Interventional Audiology: Moving from Concept to Clinical Practice
17 May 2017 (online)
Since the advent of the audiology profession following World War II, the delivery of hearing care has remained relatively static. Almost without exception audiologists wait in their clinic for patients to present with a problem or symptom that causes them to schedule an appointment for an assessment. Depending on your setting—medical or retail—“the wait” comes in two forms: audiologists employed in medical (ear, nose, and throat) settings standby, waiting to conduct auditory assessments and hearing aid evaluations on patients referred from a physician. At the same time, retail-oriented private practice audiologists, who usually do not have the luxury of an integrated referral source, wait for their marketing efforts—which almost always center on promoting the latest and greatest hearing aid technological innovation—to bear fruit. Until recently, this passive approach to delivering hearing care services has been acceptable. Now, however, as consumers become more sophisticated shoppers of health care and various advocacy groups and governmental agencies recognize an unmet need for hearing care services among some populations, it is imperative for audiologists to identify new approaches to delivering services.
Today, like Rip van Winkle, audiologists wake up to find some shocking changes. Hearing aids have become commodified and could soon be sold over the counter; additionally, direct-to-consumer, computer-based audiometry enables nonaudiologists to conduct a complete hearing assessment—all while a growing number of audiologists find themselves employed at big-box stores and other retail chains. The evolution of the professional landscape may seem like a dystopian nightmare to many experienced audiologists, but it is reality: Changes in consumer behavior, improvements in technology, increased competition and looming deregulation of hearing aids require audiologists to rethink their contribution to health care and the patients they serve.
You did not have to be asleep for more than 20 years to hear the rising clamor of consumer-driven health care. This hubbub has not only disrupted audiology, but the larger health care arena is undergoing its own big changes. Consumers, along with third-party payers, are demanding health care become more accessible, lower in cost, and higher in quality. The recently published National Academy of Sciences, Engineering and Medicine report Hearing Health Care for Adults: Priorities for Improving Access and Affordability  attests to these facts. Their report, comprised of 12 recommendations for the profession and the public that it serves, reflects how the general debate about health care in the United States is affecting audiology. We find ourselves in an era in which the profession of audiology is defined not by the products we dispense but by what consumers want.
So, what exactly do consumers of hearing-related services want? As we debate this question, a group of ambitious, forward-thinking clinicians have been dabbling with some innovative approaches to improving the accessibility of hearing care. Fitting under the rubric interventional audiology, these clinicians are demonstrating that the practice of audiology does not have to be confined to the test booth. Rather than passively waiting for patients to arrive at their clinics, these pioneers in interventional audiology look at hearing loss in the broader context of its relationship to other medical conditions and strive to bring their services to where communication breakdowns occur, and thus often have a dramatic impact on broader health care outcomes. Places such as dementia care facilities, hospital-based outpatient clinics and community centers are the focus of these activities.
To be clear, interventional health care is not new. Interventional radiology and cardiology have been in existence for more than 25 years. Regardless of the specific medical subspecialty, interventional health care specialties aim to identify and treat problems inside the body in the least invasive manner or to deliver innovative treatments exactly where needed most. As you read this issue of Seminars in Hearing, you will encounter a few clinicians who have applied an interventional approach to their practice. Whether it is using community health workers to improve the accessibility of care, or the use of personal sound amplification products to get amplification on the ears of individuals in critical interactions with a physician, interventional audiology means recognizing hearing loss is neither the individual's nor the other health care provider's primary concern.
Interventional audiology, moreover, requires audiologists to take a collaborative approach with other health care and social service providers to provide practical solutions to those with hearing challenges. In some cases, audiologists will be stretched to broaden their scope of practice to provide services to individuals with normal hearing. That some of these solutions might require us to get out into the community, or to hand off some of the direct care to entry-level professionals, forces us to respect the context of how we provide care by recognizing that every patient does not need to be fitted with hearing aids in the clinic.
As successful entrepreneurs know, opportunities can be found at the edges of existing business models. For entrepreneurial audiologists, who want to be successful in the era of consumer-driven health care, this means creating and implementing programs that address the needs of individuals at the margins: populations with communication challenges, until now underserved by audiologists, and groups such as the “older old” (defined as individuals aged 85 and older) and adults who struggle with their hearing in specific listening situations but, for whatever reason, fail to acknowledge they have a hearing problem. These are two large swaths of individuals that could potentially benefit from novel approaches to intervention from audiologists. As audiologists move away from their binary world of a one-size-fits-all-approach of dispensing hearing aids to those who find their way to the clinic, this issue is a template for putting interventional audiology into practice. Unlike the meek Rip Van Winkle, who wandered off into the woods and fell asleep for 20 years to avoid his wife's nagging, allowing his farm to fall into disarray, audiologists must be assertive about how they build the practice of the future. We cannot afford to fall asleep while technological progress and changing consumer demands pass us by.
- 1 The National Academy of Sciences, Engineering, and Medicine. Hearing Health Care for Adults: Priorities for Improving Access and Affordability. Washington, DC: The National Academies Press; 2016
- 2 Taylor B, Tysoe B. Interventional audiology: partnering with physicians to deliver integrative and preventive hearing care. Hearing Rev 2013; 20 (12) 16-22
- 3 Palmer C Interventional audiology: when is it time to move out of the booth? AudiologyOnline, Article 15226. September 2015. Available at: http://www.audiologyonline.com/articles/interventional-audiology-when-it-time-15226 . Accessed March 31, 2017
- 4 Taylor B. Interventional audiology. Semin Hear 2016; 37 (2) 120-136
- 5 Taylor B 20Q: Interventional audiology—changing the way we deliver care. AudiologyOnline, Article 17080. May 2016. Available at: http://www.audiologyonline.com/articles/20q-interventional-audiology-17080 . Accessed March 31, 2017