KidsAudiologist

Archive for the ‘cochlear implants’ Category

Yesterday I attended the launch of the new National Commissioning Framework for Hearing Loss Services.

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This is a document was developed by members of the Hearing And Deafness Alliance (a group of representatives from professional organisations, charity sector and patient groups) with NHS England and follows the launch of the Government’s cross-sector and cross-departmental Action Plan on Hearing Loss last year.

The new framework is aimed at supporting NHS commissioners in ensuring they understand the importance of services for people with hearing loss and the potential impact of un-managed hearing and communication difficulties. The document clearly indicates that it covers the whole age range from birth onwards but understandably given the much larger numbers involved, does have some emphasis on age-related hearing loss. But section 3.1 does make it clear that CCGs should be familiar with their commissioning responsibilities in relation to hearing and wider audiology services and appendix 3 helpfully clarifies the responsibilities of CCGs, NHS England and PHE in the complex environment of commissioning the various parts of a child’s audiology journey. Finally, section 8 stresses the need to move towards more outcome based commissioning and the crucial role of service specifications in setting out the key requirements for delivery of the service.

I was therefore very pleased be invited onto the Children’s Services Content Group and to lead on developing a model service specification for commissioners on paediatric audiology services along with a series of suggested outcome measures for children plus service performance outcomes, that services and commissioners can use to measure quality of the service. A link to this document is contained within the Framework or can be downloaded here. This is the first time we have had children’s outcomes used as commissioning measures of quality and we look forward to feedback and developing these further.

I’m now looking forward to working with NDCS colleagues to share this suite of documents widely with our networks, including service professionals and commissioners.

 

 

Hearing aid wearers are most familiar with their ‘T’ switch to help them hear better in public places fitted with loop systems, such as churches, theatres, banks and post offices. These aren’t situations we generally consider as being very relevant to children and young people but a new generation of assistive devices have the potential to make hearing aids ‘cool’, improve their listening experience, and increase opportunities for language and social development.

Induction loop technology
Induction loop technology is the oldest of the wireless technologies and works with a telecoil, which has been a standard feature in NHS hearing aids for many years. Room loops help overcome some limitations of hearing aids and reduce the negative effects of distance and background noise, improving the signal-to-noise ratio and reducing listening effort for the wearer.

During the analogue era of hearing aids the telecoil was always available and a visual MTO switch meant that wearers were prompted to ask questions about it or go out and research it even if the audiologist didn’t directly tell them about it’s use. New and innovative products which use magnetic induction technology are making mainstream products more accessible to deaf children enabling them to share experiences with their hearing friends. These include inductive earhooks, neckloops and Bluetooth streamers with neckloops. These products allow a child wearing a hearing aid to listen to mobile phones or an entertainment device, such as an iPod, MP3 player, laptop or portable games console.

Modern digital hearing aids now have multiple programme capability but the telecoil setting must be activated. The wearer must be able to reliably change programmes as there is no visual indicator the ‘T’ setting is being used. Our experience at NDCS is that the majority of children and young people attending our events or visiting the Listening Bus do not know what the telecoil is and do not have it activated and so are unable to try out equipment that could be of benefit.

Deaf children and young people asking for more information
In 2007 NDCS carried out a consultation with nearly 1500 children and young people aged nine to 18. The results found significant numbers of children and young people in both the younger and older age groups wanted more information on deafness and the technologies that can support them.

Download the full article – Telecoils – making hearing aids cool for kids? – that was published in March 2013 in the UK edition of Audio Infos magazine to answer some common questions we get asked:

  • Using loop technology with children
  • Not deaf enough for a ‘T’ setting?
  • Too young for a ‘T’ setting?
  • Too hard explaining the technical information to a child?
  • Worried about noise interference?
  • T or M/T?
  • They already have an personal FM system. Isn’t that better?
  • I don’t feel confident recommending assistive listening products?

One more tool in their toolbox!
Loop technology has moved out of dusty meeting halls and has become very relevant to deaf children and young people. At the same time deaf children and young people are reporting that they need more information about both deaf and mainstream technologies and how they can access these. New technologies are making mainstream products more accessible to deaf children enabling them to enjoy the same communication, music, and entertainment devices as their hearing peers. Telecoils are one more tool for children, with the potential to enhance their language, educational and social development.

Further information

For information on the wide range of products and equipment that might be helpful for deaf children at home, at school or when socialising with friends, as well as information on the using the free Technology Test Drive to trial new equipment head to NDCS here.

Telecoils – making hearing aids cool for kids? (Audio Infos, Mar 2013)

Can Kids Benefit From Hearing Loops? (Jane Madell, Jan 2015)

 

 

 

 

 

 

“Over 60% of Britons say they are not confident communicating with a child who is deaf”
(Disability Matters Launch Report, Feb 2015)

https://www.disabilitymatters.org.uk
Over the last few months I’ve been working with the project team at the Royal College of Paediatrics and Child Health, an NDCS colleague Lucy Read, and some deaf young people and adults on a new e-learning module called ‘Deaf Communication Matters’. This forms part of a large suite of online and group learning modules that aim to tackle the inequalities that disabled children and young people face in their daily lives. Lauched last week the modules have each been co-developed with disabled young people and parent carers and the practical tips delivered within the programme are based on real, lived experiences. Through words, pictures and signs, deaf and disabled children, young people and their families challenge learners to reflect on their own attitudes and beliefs about disability and explores the practical things people can do that could make a real difference to their health and wellbeing.

The Deaf Communication Matters module uses video of several of NDCS former YAB members and material from their My Life My Health campaign with them sharing some of the typical barriers they encounter and showing the learner simple steps to take and adjustments to make to overcome those barriers and enable successful interaction with them. The module takes about 20 minutes to complete.

So far 27 modules are live with more to come. The programme is designed to support organisations, their workers and volunteers across the health, education, social care, criminal justice, travel and leisure, community sectors, as well as friends and extended family, in developing the communication and problem-solving skills required to engage confidently with disabled children and young people. All resources are FREE and are designed to be easy to use and done at the learners pace.

Have a look at the site, register and have a look through the many modules – there is bound to be something of interest and value to everyone – including communication, advocacy, safeguarding, confidence, relationships, bullying, inclusion, decision making etc. You could complete them all with one 20-40 minutes session a week for a year! But for ease of decision making the system will recommend a shorter list of modules based on their profession or sector selected when registering.

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.

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!

IMG_0829My 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…

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


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