Audiology Services. Carolyn Dando Audiology Services Manager South Warwickshire NHS

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1 Audiology Services Carolyn Dando Audiology Services Manager South Warwickshire NHS

2 What are we going to cover today? General overview of the ear Hearing loss Hearing assessments, results Hearing aids Paediatric Services Initial signs of hearing loss Hearing tactics Tinnitus and Hyperacusis Our future at SWFT

3 Hearing Facts Hearing loss affects around 10million people Estimated increase to 14.5 million by Noise Induced Hearing loss is more common now than it was 50 years ago Up to 20% of young people have some degree of hearing problems as a consequence of exposure to loud sounds

4 How the Ear works 3 parts to the ear: Outer, Middle, Inner

5 The ear changes acoustical energy in the form of sound waves into electrical impulses which are transmitted to the brain The sound waves travel through the outer, middle and inner ear and up the auditory nerve to the brain In order for us to hear normally all parts of the ear need to be working well

6 2 different types of hearing loss: Conductive hearing loss (Outer or middle ear affected) eg: Wax, Glue ear, perforation, Infections Sensorineural hearing loss (Inner ear affected) eg: Age related, Noise damage, congenital Conductive hearing loss: often reversible eg: removal of wax, grommets. Sensorineural hearing loss: permanent and requires assistance with hearing aids and or Cochlear Implantation depending on severity of the hearing loss

7 Hearing Assessments Otoscopy examination to assess the condition of the ear, ear canal and tympanic membrane Headphone/Insert Puretone Audiometry a series of tones are played and the quietist intensity of sound is located known as the threshold of hearing

8 Degrees of hearing loss

9

10 Audiology results Hearing results within normal limits:

11 Audiology Results A typical hearing loss Conductive in nature: Glue Ear

12 Audiology Results A typical age related hearing loss with no other risk factors:

13 Audiology Results A Profound Sensori-Neural Hearing Loss

14 Conductive Hearing Loss There is NO distortion of sound and the cochlear function is satisfactory or better than air conduction hearing. Glue Ear Watch and wait Grommet insertion Hearing Aids Perforations Hearing affected? Discharge/recurrent infections present? Surgical intervention Hearing Aids Middle Ear Disease Otoschlerosis Ossicular Discontinuity Mastoid Cavities Chlosteatoma

15 Sensori-Neural Hearing Loss There is distortion of sound due to damage of inner ear at different pitches of sound. Assistance with this type of hearing loss is provided by fitting of hearing aids A Sensori-Neural Hearing Loss is Permanent in nature. Types of Sensori-Neural Hearing Loss: Congenital Noise Exposure Syndrome Meniere s disease Syndrome Age related Acquired Head Injury, Acoustic Neuroma Ototoxic Drugs

16 Type of Hearing Aids Bone Conductor Hearing Aid: Bone Anchored Hearing Aid:

17 Types of Hearing Aids Behind the Ear Hearing Aid with an Earmould Behind the Ear Hearing Aid on a Slim Fit Tube

18 Other aids to Hearing Spectacle aids: suitable for conductive hearing losses. CROS/BICROS hearing devices for single sided hearing loss RITE/RIC receiver in the ear/canal hearing aids Body worn hearing Aids: Old analogue technology, now only used for severe / profound hearing losses with dexterity issues Cochlear Implants: suitable for profound hearing losses only.

19 Newborn Hearing Screening Universal Hearing Screening commenced in the UK in 2004, replaced Health Visitors distraction test. National programme targeted to screen all newborn babies Statistically 1 baby per 1000 will be identified with a Permanent Childhood Hearing Loss 1 in 13 assessments referred will have a permanent hearing loss in one or both ears

20 Paediatric Audiology Hearing loss will be identified from approximately 4weeks corrected age and hearing aids aim to be fitted within the first 3 months of life. This time frame brings new challenges: tiny ears, frequent visits, replacement, feedback issues, not small adults! Multidisciplinary network support with immediate involvement of Educational services, Teacher of the Deaf, Speech and Language Therapy, ENT, Paediatricians Broad area coverage: Nuneaton, Rugby and South Warwickshire Ongoing surveillance for individuals with Downs Syndrome, Neurofibromatosis, CMV

21 What we do for our hearing impaired Children in Warwickshire? Approximately 100 children have hearing aids 8 children have Cochlear Implants Unilateral/bilateral with/out hearing aids Those without additional needs attend mainstream school, normal speech development, not disadvantaged Little Ears: Deaf baby and toddler group supported by Education and Paediatric Audiology monthly club All children with a hearing loss are supported throughout education and additional devices can be supplied if appropriate. Hearing aid repairs appointments are classified as urgent and therefore will be force booked on the day of contact

22 How do you get your Hearing GP consultation Assessed? Referral to Audiology or ENT depending on age/symptoms AQP alternatives for NHS hearing aid provision can be sought through GP Hearing Aid assessments direct to Audiology/AQP for individuals aged 55years and over Exclusion criteria adherence allows provision for NHS Hearing Aids If you are an existing hearing aid user speak to your Audiologist regarding reassessment options

23 Hearing signs TV volume increases Hearing difficulties in social situations Concentration on face and lip patterns Discrimination difficulties, you can hear but your haven t caught what has been said Fatigue Withdrawal Frustration

24 Private of NHS you decide? Why are you looking to purchase a hearing aid? Assurance of what you are buying? Comparison What are the ongoing maintenance charges? What happens if the aid breaks down What additional verifications can be undertaken?

25 SWFT Audiology Referral Targets Patients 55 years and over will be offered an assessment appointment within approximately 2 weeks of receiving the referral for a hearing assessment. If hearing aids are agreed impressions will be taken if appropriate. Hearing aid fitting will take place within 4 weeks after your hearing assessment A review appointment will be offered within 8 weeks of initial issue.

26 Limitations of hearing Aids Although extremely helpful hearing aids do have some limitations and this is the case for all hearing aids. Price is not an exception Users of hearing aids may still have some difficulties in hearing in the following situations: Background noise Groups of people Telephone use Fine tuning is required to maximise the hearing benefit Verification of hearing aid performance against the individuals hearing test and real ear measurements Pre-set programmes to maximise options of hearing Regular maintenance and check ups

27 Tactics to help hearing Impaired people Keep background noise to a minimum when having a conversation / move away from background noise where possible. Background reduction programmes can be introduced. Face the hearing impaired person and do not cover lips / mouth (to enable lip-reading / reading of body language) Ensure the Telecoil loop system in on and working if applicable Ensure light is on the speakers face If in a restaurant / pub arrange seating so that the hearing impaired person has their back to a wall Speak clearly and slowly rephrasing where required Ensure you have engaged with the individual before starting a conversation no conversing from other rooms within the house! Do not shout

28 Tinnitus Tinnitus: described as a noise inside a persons head in the absence of auditory stimulus It affects nearly 5 million people in the UK and often comes hand in hand with hearing loss There is no cure for tinnitus, but it can be helped with the use of: Hearing Aids White noise generators Counselling / retraining therapies

29 Tinnitus Assessment clinics at SWFT Accessed via ENT Seen by a Senior Audiologist who has undertaken Tinnitus training qualifications Identify tinnitus severity and impact of wellbeing Review devices available Counselling Onward referral for additional support if required. Regular reviews SWFT Tinnitus Workshop held every month.

30 Hyperacusis Hyperacusis: described as "the collapse of the normal range of tolerance for sounds." People with Hyperacusis still find soft sounds to be acceptable, but louder sounds to be uncomfortable It can affect people of all ages and is often related to tinnitus. About half of people with tinnitus will also have hyperacusis SWFT assess for Hyperacusis and run clinics alongside the Tinnitus Assessments. An ENT consultation is required to access the clinic

31 Tinnitus and Hyperacusis Mindfulness A practical guide to finding peace in a frantic world by Prof Mark Williams Living with Tinnitus and Hyperacusis by Dr David Baguley British Tinnitus Association

32 Audiology Services at SWFT Our Future We have been granted 150,000 to invest in replacement equipment All software will be upgraded to be able to fit the latest technology Demonstration room for assistive listening devices Additional device services as income generation Discussions taking place for Private hearing aids to be offered within the department for patients who request speciality devices A really happy, motivated team of Audiologists

33 Useful links - Good to know Hearing link Action on Hearing Loss NHS choice Social Services: British Tinnitus Association:

34 Thank you for listening Any questions?

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