Audiologists Bring Vital Hearing and Balance Care to Ukrainian Refugees in Poland

All right, everybody, and welcome to another episode of this Week in Hearing. I’m thrilled to be joined today by two great doctors of audiology. I’m joined by Daniel Romero and King Chung. So why don’t we go around real quick, introduce ourselves. We’ll start with you, King. Thank you. I’m a professor at Northern Illinois University, and then I have been involved in humanitarian services and research for the past twelve years, and I’m very glad to be here. Awesome. I’m glad that you’re here. Daniel. Yeah. My name is Daniel Romero. Currently I’m an assistant professor at Vanderbilt University Medical Center. This was a very unique opportunity for me, both as a professor now, but also as a student, since Dr. Chung’s been doing this work for quite some time. So that’s kind of how I got involved. But again, just happy to be here and share our experiences. Yeah. So I appreciate you two coming on. I’ve been very intrigued by Dr. Chung’s work. I saw the article that was published not long after the Ukrainian war with how it was relevant to some of the different humanitarian work that you’ve been doing in that part of the world. So I wanted to have you two on because I know you two just recently came back from Poland, so I thought we could talk about the Poland trip and then if you want to use that to launch into a broader conversation about the work that know, humanitarian work and trips that you’ve been doing. King over the last decade or so. And then, Daniel, you can obviously chime in with the experience that you’ve had, so I’m going to kick it over to you. King why don’t you just sort of paint the picture for us of how this came to be and what you’re all doing over there. All right, thank you. Well, this one started before the Ukrainian war, and there was a professor from Jagiellonian University from Poland who came to Northern Illinois University. So then I happened to have a conference that it was scheduled in April 2022. And then before that, my chair said that, oh, he came here, why don’t you go and then visit him and then see if we can have any study abroad opportunities that you can take students there. So then I said, okay, great. But in that February, then the war broke and I was so angry. And then I was thinking, what the heck? This is the modern day, and then how can this happen? So then I want to do something about it. So then I went to see the professor in April and then we discussed how to test school children. That was. Initial intent, but because of the war. Then I contacted the Jewish Community Center in Krakov, and then we, hey, you know, do you have any connections with Ukrainian refugees? And then we want to provide services for them. And then that’s how it started. So then we went in that Thanksgiving, and then we tested the school kids and then also the Ukrainian refugees. And there were about 150 of them, but then about 60, something close to 70 of them had hearing loss. And then I was thinking, whoa, how is that possible? Like, half of them have hearing problems. And then we said, okay, how is the Polish system? Then we found out that in the Polish system, they would get free hearing tests and then hearing programming, but then they don’t buy the hearing aids for them. So that means most of them, they would not be able to hear and would not be able to get the devices. So then after we came back in that November, then we planned to go back in the spring. And then during that time, we contacted quite many people, including you, for hearing aids and hearing aid supplies and then all the things that we would need in the trip to fit hearing aids. So then we were very glad that ReSound decided to support that. And then you also donated some and then also MedRx donated the calibration of the equipment. So then we were ready to go in March. Then in March, we fitted about 70 something hearing aids. Well, I think it was more than let me think about that. It was 80 some hearing aid. And then we said, okay, there are still other people that we have not seen. And then we also want to provide follow up surfaces because one of the here interior things is that when we go to fit hearing aids to a population, we have to provide fine tuning surfaces. Otherwise then the hearing aids may be in the drawer. It will not be used. And then if there’s any problems, we also want to resolve that. So then we also planned the June trip to go back. And then that’s when I was thinking, oh, okay, one of the schools goal is to say, okay, how can we involve alumni? So then we said, well, this will be a perfect opportunity, and then we have trained all the very capable audiologists through the years, and then how can we involve them? So then we just say, okay, hey, come on, if you’re interested. Stood, then join us. So that’s how Daniel and also other alum joined our trip and know the rest of is history then that’s so cool. I love that. Thank you for painting a picture for us there. So it’s very noble work that you all are doing. So, Daniel, you just got back, it sounds like, or about a month or two ago from Poland. So tell us about your experience over there, what you were doing and just kind of like how this all? So I guess, you know, like King had mentioned, she had sent out an email to several different Alum, and it certainly was something that I knew I wanted to be involved with and help in some way. And so it’s kind of just a pain of backstory. I received my AuD from Northern Illinois University. So as a second year, I went on one of these humanitarian trips where we served the Aboriginal community in Australia. And it was just an outstanding experience and know, one of the more most memorable things for my AuD program. So I knew something like this I’ve always wanted to continue to be involved in. So when Dr. Chung sent out that email, I was, you know, I don’t necessarily do anything with hearing aids. You don’t want me fitting a hearing aid at this point, but I still want to try to of my work. All of my work really is on the vestibular side of it. And so dizziness and balance, and given the amount of people with hearing loss, I wanted to see, there has to be a subgroup of these patients. Just based on what we know about the incidence of dizziness or vestibular problems in people with hearing loss, I wanted to see what was the percentage, what subgroup were also experiencing dizziness and imbalance. So before the trip, a few months before in the March trip? Yeah, during the oh, that’s right. Yeah, right before the March trip in the spring, I worked with King and one of her translators colleagues, and we translated a case history form. And it was just a standard case history form that we wanted to see just to get an idea of how many were also experiencing dizziness, imbalance. And sure enough, there were a significant amount, I want to say anywhere from 30% to 40% were at least having symptoms of vertigo, imbalance, tendency to falls, those types of things. And so I think initially that provided a good justification to also go over there, but there were just so many different logistical things that we also had to take care of. So, fortunately, in. Acoustics was able to provide some funding, also able to provide some equipment that allowed us to go over there and do some objective testing out in the field, as well as funding for travel and for me to bring a few students from the Vanderbilt program. So I was really surprised on how well everything ended up turning out. It was certainly a lot of work on the front end, and I was like, okay, where’s something going to go wrong here? Because there’s certainly a lot of humanitarian trips that focus on hearing and hearing aids out there, but there aren’t necessarily not one that I know of, at least in the audiology community, that focused on providing vestibular services. And so we wanted to be able to not only do a combination of objective and bedside testing to get an idea of vestibular function, but we also wanted to be able to provide them with something. So there were certainly a lot of meetings on the front end, meeting with some physical therapists, getting things translated to be able to make this work. So certainly we can go into a lot more detail on some of the more logistical things. But, yeah, we were able to provide a pretty comprehensive vestibular assessment and provide translated handouts that they were able to do VRT exercises, balance exercises. So I really feel like it was something that was successful, especially for the first go around. Yeah, I think it’s obviously really cool for a number of reasons. You’re overhelping refugees from that part of the world and providing with audiological services. I agree with you, Daniel. I’ve not heard of any of these humanitarian trips that seem relatively pervasive within the audiology community. I don’t know if I’ve ever heard any that are focused on vestibular. So I am curious about some of the logistics of why maybe that has historically been the case, what maybe some of your preconceived notions of why it might be difficult and how you overcame them. So we can get into that as the conversation goes. But just to fixate a little bit longer on this, I want to make sure I kind of understand this. So obviously you’re providing clinical services and humanitarian aid, but is there a research element to this too, that was occurring during these trips? So, for the Polish students that we were trying to see, because although on the books that Poland wants to do school hearing screening, and then they also had some research studies showing that, oh, okay, what is the preference of hearing loss among students? But they actually do not. Have annual or planned screening programs. So then we wanted to see, okay, how many students would have hearing difficulties or problems, ear and hearing problems. And then we want to compare between the private school and also the public school kids. And then that part is the research part. And then we want to say because historically, if someone has lower socioeconomic status and then if they live in rural areas, they often have more difficulties getting access to any hearing or health or medical services. So that’s why we want to do that comparison. Okay, that makes sense. And then so you’ve identified this trip and you go over there. Can you kind of walk me through it? Sounds like this was about a ten day trip. So what was this day to day like for you all? How did this actually work? Kind of on that level of Granularity Daniel, you want to talk? No. A little bit. Can always I can always chime know. Certainly with the setup and all of working with the JCC and working with the KOD over there, the Jewish community, we were able to at least have a testing site that really consisted it wasn’t a large space, it was near old Town Krakow, and it was pretty much consisted of three rooms. Can you the primary function of that space, what they use? They actually organize demonstrations. Okay, yeah. So organizing demonstrations, but they were just so gracious to be able to provide a setting for us to do these assessments. And so it was three main rooms. Two rooms were used for more diagnostic, pure tone audiometry, hearing aid fittings, hearing aid fine tuning, and calibration. And then there was this center room that consisted of a long table, and that’s where we provided our vestibular assessments on one side of the table and on the other side was Dr. Chang providing counseling as well as creating instant molds for doing ear mold impressions for the hearing aids. And so there was a lot of maneuvering around certain of people in places, but we made it work. And it was. You know, there was you know, we we were able to kind of see the site first thing Monday morning. And, you know, thankfully, that was, I think, our slowest day, but it really allowed us plan and, you know, provide some adjustments to, you know, where the equipment was going to be, where the testing was going to be, where is the counseling going to be. So, thankfully, it wasn’t a crazy busy day because it allowed us to prepare for the rest of the patients coming in for the rest of the week. And so really, things picked up Tuesday to Friday, and by that point, I feel like we were really well prepared. We had our own little stations, at least on the vestibular side. We had one end of the table where we were doing positional positioning, checking for things like BPPV. We had a little station where we were testing their balance. We had a little station where they were having an ocular motor exam, just testing for any central ocular motor issues, doing other bedside stuff like dynamic visual acuity. And again, this is really on the spot in an area where you sort of have to improvise. It really helped bring out your creativity, I will tell you that, because you had to be creative in where you wanted to do all of this. But yeah. King you want to provide any other details about the hearing side of it and how you guys prepared for that for the ten days we went there on Saturday, so everyone arrived on Saturday and then on Sunday because most of us didn’t know, while some of us know some people. So then we had a group activity and we went to the Auschwitz and Birkenau concentration camp to get to know a little bit about the Poland’s, the Nazi camps concentration camp in Poland. And that was one thing to one of the activities that we can get to know each other and then also to know about the culture. And then we had meetings at night to discuss what are we going to do the clinical procedures, get to know the equipment and then all those things. And then on Monday morning, so we scheduled Mondays patients to be lighter than other days because we know that we get into the space and then we all need to know how to do things and then where to do things. And then so we have a lighter schedule on Monday and then on Tuesday and Thursday and Friday, the rest of the week, we have full schedule. So then about 12-13 people a day and. Day was only eight. And then our JCC partner, he’s very good, and then he scheduled people and then every half hour so then we will be able to take care of them. So then they need the space at 05:00 p.m.. So then we shift our time to early in the morning and then make sure that at 08:00 we are ready to start. And then went all the way to 05:00 in the afternoon and then on Saturday because all the members have been in Krakow for a week. And then we say, okay, just go, do whatever you like. So then we have a free playday on Saturday and then on Sunday then it is the leaving day. So we can either leave, know, stay in Krakow for a little bit, know, Daniel’s group left on Monday morning, very early Monday morning. So then they also have part of the Sunday to see Krakow a little bit. So those are the day to day. And then because we only have three rooms and then we use one room for hearing tests and then the other room is the vestibular and then also hearing aid counseling. And then the other room, the most quiet room was reserved for the hearing aid fitting. And we actually hauled in the first trip we used MedRx, but then in the second trip because hearing aids might, some hearing aids might not be working and then we need to be able to check. So we actually hauled a Verifit unit to go. So then the Verifit was used to fit hearing aids and then also check the hearing. Very cool. Thank you for painting me a picture of the logistics of this, of how this all works. It sounds like you were able to see a lot of different patients both on the hearing side, the vestibular side. You had a nice space that was set up for you. Sounds like maybe you were able to have some of the Polish doctors and aspiring audiologists or hearing care professionals in their own right over there that were able to kind of shadow some of these different procedures. No, we have been trying to contact the hearing professionals in Poland and then we didn’t get any response. And then I also asked the Jagiellonian University’s professors to connect us with the local providers and then we were not able to do it. At least I tried for quite some time and then I know Daniel also tried and we were not able to do that. And then the JCC person is actually a person who can speak Ukrainian and then he connects us. With the Ukrainian population that they were serving. So he also organized and then find the translators so that we can talk with the patients. So they have been really helpful. So JCC is the Jewish Community Center in Krakow, and then for the local professionals, we are still trying to connect with them because it is very important that the locals know what we are doing. And then it’s like someone go to your home and then they do something to your people and then you didn’t tell them. So it’s not so then, you know, we always, always try to connect with professionals there. Gotcha. Okay, that was the other thing that was really nice was King had mentioned that we did have translators there. There were three that kind of were on call to wherever we know if somebody needed instruction for a hearing test, they moved to that room. Instructions for counseling, instructions for real ear verification, that type of thing. So we really couldn’t have done this without the translators too, because they were so incredibly helpful. At least on the vestibular side, we had translated instructions on paper, but we used a lot of again, really promoting a lot of creativity on the spot, especially because we’re doing this out in the field. So we were using a lot of body language, a lot of hand gestures when we didn’t have access to the translators at that particular moment in time. But other than with counseling, that of course is the most important part. And the translators were absolutely profound, a profound component to this entire trip. Yeah, and I also want to say that JCC was very helpful and then the know all of them were also very so in the first trip in March. And then because we have hearing aids and then with those apps, then we need to download the app and then into their phone so that they can adjust the hearing aids. Right, so these are rechargeable Resound One hearing aids. So very high end and also very good hearing aids. And at that time, KOD didn’t have good Internet, so we were really having a lot of trouble and then try to work with the Internet. That JCC was thinking that, oh, okay, maybe I can buy the Internet for you. And then the second trip when we were there, KOD, which is the organization who provided the space for us, actually got fast internet for us. So that was very helpful and I was very grateful that they were also supporting us in that way too. Very cool. So were the people that you were working with, the patients, had they ever been exposed to anything in this vein before? Like a hearing assessment, a vestibular assessment? What kinds of vestibular conditions were you finding, Daniel? Was it primarily like dizziness know, what was this? So I guess we kind of classified it as overall, throughout the test, we classified it as a significant cases. So significant cases in our sense, consisted of either a true vestibular impairment, BPPV, significant unsteadiness migraines, and or central issues. So I would say out of the 54 refugees that we tested on the vestibular side, there was about 35% to 38% of them we considered significant cases. And that 35% to 38% consisted of four vestibular impairments. I want to say three cases of BPPV, two central cases, which was really interesting to see out there, and then a handful of people suffering from just significant imbalance. And so that’s kind of how it divvied up. So as far as dizziness from a vestibular problem, it was anywhere from like 17% to 19%. And we were using a combination. We did have some video goggles that Interacoustics was able to provide for us to be able to do to look at eye movements in the dark, because we know that that’s so important on the vestibular side. So we had some objective data that we were able to use. But a lot of our testing was doing was at bedside really low cost, really nothing that really requires any fancy equipment. And we were still able to identify some of these. So it’s actually my guess that we under-shooted a lot of what was actually there because just because of with the sensitivity of bedside, it’s not going to catch. Some of these mild to moderate cases of vestibular damage. And so for us to kind of catch the numbers that we did, I would say that the number is actually higher in this particular population, I would say anywhere. And that’s really lined up pretty perfectly with the value and the figures that we obtained from the case history forms that we had translated and completed by them in March. So it was certainly lined up. The two questions I wanted to answer for this being, like, the first vestibular component to these humanitarian trips. The first one is, is vestibular testing or is there an actual need in this population? And then figures that I just provided to you this trip really confirmed that there was a need in this population. And then the second one was, can vestibular testing be done out in the field? And certainly answered yes to both of those questions, which was really enlightening, and that was really just additive on the philanthropic impacts that we had doing a trip like this for them. And you were also able to recommend some people to do exercise at home. And I also believe that you also treated some people with BPPV. Yes, that’s spot on. So, yeah, the cases that we found, BPPV, we were able to do treatments for them. Epleys, Yacovinos, whatever we found. I think we had one case of anterior BPPV that didn’t require an Epley, but a different maneuver. So we were able to treat right there on the spot those that we found had true vestibular problems. We provided vestibular rehab exercises, and that was really in the support from our PT colleagues at Vanderbilt, providing simple home based instructions for them to do these exercises at home, in the comfort of their own home, for a few minutes a day. And so same thing with the balance. Those patients that had significant imbalance, we were able to at least provide them with some balance exercises in hopes of driving up vestibular information that they could use to maintain postural. Certainly had were able to provide a discussion there. And I know Dr. Chung and I are thinking of returning back over the Thanksgiving holiday to just follow up on. So I’m really curious to see how these patients are doing after the exercises. Did the exercises get translated by the translators? They did, yeah. So we had an English. Kind of side for us to kind of look at. And then on the backside was it translated word for word in Ukrainian. And a lot of that was really with the help of Dr. Chun’s colleague on the front, know the weeks prior getting these things translated, making sure that the grammar and everything else was correct and then printing them and literally bringing them with us on the plane. So was going to ask, you already jumped the gun, Daniel, is are you going to go back, what’s next? So it sounds like you already have a trip in line with what’s that trip going to entail. Yeah, well, for the vestibular side, we want to make sure that these exercises are helping and so hopefully we can see through the objective and bedside test, hopefully see some improvement in their symptoms and if we’re still finding things, we can always try to kind of make the exercises more difficult. So we certainly have a lot of things that we can still provide. And then one thing to keep in mind too is the recruitment of the refugees. Their primary concerns were hearings and so hopefully we can kind of get the word out to also let them know, hey, we’re able to provide some balance services as well, or if you’re dizzy or if you’re imbalanced, come and get tested and we’ll go from there. So there’s certainly a lot of things I know that this is particularly a door that has been opened that I don’t want to close at this point. It not only has a clear impact on the refugees that are going through so much over there, but also, I think, just opens the door to what’s possible in vestibular audiology as well as what’s possible and has broader implications for education and communication sciences and disorders. Because I brought three students with me and so certainly that is going to be an experience that they’ll remember after they’re done. Awesome closing thoughts from you. King okay, so for us, we definitely want to apply fine tuning to the patients that we have fitted in the last two trips and we also want to fit the 13 years. And after the trip, the JCC person told me that there were four other people who did not respond in the first time and then they also wanted to get hearing aids. I think that was good probably because they heard the good things from their friends and then they say, oh, okay. I want to be a part of that too. So I have just left Northern Illinois and I’m taking a job at MGH/IHP, which like just the abbreviation is a mouthful, but then the whole sequence is actually Mass General Hospital and then Institutes for Health Professionals. So then I am in Boston at this going to I have already recruited one of the Boston audiologists and then I need two more. The main thing is and then we try to keep the size small. One is that you know that the rooms are small and then we cannot just have a lot. The first time we had 13 people and then it was just too many people. And then the second time when we went with Daniel, and then we have about ten people, so that was good. And then I need two more audiologists. Mainly is because for the hearing aids, we counted that we need four carry on bags in order to take all the equipment over. So we usually take the equipment over because we want to make sure that we have them. And then coming back, we can ship them or we can put them into the check bag, but then going over, we always want to make sure that all the equipments are with us all the time. So we’re going to have two more audiologists from the Boston area. And then one of the translators who were there in June said has a child with special needs. And then she was looking at us and then testing kids and also adults hearing. And then she was wondering, oh, how does my son hear? So she brought her son to come with us and then she saw how our pediatric audiologist tested him and we were able to confirm that he had normal hearing. And then he you know, in Poland, nobody does this for children with special needs. So how about if I connect you with the center that provides services to children with the special needs and then you guys can come over and then to test and then we say, yes, we definitely are up to this challenge. And from my previous experience, we know that about 33% of the children with a special needs, they may have ear or hearing. Problems. They usually have a higher rate of hearing, ear and hearing disorders. So we’re also going to test those children. And then if we find anything, then we are going to refer them to the Polish system as you know that they have free hearing services. But then it’s just sometimes nobody knows they actually have problem. So we want to be able to identify who has problems so that they can take care of them. So that’s the plan for the coming Thanksgiving. Very cool. Well, thank you two so much for coming on and sharing this experience. It sounds like it was pretty profound experience and life changing in many ways. It sounds like you’ve made a big impact on a part of the world and part of the human population that really needs it. So I think it’s very commendable and I look forward to hearing about your trip when you guys go back in November. So thank you two so much for coming on today. Thanks for everybody who tuned in here to the end. We will chat with you next time. Cheers. Thank you.