AMTAS Flex automated audiometry testing on a tablet computer

Synchronous vs Asynchronous Teleaudiology

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by Laura Prigge, AuD

Teleaudiology is gaining significant momentum in today’s ever-changing world. There are a couple of driving factors:

  • Aging population
  • Not enough audiologists
  • Geographic challenges
  • Patient load

There are two main ways to perform teleaudiology. Synchronous, or live face-to-face, is the most common form of teleaudiology. This is typically what people think of when they imagine telemedicine. It requires a video connection between the audiologist and the patient. A technician or an audiology assistant is required at the patient site to be the audiologist's “hands”. It's truly just like a live appointment in the sense that the audiologist is present and running the appointment. The equipment used for synchronous teleaudiology must be PC based and paired with a two-way video stream. The audiologist controls the equipment from their office while the patient and the technician are in a different location. Audiometry, hearing aid fittings, and counseling can be formed this way. If your technician is trained appropriately, you may also utilize video otoscopy and REM.

The second way to perform teleaudiology is asynchronous, or Store-and-Forward. The audiologist does not need to be present for the appointment because the patient "runs" the program to obtain basic air/bone/speech information. The setup is with a GSI audiometer and a computer with GSI AMTAS teleaudiology software loaded on it. AMTAS was developed by Dr. Bob Margolis from University of Minnesota and has been validated and researched extensively. A technician or medical assistant puts the headphones and bone oscillator (forehead placement) on the patient and then begins the software program. AMTAS uses a modified Hughson-Westlake method to obtain thresholds and then a closed set speech test that is based on the thresholds. At the end of the evaluation, a report is generated with up to nine quality indicators that give the audiologist who is interpreting the results a clear idea of what the patient was "doing" during the test. AMTAS tells you how many false positives there were (there are catch trials). It does a test-retest at 1kHz in both ears, reports any masking dilemmas, and does a quality check when it establishes each threshold by bumping the intensity up by 5 dB and looking for a response.

The patient performs the automated test and the results are "stored and forwarded" to the audiologist for interpretation. The benefits of this model is it increases access. You don't have to wait for a schedule to clear for basic diagnostic audiometry. The audiologist will get the results of the initial testing and make decisions based on the data. GSI has seen this implemented in several ways. ENT clinics and VA Medical Centers use AMTAS for walk-in appointments and annual evaluations. AMTAS is being implemented to gather basic data so that audiologists can perform more tasks that require their attention like tymps/reflexes, OAEs, counseling, and more. Dr. Margolis developed this program when he realized that his audiologists and students were spending up to 40% of their time on basic pure tone testing and this wasn't the best use of their knowledge or time.