Anna Marie Jilla

The demand for telehealth services will continue to grow alongside an increased need for audiology services among both children and adults. Insurance coverage policies for audiologic services are specific to each payer and vary widely in the level of coverage provided for both in-person and telehealth-based audiology services. While benefits for children are fairly comprehensive, coverage for audiology services for adults is generally poor. Traditional Medicare does not cover hearing aids or other rehabilitative audiologic services, and other payer policies vary widely. Lack of benefits for hearing and balance services is inconsistent with the evidence base and leaves many beneficiaries without access to meaningful care for hearing and balance disorders, which are highly prevalent among and disproportionately affect Medicare beneficiaries. The purpose of this article is to discuss regulatory and reimbursement considerations for telehealth provision in audiology and elucidate opportunities to influence related health policy at both state and federal levels.

The high prevalence of hearing loss among older adults creates a perception that it is simply a benign consequence of aging, which leads to unaddressed communication needs. Strategies to address hearing loss as part of routine clinical care are pertinent to the geriatric care setting where hearing loss is prevalent in two out of every three patients 70 years and older. Our objectives are to briefly discuss the pathophysiology of hearing loss, describe the epidemiologic prevalence and impact, identify statutory barriers facing older adults in accessing hearing care, discuss current progress on legislation to address accessibility issues, and provide actionable strategies for addressing hearing loss as a barrier to effective communication. Simple steps can be taken to improve hearing care accessibility for older adults with hearing loss and can optimize understanding in daily communication, re‐engage patients in being actively involved in their care, and promote patient autonomy in informed decision‐ making.

Substantial out-of-pocket costs for hearing aids constitute a barrier to hearing health care accessibility for older adults among whom prevalence of hearing loss is high. This study is the first to...

This issue of Seminars in Hearing has focused on the early intervention of adult sensorineural hearing loss (SNHL). Contributions to this monograph have taken a contemporary issues approach to the prevention, diagnosis, and treatment of mild SNHL. This article looks toward the future and discusses clinical and research implications for the early intervention of adult SNHL.

Limited accessibility to and affordability of hearing health care (HHC) and hearing aids (HAs) are two reasons why people do not seek treatment for their hearing losses. This article is the first in a series of two and discusses affordability issues (i.e., billing models, cost-effectiveness, insurance coverage, and reimbursement) related to and provides a historical context for the Over-the-Counter Hearing Aid Act of 2017. This piece of legislation supports development of a new class of over-the-counter HAs that represents a disruptive technology that may transform the HHC industry by reducing costs specific to the device. A discussion of ethical issues and the importance of using evidence-based practice guidelines set the stage for the second article in this series, which reviews relevant research on issues pertaining to persons with mild hearing loss.

Recently, President Trump signed into law the Food and Drug Administration (FDA) Reauthorization Act of 2017, which included the Over-the-Counter Hearing Aid Act designed to provide greater public accessibility to and affordability of amplification for individuals with self-identified mild and moderate hearing loss through the provision of over-the-counter (OTC) hearing aids (HAs) with a direct-to-consumer (DTC) delivery model. American Speech-Language-Hearing Association and American Academy of Audiology Position Statements on OTC HAs state that these devices should only be used for adults with mild hearing losses. DTC amplification and service delivery has been available to consumers in a variety of forms for a significant period of time. However, FDA-regulated OTC HAs will not be available as described in the new law until the FDA publishes the required guidance related to the technology, safety, and labeling of such devices. With the clear similarities in mind between present and future amplification options, a literature search was conducted to review studies assessing outcomes for low-cost and DTC HAs and service-delivery models to inform what we may expect as OTC HAs enter the market. Nine studies were identified which assessed: (1) electroacoustic capabilities of low-cost and DTC HAs, (2) use of these devices in field trials, or (3) efficacy of DTC models. None of the studies reported outcomes specifically for participants with mild hearing loss. The studies had poor external validity because none included all factors that would exist in realistic uses of OTC HAs within a DTC model. Additional research will be needed as OTC HAs become available and different delivery models are proposed.

Audiologists are an integral part of the management of those with dizziness and vestibular disorders. However, little research has been performed on counseling approaches for patients who present with dizziness as a primary concern. Accordingly, it is important that audiology students are provided with didactic and experiential learning opportunities for the assessment, diagnosis, and management of this population. Benign paroxysmal positional vertigo is the most common vestibular disorder among adults. Doctor of Audiology students, at a minimum, should be provided with learning opportunities for counseling patients with this particular disorder. Implementation of patient-centered counseling is applied across various parts of the patient encounter from initial intake to treatment and patient education. The purpose of this article is to present the available evidence and to apply widely accepted theories and techniques to counseling those with benign paroxysmal positional vertigo. Didactic resources and experiential learning activities are provided for use in coursework or as a supplement to clinical education.