By Gordon Glantz
Editor's note: This is an online-exclusive supplement to the June 2021 cover story. Read it here.
While Led Zeppelin may have unknowingly caused hearing loss with its music, one song – “Communication Breakdown"—still resonates like an amplifier from Jimmy Page's electric guitar.
Ironically, there is a major disconnect—or communication breakdown, if you will—between primary care physicians/geriatricians and audiology professionals.
Studies show no more than 50 percent (and that might be generous) of PCPs discuss hearing loss with age 50-plus patients at office visits.
This is the age group where there is an opportunity to be more proactive.
For geriatricians, the numbers are not much better with patients 65 and over.
Well aware of the situation is Dr. Virginia Gural-Toth AuD CCC/A, who is the manager of the Tinnitus, Balance and Audiology Programs at Hackensack Meridian Health JFK Johnson Rehabilitation Institute in Edison, NJ with over 30 years of clinical experience specializing in tinnitus management and amplification.
“As a profession, audiology needs to be proactive in informing the PCPs of the services we provide and the positive outcomes that are achieved," said Gural-Toth. “For example, the positive impact treating hearing loss has on cognition in the elderly. An opportunity exists for the audiologist to contact the PCPs directly to discuss results as opposed to just forwarding a report."
She went on to add that communication can establish rapport, engage in a question and answer discussion, and is a great educational tool for teaching the PCPs about the benefits of audiology.
Danielle S. Powell, AuD, PhD, has a clinical background as an audiologist, completing her AuD in 2013. She worked in the greater Washington D.C. area for a number of years before beginning a PhD program in Epidemiology at the Johns Hopkins Bloomberg School of Public Health in 2017, where she was a fellow at the Cochlear Center for Hearing and Public Health.
“I can kind of think about two main breakdowns between PCP/geriatrics and audiology," she said. “For many, even other health care providers, as a field, we haven't made hearing and hearing test results very easily understood. Terms like 'mild or moderate hearing loss' are meaningless to others out of context.
“While the attention of primary care physicians and geriatricians towards hearing has grown in recent years, there is, of course, a long way to go."
Gural-Toth also brought up the issue of consumers directly accessing information about audiology on the internet rather than through their PCP.
She said: “The wealth of information that is available can be confusing to the consumer on how to access services. In light of this, having an informed PCP helps guide the consumer to the correct professional and service."
As for the idea of self-administered tests, lasting 1-2 minutes that patients can take as part of their visits to the doctor, Gural-Toth could foresee better outcomes.
She noted benefits to a quick screen as a preliminary test during a physical to confirm suspected hearing loss and let the consumer know when they need to see an audiologist.
“However, there are limitations to these quick screens including the type of device used, the way it was administered as well as the noise in the room when it is administered," she said. “All of these limitations can lead to both false positives and false negatives."
Also, audiologists on the long list of specialists—eye doctors, dentists, podiatrists, etc. —that were, and still are, placed on hold due to COVID.
“It has been our experience, during the height of the pandemic, that consumers were not returning," said Gural-Toth. “However, that trend seems to be slowly changing. To counter some of these fears, we provided information to our patients as well as offered curbside hearing aid services for those that were concerned about entering the facility."
In addition to age, the role of socio-economics with older people (lack of transportation, etc.) looms large with older patients not seeing the process all the way through.
This can be the case, even if they are referred to an audiologist from a primary care physician/geriatrician.
“As professionals, we are concerned about the social determinants of healthcare that create barriers to patients receiving healthcare including Audiological care," said Gural-Toth, adding that audiology professionals must work toward a common goal of removing these barriers.
She added: “Whichever it is -- transportation, cost of services, or lack of knowledge of our services, working with local agencies for transportation services, offering payment plans as well as working with our PCPs to help the consumers understand our services are just a few things that we can do."
Powell is aware of the same hurdles.
“For parts of the country, simply having access to hearing care can pose significant challenges as there are regions, especially in rural areas, where older adults have to drive extended lengths to reach a hearing provider," she said. “Many other older adults, in general, find navigating the health care system – and Audiology services in particular with all of the steps involved like additional appointments with PCP and ENT – very challenging and therefore get lost in the process."
Going forward, Gural-Toth views bridging the communication gap as a grassroots effort.
“Audiology has an opportunity to work with their local communities and PCPs to educate them on the services we provide," she said. “On a national level, Audiology has an opportunity to become more involved in their organizations to promote more visibility and support these initiatives that allow for greater access to services."
Powell pointed to campaigns such as “Know Your PTA" as being lifelines, in terms of what a given degree of hearing loss means, as it presents new ideas on ways in which those outside the realm of Audiology and Otolaryngology can better understand hearing loss and communication needs.
“This, in turn, may help educate patients and providers on the impacts of hearing loss and potential treatment strategies," she explained. “Up until recently, however, our research evidence hasn't really shown the importance of hearing loss across other aspects of health beyond communication ability. This will take time to sink in for providers across other disciplines."
Editor'​s note: This is an online-exclusive supplement to the June 2021 cover story. Read it here.
