5 Key Considerations When Choosing Your Tele-Audiology Equipment

Tele-audiology is the utilization of electronic information and telecommunication technologies to deliver audiological services to remote and distant clinics. Although the implementation of tele-audiology services is straightforward, the provision and the extent of tele-audiology services relies heavily on the equipment being used. This paper will outline key considerations when choosing your tele-audiology equipment. 

A take-home-message: Not all audiological equipment is created equally. 

Ambient noise attenuation

Ambient noise attenuation is the key to accurate and reliable audiometric assessments. Ambient noise attenuation refers to the reduction of noise or sound in a testing environment. By removing or suppressing the background noise during testing, we ensure that the patient can hear and respond to presented tones without interference. It is an accepted fact that ambient noise may potentially elevate the patient hearing thresholds during testing – resulting in inaccurate test results. In remote and inaccessible areas that often do not have access to audiological services, tele-audiology generally utilises mobile audiometry systems to reach patients. As a result, a sound-treated booth is not needed in the majority of cases. Supra-aural and circumaural earphones attenuate very little ambient noise, as they are designed for use in sound-treated booths. As a result, these earphones may not be able to attenuate noise sufficiently to warrant accurate and reliable hearing evaluations outside of a sound booth – such as required for  tele-audiology services. 

The graph below shows the attenuation of commonly known headsets and sound booths – including the KUDUwave™. Although one can note that common supra-aural and circumaural earphones attenuate higher frequencies better, it is known that low frequency noise is common background noise in various environments. When purchasing tele-audiology equipment, it is crucial to ensure that your equipment can sufficiently attenuate ambient noise to allow for accurate and reliable test results.

Comprehensive audiological test battery

Tele-audiology services do not equate to lower quality services. The idea of providing services with a limited test battery may prove detrimental to many patients. When procuring tele-audiology equipment it is important to ensure that it provides you, and specifically your patients, with the full test battery to allow for diagnostic audiological services. It goes without saying that otoscopic examination, air and bone conduction, as well as immittance audiometry are key in ensuring accurate diagnosis and differentiating between diagnosis. 

However, having a comprehensive test battery for tele-audiology has its own challenges, such as having the facilitator travel with multiple devices and accessories that provide different evaluation capabilities. This can prove to be problematic. The novel KUDUwave™ TMP allows for pure tone (air and bone conduction), speech and immittance audiometry, all with one device . This allows for the quick and easy, all-in-one, implementation of tele-audiology services. 

Tele-audiology enabled 

Many audiometric devices cannot be incorporated into tele-audiology services. For effective and efficient implementation of tele-audiology, the equipment should be computer-based (or tablet-based/ mobile-based etc). This allows the audiologist or clinician to control the testing, provide treatment and management plans, as well as share results and recommendations with both the patient and the facilitator. This is difficult to do with a traditional audiometer due to the restrictive nature of the devices. 

The KUDUwave is a computer-based audiometer that can be incorporated into tele-audiology services. With the KUDUwave, one can implement asynchronous, synchronous, or hybrid tele-audiology principles. The asynchronous model can be used as the KUDUwave’s automated audiometry has been validated to yield accurate and reliable audiometric results. With the synchronous model,  third party desktop-control software ,such as TeamViewer, can be used to control the KUDUwave audiometer at the patient testing site. 

Integration with NOAH

Tele-audiology services have extended from screening, to diagnostic testing, and now include management of hearing-related disorders. 

Most audiologists today use NOAH in their clinics. Ensuring that your tele-audiology equipment integrates with the NOAH module will allow for seamless implementation of hearing-aid fitting and adjustment in your tele-audiology practice, instead of having different software for each test or management of the patient. The NOAH module also allows for an all-in-one information system, ensuring that your audiological results are saved in one place. 

The KUDUwave integrates seamlessly with NOAH, allowing for an all-in-one tele-audiology solution. One can easily import KUDUwave EMR data into the NOAH system.

Quality Control

No transducer or sound-treated booth is noise proof. As a result, much louder noise can penetrate through the transducer or booth that is used to attenuate environmental noise. Audiologists are experts in subjectively monitoring noise. Once noise is assumed to be loud, the tester should stop testing, wait for the noise to dissipate,or control the noise, before continuing to test. This speciality may prove difficult to acquire with facilitators and audiometric technicians during tele-audiology services. As a result, it is paramount that the tele-audiology equipment utilised has the necessary, and validated, measures to monitor and alert the off-site facilitator and the audiologist when ambient noise is excessive at a particular frequency. 

The KUDUwave has this capability. Utilising the two validated as accurate microphones on each side of the earcups, they measure and actively monitor the ambient noise levels during testing. The software then alerts the tester should the environmental noise surpass what the KUDUwave can attenuate at a specific frequency. This measure is useful in any implementable tele-audiology principle. During automated testing, the KUDUwave noise monitoring system pauses the test each time noise is excessive, and only tests that particular frequency once the noise has stopped. The KUDUwave noise monitoring system is frequency specific, therefore, if noise is persistent at a certain frequency, then the automated testing will continue at frequencies in which noise is not present, and test the affected frequency once completed with the frequencies not affected. 

The last but important quality check is patient response reliability. Audiologists are trained to monitor and observe patient body language and response patterns in order to ensure that their responses are reliable. This skill takes time to acquire and perfect. As a result, when purchasing tele-audiology equipment, ensure that it can monitor patient responses for both manual and automated audiometry objectively. This way, one can be certain that hearing thresholds assessed remotely are accurate and reliable. 

The KUDUwave has a patient response monitoring system. The equipment counts the amount of times the response button is clicked during a hearing test and automatically determines which of the clicks are false positive or true positive responses. This is where a response button is of a significant advantage, compared to having your patient raise their hand during audiometry testing. Patient response statistics does all the work for you. As the tester, your job will be analyzing the response data and making an informed decision on whether to accept the patient thresholds or to retest. 

Conclusion

It is important that we do not associate tele-audiology services with decreased services or lack of quality. Patients can still be given the best audiological care with systems such as the KUDUwave™. Ensuring accurate and reliable comprehensive diagnostic services and appropriate management of hearing-related disorders to our patients.