The Welch Allyn LumiView Clear Specula is new and totally worth checking out. Why? The disposable specula are transparent, providing a much brighter field of view than the opaque specula we are all used to using. Since the otoscope light shines through the specula, the light output is 4X – 8X greater in the ear canal than traditional adult and pediatric specula respectively. Compatible with the Welch Allyn MacroView, Digital MacroView, 3.5V Diagnostic, and Pocket otoscopes, the LumiView Clear Specula are available by the bag (850 specula) or sleeve (34 specula) at the same price as traditional disposable Welch Allyn diagnostic specula.
Order adult and/or pediatric size Welch Allyn LumiView Clear Specula from Oaktree Products by calling toll free 800.347.1960, sending an email to otp@oaktreeproducts.com, or logging into your account on the Oaktree Products website. These new specula are cool, cost the same as what you are already using, and make it easier to see what you need to see!
Much to the disappointment of many in the world, humanity is still dealing with the impact COVID-19 is having on the way we live our lives. As we continue to social distance and restrict our out-of-home activities to as little as simply acquiring groceries, we exacerbate a myriad of psychological and physical side-effects that extend beyond the risk of contracting the virus. It is true that many hearing health care practices in the United States have crafted both innovative and extraordinary ways to continue to treat people with hearing issues as we try to carry on within the boundaries of this contagious new reality. But, as we have done so, we have also identified new issues that our patients are confronting as a result of their virus mitigation efforts.
Prior to the onset of COVID-19, it had been estimated that approximately 850 million people worldwide experienced complete occlusion of their ear-canal approximately every three months due to excessive cerumen. Now that stay-at-home patients are regaining some access to professional hearing care, patients seeking treatment for excessive cerumen is exploding. One hearing care professional describes current trends as a “tsunami of cerumen”. Google searches using ear wax-related terms are up 5000% compared to pre-pandemic trends. All of this is likely the direct result of the interruption to regular hearing health care access the pandemic has fostered.
Excessive cerumen not only can contribute to a loss of hearing, its presence can complicate or even confound efforts to treat other more permanent aspects of hearing loss. As a result, when a hearing care professional encounters a patient with excessive cerumen, the first order of the day must be to remove it. For some hearing health professionals, this may entail referring the patient to another provider. And, data suggests that this referral process alone can significantly reduce the likelihood that the patient will return to the original hearing health professional for continued care. For other providers, the wax removal process becomes the next step in their treatment of that patient – a step that may take time and introduce the potential for re-scheduling the patient for the treatment they originally expected to receive. In addition, all re-usable equipment employed for cerumen extraction must be sterilized and decontaminated prior to its safe use with the next cerumen-challenged patient. This is especially important since recent evidence suggests that cerumen may be a source of COVID-19 spreads.1 With COVID-19 significantly expanding the need for such treatment, these time and procedural issues represent a new challenge for the hearing care practitioner.
In a recent online survey conducted by AUDNET Hearing Group, collected data indicated that only 17% of the respondents (all in private practice) who provide cerumen removal services do so using disposable devices. This means that for 83% of the procedures, inter-patient sterilization and decontamination protocols are required. In addition, the survey found that only 1% of the respondents indicated that they use a disposable technology purposely designed to significantly reduce the time involved in effective cerumen removal.
Since 2014, EarWays Medical (a company located within the thriving Israeli life sciences community) has been researching, producing and ultimately distributing an innovative cerumen removal technology called “EarWay Pro”. This, single-use cerumen extraction device consists of a flexible helix (corkscrew) styled and open profiled tip that, when rotated inward into the ear canal, can effectively encapsulate and collect cerumen for extraction as a single cluster. It enables expedient extraction of cerumen impaction quickly, effectively, and hygienically with no need for a subsequent sterilization/decontamination effort. See procedural video HERE.
Prior to the pandemic reaching the United Sates, AUDNET Hearing Group organized a clinical field trial of the EarWay Pro device with several private practice clinics across the country participating. Of the twenty-one ears that were treated using the device, it took on average less than one minute per ear to remove excessive earwax and gain sufficient visualization of the tympanic membrane to proceed with the next phase of testing/treatment. Participating clinicians judged the procedure as both very effective and very safe.
In a recent webinar, Alicia Spoor, Au.D., owner of Designer Audiology and past-president of the Academy of Doctors of Audiology (ADA), acknowledges a learning curve with the product. Once sufficient proficiency and comfort using the product is achieved, she reports great satisfaction and success in being able to remove cerumen quickly and effectively, and finds this technology useful in delivering cerumen removal services, especially in a COVID environment.
Since FDA approval of the EarWay Pro in December of 2019, the product has been steadily gaining traction as an effective and useful clinical tool in the U.S. Considering the effectiveness of this procedure in significantly reducing the amount of time needed to remove excessive ear wax, eliminating the need for inter-patient sterilization procedures, and recognizing the potential “tsunami” of cerumen extraction need fostered by months of social distancing, it seems reasonable to encourage all hearing health care professionals in the Unites States to explore the use of this technology in their clinical practice. To assist, AUDNET Hearing Group will be conducting its second webinar detailing the EarWay Pro product and procedures March 24, 2021 at 12:00 pm EST. For more information about this webinar, visit the AUDNET Hearing Group Blog.
References:
Hanege et al (2020). SARS-CoV-2 presence in saliva, tears, and cerumen of COVID-19 patients. Laryngoscope, October 23, 2020. www. onlinelibrary.wiley.com/doi/10.1002/lary.29218
David J. Smriga is an audiologist and Vice-President of Corporate Communications for AUDNET Hearing Group, a national organization that provides business, marketing and buying support services for independent hearing care practices. As well as positions in both clinical and research audiology, Mr. Smriga has held senior management positions in sales, marketing product management and public relations for some of the industries top manufacturing firms. Since 2002, Mr. Smriga has also been Senior Audiology Consultant for Audioscan, a premier manufacturer of real-ear measurement and hearing aid verification test equipment.
Do you remember the start of 2020? It was going to be the year of focus, the year of foundation, the year to burn the candle far into the night. Many of you probably purchased daytime planners or already has an influx of iCalendar events extending well into the future. Travel plans were mapped out with pre-purchased tickets because it was going to be that kind of a new year. Success and ease of life was at the fingertips.
Well, if that sounds familiar, it should be no surprise to hear that this was my story as well. I was safely and conveniently located within an ENT clinic. Five years of a Tax ID that sat by the wayside as I let the ENT do my billing and liaison contracts. Then COVID-19 hit and I initially wasn’t sure if those of us in the Audiology arena could sustain our businesses. I, along with many of my colleagues, temporarily shut-down our practices and stayed home for a span of time (6 weeks for me) while the world turned right, left, and every other direction except forward. There was stagnation, zoom meetings galore, extra drinking, a few extra pounds, and an unforeseeable future.
When businesses were offered the opportunity to re-open, I realized that I was about to go back to work in an environment of an ENT practice that was seeing patients with the symptoms to which my aging population was advised to stay away. I started realizing that my choices for addressing the needs of my patient’ were severely curtailed. I had no control of the front desk, the protocols outside of my one room office door, nor the staff. I was a ship taking a downward dip into a large unattended wave.
And that’s when Facebook Groups, Colleague virtual hugs, and ALL of us experiencing the same “sideways life” started to turn towards one another for support. This had the effect of making us stronger. In the kaleidoscope of online activity, I was learning how other audiology practice owners were staying a float including pursuance of PPP and SBA loans. With much apprehension, I applied for both loans and was shocked that my PPP application was accepted and in awe that my SBA loan was approved. I had money in hand, so what was I going to do? I could either play it safe and hope to stay afloat until things retuned to normal, or I could take a leap and use the money in a way that would best work in my favor. It was time to take everything I learned and heard from others to build my very own dream practice.
As I was getting ready to move forward with my plan, something more awful than the earlier business shut-downs happened. In July 2020, I was diagnosed with COVID-19. While out from work for another three weeks, my recovery was not easy; at one point in time I was concerned that I would become a statistic, leaving this world without having achieved by dream practice. I did fully recover but it turns out, this scare made me push harder, dream bigger and believe in myself more.
I literally started to dream my bank account into action. I would lean into and believe that I could open a new business. I would walk away from the ENT and known financial safety net and seek out a location that would have all my ideals: location, cleanliness, staffing, protocols, equipment, more clients, more staff, more help for the hearing impaired, more help to the community. I dared to board the ship to a new adventure! And that’s when my real year of 2020 began. Right there, in my mind, with my small school-lined paper notebook, in August 2020. If COVID-19 taught me anything in 2020, it taught me that the quiet of the night, amidst all my insecurities, was when my hand did the most pen to paper engagement. Before I knew it, I had secured a Commercial Real Estate Broker, a 2nd Floor Corner Office with a view, an architect that drew to my dream and dimensions, and a building contractor – all who answered to me, the owner, and business decision maker, the purse strings. And I did all this WHILE continuing to work at the ENT.
I secured my current staff well before my doors opened. I purchased office equipment, with a now known end date in mind. I had the audacity to hold tight to my dream and not release it into existence until it was ready. I dreamed my new life and office space and before I knew it, the dream became a reality. Me, a woman who was once a young girl growing up in Colorado, who was afraid of her shadow and who struggled through many of her last adult years with her identity and self-worth.
My blessing was that I had many who supported me in my dream. They pushed me when I was saying forget it, they reminded me of my why when I was feeling defeated, they encouraged me with flowers, videos, friendships, and inclusion. I credit these individuals, including my three kids, Brayden, Taylor, and Sydney for helping me to defy the odds. A female business titan – 100% owner that has tripled my revenue in 3 years to over $600,000. All of this from a small ENT location with a footprint of about 200 square feet. If I can do it, trust me, you can do it too.
My many thanks to so many but especially to my parents, family, Entheos Cooperative, Dr. Gyl’s Women of Wonder Network and hosts, Entre Audiology, Sofia Figueroa, Sandi Mierish, Glenn Lundy, Danielle Delgado, Karen Michaelle, Chris Crumley, and Angela Loucks Alexander. You helped me to believe in myself and for this I am eternally grateful. But above ALL else, my greatest cheerleader and hope giver is God who is my true and constant North.
Kristi Mendoza, AuD is owner of Optimum Audiology in Apple Valley, California. Since 1991, Dr. Mendoza has been helping people improve their hearing by identifying custom solutions and offering products from a variety of leading hearing aid manufacturers. Prior to establishing her own private practice in 2015, she worked as an audiologist in private practice and as an outside sales representative for a large hearing aid manufacturer. Dr Mendoza earned her clinical doctorate from A.T. Still University in 2009. She has volunteered for numerous hearing mission trips, bringing the gift of hearing to children and adults in New York and the people of Kenya, Africa.
Disinfectants are chemicals designed to kill microorganisms residing on non-living surfaces. These productsmust be registered with the Environmental Protection Agency (EPA) and are required to display the designated EPA-Registration Number on the product label. The main ingredient found in EPA-registered, hospital grade disinfectants used throughout the hearing industry range from a form of alcohol, quaternary ammonium compound (“quat”), hydrogen peroxide, citric acid, or a combination formula of alcohol/hydrogen peroxide or quat/alcohol mix. With so many products available, here are things to know when choosing disinfectants for your clinical practice:
USE EPA-REGISTERED, HOSPITAL GRADE PRODUCTS
While household products kill germs, EPA-registered, hospital grade disinfectants kill a broad spectrum of microorganisms commonly found in hospitals and other facilities providing patient care and/or provision of allied health services. The Centers for Disease Control and Prevention (CDC) recently qualified EPA-registered, hospital grade disinfectants as effective against SARS-CoV-2 (the virus causing COVID-19) in healthcare settings.1 A list of EPA-registered, hospital grade products offered by Oaktree Products is found HERE.
USE ALCOHOL-FREE DISINFECTANTS WHEN RECOMMENDED
Alcohol chemically denatures acrylic, rubber, plastic and silicone. Since most audiology components are composed of these materials, many manufacturers recommend using alcohol-free chemicals to disinfect smaller components and items like hearing instruments, earmolds, remote microphone systems, and headphone cushions. A table of alcohol-free disinfectants (click to see product details) offered by Oaktree Products is available HERE.
DWELL TIME
The EPA registers the specific microorganisms a disinfectant kills and the corresponding amount of time it takes to kill those specific microorganisms. The product must stay wet on a surface for the required amount of time in order to be effective. Referred to as dwell time (or kill time), most EPA-registered, hospital grade disinfectants require 30-seconds to 3 minutes to effectively kill microorganisms although some products require 10 minutes to effectively kill certain microorganisms. It is important to read and follow product instructions.
Final Thoughts:
For larger touch and splash surfaces (e.g. countertops, table surfaces, door handles, etc), use any available EPA-registered, hospital grade disinfectant in any form (e.g. spray, wipes)
For equipment and related components comprised of acrylic, rubber, plastic or silicone parts, use an alcohol-free, EPA-registered, hospital grade disinfectant in any form.
As stock of infection control supplies stabilize, the demand for some key products continues to outpace supply. For example, COVID-19 disrupted manufacturing operations, creating large-scale bottlenecks in the production oflarge AudioWipes™ canisters throughout most of 2020. While the situation has been challenging, it demanded a solution and necessary steps were taken to make large canisters of AudioWipes available without compromising quality and/or increasing price to the provider.
What is DIFFERENT?
Canister size is 1.5″ shorter and 0.5″ wider
Easier-to-pop-open lid
Larger wipe size (6″ x 6.5″) than original (6″ x 3.87″)
Different cloth material than original
What is the SAME?
Formula
Number of wipes (160)
Price to providers
This solution ultimately involved sourcing some things out to different vendors which explains changes in the look and feel of the canister and wipe material/dimensions. While this approach did increase production costs, pricing will stay the same for providers. From that perspective, the revamped large AudioWipes canister currently in-stock may only serve as a temporary stop-gap. That decision will be made sometime in the future; until then, order away as the large canisters ofAudioWipes are back in stock!
SHARABLE COMMUNICATION: A previous blog post offers sample communication to share with patients or parents about cleaning hearing aids with AudioWipes. Click SAMPLE COMMUNICATION for more information.
TO PLACE ORDERS: If you already have an Oaktree Products account, log in at www.oaktreeproducts.com to place your order. Prefer to talk to us or not sure how to log in to your account? Call toll free 800.347.1960 or e-mail us at otp@oaktreeproducts.com. Order by the each or by the case of 12.
If you would like to set up an account with Oaktree Products, click CREATE ACCOUNT.
The year 2020 catapulted infection control to the forefront of clinical practice. The COVID-19 pandemic forced providers to step-up the infection control game because the services we provide are essential. Part of this involves not only using disposable supplies where possible, but treating disposable supplies as intended. For example, immittance audiometry is an essential component of the audiological assessment that requires use of eartips, the majority of which are disposable. While it may be disappointing to learn most eartips are packaged as disposable and intended for one-time use only, integrating disposable ear tips within a clinical protocol is straight-forward and reduces potential for cross-contamination.
To help replenish your supply, Oaktree Products is extending unprecedented savings throughout January 2021 on disposable immittance eartips by offering more than 50% off Sanibel ADI Series and nearly 20% off Grason & Associates*IA, GS, MO, IT, and PM single-use eartips. Why?Because YOU are essential and so are your disposable immittance eartips.
*Grason & Associates KR tips already available at lowest industry prices.
TO PLACE ORDERS: If you already have an Oaktree Products account, go to www.oaktreeproducts.com, log in to your account to see pricing, and place your order. Prefer to talk to someone or not sure how to log in to your account? Contact customer service toll free 800.347.1960 or via email at otp@oaktreeproducts.com.
If you would like to set up an account with Oaktree Products, click CREATE ACCOUNT.
A wide range of microbes (e.g. bacteria, viruses, fungi) grow on hearing aid surfaces1,2 and audiologists and other providers should either clean and disinfect hearing aids prior to handling devices with bare hands, or put on a pair of gloves before handling devices. The COVID-19 pandemic has raised questions about the general efficacy of ultraviolet (UV) light for disinfecting hearing aid surfaces. Is it effective? The short answer: it depends.
There are different categories of UV light with the UVC spectrum (200-280nm) effectively used for surface disinfection. UVC does kill bacteria and viruses although germicidal effectiveness is influenced by several factors including surface contamination with organic matter.3 Since hearing aids are typically contaminated with cerumen, dirt, dust, and/or other particles,4 surfaces must first be cleaned (with tissue or disinfecting wipe) for UVC to inactivate bacteria and viruses.5,6
Bulb strength and the distance between the bulb and surface also come into play.3 Higher intensity bulbs require shorter periods of UVC exposure, whereas lower intensity bulbs require more. In addition, efficacy of disinfection decreases as the distance from the bulb increases. Some manufacturers of hand-held UVC lights (i.e. light wands) claim it takes ten seconds for an average bacterium to be killed at a distance of about six inches,7 however, it’s just not that straightforward. Depending on the product, it may take as many as 30 minutes to kill certain bacteria or viruses because the intensity of the UVC bulb is not strong enough8 and/or the distance between the bulb and surface is too far to render disinfection within claimed time periods.
Bottom line, UVC is effective in killing germs yet most effective when combined with traditional disinfecting methods. Regarding COVID-19, UVC has been shown to destroy the outer protein coating of the SARS coronavirus (SARS-CoV) although it is not same virus that causes COVID-19 (SARS-CoV-2).6 According to the FDA, since UVC does inactivate the SARS-CoV, it may be effective in doing the same to SARS-CoV-2. The main way COVID-19 is transmitted is via droplet contact transmission; although the virus can survive for periods of time on surfaces, the CDC continues to state that transmission via a contaminated surface is not likely nor the main way the virus spreads.9 The best approach is to clean and disinfect hearing aid surfaces with an EPA-approved (preferably non-alcohol based) disinfectant spray or wipe, making sure to follow instructions pertaining to dwell time if the intent is to handle devices with bare hands.
Concluding Insights:
A handful hearing aid dehumidifiers come equipped with UVC lamps including the PerfectDry Lux,PerfectDry Lux Rechargeable for Zpower, PerfectClean, Smart Dryer Li-Ion, Dry & Store Global, Dry & Store DryMax UV. The design of these products places hearing aids at a close and consistent distance from the UVC lamp, offering quick germicidal cycles (90 seconds to 5 minutes) effective in killing certain bacteria and/or viruses. Keep in mind, UVC is limited to line of sight; only those surfaces exposed to the light will be disinfected.10 From this perspective, it is critical to clean and then disinfect hearing aid surfaces with a disinfectant spray or wipe prior to exposing devices to UVC. Depending on the design of the hearing aid dehumidifier, it may necessary to rotate or change positions of hearing aids after the initial UVC cycle and then repeat a second UVC cycle if the goal is to ensure all outer hearing aid surfaces are exposed to UVC light.
Representatives from major hearing aid manufacturers were asked about UVC. As listed in the table below, most did not object to the use of UVC on their products. In the absence of safety data, Starkey did not offer a recommendation while ReSound did not object but added to use UVC at your own risk.
Manufacturer
UVC Recommendation
Product Rx?
Phonak
UVC recommended
Phonak D Dry
Signia
No objection as no known issues for circuit damage from UVC as our components are coated.
PerfectDry Lux
Widex
No objection but check manuals to ensure appropriateness for rechargeable hearing instruments
None
Starkey
No recommendation at this time
None
Oticon
No objection although no claims about COVID-19 can be made; recommend cleaning hearing aids with any wipe that does not contain alcohol with or without UVC
None
ReSound
No objection but use dehumidifiers with UVC cycle at your own risk as ReSound has not yet approved any specific UVC disinfectant cycles
No official recommendations although providers offer positive feedback on PerfectDry Lux and Perfect Clean
Unitron
No objection although recommend use of gloves to clean and disinfect hearing aid surfaces prior to handling hearing instruments using disinfectant wipe.
None
Table 1: recommendations regarding the use of UVC light on hearing aid surfaces from hearing aid manufacturers in regard to any contraindications to the safety of the process on product integrity
Hearing aid dehumidifiers equipped with UVC lamps can be incorporated within the clinic as part of the general maintenance service offering. Providers can place hearing instruments in the unit and run the initial UVC cycle as a supplement to traditional hearing aid disinfecting protocols. This may serve as an opportunity to re-educate patients about proper hearing aid cleaning and facilitate adoption of hearing aid dehumidifiers for home use. For more information on dehumidifier considerations related to Zpower batteries, see the previous blog post Special Dehumidifier for ZPower Charging System.
About the Guest Blogger
Lori Zitelli, AuD is a Senior Audiologist at the University of Pittsburgh Medical Center (UMPC) and Lab Instructor at the University of Pittsburgh. She received her clinical doctorate in Audiology from the University of Pittsburgh. Her interests include amplification, tinnitus treatment, clinical education, clinical research, and interventional audiology. Dr. Zitelli is an active fellow and member of the American Academy of Audiology.
References
Bankaitis, A.U. (2002). What’s growing on your patients’ hearing aids? The Hearing Journal, 55(6), pp. 48-56.
Sturgelewski, S., Bankaitis, A.U., Klodd, R. and Hamberkamp, C. (2006). What is still growing on your patient’s hearing aids? The Hearing Journal, 59(9): pp. 45-48.
Bankaitis, A.U. & Kemp, R.J. (2002). Hearing Aid-Related Infection Control. In: M. Valente (Ed.), Strategies for Selecting and verifying Hearing Aid Fittings, Second Edition (pp. 369-383). New York: Thieme Medical Publishers.
Gostine, A., Gostine, D., Donohue, C., & Clarlstrom, L. (2016) Evaluating the effectiveness of ultraviolet-C lamps for reducing keyboard contamination in the intensive care unit: a longitudinal analysis. American Journal of Infection Control, 44(10): pp. 1089-1094.
If you haven’t heard Dr. Gyl Kasewurm’s story, it is pretty incredible. In her own words…
“In the middle of the recession in 2008 and 2009 I went absolutely broke. I was devastated! I had worked so hard to build my practice and I was confident I knew what I was doing! I had the protocols in place and a great team. So, how could this happen??
Sometimes, things happen that are out of your control. I realized I had to do some things differently. I had to make some changes.
So, I didn’t give up and I learned some new tools and I made a few changes…
What I learned helped me come back stronger and I gained back everything I had lost…and more!”
AND YOU CAN TOO!
This is precisely why Dr. Gyl’s Women of Wonder Network organized the Rise & Thrive Virtual Seminar 2020 on September 10-11. Two action-packed days offering 1.15 CEU (11.5 hours) with 20 amazing speakers will give you the tools to RISE above what is happening in the world and to THRIVE.
Take away actionable, usable, and unforgettable information on topics including:
Finding the Courage to Rise and Thrive
Ways to Rise Above Burnout to Thrive
Using Your Numbers to Rise and Thrive
Women in Business – Using the Right Tools
More than a Manager – How to Get Employees to Like You and Rise to the Occasion
Infection Control – Rise Above COVID-19 Noise
Panel discussions will also help navigate important issues of the current day including How to Rise Above Issues Affecting Women and The Importance of Girlfriends – Strength in Numbers.
REGISTER to reserve your seat now! First 100 registrants get a Dr. Gyl Swag Box (some packed with some pretty cool surprises)! The event starts on Thursday, September 10:00 at 10 AM EDT via an online Facebook Live Stream. Attendees will be invited to Private Facebook Group for the event. See you there!
Registration Fee information for Live Attendance, Live & Recorded CEU Access Through December, or All-Access Pass here.
