validation of audiological measures via telepractice for ...€¦ · validation of audiological...
TRANSCRIPT
![Page 1: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/1.jpg)
Validation of Audiological Measures Via Telepractice for Cochlear
Implants
Michelle L. Hughes, Ph.D., CCC-A Coordinator, CI Program Director, CI Research Lab
Boys Town National Research Hospital, Omaha, NE
ACIA 2013, Washington D.C.
![Page 2: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/2.jpg)
Outline
• Why the interest in telepractice for CI recipients?
• Summary of existing validation studies (audiology)
• Description of barriers that remain
![Page 3: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/3.jpg)
Outline
• Why the interest in telepractice for CI recipients?
• Summary of existing validation studies (audiology)
• Description of barriers that remain
![Page 4: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/4.jpg)
Why Telepractice for CIs?
• Numerous visits required post-implant – Audiology/Programming:
• 6-8 visits in first year • 1-2 visits yearly thereafter • Additional visits for problems or upgrades
– Speech/language/listening therapy: • Number of sessions depends on recipient needs & resources
– Medical follow-up: • Typically just one visit prior to IS; more if complications
![Page 5: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/5.jpg)
Why Telepractice for CIs?
• Limited access to specialized services
![Page 6: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/6.jpg)
Why Telepractice for CIs?
• Limited access to specialized services
Omaha: 3 CI centers
7-hr drive
![Page 7: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/7.jpg)
Why Telepractice for CIs?
• Options:
1. Make numerous long-distance trips – Monetary costs (travel, meals, missed work) – Time costs (missed work, school)
![Page 8: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/8.jpg)
Why Telepractice for CIs?
• Options:
1. Make numerous long-distance trips – Monetary costs – Time costs
2. Forego services – Suboptimal performance – Device nonuse
![Page 9: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/9.jpg)
Why Telepractice for CIs?
• Options:
1. Make numerous long-distance trips – Monetary costs – Time costs
2. Forego services – Suboptimal performance – Device nonuse
3. Remote access to follow-up services
![Page 10: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/10.jpg)
Why Telepractice for CIs?
• Potential benefits of remote services:
– For the recipient: • Less time lost from work/school • Reduced travel expenses • More immediate access to specialized services
– For the clinic: • Fewer cancelled appointments (e.g.,
inclement weather, insufficient travel time)
Photo courtesy of MED-EL
![Page 11: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/11.jpg)
Outline
• Why the interest in telepractice for CI recipients?
• Summary of existing validation studies (audiology)
• Description of barriers that remain
![Page 12: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/12.jpg)
Existing Studies
• Most have focused on comparing map levels in adult recipients for in-person versus remote programming:
– Ramos et al. (2009) – McElveen et al. (2010) – Wesarg et al. (2010) – Hughes et al. (2012)
![Page 13: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/13.jpg)
Existing Studies
• Ramos et al. (2009) Methods:
– 5 AB recipients, split-half design – Mapping done either in person or remotely – Main outcome measures:
1) M-levels 2) ECAP thresholds 3) SF thresholds 4) Open-set words
Las Palmas
![Page 14: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/14.jpg)
Existing Studies
• Ramos et al. (2009) Results (in-person versus remote):
1) M-levels not significantly different 2) ECAP thresholds “similar” (no statistics reported) 3) Average SF thresholds not significantly different 4) Open-set word scores not significantly different
![Page 15: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/15.jpg)
Existing Studies
• Ramos et al. (2009) Limitations:
– SF thresholds and speech perception conducted in traditional in-person setting
• OK for assessing validity of remote maps • Doesn’t solve the problem of validating these assessments
for remote use
![Page 16: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/16.jpg)
Existing Studies
• McElveen et al. (2010) Methods:
– 2 groups of adult Nucleus recipients • 7 mapped in person (Raleigh, NC) • 7 (1 teenager) mapped remotely (Greenville, SC) • Similar durations of deafness between groups
– Main outcome measures: • SF thresholds • HINT, CNC
![Page 17: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/17.jpg)
Existing Studies
• McElveen et al. (2010) Results:
1) SF thresholds significantly lower for remote group 2) HINT and CNC scores not significantly different
between groups
![Page 18: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/18.jpg)
Existing Studies
• McElveen et al. (2010) Limitations:
– Not a within-subjects comparison – Groups not matched; small N – Speech perception and SF thresholds appear to have
been conducted locally for each group (not explicitly described)
• Can’t parse out map effects versus environment/tester effects
![Page 19: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/19.jpg)
Existing Studies
• Wesarg et al. (2010) Methods:
– 57 adult, 13 pediatric Nucleus recipients (1-72 years old; 4 centers)
– 1 remote and 1 in-person visit within 2 days (split-half design)
– Main outcome measures: • T and C levels (adjusted from pre-study baseline map)
![Page 20: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/20.jpg)
Existing Studies
• Wesarg et al. (2010) Results:
– T and C levels not significantly different for in-person versus remote.
![Page 21: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/21.jpg)
Existing Studies
• Wesarg et al. (2010) Limitations:
– No details regarding age, duration of CI use, programming methods for the 13 pediatric subjects tested.
![Page 22: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/22.jpg)
Existing Studies
• Hughes et al. (2012) Methods:
– 29 subjects (14 AB, 15 Cochlear) – 3 remote sites – 1 remote and 2 in-person visits within 2 weeks (ABA
design) – Each outcome measure repeated twice/visit
![Page 23: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/23.jpg)
Existing Studies
• Hughes et al. (2012)
Methods, continued:
– Main outcome measures: 1) Electrode impedance 2) ECAP thresholds (clinical & research software) 3) Psychophysical thresholds (3IFC; research software) 4) T and M/C-levels 5) Speech perception (CNC, HINT, BKB-SIN)
![Page 24: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/24.jpg)
Existing Studies
• Hughes et al. (2012)
Methods, continued:
– Speech perception methods differed from other studies:
• Others: Speech perception used to measure remote maps; testing done in traditional setting
• Ours: Used daily map (not remote map) • Ours: Tested in realistic remote environments (hospital,
universities with no sound booth)
![Page 25: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/25.jpg)
Session Demonstration • Speech Perception Testing (2 CNC, 1 HINT, 1 BKB-SIN)
![Page 26: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/26.jpg)
Existing Studies
• Hughes et al. (2012) Results (in-person versus remote):
1) Impedance not significantly different 2) ECAP thresholds not significantly different 3) Psychophysical thresholds not significantly different 4) T, C, M levels not significantly different 5) Speech perception significantly poorer for remote
![Page 27: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/27.jpg)
CNC PHONEMESCNC WORDS
Perc
ent C
orre
ct
0
20
40
60
80
100Measure 1Measure 2
Visit 1 Visit 2 Visit 3
N = 29
Visit 1 Visit 2 Visit 3
CNC Words & Phonemes
• Significant effect of visit: remote site poorer – Words: ~14% lower for visit 2 (p<0.0001) – Phonemes: ~10% lower for visit 2 (p<0.001)
*2-way RM MANOVA
![Page 28: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/28.jpg)
HINT (QUIET)
Perc
ent C
orre
ct
0
20
40
60
80
100
Visit 1 Visit 2 Visit 3
BKB-SIN
Sign
al-to
-Noi
se R
atio
(dB
)
0
5
10
15
20
25 Measure 1Measure 2
Visit 1 Visit 2 Visit 3
N = 29
HINT Sentences (Quiet) & BKB-SIN
• Significant effect of visit: remote site poorer – HINT: ~19% lower for visit 2 (p<0.001) – BKB-SIN: ~3.1 dB poorer for visit 2 (p<0.001)
*2-way RM MANOVA
![Page 29: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/29.jpg)
Existing Studies
• Goehring et al. (2012)
Aim:
– Examine effects of test environment (booth, office) and remote technology (Polycom, hybrid system) on speech perception in CIs
– Total of 4 listening conditions
![Page 30: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/30.jpg)
Existing Studies
• Goehring et al. (2012)
Methods:
– 16 recipients (12 adult, 4 older pediatric; age 12-87 years)
– 3 tests: • CNC • HINT (quiet) • BKB-SIN
![Page 31: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/31.jpg)
Existing Studies
• Goehring et al. (2012)
Methods:
– Polycom system: • Used in Hughes et al. (2012) • Transmits recorded speech
stimuli from tester’s computer to speaker at recipient site
![Page 32: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/32.jpg)
Existing Studies
• Goehring et al. (2012)
Methods:
– Hybrid system: • Examiner remotely
controls presentation of stimuli that reside on computer at recipient site (eliminates compression, bandwidth, transmission effects)
Examiner
Subject
![Page 33: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/33.jpg)
Existing Studies
• Goehring et al. (2012)
Results:
– Speech in quiet: • Booth significantly
better than office • No effect of
presentation system
HINTPe
rcen
t Cor
rect
0
20
40
60
80
100
Office Sound Booth
**
CNC Words
Perc
ent C
orre
ct0
20
40
60
80
100CNC Phonemes
Perc
ent C
orre
ct
0
20
40
60
80
100
PVCHPS
N = 16
**
**
Polycom Hybrid
![Page 34: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/34.jpg)
Existing Studies
• Goehring et al. (2012)
Results:
– Speech in noise: • Polycom poorer than
Hybrid in the office only
poorer
better
BKB-SIN
Sign
al-to
-Noi
se R
atio
(dB
)0
5
10
15
20
PVCHPS
Office Sound Booth
*
N = 16
Polycom Hybrid
![Page 35: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/35.jpg)
Existing Studies
• Goehring et al. (2012)
Conclusions:
– For speech in quiet, test environment is main factor.
– For speech in noise, combination of environment and test system affect results. Hybrid system better for noisy/reverberant environments.
![Page 36: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/36.jpg)
Questionnaire Results
• Ramos et al (2009):
– 2/12 remote sessions experienced overstimulation (0 for in-person)
– 4/12 remote sessions judged as too long (0 for in-person)
– All 12 remote sessions satisfied with results of remote programming
![Page 37: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/37.jpg)
Questionnaire Results
• Wesarg et al (2010):
– 62% able to communicate effectively via remote – 78% were comfortable interacting via distance
technology – 93% judged duration of session acceptable – 83% judged remote fitting as efficient alternative – 22% afraid of negative influence on relationship with
audiologist
![Page 38: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/38.jpg)
Questionnaire Results
• Hughes et al (2012):
– Travel expense to remote site better – Subjects did not feel overwhelmed by the
technology – Room at remote site poorer (noisier, harder to hear) – How often would you take advantage of remote
option for clinic or research: “sometimes”
![Page 39: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/39.jpg)
Examination Time
• Ramos et al. (2009): Remote session averaged 1 min longer (20 vs. 21 minutes)
• McElveen et al. (2010): “No substantial difference in time commitment”
• Wesarg et al. (2010): Remote visit 10 or more minutes longer for 53% of audiologists
• Hughes et al. (2012): Remote visit averaged 12 mins longer (excluding connection time)
![Page 40: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/40.jpg)
Summary
• Electrode-specific measures made via remote testing are comparable to those made face-to-face.
• Generally acceptable to patients.
• Remote sessions may take slightly longer. • Poorer speech perception in remote condition.
![Page 41: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/41.jpg)
Outline
• Why the interest in telepractice for CI recipients?
• Summary of existing validation studies (audiology)
• Description of barriers that remain
![Page 42: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/42.jpg)
Next Steps
• Issues not specifically related to audiology:
– Multi-state licensure/reciprocity – Reimbursement – Technological access (areas/homes without high-
speed internet, computers, etc.)
![Page 43: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/43.jpg)
Next Steps
• Need to empirically validate use of remote technology for all services that are typically provided for patients of all ages.
Photos courtesy of MED-EL
![Page 44: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/44.jpg)
Next Steps
• Some remaining areas:
1) Troubleshooting equipment • Ample supply of spare parts needed at remote site • Other specialized tests?
Images courtesy of Advanced Bionics
![Page 45: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/45.jpg)
Next Steps
• Some remaining areas:
2) Pediatric mapping & testing • Mapping procedures differ from adults (CPA, BOA) • Speech perception materials and procedures differ
![Page 46: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/46.jpg)
Next Steps
• Some remaining areas:
3) Sound-field threshold testing • Used to verify map settings • Sound booth needed
![Page 47: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/47.jpg)
Next Steps
• Some remaining areas:
4) Adult aural rehabilitation • Children typically have better access (EI, IFSP, IEP) • Adult AR services not routine • If provided, typically just auditory training (computer-
based listening exercises) • Counseling/coaching component is very important and
often omitted
![Page 48: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/48.jpg)
Next Steps
• Some remaining areas:
5) Solutions for improving speech perception test results if no sound booth available • Acoustic treatments to test rooms • Correction factors based on noise, reverberation? • Direct-connect testing
![Page 49: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/49.jpg)
Bottom Line
• We’ve come a long way, but still have more work to do to expand access to specialized services for cochlear implant recipients
![Page 50: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/50.jpg)
References
Hughes ML, Goehring JL, Baudhuin JL, et al. (2012). Use of telehealth for research and clinical measures in cochlear implant recipients: A validation study. J Sp Lang Hear Res, 55, 1112-1127.
McElveen JT, Blackburn EL, Green Jr. D, et al. (2010). Remote programming of cochlear implants: A telecommunications model. Otol Neurotol, 31, 1035-1040.
Ramos A, Rodriguez C, Martinez-Beneyto P, et al. (2009). Use of telemedicine in the remote programming of cochlear implants. Acta Oto-Laryngol, 129, 533-540.
Wesarg T, Wasowski A, Skarzynski H, et al. (2010). Remote fitting in Nucleus cochlear implant recipients. Acta Oto-Laryngol, 130, 1379-1388.
![Page 51: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/51.jpg)
Acknowledgements
Funding: NIH, NIDCD R01 009595-01A1S1 and P30 DC 04662
![Page 52: Validation of Audiological Measures Via Telepractice for ...€¦ · Validation of Audiological Measures Via Telepractice for Cochlear Implants Michelle L. Hughes, Ph.D., CCC-A Coordinator,](https://reader033.vdocument.in/reader033/viewer/2022050103/5f41e088efdea56af8288a6b/html5/thumbnails/52.jpg)
THANK YOU FOR YOUR ATTENTION!