As we think back to the first days of the pandemic lock down, it brings back vivid memories of uncertainty; fear for ourselves and our patients and wondering how we could continue to serve our patients who were already predisposed for isolation by the pure nature of hearing loss.  Never in our lifetime had we been asked, or in some cases told, to shelter-in-place due to a medical threat. The healthcare world was managing difficult questions of how we keep people safe while still being able to serve their medical needs.  The discussions were swirling in the media, in phone conversations with colleagues and within practices on what is considered “essential healthcare services” when a community is faced with a global pandemic?  Some classified “essential” as anything required to save a patient’s life; others considered anything that negatively impacts a patient’s quality of life as “essential care”.  As a medical provider that witnesses the impact on the overall health and wellness that even an untreated mild hearing loss can bring, knows that for most, untreated hearing loss has substantial consequences when the world is managing normal circumstances. Now to be isolated at home, without support systems like family and friends, created an environment where a patient’s only contact with the world is through a video or phone call, television, radio, and social media.  We argued that hearing care services were even more essential in everyday life, now more than ever, hearing was a person’s primary lifeline.

At that point, we started asking ourselves, how can our physicians and providers meet patients where they are: in the community, at their homes, and on their connected devices. Although some of these changes will reverse as the world feels safer and more comfortable, we believe that there has been a fundamental shift in the delivery care.  We already had digitally enabled care in some ways, through apps and our patient portal, we needed to expand our care delivery and inform our patients.  We ultimately learned to connect to our patients in new ways, through: telemedicine appointments, remote-programming schedules, drop-off services and curbside care; and we are not looking back. 

To make patients feel as safe as possible and meet the social distancing guidelines, medical professions were able to start providing telehealth visits to meet their healthcare needs in a time that being in an exam room with a patient was not “safe”.  In audiology, we can provide a vast number of services via telehealth, however, we must have our patients positioned to move to this type of care.  What do I mean by this?  Remote programming has been available in hearing instruments for quite some time, but not widely adopted due to licensing concerns as it relates to telemedicine and audiology.  But once again, COVID 19 created a window where prior telehealth regulations by insurers were loosened so patients could be provided healthcare as it was needed, and providers could receive payment.

In hearing care, we had the answer – remote programming.  Thankfully, the hearing instrument manufacturers had been incorporating remote programming capabilities for quite some time. That said, many of us did not wholly appreciate the effort until COVID hit unexpectedly. And even then, many of us were not fully prepared to deliver it to the bulk of our patients. Our practice had written hearing aid delivery guidelines that include activating any remote programming capabilities in the hearing instrument. So, in theory, as part of our clinical protocol, all instruments are to be set up for remote care services.  Guess what happened when the pandemic started?  We quickly discovered that for whatever reason, many providers had not initiated the remote capability.   As I investigated the reasons why it had not been done, the first reason was time, they didn’t have enough of it during the delivery of the technology to add another feature and counsel on it.  However, the biggest reason was they didn’t think the patient would use it.  And for the most part, at that time, they weren’t wrong.  Most of our patients set in-person appointments for their follow-up and on-going hearing care.  When we look back now, we just weren’t planning for a pandemic-like environment.  We had been delivering care one way, for a very long time; and only for extreme cases, like illness or distance, did we ever really use any type of phone consult, telemedicine visit or remote programming capability as a practice.  Wow.  We were wrong about adaptation when there are extenuating circumstances and other available care channels to receive help. 

This is where the Curbside Care Channel journey began for ENT and Allergy Associates of Florida.  To service our patient’s hearing instrument needs, we first had to have all hearing aids prepared for remote programming, which for most patients meant we needed their instruments in the clinic. However, at this time during the pandemic, we couldn’t have the patients physically in the hearing aid clinic, and thus, Curbside Care was born.  While servicing the patient this way, we could wear proper personal protective equipment, do the proper patient attestation, take temperatures, and mostly stay at the required social distance. Best of all, we could take the patients hearing instruments from them and prepare them for remote programming while they sat in the safety of their own car.

The next hurdle was figuring out how to inform our patients about the new way to visit the office. We wanted them to know that we were here for them.  The fastest way to engage with them was on our social media of course.  We went “Live on Facebook” on ENTAAF’s Hearing Clinic social channel and talked about the new way to visit the office, how the Curbside Care would allow us to assist them safely, what remote programming meant and communicated that they did not have to be our patient to get help. 

As providers, we focused on how we could manage the situation within the government guidelines and still find solutions that would meet the needs of our patients while protecting the staff.  Even though what we came up with may even seem outside-of-the-box, we simply focused on how to meet the needs of the patient by managing them “where they were”; and in this case, they were in their car. After all, some practices still utilize the care channel of ‘at-home’ care, and take care of patients where they live, we surely could be creative enough to manage care if they would drive to us.

Considerations when adding or maintaining this modern delivery channel:

1. Put a clinical guideline in place that requires that if remote programming features are available, they are activated at time of fitting.  Next, add this feature to your chart review process to monitor provider compliance.
2. Assess the parking spaces around the practice to determine best parking spots to assign as Curbside Services.
3. Assure you have adequate signage designated for the curbside area and that you have communicated to the patient how to notify the office when they arrive.
4. Familiarize and train support staff on services that can be provided curbside and how to triage patients between face-to-face care, drop-off service, remote programming appointment and curbside care.
5. Become familiar with all manufacturers remote capabilities allowing your team to manage patients that may have purchased from other locations. Understanding what is available also allows the practice to determine if there are other products that may meet the needs of current patients.  
6. Develop manufacturer specific checklists listing the required steps the provider must execute to enable remote programming capabilities in products.
7. Regroup with your providers and staff to discuss benchmarks around different care channels, talk about how they are doing, and what they are seeing with patient outcomes.  Remember, there is always a way to improve the experience for both your patients and the team that is providing the care.

Hopefully, we are turning the corner on this pandemic.  With that, many patients are still not comfortable being in the office, and for many, having to come into the office is a burden. We believe that Curbside Care and Remote Programming Appointments are here to stay in the world of hearing care.  Moving forward, we will continue to deliver hearing care in these newer channels.

Clinical trials have been used in the world of medicine for years, but now we are seeing an increase in trials that are more ENT-Audiology based.  An analysis of trial registration data downloaded from Clinical Trials.gov and utilizing administrative data from the Duke University Medical Center from October 1, 2007 to September 27, 2010 revealed a total of 1115 registered interventional trials assigned to otolaryngology.  Of these, head and neck cancer trials predominated.  But what is happening in this space in 2021 is nothing short of an explosion. At the time of this article, there are 797 current clinical trials in the hearing loss space as listed on Clinicaltrials.gov.  Although head and neck cancer trials are still leading in number, there is a significant uptick in trials for new pharmacological treatments & medications for sensorineural hearing loss, age-related hearing loss, tinnitus, and dizziness just to mention a few. There are also a number of ongoing FDA studies related to different devices used in treating hearing loss.

Our practice is currently involved in 14 clinical trials ranging from procedure trials to medication trials.  We have a clinical trial team that finds trials that may interest our physicians and providers, presents them as opportunities for the practice and then applies to the study. There are several steps from the time of application to when a site is accepted for participation in the trial. Each step of the process builds on the other until subject recruitment can begin. Look for our upcoming article on the Business of Clinical Trials.

As an audiologist, I believe some of the most exciting trials today are the studies investigating restoring the cochlear synapse.  It is more recently believed that when the cochlear synapse is impaired, it directly impacts a person’s ability to understand in noise.  This is supported in research on hidden hearing loss. This article discusses hidden hearing loss at length; the authors suggest this type of selective neural loss may be the physiological basis for many of the cases of hearing disability with a normal audiogram.

If you have been performing audiological testing on patients for any period of time, you most likely have come across a patient with a similar story. A patient presents with a concern about their hearing, you perform a hearing test, and everything appears to be within normal limits.  If we weren’t performing speech in noise testing at the time, did we tell them they had normal hearing? did we miss them altogether? I think about early in my career where we assured patients, as did our physicians, that their hearing was “within normal limits”, but was it really hidden hearing loss that went undiagnosed because the current research hadn’t suggested it existed yet, we weren’t performing an expanded standard battery on all patients, or we simply weren’t asking the right questions?

As we know, speech-in-noise testing is often not standardly performed, unless it is tied to a larger work-up like a cochlear implant assessment, an auditory processing disorder battery or part of hearing aid verification. Today, providers have the opportunity to dig a little deeper when the patient’s primary complaint is specifically related to difficulty understanding in noise, and their hearing is within normal limits.   In this situation, hidden hearing loss could still be missed without pushing beyond the basic audiometric testing. Now that the clinical trials and research are focused more than ever on hearing loss and other audiologically related symptoms, we need to become even more vigilant by consistently managing patients with robust patient history and expanded standard diagnostic practices.

Within our clinical guidelines at ENTAAF, the Quick Sin is included as part of our standard audiological battery, and still there are times where it isn’t done.  It is true that it takes slightly more time, and sometimes that makes it difficult to keep schedules on time. We find that performing the QuickSin or the Words in Noise (WIN) test adds about 3 minutes to the testing battery.

As audiologists, one of the most important things that we can do is to take the lead in educating the other medical providers that are involved in managing our patients with hearing loss.  When we provide them with peer reviewed articles that support the benefits of adding this into our regular battery, it better aligns our recommendations.  The audiogram has been thought by many to be the picture of what is happening with our patients hearing, but the truth is, we are finding that the basic audiologic battery used in most practices may not be robust enough to tell the whole story.

Listed below are a few things discovered in this journey to gain a better picture of our patient’s hearing health. By adding speech in noise testing to our clinical battery we have seen a number of benefits. 

The additional test:

1. Assists patients in understanding the complexity of hearing speech in a noisy background.
2. Allows us to quantify the degree of difficulty that patients are experiencing when listening in noisy environments and compared against normative data
3. Presents a testing environment that mimics where our patients complain they have the most difficulty, in noise.
4. Provides insight into those that end up having thresholds within normal limits but still feel they have significant difficult with speech in noise environments.
5. Gives us a baseline of performance to assess the benefit and project outcomes for the recommended aural rehabilitation programs.
6. Provides a robust group of patients to access information on speech in noise performance, allowing us to participate in clinical trials surrounding cochlear synaptopathy as well as opens up other clinical trials that involve hearing loss & audiological testing.  

If your practice location has been involved in clinical trials, then you know that there are several considerations before adding this service into your practice. Look for our upcoming series on the Business of Clinical Trials.

If your patients have uttered these words recently, they are not alone.

The World Health Organization estimates that over 1 billion young adults are at risk for hearing loss[1] and there are an estimated 37.5 million adults in the USA who report some trouble hearing.[2] Additionally, with the majority of people in America wearing masks/face coverings due to COVID-19, it has created communications challenges even for those without hearing loss.

New hearing challenges in a pandemic

The face coverings worn throughout the pandemic, as well as plexiglass partitions and social distancing, have made it difficult to hear others. It is estimated that different types of facemasks attenuate everyday speech sounds by as much as 10-15 decibels.[3] This is like having a mild hearing loss, meaning people realized very quickly what it was like to suddenly have difficulty communicating each day.

Indeed, throughout the pandemic your patients likely noticed that listening was no longer easy.  Sorting out words and filling in the “missing” parts of a sentence from a loved one, colleague, or friend became difficult and tiring. Even those with otherwise normal hearing levels likely understood what it was like to have hearing loss, finding it more difficult to understand others than before. 

Discussing hearing loss

Given the widespread hearing challenges, now is the perfect time to have a conversation with your patients about their hearing. How can you begin? Try asking about their experiences during the pandemic, and if they can recognize instances before the pandemic when they had difficulty hearing or understanding conversations. And as face mask restrictions continue to ease up, you can ask them if they have any challenges when communicating even when speaking to people who aren’t wearing masks.

You can also bring up the following example, which illustrates how simple misunderstandings can be an early sign of hearing loss. For instance, your spouse or significant other may say “Please go and get my keys,” but you might hear “Please go and get some bees.” This demonstrates how quickly communications can break down by mis-hearing just one word. Given the many conversations that happen throughout the day – at home, in work meetings, at the grocery store, and even when watching TV – these simple misunderstandings can add up and cause a great deal of frustration. If left untreated, hearing loss can lead to more serious conditions, such as social isolation and even increase your risk for dementia. Unfortunately, many people with hearing loss

choose to avoid social situations out of fear of embarrassment or frustration by not being able to participate in a conversation. 

New technology delivers an enhanced hearing experience

What can patients do to address their hearing loss? The first step is to get their hearing baseline checked by an Audiologist. You’ll also want to let them know that hearing loss shouldn’t stop or limit them from going out and enjoying life again – especially as life gets back to normal! We were stuck inside for too long to miss out on any more fun, and with proper hearing treatment, they can hear all the sounds around them like never before.

Of course, some patients may be nervous about wearing hearing aids and even getting a hearing test. You can help calm their nerves by explaining the process and the wonders of today’s hearing technology.

Make sure to let them know that today’s audiology consultation involves a lot of cool tech and listening experiences that are NOT anything like the hearing aids of the past. Today’s technology like that from Widex, a 60+ year old Danish tech company, includes the WIDEX MOMENT, the smallest rechargeable receiver-in-the canal device with Artificial Intelligence and machine learning. The WIDEX MOMENT hearing device is fully automatic and can learn how wearers like to hear/listen and adapt to their unique preferences over time with My Sound. 

The sound quality from WIDEX MOMENT is one of the most coveted natural sound experiences, thanks to ZeroDelay technology that delivers the fastest processing time in the industry and eliminates the artificial sound experienced with other devices. No matter how they like to spend their time,  wearers can enjoy it with their individual listening preferences, from listening to their favorite music to enjoying social activities. 

If they still aren’t convinced about the benefits for checking and treating their hearing loss, you may want to mention how 91% of the adults who tried the new WIDEX MOMENT could now participate in life once again![4]  

The time to act is now

To help your patients hear like they used to and live life to the fullest, be sure to refer any patients with hearing loss to your practice’s Audiologists. To learn more about Widex, visit: https://www.widexpro.com/en-us/

[1] World Health Organization. (2021, April 1). Deafness and hearing loss. https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss

[2] National Institute on Deafness and Other Communication Disorders. (2021, March 25). Quick Statistics About Hearing. https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing

[3] Corey RM, Jones U, Singer AC. Acoustic effects of medical, cloth, and transparent face masks on speech signals. The Journal of the Acoustical Society of America 148, 2371 (2020).

[4]Balling LW, Townend O, Helmink D. Sound quality in real life–Not just for experts. Hearing Review. 2021;28(2):27-30.(2):27-30.

Diabetes and hearing loss are two of America’s most widespread chronic health concerns. More than 34 million people in the US have diabetes, and an estimated 34.5 million have some type of hearing loss. Those are large segments of patients, and it appears there is a lot of overlap between the two groups. 

Studies continue to reveal a correlation between diabetes and the increased risk for hearing and balance disorders. A recent study found that hearing loss is twice as common in people with diabetes as it is in those who don’t have the disease. What is even more alarming is what may be happening in the prediabetic segment. Of the 88 million adults in the U.S. who have prediabetes, the rate of hearing loss is 30 percent higher than in those with normal blood glucose. Often we ask patients about their history, and if they have diabetes may be in the list of questions we run through; however as providers evaluating a patient’s hearing and balance, it’s important to dig a little deeper. When is the last time we inquired about prediabetes? And on top of a more robust history, the more we understand about the basics of the disease, the better we will do as we manage their care over their lifetime. 

Blocking and tackling – understanding the basics of Type 1 & Type 2 diabetes.

Type 1 Diabetes

So, what is important to know out of the gate about Type 1 diabetes? Type 1 diabetes happens at every age and in individuals of every race, shape, and size. Basically, the key message is that in type 1 diabetes, the body does not produce insulin. The body breaks down the carbohydrates we eat into blood sugar, called blood glucose, and uses for it for energy.  Insulin is a hormone that the body needs to get glucose out of the bloodstream and into the cells of the body, where it can do its work. This condition can usually be managed with a lifestyle of proper diet and exercise. Insulin therapy and other lifestyle related treatments and long-term habits can lead to successful management of this condition.

Understanding Type 2

Type 2 diabetes is the most common and instead of not producing insulin, the body doesn’t use insulin properly. Type 2 diabetics can sometimes manage their disease with healthy eating and exercise, others more often, patients require medication or insulin to help manage it.

When managing a patient with diabetes, there are often a lot of players on the field.  The patient is the most important one on the team, as they are responsible for new habits and sometimes a new medication to successfully address the issues.   As a provider, getting to know the other players, communicating and collaborating on care is really important to the team’s star, as the more support a person has, be easier it is to stay on track.

Let’s get to know the different kinds of health care providers who can be part of the diabetes management team.

These can include the professionals listed below, but keep in mind, this team is broad. Talking with your patient to understand who is involved in their care is key to getting the entire picture of who is in the know, and helping with the overall management of your patient’s health.

• Primary Care Provider: the general practitioner physician or mid-level provider such as a nurse practitioner or physician assistant provides the routine medical care, including physical exams, lab tests and prescriptions for medication.
• Endocrinologist: this physician specializes in diabetes and other diseases of the endocrine system, when things get tough, they call in the big dawgs.  This team is the specialist.
• Ophthalmologist or Optometrist: Just as hearing is impacted by this disease, so are the eyes.  The medical physician or Doctor of Optometry both can play a part in the diagnosis and treatment of patients and any related eye diseases and disorders.
• Podiatrist: The foot doctor jumps in when circulation to the lower extremities is impaired.  The podiatrist is trained to treat feet and lower leg problems.
• Pharmacist: Everyone has a job here; the local pharmacist often is the one who sees the big picture when it comes to patients and their medications.  They keep an eye how they interact with each other.
• Dentist: Diabetes impacts our oral care too.  The patient’s dentist is an important player, keeping tabs on our patient’s teeth and gums.
• Registered Nurse: Often there is an RN that is overseeing chronic care management and coordinating the patient’s visits to multiple providers.  They can really make the difference for our patients and asking if there is someone in the primary care office that provides an extra hand is a good habit to get into when taking this patient’s history.
• Registered Dietitian: Being an expert in nutrition, the registered dietitian an important part of the team.  They are often advising our patients about the best foods that help manage blood sugar.
• Certified Diabetes Care and Education Specialist:  Certified Diabetes Educators have extensive training and experience working with people with diabetes.  They are coach our patients about from manage the things you need to do to take care of your diabetes, in a way that fits with your daily life, routines, environment and family dynamics. To work with an expert in a diabetes education program recognized by the American Diabetes Association, visit diabetes.org/findaprogram or call 1-800-DIABETES (800-342-2383) to find a program in your community.
• Mental Health Professional: This person may be a psychiatrist (MD or DO), psychologist (PhD) or clinical social worker (LCSW or LISW). These professionals can help you deal with the day-to-day challenges of living with diabetes as well as more serious emotional issues. Be sure to work with a mental health professional who understands diabetes and the medicine and insulin you are taking that may affect your blood sugar.
• Fitness Professional: A physical activity specialist may be an exercise physiologist, personal trainer or physical therapist. These professionals can help you find exercises that are safe for you, and ensure you get the most out of your exercise program. Be sure to work with a fitness professional who understands diabetes and the medicine and insulin you are taking that may affect your blood sugar.
• It is important to choose diabetes care team members who can provide the level of support you want and provide help when you need it. The more information you can give when you get help, the easier it is for someone to assist you. Be sure to write down questions and concerns to bring with you to your appointments.

Check out the CDC brochure that talks Ears and Diabetes – and suggests ways to prevent the negative outcomes of hearing and balance impairments. Download a quick reference here! https://www.cdc.gov/diabetes/pdfs/library/Diabetes-Ears-h.pdf

While excellent clinicians will always be in high demand, the definition of excellent is expanding far beyond having top-notch, specialty-based capabilities.   Most young healthcare providers have the technical knowledge and quickly develop the clinical skills they need for their role; however, many even more experienced professionals continue to need training when it comes to complex problem solving, teamwork, conflict management, business understanding, communication and leadership, known as behavioral or soft skills. These skills are harder to acquire and are learned through life and work experience versus a textbook. 

All medical providers deal with many challenges every day.  The real-life situations involve trying to adapt to constant change, prioritizing our time, learning to listen & collaborate in a team and understanding how to communicate our ideas, findings, and recommendations in a compelling way. However, most of us were never truly taught how to properly go about handling these situations. Even in other professions, roles that require high social skills like sales, leadership, project management, and marketing have seen an increased focus on the importance of heightened behavioral skills.  In 2020, healthcare providers managed changes from the in-person, traditional care model to more non-traditional professional and patient care environments, like telemedicine and remote practice. During this time, they discovered or were reminded just how important the ability to empathize, actively listen, communicate and collaborate is to the success of the patient. A basic lesson: it is never too late to work on your communication skills.

Numerous research studies have shown that no matter how knowledgeable a provider might be, if they are not able to open communication channels with other medical colleagues, their teams and patients, they may be of no help to anyone.  A patient’s perception of the quality of the care they receive is highly dependent on the quality of the interaction with their healthcare provider.  Yet, communication training for physicians and other providers historically has received far less attention in training and mentorship programs. 

Here are six reasons why communication skills really matter for providers.

• The history-taking aspect of a patient interview is critical to diagnostic decisions. When multiple providers are involved in the same patient visit, the opportunity for incomplete data and interruptions is higher, which can compromise the information.
• A patient’s adherence to recommendations is directly impacted by effective patient-provider communication.  There are examples of this in every medical specialty; motivational interviewing was grown out of this basic concern. 
• Patient satisfaction is impacted by realistic expectations, having the opportunity to express their ideas & concerns, the length of their appointment, the provider team in which they have interacted with and their perception of continuity of care among many others.  Communication lives at the core of each of these elements. 
• Patient Safety requires that all the members of a health care team communicate effectively, or medical errors increase, and patient care often suffers.
• The leading cause of most malpractice claims is a breakdown in communication. CRICO Strategies reviewed 23,000 medical malpractice lawsuits filed between 2009 and 2013.  Communication failures were a contributing factor in over 30% of those cases.
• Overall healthcare team satisfaction is impacted when providers do not feel supported, valued, and listened to in the work environment.  The quality of communication breaks down further when working relationships are not maintained.  There is a direct relationship between the provider’s satisfaction and their ability to build rapport with their patients.

There are strong relationships between a provider’s communication skills and a patient’s capacity to follow through with medical recommendations. The clinician’s ability to listen and empathize can have a significant impact on patient outcomes and satisfaction. Further, communication among providers & their teams influence working relationships, job satisfaction and can easily impact patient safety. Keep in mind, just like technical training and book knowledge, softer skills, like communication, can be improved upon through practice.

In January 2021, we passed the one-year mark since the first reported case of COVID-19 in the US.  There is still much unknown about how the virus impacts the health of multiple systems within the human body. Initially with COVID, the presentation of sudden onset hearing loss, tinnitus and dizziness were not associated as the acute, primary symptoms.  Since then, there has been documentation that not only have patients who have presented with these symptoms tested positive for COVID-19, these were their only presenting symptoms.   Ongoing retrospective and post-mortem studies promise to shed light on the systemic damage and the possible long-term impact to the hearing and balance mechanism. Additionally, there have been reports of sudden onset hearing loss, recorded outer hair cell damage, and self-reports of hearing loss and tinnitus post hospitalization.  To further complicate these cases, some of the medications utilized to treat the more severe presentations are known to have an ototoxic effects. 

One thing we noticed initially was how imperative it became to include COVID-19 exposure, length of infection, treatments and any on-going symptoms in our patient case history.  As the year progressed, we made a number of adjustments and even added completely new processes to the clinical and operational protocols within our practice. 

These are some of the more significant adjustments we have made in our clinics:

• Patient attestation of health status and questions about personal travel both domestic and internationally at the time of making the appointment
• Patient attestation of health status and temperature checks prior to checking into the office waiting room.
• Curbside check-in for those patients that are more comfortable waiting in the car until the time of the appointment or until notified by the office staff that the provider is ready to see the patient.
• Limited seating for patients inside waiting room for social distancing
• Switched patient chairs in waiting room that can hold up under the continued disinfecting process between every patient.
• Providing proper and complete PPE to protect our clinical staff based on interaction with the patient, i.e., sneeze guards on the check-in desk, KN95 masks, face guards, safety goggles, and consistent glove use for all patient contacts.
• Enhanced and created new care delivery channels to accommodate patients that were not comfortable with in-person appointments.  These delivery channels allowed all patients to access care with in both the ENT and Audiology Departments while remaining aligned with state or personal social distancing guidelines.  New patient care delivery channels included telemedicine, e-visits, remote programming, curbside care and phone consults.
• Digital outreach to hearing aid users for accessory offerings to assist in better communication for: (1) those who felt isolated at home and needed to more easily communicate with family, friends and medical providers and (2) patients who were in a work from home scenario and found they needed additional assistance.
• Implemented e-visit program for established audiology patients that allowed them to connect to our practice through a secure web interface to communicate the status of their medical condition to our providers.  This new care channel continues to allow us to serve patients quickly and in a number of cases, without the need for an in-person appointment.  
• Case history expansion and audiological monitoring plan for those with reported COVID-19 exposure and history.
• Developed clinical process to track patients for monitoring of long-term impact on auditory system post-COVID.

COVID-19 has heightened our need to have candid conversations about any weakness in the patient journey throughout our practice.  It will continue to drive efforts for consistent quality improvement, the formalization of processes and to avidly work on communication gaps between providers, physicians and all staff members within a multi-specialty practice. It’s a good reminder that even the worst of experiences can often be the catalysts of innovation, improvement and betterment – and we see it every day within our teams and in our patient outcomes.

During the Florida Combined Otolaryngology Meeting in November 2020, I presented a short literature review that covered some of the COVID-19 research related hearing loss and tinnitus.  You can find that video on the MedAudPro YouTube Channel HERE!

Since then, there have been additional studies published by Science Daily & Ear, Nose & Throat Journal, along with many others. These studies continue to reference acute symptoms of hearing loss and tinnitus.  There have been a number of compilation articles published that provide excellent at-a-glance reviews for clinicians that need a broad understanding of what to look for but don’t have time and resources to do the research.  Here is a good overview in Healthy Hearing published in December 2020.

Let us know how your clinic is managing new COVID clinical and operational practices!  Join the conversation www.facebook.com/groups/medaudpro

A Tale as Old as Time.

How many times have you seen a patient that told you they went to the ER because they lost their hearing?  Had a change in hearing? Or were dizzy?  When they finally arrive at your ENT practice, and you ask what was wrong, they report they had a middle ear infection.  However, after the round of antibiotics and decongestants, they still feel like their hearing isn’t any better, so they thought they would follow up with the ENT physician. The majority of time, the patient has already waited several weeks or months before they decided to come in for the appointment. When they arrive, the ENT completes a simple TFT and finds immediately that the loss is most likely not conductive in nature.

So, it makes you think, are there other medical providers that could provide better patient care if they knew how to perform a TFT? 

In talking with a number of our otologists and general ENT providers, it’s a common frustration.  Many voiced that if ER providers had performed a simple TFT, they would have made a different diagnosis! They could have treated the patient for sudden sensorineural hearing loss, referred them more urgently and the likelihood of the patient regaining some, if not all, of their hearing would had been a greater possibility. 

So, let’s think about it from inside our own house – within the ENT practice. What is the benefit of the ENT physician and other providers doing a TFT when they have audiology available to them and they indeed intend to order an audiological workup?

I recently sat down with our neuro-otologist, Mark Widick, MD, FACS and posed the question: 

“What are the benefits of performing a TFT when you have an audiogram in front of you?”

” When I was at Vanderbilt, all the audiologists did TFTs as part of their workup. The TFT would help them understand if they might have a conductive component prior to starting the testing. It helped them pick what ear to begin in, sometimes what test to start with and also sometimes they would ask different or more detailed questions. Would this not help you have more confidence in your results, especially when they are not necessarily following the pattern of hearing loss that you expected to see?

As a physician, it allows me to confirm that what I see on the audiogram is consistent with what I am hearing from the patient and finding during my TFT testing. I’m looking for consistency for diagnosis and treatment plan.

By using multiple placement sites for a Weber; forehead, mastoid, and front incisors, typically with a 512 Hz tuning fork, you can again see the consistency or inconsistencies between the placements, which when dealing with bilateral conductive hearing loss with possible masking dilemmas, gives you added confidence!

Many times, the TFT will be the final confirmation for which ear I consider performing surgery on first, in the case of bilateral involvement, i.e., typically selecting the ear with the best bone line that I see on the audiogram and again has been confirmed with the TFT. 

Sometimes the things we do are more for the patient than for us providers. Many times, the patient has an ah-ha moment when I put a tuning fork on the mastoid or teeth and an ear that the patient considered “dead” or “of no use” all of the sudden can “hear”. This helps open them up to different treatment options, where they may have not been in a place where they would had truly considered them without the experience.”

As we continued our conversation, Dr. Widick asked me to put myself in his shoes, the shoes of the surgeon, and it quickly gave me insight into why they SHOULD be validating the audiogram.  If I was the surgeon, and there was a simple way to back up the results of the audiometric battery, which can reveal conflicting results particularly when there is disease, I would feel it was my responsibility to do so.  Also, as providers, we want our patients to trust that we are aligned as a team and working toward the most positive outcome possible. 

Ultimately, the physician performing the TFT had nothing to do with his trust in my ability as an audiologist nor was it a dispute that the TFT was a more scientific approach to the assessment and diagnosis of hearing loss.  More holistically, as a physician that is getting ready to take a patient into surgery, it was about knowing that he did everything to confirm that the results were aligned, and the procedure was truly indicated. 

Not every patient will need a TFT; however, for many it may be the final piece of the puzzle that confirms results and assures the provider that their medical or surgical treatment plan is the best path for the patient.  

A big thank you to Dr. Mark Widick for his time and insight.  Check out the “Under the Microscope” presentation for great information and discussion of the TFT.

About Mark H. Widick, MD, FACS

Dr. Mark H. Widick graduated from the University of Florida School of Medicine in Gainesville, FL in 1987. He completed his general surgical residency and otolaryngology residency at Vanderbilt University and completed a fellowship in Otology and Neurotology under Dr. Michael Glasscock at The Otology Group. Dr. Widick is Board Certified by the American Board of Otolaryngology.

Dr. Widick has served as President of the EAR Foundation of Florida and Delegate to the Board of Governors at the American Academy of Otolaryngology – Head and Neck Surgery.

He is actively involved with the American Academy of Otolaryngology – Head and Neck Surgery, the Florida Medical Association and the Palm Beach County Medical Society. He is currently the President of the Florida Society of Otolaryngology – Head and Neck Surgery. Dr. Widick has lectured at numerous conferences and has published in several medical journals. He has also served on the faculty of Vanderbilt University as a Clinical Instructor in the Department of Otolaryngology.

Read Dr. Mark Widick’s Bio