of six weeks, and once in between. One group of patients received the remote services for three weeks, but not the last three weeks. Another group was not informed of the remote services for the first three weeks, but offered remote services the next three. Midway during the three weeks, when the participants were not able to communicate remotely, they had a clinic visit, along with their caregivers.
The results: Caregivers rated the participants “general comprehension” as 4.5 on average on a 5-point scale in the telehealth period, compared to 2.7 when they weren’t using the remote service. Caregivers said the remote service decreased their stress and improved the patients’ “alertness” and “awareness.”
The university clinic is now using remote services to monitor the auditory brainstem response of babies who didn’t pass their newborn hearing screening, reports study co-author, audiologist and associate professor Lindsey Jorgensen.
A 'truly touching moment'
The current goal of telehealth audiology is convenience. However, over time, it could bring down hearing aid prices, Younker said. Regulations and insurance coverage vary by state, but Younker says the trend is towards more coverage of telehealth.
Patrick Quelhas, a hearing instrument specialist at HearingLife Canada in Toronto, describes a touching experience with a customer who communicated with him from a clinic 83 miles away. The man, who had severe hearing loss, complained that he felt isolated.
“All he wants is to be able to hear his family in the few times he sees them,” Quelhas said. Quelhas suggested Oticon hearing aids, and technician Colette Doucette found a pair in the clinic that Quelhas could remotely program on the spot.
“As soon he put them on his face lit up and he said 'I can hear. I can’t believe how clear it is!' He started crying and said he was so happy that he had come in to see us. At this point, even Colette and I had to fight to hold back our own tears. It was truly a touching moment, which reminded me why we are in this industry.”