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Tuesday, May 26, 2020

By Shane Tagupa

Adults who have concurrent vision and hearing impairment or dual sensory impairment (DSI) are less likely to be part of the workforce, a recent study finds.

"American adults with dual sensory impairment had 40 percent lower odds of employment, while those with vision or hearing impairment alone had about 20 percent lower odds of employment when compared to American adults without either sensory impairment," said Varshini Varadaraj, MD, and Bonnielin K. Swenor, PhD, two of the study authors of the research letter, "Trends in Employment by Dual Sensory Impairment Status."

"While prior research has reported lower employment rates among individuals with either hearing or vision impairments, studies have not examined those with dual sensory impairment (that is, concurrent vision impairment and hearing impairment), a group that may be at increased risk for unemployment," Varadaraj and Swenor told The Hearing Journal.


The authors examined data from the National Health Interview Survey (NHIS) from 2008 to 2017, and included those from 277, 251 participants aged 18 to 75 years old, who had no sensory impairment, a visual impairment only, a hearing impairment only, and those with dual impairment.

The majority (61 percent) of participants with DSI reported that they were unemployed. Of these, 51 percent claimed that the reason for their unemployment was that they had a disability. In comparison, only 46 percent of visually impaired participants and 44 percent of hearing-impaired participants were unemployed.

"This corroborates evidence from previous studies that have shown lower employment rates among those with sensory impairments, possibly because they face greater difficulties entering or remaining in the workforce," the authors reported. "Individuals with DSI may be especially susceptible given an inability to rely on sensory substitution to overcome impairment."

While this study provides an important glimpse into the employment vulnerability of adults with DSI, it also comes with notable limitations.    

"First, these data estimate functional sensory impairment and are based on participant self-report, which likely are underreported, and therefore the observed associations between impairment and employment are likely underestimates," said Varadaraj and Swenor, who are both from the Wilmer Eye Institute at Johns Hopkins University School of Medicine.

"Second, the NHIS study population does not include persons on active duty with the Armed Forces, and therefore our results are not generalizable to that specific population."

Regarding the study's data collection via self-reporting, the researchers asked questions that were "informed by established biopsychosocial models of disability (rather than the medical model) that take into account features of the person and the overall context in which the person lives."

"The biopsychosocial model from the International Classification of Functioning, Disability, and Health (ICF) by the World Health Organization integrates medical and social perspectives of health," Varadaraj and Swenor explained.

"There is value in examining self-reported impairments as experienced by the individual as well as for future studies to examine objective measures (visual acuity, pure tone audiometry, etc.) to allow for clinically meaningful definitions of impairment that can be compared across studies."


Noting the marked association between health and productivity as shown by previous studies, the authors are hopeful that their analysis could help spark a national discussion on the employment of people with DSI.

"To our knowledge, this is the first description of DSI and employment in a nationally representative population and highlights the need for understanding barriers for employment in people with DSI, focusing on strategies for engaging them, and addressing their specific needs in the workforce."

A previous analysis from the Disability Statistics Annual Report based on the American community "only captures the most severe impairment and… fails to present data on those with dual sensory impairment," said the authors.

Their study also suggests that people with sensory impairments may benefit from further research on improved access to eyeglasses, use of hearing aids, use of low-vision rehabilitation, and integration of vision and hearing interventions.

When asked specifically about the role of hearing aids among the study participants, Varadaraj and Swenor told The Hearing Journal that they did not examine this in their study. "However, the National Health Interview Survey does include a question for participants on whether they currently use hearing aids, to which only 1.8 percent (weighted estimate among adults 18-75 years from years 2008 to 2017) answered in the affirmative."

"With the aging of the U.S. population, the number of people with DSI is expected to increase, magnifying the public health significance of this subset."

Thursday, May 21, 2020

Cochlear Americas has received approval from the U.S. Food and Drug Administration (FDA) to lower the age of cochlear implantation from 12 months to 9 months for children with bilateral, profound sensorineural hearing loss. With abundant research demonstrating the benefits of early cochlear implantation in children with prelingual deafness, this update is an important step toward ensuring that children with hearing loss develop speech and language at a trajectory similar to their peers with normal hearing (Hearing Journal. 2019; 72 [11]:16. doi: 10.1097/01.HJ.0000612572.81490.e2). With U.S. states currently developing strategies to safely reopen and resume elective surgeries amid the COVID-19 pandemic, this FDA approval enables cochlear implant (CI) surgeries for younger children with hearing loss to be prioritized, thereby giving these children access to sound as early as possible.

"As states begin to allow more surgeries, we hope this expanded indication will help hospitals to prioritize pediatric cochlear implant surgeries,” said Patricia Trautwein, MA, AuD, the vice president of product management and marketing at Cochlear Americas, in a press release. "Our hopes are that children get access to hearing technology that will help them obtain age-appropriate speech and language as soon as they can."

Three in 1,000 infants born in the U.S. each year have moderate, severe, or profound hearing loss (AAP, 2020). Additionally, hearing loss is the most common congenital condition in the U.S. Hearing loss has a major impact on a child's life, including speech and language development, literacy, mental health, social and cognitive functioning, educational achievement, employment, and socio-economic opportunity (Ear Hear. 2013; 34[5]: 535-552).

Cochlear implants have been FDA-approved for use in children since 1990, with CochlearTM Nucleus® cochlear implants obtaining the first approval. Research shows that children with a severe-to-profound hearing loss who receive cochlear implants early achieve better speech recognition than children who continue to use hearing aids, underscoring the importance to not delay access to cochlear implants because doing so can have lingering developmental consequences (Int J Aud. 2016; 55:S9-S18.)
Cochlear Nucleus.jpg

“Pediatric indications have only changed twice in the history of our field, starting with the initial pediatric indication in 1990 and then an update in 2000. While there was extensive existing data to support the safety and effectiveness of lowering the age for pediatric cochlear implantation, supporting data was not in a cohesive format or database,” explained Trautwein.
“Our greatest challenge [in getting the FDA approval] was being able to consolidate all of the existing clinical research and evidence in the published literature and combine this with data from our internal database and databases of clinics from around the world to demonstrate the safety and benefit of earlier cochlear implantation in children,” she told The Hearing Journal. “One of the greatest accomplishments was the partnership with the FDA throughout the planning and review of the evidence that secured the regulatory approval to lower the age of implantation from 12 months to 9 months. Based on the evidence, the benefits associated with early implantation may contribute to permanently closing the gap between children with cochlear implants and their normal-hearing peers for speech, language, psychosocial, and academic outcomes.”
A notable study in Australia, for example, has shown that up to 80 percent of children who received CIs younger than 12 months of age demonstrated receptive vocabulary knowledge within the normal range by school entry, and 81 percent of children who received CIs early attended mainstream schools (Otol Neurotol. 2016 Feb; 37[2]: e82-95).
“It is important for families of children born deaf to have a treatment option that provides access to sound for better hearing, speech, and language outcomes in their life,” said Trautwein.
In the U.S., the CochlearTM Nucleus® Implant System is intended for use in children 9 to 24 months of age who have bilateral profound sensorineural deafness and demonstrate limited benefit from appropriate binaural hearing aids. Children 2 years of age or older may demonstrate severe to profound hearing loss bilaterally. This FDA approval is extended to all current CochlearTM Nucleus® Implant models, as well as all models developed in the future by Cochlear.

Tuesday, May 19, 2020

On April 30, the Centers for Medicare and Medicaid Services (CMS) issued an interim regulation expanding the coverage of telehealth services to include all Medicare-billing professionals during the COVID-19 public health emergency. This effectively included audiologists as eligible telehealth providers, allowing them to be reimbursed for remote audiology services.
As audiologists gear up for telepractice, experts from the American Academy of Audiology (AAA) provided up-to-date guidance on telehealth reimbursement and practical tools for teleaudiology in the webinar “Supporting Patients at a Distance: Telehealth Now and in the Future.”
AAA Coding and Reimbursement Committee Chair Anna Jilla, AuD, PhD, gave an overview of telehealth coding and billing. She reminded participants that telehealth policies vary from state to state. Other payers beyond traditional Medicare—such as state Medicaid, CHIP, Medicare Advantage, commercial payers, and third-party insurance networks—may have more flexibility for telehealth reimbursement. Audiologists should check the specific websites of states and payers for the latest policy changes related to COVID-19.
Jilla also shared a simple decision matrix for billing telehealth services. If a service is typically billed for and is covered by the latest regulations, the audiologist may bill for its telehealth delivery.Decision Matrix.JPG

Remote programming and reprogramming of cochlear implants (CIs)–codes 92601, 92602, 92603, and 92604–are also among the billable telehealth services. The AAA specified these to the CMS, as these codes are already covered via traditional (non-telehealth) delivery. “All that would really change would be the method of delivery of the service,” said Erin Miller, AuD, chair of the AAA Professional Development Council, and noted that remote CI programming was approved by the FDA in 2017 and is even covered by some commercial payers and state Medicaid programs.
Finally, AAA President Catherine V. Palmer, PhD, spoke at the webinar about maximizing practical tools for telepractice. Among these are remote conferencing services such as Microsoft Teams, Facetime, and Zoom. She also enumerated some additional considerations when working with patients from home, such as eliminating environmental distractions, ensuring appropriate lighting, and maintaining eye contact with the camera, not the screen.
Palmer emphasized, however, that teleaudiology is more than just doing calls.
“[Getting on] a telephone call and telling someone their hearing aid is ready to be picked up – that’s not teleaudiology,” she said. “The ones we were talking about – and I use the word ‘visit’ – means it’s really taking the place of an in-person visit. So, you’re providing advice and treatment and a plan for this person. That could be over the telephone, it could be video, it could also be email.”
Palmer shared some recent cases where various teleaudiology tools proved helpful for audiologists and patients. In one case, a smartphone app was used to administer an online hearing test. While the test was not considered as accurate for looking at a threshold, it was useful in examining relative changes.
“[These were] honestly things we thought we would literally never use,” Palmer admitted. She acknowledged that audiologists have always been in a position of further exploring telehealth, but the coronavirus emergency has challenged them to transition much faster than anticipated.
“We were really seeing people 100 percent in person on a Friday, and by Monday, we were seeing almost zero percent. And so, we were faced with needing to suddenly provide remote care very quickly.”
The availability of remote communication tools, coupled with the updated regulations of the CMS, has come as a boon for audiologists transitioning to telepractice.
“Our whole goal here is to save people a trip into the clinic,” said Palmer. “We’re trying to keep people away right now who don’t need to come in, but we’re trying to care for them at the same time.”
The AAA continues to push for the consideration of other audiology services for Medicare telehealth provisions. Potential services for further expansion include reviewing medical history, obtaining a problem-focused history, and clinical decision-making. Alongside this, the Academy advocates for the advancement of H.R.4056, S.2466, or the Medicare Audiologist Access and Services Act (MAASA).

Friday, May 15, 2020

Leading hearing technology manufacturers have partnered with the United States Department of Veterans Affairs (VA) to improve the remote delivery of audiology care to U.S. veterans. With the VA recently expanding the approval of more telehealth solutions, this significant move contributes to the continuity of audiological care for veterans, many of whom are particularly vulnerable to the human coronavirus. These partnerships also help in ensuring access to proper communication among veterans with hearing loss during this public health emergency.
Livio Edge AI, Starkey’s latest hearing technology, is now available through the VA, the U.S. Department of Defense, and other federal agencies. With this release, veterans now have access to:
•  Industry’s first and only 2.4 GHz Li-Ion custom rechargeable:  allows for a simple and perfect fit, and no external batteries
•  Edge Mode:  conducts an AI-based analysis of the environment and makes smart, instantaneous adjustments for patient comfort
•  Easiest to Use:  utilizes voice-activated commands and tap controls for seamless adjustments
•  Table Microphone:  a smart, sleek 8-mic array, providing superior sound in noisy group settings
•  Thrive Hearing Control App:  offers users everyday connectivity and personalization
•  Thrive Care App:  lets caregivers see information Livio Edge AI wearers choose to share
Phonak has partnered with the VA to make remote hearing care, including hearing aid fine-tuning and adjustments, a reality for U.S. veterans amid the COVID-19 pandemic and beyond. With Phonak Remote Support, VA audiologists can now extend care beyond the walls of their clinics to patients who are social distancing, have mobility challenges, or to those who prefer virtual follow-up sessions. The technology comes only five weeks after the VA released its COVID-19 Response Plan, which highlighted telehealth services as a preferred health care delivery system for Veterans without COVID-19.
VA audiologists can initiate a Remote Support session through a tab in Phonak’s professional fitting software. At appointment time, patients use the free myPhonak app on their smartphone to virtually connect with their audiologist via secure voice, text, or video chat. Because the patient’s phone is linked to his/her hearing aids via Bluetooth® technology, the audiologist gains direct access to all hearing aid settings via the smartphone. This allows veterans to receive on-the-spot tuning, program changes, counseling, and more in real-time while remaining safely at home.
Signia’s TeleCare, a pioneering program launched in 2016, is now available to hearing care professionals in the VA. TeleCare enables providers to connect via phone, video, or text-based chats with patients, discuss success or challenges, and make any necessary adjustments in real-time.
A study by Signia found that 70 percent of hearing health care providers who use TeleCare received increased patient satisfaction, while 75 percent agreed that it provides greater convenience for them and their patients.  Another study of 23,000 hearing aid patients worldwide indicated that TeleCare improves hearing aid acceptance by 19 percent.
TeleCare is currently available for use with any Bluetooth®-enabled hearing aids on Signia’s Xperience and Nx platforms, and comes with a smartphone app.

Editor’s note: Original contents were provided by Phonak, Starkey, and Signia. 

Friday, May 15, 2020

As social distancing and self-quarantines have become the norm in the face of COVID-19, individuals with hearing loss may find it difficult to get the help they need. Responding to this reality, Signia recently introduced Remote Care, a new program enabling hearing care professionals (HCPs) to prescribe, fit, and fine-tune hearing aids remotely. It also includes Signia Assistant, a new virtual assistant built upon the latest artificial intelligence technology and provides 24/7 support in the form of intuitive, text-based dialogue.
Early adopters of the comprehensive program, like Stella Fulman, AuD, co-owner of Audiology Island clinic in Staten Island, NY, have experienced great success with the solution.
“I am extremely happy with Remote Care from Signia,” Fulman commented. “It gives me the agility and flexibility to deliver the care my patients expect in a manner that is safe for everyone involved. I am also confident the program will help me remain resilient in the face of any future disruptions, while meeting growing patient demand for telehealth services.”

The COVID-19 pandemic has accelerated the use of telehealth solutions to maintain the safety of the health care provider and patient alike. At the same time, hearing is a basic requirement for one’s safety, like face masks and hand sanitizers; proper hearing can help reduce risk of infection by enabling people to hear others from safe distances. Also, as many people rely on phone calls and video conferencing to stay connected, untreated hearing loss can impact one’s ability to communicate. Remote Care from Signia is designed to provide the telehealth services while helping people benefit from hearing aids during this challenging time. This is especially important for high-risk patients, individuals with limited mobility and those who rely on others for transportation.
“With in-person service now difficult or impossible, hearing care professionals must adapt quickly to support current and new patients with high-quality care,” said Tish Ramirez, AuD, Signia’s vice president, clinical education & professional relations. “Remote Care is a versatile solution to meet patient needs at any stage of their journey to better hearing. As a result, the hearing care professional can fine-tune a current wearer’s devices or conduct the complete screening and fitting process for new patients and ensure each individual’s long-term success.”
Remote Care gives HCPs the flexibility to conduct any or all steps of a hearing aid fitting, depending on their location’s licensing laws, social distancing guidelines or a patient’s preferences, while providing the same level of care as if they were in the office.
For patients in need of a hearing test, Signia can support them with an online screening. Signia has partnered with SHOEBOX, which offers a proven and easy-to-use test to screen hearing loss remotely. The HCP will then meet to discuss the results with the patient and recommend hearing aids, continuing to conduct their normal workflow virtually.  
As added support during this time of social distancing, Signia offers pre-programmed hearing aids direct to patients. Alternately, devices can be sent to the HCP and given to the patient via curbside pickup. Then, via follow-up appointments, the HCP will adjust and fine-tune the hearing aids, as they can with their current patients. 

Editor’s note: Original content was provided by Signia.