Telemedicine Chapter 2: Telemedicine and Audiology

This chapter is part of Literature reviews carried out for the Heath Service Executive National Telehealth Steering Group April – July 2020

Systematic Reviews

Charalambous, Anna Pavlina et al (2020) [Systematic Review and Meta-Analysis] Tools for App- and Web-Based Self-Testing of Cognitive Impairment: Systematic Search and Evaluation[1]

Background: Tools for app- and web-based self-testing for identification of cognitive impairment are widely available but are of uncertain quality. Objective: The objective of this study was to undertake a scoping review of app- and web-based self-tests for cognitive impairment and determine the validity of these tests. Methods: We conducted systematic searches in electronic databases, including Google search, Google Play Store, and iPhone Operating System App Store, using the search terms ‘Online OR Internet-based AND Memory OR Brain OR Dementia OR mild cognitive impairment OR MCI AND Test OR Screen OR Check.’ Results: We identified 3,057 tools, of which 25 were included in the review. Most tools meeting the inclusion criteria assessed multiple cognitive domains. The most frequently assessed domains were memory, attention, and executive function. We then conducted an electronic survey with the developers of the tools to identify data relating to development and validation of each tool. If no response to the survey was received, Google (to identify gray literature), Google Scholar, and Medical Literature Analysis and Retrieval System Online were searched using key terms ‘[name of developer, if available]’ AND ‘[name of the tool]’ to identify any additional data. Only 7 tools had any information concerning psychometric quality, and only 1 tool reported data on performance norms, reliability, validity, sensitivity, and specificity for the detection of cognitive impairment. Conclusions: The number of cognitive self-assessment electronic health tools for cognitive impairment is increasing, but most are of uncertain quality. There is a need for well-validated tools and guidance for users concerning which tools provide reliable information about possible cognitive impairment that could warrant further investigation.

Nagaraj, Megha Kondli et al (2020) [Systematic Review] Internet/smartphone-based applications for the treatment of tinnitus: a systematic review[2]

Introduction: Most of the individuals suffering from tinnitus report of negative effects on their lives to the extent that clinical intervention is necessary. Although traditional tinnitus management has proven to be effective in treating tinnitus, there are a few drawbacks. The major drawback is the lack of professionals for the treatment of tinnitus, especially in remote areas. Considering the growing usage of the Internet as a platform for availing treatment, there is a requirement for the development of applications in the health care sector. Recent search related to tinnitus treatment revealed that more than 200 applications are available online in the most popular platforms such as Android and iOS. However, most of the applications for the treatment of tinnitus lack validation, and thus, there is a need for research on this ground. Method: Five studies evaluating the efficacy of Internet/app delivered tinnitus treatments were identified. The treatment forms included were Tinnitus E-program, Mobile serious game, Tinnitus web-based sound therapy, and Tailor-made notch music therapy delivered through a smart phone. Results: Each study used a variety of standardized and validated questionnaires to measure the outcome of the treatment. The outcome measures were diverse, but both Internet/app-based and traditional methods such as Tinnitus Retraining Therapy, Cognitive Behavioral Therapy, and Acceptance and Commitment Therapy had similar improvements in terms of tinnitus distress and quality of life. Conclusion: It can be construed that the development of tinnitus treatment applications and web-based platforms will have a significant impact on the normal life of individuals with tinnitus.

Nunn, Terry B et al (2019) [Systematic Review] A systematic review of the impact of adjusting input dynamic range (IDR), electrical threshold (T) level and rate of stimulation on speech perception ability in cochlear implant users[3]

Objective: To systematically review the evidence of how adjustments of the electrical threshold (T) level, input dynamic range (IDR) and electrical stimulation rate impact on speech perception for cochlear implant (CI) users. Design: Systematic review. Study sample: A search of two electronic data sources yielded 32 studies, which met the inclusion criteria. A quality assessment and two evidence-based practice (EBP) review rating schemes were used to grade studies. Results: Due to the heterogeneity of speech perception measures, CI device type and study design, comparisons were made by structured review. Conclusion: The quality of studies was found to be moderate to poor. Increasing T levels above behavioural threshold, or as a proportion of electrical dynamic range (EDR), has been demonstrated to improve perception of monosyllables in quiet and sentences in both quiet and in noise. Specific IIDR and IDR setting may improve perception of monosyllables in quiet and sentences in noise. However, no recommendation could be determined for setting rate of stimulation as speech perception varied significantly across rates examined. To optimise speech perception, a bespoke approach to parameter setting providing an individualised CI fitting is recommended; however, detail of how to optimise settings and the interactions between parameters is as yet unknown.

Sorgini, Francesca et al (2019) [Systematic Review] Haptic-assistive technologies for audition and vision sensory disabilities[4]

Purpose: The aim of this review is to analyze haptic sensory substitution technologies for deaf, blind and deaf-blind individuals. Method: The literature search has been performed in Scopus, PubMed and Google Scholar databases using selected keywords, analyzing studies from 1960s to present. Search on databases for scientific publications has been accompanied by web search for commercial devices. Results have been classified by sensory disability and functionality, and analyzed by assistive technology. Complementary analyses have also been carried out on websites of public international agencies, such as the World Health Organization (WHO), and of associations representing sensory disabled persons. Results: The reviewed literature provides evidences that sensory substitution aids are able to mitigate in part the deficits in language learning, communication and navigation for deaf, blind and deaf-blind individuals, and that the tactile sense can be a means of communication to provide some kind of information to sensory disabled individuals. Conclusions: A lack of acceptance emerged from the discussion of capabilities and limitations of haptic assistive technologies. Future researches shall go towards miniaturized, custom-designed and low-cost haptic interfaces and integration with personal devices such as smartphones for a major diffusion of sensory aids among disabled. Implications for rehabilitation Systematic review of state of the art of haptic assistive technologies for vision and audition sensory disabilities. Sensory substitution systems for visual and hearing disabilities have a central role in the transmission of information for patients with sensory impairments, enabling users to interact with the not disabled community in daily activities. Visual and auditory inputs are converted in haptic feedback via different actuation technologies. The information is presented in the form of static or dynamic stimulation of the skin. Their effectiveness and ease of use make haptic sensory substitution systems suitable for patients with different levels of disabilities. They constitute a cheaper and less invasive alternative to implantable partial sensory restitution systems. Future researches are oriented towards the optimization of the stimulation parameters together with the development of miniaturized, custom-designed and low-cost aids operating in synergy in networks, aiming to increase patients’ acceptability of these technologies.

Beukes, Eldré W et al (2018) [Systematic Review] Internet-based interventions for adults with hearing loss, tinnitus and vestibular disorders: a protocol for a systematic review[5]

Background: Internet-based interventions are emerging as an alternative way of delivering accessible healthcare for various conditions including hearing and balance disorders. A comprehensive review regarding the evidence-base of Internet-based interventions for auditory-related conditions is required to determine the existing evidence of their efficacy and effectiveness. The objective of the current protocol is to provide the methodology for a systematic review regarding the effects of Internet-based interventions for adults with hearing loss, tinnitus and vestibular disorders. Method: This protocol was developed according to the Preferred Reporting Items for Systematic reviews and Meta-analyses for Protocols (PRISMA-P) 2015 guidelines. Electronic database searches will include EBSCOhost, PubMed and Cochrane Central Register performed by two researchers. This will be complemented by searching other resources such as the reference lists for included studies to identify studies meeting the eligibility for inclusion with regard to study designs, participants, interventions, comparators and outcomes. The Cochrane risk of bias tool (RoB 2) for randomised trials will be used for the bias assessments in the included studies. Criteria for conducting meta-analyses were defined. Discussion: The result of this systematic review will be of value to establish the effects of Internet-based interventions for hearing loss, tinnitus and vestibular disorders. This will be of importance to guide future planning of auditory intervention research and clinical services by healthcare providers, researchers, consumers and stakeholders.

Tao, Karina FM et al (2018) [Systematic Review]  Teleaudiology Services for Rehabilitation With Hearing Aids in Adults: A Systematic Review[6]

Purpose: This review examined 1. the current evidence from studies on teleaudiology applications for rehabilitation of adults with hearing impairment with hearing aids; and 2. whether it is sufficient to support the translation into routine clinical practice. Method: A search strategy and eligibility criteria were utilized to include articles specifically related to hearing aid fitting and follow-up procedures that are involved in consultations for the rehabilitation of adults, where the service was provided by the clinician by teleaudiology. A search using key words and Medical Subject Headings (MeSH) was conducted on the main electronic databases that index health-related studies. The included studies were assessed using validated evaluation tools for methodological quality, level of evidence, and grade recommendations for application into practice. Results: Fourteen studies were identified as being within the scope of this review. The evaluation tools showed that none of these studies demonstrated either a strong methodological quality or high level of evidence. Analysis of evidence identified 19 activities, which were classified into service outcomes categories of feasibility, barriers, efficiency, quality, and effectiveness. Recommendations could be made regarding the feasibility, barriers and efficiency of teleaudiology for the rehabilitation of hearing loss with hearing aids. Conclusion: This review provides up-to-date evidence for teleaudiology hearing aid services in new and experienced hearing aid users in different practice settings. Findings direct future research priorities to strengthen evidence-based practice. There is a need for further studies of many aspects of teleaudiology services for rehabilitation with hearing aids to support their implementation into clinical practice.

Bush, Matthew L et al (2016) [Systematic Review] The Role of Telemedicine in Auditory Rehabilitation: A Systematic Review[7]

Objective: The purpose of this study was to assess the feasibility and effectiveness of live telemedicine applications in hearing amplification and cochlear implantation. Data sources and study selection: A systematic search was performed in PubMed, MEDLINE, PsychINFO, CINALH, and Web of Science to identify peer-reviewed research. Inclusion criteria were titles containing words from the search terms: 1 audiology, otolaryngology, and hearing impairment; 2 rehabilitative methods; and 3 telemedicine. Exclusion criteria were: 1 non-English articles; and 2 non-original research. Data extraction and synthesis: Twelve eligible studies were identified. The studies employed a prospective design in nine of the articles and retrospective case series in three. The use of telemedicine for the provision of cochlear implant services was examined in eight of the articles and with hearing aids in four of the articles. The types of services include intraoperative cochlear implant telemetry; implant programming and assessment of electrode-specific measures and speech recognition after implantation. Hearing aid programming and remote gain assessments were also reported. Many studies assess patient and provider satisfaction along with encounter time comparison. The studies occurred from 2009 to 2014 and took place in seven countries. Conclusions: This review examined the feasibility of remote telemedicine connection to provide in auditory rehabilitation services through hearing aids and cochlear implants. There are significant concerns regarding Internet bandwidth limitations for remote clinics. There is a paucity of research examining reimbursement and cost-effectiveness for services. Further prospective research investigating cost-effectiveness and bandwidth limitations is warranted to assess long-term sustainability of remote audiological rehabilitative service delivery.


Cheng, Yen-Fu et al (2020) [Pilot Study] Increased risk of tinnitus following a trigeminal neuralgia diagnosis: a one-year follow-up study[8]

Background: Tinnitus due to hyperactivity across neuronal ensembles along the auditory pathway is reported. We hypothesized that trigeminal neuralgia patients may subsequently suffer from tinnitus. Using nationwide, population-based data and a retrospective cohort study design, we investigated the risk of tinnitus within 1 year following trigeminal neuralgia. Methods: We used the Taiwan National Health Insurance Research Dataset, a claims database, to identify all patients diagnosed with trigeminal neuralgia from January 2001 to December 2014, 12,587 patients. From the remaining patients, we identified 12,587 comparison patients without trigeminal neuralgia by propensity score matching, using sex, age, monthly income, geographic region, residential urbanization level, and tinnitus-relevant comorbidities [hyperlipidemia, diabetes, coronary heart disease, hypertension, cervical spondylosis, temporomandibular joint disorders and injury to head and neck and index year]. All study patients (n = 25,174) were tracked for a one-year period to identify those with a subsequent diagnosis of tinnitus over 1-year follow-up. Results: Among total 25,174 sample patients, the incidence of tinnitus was 18.21 per 100 person-years (95% CI = 17.66 ~ 18.77), the rate being 23.57 (95% CI = 22.68 ~ 24.49) among patients with trigeminal neuralgia and 13.17 (95% CI = 12.53 ~ 13.84) among comparison patients. Furthermore, the adjusted Cox proportional hazard ratio for tinnitus in the trigeminal neuralgia group was 1.68 (95% CI = 1.58 ~ 1.80) relative to the comparison cohort. Conclusions: We found a significantly increased risk of tinnitus within 1 year of trigeminal neuralgia diagnosis compared to those without the diagnosis. Further studies in other countries and ethnicities are needed to explore the relationship between trigeminal neuralgia and subsequent tinnitus.

Cho, Young Sang et al (2020) [Pilot Study] Automated measurement of hydrops ratio from MRI in patients with Ménière’s disease using CNN-based segmentation[9]

Ménière’s Disease (MD) is difficult to diagnose and evaluate objectively over the course of treatment. Recently, several studies have reported MD diagnoses by MRI-based endolymphatic hydrops (EH) analysis. However, this method is time-consuming and complicated. Therefore, a fast, objective, and accurate evaluation tool is necessary. The purpose of this study was to develop an algorithm that can accurately analyze EH on intravenous gadolinium-enhanced inner-ear MRI using artificial intelligence with deep learning. In this study, we developed a convolutional neural network (CNN)-based deep-learning model named INHEARIT (INner ear Hydrops Estimation via ARtificial InTelligence) for the automatic segmentation of the cochlea and vestibule, and calculation of the EH ratio in the segmented region. Measurement of the EH ratio was performed manually by a neuro-otologist and neuro-radiologist and by estimation with the INHEARIT model and were highly consistent [intraclass correlation coefficient = 0.971]. This is the first study to demonstrate that automated EH ratio measurements are possible, which is important in the current clinical context where the usefulness of IV-Gd inner-ear MRI for MD diagnosis is increasing.

Corona, Ana Paula et al (2020) [Evaluation Study] Validity of hearing screening using hearTest smartphone-based audiometry: performance evaluation of different response modes[10]

Objective: To investigate the validity of hearing screening with hearTest smartphone-based audiometry and to specify test duration addressing the two response modes and hearing loss criteria. Design: A diagnostic accuracy study comparing hearing screening with conventional audiometry. Study sample: Three hundred and forty individuals, aged between 5-92 years. Results: Of the 340 participants, 301 undertook all test procedures; 273 adults and 28 children. Sensitivity and specificity were >90% for hearTest hearing screening to identify disabling hearing loss for both response modes with adults and children. We found similar sensitivity in identifying any level of hearing loss for both response modes in children, with specificity >80%, and for the self-test mode in adults. Low specificity was observed when identifying any level of hearing loss in adults using the test-operator mode. In adults, there was a significant difference between test duration for the test-operator and self-test modes. Conclusion: Hearing screening using hearTest smartphone-based audiometry is accurate for the identification of both disabling hearing loss and any level of hearing loss in adults and children in the self-test response mode. The test-operator mode is also an option for children; however, it does not provide good accuracy in identifying mild level of hearing loss in adults.

Cottrell, Elizabeth et al (2020) [Evaluation Study] Telescopic otology referrals: Evaluation of feasibility and acceptability[11]

Objective: A remote telemedical otology referral and advice service was introduced to interested general practices. General practitioners (GPs) were given a new device, “endoscope-i” that combines an optimized smartphone high definition video app with an otoendoscope. They were specifically trained to examine and capture images of patients’ eardrums, which were sent electronically with a summary of clinical information and an in-app hearing testing, if required, for specialist advice to two ear, nose, and throat (ENT) consultants. We describe the findings from an evaluation of the first 6 months of this service to establish the feasibility and acceptability of an otology telemedical referral and advice service. Methods: The new service was advertised to GP practices in Northern Staffordshire. All interested GPs were provided with training and equipment to deliver the remote referral service. Data were collected from GPs at baseline, informal feedback in response to referral outcomes and end of service feedback. Referral data were collected routinely during the service delivery. Results: Fifteen GP leads from 15 practices received training and equipment. One quickly lost the equipment. Of the remaining 14 practices, eight sent a total of 53 remote referrals using this technology over 6 months. The most common reason for referral was an uncertainty of what could be seen in or around the eardrum. The primary barrier for implementation was lack of wireless Internet connections within practices. GPs reported that they used this technology to share examination findings with patients. Conclusions: GPs were positive about the technology, from initial engagement with training and after advice were given. Some GPs expanded the role of the technology to a consultation aid. Referral volume was manageable. Commissioners should consider tariffs structures for such services; empirical cost-effectiveness and workload-impact evaluation would inform this.

Fletcher, Mark D et al (2020) [Evaluation Study] Electro-Haptic Enhancement of Spatial Hearing in Cochlear Implant Users[12]

Cochlear implants (CIs) have enabled hundreds of thousands of profoundly hearing-impaired people to perceive sounds by electrically stimulating the auditory nerve. However, CI users are often very poor at locating sounds, which leads to impaired sound segregation and threat detection. We provided missing spatial hearing cues through haptic stimulation to augment the electrical CI signal. We found that this electro-haptic stimulation dramatically improved sound localisation. Furthermore, participants were able to effectively integrate spatial information transmitted through these two senses, performing better with combined audio and haptic stimulation than with either alone. Our haptic signal was presented to the wrists and could readily be delivered by a low-cost wearable device. This approach could provide a non-invasive means of improving outcomes for the vast majority of CI users who have only one implant, without the expense and risk of a second implantation.

Geronazzo, Michele et al (2020) [Pilot Study] Superhuman Hearing – Virtual Prototyping of Artificial Hearing: a Case Study on Interactions and Acoustic Beamforming[13]

Directivity and gain in microphone array systems for hearing aids or hearable devices allow users to acoustically enhance the information of a source of interest. This source is usually positioned directly in front. This feature is called acoustic beamforming. The current study aimed to improve users’ interactions with beamforming via a virtual prototyping approach in immersive virtual environments (VEs). Eighteen participants took part in experimental sessions composed of a calibration procedure and a selective auditory attention voice-pairing task. Eight concurrent speakers were placed in an anechoic environment in two virtual reality (VR) scenarios. The scenarios were a purely virtual scenario and a realistic 360° audio-visual recording. Participants were asked to find an individual optimal parameterization for three different virtual beamformers: 1. head-guided, 2. eye gaze-guided, and 3. a novel interaction technique called dualbeamformer, where head-guided is combined with an additional hand-guided beamformer. None of the participants were able to complete the task without a virtual beamformer  ie in normal hearing condition  due to the high complexity introduced by the experimental design. However, participants were able to correctly pair all speakers using all three proposed interaction metaphors. Providing superhuman hearing abilities in the form of a dual acoustic beamformer guided by head and hand movements resulted in statistically significant improvements in terms of pairing time, suggesting the task-relevance of interacting with multiple points of interests.

Kıroğlu, Mete et al (2020) [Pilot Study] The Role of Mobile Phone Camera Recordings in the Diagnosis of Meniere’s Disease and Pathophysiological Implications[14]

Objectives: This study aimed to understand if videos of the patients’ nystagmus recorded by themselves during the attacks can help in the diagnosis of Meniere’s disease (MD). Materials and Methods: Sixty patients age range 32-78 years who had vestibular attacks and hearing complaints admitted to Çukurova University Hospital Otolaryngology Department and a private office between September 2013 and January 2017 were included in this randomized clinical trial study. Two groups with 30 patients each were formed. The first group was asked to send eye-videos recorded during the attack, while the patients in the second group were followed with conventional methods. Twenty-six patients in the first group were able to send satisfactory eye movement videos; four patients were excluded due to repeated recording faults. Twenty-seven patients in the second group could be followed; three patients were lost to follow-up. The number of attacks and time needed to diagnose both groups were compared. Results: The video group could be diagnosed in a shorter period compared to the control group. The diagnosis was made within two attacks [38 days] in the video group and within four attacks [92 days] in the control group. Conclusion: This study shows that cell phone camera recordings of nystagmus of the patients are very helpful to diagnose MD. These recordings can also be used as an adjunct to understand the pathophysiology of the disease.

Luria, Alexander L et al (2020) [Feasibility Study] Cochlear Implant Mapping Through Telemedicine-A Feasibility Study[15]

Objective: Access to postoperative aural rehabilitation limits cochlear implant (CI) penetration to the candidate population. The purpose of this study was to evaluate the effectiveness of remote CI programming and aural rehabilitation via telehealth. Study design and setting: Retrospective study of one cochlear implant center. Patients and intervention: Patients undergoing cochlear implantation from 2015 to 2018 undergoing remote programming as part of routine audiologic follow up. Main outcome measures: AzBio scores, impedances, comfort and threshold levels, and responses to the International Outcome Inventory for Hearing Aids questionnaire modified for CIs (IOI-CI). Results: A total of 22 CIs in 20 patients were included during the study period. Threshold, comfort, and impedance levels were readily obtained via telehealth and were not significantly different between telehealth and live sessions. AzBio scores and warble tone pure tone averages were also similar and acceptable in both session modalities. Based on IOI-CI scores, patients were very satisfied with their hearing outcomes. Conclusions: Using telemedicine, reliable measurements were readily obtained and hearing outcomes after remote programming were comparable to those expected after in-person programming sessions. Patients were overall satisfied with their remote programming sessions. Telehealth is a cost-effective and safe way to deliver post-CI audiologic care, particularly to patients with limited mobility or those in remote locations.

Meeuws, Matthias et al (2020) [Feasibility Study] Cochlear implant telemedicine: Remote fitting based on psychoacoustic self-tests and artificial intelligence[16]

Objective: This study aims to assess the feasibility of autonomous cochlear implant (CI) fitting by adult CI recipients based on psychoacoustic self-testing and artificial intelligence (AI). Design: A feasibility study was performed on six adult CI recipients implanted with a Nucleus device. Two weeks after processor activation in the clinic, a ‘self-fitting’ session was organized in a supervised simulated home environment. The CI recipient performed pure tone audiometry and spectral discrimination tests as self-tests. The AI application FOX analysed the results and recommended a new map. The participants filled out a questionnaire and were tested again after 2 months of take-home experience. Results: Four out of six patients performed the self-tests without any help from the audiologist and four were fitted by FOX without any manual intervention. All patients were comfortable with the concept of self-testing and automated fitting. Patients acknowledged that at this stage the remote supervision of an audiologist remains essential. Conclusions: The study showed that audiological self-assessment and remote CI fitting with AI under the supervision of an audiologist is feasible, at least in a number of CI recipients. Currently, there are still some technical and regulatory challenges to be addressed before this can become routine practice.

Ratanjee-Vanmali, Husmita et al (2020) [Evaluation Study] Patient Uptake, Experience, and Satisfaction Using Web-Based and Face-to-Face Hearing Health Services: Process Evaluation Study[17]

Background: Globally, access to hearing health care is a growing concern with 900 million people estimated to suffer from disabling hearing loss by 2050. Hearing loss is one of the most common chronic health conditions, yet access to hearing health care is limited. Incorporating web-based (voice calling, messaging, or emailing) service delivery into current treatment pathways could improve access and allow for better scalability of services. Current electronic health studies in audiology have focused on technical feasibility, sensitivity, and specificity of diagnostic hearing testing and not on patient satisfaction, experiences, and sustainable models along the entire patient journey. Objective: This study aimed to investigate a hybrid [web-based and face-to-face] hearing health service in terms of uptake, experience, and satisfaction in adult patients with hearing loss. Methods: A nonprofit hearing research clinic using online and face-to-face services was implemented in Durban, South Africa, using online recruitment from the clinic’s Facebook page and Google AdWords, which directed persons to an online web-based hearing screening test. web-based and face-to-face care pathways included assessment, treatment, and rehabilitation. To evaluate the service, an online survey comprising: 1. a validated satisfaction measurement tool [Short Assessment of Patient Satisfaction]; 2. a process evaluation of all the 5 steps completed; and 3. personal preferences of communication methods used vs methods preferred was conducted, which was sent to 46 patients who used clinic services. Results: Of the patients invited, 67% (31/46) completed the survey with mean age 66 years, (SD 16). Almost all patients, 92% (30/31) reported that the online screening test assisted them in seeking hearing health care. Approximately 60% (18/31) of the patients accessed the online hearing screening test from an Android device. Patients stayed in contact with the audiologist mostly through WhatsApp instant messaging (27/31, 87%), and most patients (25/31, 81%) preferred to use this method of communication. The patients continuing with hearing health care were significantly older and had significantly poorer speech recognition abilities compared with the patients who discontinued seeking hearing health care. A statistically significant positive result (p=.007) was found between age and the number of appointments per patient. Around 61% (19/31) of patients previously completed diagnostic testing at other practices, with 95% (18/19) rating the services at the hybrid clinic as better. The net promoter score was 87, indicating that patients were highly likely to recommend the hybrid clinic to friends and family. Conclusions: This study applied web-based and face-to-face components into a hybrid clinic and measured an overall positive experience with high patient satisfaction through a process evaluation. The findings support the potential of a hybrid clinic with synchronous and asynchronous modes of communication to be a scalable hearing health care model, addressing the needs of adults with hearing loss globally.

Saunders, Gabrielle H et al (2020) [Recommendation] Application of Big Data to Support Evidence-Based Public Health Policy Decision-Making for Hearing[18]

Ideally, public health policies are formulated from scientific data; however, policy-specific data are often unavailable. Big data can generate ecologically-valid, high-quality scientific evidence, and therefore has the potential to change how public health policies are formulated. Here, we discuss the use of big data for developing evidence-based hearing health policies, using data collected and analyzed with a research prototype of a data repository known as EVOTION [EVidence-based management of hearing impairments: public health pOlicy-making based on fusing big data analytics and simulation], to illustrate our points. Data in the repository consist of audiometric clinical data, prospective real-world data collected from hearing aids and an app, and responses to questionnaires collected for research purposes. To date, we have used the platform and a synthetic dataset to model the estimated risk of noise-induced hearing loss and have shown novel evidence of ways in which external factors influence hearing aid usage patterns. We contend that this research prototype data repository illustrates the value of using big data for policy-making by providing high-quality evidence that could be used to formulate and evaluate the impact of hearing health care policies.

Sun, Zhuoyi et al (2020) [Pilot Study] A Supervised Speech Enhancement Method for Smartphone-Based Binaural Hearing Aids[19]

It is essential but quite challenging to alleviate speech information loss and distortion while developing the speech processing algorithms in hearing aids. Recently, many speech enhancement methods based on deep learning are proven effective. However, most of the algorithms fail to achieve real-time processing, which is significant for hearing aids, especially for a smartphone-centered binaural hearing aid system. A supervised speech enhancement method based on an RNN structure is proposed to address the real-time problem. The problem is explored as a resource-constrained speech intelligibility improvement problem with the target of improving speech intelligibility at low SNR situations. Both the objective and subjective experimental results, using the standard evaluation metrics and the experiments on volunteers, respectively, have verified the superiority of the proposed method.

Wesarg, Thomas et al (2020) [Evaluation Study] Application of Digital Remote Wireless Microphone Technology in Single-Sided Deaf Cochlear Implant Recipients[20]

Background: Previous research showed benefits of remote wireless technology in bilaterally moderate- to-severe hearing-impaired participants provided with hearing aid(s), cochlear implant(s) (CIs), or bimodal devices as well as in single-sided deaf (SSD) cochlear implant recipients (with CI from Cochlear™) and normal-hearing (NH) participants. Purpose: To evaluate the effect of the digital remote wireless microphone system, Roger™, on speech recognition at different levels of multisource noise in SSD CI recipients using MED-EL CI sound processor OPUS 2. Outcomes were assessed as a function of the listening condition (NH only, NH + CI, NH + CIRog, NHRog + CI, and NHRog + CIRog), Roger™ receiver type (Roger™ Focus for NH; Roger™ Xand Roger™ MyLink for CI) and accessory mixing ratio. Study sample: Eleven adult, SSD participants aided with CI from MED-EL. Data collection and analysis: Speech recognition in noise was assessed in two no-Roger™ conditions, one Roger™ X condition, and two Roger™ MyLink conditions. For the Roger™ X and no-Roger™ conditions, speech recognition was tested at 60.3 dB(A) with the Oldenburg Sentence Test in classroom noise at levels of 55, 65, and 75 dB(A). For the two Roger™ MyLink conditions, speech recognition at 60.3 dB(A) was measured at a noise level of 75 dB(A). Roger™ X was assessed with an accessory mixing ratio of 1:1 (summation of unattenuated microphone and audio accessory input). For Roger™ MyLink, two accessory mixing ratios were investigated, MT (1:1, summation of unattenuated microphone and telecoil input) and T with maximum attenuation of microphone input. Results: Speech recognition at higher noise levels (65 and 75 dB(A)) improved significantly with Roger™ in both unilateral use conditions (NH + CIRog and NHRog + CI) as well as bilateral use condition (NHRog + CIRog). Both the bilateral application of Roger™ and the unilateral Roger™ application on the NH ear outperformed the Roger™ application on CI alone. There was no statistically significant effect of type of CI Roger™ receiver (Roger™ X or Roger™ MyLink) and the accessory mixing ratio (MT or T) on speech recognition. Conclusions: Speech recognition for distant speakers in multisource noise improved significantly with the application of Roger™ in SSD CI recipients. Both the unilateral Roger™ application on the NH ear or the CI as well as the bilateral Roger™ application can be recommended.

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[2] Nagaraj MK, Prabhu P. Internet/smartphone-based applications for the treatment of tinnitus: a systematic review. Eur Arch Otorhinolaryngol. 2020;2773.:649‐657. doi:10.1007/s00405-019-05743-8

[3] Nunn TB, Jiang D, Green T, Boyle PJ, Vickers DA. A systematic review of the impact of adjusting input dynamic range (IDR), electrical threshold (T) level and rate of stimulation on speech perception ability in cochlear implant users. Int J Audiol. 2019;586.:317‐325. doi:10.1080/14992027.2018.1564844

[4] Sorgini F, Caliò R, Carrozza MC, Oddo CM. Haptic-assistive technologies for audition and vision sensory disabilities. Disabil Rehabil Assist Technol. 2018;134.:394‐421. doi:10.1080/17483107.2017.1385100

[5] Beukes EW, Manchaiah V, Baguley DM, Allen PM, Andersson G. Internet-based interventions for adults with hearing loss, tinnitus and vestibular disorders: a protocol for a systematic review. Syst Rev. 2018;71.:205. Published 2018 Nov 23. doi:10.1186/s13643-018-0880-9

[6] Tao KFM, Brennan-Jones CG, Capobianco-Fava DM et al Teleaudiology Services for Rehabilitation With Hearing Aids in Adults: A Systematic Review. J Speech Lang Hear Res. 2018;617.:1831‐1849. doi:10.1044/2018_JSLHR-H-16-0397

[7] Bush ML, Thompson R, Irungu C, Ayugi J. The Role of Telemedicine in Auditory Rehabilitation: A Systematic Review. Otol Neurotol. 2016;37(10):1466‐1474. doi:10.1097/MAO.0000000000001236

[8] Cheng YF, Xirasagar S, Yang TH et al Increased risk of tinnitus following a trigeminal neuralgia diagnosis: a one-year follow-up study. J Headache Pain. 2020;211.:46. Published 2020 May 6. doi:10.1186/s10194-020-01121-6

[9] Cho YS, Cho K, Park CJ et al Automated measurement of hydrops ratio from MRI in patients with Ménière’s disease using CNN-based segmentation. Sci Rep. 2020;101.:7003. Published 2020 Apr 24. doi:10.1038/s41598-020-63887-8

[10] Corona AP, Ferrite S, Bright T, Polack S. Validity of hearing screening using hearTest smartphone-based audiometry: performance evaluation of different response modes [published online ahead of print, 2020 Mar 5]. Int J Audiol. 2020;1‐8. doi:10.1080/14992027.2020.1731767

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