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. 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 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

UNHS Risk Factor FormTick 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• 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 currentOtological issues?Ear Pain, Dizzy?

Audiology-Direct Referral

H/Aid Clinic

Audiology-Hearing Assessment

ClinicENT 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??!

• Whistling is simply FEEDBACK, the sound of the aid amplifying its own output

• There are 4 main causes:1. INCORRECT INSERTION OF EARMOULD2. INFECTION OR DISCHARGE IN EAR3. IMPACTED WAX IN EAR CANAL4. 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(!)