Aug 2020 The Hearing Journal

Could cochlear implant (CI) candidacy be evaluated remotely? It may be feasible, says a pilot study published in Otolaryngology–Head and Neck Surgery. Testing 13 subjects (eight with normal hearing and five with hearing loss), researchers from the University of Kentucky College of Medicine compared results of CI evaluations done in person and via teleaudiology to determine the accuracy and viability of remote evaluations using standardised consonant-nucleus-consonant (CNC) and Arizona Biological Test (AzBio) testing protocols. They found a mean (SD) difference of 1.7 percent (2.06%) in the participants’ AzBio scores between each method. They also found similar pure tone average, speech reception threshold, and word recognition scores between the two methods. CNC testing showed a mean (SD) difference of 6.8 percent (10.2%) between in-person and teleaudiology methods. “It appears that [a telemedicine approach] is feasible to perform with the current technology,” the study authors concluded, albeit noting that “CNC testing may have a higher than acceptable variability between methods and should be examined more closely.”

The study was conducted amid a shortage of access to CI specialists, said corresponding author Matthew L. Bush, MD, PhD. At present, it offers an optimistic outlook in audiology, with COVID-19 restrictions hampering access to specialised services. “Many patients with hearing loss have limited access to specialists who could provide counselling and/or testing to determine their candidacy for CIs. How can we expand our reach to patients who would benefit from CIs?”, Bush said. “So, we asked the following research question: Can we remotely, yet reliably and accurately, perform the audiological testing necessary for evaluation for cochlear implantation?”

In particular, the study saw a potential for telemedicine to connect CI specialists with patients in remote rural locations.The researchers conducted the in-person tests in the best-aided condition with +5 signal-to-noise ratio. Meanwhile, the telemedicine tests used an OTOSphere comprehensive audiology setup with a Polycom 500 series teleconferencing system for live audio and video.

After seeing minimal differences between the in-person and teleaudiology test scores (less than five percent in most tests), the authors concluded that this technology “could be used to extend the reach of an implant center to more rural areas and improve the access to hearing health care.”

Bush said that while their study “demonstrates that it is feasible to conduct accurate and consistent complex audiological testing remotely,” the set-up they used “was expensive, cumbersome, and subject to technological limitations. The main challenges were primarily technological as the telemedicine cart placed in front of research participants needed to be controlled remotely and securely by the audiologist,” he explained. “That means the software has to operate behind the IT security firewall. Each software update to any aspect of the telemedicine cart would typically result in long conversations and troubleshooting with the IT staff. Remote testing can be complicated by ambient noise and the need for soundproof testing environments,” Bush added. And since the tests were done in the audio booth, he noted the importance of integrating real-world factors into testing to accurately predict CI candidacy.

To Bush, their study's limitations can be overcome in subsequent researches. “The key to moving forward is not replication of this exact set-up but rather innovation in developing and testing software and hardware that patients have access to in order to assess candidacy for cochlear implantation,” he said. “I would love to see my colleagues in this field take the bulky tele-medicine cart we used in this study and put that same high-fidelity audiological testing technology into a tablet or smartphone. It is our responsibility, as leaders in hearing health care, to innovate and ‘think outside the box (and the audio booth)’ as to how we can reach patients safely and consistently.”

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