Virtual Hearing Aid Care Clinical Practice Guidance Document v1.9 (Draft)

This document provides clinical practice guidance around virtual hearing aid care including services provided at a distance and delivered directly to a client by a provider and/or using facilitator-supported services and specialized equipment. Guidance is provided for services including virtual hearing aid programming, verification, validation, and management (counselling and education). Implementation guidance is focused on processes including technical requirements for virtual service delivery, considering client factors, care type, and timepoint in the care process. This guidance document was developed as part of a grant funded project entitled “A team-based approach to action - rapid implementation of innovative virtual audiology services in response to COVID-19” from Western University’s Faculty of Health Sciences Strategic COVID-19 Research Support, a project initiated in July 2020. Guidance is based on evidence resulting from several literature reviews and is the result of an international collaboration. This document has been reviewed by hearing healthcare providers and clinician/scientist leaders in the field of audiology, across multiple clinical and academic sites

A Scoping Review of Technology and Infrastructure Needs in the Delivery of Virtual Hearing Aid Services

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

An examination of clinical uptake factors for remote hearing aid support: a concept mapping study with audiologists

© 2020 The Authors. Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of British Society of Audiology, International Society of Audiology, and Nordic Audiological Society. 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

Reduction of Automobile and Aircraft Collisions with Wildlife in Indiana

Conflicts between wildlife and human interests have increased in recent decades due to growing human populations and the resulting expansion of anthropogenic pressures into wildlife habitat. Our overall objectives were to evaluate the the potential impacts of wildlife on transportation in Indiana and vice-versa. The results presented in this final report summarize two aspects of our research: the impact of automotive traffic on wildlife (“road kill”; Part I), and the wildlife hazards present at general aviation airports around the state (“airstrike”; Part II). The road kill dataset indicated that at 13 survey routes traversing 180 linear km of road, 11,068 animals were killed by traffic. These animals included mammals, birds, reptiles, and (mostly) amphibians. GIS data indicates that nearby wetlands were typically associated with a high incidence of road kill. While road kills were detected in all months, there were obvious seasonal and weather related patterns in the data. Most road kills occurred from July through September, which was concurrent with peak temperatures and precipitation levels. We highlight a variety of animal-friendly engineering options that can be used to effectively reduce encounters between wildlife and drivers, resulting in fewer accidents and less road kill. With regard to the airstrike dataset, airport habitats consisted mainly of short grass (40.2% of total airport area), soybean fields (10.3%), corn fields (9.5%), runway systems (8.1%), other development (6.6%), woodlots (5.2%), medium grass (4.8%), tall grass (4.6%), and hayfields (3.2%). At least two types of wildlife attractants were present at each airport property, and the most common wildlife attractants included standing water (ephemeral), open culverts, crop fields, woodlot refugia, and gravel piles. Proportion of airport perimeters fenced ranged from 7.5% to 100%, but most airport perimeters were \u3e40% fenced. Most airports with \u3e25% of the perimeter enclosed by chain-link fencing had 0.2-0.5 openings per 100 m of fence, with gaps and dig-holes being the most common openings. Considering the most hazardous species, 0-92 white-tailed deer and 0-28 coyotes were observed at individual airports combining all survey methods across a year. Of 16 bird species groups identified as hazardous to aircraft, American kestrel, blackbirds-starling, crows-ravens, mourning dove, shorebirds, sparrows, and swallows were present at 9-10 of the airport properties; geese, hawks (buteos), and vultures were present at 7-8 of the airport properties; and ducks, herons, and rock doves were present at 5-6. Questionnaires indicated that pilots using focal airports were accustomed to wildlife hazards: 69% of respondents reported that they had altered aircraft operation due to wildlife within the past year, and 25% reported involvement in a wildlife strike during the past year. Furthermore, 88% of respondents felt that wildlife populations at Indiana airports were at least “somewhat hazardous”. Despite pilots’ awareness of wildlife hazards, less than 70% of respondents supported the use of fencing or wildlife deterrents, 43% supported modification/elimination of wildlife habitat, and only 38% of respondents supported for lethal removal of wildlife on airport properties. Hazards associated with deer and coyotes can be alleviated by installing suitable fencing; for airports with extant fences, care should be taken to monitor fences regularly and repair gaps as soon as they are discovered. Presence of deer and coyotes inside airport fences should not be tolerated. Birds are best managed by maintaining airport habitats in a manner that minimizes availability and/or quality of food, water, cover, and loafing sites for hazardous species. Furthermore, several new technologies and refinements in techniques for wildlife damage management at airports have emerged recently and may benefit small airports, such as advancements in electric fencing and the use of dead bird effigies to repel some hazardous bird species

A Pilot Study on Cortical Auditory Evoked Potentials in Children: Aided CAEPs Reflect Improved High-Frequency Audibility with Frequency Compression Hearing Aid Technology

Background. This study investigated whether cortical auditory evoked potentials (CAEPs) could reliably be recorded and interpreted using clinical testing equipment, to assess the effects of hearing aid technology on the CAEP. Methods. Fifteen normal hearing (NH) and five hearing impaired (HI) children were included in the study. NH children were tested unaided; HI children were tested while wearing hearing aids. CAEPs were evoked with tone bursts presented at a suprathreshold level. Presence/absence of CAEPs was established based on agreement between two independent raters. Results. Present waveforms were interpreted for most NH listeners and all HI listeners, when stimuli were measured to be at an audible level. The younger NH children were found to have significantly different waveform morphology, compared to the older children, with grand averaged waveforms differing in the later part of the time window (the N2 response). Results suggest that in some children, frequency compression hearing aid processing improved audibility of specific frequencies, leading to increased rates of detectable cortical responses in HI children. Conclusions. These findings provide support for the use of CAEPs in measuring hearing aid benefit. Further research is needed to validate aided results across a larger group of HI participants and with speech-based stimuli

Perceptual benefits of extended bandwidth hearing aids with children: A within-subject design using clinically available hearing aids

© American Speech-Language-Hearing Association. All rights reserved. Purpose: The aim of the study was to investigate the achieved audibility with clinically available, modern, high-end, behind-the-ear hearing aids fitted using the Desired Sensation Level v5.0 child prescription for a clinical sample of children with hearing impairment and the effect of the extended bandwidth provided by the hearing aids on several outcome measures. Method: The achieved audibility was measured using the maximum audible output frequency method. Twenty-eight children (7–17 years old) with mild to severe hearing losses completed this study. Two hearing aid conditions were fitted for each participant: an extended bandwidth condition, which was fitted to targets as closely as possible, and a restricted bandwidth condition, for which aided output was restricted above 4.5 kHz. Consonant discrimination in noise, subjective preference, aided loudness growth, and preferred listening levels were evaluated in both conditions. Results: The extended bandwidth hearing aid fittings provided speech audibility above 4.5 kHz for all children, with an average maximum audible output frequency of 7376 Hz (SD = 1669 Hz). When compared to a restricted bandwidth, the extended bandwidth condition led to an improvement of 5.4% for consonant discrimination in noise scores, mostly attributable to /s/, /z/, and /t/ phoneme perception. Aided loudness results and preferred listening levels were not significantly different across bandwidth conditions; however, 65% of the children indicated a subjective preference for the extended bandwidth. Conclusion: The study suggests that providing the full bandwidth available, with modern, behind-the-ear hearing aids, leads to improved audibility, when compared to restricted bandwidth hearing aids, and that it leads to beneficial outcomes for children who use hearing aids, fitted to the Desired Sensation Level v5.0 child prescription, without causing significant increases in their loudness perception

A review of mitigation measures for reducing wildlife mortality on roadways

A growing literature in the field of road ecology suggests that vehicle/wildlife collisions are important to biologists and transportation officials alike. Roads can affect the quality and quantity of available wildlife habitat, most notably through fragmentation. Likewise, vehicular traffic on roads can be direct sources of wildlife mortality and in some instances, can be catastrophic to populations. Thus, connectivity of habitat and permeability of road systems are important factors to consider when developing road mortality mitigation systems. There are a variety of approaches that can be used to reduce the effects of roads and road mortality on wildlife populations. Here, we briefly review wildlife-crossing structures, summarize previous wildlife road mortality mitigation studies, describe common mitigation measures, and discuss factors that influence the overall effectiveness of mitigation strategies. Because there are very few road mortality studies “before” and “after” the installation of wildlife-crossing structures, their efficiency is nearly impossible to evaluate. However, simple and relatively inexpensive measures reviewed herein can almost certainly reduce the number of collisions between wildlife and automobile

Cybersafety: Educating individuals with aphasia or cognitive-communication disorders

The Internet poses risks, also known as cyberthreats. Everyone is vulnerable to cyberthreats, including individuals with aphasia (IwA) or cognitive-communication disorders (IwCCD). When speech-language pathologists introduce Internet into treatment plans for IwA or IwCCD the ASHA Code of Ethics dictates they “shall fully inform the persons they serve of the nature and possible effects of services rendered and products dispensed”. Yet safe-use products and protocols designed to inform or educate IwA and IwCCD about cybersafety are not reported in the literature. In this project we examine cyberthreats and cybersafety as they affect IwA and IwCCD by1) reviewing literature on cyberthreats; 2) reporting anecdotes from IwA and IwCCD who are Internet users; and 3) proposing strategies to support safer Internet use. We examine information and knowledge needed to create adaptations and scaffolds supporting safer Internet-use for people with language/cognitive-communication disabilities, and propose strategies for teaching cybersafety concepts. Issues drawn from the human-computer interaction (HCI) literature will facilitate discussion of privacy, accessibility, and universal design (Hochheister & Lazar, 2007)

A Scoping Review of Virtual Focus Group Methods Used in Rehabilitation Sciences

Virtual methods for conducting focus group studies are increasingly being used in many fields, including rehabilitation sciences. This is partly due to the current pandemic, and the need for social distancing, however, may also relate to factors such as convenience and practicality. Virtual research methods enable investigators to collect data at a distance from the participant(s) through the use of technology-mediated data collection methods incorporating new tools and technologies. The aim of this scoping review was to identify, synthesize, and present current evidence related to the methods for conducting virtual focus groups. A comparison of asynchronous and synchronous data collection methods was conducted. The objectives, inclusion criteria, and scoping review methods were specified in advance and documented in a protocol. The 40 articles in this review included virtual focus group research conducted in rehabilitation sciences including data collection conducted using both synchronous (22.5%) and asynchronous (77.5%) models and using a defined moderation method. Three modes of focus group discussion were reported including email, chat-based, and videoconferencing; these were facilitated through the various technology platforms reported in the review. Reported barriers and facilitators to conducting virtual focus group research were extracted and summarized. Commonly reported facilitators to virtual focus group research included the ability to recruit participants from diverse geographical locations and the participants’ ability to engage at times convenient to them. Both computer literacy and access to technology were reported as common barriers. This review highlighted the need for further research and guidance around virtual focus groups conducted using face-to-face synchronous methods and with younger participants groups

Sound quality effects of an adaptive nonlinear frequency compression processor with normal-hearing and hearing-impaired listeners

© 2019 American Academy of Audiology. All rights reserved. Background: Frequency lowering (FL) technology offers a means of improving audibility of high-frequency sounds. For some listeners, the benefit of such technology can be accompanied by a perceived degradation in sound quality, depending on the strength of the FL setting. Purpose: The studies presented in this article investigate the effect of a new type of FL signal processing for hearing aids, adaptive nonlinear frequency compression (ANFC), on subjective speech quality. Research Design: Listener ratings of sound quality were collected for speech stimuli processed with systematically varied fitting parameters. Study Sample: Study 1 included 40 normal-hearing (NH) adult and child listeners. Study 2 included 11 hearing-impaired (HI) adult and child listeners. HI listeners were fitted with laboratory-worn hearing aids for use during listening tasks. Intervention: Speech quality ratings were assessed across test conditions consisting of various strengths of static nonlinear frequency compression (NFC) and ANFC speech. Test conditions included those that were fine-tuned on an individual basis per hearing aid fitting and conditions that were modified to intentionally alter the sound quality of the signal. Data Collection and Analysis: Listeners rated speech quality using the MUlti Stimulus test with Hidden Reference and Anchor (MUSHRA) test paradigm. Ratings were analyzed for reliability and to compare results across conditions. Results: Results show that interrater reliability is high for both studies, indicating that NH and HI listeners from both adult and child age groups can reliably complete the MUSHRA task. Results comparing sound quality ratings across experimental conditions suggest that both the NH and HI listener groups rate the stimuli intended to have poor sound quality (e.g., anchors and the strongest available parameter settings) as having below-average sound quality ratings. A different trend in the results is reported when considering the other experimental conditions across the listener groups in the studies. Speech quality ratings measured with NH listeners improve as the strength of ANFC decreases, with a range of bad to good ratings reported, on average. Speech quality ratings measured with HI listeners are similar and above-average for many of the experimental stimuli, including those with fine-tuned NFC and ANFC parameters. Conclusions: Overall, HI listeners provide similar sound quality ratings when comparing static and adaptive forms of frequency compression, especially when considering the individualized parameter settings. These findings suggest that a range in settings may result in above-average sound quality for adults and children with hearing impairment. Furthermore, the fitter should fine-tune FL parameters for each individual listener, regardless of type of FL technology