Improving outcomes for those with severe and profound hearing loss

With thirty years of experience in hearing healthcare, Judith Bird, Clinical Scientist (audiology) at Cambridge University Hospitals NHS Foundation Trust, is an expert in the field and passionate about providing best audiological care. She was an ideal choice to be included as one of the international experts Phonak convened to author the recently published guidelines on the management of adults with severe and profound hearing loss.

In this short interview, Judith shares what she believes audiologists can do to ensure they are delivering effective audiological management for those with severe and profound hearing loss.

Here is our interview…

Hi Judith, thank you for joining us today. It is very exciting that the Guidelines for Best Practice in the Audiological Management of Adults with Severe and Profound Hearing Loss have been published in Seminars in Hearing. As one of the experts who created the guidelines, can you please give us a bit of background. Who are they intended for and why are they important?

The guidelines are an amazing resource for any audiologist who sees patients with severe and profound hearing loss. They pull together current research and make clear recommendations about what best care should look like.

One of the areas that the guideline explores is the area of on-going care and what this should include. Follow up appointments are a really valuable stage in care to assess much more than just how well somebody might be adjusting to their new hearing aids and if they know how to look after them.

How do audiologists know if their management has been effective? Do you have any tips?

In truth many audiologists do the best job they can but do not know how effective their intervention has been as they make no attempt to measure it! As yet, no outcome questionnaire has been designed purely for those with severe hearing loss but is still a good idea to use structured patient report tools to evaluate if goals have been met and to identify any need for further intervention. The guideline gives examples of patient reported outcome measures (PROMs) that you may find helpful. So make sure you see your patients for a follow up appointment and properly assess if their hearing and communication needs have been met.

It is also a good idea to regularly measure aided speech scores – this can help assess performance with hearing aids over time in a less subjective way than questionnaires. A decrease in functional speech scores may indicate that hearing aids are no longer giving sufficient benefit and that other options need to be considered.

Is a referral for cochlear implant assessment the only alternative treatment option?

Many people with severe hearing loss may benefit from cochlear implants and it is important they are given the opportunity to explore this. So if your speech testing suggests implants might be an option or a future possibility, then start the conversation. Remember, it is a big decision for people so make sure they have time to think about it, discuss it and research it for themselves.

However, cochlear implants are not suitable for everyone. It is really important to use a holistic approach to ensure all aspects of support are considered whether someone uses hearing aids or implants. Make sure people have access to communication training, support groups and assistive technology specific to their hearing needs.

It is also important to consider if a review by an ear nose and throat specialist is indicated. This particularly important for people with conductive hearing loss that has never been investigated or for those where middle or outer ear disorders are hindering hearing aid use. You may even see patients with otosclerosis who opted for hearing aids many years ago but the option of surgery has never been re-visited.

In your opinion, what are audiologists doing really well and what could be improved?

I’d like to think we are getting better all the time at giving individualized quality care to people with hearing loss. But we could do better at ensuring people have access to a wide range of treatment options, not just hearing aids. Evidence shows that lack of professional awareness is a barrier to up-take of cochlear implants¹ and that many professions do lack confidence in discussing implants and making referrals.

Is independent learning enough or do audiologists need peer support to deliver effective audiological management for this group? 

Reading articles and watching webinars helps learning but it might not build confidence. Peer support can be really important in learning from each other in a safe environment. Forums for discussion can help consolidate theoretical learning. Why not try and connect with other audiologists for a regular session?

What would you tell audiologists to do next?

Why not audit your clinical practice to see how your clinic performs against the guidelines for follow-up and ongoing care? You might want to consider some of the following example questions?

• Does everyone get a follow up appointment?
• Does everyone get access to communication advice and training?
• Does everyone in cochlear implant criteria get to have a discussion about whether this might be an option for them?

Think about areas where you don’t feel confident. Check out some of the resources within the guideline and appendices. Why not try and set up a forum in your area to encourage and support each other.

Finally, make sure you are not one of those professionals whose lack of awareness is limiting access to options that may be really valuable for your patients. So go and find out more. There are some great resources available at Adult Hearing website.

These are wonderful key takeaways for audiologists. Thank you very much Judith for sharing your expertise!

---

Summary of Judith Bird’s recommendations for audiologists who see people with severe and profound hearing loss Regularly measure aided speech scores – this can help assess performance with hearing aids over time in a less subjective way than questionnaires. If speech testing suggests cochlear implants might be an option or a future possibility, then start the conversation. Use a holistic approach to ensure all aspects of support are considered and people have access to a wide range of treatment options. Connecting with other audiologists (e.g., online forums) can give you opportunities to learn from each other in a safe environment. The guidelines are an amazing resource. Audit your clinical practice to see how your clinic performs against the guidelines for follow-up and ongoing care. Also, find out about resources that are available for your patients.

Resources for managing severe-to-profound hearing loss are also available on Phonakpro.com.

References

1. Bierbaum, M., McMahon, C.M., Hughes, S., Boisvert, I., Lau, A.Y.S., Braithwaite, J., & Rapport, F. (2020). Barriers and facilitators to cochlear implant uptake in Australia and the United Kingdom. Ear and Hearing; 41(2):374-385.
   
2. Buchman et al. (2020). Unilateral cochlear implants for severe, profound, or moderate sloping to profound bilateral sensorineural hearing loss: A systematic review and consensus statements. JAMA Otolaryngol Head Neck Surg. doi: 10.1001/jamaoto.2020.0998. Online ahead of print.