Hearing loss negatively affects the lives of millions of Americans (Lin, Niparko, & Ferrucci, 2011). Amplification can enhance audibility and in turn improve quality of life (Mulrow et al., 1990). Yet it is estimated that only 20% of those who would benefit from amplification in the United States actually utilize it (Chien & Lin, 2012). Discomfort and insufficient value have been cited as reasons for low uptake as well as low motivation, negative attitudes towards hearing aids, and lack self-perceived handicap (McCormack & Fortnum, 2013; Vestergaard-Knudsen et al., 2010). Studies have also attributed the out-of-pocket cost for hearing aids as a substantial barrier (Bainbridge & Ramachandran, 2014; Kochkin, 2000). Cost as a barrier to hearing aid access may be an issue of particular importance in regions with high poverty, as low-income adults are less likely to report hearing aid use (Bainbridge & Ramachandran, 2014). Hearing aids can typically cost about $2,000 each, possibly making them out of reach for individuals living at or below the poverty line. Arizona has one of the highest poverty rates in the United States (Bishaw & Fontenot, 2014). Using US Census data and epidemiologic studies, we estimate that there are approximately 1,145,166 adults over the age of 19 living with significant bilateral or unilateral hearing loss in Arizona. An estimated 204,984 of these individuals are living at or below the federal poverty line (Lin, Naparko, & Ferrucci, 2011; Bishaw & Fontenot, 2014, Muller et al., 2015, US Census). These numbers are particularly alarming, as there are limited resources to support adults with hearing loss in Arizona. The aim of this study was to gather provider perspectives on the accessibility and affordability of hearing healthcare in Arizona. The long-term goal is to develop a state-level initiative to increase hearing aid use among low-income adults. Based on previous research from the Hearing Aid Coalition, we hypothesized that Arizona providers would prefer a state-level plan that mirrors service coverage and reimbursement mechanisms of private insurance (Hearing Aid Coalition, 2004) Audiologists and hearing instrument specialists were recruited via email to participate in focus groups and surveys. Three focus groups were held across the state in Phoenix, Flagstaff and Tucson (n = 26). The survey methodology included open and closed questions and was administered in paper-based and online versions (n = 77). Data were transcribed, coded, and analyzed using descriptive and basic regression analyses. There was wide-ranging participation from providers across the state representing urban and rural practice locations (All 15 counties represented). Data revealed most providers would prefer to see changes in the current state of hearing access for low-income adults. Providers considered a number of factors to be important when developing and implementing changes to existing service delivery. These factors included a centralized entity to distribute referrals across practices and sufficient reimbursement for service providers. Common themes included the need for a balance between quality of care and expense as well as creating a fee-for-service component to invest the patient in the process. Increased philanthropic practice image and fair compensation were cited as the greatest motivations for provider participation. Survey results also indicated that most providers are already doing pro-bono work. This study highlights that providers are willing to participate in state-level initiatives to improve hearing aid access. Ultimately, these results will inform policy makers of provider preferences for mechanisms of service-delivery and reimbursement. This research is a collaborative project funded by the Arizona Commission for the Deaf and the Hard of Hearing.

Background: Patients often report that living with a condition such as tinnitus can be debilitating, worrying, and frustrating. Efficient ways to foster management strategies for individuals with tinnitus and promoting tinnitus self-efficacy are needed. Internet-based cognitive behavioral therapy (ICBT) for tinnitus shows promise as an evidence-based intervention in Europe, but is not available in the United States. The aim of this pilot study was to evaluate the feasibility of an ICBT intervention for tinnitus in the United States. Method: This study reports the Phase 1 trial intended to support implementation of a larger randomized clinical trial (RCT) comparing ICBT to a weekly monitoring group. As a pilot study, a single-group pretest–posttest design was used to determine outcome potential, recruitment strategy, retention, and adherence rates of ICBT for tinnitus. The primary outcome was a change in tinnitus distress. Secondary outcome measures included measures of anxiety, depression, insomnia, tinnitus cognitions, hearing-related difficulties, and quality of life. Results: Of the 42 screened participants, nine did not meet the inclusion criteria and six withdrew. There were 27 participants who completed the intervention, with a mean age of 55.48 (± 9.9) years. Feasibility was established, as a large pretest–posttest effect size of d = 1.6 was found for tinnitus severity. Large pretest–posttest effect sizes were also found for tinnitus cognitions and hearing-related effects, and a medium effect was found for insomnia and quality of life. Treatment adherence varied with a retention rate of 85% (n = 23) at post-intervention assessment and 67% (n = 18) for the follow-up assessment. Conclusions: This pilot study supported the feasibility of ICBT for tinnitus in the United States. Ways of improving intervention retention and recruitment rates need to be explored in future ICBT studies. Protocol refinements that were identified will be implemented prior to further RCTs to investigate the efficacy of ICBT for tinnitus in the United States.

Thesis (D. Phil. Communication Pathology)--University of Pretoria, 2003. / Summary in English and Afrikaans. Includes bibliographical references.

In most classrooms, where information is presented orally via spoken language, accurate knowledge of a student's hearing status is crucial so that the interdisciplinary team can ensure appropriate service provision. Audiologists play a key role on the interdisciplinary team to provide other professionals with information about children's hearing status, communication needs, device use, and intervention strategies. Conversely, audiologists gain valuable information and strategies from other team members.

This study explores and describes the experiences of hearing children growing up in Deaf Parented families in Gauteng. The specific objectives of the study were to explore the delegation of different roles including South African Sign Language interpreting in the family; the influence of having Deaf parents in occupational choices of hearing adult-children of Deaf parents; the availability of support services to CODAs and their perceptions of their parents in terms of disability. A purposive sampling strategy in conjunction with snowball sampling was used to identify and recruit participants. Two males and eight females between the ages of 21 and 40 years, with different occupations were recruited for this study. A qualitative design, embedded within the constructivism and interpretivism framework was used in this study. Data were collected through semi structured; open ended and in-depth interview questions were used to obtain data for the study. A pilot study was conducted prior to commencing with the main study. Thematic content analysis was employed to describe themes qualitatively. The following themes emerged from the study. Participants reported to have developed a bicultural identity; however, they primarily identify themselves as CODAs regardless of their racial identity. Participants expressed frustrations with the interpreter role and female children reported to have interpreted for their parents more than their male counterparts. Seven participants are currently employed as SASL interpreters. The study highlights that there are mixed emotions regarding interactions with the extended family members. The study identifies a strong need for support services for Deaf parented families. Lastly; participants viewed Deafness as a cultural minority, and not a disability. Findings revealed a need for audiologists to clearly define their role in Deaf parented families, and to also adopt emic view of Deafness and family system perspective model.

Modern sjukvård har blivit fragmenterad vilket medför nackdelar för patienter och personal. Teamarbete över professionsgränserna har identifierats som ett sätt att motverka fragmentering och erbjuda god heltäckande vård. Detta har relevans för hörselvården där många patienter behöver insatser från olika professioner. Arbetets syfte var att göra en kartläggning av teamarbete inom svensk offentlig hörselvård samt att undersöka hur teamarbetet ser ut. En totalundersökning har gjorts av Sveriges 21 landsting/regioner. Strukturerade intervjuer har genomförts med personer med kunskap om teamarbete inom varje landsting/region. Resultatet visar att teamarbete förekommer inom samtliga landsting/regioner men att både antalet team och deras arbetssätt varierar. De vanligaste är barnteam och team för hörselnedsättning och ytterligare funktionsnedsättning. De flesta team gör målsättning, planering och utvärdering gemensamt. I två av tre team uppges teammedlemmarna delvis kunna ersätta varandra. Olika professioner förekommer i hörselvårdens team. De som förekommer i störst utsträckning är audionomer, pedagoger och kuratorer. 69 % av teamen har en formell teamledare. Audionomer, läkare, kuratorer respektive chefer är teamledare i ungefär samma utsträckning. Interprofessionella aspekter dominerar men det går inte att kategorisera teamen som multi-, inter- eller tvärprofessionella då deras arbetssätt överlappar. Teamarbete upplevs som väsentligt i den offentliga hörselvården och anses fördelaktigt för både patienter och personal.

Both audiologists and hearing instrument specialists (HIS) can assess hearing loss and fit hearing aids; consumers interested in purchasing hearing aids can choose the type of hearing professional they see. However, there are vast differences in required training and scope of practice for each professional and advanced test batteries, such as those associated with vestibular assessment and tinnitus management, may distinguish the two professional groups more thoroughly than standard hearing testing and hearing aid fitting. This study aimed to determine the knowledge and opinions the average individual possesses regarding differences between these two types of hearing professionals in order to identify areas in which audiologists can more effectively differentiate themselves from hearing instrument specialists. A one-time survey was administered at 3 locations to a total of 47 English-speaking participants over the age of 18. Locations included the 2018 Remote Area Medical event in Gray, TN; the Johnson City Senior Center, and the Bristol Public Library. The survey consisted of 8 demographic questions with 3 additional questions if the participant wore hearing aids, followed by 18 questions that covered “Diagnostics,” “Intervention,” and “Interpersonal Patient Interactions.” Responses were analyzed for trends in overall data as well as in sub-categories for gender, household income, education level, age, and hearing aid use. Overall, participants tended to believe audiologists were most likely to perform tasks in the “Diagnostic” category, while a majority of participants believed both professionals could perform tasks in the “Intervention” category. There was no clear trend within the “Interpersonal Patient Interactions” category. Most participants believed that either both professional groups, or only audiologists, could perform most tasks adequately, indicating subjects likely do understand differences between the two professionals. In analyzing results, two issues emerged. The first was that the majority of participants believed that they would not be likely to pay a reasonable price for hearing aids when visiting either professional. One reason may be that only a few hearing aid companies produce most of the world’s hearing aids, leaving little room for low-cost competition. The “bundled” method which most hearing healthcare providers use for selling hearing aids along with services might also exert an influence on the perception of hearing aid pricing and may not be clear to patients who try to understand the actual cost of devices and services. Another issue identified in this survey was access. A significant number of respondents believed it was difficult to make and attend appointments with either professional, signifying a possible deficit in this area in access to hearing healthcare. The barriers to access included income, availability of transportation, inconvenient provider hours, and lack of insurance coverage. The results suggested that audiologists and HISs face challenges when recommending personal hearing devices to support rehabilitative efforts. Additionally, the provision of services that utilize advanced diagnostic batteries, such as balance assessment and tinnitus services, may offer audiologists an opportunity to distinguish their practices from those managed by HISs.

This study examined the nature of the undergraduate curricula for Auditory Processing Disorders (APD) for communication pathologists (speech-language therapists and audiologists) within the South African context. An exploratory descriptive survey design was utilised. The respondents were the authoritative voices in the area of APD, i.e. academics based at training institutions involved in the training of Speech-Language Therapists and Audiologists in the field of APD. They represented five of the six South African training institutions training speech-language therapists and audiologists. Information on the training programmes offered in APD was obtained with the use of a specifically designed questionnaire. This was further supplemented by copies of the course descriptors and / or study guides supplied by the respondents from the respective training institutions. A curriculum analysis framework was utilised to analyse the curricula (Jansen&Reddy, 1998). The findings of the study indicated that the curricula offered in APD at all training institutions compared well to current research and literature in the field of APD. However, information was not transparent on how the South African social and contextual issues were incorporated into training in APD. The researcher proposed that the curricula currently in use did not require major changes but appropriate amendments are required to be considered. The critical paradigm of inquiry was advocated to be used when training in the area of APD. Additionally, the researcher motivated for and recommended additions to the curricula on APD to address the South African situation as an essential part of the curriculum. The researcher’s principle guideline for amending the curricula was to incorporate these issues into the training based on the adoption of an ecological approach to assessment and remediation of APD. / Dissertation (M(Communication Pathology))--University of Pretoria, 2005. / Speech-Language Pathology and Audiology / unrestricted

Hearing impairment has been hailed a silent epidemic. Early Hearing Detection and Intervention (EHDI) models of service delivery have therefore been proposed for infants in South Africa so that they may be provided with timely, and appropriate audiological, educational and medical intervention. Neonatal hearing screening in South Africa is currently primarily conducted at Primary Health Care (PHC) clinics. The main objective of the study was to determine whether the neonatal hearing screening services provided at PHC clinics in the City of Johannesburg (CoJ) adhere to the guidelines, norms and standards as outlined by the Integrated National Disability Strategy [INDS] (1997), the Health Professions Council of South Africa [HPCSA] Position Statement (2007) on EHDI and the PHC Package (2002). This was achieved through a non-experimental, descriptive, survey research design. Nurses employed at PHC clinics and children who attended the PHC clinics formed the two participant groups. Data was collected via a self-administered questionnaire, a retrospective data compilation form and observations. Descriptive statistical measures were used to describe the information obtained during data collection. Results indicate that nurses employed within the CoJ PHC clinics do not comply with the proposed neonatal hearing screening practices as outlined in the INDS and the PHC Package. Context specific barriers, including limited knowledge, service delivery gaps, and workload inequities have been identified as contributory factors to the variations and inconsistencies of protocol adherence by PHC nurses. Effective referral systems are important to ensure that these children are provided with appropriate services within the critical period for language development. The optimisation of current governmental hearing screening protocols are thus a feasible, temporary measure until such time that EHDI programmes be mandated at a governmental level.

Audiologisk rehabilitering är en komplicerad process som ska innehålla olika insatser byggda på ett holistisk synsätt med medicinska, tekniska och beteendevetenskapliga aspekter involverade. Historiskt har dock den tekniska och medicinska delen ofta fått ta större plats än psykosociala bitar i rehabiliteringen. Syftet med studien var att undersöka likheter och skillnader angående audiologisk rehabilitering utifrån ramverket, ideologin samt praktiken i Danmark, Norge, Sverige och på Island. Metod: För att kunna uppnå syftet och få en mer helhetlig inblick i ämnet delades studien i två delar (litteraturstudie och enkätstudie). Litteraturstudien berörde ramverket i samtliga länder samt ideologin. Enkätstudien berörde praktiken i form av audionomens egen syn på audiologisk rehabilitering samt deras uppfattning av tillvägagångssättet på arbetsplatsen. Resultat: En röd tråd går genom ramverket, ideologin och praktiken i varje land. Vad gäller dessa huvudpunkter visade studien att det fanns både likheter och skillnader länderna emellan. I det stora hela visar resultatet av studien att tankesättet inom audiologisk rehabilitering är något mer holistiskt i Sverige än i de övriga länderna. Slutsats: Trycket om en kostnadseffektiv vård står i kontrast till sjukvårdslagarna då en kortsiktigt planerad hörselvård riskerar att motverka en holistisk audiologisk rehabilitering. / Audiological rehabilitation is a complicated process entailing different aspects from medical, technical and behaviour science forming a holistic treatment. Historically more emphasis has been placed on the technical and medical facets of the treatment compared to the psychosocial. Purpose: The study´s purpose was to inspect similarities and differences regarding audiological rehabilitation by examining the framework, ideology and practice in Denmark, Norway, Sweden and Iceland. Method: To be able to achieve the purpose and to get a holistic insight the study was divided into two parts, namely litterature study and questionnaires. The litterature study reviewed the countries framework and ideology. The questionnaire analyzed the audiologists thoughts on audiological rehabilitation as well as the workplace approach. Results: There is a fine thread within each country that goes through the framework, ideology and practice. Furthermore, the study showed that there are both similarities and differences between the different countries. In general the study proved that the mindset in Sweden is more holistic compared to the other countries. Conclusion: The pressure for cost-effective care is in contrast with health care laws as short-term planned health care can counteract an holistic audiological rehabilitation