Interventional Audiology: Clinical Advancements and New Research

March 20, 2019

A number of new initiatives, research projects, and program updates have occurred in recent years on the audiology front in the Department of Otolaryngology.

Catherine V. Palmer, PhD, director of the UPMC Center for Audiology and Hearing Aids, describes much of the current work as fitting under the theme of interventional audiology (IA), which primarily involves treating hearing loss when it is not the primary concern of the patient, but the untreated hearing loss will negatively impact the health outcome that is of concern.

“This is a new approach and not widely adopted at this time in the field, but there is a growing interest in it as centers like ours have begun to publish data on the impact of interventional audiology. IA takes audiologists out of the clinic to where patients need them. It relies on audiologists overseeing these programs but often using assistants to provide the workforce at this level. It is a model that is showing many benefits,” says Dr. Palmer.

Dr. Palmer is an associate professor in both the Department of Communication Science and Disorders and the Department of Otolaryngology. She serves as the Director of Audiology for the UPMC Health System. Dr. Palmer conducts research in the areas of auditory learning post-hearing aid fitting, the relationship between hearing and cognitive health, and matching technology to individual needs.

She has published more than 90 articles and book chapters on these topic areas, as well as provided more than 100 national and international presentations. Dr. Palmer is the Director of the AuD program at the University of Pittsburgh and teaches the graduate level amplification courses. She serves as Editor-in-Chief of Seminars in Hearing and currently is President-Elect
for the American Academy of Audiology.

Dr. Palmer has been awarded the Editor’s Award for the American Journal of Audiology, the Dean’s Distinguished Teaching Award SHRS, the University of Pittsburgh Provost’s Award for Excellence in Mentoring, and the Pennsylvania Academy of Audiology Award for Outstanding Service.

EAR: Embedded Audiology Resources

This program entails having an embedded audiologist in the Division of Geriatric Medicine outpatient clinic one day per week. Individuals are provided hearing screenings prior to their appointment with the geriatrician.

Individuals who do not pass the screening are offered a noncustom amplifier to use during the appointment so they can more easily communicate with the physician and other health care providers in the clinic.

Dr. Palmer indicates that these individuals are offered a full hearing evaluation and may then pursue customized amplification options.
“Our most interesting finding in this clinic is the large number of individuals who purchase the simple amplifier because it meets their current needs. These data suggest both the need for amplification to be available in physician offices since the majority of individuals with impactful hearing loss do not have personal amplification and the need to offer simple, low-cost devices for patients to purchase,” says Dr. Palmer.

HearCARE: Hearing for Communication Accessibility and Resident Engagement

This program involves having an audiologist in each of 33 UPMC senior living facilities (independent living, assisted living, and skilled nursing and rehabilitation facilities) once per month.

In addition, the program has a “Communication Facilitator” in one of the assisted living facilities who is there to ensure that everyone can communicate day-to-day. This aspect of the program is a new model undergoing testing and evaluation.

The program involves various activities, including caring for hearing aids, using assistive devices (phone devices, TV devices), ensuring common rooms are equipped with listening devices, and other interventions.

“We received funding from the Hearst Foundation to begin and test this program for its first year, and we are now applying for PCORI funding to test these intervention models on a broader scale,” says Dr. Palmer.

In 2017, Dr. Palmer and colleagues published initial findings of their pilot program in the journal Seminars in Hearing, where they outline the key components of this communication assistance program and innovative model for delivering audiology services to a diverse group of older adults in multiple residential living and care settings.

GATE: Geriatric Testing for Everyone

Impaired hearing is related to poor health outcomes, yet only 18 percent of individuals who need amplification use hearing aids. Data collected locally by Dr. Palmer and colleagues indicate that hearing loss is an under-recognized problem in older adults.

The GATE program aims were to develop an incremental cost-effectiveness analysis examining hearing screening techniques assessed against a gold standard hearing evaluation. The settings of the program included a geriatric outpatient clinic and the same senior living facilities (independent living, assisted living, and skilled nursing) as previously mentioned in the HearCARE pilot quality improvement initiative.

“Our data collection phase in the GATE program is complete, with 959 individuals being tested. Analysis is underway to identify the most cost-effective way to identify hearing loss in this population.

The data we have collected in the GATE program also are being used to help support our PCORI proposal to continue and extend the HearCARE pilot. Preliminary data reveal that less than 50 percent of individuals with impactful hearing loss and their health care providers accurately identify hearing loss, which supports the need for effective hearing screening for this population in order to promote a pathway to hearing care.

Audiology and the Head and Neck Survivorship Clinic

With the high incidence of hearing loss and tinnitus affecting patients treated for head and neck cancer, either as a result of surgical procedures or from the side effects of chemotherapy and radiation treatments, managing patients’ hearing health and audiology concerns are important aspects of their overall post-treatment care plan. Dr. Palmer’s Center has an embedded audiologist assigned to work within the HNC Survivorship Clinic for this very purpose.

“Every HNC survivor patient has their hearing screened on the day of their first visit. If they fail the screening, they are provided with a simple amplifier so they can fully participate in their extended appointment in the clinic where they will be seeing and communicating with multiple professionals. The first visit is such an important time for these individuals. We want them to fully understand and hear everything being said, and we also want them to know exactly how vested we are in their overall health. This aspect of our approach has met with a great deal of success and positive feedback since the clinic first started in 2016,” says Dr. Palmer.

Patients who fail the initial hearing screening also are offered a full audio evaluation the same day to help put them onto a pathway to hearing health care at the outset. Dr. Johnson has been interested particularly in the prevalence of hearing loss in these HNC survivors.

“These individuals experience hearing loss and tinnitus at a higher rate than the general population. Physicians treating individuals for head and neck cancer with chemotherapy or radiation should be connecting them as early as possible to audiology, so the patient will know what options exist in managing these side effects. There are data to indicate that the majority of individuals are not referred to audiology. This would be a simple practice change for most ENT physicians given the proximity of audiology services and one that could significantly improve HNC survivors’ quality of life and overall hearing health,” says Dr. Palmer.

These same services are provided in the UPMC Trauma Outpatient clinic, which is another example of a clinic where individuals see a number of health care providers in one day and access to communication through improved hearing is essential to support full participation.

IHEAR and UHEAR

Untreated hearing loss is linked to increased use of health care, increased hospitalization, increased readmission to the hospital, and more than $3.3 billion in excess health care expenditures per year. The audiology group manages the UHEAR (UPMC Hearing Education and Amplification for Recovery) program, which provides simple, noncustom amplifiers to inpatients in any UPMC hospital. The hospital system views this as an accessibility issue and provides these devices at no charge.

IHEAR (Interprofessional Help Encouraging Auditory Rehabilitation) arms our physical therapy, occupational therapy, and speech-language pathology home health colleagues with education and simple amplifiers to use during their home care visits enabling ease of communication with individuals with impactful hearing loss. Care is compromised when the patient must use excessive cognitive resources just to hear the message.

These simple amplifiers allow the patient to fully and easily participate in their ongoing care.
These programs are possible because of the support of Dr. Johnson, Department executive administrator Edward Harrison and his team, and the outstanding audiologists at UPMC.

About The UPMC Center for Audiology and Hearing Aids

The UPMC Center for Audiology and Hearing Aids performs routine and specialized hearing evaluations and provides treatment for permanent hearing loss. Its goal is to provide evidence-based care related to hearing loss and unique communication challenges.

The UPMC Center for Audiology and Hearing Aids offers a variety of hearing assessments and diagnostic testing, and a number of specialized programs, including:
• Tinnitus Treatment Program — for those who suffer from the effects of tinnitus and/or decreased sound tolerance; the program specializes in the use of tinnitus retraining therapy (TRT)
• Musicians’ Hearing Center — a specialized program that cares for the auditory needs of musicians
• Cochlear implants

References and Further Reading

References noted in the article above, and further reading of some of Dr. Palmer’s recent research can be found in the following published papers.

Mady LJ, Sukato DC, Fruit J, Palmer C, Raz Y, Hirsch BE, McCall AA. Hearing Preservation: Does Electrode Choice Matter? Otolaryngol Head Neck Surg. 2017 July 1; 194599817707167. Epub ahead of print.

Palmer CV, Mulla R, Dervin E, Coyan KC. HearCare: Hearing and Communication Assistance for Resident Engagement. Semin Hear. 2017 May; 38(2): 184-197.

Zitelli L, Palmer CV. The Role of Audiology in an Outpatient Interdisciplinary Post Trauma Clinic. Semin Hear. 2017 May; 38(2): 169-176.

Zitelli L, Palmer CV. The Effect of Outpatient Interventional Audiology on Inpatient Audiology Services. Semin Hear. 2017 May; 38 (2): 160-168.

Jorgensen LE, Palmer CV, Pratt S, Erickson KI, Moncrieff D. The Effect of Decreased Audibility on MMSE Performance: A Measure Commonly Used for Diagnosing Dementia. J AM Acad Audiol. 2016 Apr; 27 (4): 311-23.