NHS Glasgow Audiology Services

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NHS Glasgow Audiology Services

• Presented by Barry Campbell,
• Senior Audiologist,
• Paediatric Audiology Department,
• RHSC, Glasgow

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Audiology? Whats that? (eh?!)

• au diol ogist 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
• 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)

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Paediatric Service- Referral 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

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UNHS Risk Factor Form
Tick all risk factors which apply No risk factors known ? 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 Ushers 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 gt 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 gt48 hours (Now only for Audit purposes)
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Paediatric Audiology- caseloads

• 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

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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

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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
  12s, under 60s with no significant ENT history
• DVs available to patients who are housebound

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Adult service- Referral Pathway Vetting Criteria
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Hearing Loss- Categorization
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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

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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

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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

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Moulds

• Earmoulds connect the hearing aid to the
  patients ear via a piece of tubing
• Custom made from an impression of the patients
  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

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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
  patients ear for wax. (MORE ON THIS LATER!)

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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

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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)

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AND FINALLY!!!Whistling Hearing Aids- WHY??!

• Whistling is simply FEEDBACK, the sound of the
  aid amplifying its own output
• There are 4 main causes
• INCORRECT INSERTION OF EARMOULD
• INFECTION OR DISCHARGE IN EAR
• IMPACTED WAX IN EAR CANAL
• AID TURNED UP TOO HIGH

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Other acknowledgments

• Hamilton, L Newborn Screening Manager, Audiology
  RHSC Universal Newborn Hearing Screening,
  October 2005

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Any Questions?

• Thank you for listening(!)