KidsAudiologist

Archive for the ‘hearing tests’ Category

Can you help us by sharing your views?

The NHS in England has made a commitment to introduce new services for hearing care, eye care, and dental health for children and young people who attend residential special schools.

And the NHS has asked NDCS to develop information leaflets about hearing care for parents and carers that accompany this project.

Why is this new NHS project important?

  • Children with autism, a learning disability or both have a right to be able to access high quality care for their ears and hearing no matter where they go to school.
  • We know that children with autism, a learning disability or both are more likely to have difficulties with their hearing than their non-disabled peers.
  • Hearing is not only important in speech development and learning, hearing also connects us to our environment. For example, being able to hear and understand our environment, such as hearing footsteps coming or hearing music.
  • But we know that hearing difficulties are often unrecognised or undiagnosed because behaviours associated with hearing difficulty may be thought of as being part of the child’s personality, physical or learning difficulties, or complex needs.
  • And children often don’t have access to an audiology (hearing) clinic because there isn’t a suitable service that is nearby to attend, because hearing difficulties are not considered a priority for the child because of other more pressing health needs, or because those people working with or caring for the child believe that it is not possible for their child to have their hearing assessed.

By sharing your views you can help us develop accessible information for all parents and carers to help them understand why this work is happening, why it matters and how they can help their children to access these services.

We would like to hear more about your personal experiences of hearing tests and what you feel you would have found useful to have known beforehand. Or if your child has never had a hearing test, why this is the case and if you have any views are on what information you would need to help you access the hearing clinic. Please let us know by completing this 10 minute questionnaire

If you would prefer, I would be happy to organise a time to talk to you in person, by phone or by Skype. Please contact me at NDCS:

Vicki Kirwin
Senior Policy Adviser
Direct dial: 023 8065 2735
Email: vicki . kirwin @ ndcs . org . uk

All your feedback will be used confidentially unless you specifically give us permission otherwise. And once the project is finished we will ensure that you receive a copy and are told how your views and feedback was used.

Thank you!

 

The Hear Glue Ear app, created by a Cambridge Paediatrician Dr Tamsin Brown, won ‘Children’s App of the Year’ at the UK App Awards last month.Children with glue ear often have long periods of time with mild-moderate deafness during the critical stages for speech and language development (for example, during the ‘watch and wait’ period in the care pathway, whilst waiting for hearing aid fitting or grommet surgery, when hearing aids or grommets are not available, suitable or acceptable to the family for some reason). Pressures on NHS and education services mean that there is very limited support during these periods. The app was developed by Cambridge Digital Health and funded by the Cambridge Hearing Trust for families to use during these times. It includes:

  • Information and advice for families on glue ear, it’s effects, and what you can do to help overcome the temporary hearing loss during the watch and wait period
  • The ability to upload the child’s speech and language plan to work from
  • Links and suggestions of other resources to directly help the children
  • Free audiobooks and games that encourage reading together and working on certain developmental skills
  • A hearing game (level monitor) that gives parents an idea of how their child’s hearing is today if it tends to fluctuate
  • The ability to open access to your child’s records/notes within the app to a professional by entering their email address

The app can be downloaded free here and you can read more about the app and research here

Congratulations to Dr Brown and her team on winning this award for a really innovative approach to helping children with glue ear. Before the awards ceremony her daughter Lilac, 9 years old, explained how her mum came up with headphones and the app to help her hear when she had glue ear:

“I am going to the app awards in London and I am so excited. My mum made an app to help children with ear problems like mine.

When I was little I got ear ache every month. Then mum noticed that I  couldn’t hear some of the words because I was missing letters. Mum took me to have a hearing test.

I couldn’t hear very well, at that time I was in playgroup.

Mum said I had glue ear. I  couldn’t hear for a year before I had a grommet operation.

The grommet operation did help and was fine but I got more ear aches afterwards.

When the grommets came out, I got a hole in my ear drum for another year. That didn’t help my hearing either.

Mum thought I needed a operation because there was a hole in my ear but soon it got better all by itself.

Everyone was surprised because it’s not often an ear drum gets itself better like that when there is so much happening with your ear.

Mum noticed that when I got a cold or an ear-ache I asked “what” some of the time and got words wrong. For example I loved collecting conkers but I called them “onkers”, I didn’t really notice people were saying the ‘c’ at the beginning.

I started school and I wasn’t that good at reading because If I asked the grown-ups what the word was maybe I wouldn’t hear it right. It also makes spelling difficult.

It’s really difficult when children can’t hear because we don’t want to argue with the teachers or other adults. Because if we accidentally hear a word wrong and then say it then the teacher might think we have said the wrong thing and tell you off. I remember once I thought the teacher said to get my  lunch box, and I walked out of class, she hadn’t said that, so I got into trouble. It was because I was looking away for a second when she was talking. I am more deaf when I am not concentrating on the teacher.

It’s hardest to hear when I’m in a crowded place in public. And that is when I would most like to have a headset.

Mum didn’t want children to have a hard time at school and at home like I did. So mum found some headphones that you can Bluetooth to a microphone so that you can hear the teacher better at school [the cost is £100-150 and can be trialled from NDCS] . Or you Bluetooth the headphones to Mum’s app. If you use the app you get stories, songs and games which makes it fun and it helps your listening  and it helps you to not fall behind with your learning.

Mum says children don’t want to fall behind when they have glue ear. I think Mum’s right and I think I also want people to have better hearing.

The app that Mum created is called Hear Glue Ear. When I saw it, mum said I could look at it and change anything. I helped mum to make it better and better and better, and so did all my family and other families and children who had glue ear.

It’s a lot of work and usually I have to wait while mum is doing a meeting and I have to be super super quiet. 

Now my glue ear has gone,  I still have a little bit of hearing loss in one ear,  but it’s only a problem now and then.

One day mum got asked to go to a conference in Australia. She didn’t want to leave us at home, so we went and had a lovely holiday. I did feel bad for her working, but I knew if she went to this conference it would not only give us a nice holiday but it might save children’s hearing. When she was there someone else asked her to go to Sweden for a different conference, so then we went to Sweden on holiday the following year. It’s because she is such an amazing doctor.

On a plane journeys it helps me when I can suck sweets otherwise my ears are really bad and it lasts for 2 days.

The app got asked to come to London so that it can win children’s best app [Hear Glue Ear app has been shortlisted for Children’s app of the year at the UK app awards ceremony in London on November 26th]. I get to go to London with Mummy and hopefully I can get to see her win the children’s best app award.

To other children who have glue ear remember it’s the glue ear that’s difficult and not you. And could you cross your fingers my mummy wins the best app award.

Love Lilac”

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.

 

 

This article was originally written for the Netbuddy website which has since merged with Scope where an edited version appears. I have re-published it here for Learning Disability Week 2015.

https://www.mencap.org.uk/get-involved/learning-disability-week

Research suggests that as many as 40% of adults with a learning disability have a hearing loss although for some groups this figure can be much higher. For example, hearing loss affects up to 75% of young people with Down syndrome.

Hearing problems may be unrecognised or undiagnosed because behaviours associated with hearing loss may have been thought of as being part of the learning disability, or because local audiology services are not accessible to them.

Unrecognised and unmanaged hearing loss can cause or contribute to speech or language delays, difficulties learning and reading, and cause difficulties communicating with others. Hearing loss can therefore have a significant impact and exacerbate the effects of an individuals learning disability.

Some people are born with a hearing loss but for many people it develops later in childhood or as an adult.

Types and levels of hearing loss

Conductive hearing loss happens when sound cannot pass efficiently through the outer and middle ear to the cochlea and auditory (hearing) nerve. Conductive hearing loss is most common in childhood and is usually caused by ‘Glue ear’ (Otitis media). Glue ear is a build up of fluid in the middle ear that makes it harder for sound to pass through to the inner ear. Glue ear causes the hearing to fluctuate and often clears up on its own without needing any treatment. However, for some children with learning disabilities glue ear may persist longer term.

Sensori-neural (or nerve) hearing loss happens when there is a fault in the inner ear (most often because the hair cells in the cochlea are not working properly) or auditory (hearing) nerve. Sensori-neural deafness is permanent. Sensori-neural deafness is most common in adulthood and is usually caused by normal wear and tear of the ear and the ageing process. In some individuals with learning disabilities this ageing may happen much earlier than would be expected in the general population.

It is also possible to have a sensori-neural and conductive hearing loss together and this is known as mixed hearing loss.

There are different levels of hearing loss that are measured in decibels (dB) and described as mild (21-40 dB), moderate (41-70 dB), severe (71-95 dB) or profound (95+ dB).

Balance

As well as hearing our ears also help us to balance. The brain uses information from the eyes (what we see), our body (what we feel) and the inner ear to balance. The semicircular canals in the inner ear are three tubes, filled with liquid and movement-sensitive hair cells. As we move, the fluid moves. This creates signals that are sent to the brain about balance.

Balance problems can occur when the organ of balance in the inner ear does not work properly (vestibular hypofunction). Children can be born with this or acquire it with illness or trauma. With hypofunction development of balance function may be delayed and this might mean that babies and young children take longer to reach developmental milestones such as sitting unsupported and walking. Older children may have difficulties with certain activities such as learning to ride a bike. This is called imbalance.

Other types of balance problem can give rise to dizziness or vertigo or episodes of unsteadiness. These can occur at any time in childhood.

Possible indicators of a hearing loss

The list below contain behaviours that can indicate a problem with the ears or a hearing loss. It is also possible that they could be explained by a persons learning disability but it is worth asking for a hearing test to rule out any hearing difficulties particularly if it is noticed for the first time or it is a change from their normal behaviour:

  •  Does not respond when called by name
  • Does not respond to verbal instructions or needs visual clues
  • Watches faces intently
  • Appears to hear some voices better than others (e.g. low or high pitched)
  • Has difficulty following a conversation in a group (e.g. when there is a change in topic of conversation)
  • Struggles to hear conversation in the presence of background noise
  • Sits very close to the television or turns the volume up loud
  • Is upset by loud noises
  • Is startled by people approaching from behind who they haven’t seen/heard
  • Speaks very quietly or loudly, or vocalises very loudly
  • Breathes through their mouth and has a ‘blocked nose’ most of the time
  • Has discharging ears and/or ears have an unpleasant smell
  • Frequently rub or poke the ears
  • Problems with balance

What can be done to help?

Ask your GP for a referral to an audiology service. For children you should be referred to your local paediatric audiology service. For adults ask your GP to refer you to an audiology service that runs special clinics for adults with learning disability. Hearing tests can be carried out from birth on children and adults with all developmental abilities.

The audiologist will work with the individual, family, carers, key worker and support workers to find the most appropriate hearing tests and best way to get hearing test results. Sometimes this can mean undergoing a series of appointments. It may be necessary for some individuals to get used the audiologist, department and procedures very gradually, including getting used to having their ears touched etc. The audiologist will discuss with the individual, family and carers an Individual Management Plan for assessing the hearing and managing any hearing loss that is identified.

There is a wide range of equipment that can be helpful including:

  • Hearing aids
  • Radio aids or soundfield systems (specialist listening equipment mostly used in schools)
  • Assistive listening devices that can be used with or without hearing aids, such as amplified headphones, amplified telephones, flashing and/or vibrating doorbells, alarm clocks and fire alarms

People with learning disabilities communicate in lots of different ways including speech, makaton or other sign language, communication systems using pictures and symbols or a combination of these. Additionally it can be helpful just to know that an individual has hearing difficulty as this means that parents, carers, teachers, family and friends can make simple adjustments that make hearing and listening as easy as possible. Here are some communication tips that will help:

  •  Make sure you have the person’s attention before you start to talk to them.
  • Make sure you are facing the person you are talking with and maintain good eye contact.
  • Try to be get down to the same level as children, or adults who use wheelchairs, and allow some space for them to see you clearly.
  • Use a well-lit room and don’t have your back to a window, as this creates a shadow and makes it difficult to read facial expressions or to lipread.
  • If you are naturally a fast talker you may need to slow down a bit, but try to speak clearly, naturally and at a normal pace. Don’t shout as it distorts lip patterns and facial expressions, and can appear as if you are angry.
  • Try to make sure that background noise is kept as low as possible. A room that is carpeted or that has curtains will help cut down the effects of noise in a room.
  • Don’t be afraid to use gestures and facial expressions to support what you say.
  • While speaking don’t smoke, eat or block the view of your face. Keep beards or moustaches trimmed and also remember that glasses and sunglasses can make it difficult to maintain eye contact.
  • When in a group, speak one at a time and indicate when a different person starts speaking.
  • Make sure you make it clear when there is a new topic of conversation.
  • Some words or signs may not be easily understood or may not be in the vocabulary of the listener. Try a different word or sign with the same meaning.
  • Always give plenty of time for the person to respond to anything you say.
  • Pause between sentences and check the listener has understood you, and that you have understood them. Encourage them to stop you if they don’t understand what you are saying.

Further information and advice

For further information on any aspect of hearing loss, equipment, or accessing audiology and hearing tests contact:

 

For children – National Deaf Children’s Society (NDCS)

Freephone Helpline 0808 800 8880 (Monday to Thursday 9.30am-9.30pm and Friday 9.30am-5pm)

Or email helpline@ndcs.org.uk

 

For adults – Action on Hearing Loss (formally the RNID)

Information Line 0808 808 0123 (Monday to Friday 9.00am-5.00pm)

Or email informationline@hearingloss.org.uk

 

Scope have an active online forum to ask questions and get support from other families, including a ‘Community Advisor’ section where professionals will reply to your queries. Catch me here if I can help.

 

Useful Resources

Hearing and Learning Disabilities (HALD)

HALD is a special interest group for professionals who work in ENT and audiology services. Their website contains example information leaflets developed for adults with learning disabilities about audiology appointments, including easy read language as well as photos and symbols including:

  • using and looking after hearing aids
  • ear infections
  • wax
  • how people can help

 

Foundation for People with Learning Disabilities

The Foundation for People with Learning Disabilities has published Good health care for all: What can I expect from the NHS? that provides practical hints and tips for people with learning disabilities, family carers and anyone who supports a person with learning disabilities on how to go about using the NHS, what to expect, real life examples of challenges and how they can be overcome as well as some advice about how to get help and some useful contacts to get more information.

 

General Medical Council’s Learning Disabilities website

The General Medical Council (GMC) has launched a new website which aims to help doctors provide better care for people with learning disabilities by:

  • identifying the issues
  • highlighting patient perspectives
  • showing how to put GMC guidance into practice.

The website expands on the guidance in Good Medical Practice and Consent and demonstrates how it applies to practices when treating patients with learning disabilities.

 

 

 

Atresia or microtia is the absence or underdevelopment of the outer ear and is frequently associated with other craniofacial conditions that may impact on all aspects of their lives. It is essential that these patients and their families have access to specialised microtia teams able to provide up to date and unbiased information. A multidisciplinary approach should be taken to provide holistic, individualised assessments and interventions. This should encompass cosmetic, audiological and psychological aspects of their care. Close liaison between local services and the ear reconstruction team is a key component to achieving the best outcomes for these patients. There is a recognised need for agreed care standards for these patients, and this document aims to reflect a consensual view of how this care can be provided in an integrated fashion.

I was pleased to be involved in their development for NDCS along with other patient, parent and carer groups, working together with a passionate group of professionals who work with children and adults born with atresia or microtia.

Download UK Care Standards for the Management of Patients with Microtia and Atresia (Edited by: Henderson, R., Moffat, C., Stewart, K., and Clapperton, K.) March 2015

For further information about microtia and atresia you can also order or download a free booklet on atresia and microtia written for families from NDCS here, contact Microtia UK or join the Microtia Mingle Facebook Group.

 

Can you help?

EarCampNepal1Ear Aid Nepal are urgently looking for one or two volunteer audiologists for a charitable ear camp in Nepal this April:

“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.

EarCampNepal2PLEASE 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 mike.smith@earaidnepal.org

http://www.earaidnepal.org

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?


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