KidsAudiologist

Archive for the ‘cochlear implants’ Category

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.

Good toy hearing aids and cochlear implants are hard to come by but some parents have ordered the Build-A-Bear soft hearing aid from the USA. In what has to be the best example of ‘if you don’t ask, you don’t get’ that I’ve seen in a while it’s wonderful to see that Build-A-Bear in the UK are now stocking soft hearing aids for their toys. Sarah Smith, who is the mother of a deaf child and active contributor in the Pimp my hearing aids / cochlear implants UK Facebook group, tweeted the CEB of Build-A-Bear in the USA and as you can see the result was positive and speedy.

So far they have no plans to make a cochlear implant for their teddies so who is going to begin the asking? If you don’t ask…

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.

Updated 29th December 2018 to include additional references and 14th February 2020 to include a safety alert issued to NHS audiology clinics

A recent study looked at 20 years worth of data from emergency departments in the USA about children who had attended following a battery related incident. Whilst incidents were rare at 4.6 hospital visits per 100,000 children in the population that amounted to an average 3289 visits annually. The study looked at four scenarios – swallowing batteries (which accounted for 76.6% of visits), and putting them in the mouth (7.5%), the ear canal (5.7%) and the nose (10.2%). And it was most likely to happen in the under 5’s (mean age 3.9 years). More than 8 out of 10 visits were related to button batteries which are widely used in hearing aids, cochlear implants and other electronic devices. It’s also worth considering that the magnets used in some cochlear implant coils are a similar size and shape to button batteries and could also be a potential hazard. In December 2019 a National Patient Safety Alert was released to all NHS audiology clinics about battery safety in children’s hearing aids. The safety alert states that all hearing aids fitted to babies and children under five years of age must have secure battery compartments. And where hearing aids are issued to older children and adults, the audiology clinic is required to consider the need for a secure battery compartment for anyone living with young children and babies, or with a person with additional risk factors, such as those with a significant learning disability, dementia or other cognitive or sensory impairment. This safety alert follows an investigation by the Healthcare Safety Investigation Branch into the case of a three year old child who had an unknown and undetected ingestion of a button battery and sadly died. The child was not deaf and the battery in question had come from another household device.

This means that audiologists and parents of young deaf children need to be aware of the risks and ensure children’s equipment is used safely:

  • Make sure young children have childproof battery locks fitted to their hearing aids so that they can’t remove the battery themselves.
  • Try not to let young children see batteries being changed. It is safer if they do not know that the battery compartment opens.
  • Ensure both the used and new batteries are stored safely and out of sight of young children.
  • 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.
  • Remember that even if you trust your own child not to fiddle with their batteries there may be other children in their school or nursery who don’t understand that they shouldn’t play with them.

Fortunately the majority of battery related injuries aren’t serious and can be easily treated. But occasionally injuries are serious so it is important to follow up any concerns you may have immediately. If you are concerned that your child may have swallowed a battery or put one somewhere they shouldn’t – take them to your nearest A&E department. Take a similar battery and the packaging with you so that the hospital staff can identify the type of battery and know what action they need to take.

References:

Button Batteries Pose Dangers to Children, Advance for Speech-Language Pathologists & Audiologists [Published online December 2011]

George, A.T., & Motiwale, S. Magnet ingestion in children – a potentially sticky issue? The Lancet, Volume 379, Issue 9834, Pages 2341 – 2342, June 2012

Hearing Aids; Information for families, NDCS, January 2012

Sharpe, S.J., Rochette, L.M., & Smith, G.A. Pediatric Battery-Related Emergency Department Visits in the United States, 1990–2009, Pediatrics [Published online May 2012]

UK’s top paediatric doctors warn of devastating impact of button batteries, GOSH Sept 2016

Hearing aid battery compartments need locks, CHI+MED Making medical devices safer, 2016

Keeping children safe from button batteries during the festive season and beyond! PHE Dec 2018

 

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.

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!


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