Transcript Glasgow Audiology Services

NHS Glasgow Audiology
Services
Presented by Barry Campbell,
Senior Audiologist,
Paediatric Audiology Department,
RHSC, Glasgow
2 October 2012
Audiology? What’s that? (eh?!)
• au di·ol o·gist n. 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 (in process of moving to
State Registration through HPC)
• Audiology Services over 6 sites across Glasgow, 5 Adult sites (20
Audiologists), 1 Paediatric site (9 Audiologists)
• 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 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 (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 as
young as 3 months old
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
• Audiologist has an assigned caseload, ranging 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
Visual Reinforcement Audiometry
• Used to test children
between 6-7 months old
and between 2 and 3 years
old
• Minimal Response Level
is sought, NOT threshold
• Child is conditioned to
show a headturn in
response to Sound and Toy
Reinforcement together
•Then present sound and
when response, the visual
reinforcement is presented
as reward (2 repetitions to
chart MRL)
• Not usually ear specific
unless asymmetry is known
or suspected
Paediatric Service- Medical Referrals
• Referrals up to age 12 to be assessed at
community based clinics across Glasgow
• 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
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
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 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
• 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
Acknowledgments…
So this is how you
cut and paste a
presentation?!
How to perform Otoscopy by Johnny!
Are we getting
paid for this?!
Cara using her Blackberry to write
Daddy’s PowerPoint!
(Thanks also to Gran for being a willing patient!!!)
Other acknowledgments…
• Hamilton, L; Newborn Screening Manager,
Audiology RHSC “Universal Newborn Hearing
Screening”, October 2005
And to the thousands of patients, young and old,
that I have worked with since 1997,
THANK YOU!!!
Any Questions?
Thank you for listening(!)