Put Hearing Loss Prevention Into Practice

May 2019

Vickie Tuten

Why consider integrating hearing loss prevention into your existing audiology practice? One argument for doing so is that nearly every patient you see has some potential for risk of hearing loss from recreational noise exposure.

The Centers for Disease Control and Prevention (CDC) stated some conclusions following analysis of the most recent (2011–2012) data collected in the National Health and Nutrition Examination Survey (National Center for Health Statistics, 2017):

• After aging, noise exposure is the second most common cause of acquired hearing loss.
• Noise exposure is associated with numerous adverse health effects, and reducing noise exposure is likely to improve health.
• Avoiding exposure to loud environments and the effective use of personal hearing protection devices have been shown to prevent hearing loss. (CDC, 2017)

The CDC (2017) went on to suggest the following:

• Hearing screenings can reduce delays in diagnosis and improve access to hearing aids for those with hearing loss, thus improving health-related quality of life (yet, only 46% of adults who had trouble hearing had seen a health care professional for the problem in the past 5 years).
• During office visits, primary care providers can screen patients' hearing, ask about their hearing concerns and any noise exposures, inform patients about the benefits of maintaining good hearing health, and counsel and refer as appropriate.

Audiology Standard of Care

The World Health Organization (WHO)—in one of the principles within their Constitution—defines health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity" (World Health Organization, 2006, p. 1).

The definition of audiology as stated in the Oxford English Dictionary is "the branch of science and medicine concerned with the sense of hearing" (2019). This rather broad definition suggests that concerns about hearing should exist across a broad spectrum and include the prevention and mitigation of hearing loss, the evaluation of hearing function and related disorders, and the subsequent rehabilitation of hearing impairment and problems related to hearing. 

ASHA defines audiologists as "healthcare professionals who provide patient-centered care in the prevention, identification, diagnosis, and evidence-based treatment of hearing, balance, and other related disorders for people of all ages." (ASHA, n.d.). Prevention is also detailed in Preferred Practice Patterns for the Profession of Audiology (ASHA, 2006).

Despite the mention of prevention in ASHA's definition and in the Preferred Practice Patterns document, based on the ASHA Audiology Survey Summary Report [PDF] (2018), more than 70% of surveyed audiologists report providing little or no hearing conservation services. Promoting prevention should not be relegated solely to audiologists practicing in industrial/occupational audiology settings. Whether we work in private practice, hospitals, schools, or any other setting, we should promote healthy hearing behaviors with all of our patients to support their physical, social, emotional, and mental well-being. This should be a standard of care regardless of work setting or reimbursement issues. A conversation should occur not only at every face-to-face encounter with our patients but also through proactive community engagement and outreach.

Benefits of Hearing Loss Prevention Efforts

The benefits of hearing loss prevention efforts are as follows:

• From a public health standpoint, empowering patients to engage in healthier hearing habits can help mitigate preventable hearing loss.
• Counseling individuals on hearing loss prevention sends the message to your patients that you care about them and are invested in their overall well-being. Caring about your patients establishes a trust factor that may help patients obtain treatment they need but are hesitant to accept.

A Prevention Model

The audiology profession could look to the dental profession as a model to emulate. In addition to routine exams and cleanings, dentists perform treatment and restoration. At routine dental appointments, the dentist and hygienist discuss with patients how to care for their dental health and prevent future problems. Patients leave with information and strategies they can use. What if every patient who interacts with an audiologist leaves with an increased awareness of the risks of noise-induced hearing loss, information about strategies to prevent this preventable hearing loss, and earplugs or hearing protection that they can and will use?

Tips to Integrate Prevention Into Your Practice

Here are some ideas for integrating prevention into your work setting.

1. If you have a waiting room area, position framed posters visible to patients that promote the importance of good hearing and communication to one's quality of life. Other messaging could include risks for health conditions associated with hearing loss and the importance of early intervention to mitigate those risks. Make sure that the messaging is appropriate to the ages seen in your setting. For instance, if you have younger patients, posters that talk about loud music may be appropriate. If aural rehabilitation services are a part of your practice, promoting the importance of hearing and communication will enforce that moving quickly to intervention is important to one's quality of life. There are several websites (e.g., CDC, Noisy Planet, Hearing Center of Excellence, and the websites of many hearing protection manufacturers) that offer free, downloadable posters. Even better, with the capabilities of modern software applications, it can be relatively easy to create your own educational presentations and posters.
2. Moving individuals to change is best accomplished by reaching them at an emotional level. Consider a video in your waiting room that is short and plays on a loop. There are some professional videos available for purchase and for free on YouTube that discuss hearing loss prevention, but these are largely occupationally focused. Consider creating a more personalized video, offering testimonials from your patients or their family members, or record a video of yourself relaying a heartfelt message that speaks to the importance of hearing, how to identify hearing loss risks, and how and when to use prevention strategies.
3. Most clinicians, when they take case histories, gather information about noise exposure. This information should become part of every case history because noise exposure is a population health risk and an occupational issue that crosses the lifespan. Information gleaned during the case history may be helpful in guiding your discussion about prevention recommendations with patients.
4. Most clinicians provide the patient with information about test results and discuss a plan of action. This is the time to talk with your patient about hearing loss prevention. If a patient comes in complaining of a possible noise exposure, spending more time with that patient is warranted. But, regardless of a patient's age or reason for their visit, even a few minutes of discussion about the risks of unprotected exposures to loud sounds and strategies to minimize the risk would be beneficial. The amount of time can vary depending on the patient and what was revealed in the case history. Discuss possible noise hazards that they may encounter and when to know if something is too loud. A simple rule is that if you have to raise your voice to be understood by someone standing approximately 3 feet away from you, the noise level is likely hazardous. There are many free sound-level meter apps that can be downloaded and will indicate the actual decibel level of your environment. Provide practical strategies to your patients—strategies such as moving away from the noise, turning down the volume, or using hearing protection.
5. Consider sending your patient home with inexpensive reusable hearing protection (earplugs) that you have shown them how to insert properly. Encourage them to use hearing protection whenever they find themselves in an environment where they cannot use strategies like walking away or turning down the volume.
6. In addition to these suggestions, there are ways to engage others within the medical community or your community at large. Consider speaking about hearing screening with other medical providers who see patients more frequently (e.g., family practitioners, pediatricians, internists). They will learn a little more about patients' hearing status and can potentially refer patients to you for further assessment.

Community engagement can be another channel to bring patients into your practice who may not be identified otherwise. Boothless technology—that is, conducting screenings outside of the sound booth—may be offered at health fairs or other events. Something as simple as dispensing inexpensive hearing protection at these events can send the message that you are someone who cares about individuals' well-being. If they should end up seeking out the services of an audiologist, they will remember where they first learned about hearing health—from you!

Revenue sources related to prevention may also include providing choices in more specialized hearing protection such as custom products, musician earplugs, hunter/shooter earplugs, and so forth. If you establish a reputation for promoting hearing loss prevention, you may consider working as a consultant for industrial clients.

Conclusion

The ability to communicate and interact with the world around us most definitely affects one's well-being. The benefits of integrating prevention into audiology practice, and empowering patients to take a vested interest in their hearing health, can (and, we hope, will) result in the desired outcome of improving individuals' overall well-being throughout their lifespan. Audiologists have a moral and ethical obligation to offer the full spectrum of care. Preventing or mitigating hearing loss in our patients and communities, when within our power to do so, should not be viewed as optional.

About the Author

Vickie Tuten, AuD, CCC-A, C/PS, has more than 35 years of experience as an audiologist in both the Department of Defense and the civilian sector. She started out as an occupational audiologist prior to commissioning in the Army as a uniformed audiologist, where she served as hearing program manager at several large installations, worked as a staff officer in the Office of the Surgeon General, and served as director of the Otolaryngology Technician Program at the Medical Education and Training Campus. She served as branch chief, Prevention and Surveillance, for the Department of Defense Hearing Center of Excellence. She is recently semi-retired and instructs an occasional hearing technician course approved by the Council for Accreditation in Occupational Hearing Conservation (CAOHC). 

Dr. Tuten received her AuD from Central Michigan University. She is currently the coordinator of ASHA Special Interest Group 8 (Audiology and Public Health) and is past president of the National Hearing Conservation Association. She holds certification as a CAOHC Course Director and Professional Supervisor. She can be reached at Vickie.tuten@yahoo.com.

References

American Speech-Language Hearing Association. (n.d.). Audiology frequently asked questions. Retrieved from www.asha.org/aud/faq_aud/#definition.

American Speech-Language-Hearing Association. (2006). Preferred practice patterns for the profession of audiology. Retrieved from www.asha.org/policy/PP2006-00274/#sec1.4.1.

American Speech-Language-Hearing Association. (2018). 2018 Audiology Survey: Survey summary report. Retrieved from www.asha.org/siteassets/uploadedfiles/2018-Audiology-Survey-Summary-Report.pdf [PDF].

Audiology. (n.d.). In Oxford English Dictionary. Retrieved from https://en.oxforddictionaries.com/definition/us/audiology.

Centers for Disease Control and Prevention. (2017, February 10). Vital signs: Noise-Induced Hearing Loss Among Adults—United States 2011 – 2012.Morbidity and Mortality Weekly Report, 66(5), 139–144 Retrieved from https://www.cdc.gov/mmwr/volumes/66/wr/mm6605e3.htm.

Carroll, Y. I., Eichwald, J., Scinicariello, F., & … Breysse, P. (2017) Vital Signs: Noise-Induced Hearing Loss Among Adults — United States 2011–2012. Morbidity and Mortality Weekly Report, 66(5), 139–144, U.S. Centers for Disease Control and Prevention. doi: http://dx.doi.org/10.15585/mmwr.mm6605e3.

World Health Organization. (2006). Constitution of the World Health Organization. Retrieved from https://www.who.int/governance/eb/who_constitution_en.pdf [PDF].