Toward Better Outcomes in Audiology Distance Education: An Educational Data Mining Approach

Purpose

This article introduces concepts and a general taxonomy used by the educational data mining (EDM) community, as well as examples of their applications, with the aims of providing audiology educators with a referential basis for developing this area.

Method

A narrative review was carried out to present an overview of EDM and its main methods. Some of these methods were exemplified with analysis of real data from an Internet-based specialization course on pediatric auditory rehabilitation.

Results

The review introduced EDM main concepts and applications and described methods from its area. Real data examples illustrated EDM use to predict interpersonal help-seeking, model interpersonal interaction, analyze students' trajectories within a course's module, and understand how students approached group assignments. Some of the insights provided by EDM to support teaching and learning processes were also described.

Conclusions

EDM methods offer new tools to discover knowledge from digital traces (i.e., logs) and support key stakeholders (students, instructors, or course administrators) to raise awareness about course dynamics. This approach has the potential to foster a better understanding and management of educational processes in audiology distance education.

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An Application of the Medical Research Council's Guidelines for Evaluating Complex Interventions: A Usability Study Assessing Smartphone-Connected Listening Devices in Adults With Hearing Loss

Purpose

The purpose of this study is to provide an example of the Medical Research Council's guidelines for evaluating complex health care interventions in the context of smartphone-connected listening devices in adults with hearing loss.

Method

Twenty existing hearing aid users trialed 1 of the following smartphone-connected listening devices: made-for-smartphone hearing aids, a personal sound amplification product, and a smartphone “hearing aid” application used with either wireless or wired earphones. Following 2 weeks of use in their everyday lives, participants completed self-report outcome measures.

Results

Relative to conventional hearing aids, self-reported use, benefit, and satisfaction were higher, and residual disability was lower for made-for-smartphone hearing aids. The converse was found for the other smartphone-connected listening devices trialed. Similarly, overall usability was judged to be “above average” for the made-for-smartphone hearing aids, but “below average” for the remaining devices.

Conclusions

This developmental work, guided by the Medical Research Council's framework, lays the foundation for feasibility and pilot studies, leading to high-quality research assessing the effectiveness of smartphone-connected listening devices. This future evidence is necessary to guide health care commissioners and policymakers when considering new service delivery models for adults living with hearing loss.

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Innovation in the Context of Audiology and in the Context of the Internet

Purpose

This article explores different meanings of innovation within the context of audiology and the Internet. Case studies are used to illustrate and elaborate on the new types of innovation and their levels of impact.

Method

The article defines innovation, providing case studies illustrating a taxonomy of innovation types.

Results

Innovation ranges from minor changes in technology implemented on existing platforms to radical or disruptive changes that provide exceptional benefits and transform markets. Innovations within the context of audiology and the Internet can be found across that range. The case studies presented demonstrate that innovations in hearing care can span across a number of innovation types and levels of impact. Considering the global need for improved access and efficiency in hearing care, innovations that demonstrate a sustainable impact on a large scale, with the potential to rapidly upscale this impact, should be prioritized.

Conclusions

It is unclear presently what types of innovations are likely to have the most profound impacts on audiology in the coming years. In the best case, they will lead to more efficient, effective, and widespread availability of hearing health on a global scale.

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Identification and Management of Middle Ear Disorders in a Rural Cleft Care Program: A Telemedicine Approach

Purpose

The aim of this study was to devise a grassroots-level strategy for identification and management of middle ear disorders in a community-based program for individuals with cleft lip and palate in 2 rural districts in the state of Tamil Nadu in South India.

Method

Community workers underwent training to conduct video otoscopy using the ENTraview device. Community workers conducted video otoscopy on 160 individuals with cleft lip and palate between 3 and 35 years old in the community. Middle ear conditions were identified using store-and-forward telepractice. Diagnostic telehearing evaluation was conducted using synchronous pure tone audiometry and tympanometry for those who were identified with tympanic membrane (TM) and/or middle ear diseases (MEDs). A review of data collected over a 13-month period was carried out to assess coverage and follow-up intervention rates.

Results

The program was successful in achieving 80% coverage for identification of TM and MEDs within 13 months of program implementation. TM and/or MEDs were identified in 26% (82/320 ears) of those who underwent video otoscopy. Telehearing evaluations were completed on 42 ears of individuals with TM and/or MEDs; 52% (22/42 ears) of these individuals had a minimal, mild, or moderate degree of hearing loss. Regarding follow-up for intervention, 78% qualified for surgical intervention, and 31% qualified for medication.

Conclusions

This grassroots-level telemedicine approach was successful in achieving better coverage, and store-and-forward telepractice helped in providing remote diagnosis and recommendation by otolaryngologists to all individuals with TM/MEDs in the rural community. The follow-up for otological intervention significantly improved from that achieved in the previous years.

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Techniques for Remotely Programming Children With Cochlear Implants Using Pediatric Audiological Methods via Telepractice

Purpose

The purpose of this report is to describe the equipment setup and techniques for successfully testing behavioral thresholds in young children with cochlear implants (CIs) using telepractice. We will also discuss challenges associated with pediatric CI programming that are unique to the use of distance technology, and we will describe ways to overcome those challenges. Last, we will review the results from 2 recent studies specifically targeted toward testing behavioral thresholds in young children with CIs.

Method

Conditioned play audiometry or visual reinforcement audiometry was used to measure behavioral thresholds (T levels) for 35 young children with CIs (n = 19 for conditioned play audiometry and n = 16 for visual reinforcement audiometry). Participants were tested in the traditional in-person condition and in the remote condition using an AB-BA study design over 2 visits.

Results

There was no significant difference in T levels between the in-person and remote conditions, indicating that it is feasible to test young children using conventional pediatric testing procedures via remote technology. The primary challenges encountered were in regard to proper camera and video monitor placement at the remote site and the timing of communication between the audiologist and test assistant.

Conclusions

The results from studies to date suggest that distance technology can be used successfully to program CI sound processors for young children using standard, age-appropriate testing techniques. The alternative of remote testing has substantial implications for reducing time and travel burdens for families, potentially leading to the construction of appropriate maps for young children with CIs in a timelier manner.

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Big Data for Sound Policies: Toward Evidence-Informed Hearing Health Policies

Purpose

The scarcity of health care resources calls for their rational allocation, including within hearing health care. Policies define the course of action to reach specific goals such as optimal hearing health. The process of policy making can be divided into 4 steps: (a) problem identification and issue recognition, (b) policy formulation, (c) policy implementation, and (d) policy evaluation. Data and evidence, especially Big Data, can inform each of the steps of this process. Big Data can inform the macrolevel (policies that determine the general goals and actions), mesolevel (specific services and guidelines in organizations), and microlevel (clinical care) of hearing health care services. The research project EVOTION applies Big Data collection and analysis to form an evidence base for future hearing health care policies.

Method

The EVOTION research project collects heterogeneous data both from retrospective and prospective cohorts (clinical validation) of people with hearing impairment. Retrospective data from clinical repositories in the United Kingdom and Denmark will be combined. As part of a clinical validation, over 1,000 people with hearing impairment will receive smart EVOTION hearing aids and a mobile phone application from clinics located in the United Kingdom and Greece. These clients will also complete a battery of assessments, and a subsample will also receive a smartwatch including biosensors. Big Data analytics will identify associations between client characteristics, context, and hearing aid outcomes.

Results

The evidence EVOTION will generate is relevant especially for the first 2 steps of the policy-making process, namely, problem identification and issue recognition, as well as policy formulation. EVOTION will inform microlevel, mesolevel, and macrolevel of hearing health care services through evidence-informed policies, clinical guidelines, and clinical care.

Conclusion

In the future, Big Data can inform all steps of the hearing health policy-making process and all levels of hearing health care services.

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Stories From the Webcams: Cincinnati Children's Hospital Medical Center Audiology Telehealth and Pediatric Auditory Device Services

Purpose

The purpose of this manuscript is to describe the regulatory, technological, and training considerations for audiologists investigating telehealth and to offer some examples of audiology services provided through telehealth.

Method

The authors presented the regulatory components, the technology required for audiology staff and patients, and staff training for the audiology telehealth program at Cincinnati Children's Hospital Medical Center. Four case studies highlighting the successful use of telehealth in providing auditory device services to patients were also presented.

Results and Conclusion

The described regulatory, technological, and training hierarchy provides a framework for audiologists interested in starting a telehealth program. The cases presented illustrate that telehealth can be used to provide some auditory device services, such as troubleshooting, mapping, and parent consulting.

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Internet and Audiology: A Review of the Third International Meeting

Purpose

In this introduction, the four members of the scientific committee for the Third International Meeting on Internet and Audiology describe the meeting that took place at the University of Louisville on July 27–28, 2017.

Method

This special issue, with a decidedly clinical focus, includes 14 articles that arose from presentations given at the Third International Meeting on Internet and Audiology. All touch upon the theme of innovation as it pertains to teleaudiology and mobile health (mHealth), application of Big Data to audiology, and ethics of internet and telemedicine.

Conclusion

Innovations in teleaudiology, mHealth, and Internet-based audiology are developing at a rapid pace and thus research in the field must continue. We invite readers to the next International Meeting on Internet and Audiology that will take place in Southampton, England, June 17–18, 2019.

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User-Innovated eHealth Solutions for Service Delivery to Older Persons With Hearing Impairment

Purpose

The successful design and innovation of eHealth solutions directly involve end users in the process to seek a better understanding of their needs. This article presents user-innovated eHealth solutions targeting older persons with hearing impairment. Our research question was: What are the key users' needs, expectations, and visions within future hearing rehabilitation service delivery?

Method

We applied a participatory design approach to facilitate the design of future eHealth solutions via focus groups. We involved older persons with hearing impairment (n = 36), significant others (n = 10), and audiologists (n = 8) following 2 methods: (a) human-centered design for interactive systems and (b) user innovation management. Through 3 rounds of focus groups, we facilitated a process progressing from insights and visions for requirements (Phase 1), to app such as paper version wireframes (Phase 2), and to digital prototypes envisioning future eHealth solutions (Phase 3). Each focus group was video-recorded and photographed, resulting in a rich data set that was analyzed through inductive thematic analysis.

Results

The results are presented via (a) a storyboard envisioning future client journeys, (b) 3 key themes for future eHealth solutions, (c) 4 levels of interest and willingness to invest time and effort in digital solutions, and (d) 2 technical savviness types and their different preferences for rehabilitation strategies.

Conclusions

Future eHealth solutions must offer personalized rehabilitation strategies that are appropriate for every person with hearing impairment and their level of technical savviness. Thus, a central requirement is anchoring of digital support in the clients' everyday life situations by facilitating easy access to personalized information, communication, and learning milieus. Moreover, the participants' visions for eHealth solutions call for providing both traditional analogue and digital services.

Supplemental Material

https://doi.org/10.23641/asha.7310729

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Geographic Distribution of the Hearing Aid Dispensing Workforce: A Teleaudiology Planning Assessment for Arizona

Purpose

Teleaudiology helps connect patients in rural and underresourced areas to hearing health care providers, minimizing the barrier of geography (Swanepoel et al., 2010). In the United States, teleaudiology is at the initial stages of implementation (Bush, Thompson, Irungu, & Ayugi, 2016). Telehealth researchers recommend conducting a comprehensive planning assessment to optimize implementation and adoption (AlDossary, Martin-Khan, Bradford, Armfield, & Smith, 2017; Alverson et al., 2008; Krupinski, 2015). A geographic analysis of the hearing aid dispensing workforce served as the initial stage of a teleaudiology planning assessment in Arizona.

Method

The analysis used publically available data sets from the U.S. Census, Arizona Department of Health Services, and the U.S. Veterans Administration. Geographic information system tools were used to analyze and visually represent population, potential teleaudiology site data, and hearing aid dispensing workforce (defined as audiologists and hearing instrument specialists licensed to dispense hearing aids in Arizona). ArcGIS was used to generate road networks and travel distance estimations.

Results

The number of audiologists per county ranged from 0 to 216 (average 22.1). Six out of Arizona's 15 counties lacked a single audiologist, and 2 counties lacked a hearing instrument specialist. Potential expansion sites for teleaudiology were located in areas of the state that lacked practice locations for hearing aid services.

Conclusions

There are geographic areas of Arizona that lack licensed hearing aid locations yet are populated by individuals who may need services. Resource availability data inform teleaudiology program expansion. Future research will include data from providers and community members on their perceived needs for services.

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Empowering Senior Cochlear Implant Users at Home via a Tablet Computer Application

Purpose

The introduction of connectivity technologies in hearing implants allows new ways to support cochlear implant (CI) users remotely. Some functionalities and services that are traditionally only available in an in-clinic care model can now also be accessed at home. This study explores the feasibility of a prototype of a tablet computer application (MyHearingApp [MHA]) in a group of senior experienced CI users at home, evaluating usability and user motivation.

Method

Based on user feedback, a tablet computer application (MHA) for the Cochlear Nucleus 6 CP910 sound processor was designed implementing six different functionalities: (a) My Hearing Tests, (b) My Environment, (c) My Hearing Journey, (d) Tip of the Day, (e) Recipient Portal, and (f) Program Use and Events. The clinical evaluation design was a prospective study of the MHA in 16 senior experienced CI users. During 4 weeks, participants could freely explore the functionalities. At the end, the usability and their motivation for uptake and adherence were measured using a baseline and follow-up questionnaire.

Results

Based on the System Usability Score (as part of the follow-up questionnaire), a good level of usability was indicated (M = 75.6, range: 62.5–92.5, SD = 8.6). The ability to perform hearing tests at home is ranked as the most relevant functionality within the MHA. According to the Intrinsic Motivation Inventory (Deci, Eghrari, Patrick, & Leone, 1994) questionnaire (as part of the follow-up questionnaire), participants reported high levels of interest and enjoyment, found themselves competent, and did not experience pressure while working with the app.

Conclusions

This study evaluated a tablet computer application (MHA) for experienced senior CI users by means of a prospective design, which provided novel insights into delivering CI care into the home of the CI user. The user feedback from this small-scale study suggests that the participants are open to take more responsibility for and to become a more active actor in their own hearing care, if only this is facilitated with the right tools. This may foster the evolution from a clinic-led to a more patient-centered care model, where CI users feel more empowered in the self-management of their hearing implant device.

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Automated Characterization of Mobile Health Apps' Features by Extracting Information From the Web: An Exploratory Study

Purpose

The aim of this study was to test the viability of a novel method for automated characterization of mobile health apps.

Method

In this exploratory study, we developed the basic modules of an automated method, based on text analytics, able to characterize the apps' medical specialties by extracting information from the web. We analyzed apps in the Medical and Health & Fitness categories on the U.S. iTunes store.

Results

We automatically crawled 42,007 Medical and 79,557 Health & Fitness apps' webpages. After removing duplicates and non-English apps, the database included 80,490 apps. We tested the accuracy of the automated method on a subset of 400 apps. We observed 91% accuracy for the identification of apps related to health or medicine, 95% accuracy for sensory systems apps, and an average of 82% accuracy for classification into medical specialties.

Conclusions

These preliminary results suggested the viability of automated characterization of apps based on text analytics and highlighted directions for improvement in terms of classification rules and vocabularies, analysis of semantic types, and extraction of key features (promoters, services, and users). The availability of automated tools for app characterization is important as it may support health care professionals in informed, aware selection of health apps to recommend to their patients.

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Long-Term Efficacy of Audiologist-Guided Internet-Based Cognitive Behavior Therapy for Tinnitus

Purpose

The purpose of this study was to investigate the long-term outcomes 1 year after undertaking an audiologist-guided Internet-based cognitive behavioral therapy (iCBT) intervention for tinnitus. Secondary aims were to identify any predictors of outcome and whether there were any unwanted events related to undertaking iCBT for tinnitus.

Method

Participants who had previously undertaken a randomized iCBT efficacy trial for tinnitus were invited to participate. Of the 146 who were initially randomized for the efficacy trial, 104 participants completed the 1-year postintervention assessment measures. The primary outcome was a change in tinnitus distress as assessed by the Tinnitus Functional Index. Secondary assessment measures were included for insomnia, anxiety, depression, hearing handicap, hyperacusis, cognitive failures, and satisfaction with life. An intention-to-treat analysis using repeated-measures analysis of variance and hierarchical multiple regression was used for statistical analysis. Unwanted effects were categorized according to the unwanted events checklist.

Results

Undertaking iCBT for tinnitus led to significant improvements 1 year postintervention for tinnitus and related difficulties, for example, insomnia, anxiety, depression, hearing handicap, hyperacusis, and life satisfaction. The best predictors of improving tinnitus severity at 1-year postintervention were greater baseline tinnitus severity scores, reading more of the modules, and higher satisfaction with the intervention. Unwanted events were reported by 11% of the participants and were more likely to be reported by women than men. These events were related to worsening of symptoms, the emergence of new symptoms, negative well-being, and prolongation of treatment.

Conclusions

The clinical benefits of audiologist-guided iCBT for tinnitus and tinnitus-related difficulties were sustained 1 year postintervention. Predictors of outcome indicated that the intervention is applicable to a wide range of participants regardless of their demographic backgrounds. Attempts should be made to minimize unwanted events in subsequent trials.

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Findings and Ethical Considerations From a Thematic Analysis of Threads Within Tinnitus Online Support Groups

Purpose

Tinnitus is the perception of noise without a corresponding external stimulus. Current management typically aims to moderate associated psychosocial stressors and allow sufferers to retain an adequate quality of life. With the increasing recognition of the Internet as a repository for health advice, information, and support, the online support group has become a popular coping strategy for those living with chronic conditions such as tinnitus. Patients find that communicating with each other, providing encouragement, and sharing information in the absence of physical and temporal boundaries are invaluable ways of managing their condition. The purpose of this study was to explore the potential positive and negative consequences of participating in online support groups for tinnitus.

Method

Discussion forum threads were collated from across 4 public online support group websites. All threads were initiated between February and April 2016. Texts from these threads were coded by 3 separate analysts using both inductive and deductive thematic analysis, until data saturation was reached.

Results

Analysis of 75 threads (641 individual posts) found 9 independent themes pertaining to aspects of participation in tinnitus online support groups. The results revealed that using the forums allowed users to exchange knowledge and experiences, express complex emotions, profit from a network of support, and engage in everyday conversation away from the burden of their tinnitus. However, some experiences appeared to be compromised by negative messages, limited communication, and informational issues such as conflicting advice or information overload.

Conclusions

This study represents the 1st research into discussion forums in tinnitus online support groups. A nonintrusive (passive) analysis method was used, whereby messages comprising the dataset were retrieved without direct interaction with the discussion forum. Individuals and the community of tinnitus online support groups are deemed to be at low risk from potential harm in this study. Most tinnitus patients likely benefit from accessing online support groups, for example, they discover they are not alone, and they find new coping strategies. However, for those who are particularly vulnerable or prone to psychological stress, accessing these groups could be detrimental.

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A Smartphone National Hearing Test: Performance and Characteristics of Users

Purpose

The smartphone digits-in-noise hearing test, called hearZA, was made available as a self-test in South Africa in March 2016. This study determined characteristics and test performance of the listeners who took the test.

Method

A retrospective analysis of 24,072 persons who completed a test between March 2016 and August 2017 was conducted. User characteristics, including age, English-speaking competence, and self-reported hearing difficulty, were analyzed. Regression analyses were conducted to determine predictors of the speech reception threshold.

Results

Overall referral rate of the hearZA test was 22.4%, and 37% of these reported a known hearing difficulty. Age distributions showed that 33.2% of listeners were ages 30 years and younger, 40.5% were between ages 31 and 50 years, and 26.4% were older than 50 years. Age, self-reported English-speaking competence, and self-reported hearing difficulty were significant predictors of the speech reception threshold.

Conclusions

High test uptake, particularly among younger users, and high overall referral rate indicates that the hearZA app addresses a public health need. The test also reaches target audiences, including those with self-reported hearing difficulty and those with normal hearing who should monitor their hearing ability.

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Masthead

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Toward Better Outcomes in Audiology Distance Education: An Educational Data Mining Approach

Purpose

This article introduces concepts and a general taxonomy used by the educational data mining (EDM) community, as well as examples of their applications, with the aims of providing audiology educators with a referential basis for developing this area.

Method

A narrative review was carried out to present an overview of EDM and its main methods. Some of these methods were exemplified with analysis of real data from an Internet-based specialization course on pediatric auditory rehabilitation.

Results

The review introduced EDM main concepts and applications and described methods from its area. Real data examples illustrated EDM use to predict interpersonal help-seeking, model interpersonal interaction, analyze students' trajectories within a course's module, and understand how students approached group assignments. Some of the insights provided by EDM to support teaching and learning processes were also described.

Conclusions

EDM methods offer new tools to discover knowledge from digital traces (i.e., logs) and support key stakeholders (students, instructors, or course administrators) to raise awareness about course dynamics. This approach has the potential to foster a better understanding and management of educational processes in audiology distance education.

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An Application of the Medical Research Council's Guidelines for Evaluating Complex Interventions: A Usability Study Assessing Smartphone-Connected Listening Devices in Adults With Hearing Loss

Purpose

The purpose of this study is to provide an example of the Medical Research Council's guidelines for evaluating complex health care interventions in the context of smartphone-connected listening devices in adults with hearing loss.

Method

Twenty existing hearing aid users trialed 1 of the following smartphone-connected listening devices: made-for-smartphone hearing aids, a personal sound amplification product, and a smartphone “hearing aid” application used with either wireless or wired earphones. Following 2 weeks of use in their everyday lives, participants completed self-report outcome measures.

Results

Relative to conventional hearing aids, self-reported use, benefit, and satisfaction were higher, and residual disability was lower for made-for-smartphone hearing aids. The converse was found for the other smartphone-connected listening devices trialed. Similarly, overall usability was judged to be “above average” for the made-for-smartphone hearing aids, but “below average” for the remaining devices.

Conclusions

This developmental work, guided by the Medical Research Council's framework, lays the foundation for feasibility and pilot studies, leading to high-quality research assessing the effectiveness of smartphone-connected listening devices. This future evidence is necessary to guide health care commissioners and policymakers when considering new service delivery models for adults living with hearing loss.

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Innovation in the Context of Audiology and in the Context of the Internet

Purpose

This article explores different meanings of innovation within the context of audiology and the Internet. Case studies are used to illustrate and elaborate on the new types of innovation and their levels of impact.

Method

The article defines innovation, providing case studies illustrating a taxonomy of innovation types.

Results

Innovation ranges from minor changes in technology implemented on existing platforms to radical or disruptive changes that provide exceptional benefits and transform markets. Innovations within the context of audiology and the Internet can be found across that range. The case studies presented demonstrate that innovations in hearing care can span across a number of innovation types and levels of impact. Considering the global need for improved access and efficiency in hearing care, innovations that demonstrate a sustainable impact on a large scale, with the potential to rapidly upscale this impact, should be prioritized.

Conclusions

It is unclear presently what types of innovations are likely to have the most profound impacts on audiology in the coming years. In the best case, they will lead to more efficient, effective, and widespread availability of hearing health on a global scale.

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Identification and Management of Middle Ear Disorders in a Rural Cleft Care Program: A Telemedicine Approach

Purpose

The aim of this study was to devise a grassroots-level strategy for identification and management of middle ear disorders in a community-based program for individuals with cleft lip and palate in 2 rural districts in the state of Tamil Nadu in South India.

Method

Community workers underwent training to conduct video otoscopy using the ENTraview device. Community workers conducted video otoscopy on 160 individuals with cleft lip and palate between 3 and 35 years old in the community. Middle ear conditions were identified using store-and-forward telepractice. Diagnostic telehearing evaluation was conducted using synchronous pure tone audiometry and tympanometry for those who were identified with tympanic membrane (TM) and/or middle ear diseases (MEDs). A review of data collected over a 13-month period was carried out to assess coverage and follow-up intervention rates.

Results

The program was successful in achieving 80% coverage for identification of TM and MEDs within 13 months of program implementation. TM and/or MEDs were identified in 26% (82/320 ears) of those who underwent video otoscopy. Telehearing evaluations were completed on 42 ears of individuals with TM and/or MEDs; 52% (22/42 ears) of these individuals had a minimal, mild, or moderate degree of hearing loss. Regarding follow-up for intervention, 78% qualified for surgical intervention, and 31% qualified for medication.

Conclusions

This grassroots-level telemedicine approach was successful in achieving better coverage, and store-and-forward telepractice helped in providing remote diagnosis and recommendation by otolaryngologists to all individuals with TM/MEDs in the rural community. The follow-up for otological intervention significantly improved from that achieved in the previous years.

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Techniques for Remotely Programming Children With Cochlear Implants Using Pediatric Audiological Methods via Telepractice

Purpose

The purpose of this report is to describe the equipment setup and techniques for successfully testing behavioral thresholds in young children with cochlear implants (CIs) using telepractice. We will also discuss challenges associated with pediatric CI programming that are unique to the use of distance technology, and we will describe ways to overcome those challenges. Last, we will review the results from 2 recent studies specifically targeted toward testing behavioral thresholds in young children with CIs.

Method

Conditioned play audiometry or visual reinforcement audiometry was used to measure behavioral thresholds (T levels) for 35 young children with CIs (n = 19 for conditioned play audiometry and n = 16 for visual reinforcement audiometry). Participants were tested in the traditional in-person condition and in the remote condition using an AB-BA study design over 2 visits.

Results

There was no significant difference in T levels between the in-person and remote conditions, indicating that it is feasible to test young children using conventional pediatric testing procedures via remote technology. The primary challenges encountered were in regard to proper camera and video monitor placement at the remote site and the timing of communication between the audiologist and test assistant.

Conclusions

The results from studies to date suggest that distance technology can be used successfully to program CI sound processors for young children using standard, age-appropriate testing techniques. The alternative of remote testing has substantial implications for reducing time and travel burdens for families, potentially leading to the construction of appropriate maps for young children with CIs in a timelier manner.

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Big Data for Sound Policies: Toward Evidence-Informed Hearing Health Policies

Purpose

The scarcity of health care resources calls for their rational allocation, including within hearing health care. Policies define the course of action to reach specific goals such as optimal hearing health. The process of policy making can be divided into 4 steps: (a) problem identification and issue recognition, (b) policy formulation, (c) policy implementation, and (d) policy evaluation. Data and evidence, especially Big Data, can inform each of the steps of this process. Big Data can inform the macrolevel (policies that determine the general goals and actions), mesolevel (specific services and guidelines in organizations), and microlevel (clinical care) of hearing health care services. The research project EVOTION applies Big Data collection and analysis to form an evidence base for future hearing health care policies.

Method

The EVOTION research project collects heterogeneous data both from retrospective and prospective cohorts (clinical validation) of people with hearing impairment. Retrospective data from clinical repositories in the United Kingdom and Denmark will be combined. As part of a clinical validation, over 1,000 people with hearing impairment will receive smart EVOTION hearing aids and a mobile phone application from clinics located in the United Kingdom and Greece. These clients will also complete a battery of assessments, and a subsample will also receive a smartwatch including biosensors. Big Data analytics will identify associations between client characteristics, context, and hearing aid outcomes.

Results

The evidence EVOTION will generate is relevant especially for the first 2 steps of the policy-making process, namely, problem identification and issue recognition, as well as policy formulation. EVOTION will inform microlevel, mesolevel, and macrolevel of hearing health care services through evidence-informed policies, clinical guidelines, and clinical care.

Conclusion

In the future, Big Data can inform all steps of the hearing health policy-making process and all levels of hearing health care services.

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Stories From the Webcams: Cincinnati Children's Hospital Medical Center Audiology Telehealth and Pediatric Auditory Device Services

Purpose

The purpose of this manuscript is to describe the regulatory, technological, and training considerations for audiologists investigating telehealth and to offer some examples of audiology services provided through telehealth.

Method

The authors presented the regulatory components, the technology required for audiology staff and patients, and staff training for the audiology telehealth program at Cincinnati Children's Hospital Medical Center. Four case studies highlighting the successful use of telehealth in providing auditory device services to patients were also presented.

Results and Conclusion

The described regulatory, technological, and training hierarchy provides a framework for audiologists interested in starting a telehealth program. The cases presented illustrate that telehealth can be used to provide some auditory device services, such as troubleshooting, mapping, and parent consulting.

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Internet and Audiology: A Review of the Third International Meeting

Purpose

In this introduction, the four members of the scientific committee for the Third International Meeting on Internet and Audiology describe the meeting that took place at the University of Louisville on July 27–28, 2017.

Method

This special issue, with a decidedly clinical focus, includes 14 articles that arose from presentations given at the Third International Meeting on Internet and Audiology. All touch upon the theme of innovation as it pertains to teleaudiology and mobile health (mHealth), application of Big Data to audiology, and ethics of internet and telemedicine.

Conclusion

Innovations in teleaudiology, mHealth, and Internet-based audiology are developing at a rapid pace and thus research in the field must continue. We invite readers to the next International Meeting on Internet and Audiology that will take place in Southampton, England, June 17–18, 2019.

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User-Innovated eHealth Solutions for Service Delivery to Older Persons With Hearing Impairment

Purpose

The successful design and innovation of eHealth solutions directly involve end users in the process to seek a better understanding of their needs. This article presents user-innovated eHealth solutions targeting older persons with hearing impairment. Our research question was: What are the key users' needs, expectations, and visions within future hearing rehabilitation service delivery?

Method

We applied a participatory design approach to facilitate the design of future eHealth solutions via focus groups. We involved older persons with hearing impairment (n = 36), significant others (n = 10), and audiologists (n = 8) following 2 methods: (a) human-centered design for interactive systems and (b) user innovation management. Through 3 rounds of focus groups, we facilitated a process progressing from insights and visions for requirements (Phase 1), to app such as paper version wireframes (Phase 2), and to digital prototypes envisioning future eHealth solutions (Phase 3). Each focus group was video-recorded and photographed, resulting in a rich data set that was analyzed through inductive thematic analysis.

Results

The results are presented via (a) a storyboard envisioning future client journeys, (b) 3 key themes for future eHealth solutions, (c) 4 levels of interest and willingness to invest time and effort in digital solutions, and (d) 2 technical savviness types and their different preferences for rehabilitation strategies.

Conclusions

Future eHealth solutions must offer personalized rehabilitation strategies that are appropriate for every person with hearing impairment and their level of technical savviness. Thus, a central requirement is anchoring of digital support in the clients' everyday life situations by facilitating easy access to personalized information, communication, and learning milieus. Moreover, the participants' visions for eHealth solutions call for providing both traditional analogue and digital services.

Supplemental Material

https://doi.org/10.23641/asha.7310729

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Geographic Distribution of the Hearing Aid Dispensing Workforce: A Teleaudiology Planning Assessment for Arizona

Purpose

Teleaudiology helps connect patients in rural and underresourced areas to hearing health care providers, minimizing the barrier of geography (Swanepoel et al., 2010). In the United States, teleaudiology is at the initial stages of implementation (Bush, Thompson, Irungu, & Ayugi, 2016). Telehealth researchers recommend conducting a comprehensive planning assessment to optimize implementation and adoption (AlDossary, Martin-Khan, Bradford, Armfield, & Smith, 2017; Alverson et al., 2008; Krupinski, 2015). A geographic analysis of the hearing aid dispensing workforce served as the initial stage of a teleaudiology planning assessment in Arizona.

Method

The analysis used publically available data sets from the U.S. Census, Arizona Department of Health Services, and the U.S. Veterans Administration. Geographic information system tools were used to analyze and visually represent population, potential teleaudiology site data, and hearing aid dispensing workforce (defined as audiologists and hearing instrument specialists licensed to dispense hearing aids in Arizona). ArcGIS was used to generate road networks and travel distance estimations.

Results

The number of audiologists per county ranged from 0 to 216 (average 22.1). Six out of Arizona's 15 counties lacked a single audiologist, and 2 counties lacked a hearing instrument specialist. Potential expansion sites for teleaudiology were located in areas of the state that lacked practice locations for hearing aid services.

Conclusions

There are geographic areas of Arizona that lack licensed hearing aid locations yet are populated by individuals who may need services. Resource availability data inform teleaudiology program expansion. Future research will include data from providers and community members on their perceived needs for services.

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Empowering Senior Cochlear Implant Users at Home via a Tablet Computer Application

Purpose

The introduction of connectivity technologies in hearing implants allows new ways to support cochlear implant (CI) users remotely. Some functionalities and services that are traditionally only available in an in-clinic care model can now also be accessed at home. This study explores the feasibility of a prototype of a tablet computer application (MyHearingApp [MHA]) in a group of senior experienced CI users at home, evaluating usability and user motivation.

Method

Based on user feedback, a tablet computer application (MHA) for the Cochlear Nucleus 6 CP910 sound processor was designed implementing six different functionalities: (a) My Hearing Tests, (b) My Environment, (c) My Hearing Journey, (d) Tip of the Day, (e) Recipient Portal, and (f) Program Use and Events. The clinical evaluation design was a prospective study of the MHA in 16 senior experienced CI users. During 4 weeks, participants could freely explore the functionalities. At the end, the usability and their motivation for uptake and adherence were measured using a baseline and follow-up questionnaire.

Results

Based on the System Usability Score (as part of the follow-up questionnaire), a good level of usability was indicated (M = 75.6, range: 62.5–92.5, SD = 8.6). The ability to perform hearing tests at home is ranked as the most relevant functionality within the MHA. According to the Intrinsic Motivation Inventory (Deci, Eghrari, Patrick, & Leone, 1994) questionnaire (as part of the follow-up questionnaire), participants reported high levels of interest and enjoyment, found themselves competent, and did not experience pressure while working with the app.

Conclusions

This study evaluated a tablet computer application (MHA) for experienced senior CI users by means of a prospective design, which provided novel insights into delivering CI care into the home of the CI user. The user feedback from this small-scale study suggests that the participants are open to take more responsibility for and to become a more active actor in their own hearing care, if only this is facilitated with the right tools. This may foster the evolution from a clinic-led to a more patient-centered care model, where CI users feel more empowered in the self-management of their hearing implant device.

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Automated Characterization of Mobile Health Apps' Features by Extracting Information From the Web: An Exploratory Study

Purpose

The aim of this study was to test the viability of a novel method for automated characterization of mobile health apps.

Method

In this exploratory study, we developed the basic modules of an automated method, based on text analytics, able to characterize the apps' medical specialties by extracting information from the web. We analyzed apps in the Medical and Health & Fitness categories on the U.S. iTunes store.

Results

We automatically crawled 42,007 Medical and 79,557 Health & Fitness apps' webpages. After removing duplicates and non-English apps, the database included 80,490 apps. We tested the accuracy of the automated method on a subset of 400 apps. We observed 91% accuracy for the identification of apps related to health or medicine, 95% accuracy for sensory systems apps, and an average of 82% accuracy for classification into medical specialties.

Conclusions

These preliminary results suggested the viability of automated characterization of apps based on text analytics and highlighted directions for improvement in terms of classification rules and vocabularies, analysis of semantic types, and extraction of key features (promoters, services, and users). The availability of automated tools for app characterization is important as it may support health care professionals in informed, aware selection of health apps to recommend to their patients.

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Long-Term Efficacy of Audiologist-Guided Internet-Based Cognitive Behavior Therapy for Tinnitus

Purpose

The purpose of this study was to investigate the long-term outcomes 1 year after undertaking an audiologist-guided Internet-based cognitive behavioral therapy (iCBT) intervention for tinnitus. Secondary aims were to identify any predictors of outcome and whether there were any unwanted events related to undertaking iCBT for tinnitus.

Method

Participants who had previously undertaken a randomized iCBT efficacy trial for tinnitus were invited to participate. Of the 146 who were initially randomized for the efficacy trial, 104 participants completed the 1-year postintervention assessment measures. The primary outcome was a change in tinnitus distress as assessed by the Tinnitus Functional Index. Secondary assessment measures were included for insomnia, anxiety, depression, hearing handicap, hyperacusis, cognitive failures, and satisfaction with life. An intention-to-treat analysis using repeated-measures analysis of variance and hierarchical multiple regression was used for statistical analysis. Unwanted effects were categorized according to the unwanted events checklist.

Results

Undertaking iCBT for tinnitus led to significant improvements 1 year postintervention for tinnitus and related difficulties, for example, insomnia, anxiety, depression, hearing handicap, hyperacusis, and life satisfaction. The best predictors of improving tinnitus severity at 1-year postintervention were greater baseline tinnitus severity scores, reading more of the modules, and higher satisfaction with the intervention. Unwanted events were reported by 11% of the participants and were more likely to be reported by women than men. These events were related to worsening of symptoms, the emergence of new symptoms, negative well-being, and prolongation of treatment.

Conclusions

The clinical benefits of audiologist-guided iCBT for tinnitus and tinnitus-related difficulties were sustained 1 year postintervention. Predictors of outcome indicated that the intervention is applicable to a wide range of participants regardless of their demographic backgrounds. Attempts should be made to minimize unwanted events in subsequent trials.

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Findings and Ethical Considerations From a Thematic Analysis of Threads Within Tinnitus Online Support Groups

Purpose

Tinnitus is the perception of noise without a corresponding external stimulus. Current management typically aims to moderate associated psychosocial stressors and allow sufferers to retain an adequate quality of life. With the increasing recognition of the Internet as a repository for health advice, information, and support, the online support group has become a popular coping strategy for those living with chronic conditions such as tinnitus. Patients find that communicating with each other, providing encouragement, and sharing information in the absence of physical and temporal boundaries are invaluable ways of managing their condition. The purpose of this study was to explore the potential positive and negative consequences of participating in online support groups for tinnitus.

Method

Discussion forum threads were collated from across 4 public online support group websites. All threads were initiated between February and April 2016. Texts from these threads were coded by 3 separate analysts using both inductive and deductive thematic analysis, until data saturation was reached.

Results

Analysis of 75 threads (641 individual posts) found 9 independent themes pertaining to aspects of participation in tinnitus online support groups. The results revealed that using the forums allowed users to exchange knowledge and experiences, express complex emotions, profit from a network of support, and engage in everyday conversation away from the burden of their tinnitus. However, some experiences appeared to be compromised by negative messages, limited communication, and informational issues such as conflicting advice or information overload.

Conclusions

This study represents the 1st research into discussion forums in tinnitus online support groups. A nonintrusive (passive) analysis method was used, whereby messages comprising the dataset were retrieved without direct interaction with the discussion forum. Individuals and the community of tinnitus online support groups are deemed to be at low risk from potential harm in this study. Most tinnitus patients likely benefit from accessing online support groups, for example, they discover they are not alone, and they find new coping strategies. However, for those who are particularly vulnerable or prone to psychological stress, accessing these groups could be detrimental.

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A Smartphone National Hearing Test: Performance and Characteristics of Users

Purpose

The smartphone digits-in-noise hearing test, called hearZA, was made available as a self-test in South Africa in March 2016. This study determined characteristics and test performance of the listeners who took the test.

Method

A retrospective analysis of 24,072 persons who completed a test between March 2016 and August 2017 was conducted. User characteristics, including age, English-speaking competence, and self-reported hearing difficulty, were analyzed. Regression analyses were conducted to determine predictors of the speech reception threshold.

Results

Overall referral rate of the hearZA test was 22.4%, and 37% of these reported a known hearing difficulty. Age distributions showed that 33.2% of listeners were ages 30 years and younger, 40.5% were between ages 31 and 50 years, and 26.4% were older than 50 years. Age, self-reported English-speaking competence, and self-reported hearing difficulty were significant predictors of the speech reception threshold.

Conclusions

High test uptake, particularly among younger users, and high overall referral rate indicates that the hearZA app addresses a public health need. The test also reaches target audiences, including those with self-reported hearing difficulty and those with normal hearing who should monitor their hearing ability.

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Masthead

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Signia TeleCare Facilitates Improvements in Hearing Aid Fitting Outcomes

This course describes the advantages of using Signia TeleCare 3.0 for both patients and professionals. It also describes a clinical study which validates TeleCare benefits for patients.

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Fall 2018: Super Power Made Super Easy

Fitting Super Power hearing instruments is about to get super easy. With advanced technology optimized for patients with severe-to-profound hearing loss, you can provide all the positive benefits associated with switching to a new hearing instrument, plus a whole new level of freedom. This course will focus on the technological advancements of Unitron’s new super power BTE.

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ReSound Relief: Tinnitus Management in the Digital Age

It is challenging to provide appropriate tinnitus services relative to the number of people who are seeking help, and mobile apps could help fill the void. This paper discusses the clinically validated components of the ReSound Relief app, its efficacy in helping to manage tinnitus, and how data collected in the app is used.

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Signia TeleCare Facilitates Improvements in Hearing Aid Fitting Outcomes

This course describes the advantages of using Signia TeleCare 3.0 for both patients and professionals. It also describes a clinical study which validates TeleCare benefits for patients.

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Fall 2018: Super Power Made Super Easy

Fitting Super Power hearing instruments is about to get super easy. With advanced technology optimized for patients with severe-to-profound hearing loss, you can provide all the positive benefits associated with switching to a new hearing instrument, plus a whole new level of freedom. This course will focus on the technological advancements of Unitron’s new super power BTE.

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ReSound Relief: Tinnitus Management in the Digital Age

It is challenging to provide appropriate tinnitus services relative to the number of people who are seeking help, and mobile apps could help fill the void. This paper discusses the clinically validated components of the ReSound Relief app, its efficacy in helping to manage tinnitus, and how data collected in the app is used.

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