Although hearing loss is among the most common chronic conditions in the U.S., many individuals never speak to a healthcare provider about it. Thus, evaluation and rehabilitation services remain underutilized. Even mild hearing loss may result in decreased quality of life, social isolation, and decreased selfsufficiency. The purpose of this study was to assess factors that influence hearing healthcare access and hearing aid acquisition by individuals in Southern Appalachia. The identification of barriers to hearing healthcare access may help audiologists tailor care to this group‘s specific needs. The Hearing Handicap Inventory for Adults (HHIA), a questionnaire assessing self-perceived hearing handicap (a major determinant in help-seeking behaviors in people with hearing loss), was administered along with a researcher-designed survey. The researcher-designed survey was comprised of two forms. Form A asked questions specific to unaided individuals, with half pertaining to individuals with normal hearing, and the other half pertaining to individuals with unaided hearing loss. Form B asked questions specific to hearing aid users. Both forms collected demographic information. Survey participants were recruited from the Remote Area Medical (RAM) clinic held in Bristol, TN on May 1-3, 2015. HHIAs and surveys were obtained from 127 individuals. Two major barriers to hearing healthcare were identified: financial barriers and transportation-related barriers. 62% of respondents reported a household income of $20,000 or less, with an average household size of 2.6 members. Because hearing aids must often be purchased out of pocket, individuals in this income bracket may not be able to afford assistive devices. Some individuals in Southern Appalachia live far from the urban centers where audiologists tend to be located. Although the unaided individuals surveyed indicated they could travel some distance for hearing healthcare services, more than half indicated that they would be unable to travel more than an hour. In contrast, more than half of the aided group indicated that they were required to travel more than an hour for services. Since rural areas often lack public transportation, costs associated with traveling a long distance using personal transportation may present a barrier to hearing healthcare access. These barriers may be at least partially remediated by financial aid programs, telehealth services, and self-help/support group initiatives. The Bristol RAM clinic, in partnership with ETSU‘s audiology department, attempts to overcome these barriers by providing free hearing screenings and low-cost amplification options to individuals with hearing loss living in rural areas.

It is estimated that 10% of the global population is impaired to a significant degree by a decrease in hearing sensitivity. With the greatest proportion of these persons residing in developing countries where communities are grossly underserved, it is incumbent on hearing healthcare professionals to seek means of offering equitable hearing health care services to these communities. The delivery of conventional diagnostic hearing services to these population groups is challenged by limitations in human resources, financial constraints and by the dearth of audiometric testing facilities that are compliant with permissible ambient noise levels for reliable testing. Valid diagnostic hearing assessment without an audiometric test booth will allow greater mobility of services and could extend hearing healthcare service delivery in underserved areas. The purpose of this study was to investigate the validity of diagnostic pure tone audiometry in a natural environment, outside a sound treated room, using a computer-operated audiometer with insert earphones covered by circumaural earcups incorporating real-time monitoring of environmental noise. A within-subject repeated measures research design was employed to assess elderly adults with diagnostic air (250 to 8000 Hz) and bone (250 to 4000 Hz) conduction pure tone audiometry. The study was of a quantitative nature and the required data was collected by testing subjects initially in a natural environment and subsequently in a sound booth environment to compare the threshold measurements. One experienced audiologist used audiometric KUDUwave test equipment to evaluate subjects in both environments. A total of 147 adults with an average age of 76 (± 5.7) years were tested. Ears had pure tone averages (500, 1000, 2000 and 4000 Hz) of ≥ 25 dB in 59%, >40 dB in 23% and ˃ 55 dB in 6% of cases. Analysis of collected data showed air conduction thresholds (n = 2259) corresponding within 0 to 5 dB in 95% of all comparisons between testing in the natural and sound booth environments. Bone conduction thresholds (n = 1669) corresponded within 0 to 5 dB in 86% of comparisons and within 10 dB or less in 97% of cases. Average threshold differences (–0.6 to 1.1) and standard deviations (3.3 to 5.9) were within typical test-retest reliability limits. Recorded thresholds showed no statistically significant differences with a paired samples t-test (p ˃ 0.01) except at 8000 Hz in the left ear. Overall the correlation between the air-conduction thresholds recorded in the sound booth environment and the natural environment was very high (˃ 0.92) across all frequencies while for bone conduction threshold correlation for the two environments fell between 0.63 and 0.97. This study demonstrates that valid diagnostic pure tone audiometry in an elderly population can be performed in a natural environment using an audiometer employing insert earphones covered by circumaural earcups with real-time monitoring of ambient noise levels. Mobile diagnostic audiometry performed outside of an audiometric sound booth may extend current hearing healthcare services to remote underserved communities where booths are scarce or inaccessible. In combination with Telehealth applications this technology could offer a powerful and viable alternate diagnostic service to persons unable to attend conventional testing facilities for whatever reasons. / Dissertation (MCommunication Pathology)--University of Pretoria, 2013. / gm2014 / Speech-Language Pathology and Audiology / Unrestricted