Learn How Cochlear Commits to Improved Hearing Health for all Through Hearing Health Literacy and Standard of Care Guidelines

Interview with Patti Trautwein, MA, AuD, Vice President, Market Access and Reimbursement on hearing health literacy and standard of care consensus guidelines.

 

AudiologyOnline: It is obvious that you are very passionate about your work. What inspires you to come to work every day?

Patti Trautwein: By far, I am most inspired by people with hearing loss. I have been so fortunate to work directly and indirectly with families over the years to navigate diagnostic and treatment options. I actually began working in research studying hair cell regeneration. One day in the early 90s, I met a cochlear implant recipient. I was amazed at what she could hear. She shared how it changed her life, and I wanted to be part of bringing that to more people. I relocated to House Ear Institute in Los Angeles. I still have many hopes for a cure someday, of course, though for now, it is a privilege to play even a small part in restoring a human sense to people with hearing loss through cochlear implants, bimodal and electric-acoustic hearing solutions.

AudiologyOnline: What is the burning issue that keeps you up at night?

Patti Trautwein: How do we connect people with hearing loss to appropriate diagnosis and treatment as soon as possible? We know that good hearing and communication are important to all stages of life. The number of people living with disabling hearing loss continues to grow in the United States and around the world especially among the adult population. If left unaddressed or under addressed, hearing loss poses significant challenges to healthy aging. The Lancet identified midlife hearing loss as the most modifiable risk of dementia.¹ The recent World Hearing Report from the World Health Organization highlighted the growing need for awareness and access to appropriate hearing care. A Delphi panel of experts developed and published comprehensive consensus statements on cochlear implantation for the treatment of moderate to profound hearing loss in adults.² Despite the growing body of evidence and concern, we continue to see lack of public awareness, low use of hearing aids and extremely low use of cochlear implants.³

AudiologyOnline: There is solid public health data making it very clear how many people with hearing loss are untreated or undertreated. Why?

Patti Trautwein: A great question. The out-of-pocket costs for hearing aids, that are statutorily excluded from Medicare coverage, have long been a suspected barrier to hearing health care accessibility. A recent study concluded that for three-fourths of Americans with functional hearing loss, hearing aids were unaffordable and actually would constitute a catastrophic expense. Further, affordability varied significantly by demographic characteristics such as age, sex, gender, providing evidence of inequitable access to care (Jilla et al., 2020). Affordability is not the only barrier of course. Cochlear implants for example are covered by Medicare* and yet we see extremely low utilization. When we take a closer look at hearing health literacy we see a significant gap among the public as well as primary care providers. In recent publications, only 9% of patients were able to correctly identify what constitutes a "normal" range for hearing. By comparison, a "normal" range of values for vision, blood pressure, and total cholesterol were identified correctly by 93%, 85%, and 52% of the 1,250 surveyed adults, respectively. Most of those surveyed believe that few treatment options exist for the management of hearing loss and had a lack of awareness for the long-term health sequelae of untreated hearing loss (Carlson et al., 2022). Few providers prioritize hearing health or regularly recommend an annual hearing evaluation (Sydlowski et al., 2022). All of this contributes to delays in treatment.

AudiologyOnline: Cochlear is very supportive of efforts to improve hearing health literacy. Can you share some of the key initiatives your team is focusing on?

Patti Trautwein: Yes, we are pleased to provide funding support for the Cochlear Center for Hearing and Public Health at the Johns Hopkins Bloomberg School of Public Health. Led by Frank Lin, MD, PhD, the program recently launched a public awareness campaign. The Know Your Hearing Number campaign (https://hearingnumber.org/ ) introduces the Hearing Number to understand hearing health. The Hearing Number uses the four-frequency pure tone average as a simple, universal metric to help the public better understand hearing and how it changes over time. The campaign motivates and educates people to take control of their hearing health and guides them toward strategies that can improve hearing and communication and when to seek the services of audiologists and otolaryngologists.

We also provide financial support as a founding sponsor of the Hearing Health Collaborative; a passionate group spanning multiple professional, provider, and consumer organizations, dedicated to overcoming the challenges to advance good healthcare practices and public policy on hearing care in connection with healthy aging. The hearing health collaborative is building an action plan to address the barriers to hearing healthcare access including building awareness, simplifying treatment pathways and improving reimbursement for care. The group has already started with monthly educational webinars that I encourage anyone who wants to be an ambassador for hearing health care to join by visiting the website; https://adulthearing.com/hearing-health-collaborative/

AudiologyOnline: Tell me more about how Cochlear is working to improve cochlear implant awareness specifically.

Patti Trautwein: One of our biggest efforts has been investment in consumer education. We conducted extensive research on the needs, knowledge gaps, and misunderstandings. Then, developed campaigns in partnership with our clinical and medical advisors to place in popular media such as AARP, WebMD, and even most recently, television commercials. We executed extensive online and community-based education events that included cochlear implant recipients sharing personal experiences. We also engaged celebrities such as Lou Ferrigno** to help us raise awareness! In parallel, we concentrated our professional education efforts on clinicians who primarily work with hearing aids and therefore have limited exposure to the candidacy criteria and outcomes for cochlear implants. This has helped build confidence and connections within local professional networks on which to counsel and make a recommendation for a cochlear implant evaluation. There is an evidenced-based approach using a 60/60 referral guideline which states patients should be referred if they demonstrate a best ear unaided monosyllabic word score less than or equal to 60% correct and if they demonstrate an unaided pure-tone average in their better ear that is greater than or equal to 60 dB HL (Zwolan et al., 2020). It is hoped that this simple 60/60 guideline will improve access to cochlear implantation.

AudiologyOnline: What does it mean to be a standard of care and what is Cochlear doing to support standards in hearing health?

Patti Trautwein: Standards of care set an expectation that when visiting a healthcare provider, you are going to receive the most appropriate treatment for your condition, regardless of who you see and where. You also trust that the provider will treat you in the same way they would treat any other patient suffering from the same illness. If the provider is unable to provide the necessary treatment within their facilities, or the treatment required is outside of their training and expertise, the expectation is that they will refer you to a location or specialist prepared to meet your medical needs. Standards begin with professional consensus and evidence-based guidelines. We have supported two important projects in this area. First, with the goal of addressing the lack of awareness and improving literacy surrounding cochlear implant use in adults, an international group of clinical experts in the fields of otology, audiology, and hearing science was brought together to form a Delphi panel. From the Delphi panel, a consensus around cochlear implant candidacy was agreed upon, and the International Consensus Paper was created in response. We offer you open access to the International Consensus Paper via JAMA Otolaryngology: Unilateral Cochlear Implants for Severe, Profound, or Moderate Sloping to Profound Bilateral Sensorineural Hearing Loss; A Systematic Review and Consensus: Delphi Consensus Paper (https://adulthearing.com/consensus-process-and-publication/). Here you will find videos and other resources specific to the consensus statements on awareness, diagnosis, surgery, outcomes, relationship to cognitive health, and clinical and cost effectiveness. Second, we support the development and education of guidelines that are inclusive of the care continuum that today overlooks cochlear implants. Developing a consistent approach to optimizing care for adults with significant hearing loss who may not receive adequate benefit from hearing aids is essential to overcoming the burden affecting 1 in 5 adults (Buchman et al., 2020). An international and local US based taskforce has been formed to translate the evidence into recommendations for the real world. To learn more about the guidelines and how to get involved, you can visit https://adulthearing.com/living-guidelines/.

AudiologyOnline: Exciting to consider how these standards will allow us to help more people to hear better. What is the impact on the current clinical care model? 

Patti Trautwein: Great question. To serve a growing population with hearing loss, we need to make sure we have enough points of care, trained clinicians, and sustainable care models. With the recent availability of over-the-counter hearing aids, it is anticipated and hoped that people will seek help sooner. Many will need more than the device and seek the service support of clinicians. To accommodate the need, we must consider new care models that can treat patients in new ways that are convenient for the patient and efficient for our healthcare systems.

AudiologyOnline: How is R&D at Cochlear supporting hearing health literacy and treatment?

Patti Trautwein: We recently launched new Remote Care innovations that enable clinicians and patients to connect through telehealth. While the benefits were highly valued during the pandemic, many patients have expressed a desire to continue to manage care remotely when appropriate. Our smart apps also provide patients greater autonomy to manage their hearing and cochlear implant daily.

AudiologyOnline: What services does Cochlear provide beyond R&D?

Patti Trautwein: Cochlear Customer Care offers a range of services for patients and for clinicians. For patients, we have device onboarding, learning how to use and pair your technology, and troubleshooting support when needed. We also offer a range of rehabilitation tools. For professionals, we have an extensive offering of education events online, on-demand, and in person. We also provide a Reimbursement Hub with education and resources for surgeons, audiologists, and facilities.

AudiologyOnline: What does the future look like?

Patti Trautwein: As the population of people with hearing loss grows, I look forward to how we can embrace change and deliver patient-centered care. Technology to treat hearing loss will continue to evolve leveraging better electronics, intelligence, power, and interchangeable connectivity. Care models will also evolve to integrate telehealth and value-based practices. As we navigate this new world with our colleagues, patients, and the public, I look forward to a day when hearing is routinely viewed as part of health care and people with hearing loss equitably get the treatment they need, when and where they need it.

_{*Cochlear implants are covered for Medicare beneficiaries who meet CMS criteria for coverage.}

_{**Lou Ferrigno is a paid brand advocate for Cochlear; however, medical treatment and health decisions were made independently by him and his hearing health provider.}

References

Buchman, C. A., Gifford, R. H., Haynes, D. S., Lenarz, T., O’Donoghue, G., Adunka, O., Biever, A., Briggs, R. J., Carlson, M. L., Dai, P., Driscoll, C. L., Francis, H. W., Gantz, B. J., Gurgel, R. K., Hansen, M. R., Holcomb, M., Karltorp, E., Kirtane, M., . . . Zwolan, T. (2020). Unilateral cochlear implants for severe, profound, or moderate sloping to profound bilateral sensorineural hearing loss: A systematic review and consensus statements. JAMA Otolaryngology–Head & Neck Surgery, 146(10), 942-53.

Carlson, M. L., Nassiri, A. M., Marinelli, J. P., Lohse, C. M., Sydlowski, S. A., & Hearing Health Collaborative. (2022). Awareness, perceptions, and literacy surrounding hearing loss and hearing rehabilitation among the adult population in the United States. Otology & Neurotology: American Otological Society, American Neurotology Society and European Academy of Otology and Neurotology, 43(3), e323–e330. https://doi.org/10.1097/MAO.0000000000003473

Jilla, A. M., Johnson, C. E., & Huntington-Klein, N. (2020). Hearing aid affordability in the United States. Disability and rehabilitation. Assistive technology, 1–7. https://doi.org/10.1080/17483107.2020.1822449

Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., Brayne, C., Burns, A., Cohen-Mansfield, J., Cooper, C., Costafreda, S. G., Dias, A., Fox, N., Gitlin, L. N., Howard, R., Kales, H. C., Kivimäki, M., Larson, E. B., Ogunniyi, A., Orgeta, V., . . . Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet (London, England), 396(10248), 413–446. https://doi.org/10.1016/S0140-6736(20)30367-6

https://www.who.int/publications/i/item/world-report-on-hearing

Sydlowski, S. A., Marinelli, J. P., Lohse, C. M., Carlson, M. L., & Hearing Health Collaborative. (2022). Hearing health perceptions and literacy among primary healthcare providers in the United States: A national cross-sectional survey. Otology & Neurotology: American Otological Society, American Neurotology Society and European Academy of Otology and Neurotology, 43(8), 894–899. https://doi.org/10.1097/MAO.0000000000003616

Zwolan, T. A., Schvartz-Leyzac, K. C., Pleasant, T., & Hearing Health Collaborative. (2020). Development of a 60/60 guideline for referring adults for a traditional cochlear implant candidacy evaluation. Otology & Neurotology: American Otological Society, American Neurotology Society and European Academy of Otology and Neurotology, 41(7), 895-900. https://doi.org/10.1097/MAO.0000000000002664