amplification psaps in audiology

Using Non-Custom Amplifiers and Telehealth in Audiology Clinical Practice: Interview with Lori Zitelli, AuD

The practice of audiology is rapidly changing. It’s simply not enough to passively wait in your clinic for patients to show up looking for help; audiologists must become actively involved in providing care in places beyond the four walls of their clinic.

One of the pioneers in the practice of interventional audiology is Lori Zitelli, AuD of the University of Pittsburgh Medical Center.

In this episode of This Week in Hearing, we ask Lori how she and her team spearheaded a program that puts non-custom amplifiers on the ears of individuals seeking services in other departments inside UPMC. Additionally, Lori shares her experiences using tele-care to fine-tune and adjustment hearing aids; a topic, based on her recent articles which can be found in the March 2021 20Q at AudiologyOnline, in which she has become an expert.

Full Episode Transcript

Brian Taylor 0:10
Welcome, everybody to another edition of This Week in Hearing this episode, we have a very special guest, Dr. Lori Zitelli, who is an audiologist at the University of Pittsburgh Medical Center. The topic today is broadening the scope of Audiology within the community. And specifically we’re going to talk about a couple of different things. We’re going to talk about non custom amplification, and we’re going to talk about tele- audiology or telehealth. Welcome, Lori to the broadcast.

Lori Zitelli 0:41
Thank you so much. I’m so pleased you’re asked me.

Brian Taylor 0:44
Well, it’s great to have you an actual clinical audiologist extremely busy sees a lot of patients. So I think there’s a lot that our audience can learn from you.

First, I think Laurie would be helpful if you could just kind of tell us a little bit about your background, what you do at the University of Pittsburgh Medical Center what you love about audiology, I know you’re very enthusiastic. It’s always great talking with you. So go ahead and share with us.

Lori Zitelli 1:09
Sure, I’m an audiologist at UPMC. And that involves seeing patients and being involved in some of the administrative work in the clinic. And I also teach a lab for audiology students at the University of Pittsburgh related to clinical procedures. I participate in clinical research. And so I get to do a little bit of everything, which is what I love most about my job. As far as what I love about audiology, there’s so much to love. I don’t know that I can pick just one thing. I’ve heard people say that a satisfying career is one that you love, one that the world needs, one that you’re good at, and when you get paid for. So I really think for me audiology just checks all of those boxes. I get to do so many interesting things. And I think the big problem that I encounter regularly is that my interests are just too diverse. I want to every time I learn about something new, I want to become expert in it. And I think I just have to get over the fact that I probably can’t with everything. But my career’s young though, Brian, so I guess we’ll see what happens.

Brian Taylor 2:09
Yeah, no, that’s good to know, I think that I share some of those same interests that you do. I’ve seen your name, and more and more places. I know you’ve written about a lot of different things. Just recently, you were the guest editor for one of the issues this year of seminars and hearing. And I know that you’ve sat on some panels that I’ve been a part of over the years. I guess the first thing I’d like to talk to you about is your experience with non custom amplification. I think this is a really interesting, really dynamic kind of a place to be involved. Could you kind of explain your role or how you implemented this program around non custom amplifiers at UPMC?

Lori Zitelli 2:53
Yeah, so we we have a big inpatient program, and we have expanded to several outpatient clinics as well. And the goal of this program overall, is interventional radiology. And I know this is a term that’s near and dear to you. And it’s become the same to us. So I think you first described this way back in 2013, with Rich Tysoe. And thought, right, yeah, it’s it’s something that we’ve been kind of obsessed with ever since we ever since you introduced it to us. Interventional Audiology is all about finding the people who need our help, but maybe don’t realize it or they’re not actively seeking our care. So it’s all about intervening to try to improve their outcomes when something else is the primary concern. So we want to try to identify and manage their hearing loss, even if that’s not the reason they’re being seen, the provider that they’re seeing might also not have any idea that they have hearing loss, or frankly, they might not care. So it’s our jobs, to help the people who need our help recognize it, and to intervene to provide the help in the moment that they’re, that they’re receiving care. So that’s the goal of our program. And we do it in several different ways in several different

Brian Taylor 4:03
settings. Maybe you can explain some of those settings, which is I think, when I think of Interventional Audiology, I think of primarily when somebody goes to see their physician or nurse practitioner, somebody that maybe has a little bit of trouble hearing. There’s so much of the message that they could miss because of their hearing loss. And anyway, if you could kind of explain specifically, how you brought this program to life at UPMC.

Lori Zitelli 4:31
Yeah, absolutely. So I mentioned we have an inpatient program and an outpatient program. And it’s, it’s been so fun to watch them both grow over the last couple of years. So we when I was an extern in our hospital system in 2011, we dispensed 36 amplifiers across the whole hospital that I work in over a year. And I was just looking at the data related to last year and we dispensed over a thousand. So that’s been really exciting. It’s just keeps growing and growing and working. We’re trying to keep up and we’re doing it but it’s it’s sometimes a challenge. So we really attribute this increase to the hard work and dedication of our department who just continue to show up and keep advocating for our patients who need us at every opportunity. And on the outpatient side, we started our first outpatient clinic in 2014. So this was our post trauma clinic, I think I got the chance to talk about it at AAA that year. So the way this clinic works is we acknowledge that people who are discharged from the trauma unit probably don’t have all the information that they need, or maybe don’t understand all the things that they need to do at the point that they’re discharged. So we bring them back within two weeks, and there’s an outpatient interdisciplinary clinic, where we try to consolidate all of their real rehabilitation resources. So there’s an audiology provider, physical therapists, occupational therapists, nutritionists, advanced practice providers who are running the clinic. And the goal is to give them all the resources that they need to facilitate their recovery. So we started this in 2014. And we showed up every time they had clinic faithfully, and continued to preach our gospel about how untreated hearing loss interferes with health outcomes. And eventually the providers became converts. And we started receiving other invitations to be participating in other similar clinics. So now we’re in the anti head neck cancer survivorship clinic. We are in perioperative clinic, which is our newest adventure. And we have two outpatient geriatric clinics that you can see that we have an embedded audiologist. And we also have audiologists and students and communication facilitators in senior living facilities that are operated by UPMC. And we’ve partnered with our home health colleagues as well. So we were like, what you’re tripping over us, we’re everywhere, it’s great. And we are just hoping to continue expanding what we’re doing.

Brian Taylor 7:01
Well, I think the number one, that’s a lesson in how important it is to be actively involved to kind of take audiology to other departments, rather than sit back and wait for people to send people to you. I think that’s a great way for anybody to grow their practice. If you could kind of maybe we’ll get into the weeds a little bit. How do you decide what maybe, First of all, kind of define what a what a non custom amplifier is? How that differs from traditional hearing aids? What is your selection process? Maybe kind of take us through all of that, if you could?

Lori Zitelli 7:36
Yeah, sure. So the device that we use, is non custom, meaning it’s not, we actually in most cases, don’t know how these patients here, because we don’t measure thresholds. So there, of course, there are times when you need to know that. And if you’re customizing a solution that would be impossible to do without that information. But in the situations where we’re in, we’re trying to identify someone with hearing loss. So in that case, a screening is often helpful. So that’s a pass fail activity. And really, all it tells us is that they have impactful hearing loss or they don’t. And then if we determine it helps us to identify who might need us. So if they fail the screening, we can use a non custom device that has a headset with a cable that goes to a microphone, and there’s a clip on the back of the microphone, so you can put it on the patient’s lapel or in their pocket, it’s hands free, nobody has to worry about carrying it or managing it. And throughout these interactions with other care providers, it goes with them wherever they go. So it’s it’s non custom, because it’s not programmed to their audiogram, it’s not computer, it doesn’t attach to the computer. It’s not digitally programmable, but there’s a volume control. So the patient is able to adjust it to a level that they find comfortable and is helpful. So the device that we use is very low cost and is simple for people to operate it which is important because once we teach them how to use it, they they have to use it with their healthcare providers, and we’re not present. And it’s effective. So the it really kind of checks all the boxes for us. It’s we I don’t know if I’m allowed to say the device that we use, but I guess Okay, not okay. It’s a Sonic Technology Super Ear is the device that we use, and we get a really good price on them because we order so many of them.

Brian Taylor 9:26
Yeah, let’s see, the volume discounts are always good. Yeah. But maybe you could maybe share some of the stories around what providers, healthcare providers and what patients say about this type of intervention.

Lori Zitelli 9:44
Yeah. So we it’s really fun to interact with some of the providers who have used them, because I think especially some of the busy hospital providers, they don’t always think about hearing and when you’re able to give them the opportunity to see the difference that it can make for themselves. I think sometimes that’s just what they need, you can tell them anything you want to tell them, but until they see the difference for themselves with one of their own patients, I think that’s what makes it stick. So one of the surgeons that we work with loves to tell the story of a patient that she was working with, who was very groggy, not totally unresponsive, but just not totally with it. They were really concerned about a brain bleed. So they were about to order some imaging, and her intern who was rounding with her, was like, oh, there’s, I see one of those headsets over there. I’ve seen them before. I’m familiar with them. Maybe we could try that and see if it helps. So they put the headset on and they start talking to them through the microphone to the patient. And he just perked right up, he’s totally fine. He just couldn’t hear them when they were trying to yell at him. And so that just illustrates a couple of things. I mean, communication, obviously is important the ability to participate in their care, and the cost savings that the medical system can can experience. So we know that untreated hearing loss is linked to a whole bunch of horrible things related to healthcare outcomes. And if we’re able to identify and mitigate it, it, it produces those things. So right

Brian Taylor 11:19
No, uh, we had Nick Reed was on an episode a few a few weeks back, and he went into some of the details some of the data to kind of underscore what you’re seeing in the clinic. I think with your testimony here,

Lori Zitelli 11:33
yeah, I think the data are really compelling. And we see this stuff day to day. So I get a report every time there’s an incident in the hospital, if there’s if the word ‘hearing’ occurs in the report, and a lot of them are related to lost or damaged hearing aids within the within the hospital system for inpatients. And we do help them to replace the devices. So that’s also a cost savings for the for the hospital. But sometimes the reports I get are not device related. So there are a ton of adverse events that can be linked to untreated hearing loss. And even simple things like patients being admitted under the wrong name, because they were asked to spell the name. And the person spelled it off, and they didn’t hear them correctly. And they said oh yeah, that’s right. But it wasn’t, so we see this stuff all the time.

Brian Taylor 12:22
That’s really interesting. And I’m guessing that when somebody has an opportunity to wear one of these devices, and they see how well they work, oftentimes they probably end up in your clinic for a hearing aid evaluation.

Lori Zitelli 12:36
So that’s the that’s the goal. So the goal in the moment is to improve their communication and give them the ability to participate in the care. But we also want to connect them to one of our clinics so that they can follow up and receive a customized solution. So the way it works in our hospital system for inpatients is that the hospital will pay for these devices, the patient does not pay anything, it does not go through insurance. UPMC really considers this an accessibility issue. So it’s all about giving the patient access to whatever communication they need to participate. So they, when they’re discharged, the device goes home with them. And we are acknowledging they’re going to need this throughout the rehabilitation. And when they get to the point where they’re well enough or able to pursue a customized solution, they already have the information for where they can find us. Because the boxes that we deliver these devices in have a pamphlet with all of our clinic information, we have several satellite offices that are hopefully convenient to at least one location for them. And the devices themselves have a sticker on them with our contact information. So the goal is to always link them back to us so that we can help them to take that next step.

Brian Taylor 13:46
Right. And it’s really a win for everybody. It’s a win for the department. It’s a win for the patient, obviously. And it’s a win for healthcare providers and makes it easier for them to communicate with the patient and their family. So no, it’s a great program,

Lori Zitelli 13:59
we do follow up with the patients and the providers and the family members of the patients who receive these when they’re in patients in the hospital. And we follow up a day or two after just to ask one Do you know how to use the device? And two, do you think it’s helping? So 88% or more of the patients, the nurses and the family members all say yes, I know how to use the device. It’s simple. I’m not having any problems with it. And 95% of patients say yes, that it’s helping them to communicate and the majority of nurses and family members agree.

Brian Taylor 14:33
It shows again, the power of data, the fact that you’re tracking things, you know what’s going on, you know what’s going on, and see how the program is ramped up over time. And it’s really impressive. It’s kind of one of those things that everybody should be doing that’s within you if you’re in a medical center.

Lori Zitelli 14:50
I agree. Yeah, we it’s really helped us to just interact with so many more different groups and just kind of keep spreading the word about what we can offer. And I think a lot of people, a lot of providers are not resistant to it, it’s just that they don’t think about us. So we’re, we’re not even at the top of their minds.

Brian Taylor 15:11
They have so many things going on in their day if somebody requirements when it comes to managed care and taking care of people. So you kinda have to go out there and be proactive about what you bring to the table.

Lori Zitelli 15:22
And at this point, we’ve been doing this long enough that we kind of have a system. So when we integrate ourselves into a new outpatient clinic, we we know how it works, we need to be the first person to see the patient. So if the patient is in a room, and there’s going to be three different providers coming in to see them, we have to be first because what’s the point of having someone come in and have a whole conversation if the patient is missing half of it? So we, we kind of are expert lurkers… we kind of lurk in the hallway and then as soon as someone is roomed, we duck in and do our thing. So it’s kind of a joke around here ‘we teach our our students to be creepy’. It works very well for us and other we don’t miss very many patients. They’re they’re very, very good lurkers.

Brian Taylor 16:06
Yeah, I don’t think I’ve ever heard of Audiology and lurker in the same sentence. So that’s, that’s a very memorable way to think of

think of things. Well, the other thing I wanted to talk to you about and why why and you have have you on the episode was around your writing. What you’ve talked about with respect to telecare and it for for anybody out there that wants to read what a lori wrote, seminars and hearing and it came out maybe in May or June. There’s some excellent articles in there about telecare. maybe explain to us what you do around telecare how it benefits you and it benefits the patient at UPMC.

Lori Zitelli 16:49
Absolutely. So before the covid 19 pandemic, we didn’t do very much at all. It’s and it’s not that we didn’t want to, it’s just that we didn’t need to so then it was it was a matter of are we going to expend all this effort to ramp up for this. When, when at this point, all of our patients needs are being met or so we thought. So the juice wasn’t worth the squeeze at that time, so to say. So then COVID-19 hit and suddenly, we were forced to come up with new and creative and interesting ways to provide care to people that we couldn’t access face to face. So pretty much overnight, we geared up to do video visits, either from the office or from our own homes, because a lot of us were still working from our homes at that time, telephone visits, finding a way to hide your personal cell phone number, if you were calling from home. Think about things like that curbside visits, patients pull their car up and call our office and one of us would run down to drop something off or pick something up in remote device programming is a is a big part of what we do now. So I think I at least I initially was kind of reluctant to, to pick up that whole area, because it just felt kind of daunting. every manufacturer does it differently. And then there’s a whole aspect of like, how do you fit this into your day? You know, am I going to be having all these requests coming at me while I’m already with patients? And I’m not going to have time to do all this? And how do I schedule these? And how do I get built, you know, paid for it and all these things. But we took a little bit of time to think about that. And I really think that in the end it was worth the effort to to figure it all out. So little shameless plug here, you guys can benefit from all the work that we did to figure all this out by looking at a recent 20 Questions I did with AudiologyOnline for Dr. Gus Mueller. It’s called remote hearing aid programming getting started. So there are a lot of resources related to several hearing aid manufacturers that tell you how to set up your accounts, how to activate the capability for your patients, just some considerations in terms of scheduling and reimbursement. Talking about some data related to satisfaction, basically just trying to help you think through how this might fit in your practice. So that’s something you could check out if you’re interested. There are a lot of good resources there.

Brian Taylor 19:15
I’m glad you brought that up. It was published maybe what? Earlier this year. I know Yeah. Yeah, it was so you can find that out AudiologyOnline. Thanks for bringing that up because that’s a good starter around this. If you’re not that familiar with telecare or want to learn more about it. I’m kind of curious, Lori, how many patients on an average month would you say are you using telecare as part of the adjustments for follow up

Lori Zitelli 19:40
so my co workers tease me that I never want to see a patient in person again, because I try to make a lot of things telemedicine if they can be. So I run the tinnitus retraining therapy program at UPMC. And everything needs to be in person and now there are really only two visits that we require the person to come to the office for. Everything else is telemedicine. And it’s great. The I think a lot of times people think about patients in rural areas really benefiting from this type of care. But if you saw the hospital that I work in, in this part of town and how difficult it can be to get there and navigate through the hospital, and pay for parking and, and all that, our patients really, really like it and they are very much appreciating the opportunity to to receive that type of care.

Brian Taylor 20:28
Yeah, no

doubt, I think audiology of any adult hearing aid fittings are an ideal place for tele health. I know just in my work with Signia. We’ve done some studies around the telecare app that Signia has, and it shows people that use the app, their outcomes are, like 10% higher than those that don’t use the app. So it does work. No doubt about it.

Lori Zitelli 20:54
Absolutely, it’s great and patients love it. And just like in general, not even specific to remote programming. I things are so crazy right now, just with COVID-19 and closures and things. Right now my, I have two boys, their daycare is closed because of a COVID exposure. And I ordinarily would have had to rearrange a bunch of things on my schedule and reschedule patients. But I had yesterday an afternoon of telemedicine video visits, which I was able to complete from home. So that was really great. And in the patients were very glad not to have to reschedule those.

Brian Taylor 21:29
Yeah, no, it just shows you how much audiology is in the midst. And the involved in the midst of a lot of changes. Yeah, I think you’re gonna see more and more people use it for adjusting hearing aids, I think probably down the road and not too distant future you’re gonna see more people do it. Use remote testing. So it’s, it’s definitely not going away. It’s only going to become more user friendly. I agree more thorough and how you take care of the patient. So it’s very much a part of, of daily practice.

Lori Zitelli 21:59
Right? Can I can I just say if there are any hearing aid manufacturer or people listening, I want to be able to adjust the tinnitus sound generator remotely. So if I can’t do that with your device, please let me

Brian Taylor 22:12
Well, I hope everybody that’s in industry heard that. Well, I just wanted I guess we kind of wrap things up here, Lori, any you know, one of the things I really admire about you and about UPMC is how active you are within the healthcare center there. You don’t sit like I said before, you don’t just sit in your office and wait for people to come to you. You actually get out there and get really involved and

Lori Zitelli 22:41
literally chased them. Yeah, I

Brian Taylor 22:42
mean, it to me that’s a lesson for everybody in the profession to learn from. So if there’s one thing about your experience doing that, that you could share with us as we wrap things up, what would it be?

Lori Zitelli 22:56
I think it’s exactly what you said Brian, you keep showing up and you keep taking, taking advantage of opportunities to connect with patients and providers and show everyone the value of what you can provide to them. So this program wasn’t built overnight we’ve been inducted my director, Dr. Catherine Palmer has been laying the groundwork for this for years and we’re just over the last couple years really seeing it take off and it’s it’s been really fun to watch so but it only happened because we kept showing up. So that would be my advice.

Brian Taylor 23:29
Shows you success in life, half of it or more is just showing up and being there. Great. So, uh, real rising star in audiology Lori Zitelli, we’re so happy that you could be here. You know, all the great things that you it’s, I really admire the fact that you’re not only seeing patients but you’re writing. You’re getting recognized for that. So thank you so much for for being on the broadcast today. Really,

thank you so much for asking me It’s always fun to talk to you.

Yeah Likewise, have a good day. Thank you.

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About the Panel

Brian Taylor, AuD, is the senior director of audiology for Signia. He is also the editor of Audiology Practices, a quarterly journal of the Academy of Doctors of Audiology, editor-at-large for Hearing Health and Technology Matters and adjunct instructor at the University of Wisconsin.


Lori Zitelli, AuD, joined UPMC as an audiologist in 2012. She received her clinical doctorate in Audiology from the University of Pittsburgh. She is a part-time lab instructor at the University of Pittsburgh and teaches a Clinical Procedures Lab for first year AuD students. Her special interests include amplification, tinnitus/decreased sound tolerance evaluation and treatment, clinical education, clinical research, and interventional audiology.  She is an active fellow of the American Academy of Audiology.

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