Covid-19: Audiology “in the Trenches”

We sat down with Marylyn Koble, M.S., CCC-A, of Audiology Associates of DFW, to find out how her practice is handling the myriad challenges of staying open and serving her clients in the midst of the pandemic.

  1. What are a few of the considerations and precautions you’ve had to take in order to return to your practice? 

A large portion of our patient population is over 60; therefore, they’re considered high risk for developing serious complications should they contract the virus. I employ four other staff members, and all of them are either personally high-risk or live with someone who is. These are the people I considered when implementing Covid safety protocols. The first step in the re-opening process was educating myself and my staff about the virus. I gathered information from the WHO, CDC, county health officials and audiology professional organizations. Information from all these sources were used to develop our Covid-19 protocols. Screening questions were created and the Infection Control Protocol already in place, was ramped-up. Basically, it is Infection Control Protocol on steroids.

A large initial investment of PPE was made to stock the practice with gloves, various types of masks, hand sanitizer, disinfecting wipes, face shields, plexiglass dividers and thermometers. We have two locations and three audiologists, so PPE is a significant, re-occurring expense.

I also had to rethink some of the fundamental ways we provide hearing healthcare. I suspended house calls and outreach to senior living facilities. We have stopped seeing walk-in patients. Everything, even picking up supplies, is by appointment only, because the front door remains locked. It’s all about controlling who comes into the office environment.

Appointment times have been extended to allow time for cleaning and disinfecting of rooms between patients. This means we see fewer patients. Our schedule fills faster; patients have longer wait times to get an appointment; and revenue decreases.

  1. Have you seen any changes in how your clients are dealing with their work environment, as a result of COVID-19 (i.e., using disposable PPE; cleaning/hygiene procedures implemented at their workplace, etc.).

The changes have been variable, according to the industry. I see a fair number of firefighters and EMTs. As first responders, they are at high risk of exposure; so obviously, their safety protocols at work are stringent–N95 masks required, frequent glove changes and face shields. Most others are required to wear some type of face covering and wash hands frequently. One patient, a roofer by trade and over the age of 60, told me he no longer shakes hands with customers and recently stopped an elderly customer from giving him a hug of appreciation. He said it bothers him to be “so impersonal,” but needs to keep himself safe and healthy.

  1. Does your practice use video-otoscopy or other otoscopy technology that allows for adequate light and ability to view the ear, ear canal and tympanic membrane, while allowing physical distancing from the client/patient during otoscopic inspection? Do you think video-otoscopy technology might be used more regularly and with more frequency in the future?

We a video otoscope that is used infrequently because it does not function on a reliable basis. There has been more discussion in professional circles regarding using video-otoscopy, but long- term, I don’t think we will see a significant increase in its use. A video-otoscope is not always conducive to performing other audiology tasks, such as cerumen removal and placement of otoblocks for ear impressions. I have a hand-held otoscope designed to allow me to place ear-cleaning tools, such as suction and curettes, through the head of the device. This device makes ear cleaning faster, easier and safer for the patient. The bulk of the video-otoscope makes pointing the light source into the ear canal with one hand and manipulating the ear-cleaning tool in the other hand a juggling act. In addition, the cost is prohibitive. It is difficult to justify investing thousands of dollars into a single piece of equipment that has limited utility—especially in the era of Covid, when an increased portion of financial resources must be spent on PPE.

  1. One of the recommendations by the ASHA is to use disposable items for each patient interaction. (This can include the speculum, inserts for audiometry, electrodes, immittance tips and/or ear light ). How has this impacted your practice?

The practice has not been impacted in this area because our pre-Covid Infection Control Protocol called for the use of disposable speculum, immittance ear tips, etc. Items specified as single use are disposed of following use on a patient. This is just part of our profession’s Best Practices. We do utilize some surgical steel cerumen management tools that are not disposable but can be sterilized.

  1. Have you required the use of masks for clients/patients, staff and providers?

Absolutely! Everyone in our office is required to wear a mask, including, staff, patients and any visitors.

  1. Do you make use of plexiglass barriers or other social distancing solutions on a daily basis?

Yes. We have plexiglass barriers in the front office area, where patients and guests enter and exit. To encourage social distancing and control the flow of traffic in the office, we have  additional Covid protocols: 1) Patients are permitted to bring only one guest with them to the appointment. 2) Appointment times are staggered to minimize patient contact with other patients. 3) Our front door remains locked at all times. Patients call when they arrive, and the provider goes to the patient’s car, takes their temperature and asks the screening questions. If the patient (and their guest) pass the screening, they are escorted inside and directly to the examination room. No one sits in the lobby. 4) We see patients by appointment only, no walk-ins are permitted. Patients picking up supplies or dropping off hearing aids for repair must schedule a curbside appointment time. After they arrive they call the office and the provider will go out to the car to give them the supplies or retrieve the hearing aid. IHW