Govindan Aparna, Singer Adina, Zekavat Lily, Jia Tianyi, Wong Kevin, Kuang Jianjing, Cosetti Maura K, Hwa Tiffany P
Department of Otolaryngology-Head and Neck Surgery, University of Miami/Jackson Health System, Miami, Florida, USA.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Otolaryngol Head Neck Surg. 2025 Apr;172(4):1232-1241. doi: 10.1002/ohn.1089. Epub 2024 Dec 26.
Clinicians face challenges in managing the growing population of patients with limited English proficiency (LEP) and hearing loss (HL) in the United States. This study seeks to investigate provider perspectives on evaluating, counseling, and treating HL in LEP patients.
Prospective descriptive study.
Tertiary care center.
Researchers employed a mixed methods design: (1) structured clinician interviews, (2) cross-sectional, national electronic survey, both regarding perspectives on managing hearing loss in LEP patients. Structured interviews were analyzed using modified grounded theory.
Twenty-nine providers participated in interviews (16 otologists, 13 audiologists). The most reported non-English language was Spanish, followed by Chinese languages. Four thematic domains were derived: barriers to care, cochlear implant (CI) candidacy evaluation, counseling, and ideal resources. Major barriers were patient desire (97%; n = 28), and lack of validated tests (72%; n = 21). Methods of CI evaluation included improvising on validated speech perception testing (59%; n = 17) and use of non-speech evaluation (52%; n = 15). One-quarter forgoes speech testing in non-Spanish-speaking patients (24%; n = 7). Suggestions to improve management include in-person interpreters (62%; n = 18) and testing battery in all languages (31%; n = 9). National survey results (n = 87 providers) demonstrated that respondents were significantly less confident in the methods of speech perception testing and in counseling on surgical hearing rehabilitation in LEP.
Clinicians encounter challenges in managing LEP patients with HL, including limitations in audiometric and CI candidacy assessment, communication barriers, information accessibility, and cultural competency. Opportunities for improving care include developing language-specific test batteries, linguistically and culturally appropriate education materials, and cultural competency training.
在美国，临床医生在管理英语水平有限（LEP）且患有听力损失（HL）的患者群体时面临挑战。本研究旨在调查医疗服务提供者对评估、咨询和治疗LEP患者HL的看法。
前瞻性描述性研究。
三级医疗中心。
研究人员采用混合方法设计：（1）结构化临床医生访谈，（2）横断面全国电子调查，均涉及对管理LEP患者听力损失的看法。结构化访谈采用改良的扎根理论进行分析。
29名医疗服务提供者参与了访谈（16名耳科医生，13名听力学家）。报告最多的非英语语言是西班牙语，其次是汉语。得出了四个主题领域：护理障碍、人工耳蜗（CI）候选资格评估、咨询和理想资源。主要障碍是患者意愿（97%；n = 28）和缺乏经过验证的测试（72%；n = 21）。CI评估方法包括在经过验证的言语感知测试中即兴发挥（59%；n = 17）和使用非言语评估（52%；n = 15）。四分之一的人在非西班牙语患者中放弃言语测试（24%；n = 7）。改善管理的建议包括现场口译员（62%；n = 18）和所有语言的测试组合（31%；n = 9）。全国调查结果（n = 87名医疗服务提供者）表明，受访者对言语感知测试方法和为LEP患者提供手术听力康复咨询的信心明显较低。
临床医生在管理患有HL的LEP患者时遇到挑战，包括听力测定和CI候选资格评估的局限性、沟通障碍、信息获取和文化能力。改善护理的机会包括开发特定语言的测试组合、语言和文化上合适的教育材料以及文化能力培训。
