From this month NHS England (briefly known as the NHS Commissioning Board) takes over responsibility for commissioning specialist services for deaf children. This includes specialist implantable devices such as cochlear implants, bone anchored hearing aids and middle ear implants etc. Bilateral cochlear implants are currently and continue to be funded in line with NICE recommedations which children have a right to access under the NHS Constitution.
This month NHS England have announced their clinical access policies for bone anchored hearing aids and active middle ear implants. These are important because they relate to services that don’t have NICE recommendations and were previously commissioned locally by Primary Care Trusts and were subject to wide variation in provision. In summary:
Bone anchored hearing aids
- are of safe and of proven benefit
- should be provided in a specialist centre doing at least 15 a year. The team should include an ENT surgeon, audiologist, paediatric anaesthetist and speech and language therapist.
- for children with microtia their care must be coordinated by a multidisciplinary team that can provide appropriate hearing and reconstructive support.
- early intervention is vital and children born deaf should be provided with a bone anchored hearing aid on a soft headband until they are old enough for surgery.
- funding will be available for children with bilateral conductive hearing loss to have bilateral bone anchored hearing aids if multidisciplinary assessment suggests that this would provide children with the best hearing environment in the classroom situation.
- although bone anchored hearing aids would not normally be funded for children with unilateral deafness, an ‘exceptional case’ request can be made centred on information regarding the child’s development, audiometry results and communication needs.
- and for the first time service providers will be expected to collect and provide audit data on request.
“Documents which have informed this policy – The National Deaf Children’s Society. Quality Standards in Bone Anchored Hearing Aids for Children and Young People. 2010″
Middle Ear Implants
Middle ear implants are a relatively new technology and very few children world-wide have been fitted with them. The evidence base is therefore almost non-existent at the current time. For these reasons it was not unexpected that active middle ear implants will not be routinely commissioned and will only be used as part of a recognised and structured clinical research project. However, they will be commissioned in the following limited circumstances:
- Bilateral sensorineural hearing loss when conventional hearing aids have been used and found to be medically unsuitable due to conditions of the external ear.
- Mixed hearing loss when conventional hearing aids have been used and found to be medically unsuitable due to conditions of the external ear and when a bone anchored hearing aid has been implanted and been associated with medical problems of the soft tissues or loss of fixture on more than one occasion.
Posted January 29, 2013on:
Can you help?
“The International Nepal Fellowship has run these ear camps in remote areas of Nepal twice a year since 1993. We have an excellent local Nepali team and we also take 4 otologists, anaesthetists, theatre nurses and usually 3 audiologists from abroad. We travel to Kathmandu then fly on into western Nepal, finishing the journey to a small district hospital by Land rover. I am an ENT consultant / otologist in Hereford and Worcester and I am the main organiser of volunteers and the regular surgeon on these ear camps . We have had many volunteer audiologists from Britain and other countries. Our next camp is for two weeks in April 2013, we usually take 3 audiologists with us but two had to cancel recently.
Our next camp is in April 2013, leaving the UK on the evening of Friday 5th and returning by Sunday 21st, though some volunteers stay longer to go sight seeing and trekking (we can arrange that if you would like).
We generally book volunteers a year or more in advance but we have two spaces that have fallen vacant for this April, so we are in URGENT need of at least one replacement. Volunteers are self funding (many volunteers have raised their own fares with local events), the experience is amazing and valuable. We can easily put you in touch with previous volunteers and there is a lot of information on our website.
PLEASE consider this, it will be a very special and worthwhile chance.
Between us we saw over 1200 patients on our most recent camp in November 2012. Of these 150 had surgery and a record 200 were fitted with hearing aids.
we have staff and people with local language skills to help.”
If you want any more information then please contact:
Mike Smith firstname.lastname@example.org
Posted January 26, 2013on:
The new NDCS weekend for teenagers with acquired, progressive, or late-onset deafness and their families has been a while in the planning and last weekend it finally arrived. As did the snow! Which was a shame because it meant three families weren’t able to make it but for the ones who made it through the snow I’m sure they got a huge amount out of the weekend.
Over the weekend we ran three programmes – one for the adults, one for the deaf teenagers, and one for their siblings. There were opportunities to share experiences, information sessions, and fun activites all in a relaxed environment. I led an information session with all the teenagers and their siblings on the ear, hearing and deafness. All the teenagers had become deaf in the last 18 months and all were using hearing aids or cochlear implants. Many young deaf people know very little about their own hearing or the technology they use and large numbers told NDCS they want more information on these topics. I have often assumed this to be that, as audiologists and other professionals working with deaf children, we’ve often concentrated on sharing information with families – especially in the early years – and forget to share with children directly as they get older or maybe assume they’ve picked it all up along the way somehow. I was pretty surprised that the teenagers at this weekend appeared to know very little because they were all older when their hearing started to change and we might assume they’d been more involved in their own care. So I thought I’d share an outline of how our information session ran and maybe it will help local services to think about something similar for their kids or inspire new ideas – let me know!
I have a small overnight suitcase that is packed with demonstration equipment. I have a large model of the ear, some laminated diagrams, an otoscope, some old hearing aids on stetoclips, dummy hearing aid and cochlear implants, disposable ear plugs, and my iPad with some ‘drag and drop’ build-an-ear apps. We all sat round in a circle on the floor and basically tipped out all this stuff! They could handle anything they wanted and ask any questions they had. They all loved having a look in one anothers ears and were fascinated by the internal parts of a cochlear implant. The hearing siblings tried out earplugs and listened to hearing aids and they thought this was helpful in understanding their brother or sister’s deafness. A little competition broke out trying to build parts of the ear the quickest on the iPad. We talked wax, how sound moves through the ear, and using the ‘T’ programme to connect to Bluetooth streamers and iPods. Second big surprise was that not one of the teenagers had the ‘T’ programme activated in their hearing aids. In fact one lad told me he’d asked his audiologist for it at his last apointment and had been told it ‘wasn’t necessary because you only have a moderate hearing loss’. Given that the main benefits of using the ‘T’ setting are little to do with the level of hearing and much more to do with overcoming limitations in hearing aid technology (such as hearing sounds clearly that come from a distance, reducing distracting background noise, and enabling use of audio equipment without the need for headphones) this seemed like missing an important opportunity and we’ve encouraged him to ask again!
My session was just one part of the weekend so it was lovely to hear their views at the end when they completed an evaluation activity and shared what they’d done and learned throughout the weekend with their parents (and vice-versa!)
They loved these ear anatomy post it notes (available from Blue Tree Publishing) that they used to write down some of the things they’d learned in my session! And we’re going to be developing some resources for kids who lose their hearing and their families to help address some of the issues they raised – watch this space…
The WordPress.com stats helper monkeys prepared a 2012 annual report for this blog.
Here’s an excerpt:
600 people reached the top of Mt. Everest in 2012. This blog got about 10,000 views in 2012. If every person who reached the top of Mt. Everest viewed this blog, it would have taken 17 years to get that many views.
This week NDCS launched their first information publication for audiology and ENT clinics to offer the under 10′s. I developed the concept and story, and Tim Bradford did the illustrations.
What it is?
A comic for young children who have been diagnosed with glue ear and whose parents have been offered and opted to have grommet surgery. The comic leads a child through the steps they have encountered and what will happen next – coming into hospital, the surgery, and how afterwards they can expect to hear a lot better. The comic can be read alone or with their parents, and there is a space to draw pictures when readers imagine what Harvey might be dreaming about. Download a copy here but it would be even better to have paper copies available to hand out to kids in clinic. Order some free online or from the Helpline.
What it isn’t?
Harvey gets grommets isn’t a decision aid for families. There are several potential options for children including ‘watchful waiting’ or trial of hearing aids. For some surgery isn’t acceptable or appropriate. The vast majority find grommets resolve the issue of glue ear for them. But there are a smaller group where grommets don’t work for them, occassionally they have to be removed due to infection, and those who unfortunately end up with long-term hearing loss (a potential complication of surgery but also of leaving the glue ear alone and not treating, putting parents in a no-win situation).
NDCS also has information for parents that discuss the different options available as well as links to other resources that are useful.
I’m hoping now to build on this resource and develop some further comics for children. What do you think? I’m thinking a trip to the audiology clinic, or perhaps one on getting hearing aids for the first time? Any other suggestions?
One in 10 children who survive meningitis are deafened as a result of the illness. Great strides have been made in vaccination for some types of meningitis including the vaccination for Hib (Haemophilus influenzae type b) which was the biggest cause of meningitis in children under the age of 5 years and a major cause of deafness. The Hib vaccine was introduced in 1992 into the childhood vaccination schedule. However, even after this, hearing problems remain one of the most common after effects of bacterial meningitis. Other forms of meningitis which are not vaccine preventable, and which pose a significant risk of hearing loss, are group B streptococcal and E coli meningitis, which together account for most cases of meningitis in newborn babies (neonatal meningitis). This means that health professionals working in paediatrics must remain vigilant and refer all babies and children who have had meningitis to audiology for hearing tests, and audiologists must continue to educate their local teams about the risks.
In November 2009 I spoke at the ‘After Meningitis Conference’ in London hosted by the Meningitis Trust on the ‘Impact and Challenges of Hearing Loss Following Meningitis’. I have uploaded the slides below for those that are interested in the facts and figures, and listed the references below.
Resources, references & further information
- Balance and balance disorders factsheet, NDCS, 2008
- Meningitis and childhood deafness, NDCS/The Meningitis Trust, 2012
- Meningitis & Hearing Loss (Deafness Research UK, 2005)
- NDCS Family Weekend for teenagers with acquired and late-onset deafness
- NHS Choices Meningitis, 2010
- Guidelines for surveillance and audiological referral of infants & children following the newborn hearing screen (NHSP Clinical Group, 2012)
- Fortnum HM., Davis AC., Hearing impairment in children after bacterial meningitis: incidence and resource implications. Br J Audiol. 1993 Feb;27(1):43-52.
- Fortnum HM, Summerfield AQ, Marshall DH, Davis AC, Bamford JM (2001). Prevalence of permanent childhood hearing impairment in the United Kingdom and implications for universal neonatal hearing screening: questionnaire based ascertainment study. Brit Med J 323(7312), 536-40
- Richardson, MP., Reid, A., Tarlow, MJ., Rudda, PT., Hearing loss during bacterial meningitis. Archives of Disease in Childhood 1997;76:134-138
Posted September 14, 2012on:
Yesterday I published news that specialist paediatric audiology services are to be nationally commissioned from next April. Discussion with colleagues and on Twitter has confirmed confusion about the plans. And in response to the link posted on the BAA Facebook page I received some varied responses:
The biggest question appears to be how much of a typical paediatric audiology service will fall under “Specialist Audiology Services. Specialised audiology services consist of those audiological services which are part of a paediatric hearing aid service”? We don’t know at this stage – it could mean just the advanced audiological tests such as diagnostic ABRs (used mostly for diagnosis following newborn screening) or it could also include hearing aid fittings since we know that fitting aids to babies is very complex. My working assumption is that they are using the same kind of definition that the Department of Health used in their Transforming services for children with hearing difficulties and their families; A good practice guide (2008) that used the term to mean fitting of hearing aids on the under 3′s and associated testing.
Whichever parts of the service are included the issues remain the same, with the most important of all – how to ensure good integrated care across the child’s care pathway when several different services and commissioning bodies are involved? Lots to tease out and lots of clarity still needed about what this announcement will mean.
UPDATE 18th September 2012: The NDCS response to this news can now be read here