Tele-audiometry – a KUDUwave solution

There has been an exponential increase in the number of COVID-19 cases worldwide. As a result, the disease has been declared a Public Health Emergency of International Concern and a pandemic, causing many countries to go into lockdown in order to prevent and control the disease. Health practitioners around the globe are faced with challenges on how to continue serving patients during the lockdown. Many governments have released a list of essential health services to ensure free movement of healthcare providers in order to allow health services to continue. The World Health Organization emphasised that health services must continue even in the midst of this pandemic. Bones are still broken, patients still have dysphagia, people still need life-saving treatments, and mental health conditions still need attention. 

Many healthcare practitioners are faced with a moral dilemma on how to contribute to the national requests of self-isolation and social distancing and to be able to continue providing services to their patients. 

As a result, various health professional bodies have permitted and outlined telemedicine guidelines to allow for practitioners to access their patients. In an attempt to assist hearing healthcare practitioners, this document outlines specifically how to use the KUDUwave audiometer for tele-audiometry purposes. 

Now, more than ever, technology keeps us connected, allows us to purchase goods and to provide services to our patients. 

Before we get into the technicalities, there are a few articles you might need to read to supplement this current one. See below.

  1. How to Successfully plan for a Tele Audiology Practice
  2. The Right Tools For TeleAudiology
  3. How to Implement Tele-Audiology in your Practice

Some of the basic foundations of tele-audiometry is task shifting and automated audiometry

Task-shifting is the assignment of tasks to less qualified healthcare personnel. More specifically, it is the identification and assignment of tasks to a facilitator or technician to perform. Task-shifting is mostly implemented in areas where there aren’t enough specialised healthcare providers. Specific to audiology, task-shifting and automation (the basis of tele-audiometry) enable hearing healthcare professionals to train less qualified health workers (i.e. home-based carers) to conduct and facilitate audiometry services without hearing healthcare professionals being physically present. While audiometric assessments are paramount, it is not always possible for the audiologist to be physically present. In this case, the facilitator can apply the principles of tele-audiology to provide the services. 

Tele-health is not new nor groundbreaking. However, in this article, we will cover the equipment technicalities and solutions – focusing specifically on automation and task-shifting. This article is divided into two sections: section one will outline various conditions in which you can apply tele-audiometry and section two will cover the KUDUwave software and how clinicians can incorporate it into tele-audiology practices. Before we delve into it, it is imperative to note that the KUDUwave has been validated as an accurate audiometer in the provision of tele-audiometry services. The longest distance that the KUDUwave has been used to provide tele-audiometry services is between North America and South Africa. See one of the articles here

Tele-audiometry conditions with the KUDUwave

Audiologists and other hearing healthcare providers across the globe are faced with different challenges. Resultantly, how tele-audiometry services are provided will vary from one clinician to another. There are three main principles or methods of delivering tele-audiometry services, namely: synchronous, asynchronous and hybrid. The below conditions will cover how one can provide tele-audiometry services using the principles in various cases. 

1.

Because of the shortage of Audiologists across the globe and specifically in developing parts of the world, many Audiologists provide services in more than one area – thanks to portable, automated and increased passive attenuation audiometers like the KUDUwave. This may not always be feasible during the national lockdown or for many reasons that are specific to the clinician. 


In such cases, synchronous (Live and in Real-Time) tele-audiometry can be utilised. This requires active internet connectivity for both the KUDUwave PC and the PC used to control the KUDUwave remotely. The patient is assisted by a technician or a facilitator in order to set-them up for testing (attaching the KUDUwave to them). The audiologist then joins the consultation via live video streaming and conducts the test via a remote computer control software like TeamViewer. Note that this is exactly like a normal face-to-face consultation, except it is through technology. This allows both the clinician and their patients not to be bound by their location.

Tele-audiometry – a KUDUwave solution

 

2.

Many areas do not have a stable internet connection or may not have an audiologist to attend to patients immediately. In such cases, asynchronous tele-audiometry can be utilized to deliver audiometry services. This method may also be used to assess many patients at a time. Again, the patient has access to the service and they will be assisted by an allocated facilitator or by themself*. 

The test can be conducted by the trained assistant and the results are sent to the audiologist either via email, cloud-based storage or similar. 

Alternatively, automated audiometry can be employed, and results from tested patients can be sent to the audiologist at the end of the day (the second tele-audiometry with the KUDUwave will show you how to do this). This may also be deployed through self-application. A KUDUwave can be placed in a centralised location (i.e. pharmacy) and the patient can apply the KUDUwave on themselves following the instructions on the screen. It is paramount that instructions are given to the patients to disinfect the KUDUwave after use, otherwise a dedicated community member should be employed to ensure that disinfection processes are being carried out. After the test, the results will be saved for later review and follow-up by the clinician. See image example below.

Tele-audiometry – a KUDUwave solution

 

It is important to note that the accuracy of the test results through tele-audiology depend heavily on the equipment used. It is STILL important to ensure that your device can attenuate ambient noise sufficiently to ensure accurate diagnostic results. As mentioned earlier, it is also key to ensure that your equipment has been validated as a medical device to provide audiometry through telehealth. 

Procedures to provide via Telehealth with the KUDUwave

*Both screening and diagnostic services. 

  1. Medical history
  2. Pure tone audiometry [air and bone conduction]
    1. This includes occupational health services
  3. Speech audiometry [SRT, Word Recognition, CAPD, Speech-In-Noise etc]
  4. Immittance audiometry [Tympanometry and Ipsi- & Contra acoustic reflexes]

Tele-audiometry with the KUDUwave 

Many are familiar with the KUDUwave software. Below is a description of how easy it is to incorporate it into tele-audiometry services. Although there are many desktop sharing and remote control softwares, this article will use TeamViewer as an example. 

Please note that tone threshold and immittance audiometry with the KUDUwave can be operated in either manual or automated mode. The use of a desktop sharing software such as TeamViewer does not change the user interface nor the software interaction of the KUDUwave. 

  1. In order to use the TeamViewer application, download and install the application from their website onto both the PC which will be used to plug and run the KUDUwave (in the field) and your home/ office PC. 
  2. Once installed, open the application on both the PC’s and use the given ID and password on the KUDUwave computer to gain access to it through the PC that you have on you.



  3. TeamViewer will give you full control of the KUDUwave software and PC allowing you to assess patients from anywhere in the world. If you have more than one KUDUwave on the field, TeamViewer will require you to purchase a commercial license in order to have access to more than one PC at once. 


  4. While running the KUDUwave test, you can view both the facilitator and the patient or the patient alone by arranging the TeamViewer application (KUDUwave test screen) and Skype/ Google Hangouts on your PC to the dimension of your choice.




In cases where your home/ office PC screen is small, it might be difficult to visualize both the KUDUwave test screen and the patient through TeamViewer. In such cases, WhatsApp may be used and placed next to the KUDUwave PC to allow you to visualize the patient during the assessment.

Audiometry data storage

For efficient and effective tele-audiometry implementation and execution the filing and data management system needs to be systematically efficient. Two things: Your audiometer needs to have a folder management system known as electronic medical records, and a secure data storage. The KUDUwave provides the perfect solution. 

  • Folder management with the KUDUwave. With the KUDUwave software, you can create as many folders as you need. These folders make patient profile storage and retrieval efficient. The clinician can organize their patients into area names or centre served, and further by grouping them into sub-folders such as their diagnosis, plan of action or age group. See the image below. 

Data can also be grouped by data of consultation, or better yet, whether patients have been billed or not. 

  • Secure data storage, backup and restore with the KUDUwave. Patient records are a sensitive business. The KUDUwave allows you to store patient data on the software, this data is encrypted, thus it can only be viewed with the software. With that being said, it is good practice to always backup your data, preferably in the cloud because anything can happen to your PC and hard drive. Ever heard of Murphy’s Law?

    When running tele-audiometry services, especially asynchronously, you will need to send the data from the KUDUwave PC to the audiologist. The KUDUwave allows you to synchronize data on all your PCs (and the PC that you will be using remotely). As an alternative, the facilitator in the field can backup the data on the cloud, and the audiologist can download the data at the end of the day and restore the backup to their PC to view the data and manage patients appropriately. Please read how to backup and restore data with the KUDUwave here


Conclusions

The need for comprehensive diagnostic audiometry has always exceeded the current hearing healthcare resources. Today more than ever, hearing healthcare professionals are faced with challenges on how to provide services while ensuring that the pandemic is under control. The KUDUwave opens up access possibilities for delivering hearing healthcare services through tele-audiometry.

We, as hearing healthcare professionals, need to capitalize on such technological advancements and developments to be able to continue providing services. We need to think outside the box, literally, rethinking current methods of delivering audiological services. Ultimately, the goal is to provide quality services to our people and the KUDUwave has been researched and certified to be a perfect solution.