If you were living 100 years ago, there is a good chance you
knew
more than a few coopers. Coopers, sometimes fondly referred to as
barrel makers, were among the most popular skilled professions in
the early 1900s. By 1930, however, coopering was a marginalized
profession, nearly non- existent, unless of course, you live in the
states of Tennessee or Kentucky, where it thrives as an artisanal
craft.
The virtual elimination of a once thriving profession is an example
of creative destruction, and there are many examples of it
throughout our
modern society. Pager salesmen, typists, and video store clerks are
three quick examples from the past 30 years of once relatively
prevalent occupations that currently barely exist. “Creative
destruction” is a paradoxical term introduced to economics in the
1940s by the Austrian economist and Nobel laureate Joseph
Schumpeter (1883–1950). He used the term to describe the special
form of economic growth that entrepreneurs bring to capitalism.
Schumpeter argued that it was the entrepreneur’s introduction of
radical innovation into the capitalist system that was the real
force sustaining long-term economic growth, even as it destroyed
the economic value of established enterprises that may have
previously enjoyed a substantial degree of unchallenged power. The
questions for hearing care professionals are twofold: What forces
at work in today’s economy have the potential to creatively destroy
audiology and hearing instrument dispensing? And, Learn how
hearing
healthcare professionals can adapt to more effectively meet the
changing demands of the marketplace
Creative Destruction in Hearing Care from Hearing Tests to
Smartphones
By Brian Taylor, AuD
Read this article and take the quiz on page 55 for continuing
education credit.
14
15
how will audiologists and hearing aid specialists adapt to more
effectively meet the changing demands of the marketplace? No one
can predict the future, but we can be relatively certain there will
be significant changes in the way the two established professions
of audiology and hearing aid specialists create value for the
hearing impaired population over the next decade. The objective of
this article is to review many of the forces that could lead to
creative destruction and offer an antidote for overcoming
them.
Tablet-based Audiometer Apps Over the past few years, tablet-based
audiometry apps have emerged as viable options for completing
portions of the diagnostic battery. According to Sanchez et al
(2015) one such tablet-based audiometer (iAudiometer Pro) is
accurate enough for clinical use, as the researchers compared the
iAudiometer Pro app to a professionally calibrated GSI16
audiometer, using three different transducers and found no
significant differences in thresholds compared to the GSI 10
audiometer. The iAudiometer apps allows for air and bone conduction
testing. Additionally, other versions of the iAudiometer have
speech tests as well as special audiometric tests for the pediatric
population.
These results, while promising, warrant further investigation, but
they do suggest table-based audiometry, given its portability,
allows hearing care professionals to more easily provide services
in remote areas or they cannot travel to the clinic. Interestingly,
Sanchez and colleagues found that while 63% of participants
believed that a table-based hearing test yields accurate results,
86% preferred obtaining a hearing test from a hearing care
professional.
Self-guided Hearing Screening Apps In addition to tablet-based
audiometry, there are a variety of hearing screening apps allowing
individuals to monitor their own hearing without seeing a hearing
care professional. Although there is a paucity of data supporting
their validity, there is significant potential for self-guided
hearing testing apps to allow younger patients to engage in the
process of checking their hearing from the convenience of home
without the hassle of making an appointment. Similar to automated
blood pressure tests, automated hearing screening might be an
effective approach to facilitate more active patient involvement at
a younger age when hearing loss is milder and less
debilitating.
Automated Hearing Aid Algorithms A significant part of digital
evolution is the use of signal processing strategies that
automatically assess the patient’s listening environment and make
adjustments to the signal processing strategy based on the
listening needs of the individual. Historically, hearing aids have
been programmed and adjusted in the hearing care professional’s
office, mainly because considerable expertise was needed to
determine the proper adjustments and to effectively operate the
programming device. In the future, these time- held procedures may
be no longer needed, as adjustments could be made remotely and many
of tweaking of the hearing aids parameters could
be accomplished with intelligent, automated algorithms. Arguably,
automated algorithms have been in existence for several years, but
as their sophistication grows, the ability to program and adjust
them may greatly reduce the need of the expert guidance of the
hearing care professional.
PSAPs and Hearables* (See IHS statement on PSAPs on page 24) There
are a variety of over-the- counter personal sound amplification
products (PSAPs) that are slowly becoming known as “hearables.”
While PSAPs and hearables are not allowed to be marketed as medical
devices for the remediation of hearing loss, many of them are used
for this purpose. Also, given the uneven sound quality of PSAPs and
hearables, hearing care professionals need to be involved in the
process of verifying the quality of their coupling to the
individual’s ear. This is especially important for patients with
mild loss who might chose to wear a PSAP before transitioning to
conventional hearing aids over time. Hearing care professionals
would be wise for developing a strategy around getting directly
involved in the verification of PSAPs fittings with probe
microphone measures. A fee for service could be charged to check
the quality of the fit, as a poorly fitting PSAP is likely to
result in poor benefit.
Smartphones Apps The stigma associated with hearing aids probably
has some influence on the uptake of PSAPs and hearables. After all,
if it looks like a hearing aid it must be a hearing aid.
Smartphones
Continued on page 16
16
this results in a marked improvement in speech intelligibility when
watching TV. They are programmable, so they can be customized to
the patient’s hearing loss. Customizable directed audio devices
represent a new product category in the industry that patients,
especially younger patients with milder hearing loss who might find
it appealing because they offer an effective solution for a hearing
problem and do not have the unfortunate stigma of a hearing aid. In
that vein, devices like hearables, directed audio solutions, and
smartphones might provide the untapped mild to moderate high
frequency market with products they find appealing. As shown in
Figure 1 below, this segment of the hearing impaired marketplace
has been largely underserviced by conventional hearing aids.
apps, which there are dozens available, are, like PSAPs, plagued
with uneven sound quality. However, they do offer an alternative to
traditional hearing aids some individuals might find appealing.
Amlani et al (2013) compared the performance of two apps, which
essentially turn the smartphone into a body aid when coupled to the
ears with headphones or earbuds, to hearing aids at the basic level
of technology. Results indicated that on several measures of
outcome, including benefit, quality of life improvements and
audibility there were not significant differences between the
“bare-bones” hearing aids and smartphone apps. Amlani et al (2013)
demonstrated that smartphone hearing aid applications have similar
electroacoustic characteristics and perceived performance when
compared to a traditional hearing aid, and could be useful as a
temporary or starter solution to a hearing deficit.
Directed Audio Solutions Directed audio solutions represent the
morphing of programmable hearing aids and consumer electronics. One
such device, Hypersound (www. hypersound hearing.com), allows
patients to enjoy television and other home media activities
without disturbing others. These systems work by using an
ultra-high frequency carrier signal to transmit audio in a tight,
narrow beam over several feet without interference from noise or
reverberation. Utilizing the non- linear properties of air,
ultrasonic transmission of audio allows listeners situated in the
2-3 foot wide beam, even several feet from the television, to
experience more audibility high frequency sounds. For many
listeners,
Biotechnology Hair cell regeneration and gene therapy represent
some of the future innovations that may transform the practice of
audiology. Although still in its infancy, in the future
audiologists and other hearing care professional may be directly
involved in the regeneration of hair cells within the cochlea. For
more details on the potential of biotechnology in audiology, see
Parker, 2011.
Interventional Hearing Care As previously mentioned, no one has a
crystal ball, but all of us can prepare for a future where
audiology and hearing aid dispensing are practiced in a different
way. One way to prepare for a different future, one that is likely
to be creatively disrupted by cheaper, faster and smarter
technology is to examine
Profound or Residual:
75%
30%
Figure 1. Hearing loss segmented by degree. Data compiled from Nash
(2013), Lin et al (2011), Lin (2011) and Wallhagen & Pettengill
(2008)
17
existing gaps in the marketplace and how our professions can add
additional value that may not be centered on the selection,
adjustment and tweaking of hearing aids, or the ability to conduct
a basic hearing assessment. Practicing in a different way involves
getting out from your test booth and directly connecting with the
community, especially individuals who are beginning to experience
difficulties with communication, but remain reluctant to take
action. The key to long term professional survival may rest on our
ability to intervene with patients at an earlier age when hearing
loss is typically milder and easier to manage.
Let’s cut to the chase, here are four pillars of an interventional
audiology strategy that are designed to keep hearing care
professionals actively involved in the direct care of
patients.
1. Exert more social pressure to get non-consulters to act sooner,
using self-guiding hearing screening apps to speed the journey to
your office.
2. Engage younger patients, many with milder hearing losses by
offering them products and services that don’t carry the stigma of
hearing aids.
3. Leverage changes in U.S. healthcare system to partner directly
with primary care physicians and other medical gatekeepers in the
early management & intervention of age-related hearing loss and
its co-morbid conditions.
4. Modify or update your clinic approach to patient interaction by
focusing on patient-centered communication and participatory
care.
Let’s briefly examine each of these pillars of interventional
hearing care and how you can begin to bring them to life in your
practice. Using positive triggers to action requires hearing care
professionals to use advertising that highlights the hidden risk of
hearing loss while simultaneously empowering the individual to take
action to seek help for a possible condition. Curtis Alcock of
Audira has written and lectured extensively on positive
cues to action and how they can be used in marketing. (Alcock’s
articles have appeared in prior THP editions archived on the IHS
website www. ihsinfo.org.) Figure 2 is an example of an advertising
campaign utilizing many of Alcock’s ideas.
The second pillar of interventional hearing care is to
systemically
Figure 2. An example of an advertising campaign using positive
triggers to action.
Continued on page 18
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• 1+ Year Battery Lifespan
Come Visit us at the IHS Convention at Booth #401
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ZP_IHS_Ad_Issue Version.indd 1 7/29/15 12:45 PM
Listening to Television with a Hearing Loss: TV Device or Hearing
Aids?
An Interactive Decision Aid
My difculty with the TV is affecting my personal and social
life. My spouse or other family members can’t be in
the same room.
The TV is too loud!
A TV device is less costly than hearing aids
No long clinic appointments needed
A TV device is easy to install, use and maintain
Device only works for TV; other listening situations
may still be difcult, indoor use only
Device overcomes distance and background noise to isolate the TV
signal and
improve viewing experience
view TV normally
Hearing aids are expensive, but they can be used in
all situations
Usually, 3–4 clinic visits are needed, to t, ne tune and
troubleshoot hearing aids
I will have to learn how to use hearing aids; regular
cleaning and care are needed
Hearing aids are designed to enhance speech
understanding; they can be used in all situations
Hearing aids may not solve my TV problem; I might
need to buy extra devices that connect hearing aids to
the TV
view TV normally
TV Device
Do you responses appear to favor one over the other? With your
audiologist, explore your preferences and dislikes.
Discuss them together to aid your decision.
Total
Total
If you dislike a statement place an in the box
I have difculty understanding dialog, especially fast talkers,
female talkers
or foriegn accents.
I have difculty when the TV is at normal volume. I can hear it, but
cannot understand what is
being said.
The speech is too soft but the music is too loud. I can’t nd
the right volume.
The more items you checked, the more likely it is that you
need
help listening to TV
If you feel ready to address the difculties, your audiologist
can help you decide on the next step
All rights reserved © 2015 Jennifer Gilligan
Introducing The World’s First Rechargeable Hearing Aid System
With:
• 24+ Hours Between Charges
• 1+ Year Battery Lifespan
Come Visit us at the IHS Convention at Booth #401
Ask How to Become a Distributor
Say Goodbye to Changing Batteries Forever
[email protected]
ZP_IHS_Ad_Issue Version.indd 1 7/29/15 12:45 PM
recommend alternative products and services that do not have the
stigma of traditional hearing aids. These offerings may include
auditory training apps and directed audio solutions (e.g.,
Hypersound) that still need to be customized by the professional,
while still being an attractive option for patients, especially
those with milder losses in need of situational help. In order to
effectively educate patients on their options, hearing care
providers are encouraged to utilize decision aids, like the one
shown in Figure 3. A patient decision aid is a structured tool
designed to facilitate knowledge transfer and patient engagement.
It can be used to compare the pros and cons of more than one
treatment option with more direct involvement from the patient in
the decision-making process.
The third pillar of interventional hearing care necessitates the
need to directly interact and educate primary care physicians.
Given the well-documented relationship age- related hearing loss
has to cognitive decline, increased hospitalization and social
isolation, hearing care professionals are obliged to adhere to
scientifically-defensible principles in order to responsibly
educate medical gatekeepers and spur them in to action. The
consequence of successfully educating medical gatekeepers is likely
to be a significant uptick in the number of adults aged 55 and
older who visit your practice for a hearing screening
appointment.
To make this appointment valuable to consumers, and not simply a
hearing test that can be completed with a self-guided app, hearing
care professionals are urged to practice
patient-centered, participatory care. Ultimately, this change from
product- centric to patient-centric care in which providers are
reimbursed for their time helping patients cope with the
consequences of hearing loss may provide our profession with a new
value proposition for consumers.
Figure 3. An infographic that compares directed audio to
traditional hearing aids for television watching. Reprinted with
permission of Jennifer Gilligan of CUNY-Graduate Center
Continued on page 20
20
Known as participatory care, the six steps listed in the center of
Figure 4 comprise the foundational elements of patient-centered
communication. Participatory care is a model of healthcare in which
patients take a more active role in the generation and
implementation of treatment options. It is thought that
participatory care may be an effective way to address the needs of
patients with chronic conditions, such as age-related hearing loss.
Participatory care, also commonly referred to as shared decision
making, falls in the middle of the patient-provider decision making
continuum shown in Figure 5. Traditionally, healthcare
services
have been delivered in a paternalistic manner whereby patients
assume a relatively passive role in their relationship with the
provider. As patients have become more actively involved in their
healthcare choices, and, as the internet and other forms of social
media have become more ubiquitous, DIY care has become a popular
healthcare delivery model in some circles. This is depicted in
Figure 5 as the informative relationship, which removes the
provider from the essential decision making duties, and leaves the
patient to fend for himself. PSAPs in their current form are bought
under this informative model.
Shared-decision making (or participatory care), on the other hand,
requires the professional to actively guide patients through the
stage of health behavior change. (For an introduction to the stages
of change model see Leplante-Levesque’s recent article in The
Hearing Journal .)
In today’s era of consumer-driven healthcare, participatory care
appears to be popular among baby boomers, especially those with
chronic medical conditions. Practicing participatory care requires
a relatively high degree of healthcare literacy on the part of the
patient and involves the use of shared decision making by both the
patient and hearing healthcare professional. Shared decision
making, which is an essential component of patient-centric
communication, is the process in which the patient and the hearing
healthcare professional exchange information about the scale and
scope of the patient’s condition, express the preferences of
intervention options and collaborate on the implementation and
evaluation of a solution. Shared decision making and participatory
care cannot be supported without adequate information provision
(Poost-Faroosh, et al 2015). It requires a hearing care
professional, skillful in motivational interviewing and other
interpersonal communication abilities, to guide patients through
the process of behavior change. To learn more about motivational
interviewing readers are encouraged to visit
www.motivationalinterviewing. com and read the works of industry
experts Kris English, Jill Preminger, Gaby Saunders, John Greer
Clark and Michael Harvey.
Figure 4. The six components of participatory care and five steps
of patient-centric communication.
21
As the American healthcare system evolves, moving toward a model
emphasizing preventive care and management of chronic conditions,
there will be ample opportunities for professionals to become more
actively involved in delivering care to younger patients, many with
milder hearing losses. Practicing the six steps of participatory
care, shown in the center of Figure 4, will require less focus on
technology and more
care professionals would be wise to develop skills in these five
areas.
• Ensure patient comfort. In addition to providing physical comfort
through the use of ergonomically correct chairs and providing an
inviting ambience, it is vital for professionals to foster
emotional comfort too. Basic interpersonal skills such as good eye
contact, an engaging smile and a warm,
to receive help. Insights into the patient’s perceptions of
readiness and motivation on a quantifiable scale help hearing aid
specialists match the support, feedback and guidance depending on
the patient’s self-rating. For example, patient A with a low
self-rating on the readiness to accept treatment would warrant a
much different set of tactics than patient B who has a high
self-rating and is read to move ahead with treatment. In this
example, patient A would probably benefit from much more
exploration around why treatment uptake would be beneficial to him
and his family. The role of the hearing care professional in this
case is to help the patient “paint the picture” of all the
potential benefits of help.
• Acknowledge and understand the patient as an individual. Using
customizable, open-ended assessment tools like the COSI or TELEGRAM
(Thibodeau, 2004) are an effective approach to individualizing the
initial discovery of the scale and scope of the patient’s
challenges. Additionally, it is helpful to focus on specific
behaviors, which are a consequence of the hearing loss that the
patient may be willing to change. For example, if the patient
expresses concern that he is avoiding certain listening situations
because he cannot hear, devise some goals and strategies that will
allow the patient to become more actively involved in these places
with your guidance and support. Taking a deeper dive into the
individual needs of the patient and the associated behavior
resulting
Figure 5. The continuum of patient-provider relationships
emphasis on guiding patients through the process of behavior
change. It will require professionals to become less reliant on the
crude tools such as the audiogram and more adept at using
interactive practices, such as goal setting when making important
treatment decisions with respect to the individual.
The five attributes of patient centered communication, summarized
from the work of Canadian audiologist Laya Poost-Faroosh below, can
be utilized to optimize the individual’s experience in your clinic.
Of course there are no guarantees, but hearing
authentic manner help establish a safe and emotionally inviting
atmosphere where patients can feel comfortable.
• Consider patient motivation and readiness. Rather than using the
audiogram results as a guide, professionals are encouraged to ask
patients simple scaling questions to ascertain the degree of
readiness and motivation to receive help. A scaling question asks
patients to self-rate on a 1 to 10 scale (1 is no problem, 10 is a
great deal of problems) how motivated or how ready they are
Patient-Provider Relationship
Patemalistic: 1. Passive role for patient
2. Works well when patients have limited information and an acute
problem
Informative: 1. Professional provides information and patient makes
decision independently
2. Information can be outsourced to call center or website-
direct-to- consumer example
Shared-decision: 1. Patient and professional work together 2. Works
well when patient has long-term, chronic condition 3. Collaboration
on options, goals and results
Continued on page 22
22
from untreated hearing loss takes more time, but in the end that
added time is more likely to result in a patient that feels they
were profoundly heard by their hearing care provider.
• Provision of useful and actionable information. As a general rule
the information you provide that patient needs to be in alignment
with their stage of readiness. The Stage-of- Change (or
Transtheoretical) Model recently summarized by LaPlante- Lesvesque
(2015) suggests that hearing impaired patients are likely to be in
one of the following stages: pre-contemplation, contemplation,
preparation or action. Patients are likely to progress through the
stages of change in the order listed above. Currently, the
University of Rhode Island Change Assessment (URICA) self-report
has been used to identify the individual’s stage of change,
however, given its 32-question length, the URICA is probably
feasible to conduct clinically. That doesn’t mean identifying a
patients stage of readiness cannot be ascertained during the
interview process. One quick way to gather some helpful information
about a
patient’s stage of change is to use the one question shown in Table
1. By asking the patient to check the box next to the statement
most accurately describing their current status with respect to
their hearing, the hearing professional can estimate how ready the
patient may be to take action resolving the handicapping conditions
caused by their hearing loss.
“Which of the following statements best describes your attitudes
and beliefs about your hearing ability today”: (check one circle).
Note that the third, far right column is not visible to
patients.
The important consideration is that the actions taken by the
hearing care professional to help the patient must be congruent
with the patient’s stage of change. For example, if the patient
checks the top box placing him in the pre-contemplation mode, it is
wise for the professional to avoid talk about treatment options –
even in the event of a significant hearing loss of the audiogram.
Further, identifying the patient stage of readiness is an effective
springboard into deeper dialogue around behavior change.
Let’s say the patient checks the box corresponding to the
contemplation mode, this could be a cue for the professional to
explore some of the reasons why it might be important to seek help
for their hearing impairment. More research is needed on how this
one-question approach aligns with the URICA and the stages-
of-change model, however, it does provide useful information about
the patient’s self-perception of readiness to seek help and take
action.
• Facilitate shared decision making. The final patient-centered
attribute is the ability to enable shared decision making between
the patient and hearing aid specialist. In addition to the
previously mentioned use of patient decision aids, shared decision
making implies that you have an assortment of treatment options
from which to choose. Putting shared decision making into practice
does not mean scientifically-based principles are abandoned. The
science behind fitting hearing aids and other devices are more
important than ever before.
Baby boomers and others classifying
I don’t have any problems or concerns that need changing.
Pre-contemplation
It might be worth it to work on my problems and concerns.
Contemplation
I am very close to doing something about my problems and concerns.
Preparation
I am currently working on addressing my problems and
concerns—that’s why I am here. Action
Table 1. One question stages-of-change assessment
23
this requires the hearing care professional guide them to the
action stage of change. Additionally, many of these younger
patients, seeking first time help are likely to have milder
communication challenges, thus traditional hearing aids may not be
of interest to them, at least in the earlier stages of their loss.
Rather than telling these patients to wait, interventional hearing
care professionals (who put patient-centered and participatory care
skills into practice) will be providing treatment choices which may
not be traditional hearing aids.
Apps like the iAudiometer and devices such as Hypersound that have
an edgy consumer electronic look and feel may captivate the new,
younger help seeker. Alternative treatment choices may be even
involve the delivery of a product and could be therapy-driven
approaches to behavior change. As the healthcare landscape
continues to evolve, hearing care professionals must continue to
offer value to the marketplace by offering a wider range of
treatment options. Introducing
themselves as healthy agers take a more active role in their
healthcare choices. Anecdotal reports are consistent with this
finding, as a recent poll of A.T Still University School of Health
Sciences students who are also active clinicians report a
substantial upswing in the number of patients under the age of 60
seeking help and information for their hearing. If it is indeed the
case that younger individuals are seeking hearing care services it
is logical for many of them to be in pre-contemplation or
contemplation stage, and therefore, Continued on page 24
24
these alternative options starts with the consistent use of
patient- centered communication skills and participatory care. In
today’s digital age, the irony is that our future as hearing care
professional is predicated on our ability to master the basic human
skills of communication and trust. n
The views expressed in this article are those of the author and do
not represent the opinions or advice of the International Hearing
Society. According to the FDA, personal sound amplifiers (PSAPs)
are not medical devices, nor are they to be marketed to people with
hearing loss. IHS advises hearing aid dispensing professionals to
use caution in attempting to modify or fit personal sound
amplifiers and to ensure they are following all applicable state
and federal laws.
Brian Taylor, AuD is the Senior Director of Clinical Affairs at
Turtle Beach/ Hypersound. He is also the clinical audiology advisor
for the Fuel Medical Group. Brian is an adjunct professor for A.T.
Still University Arizona School of Health Sciences, and editor of
Audiology Practices, the quarterly journal of the Academy of
Doctors of Audiology. He serves as the treasurer for the
Accreditation Commission for Audiology Education (ACAE) whose
mission is to assure the public that AuD programs graduate
competent audiologists trained to the highest standards. Over the
past decade, Dr. Taylor has held a variety of positions within in
the industry, including stints with Unitron and Amplifon. He can be
contacted at
[email protected]
References
Amlani AM, Taylor B, Levy C, Robbins, C. (2013). Utility of
smartphone hearing aid applications as a substitute to traditional
hearing aids. Hearing Review, 20, 13, 16-18, 20, 22.
Laplante-Levesque, A., Hickson, L., & Worrall, L. (2012). What
makes adults with hearing impairment take up hearing aids or
communication programs and achieve successful outcomes? Ear and
Hearing. 33, 79-93.
Lin, F. et al (2011). Hearing loss prevalence and risk factors
among older adults in the United States. J Gerontol A Biol Sci Med
Sci. 66: 582-590.
Lin, F. et al (2011). Hearing loss prevalence in the United States.
Arch Intern Med. 171.
Nash, SD et al (2013). Unmet hearing health care needs: The Beaver
Dam Offspring study. American Journal of Public Health. 103, 6,
1134-1139.
Parker, M (2011) Biotechnology in the treatment of sensorineural
hearing loss: foundations and future of hair cell regeneration.
Journal of Speech, Language & Hearing Research. 54,
1709-1731.
Poost-Faroosh, et al (2015) Comparions of client and clinician
views of the importance of factors in client-clinician interaction
in hearing aid purchase decisions. JAAA. 26, 247-259.
Sanchez, C. Ortiz, E., & LePrell, C. (2015) Tablet audiometry:
accurate enough for clinical use? Poster presented at American
Academy of Audiology annual meeting, San Antonio, TX
Thibodeau, L. (2004). Plotting beyond the audiogram to the
TELEGRAM, a new assessment tool. Hearing Journal. 57,11,
46-51.
Wallhagen, MI & Pettengill, E. (2008). Hearing impairment:
Significant but underassessed in primary care settings. J Gerontol
Nurs. 34: 36-42.
Take the continuing education quiz on page 55.
IHS Continuing Education Test 1. An example of a profession
that
has already undergone creative destruction is
a. hearing aid specialist b. cell phone sales person c. audiologist
d. pager sales person
2. A client who states that they are very close to doing something
about their hearing problems and concerns would be considered to be
in this stage of readiness:
a. pre-contemplation b. contemplation c. preparation d.
action
3. A recent study by Sanchez revealed that this percentage of
people prefer to obtain a hearing test from a hearing care
professional
a. 36% b. 63% c. 68% d. 83%
4. Professionals who adopt a participatory care methodology of
approaching patients will
a. become less reliant on the audiogram b. place more emphasis on
the
behavioral change process c. place less focus on technology d. all
of the above
5. Creative Destruction a. is an economic term introduced in
the 1880s b. describes the economic growth that
entrepreneurs bring to socialism c. states that long-term
economic
growth is fueled by radical innovation
d. none of the above
6. As it relates to creative destruction, hearing care
professionals would be wise for developing a strategy around
getting directly involved in the verification of PSAPs fittings
with probe microphone measures.
a. true b. false
7. Hearing healthcare professionals will experience significant
change in how they create value for the hearing impaired population
over the next decade.
a. true b. false
8. Using self-guiding hearing screening apps is likely to slow a
prospective client’s journey to your practice.
a. true b. false
9. Participatory care is a model of hearing healthcare where
a. patients take a more active role in the generation of treatment
options
b. patients take a less active roll in the implementation of
treatment options
c. patients are guided in a paternalistic manner in their treatment
plan of action
d. none of the above
10. A patient decision aid is a structured tool designed to
a. facilitate knowledge transfer b. increase patient engagement c.
compare the pros and cons of more
than one treatment option with more direct involvement from the
patient in the decision-making process
d. all of the above
For continuing education credit, complete this test and send the
answer section to: International Hearing Society • 16880 Middlebelt
Rd., Ste. 4 • Livonia, MI 48154
• After your test has been graded, you will receive a certificate
of completion. • All questions regarding the examination must be in
writing and directed to IHS. • Credit: IHS designates this
professional development activity for one (1) continuing education
credit. • Fees: $29.00 IHS member, $59.00 non-member. (Payment in
U.S. funds only.)
Name
____________________________________________________________________________
Address
___________________________________________________________________________
Please check one: o $29.00 (IHS member) o $59.00 (non-member)
Payment: o Check Enclosed (payable to IHS)
Charge to: o American Express o Visa o MasterCard o Discover
Card Holder Name
__________________________________________________________________
CREATIVE DESTRUCTION IN HEARING CARE
(PHOTOCOPY THIS FORM AS NEEDED.)
Answer Section (Circle the correct response from the test questions
above.)
1. a b c d
2. a b c d
3. a b c d
4. a b c d
5. a b c d
6. a b
7. a b
8. a b
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