Novel Technology Adoption in the Audiology Clinic: Investigations of Ear Tip Performance, Perceptions, and Experiences

Abstract

Background: Hearing healthcare is not accessible. These issues can, at least in part, stem from the traditional service-delivery model in which audiologists overly rely on third-party manufacturers to create and supply custom hearing health components. The advancement of technology is rapidly shifting the landscape of healthcare, empowering clinicians to be more autonomous and deliver better care for their patients. Yet, not all technology is successfully adopted and implemented into practice. This study seeks to establish an evidence-base that explores the performance, perceptions, and experiences of novel technologies through the lens of three-dimensional (3D) printing technology in the fabrication of custom earmolds. Methods: A total of four studies were conducted. In the first study, a scoping review was undertaken to evaluate adoption and implementation of three-dimensional printing technology in hearing healthcare research. Secondly, audiologists' perspectives of technology adoption and implementation were explored using a qualitative semi-structured interview approach. Thirdly, a feasibility study was conducted to compare custom earmolds made using the traditional service-delivery pathway versus a proposed service-delivery pathway using in-house three-dimensional printers. The study design included a repeated-measures, crossover trial, in which 30 normal hearing individuals were recruited. Each individual was made, wore, and compared three custom earmolds: one that was professionally-made with acrylic and served as the control, and the other two 3D printed in-house using polylactic acid (PLA) and a photopolymer resin. Main measures included production time, production costs, physical dimensions, objective acoustic measures, and subjective perceptual measures. Lastly, a pilot study was completed to evaluate protocol and resource feasibility for a future clinical trial that seeks to establish a non-inferiority criteria to better compare in-house 3D printed earmolds to third-party control earmolds. Results: The scoping review demonstrated that 3D printing technology in hearing healthcare research was discipline specific, with a majority of articles being from otolaryngology. Furthermore, adoption and implementation of 3D printing technology in hearing healthcare research is still relatively early, as evidenced by the steady increase in articles over time, preponderance of low level experimental designs, and non-uniform geographic distribution of institutions incorporating this technology. In the second study, the Audiology Technology Adoption and Implementation Model (ATAIM) emerged from the perspectives and experiences of clinical audiologists. Facilitators, barriers, and perceptions of novel technology emerged as core-categories that contribute to an audiologists' decision to adopt and implement technology. In the third feasibility study, in-house 3D printed earmolds were significantly more efficient and cost-effective to fabricate compared to third-party control earmolds. Additionally, despite significant differences in real ear aided gain and physical dimensions between all material type groups, a majority of participants still preferred in-house resin 3D printed earmolds during the brief wear period. The final pilot study aided in further optimization of the protocol refinements and resources to increase future study efficiency while also reducing participant burden. Conclusions: While the feasibility of 3D printing technology in clinical audiology has been successfully demonstrated, its adoption and implementation by clinical audiologists is unknown. Part of this uncertainty can be contributed to by the lack of evidence-base and research that supports its utility. Additionally, decisions to adopt and implement technology are complex and informed by facilitators, barriers, and perspectives. Future studies that use rigorous experimental designs should be conducted to compare objective acoustic and subjective perceptual measures of in-house 3D printed earmolds to third-party manufactured earmolds in an older adult population with hearing loss. Furthermore accessible resources and guides should be collaboratively developed to help train hearing healthcare professionals on how to use 3D printing technology in their practice. Once established, evaluation of the 3D print service delivery pathway may be evaluated using implementation science frameworks.