Transcript Glasgow Audiology Services - General Practice Specialty

NHS Glasgow Audiology
Services
Presented by Barry Campbell,
Senior Audiologist,
Paediatric Audiology Department,
RHSC, Glasgow
11 December 2014
Beardmore Conference Centre Clydebank
Paediatric ServiceReferral Pathway from UNHS
• All Newborn Patients receive Automated Auditory Brainstem
Response (AABR) test before leaving maternity Unit as part of
Universal Newborn Hearing Screening (UNHS) Program (GGC
Healthboard-wide)
• This would be repeated if no clear response
• Diagnostic ABR testing carried out in OPD
• Referral from here will result in appointment with Consultant
Audiological Physician to discuss diagnosis. Intervention (Hearing
Aids) is then offered here.
• Hearing aids may then be prescribed for patient as young as 3
months old (or age corrected)
HEARING RISK FACTOR FORM
Tick any risk factors which apply
No risk factors known 
1 *
Congenital infection toxoplasmosis, cytomegalovirus, rubella, syphilis, HIV, herpes
simplex and zoster
2 *
Syndrome/chromosomal disorder affecting hearing Trisomy 21, 18, 13;
Waardenburgs; Pierre Robin; Treacher Collins; CHARGE
3 *
Craniofacial anomalies (including Cleft lip/palate); excluding ear tags
Meningitis: All survivors of strongly suspected or confirmed bacterial meningitis or
septicaemia should be referred to Audiology on recovery from the acute episode. This is
the responsibility of the medical team caring for the child.
Ototoxic drugs :the responsibility for referral to Audiology in cases where
the therapeutic range is exceeded lies with the medical team.
•
Infants with these risk factors are also at risk of late-onset, progressive or acquired
hearing loss and will be offered an Audiology surveillance appointment. Hearing
screeners to be informed so that they can arrange this with Audiology
Screening complete Y/N
Diagnostic Testing required Y/N
Surveillance required
Y/N
Paediatric Service- Medical Referrals
• Referrals up to age 12 to be assessed at community based clinics
across Glasgow which are led by Audiologist(s)
• Many children seen have conductive HL, where surgical intervention
may be more appropriate to amplification (e.g. grommet insertion)
• Option to refer to Consultant Audiological Physician and/or ENT
Consultant available
• Referral to Crosshouse Hospital for assessment regarding Cochlear
Implant is also an option
• New clinics now in operation for diagnosis of APD and management
of Hyperacusis
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.
• At 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 (grounds
for this must be stated on referral)
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
• Digital Signal Processing hearing aids to anyone
who is appropriate
• BTE (Behind The Ear) aids as standard and ITE
(In The Ear) aids only to patients with anatomical
complications or to some children
• Referral option 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 hollow
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!!! It is digital, after all…
• 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.
• If the aid is whistling then check the mould or
patient’s ear for wax. (MORE ON THIS LATER!)
Batteries & Repairs
• 5 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
• Some large health centres have a supply of
batteries for NHS users only, and are free
Wax Management
• Please check patients for impacted wax before referral
as this limits the tests we can carry out
• Audiology provide no service in wax removal.
• 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??!
•
•
Whistling is simply FEEDBACK, the
sound of the aid amplifying its own
output
There are 4 main causes:
1.
2.
3.
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(!)