Challenges of Getting Otology Care in Socioeconomically Impacted Areas

by Karen Appold •

Increasing Access to Otology Care

Improving otology care in socioeconomically depressed areas is particularly challenging and should be addressed at several different levels, said Dr. Kim. At the national and state levels, hearing loss should be made a priority by governmental agencies allotting sufficient funding to support hearing loss-related campaigns, activities, and research.

Early intervention only covers services up to age three. Prevention of hearing loss through vaccination (e.g., measles, rubella), screening (e.g., cytomegalovirus, HIV, syphilis), and early screening of hearing loss through education (e.g., congenital, genetic, maternal factors associated with hearing loss) should all be prioritized, Dr. Kim said. Importantly, otological services should be made more accessible, available, and affordable.

At the hospital level, outreach services are needed to assist communities in need. “Community leaders should encourage the public to participate in hearing assessment and address particular community needs,” Dr. Kim says. At the school level, administrators, counselors, teachers, and students should be educated regarding the impact of hearing loss and hearing protection.

Dr. McGrath said patient-centered information and education regarding services and interventions needs to be improved. “Providing such information to primary healthcare providers doesn’t ensure that the information reaches the patient and leaves room for continued patient confusion in medical decision making,” she said. Direct-to-patient information would provide support to help patients understand their options, access services, and realize the potential benefits intervention can have on their overall quality of life.

Hearing screenings also need to be more readily available to patients, especially adult patients, where this is lacking (JAMA. 2021;325:1196-1201; Am J Audiol. 2008;17:3-13). This could include educating PCPs on the association of hearing loss with compounding medical issues that a provider may find more pertinent, such as dementia, diabetes, and depression, Dr. McGrath said. Expanding provider education on the association of hearing loss and its impact could raise the importance of discussing hearing healthcare at primary care visits and facilitating more regular screenings and specialist referrals.

Improving direct access for patients with public insurance to audiology would improve cost-effectiveness, time efficiency, and quality of care for patients, Dr. McGrath continued. Currently, public insurance allows direct access to social workers, psychologists, chiropractors, and optometrists, none of whom have an MD or DO degree. Allowing patients with hearing concerns direct access to an audiologist without first seeing a physician for a referral could significantly reduce the time between noticed hearing concerns and hearing loss management.

The bottom line is that although people in socioeconomically depressed areas are at a disadvantage for obtaining otology care, there are ways to improve access and availability.