Outside of major metropolitan areas, Arizona has limited options for hearing healthcare. The Arizona Affordable Hearing Aid Task Force proposed the development of a statewide program to provide low-cost hearing aids and audiologic care to low-income residents. The purpose of this review was to determine the status of the literature on the clinical outcomes of teleaudiology services for evaluations and hearing aid fittings which could be used to serve inhabitants of rural counties and address the goals of the Task Force. A literature search was performed to identify articles with original research in teleaudiology in the areas of evaluation and treatment and yielded 234 results. After exclusion criteria were applied, there were 15 articles for review; 10 articles focused on audiological evaluation and 5 articles focused on verification, validation, and counseling for hearing aid fittings. Evaluation-related articles showed that pure-tone air conduction testing was generally within the ± 5 dB acceptable range of variability, with little evidence on bone conduction or speech testing reliability. Studies reporting real-ear measurements with probe microphones were shown to yield similar results in traditional and teleaudiology fitting sessions and validation measures documented similar or better outcomes from teleaudiology fittings. Based on the literature, it is concluded that the use of teleaudiology is feasible for hearing aid fittings and counseling in rural areas, if associated barriers related to costs and limitations related to the availability of technology are overcome.

BACKGROUND: Tinnitus is a symptom that can be very distressing owing to hearing sounds not related to any external sound source. Managing tinnitus is notoriously difficult, and access to evidence-based care is limited. Cognitive behavioral therapy (CBT) is a tinnitus management strategy with the most evidence of effectiveness but is rarely offered to those distressed by tinnitus. The provision of internet-based CBT for tinnitus overcomes accessibility barriers; however, it is not currently readily available in the United States. OBJECTIVE: The aim of this study is to investigate the efficacy of internet-based CBT compared with that of weekly monitoring for the management of tinnitus in reducing tinnitus distress; reducing tinnitus-related comorbidities, including tinnitus cognitions, insomnia, anxiety, and depression; and assessing the stability of the intervention effects 2 months after the intervention. METHODS: A 2-arm randomized clinical trial comparing audiologist-guided internet-based CBT (n=79) to a weekly monitoring group (n=79) with a 2-month follow-up assessed the efficacy of internet-based CBT. Eligible participants included adults seeking help for tinnitus. Recruitment was conducted on the web using an open-access website. Participants were randomized via 1:1 allocation, but blinding was not possible. The study was undertaken by English or Spanish speakers on the web. The primary outcome was a change in tinnitus distress as measured using the Tinnitus Functional Index. Secondary outcome measures included anxiety, depression, insomnia, tinnitus cognition, hearing-related difficulties, and quality of life. RESULTS: Internet-based CBT led to a greater reduction in tinnitus distress (mean 36.57, SD 22) compared with that in weekly monitoring (mean 46.31, SD 20.63; effect size: Cohen d=0.46, 95% CI 0.14-0.77) using an intention-to-treat analysis. For the secondary outcomes, there was a greater reduction in negative tinnitus cognition and insomnia. The results remained stable over the 2-month follow-up period. No important adverse events were observed. Further, 16% (10/158) of participants withdrew, with low overall compliance rates for questionnaire completion of 72.3% (107/148) at T1, 61% (91/148) at T2, and 42% (62/148) at T3. CONCLUSIONS: This study is the first to evaluate and indicate the efficacy of audiologist-delivered internet-based CBT in reducing tinnitus distress in a US population. It was also the first study to offer internet-based CBT in Spanish to accommodate the large Hispanic population in the United States. The results have been encouraging, and further work is indicated in view of making such an intervention applicable to a wider population. Further work is required to improve compliance and attract more Spanish speakers. TRIAL REGISTRATION: ClinicalTrials.gov NCT04004260; https://clinicaltrials.gov/ct2/show/NCT04004260.