Telemedicine in Audiology. Best practice recommendations from the French Society of Audiology (SFA) and the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL)

Abstract

Objectives: Access to diagnosis and treatments for auditory disorders and related pathologies has regressed in France during the COVID-19 pandemic, posing a risk to the patient's chance of recovery. This best practice recommendations guide aims to list the existing technological solutions for the remote examination of a patient with hearing complaint, and to outline their benefits and, where applicable, their limitations.

Methods: The recommendations were developed both from the clinical experience of the medical experts who drafted the guide, and from an extensive review of the literature dealing with clinical practice recommendations for tele-audiology. Tele-audiometry solutions were identified on the basis of a search engine query carried out in April 2020, prior to verification of their availability on the European market.

Results: Video otoscopy solutions allow for the teletransmission of images compatible with a high-quality diagnosis, either by connecting via internet to a tele-health platform or using a smartphone or a tablet with an iOS or Android operating system. Using the same telecommunication methods, it is possible to remotely conduct a pure-tone audiometry test in accordance with standard practice, a speech-in-quiet or a speech-in-noise audiometry test, as well as objective measures of hearing. Clinical and paraclinical examinations can be accessed by the physician to be interpreted on a deferred basis (asynchronous tele-audiology). Examinations can also be conducted in real time in a patient, at any age of life, as long as a caregiver can be present during the installation of the transducers or the acoumetry. Tele-audiology solutions also find application in the remote training of future healthcare professionals involved in the management of deafness and hearing impairment.

Conclusion: Under French law, tele-otoscopy is a medical procedure that is either a tele-expertise (asynchronous adive) or a teleconsultation act (synchronous advice). Subjective and objective evaluation of the patient's hearing functions can be done remotely provided that the listed precautions are respected.

Keywords: Acoumetry; Audiophonology; Auditory evoked potentials; COVID-19; Cochlear implant; Otoacoustic emissions; Presbycusis; Pure-tone audiometry; Speech audiometry; Tele-audiometry; Tele-otoscopy; Virtual reality.

Fig. 1

Examples of video-otoscopy (A, C and E) and smartphone otoscopy (B, D and F). Real-time video-otoscopy was performed using a 4-mm, 0° endoscope (Hopkins Optic) and a high-definition video recorder for different pathologies: perforated eardrum (A), serous otitis media (C), and cholesteatoma (E). Images of the same eardrums were acquired using a digital otoscope connected to a smartphone (perforated eardrum (B), serous otitis media (D) and cholesteatoma (F)). These can be easily transmitted wirelessly to a computer or to any equipment connected to the Internet via Wifi or 3/4G network for remote interpretation.

Fig. 2

Principle of digital audiometry with air and bone conduction stimulation (headphones, earphones, free field). Any connected computer can be use as an audiometer, the transducers being connected to a USB port, for example. Resources are thus centralised: multilingual word lists, test protocols and results, questionnaires, creation of audiological databases.

Fig. 3

Screenshot of otoacoustic emissions filtered around 1 kHz (ILO 98) in a patient with endolymphatic hydrops on the left side. The red and black graphs are recorded in the lying and sitting position. The abnormal phase shift here is largely > 40°.