Barriers to Hearing

By Rich Shopes

Before her academic career, when Michelle Arnold was an audiologist at the James A. Haley Veterans’ Hospital in Tampa, she had a hunch many older Americans went without hearing aids because they believed, often mistakenly, they did not qualify for the devices under their health insurance or simply didn’t know how to access the coverage.

“Many of them said they knew a parent, grandparent or uncle who never got tested because they just thought they weren’t covered and couldn’t afford to get hearing aids on their own,” said Arnold.

“It was nothing more than anecdotal at the time, but it made me wonder about how many more people were in that same boat and how many could benefit from these programs if they just knew how to access them,” she said.

Fast-forward 10 years and Arnold is now an assistant professor in the Language-Speech-Hearing program at the University of South Florida Sarasota-Manatee campus. She is steadily chipping away at those questions, and others, as she explores issues around hearing loss, access to health insurance, the impact of language barriers in attaining coverage and how hearing loss relates to cognitive decline in older adults.

Her research has been tied to several prominent research grants, including a five-year grant in 2014 examining help-seeking behaviors related to hearing loss and a 2017 grant exploring the impact of hearing aids and related therapies in slowing the onset of dementia in older adults.

"Learning about hearing healthcare utilization patterns can help pinpoint barriers to use and help us generate ideas on how to reduce those barriers to increase access to proper hearing healthcare."

At the same time, her work has enabled her to produce several articles for prestigious academic journals. Among them is a recent report in the American Medical Association’s “JAMA Otolaryngology – Head & Neck Surgery” that found hearing loss was more likely to be untreated among older U.S. adults of Hispanic/Latino backgrounds because of language barriers and access to insurance.

Her article, “Hearing Aid Prevalence and Factors Related to Use among Older Adults from the Hispanic Community Study/Study of Latinos,” raises questions about the roles of government and the health care industry in bridging language barriers within this growing subset.

Analyzing results of a 2008-2011 cross-sectional study of 1,898 adults with mild hearing loss of varied Hispanic/Latino backgrounds, Arnold found hearing aid usage among the study’s participants at only 4.6 percent. That is less than a third of the national average for individuals with similar hearing levels. Why so low? Arnold points to limited access to health insurance as the primary culprit, but she also cites another contributor, what researchers call “low acculturation,” or the preference to maintain one’s native language and customs over that of the prevailing culture.

“Whether or not the person has current insurance, that was the main barrier,” she said, “but historically, Spanish-speakers in the U.S. face huge problems navigating the insurance system when unable to speak or read a sufficient level of English.”

That’s only natural, she said. Sifting through reams of insurance forms, brochures, policy sections and subsections, websites and other materials to uncover relevant information can be difficult enough. Combine those challenges with language barriers and the task can seem impenetrable, leaving many to relent and go untreated.

Now Arnold, who also serves as a principal investigator in the Auditory Rehabilitation and Clinical Trials Laboratory at USF in Tampa, is expanding her research interests to include several additional areas of study. Among them:

  • She is co-investigator of a study examining the connection between hearing loss and decreased cognitive ability, including whether hearing aids and other interventions can slow impairment and ultimately prevent Alzheimer’s disease in adults 70 and older. This work builds on previous research Arnold has produced in the field.
  • In a collaboration with Troy Quast of the USF College of Public Health in Tampa, Arnold is requesting Medicaid claims from states that recently expanded coverage to include hearing loss. Using a $10,000 USF New Researcher Grant, the two professors are seeking to examine the impact of Medicaid expansion in states that include hearing aid benefits for adults.
  • Arnold is the principal investigator of a recently funded $450,000 grant from the National Institute on Deafness and Other Communication Disorders (NIDCD) of the National Institutes of Health, to enable her to research how culturally and linguistically attuned patient-education programs impact Spanish speakers with hearing loss.
  • Arnold is co-investigator of a recently submitted five-year grant to the NIDCD to examine hearing aid use and patient satisfaction in older adults who receive follow-up services through telehealth.
  • Her research team is currently seeking grant funding from the NIH to explore hearing-related services delivered through telehealth, the video-chat service that enables health clinicians to communicate with patients and other doctors. Arnold’s goal is to evaluate patient outcomes and overall satisfaction with the technology.
Michelle Arnold, PhD and AuD
Michelle Arnold, PhD and AuD

A growing trend, telehealth connects physicians to patients in rural areas or with limited mobility and transportation options, including many seniors. The technology has also helped trauma doctors connect with neurologists and other specialty providers after hurricanes, bridging the gap between patients and doctors across vast distances. But questions remain about telehealth’s effectiveness for wider use, including how far to take the technology as a day-to-day diagnostic tool and whether it will ever measure up to face-to-face doctor visits.

Click image to enlarge

Arnold said telehealth likely won’t replace in-person medical assessments altogether, but its growing usage signals the technology’s place as a cost-effective assessment option. Yet as the professor points out, most research regarding telehealth originates from the practitioner’s point of view with little conducted to consider patients’ opinions, including whether they are satisfied with the technology and feel they’re receiving adequate treatment.

Arnold intends to explore hearing-related patient outcomes involving telehealth, overall patient satisfaction and patients’ responses to listening quality.

“Learning about hearing healthcare utilization patterns can help pinpoint barriers to use and help us generate ideas on how to reduce those barriers to increase access to proper hearing healthcare,” she said. “Removing these barriers could bring help to thousands of hearing-deficient Americans.”

- Rich Shopes

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The Rise of Telehealth

From 2005 to 2014, the number of telehealth visits soared at an average compound annual growth rate of 52% and is expected to increase at a 16.8% compound annual growth rate between 2017 and 2023. While many studies have focused on the industry's undeniable growth, one of Michelle Arnold’s upcoming research questions will investigate the telehealth industry from a different point of view-the patients' perspective on the ease and effectiveness of teleheath technology in hearing health treatment.

telehealth is projected to grow at a 16.8% compound annual growth rate from 2017-2023.