Embracing and Implementing Innovated Audiology Service Models during and post COVID 19

Coronovirus disease (COVID-19) dramatically changed the traditional approach to audiological assessment and management — with a shift from in-person face-to-face care to the need to quickly pivot to telehealth options. Prior to the pandemic, telehealth options in Cleveland Clinic’s audiology practice included traditional telephone calls in the office setting to check on patient progress, contacts that were not accounted for on appointment schedules. This model lacked capabilities for virtual visits, remote hearing needs management (programming, troubleshooting of hearing aids or other sensory devices), and triage encounters to determine need for in-person care. Since the start of the pandemic, telehealth options have been embraced and as the transition is made back to in-person care, the lessons learned from the experience have opened the door to new innovative models, as demonstrated by Cleveland Clinic’s Vestibular Clinic.

During the COVID-19 pandemic it was imperative to triage patients to determine the appropriate plan of care for in-person contact. With this in mind, previsit screening appointments were developed for new “dizzy” patients to the practice. Fifteen-minute video/teleconferences were scheduled to review and clarify symptoms to parse out the following:

  1. Signs and symptoms suggestive of brainstem, cerebellar or vestibular etiologies
  2. Functional impairments on activities of daily living

Videoconference platforms offered real-time initial screening for ocular motility, neck range of motion, and observations of nystagmus.

Those patients with high suspicion of vestibular impairment were seen in the clinic for evaluation; appropriate test measures to address clinical concerns (specific components of the vestibular test battery) were selected based on the telehealth encounters with the patients. This allowed for more efficient use of in-person contact time at the height of the pandemic.

Telehealth Triage Process for Selected Test Measures Based on Patient-Reported Symptoms
SymptomsDiagnostic Measures
Vertigo triggered with position changes lasting seconds to minutesCheck for benign paroxysmal positional vertigo: eg positional testing
Unsteadiness when walking or standing, increased symptoms in darkness and on uneven surfaces; oscillopsia, lack of symptoms when sitting/laying downCheck for bilateral vestibular loss: eg rotational chair testing
Spontaneous episode of vertigo/imbalance lasting hours to days, resolving to head/body provoked symptomsCheck for unilateral vestibular loss and status of compensation: eg VNG with caloric irrigations
False sense of motion, rocking, or tilting, imbalance/disorientation, distorted visual perceptionCheck for otolith dysfunction: eg VEMP
Brief symptoms (seconds to minutes) of dizziness, autophony, disequilibrium, oscillopsia, postural vertigo and/or vertigo associated with loud sounds/pressure changes or strainingCheck for third window effect: eg screening for superior semicircular canal dehiscence or fistula

VEMP = vestibular evoked myogenic potential, VNG = videonystagmography

In 2020 (during height of pandemic June – December 2020) there were a total of 334 virtual vestibular appointments, up from 10 virtual visits in 2019.

Vestibular Virtual Visits