1. NHS Glasgow Audiology Services Presented by Barry Campbell, Senior Audiologist, Paediatric Audiology Department, RHSC, Glasgow 2 October 2012

2. 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)

3. 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 (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

4. 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)

5. 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

6. 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

7. 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

8. 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

9. 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

10. Hearing Loss- Categorization

11. 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

12. 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

13. 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

14. 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

15. 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!)

16. 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

17. 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)

18. 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

19. Acknowledgments… How to perform Otoscopy by Johnny! Cara using her Blackberry to write Daddy’s PowerPoint! So this is how you cut and paste a presentation?! Are we getting paid for this?! (Thanks also to Gran for being a willing patient!!!)

20. 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!!!

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