1. NHS Glasgow Audiology Services Presented by Barry Campbell, Senior Audiologist, Paediatric Audiology Department, RHSC, Glasgow 11 December 2014 Beardmore Conference Centre Clydebank

2. Paediatric Service- Referral 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)

3. 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

4. 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

5. 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)

6. Adult service- Referral Pathway Vetting Criteria Pt attends GP, c/o Hearing Loss & is referred Over 60? No previous Otological issues? Audiology- Direct Referral H/Aid Clinic Under 60? No previous Otological issues? Audiology- Hearing Assessment Clinic Under 60? Previous or current Otological issues? Ear Pain, Dizzy? ENT Clinic

7. Hearing Loss- Categorization

8. 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

9. 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

10. 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

11. 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

12. 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!)

13. Batteries & Repairs 5 Adult sites run repair services to replace/maintain NHS hearing aids, Yorkhill have a separate appointments system outlined at 1 st 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

14. 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)

15. 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 EARMOULD 2.INFECTION OR DISCHARGE IN EAR 3.IMPACTED WAX IN EAR CANAL 4.AID TURNED UP TOO HIGH

16. Other acknowledgments… Hamilton, L; Newborn Screening Manager, Audiology RHSC “Universal Newborn Hearing Screening”, October 2005

17. Any Questions? Thank you for listening(!)