Audiology, Daily Updates, Future Ear Radio, Hearing Healthcare, Podcasts

105 – Lori Zitelli, Au.D. – Maximizing the Audiologist’s Reach & Impact

Hello and welcome back for another episode of the Future Ear Radio podcast!

For this week’s episode, I had the pleasure of speaking with Dr. Lori Zitelli, Managing Audiologist at University of Pittsburgh Medical Center (UPMC).

In this episode, Lori and I discuss:

  • Lori’s backstory, Pittsburgh roots and motivation for pursuing Audiology
  • Lori’s mentor, Dr. Catherine Palmer, and the various projects that the two have developed together
  • Interventional Audiology and the benefits of “enlisting” other medical professionals to be champions of proper hearing healthcare
  • Way to utilize non-custom amplification solutions and how these type of solutions can maximize the Audiologist’s impact
  • Lori’s passion for tinnitus, the ups-and-downs with treating patients with tinnitus, and helping to usher in the next cohort of Audiologists specializing in tinnitus therapy through the course she teaches at UPMC
  • How Lori is incorporating telehealth with her patients and how the pandemic has shifted her thinking of how telehealth can be used within Audiology
  • UPMC’s upcoming plans revolving around mobile Audiology

Another really inspiring Audiologist who is helping to shape the future of Audiology!

– Thanks for Reading-


Dave Kemp  00:08

All right, everybody, and welcome to another episode of the Future Ear Radio Podcast. I’m very excited for today’s conversation with Dr. Lori Zitelli. So Lori, thanks so much for being here. Why don’t we start by having you tell us a little bit about who you are and what you do.

Lori Zitelli, Au.D.  00:21

Hi, thank you. I’m happy to be here. I’m Lori Zitelli. I am the Audiology Manager at UPMC, which is one of the large medical centers in Pittsburgh, Pennsylvania. I’m also an adjunct instructor at the University of Pittsburgh, which is my alma mater. I teach a couple of clinical procedure labs. So I work with the first year AUD students at Pitt. And I also just recently started teaching a course in tinnitus and decreased sound tolerance to the students as well. So I do I get a little bit of this a little bit of that it’s a good mix.

Dave Kemp  00:52

I know, as I’ve like, gotten to know you a little bit. It definitely seems like you have a like a far reaching purview of all the different things that you’re interested in.

Lori Zitelli, Au.D.  01:03

I have a lot of interests, which is good. But you know, I sometimes overextend a little bit, because I want to say yes to everything.

Dave Kemp  01:11

Yeah. It can be a little bit of a niche issue. You get a little stretched thin there. You’re very Pittsburgh through and through, though, like so you grew up in Pittsburgh, and then you went to the University of Pittsburgh. Did you do your AUD there as well?

Lori Zitelli, Au.D.  01:27

So I was I grew up in Johnstown, Pennsylvania, which is just east of Pittsburgh, still in western Pennsylvania. And then I came to Pitt for my undergraduate studies. And there’s actually a Pitt branch in Johnstown as well, where both my parents went. But I came to the main campus in Pittsburgh, because I wanted to go into the health field, which you need to be in the main campus for. So I’ve, I’ve been here since what 2004, I think, and then I was a graduate student at Pitt and AUD program. Luckily, they accepted me. Honestly, I think if I applied today, I don’t know if I’m glad I went when I did. And then I was in a u dx turn at UPMC as well. So I’ve been here for quite some time. Now. I’ve I’ve made a home here.

Dave Kemp  02:13

That’s awesome. So why audiology, though? How did you even come to that path?

Lori Zitelli, Au.D.  02:18

I like many people, I I assume I wanted to be a speech language pathologist. First. One of my my mom’s best friends is speech language pathologist. And as a kid, I had a list. I was in speech therapy for years. So I just thought that was what I wanted to do. And then first semester of college undergrad, I was in an intro to audiology course, which was required for the SLP students and Dr. Elaine Mormor. As she does all the time with students who think they want to be speech pathologist just grabbed my interest. It was the best class I had ever had. And then the next semester, I was excited, because I thought, Oh, I’m going to be in the intro to SLP class, this is what I’m here for. And it just didn’t grab me the same way. So, Dr. Mormor, you know, she grabbed me and reeled me in all the time with her first year, first semester, undergraduate students.

Dave Kemp  03:11

Yeah, you’re probably I would, if I had to, like, give it a percentage of the amount of, you know, people that have gone into audiology from the SLP route, like, you know, started off thinking they were gonna go SLP. And then they just diverted to add feels like it’s like 75% of the people I’ve talked to, there’s a lot of people that seem to have follow that same trajectory.

Lori Zitelli, Au.D.  03:33

I believe it I think, you know, SLP is something that you’re more likely to hear about and know of, or if needed services for yourself. But then once you hear about how awesome audiology is, it’s hard to resist. So like,

Dave Kemp  03:45

real talk, like what was it about audiology that you found so interesting, that obviously still captivates you today? Like, if you can go back to that, that moment, in time of like, what was it that made you so fascinated by this whole subject,

Lori Zitelli, Au.D.  04:02

Marie of doing this exercise, and Dr. murmurs class where she made us stand up. And I don’t know, I don’t remember the details. But we were we were being hair cells, we were, we were doing something specific, acting out the way that hair cells would respond to sound. And I just remember thinking that it was so interesting and so cool. And then I got to the speech class, and it was all about, you know, the swallowing and the speech perception. And it just, I don’t know, it just didn’t resonate the same way. I think it was Dr. mormor, to be honest,

Dave Kemp  04:30

that’s that well, that tends to be the case. strong mentors and stuff like that. Speaking of which, good segue to Katherine Palmer who I’ve I’ve only met sort of briefly, but I feel like vicariously through just so many of the people that especially the UPMC crowd, it seems like you guys all revere her so can you maybe talk a little bit about her influence how you met her and the relationship that you have today?

Lori Zitelli, Au.D.  04:56

Yes, I I feel like every opportunity Do that I’ve had as an audiologist is because of her. Her office is right across the hall from mine. And it’s so I feel so lucky. I can just yell across the hall anytime I have a question. So many people would kill for that. She She knows everything about everything she can, she always has an answer or she can connect me to someone who, who is the right person. So she is the director of the AED program at the University of Pittsburgh. So she was an insert. She was one of my professors, I was lucky enough to have an amp one and an amp two, and a practice management course with her as the instructor. And then I was her student in clinic, I was under her direct supervision for a semester during my first year, which I think really helped me to get a lot of hearing aid experience and set me on the path that I that I was on. And then during my externship I was at UPMC, where she’s the Clinical Director at Evolve audiology. So she’s the director for Children’s Hospital of Pittsburgh and the whole adult side as well. So I’ve known her since I started the ad program at Pitt, you know, 15 or so or so years ago. And I’ve gotten a lot of opportunities to work very closely with her as I’ve started as an audiologist last next turn, and then went to audiologist, senior audiologist. And I’m currently the manager in the department. And we we just start a lot of projects together. It’s very fun to to do new things with her and think of different ways that we can reach people. And her leadership style just makes it really easy. She is someone who doesn’t care about getting credit for things herself, as long as things get done. And I think that it just makes people want to work with her and want to do a good job. So she is a really effective leader, she has great ideas. It’s clear to all of us that she really cares about us. And I couldn’t ask for a better mentor. Yeah, I’m really lucky.

Dave Kemp  06:59

It seems like the cohort of people that I’ve met the audiologists that are roughly in this age range of like 30 to 40 that have gone and had her as the mentor speaks so highly of her. So like these projects that you’re alluding to, can you give me an example of something that stands out in your mind of the work that you guys have done together at UPMC in terms of, you know, these kinds of big, ambitious projects.

Lori Zitelli, Au.D.  07:28

So our first foray into interventional audiology was back in 2014. So it started with a PA named Benjamin Reynolds. And he, he had this vision to create what they called a post trauma clinic. And he wanted it to be a multidisciplinary activity where it would be one visit for a patient after they had been discharged from the trauma unit at Presbyterian Hospital, which is our flagship hospital. So it’s kind of acknowledged that when patients are discharged from the hospital, they don’t always know, they don’t remember what to do. It’s like so much information that they they don’t know when to take their meds or what to take or what they should be doing or what they should be avoiding and things like that. So the idea was two weeks after they’re discharged, we can have a place for them to go, where they’ll see multiple providers, and their care is being managed by a PA. So it’s allowing the surgeons to practice at the top of their scope. But the PA is the one managing the clinic, and they’re working with an audiologist, a speech pathologist, a nutritionist, a physical therapist, you know, this whole group of people who are all working together to try to help the patient obtain optimal rehab outcomes. So we became involved in this because people started to realize, Oh, if we’re going to be seeing, you know, six providers in one appointment on one day, we should probably make sure that they could hear all of the recommendations and that they can communicate effectively. So we became involved in this clinic. And we really had to think about how we wanted to do this in a way that would let us integrate effectively. So we started thinking, Okay, we need to be the first person to see these people because we need to screen their hearing and determine if they need an amplifier to communicate, or if we need to fix their hearing aids or, you know, whatever we needed to do. So we worked with everybody in the clinic, to come up with this protocol, you know, we go in, we evaluate them, we have a really efficient way of translating our findings to the rest of the team so that they know, okay, this person has normal hearing, I can just kind of talk normally, or you know, this person has hearing aids, and even though they’re wearing them, and they’re working, we still need to be looking at them and talking slowly and clearly and all that you know, or they’re wearing an amplifier and I need to make sure that I’m, you know, facing them and talking into the microphone and things like that. So that was back in 2014. And I think that was the start of of so many other things that we’ve done. So we’ve taken that initial initiative and expanded it into all of these other different settings. And it’s really had a big impact on the inpatient care that we provide as well. So we do bed, you know, bedside testing when when it’s needed. But a lot of what we do on the inpatient side is provision of non custom amplifiers. So headset amplifiers with a, a corded microphone that’s attached. And when we started doing this, almost 10 years ago, we were delivering amplifiers to inpatients when they were requested, but we were doing maybe 100 or so a year. And since we started with these intervention, interventional audiology projects, and going out to these other clinics, everybody knows about them, all the nurses know how to get them how to use them, they feel like they’re helpful. All the physicians are familiar with them. So I think last year, I was just looking at the numbers, I think we did more than 1000. So over every year, we’ve seen it increase, you know, pretty steadily. And now we’re at a point where we’re doing way more when I was an X turn back in 2011. I think I distributed maybe 40 amplifiers throughout the course of the year. And our ex turns can do 40 amps. Did they do more? More than 40 in a month? So so you’re helping them by getting their steps in?

Dave Kemp  11:15

Yeah, well, so you said two things that really kind of, like caught my attention there. So first of all, is just to comment, which is, you know, this idea that the you said like, previously, we were just sort of providing amplification, for people that requested it. And I think that’s such a important like, caveat is like when they request it, because I think this sort of shines a light on like the much bigger thing, which is, so many people are oblivious to this. And so I think that it’s like a really, it’s really good that like you got to start somewhere. And so now you’ve obviously started to penetrate into the the like collective mindshare of all the Allied medical professionals, which is where I kind of want to segue this and say that, for me, that seems to be one of the biggest opportunities for Audiology, broadly speaking is to find, call it a seat at the table with their with their like, medical brethren, and find a way to like, establish who they are in the minds of their colleagues. And so then people start to recognize, because I bet you can attest to this through this specific program that you’re describing is like, how often now do you have the occupational therapist saying, we need amplification in here? And that’s like, how different is that then say 10 years ago?

Lori Zitelli, Au.D.  12:31

Oh, it’s, it’s, the program is massive compared to what it was 10 years ago, we, we now kind of do things in a different way, where a lot of the times the hospital units will reach out to us and say, Hey, we have a little drawer that we keep these in because we use them so frequently, can we have 10 for our drawer, and we have contacts on every floor. So I reach out to these people every two weeks and ask if they need more. So they’re now reaching out to us to ask for them, which is awesome, because one, they they know what the device is and how to use it and how it helps, but to they know where to find us, which was not always the case before as well. So I like that you mentioned the, you know, using other healthcare providers to to prompt the services. And I think that is something that our, our department and Dr. Palmer specifically are thinking a lot about right now, because there are data to say that healthcare providers largely don’t know how to identify hearing loss and their patients that either don’t think about it, or they don’t know how to how to recognize it, like 50% have have no idea what to look for or how to do it. So I think we really need as a profession need to be thinking about cost effective, and, and efficient. And easy ways to do this. It doesn’t need to be audiologists doing this, you know, it shouldn’t be if we’re practicing at the top of our scope. So this is where we need to be thinking about coming up with ways that other that we can train other people to do this in a way that they can do it in a way that doesn’t take 15 minutes out of their appointment time. And just make it as easy as possible for them. So Dr. Palmer actually is working with one of the groups at Pitt in the engineering department to come up with a device that is a really simple screener that’s automated. So you you put it in their ear, and it goes through a series of tones. And then if they fail the the headphones that are on their ears, you can turn it into an amplifier, so they’re already wearing it. It’s a really, really cool project that I’m hoping we’ll see some actual devices that we can use soon. But yeah, so it’s it’s hard to identify these people. And it takes time and effort and, and resources. So I think it would be good if we could come up with better ways to do this.

Dave Kemp  14:46

And like you said, like the there’s this isn’t really where the audiologist needs to like spend their time is thinking that every person there’s just so many people you know when you really look Get the big numbers. And you see like how giant of an issue this really is like how pervasive hearing loss is how undertreated it is, you can’t possibly imagine that a profession of like 13, to 15,000, professionals can, or even 20,000, if you include the hearing instrument specialists, like, there’s just, it’s just not feasible. And so what makes a whole hell of a lot more sense in my mind is to deploy the, like, the theories and like the low cost technology, like you said, and enlist other medical professionals to to be like, your, you know, extenders and right. So I just think that, that, because obviously, like, they’re ultimately going to come back to audiology and understand like, that’s in their purview, this is where this is the expert, and so I need to consult with them and stuff like that. But the actual implementation, deployment execution, whatever you want to call it, it seems like we’re gonna need a whole lot more hands on deck than just like the actual audiologist.

Lori Zitelli, Au.D.  15:58

I agree. So we use assistance for this. And we have students that we employ as well. So right now, five days a week in the center for perioperative care at UPMC. We have students who are screening hearing pit at students. So these are all patients who are going to this clinic because they’re going to have surgery. So they do a whole set of evaluations to try to identify potential problem areas so that they can improve their surgical outcomes. So we’re collecting a lot of data. And we we haven’t done anything with it yet. But we’re working on, you know, getting everything together and starting to analyze it, I think we’re gonna see some interesting things. But another thing that you said just made me think, you know, we have these students and these assistants that we can train exactly how we want. And it’s easy to get buy in from them, because they’re a part of our group. But when you want to rely on other providers to do this kind of thing, and to think of this kind of thing, it’s I think you need buy in from them. Otherwise, they’re gonna say, Oh, I don’t have time for that. Or oh, I can tell when someone has hearing loss, like you really can’t. And the patient doesn’t know, either. When you ask them if they have age related gradual hearing loss, they have no idea. Exactly. So I think a lot of times when they have these experiences for themselves, it makes a huge impact on them. You know, so you like the one of the surgeons that we work with always tells the story of she had an inpatient, who she went in to check on with her intern, and the person was not responsive in their hospital bed. So she was, you know, shouting at him, he didn’t respond. And she was about to do a sternal rub to try to, to try to wake him. And her intern who was a first year resident said, Oh, there’s one of those amplifiers right next to the bed on the table there. Maybe we should put it on him and see what happens. So they put it on, they turned it up. And they started talking to him, and he just perked right up. So they were about to possibly order this whole, you know, imaging this whole other battery of tests that because they thought he was not responsive, and he just couldn’t hear you.

Dave Kemp  17:59

So think put on full display both the problem, but the opportunity is like, how much of it’s like the like, what is it a parable of like, you can teach a man to fish or you can you know, like fish for him, it’s kind of the same thing where it’s like, if you can just enlist all of these other medical professionals and give them like that firsthand experience, then they’re going to be giant advocates for this themselves. Right? Which is help them

Lori Zitelli, Au.D.  18:24

to realize like, oh, this actually impacts what I do. It impacts my ability to evaluate and communicate and you treat this person.

Dave Kemp  18:34

I think to that, then maybe we can like talk a little bit about this as like, you know, I think one of the big things that’s changed and continues to change is I do think that there is becoming more awareness within just like the mainstream in general of the comorbidities associated with hearing loss. And so I think people are starting to realize that in the past that used to be dismissed as like, just this isolated, you know, thing where you can’t hear as well, oh, well, you must just be getting old. But now, I think people are really understanding that that is a giant red flag, because it might mean there’s a whole lot lurking underneath the surface, which again, I think is it adds weight to this, the severity and urgency of like, why this is actually something that really needs to be treated at scale. But again, I think it highlights the opportunity for Audiology, broadly speaking is like we’ve barely scratched the surface with from this standpoint of making hearing loss, something that people recognize as being a much more severe medical issue than I think it’s understood as today kind of in the mainstream.

Lori Zitelli, Au.D.  19:42

Totally agree. And we we work with two of the geriatric clinics here at Shadyside. We actually have an audiologist embedded in those clinics one day a week. And I like to think that we are impacting the way that geriatricians provide care and I hope our presence there and even on the days when we’re not physically there has changed the way that they think about hearing loss. So the way that we like to talk about it is that in someone who is a patient at a geriatric clinic, hearing loss is expected, but it’s not benign. You know? So I think a lot of times previously, or you know, if you read literature about it, the the attitude is, oh, well, of course, they have hearing loss. They’re 90 years old. It’s like, no, we need to change that attitude. Because yes, of course, they have hearing loss, but it matters. And there’s something that we can do about it, and it impacts other things.

Dave Kemp  20:33

Yeah, couldn’t agree more with that. The, I know that another one of the big things that you’re you focus on in that, like, is part of your day to day is tinnitus, just like broadly speaking. So do you want to talk a little bit about how that became a specialty of focus for you, where you sort of see that, like therapy for it and stuff like that, like the state of that just general thoughts on tinnitus, and kind of like how that is included within your day to day scope.

Lori Zitelli, Au.D.  21:07

So I started developing my skills related to tinnitus and decreased sound tolerance because I wanted a job. The the audiologist, who did this before me was Randall Kesterson. He’s a legend in Pittsburgh. And he ran the tinnitus retraining therapy program at UPMC. Like since the early 90s, I think. So he had done this for a very long time. And he was getting close to retirement, by the time that I was starting to think about graduation and where I would be looking for a job. So we sat down and thought about it. And it was like, well, if, if you want a job, this is going to be something that you’re going to need to do, because we need someone who does this. So I spent a lot of time during my externship, and my first year of independent practice, with Randall, evaluating patients, learning how to manage and entreat them. And so we have a tinnitus retraining therapy program at UPMC that I now manage, we see a lot of people. And, you know, when I was in school, I don’t really think I had an appreciation for how much tinnitus and sound intolerance can impact someone. Right. So it’s been, it’s kind of a different way to practice audiology than I thought I would be getting into. It’s a almost a strange intersection of psychology and an ideology where we spend so much time with these people hours and hours, and we meet them at a point where they’re suffering significantly, and we don’t know who they were before, but we want to try to help them get get back to a version of themselves that they are happy with, and like and want to be. So it’s, it can be effortful. I go home at night, and I worry about some of these people. And, you know, a, it’s hard not to, but it also is extremely rewarding, you know, most people improve with with time and care and, you know, it’s, it’s really rewarding to see and be a part of,

Dave Kemp  23:05

do you? Because it does, it seems like you’re Yeah, you’re like almost like a therapist, you know, combined with like, a little bit of neurology combined with you know, audiology, so it is kind of like you almost have to have a certain aptitude I would think for if you really want to specialize in tinnitus, because it seems like you know, the severity of it can range to the point to where you have people that are, you know, borderline like suicidal about it, right. So it just seems like you have to be, you know, prepared for the kind of patients that you’re going to see for it. What’s the typical patient journey, if you will, like is it how long are people going through the types of therapies that you guys are administering?

Lori Zitelli, Au.D.  23:55

So we tell people when they start the tinnitus retraining therapy program that most people we see experienced an improvement within the first six months of treatment. And some within the first three, you know, some sooner than that, some take a little bit longer, but most within that first six month period. And the goal that we’re trying to achieve is habituation, habituation of the perception of the tinnitus or the sound in the environment that’s bothersome, habituation of the reaction, the emotional reaction, habituation of the physical body response. So you can teach your brain to do that, it just takes time. So the people who tend to be the most bothered by their tinnitus or by their sound intolerance, tend to have very strong connections in their brain that link their emotional reactions to their to their auditory system, because those connections are used all the time. So it does take some time to weaken them and eventually extinguish them. So I think it’s hard for me to pinpoint exactly what it is about our program that I think helps people and I think it’s probably a combination of things. You know, is it the fact that someone has validated what they’re experiencing? Which seems invisible to probably a lot of other people? Is it the fact that they feel like they’re doing something about it actively? Is it the fact that I am giving them these tools that they can use, you know, kind of CBT light coping strategies day to day to help them change their thoughts about the tinnitus and reframe and change their reactions and things like that? Is it the sound therapy itself? You know, using partial mixing to help to make their tinnitus less noticeable? Is it the fact that we’ve encouraged them to work with their PCP and their mental health providers to treat anxiety or depression or anything that might be a barrier? Is it the fact that six months have gone by? You know, how do you separate all these things? I don’t think you can, at least not easily. So I don’t know exactly what it is about it. But something about it works for most people. And that makes it something that I really enjoy doing. So you mentioned suicide. And I think that’s something that’s really important to think about and talk about, if you’re going to be someone who’s in this area. And I work with a lot of students and I’m, you know, training the pit students in this area, I have them in clinic with me when we see patients who are suffering from tinnitus and sound intolerance. And something that we ask every patient is whether they’ve considered suicide. And if it’s something that we ask everyone, it’s so that way I can say to them, oh, it’s not like I didn’t ask you this specifically, because something you said concern me, we ask everyone, because we know based on previous research, that this is a concern for some people who have tinnitus, a nonzero percentage. And I did lose a patient to suicide early in my career, and it was a really hard period of time. So I think I went through a period of time after that, where I was trying to decide, like, is this something that I really want to do? Is this something that I think I can do, you know, you doubt yourself, you doubt your abilities, you doubt your mental and emotional fortitude to deal with something like this? And I like to think that the way that I reacted to that was the best reaction I could have had, you know, now I think about this, I look for it, I teach others to look for it. I teach others how to ask about it, and what to do based on what the answer is. And I like to think that it’s hopefully making an impact, at least somewhere for at least someone

Dave Kemp  27:30

for sure. I mean, first off that that is very, like a traumatic experience to go through for anyone. And I can imagine that totally rocked your world in terms of like, do you want to continue doing this, but I just from what I’ve kind of gathered and getting to know you a little bit is like, you’ve helped so many more people, and now you’re helping to usher in like the next cohort of, of providers that will be able to administer this kind of thing. Tinnitus is just such a, it’s such an like, odd thing, because it is. So it’s such a symptom of the brain in so many different ways. And it has to be massively frustrating for people that there’s not really, as far as I can tell, like an objective way to really measure it. Like it’s like, I think there are some very rare instances where it does actually emit a noise, but like, by and large, it’s something that only you’re experiencing. And to your point, how many of the underlying factors are contributing to it? Like, is it because you are? Is it stress? Is it diet related, you know, and then you have like, all kinds of different things that could be, you know, factoring into this. So it’s hard, it just seems like you’re kind of like having to put together a jigsaw puzzle of like, all of these things, but then also, there’s not a really clear cut way to treat it. So there’s not a silver bullet of like, you know, okay, you’re gonna just do this, like therapy, and then you’re going to be fine, because it seems extremely variable in terms of each person’s tinnitus is different. So how is that part of it been? Where, you know, is it pretty frustrating when you feel like some people maybe respond well, to the types of sound therapy and in the kinds of things that you guys are administering? While others, it’s, it says, if they’re not seeing any improvement, maybe the only improvement is time? I don’t know.

Lori Zitelli, Au.D.  29:21

It’s, you know, there are certain things that tend to help most people. But if you’re going, you know, there are certain things that can be specific to a person’s history or to a person’s tinnitus that might make us think, okay, maybe we need to take a little bit of a different approach for this person. So for example, I have a patient that I’ve been working with for a long time who has TMJ and there is a link between malocclusion TMJ and tinnitus. And at one point, she got a new bite guard that didn’t fit her as well and she had this spike in her tinnitus. And we were able to, to figure out like, oh, this started or On the time you got this new blank card that doesn’t fit well, so go back to your dentist and get a new one and it it completely took her tinnitus back to her baseline, which at that point she had learned to reasonably cope with. So I have other patients who have tinnitus that they’re able to modify by moving their head or their neck or their jaw. And sometimes cervical PT can help with those patients. So most people have primary tinnitus that’s related to hearing loss or some sort of subclinical damage to the auditory pathways. And for most people, sound therapy, counseling, CBT relaxation exercises, those kinds of things. You know, treating depression, anxiety, improving coping skills, most people find that those things help. But sometimes you just need to think a little bit further about what the person is saying that makes them unique and try to think what else you can add to it that will that will benefit them specifically. Yeah, for

Dave Kemp  30:59

sure. So that’s obviously a big passion of yours. And something that you’re focused on is like you clearly you’re running the program. So tinnitus, but I know that another area that you’re interested in, is telehealth. So do you want to maybe discuss a little bit about or share how this part of your passion I guess, or your scope kind of evolved and came to be?

Lori Zitelli, Au.D.  31:27

Mostly, Dr. Palmer teases me about this, she says doctors Italia would never see a patient in person, again, if she I really enjoyed using telehealth over the past couple of years. And there’s so much that we can do that we never even thought about before the pandemic kind of forced us to. So we do a lot of remote device programming now, which I think my patients love, because it is physically difficult to get to my clinic in it’s in the Oakland neighborhood of Pittsburgh, everything is constantly under construction. So patients have to drive to a part of town that’s difficult to navigate. And then you know, the parking garage is closed, they have to pay for parking, you know, they have to navigate through the hospital to actually get to us, which is the next building over and we’re physically hard to access. So when I, when I provide this option to people there, they kind of can’t believe it. They’re like, You mean I don’t have to come here. So I’ve been doing an tinnitus is kind of uniquely suited to be perfect for telehealth, yeah, it’s a lot of counseling, a lot of education, you know, and now we can do this device programming. We can do device troubleshooting, you know, they can show me things by holding it up to the camera, and I can send them PDFs, of instructions of how to reconnect things to their phone. And it’s been a really, really nice way to improve access for people that that we didn’t provide before. You know, we always talk to people on the phone. But I think the remote programming and the video services have really opened up this whole new avenue for us. So I there are certain appointments that we do in person always. So we there’s a testing visit related to our program that always has to be done in person, you know, comprehensive audiometry pitch and loudness matching loudness, discomfort levels, oh, AES tympanometry, those kinds of things we do in person, but the initial consult is over a video visit. You know, it’s basically a triage appointment of do we shall we bring you in for this next step? Or are there things that we can recommend for you that are likely to help you without you having to pursue everything else. So we do the in person testing visit and the in person device fitting, but we do a ton of counseling, and follow up appointments over telemedicine. And I think it’s been a really wonderful addition to our program. And I love I love introducing the students to it too, because they don’t see a lot of it in some of our clinics. And it’s really fun to get them to see like, Oh, we did everything over tellement that we would have done in person. And it took half the time. And the person didn’t have to take a day off of work, you know.

Dave Kemp  34:02

So I’m like I’m on. I’m in the same camp where I personally think that like this is an unlock for so much efficiency in this industry that isn’t really being tapped into. And I was really hoping that like one of the Silver Linings coming out of the pandemic was going to be that we would see this like macro rise in telehealth. And I think that there’s pockets of it, but it doesn’t seem like much of the industry has responded in a way where I think everybody just sort of has already reverted back to the way in which it was before. And that’s fine. But I kind of think that like we’re you said something where you’re like we can do things that all kinds of things that like maybe we didn’t think of before. And again, I think that the pandemic has been a catalyst for like forcing people to have to examine it and see like what limitations there are. So in your mind, like when you were sort of going through that exercise, and now you’re sort of a believer, what were some of the things that maybe like, historically you would thought that’s not feasible. And now you’re like, that’s actually totally feasible to do over telehealth in this.

Lori Zitelli, Au.D.  35:05

So, yeah, so something that I think is kind of cool that I just started using recently is, resound has a feature within their app called check my fit, that allows the patient to take pictures of their hearing aid on their ear. So if they’re not sure that it’s incorrectly or if they’re there, they’re having trouble getting it where they want it, you know, there’s a tool for that now, which, you know, if someone was struggling before, they would either have to have someone to help them, or they would have to come into the office, and we would have to spend time doing this. So that’s been cool. And a lot of the, I don’t want to say a lot, some of the manufacturers don’t allow remote adjustment of the tinnitus sound generator, it’s only remote adjustment of the hearing aid features. So kind of going through each of the manufacturers and parsing out what I can do with each one. And getting all of the accounts set up and learning how to use it. And, you know, learning what I need to explain to the patient, that was a lot of work upfront, because we you know, we work with all of the major hearing aid manufacturers in our clinics. So I had to do that for every single manufacturer. I’m really glad I did, though, you know, because now we can help anyone. And we have handouts that we give to people that explain to them what they need to do, we sometimes if someone is not sure that they’re going to be able to access telemedicine, I bring them into the office, and we do a telemedicine visit sitting face to face just to prove to show them what they need to do and to prove that, you know that they can do it. So I think there’s a lot of, of interesting stuff that we never even thought about before that, you know, as we keep doing this, we realize, oh, we could probably do this remotely, and we don’t need to physically see them. And I’m just continuing to move in that direction. Maybe someday I will never see someone in person.

Dave Kemp  36:50

Well, you know, like, I’ve thought a lot about like, what does the future of brick and mortar clinic look like? And you know, there’s like, obviously, a lot of different shades of the more medical settings, real retail retail oriented ones. But like, I’ve long thought that there will probably be a point in time where you’ll have a real hybrid of in person, people and then you’ll have like audiologists that will basically be working at a workstation or just interfacing with patients. Again, I just think that, like you said, and what I’m really curious about is to understand what’s the patient response been? Like, you know, obviously, we all in this industry, and the professionals have their preconceived notions of this. But what about the patient’s sounds like they’re responding pretty favorably to this, like you said, they’re, you know, I don’t have to go and Dr. Park, whatever, I don’t have to go through all that. But in general, like, are they able to navigate this relatively easily? What’s that initial setup look like? You know, so you said, you do a lot of like triaging of that initial evaluation, how did that how’s that facilitated? Can you just speak a little bit to that kind of stuff?

Lori Zitelli, Au.D.  37:54

Yeah. So, um, for example, a fitting that I just did last week was with resound devices. And resound actually offers two different ways that you can provide remote services. One of them is asynchronous, where I would go into the software, send the settings to the person’s phone, and then they would download them whenever it’s convenient for them. And another option is to do a synchronous video visit where I’m in the office, and they’re on their cell phone, and we’re connected at the same time. Are you

Dave Kemp  38:21

so are you connected through the app? So yes, so are you typically interfacing through each manufacturers app with the patients? Oh, yes,

Lori Zitelli, Au.D.  38:31

yeah. So it’s nice to have options One, and two, there might be patients who feel like they can’t manage one thing that can manage the other. So it’s nice to have the choice to do that. Whenever we connect the device to their phones, we walk through, you know, this is how you operate it and change volume and settings and all that. But when you’re ready to do your video visit, this is what you’re going to tap in this, you have to allow your microphone access and your you know, camera access and all this stuff. So I would say it definitely adds a little bit of time to the appointment upfront. And sometimes people need reminders. But then it’s nice to have these handouts. And the most manufacturers have an instruction manual that’s specific to the app or something that’s specific to telehealth, that will walk the patient through with pictures, you know what they need to do, and we provide those as well when people want them. So it’s, for some people who don’t even have a cell phone, the choice is kind of made for you. Right? Those people are never going to do telehealth, and that’s okay. Some people don’t want that. But I think especially given the way that people were forced to adapt their behavior and in communication over the pandemic, I think a lot more people are willing to do it now. And there are actually a lot of data to say that patients are satisfied with remote programming services in levels that are very similar to in person programming experiences. So I think the response from patients personally and based on the research that I’m aware of has been Very positive.

Dave Kemp  40:00

That’s really interesting, because it is like almost a disparity of there’s a little bit of a disconnect. It seems like where, again, I kind of feel like sometimes I only am seeing what I have seen in this industry. But I bet this is applicable across like many different industries, which is that there are these like antiquated notions that people hold, and they just sort of assume that, oh, my patients are never going to be candidates for telehealth, and they make these broad assumptions and generalizations and I think to your point is, is understanding that there’s actually segments of your patient base or target base. So you could have people that are absolutely not candidates for this and will probably have generational like, it will take generations worth of people who there really to be like widespread ushering in of telehealth. But I think there are definitely people within your any given practitioners patient base that are candidates for this. And it’s one of those things that I just think that it’s hard because you have to take the time to become familiar with it to really kind of like, appreciate the unlock of efficiency that you’ve gained. But so you got to do that upfront work. But I don’t know, I just feel like it’s one of those things that is really obvious in terms of how you can more you can maximize your footprint, if you will, in terms of the amount of patients you can see on a daily basis, you can increase your workload that way.

Lori Zitelli, Au.D.  41:29

Yeah, I absolutely agree. I’m way more efficient over tele med because, you know, you get on and you’re just like, what are we doing today? And when you’re in person, it just seems easier to fall into the like the small talk and the it’s, it’s, it’s more efficient, for sure for me. And I’m sorry, good.

Dave Kemp  41:46

I was just gonna say like going off at that point. So because so much of the role of the audiologist is sort of like, like, if you kind of have to boil down like their value is being an expert. And so it’s like, so much of the job, if you think about it is like information sharing and expertise, arbitrage. And so it’s like, that seems like that can be facilitated fairly easily over conference, right? Because really, what you’re trying to do is gather, like, Tell me your situation, and then I’m going to try to kind of match you to different solutions.

Lori Zitelli, Au.D.  42:19

Yeah, tinnitus is pretty uniquely suited for that. Definitely. It’s a great fit, I’ve, I’ve had a lot of success, and I’ve actually really enjoyed it myself.

Dave Kemp  42:29

That’s great. So as we kind of go down the list of all the different things that that you’re really passionate about, one of the things I’m really looking forward to at this AAA, that I was completely oblivious to is that you do a session every year, where you sort of round up some of the best research and articles and just, you know, information. Is it all specific to tinnitus? Or is it broadly just like, can you kind of give me an overview and audience and overview of the session that you’re going to be doing there? Because I’m really looking forward to it?

Lori Zitelli, Au.D.  43:03

Yes, thank you. I hope we don’t disappoint you. So we submitted every year as a learning module. And we are lucky that it’s been accepted each year that we’ve submitted it. So we started maybe in 2000, or 2019, I can’t remember Dave Jedlicka, who works up at the Pittsburgh VA, and is in the process of getting his PhD from the University of Pittsburgh. And Trisha Scaglione, who works down at the University of Miami health clinic. And I, we spent some time compiling as many tinnitus articles from the previous year that we can. So this year, we’ll be looking at everything that was published in 2022. We categorize everything based on the topic of the article. So we have a category for pediatrics and a category for COVID-19. Because there were there have been a ton of those recently, a category for audio logic tests and a category for questionnaires. And you know, anything that attended, any category that attended his article might fall into, we try to sort them all out. And then we each take a couple of categories. And we collectively decide which articles that we think are the most clinically relevant, because we don’t want it to be just, you know, just talking about animal models, we want to impart strategies and things that people can take away and implement Monday morning. Clinically, relevant, relevant, and applicable, interesting, and novel. So anything that we think people might not know about or should know, we try to focus on and then we give you a zero to 10. Zero to 60. Summary of it, we get through a lot of articles in an hour. A lot of the feedback that we’ve been getting is that we should have two hours. So conference committee, if you’re listening, at least 90 minutes will be nice. We give him as much information about each of the articles that we can and then at the end of the presentation, we provide a QR code with a link to a spreadsheet that lists all of the articles that we looked at. Okay, it’s a lot of work, but it’s very fun. On

Dave Kemp  45:00

Well, first off, it’s an absolutely brilliant, like, presentation because it’s so replicable you can do that every single year.

Lori Zitelli, Au.D.  45:08

Well, it’s based on hearing aids and review, which is been done by Katherine Palmer, Gus Mueller, and previously Bob Turner, but now Brian McLaren career for a long time. So I help them to gather articles for hearing aids in review every year. So then Dave did look, I was like, We should do this for tinnitus, I bet people would come. So here we are.

Dave Kemp  45:27

It’s smart. I’m a fellow aggregator of information. So I personally think it’s, it’s a great way to look, if you’re, if you’ve published something, it’s hard enough to kind of toot your own horn, it’s a lot better for somebody else to kind of surface it on your behalf. So I bet that everybody that you’re all of the academics that are publishing this research that you all are highlighting is probably really well appreciated by them. But I think that it’s awesome to round it all up. Because not only are you doing that the publisher a favor, but you’re actually doing a giant favor for all of the attendees to say like I took the time to like gather all this information, distill it down, and give you the cliffnotes of it. So what’s been some of the things that really stand out? Maybe in the last like, what have we had to know just one AAA, I guess, post pandemic, or if we’re still in the pandemic, whatever the world is considered now, whatever this era is that we’re in. So last year, what’s the stands out? Was there anything really interesting that that you still think about? Well, one

Lori Zitelli, Au.D.  46:35

of the categories that we put articles into we call wildcard. So that’s just kind of like things that are interesting, that don’t really fall into any other category. So we started by having all of the COVID-19 articles in that wildcard category. And then there were so many of them that we were like, this kind of needs to be its own thing. So I focused on those articles last year. And it’s been really interesting to see the number of people who feel like they have a new onset of tinnitus, or a change in their tinnitus, following a COVID-19 diagnosis or COVID-19 symptoms or a COVID-19 vaccine. So it’s been really interesting to look actually at those data, because those data are reported in a vaccine adverse event database that’s maintained. And a lot of patients ask about that. So I did the best that I could to, you know, summarize all of that. And last year, the information that we shared was, you know, a lot of people might be pointing to this too, as a causal relationship. But if you look at the number of vaccine doses that were administered, and the number of tinnitus reports that were that were submitted, the number the percentage is actually very low. So I think a lot of patients are really interested in that information, especially recently, and you know, especially given the potential changes and how the vaccine program may look in the future. So the COVID-19 section has been interesting to a lot of people, because I think a lot of people are getting patient questions about it. So hopefully, we did a good job of summarizing everything for people.

Dave Kemp  48:08

That’s really interesting. Okay, and then what about just while you’re on the topic of COVID? What about is there any? Are you seeing any correlation between tinnitus and just being having COVID? Like, is there spikes associated with it or anything like that?

Lori Zitelli, Au.D.  48:24

I think it’s really hard to separate out what specifically about the whole experience of COVID-19 could be related to tinnitus? You know, is it is it the fact that you’re isolated in your home and you’re not able to do all the things that you enjoy that would typically distract you from your tinnitus, is the fact that you’re depressed? Because you, you know, all the things that you want to do are closed? Is it the fact that you’re stressed because of a, you know, job, or money or relationship or, you know, all these things that are related to the pandemic and isolation and not feeling well, in general, which can be a stressor that impacts tinnitus? I think it’s very hard to separate all of those things out,

Dave Kemp  49:01

for sure. Yeah, that’s tough. Okay, so as we kind of come to the close here, you know, what sort of obviously you have this this presentation at AAA, but what’s on the docket? What’s in Lori’s world, for this year and beyond? Like, what are the things that get you excited about what you’re currently working on both as an academic and then also what you’re doing within your clinic and all the different areas that you’re involved with.

Lori Zitelli, Au.D.  49:25

So the next thing coming up, I think, is an audiology online webinar. So I’m going to be going into a lot more detail about all of the interventional stuff that we do with some of the outcomes and some strategies for people who might be interested in implementing something similar. So that’s coming up in March, and something that I’m kind of working on in the background, all year is going to be an update to the tinnitus clinical practice guidelines for the American Academy of Audiology. So I’m chairing that update and we’ve got a group of really awesome contributors that are all going to be working together to update this guideline, which the previous version I think was 2001 So it’s been quite some time. It’s time It’s time to long overdue. Go on to the next version of that. Yes. And then AAA, of course. So those are the next things that are that are coming up. And we’re excited about everything.

Dave Kemp  50:12

That’s awesome. And then in in the UPMC, clinic, any programs that you and Dr. Palmer, anything in particular that you all are working on, that’s exciting to you.

Lori Zitelli, Au.D.  50:22

Oh, we are getting a van. You’re getting

Dave Kemp  50:25

a van. Oh, we’re getting the band taking the audiology to the people?

Lori Zitelli, Au.D.  50:29

Yes, we certainly are. Are you really exactly what it’s going to look like yet? And we’re going to be working with the department down at Pitt with, you know, some resources and some students and trying to figuring out how we’re going to do it. We can’t it’s funny, because every time we talk about it, all we can think of in our minds is Chris Farley in a van down by the river. All right. So that’s the next next thing we’re working toward.

Dave Kemp  50:54

Okay, well, we got to talk about this. This is this is really funny and interesting. So you guys are? Are you like starting a mobile clinic or something like that?

Lori Zitelli, Au.D.  51:02

Yeah, that’s the idea. So I don’t know exactly who’s going to be working directly with this. But it I think my colleague, Taylor Murray is going to likely be involved. She’s the one that that heads up our free clinics. So we have a couple of free clinics that we work with for patients who are underserved. And, you know, she goes out into the community and does these things in different places. So it kind of ties in nicely with with what she already does. So I think there’s a department at Alabama that has a mobile hearing ban. So we’re working with them to try to think about maybe some of the things that we need to think about or, you know, things that are important to figure out how to actually implement this. But it’s coming up hopefully this year. Well, it’s stay tuned.

Dave Kemp  51:48

It’s another one of those things that you know, if I’m like kind of thinking about all the different conversations I’ve been having lately. Mobile audiology is so hot right now, it seems like and I, I’ve been trying to kind of like parse out why that might be like, I think it’s a combination of things. I just think in general, people are feeling comfortable about the idea of like, just the mobility and the portability with a lot of the equipment and stuff like that. But it does seem like I don’t know, it seems like there is a really strong undercurrent right now in that direction, which is really cool. I mean, I think the idea of being able to just like go directly to, even if it’s an a single person, let alone like if you’re doing like occupational therapy testing, or something like that. But a single person, like you can be in their actual setting, which seems like that’s huge. I mean, if they spend a lot of time at home, like in your, in that setting, you can configure their, all of their, you know, solutions, or the main place that they reside, rather than them have to come to you and like try to give you a recreation of it in their own words. I have a bunch of loud dogs and all this stuff, you know, whatever it might be?

Lori Zitelli, Au.D.  53:02

Absolutely, we I mean, we do that to some extent already. We have a program we call haircare where we have audiologists, and assistants that we call communication facilitators in the senior living facilities that are owned by UPMC. So we have we already have people in those environments. We’re already partnered with home health. So these are speech pathologist, occupational therapists, and physical therapists who all carry amplifiers with them, and distribute them and, and help patients to use them. So we’re definitely already moving in that direction. I think this is just another thing that will push us that way.

Dave Kemp  53:36

With the home health stuff. Do you guys find that the like, it goes back to the beginning of the conversation where you’re trying to sort of get buy in from these allied medical professionals? Are there? Are you seeing a pattern with like, the occupational therapists, for example, really understand this? And they’re the ones that are really like, they’re a really good proponent, even within that like, or is it kind of across the board like physical therapists, nurses, whoever it might be? Are you seeing there being any sort of consistency with like any one particular group that seems to really be pushing this?

Lori Zitelli, Au.D.  54:13

Yeah, I think we get pretty good responses across the board. And it’s not always from things that you would necessarily think of like one example that’s coming to mind right now is the occupational therapist, one of the things that they probably focus on with their patients is their ability to use the phone. So there’s a lot of overlap there with what we do and being able to communicate with them. So you know, they all know about caption call and in no caption and have these resources that they can provide to people and connect them back to us for when they need help doing them and or maybe a personalized solution. So that’s always the end goal is to connect them back to us so that if they want to pursue a customized solution, we can help them to do that.

Dave Kemp  54:52

That’s fantastic. Well, Laurie, thank you so much. I’ve it’s been a great conversation. I’ve learned a lot from you. Any closing thoughts? And for anybody that might want to connect with you, what’s the best way to connect and reach out?

Lori Zitelli, Au.D.  55:05

Yes, I would love to hear from you. It’s the tele So ZTLI is my email. I have a huge social media person. I have two young kids, and I work full time. I am on social media so you can find me there as well. I’m under Lori’s Italie. But, you know, it’s a good way to do it. I’ll come directly to me. I don’t always check those inboxes

Dave Kemp  55:33

sounds good. So thank you, again, really learned a lot from you today. And thanks for everybody who tuned in here to the end. We’ll chat with you next time. Thank you.

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