The State of the State of Audiology: Focusing on Preventing Hearing Loss and Falls

The vast majority of Americans born since 1999 have had their hearing screened at birth. From these screening results, audiologists focus their efforts on the approximately 10% who fail the follow-up diagnostic testing. My question is: What happens to the 90% of babies who are born normal hearing? Do we recommend hearing protection as part of our newborn hearing screening processes? What happens to our focus on their hearing and balance as they age? Do we care? Collectively, we seem to lose interest in individuals between the ages of three months and 70 years. We seem solely interested in treating the condition or disorder rather than preventing its existence in the first place.

There have been attempts over the years to focus on protection and prevention. Curtis Alcock and Dangerous Decibels, ?for example, tried desperately to change the narrative and the language we use.? Both had interest and traction for a while.? After a few years though, most audiologists went back to focus their practices solely on the tried and true: treatment of hearing loss and aids.? They were not ready to play the long game and establish life long relationships centered around screenings, hearing protection and auditory rehabilitation.

This is where a boatload of unmet need exists, as every human on earth needs education, resources, and products solely geared to hearing protection, hearing loss and tinnitus prevention and mitigating falls. There are people who want and need our help; we just have to consistently provide it.? Prevention is not a focus because we have never made it a priority. We need to teach AuD students of its value from the outset of their audiology journey and make it a common feature in continuing education offerings.

All of our marketing activities, community and physician outreach, and websites need to focus on hearing loss prevention, hearing protection and falls risk. We need to pass out branded foam ear plugs like candy (literally, earplug bowls should sit next to candy bowls in offices). We need to have videos available on hearing protection, hearing loss prevention and mitigating falls. We need to show up at health and community fairs, children music and band events and classes, concerts, fireworks, shooting ranges, motorcycle and farming events (literally around any noisy activity or event) armed with earplugs and business cards with QR codes focusing on the value of protecting your hearing. This is about marketing awareness of the value of hearing and hearing care.

A few years ago, I was at Railbird in Lexington, KY and there was a booth and vendors walking around selling hearing protection and touting its value. It was awesome to see. I even bought some to support them.? We need audiologists at every event like this. ?

Hearing screening does not have to be acoustic! You can screen someone’s hearing or communication with a pencil and paper screening, such as the Hearing Handicap Inventory – Screening (HHI-S) (this is how people are typically screened in the Welcome to Medicare examination). If you work in a health system or medical office, you could have every patient over 50 screened with an HHI-S as part of their intake paperwork (as you need to be able to hear effectively to actively participate in your own healthcare). You can measure their risk of hearing loss or falls with a self-made questionnaire. ?If you want an acoustic screening, you could also links have self-assessment screening tools or apps on your website or have self-screeners readily available in your offices or lobbies (great for the person accompanying the patient). Screening needs to be more common.? Everyone does not need to start with a diagnostic evaluation. Screening is where most disciplines begin their evaluative processes.

If the patient is a falls risk (fallen two or more times in the past year or once with an injury that required medical attention) , we should screen them using tools like the Timed Get Up and Go, Tinetti, or Berg (among many others). Balance is a hallmark of our comprehensive scope of practice.? I see many audiologists market the link between falls and untreated hearing loss but don’t as frequently see those same audiologists screening for falls risk or focusing on reducing falls by other means. Home falls risk assessment is also an unmet need in many communities. You can establish a relationships with other audiologists (if you do not provide comprehensive assessment), a local otolaryngologist, neurologist, or physical therapist to refer these patients to for additional assessment or support and to expand your referral relationships.

Every plan of care for every patient should recommend hearing protection and, for many, falls risk mitigation. It should be mentioned in every physician and patient report. This is something I focused on in my training on documentation and report writing when I taught in an AuD program and what I continue to teach in my boot camps. We need to make every stakeholder aware of the importance of hearing loss prevention, hearing protection, and falls risk mitigation. We need to normalize the value and the value of audiology in the process. This is part of what makes an audiologist an audiologist; are unique training and skillset prepare us to spearhead these initiatives.

Your office could be stocked with hearing protection products, such as Etymotic plugs or other options you have tested and are comfortable recommending. You should have muffs available for children (again, that you recommend). You should have your own custom ear protection that you wear to community events.? Your children and families should also wear ear protection when appropriate.? You can’t expect your patients and community to wear what you don’t wear and model yourself. I cannot tell you how many referrals I have made over the years because people saw my Sensaphonics custom hearing protection (mine are red and blue glitter and make shows sound better) or AirPod sleeves (one of the best purchases I have ever made and something I am always asked about when I take them out to speak to people). ?Did you know that there are custom snore plugs (another must have purchase)? Audiologists should be ALL things hearing and balance, not just hearing aids.

Industrial audiology is also a very viable way to expand the reach and revenues of an audiology practice while helping to mitigate occupational hearing loss. So are school screenings. In many communities, there is a significant need for audiologists to engage in these types of programs. This also affords you an opportunity not only to screen, but to educate.? It also might lead to referrals to your practice for other services.

The vast majority of hearing loss prevention, hearing protection, and falls risk related items and services are not covered by insurance and can be provided private pay. Industrial audiology and school screenings are typically paid by the employer or school on a per person, hourly or daily rate you negotiate with the entity.

If you are unfamiliar with hearing loss prevention or protection, especially as it relates to at risk populations, there are training opportunities available.? I strongly recommend the following training opportunities:

• Sensaphonics Gold Circle Music Audiology Class
• CAOHC Hearing Conservation Course

So many unmet needs and resulting opportunities exist in hearing care.? Prevention is one of them. These items and services can be operationalized and monetized.? We just have to begin to move beyond hearing aids and begin to focus on the comprehensive practice of audiology to top of license and top of scope.

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