The “Aud” Future of Technology: A Double-Edged Sword
By Janet Kim, Winner of the 2016 Isabel Richard Student Paper Award (Below Doctoral Category)
Please note that this paper appears in its original form, in the language in which it was submitted; we have not edited it for style or grammar.
At the turn of the century fifteen years ago, it would have been difficult to imagine the changes in the landscape of technology today. Pocket-sized smartphones boast faster speeds and larger disk spaces than computers of yesteryear. Clouds have replaced compact disks, Global Positioning Satellite devices have replaced maps, and driverless cars are on the horizon. In the world of audiology, hearing technology offers more comfort, clarity, and individualized sound amplification than ever before. Whilst it is challenging to predict with accuracy how technology will evolve, it is clear that changes will occur at an astounding pace and influence the delivery of hearing healthcare. There are three spheres through which innovation will impact practice in the field: developments within the microcosm of audiology, on a broad technological level, and at the intersection of the two. Positive changes to the field will depend on how effectively practitioners are able to learn and adapt to the evolving technology on these three levels. In addition to exploring the possible positive and negative impacts within each sphere, this paper aims to provide guidance on equipping audiology trainees and practitioners with the skill set to mobilize technological changes. This will ensure that the leading edge of the field is shaped in a strategic manner so as to provide the best possible patient care.
Within the past ten years, hearing technology has advanced faster than it ever has. The earliest hearing devices were not readily accepted because the technology at the time did little more than amplify sound. They were also bulky and physically unappealing. Modern hearing devices are far more sophisticated, drawing upon digital technology to provide an improved listening experience with algorithms that enhance speech, minimize feedback, and reduce background noise. Newer designs are more comfortable and can be virtually invisible to others. In tandem, improvements in diagnostic equipment and fitting methods allow audiologists to tailor increasingly personalized prescriptions for patients. These advances are consequently benefitting patient satisfaction and adherence vis-à-vis their hearing devices (Kochkin, 2010). Whilst being optimistic about these continued progressions, one important risk that should be addressed is that of increasing complexity. Practitioners should be cognizant of the time and cost associated with implementing better diagnostic tools and personalizing hearing devices. For instance, is it worth spending more time for a slightly improved hearing aid fit and sound quality? An ethical question arises of whether the extra time required for each assessment or fitting appointment will incrementally reduce the overall number of patients an audiologist is able to see. In a society where there is approximately five audiologists per 100,000 Canadians on average (SAC, 2013b), a slight variation to practices can have significant downstream effects.
Another domain that can influence the practice of audiology on a large scale is that of global communications technology. The capacity to videoconference with someone across the world has given birth to the field of teleaudiology. By enabling an audiologist to evaluate and treat patients through a virtual consultation, technology could grant access to hearing care for patients that were previously limited by factors ranging from a lack of a nearby clinic, to physical ailments, or agoraphobia. Although teleaudiology could expand access to care to a vast number of patients, it brings the challenge that patients may be required to manage the physical benefits provided through a clinic themselves. A possibility of harm is introduced when services such as hearing aid adjustments are completed by someone other than a trained expert. A thorough exploration using a risk-benefit analysis would be critical before harnessing such powerful technologies for use by audiologists.
In addition to enabling virtual consultations, communication technology through the internet has enabled the evolution of video hosting services, such as YouTube and TED. These forums make it possible for ideas and information to be stored online where they can be accessed by multitudes of viewers. For a field such as audiology that is still in its youth, dissemination of its principles and services to the general public would improve access to care by raising awareness. More than one million adults across Canada reported having a hearing-related disability (StatsCan, 2002) and would benefit from seeing an audiologist. An important target population in which to raise awareness is the primary care physician – the gatekeeper of the healthcare system. In this vein, an award winning video was developed by the author of this paper in collaboration with classmates to reach out to physicians and guide their understanding of audiology to facilitate referrals (https://www.youtube.com/watch?v=6dBeDTBnHw0). However, audiologists must be wary of the spread of misinformation through these channels of communication. The challenges faced by the medical field in dealing with anti-vaccination groups evidences how media can seize and rapidly distribute misleading information. A similar difficulty was faced recently by audiologists following a report on the prices of hearing aids from CBC (Moore, 2013; Murphy, 2013) that was not of the highest journalistic caliber. This segment had a negative impact on the public’s view of the profession (SAC, 2013a), and potentially, the hearing health of many Canadians.
As separate technologies within communications and audiology evolve, they begin to intersect and give rise to an interface that enables patients to interact with their hearing devices. New smartphone applications are emerging that attempt to provide rudimentary hearing assessments, and others that allow users to modify the settings on their hearing devices. Empowering people to take initiative and responsibility for their hearing health through technology is a sensible concept. A study in diabetic patients demonstrated an improvement in glycemic control with the use of a smartphone application used to track glucose levels (Kirwan, 2013). Applications that flag clinically significant hearing loss may prompt individuals to seek the care they need. Using one’s smartphone to fine-tune the setting on a hearing device may prevent an unnecessary clinic visit and simultaneously improve patient satisfaction with their device. On the other hand, a false negative result from a smartphone hearing assessment can have devastating results on an individual’s hearing status. An incorrect adjustment to their hearing device could also lead to long-term damage. Audiologists go through rigorous training to be able to understand and problem-solve issues safely. Mobilized correctly, technology may be able to help streamline the role of the hearing professional.
Since audiologists are healthcare professionals, it is an expectation that one stays on top of advances within the field by attending conferences, following literature updates, and engaging with their professional network. These venues will help inform practitioners of the latest developments within the microcosm of audiology. A unique set of skills are required to remain informed and achieve competency in the changes occurring outside of the field as well. A simple yet effective strategy of engaging with patients is a practical approach to learn how they interface with technology. Open-ended questions during appointments enquiring how they combine other technologies with their hearing care can simultaneously build rapport and provide insight. Furthermore, there is value in developing mobile applications that update audiologists on latest developments, as they are currently lacking, if at all existent. With the ability to effortlessly carry mobile devices throughout the day, such an application would benefit not only audiologists but also patients in the management of their hearing healthcare. Being aware of evolving technology is helpful to an audiologist interested in sustaining excellence of practice, but maintaining competency in these domains is also crucial for those who wish to be pioneers in the field.
The principles of life-long learning are important to instill in trainees to provide the means for remaining a student whilst out in practice as a professional. A Canadian pioneered concept of Problem-Based Learning (PBL) has been adopted by medical schools in response to the exponentially growing knowledge base in medicine; impossible to cover in a curriculum. PBL is designed to help students “learn how to learn” by identifying learning resources, group collaboration, and concept integration (Ngeow, 2001). Incorporating principles of PBL into the audiology curriculum with a focus on technology, future generations of students will have formal skill development in identifying what they need to know, and strategizing how to go about learning it. This will help ensure that audiologists are at the leading edge of incorporating technology into the field.
As audiology emerges from its youth and takes a place alongside other healthcare specialties, technological advancement presents a double-edged sword – ripening the field with both opportunities and challenges. Confucius has been credited with saying, “Success depends upon previous preparation, and without such preparation there is sure to be failure.” It is important for trainees and practitioners alike to stay abreast of the latest advances, and develop the skills necessary to be able to direct the influence exerted on the practice of audiology. Like fire, new developments in technology can spread wildly if left unchecked to damage the quality of care that a hearing expert can provide. If new technology is harnessed in a thoughtful and strategic manner, it can continue to fuel the remarkable trajectory of the field.
References
Kirwan, M., Vandelanotte, C., Fenning, A., and Duncan, M.J. (2013). Diabetes self-management smartphone application for adults with type 1 diabetes: randomized controlled trial. J. Med. Internet. Res., 13:15(11), 53-66.
Kochkin, S. (2010). MarkeTrak VIII: Consumer satisfaction with hearing aids is slowly increasing. The Hearing Journal, 63(1), 19-27.
Moore, H. (2013, February 7). Hearing aid subsidies vary in Canada, fall short in Manitoba. CBC News. Retrieved from http://www.cbc.ca/news/canada/manitoba/hearing-aid-subsidies-vary-in-canada-fall-short-in-manitoba-1.1367191
Murphy, B. (2013, February 7). Hearing aids out of reach for many seniors. CBC News. Retrieved from http://www.cbc.ca/informationmorningns/2013/02/07/hearing-aids-out-of-reach-for-many-seniors/
Ngeow, K., and Kong, Y.S. (2001). Learning To Learn: Preparing Teachers and Students for Problem-Based Learning. (ERIC Digest D163). ERIC Clearinghouse on Reading, English, and Communication, Indiana University, IN. Retrieved from ERIC database. (ED457524)
Speech-Language and Audiology Canada (SAC). (2013a). The Value of Hearing Aids. Retrieved from http://us4.campaign-archive2.com/?u=702bf2bc76b4efd8d465b76e9&id=9edf8cd27e
Speech-Language and Audiology Canada (SAC). (2013b). Speech-language pathologists and audiologists per 100,000 people in Canada [Fact sheet]. Retrieved from http://sac-oac.ca/sites/default/files/resources/Stats%20Map%20Canada_EN.pdf
Statistics Canada (2002). Participation and Activity Limitation Survey: A profile of disability in Canada. Retrieved from the Statistics Canada website http://www.statcan.gc.ca/daily-quotidien/021203/dq021203a-eng.htm
Janet Kim, M.Sc. Audiology
Winner of the 2016 Isabel Richard Student Paper Award (Below Doctoral Level)
McMaster University
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