KidsAudiologist

Archive for the ‘cochlear implants’ Category

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!

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!)

Families who have a child with a mild, moderate or unilateral deafness frequently report that their child’s needs are poorly understood. This is often because the effect of their hearing loss may be more subtle than for those children with a more severe hearing loss. For example a mainstream teacher will find the child can hear them fine when working one-to-one with the child and not appreciate that the they can’t hear voices from further away and when there is background noise. This means that children have very reduced opportunities to benefit from hearing what is going on around them – incidental learning – and are therefore more likely to show delays in speech, language, educational, & social development than their normally hearing peers. Sadly, due to funding and capacity issues, local specialist support resources are often prioritised towards those children with more severe hearing losses so that training and awareness in schools may be low. Parents understanding and advocating for their child’s needs becomes even more important.
In 2010, NDCS was awarded a 2 year grant from the Department for Education under the SEN and Disability “Improving Outcomes” theme. We have been working with parents and professionals, providing specialist information and support on key barriers to achievement and to specific groups with a significant attainment gap. One strand of this work that I’ve been involved with has been to provide new information resources for parents that are available free to download – ‘Mild deafness’ and ‘Unilateral deafness’. This weekend I was involved in developing our first weekend for families of children who have a mild, moderate or unilateral deafness. All the deaf children were between 3 and 7 years old and they and their siblings appeared to have a great time occupied in the children’s activities sesssions. Parents attended sessions sharing their experiences, and heard from a young adult role model who grew up with moderate hearing loss in both ears. They also attended information sessions on audiology, technology, education, and NDCS events and services. 12 families attended and for 10 of them it was the first time they or their children had ever attended an NDCS event. Many had been told or held the perception that their child wasn’t ‘deaf enough’ to access specialist services, Disability Living Allowance, resources that help children develop listening skills, and even NDCS. A few families had shown an interest in learning sign language to help communication at times when their hearing aids couldn’t be used and to mix with other deaf children, but many had been poorly advised including that it would have a negative impact on their child’s spoken language development. This may have been one dimension of why families often hadn’t persued joining local groups and meeting other families with deaf children. Most of the children had never met another child that uses hearing aids and it was a real joy watching them playing together and making new friends ‘like them’ over the weekend. I believe the parents have all gone away feeling more confident that they understand their child’s needs and will be better able to make informed choices on behalf of and with their child.

So if you have a child with a mild, moderate or unilateral deafness remember that “NDCS uses the word ‘deaf’ to refer to all levels of hearing loss” and that all of our current services and events are open to you.

#FollowFriday (or #FF) is a way of recommending interesting and/or helpful people on Twitter to your followers. For more information on using #FollowFriday well see @SLPTanya‘s excellent blog. I find Twitter really valuable and struggle to narrow down my recommendations to just a handful each week, risking cluttering up everyone’s timelines! So I’ve had a browse through my favourites and have come up with a list of those Twitter accounts that I most often save tweets from. I’ve also included links to their websites for those readers who aren’t Twitter users.

So for really useful audiology content (in no particular order) here are my #FollowFriday’s:

For wonderful #AudPeeps (audiologists and other professionals interested in hearing care) who are always happy to tweet/chat my #FollowFriday’s are:

They’re popping up everywhere and are chosen for their status providing renewable and clean energy – wind farms. Earlier this month I was asked if I could answer a couple of questions about how wind turbines may impact on the hearing, and hearing aid / cochlear implants, of local residents. I have to admit to not really knowing anything about them so I put the question out on Twitter too…

… and although I didn’t get any responses that answered the question I did get some from other users who said they’d be interested in what I found out. So here’s a summary of what I learnt after some research, but I’m still learning so do add any comments with further evidence if you have it.

Q 1. Is there is any research on the implications for deaf people with hearing aids of living near to turbines?

A. No. There is no research, literature or other evidence (that I can find) of any positive or negative impact on hearing aids, cochlear implants or their wearers living near wind turbines. I can find two statements written by members of the public saying that turbines cause problems for hearing aid / cochlear implant users but cannot find any fuller description, case study, or evidence as to why this should be.

and

Q 2. Can you offer a professional opinion about the impact on of the turbine on a young person’s hearing and possible damage?

A. What I have established in relation to wind turbines and the ear/hearing:

  • There is no evidence that the noise generated by wind turbines causes hearing loss, and wind turbines are not loud enough to cause hearing loss.
  • It is known and widely acknowledged that wind turbines generate significant levels of infrasonic acoustic energy (noise that is below the frequency range that the human ear detects as sound).
  • There is some limited lab-based research evidence  (such as this) that suggests infrasonic sound (vibration) may cause some disruption or abnormal stimulation of the inner ear (cochlea and vestibular system) that may form the basis of the symptoms of ‘wind turbine syndrome’. These symptoms include tinnitus, vertigo, disturbed sleep, headaches, memory and concentration deficits, irritability and anger, fatigue and loss of motivation.
  • Wind turbine syndrome is not experienced by the majority of people living near turbines. The data may be difficult to establish as those closest to the turbines (ie those who rent land to the energy companies) are often motivated to be positive about turbines due to financial incentives, and/or gagging clauses in contracts that prevent them saying anything negative about them. But many of the symptoms can also be explained by other factors such as stress and annoyance etc.
  • Planning guidelines in the UK says that turbine noise should not exceed 5 decibels above background, ambient noise. A wind farm produces a noise of about 35-45 decibels at a distance of 350m. Rural night-time background noise typically ranges from 20 to 40 decibels. No indoor levels are specified.
  • Most hearing aid wearers would be able to follow a close one-to-one conversation easily in this level of background noise.
  • In terms of background noise levels and the effect on hearing aid wearers it would be my opinion that if these levels were accurate and maintained, that outdoors the natural noise of the wind would be likely to be more of a hindrance than the turbine noise to the hearing aid or cochlear implant wearer (wind blows over the microphone and is amplified, wind also carries voices away from the listener etc). Indoors it is unlikely that these levels of background noise from outside would be significant or even heard. These background noise levels are certainly a lot lower than the average town or city dweller experiences most of the time.

I have located just one document for audiologists “Wind-Turbine Noise; What Audiologists Should Know” (Audiology Today, Jul/Aug 2010). It includes lots of information on the acoustics, infrasonic vibration levels, and the potential health problems that could be associated with wind turbines (such as tinnitus and vestibular disturbance) but is clear that the levels generated aren’t loud enough to cause noise damage and makes absolutely no mention of problems associated with hearing aids or cochlear implants.

There is probably still much we don’t know about the turbine technology, as well as the potential impact on the technologies on the human body. At the moment audiologists serving populations in areas where there are wind farms should be aware of potential health problems that patients may complain of. But I can find no evidence of any significant negative impact on existing hearing loss or on any hearing aids or cochlear implants that are worn.

Further reading

Wind turbine sound and health NHS Choices, January 2010

Scientist Challenges the Conventional Wisdom That What You Can’t Hear Won’t Hurt You June 2010

Analysis of How Noise Impacts are Considered in the Determination of Wind Farm Planning Applications Hayes McKenzie Partnership, June 2011

Wind myths: Turbines can damage your health February 2012

Hansard – Written Answers (Wind Power), 27th March 2012


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