Transcript Glasgow Audiology Services

NHS Glasgow Audiology
Services
Presented by Barry Campbell,
Senior Audiologist,
Paediatric Audiology Department,
RHSC, Glasgow
Audiology? What’s that? (eh?!)
• au di·ol o·gist n.
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A health care professional who
is trained to evaluate hearing loss and related disorders,
including balance (vestibular) disorders and tinnitus
(ringing in the ears) and to habilitate individuals of all
ages with hearing loss and related disorders.
Healthcare Scientists regulated by RCCP
Audiology Services over 6 sites across Glasgow, 5 Adult
& 1 Paediatric
20 Audiologists in Adult Departments, 9 in Paediatric
Department
Serving a population of around 1.2 million across
Greater Glasgow Urban Area conurbation (of which
approx. 1 in 3 are children under 16)
Paediatric ServiceReferral Pathway
• All Newborn Patients receive Automated
Auditory Brainstem Response (AABR) test
before leaving maternity Unit as part of Universal
Newborn Hearing Screening (UNHS) Program
(Greater Glasgow area)
• This would be repeated if no clear response
• Diagnostic ABR testing carried out in OPD
• Cause for referral from here can result in
appointment with Consultant Audiological
Physician
• Hearing aids may then be prescribed for patient
UNHS Risk Factor Form
Tick all risk factors which apply
No risk factors known 
1 *
Family history of permanent childhood hearing loss** (parent / sibling / grandparent delete as appropriate)
2 *
Congenital infection toxoplasmosis, cytomegalovirus, rubella, syphilis, HIV, herpes
simplex and zoster
3 *
Syndrome/chromosomal disorder affecting hearing Trisomy 21, 18, 13; Pendreds;
Waardenburgs; Usher’s; Pierre Robin; Treacher Collins; CHARGE; Alport syndrome
4 *
Jaundice at exchange transfusion level
5 *
Congenital abnormality of head/neck cleft lip/palate, low hairline or accessory auricle
6 *
Neonatal Intensive Care > 5 days (BAPM criteria)
7 *
Aminoglycoside administration repeated courses or toxic levels
8 *
Bacterial meningitis confirmed or suspected bacterial meningitis or meningococcal
disease
9 *
Neurodegenerative or neurodevelopmental disorder (including encephalopathy)
10 
Admission to NICU/SCBU for >48 hours (Now only for Audit purposes)
Paediatric Audiology- caseloads
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Each Audiologist has an assigned caseload
Range from 3 months to 5 years (start school)
Up to Secondary School leavers
Then transferred into Adult Audiology through
Transition clinic
• Caseload for Children with additional needs in
Special Schools across Glasgow
• Visits to Hearing Impaired units within
mainstream schools and School for Deaf
Children
Paediatric Service- Referrals
• Children can be referred up to age 12 to be
assessed at Community based clinics across
Glasgow
• We may see many children with conductive HL,
where surgical intervention may be more
appropriate to amplification
• The options to refer to Consultant Audiological
Physician and/or Ear, Nose and Throat
Consultant are available
• Referral to Crosshouse Hospital for assessment
regarding Cochlear Implant is also an option
Adult Service- Referrals
• ENT consultants vet referrals for new
assessments (Senior Audiologists pull any
obvious referrals marked for HAC)
• Patients who have or have had a NHS hearing
aid can self refer to have a reassessment done.
They do not need a GP ref.
• On 3 sites (GGH,GRI & VI) audiology will see
over 12’s, under 60’s with no significant ENT
history
• DV’s available to patients who are housebound
Adult service- Referral Pathway
Vetting Criteria
Pt attends GP,
c/o Hearing Loss
& is referred
Over 60?
No previous
Otological issues?
Under 60?
No previous
Otological issues?
Under 60?
Previous or current
Otological issues?
Ear Pain, Dizzy?
AudiologyDirect Referral
H/Aid Clinic
AudiologyHearing Assessment
Clinic
ENT Clinic
Hearing Loss- Categorization
Types of Aids
• We supply digital hearing aids to anyone
who is appropriate
• We supply BTE aids as standard and ITE
aids only to patients with anatomical
complications or to some children
• We also offer referral to the cochlear
implant centre at Crosshouse Hospital via
ENT as well as BAHA (Bone Anchored
Hearing Aid) in special circumstances
BTE Aid
• Standard issue digital
hearing aid
• Some come with volume
controls
• Some have a button to
change the programme to
adapt to background
noise or to use a telecoil
loop
• Battery powered – it will
give a beep when battery
is low
Open Fit BTE
• Smaller tube without a
custom mould so a
smaller aid
• Used for milder hearing
losses only
• Works automatically so
no additional controls
• Battery powered - it will
give a beep when battery
is low
Moulds
• Earmoulds connect the
hearing aid to the
patient’s ear via a piece
of tubing
• Custom made from an
impression of the
patient’s ear
• Can be made from hard
acrylic and a softer
silicone depending on the
hearing loss
• If the aid is whistling
then the mould is not
fitting the ear correctly
and must be altered or
replaced
Hearing Aid Care
• Keep away from water!!!
• And pets!!! (Dogs seem to like chewing hearing aids!!!)
• The tubing needs to be changed and the aids checked
every 6 months via the repair department.
• The mould can be cleaned using a damp cloth or
alcowipe every day
• Wax build up in the tubing can be removed with a wax
tool.
• If the aid is whistling then check the mould or
patient’s ear for wax. (MORE ON THIS LATER!)
Batteries & Repairs
• The five Adult sites run repair services to
replace/maintain NHS hearing aids, Yorkhill
have a separate appointments system outlined
at 1st Issue
• This is a self referral system – patients do not
need to see GP
• Glasgow Royal Infirmary, Victoria (New) &
Southern General- APPOINTMENT SERVICE
• Gartnavel General &
Stobhill (New)- DROP IN SERVICE
• Some large health centres have a supply of
batteries for NHS users only, and are free
Wax Management
• Audiology provide no service in wax removal.
• Please check patients for impacted wax before
referral as this limits the tests we can carry out
• If referring to hospital for wax removal in difficult
cases (e.g. perforations) this must be sent to
ENT (nurse practitioner) not Audiology
• Before wax removal almond / olive oil to be used
for min 5 days (2-3 drops – warm)
AND FINALLY!!!
“Whistling” Hearing Aids- WHY??!
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Whistling is simply FEEDBACK, the
sound of the aid amplifying its own
output
There are 4 main causes:
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4.
INCORRECT INSERTION OF EARMOULD
INFECTION OR DISCHARGE IN EAR
IMPACTED WAX IN EAR CANAL
AID TURNED UP TOO HIGH
Other acknowledgments…
• Hamilton, L; Newborn Screening Manager,
Audiology RHSC “Universal Newborn
Hearing Screening”, October 2005
Any Questions?
Thank you for listening(!)