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Designing a Mobile Audiology Clinic: A Comprehensive Blueprint for Expanding     Hearing Healthcare Access in Rural Washington

Haeli Jo Simmelink

Western Washington University

Au.D. Program

March 15, 2026

Abstract

Mobile audiology clinics represent a growing strategy for addressing disparities in hearing healthcare, particularly among older, rural, and underserved adults who face transportation, geographic, and socioeconomic barriers to diagnostic and rehabilitative services. Untreated hearing loss has been proven to have associations with significant psychosocial, cognitive, and public‑health consequences, emphasizing the need for more accessible models of care. This capstone project examines various sources of evidence supporting mobile audiology service delivery and evaluates its potential to reduce barriers to access and improve hearing healthcare in Northwest Washington. Although research regarding mobile audiology vans remains limited, many less research focused sources provide consistent operational and cost data which supports feasibility of a mobile clinic. This project also includes a comprehensive implementation plan for a mobile audiology clinic to be run through the Western Washington University (WWU) Hearing Clinic. This mobile clinic involves integrating ADA‑accessible layout, sound‑treated diagnostic spaces, secure data management, and a sustainable staffing model to provide equitable hearing healthcare. Findings suggest that mobile audiology clinics are a promising, community‑aligned approach to improving access and reducing disparities, while also strengthening community partnerships with WWU. Future research should evaluate diagnostic accuracy, patient outcomes, long‑term adherence, and cost‑effectiveness to further inform implementation.

Keywords: Mobile clinic, Audiology, Rural communities, University Clinic

Acknowledgements

I am deeply grateful to the people who have supported, encouraged, and guided me throughout my academic and clinical journey. Their belief in me has shaped not only my motivation for this project, but the clinician and person I have become.

To my mom, Dr. Staci Simmelink, thank you for modeling intellectual curiosity, compassion, and resilience. Your guidance has shaped the way I think, reflect, and approach life’s many challenges. Your mentorship and unwavering support have carried me through every stage of this program, and I am profoundly grateful.

To my supervisors and professors, Dr. Cooper, Dr. Reed, Ms. Bryan, Dr. Sheffield, Dr. Diedesch, Dr. Peters, and Dr. Xu, thank you for your mentorship, your thoughtful guidance, and the countless ways you have invested in my growth. Each of you has contributed uniquely to my development as a clinician, and I am sincerely grateful for your expertise, encouragement, and belief in my potential.

To my cohort/friends, thank you for being a community of strength, humor, and shared purpose. Learning alongside you has been one of the greatest gifts of this program. Your support has made even the most challenging moments meaningful.

To my family, thank you for your love, patience, and encouragement. Your belief in me has been a steady foundation, and I could not have reached this milestone without you.

This project reflects the combined influence of everyone who has supported me, challenged me, and helped me grow. I am sincerely thankful.

Dedication

To my family, whose love, passion for helping others, and never ending encouragement have carried me through every step of my life.

And to the communities this project is designed to serve. May it bring affordable and equitable hearing healthcare closer to home.

Table of Contents

Abstract _____________________________________________________________________ 2

Acknowledgements ____________________________________________________________ 3

Dedication ___________________________________________________________________ 4

Introduction __________________________________________________________________ 6

Review of Literature  ___________________________________________________________ 7

Method _____________________________________________________________________   8

Procedure _____________________________________________________________  9

Materials and Equipment   ________________________________________________  9

Design Rationale   _______________________________________________________ 9

Implementation Plan   ___________________________________________________ 10

Discussion and Conclusion  _____________________________________________________10

References  _________________________________________________________________  12

Appendices

Appendix A: Workflow Model ___________________________________________  16

Appendix B: Cost Tables ________________________________________________ 18

Appendix C: Route Plan and Van Design ___________________________________  20

Appendix D: Service Menu  ______________________________________________ 21

Designing a Mobile Audiology Clinic: A Comprehensive Blueprint for Expanding

Hearing Healthcare Access in Rural Washington

Mobile audiology clinics have become gradually more important for expanding access to hearing healthcare, especially in rural and underserved communities where limited transportation, geographic distance, and provider shortages create barriers to timely hearing assessment and intervention. Untreated hearing loss has been proven to be associated with reduced communication ability, increased risk of cognitive decline, social isolation, and increased non hearing related healthcare utilization (Lianou, 2025). All of this makes early identification and intervention a public‑health priority. As other health systems and universities explore innovative service models, mobile clinics offer a promising approach that brings diagnostic and rehabilitative care directly to the environments where individuals live and age.

Statement of Purpose

This project examines how a mobile audiology clinic could address gaps in access, improve continuity of care, and reduce disparities in hearing healthcare across Northwest Washington.

Rationale

Since this capstone is a project‑based design rather than original research, the focus of this paper is on looking at existing literature evidence, identifying operational requirements, and developing an implementation plan for a future mobile audiology clinic. The rationale for this project focuses on whether mobile audiology clinics effectively reduce access barriers and improve diagnostic and rehabilitative outcomes for older, rural, and underserved adults. Literature suggests that mobile health (mHealth) models can increase service usage, reduce missed appointments, and improve continuity of care (Frisby et al., 2022). However, evidence specific to mobile audiology remains somewhat limited, requiring a combined look at related fields such as mobile primary care, telehealth, and community‑based hearing healthcare. This project aims to examine the existing evidence, identify gaps, and evaluate the feasibility and potential impact of a university‑driven mobile audiology clinic serving Northwest Washington.

Review of Literature

Studies have consistently shown that older adults and rural populations experience significantly higher rates of untreated hearing loss, delayed diagnosis, and reduced access to rehabilitative services due to transportation barriers, geographic isolation, and limited provider availability (Bush, 2021; Hay‑McCutcheon et al., 2021). These disparities emphasize the need for alternative service-delivery models that would bring care directly into these communities.

Research also demonstrates the larger consequences of untreated hearing loss. Many studies have linked untreated hearing loss with an increased risk of cognitive decline, social isolation, and reduced quality of life (Jayakody et al., 2022; Cormier et al., 2024; Lianou et al., 2025). Although these studies vary in design, they collectively provide strong evidence that early identification and intervention are essential for supporting healthy aging and reducing future non hearing healthcare utilization. This perspective on public‑health reinforces the rationale for expanding access to diagnostic services in underserved regions.

Evidence supporting mobile or virtual hearing service models further reinforces the importance of a mobile audiology clinic. Teleaudiology research demonstrates that remote follow‑up and connectivity tools can reduce the travel burden and improve continuity of care, particularly for rural patients (Gladden et al., 2015; Eikelboom & Swanepoel, 2016).     Similarly, m‑health applications have shown benefits in increasing access to screening and monitoring tools, although many studies remain in early‑stages (Frisby et al., 2022). While these models do not replace comprehensive diagnostic evaluations, they help to show the effectiveness of bringing hearing healthcare closer to patients and reducing logistical barriers.

Although specific research on mobile audiology vans is limited, available sources describe operational feasibility and alignment with community‑based healthcare goals. Reports on mobile medical and audiology clinics emphasize the importance of sound‑isolated booths, ADA‑conscious layouts, and secure data management systems (Mobile Audiology Clinic, 2025; Mobile Audiometric Vehicles, 2016). These specifications support the ability to deliver high‑quality diagnostic services in a mobile environment. Additionally, literature on aging in place and rural health discuss the value of community‑embedded services that reduce the need for travel and support long‑term engagement in care (Gonçalves & Sequeira, 2024; Zai, 2024).

Overall, these references and more provide a strong foundation for the development of a mobile audiology clinic. Research clearly identifies the populations that are most affected by access barriers, the consequences of delayed intervention, and the potential of mobile and telehealth models to expand reach. Although studies on mobile audiology vans remain limited, the existing evidence supports the importance, relevance, and potential impact of a mobile clinic designed to serve rural and underserved adults.

Method

Since this capstone project centers on the design and implementation of a mobile audiology clinic rather than empirical data collection, the Method section describes the development process, design decisions, materials, and operational planning that informed the final model. No human participants were involved in this project. All content was developed using existing literature, professional guidelines, and university clinical training requirements.

Procedure

The development of the mobile audiology clinic model followed a multi‑step process. First, a review of peer‑reviewed literature was conducted to identify the primary barriers to hearing healthcare access among rural and underserved adults. This review also examined evidence related to teleaudiology, mobile health (m‑health), and community‑based service delivery. Grey literature and vendor resources were also analyzed to determine the technical, spatial, and financial requirements for mobile audiology units. These findings were then turned into a comprehensive design which includes layout, equipment selection, workflow, staffing, data management, and cost‑benefit considerations.

Materials and Equipment

The proposed mobile clinic includes a sound‑isolated booth, diagnostic audiometer, tympanometer, OAE system, encrypted tablets, NOAH‑compatible laptop, and secure EHR software. Equipment cost ranges were determined through various vendor site specifications and financial resources. For example, clinical audiometers typically range from $3,000 to $12,000, while sound booths range from $7,000 to $12,000 for new single‑wall units. Additional materials include ADA‑compliant ramps, storage cabinetry, infection‑control supplies, and signage for community outreach. See Appendix B

Design Rationale

The design of this mobile clinic focuses on noise isolation, safety, efficiency, and storage optimization. The sound booth is positioned at the front of the van and additional interior acoustic paneling is placed along the walls to reduce ambient noise and support reliable thresholds. ADA accessibility is ensured through a ramped entrance, and patient seating is placed near the workstation to allow for counseling and device checks without unnecessary movement. All HIPAA‑sensitive materials are stored securely in a locked fireproof box when traveling or in the university’s secure file room. See Appendix C

Implementation Plan

The implementation plan includes a staffing model consisting of two graduate student clinicians per rotation supervised by a licensed audiologist. Services include hearing screenings, full diagnostic evaluations, tympanometry, OAEs, hearing aid evaluations and fittings, counseling, and community education. Patient flow follows an organized layout from initial outreach and scheduling to assessment, counseling, intervention, and follow‑up. Clinic routes rotate monthly across communities such as Blaine, Anacortes, Mount Vernon, and Bellingham low‑income housing sites. Patient records and data management relies on encrypted devices, VPN‑secured connectivity, and cloud‑based EHR systems. See Appendices C and D

Discussion and Conclusion

The evidence reviewed in this project suggests that mobile audiology clinics have significant potential to improve access to diagnostic hearing healthcare for older, rural, and underserved adults. Mobile service delivery addresses the major barriers such as transportation limitations, geographic isolation, and limited provider availability. When combined with teleaudiology follow‑up, mobile clinics can enhance continuity of care and reduce delays in intervention. Literature also indicates that community‑based models may increase hearing aid adoption and adherence, although more research is needed to confirm long‑term outcomes.

The proposed mobile audiology clinic aligns with research findings by combining ADA‑accessible design, sound‑treated spaces, secure data management, and a sustainable staffing model supported by graduate student clinicians. The cost‑benefit analysis demonstrates that while startup costs are substantial, the societal and healthcare savings associated with early identification and intervention far outweigh the operational expenses. This model also strengthens university and community partnerships and expands clinical training opportunities.

Future research should examine patient outcomes specific to mobile audiology, including diagnostic accuracy, hearing aid usage, follow‑up adherence, and patient satisfaction. Longitudinal studies are needed to evaluate the long‑term impact of mobile clinics on communication, cognitive health, and healthcare utilization. Additional research should explore cost‑effectiveness, expandability, and integration with other mobile health services. These questions represent promising directions for future capstone projects and professional inquiries.

References

American Academy of Audiology (AAA). (2024, February 9). New study reveals prevalence of bilateral hearing loss in United States. https://www.audiology.org/new-study-reveals- prevalence-of-bilateral-hearing-loss-in-united-states/

American Speech-Language-Hearing Association (ASHA). (2019, November 26). Comments submitted to The Committee on Ways & Means Rural and Underserved Communities Health Task Force: Advancing legislation to improve health care outcomes in underserved communities. https://www.asha.org

Asutosh Padhi. (2025, December 9). How Much Does It Cost To Operate An Audiology Clinic Monthly? Financial Models Lab. https://financialmodelslab.com/blogs/operating-costs/ audiology-clinic

Bush, M. L. (2021). Hearing Health Healthcare Disparities in Appalachia. Journal of Appalachian Health, 3(4), 5–10. https://doi.org/10.13023/jah.0304.02

Cao, X., Liu, Q., Liu, J., Yang, B., & Zhou, J. (2023). The impact of hearing loss on cognitive impairment: The mediating role of depressive symptoms and the moderating role of social relationships. Frontiers in Public Health, 11(1149769). https://doi.org/10.3389/fpubh.2023.1149769

Chan, S., Hixon, B., Adkins, M., Shinn, J. B., & Bush, M. L. (2017). Rurality and determinants of hearing healthcare in adult hearing aid recipients. The Laryngoscope, 127(10), 2362–2367. https://doi.org/10.1002/lary.26490

Cormier, K., Brennan, C., & Sharma, A. (2024). Hearing loss and psychosocial outcomes: Influences of social emotional aspects and personality. PLOS ONE. https://doi.org/10.1371/journal.pone.0304428

Eikelboom, R. H., & Swanepoel, D. W. (2016). International Survey of Audiologists’ Attitudes Toward Telehealth. American Journal of Audiology, 25(3S), 295–298. https://doi.org/10.1044/2016_aja-16-0004

Frisby, C., Eikelboom, R., Mahomed-Asmail, F., Kuper, H., & Swanepoel, D. W. (2022). m-Health Applications for Hearing Loss: A Scoping Review. Telemedicine and E-Health, 28(8), 1090–1099. https://doi.org/10.1089/tmj.2021.0460

Gladden, C., Beck, L., & Chandler, D. (2015). Tele-audiology: Expanding Access to Hearing Care and Enhancing Patient Connectivity. Journal of the American Academy of Audiology, 26(09), 792–799. https://doi.org/10.3766/jaaa.14107

Gonçalves, H., & Sequeira, T. (2024). Quality of Life and Aging in Place in Rural Areas: What Community Social Support Systems? Revista de Gestão Social E Ambiental, 18(11), e09800. https://doi.org/10.24857/rgsa.v18n11-132

Hay-McCutcheon, M. J., Yuk, M. C., & Yang, X. (2021). Accessibility to hearing healthcare in rural and urban populations of Alabama: Perspectives and a preliminary roadmap for addressing inequalities. Journal of Community Health, 46, 719–727. https://doi.org/10.1007/s10900-020-00943-4

How Much Does It Cost to Start or Open a Hearing Clinic? (2025, March 29). Business Plan Kit. https://businessplankit.com/blogs/startup-costs/hearing-clinic

Jayakody, D. M. P., Wishart, J., Stegeman, I., Eikelboom, R., Moyle, T. C., Yiannos, J. M., Goodman-Simpson, J. J., & Almeida, O. P. (2022). Is There an Association Between Untreated Hearing Loss and Psychosocial Outcomes? Frontiers in Aging Neuroscience, 14(868673). https://doi.org/10.3389/fnagi.2022.868673

Kornak, J. (2022). An audiologist puts a clinic on wheels [Dataset]. Leader Mag Digital Object Group. https://doi.org/10.1044/leader.lml.27032022.20

Lianou, A. D., Evangelos Kokkinis, Bastas, N. S., Athanasios Basios, & Mega, I. (2025). Age-Related Hearing Loss and Correlation with Cognitive Decline: a Narrative Review. Maedica – a Journal of Clinical Medicine, 20(4), 864–871. https://doi.org/10.26574/maedica.2025.20.4.864

Mick, P., Reed, M., & Pichora-Fuller, M. (2015). Hearing, Cognition, and Healthy Aging: Social and Public Health Implications of the Links between Age-Related Declines in Hearing and Cognition. Seminars in Hearing, 36(03), 122–139. https://doi.org/10.1055/s-0035-1555116

Mobile Audiology | Mobile Audiology Unit. (2017). Mobile-Isolation-Unit.com.. https://www.mobile-isolation-unit.com/mobile-audiology-mobile-audiology-unit.html

Mobile Audiology Clinic. (2025, January 13). Odulair Modular and Mobile Medical Solutions. https://odulair.com/medical-vehicles/mobile-audiology-mobile-audiology-unit

Mobile Audiometric Vehicles. (2016). Craftsmenind.com.. https://www.craftsmenind.com/ industrial-fabrication-services/mobile-medical-vehicles/service/audiometric/

Mobile Medical Clinic Cost Guide – Cost Digest. (2026, January 20). Costdigest.org.. https://costdigest.org/mobile-medical-clinic-cost

Murray Law, B. (2024, January 25). Study maps U.S. hearing loss, right down to the county. The ASHA Leader. https://doi.org/10.1044/2024-0125-hearing-loss-map-aud

Nieman, C. L., & Lin, F. R. (2017). Increasing access to hearing rehabilitation for older adults. Current Opinion in Otolaryngology & Head & Neck Surgery, 25(5), 342–346. https://doi.org/10.1097/moo.0000000000000386

Ramkumar, V., Hall, J. W., Nagarajan, R., Shankarnarayan, V. C., & Kumaravelu, S. (2013). Tele-ABR using a satellite connection in a mobile van for newborn hearing testing. Journal of Telemedicine and Telecare, 19(5), 233–237.

Saliba, J., Al-Reefi, M., Carriere, J. S., Verma, N., Provencal, C., & Rappaport, J. M. (2017). Accuracy of mobile-based audiometry in the evaluation of hearing loss in quiet and noisy environments. Otolaryngology–Head and Neck Surgery, 156(4), 706–711.

Sharkova, I., Kohlenberg, L., & Felver, B. E. M. (2011). Demographic and socio-economic characteristics of persons with serious hearing loss and other serious health conditions in Washington State: From the 2008 American Community Survey (RDA Report 11.154). Department of Social and Health Services, Research and Data Analysis Division.

What Are the Startup Costs for an Audiology Clinic? (2025, August 2). Financial Model Net. https://financialmodel.net/blogs/cost-open/audiology-clinic-hearing-loss

Zai, X. (2024). Evaluating the health outcomes of aging in place: the role of medicaid aging waiver program on U.S. older adults. BMC Public Health, 24(1). https://doi.org/10.1186/s12889-024-19498-3

Appendices

Appendix A: Workflow Model

The workflow model for the proposed mobile audiology clinic outlines the full patient journey from initial outreach to long‑term engagement. This model ensures consistency, efficiency, and patient‑centered care across all service sites.

Outreach. Community engagement begins with distributing flyers and collaborating with senior centers, tribal clinics, libraries, social workers, and primary‑care providers. These partnerships help identify individuals who may benefit from hearing healthcare and reduce barriers to awareness.

Scheduling. Appointments may be scheduled through an online portal, by phone, or through partner‑site sign‑ups. Community organizations may pre‑book groups of patients to streamline service delivery.

Arrival. Patients access the mobile clinic via an ADA‑compliant ramp. Intake is completed on a HIPAA‑compliant tablet, including case history and communication‑needs assessment.

Assessment. Depending on the setting, patients receive either a hearing screening (common at community events) or a full diagnostic evaluation for scheduled appointments.

Counseling. Results are explained in plain language, and recommendations are tailored to patient needs. Options may include private‑pay devices, over‑the‑counter hearing aids, hearing‑aid banks, or referrals to additional services.

Intervention. Services may include hearing‑aid fitting, communication‑strategy counseling, or referral to medical or rehabilitative care.

Follow‑Up. Follow‑up occurs through teleaudiology check‑ins or during the next scheduled route cycle.

Long‑Term Engagement. Ongoing services include annual hearing checks, community workshops, and device maintenance, supporting continuity of care and aging‑in‑place.

Appendix B: Cost Tables

The following tables summarize estimated startup and annual costs for implementing a mobile audiology clinic. These values reflect ranges from vendor specifications, financial modeling resources, and industry standards.

Startup Costs

Annual Costs

These cost estimates support feasibility planning and help identify funding needs for grants, partnerships, and long‑term sustainability.

Appendix C: Route Plan and Design

The mobile audiology clinic follows a rotating monthly schedule designed to reach multiple rural and underserved communities in Northwest Washington. Routes may be adjusted seasonally or based on community demand.

Example Monthly Rotation

• Week 1: Blaine Community Center
• Week 2: Anacortes (clinic partnership to be identified)
• Week 3: Mount Vernon Senior Center
• Week 4: Bellingham low‑income housing sites

This rotation ensures consistent access to hearing healthcare across diverse community settings while supporting continuity of care for returning patients.

Appendix D: Service Menu

The mobile audiology clinic provides a comprehensive range of diagnostic, rehabilitative, and educational services aligned with university training goals and community needs.

Clinical Services

• Hearing screenings
• Full diagnostic audiometry
• Tympanometry
• Otoacoustic emissions
• Hearing‑aid evaluations
• Hearing‑aid fittings and verification

Counseling and Education

• Communication‑strategy counseling
• Device‑care instruction
• Community education workshops

Follow‑Up Services

• Teleaudiology check‑ins
• In‑person follow‑up during next route cycle
• Annual hearing checks
• Device maintenance and troubleshooting