AUDIOLOGY MEASUREMENT USING TELEMEDICAL SOLUTION IN CENTRAL ASIA

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JOURNAL OF THE INTERNATIONAL SOCIETY FOR TELEMEDICINE AND EHEALTH
Tomaszewska-Hert, I, et al, J Int Soc Telemed eHealth 2017;5(GKR):e56 1
AUDIOLOGY MEASUREMENT USING TELEMEDICAL SOLUTION IN CENTRAL ASIA
Iwona Tomaszewska-Hert MA1,2, Piotr H Skarzynski MD, MSc1,2,3,4, Maciej Ludiwkowski MSc1, Bakyt
Karmelieva MD5, Cholpon Beisheeva MD2,5
1 World Hearing Centre of Institute of Physiology and Pathology of Hearing
2 Centre of Hearing and Speech Medicnus
3 Institute of Sensory Organs
4 Heart Failure and Cardiac Rehabilitation Department of the Medical University of Warsaw
5 The Centre of Hearing and Speech Medincus in Bishkek
Abstract
Nowadays, the telemetry mediated systems tend to
be an alternative to the standard measurement
systems. With the decreasing cost of electronic
devices, the use telemetry systems is becoming
more and more common, as it allows to test
remotely and to send the results to the specialised
centres with experienced staff. Healthcare
personnel involved with hearing services in less
modern locations need consistent training,
oversight and feedback by audiologists in order to
provide quality services. The aim of the study is to
present usage of telemedical tools for diagnosis
between Poland and Kyrgyzstan. A hybrid
synchronous and asynchronous model of testing is
used in Kyrgyzstan. Before starting the remote
Auditory Brainstem Response (ABR) testing
Kyrgyz technicians completed comprehensive
training courses. They were instructed on the
correct patient preparation for testing, abrasions of
the skin, electrode sticking, clip attaching, and
launching of the appropriate software. Support
documentation was prepared; instructional
materials including a brochure and instructional
video. The equipment was sent to the centre in
Kyrgyzstan. At the beginning of the project we
made numerous mock examinations, after that we
started the remote Kyrgyz-Polish testing. The
whole process was performed with the use of the
Team Viewer application (a proprietary computer
software package for remote control, desktop
sharing, online meetings, web conferencing and file
transfer between computers). During the process,
the testing room can be seen on the video and we
can speak with the technician depending on our
Russian speaking personnel. After the test, the
results are collected and sent to a specialist in
Poland to determine the result. The documents are
then translated and sent to Kyrgyzstan. Up to 20
remote examinations can be performed weekly.
This technology assists clinicians by making it
easier for them to consult with other more
experienced audiologists.
Keywords: teleaudiology; diagnostic auditory brain-
stem responses
Introduction
When distance and inaccessibility pose barriers to
audiology care, the answer in Poland is tele-audiology.
According to the American Speech-Language-Hearing
Associations (ASHA) position statement, telemedicine
offers “the potential to extend clinical services to rural,
remote, and underserved populations, and culturally
and linguistically diverse populations”.1 This short
paper will present usage of telemedical tools for
diagnostic audiology between Poland and Kyrgyzstan
– diagnostic Auditory Brainstem Responses (ABRs).
In Kyrgyzstan, there is a very big problem with
access to audiological services. Children and even
adults are often not diagnosed at all, mainly because of
the lack of adequately trained personnel and financial
reasons. Sometimes it can be both: parents have a
poor interest and lack perception of a child’s hearing
problems. An additional and important aspect is the
need to travel long distances to obtain diagnostic
testing. Because there are only a few clinics available
in major towns, parents often have to travel several
kilometres to get to the specialised clinic. In addition,
travel expenses and loss of earnings due to absence
from work are major reasons parents abandon further
diagnostic testing.2,3 As a result, the diagnosis of
hearing loss in infants is delayed.4 Recognising the

JOURNAL OF THE INTERNATIONAL SOCIETY FOR TELEMEDICINE AND EHEALTH
Tomaszewska-Hert, I, et al, J Int Soc Telemed eHealth 2017;5(GKR):e56 2
need to improve services related to the early detection
of hearing defects, it was suggested that a new model
of service delivery should be implemented for
medical screening.
Telemedicine, a modern technological approach,
allows provision of adequate audiological services. It
is a solution that allows to conduct of ABR testing via
Internet. The results have been shown to be consistent
with the results of tests performed in a standard
way.2,5,6
Methods
With the opening of a new branch of The Centre of
Hearing and Speech in Bishkek activities began related
to objective hearing measurements using the
telemedicine system. The most important factors for
successful teleaudiology are connectivity and well
trained personnel at the remote site. Consequently
training for personnel in remote sites was a priority.
Before starting remote ABR testing, several training
courses were given to Kyrgyz technicians in Poland.
They were instructed on the correct patient preparation
for testing, abrasions of the skin, electrode placement,
clip attaching and launching of the appropriate
software. In addition instructional materials were
prepared, including an information brochure and
instructional video. Thereafter, the equipment was sent
to the centre in Kyrgyzstan. At the beginning of the
project numerous mock examinations were performed
to understand how the project would run in the real life
setting.
For tele-ABR the audiologist at the telemedicine
centre in Poland used a laptop computer with Internet
connection and the Team Viewer application installed
on it. Team Viewer is proprietary software for remote
control, desktop sharing, online meetings, web
conferencing and file transfer between computers.
During the testing, the testing room was seen on the
video it was possible to speak with the technician
(depending on availability of Russian speaking
personnel). The Kyrgyz remote site used a laptop with
the Vivosonic system and Team Viewer application
installed. Every week a schedule of ABR’s in
Kyrgyztan was received. Remote staff prepared
patients for testing and connected the equipment.
When the patient was ready for testing (natural sleep),
the coordinator in Poland took control of the remote
computer over a secure private network. The first test
made is impedance control. (Figure1)
Figure 1. Impedance levels checked before testing.
Once the impedance level was acceptable, ABR
testing began with protocols for 500 Hz and click
stimuli. The remote site in Poland was connected to
Kyrgyzstan using a hybrid connection of synchronous
and asynchronous exchange. The synchronous part
was remote desktop testing with videoconferencing
during the entire process. Asynchronous connectivity
was used when the results were gathered and stored,
then sent for review and description to a specialist in
Poland.
Results
Extensive experience in the telemedicine helped in
developing this and other projects.7-11 All connections
were successful, including completion of remote
measurements and obtaining the results and
descriptions from specialists in Poland. Our hybrid
model requires a moderately fast network connection
at both sites. However, even with a very good and

JOURNAL OF THE INTERNATIONAL SOCIETY FOR TELEMEDICINE AND EHEALTH
Tomaszewska-Hert, I, et al, J Int Soc Telemed eHealth 2017;5(GKR):e56 3
reliable connection there are sometimes delays in
transmission and dys-synchrony between voice and
video or moves made on the desktop. This requires
patience from remote staff and coordinators in Poland.
Despite these difficulties the results achieved have
been equivalent to conventional onsite testing. This
approach had given the centre several advantages.
First, it is possible to conduct remote objective hearing
measurements in remote locations, where it is very
desirable. Second, it is possible to mentor and
supervise trained staff in remote sites in real time
while diagnosing patients. Third, practices at distant
centres can be observed to check and control the
quality of services in the distant branch.
Conclusion
This tele-ABR project has increased accessibility to
diagnostic hearing services in Kyrgyzstan which, with
the help of specialists from Poland, provides a high
level of service in our remote branch.
…………………………………………………………
Corresponding Author:
Iwona Tomaszewska-Hert
World Hearing Center of Institute of Physiology and
Pathology of Hearing
Mokra 17 Street
Kajetany 05-830 NadarzynPoland
e-Mail: i.tomaszewska@csim.pl
Conflict of interest. The authors report no conflicts of
interest.
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