An Integrative Hearing Healthcare Model Using Boothless Audiometry

Recorded On: 06/15/2021

An Integrative Hearing Healthcare Model using Boothless Audiometry

DATE: June 15, 2021, 1:00 - 2:00 PM ET

Presenters: Kathy E. Gates, AuD and Marjorie A.M. Grantham, PhD

Duration: 1 hour

CEUs: 0.1 AAA CEUs

Instructional Level: Introductory

Program Focus: Knowledge

Learning Outcomes: Upon completion, each participant in the eAudiology Web Seminar will be able to:

  1. Identify current hearing health trends, statistics, and recent studies supporting the need to increase hearing healthcare access options for adults.
  2. List the many venues where hearing healthcare services may be provided outside of an audiology clinic or sound booth.
  3. Summarize the various boothless audiometry products and their individual capabilities. 


The purpose of this talk is to discuss how changes in hearing healthcare services over the past few years answer the need to expand beyond waiting for a patient to present at traditional audiology clinics for hearing services. Primary drivers for change include the COVID-19 pandemic, our aging population, comorbid effects of unidentified hearing loss, and the critical need for effective communication between patients and providers. Currently, boothless audiometry technology is revolutionizing the way we do business. This talk will highlight the key features and technical capabilities of boothless audiometry, provide an overview of FDA-approved boothless audiometry products, and describe how to leverage these products to increase access to hearing health services across the continuum of healthcare.

Hearing loss is a significant public health concern, estimated to affect approximately 48 million Americans, i.e., 20% of the population. Hearing loss affects people of all ages (Federal Interagency Forum on Aging-Related Statistics, 2010). Its prevalence increases with each decade of life (Lin et al., 2011). Hearing loss is ranked as the second-highest cause of “years of healthy life lost because of disability,” outranked only by depression (Mathers et al., 2003). Hearing loss contributes to cognitive decline in adults (Lin et al., 2013) and significantly increases social isolation and economic burden on individuals, families, and communities (Huddle et al., 2017; Shukla et al., 2020; WHO, 2017). Hearing loss is also a population health concern. According to the Centers for Disease Control and Prevention (CDC), approximately 40 million US adults, age 20 to 69 years, have noise-induced hearing loss, yet more than half of all adults with noise-related hearing damage do not work in noisy environments (CDC, 2017). Hearing loss is often overlooked or missed in the context of general healthcare delivery. As part of the Over-the-Counter (OTC) Hearing Aid Act launched in 2021, providing amplification options sold direct to consumers, boothless audiometry has enabled a connection between audiologists and primary care physicians, with the goal to deliver comprehensive hearing health services and well-fit amplification.

This talk will also consider challenges associated with boothless audiometry testing. One of the biggest challenges hearing healthcare professionals faced in 2020 was the need to implement COVID-19 infection control measures. The current gold standard of hearing healthcare, i.e., testing inside an audiometric booth, was complicated during the pandemic and patient care was slowed by requirements for social distancing; increased cleaning and sanitizing; mask wearing (interference with speech clarity, volume, and visual cues); and compliance with CDC guidance (CDC, 2003) concerning room air exchange.  With boothless audiometry, it is possible to use low-touch procedures for testing in non-booth spaces, reducing the negative impact of COVID-19 infection control restrictions and increasing access to care.  

Arguably, the most significant challenge to boothless audiometric testing is the need to overcome potential interference from background noise, which can cause inaccurate test results. Several studies have identified effective strategies for reducing the interference of background noise. There are numerous real-time noise monitoring technologies available to verify if background noise levels in every hearing test environment meet the ANSI/ASA S3.1-1999 (R2018) standard: Maximum Permissible Ambient Noise Levels (MPANLs) for Audiometric Test Rooms (ANSI, 2018). An example of such technology monitors environmental noise in octave frequency bands during boothless audiometry, which can be visually represented in real time by the audiometer's software. The headphone’s noise-monitoring function, which includes a microphone on each circumaural ear cup, applies low-pass and high-pass filters to separate the incoming sound. Using an automated, mobile, diagnostic audiometer with increased attenuation and real-time ambient noise monitoring, Swanepoel and colleagues (2015) demonstrated accurate and reliable testing outside the booth, in a natural environment and in an office at a farm worksite.

We will provide an overview of the diverse ways boothless audiometry can be used to promote hearing health and to conduct hearing screenings and diagnostic audiometry in non-clinical audiology settings, such as military deployed environments, schools, nursing homes, community outreach venues, pharmacy waiting areas, primary care clinics, and in-patient care settings. This approach enables healthcare providers to identify significant hearing loss early, supporting timelier referral for comprehensive services to treat and prevent additional hearing loss. Comprehensive audiology services include options for personal sound amplification products, smart technologies (e.g., hearables), and assistive listening devices to improve effective patient-provider communication. Earlier intervention may also reduce the potentially adverse, synergistic effects of co-morbid conditions. By providing hearing health services during primary care patient encounters, it is possible to increase patient and provider satisfaction and improve treatment outcomes in general. Reduction or elimination of unnecessary follow-up visits can also decrease healthcare costs, improve efficiency, and increase revenue. By expanding our current hearing healthcare delivery model beyond the traditional audiology clinic visit, we envision better outcomes, increased access to hearing healthcare, early identification and treatment of hearing loss, and reduced overall health impacts from the co-morbid effects of hearing impairment.

Dr. Kathy Gates joined the Department of Defense Hearing Center of Excellence (HCE) in October 2012, and is currently working under the Prevention Branch. One of her primary roles is to support distribution and launch of the Comprehensive Hearing Health Program to Audiology and Hearing Conservation/Program Clinics across the DOD and VA. Colonel (Retired) Gates served 26 years in the U.S. Army Medical Service Corps as an Army Audiologist. Her last assignment was as Integrated Service Chief, Audiology and Speech Center, Walter Reed National Military Medical Center. 

Dr. Marjorie Grantham is a 30-year Army Veteran with over 25 years of experience as a servant-leader in preventive medicine, education, public health, and research. She currently works for zCore Business Solutions, Inc., supporting DOD and VA hearing loss and tinnitus prevention and hearing health education efforts. Her driving interests include lifelong learning, mentoring and empowering human beings to become their best version of themselves, and collaborating across disciplines to achieve international strategic diversity and equity in science, research, leadership, and human rights.


An Integrative Hearing Healthcare Model using Boothless Audiometry
06/15/2021 at 1:00 PM (EDT)   |  60 minutes
06/15/2021 at 1:00 PM (EDT)   |  60 minutes
Captioned Webinar
Recorded 06/15/2021
Recorded 06/15/2021
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