KidsAudiologist

Archive for the ‘audiologist’ Category

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.

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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.

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Resources, references & further information

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:

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In summary:

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

As part of the new Health and Social Care Act 2012 the commissioning (or purchasing) of NHS services will be the responsibility of local Clinical Commissioning Groups (CCGs) except where the service is prescribed in legislation. Prescribed services will be commissioned by the NHS Commissioning Board (NHSCB). Yesterday the DH published the recommendations of the Clinical Advisory Group for the services that should be nationally commissioned from April 2013. (The document is dated June 2012 but it was only publically available yesterday!)

The recommended services that are included and of interest to the audiology and ENT profession, as well as parents of deaf children are:

  • Specialist Ear, Nose and Throat Services for Children and Young People including surgical management of rare conditions, surgical management of more common conditions when the child or the procedure is high risk (including the need for PICU or Specialist Anaesthetic management), provision of specified procedures and Specialist Audiology Services. Specialised audiology services consist of those audiological services which are part of a paediatric hearing aid service. In some cases specialised audiology services may not be co-located with specialised ENT surgery services. (p21 & 130)
  • Cochlear Implantation Services (p26 & 200)
  • Bone Anchored Hearing Aid Services (p26 & 201)
  • Auditory Brainstem Implantation Service (p26 & 203)
  • Middle Ear Implantable Hearing Aid Services (p26 & 205)
  • Other Specialised Ear Surgery (the plastic surgery element is included within the proposed regulation on Specialist Plastic Surgery for Children and Young People.) (p26 & 207)
  • Specialist Mental Health Services for Deaf Adults & Deaf Children & Adolescents (p17 & 103)

Also of interest to us because of the populations involved:

  • Specialist Services to support patients with complex physical disabilities which including Specialist Augmentative and Alternative Communication Aids (p11 & 44)
  • Cleft Lip and Palate Services (p15 & 77 & 152 & 158)
  • Specialist Genetic Services (p20 & 95)
  • Specialist Plastic Surgery Services for Children and Young People which includes congenital malformations of the ear including: absence of ear, absence/atresia/stricture of auditory canal, macrotia, microtia, misshapen ear, misplaced ear. And congenital malformation syndromes predominately affecting facial appearance incl Goldenhar syndrome, Robin syndrome and Treacher-Collins syndrome. (p23 & 158)

There are also some exisitng services that are already regionally or nationally commissioned that are recommended for transfer to new regulations:

  • Alström services (p28)
  • Complex neurofibromatosis type 1 services  (p29)
  • Mental health services for Deaf children and adolescents will include services provided by Highly Specialist Deaf Child and Adolescent Mental Health centres including outreach when delivered as part of a provider network. (p29)
  • Craniofacial services (p29 & 152)
  • Neurofibromatosis type 2 services (p31)
  • Primary ciliary dyskinesia management services (p32 & 166)
  • Rare mitochondrial disorders services (p32)
  • Stickler syndrome diagnostic services (p34)

What do you think?

National commissioning has the potential to be a very positive move for those low volume, highly complex, high cost interventions such as cochlear implants, and this could mean much greater equity of access across the country to these types of procedures. The big surprise to me is the paediatric hearing aid services included in the recommendations as it neither fits the low incidence or high cost descriptions used to identify national specialist services. More so than many of the other services this recommendation has the potential to have a very major impact on how current services are provided in terms of location, staff, and integration with the rest of the paediatric audiology service. Specialist services are likely to have more experienced staff who see larger numbers of children and build up more expertise. But how is this organised? It isn’t fair to expect families with young deaf children to travel great distances on a regular basis to attend specialist services so how will care closer to home be managed? With a split between local and specialist centres? With a network arrangement where staff travel to see children in outreach centres and/or work with local teams? Or another way?

What are your views? What would you like to see happen?

Update 14th September 2012: Some of your views can be found here.

Update 18th September 2012: The NDCS response to this news can now be read here.

How long a battery lasts depends on the type and power of hearing aid, how long it is worn each day, what kinds of situations the hearing aid is worn in (it’s processor has to work harder in noisier environments for example) and whether it is also supplying power to integrated FM or wireless FM receivers. Most children in the UK are issued with disposable batteries and many of them are using several hundred every year – wow! What are you doing with your used ones?

All used batteries should be disposed of safely and preferably recycled. Some audiology services will ask you to return old batteries when requesting new ones and they will recycle the old ones. It is good practice to keep your used batteries in the original packaging so that you can be sure that no old batteries have gone missing and to keep the batteries safe. If you are not asked to return old batteries you can safely dispose of them in your household rubbish. However, many local councils now have recycling schemes for batteries including household collection. Alternatively many large stores that sell batteries offer boxes to keep old batteries in and recycling schemes. For more informaton on recycling batteries in your area go to the Directgov website or visit Battery Back and type in your postcode to find the collection point nearest your home.

Children in the UK who are clinically suitable candidates and whose family chooses this option for them, have been offered bilateral cochlear implants since 2009. This followed recommendations made by the National Institute for Health and Clinical Excellence (NICE) who also said that children who had one cochlear implant prior to their guidance being published could be offered a second implant in the other ear (sequential implantation). At the time the evidence base was poor due to the small number of studies and the small numbers of participants, but NICE were persuaded that there were benefits to children having two implants including improved speech understanding in noisy situations, directional perception of sound, easier and less exhausting listening, and prevention of auditory deprivation and impaired development of central pathways by early stimulation of the auditory nerves. Within the guidance NICE recommended further research into the benefits of bilateral cochlear implantation in children and plan to review the evidence and their recommendations in the future.

As a result of this recommendation 15 cochlear implant centres across the UK formed a consortium and agreed on appropriate test procedures to audit the benefit children receive from bilateral cochlear implants. This group now have data from around 900 children and will be presenting their findings at a conference in Southampton on 11th April 2013. The conference is free to attend for adults and parents of children who use cochlear implants, and costs £50 for professionals. The National Paediatric Bilateral Audit website includes more information on the research, some preliminary results and online booking form for the conference.

We now have three videos in our ‘How to…’ series – How to manage the whistling in your child’s hearing aids, How to use your hearing aid care kit and the latest How to change the tubing in your child’s earmoulds:

Don’t forget to tell us whether the video was helpful using this 1 minute survey. Thank you!

The next in the ‘How to…’ video series from NDCS is now available – ‘How to use your hearing aid care kit’. This video gives you step-by-step instructions on daily listening checks, changing batteries and cleaning the earmould.

Don’t forget to tell us whether the video was helpful using this 2 minute survey. Thank you!

Hearing aids should blend in with the wearers hair (not skin colour) and have been available for many years in a range of brown and grey shades. For many adult wearers who don’t want other people to see them this is great, but makes no sense to me why the NHS continues to market beige as the standard colour. As a red-head myself I’ve always wondered what colour I’d go with if or when my hearing starts to go? But beige it doesn’t have to be and the good news is that all of the current NHS range is available in a range of colours – from bright primary colours, to softer pastels, metallics, and a few with designs such as animal print. All the cochlear implants are also available in a range of colour/design options. So if beige isn’t your child’s thing (and let’s face it, whose is?) ask your audiologist about the range of colours available for their model. There’s no reason why you shouldn’t, but if you can’t get coloured hearing aids from your audiologist, or you want to go one stage further to really customise yours then here are some other ideas to think about…

  • Customise your earmoulds – next time you have impressions taken for new moulds ask what colours are available. They are available with solid colours, marble effects, transparent with glitter, and with logos/pictures inside such as your favourite football team or television cartoon character.
  • Add removable charms or tube riders to the earmould tubing.
  • Skinit covers are available for Cochlear’s Freedom and N5 processors, and Advanced Bionics’ Harmony processor. Advanced Bionic’s waterproof Neptune also has a range of colour options.
  • Covers are available for Cochlear’s N5 cochlear implant processors
  • Ear Gear come in a range of colours, are fully removable and help protect the aids against moisture and dirt.
  • Use stickers, diamante, and nail art to decorate the hearing aid. Some of the manufacturers give away sheets of stickers the perfect size for their hearing aids. Alternatively you can decorate them yourself. Here I have to credit an amazingly creative group of parents and hearing aid / cochlear implant wearers who share their designs and ‘how to do it’ on this Facebook page – go and check them out!

That’s about it but before I go a quick word of warning! Almost all the audiologists I have met would have absolutely no problem with parents customising their child’s hearing aids with stickers or charms as described above. But make sure that you only use double-sided tape or stickers. Remember to take care that any parts in the casing that musn’t be covered aren’t, such as additional microphone ports or direct audio input contacts. NEVER glue anything directly onto the casing, or use paints or nail polish. Remember that the hearing aids are a long-term loan to you from the NHS and are not your property – so take care not to damage them or you may invalidate any warranty the aid has and/or may be charged for it’s repair if the NHS considers the damage negligent.

What are you waiting for – get out there and bling those hearing aids!

Having recently joined the iPad revolution I’ve been thinking about apps which might be useful in our day-to-day work. Tina Childress is an Educational Audiologist and keeps a very comprehensive list of Apps for Kids (and Adults) with Hearing Loss. Also, the Apps in Education blog includes a good section on So what’s on the iPad for the kid in your class with a Hearing Impairment? and the Earmeter site includes How an iPad can be an incredibly useful tool for hearing aid practices. But here are a few that I’ve downloaded, had a play with and that I think have the potential to be useful tools in counselling children, young adults and families about the ears and hearing:

Auditory Verbal Price – £2.49
This little app uses sound, pictures and text of the 6 Ling sounds. The Ling sounds are a fantastic daily check for parents to do with their child to check their child’s hearing aids are working properly and that they are picking up the frequency range of speech sounds. You could download a free sheet of the Ling sounds with pictures from The Listening Room but some parents / teachers may like the convenience of having it on their iPad for daily checks.

Hearing Aid TicTacToe Price – £5.99
This is a game for 2-4 players aged 4+ years to help kids develop independence in using and understanding their hearing aids – first by matching pictures, then matching pictures with labels, and finally pictures with function. This app is one the the most expensive I’ve ever purchased but I can see that it could be a really useful tool for audiologists and Teachers of the Deaf that can be used over and over with different cohorts of children and at different times as they develop.

Cochlear Baha Support Price – £free
Love this and want to see many more of them for the various products around. It’s basically a manual for your Baha on your iPad, but because it’s on your iPad you have all the information to hand during the day if something goes wrong and you can troubleshoot it easily. There is also advice on travelling, using the telephone and MRI scans and includes helpful videos to follow on cleaning etc. Brilliant, really useful.

Blue Tree Publishing Price – £1.99 each
Have produced a range of iEducate apps which include animations and video which are really useful for demonstrating how the parts of the ears work. I think I would use this one quite a lot and it’s worth the £1.99. Bluetree have also produced a range of Drag & Drop Identification apps. These are basically jigsaws although I found them quite hard to do and think they might be good revision aids for students. There might also be the older child who is very interested in the ear or science more generally who would enjoy the challenge. I wasn’t sure if the content alone and the fact that you’re unlikely to use it very often was enough to justify the £1.99 each as it becomes quite expensive to get the full set. So try with one and see how you go first. Inner Ear, Middle Ear and Labyrinth all available.

Draw MD ENT Price – £free
At it’s most basic this is a lovely tool for showing an older child, teenager and family more about the workings of the ear. It gives some really nice detailed pictures of the ear that you can draw on with your finger to highlight parts as you discuss the anatomy and cause of hearing loss etc with them. At it’s most impressive, you can use your own photos which I’m sure ENT surgeons would find useful for showing patients photographs of their own ears. You can add labels and even email the finished picture to the patient if they want it!

Hearing Loss Simulator Price – £2.49
I think this app has the potential to be a great counselling tool for use with families. There are graphics to show where the common sounds, speech, and individual speech sounds are located for loudness and frequency, and there are lots of options in terms of audiogram configurations. All the recorded voices have an American accent but it is possible to record your own voice for use in simulations.

Play it down Price – £free
Pick a song from your library and crank up the age dial for a feel of what music may sound like in the future. It’s a bit gimmiky but it could be a useful tool in couselling teenagers about the potential effects of noise damage.

Relaxing Sounds of Nature Price £0.69 (lite version free)
Finally, there are masses of nature sound apps out there to choose from. I really like this one as it has a really large range of sounds to choose from, you can mix sounds to your taste, and there’s some beautiful pictures of scenary to accompany the sounds. It also includes a variety of white/pink noise to choose from. I wouldn’t hesitate to recommend this one to my tinnitus patients (and anyone else who wants to relax!)


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