Article

Remote Hearing Aid Support: The Next Frontier

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Abstract

Background: In an effort to reduce health-care disparities, there has been a recent surge of interest in the remote provision of care. Audiologists have begun to provide screening, diagnostic, and rehabilitative services via telehealth technologies. Purpose: To evaluate the feasibility and perceived benefits of providing remote hearing aid follow-up appointments in a controlled clinical environment and in participants' homes. Research design: A descriptive quasi-experimental study was completed. Study sample: The study consisted of two phases. The in-clinic phase included 50 adults with hearing loss who participated in remote hearing aid follow-up appointments at Vanderbilt University Medical Center. A subgroup of 21 adults from the original in-clinic phase plus one additional participant completed the in-home appointments. Data collection and analysis: All participants completed the Montreal Cognitive Assessment and study-designed questionnaires. All participants were asked to install proprietary distance support (DS) client software on a laptop or desktop computer and participate in hearing aid follow-up appointments. Results: The majority of participants in both groups installed the DS client software with no assistance other than written instructions, and indicated a preference for DS appointments over face-to-face appointments. Conclusion: On average, participants and the study audiologist were satisfied with remote hearing aid follow-up visits. Additional support might be needed for older patients with little confidence in their ability to interact with technology.

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... Hearing aid services were delivered to different remote locations including the client's home and workplace (n = 4) and remote clinic locations (n = 9) that simulated clinic environments and/or provided specialized remote equipment in both urban and rural facilities. Two studies provided an optional in-person supervised instructional setup of the virtual equipment (Angley et al., 2017;Muñoz et al., 2017). ...
... Of the remaining six studies that included virtual hearing aid management with adults, most incorporated a facilitator to deliver or assist with services. Virtual hearing aid management was focused on informational and coaching-based counseling specific to hearing aid use, care and handling, demonstrations, and management of hearing aid expectations/ limitations (Angley et al., 2017;Campos & Ferrari, 2012;Muñoz et al., 2017;Novak et al., 2016;Pearce et al., 2009;Penteado et al., 2014;Tao et al., 2020). All studies that included hearing aid management used synchronous delivery of virtual services and the use of videoconferencing. ...
... Remote technologies, including videoconferencing and remote access software, enabled the provider to oversee or deliver controlled acts via facilitator collaboration and the use of a computer situated in a remote clinic location. Reported virtual programming activities varied across studies and included adjustments to the physical fit, volume, frequency-gain adjustments, program management, and changes to hearing aid features/settings, such as frequency lowering, occlusion compensation, and noise management (Angley et al., 2017;Campos & Ferrari, 2012;Convery et al., 2020;Penteado et al., 2012;Tao et al., 2020). Across studies, programming adjustments were motivated by client-related feedback and/or according to a study protocol. ...
Article
Purpose The digital health revolution has brought forward integral technological advancements enabling virtual care as a readily accessible delivery model. Despite this forward momentum, the field of audiology still faces barriers that impede the uptake of virtual services into routine clinical practice. The aim of this study was to gather, synthesize, and summarize the literature around virtual hearing aid intervention studies and the related technology and infrastructure requirements. Method A scoping review was conducted using MEDLINE, CINAHL, Scopus, Nursing and Allied Health, and Web of Science databases. Objectives, inclusion criteria, and scoping review methods were specified in advance and documented in a protocol. Results The 11 studies identified through this review related to virtual hearing aid services delivered by a licensed health care provider and/or facilitator(s) specific to hearing aid management, programming, verification, and validation services. Service delivery models varied according to patient population, technology experience, type(s) and time course of care, type of remote location, and technology/support requirements. Barriers and facilitators to implementation-related themes including technology access and function, client sociotechnical, convenience, education and training, interaction quality, service delivery, and technology innovation. Conclusions This scoping review provides evidence around the technology and infrastructure required for full integration of virtual hearing aid services into practice and according to care type. Low-tech versus high-tech requirements may be used to guide virtual service delivery triaging efforts. Research and development efforts in the areas of pediatrics, clinical support tools, and hearing aid/app-based solutions will support further uptake of virtual service delivery in audiology.
... В настоящее время телеаудиология применяется для аудиологического скрининга (неонатального, школьного и т.д.), диагностики нарушений слуха, а также реабилитации пациентов с такими нарушениями [6][7][8][9][10][11][12]. Созданы мобильные приложения для проведения тональной и речевой аудиометрии, видеоотоскопии при скрининговых исследованиях слуха у взрослых [13][14][15][16][17]. Есть опыт первичной и повторной настройки слуховых аппаратов (СА) у взрослых в дистанционном режиме [18][19][20]. Активно внедряется удаленная поддержка пользователей систем кохлеарной имплантации (КИ) (интраоперационный мониторинг, настройка речевых процессоров) [21][22][23]. Развивается дистанционная сурдопедагогическая поддержка детей с нарушением слуха и их семей [24]. ...
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Objective: To evaluate advantages and effectiveness of remote rehabilitation services for hearing-impaired children at Center of Pediatric Audiology during COVID-19 pandemic. Material and methods: 181 children with different types and degrees of permanent hearing loss, their parents and 10 hearing care professionals (audiologists, speech-language therapists) were included in the study. 2115 rehabilitation services were provided during 3 months: video- and text consultations, video lessons with child, sending homework to parents, etc. Results: The results of questionnaires showed that, on specialists' and parents' opinion, remote rehabilitation care is effective tool for hearing impaired children during emergency situations. TeleCare allowed to improve parents' abilities to manage with children by themselves, their understanding goals and methods of rehabilitation, improving child's hearing and speech skills. 95% of parents were satisfied by remote rehabilitation. Advantages and problems of remote hearing rehabilitation were analyzed from the sides of professionals and parents. The most challenging activities for professionals during TeleCare were: evaluation of HA/CI effectiveness, diagnosis and developing of hearing and speech. Conclusions: The experience of remote hearing rehabilitation in emergency situation allows to conclude that this type of care could be useful in clinical practice after pandemic for parents consulting and for children with motor problems.
... As the review by Paglialonga et al. (2018) highlighted, hearing aid fitting and fine-tuning can also be conducted using teleaudiology apps and this functionality is now supported by all major hearing aid manufacturers. In a recent study to evaluate the feasibility and perceived benefits of providing teleaudiology hearing aid follow-up appointments, Angley, Schnittker, and Tharpe (2017) found over 80% of the 50 participants (mean age ¼ 65 years) reported preferring teleaudiology follow-up appointments, rather than face-to-face, and over 90% would recommend teleaudiology hearing aids appointments to others. ...
Article
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Objective Although the availability of mobile device applications (apps) to support people with hearing impairment is rapidly increasing, there are few reports of the use of such apps by the target population. The aim of this paper is to describe research that has applied apps at various stages of the adult rehabilitation journey. Design A summary of studies utilising apps to investigate (1) the hearing difficulties and acoustic environments of adults with mild hearing impairment, (2) hearing aid benefit in this population and (3) useability of an app to guide hearing aid handling tasks. Study sample Older adults with no previous experience with hearing aids, who owned a smartphone or tablet and were confident in using apps. Participant samples ranged from 10 (hearing aid benefit pilot study, mean age = 70 years) to 30 participants (app useability study, mean age = 69 years). Results All studies showed that smartphone apps can provide real-world insights during the early stages of the patient journey and hearing aid management support during the latter stages. App useability was rated positively by participants. Conclusion Smartphone apps may be used as a feasible complement to face-to-face interaction in audiology practice.
... Considering the limited number of intervention studies that included aspects of HA follow-up consultations (e.g. HA programming, counselling, and instructions) (reviewed in Tao et al. 2018;Angley, Schnittker, and Tharpe 2017), comparison of these results is difficult. The closest studies of teleaudiology services have been those examining real ear measurements (Campos and Ferrari 2012;Pross, Bourne, and Cheung 2016), counselling programme Rubinstein 1994, 1995;Laplante-Levesque, Pichora-Fuller, and Gagne 2006;Lundberg, Andersson, and Lunner 2011;Thoren et al. 2011;Thoren et al. 2014), and of specific procedures performed by teleaudiology but in isolation from the other procedures (Tao et al. 2018;Ferrari 2006;Ferrari and Bernardez-Braga 2009;Reginato and Ferrari 2014;Campos and Ferrari 2012;Pearce, Ching, and Dillon 2009;Penteado et al. 2012Penteado et al. , 2014Venail et al. 2019). ...
Article
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Objective: To evaluate and compare the effectiveness and quality of standard face-to-face and teleaudiology hearing aid fitting follow-up consultations and blended services for adult hearing aid users. Design and study sample: Fifty-six participants were randomly allocated to two equal groups, with equal numbers of new and experienced users. One standard and one teleaudiology follow-up consultation were delivered by an audiologist, the latter assisted by a facilitator. The order was reversed for the second group. Outcome measurement tools were applied to assess aspects of participants' communication, fitting (physical, sensorial), quality of life, and service. Cross-sectional and longitudinal outcomes were analysed. Results: Most participants presented with moderate, sloping, and symmetrical sensorineural hearing loss. The duration of teleaudiology (42.96 ± 2.73 min) was equivalent to face-to-face consultations (41.25 ± 2.61 min). All modes of service delivery significantly improved outcomes for communication, fitting, and quality of life (p > 0.05). Satisfaction for both consultation modes was high, although significantly greater with standard consultations. The mode and order of delivery of the consultations did not influence the outcomes. Conclusion: Teleaudiology hearing aid follow-up consultations can deliver significant improvements, and do not differ from standard consultations. Blended services also deliver significant improvements. Satisfaction can be negatively impacted by technical or human-related issues.
... These adult-focussed subthemes speak to the need for more research around remote HA support services and studies that directly compare to a face-to-face service model. The majority of studies evaluating remote audiological management, including remote HA support, have focussed on the feasibility of the service delivery model and/or the perceived benefit/satisfaction of the end-user (Angley, Schnittker, and Tharpe 2017;Br€ annstr€ om et al. 2016;Gladden, Beck, and Chandler 2015;Govender and Mars 2017;Penteado et al. 2014). Studies related to the verification and validation of remote follow-up HA support services are also warranted. ...
Article
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Objective: To develop a conceptual framework around the factors that influence audiologists in the clinical uptake of remote follow-up hearing aid support services. Design: A purposive sample of 42 audiologists, stratified according to client-focus of either paediatric or adult, were recruited from professional associations in Ontario, Canada, as members of the six-step, participatory-based concept mapping process. Analyses included multidimensional scaling and hierarchical cluster analysis. Results: Six main themes emerged from this research according to overall level of importance: (1) technology and infrastructure; (2) audiologist-centred considerations; (3) hearing healthcare regulations; (4) client-centred considerations; (5) clinical implementation considerations; and (6) financial considerations. Subthemes were identified at the group-level and by subgroup. These highlight the importance of TECH factors (accessible Technology, Easy to use, robust Connection, and Help available), as well as the multi-faceted nature of the perceived attitudes/aptitudes across stakeholders. Conclusion: Findings can be utilised in tailored planning and development efforts to support future research, knowledge dissemination, best-practice protocol/guideline development, and related training to assist in the clinical uptake of remote follow-up hearing aid support services, across variable practice contexts.
... First, patients who have mobility problems, are time-poor, or do not live near an audiology clinic can find it difficult to make repeated in-person visits to a provider. 10 As a result, they may delay or forgo seeking help for their hearing aid problems. Second, patients can struggle to accurately describe listening problems retrospectively. ...
Article
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Background: Patients often need multiple fine-tuning appointments with their hearing health care provider to achieve satisfactory hearing aid outcomes. A smartphone app that enables patients to remotely request and receive new hearing aid settings could improve hearing health care access and efficiency. Introduction: We assessed the usability of ReSound Assist, the remote communication feature of a hearing aid app, and investigated whether hearing aid outcomes are influenced by app-based versus in-person patient-provider communication. Materials and Methods: Thirty adults were fit bilaterally with hearing aids and randomized to intervention and control groups. During a 6-week field trial, participants reported hearing aid problems via ReSound Assist (intervention) or at a scheduled face-to-face follow-up appointment (control). Usability of ReSound Assist was assessed with a questionnaire and interview. Hearing aid performance, benefit, satisfaction, and daily usage were compared for both groups. Results: ReSound Assist was rated as highly usable. Participants identified specific aspects of effectiveness and efficiency that could be improved. Similar problems were reported by intervention and control participants regardless of communication mode (app-based vs. in-person). However, almost half the requests received via ReSound Assist were for problems that required advice from the provider or physical modifications to the hearing aids rather than fine-tuning, highlighting the continued importance of in-person hearing health care. There was no significant difference in hearing aid outcomes between intervention and control participants. Conclusions: Apps enabling remote patient-provider communication are a viable method for hearing aid users to seek and receive help with hearing aid problems that can be addressed through fine-tuning.
... Similarly, a systematic review of hearing aid and cochlear implant telemedicine encounters by Bush, Thompson, Irungu, and Ayugi (2016) found similar outcomes and patient satisfaction between services delivered in person and those delivered through telemedicine. Some specific examples of successful telehealth encounters include remote hearing aid programming, verification and counseling (Campos & Ferrari, 2012), and hearing aid follow-up services (Angley, Schnittker, & Tharpe, 2017). In addition, both studies resulted in high patient satisfaction. ...
Article
Purpose: The purpose of this manuscript is to describe the regulatory, technological, and training considerations for audiologists investigating telehealth and to offer some examples of audiology services provided through telehealth. Method: The authors presented the regulatory components, the technology required for audiology staff and patients, and staff training for the audiology telehealth program at Cincinnati Children's Hospital Medical Center. Four case studies highlighting the successful use of telehealth in providing auditory device services to patients were also presented. Results and conclusion: The described regulatory, technological, and training hierarchy provides a framework for audiologists interested in starting a telehealth program. The cases presented illustrate that telehealth can be used to provide some auditory device services, such as troubleshooting, mapping, and parent consulting.
Article
Purpose The aim of this study was to provide insight for the feasibility and outcomes of hybrid (combination of in-person office and Internet-based appointments) audiology services. Method This pilot included two phases. First, we surveyed audiologists regarding what elements of a best-practice, in-person delivery of a hearing intervention could be delivered via Internet-based appointments. Next, we piloted the feasibility and assessed outcomes of the procedures identified. Ten first-time hearing aid users aged 70 years and older were fit with Phonak Audeo M90-312T hearing aids. Two Internet-based follow-up appointments were completed using the myPhonak app. We administered the Hearing Handicap Inventory for the Elderly–Screening Version (HHIE-S), the Client Oriented Scale of Improvement (COSI), the Quick Speech-in-Noise Test (QuickSIN), and real-ear aided responses (REARs) to determine whether participants experienced improvements on hearing-related outcomes. The Telehealth Acceptance Questionnaire (TAQ) and the Visit-Specific Satisfaction Questionnaire (VSQ-9) were administered to gauge comfort with telehealth and satisfaction with Internet-based appointments. Results Survey results revealed that after an initial in-person appointment, nearly all follow-up hearing intervention components could be delivered remotely. We performed Wilcoxon signed-ranks tests to determine if the baseline and outcome results differed for outcomes. Baseline scores improved after 6 weeks ( p s = .02 and. 005 for QuickSIN and HHIE-S) for speech-in-noise performance and self-perceived hearing difficulties. REARs from 500 to 4000 Hz measured after 6 weeks did not differ from baseline ( p s = .612 and .398 for the right and left ears), suggesting no significant deviation from prescriptive targets because of remote fitting adjustments. All participants reported improvement in COSI goals after the intervention. TAQ results suggested that comfort with telehealth improved after attending Internet-based appointments ( p = .005). VSQ-9 results revealed no differences in reported patient satisfaction between in-person and Internet-based appointments. Conclusions We were able to develop a feasible hybrid audiology service delivery model for older adults. Our results enhance the evidence base for the implementation of telehealth audiology services.
Article
Objective This retrospective study sought to characterize the incidence of mortality in elderly patients following bariatric surgery and assessed the association of geriatric status with postoperative outcomes and resource use. Background Bariatric surgery is a safe and efficacious intervention for obesity and related diseases. The clinical and economic impact of geriatric status on bariatric surgery is largely unexplored. Methods Adults (≥45 years) undergoing elective laparoscopic gastric bypass or sleeve gastrectomy were identified in the 2016-2019 Nationwide Readmissions Database. Patients ≥65 years were categorized into the geriatric cohort. Multivariable linear and logistic models were developed to evaluate the independent association of geriatric status with outcomes of interest. Results Of an estimated 351,292 patients meeting inclusion criteria, 44,183 (12.6%) comprised the Geriatric cohort. Of these patients, 0.3% died during index hospitalization. Geriatric status was associated with significantly increased odds of in-hospital mortality (AOR 2.39, 95% CI: 1.33-4.30), respiratory (AOR 1.34, 95% CI: 1.13-1.59), infectious (AOR 1.65, 95% CI: 1.25-2.17), and renal complications (AOR 1.27, 95% CI: 1.12-1.46), as well as prolonged hospitalization (AOR 1.35, 9% CI: 1.24-1.48). Elderly patients experienced a 0.19-day increment in LOS (95% CI: 0.11-0.27) and $620 in attributable hospitalization costs (95% CI: 310-930). Conclusions While overall rates of postoperative death and complications are low, geriatric patients experience significantly increased mortality, morbidity, and resource use following bariatric operations relative to younger adults. These findings may aid in shared decision making for obesity management in geriatric patients.
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Objective: The purpose of this scoping review was two-fold, (1) to provide information about the characteristics, type of service delivery, participant information and outcomes related to tele-audiology in clinical popluations, and (2) to describe documented facilitators and barriers to tele-audiology delivery from the perspectives of practitioners and service recipients. Knowledge of these findings can assist audiologists in considering remote service delivery options for their practices. Design: A scoping review was conducted in November 2019 to identify English-language peer-reviewed journal articles published from 1 January 2010 to 30 October 2019 related to remote clinical service delivery in audiology. Results: Thirty-six published research articles were included. Research studies were classified into four broad areas with some articles including more than one area within the scope of their article: Screening (n = 5), Diagnostic (n = 5), Intervention (n = 18), and Perspectives (n = 22). Conclusion: Hearing healthcare service delivery is expanding with the changing technological landscape, providing greater opportunities and flexibility for audiologists and patients. There are clear opportunities for interdisciplinary collaboration and for collaboration with on-site local facilitators. Local facilitators, with training, can assist in connecting individuals to follow-up care, provide educational support, and needed hands-on assistance for specialised testing.
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The objective of this study was to evaluate patient satisfaction when telemedicine is used for clinical consultations. Patient satisfaction data from 495 real-time interactive telemedicine clinical consultations at the Telemedicine Center at East Carolina University School of Medicine in Greenville, NC were collected and evaluated. Patient satisfaction was examined in relation to patient age, gender, race, income, education, and insurance. Overall patient satisfaction was found to be 98.3%. Because so few patients were dissatisfied with their telemedicine consultation, correlation with the sociodemographic variables was limited. Patients are highly satisfied with consultations through telemedicine, and report that care was easier to obtain. The sample size in this study is larger than other reported telemedicine studies, but its findings are consistent with those of previous studies. In non-telemedicine settings where patient satisfaction has been studied, several significant factors have been correlated with dissatisfaction. These factors include appointment scheduling, travel time, and patient involvement in the physical examination. In telemedicine, the same factors may be associated with higher patient satisfaction rates. To determine correlation between demographic factors and satisfaction, additional studies using different constructs relating to patient satisfaction are needed.
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Objective: The study investigated whether video-otoscopic images taken by a telehealth clinic facilitator are sufficient for accurate asynchronous diagnosis by an otolaryngologist within a heterogeneous population. Subjects and methods: A within-subject comparative design was used with 61 adults recruited from patients of a primary healthcare clinic. The telehealth clinic facilitator had no formal healthcare training. On-site otoscopic examination performed by the otolaryngologist was considered the gold standard diagnosis. A single video-otoscopic image was recorded by the otolaryngologist and facilitator from each ear, and the images were uploaded to a secure server. Images were assigned random numbers by another investigator, and 6 weeks later the otolaryngologist accessed the server, rated each image, and made a diagnosis without participant demographic or medical history. Results: A greater percentage of images acquired by the otolaryngologist (83.6%) were graded as acceptable and excellent, compared with images recorded by the facilitator (75.4%). Diagnosis could not be made from 10.0% of the video-otoscopic images recorded by the facilitator compared with 4.2% taken by the otolaryngologist. A moderate concordance was measured between asynchronous diagnosis made from video-otoscopic images acquired by the otolaryngologist and facilitator (κ=0.596). The sensitivity for video-otoscopic images acquired by the otolaryngologist and the facilitator was 0.80 and 0.91, respectively. Specificity for images acquired by the otolaryngologist and the facilitator was 0.85 and 0.89, respectively, with a diagnostic odds ratio of 41.0 using images acquired by the otolaryngologist and 46.0 using images acquired by the facilitator. Conclusions: A trained telehealth facilitator can provide a platform for asynchronous diagnosis of otological status using video-otoscopy in underserved primary healthcare settings.
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We assessed the feasibility of obtaining probe microphone measurements of hearing aids at a distance. Face-to-face and remote probe microphone measurements were carried out in 60 hearing aid users (mean age 67 yrs) with uni- or bilateral hearing losses (105 ears tested). The participant and a facilitator were located in a room equipped with a probe microphone system interfaced to a PC. Desktop videoconferencing and application sharing was used to allow an audiologist in another room to instruct the facilitator and control the equipment via the LAN. There were significant correlations between face-to-face and remote real ear unaided response (REUR), aided response (REAR) and insertion gain (REIG) at seven discrete frequencies from 250 to 6000 Hz. Differences between face-to-face and remote responses were within the reported variability for probe microphone measurements themselves. The results show that remote probe microphone measurements are feasible and might improve the quality of public hearing aid services and professional training in Brazil.
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Distortion product otoacoustic emissions (DPOAE) and automated auditory brainstem response (AABR) screening were conducted in infants at a distant hospital using remote computing. Eighteen males and twelve females ranging in age from 11-45 days were tested. Both DPOAE and AABR data were recorded using an integrated test system which was connected to the computer network at the Utah Valley Regional Medical Center. Using a broadband Internet connection, an examiner at Utah State University, 200 km away, could control the DPOAE and the ABR equipment. Identical hearing screening results were obtained for face-to-face and telemedicine trials with all infants. The DPOAE means for face-to-face and telemedicine trials were not significantly different at any frequency. In an analysis of variance, there was no significant difference for the test method (F = 0.8, P > 0.05). These results indicate that remote computing is a feasible telemedicine method for providing DPOAE and ABR hearing screening services to infants in rural communities.
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To determine if video otoscope still images of the tympanic membrane taken in remote clinics are comparable to an in-person microscopic examination for follow-up care. Comparative concordance, diagnostic reliability. Community health aide/practitioners in remote Alaska imaged 70 ears following tympanostomy tube placement. The patients were then examined in person by two otolaryngologists. Images were later reviewed at 8 and 14 weeks. Intraprovider concordance for physical examination findings was: "Tube in," 94 percent -97 percent (kappa = 0.89-0.94); "Tube patent," 94 percent -97 percent (kappa = 0.89-0.94); "Drainage," 90 percent -96 percent (kappa = -0.04-0.38); "Perforation," 90 percent -96 percent (kappa = 0.61-0.82); "Granulation," 97 percent -100 percent (kappa = 0.49-1.0); "Middle ear fluid," 88 percent -96 percent (kappa = 0.28-0.71); "Retracted," 83 percent -91 percent (kappa = 0.26-0.58). These agreement rates are similar to interprovider concordance when two otolaryngologists examine the same patient in person. Intraprovider concordance for diagnoses was 76 percent -80 percent (kappa = 0.64-0.71) and 77 percent -88 percent (kappa = 0.66-0.81) when poor images were excluded. Interprovider diagnostic concordance for the in-person exam was 89 percent (kappa = 0.83). Video-otoscopy images of the tympanic membrane are comparable to an in-person examination for assessment and treatment of patients following tympanostomy tubes. Store-and-forward telemedicine is an acceptable method of following patients post tympanostomy tube placement.
  • M Krumm
  • M J Syms
Krumm M, Syms MJ. (2011) Teleaudiology. Otolaryngol Clin North Am 44(6):1297-1304, viii.
Telepractice in audiology: a model for development and implementation
  • D Mccaslin
  • A M Tharpe
McCaslin D, Tharpe AM. (2015) Telepractice in audiology: a model for development and implementation. Audiology Today 27(4): 12-20.