Tinnitus Management and Telehealth: A Personal Journey to Innovation in Audiology

My Trajectory to Tinnitus Care

As an AuD student who envisioned a traditional career path, I anticipated a routine filled with hearing assessments and hearing aid services, with tinnitus cases interspersed. Early in my career in audiology, it was very much like what I envisioned. However, the rapid advancements in audiology over the last decade have dramatically altered my professional trajectory. Tinnitus care has evolved from a peripheral role to a central focus in my practice, presenting exceptional opportunities for patient care. I now offer excellent patient care opportunities and require continuous learning, strategic planning, and the willingness to embrace risks. This shift necessitated a commitment to ongoing education, strategic foresight, and an openness to embracing new challenges.

My interest in tinnitus began during my time as an AuD student, when I was captivated by the intricate connection between our auditory and neurological systems. This fascination led me to specialize in tinnitus, recognizing that its assessment and treatment required more than a cursory understanding—it necessitated comprehensive education, hands-on experience, and interdisciplinary collaboration. My education at Salus University, coupled with clinical rotations at the Philadelphia Department of Veterans Affairs Medical Center and my time with Dr. Gail Brenner and her practice, the Tinnitus Treatment Center of Philadelphia, provided a solid foundation to begin my path of expertise in this area.

Tinnitus Care and Tele-Audiology

In 2015, I opened my first practice with a clear focus on tinnitus management, recognizing the need for updated practices and services in my community. Living in Alaska, where distance poses a significant barrier to health care, I identified the urgent need for accessible audiology services. With more than half of U.S. counties lacking an audiologist (Goman et al, 2017; Planey, 2019), tele-audiology (Gans, 2024) emerged as a solution to bridge the accessibility gap (Institute of Medicine, 2012). Despite the absence of prior experience in this domain, I was determined to develop a tele-audiology program that adhered to state licensure laws, Health Insurance Portability and Accountability Act regulations, and cyber-security measures (Dykstra, 2021).

My initial time in telehealth began with remote hearing aid adjustments for patients living far from me or in other urban centers. This initiative evolved into a comprehensive remote-care model, replicating most in-office services, including diagnostic testing. The expansion of tele-audiology services led to a focus on tinnitus consultations and management, addressing the need that existed locally.

Residing in Alaska, I quickly recognized the critical need for reachable audiology services. With a substantial number of U.S. counties devoid of an audiologist (Planey, 2019), tele-audiology surfaced as a viable solution earlier than in more populated areas of the United States. Despite lacking previous experience in this field, I was resolute in establishing a tele-audiology program, particularly for individuals who did not have direct access to audiology services. However, I did not want to completely abandon in-person appointments, so I set up field clinics across the western United States to provide fitting services in person. This allows me to continue the level of best practices I strive for in all of my patient journeys.

Models of Telehealth Service Delivery

Telehealth care delivery is diverse, encompassing various models that cater to different patient needs and health-care system requirements. An expanded look at each model is as follows (Kim et al, 2021; American Academy of Family Physicians, 2022; Wallace, 2023):

Synchronous: This model involves direct audiovisual communication between the health-care provider and the patient, closely mirroring an in-person consultation. It allows for real-time interaction, immediate feedback, and the ability to assess visual cues and patient responses. Examples include live video conferencing for a diagnostic consultation.

Asynchronous: Also known as “store-and-forward,” this model involves the exchange of pre-recorded information, such as documents, images, messages, or advice intended for later review by the health-care provider. It does not require the simultaneous presence of both parties, thus providing flexibility. Asynchronous communication is particularly useful for follow-up questions or sharing test results.

Hybrid:This model combines synchronous and asynchronous methods. The hybrid model merges both face-to-face and virtual interactions to optimize patient care. For example, a patient might have an initial in-person visit followed by remote monitoring and virtual check-ins. This model provides a balanced approach, leveraging the benefits of both immediate and flexible communication.

Each model serves a unique purpose and can be utilized based on the preferences of the patient. By offering a range of service delivery models, telehealth can provide more accessible, efficient, and patient-centered care.

My practices, Alaska Hearing & Tinnitus Centers, thrive on the hybrid model of telehealth. The hybrid telehealth model is particularly effective because it combines the best of both worlds: the personal touch of face-to-face appointments and the convenience of telehealth. In the treatment of their tinnitus, many of my patients express their gratitude for the flexibility my clinic offers. They feel safe and supported even during vulnerable appointments. The benefits of providing both in-person and telehealth appointments include the following:

Building patient trust: In-person visits allow health-care providers to establish a rapport with patients, which is crucial for building trust. Face-to-face interactions enable providers to demonstrate empathy, understand patient concerns more deeply, and engage in nonverbal communication—all of which contribute to a stronger patient-provider relationship.

Enhanced communication:During an in-person visit, health-care providers can pick up on subtle cues that might be missed during a virtual consultation. This can lead to more accurate and personalized care plans. Moreover, patients may feel more comfortable discussing sensitive issues when they are in the same room as their provider.

Flexibility of telehealth: After the visit, the hybrid model allows for the flexibility of remote monitoring and virtual check-ins. This means patients can receive care from the comfort of their own homes, which is especially beneficial for those with mobility issues or those who live in remote areas.

Continuity of care: The hybrid model ensures continuity of care by allowing health-care providers to follow up with patients after the initial visit without requiring them to come back to the clinic. This can lead to better health outcomes as providers can track progress and adjust treatment plans as needed.

Efficient use of resources: By employing a hybrid approach, health-care systems can optimize their resources. In-person visits are reserved for initial assessments and situations where physical examination is necessary, whereas follow-up care can be managed virtually, reducing the need for patients to travel and wait in clinics.

Overall, the hybrid model of telehealth service delivery is a balanced approach that maximizes patient satisfaction and care quality while also offering the efficiency and accessibility of modern technology (Saliba et al, 2017). It caters to the diverse needs of patients and can be tailored to individual preferences and medical requirements.

Telehealth and the Pandemic

The onset of the COVID-19 pandemic further served as a catalyst for the rapid expansion of telehealth services, including tele-audiology (Kim et al, 2021). The need for social distancing and the reduction of in-person interactions accelerated the adoption of remote health-care delivery. This shift was impactful in audiology, where the demand for quality audiology care surged as patients sought services that were not readily available locally.

During the pandemic, my practice experienced a significant increase in the number of individuals with tinnitus reaching out for help. The feedback from these patients was invaluable; they expressed a need for a secure and comfortable environment that traditional clinical settings could not provide during such uncertain times. This led to the development of a strategic plan focused on delivering comprehensive tinnitus care through tele-audiology platforms.

The plan aimed to address several key aspects:

Accessibility: Ensuring that patients could receive high-quality tinnitus care regardless of their location.

Comfort: Creating a safe and trigger-free environment for patients, which is especially important for those with tinnitus who may be sensitive to new and unpredictable situations.

Education: Providing patients with the necessary information and resources to understand and manage their condition effectively.

Technology: Utilizing the latest tele-audiology tools to facilitate remote assessments, counseling, and treatment interventions.

The pandemic highlighted the critical need for audiologists who are not only trained in tinnitus management but also adept at using telehealth technologies. As a result, there has been a push for more comprehensive training programs that equip audiologists with the skills needed to provide remote care effectively, but not just for tinnitus!

The expansion of tele-audiology services has the potential to transform the landscape of audiology care, making it more accessible and patient-centered than ever before.

Expanding Tele-Audiology

For my practice and those who embraced telehealth, the pandemic has underscored the importance of tele-audiology in providing essential services to patients with tinnitus (American Academy of Family Physicians, 2022; Wallace, 2023). It has also emphasized the need for ongoing education and training for audiologists to ensure that they are prepared to meet the evolving demands of the field. The expansion of tele-audiology services has the potential to transform the landscape of audiology care, making it more accessible and patient-centered than ever before.

Over time, the expansion of telehealth services required me to obtain licensure in 11 states to provide tele-audiology services to a broader patient base. Remote appointments require stringent protocols to ensure patient safety and adherence to best practices. A hybrid approach, combining telemedicine with in-person visits, allows for the delivery of high-quality care while respecting the limitations of remote fittings.

For audiologists seeking to expand their expertise in tinnitus management, a multitude of advanced training opportunities are available. The American Academy of Audiology (2024) offers the Certificate Holder–Tinnitus Management (CH-TM) program, which is a comprehensive education program providing essential information for assessing and managing patients with tinnitus or decreased sound tolerance. This program is structured into two parts: the foundational principles of tinnitus management and the practical application of these principles in clinical settings. Telehealth innovations have also become integral to audiology practice, especially in the context of tinnitus management. The American Academy of Audiology (2022) has highlighted the role of tele-audiology in improving patient access to care, increasing follow-up rates, and reducing travel time and costs. The COVID-19 pandemic has underscored the importance of telehealth services, including tele-audiology, to provide essential services to patients while ensuring safety and reducing the need for in-person interactions. This has led to a rapid expansion of telehealth services and a greater emphasis on the need for audiologists to be trained in both tinnitus management and the use of telehealth technologies.

The field of audiology needs to experience a significant shift toward both advanced tinnitus management and the incorporation of telehealth services. Audiologists who are committed to continuous learning and adapting to new technologies will be well-positioned to meet the evolving demands of the profession and provide the highest quality of care to their patients. The expansion of tele-audiology services has the potential to transform the landscape of audiology care, making it more accessible and patient-centered than ever before. Our ability as audiologists to not only accept this change but also embrace it and master the art of telecare visits is crucial. Flexibility to meet our patient’s needs will continue to set us apart from over-the-counter products and hearing-health-care offices with poor follow-through or accessibility in their schedules. We need to continue discussing the broader implications of telehealth in audiology and its potential for future growth to provide a comprehensive view of the field’s evolution. Every office considering telemedical appointments needs to have a cybersecurity plan (Dykstra, 2021) in the same manner that we have safekeeping methods for in-person protected documents within our clinic walls.

Conclusion

My journey in tinnitus care and telehealth has expanded and will continue to grow as the importance of adaptability and innovation in audiology progress. By leveraging telemedicine, we can improve accessibility and patient satisfaction and extend our reach to underserved populations (Goman et al, 2017). As we continue to navigate the challenges of remote technology and patient care, our commitment to best practices and continuous learning will shape the future of audiology. 

References

American Academy of Audiology. (2022) The utilization of telehealth services. www.audiology.org/the-utilization-of-telehealth-services (accessed May 17, 2024).

American Academy of Audiology. (2024) CH-TM program information: Certificate Holder–Tinnitus Management (CH-TM). https://eaudiology.audiology.org/tinnitus(accessed May 17, 2024).

American Academy of Family Physicians. (2022) Telehealth and telemedicine. www.aafp.org/about/policies/all/telehealth-telemedicine.html (accessed May 17, 2024).

Dykstra J. (2021) Cybersecurity for telehealth. AudiologyOnline.   www.audiologyonline.com/articles/cybersecurity-for-telehealth-27829 (accessed May 17, 2024).

Gans J. (2024) Mindfulness based tinnitus stress reduction. https://mindfultinnitusrelief.com (accessed May 17, 2024).

Goman AM, Reed NS, Lin FR. (2017) Addressing estimated hearing loss in adults in 2060. JAMA Otolaryngol Head Neck Surg 143(7):733–734.

Institute of Medicine. (2012) The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary. Washington, DC: National Academies Press. www.ncbi.nlm.nih.gov/books/NBK207145 (accessed May 17, 2024).

Kim J, Jeon S, Kim D, Shin Y. (2021) A review of contemporary teleaudiology: literature review, technology, and considerations for practicing. J Audiol Otol 25(1):1–7.