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Journal articles on the topic 'Audiologi'
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1
Ramachandran, Virginia, James D. Lewis, Mahsa Mosstaghimi-Tehrani, Brad A. Stach, and Kathleen L. Yaremchuk. "Communication Outcomes in Audiologic Reporting." Journal of the American Academy of Audiology 22, no. 04 (April 2011): 231–41. http://dx.doi.org/10.3766/jaaa.22.4.6.
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Background: Audiologists often work collaboratively with other health professionals—particularly otolaryngology providers. Some form of written reporting of audiologic outcomes is typically the vehicle by which communication among providers occurs. Quality patient care is dependent on both accurate interpretation of outcomes and effectiveness of communication between providers. Audiologic reporting protocols tend to vary among clinics and providers, with most methods being based on preference rather than standardized definitions. Purpose: As part of an ongoing quality-improvement program, audiologic communication was reviewed by comparing written audiometric reports to descriptions of the audiometric results dictated by otolaryngology providers to evaluate the agreement of communication between provider groups. Research Design: Retrospective chart review. Study Sample: The study sample consisted of 6000 randomly selected charts from a total of 15,625 for the years 2004 and 2008 in the electronic medical record system of a large academic health-care system. Data Collection and Analysis: Audiogram reports and associated otolaryngology reports were reviewed by an audiologist and two audiology doctoral students. Communication occurred among 37 audiology providers and 39 otolaryngology providers. Data collected included rating of congruence or incongruence between reports, normal versus abnormal audiologic outcomes, and the nature of communication disparities. Data also included provider type (audiologist, audiology doctoral student, or trainee in clinical fellowship year [CFY]; otolaryngologist, otolaryngology resident, physician assistant, or nurse practitioner). Results: Incongruent results were higher among the sample of audiologic evaluations with abnormal outcomes (29.2%) compared with normal outcomes (9.5%). Of those cases rated as incongruent, differences in reporting audiometric results stemmed largely from variance in reporting of numerical values from the audiogram (20%), apparent dictation errors (10.1%), and communication of the ear tested (8.6%). Of those cases in which the interpretations of audiology providers differed from those of otolaryngology providers, incongruent results occurred in the interpretation of degree (29.4%), tympanometric results (28.2%), type of hearing loss (12.8%), acoustic reflex results (4.0%), symmetry (3.3%), and other domains (4.2%). Rates of incongruent results were similar regardless of experience level of the audiology provider (audiologist or audiology doctoral student/CFY) but differed depending on the educational background and experience of the otolaryngology provider. The highest incongruent interpretations were found among residents (32.5%), followed by otolaryngologists (25.2%) and physician assistants and nurse practitioners (21%). Conclusions: This study highlights the need for audiologists to critically evaluate the effectiveness of their communication with other health-care providers and demonstrates the need for evidence-based approaches for interpreting audiologic information and reporting audiologic information to others.
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Muyassaroh and Dwi Marliyawati. "Diagnosis dan Tata Laksana Tinitus Pulsatil." Jurnal Kedokteran Meditek 29, no. 1 (January 14, 2023): 41–44. http://dx.doi.org/10.36452/jkdoktmeditek.v29i1.2320.
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Tinitus pulsatil merupakan kasus yang jarang dijumpai, terjadi akibat adanya gangguan vaskular atau malformasi pembuluh darah. Tinitus pulsatil umumnya terjadi unilateral, terdengar seirama dengan jantung, berdenyut dan mengganggu aktivitas. Tata laksana yang dilakukan adalah mengatasi penyebab tinitus dan manajemen diri untuk mengurangi gejala tinitus. Tujuan laporan kasus ini memaparkan kasus tinitus pulsatil. Kasus pertama, perempuan 51 tahun keluhan utama telinga kanan berdengung disertai nyeri kepala dan hiperlipidemia. Otoskopi dan hasil pemeriksaan audiologi telinga kanan normal. Hasil Transcranial Color-Coded Duplex (TCCD) didapatkan stenosis arteri cerebri. Hasil Digital Substraction Angiography (DSA) didapatkan stenosis di sinus transversosigmoid junction kanan. Hasil MRI tak tampak neurovascular compression. Kasus kedua, perempuan 57 tahun telinga kanan berdengung, bila leher ditekan suara dengung berkurang, otoskopi dan hasil pemeriksaan audiologi dalam batas normal. Hasil TCCD & DSA didapatkan stenosis arteri cerebri. Hasil MRI terdapat singgungan antara anterior inferior cerebellar artery dengan proksimal nervus vestibulocochlearis kanan. Kedua kasus dilakukan konseling, habituasi dengan hasil tinitus menetap, pasien teradaptasi dengan tinitusnya. Telah dilaporkan 2 kasus tinitus pulsatil yang diakibatkan oleh stenosis arteri carotis. Kedua kasus ini dilakukan tata laksana habituasi, konseling. Hasil dari evaluasi adalah tinitus menetap dan teradaptasi.
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Henry, James A., Michael Piskosz, Arnaud Norena, and Philippe Fournier. "Audiologists and Tinnitus." American Journal of Audiology 28, no. 4 (December 16, 2019): 1059–64. http://dx.doi.org/10.1044/2019_aja-19-0070.
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Purpose Although tinnitus is highly prevalent among patients receiving audiology services, audiologists are generally untrained in tinnitus management. Audiology graduate programs, as a rule, do not provide comprehensive instruction in tinnitus clinical care. Training programs that do exist are inconsistent in their recommendations. Furthermore, no standards exist to prevent the delivery of unvetted audiologic services, which can be expensive for patients. Patients seeking professional services by an audiologist, therefore, have no basis upon which to be assured they will receive research-based care. The purpose of this article is to describe the current status of tinnitus management services that exist within the general field of audiology and to suggest specific approaches for improving those services. Conclusion Audiologists may be in the best position to serve as the primary health care providers for patients experiencing tinnitus. Tinnitus care services by audiologists, however, must achieve a level of evidence-based standardization.
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Forli, F., G. Giuntini, L. Bruschini, and S. Berrettini. "Diagnosi eziologica dell’ipoacusia nei bambini identificati attraverso lo screening audiologico neonatale." Acta Otorhinolaryngologica Italica 36, no. 1 (February 2016): 29–37. http://dx.doi.org/10.14639/0392-100x-1076.
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Parallelamente alla attuazione dei programmi di screening audiologico neonatale e di diagnosi audiologica e trattamento precoci, si è resa evidente la necessità di mettere a punto e attuare un protocollo per la diagnosi eziologica della sordità, che sia sistematizzato e che si coordini, senza interferire, con il percorso diagnostico audiologico. Nell’ambito del progetto del Ministero della Salute CCM 2013 “Programma regionale di identificazione, intervento e presa in carico precoci per la prevenzione dei disturbi comunicativi nei bambini con deficit uditivo” è stata presa in considerazione la problematica relativa alla diagnosi eziologica della ipoacusia infantile nell’ambito dei programmi di screening audiologico neonatale. L’obiettivo specifico è quello di attuare il protocollo diagnostico per ottenere una definizione della causa della ipoacusia in almeno il 70% dei casi con diagnosi audiologica confermata. Nell’ambito di questa parte del progetto, sono state individuate quattro principali raccomandazioni utili nella ricerca di una diagnosi eziologica nei bambini affetti da ipoacusia, che possono costituire, per i centri audiologici di III livello, dei validi suggerimenti per ottimizzare le risorse e produrre cambiamenti positivi.
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Miller, Erin L., Anna Marie Jilla, and Michelle L. Arnold. "Defining Audiology through Occupational and Health Policy Action." Seminars in Hearing 43, no. 01 (February 2022): 003–12. http://dx.doi.org/10.1055/s-0042-1743123.
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AbstractMany barriers to accessibility exist for Medicare beneficiaries seeking hearing and balance care such as availability of providers, coverage for services, and ability to pay. Other statutory and administrative barriers exist including the need for physician orders to have audiology services covered, the classification of audiologists as suppliers of “other diagnostic tests” under Medicare payer policy, and non-coverage of certain audiologic management and treatment services. Nearly two decades of legislative efforts have not resulted in any substantial changes to U.S. health policy, while the need for audiology services has increased due to a growing demographic of older adults. The Medicare Audiologist Access and Services Act (MAASA) has been introduced in the 116th and 117th Congress and proposes amendments to the Social Security Act that would address statutory barriers to accessing hearing and balance care among Medicare beneficiaries and would recognize audiologists for their scope of practice within the Medicare program. Objectives of the present review are to provide a summary of statutes in the Social Security Act and Standard Occupational Classification system which affect audiologists, audiology services, and Medicare beneficiaries and to discuss previous and current legislative health policy efforts to address these statutory barriers to hearing and balance care access.
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English, Kris, Susan Naeve-Velguth, Eileen Rall, June Uyehara-Isono, and Andrea Pittman. "Development of an Instrument to Evaluate Audiologic Counseling Skills." Journal of the American Academy of Audiology 18, no. 08 (September 2007): 675–87. http://dx.doi.org/10.3766/jaaa.18.8.5.
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This study describes the development of an instrument designed to evaluate audiologic counseling skills. In simulated counseling sessions, a trained actor portrayed a parent, and ten graduate audiology students role-played counseling sessions as audiologists informing the “parent” that her infant has a hearing loss. The ten sessions were videotaped, and three raters viewed the taped sessions while evaluating counseling skills with a new evaluation tool, the Audiologic Counseling Evaluation (ACE). The ACE was found to have excellent internal reliability (α = .91) and moderate-to-good inter-rater reliability. Raters' subjective evaluations of the tool were generally positive, and students' evaluations of the simulated counseling experience were overwhelmingly so. This instrument can be used by audiology faculty and clinical instructors to help students improve their counseling skills before interacting with parents. It can also be used in clinical settings for professional development by way of self- and peer-evaluation. Este estudio describe el desarrollo de un instrumento designado para la evaluación las destrezas en la consejería audiológica. En sesiones simuladas de consejería, un actor entrenado actuó como un progenitor, y 10 estudiantes graduados de audiología actuaron en dichas sesiones como audiólogos que informaban al "padre" que su niño tenía una pérdida auditiva. Las 10 sesiones fueron filmadas en video, y tres observadores calificaron las sesiones grabadas en tanto que evaluaban las destrezas de consejería con una nueva herramienta de evaluación, la Evaluación de Consejería Audiológica (ACE). Se encontró que la ACE tenía una excelente confiabilidad interna (α = .91) y una confiabilidad moderada a buena entre los evaluadores. Las evaluaciones subjetivas de la herramienta por parte de los jueces fueron positivas, y también las evaluaciones de los estudiantes simulando la experiencia de consejería. Este instrumento puede ser utilizado por profesores de audiología y por instructores clínicos para ayudar a los estudiantes a mejorar sus destrezas de consejería antes de interactuar con los padres. Puede utilizarse en situaciones clínicas para desarrollo profesional por medio de auto-evaluaciones y evaluaciones entre estudiantes.
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Jilla, Anna Marie, Michelle L. Arnold, and Erin L. Miller. "U.S. Policy Considerations for Telehealth Provision in Audiology." Seminars in Hearing 42, no. 02 (May 2021): 165–74. http://dx.doi.org/10.1055/s-0041-1731697.
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AbstractThe demand for telehealth services will continue to grow alongside an increased need for audiology services among both children and adults. Insurance coverage policies for audiologic services are specific to each payer and vary widely in the level of coverage provided for both in-person and telehealth-based audiology services. While benefits for children are fairly comprehensive, coverage for audiology services for adults is generally poor. Traditional Medicare does not cover hearing aids or other rehabilitative audiologic services, and other payer policies vary widely. Lack of benefits for hearing and balance services is inconsistent with the evidence base and leaves many beneficiaries without access to meaningful care for hearing and balance disorders, which are highly prevalent among and disproportionately affect Medicare beneficiaries. The purpose of this article is to discuss regulatory and reimbursement considerations for telehealth provision in audiology and elucidate opportunities to influence related health policy at both state and federal levels.
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Jin, In-Ki, and Soo Hee Oh. "Comparison of Domestic and Foreign Audiologist Education Status and Qualification System." Audiology and Speech Research 17, no. 3 (July 31, 2021): 255–68. http://dx.doi.org/10.21848/asr.210028.
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Audiologists are experts in providing specialized treatment for evaluating and managing hearing loss through hearing technology. The purpose of this study is to review the education status of major foreign countries regarding the training of audiologists, their certification management systems, and the audiology education regulations according to international standards; this study compares these with the domestic (i.e., Republic of Korea) education status, certification management system, and audiology education regulations. The regulations, reports, and official documents related to domestic and overseas regarding audiology systems were reviewed and compared. The domestic audiologist education and qualification system is in fair conformity with foreign countries and international standards, but there are areas that need to be improved. If the domestic audiologist qualification system is improved to comply with advanced foreign national audiologist qualification systems and international standards, it will be possible to cultivate a more professional domestic audiologist workforce.
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Chang, Kay W., and Nina Chinosornvatana. "Practical Grading System for Evaluating Cisplatin Ototoxicity in Children." Journal of Clinical Oncology 28, no. 10 (April 1, 2010): 1788–95. http://dx.doi.org/10.1200/jco.2009.24.4228.
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Purpose We present a new ototoxicity grading system that has clearly defined and frequency-specific audiometric criteria. The purpose of this study was to validate this grading system by assessing its correspondence to audiology treatment recommendations and comparing it with the currently utilized Common Terminology Criteria for Adverse Events (CTCAE). Patients and Methods A retrospective chart review was conducted using audiologic, demographic, and clinical data from 134 children receiving 149 courses of chemotherapy consisting of cisplatin and/or carboplatin. Pure-tone audiograms were evaluated using both our proposed grading criteria and the CTCAE criteria. The resulting grades were then compared with charted audiologic interventions and a number of clinical parameters to assess the clinical validity of the grading scale. Results Chang grade 2a or higher predicted audiologic intervention. Although both the Chang and CTCAE ototoxicity grades were significantly related to audiologist recommendations for assistive devices such as hearing aids and/or frequency modulated systems (P < .0001), the Chang scale was more specific, with the CTCAE scale diverging from clinical recommendation at higher grades. As expected, patients receiving cisplatin had more severe hearing loss with concurrent carboplatin administration, radiation therapy exposure, younger age, smaller body-surface area, longer treatment exposure, and more severe disease. Conclusion This grading system provides robust and clinically useful criteria to represent clinical hearing loss induced by ototoxicity with regard to the impact on speech and language and the need for assistive hearing devices. It is both more specific and more sensitive than the traditional CTCAE criteria for identifying clinically significant ototoxicity.
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Olsen, Wayne O., Darrelle E. Rose, and LeRoy D. Hedgecock. "A Brief History of Audiology at Mayo Clinic." Journal of the American Academy of Audiology 14, no. 04 (April 2003): 173–80. http://dx.doi.org/10.1055/s-0040-1715724.
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Audiometric hearing tests were conducted at the Mayo Clinic in Rochester at the beginning of the 1930s. The list price for one of its audiometers at that time was $3,500, which translates into approximately $37,000 in 2003 currency. Physicians and residents in training were responsible for conducting hearing tests in the 1930s and 1940s. In the early 1940s a registered nurse was trained as an audiometrist to assist for some of the audiometric testing. The first "consulting audiologist" at the Mayo Clinic in Rochester was hired in 1949, early in the development of audiology as a profession. Growth in demand for audiologic services for larger numbers of patients and in the variety of services provided to them led to marked increases in personnel, space, and specialization over the years. En la Clínica Mayo en Rochester, se Ilevaron a cabo estudios auditivos desde el inicio de la década de los treintas. El precio de lista, en ese momento, de uno de sus audiómetros fue de $ 3.500, que corresponde en el año 2003 a cerca de $37.000. Los médicos y los residentes en entrenamiento eran responsables de conducir estas pruebas auditivas en los treintas y cuarentas. A inicios de la década de los cuarentas se entrenó una enfermera graduada como audiometrista, para que ayudara en la elaboración de estas evaluaciones audiométricas. El primer "audiólogo consultor" en la Clinica Mayo de Rochester fue contratado en 1949, en etapas tempranas del desarrollo de la audiología como profesión. Un incremento en la demanda de servicios audiológicos para un número mayor de pacientes y un incremento en la variedad de servicios ofrecidos a ellos, Ilevó con los años a un marcado aumento en el personal, en el espacio de trabajo y en la especialización.
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Lenich, Jennifer Komnick, Mark E. Bernstein, and Amanda Nevitt. "Educational Audiology." Language, Speech, and Hearing Services in Schools 18, no. 4 (October 1987): 344–56. http://dx.doi.org/10.1044/0161-1461.1804.344.
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The increase in the numbers of hearing-impaired students served in public schools in recent years has led to concern over the availability and quality of audiological services in that setting. Within the field of audiology, the specialty practice of Educational Audiology has begun to be recognized as one way to insure that students receive services from qualified individuals, but training in educational audiology is not yet widely available. This paper reviews the public schools' audiologic service needs, presents a plan for in-service education in this specialty, and proposes the establishment of a new accreditation in Educational Audiology.
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Saunders, Gabrielle H., and Theresa H. Chisolm. "Connected Audiological Rehabilitation: 21st Century Innovations." Journal of the American Academy of Audiology 26, no. 09 (October 2015): 768–76. http://dx.doi.org/10.3766/jaaa.14062.
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Background: Tele-audiology provides a means to offer audiologic rehabilitation (AR) in a cost-, resource-, and time-effective manner. If designed appropriately, it also has the capability of personalizing rehabilitation to the user in terms of content, depth of detail, etc., thus permitting selection of the best content for a particular individual. Synchronous/real-time data collection, store and forward telehealth, remote monitoring and mobile health using smartphone applications have each been applied to components of audiologic rehabilitation intervention (sensory management, instruction in the use of technology and control of the listening environment, perceptual and communication strategies training, and counseling). In this article, the current state of tele-audiological rehabilitation interventions are described and discussed. Results: The provision of AR via tele-audiology potentially provides a cost-effective mechanism for addressing barriers to the routine provision of AR beyond provisions of hearing technology. Furthermore, if designed appropriately, it has the capability of personalizing rehabilitation to the user in terms of content, depth of detail, etc., thus permitting selection of the best content for a particular individual. However, effective widespread implementation of tele-audiology will be dependent on good education of patients and clinician alike, and researchers must continue to examine the effectiveness of these new approaches to AR in order to ensure clinicians provide effective evidence-based rehabilitation to their patients. Conclusions: While several barriers to the widespread use of tele-audiology for audiologic rehabilitation currently exist, it is concluded that through education of patients and clinicians alike, it will gain greater support from practitioners and patients over time and will become successfully and widely implemented.
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Messersmith, Jessica J., and Lindsey Jorgensen. "The Impact of the Affordable Care Act on Insurance Coverage of Hearing Healthcare." Perspectives on Public Health Issues Related to Hearing and Balance 15, no. 1 (November 2014): 19–26. http://dx.doi.org/10.1044/phi15.1.19.
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Implementation of the Affordable Care Act (ACA) impacts the profession of audiology beyond individual audiology practice patterns in the clinic. The legislation and further required implementation of the ACA may dictate coverage of audiologic services and devices now and into the future. Audiologic (re)habilitative services and devices have not historically been covered and are unlikely included in benchmark plans. Under the current language of the ACA, states without mandated coverage of hearing healthcare prior to 2011 will face significant challenges in creating mandates. Arguments for including audiologic services and devices as an Essential Health Benefit (EHB) include quality care, improved patient outcomes, and improved consistency in coverage patterns across the United States. Due to the limited definition of EHB from the Department of Health and Human Services (HHS) and loopholes in plans required to follow ACA guidelines, it is very possible that the inconsistencies across plans and states may increase and that financial repercussions at the state level may hinder passage of state-level mandated coverage of hearing healthcare.
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Grunblatt, Henna, and Lisa Daar. "A Support Program." Language, Speech, and Hearing Services in Schools 25, no. 2 (April 1994): 112–14. http://dx.doi.org/10.1044/0161-1461.2502.112.
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A program for providing information to children who are deaf about their deafness and addressing common concerns about deafness is detailed. Developed by a school audiologist and the school counselor, this two-part program is geared for children from 3 years to 15 years of age. The first part is an educational audiology program consisting of varied informational classes conducted by the audiologist. Five topics are addressed in this part of the program, including basic audiology, hearing aids, FM systems, audiograms, and student concerns. The second part of the program consists of individualized counseling. This involves both one-to-one counseling sessions between a student and the school counselor, as well as conjoint sessions conducted—with the student’s permission—by both the audiologist and the school counselor.
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Meibos, Alex, Karen Muñoz, and Michael Twohig. "Counseling Competencies in Audiology: A Modified Delphi Study." American Journal of Audiology 28, no. 2 (June 10, 2019): 285–99. http://dx.doi.org/10.1044/2018_aja-18-0141.
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Purpose Counseling practices in audiology play a critical role in helping patients and families understand, accept, and adjust to the dynamic impacts ear-related disorders have on their lives. The purpose of this study was to identify what competencies (i.e., knowledge, skills, and attitudes) are important for audiologists to possess to provide effective counseling in practice. Method A modified Delphi study design was used to survey a panel of 33 professionals with expertise in audiologic counseling from 5 different countries. In the 1st survey round, experts were asked to respond to 3 open-ended prompts. Responses were condensed and revised into items experts were asked to rate during the 2nd and 3rd survey rounds, on a 6-point Likert scale of importance. Results A total of 819 items were generated from the open-ended prompts. A total of 72 items were included in the 2nd and 3rd rounds of survey instruments. Consensus was met on 64 audiologic counseling competency items. Conclusions The competency items identified in this study reflect important knowledge, skills, and attitudes that are important to audiologic counseling. Items that met consensus in this study can inform competencies audiology students can acquire during graduate training. Practice guidelines in the field currently lack the necessary clarity and detail needed for implementation of counseling competencies in clinical education. Future research is needed to explore factors important for implementation of evidence-based counseling training in graduate audiology programs.
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Milyantono, Riyan Charlie, and Titiek H. Ahadiah. "Laporan Kasus: Otitis Media Tuberkulosis dengan Kolesteatoma pada Anak." Jurnal Ilmiah Kedokteran Wijaya Kusuma 8, no. 1 (April 17, 2019): 70. http://dx.doi.org/10.30742/jikw.v8i1.550.
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Otitis media tuberkulosis adalah peradangan kronik mukosa telinga tengah yang disebabkan oleh mycobacterium tuberculosis. Gejala klasik otitis media tuberkulosis adalah perforasi multipel membrane timpani, otore tanpa nyeri dan jaringan granulasi yang banyak. Diagnosis pasti berdasarkan ditemukan BTA dari sekret telinga atau aspirasi telinga tengah dengan atau tanpa kultur mycobacterium tuberculosis serta pemeriksaan histopatologi jaringan granulasi. Tujuan penulisan ini untuk melaporkan satu kasus jarang, yaitu Otitis media tuberculosis dengan kolesteatoma. Kasus: Anak perempuan usia 4 tahun dengan keluhan utama bengkak di depan dan belakang telinga kiri sejak 20 hari sebelum datang ke rumah sakit. Dilakukan insisi drainase abses, urgent canal wall down mastoidectomy sinistra dan kraniotomi untuk evakuasi abses. Metode penulisan dengan pencarian literatur melalui PubMed didapatkan 3 literatur yang dianalisis. Dari laporan kasus yang didapatkan, diagnosis otitis media tuberculosis dilakukan dengan pemeriksaan otoskopi, audiologi, mikrobiologi dan histopatologi, foto polos dada, CT scan tulang temporal. Kesimpulannya adalah otitis media tuberculosis merupakan kasus yang jarang dan sulit untuk dilakukan diagnose tepat. Sehingga memerlukan tingkat kewaspadaan tinggi pada gejala-gejala klinis otitis media yang disertai dengan komplikasi.
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Zapala, David A., Greta C. Stamper, Janet S. Shelfer, David A. Walker, Selmin Karatayli-Ozgursoy, Ozan B. Ozgursoy, and David B. Hawkins. "Safety of Audiology Direct Access for Medicare Patients Complaining of Impaired Hearing." Journal of the American Academy of Audiology 21, no. 06 (June 2010): 365–79. http://dx.doi.org/10.3766/jaaa.21.6.2.
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Background: Allowing Medicare beneficiaries to self-refer to audiologists for evaluation of hearing loss has been advocated as a cost-effective service delivery model. Resistance to audiology direct access is based, in part, on the concern that audiologists might miss significant otologic conditions. Purpose: To evaluate the relative safety of audiology direct access by comparing the treatment plans of audiologists and otolaryngologists in a large group of Medicare-eligible patients seeking hearing evaluation. Research Design: Retrospective chart review study comparing assessment and treatment plans developed by audiologists and otolaryngologists. Study Sample: 1550 records comprising all Medicare eligible patients referred to the Audiology Section of the Mayo Clinic Florida in 2007 with a primary complaint of hearing impairment. Data Collection and Analysis: Assessment and treatment plans were compiled from the electronic medical record and placed in a secured database. Records of patients seen jointly by audiology and otolaryngology practitioners (Group 1: 352 cases) were reviewed by four blinded reviewers, two otolaryngologists and two audiologists, who judged whether the audiologist treatment plan, if followed, would have missed conditions identified and addressed in the otolaryngologist's treatment plan. Records of patients seen by audiology but not otolaryngology (Group 2: 1198 cases) were evaluated by a neurotologist who judged whether the patient should have seen an otolaryngologist based on the audiologist's documentation and test results. Additionally, the audiologist and reviewing neurotologist judgments about hearing asymmetry were compared to two mathematical measures of hearing asymmetry (Charing Cross and AAO-HNS [American Academy of Otolaryngology—Head and Neck Surgery] calculations). Results: In the analysis of Group 1 records, the jury of four judges found no audiology discrepant treatment plans in over 95% of cases. In no case where a judge identified a discrepancy in treatment plans did the audiologist plan risk missing conditions associated with significant mortality or morbidity that were subsequently identified by the otolaryngologist.In the analysis of Group 2 records, the neurotologist judged that audiology services alone were all that was required in 78% of cases. An additional 9% of cases were referred for subsequent medical evaluation. The majority of remaining patients had hearing asymmetries. Some were evaluated by otolaryngology for hearing asymmetry in the past with no interval changes, and others were consistent with noise exposure history. In 0.33% of cases, unexplained hearing asymmetry was potentially missed by the audiologist. Audiologists and the neurotologist demonstrated comparable accuracy in identifying Charing Cross and AAO-HNS pure-tone asymmetries. Conclusions: Of study patients evaluated for hearing problems in the one-year period of this study, the majority (95%) ultimately required audiological services, and in most of these cases, audiological services were the only hearing health-care services that were needed. Audiologist treatment plans did not differ substantially from otolaryngologist plans for the same condition; there was no convincing evidence that audiologists missed significant symptoms of otologic disease; and there was strong evidence that audiologists referred to otolaryngology when appropriate. These findings are consistent with the premise that audiology direct access would not pose a safety risk to Medicare beneficiaries complaining of hearing impairment.
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Smiley, Donna F. "Listen Up, Class." ASHA Leader 18, no. 5 (May 2013): 16–17. http://dx.doi.org/10.1044/leader.ov.18052013.16.
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Chan, Kenny H., Phyllis Carosone-Link, Mary Thatcher G. Bautista, Diozele Sanvictores, Kristin Uhler, Veronica Tallo, Marilla G. Lucero, Joanne De Jesus, and Eric A. F. Simões. "Population-based otoscopic and audiometric assessment of a birth cohort recruited for a pneumococcal vaccine trial 15–18 years earlier: a protocol." BMJ Open 11, no. 2 (February 2021): e042363. http://dx.doi.org/10.1136/bmjopen-2020-042363.
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IntroductionA cohort of 12 000 children in the Philippines who had enrolled in a 2000–2004 (current ages 16 to 20 years) Phase 3 11-valent pneumococcal conjugate vaccine for the prevention of radiographically confirmed pneumonia are now being asked to participate in a separate study (expected completion date September 2021) to assess the cohort’s current long-term audiometric and otologic status. This new study would allow assessments of the utility of the pneumococcal vaccine in conferring its protective effects on the long-term sequelae of otitis media (OM), if any. Lack of trained local healthcare providers in otolaryngology/audiology and testing equipment in Bohol, Philippines, necessitates the development of a distinct methodology that would lead to meaningful data analysis.Methods and analysisReliable data collection and transfer are achieved by a US otolaryngologist/audiologist team training local nurses on all procedures in a didactic and hands-on process. An assortment of portable otolaryngologic and audiologic equipment suitable for field testing has been acquired, including an operating otoscope (Welch-Allyn), a video-otoscope (JedMed), a tympanometer with distortion product otoacoustic emission measurements (Path Sentiero) and a screening audiometer (HearScreen). Data will then be uploaded to a Research Electronic Data Capture database in the USA.Tympanometric and audiologic data will be codified through separate conventional algorithms. A team of paediatric otolaryngology advanced practice providers (APPs) have been trained and validated in interpreting video otoscopy. The protocol for classification of diagnostic outcome variables based on video otoscopy and tympanometry has been developed and is being used by APPs to evaluate all otoscopy data.Ethics and disseminationThe study was approved by the Research Institute of Tropical Medicine, Alabang, Manila, Philippines, and the institutional review board and the Colorado Multiple Institutional Review Board of the University of Colorado School of Medicine, Aurora, Colorado, USA.Research results will be made available to children and their caregivers with abnormal audiologic outcomes, the funders and other researchers.Trial registration numberISRCTN 62323832; Post-results.
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Torre, Peter, and Kelly M. Reavis. "Fundamentals of Epidemiology for the Audiologist." Perspectives of the ASHA Special Interest Groups 6, no. 5 (October 20, 2021): 1113–22. http://dx.doi.org/10.1044/2021_persp-20-00241.
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Purpose Epidemiology is the study of the distribution and determinants of disease and other health-related events in populations. An understanding of epidemiology among audiologists is important for ear and hearing health care practice. This tutorial presents an overview of the fundamental concepts of epidemiology for the practicing audiologist and audiology students. Method The authors provide an overview of epidemiology and focus on its applicability to audiology. The most common epidemiologic study designs, measures of occurrence, and measures of association are highlighted and discussed. Concepts related to p values, confidence intervals, confounding, and bias are introduced. Finally, the authors discuss screening as a means to control adverse hearing health outcomes. Conclusions Epidemiologic approaches are of value to the audiologist involved in the evidence-based decision processes of planning, monitoring, and treating individuals with ear and hearing problems. For audiologists to make practice recommendations based on epidemiologic data, they need insight into epidemiologic study design and interpretation of data from these studies. Understanding the fundamentals of epidemiology and applying epidemiologic principles to the clinical practice of audiology can increase the quality of care individuals receive.
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Skinner, Kimberly, Barbara Maxwell, Amanda Baskerville, and Jovan Milanović. "Audiology, an Important Contributor to Interprofessional Holistic Care: An Interprofessional Collaborative Case Example." American Journal of Audiology 31, no. 1 (March 3, 2022): 204–10. http://dx.doi.org/10.1044/2021_aja-21-00118.
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Purpose: Interprofessional collaboration improves health outcomes, enhances health care satisfaction, and facilitates more effective use of resources. Interprofessional collaborators increasingly understand and value other professions. A.T. Still University provides students from multiple programs with opportunities to develop interprofessional collaboration skills. This research note presents details of one such interprofessional education (IPE) opportunity, a collaborative case. Audiology was part of this case in two ways: Audiologic details of the simulated patient were provided to all students, and audiology students participated in the experience. The results of this involvement are reported. This research note is primarily descriptive in nature; however, the question of whether students viewed their interprofessional competencies as improving following the IPE experience was explored using a validated self-report tool, the Interprofessional Collaborative Competency Attainment Survey (ICCAS). Method: A total of 23 students completed the ICCAS. Additionally, student case presentations were reviewed and audiology-based recommendations were tallied. Results: Highly significant differences ( p ≤ .01) for all 20 items on the ICCAS were observed for differences in self-assessed interprofessional skills knowledge. All but one of the 12 teams made specific recommendations regarding the communication needs of the patient. Conclusions: Students viewed their own competencies related to interprofessional collaboration as improved following the collaborative case experience. Overall, the collaborative case experience was effective in providing students with the opportunity to develop a breadth of skills needed for interprofessional collaboration. Providing audiologic information in the case history prompted all but one team to consider patient communication needs.
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Santos-Cortez, Regie Lyn P., Charlotte M. Chiong, Ma Luz San Agustin, Charina Melinda C. Elgar, Genilou Liv M. Gimena, Scheherazade C. Ibrahim, Rodante A. Roldan, Ma Rina T. Reyes-Quintos, Abner L. Chan, and Generoso T. Abes. "The Philippine National Ear Institute: Patient and Audiologic Profiles." Philippine Journal of Otolaryngology-Head and Neck Surgery 22, no. 1-2 (November 28, 2007): 12–18. http://dx.doi.org/10.32412/pjohns.v22i1-2.789.
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Background: The Philippine National Ear Institute (PNEI) was created to promote health of hearing and balance among Filipinos. Over the years it, has provided audiologic services to thousands of patients annually and has published relevant hearing and balance research.
Objective: To describe the patients served by the PNEI in terms of age, region of origin, occupation, pretest diagnosis, and audiologic results.
Methods:
Study Design: Cross-sectional study
Setting: National tertiary care center
Population: All records of patients referred for audiologic testing at PNEI in 2006 were reviewed and encoded into analyzable format.
Results: A total of 1,756 patients had audiologic records for review. Median age was 32.5 years, with the age distribution presented according to sex, type of tests done including common reasons for referral, and median threshold levels by frequency. Coverage was national in scope, with most patients coming from the National Capital Region and from Regions III and IVa. Occupation was indicated in 37.8% of the working age group, most of whom were unemployed. The most common pretest diagnosis was chronic otitis media (26.6%), followed by hearing loss of unknown etiology (13.0%) and tinnitus (9.3%). Severity of hearing impairment based on pure tone audiometry was variable, and was presented according to common diagnoses. About 39% of hearing impairment cases were sensorineural, 36% conductive and 25% due to mixed defect. Bilateral Type A ears were found in 45.4% of patients by tympanometry, while 29.3% were bilateral Type B. For otoacoustic emissions, 69.0% were labeled as “refer” in at least one ear.
Conclusion: The PNEI is a major national referral center for audiology that holds much promise in developing programs for national surveillance of the hearing status of different sectors in Philippine society.
Keywords: Philippine National Ear Institute, Philippines, patient profile, audiology, audiometry, tympanometry, otoacoustic emissions, chronic otitis media
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Stepkin, Richard L. "A Little Occupational Audiology for the Clinical Audiologist." ASHA Leader 10, no. 8 (June 2005): 4–11. http://dx.doi.org/10.1044/leader.ftr1.10082005.4.
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Benson, Emily A., and Jessica J. Messersmith. "Audiologic Assessment." Seminars in Hearing 43, no. 02 (May 2022): 058–65. http://dx.doi.org/10.1055/s-0042-1749176.
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AbstractPrior to the fitting of hearing aids, clinicians and patients must discuss the best treatment options for the physical and audiologic needs of the patients. To be able to confidently make these decisions, the clinician should complete a medical and audiological case history. Additionally, clinicians need accurate results from a comprehensive audiologic evaluation. The evaluation should include the following: pure-tone testing, word recognition testing, speech-in-noise testing, and loudness discomfort level measures. This article will outline the process and procedures for acquiring this information in line with the Audiology Practice Standards Organization (APSO) Guidelines for Adult Hearing Aid Fittings Standards 1 and 4. This article will also discuss how results can affect decision-making during the hearing aid selection and fitting process.
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Wilson, Jaime A. B., and Samuel R. Atcherson. "Audism and Its Implications for Audiology." Perspectives of the ASHA Special Interest Groups 2, no. 8 (January 2017): 18–28. http://dx.doi.org/10.1044/persp2.sig8.18.
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Purpose Two healthcare providers with hearing loss, one neuropsychologist, and one audiologist, explore the concept of audism and its implications within the field of audiology. Method Literature review and frank contemplation. Results The present investigation found no peer-reviewed literature on the topic of audism within the audiology discipline. Awareness of audism and its manifestations have implications for helping audiologists and other hearing healthcare professionals to improve patient satisfaction and treatment compliance. Conclusions Audism is the notion that one is superior based on one's ability to hear or to behave in the manner of one who hears. Strong consideration should be given to including language and cultural studies of the Deaf community within audiology graduate training curriculums. Suggestions for overcoming audism—whether intentional or unintentional—are provided along with research recommendations.
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Barajas del Prat, José Juan. "Auditio; Revista Electrónica de Audiología." Auditio 1, no. 1 (September 15, 2021): 1–2. http://dx.doi.org/10.51445/sja.auditio.vol1.2001.003.
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Las revistas científicas han sido el vehículo de comunicación de la ciencia desde el siglo XVII. Han servido para organizar el conocimiento en áreas de interés común y para el establecimiento de un nivel en la calidad de las publicaciones. Sin embargo y al mismo tiempo han segmentado la investigación en multitud de revistas y encarecido el acceso a las mismas. Por ejemplo, un tema de estudio como la esclerosis múltiple, puede encontrarse referenciada en más de 50 revistas distintas. Esto, para el profesional, significa una inversión en tiempo y coste en la adquisición de los artículos muchas veces desalentadoras. Las suscripciones han subido un 207% durante el período comprendido entre los años 1986 y 1999. Así mismo en ese mismo período ha habido un incremento del número de revista del 55%. Esto ha llevado a las editoriales a una inflación en los precios no justificada en la mayoría de los casos. Así, por ejemplo, la suscripción anual en Brain Research cuesta aproximadamente $15000. El desarrollo de las revistas en formato electrónico ha sido vertiginoso. Las ventajas son obvias, la reducción de los costes de producción y de distribución, la posibilidad de interaccionar entre el lector y el autor, la amplia gama de presentación y diseño que permiten rapidez para difundir la información científica. La mayoría de las publicaciones científicas tradicionales ofrecen hoy en la red su versión electrónica. Algunas incluso han llegado a desaparecer en su formato tradicional y hoy solo están disponibles electrónicamente. No cabe duda que estamos asistiendo a una revolución en la publicación científica en la que los próximos 5 años serán decisivos. En Europa existen en lengua inglesa cinco revistas dedicadas a la audiología: Audiology, Neuro Otology and Audiology, British Audiology, Journal of Audiological Medicine y Scandinavian Audiology. Las personas responsables de estas revistas se dan cuentan que mantener un alto nivel académico a la vez que reducir los costes exige plantearse la posibilidad de fusionar las publicaciones. En estos últimos meses nos consta que ha habido intentos por Scandinavian Audiology, Audiology y British Audiology de tratar de formar una sola publicación. En español, las revistas de audiología son escasas y de aparición irregular. En general los artículos son de bajo nivel académico reflejando la poca tradición que tienen este disciplina como tal en el ámbito de nuestra comunidad hispano parlante. El portal que nosotros presentamos contiene, como no podía ser de otro manera, una parte fundamental dedicada a una revista electrónica en lengua española. Bajo esta perspectiva nace Auditio, publicación dedicada a la Audiología en formato electrónico. Nuestra revista asume un papel internacionalmente importante toda vez que trata con una disciplina extraordinariamente amplia y compleja. A decir verdad, la Audiología podría seguir muy bien la definición cervantina de la caballería andante: “ una ciencia que encierra en sí todas o las más ciencias del mundo”. Efectivamente, el audiólogo debe saber anatomía para reconocer las distintas estructuras que constituyen el sistema auditivo, ha de ser fisiólogo porqué debe estar familiarizado con los mecanismos íntimos de la audición. Debe tener conocimientos de física, especialmente de acústica porqué tiene que entender los estímulos desencadenantes de la audición. Debe ser psicólogo para ayudar a sus pacientes en su rehabilitación. Tiene que conocer los distintos métodos de diagnóstico pues debe establecer la naturaleza de las distintas disfunciones audiológicas... en suma, juzguen usted “ sí es ciencia mocosa lo que aprende el audiólogo que la estudia y profesa”. Nuestro propósito es que esta revista electrónica consiga los objetivos que las revistas impresas sobre audiología escritas en español no han podido conseguir hasta el momento: (1) distribución universal (2) bajos costes (3) aparición regular y (4) nivel científico aceptable. Que duda cabe que para que estos objetivos se puedan conseguir necesitamos la colaboración de todos. Sobre todo que perdamos la suspicacia y enviemos nuestras contribuciones más relevantes a estas revistas que ahora surgen en nuestra red. Que se sometan con gusto a los revisores internacionales del consejo editorial y sobre todo que se sientan reconocidos científicamente en nuestra revista. En nombre propio y del comité editorial le agradecemos su colaboración y le damos la más calurosa bienvenida a la Revista electrónica de Audiología: Auditio.
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Antonites, Alex, and Annemarie Ross. "Audiology, Entrepreneurship and Innovation: A perspective on private practice." Southern African Journal of Entrepreneurship and Small Business Management 6, no. 1 (December 31, 2013): 87. http://dx.doi.org/10.4102/sajesbm.v6i1.35.
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<p><strong>Objective:</strong> This paper investigates the correlation and contact points between entrepreneurship as a discipline and the profession of audiology. The research focuses on specific areas of entrepreneurship (e.g. innovation as an entrepreneurial skill) and the impact it has on audiology private practices as key role players in the biotechnology industry.</p><p><strong>Design:</strong> This study used a two-stage research design comprising of an exploratory study and a formal study to survey the entrepreneurial and business skills of audiologists as entrepreneurs in private practice.</p><p><strong>Findings:</strong> The findings describe severe deficiencies - specifically the business and entrepreneurial skill sets of the professional audiologist as an entrepreneur. The mind-set of the audiologist is not that of an entrepreneur, but rather of a small business owner. A lack of self-confidence to be creative, take risks, and identify new opportunities or innovate in terms of products, process and services was found. Audiologists are not necessarily concerned about the creation of employment, or the growth and profitability of their practices. Autonomy and security are the primary objectives of most practice owners.</p><p><strong>Keywords: </strong>Innovation, Entrepreneurs, Women Entrepreneurs, Entrepreneurship, Audiology, Biotechnology</p>
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Coco, Laura, Craig A. Champlin, and Robert H. Eikelboom. "Community-Based Intervention Determines Tele-Audiology Site Candidacy." American Journal of Audiology 25, no. 3S (October 2016): 264–67. http://dx.doi.org/10.1044/2016_aja-16-0002.
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Purpose Sections of the community face barriers to accessing audiology services. The aim of this study was to assess the barriers faced by people in typically underserved community settings and to provide audiology services in their natural environment. Information gathered by questionnaire was used to determine each site's candidacy as a potential tele-audiology site. Method Sixty-three participants were recruited across 3 community sites that were identified as gathering places for individuals who experience barriers to accessing traditional clinical audiology services. Information about demographics and participant experience with barriers to access was gathered by a locally generated, self-administered questionnaire. Pure-tone air-conduction audiometric exams were performed on participants with an automated portable diagnostic audiometer. Afterward, the investigator provided counseling regarding hearing loss rehabilitation or hearing protection. Referrals were made when appropriate. Results Pure-tone averages were similar within sites but varied across sites. At least 30% of individuals at each site reported they wanted to visit the audiologist more often. Each site reported different principal barriers to access, among them transportation, motivation, and money. Eleven individuals were referred to the next level of care. Questionnaire results revealed special accommodations should be considered at each potential tele-audiology site. Conclusion The present study provided audiology services to individuals in their natural environment, identified many of the obstacles preventing individuals from pursuing traditional audiology services and provided information for the foundation of a tele-audiology practice.
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Pupo, Daniel, Hillary Rouse, Lindsay Peterson, and Kathryn Hyer. "Availability of Audiology Services in Assisted Living Communities in Florida." Innovation in Aging 4, Supplement_1 (December 1, 2020): 83. http://dx.doi.org/10.1093/geroni/igaa057.272.
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Abstract Florida has one of the largest populations of older adults in the U.S., and as a result the state also has a high prevalence of hearing loss. Given the growth of assisted living as a housing option for older adults, the purpose of this study was to determine the availability of audiology services in assisted living communities (ALCs) across Florida. Data on ALC location, characteristics and audiology service availability were collected from the Florida Agency for Health Care Administration (AHCA). County socioeconomic data were collected from the U.S. Department of Labor. Logistic regression and chi2 tests were used to examine the relationship between county socioeconomics and whether an ALC provided audiology services. We found that of the 3090 ALCs in Florida, audiology services were present in only 57 (3.2%). ALCs with audiology services were significantly more likely to be located in counties with a higher education level and a higher average income. This suggests a shortage of ALCs with audiology services in counties where residents have fewer resources. The results are concerning, given that individuals with fewer resources are less able to pay for audiology services on their own and evidence showing that poor hearing health late in life impacts individuals’ health and quality of life. Policy implications will be discussed, including the need for more ALCs to provide audiology services in counties with fewer resources. One possible solution is tele-audiology, which would enable a single audiologist to diagnose and prescribe hearing aids to patients in underserved areas.
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Jorgensen, Lindsey, and Michelle Novak. "Factors Influencing Hearing Aid Adoption." Seminars in Hearing 41, no. 01 (February 2020): 006–20. http://dx.doi.org/10.1055/s-0040-1701242.
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AbstractIn the field of audiology, change is inevitable: changes in technologies with hearing devices, changes in consumer knowledge, and changes in consumer-driven solutions. With these changes, the audiologist must adapt to meet the needs of the consumer. There are potential predictors that the audiologist could use to determine who is more likely to pursue and use amplification; by using these data, the audiologists may increase their productivity and increase patient satisfaction. The goal of this article is to investigate the MarkeTrak 10 (MT10) data to determine the trends in adoption and use of hearing aids as well as examine predictive factors that can be used to determine hearing aid adoption.
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Zahorik, Pavel, Shae D. Morgan, and Christian E. Stilp. "Graduate training opportunities in the hearing sciences at the University of Louisville." Journal of the Acoustical Society of America 152, no. 4 (October 2022): A125. http://dx.doi.org/10.1121/10.0015764.
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The University of Louisville currently offers two branches of training opportunities for students interested in pursuing graduate training in the hearing sciences: A Ph.D. degree in experimental psychology with concentration in hearing science, and a clinical doctorate in audiology (Au.D.). The Ph.D. degree program offers mentored research training in areas such as psychoacoustics, speech perception, spatial hearing, and multisensory perception, and guarantees students four years of funding (tuition plus stipend). The Au.D. program is a 4-year program designed to provide students with the academic and clinical background necessary to enter audiologic practice. Both programs are affiliated with the Heuser Hearing Institute, which, along with the University of Louisville, provides laboratory facilities and clinical populations for both research and training. An accelerated Au.D./Ph.D. training program that integrates key components of both programs for training of students interested in clinically based research is under development. Additional information is available at: http://louisville.edu/medicine/degrees/audiology and https://louisville.edu/psychology/graduate/experimental.
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He, Ellie. "Evaluation of the Ototoxicity Potential of OnceDaily, Single-Entity Hydrocodone in Patients with Chronic Pain: Results of Two Phase-3 Clinical Studies." January 2018 1, no. 21;1 (January 14, 2017): E183—E193. http://dx.doi.org/10.36076/ppj.2017.1.e183.
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Background: Use/misuse of the opioid combination hydrocodone-acetaminophen has been associated with permanent hearing loss. Although reports have been rare, this potential effect can have significant detrimental effect on patients’ overall quality of life. To date, the ototoxic effect of hydrocodone alone has not been systematically investigated. Objective: In this report, we aimed to evaluate the potential ototoxicity of a novel, singleentity, once-daily, extended-release hydrocodone tablet (Hysingla® ER; HYD). Study Design: Clinical study. Setting: Audiology clinics in US. Methods: Results from 1207 patients in two phase 3 clinical studies were evaluated: A placebo-controlled study with an enriched enrollment, randomized withdrawal design in patients with chronic low back pain, and an open-label, long-term, safety study in patients with chronic nonmalignant and non-neuropathic pain. Comprehensive audiologic assessments (comprising pure-tone air-conduction audiometry in the conventional [0.25-8 kHz] and ultra-high [10-16 kHz] frequencies, pure-tone boneconduction audiometry, tympanometry, speech reception thresholds, and word recognition) were conducted at baseline and end-of-studies; air-conduction audiometry was conducted periodically during the studies. All audiologic assessments were performed in audiology clinics in the United States by licensed audiologists. The primary endpoint was changes from baseline in pure-tone air-conduction thresholds in the conventional frequencies during the studies. These trials are registered with ClinicalTrials.gov, identifiers NCT01400139 and NCT01452529 Results: During the studies, mean changes from baseline in air-conduction thresholds were clinically unremarkable. Bidirectional variability across all test frequencies was observed; 82% of patients did not experience significant threshold changes during the studies, 7% had potential hearing decrement, and 10% experienced hearing sensitivity improvement. No notable differences were observed between patients receiving HYD and placebo or between different HYD doses. Conclusion: No ototoxic signal was observed for single-entity hydrocodone tablets at the dosages and treatment durations investigated. Key words: Audiologic monitoring, clinical trials, hydrocodone, opioids, ototoxicity monitoring, sensorineural hearing loss
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Reynolds, Bailey, Sarah E. Yoho, Karen Muñoz, and Cache Pitt. "Family Involvement in Adult Hearing Evaluation Appointments: Patient Perspectives." American Journal of Audiology 28, no. 4 (December 16, 2019): 857–65. http://dx.doi.org/10.1044/2019_aja-19-0013.
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Background Many adults suffer from an array of consequences due to their hearing loss (e.g., self-efficacy, mastery, psychosocial challenges). Family involvement can help improve their outcomes. Purpose This study aimed to determine audiology adult patients hearing experiences and inquired about their perspectives on family involvement in appointments. Research Design A cross-sectional survey was completed. Descriptive statistics, item analyses, and quantitative analyses were used to examine patient's characteristics and perspectives. Study Sample Three hundred eighty-two adult audiology patients participated in the study. Data Collection and Analysis A 15-item survey was created with 4 sections, including patient demographic information, general hearing questions, hearing experiences, and family interactions and involvement. Descriptive statistics were used to examine patient's characteristics and perspectives on family involvement in audiology appointments. Chronbach's alpha was used to reveal good internal consistency of difficult feelings related to hearing and perceived negative family member reactions. Quantitative analyses were used to determine patient perspectives on family involvement. Results Though patients reported difficulties due to their hearing loss, more than half reported that they did not want family involvement or they were unsure of the benefit that the involvement would provide. Patients who were interested in having family involved reported benefits such as educational opportunities and support. Few barriers of family involvement were reported by patients. Conclusions Patients had a mixed desire about family involvement in their adult audiology appointments. Education of patients about the benefits of family involvement may need to happen for this shift in audiologic practice.
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Jorgensen, Lindsey E., and Rachel E. Barrett. "Relating Factors and Trends in Hearing Device Adoption Rates to Opportunities for Hearing Health Care Providers." Seminars in Hearing 43, no. 04 (November 2022): 289–300. http://dx.doi.org/10.1055/s-0042-1758374.
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AbstractAs with many professions, audiology is continuing to evolve. More specifically in terms of hearing device technology, we see evolution in remote accessibility to providers, public knowledge of devices, and services provided by hearing care professionals. Each of these topics plays a role in an individual's decision to pursue any sort of hearing care services. Given the variety of new devices soon coming to the market (over-the-counter devices), it is important for the audiologist to understand patient motivators and how they have a great impact on both the practice of audiology as well as the patient's overall satisfaction. The goal of this article is to investigate the MarkeTrak 2022 data to determine the trends in adoption and use of hearing aids as well as examine predictive factors that can be used to better understand hearing aid adoption.
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Doyle, John B., Rohit R. Raghunathan, Ilana Cellum, Gen Li, and Justin S. Golub. "Longitudinal Tracking of Sound Exposure and Hearing Aid Usage through Objective Data Logs." Otolaryngology–Head and Neck Surgery 159, no. 1 (March 27, 2018): 110–16. http://dx.doi.org/10.1177/0194599818766056.
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Objective To use data-logging technology to objectively track and identify predictors of hearing aid (HA) usage and aided sound exposure. Study Design Case series with planned data collection. Setting Tertiary academic medical center. Subjects and Methods Individuals with HAs between 2007 and 2016 were included (N = 431; mean, 74.6 years; 95% CI, 73.1-76.0). Data-logging technology intrinsic to new-generation HAs was enabled to track usage and sound exposure. With multivariable linear regression, age, sex, number of audiology visits, duration of audiologic follow-up, pure tone average, and HA side were assessed as predictors of usage (hours/day) and aided sound exposure (dB-hours/day; ie, “dose” of sound per day). Results Mean follow-up was 319 days (95% CI, 277-360). Mean HA usage was 8.4 hours/day (95% CI, 8.0-8.8; N = 431). Mean aided sound exposure was 440 dB-hours/day (95% CI, 385-493; n = 110). HA use (β < 0.001, P = .45) and aided sound exposure (β = −0.006, P = .87) were both stable over time. HA usage was associated only with hearing loss level (pure tone average; β = 0.030, P = .04). Aided sound exposure was associated only with duration of audiologic follow-up (β = 0.100, P = .02). Conclusion While measurement of HA use has traditionally relied on subjective reporting, data logging offers an objective tool to longitudinally track HA use and sound exposure. We demonstrate the feasibility of using this potentially powerful research tool. Usage and sound exposure were stable among patients throughout the study period. Use was greater among subjects with greater hearing loss. Maximizing aided sound exposure might be possible through continued audiology follow-up visits.
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Nicholson, Nannette, Patti F. Martin, and Karen Muñoz. "Satisfaction With Communication Using Remote Face-to-Face Language Interpretation Services With Spanish-Speaking Parents: A Pilot Study." Perspectives on Hearing and Hearing Disorders in Childhood 25, no. 2 (September 2015): 70–82. http://dx.doi.org/10.1044/hhdc25.2.70.
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Effective communication in clinical encounters is dependent upon the exchange of accurate information between clinician and patient and the use of interpersonal skills that foster development of the patient-provider relationship and demonstrate understanding of the patient's social and cultural background. These skills are of critical importance in the diagnosis and management of hearing loss in children of Spanish-speaking families. While the provision of family friendly, culturally sensitive services to families of children with hearing loss can be challenging for audiologists and speech-language pathologists, the quality and satisfaction of these services is widely recognized as the cornerstone of patient satisfaction and improved outcomes. The purpose of this pilot study was to explore patient, audiologist, and interpreter satisfaction of the use of remote face-to-face language interpretation technologies in the context of audiology services. Parent participants rated each session regarding satisfaction with the communication exchange, audiology services, and the interpreting experience. Audiologists rated their satisfaction with the communication exchange, relationship with the parent, and experience with the interpreter. Interpreters rated their satisfaction with the logistics regarding the appointment, information exchange, and experience in working with the audiologist. Audiologists and interpreters were asked to identify what worked well and what challenges needed to be addressed. Data from this pilot study can be used to guide future efforts in providing high quality language interpretation services to Spanish-speaking families of young children who are at risk for or have been diagnosed with hearing loss.
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Emanuel, Diana C. "The Auditory Processing Battery: Survey of Common Practices." Journal of the American Academy of Audiology 13, no. 02 (February 2002): 093–117. http://dx.doi.org/10.1055/s-0040-1715952.
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A survey of auditory processing (AP) diagnostic practices was mailed to all licensed audiologists in the State of Maryland and sent as an electronic mail attachment to the American Speech-Language-Hearing Association and Educational Audiology Association Internet forums. Common AP protocols (25 from the Internet, 28 from audiologists in Maryland) included requiring basic audiologic testing, using questionnaires, and administering dichotic listening, monaural low-redundancy speech, temporal processing, and electrophysiologic tests. Some audiologists also administer binaural interaction, attention, memory, and speech-language/psychological/educational tests and incorporate a classroom observation. The various AP batteries presently administered appear to be based on the availability of AP tests with well-documented normative data. Resources for obtaining AP tests are listed.
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Davidson, Alyssa, and Nicole Marrone. "A Clinically Valuable Interaction in the Midst of COVID-19 and Beyond: A Viewpoint on the Importance of Patient-Centered Outcomes in Rehabilitative Audiology." Perspectives of the ASHA Special Interest Groups 5, no. 4 (August 17, 2020): 940–45. http://dx.doi.org/10.1044/2020_persp-20-00102.
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Purpose In this article, we describe the problems that patients and audiologists face today during the COVID-19 pandemic when accessing and delivering hearing health care. Additionally, we introduce a proactive rehabilitative counseling approach to hearing aid follow-up care now and how it may continue in future practice. Method Combining current literature, clinical practice, and results from a recent dissertation study, decision trees were created to guide patient engagement and prioritize follow-up care. Results The central focus is on patient-centered communication needs and self-efficacy. The benchmark for the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids questionnaire is set at an 80% composite score, with further interpretation of subscales to identify the format and focus of subsequent clinical interactions. Follow-up care can be delivered remotely during the COVID-19 pandemic and in hybrid formats combining remote and in-person services in the future. Conclusions Audiology follow-up appointments may be elective, but patients are still in need of clinician interaction to help mitigate social isolation. We suggest that audiologists reach out to proactively manage communication needs of patients through increased access to rehabilitative audiology.
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Purnami, Nyilo, Cintya Dipta, and Mahrus Ahmad Rahman. "Characteristics of infants and young children with sensorineural hearing loss in Dr. Soetomo Hospital." Oto Rhino Laryngologica Indonesiana 48, no. 1 (June 28, 2018): 11. http://dx.doi.org/10.32637/orli.v48i1.251.
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Background: Hearing loss is one of the congenital abnormalities frequently found in children, which is followed by delayed speech and language development. The majority of cases have unknown causes of hearing loss resulting in late diagnosis. Newborn Hearing Screening Program (NHSP) recommended Otoacoustic Emissions (OAE) and Brainstem Evoked Response Audiometry (BERA) as detection of hearing loss in infants and children. Objective: To obtain the prevalence and description of sensorineural hearing loss in infants and children. Method: A retrospective descriptive study of infants underwent OAE and BERA between 2011-2013 at Dr Soetomo Hospital. The degree of hearing loss was according to the International Standard Organization (ISO). Result: A total number of 552 infant and children were examined, and 377 (68%) were detected with sensorineural hearing loss (SNHL). This group of SNHL consisted of 199 males (52.79%) and 178 females (47.21%). The largest age group was 12 to 36 months, revealed 237 patients (62.86%) with SNHL. The majority degree of hearing loss was profound hearing loss in 329 patients (87.27%). The risk factors of SNHL mostly were not found, in 310 patients (82.23%). The majority number of SNHL was bilateral, in 357 patients (94.69%). Conclusion: SNHL was found in majority of infant and children in the Audiology Clinic of Dr.Soetomo Hospital. The hearing loss found were mostly profound and bilateral, with unknown risk factors, which might contribute to speech and language developmental delay. This is relevance with the Universal NHSP recommendation that early detection should be implemented to all newborn. ABSTRAK Latar belakang: Gangguan pendengaran adalah salah satu kelainan kongenital yang sering ditemukan, dan berpengaruh pada perkembangan bicara dan bahasa anak. Sebagian besar gangguan pendengaran tidak jelas ada faktor risikonya, sehingga tidak segera terdeteksi. Bila tidak dilakukan deteksi dini, akan menyebabkan keterlambatan diagnosis dan intervensi. Telah direkomendasikan oleh Newborn Hearing Screening Program (NHSP) pemeriksaan Otoacoustic Emissions (OAE) dan Brainstem Evoked Rresponse Audiometry (BERA) sebagai alat deteksi dini gangguan pendengaran pada bayi dan anak. Tujuan: Mendapatkan prevalensi dan deskripsi gangguan pendengaran sensorineural pada bayi dan anak. Metode: Penelitian deskriptif retrospektif dengan mengumpulkan data subjek periode 2011- 2013 di Rumah Sakit Dr.Soetomo. Pemeriksaan OAE menggunakan Distortion Product Otoacoustic Emissions. Pemeriksaan BERA berdasarkan International Standard Organization (ISO). Hasil: Terdapat sebanyak 377 pasien (68%) dengan gangguan pendengaran sensorineural dari total 552 bayi dan anak. Pada kelompok umur 12 sampai 36 bulan didapati gangguan pendengaran sensorineural tertinggi sebanyak 237 (62,86%) pasien. Sebagian besar pasien laki-laki sebanyak 199 (52,79%). Mayoritas pasien mengalami gangguan pendengaraan derajat sangat berat sebanyak 329 (87,287%) dari total 377 penderita. Mayoritas faktor risiko dari gangguan pendengaran yang tidak diketahui sebanyak 310 kasus (82,23%), dan mayoritas penderita mengalami gangguan pendengaran sensorineural bilateral sebanyak 357 (94,69%). Kesimpulan: gangguan pendengaran sensorineural ditemukan terbanyak pada bayi dan anak di Klinik Audiologi RSUD Dr. Soetomo. Derajat keparahan terbanyak adalah profound, dan ditemukan terbanyak bilateral. Faktor risiko yang tidak diketahui terbanyak ditemukan, dan bisa merupakan faktor yang berpengaruh pada kejadian lambat bicara dan berbahasa. Temuan ini sesuai dengan rekomendasi program skrining pendengaran yang seharusnya diterapkan pada semua bayi baru lahir.
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Nichols, Natalie, Karen Muñoz, Guadalupe G. San Miguel, and Michael P. Twohig. "eHealth Education and Support for Pediatric Hearing Aid Management: Parent Goals, Questions, and Challenges." American Journal of Audiology 31, no. 1 (March 3, 2022): 189–203. http://dx.doi.org/10.1044/2021_aja-21-00098.
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Purpose: The purpose of this study was to investigate parent goals, questions, and challenges that emerged during coaching phone calls in an eHealth program designed to provide education and support for hearing aid management. Method: Coaching phone calls were audio-recorded, transcribed, and qualitatively analyzed for emergent themes within the categories of goals, questions, and challenges. Results: Emergent themes revealed that parent goals were focused on self-efficacy, routines, device care, and child development. Emergent themes for questions revealed that parents asked questions related to the device care, audiology appointments, confirmation of learning, and child development. For challenges, emergent themes revealed parents' own struggles (e.g., with emotions), issues related to working with their audiologist, child factors, and anticipated challenges. Conclusions: The eHealth intervention allowed parents to raise questions and discuss their challenges in a supportive environment. Supportive accountability helped participants identify and address barriers to hearing aid management based on their priorities and current challenges. Providing supplemental learning support, in addition to routine audiology visits, can help parents develop more effective hearing aid management routines.
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Kasewurm, Gyl A. "Gaining Greater Adherence from Patients for Amplification." Seminars in Hearing 40, no. 03 (August 2019): 245–52. http://dx.doi.org/10.1055/s-0039-1693491.
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AbstractEvery audiology curriculum features coursework and clinical practicum experiences on the knowledge and skills necessary to complete a basic audiological evaluation, diagnose the source of any abnormalities, and a plan for intervention. More advanced coursework typically includes information on balance disorders, newborn infant hearing screening, hearing conservation, amplification, and other electrophysiological tests. In addition, most programs include at least one course on the basic management principles on how to start and maintain a private practice in audiology. However, educational programs rarely include any type of coursework on how to handle common objections to obtaining help in the form of amplification. This is rather surprising considering that more than 90% of patients whom an audiologist evaluates have sensory neural hearing loss where the primary treatment is amplification, except for people with severe hearing losses who are candidates for cochlear implants. This lack of training and experience often leaves clinicians intimidated by common objections to treatment involving purchasing amplification. This article will discuss common objections that patients voice each day to obtaining amplification and will offer possible solutions.
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Knight, Kristin R., Lu Chen, David Freyer, Richard Aplenc, Mary Bancroft, Bonnie Bliss, Ha Dang, et al. "Group-Wide, Prospective Study of Ototoxicity Assessment in Children Receiving Cisplatin Chemotherapy (ACCL05C1): A Report From the Children’s Oncology Group." Journal of Clinical Oncology 35, no. 4 (February 1, 2017): 440–45. http://dx.doi.org/10.1200/jco.2016.69.2319.
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Purpose Optimal assessment methods and criteria for reporting hearing outcomes in children who receive treatment with cisplatin are uncertain. The objectives of our study were to compare different ototoxicity classification systems, to evaluate the feasibility of including otoacoustic emissions and extended high frequency audiometry, and to evaluate a central review mechanism for audiologic results for cisplatin-treated children in the cooperative group setting. Patients and Methods Eligible participants were 1 to 30 years, with planned cisplatin-containing treatment. Hearing evaluations were conducted at baseline, before each cisplatin cycle, and at the end of therapy. Audiologic results were assessed and graded by the testing audiologist and by two central review audiologists using the American Speech-Language-Hearing Association Ototoxicity Criteria (ASHA), Common Terminology Criteria for Adverse Events, version 3.0 (CTCAE), and Brock Ototoxicity Grades (Brock). One central reviewer also used the International Society of Pediatric Oncology Ototoxicity Scale (SIOP). Results At the end of treatment, the prevalence of any degree of ototoxicity ranged from 40% to 56%, and severe ototoxicity ranged from 7% to 22%. Compared with CTCAE, SIOP detected significantly more ototoxicity ( P = .004), whereas Brock criteria detected significantly fewer patients with any or severe ototoxicity ( P < .001 for both). SIOP detected ototoxicity earlier than did the other scales. Agreement between the central reviewers and the institutional audiologist was almost perfect for ASHA and Brock, whereas the poorest agreement occurred with CTCAE. Conclusion The SIOP scale may be superior to ASHA, Brock, and CTCAE scales for classifying ototoxicity in pediatric patients who were treated with cisplatin. Future studies should evaluate inter-rater reliability of the SIOP scale.
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Byrne, David C., Christa L. Themann, Deanna K. Meinke, Thais C. Morata, and Mark R. Stephenson. "Promoting Hearing Loss Prevention in Audiology Practice." Perspectives on Public Health Issues Related to Hearing and Balance 13, no. 1 (December 2012): 3–19. http://dx.doi.org/10.1044/hcoa13.1.3.
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An audiologist should be the principal provider and advocate for all hearing loss prevention activities. Many audiologists equate hearing loss prevention with industrial audiology and occupational hearing conservation programs. However, an audiologist’s involvement in hearing loss prevention should not be confined to that one particular practice setting. In addition to supervising occupational programs, audiologists are uniquely qualified to raise awareness of hearing risks, organize public health campaigns, promote healthy hearing, implement intervention programs, and monitor outcomes. For example, clinical audiologists can show clients how to use inexpensive sound level meters, noise dosimeters, or phone apps to measure noise levels, and recommend appropriate hearing protection. Audiologists should identify community events that may involve hazardous exposures and propose strategies to minimize risks to hearing. Audiologists can help shape the knowledge, beliefs, motivations, attitudes, and behaviors of individuals toward self-protection. An audiologist has the education, tools, opportunity, and strategic position to facilitate or promote hearing loss surveillance and prevention services and activities. This article highlights real-world examples of the various roles and substantial contributions audiologists can make toward hearing loss prevention goals.
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Tufatulin, Gaziz Sh, Inna V. Koroleva, and Maryana Sergeevna Korkunova. "INTERDISCIPLINARY APPROACH IN AUDIOLOGY – AN EXPERIENCE OF PEDIATRIC AMPLIFICATION." Science and Innovations in Medicine 6, no. 1 (March 29, 2021): 20–24. http://dx.doi.org/10.35693/2500-1388-2021-6-1-20-24.
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Abstract
The aim of the study was to develop an algorithm for the interaction between an audiologist and speech-language therapist in initial amplification for hearing impaired children.
Methods. 219 children aged 2 months to 16 years with hearing impairments were divided into 2 groups. The experimental group consisted of children who got a special course of medical, psychological and pedagogical rehabilitation at the stage of initial fitting, based on the new algorithm of interdisciplinary interaction between an audiologist and a speech-language therapist. The control group included children with traditional procedure of hearing aids fitting, in which the audiologist didnt interact with the speech therapist.
Results. An algorithm for the interaction of an audiologist and speech-language therapist included 3 stages of hearing aids fitting (preparation, initial fitting, adaptation and fine tuning of hearing aids), the tasks of each specialist at these stages were identified, including the parents involvement in the process of fitting, a development of the protocol for the exchange of information between specialists. The algorithm was implemented in a special course of medical-psychological-pedagogical rehabilitation in the Center of Pediatric Audiology. It was found that in 1 month after the primary fitting among children who underwent this course, significantly more children used hearing aids for more than 8 hours a day and reached the integral criterion of effective hearing aids fitting compared with the control group. These children also took less time to adjust their hearing aid settings during repeated fitting sessions.
Conclusion. A structured interdisciplinary interaction between an audiologist and speech-language therapist at the stage of initial amplification significantly increases the effectiveness of medical technology for restoring hearing function in children.
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Bassett, Alaina M., and Julie A. Honaker. "Audiologist's Role Within the Changing Climate of Fall Prevention: Are We Ready?" Perspectives of the ASHA Special Interest Groups 1, no. 8 (March 2016): 4–13. http://dx.doi.org/10.1044/persp1.sig8.4.
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This article is aimed to address the vestibular audiologist's role in assessing patient fall risk as tasked by Medicare. With implementation of the Physician's Quality Reporting System (PQRS), audiologists performing standard measures of the vestibular battery must report on measures #154: Falls: Risk assessment and #155: Falls: Plan of care for Medicare beneficiaries. Mandated reporting of this measure includes vestibular audiologists in the multidisciplinary medical management of fall prevention in older adults. In order for audiologists to provide the most relevant care, it is important to evaluate the current fall risk assessments in medical settings, how the implementation of these measures can be structured within the audiology clinic, and challenges audiologist may face with implementation.
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Russo, Lěda Chaves Pacheco. "Overview of Audiology in Brazil: State of the Art: La Audiologia en Brasil: Estado del Arte." International Journal of Audiology 39, no. 4 (January 2000): 202–6. http://dx.doi.org/10.3109/00206090009073079.
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Naudé, Alida, and Juan Bornman. "Using Nominal Group Technique to Identify Key Ethical Concerns Regarding Hearing Aids With Machine Learning." Perspectives of the ASHA Special Interest Groups 6, no. 6 (December 17, 2021): 1800–1808. http://dx.doi.org/10.1044/2021_persp-21-00126.
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Purpose: Machine learning (ML) in new-generation hearing aid technology presents a beneficial opportunity for development in audiology. It is, however, important to balance new applications against the audiologist's professional ethics to protect the client from any harm. This study aimed to identify the key ethical concerns related to the latest digital hearing aid technology that incorporates ML that could potentially impact the client and/or the audiologist. Method: A nominal group technique was conducted with the audiologist to generate and prioritize a list of key ethical concerns related to human data interaction, with specific focus on hearing aids. Results: Five categories were identified in relation to the potential impact on the client: (a) privacy and confidentiality, (b) relationship and trust, (c) nonmaleficence, (d) informed decision making, and (e) financial gain. An additional five categories were identified in relation to the potential impact on the audiologist: (a) privacy and confidentiality, (b) professional responsibility, (c) relationship and trust, (d) financial gain, and (e) trust technology. Privacy and confidentiality were ranked as the highest priority that should be considered when supplying clients with the latest hearing aid technology. Conclusions: Hearing aid technology has evolved considerably, and audiologists need to keep abreast of and master the general technological developments and the associated ethical challenges that may arise. Discussions on the ethics related to ML and hearing aid fittings will help identify the key ethical concerns involved and, thereby, enhance the ethical sensitivity of the profession.
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Manchaiah, Vinaya, Ashley L. Dockens, Monica Bellon-Harn, and Erin S. Burns. "Noncongruence between Audiologist and Patient Preferences for Patient-Centeredness." Journal of the American Academy of Audiology 28, no. 07 (July 2017): 636–43. http://dx.doi.org/10.3766/jaaa.16084.
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AbstractTrends in preferences of both healthcare providers and patients to patient-centeredness have been emphasized in research. However, an understanding of the nature of preferences to patient-centeredness within the context of the audiologist–patient relationship is needed.The purpose of this study is to explore the congruence between audiologist and patient preferences for patient-centeredness.A cross-sectional survey design was used to gather data from audiologists and patients with hearing loss.Participants included 75 audiologists and 105 consecutive patients with hearing loss.Participants completed the modified Patient–Practitioner Orientation Scale (PPOS) and provided selected demographic information. Data were analyzed using an independent sample t test to evaluate the differences between audiologist and patient congruence. Regression analysis was performed to evaluate factors contributing to preferences for patient-centeredness.Patients had significantly lower scores in PPOS full scale when compared to the audiologists [t (170) = 0.78; p ≤ 0.001] with a very large effect size (Cohen’s d = 1.43). Patients also had significantly lower scores when compared to the audiologists on both the sharing [t (170) = 1.01; p ≤ 0.001] and caring [t (170) = 0.56; p ≤ 0.001] subscales. Statistically significant lower scores were noted for patients when compared to audiologists on 12 items on the PPOS. No relationship between any demographic factors and preferences for patient-centeredness were found.The current study results indicated noncongruence in preferences for patient-centeredness among audiologists and patients with hearing loss. Results point toward the need for more research considering the nature and impact of patient-centered audiology practice.
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MERAL, Merve, Ahsen KARTAL, Ümit Can ÇETİNKAYA, and R. Nükhet ÇIKRIKÇI. "Scale of Attitudes Towards Audiology Profession of Audiologist Candidate Students: Validity and Reliability Study." Turkiye Klinikleri Journal of Health Sciences 7, no. 2 (2022): 473–83. http://dx.doi.org/10.5336/healthsci.2021-83282.
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Galvan, Corinne, Elizabeth Case, and K. Todd Houston. "Listening and Learning: Using Telepractice to Serve Children and Adults with Hearing Loss." Perspectives on Telepractice 4, no. 1 (March 2014): 11–22. http://dx.doi.org/10.1044/teles4.1.11.
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Families of children with hearing loss and adults who also have been diagnosed with hearing loss require audiologic management, effective hearing technology, and consistent intervention or rehabilitation to improve their communication. Parents of young children with hearing loss who have chosen a listening and spoken language approach, such as Auditory-Verbal Therapy (AVT), may struggle to find qualified providers who can deliver these services. Similarly, adults with hearing loss also may find it challenging to enroll in aural rehabilitation services due to a lack of availability. The Telepractice and eLearning Laboratory (TeLL) in the School of Speech-Language Pathology and Audiology at the University of Akron has developed a model of telepractice service delivery to provide AVT to families of young children with hearing loss and adult aural rehabilitation services. This paper describes the rationale for establishing these services and a general framework that guides service delivery.