The 2024 Audiology Australia Online Conference enabled delegates to upskill and gain CPD points from their home or clinic, with recordings and CPD still available until 19 January 2025. The conference will continue to run every two years.
Audiology Australia’s Online conference on 24 and 25 October 2024 was a hit with delegates learning about many topics relevant to ear and hearing care.
“I am delighted with the response to this year’s contemporary audiology program headlined by international and national field leaders,” CEO Ms Leanne Emerson said. “This event is part of our continuing commitment to offer flexible, practical, contemporary CPD to members and Australian audiologists that works around life and its challenges in and beyond the clinic.”
National Acoustic Laboratories (NAL) researchers, Dr Bec Bennett, Dr Padraig Kitterick and Ms Taegan Young, discussed turning routine practice into evidence-based best practice. Young cited a study which surveyed more than 700 health professionals about views on evidence-based practice. It revealed that while 96% felt evidence-based best practice was a good idea, only 42% turned to the literature when making a difficult clinical decision.
Young said NAL was reviewing its Client Oriented Scale of Improvement (COSI) clinical tool used by clinicians to set goals with clients that are relevant to their hearing needs. The client and clinician choose SMART (specific, measurable, attainable, realistic and time bound) goals that are reviewed later, with both practitioner and patient agreeing on a score for their degree of change and final listening ability.
While the COSI is a popular clinical tool in Australia and worldwide, it has not been updated since its development in the late 1990s, she said. To review its use in audiology clinical practice, Young and her NAL colleagues took a multifaceted approach, conducting one on one interviews, observing appointments, reviewing literature and analysing COSI goal data from a major hearing service provider using AI.
“NAL reviewed data of more than one million COSI goals, representing over 400,000 clients and more than 1,200 clinicians. Only 8% of goals were marked as achieved,” Young said. “Most clinicians did not routinely give clients a copy of goals to take home. These, and other insights from the COSI review, will support the development of an updated COSI tool, the COSI 2.0.
“COSI 2.0 will have more relevant and achievable goals based on a new goal setting framework, devised by NAL, built around the client’s active participation in goal setting.”
She advised audiologists could take a more client centred approach by avoiding using jargon in patient discussions and discussing the purpose of goal setting with patients.
Discussing barriers and facilitators to app use, Dr Bennett said that in 2015 there were about 200 health apps in the audiology space and this had doubled to 400 in 2020. They were grouped into education and information sharing, hearing assessment, rehabilitation, social enrichment, and other assistive tools to manage the environment.
“Using audiology apps can be cost effective and time saving. They can improve client outcomes, including quality of life and social connectedness,” she said. Barriers to use included lack of training and resources, cost, time for clinicians to learn about apps, and client frustration including with logins or not having compatible devices.
One NAL study of 769 adults aged 40 to 75 with hearing loss found half used health apps but barriers included cost, safety, privacy and sound quality. “If health professionals recommended an app, clients were more likely to adopt it, so you guys hold the power,” Dr Bennett said.
“More than half of study participants wanted clinicians to tell them about apps that might benefit them, and then be left to download and use them themselves; whereas 20% wanted their hearing health professional to help set up the app and 22% wanted their health professional to collaborate in monitoring their progress with the app.”
The study also surveyed 149 audiologists and audiometrists across Australia, finding two-thirds recommended apps to most clients, with the other third refraining from recommending apps due to assumptions about clients’ abilities, age, lifestyle or behaviour.
“Clinicians should not act as a gateway to providing information, but rather be patient-centred; inform all clients of options available to them then let clients choose for themselves” she said. Some good apps included MindEar tinnitus CBT, Happy Hearing dealing with hearing loss, NALscribe live captioning, Braci sound alerts for doorbells and phones, Smiling Mind for mental health and Ambient Menu for quiet dining, she added.
Dr Kitterick discussed fitting hearing aids to benefit clients with significant hearing problems but ‘normal’ audiometry. “Pure tone thresholds alone should not be the only thing considered when determining the potential benefit from hearing devices,” he said.
“Research suggests that while there are an estimated 38 million people in the US with hearing loss, there are an estimated 25 million people who don’t have audiometric hearing loss but report significant problems with their hearing.”
Data from audiology clinics in Australia suggested a significant number of people attending clinics for the first time had significant hearing needs but many had normal audiometry, he added.
“A large proportion of people who need help are told they have normal hearing,” Dr Kitterick said. “While that may be good news for some people, we should also challenge the notion that audiometric hearing loss when measured at the usual frequencies in the clinic is a necessary condition for someone to experience hearing problems.
“Research increasingly demonstrates that people with audiometrically normal hearing can benefit from hearing aids if they have hearing problems.”
Pure tone audiometry was also a poor predictor of benefits of hearing aids, he said, adding studies showed the biggest predictor of benefit was the level of hearing difficulties a client reported and how tired and fatigued they feel because of those difficulties.
Workplace noise and occupational tinnitus
Perth audiologist and epidemiologist Ms Kate Lewkowski discussed workplace noise exposure and occupational tinnitus including findings from the Australian Workplace Exposure Survey (AWES) – Hearing. Over seven years, the AWES-Hearing team has published seven papers on the results. The project involved Lewkowski spending a year compiling a database of everything that made a noise in Australian workplaces.
More than 5,000 people aged 18 to 64 were randomly surveyed to gain a true representation of the national population. Results showed that 19.5% of men and 2.8% of women were exposed over the 85dB noise level on any working day.
Hand-arm vibration and ototoxic chemical exposures can also contribute to hearing loss, she said.. The AWES-Hearing study found the most common workplace ototoxic chemical exposures in Australia were to toluene, p-xylene, ethylbenzene, n-hexane, styrene and carbon monoxide. These can be found in petrol, glues, jet fuel, fibreglass, and vehicle exhaust. Lewkowski said these exposures can be found in transport, driving, welding, mining, manufacturing and construction industries.
The survey found four out of five workers who were over the noise limit (LAeq,8h ≥85 dBA) were also exposed to at least one ototoxic chemical at work. The most common expsoure was carbon monoxide, commonly from vehicle exhaust.
“Studies have shown that exposure to ototoxic chemicals and noise can increase the risk of hearing loss,” Lewkowski said.
There are hundreds of suspected ototoxic chemicals but only a few have been studied, she said. More research needed to be done to examine how exposure length and dose affects hearing loss and if co-exposures (e.g. to noise) increase the risk, she added.
She said hand-arm vibration exposure could occur from tools such as jackhammers. “In Australia, we estimated that 6.5% of all men have hand arm vibration exposure in the workplace,” she added.
The AWES-Hearing data showed power tools and equipment were the major source of noise exposure. Lewkowski said an initiative to reduce noise levels of specific tool groups could save tens of thousands of workers being exposed over the daily noise limit.
The survey was Australia’s first to document the nation’s tinnitus prevalence in the workforce. It found one in four workers or 2.4 million people experience tinnitus with 5.5% or half a million people suffering constant tinnitus.
“Mechanics and drivers were the main occupations to report tinnitus, followed by farming, trades and construction workers,” she said.
Men are more likely to have constant tinnitus. Even after adjusting for worker characteristics, including occupation. the odds of having constant tinnitus were still 57% higher for men than women, she added.
Older men were more likely to report constant tinnitus with one in six men aged 55 to 64 affected.
Workplace noise was linked to tinnitus, as were exposures of carbon monoxide, lead, and toluene, she said.
Medical management of conductive HL
Melbourne ENT surgeon Dr Nadine de Alwis detailed medical management of conductive hearing loss in children. “Audiologists are often first responders so it’s important to recognise red flags,” she said. “If children are not putting two words together at age two, be concerned.
“Middle ear infections are very common and by school age, most kids will have had one episode of acute otitis media (AOM).
“If it’s acute AOM, you should see a red, bulging tympanic membrane (not just red). Most children resolve within 24 to 48 hours with just analgesia but if not resolved in three days (after starting antibiotics) and the child is unwell, they should be referred to emergency or urgent ENT.
“Post AOM, half will have a middle ear effusion at four weeks but 90% will resolve by 12 weeks.”
Dr de Alwis said children who are not high risk can have paracetamol +/- ibuprofen +/- lignocaine ear drops (if nil perforation) for the first 24 to 48 hours. “If fever continues, an antibiotic script from a GP is required. Bilateral AOM requires antibiotics,” she added.
While the AA-OHNS guidelines suggested 40mg per kg per day oral amoxycillin, often GPs were giving 15-20mg per kg, “half the strength of what we would recommend”. “If the child is not improving, this could also be a reason,” she added.
She advised recurrent AOM (three cases in six months or four in 12 months) should be referred to an ENT. “Check to ensure it is not referred pain from teeth grinding or tonsillitis,” she added.
Suggestions to reduce recurrent infections included reducing dairy intake and avoiding swimming. “Get rid of the dummy by three months, definitely six months, and encourage kids to blow their nose,” Dr de Alwis said. “There’s low level evidence that probiotics reduce recurrent AOM and the Otovent balloon device, three times daily may help recover eustachian tube function.”
Due to long waiting lists for public speech therapy via NDIS consider referring early, she advised.
“Grommets should be kept dry initially for six weeks, then long term avoid soapy water – the surfactant in soap means that soapy water will go through the grommet,” she said.
Otitis externa (OE) was becoming more common with teens using AirPods because they reduce ventilation of the ear canal, Dr dr Alwis added. “Suspect fungal OE if ears are itchy and ‘wax’ is building up quickly.”
When referring to a GP, she advised audiologists could write they highly recommend an ENT referral.
Emerging techniques
Dr Joaquín Valderrama Valenzuela, from Spain’s University of Granada Department of Signal Theory, reviewed the fundamental principles behind standard neurophysiological methods based on electroencephalogram (EEG) recordings, such as auditory brainstem responses (ABR) and frequency-following responses (FFR). These are commonly used in hearing clinics to evaluate broad-band and narrow-band hearing detection, respectively.
“While these standardised measures provide relevant audiological information about a patient’s ability to detect sounds, other emerging techniques enable evaluation of higher levels involved in communication, such as discrimination (which can be used to evaluate binaural hearing performance), identification (useful to assess cognitive processes such as selective attention), and even, speech comprehension,” he said.
“While these new methods may take time to reach clinical practice, new solutions are required to characterise hearing difficulties that are often hidden under normal audiograms.”
Dr Jack Holman from the University of Nottingham said hearing loss could impact emotion, emotional response to sounds and affect the way people could identify emotion in others.
Research comparing the impact of hearing loss and hearing aids on experienced emotion in listening situations, social connectedness and pleasantness of interactions found “hearing aids restored the emotional experience of everyday life to near normal levels”, he said.
“This was true for most people but for some there was little or no difference,” he said.
Research into social factors showed that hearing loss was related to smaller social network sizes, increased social isolation and loneliness, he added.
A fatigue study found that two weeks after hearing aid fitting, fatigue changed significantly for the better as did social activity, although both plateaued. Dr Holman said asking patients about challenges they faced and resources they have could help assess social and emotional wellbeing along with questionnaires.
Mr Yoav Fisher from Heidi Health shared how AI scribes are helping audiologists transform their practices by streamlining documentation, enhancing client interactions and boosting day-to-day efficiency.
He said Heidi Health helped them save hours a day on patient note-taking, allowing more time for patient care and less for paperwork.
He also addressed concerns around privacy and data security, stating Heidi Health hosts all data locally in Australia, and data is encrypted and de-identified to uphold highest standards of patient confidentiality.
Register here to watch the full conference on demand and claim CPD points until 19 January 2025.
