The free papers and posters are integral to the BAA the conference. They provide the ideal opportunity for those working within the audiology field to share best practice, research, and network with colleagues. Over the last few months, delegates have been preparing their research projects to share with their colleagues. This year, we have accepted 98 abstracts and offered 10 slots to people on the 2022 programme for oral presentations!

Here are the abstracts for the forthcoming poster exhibition:

1. Case study of sudden onset bilateral auditory, visual and vestibular neuropathy

Jason Smalley1, Mr Kevin Hole, Mr Connor McCarthy

1Nottingham University Hospitals NHS Trust

Introduction

This case study describes the audiological, vestibular, visual and neurological findings from investigations into a 66 year old gentleman who presented with sudden onset profound hearing loss and blindness.

Methods

The results of all the testing performed upon the gentleman are described, including otoacoustic emissions, speech testing, tympanometry, pure-tone audiometry, vestibular function testing and auditory & visual evoked potentials to attempt to determine a condition and cause for the sudden onset.

Results

The results of testing were consistent with a sudden onset bilateral auditory, visual and vestibular neuropathy. The MRI showed no structural reason as to the cause.

Discussion

This poster will discuss the need for complex testing with patients who are ‘outside of the normal’ in order to assure that complex and rare conditions are not missed.

No conflicts of interest.

2. Sex Differences and the Effect of Female Sex Hormones on Auditory Function: A Systematic Review

Nada Aloufi1

1University Of Manchester

Aims: This systematic review aimed to investigate if there are sex differences in the auditory function, and if these differences influenced by the female sex hormones. In addition, it aimed to investigate the relation between fluctuations in female sex hormones and auditory function of pre-menopausal and post-menopausal women.

Methods: As most of the studies found in the literature search were observational studies, it may not be suitable to follow the PICOS criteria in developing the review questions as it is for intervention studies. However, Population and Outcome can be used for developing the review question for observational studies. The review protocol is pre-registered in PROSPERO (CRD42020201480), and it was performed in accordance with the guidelines of the PRISMA. Data Sources: EMBASE, PubMed, MEDLINE, PsycINFO, ComDisDome, CINAHL, Web of Science, CENTRAL via Cochrane Library, scanning reference lists of relevant studies, and internet resources were used for studies published between 1999 and 2021. The quality of evidence was assessed using Newcastle-Ottawa Scale.

Result: Women were reported of having better hearing sensitivity (in peripheral and central auditory system). In addition, women’s auditory function fluctuated during the menstrual cycle, where men tend to have more stable auditory function. During late follicular phase, the peripheral hearing was reported to improve, where it decreased during luteal phase. However, the role of oestrogen and progesterone in the central auditory system remains unclear. Women hearing sensitivity tend to rapidly decline soon after the start of menopause.

Conclusion: The possible effect of female hormones on hearing remains unclear and may needs further investigation. As the included studies highlighted the need to implement a well-designed study in evaluating the influence of oestrogen and progesterone on hearing by including men as control groups, use objective tests to measure hormonal level, and to test participants at different points across the menstrual cycle.

No conflicts of interest to declare.

 

3. Developing a Sustainable Workforce for The Royal Wolverhampton Audiology Department

Lesley Peplow1

1The Royal Wolverhampton NHS Trust

Introduction

The RWT Audiology department has an ageing workforce demographic, particularly in the higher bands. Our mission was to develop a sustainable workforce by empowering staff to develop their knowledge and skills, foster a culture of learning and embed this into practice.

Methods

Initial steps included a review of the current workforce including completion of a skills matrix and a staffing restructure because of this work.

Roles have been developed for a training officer, preceptor, supervisors, mentors & assessors.

We developed an Education/Training/Workforce sustainability group looking at talent spotting with the team feeding into Appraisals and Peer review, developing Band 5 rotations into individual specialisms.

We encourage staff to undertake MSc & HTS Modules and apprenticeships and other appropriate learning opportunities.

Results

  • Band 2 completed level 4 Healthcare Science apprenticeship and been rebanded to a Band 3 and is now on a level 6 BSc apprenticeship.
  • 3 staff have completed MSc Modules with 2 now starting HTS Modules
  • Band 6 is halfway through the Senior Leaders Management apprenticeship
  • 2 members of staff have gained STP equivalence
  • Accredited for STP Training and appointed STP Trainee Clinical Scientist
  • Upskilled staff taking on more complex roles and activities and improving capacity within those areas

Discussion

The team are all extremely positive about the changes.

Funding is an issue with a limited training budget, and there is an impact on activity, if you are training and upskilling staff this invariably takes more time however as staff gain more skills these are utilized to allow additional activity/more complex work to be undertaken. Having a training role ensures staff keep their skills honed. Staff retention is high, and plans are in place and being actively worked towards to fill future predicted gaps, using a blended approach including  “grow your own”.

No conflicts of interest.

4. Everything will be okay

Mrs Anna Leatt

1UHBW, 2The Poetry Machine

Introduction

An internal audit  at the Children’s Hearing Centre   highlighted the relatively high number of cases where parents initially declined intervention (22% of all diagnosed babies). As a result the team hope to improve the uptake of children’s hearing services within our community through several agreed ‘action plans’. The first stage of this was to understand parents’ experience of the newborn hearing diagnostic process at Bristol using arts based methods. This information would inform service development plans including producing information for the website.

Methods

We worked with the Patient Experience Team and Beth Calverley: Poet in Residence for the University Hospitals Bristol & Weston (UHBW) NHS Foundation Trust. Parents of children with permanent hearing loss were invited to work with Beth to express their experiences as poems.  Beth hosted a gentle conversation with each person. They were free to share as much or as little as they wished. She wove their words into a poem, live in the moment, and invited each co-creator to shape the poem as they wished. Some sessions took place in person while others took place via phone/video call. Each person received the original typewritten poem to keep as a memento of their experience.

Findings

Four volunteers described their journeys as family members of a baby/child with a permanent hearing loss, including unilateral, bilateral, and different severities of deafness including profound hearing loss. In addition, staff members also shared their feelings and experiences of supporting families throughout their childhood years, from the moment they find out about their children’s hearing loss. The created poems will be shared.

Discussion

The poems will be displayed on the Children’s Hearing Centre website and  UHBW social media sites. In addition, a ‘poetry gallery’ within the department is being created.  Feedback received from parents was very positive.

No conflicts to declare.

 

5. Supporting staff with hearing loss

Kirsty Fitz-poole1

1Nelft NHS Foundation Trust

I wanted to share the learning on service improvement we have in NELFT NHS Foundation Trust. The project has involved HR, E&D Team, Audiology and IT working together to create a referral pathway to support staff members with hearing loss working in the Trust. Firstly we identified there was a population in the Trust with hearing loss, advertised meet up group for peer support which then evolved into a platform for focus group on how to improve workplace for those with hearing loss.

Some of the early interventions lead on from the focus group included adding subtitles to the Trust Induction training videos, the way that BSL interpreters are booked onto training was changed, as a trust we rolled out deaf awareness training for all managers in the trust.

The huge step forward has been the development of a pathway for those staff with hearing difficulties to get help and support. This involved raising concerns with managers who could recommend the peer support network and book the staff member into the E&D meeting to discuss access to work funding and discuss with IT about equipment available. If hearing difficulties were highlighted then E+D Team can book directly into an Audiologist in the Trust for an assessment and recommendations. A template for a report was created that with permission from the staff member can now be shared with their GP to ease a referral for local Audiology support.

At NELFT we have made huge improvements in becoming a disability confident employer.

The feedback of those staff with hearing loss one year on highlighted how they felt listened to, supported and valued. This structure has worked well and we would love to see it in other large Trusts across the country to see better support for those with hearing loss working for the NHS.

I am happy to share the reports we put together, some of the advertisement strategies used to bring together the group and the challenges we faces and overcome along the way. I hope to put together a really positive presentation and encourage those working in Audiology to think about deaf awareness and support they can provide in a wider capacity.

No conflicts to declare.

6. Remote Triage appointments for vestibular patients during COVID and beyond. Streamlining the patient pathway to facilitate best practice and reduce clinical variance.

Caroline Rae1

1NHS Tayside

Introduction

The COVID 19 pandemic has produced outpatient waiting list challenges.  In 2020 the patient pathway for those presenting with vestibular disorders was redesigned and a remote triage appointment introduced.  .  The remote triage appointment aimed to reduce face to face appointments and reduce clinical variance, making sure patients were seen in the correct clinic for assessment and treatment.

The aim of this project was to map and audit the patient pathway for remote triage vestibular appointments and assess its clinical relevance as services across Scotland remobilise following the COVID 19 pandemic.

Methods

Data from 500 patients who have attended the remote triage appointment was retrospectively audited.  Referral to treatment, onward referral, discharge and DNA rates were investigated to ascertain if this pathway was beneficial for those with vestibular disorders where early intervention is beneficial.

Results

500 patients were remotely triaged.  88 (18%) were referred to ENT and 412 (82%) were managed by audiologists.  84 (17%) patients were discharged without requiring an appointment. The average wait for initial appointment was 67 days which is within RTT guidelines.  31 (6%) patients did not attend their appointment.

ENT vertigo appointments are 30 minutes.  412 patients managed by vestibular audiologists equates to 59 ENT clinics or 3 clinics a month freed up for ENT.

2019 ISD figures show total direct cost per attendance of a new patient for ENT at £153 vs. an Audiologist at £59. This £94 saving per new patient appointment is a total of £38, 728.

Discussion

The remote triage appointment reduced patient handovers and the need for an initial face to face appointment.  This reduced clinical variance and ensured that patients were seen in the correct clinic for the correct assessment and management.  Vestibular audiologists are well placed to manage this patient demographic.

no conflict of interest

7. Audiology assessment for children and young adults with complex needs; The journey to a bespoke audiology suite.

Verity Langlands1

1Seashell

Audiology access for children, young people and adults with complex needs, intellectual disabilities, Autism and ADHD has been at the forefront of conversations in recent years.  With NHS England currently leading an agenda for closing the inequality gap for children and young people in special residential schools accessing hearing checks; audiology services across the country are making progressive steps and amendments to their services to support children, young people and adults with complex needs.

Seashell Health teams work to facilitate healthcare with the needs of the individual at the forefront of decisions. The audiology team have long been exploring innovative assessment techniques and rehabilitations approaches which offer flexibility and support students to access audiological care.  Amongst the considerations, we support behaviours that challenge and physical disabilities both of which require environmental considerations and adaptations.  As well as environmental adaptations, the service is support by appropriate clinical protocols and flexible pathways.

The opportunity arose for a bespoke audiology suite to be built as part of a wider special school new build and by showcasing this journey we hope to inspire and demonstrate the facilitation of an inclusive audiology service.

Clinical appointments for children and young people with complex needs/autism/ADHD host a number of challenges, ranging from the transportation to clinical settings, waiting areas, staffing issues inflexible clinical approaches and unsuitable pathways and protocols.  When designing this bespoke audiology suite we were able to use our specialist knowledge and work with a rich trans-disciplinary design team to create an inclusive setting.

The journey of the design of this suite demonstrates considerations, challenges and collaborative working with the child/young person at the centre of the decisions.  This poster/presentation will look to showcase the unique approach taken and offer examples of the carefully considered aspects of the new build.

No conflicts to declare.

8. Datalogging findings in adult cochlear implant recipients who never developed intelligible speech.

Manuel Loureiro1, Mr Nishchay Mehta2, Jane Bradley3, Jennifer Bryant4

1University College London Ear Institute, Royal National ENT and Eastman Dental Hospitals, University College London Hospitals, 2Royal National ENT and Eastman Dental Hospitals, Hearing Health Biomedical Research Centre, University College London Hospitals, 3Royal National ENT and Eastman Dental Hospitals, University College London Hospitals, 4Royal National ENT and Eastman Dental Hospitals, University College London Hospitals

Introduction: Clinicians often face difficult decisions when assessing cochlear implant (CI) suitability for patients with pre- or peri-lingual deafness who have not developed spoken language, so-called ‘non-traditional’ (NT) cochlear implant candidates. Conventional outcome measures are not applicable to this group. The purpose of this study is to consider whether their patterns of usage can provide insights to guide decision-making for future patients.

Objectives: To gain insight into cochlear implant usage by:

  • describing daily usage and time spent in different sound environments
  • analysing relations between pre-intervention speech intelligibility and speech perception with usage
  • reporting on scene analysis as predictive factors of long-term usage
  • exploring early high usage as a predictor of long-term usage.

Methods: Daily usage, speech intelligibility and speech perception data were collected and analysed for 59 NT CI recipients. Changes in daily usage over time and scene analysis were also investigated.

Results: The correlations between speech intelligibility, speech perception and usage were weak and non-significant. Scene analysis was not a statistically significant predictor of long-term usage but daily usage at 3-month follow-up was found to be a significant predictor. The results suggest NT CI recipients generally wear their sound processors regularly (M = 8.7 hours/day, 95% confidence interval = 7.6 to 9.7 hours/day).

Conclusions: These findings have immediate relevance to patients and clinicians for candidate selection, patient counselling and management of expectations. NT CI candidates who are users at 3-month follow-up can expect to remain good long-term users, favouring listening with their CI in ‘Speech in Quiet’ and ’Quiet’ environments.

Keywords: cochlear implant, non-traditional, datalogging, daily usage, scene analysis.

10. A scoping review examining the research surrounding COVID-19 and the proposed association with hearing loss and/or tinnitus or otitis

Catherine Cass1, Dr Amanda  Hall

1Great Western NHS Foundation Trust, 2Aston University

Objectives: Published studies have proposed an association between COVID-19 and audiological dysfunction. However, due to the large volume and rapid publication of these COVID-19 studies, the quality of the reported evidence is rarely conveyed. This study aims to collate and map the research literature examining COVID-19 and its proposed association with hearing loss, tinnitus and otitis.

Design: A scoping review was conducted using the Joanna Briggs Institute framework. A search was conducted in ten databases and three grey literature data sources to identify eligible studies. Data selection and extraction was performed by the main author of this review. A second reviewer was sent a sample of extracted articles to check the appropriate inclusion/exclusion criteria had been met.

Results: The search identified ninety-two related studies published between January 1st, 2020, to December 1st, 2021.The results reported a wide variability in geographic distribution, study design, audiological outcome measure and the clinical profile of sample participants.

Conclusions: The information catalogued provides a broad overview of the underpinning literature surrounding COVID-19 and a proposed association with hearing loss, tinnitus, or otitis. The large variability within the studies can introduce bias and undermine the reported outcomes. This research can serve as a stepping-stone to developing good quality epidemiology studies which may provide further insight into the proposed association between COVID-19 and auditory dysfunction.

No conflicts of interest to declare.

 

11. Who’s here for Glue Ear?

Stella Devlin1

1South Tyneside And Sunderland Foundation Trust

Glue ear is the most common cause of childhood hearing loss and is particularly prevalent in children under 5 (1). It’s importance can be overlooked when seen as  self-limiting or easily resolved with grommets. However, there can be associated longterm auditory difficulties (2) and any hearing loss in the early years requires attention and research. To better understand the course of glue ear, we conducted a retrospective study measuring the effects of age and time on glue ear persistence and associated hearing loss.

84 children with bilateral type B tympanometry at initial assessment were included. The patient management system was used to document age, interval between assessments, tympanometry results and hearing levels. Statistics were calculated using Excel.

70% of children with bilateral glue ear were under 5. Tympanometry remained type B at the review appointment (mean wait 7±4 months) for 50% of 1-2 years olds, 51% of 3-4 year olds and 48% of children aged 5 and over. 11% of ears had non-type B tympanometry at 3 months compared to 56% in the literature (3). This difference persisted at 6 (55% versus 72%), 9 (56% versus 81%) and 12 months (74 versus 84%).  There was a significant improvement in mean hearing levels at the monitoring appointment (P=0.0005) but great variability and no pattern related to age.

Our research shows higher prevalence of glue ear in children under 5, but equal persistence across ages with no pattern of improved hearing levels with age. Therefore, although less common in school aged children, glue ear is just as likely to be problematic. Glue ear appears to be more persistent in our patients compared to the literature. In an area with high child poverty, low breastfeeding rates and high smoking rates (4), such environmental factors may be at play (1).

  1. National Institute for Health and Care Excellent (2021) Otitis Media with Effusion (summary).
  2. Tomlin D, Rance G. Long-term hearing deficits after childhood middle ear disease. Ear Hear. 2014 Nov-Dec;35(6):e233-42
  3. Rosenfeld R. and Kay D. (2003). Natural history of untreated otitis media. Laryngoscope 2003 Oct;113(10):1645-57
  4. Public Health England (2020) Sunderland Local Authority Health Profile 2019.

No conflicts of interest to declare.

 

14. The New BSA ASSR Guidance in Practice

Constantina Georga1

1Royal Berkshire Hospital

Introduction

ASSRs are evoked potentials that estimate hearing levels in patients of all ages. An audit is presented where results obtained with ABR were compared with those obtained with ASSR

Methods

Results from the assessment of 21 neonates were collected following their referral from NHSP. Both ABRs and ASSRs were conducted at 4kHz as part of their assessment.  Hearing level results suggesting a mild to severe hearing loss (either sensorineural or conductive) as defined by the ABR result were included and correlated with their corresponding ASSR levels. Where results indicated a conductive hearing loss, thresholds were only included if testing was conducted in the same session. Narrow Band CE-Chirps were used for both techniques. The BSA guidelines were used for both techniques.

Results

Results suggest good correlations of ASSR and ABR results. Mean differences were better for results before applying corrections.

Discussion

ASSRs provide reliable threshold estimations for neonates referred from NHSP. The corrections currently applied may need revision to improve the accuracy of both techniques.

References

BRITISH SOCIETY OF AUDIOLOGY (2021), Guidelines for the Early Audiological Assessment and Management of Babies Referred from the Newborn Hearing Screening Programme [Online]. Available at: https://www.thebsa.org.uk/resources/ [Accessed date]

BRITISH SOCIETY OF AUDIOLOGY (2022), Auditory Steady State Response (ASSR) Testing. Available at: https://www.thebsa.org.uk/resources/ [2022]

Sininger YS, Hunter LL, Hayes D, Roush PA, Uhler KM. Evaluation of Speed and Accuracy of Next-Generation Auditory Steady State Response and Auditory Brainstem Response Audiometry in Children With Normal Hearing and Hearing Loss. Ear Hear. 2018 Nov/Dec;39(6):1207-1223. doi: 10.1097/AUD.0000000000000580. PMID: 29624540; PMCID: PMC7664445.

No conflicts

16. Vestibular Dysmorphia and Cochlear Hearing Impairment in Down’s Syndrome

Annie Mc Mahon1, Wiktoria  Glab1, Professor Soumit Dasgupta1

1Alder Hey Children’s Nhs Foundation Trust

Introduction

Patients with Down’s Syndrome (DS) typically present with conductive hearing impairments in more than 75% of cases. Sensorineural hearing loss is rare and found in about 4.5%. Temporal bone abnormalities have been identified but the true prevalence is not known as children with this condition do not undergo routine temporal scans. In those who do, 75% have been reported with various abnormalities where less than 10% constitute third windows. This presentation highlights a mixed hearing loss in a child with DS and multiple third windows in the same subject that has not been reported before.

Methods

A child with DS, hearing loss and multiple temporal bone abnormalities was identified from the Alder Hey database of cochleovestibular dysmorphology. Pure tone audiometry in accordance with BSA guidelines and tympanometry along with a vestibular test battery were performed. To investigate the sensorineural component, aetiology investigations according to BAAP guidelines were carried out that included a high-resolution CT scan of the temporal bone and a R67 gene panel testing.

Results

Imaging showed multiple third windows with unilateral right dilated vestibular aqueduct and bilateral superior semi-circular canal dehiscence’s; audiological testing showed a progressive mixed hearing impairment beginning as purely conductive and then becoming a mixed loss. Vestibular testing and gene panel testing were normal.

Discussion

Our case highlights the observation that sensorineural hearing loss can be present in DS underpinning the importance of regular hearing surveillance for these children. Vestibular quantification is also important as vestibular structural abnormalities may accompany such a hearing loss and, in our case, the mixed loss was caused by the third windows. Multiple third windows have not been reported as yet as shown in our case. Such findings have important connotations for future vestibular symptom manifestation and management.

No conflicts of interest

17. Clinical Utility of the Ocular Counter Roll test – a new test for Utricular Function

Samuel Ranger1, David Jay1

1Manchester University NHS Foundation Trust

Introduction: Ocular Counter roll (OCR) is an emerging test for Utricular function – part of the vestibular system. Literature suggests the OCR has similar sensitivity and specificity to oVEMPs but is simpler and quicker to perform. Interacoustics’ latest Visualeyes software and VNG goggles provide a test environment to perform video OCR in clinical practice. The aim is to trial this test, establish normative values and assess its utility in a clinical setting whilst comparing results to current literature.

Methods: OCR testing was performed on 3 groups 1) healthy controls (patients with normal vestibular function testing), 2) patients with confirmed unilateral vestibular weakness and 3) patients with confirmed bilateral vestibular weakness. Measurements were manually recorded for the left roll and right roll from the pure traces.

Results: Mean OCR for healthy controls will be compared to patients with known unilateral and bilateral peripheral weaknesses. Results will also be compared with Otero-Millian et al (2017) and Sadeghpour et al (2021) to establish whether a basic clinical setup provides similar results to laboratory conditions.

Discussion: Testing carried out so far shows the OCR test is a very simple, quick, tolerable, sensitive, and specific test for Utricular function making it highly valuable in a clinical setting. Clinicians should take care in eye positioning to optimise tracking, record a reference measurement, suppress pupil size, and measure the OCR after 20 seconds to ensure accurate measurement. This poster will compare normative data for OCR measurements using a basic clinical setup and compare these to the current literature.

References:

Otero-Millan J et al., (2017) The video ocular counter-roll (vOCR): a clinical test to detect loss of otolith-ocular function

Sadeghpour S et al., (2021) Evaluation of the Video Ocular Counter-Roll (vOCR) as a New Clinical Test of Otolith Function in Peripheral Vestibulopathy

The authors have no conflicts of interest to declare

 

18. Questionnaire screening for BPPV in adults referred to a direct referral balance clinic

Hanna Jeffery1

1Cwm Taf Morgannwg Health Board

Intro: Previous studies have shown success in screening for BPPV using subsets of questions from the Dizziness Handicap Inventory (DHI). This has potential application for time saving and for streaming patients into different pathways.

Methods: This study assessed a questionnaire comprising the 10-item short-form DHI (S-DHI) and BPPV subset questions. The questionnaire was posted to 200 participants as part of a waiting list validation letter.

Participants completed the questionnaire at home using a paper form or online. Responses were given a numerical value: No=0, Sometimes=2, Yes=4.

For participants who attended clinic, their outcome was recorded as BPPV or non-BPPV. The questionnaire results were compared between these groups.

Results: 36.4% did not respond; 25.2% completed the questionnaire on paper; 22.9% online and 15.4% requested an appointment without completing the questionnaire.

61 participants tested positive for BPPV (31 secondary to other factors). 61 tested negative for BPPV.

Responses to the BPPV subset questions were significantly different between BPPV and non-BPPV groups. Responses to the S-DHI were not significantly different. (Chi-squared goodness of fit p<0.05)

The specificity of BPPV subset questions alone in identifying BPPV was up to 90%.

Discussion: The S-DHI was useful to identify patients responding ‘yes’ to almost all questions, resulting in false positives in the BPPV subset. These patients are unlikely to be suitable for a BPPV pathway.

Various criteria of the form [BPPV subset > 12 and s-DHI < 34] were analysed. There is a trade-off between specificity and the percentage of patients potentially streamed into a BPPV pathway. Specificity up to 100% was possible, but with a reduction in the percentage streamed.

Conclusion: Combining DHI BPPV subset questions with the S-DHI provides an informative pre-screening method for direct referral balance clinics.

Refs:

Whitney, S et al. Usefulness of the Dizziness Handicap Inventory in the Screening for BPPV, Otology & Neurotology. (2005) 26; 5; 1027-1033

Chen, W et al. Validation of 5-item and 2-item questionnaires in Chinese version of Dizziness Handicap Inventory for screening objective BPPV. Neurol Sci 37, 1241–1246 (2016)

Beckerman, M.L Triage System Can Save Time, Money in Diagnosing Vestibular Disorders by asking targeted questions before a patient’s initial visit (2016) https://leader.pubs.asha.org/doi/full/10.1044/leader.AEA.21112016.14

Van Vugt, V.A et al. The 25-item Dizziness Handicap Inventory was shortened for use in general practice by 60 percent. (2020) Journal of Clinical Epidemiology, 126, 56-6

No conflicts of interest to declare.

 

19. Do hearing aid users prefer hearing aids fitted with or without real-ear measurements?

Ibrahim Almufarrij1, Prof Harvey  Dillon1,2, Prof Kevin  Munro1

1The University of Manchester, 2Macquarie University

Introduction: Hearing aids are individually prescribed according to a validated prescription method (e.g. NAL-NL2). Manufacturers’ software can approximate prescribed targets, the initial fit. The use of a real ear probe tube system can improve the match to the prescription. The accuracy of the manufacturer’s approximations has improved in recent years. Thus, this study aimed to investigate whether adults with hearing loss preferred the amplification characteristics of their hearing aids with or without real-ear measurements.

Methods: Using a prospective double-blinded, within-subject counterbalanced design study, we fitted +50 participants with two hearing aids settings, the initial fit and real ear measurements, both adjusted, based on immediate patient feedback, before use. Participants were asked to compare these two settings in various real-life environments and then indicate their preferences in a small diary.

Results: The findings of this study, to be completed ahead of the BAA conference, will help us determine:

(i)            The difference in aided responses between the initial fit and real-ear measurements.

(ii)           Whether hearing aid users prefer their hearing aids to be fitted with or without real-ear measurements.

(iii)          The reasons that influence users’ preference for one setting over another.

Discussion: If we find no difference between fitting hearing aids with or without real ear measurements, this could free up resources and simplify the way that hearing aids are fit and delivered. The results of this study have implications for the emerging category of direct-to-consumer hearing aids that do not involve real-ear measures.

No conflict of interest

 

20. Skill-mix in the aetiology pathway for children identified with permanent childhood hearing Impairment (PCHI)

Mrs  Catherine  Magee1, Mrs  Debbie Rose1

1Northern Care Alliance

Introduction

The retirement, followed by unsuccessful recruitment, of a Paediatrician with a special interest in audiology, forced the service to review the aetiology pathway for children diagnosed with PCHI.  ENT and Community paediatrics were unable to take on the role as already overwhelmed by demand.

Redesign of the pathway and skill mix was required for aetiological investigations to continue. An enhanced paediatric audiologist now leads the Aetiological Investigations clinic with remote support and referral pathways into community paediatrics as required.

Methods

Through a multi-disciplinary approach, a service redesign process was followed  using quality improvement tools and PDSA cycle.  In a department where Advanced practitioners already have strong pathways and links with ENT, it was identified that the majority of the routine level 1 aetiology investigations could be requested and held by an enhanced audiology role.  Where complex results are received, and further investigations required, a secure and timely referral pathway to a paediatrician is in place.

Results

The pilot of the pathway was very successful and has allowed a 58 week wait backlog of children (both new and review) waiting to see a paediatrician for their aetiology investigations to be completely cleared. Money has been released to employ more paediatric audiologists to support general diagnostic wait times.  CMV swabbing has been incorporated into the routine diagnostic follow up appointment for babies referred from the screen shortening the diagnosis time for children identified with congenital CMV.

Discussion

SPIN modules for doctors will hopefully increase the number of paediatricians trained in delivery of this specialist area of practice.  However, this pilot has shown that with good links it is possible to prevent any delay in the provision of the early level 1 aetiology investigations for families by incorporating the role into the audiology service.

No conflicts of interest.

21. Evaluation of North Wales Cochlear Implant Remote Check Service: Including Service User and Clinician Feedback.

Rhianwen Davies

Introduction: To evaluate the Introduction of the North Wales Cochlear Implant Remote check service and to identify any advantages, disadvantages, including clinician and service user feedback.

Methods:  Analyse the data since the role out of remote check service from September 2020 to August 2022.  The date will be collated from Cochlear Portal, auditbase and completed service user and clinician questionnaire. Questionnaire consist of 5 questions surrounding the ease of set up and use, preferred future method (remote check or face to face) and time to complete the check.

Results: Enrolment of patient: 51 patients = 12% caseload.

Early outcomes:

  • 61 remote checks completed
  • No further action: 73%
  • Clinic visit required: 10%  mainly for programming adjustments
  • ‘Other action’ required: 13%   e.g. sending links to info videos

Awaiting Questionnaire results.

Discussion: Remote check was released for clinics to use during the first year of the COVID 19 pandemic, during this time face to face service was at a reduced capacity. This was an opportunity for the north wales cochlear implant team to introduce the remote care service, the role out of the remote check was a slow processes as the service is only suitable for N7 and Kanso 2 users, these patient needed to be identified and further information to be collated such as if they had compatible phone and if they have downloaded the nucleus app. Once they were identified a note was placed on their annual review waiting list and were sent an email when they were due a face to face appointment to offer a remote check instead. This continues to be an ongoing process due to new patient being upgraded to suitable processor or patient obtaining compatible mobile phones.

The evaluation of our current service shows that 12% (51 patients) of our whole caseload have enrolled onto remote check. Of 61 remote checks completed 10% needed a face to face appointment to be arranged. We continue to believe that remote check has great benefits for our service users, but it continues to be a challenging process to engage and enrol patients. Further feedback from patient and clinician will provide additional clarity on the benefits of remote check service.

Reference:

Maruthurkkara S, Case S, Rottier R. Evaluation of Remote Check: A Clinical Tool for Asynchronous Monitoring and Triage of Cochlear Implant Recipients. Ear Hear. 2021 Jul 27. doi: 10.1097/AUD.0000000000001106. Epub ahead of print. PMID: 34320523.

22. Co-Developing a Psychological Support Package for People with Vestibular Conditions

Laura Smith1, Mr  Wesley  Pyke1, Professor  David Wilkinson1, Dr S. S Surenthiran2

1University Of Kent, 2London Neuro-Otology Centre

Background

Up to 60% of people with vestibular conditions experience psychological symptoms encompassing cognitive, mental health, and somatic problems. These can impede daily activities and clinical recovery. Psychological aspects are not routinely identified, meaning that many people with vestibular conditions do not receive support to manage these and disability accrues. There is currently no evidence-based pathway to show how to manage psychological aspects in clinical practice, owing to systemic barriers. This research programme addresses this gap by adopting a systematic approach to intervention development and involving a range of stakeholders.

Objectives

(i) To understand how psychological aspects are currently addressed by vestibular services.

(ii) To understand what stakeholders think a psychological support package should comprise, and how it should be delivered.

Methods

Study 1 involved an online survey completed by UK healthcare professionals (n=101) to establish current psychological assessment and management practices in services for people with vestibular conditions and identify any local variation. In Study 2, stakeholders (n=47) including people with vestibular conditions, family members, and healthcare professionals participated in semi-structured interviews. Interviews explored how psychological aspects are experienced, what a support package could look like according to stakeholders, and the potential barriers and enablers in delivering this.

Results

All participants showed awareness of psychological aspects of vestibular disorders. Most people with vestibular conditions reported experiencing psychological symptoms including anxiety, avoidance, frustration, isolation, and brain fog. Lack of referral pathways and limited clinical expertise were barriers to addressing psychological aspects. Our findings provided insights into the content of a psychological support package. Stakeholders thought this should be person-centred, encompassing validation, psychoeducation, and strategies to help people cope and break negative cycles.

Discussion

We have developed a multi-stakeholder, co-constructed, model for addressing psychological aspects of vestibular disorders. Our model will be further refined and evaluated in our next study.

No conflicts of interest to declare.

23. Towards a better future for deaf/hard of hearing Audiologists

Michael Lawrence1

1Specsavers

Introduction

Having a hearing loss is a major asset in being able to connect with patients. I have written about some of my experiences for The IDA Institute  and The BAA  about being a deaf audiologist. There were however barriers that my educators and I were not prepared for.  I believe these experiences are valuable in making a more accessible education for future deaf audiology students.

Method

A reflective personal account of myself and other’s experiences aims to help educators and services in supporting this growing group of deaf audiologists.

Results

Although no figures are available in the UK, 11% of 2020 graduate audiologists in America have hearing loss .

50% of deaf audiologists had doubts about becoming an audiologist because of their hearing loss . It makes one wonder how many deaf individuals did not become audiologists because of these doubts.

Deaf audiologists face a number of barriers which impact self-efficacy.3 Interactions with mentors can influence a student’s self-efficacy and potential for success; seeing other deaf audiologists succeed in becoming an audiologist despite a barrier can influence that student’s self-efficacy in a positive way.4

Discussion

I intend to form a network of deaf audiologists to offer mentoring, work with educators to ensure a more accessible education and maximise self-efficacy in future deaf audiology students.

References

1LAWRENCE, M. (2021) When the Patient becomes the Audiologist. [Online] Available from: https://idainstitute.com/what_we_do/news/detail/when_the_patient_becomes_the_audiologist/.

LAWRENCE, M. (2022) My Cochlear Implant Journey: The BAA. Available from: https://www.baaudiology.org/app/uploads/2022/04/BAA-spring-2022-Final-Web-Version.pdf.

BETHEL, M. and MORMER, E. (2020) Accessible Audiology Education: Examining Self-Disclosure and Terminology Preferences of DHoH Students. The Hearing Journal, 73 (11), pp. 18-20.

BETHEL, M.R. and MORMER, E. (2021) Accessible Audiology Education, Part 3: Impact of Hearing Loss on Motivation and Self-Efficacy of AuD Students. The Hearing Journal, 74 (1), pp. 10-11.

There are no conflicts of interest

24. Our Paediatric CROS experience in Bristol

Rachel Barsley1, Janine Matthews1

1University Hospitals Bristol and Weston NHS Foundation Trust

Introduction

In Paediatric Audiology in Bristol, we have been fitting CROS devices to children with single-sided deafness and unilateral hearing loss since 2016. We aimed to understand how many children wore their CROS, how many suspended use and why, and the influence of age on usage.

Methodology

We used Auditbase to search for all CROS devices issued since 2016. The following data were extracted from clinical records: the age at fitting; current usage; the main places of use; whether suspended use and why; age at suspension and length of use before suspension.

Results

60 children received a CROS device between the ages of 3 and 16 (53 CROS and 7 BiCROS). 56% continued use of their CROS device. 22 were primary school children with use between 2-13 hours per day; 12 were secondary school /college students with use between 0.1-4.3 hours per day. The main use of the device was for education.

Of those who suspended use, most made that choice by the first review appointment. The most common reason for suspension was the child finding no or little benefit.

Discussion

We have shown that it is possible to fit CROS devices to children from as young as 3 years old and these are acceptable and worn by approximately half of children who are eligible. Our data suggests lower adherence and use when fitted in teenage years.

We plan to investigate the extent and nature of the involvement of the Hearing Support Service with these types of hearing aid and to identify a viable outcome measure to assess benefit for these children during their review appointments.

No conflicts of interest

 

25. Experience in Audiology with using patient informed choice for MRI requests

Phil Lindsey1

1Newcastle Upon Tyne Hospitals NHS Trust

Objectives:

  • Following concerns raised by Radiology we reviewed the impact on numbers of Audiology MRI referrals from applying the NICE guideline 98, 2018
  • Conversations between ENT and Audiology colleagues led to considering that an informed choice pathway could be justified as the MRI scan is looking for a rare condition which even when found usually leads to conservative management. Also the scan can show up incidental findings e.g. age related brain changes which the patient might not necessarily want to know about.
  • We have reviewed the introduction of an informed choice pathway for involving patients in the decision about whether or not to proceed with an MRI, in cases of asymmetrical sensorineural hearing loss and for unilateral non-pulsatile tinnitus.

Methods:

  • In this presentation we share the process of how we developed patient information that would facilitate an informed choice pathway.
  • Used Excel spreadsheets to record the numbers of patients referred for MRI and those patients who were given the patient information but decided not to proceed

Results:

  • For a 3 month period (February to May 2019) the numbers of Audiology MRI referrals increased from 33 to 53 due to applying the updated NICE 2018 guidance (a 60% increase)
  • For a more recent 12 month period  (June 2021 to May 2022) 438 patients with asymmetrical SNHL were given the MRI informed choice pathway and 154 chose not to proceed with the scan (35%)
  • For a 12 month period (June 2021 to May 2022) 253 patients with unilateral non pulsatile tinnitus were given the  MRI the informed choice pathway and 90  chose not to proceed with the scan (35%)
  • Patient and Audiologist feedback on the informed choice pathway has been positive

Discussion/Conclusions:

  • Developing an informed choice pathway for Audiology MRI referrals has been a valuable piece of joint working between ENT and Audiology
  • Radiology colleagues have been very supportive and the pathway fits with their Get It Right First Time (GIRFT) national strategy
  • Significant numbers of valuable MRI slots (244 in a 12 month period) have been saved making them available for other clinical priorities

Anecdotally there is very low DNA rate for patients who have elected to have the scan following the pathway

No conflicts to declare.

27. The use of auditory evoked potentials in people with learning disabilities: A scoping review summary

Simon Howe1, Dr Lynzee McShea1

1South Tyneside & Sunderland Nhs Foundation Trust

Introduction:

Auditory evoked potential (AEP) testing is often recommended for objective assessment of hearing in people with learning disabilities unable to complete behavioural hearing assessment (Bent et al., 2019; BSA, 2021). The theoretical rationale for using AEP testing in this population is clear, however the evidence base underlying these recommendations is generally not cited. The aim of the scoping review was to assess the robustness of the evidence underlying such recommendations.

Methods:

Studies including adults and children aged 4 or over were included. Specific concepts assessed include the required frequency, feasibility, acceptability, and accuracy of performing AEP testing in this population. Four electronic scientific databases were searched using combinations of key words associated with learning disabilities and AEPs, yielding an initial sample of 1270 studies after removal of duplicates. Abstracts were screened by independent reviewers against the inclusion criteria, and relevant data extracted from those meeting the criteria. 44 papers were included in the review.

Results:

No studies specifically addressed feasibility or acceptability. However, inferences were drawn from the data by noting the reasons given for participants’ exclusion (e.g. lack of understanding, poor cooperation) and the use of sedation.

Few studies showed evidence of any reasonable adjustments to encourage and facilitate participation.

The majority of studies were published pre-2000, many with historic settings and terminology, which would now be considered inappropriate.

Data regarding the accuracy of AEPs in determination of hearing thresholds was only reported in three studies, all of which assessed people with Down’s Syndrome. There is no published data regarding the accuracy of AEPs in the hearing assessment of those with other learning disabilities.

AEP testing in those with a learning disability generally yields interpretable waveforms although there are significant differences in waveform latency related to underlying aetiology of the learning disability.

Discussion:

Although AEP testing is frequently recommended for hearing assessment of those with learning disabilities who are unable to give reliable results on behavioural testing, the evidence base underlying AEP testing in this population is limited. Further work is required to understand the feasibility, required frequency, acceptability, and accuracy of performing this testing in those with learning disabilities.

References:

Bent S, Brennan S, & McShea L (2019) Hearing impairment. In V. Prasher, & M. Janicki (Eds.), Physical health of adults with intellectual and developmental disabilities (169–185) Springer.

British Society of Audiology (2021) Audiological Assessment for Adults with Intellectual Disabilities [Online]. Available at: https://www.thebsa.org.uk/resources/ [Accessed 29/06/2022]

No conflicts of interest to declare.

28. Hearing loss and deprivation: A Welsh population study

Jack Allum1

1Swansea Bay University Health Board

INTRODUCTION: Hearing loss (HL) is common among adults in the United Kingdom (UK),¹ however, the burden of HL however is not evenly distributed, with higher rates of HL observed among the most deprived². New epidemiology research is needed to understand the hearing health needs of the present adult population particularly with respect to hearing health inequalities. In the present study NHS audiological health records were used as an efficient and cost-effective means to explore the demographics of HL in a Welsh population.

METHODS: A clinical audit of all adults (aged >18) that attended Abertawe Bro Morgannwg University (ABMU) Health Board audiology services between 2016-2018. Service access, first hearing aid fitting appointment rates and hearing loss at time of first hearing aid provision were used to index population hearing loss versus area-level indices of deprivation based on patient post code. Patient entries were grouped by age (18-30, 31-40, 41-50, 51-60, 61-70, 71-80, >80) and deprivation decile.

RESULTS: 59,493 patient entries met the criteria for audit. ABMU audiology services were accessed around 50% more frequently by the most deprived versus the least deprived decile in every age group. First hearing aid fitting rates were highest among the most deprived in the four youngest age groups. Severity of hearing loss at the time of first hearing aid fitting was worse among the most deprived in the five oldest age groups.

CONCLUSIONS: Our findings suggest that deprivation increases the likelihood of developing hearing loss, brings earlier onset of hearing loss, and is linked delays to getting help for hearing problems.

References

  1. RNID [Internet]. Facts and figures. Available from: https://rnid.org.uk/about-us/research-and-policy/facts-and-figures/
  2. Scholes S, Biddulph J, Davis A, Mindell JS. Socioeconomic differences in hearing among middle-aged and older adults: cross-sectional analyses using the health survey for England. BMJ open. 2018 Feb 1;8(2):e019615.

No conflicts of interest to declare.

 

29. A pilot study exploring clinician’s decisions to implement video consultations for vestibular rehabilitation.

Harriet Withey1, Dr Amanda Hall2

1University Hospital Southampton NHS Foundation Trust, 2Aston University

Background: COVID-19 greatly increased the uptake of video consultations across healthcare, however, use in vestibular rehabilitation (VR) remains sporadic. Research exploring video VR and wider telerehabilitation indicates a positive perception of remote care but difficulties and reluctance to implement in practice. Studies have yet to identify the factors which influence this disparity between perception and decisions to implement video consultations specifically in VR.

Objectives: Understand the process of decision-making regarding implementation of video consultations for vestibular rehabilitation and the factors that influence this decision. Assess the feasibility of described methods to gather data in answer to these objectives.

Design: 11 UK audiologists and physiotherapists working in VR were interviewed about their experiences of deciding to implement video conferencing for VR. Interviews were transcribed verbatim and analysed using Grounded Theory methods.

Findings: The decision to implement video VR is a cyclical process which occurred in the context of the changing COVID-19 pandemic. Clinicians came to a decision by weighing up the value of video VR to them, in view of its positive and negative impacts. They used strategies to reduce the negative impacts and sought information from various sources to help them to implement. Certain requirements or a lack of involvement in decision making could override personal decisions to implement. Finally, clinicians’ experience of decision outcomes fed back into their value judgements for future decisions.

Discussion: This study proposes a novel theory as to how clinicians decide whether to implement and use video VR, which provides recommendations on how to support future implementation projects.

No conflicts of interest to declare.

30. Investigating the use of a GN Multi Microphone within a classroom setting and daily life for children with longstanding hearing loss

Areesa Javed1

1Hillingdon Hospital Trust

In the United Kingdom, assistive listening devices are widely used in schools for children with hearing loss. FM (frequency modulation) consists of a transmitter and a receiver and uses radio waves to transmit audio signals to the listener.  The GN Multi Mic is a wireless streamer that can stream speech and audio directly to a GN compatible hearing aid(s). The objective of this investigation is as follows:

To evaluate patient experience of the GN Multi Mic in a classroom setting as well as within an extra curricular setting

To evaluate patient experience of the GN Multi Mic in a home setting

To evaluate the use of the GN Multi Mic in daily living

METHOD

Initial fitting, All fitted with Ambio aids and paired with Multi Mic

6-week review, Fine tuning and adjustments completed

Further 6 week review, Postponed due to COVID lockdowns (telephone consultation completed)

Final 6-month review – After COVID lockdown

Results

All participants used the devices during lessons & while at home. Two eldest participants connected the Multi Mic to telephones, laptops and PlayStation to maximise listening in all situations. Two participants gave positive feedback on the Multi Mics during COVID lockdown, took full ownership of unpairing/pairing when teachers did not mute. Challenges of device control could be overcome with further training and support for school teachers and hearing impairment specialist teachers. Conference mode did not prove to be beneficial in this review and  did not result in reduced use in class from the older participants. Decreased usage was only observed due to COVID lockdowns for all participants. All participants reported the sound of the Multi Mic to be clear and comfortable.

Conclusion: Multi Mic can be a functional and portable streaming device which is appropriate for a school setting.  We noted support and training for all involved would be required to ensure successful use.

Research study funded by GN Hearing UK Ltd.

Consent obtained from parents and all participants given to option to opt out at any point.

Participants were longstanding hearing aid users and patients from the Children’s Hearing Centre at the Hillingdon Hospital Trust.

 

31. Hearing Assessment as part of a Memory Assessment Service Pathway

Susannah Goggins1, Jane Wild1, Heidi Turner1

1Betsi Cadwaladr University Health Board

Introduction

The link between hearing loss and dementia is gaining increased recognition globally.  There is a gathering body of work highlighting the importance of identification and intervention of hearing loss for dementia patients (Lancet report, 2017 and 2020, NICE Guidelines NG98).

This evidence has resulted in the development of guidance and policy supporting the early assessment of hearing loss for people with or suspected to have dementia.

In North Wales (BCUHB) a pilot project was launched (funded by Integrated Care Fund) with the purpose of identifying hearing impairment in those people with suspected dementia.

Methods

The project ran in Gwynedd and Anglesey areas of North Wales.  Audiology worked closely with Memory Assessment Services (MAS) and all patients starting on pathways for suspected Dementia were referred for hearing assessment.

Funding enabled recruitment of a band 3 part-time post to carry out screening hearing assessments, following an agreed protocol.  This included brief history, otoscopy, adapted hearing assessment (adapted responses if required, reduced test frequencies), and providing guidance and written information on outcomes.

Patients identified as having hearing loss, reporting difficulties or unable to test were referred to Audiology for hearing loss pathway appointments.

Results

Results of the project will be shared from April 21 to April 22 including:

– Number of referrals received

– Those self-reporting hearing loss and those identified with hearing loss on testing

– Details of onward referrals and further outcomes

Discussion

The pilot demonstrated the value of hearing screening for patients on the MAS pathway, rather than relying on self-reported hearing loss.  Approval and funding has been granted to roll out this pathway across all areas of North Wales.

References

Lancet Commission report “Dementia prevention, intervention, and care” (Livingston et al., 2017 and 2020).

NICE Guidelines, Hearing loss in adults: assessment and management, NG98, 2018.

No conflicts to declare.

32. Adoption and patient experience of remote hearing care in a large NHS service.

Lauren Archer1

1Royal Berkshire NHS Foundation Trust

Introduction

The Royal Berkshire Hospital was amongst the first NHS departments to offer remote care for patients. We conducted extensive data collection assessing patient interest in remote hearing care before it was available and following its adoption.  The intent of this poster is to share the data reflecting how our patients are using the app and its impact.

Methods

Preliminary work included a service evaluation of our drop-in repairs clinic, questionnaires and a remote hearing care trial.

Since introducing Ambio hearing aids, we have monitored the response to this technology by completing spot-checks of remote assistance requests, questionnaires (for patients using the BeMore app and those who have used remote assistance) and our Satisfaction Questionnaire which is sent to all adult patients fitted with hearing aids.

-Results

The preliminary work, conducted prior to the covid-19 pandemic, indicated that patients of all ages are motivated to adopt the app and remote hearing care technology. A service evaluation of our repair clinic suggested that up to 25% of patients who attended repairs within four months of their fitting appointment were good candidates for remote support.

Consistent with previous findings, current data indicates that 40% of our patients use the BeMore app. Of those using the app, 97% find it useful and 78% feel it reduces their need to attend the department. Furthermore, 55% report daily use and 33% are using it weekly. Further data on patients and clinicians experience with both the App and remote assist will be presented.

Discussion

Data collected within the department and from patients using the app is overwhelmingly positive. As with any elective and optional online service, some patients may be more interested in participating than others.  The app provides an additional pathway for patients to contact the department as well as synchronous and asynchronous remote care.

No conflicts of interest

 

34. Deaf Awareness, Accessibility and Communication in the NHS: How can we do better?

Bhavisha Parmar1,5, Shahad Howe4,5, Emma Stapleton7, Helen  Henshaw3,5, Sarah Hughes9,5, Zara Musker, Crystal Rolfe6,5, Angie Platt8, Ann-Marie Dickinson5,10, Philip La Mere, Laura Turton2,5

1Sound Lab, Department of Clinical Neurosciences, University of Cambridge, 2NHS Tayside, 3University of Nottingham, 4Advanced Bionics, 5British Society of Audiology, 6Royal National Institute of Deaf People, 7Central Manchester University Hospitals NHS Foundation Trust, 8Hearing Dogs for Deaf People, 9Centre for Patient Reported Outcome Research, University of Birmingham, 10Manchester Foundation Trust

Introduction: Barriers to communication in health services, such as a lack of BSL interpreters, and difficulty with access (e.g., telephone-only), mean that people with deafness/hearing loss are less likely to seek healthcare, have poorer access to adequate health information when they do seek healthcare, and consequently experience adverse health outcomes. It is important to understand and improve communication and deaf awareness in the NHS.

Methods: A cross-sectional survey study focussing on NHS service users’ experiences of communication and accessibility in healthcare, using both rating scales and open questions to elicit data on communication barriers faced in NHS settings, and any effect on psychological wellbeing. Inductive thematic analysis was used to identify themes in the open questions and descriptive statistics were used to present the rating scales.

Results: Respondents included people with hearing loss (n= 507), and parents/caregivers of people with hearing loss (n=45).  Results found that 50% of respondents felt dissatisfied with current NHS staff communication skills and 73% felt dissatisfied with waiting room alert systems. Over 65% of respondents felt they had understood only around half of the important information received during NHS appointments, because their communication needs had not been met. Respondents were also asked about their specific communication experiences in audiology and ENT services. Overall, 20% and 25% of respondents reported their communication experiences in each service, respectively, were not effective at all.

Conclusion: This study presents the largest cross-sectional dataset of its kind and highlights diverse communication barriers faced by NHS patients with deafness/hearing loss accessing health services. Understanding service user perspectives can inform the future adaptation and improvement of health services and service delivery. Further work using this dataset will create a list of core recommendations to help improve both deaf awareness and effective communication for people with deafness/hearing loss within the NHS.

No conflicts of interest

 

35. HAs in the CI department - The smart alliance?

Amanda Speers1, Nicola Willmott1, Stephanie Corkill1

1Auditory Implant Centre , Belfast Health and Social Care Trust

Aim

  • To fit patients bimodally in an Auditory Implant Centre with the Smart Hearing Alliance.
  • To gain initial feedback of clinicians experience of fitting HA’s in an Auditory Implant Centre.
  • To evaluate the patient’s everyday reflections with a new bimodal solution, compared to that of their previous solution, and assess their experience of Bluetooth streaming.

Method

Recipients of Cochlear Nucleus ®  7 sound processor with usable contralateral hearing were offered the opportunity to exchange their current hearing aid for GN ReSound Ambio Smart hearing aid.  Audiologists followed the bimodal fitting flow for Cochlear sound processors and ReSound hearing aids. Devices were paired via Bluetooth to the patients mobile devices for streaming.  Over a 10 day test period patients used an ecological momentary assessment (EMA) tool installed as a RealLife EXP application on  patients smartphones. Patients responded to an evening survey asking them to reflect upon their hearing experiences that day and more specifically, how they felt about their new bimodal hearing solution compared to their previous bimodal solution when streaming.  Audiologists recorded their clinical experiences after each fitting and consolidated their findings at the end of the trial.

Results

9 patients participated in the study.  3 cochlear implant audiologists participated in  patient fittings.   All audiologists reported the fitting and pairing of the CI and HA to be straightforward.  All patients appreciated having their hearing aid and CI fitted in the same clinical location.

Conclusion

The staff at the Auditory Implant Centre were able to successfully fit patients bimodally.  Our local audiology departments have requested that we continue to provide this service.  We will use the results of the EMA outcomes to identify who would best benefit from this additional service and also to counsel patients further on use and expectations.

this study was supported by GN Hearing and Cochlear Europe Ltd

36. Implementing Medical Devices Training and Monitoring in an NHS Audiology Service.

Sueann Meyer1

1BCUHB

Introduction: Standard 2.9 of the Health and Care Standards for Wales (2015) states that “all health service settings should have an on-going program of medical device competency training” and to that end the North Wales Audiology Service set out to standardize and formalise their Medical Devices Training Policy across all sites.

Methods: Betsi Cadwaladr UHB policies on medical devices management and training were consulted and input was obtained from the authors of those policies to help guide service specific Standard Operating Procedure (SOP).  A list of all equipment was compiled, each device was risk assessed and training requirement for each device was outlined.  All manuals were also made available electronically.

Results: The North Wales Audiology Service Medical Devices Training SOP, supporting documentation and training package were created and rolled out in July 2022.  The poster will share the process and tools required to embed a consistent system for ensuring safe and effective implementation of medical devices within an Audiology service.

Discussion – The new SOP ensures that all staff are aware of their obligations to maintain their knowledge and skill on all medical devices pertinent to their practice and a robust system for facilitating this and monitoring compliance are now in place.

References:

NHS Wales (2015) Health and Care Standards. Available at: Health standards framework english (gov.wales)

No conflicts of interest

 

37. Estimates of interaural attenuation in children and the implications for masking in clinical audiometry

Jackie Young1, Abby Milchard1

1Royal South Hants Hospital

Objective: To provide clinician estimates of interaural attenuation in children, under clinical test conditions, for supra-aural and insert earphones.

Design: A retrospective review of clinical audiograms for children aged 8 months to 16 years.

Study sample: There were between 2 and 22 subjects depending on the transducer and stimulus frequency.

Results:  The IA values for older children were similar to published adult IA data. There was no significant effect of stimulus frequency on the children’s IA for either transducer type. There was no significant effect of age on the children’s IA for supra-aural earphones. However, younger age groups had smaller IA estimates compared to older children when insert earphones were used, possibly due to differences in foam tip insertion depth that may occur with smaller ears and less co-operative subjects.

Conclusions: Under the clinical conditions of this study, cross hearing in children should be suspected when the difference between the better ear and poorer ear not-masked air conduction thresholds are ≥40 dB for supra-aural headphones and ≥ 40 dB for inserts with foam tips.

No conflicts of interest

38. An Exploratory Study Identifying a Possible Response Shift Phenomena of the Glasgow Hearing Aid Benefit Profile

Jonathan Arthur1,2, Dr  Tessa  Watts2,3

1Cwm Taf Morgannwg University Healthboard, 2Swansea University, 3Cardiff University

Objectives

A then-test technique was used to investigate the possibility of a response shift in the Glasgow hearing aid benefit profile (GHABP).

Methods

Following completion of part 1 of the GHABP, 16 adults were invited for hearing-aid follow up appointments. In accordance with then-test technique, participants were asked to think back to before they had their hearing-aids fitted and the GHABP part 1 was completed again to re-establish the disability and handicap scores. These scores were then compared with the initial GHABP part I scores. Paired T testing and Wilcoxon Rank tests were carried out to investigate the statistical significance of the response shift effect.

Results

Statistically significant differences were seen between initial and retrospective GHABP (disability) scores using t test. No significant differences could be seen between the initial and retrospective handicap scores.

Discussion

Results suggest participants may have demonstrated a possible response shift phenomenon with the disability construct of the GHABP questionnaire, related to a possible re-calibration effect or a denial of disability effect.

Conclusion

This exploratory study suggests that the GHABP questionnaire may be subject to a response shift phenomena. We suggest that further more robust studies are completed to verify this and recommend that this could have psychological impact on participants when explaining the results of the outcome measure and may affect hearing aid use. There is also potential for this phenomenon to affect global GHABP scores specifically when demonstrating to stakeholders the overall success of an audiology service.

No conflicts of interest to declare.

39. Endolymphatic hydrops in children

Mr Mohamed Ahmed1, Edilia Cassandra1, Mrs Emiliana Jesus1, Mr Sunil Sharma1, Professor  Soumit  Dasgupta1

1Alder Hey Children’s Hospital

Introduction

Idiopathic Meniere’s disease (MD) in adults presents with episodic vertigo, uni/bilateral fluctuating sensorineural hearing loss/aural fullness and tinnitus. The Barany criteria defines definite/probable MD.  MD is attributed to an accumulation of endolymph in the inner ear membranous labyrinth (endolymphatic hydrops ELH). ELH in children is rare.  Diagnosis in children depends on a robust medical algorithm for best outcomes.

Methods

ELH in children in Alder Hey Hospitals was identified by the Barany criteria. They all underwent rigorous audiovestibular quantification that included peripheral audiovestibular tests including videonysatgmography, vestibular evoked myogenic potentials, video head impulse and suppression head impulse tests. In addition, they underwent a full aetiological process to exclude other audiovestibular causes that included blood tests and imaging.

Results

Out of 580 children seen in Alder Hey paediatric vestibular clinic between June 2018 and December 2019, only 0.7% fulfilled Barany criteria for definite or probable ELH.  2 had systemic autoimmune disease, 1 had cranial autoimmune disease and 1 had vestibular migraine. 3 had sensorineural hearing losses with 1 bilateral and all had balance symptoms/ abnormal vestibular function tests. They showed good symptom control with medical management/vestibular rehabilitation/cognitive therapy and are monitored.

Discussion

ELH is rare in children and is usually due to a secondary cause. In our cohort the observed systemic/cranial autoimmune disease as well as vestibular migraine are recognised associations of ELH. The condition can be reliably identified with a rigorous paediatric diagnostic algorithm that must include the vestibular system. Holistic management with pharmacological/vestibular rehabilitation/cognitive intervention leads to excellent prognosis. This is the first study investigating secondary causes of paediatric ELH in detail.

References

  1. Wang C et al. Pediatric Meniere’s disease. Int J Pediatr Otorhinolaryngol. 2018; 105:16-19
  2. Hausler R et al, Ménière’s disease in children. American Journal of Otolaryngology. 1987; 8:187-193

The authors declare no conflict of interest

 

40. The experience of tinnitus in adults who are Deaf or have severe-profound hearing loss in Saudi Arabia

Lama Alzahrani1,2, Dr Derek Hoare1, Dr Magdalena Sereda1, Dr Rebecca Dewey1

1University of Nottingham, 2King Abdulaziz University

Overview: Tinnitus is a common complaint among those with hearing loss (2). However, little research involves tinnitus in participants who are Deaf or have severe-profound hearing loss. There are no validated tinnitus questionnaires or clinical guidelines for tinnitus in this population. Reportedly, congenitally deaf people rarely complain of tinnitus due to lack of prior auditory experience (1).

The aim of this project was to examine the experience of tinnitus in deaf adults, their main complaints, how it impacts them, and what they want from healthcare providers.

Methods: A mixed method approach (concurrent design) was used. Participants completed the Tinnitus Handicap Inventory (THI), Depression, Stress and Anxiety Distress (DASS), and a semi structured interview about the experience of tinnitus (with sign-language interpretation where needed).

Results:  Thirteen participants (age range: 23-60 years; mean 41.5 years) were included. Twelve participants were prelingually deaf since birth or early childhood and one post-lingually. Eight participants wore hearing aids and five used no listening devices. THI scores showed eight had slight tinnitus, three had mild tinnitus, and one had moderate-severe tinnitus. DASS scores showed one participant to have moderate depression and one mild depression, with the remaining eleven in the normal range; two participants had moderate anxiety and the rest had no measurable anxiety; finally, two participants had mild stress and the rest had no measurable stress.

Major themes emerging were Early tinnitus onset, Tinnitus impact, Management, self-management, and Discriminating tinnitus from other sounds. Six participants never sought medical treatment for their tinnitus whereas five participants had. One participant avoided asking for help whereas one participant usually wore his hearing aid during tinnitus.

Conclusion: Tinnitus affects deaf and severe-profound hearing-impaired adults similarly to hearing adults. However, specific challenges include discriminating tinnitus sounds from external sounds and communicating their tinnitus to healthcare providers when seeking medical advice.

The author Lama Alzahrani has no conflict of interest and she is funded by King Abdulaziz University (KAU), Jeddah, Kingdom of Saudi Arabia.

Derek Hoare and Magdalena Sereda are funded through the National Institute for Health and Care Research (NIHR) Biomedical Research Centre programme.  The views expressed are those of the authors and not necessarily those of the NIHR, the NHS, the Department of Health, and Social Care. Rebecca Susan Dewey is funded by Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, United Kingdom.

41. What can my hearing aids do?

Louise Wakley1, Heather Dowber1, Laura Finegold1

1Gn Hearing North West Europe

Introduction

With the aim of understanding how patients felt about Remote Care, we placed a survey on our Danalogic website for patients to complete. We also asked some questions about what you would like to see in hearing aids in the future.

The survey was completed by 710.

Conversations were held with contributors who had expressed an interest in a more detailed discussion.

Methods

We contacted those who were happy to have a more detailed discussion. There was no specific structure to the call, and we let the conversation flow naturally from the patient to us. However, we did refer to the responses the patient had given in the online survey to help guide us with talking points. We also asked patients the question “If you could improve anything about your hearing aid, what would it be?”

Results

We noticed a pattern where the patient would make a comment on a feature they wished their hearing aid would have – but this feature actually already existed (e.g. streaming, accessories etc). It seemed that patients were not aware of all features and functionalities available to them.

Discussion

This lack of awareness of the hearing aid features could be due to many reasons such as:

  • Not being informed (due to time constraints, or lack of confidence/knowledge)
  • Being informed, but forgetting about it (lots of information to take in at once during an appointment)
  • Quality of Information supplied

To address this gap, we would next need to explore the reasons behind it and as a manufacturer looking at how we can support with this. It raises many questions – do the audiologists require more training? Do we need to produce more patient-friendly literature explaining some of these features? What barriers exist which prevent this information from being shared/retained?

GN project funded by GN

 

42. A Novel Tool for Cerumen Removal: the EarWay Pro – Results of Clinical Assessments by Audiologists

Eyal Yosefof1, Doctor of Audiology Alicia  Spoor, Doctor of Audiology Christiane  Basilio, Doctor of Audiology Stephen  Griffiths, Christopher Cartwright, Dr. Ohad Hilly

1Rabin Medical Center, 2Designer Audiology, LLC, 3Connect Hearing, 4ManxCare, 5The Audiology Academy

Objective: Cerumen impaction is a very common medical condition, considered the number one cause of treatable hearing loss worldwide. Impacted cerumen can cause hearing loss, pain, tinnitus and sensation of fullness, and prevent accurate audiological assessment. As efficient removal of cerumen is usually performed by an otorhinolaryngology specialist, its high prevalence results in an economic burden on health care systems. Furthermore, waiting time for referral to a specialist can be as long as few months, resulting in significant delay in completion of audiological assessment. The EarWay Pro is designed to facilitate safe and effective cerumen removal by audiologists, general practitioners and E.N.T physicians without using the microscope. Potentially, it can reduce referrals, costs and waiting time for cerumen removal. Our goal was to present data from 8 pilot assessments, and to evaluate the safety, efficacy and efficiency of the EarWay Pro device.

Methods: Data was collected from pilot clinical assessments performed in 8 organizations. Participants were all professional audiologists. After each procedure, participants graded success and safety according to their ability to complete audiological assessment with minimal side effects. Interviews were also held with 5 experienced users, each with more than a decade of experience in cerumen management.

Results: The procedure success rate was approximately 70% among non-experienced users, while experienced users reported over 80% success. Safety was appreciated as 8.5/10 by non experienced user, although in only 1.2% of cases complications occurred, and all of them were minor.

Discussion: The EarWay Pro device presents a safe, effective and efficient method for cerumen removal by healthcare professionals. The high success rate and safety of this device make it very useful, enabling the removal cerumen prior to audiologist evaluation without the need for referral to an E.N.T specialist, and thus significantly shortening waiting time and dropout rate of patients.

O.H. acts as a medical scientific advisor for EARWAYS MEDICAL LTD.

 

43. An Audit of the incidence of vascular loops seen on MRI scans in an Audiology led screening service for vestibular schwannomas

Jonathan Arthur1,2

1Cwm Taf Morgannwg University Healthboard, 2Swansea University

Objectives

Vascular loops are often observed as incidental findings when screening for vestibular schwannomas. Currently, magnetic resonance imaging (MRI) of the internal auditory meatii (IAM) is currently managed within Audiology in areas of our health board, specifically for direct access and existing patient pathways. This audit examines associations between tinnitus, balance and hearing status with the presence of vascular loops.

Methods

A prospective audit was completed of all radiology reports received over a period of time. Ninety-nine patient reports were examined after referral was made to radiology from audiology. Data collected were age, the reason for the initial MRI referral (i.e. asymmetrical hearing loss or unilateral tinnitus for example), evidence of any hearing loss, balance problems and the nature of any tinnitus reported. The radiology reports were received from various radiologists employed within our Healthboard.

Results

Fourteen patients (14%) were reported as having an incidental vascular loop. These were either unilateral or bilateral. The association with hearing loss, balance problems and tinnitus were also explored.

Discussion

In the data observed, there were mixed and variable associations between the presence of vascular loops and hearing loss, balance problems and any reported tinnitus. Confounding factors may relate to the way that Radiologists report MRI (IAM). For example, non-significant incidental findings may not be reported by some radiologists, and there did not appear to be a standard way of reporting results.

Conclusions

Fourteen percent of patients had evidence of vascular loops, as seen by Radiologist reports after screening for vestibular schwannoma. There were mixed associations. Future audits or research should employ larger data sets to increase the potential power of the exploration. Standard radiology reporting mechanisms may help to provide a consistent approach for reporting scans.

No conflicts of interest

44. Prudent Health Care in practice: Integration of Audiology services into Primary Care

Jack Allum1, Mr Timothy Loescher1, Ms Nicola Phillips1

1Swansea Bay University Health Board

INTRODUCTION: Swansea Bay University Health Board (SB UHB) has been trialling a Primary Care Audiology pathway since 2016. The pathway enables patients with hearing, tinnitus or wax problems to be triaged directly to the Audiology department acting as the first point of contact, freeing up GPs, ENT consultants and nurses to see patients with more complex health conditions.

METHODS: An audit of clinical outcomes was completed to evaluate the efficiency of the SB UHB Primary Care Audiology pathway.

RESULTS: The vast majority of patients seen through the SB UHB Primary Care Audiology pathway are managed without the need for onward referral (>87%).

DISCUSSION: The Swansea Bay PC Audiology pathway has been shown to reduce demand on GPs, practice nurses and ENT consultants; not only saving clinical and patient time, but reducing the patient pathway by up to 6 months in some cases.

No conflicts to declare

45. Long-Term Speech Perception Stability in Adults with Cochlear Implants - The Relationship Between Stability, Age at Implantation, and Duration of Profound Hearing Loss

Maeve Dennehy1, Mrs Linor Jones1

1NHS – Betsi Cadwaladr University Health Board

Introduction

This retrospective study aimed to better understand long-term performance on speech perception tests in adult cochlear implant (CI) users and explore whether age at implantation, or years of profound hearing loss (HL) pre-implantation, affected the stability of scores.

Methods

Speech perception in quiet data were collected from 158 adult CI users over 18 years. Exclusion criteria included <18 years old at implantation, congenital HL, revision surgery, missing data at the 1-, 5-, or 10-year follow-up, and changing CI configuration.  Speech perception stability was measured as the difference between the 1- and 5- or 10-year scores on the Arthur Boothroyd (AB) word test and Bamford-Kowal-Bench (BKB) sentence test. Kendall’s tau-b correlation was performed to investigate whether a correlation existed between change in speech scores and age at implantation, or duration of profound HL.

Results

AB word, phoneme, and BKB sentence scores remained stable over 5 years (n=10, 10, and 17, respectively), with a slight deterioration in BKB scores over 10 years (n=8). The mean change was 5.8% on AB words, 8.2% on AB phonemes, 2.7% on BKB sentences over 5 years, and -6.5% over 10 years. No statistically significant correlation was found between age at implantation and change in AB word, AB phonemes, or BKB scores over 5y. No statistically significant correlation was found between duration of profound HL and change in AB word, AB phoneme, or BKB scores over 5y.

Discussion

Patients can expect to receive good benefit from their CI over 5y, similar to the findings of multiple studies. This small dataset suggests that no relationship exists between changes in AB word, phoneme, or BKB sentence scores and age at implantation or duration of profound HL. However, this study was limited by missing data at follow-up appointments and the lack of variability in duration of profound HL.

No conflicts of interest

 

46. Embedding Quality Assurance as Routine Practice; Moving On from IQIPS Accreditation

Ruth Vickerstaff1, Kirsten Mills1, Keiran Joseph1, Kerri Farah1

1Guy’s And St Thomas’ NHS Trust

Introduction

The British Academy of Audiology were invited to review the Lothian Paediatric Audiology service following a number of failures and found that “the root cause of these failures is identified as a lack of scientific leadership, knowledge, reflection and enquiring in the presence of a lack of routine and robust quality assurance processes”. The presence of routine and robust quality assurance is essential for every Audiology service. It is the systematic efforts to ensure that the work conducted by an Audiology service meets defined quality standards. The United Kingdom Accreditation Service (UKAS) runs the quality assurance assessment and accreditation scheme ‘Improving Quality in Physiological Services’ (IQIPS).

NHS England and the Care Quality Commission (CQC) strongly support IQIPSv2 and its aims to improve the quality of service, care and safety for patients attending Audiology services, however participation in this scheme is not mandated and not all services in the UK are accredited. The Paediatric Audiology Service (PAS) at St Thomas’ Hospital in London achieved IQIPS accreditation in 2018 and in 2022 the PAS were accredited to IQIPSv2, the second iteration of the standards.

In this presentation I will set out how the service has implemented the process of IQIPS accreditation into a continuous service Quality Assurance Programme.

Methods

This will be a review of the processes the service has implemented to attain IQIPS accreditation and then embed into quality assurance as business as usual in the service.

Results

We will set out the benefits that embedding quality assurance has brought to the service and outline the challenges faced and how these were overcome.

Discussion

Participation in IQIPS has improved the quality of the PAS. Further embedding this work into routine and continuous quality assurance has made the service reactive to challenges and therefore improved outcomes for our patients and staff.

No conflicts of interest

47. Outcomes of a fully-remote clinical pathway adapted for NHS

Thomas Crame2, Kevin  Munro1, Gabrielle Saunders1

1University of Manchester, 2Manchester University NHS Foundation Trust, Withington Community Hospital,

Introduction.

Most remote care pathways require some face-to-face contact, however Lively Hearing Corporation, USA, has developed an audiologist-supported hearing care pathway in which every step, from ear disease assessment to hearing aid support, is conducted remotely. This study investigated the feasibility of implementing this pathway in and NHS department.

Methods.

Patients referred to an audiology department over a 4-month period were invited to receive hearing care via the fully remote pathway which consisted of:

  • Online completion of a hearing assessment and the 15-item Consumer Ear Disease Risk Assessment (CEDRA; Klyn et al., 2019)
  • Receipt by mail of a pair of programmed hearing aids
  • Video calls with a technician and an audiologist during which

o           Fitting apps were downloaded

o           Hearing aids were fitted and adjusted

o           Support was provided

o           COSI outcome was assessed at 2- and 4-weeks post-fitting

In addition, standard audiometry was completed, and hearing aid output was measured for aids programmed using both sets of hearing thresholds.

Results.

Of 267 individuals sent invites, 16 agreed to the remote pathway. Six were ineligible based on the CEDRA, three were ineligible based on hearing sensitivity, thus 7 individuals were fitted with hearing aids. However, one encountered technical difficulties and reverted to a face-to-face pathway. Those who completed the remote pathway were generally satisfied with their hearing aids.

On average, online and standard audiometric thresholds differed by ~10dB, however there was considerable variation across participants and test frequency. Similar results were found for hearing aid outputs relative to NAL-NL2 targets.

Discussion.

There was low uptake of the fully remote pathway but satisfaction with the pathway was similar to that for face-to-face care. Online hearing test results were surprisingly close to those obtained through standard audiometry, as were hearing aid outputs for both sets of thresholds.

The hearing aids for this work were provided free of charge by GN ReSound.  Lively Hearing Corporation provided access to their online hearing test and additional support

48. Click vs CE-Chirp ABR in relation to pure tone thresholds in Adults with Normal Hearing and Sensorineural Hearing Loss

Hedayat Elfouly1, Associate professor  Mona  Hamdy1, Dr Emad Helmy1

1Faculty Of Medicine, Cairo University

Background: ABR represent the primary tool for both identification and diagnosis of hearing loss.

Click-ABR is the most popular and widely used method for ABR recordings.

Claus Elberling and his collaborators created the CE-Chirp stimulus to compensate for temporal dispersion in the cochlea due to travelling wave delay by aligning the arrival time of each frequency component in the stimulus to its place of maximum excitation along the basilar membrane.

Objective: To correlate thresholds obtained by click and CE-Chirp with the behavioral thresholds in normal hearing subjects and   patients with moderate sensorineural hearing loss.

Subjects and methods: This study consisted of 40 patients (80 ears) .The control group consists of 20 normal –hearing adults. The study group consists of 20 adults (13 males and 7 females) with moderate Sensorineural Hearing Loss. All subjects were submitted to full history taking, otologic Examination, Audiometric assessment (pure tone audiometry, Immittancemetry, Auditory Brain Stem response).

Results:  In our study, procedural time of CE-Chirp ABR test was shorter than that of Click ABR test. The analysis of wave V latency in the control group with both click and CE-Chirp stimuli at intensity levels of 90 dBnHL and threshold level revealed a highly statistically significant shorter wave V latency caused by CE-Chirp stimuli compared to click stimuli.

CE-Chirp ABR threshold values were closer to PTA 1, 2 KHz threshold values, whereas Click ABR threshold values were closer to 4 KHz behavioural threshold values.

Conclusions: When evaluating patients with bilateral sensorineural hearing loss, we recorded CE-Chirp ABR method was superior to the Click ABR method. In normal hearing patients, CE-Chirp elicited larger responses than click stimuli at (90dB nHL) and at thresholds. At threshold, however, there was no difference between the two stimuli in the SNHL group.

Key words: ABR, Click, CE-Chirp, SNHL, Latency, Amplitude, Normal Hearing.

No conflict of interest

 

49. Audiological Profile of Recovered SARS-COV-2 Patients

Hedayat Elfouly1, Dr  Mariam  Magdy1, Dr Abdul Rahman Nabil1

1Faculty Of Medicine, Cairo University

Background: Coronaviruses are large enveloped RNA viruses that cause mild respiratory diseases in animals and humans. In December 2019, several pneumonia cases with an unidentified etiology were reported in Wuhan, China. A novel coronavirus was identified on 6 January 2020 as the cause of these cases and named Coronavirus Disease 2019 [COVID-19]. On 30 January 2020, WHO declared the novel coronavirus as an outbreak. Several studies reported auditory symptoms and affection of hearing assessment tests as PTA and OAEs.

Objective: To assess hearing in recovered SARS-COV-2 patients using PTA, TEOAEs and ETF. Also, to correlate between the complaint of the patient, the disease severity and hearing affection.

Methods: A case control study, each of cases and controls group comprised 58 subjects age and sex matched with age ranged between 18 to 50 years. Hearing was assessed in both groups using extended PTA, TEOAEs, immittancemetry and ETF test.

Results: PTA showed a statistical significant difference between cases and controls in right ear thresholds at 250 Hz, 500 Hz, 4 KHZ, and 8 KHz and in left ear thresholds at 250 Hz, 4 KHZ, 8 KHz and 12.5 KHz. Also, a statistical significant difference was found between cases and controls regarding TEOAEs overall reproducibility and amplitude (SNR). There is a relation between patient’s complaint of hearing loss and PTA affection and between patient’s complaint of tinnitus and OAE affection. Furthermore, there is a relation between patient’s complaint of fullness and ETF affection. Correlation between PTA thresholds affection and COVID 19 disease severity showed a statistical significant difference in both ears.

Conclusions: COVID 19 has unfavourable effect on hearing either in symptomatic or asymptomatic patients.

Key words: Coronaviruses – COVID-19 – Hearing loss – Tinnitus – Fullness – PTA – TEOAEs – EFT.

No conflict of interest

50. Assessment of the vertical semi-circular canals using vHIT: preservation of anterior canal function in patients with severe to profound hearing losses.

David Jay1, Mr Sam Ranger1, Ms Rosie Adams1, Ms Amy Nelson1, Mr Jonathan Elilnesan1

1Manchester University NHS Foundation Trust

Introduction

Objective assessment of the vertical semi-circular canals can only be performed using Video Head Impulse Testing (vHIT). Patterns of vertical canal dysfunction are presented here in patients with severe to profound hearing loss. A summary of technical difficulties and practical tips are also discussed in relation to the challenging element of vertical canal artefact identification.

Methods

75 patients with bilateral severe to profound hearing loss underwent vHIT as part of routine workup for Cochlear Implant surgery. 61 patients had all six semi-circular canals tested. The aetiology of hearing loss was variable, though the majority were defined as idiopathic progressive losses.

Results

vHIT demonstrated normal vestibular function in 35% of patients, unilateral weakness in 21%, bilateral weakness in 28% and complete bilateral vestibular hypofunction (BVH) in 13%. There were significant numbers of patients with bilateral or unilateral weakness of the lateral and/or posterior canals only, with sparing of the anterior canals. Anterior canal weakness was almost only found in patients with BVH.

Discussion

These results build on previous work that describes sparing of the anterior canals in certain pathologies such as Meniere’s disease, aminoglycoside vestibulotoxicity, and in patients with idiopathic BVH (Tarnutzer et al., 2016). Isolated posterior canal dysfunction has also been linked to idiopathic sudden sensorineural hearing loss (Byun et al., 2020), and has been shown to correlate with poor response to steroid treatment. Posterior canal dysfunction may represent a marker of severity in inner ear disease, hence it’s relative preponderance in this patient cohort.

References

Byun, H., Chung, J.H. and Lee, S.H., 2020. Clinical implications of posterior semicircular canal function in idiopathic sudden sensorineural hearing loss. Scientific Reports, 10(1), pp.1-8.

Tarnutzer, A.A., Bockisch, C.J., Buffone, E., Weiler, S., Bachmann, L.M. and Weber, K.P., 2016. Disease-specific sparing of the anterior semicircular canals in bilateral vestibulopathy. Clinical Neurophysiology, 127(8), pp.2791-2801.

No conflicts of interest

51. Hyperacusis in children: clinical perspectives

Iskra Potgieter1, Dr Derek Hoare1, Dr Kathryn Fackrell1

1Nottingham Biomedical Research Centre

Introduction – Hyperacusis is a “reduced tolerance to sound(s) that are perceived as normal by the majority of the population or were perceived as normal to the individual before the onset of hyperacusis” (Adams, 2020). The incidence of hyperacusis in children is arguably on the increase however the research on how it presents in children and its impact on their lives is limited (Potgieter, 2019). This study aims to provide insight on the presentation and impact of hyperacusis in children using data gathered via semi-structured interviews with clinicians who manage such children routinely.

Methods – Semi-structured interviews are conducted with health-care providers including Clinical Psychologists and Audio vestibular Physicians who manage children aged 2 to 7 years in clinic. Interviews lasted approximately one hour and were conducted virtually via Teams until data saturation was reached. Qualitative thematic analysis (Braun and Clarke, 2006) was used to reveal underlying themes.

Results –Preliminary themes identified were : referral pathways, potential causes of hyperacusis, co-morbid conditions, range and characteristics of bothersome sounds and children’s reactions, factors affecting sound perception, impact of hyperacusis (at home, outside, nursery or school), factors associated with severity, current clinical assessment and treatment methods.

Discussion –  These data have important clinical and research implications including the need for age-appropriate  assessment tools to reliably monitor improvement from treatment and to  stimulate further research.

References –  Adams, B., Sereda, M., Casey, A., Byrom, P., Stockdale, D., & Hoare, D. J. (2020). A Delphi survey to determine a definition and description of hyperacusis by clinician consensus. International Journal of Audiology, 60(8).

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research in psychology, 3(2), 77-101.

Potgieter, I., Fackrell, K., Kennedy, V., Crunkhorn, R., & Hoare, D. J. (2020). Hyperacusis in children: A scoping review. BMC Paediatrics, 20(1), 1–13.

 

No conflicts of interest.

52. Potential inflammatory biomarkers for tinnitus in platelets and leukocytes: a critical scoping review and meta-analysis

Raheel Ahmed1, Alice Shadis1, Rumana Ahmed2

1Swansea University, 2Bradford Teaching Hospitals NHSFT

Objectives

To explore the association between platelets or leukocytes and tinnitus.

Methods

A meta-analysis and scoping review examining the association between tinnitus and platelets and leukocytes. All 11 studies included were critically appraised using the Joanna Briggs Institute (JBI) checklist (2017a). A random effects model was used to pool the results of the studies examining mean platelet volume (MPV) and tinnitus.

1935 studies were identified in the initial search, 11 of which were included in the scoping review. 6 of the 11 studies had their MPV values pooled in the meta-analysis.

Results

Pooled results of 818 subjects from 6 studies indicated that MPV was significantly higher in those with tinnitus compared to a comparison group without tinnitus. The overall mean difference was 0.43 fL with a 95% confidence interval (CI) from 0.31 to 0.55 and a p value of < 0.0001 which was statistically significant. MPV is the only haematological parameter which is reliably associated with tinnitus.

Discussion

Understanding the peripheral inflammation associated with tinnitus may elucidate the pathogenesis of tinnitus, aid in the development of tinnitus subtypes and allow us to use MPV as an easy to obtain and cost-effective biomarker of tinnitus. Further studies reproducing current findings with the proposed recommendations may help us to further understand the mechanism through which MPV is associated with tinnitus. Such findings may lay the foundations for the development of a novel neuroinflammatory model of tinnitus.

Conclusions

MPV could be a useful biomarker for tinnitus. Further studies should aim to standardise methodology with more rigorous exclusion criteria to reproduce and define this association. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, white blood cell count and red blood cell and platelet distribution width do not show a reliable association with tinnitus.

No conflicts of interest to declare.

 

53. A pilot study evaluating a guide for parents and carers to support the pragmatic and social communication skills of deaf children

Ibtihal Sambah1, Dr  Helen Chilton1, Dr Catherine Adams1, Prof Chris Plack2,3, Dr Antje Heinrich1

1Division of Human Communication, Development and Hearing, School of Health Sciences, University of Manchester, 2 Manchester Centre for Audiology and Deafness, University of Manchester, 3 Department of Psychology, Lancaster University,

Pragmatic language ability is less well developed in deaf children compared to typically developing children. This negatively impacts deaf children’s abilities in communicating with others and, in turn, has the potential to impact on a wide range of social, emotional and educational outcomes. Although these children would benefit from additional support, there is a lack of  accessible, national resources and guidance that Teachers of the Deaf and parents/carers can use.

Based on input from those with practical experiences of supporting deaf children in developing these skills, as well as on previous research, a guide was created for parents and carers to support the pragmatic and social communication skills of deaf children. The aim of the guide is to promote the ability of deaf children to understand language appropriately and use it effectively during social interactions with others.

The current study investigates the acceptability and feasibility of the guide from the perspective of the parents/carers of deaf children. Quantitative and qualitative data are being collected from 15 parents of deaf children in mainstream primary schools while parents use the guide for 8 weeks.

The study aims to answer the following questions:

  1. Can parents/carers successfully use the guide; are its instructions clear and the activities easy to implement with deaf children, and what challenges or barriers do parents/carers face in using the guide?
  2. What benefits do parents/carers gain from using the guide in terms of enhancing their own knowledge, understanding, and ability to provide the support their children need to enhance these skills?

The poster will present quantitative and qualitative data, mainly on the usability of the guide.

The authors declare no conflict of interest

 

54. Impact of COVID-19 on Newborn Hearing Screening Programme in a large teaching hospital

Siddhrah Malik1, Mr Jason Smalley1, Dr Garreth Prendergast2, Mr Kevin  Hole1

1Nottingham University Hospitals Trust, 2The University of Manchester

Introduction: Given the alteration to the NHSP pathway at Nottingham University Hospitals, the impact on the following areas are unknown; the referral rate of babies to diagnostic assessment; the delay in diagnostic assessment; the true positive conductive yield ascertained at diagnostic assessment and the PCHI rate in comparison to previous years. The aim of this service evaluation is investigate to these current gaps in knowledge.

Methods:

–  Babies born from 1st December  2016- 28th Feb 2021 extracted from SMaRT4Hearing software (S4H) n=31489

Statistical Analysis to explore

–  No. of Referrals to diagnostic testing (referral rate),

–  Age at attendance of first diagnostic testing appointment

–  No. of referrals to behavioural testing following identification of a conductive hearing loss (referral  rate)

–  PCHI rates

Results – During C-19

– reduced mean chronological age at screen

– increased mean chronological age at diagnostic testing

– increased chronological age at identification of PCHI

– increased number of infants failed the screen

– no increase in PCHI rate

Discussion – This shows that C-19 did affect the identification age of PCHIs, increased the conductive yield, and however did not show any changes to the PCHI rate. This highlights the negative effects of screening early on the referral rate. This also highlights the potential of screening later, which may reduce parental anxiety. Is there a time between screening and diagnostic assessment that can ensure timely identification, but reduce false positive referrals?

References:

British Academy of Audiology (2020). NHSP technical guidance and management of audiology referrals during the Covid-19 pandemic.

Davis, A., et al. (1997). ‘A critical review of the role of neonatal hearing screening in the detection of congenital hearing impairment’.

Public Health England (2021). Newborn hearing screening pathway requirements specification.

I am a trainee clinical scientist placed at Nottingham University Hospitals Trust. This project is part of the completion of my scientist training programme, falling within the Clinical Scientist MSc, which will be submitted to the University of Manchester.

55. Auditory Training: an app with Noise

Margarida Serrano1, Filipa  Maia1

1Instituto Politécnico De Coimbra, Estesc – Coimbra Health School, Audiology

Introduction: Difficulty perceiving speech in noisy environments is one of the main hearing complaints, often due to hearing loss and/or auditory processing disorders. Apps for mobile devices can offer opportunities for hearing self-care, considering that access to smartphones and tablets is relatively easy nowadays. The objective of this study was to verify if the training performed with the auditory training app developed by EVOLLU was effective in individuals between 14 and 77 years of age.

Methods: Conducting the filtered speech test in an experimental group, before, immediately after, and after four weeks of auditory training performed with the app and a control group in which the same tests were applied with an interval of four weeks. The two groups were matched according to age and educational level. The individual heard words or pseudowords with noise and after hearing each word, two options were presented that only varied between them in one phoneme, the individual chose the one he heard. Results: In the group that performed the training, there was a significant difference in the filtered speech test between before and after training, this difference remained after four weeks.

Discussion: EVOLLU’s auditory training app promotes an improvement in speech perception in noisy environments that remains after the end of training sessions and can be an essential tool in improving speech perception in adverse environments.

References:

Cruz, A. C. A., Andrade, A. N., & Gil, D. Effectiveness of formal auditory training in adults with auditory processing disorder. Revista CEFAC, 15(6), 1427-1434. 2013 DOI: 10.1590/S1516-18462013000600004

Henshaw Helen, McCormack Abby, Ferguson Melanie. Intrinsic and extrinsic motivation is associated with computer-based auditory training uptake, engagement, and adherence for people with hearing loss. Frontiers in Psychology. VOL. 6: 2015. DOI 10.3389/fpsyg.2015.01067

No conflicts of interest to declare.

 

56. Attitudes towards hearing healthcare, hearing aids and “hearables” amongst adults over 50 years.

Saima Rajasingam1, Tobias  Goehring, Alan Archer-Boyd, Srikanth Chundu, Mable  Nakubulwa, Lucy Handscomb, Deborah Vickers, Brian Moore

1Anglia Ruskin University, 2University of Cambridge, 3British Broadcasting Corporation, 4Anglia Ruskin University, 5Imperial College London, 6University College London, 7University of Cambridge, 8University of Cambridge

BACKGROUND: Untreated hearing loss is an issue of growing importance; by 2031, there will be 15.6 million people with hearing loss in the UK. Currently, only 40% of those who could benefit from hearing aids have them, and 20% of those do not use them. Reasons for low uptake include stigmatisation, low trust in hearing aid benefit, cognitive restrictions, and cost, amongst others. The emergence of “hearable” technologies, resembling wireless earphones but also claiming to provide amplification and enhanced speech in noise management, may provide an alternative approach to addressing this low uptake.

OBJECTIVES & METHODS: A survey of UK adults over 50 years (N=239) was conducted to explore (1) perceived attractiveness of hearing aid and hearable technologies and (2) willingness to use hearing aid vs hearable technologies.

RESULTS: 55% of respondents were already using wireless earphones or headphones for audio streaming. After viewing images of hearing aids and hearables, 57% of those with normal hearing, 67% of those with hearing loss but not currently using hearing aids and 88% of those using hearing aids selected hearables as the hearing device they preferred to use. Willingness to consider or recommend hearing healthcare tended to be less in adults with hearing loss who were not using hearing aids, than either hearing aid users or adults with normal hearing/ hearing untested.

CONCLUSIONS: The results indicate that adults at risk of hearing loss may be more willing to consider hearing technologies in a hearable format. The less positive attitudes towards hearing healthcare by adults who were not currently using hearing aids (but had a hearing loss diagnosis) could indicate that unsuccessful attempts at seeking help for hearing loss may reduce the likelihood of seeking help again when hearing loss worsens and/or recommending friends and family seek help for hearing loss.

No conflicts of interest to declare.

57. Decreased Sound Tolerance in Autism Spectrum Disorder: A Scoping Review

Abigail Egid1, Dr Amanda  Hall2

1Royal United Hospitals Bath NHS Foundation Trust, 2Aston University

Introduction: Decreased sound tolerance (DST) is a common yet poorly understood feature of Autism Spectrum Disorder (ASD). There is wide variation in the terminology used to describe DST, and currently there are no clinical practice guidelines. This study aimed to identify, within an ASD context: 1) terms used to describe DST, 2) definitions of each DST-term, 3) assessment and management options for DST.

Methods: A scoping review, in which five electronic databases were searched, and data analysed using quantitative frequency counts and qualitative thematic coding.

Results: 1) 26 different terms describing DST were identified, the most common of which were auditory hypersensitivity, used by psychology-related disciplines, and hyperacusis used by audiology-related disciplines. 2) Key concepts included increased perception, decreased modulation and atypical resultant behaviours. 3) Assessment involved questionnaires, clinical interviews, observations and objective testing. Management options included contrasting approaches of desensitisation and avoidance.

Conclusion: There is a widespread lack of consistency in the terminology used to describe DST across disciplines, and no clear consensus on the definition of DST. This variation is reflected in the wide range of assessment and management options. Future research must focus on uniting research from different disciplines, to work towards improved terminological consistency.

No conflicts of interest to declare.

 

58. Development and Evaluation of an All Wales Audiology Preceptorship Programme

Linor Jones1

1Bcuhb

Introduction

Preceptorships are used in many health professions including Nursing, Midwifery, Speech and Language Therapy and Physiotherapy. A preceptorship programme gives a professional the best possible start in their career and is a structured transition period for newly qualified staff. They are also thought to enhance innovation, increase independence and encourage autonomous professionals (NHS Employers website).

The aim of a preceptorship is to build upon the skills a newly qualified clinician has developed during their training to:

  • help them settle into their new role
  • develop their confidence in using their knowledge and skills gained during their training in their day-to-day clinical practice
  • fine-tune clinical skills
  • develop professional practice skills
  • give them the support needed to develop further and prepare towards the next step in their career

We identified gaps in the development of Audiology professionals within Wales at Band 5 and Band 7 level and we felt a Preceptorship scheme would be beneficial. The scheme was developed in BCUHB, shared with Wales Heads of Service and then agreement was given for its implementation across all seven Health Boards in Wales in September 2021.

Here I will present an evaluation of the scheme one year on.

Methods

The scheme was evaluated through informal interviews and structured questionnaires to Preceptors and Preceptees currently assigned on the Preceptorship scheme at each Health Board.

Results

The results of the evaluation will be presented. Feedback has been very positive and the Perceptees have been very engaged.

Discussion

The All Wales Preceptorship has been well received across Audiology departments in Wales. As our workforce grows we will continue to offer and implement the Preceptorship scheme to new Band 5 and Band 7 staff. The first Band 7 staff will begin their Preceptorship in September 2022.

References:

NHS Employers Website https://www.nhsemployers.org/articles/preceptorships-newly-qualified-staff

No conflicts of interest.

59. Reliability and validity of cervical VEMP in patients with diabetes mellitus-2

Ms KOLLI OOHA

INTRODUTION: Due to inadequate glycemic control, vertiginous crises are prevalent in PwDM-2. Integrating inputs from the vestibular, visual, and somatosensory systems to create motor responses that maintain upright position and respond to destabilising pressures is essential for balance. Balance is maintained via the vestibulo-spinal and occular reflexes. Spinal reflexes can be assessed using (cVEMP).

AIM: Aim of this study was to verify the dependability of cVEMP in PwDM-2 and to corroborate the validity.

OBJECTIVES: Estimation of the measurable characteristics of cVEMP; P1 latency, N1 latency and P1-N1 amplitude in patients with Diabetes Mellitus-2 (PwDM-2) and in  AmC(age matched control)

METHOD :The age range is from 30 to 55 years old. 40 people were divided into two groups of equal size. cVEMP recordings were done two times in each participant to examine the reliability of the measures of P1 and N1 latency and P1-N1 amplitude

RESULTS: When comparing  P1 latency was substantially different in PwDM-2 when compared to AmC in both right and left ears, according to the results of paired and independent T-tests. To verify the reliability of these measurements, Pearson correlation coefficient tests were performed independently in PwDM-2 and AmC for recording-1 and recording-2 of P1 and N1 latency, and P1-N1 amplitude. The Pearson correlation coefficient was found to be reliable.

DISCUSSION: By this present study, we found the effect of diabetes on cVEMP. Diabetes can affect different vestibular structures. Most of the time subjects with diabetes remain asymptomatic probably because of bilateral distribution of disorder. This study also showed vestibular system dysfunction due to diabetes mellitus.

REFERENCES :

1.Bryan K. Ward, MD, Angela Wenzel, MD, Rita R. Kalyani (2015) Characterization of   Vestibulopathy in Individuals with Type 2 Diabetes Mellitus, Otolaryngology.

2.Manisha Sahu, Sujeet Kumar Sinha (2015) Assessment of Sacculocollic Pathway in Individuals with Diabetes Mellitus, All India Institute of Speech and Hearing, Mysore.

No conflicts of interest to declare.

60. Hearing difficulty is associated with reduced physical activity: A 20-year cohort study from the English longitudinal study of aging.

Maria Goodwin1, Professor Rebecca Hardy1, Professor Blossom Stephen2, Professor Eef Hogervorst, Dr David Maidment1

1Loughborough University, 2University of Nottingham

Introduction: Hearing loss in older adults is an independent risk factor for developing chronic health conditions, including cardiovascular disease, diabetes, and dementia. Physical activity is a modifiable behaviour that can reduce the risk of developing chronic health conditions. Cross-sectional research has shown that hearing loss is associated with declines in physical activity. However, how hearing loss and physical activity are related over time remains unclear. Therefore, the aim of this study was to assess how these variables are related over a 20-year follow-up period.

Methods: Data (N=11,294) from the English Longitudinal Study of Aging (ELSA) was analysed. ELSA has been collecting data every two years from people aged over 50 since 2002 to understand all aspects of aging in England. In the current study, participants were classed as ‘hearing loss’ (n=4,946) or ‘normal hearing’ (n=6,346) based on self-report. Cox proportional hazard ratios and multilevel logistic regression analyses were used to investigate associations between hearing loss and physical activity over time.

Results: Baseline physical activity was not a significant risk factor for developing hearing loss over the 20-years follow-up period (OR = 0.95, 95% CI; 0.88, 1.02, p = .171). However, a wave by hearing loss interaction showed that physical activity declined more rapidly over time for individuals who reported hearing loss compared to those who did not (OR = 0.94, 95% CI; 0.92, 0.96, p<.001).

Discussion: The development of hearing loss is associated with a greater and more rapid decline in physical activity over time. This is concerning, as both hearing loss and physical inactivity are modifiable risk factors for chronic health conditions. Mitigating the decline in physical activity, ensuring physical activity is accessible, and supporting healthy aging for adults with hearing loss may be necessary to improve health outcomes.

No conflicts of interest to declare.

 

61. Audiology, Learning Disabilities and Autism Project

Siobhan Brennan1, Dr Marianne Day1, Shanice Thomas1

1Manchester Centre For Audiology And Deafness

Objectives

The objective of the Audiology, Learning Disabilities and Autism Project was to articulate and describe barriers to effective and high-quality audiological care for people with learning disabilities and autistic people.

Methods

Interviews and focus groups were held with 24 autistic people and their parents, 34 people with intellectual disabilities, family members and support staff and 16 audiology professionals.  Qualitative data was analysed using the Framework Method (Ritchie, Lewis, 2003) in which semi-structured interviews were summarised and indexed into a framework matrix (Gale et al. 2013) which was then used to explore themes in the data.

Results

5 themes were drawn from the data.  These were:

1: Managing expectations: limits to what can be done

2: Service structure and training

3: The context of the person/family/care context outside audiology

4: Making adjustments and good audiological provision

5: On-going care after the initial assessment

Conclusions

Many examples of good practice were identified and reported from all participant groups.  Aspects of care that have achievable routes to improvement were also identified.  This presentation aims to elaborate on the specifics of the emergent themes and prompt discussion on paths to better audiological care for people with intellectual disabilities and autistic people.

No conflicts of interest

62. Atypical Audiovestibular presentation in connexin 26 mutation variants

John Wong1, Prof Soumit Dasgupta, Laura Strachan, Javed Iqbal, Dr Sudhira Ratnayake

1Alder Hey Children’s Hospital

Introduction

Connexin 26 accounts for up to 50% of cases of non-syndromic sensorineural hearing loss being the commonest genetic cause for hearing loss. The majority are inherited in a recessive fashion. Hearing loss is heterogenous but is largely congenital picked up in new-born hearing screening (NHSP). Late onset/progressive hearing loss is a rare phenotype present in a few rare sub genotypes. Vestibular quantification is hardly reported upon.

Methods

From our Connexin 26 mutation database, we present 2 case studies. Case 1 is Met34Thr variant and case 2 is p.Val37lle variant both of which are rare. Pure Tone Audiometry, Tympanometry, Videonysatgmography (VNG) without optic fixation, Video head impulse test (vHIT), Suppression head impulse test (SHIMP) and Cervical vestibular evoked myogenic potential (cVEMPs) were performed with Alder Hey vestibular laboratory defined norms.

Results

Both children obtained clear responses from NHSP, and a hearing loss was subsequently identified from a school entry hearing screening test. Case 1 presented with bilateral mild/moderate progressive high frequency sensorineural hearing loss with abnormal VEMP results (large amplitude/ reduced threshold). Subsequent CT scan revealed posterior semi-circular canal dehiscence. Case 2 presented with bilateral moderate hearing loss and with middle frequency (headshake without optic fixation) vestibular hypofunction on VNG. vHIT and SHIMP were normal in both cases. Both children are post lingual.

Discussion

These cases demonstrate late-onset hearing loss. Children with SNHL are tested for Connexin 26 mutations within 4 weeks of diagnostic confirmation of a hearing loss after screening failure. However, it is important to recognise that children with late onset SNHL also require to be assessed for atypical sub genotypes early in their evaluation. This study further highlights that temporal bone abnormalities may be associated with these phenotypes. The benefit of a school entry hearing screening programme and vestibular quantification are emphasised as well.

No conflicts of interest

63. Does the configuration of a mild hearing loss effect the benefit received by adults fitted with bilateral hearing aids?

Chloe Tanton1

1Mid And South Essex NHS Foundation Trust, 2University College London

Introduction: Mild Hearing Loss is the most prevalent of all degrees of hearing loss but there is limited research into the benefits of hearing aids for this population. Of note, it is unknown whether the benefit of hearing aids for those with a mild hearing loss is affected by the configuration of the hearing loss.

Methods: It was investigated whether the configuration of a mild hearing loss has an effect on the benefit received from first time bilateral hearing aid users. Data was collected retrospectively for all adults with a mild sensorineural hearing loss fitted with hearing aids and who completed the International Outcome Inventory for Hearing Aids (IOI-HA) at follow up.  Configuration of hearing loss was divided into the following categories: flat, gentle sloping, steeply sloping and high frequency only.

Results: There were no significant differences in the benefit received from hearing aids for the different configurations of mild hearing losses. However, each configuration of mild hearing loss scored highly on the IOI-HA compared to the norms, highlighting that those with a mild hearing loss, regardless of configuration receive benefit from hearing aids.

Discussion: This is important as due to the limited research on the benefit of hearing aids for those with a mild hearing loss, there is no real consensus amongst audiologists as to when to fit a mild hearing loss or of the benefit the patient can expect to receive from them. The results highlight that hearing aids can be of real benefit to patients with a mild hearing loss which should encourage both audiologists and patients to fit hearing aids with a mild hearing loss.

References: Cox et al, (2003); Demeester et al, (2009); Ferguson et al, (2017); Johnson et al, (2018).

No conflicts of interest to declare.

 

64. When two worlds collide– The successful merger of two UK Paediatric Audiology Departments.

Eleanor Brown1, Mr Tendai  Ngwerume1, Ayesha Mullaji1

1University Hospitals Of Derby And Burton NHS Trust

Introduction – The recent merger of Derby Teaching Hospitals NHS Foundation Trust and Burton Hospitals NHS Foundation Trusts presented the challenge of merging two Paediatric Audiology departments to form a new team. There is evidence that merging of two institutions can lead to ‘widespread post-merger dissatisfaction, lowered morale, frustration and disillusionment’ (Evans 2017). By examining interview and survey results, this research explores the impact on team members and resulting effects on clinical outcomes following the merger.

Methods – A questionnaire was sent to the Audiologists employed at both sites to gain their views on the merger process.  Semi-structured interviews were conducted with service leads to gain an insight into leadership and management of the merger process.

Results – Results show that merging departments is a challenging and difficult process involving intensive resource and people leadership and management. However, the long-term outcomes however can be positive, especially for patient care.

Discussion – The process of merging two teams can be initially challenging. If managed well however, the merger can lead to increased job satisfaction and improved patient care.

References

Evans, L., The worst of times? A tale of two higher education institutions in France: their merger and its impact on staff working lives. Studies in Higher Education, 42:9, 1699-1717, DOI: 10.1080/03075079.2015.1119107

No conflicts of interest

65. Music-listening Level Preferences in Musicians and Non-Musicians

Ozgenur Cetinbag1, Dr Karolina  Kluk1, Dr  Samuel  Couth1, Prof Christopher J. Plack1,2

1Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, UK, 2Department of Psychology, Lancaster University, UK

Introduction:

Musicians differ from non-musicians on both behavioural and electrophysiological measures, and this may reflect superior auditory and/or vestibular function in musicians (Schneider et al., 2002). These differences may stem from musical training or due to increased attention to specific features in music (e.g. rhythm) (Hoover & Cullari, 1992), that this can lead to higher levels of music-listening preferences in musicians. Therefore, it is possible that musicians prefer to listen to music at higher levels than non-musicians.

Methods:

This study consisted of both online and laboratory-based music-listening preference (MLP) tests that allow adjusting volume levels manually for 6 music pieces presented via headphones/earphones, each from a different genre. In the online MLP test, 28 musicians and 41 non-musicians, all with normal hearing and aged between 18-45 years, were assessed. In the subsequent lab-based MLP test, 55 musicians and 35 non-musicians completed the MLP test via an audiometer, with the same method used in the online MLP test.

Results:

In the online MLP test, there were no significant differences between groups (p = 0.749). A preliminary analysis of the lab-based data showed that musicians had significantly higher preferred music-listening levels than non-musicians (mean±sd = 67.6±8.11 dB; 60.6±7.88 dB; p <0.001). Data collection and analysis are ongoing.

Discussion:

The results of the laboratory-based study suggest that musicians prefer to listen to music at higher levels compared with non-musicians and that this may reflect the superior function of musicians’ auditory systems, due to their musical training process.

References:

Schneider, P., Scherg, M., Dosch, HG., Specht, HJ., Gutschalk, A., & Rupp, A. (2002). Morphology of Heschl’s gyrus reflects enhanced activation in the auditory cortex of musicians. Nature Neuroscience, 5(7), 688-694.

Hoover, DM., & Cullari, S. (1992). Perception of loudness and musical preference: Comparison of musicians and nonmusicians. Perceptual and Motor Skills, 74(3), 114-1150.

No conflict of interest.

66. Examining speech recognition with the use of adaptive gain receivers and ReSound Multi Microphone technology

Megan Quilter1, Neil  Wright1

1GN Hearing

Introduction

The benefits of hearing assistive technology (HAT) are intuitive: improvement of the Signal-to-Noise (SNR) by placing a microphone closer to the target of interest and sending that audio input directly to the user’s hearing devices. To date, there have been no studies that examined speech recognition scores obtained while mixing manufacturers HAT technologies. The intention of this study is to explore and confirm that patient speech recognition scores obtained with the use of one brand of adaptive gain receivers coupled to another brand’s microphone technology, remain uncompromised between the two technologies.

Methods

In this randomized, double-blind study, subjects are fit with receiver in the ear hearing aids. Recorded speech recognition scores in noise are obtained in the following conditions: 1) hearing aid only, 2) Digital modulated receivers connected hearing aids via direct audio input, 3) digital modulated receivers connected to the hearing aids via Multi Microphone and 4) Multi Microphone only.

Results

Results indicate the preservation of an adaptive gain advantage is possible when combining different manufacturers technologies. This study describes advantages of innovative and cost-effective approaches to fitting students and adults at school and/or home.

Discussion

This study highlights the advantages and intricacies when combining different brand technologies. This research supports alternative and proven solutions that can be innovative, cost-effective, affordable and may help reduce the negative social impact that users may have experienced, leading to increased usage in hearing assistive technologies.

No conflicts of interest

67. Evaluating the Effectiveness of Using Different Algorithms per Ear with Bimodal Solutions

Dr.  Megan  Quilter1, Dr Neil  Wright1, Dr. Bryan  McDonald2

1GN Hearing A/S, 2Cochlear Americas

Introduction

Directional sound processing provided by hearing aids and cochlear implants can enhance wearers’ speech understanding while in complex listening environments.  ReSound ONE and Cochlear™ devices apply unique directional processing algorithms to help speech understanding in noise, but the algorithms act independently. The interaction between the two has not been fully investigated for complex listening environments. This poster describes a clinical investigation that evaluated the effectiveness of utilizing different ear algorithms in bimodal systems to assess hearing outcomes of bimodal users in laboratory and field settings.

Methods

This observational cohort study evaluated hearing outcomes with nine users’ bimodal systems using speech in noise testing (AzBio Sentences) and a subjective hearing performance questionnaire (Speech, Spatial and Qualities Questionnaire (SSQ-12). To evaluate the efficacy in the participants daily lives, an ecological momentary assessment tool was also used.

Results

Statistically significant improvements in mean AzBio scores in quiet conditions were seen while wearing a bimodal system (defaulted) compared to CI alone. Statistically significant improvements in mean scores were with both the +10 SNR and +5 dB conditions when using a bimodal directional program compared to CI alone. This result is as hypothesized that utilizing bimodal stimulation in noisy environments provides improvement over unilateral CI alone.

Discussion

The ReSound ONE and ReSound Enzo Q along with the Cochlear N7 and Cochlear Kanso devices each apply a unique directional processing algorithm. These independent algorithms can provide benefit to individuals fitted with a Smart Hearing Alliance bimodal hearing solution. The ReSound ONE hearing instrument utilizing directional sound processing in combination with Cochlear ForwardFocus, can enhance users’ speech understanding while in complex listening environments, compared to using the Smart Hearing Alliance default fitting program.

No conflict of interest

 

68. Advancing tinnitus research and researcher training: a case study review and future perspectives

Dawn Hazle1, Axel Schiller2, Dr Derek Hoare1, Dr Kathryn Fackrell3, Dr Winfried Schlee2

1University of Nottingham, 2University of Regensburg, 3University of Southampton

Introduction:

Tinnitus affects one in 10 people, and for many significantly impairs quality of life. Whilst there has been a notable increase in research funding and the number of publications in recent years, this is not keeping pace with other related disciplines. Tinnitus research is also not yet attracting substantial industry funding; because we do not yet understand the biological basis of tinnitus, cannot measure it objectively, and do not yet have any treatment success stories. There is a clear need for increased funding, better-quality studies, increased capacity, and interdisciplinary working in the field.

Methods:

The European School for Interdisciplinary Tinnitus (ESIT) research project was a European Union-funded doctoral training programme that brought together a consortium of clinicians, academics, commercial partners, patient organisations, and public health experts, from various European countries with students from across the world.

Results:

The programme supported various fundamental science and clinical research projects in order to advance treatments, develop innovative research methods, perform genetic and epidemiological studies, and establish a pan-European data resource. With researchers from such diverse backgrounds, there were challenges in providing relevant and suitable training for all students. These were overcome by providing a comprehensive curriculum designed to address all areas of skill and researcher competency as defined by the Vitae Researcher Development Framework. This approach allowed for systematic identification of strengths and development needs, action planning, and review of individual and group achievements.

Discussion:

There is a general need for increased capacity, as well as coordinated efforts to both improve research quality and address fundamental issues that will attract and retain funding and researchers.  ESIT provides an evidenced format for training in the field of tinnitus research.

No conflicts of interest

69. Developing Strategic Directions for Inclusive Research about Co-existing Dementia and Hearing Loss in Consultation with Key Stakeholders.

Eithne Heffernan1, Jean Straus, Emma Broome1, Tom Dening2, Helen Henshaw1

1NIHR Nottingham Biomedical Research Centre, University of Nottingham, 2Centre for Dementia, University of Nottingham

Introduction: Many people living with dementia also have hearing loss, which can impair the assessment and management of these conditions. Furthermore, hearing loss is the largest potentially modifiable risk factor for the development of dementia from midlife onwards. However, the specific mechanisms underlying this association, as well as optimal support for patients and carers, are currently unclear. Additionally, underserved groups  (e.g. ethnic minority groups, unpaid carers) often encounter barriers to participation in dementia and hearing loss studies. Therefore, this research aims to:

1) Develop strategic priorities for future research in this field in consultation with stakeholders (i.e. people living with dementia and/or hearing loss, carers, audiologists, and researchers).

2) Examine current clinical service provision within audiology for people living with dementia.

3) Co-produce a toolkit to improve the inclusion of underserved groups in dementia and hearing loss research.

Methods: This research entails:

1) Focus groups with approximately 30 stakeholders.

2) National survey of audiology services and interviews with audiology service leads.

3) Experienced-based co-design (EBCD) with approximately 30 stakeholders, including members of underserved groups, which involves focus groups, workshops, and a celebration event.

Patient and Public Involvement (PPI) is embedded throughout this research.

Results: Initial results show that strategic priorities for future dementia and hearing loss research include educating clinicians and the public, supporting carers/families, improving post-diagnosis support, reducing stigma, facilitating social engagement, and investigating causes and interventions (e.g. devices, psychological therapies).

Discussion: This research will help to ensure that future dementia and hearing loss studies address research questions that are valued by key stakeholders and are inclusive of underserved groups. It will also provide novel insights and up-to-date knowledge about clinical service provision in audiology for people living with dementia. Consequently, this research will provide a foundation for high-quality research and practice in this field in the future.

No conflicts of interest to declare.

70. Using the qualitative pre-test interview to develop a questionnaire for children with hearing loss

Sarah Somerset1,2, Dr Adam Pedley1,2, Dr Padraig  Kitterick2,3

1Nottingham Biomedical Research Centre, 2University of Nottingham, 3National Acoustics Laboratories

Introduction

Within hearing research patient reported outcome measures exist for use with children (e.g. LittleEARS, SSQ-Ch etc).  These are either self-report or proxy measures.  None were designed with children with hearing loss at the heart of their development.  Proxy measures have their uses but from a qualitative standpoint how can an adult report on a child’s lived experience in a way which represents the child.  A condition specific preference based measure (PBM) exists for adults with hearing loss, the York Binaural Hearing Related Quality of Life system (YBHRQL) (Summerfield, Kitterick et al. 2022).  The YBHRQL consists of three domains i) understanding speech in background noise, ii) localisation and iii) effort and fatigue.  This study seeks to work in partnership with children with hearing loss to identify how these domains relate to their lived experience and generate a quality-of-life questionnaire.

Methods

Semi-structured interviews with children aged 8 to 16 years with severe to profound hearing loss.  Each participant will be interviewed twice.  The first interviews explore children’s lived experience of the YBHRQL domains.  The second interviews investigate language and scenarios using the qualitative pre-test interview approach (QPI).  The QPI treats participants as equal partners in development.

Results

A total of 12 children aged 8 to 16 years participated.  Thematic analysis identified everyday scenarios where participants identified different aspects of listening and hearing as a challenge.  These scenarios were incorporated into the questions presented at the second interview.  Overall children preferred shorter questions with a brief vignette setting the scene.  They chose a five-response system ranging from none to most and selected one scenario per domain.

Discussion

There’s a need for the application of this method within hearing research.  Adapting questionnaires using appropriate language and scenarios is critical to obtaining the information needed for measuring quality of life and generating a PBM.

No conflicts of interest to declare.

71. Adaptation and Validation of the YBHRQL-Y a preference based measure for children with hearing loss

Sarah Somerset1,2, Dr Adam  Pedley1,2, Dr Padraig  Kitterick1,3

1University Of Nottingham, 2Nottingham Biomedical Research Centre, 3National Acoustics Laboratories

Introduction

Within hearing research patient reported outcome measures exist for use with children (e.g. LittleEARS, SSQ-Ch etc).  These are either self-report or proxy measures.  None were designed with children with hearing loss at the heart of their development.  A condition specific preference based measure (PBM) exists for adults with hearing loss, the York Binaural Hearing Related Quality of Life system (YBHRQL) (Summerfield, Kitterick et al. 2022).  The YBHRQL consists of three domains i) understanding speech in background noise, ii) localisation and iii) effort and fatigue.

This study seeks to adapt and validate a PBM for quality of life for children with hearing loss for use in a wider clinical trial (BEARS).

Methods

The qualitative pre-test interview approach was used to operationalise the existing domains in the YBHRQL for use with children with hearing loss.  This approach considers participants equals and ensures language and concepts used are relatable to our target population.  This adapted measure was then administered alongside CHU9D, HUI3, SSQ and VFS-CHL at two separate time points.

Results

A total of 12 children aged 8 to 16 years participated in the adaptation phase.  Thematic analysis identified everyday scenarios where participants identified different aspects of listening and hearing as a challenge.  Overall children preferred shorter questions with a brief vignette setting the scene.  They chose a five-response system ranging from none to most and selected one scenario per domain.

A total of 60 children and their parent / guardian participated in the validation phase of the study.  Participants completed the measures at two separate time points, two weeks apart.

Discussion

There is a need for a condition specific, child specific PBM within the hearing field.  The next phase of the study which is currently ongoing is developing a scoring system for this measure to enable health economic analysis.

No conflicts of interest to declare

72. Barriers and facilitators to conducting tinnitus trials in the UK audiology departments: an example of the HUSH trial

Magdalena Sereda1,2, Dr Kathryn Fackrell1,2,3

1NIHR Nottingham Biomedical Research Centre, 2Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, 3School of Healthcare Enterprise and Innovation, University of Southampton

Introduction:

The aim of the HUSH trial was to determine the feasibility of conducting a definitive randomised controlled trial (RCT) of the effectiveness and cost-effectiveness of hearing aids for adults with tinnitus and hearing loss. A nested interview study was conducted alongside the feasibility trial. Secondary analysis of the interview data was conducted to explore barriers and facilitators to conducting trials of tinnitus interventions in the UK audiology setting.

Methods:

After trial recruitment activities have ceased, clinical staff from five trial sites were interviewed to review their experience of the trial in terms of participant recruitment and integrating the research within clinical care. Secondary qualitative analysis of the interview data was performed. Data were recorded digitally, transcribed in full and handled using the N’Vivo software package. A Framework approach was utilised and data was mapped to two analytic matrices: (1) Challenges and barriers and (2) Facilitators.

Results:

Eleven clinicians across five audiology departments were interviewed. Those included Principal Investigators at trial sites and staff conducting the trial (audiologists, research support staff). Preliminary analysis identified themes around: 1) Motivations of sites and clinicians to take part in the trial; 2) Clinicians’ mindset, including equipoise regarding outcomes of the intervention; 3) Adjusting clinical processes in order to fit trial procedures; 4) Impact of the trial on usual clinical pathway; 5) Infrastructure and workforce needed; 6) Training needs.

Discussion:

Both barriers and facilitators for conducting tinnitus trials in the UK audiology departments were identified. The HUSH trial has significantly furthered our understanding of running trials within this context and patient population. Work still needs to be undertaken to help the departments to embed high quality trials alongside their clinical practice.

Authors declare no conflict of interest

73. Establishing a Core Outcome Domain Set for early-phase clinical trials of electrical stimulation interventions for tinnitus: an e-Delphi survey and consensus meeting

Mr Bas Labree1,2, Dr Derek J Hoare1,2, Dr Kathryn Fackrell1,2,3, Prof Deborah A Hall4, Dr Lauren E Gascoyne5, Magdalena Sereda1,2

1NIHR Nottingham Biomedical Research Centre, 2Hearing Sciences, Mental Health and Clinical Neurosciences, University of Nottingham, 3School of Healthcare Enterprise and Innovation, University of Southampton, 4Department of Psychology, School of Social Sciences, Heriot-Watt University, 5Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham

Introduction:

Tinnitus is the awareness of sound in the ear or head in the absence of an external source. Experimental treatments include different forms of electrical stimulation of the brain. Common standards of what specific tinnitus-related complaints are critical and important to assess in all clinical trials exist for pharmacological, psychological, and sound-based interventions for tinnitus, but not electrical stimulation-based interventions. This study addressed this by establishing a Core Outcome Domain Set (CODS) for this type of intervention.

Methods:

Participants belonged to one of two stakeholder groups, (1) healthcare users with lived experience of tinnitus, or (2) professionals with relevant clinical, commercial, or research experience. Participants completed two surveys rating the importance of 65 candidate outcomes identified in a previous systematic review. Criteria for inclusion in the CODS were 70% or more of the participants in each stakeholder groups scoring the domain as important (7-9 on a 9-point scale), and fewer than 15% scoring it not important (scores 1-3). Criteria for exclusion from the core set were 50% or less of the participants in each stakeholder group scoring the domain as important (score 7-9). The CODS was finalised in an online consensus meeting.

Results:

55 participants completed both survey rounds. Preliminary results showed that eight outcomes met the criteria for inclusion, 10 met the criteria for inclusion by one stakeholder group only, the remaining 47 met the criteria for exclusion. An online consensus meeting involving a subgroup of e-Delphi survey participants resulted in a finalised CODS.

Discussion:

This study established a CODS for the evaluation of electrical stimulation-based interventions for tinnitus. The recommendations will act as a minimum expectation for reporting outcomes in future clinical trials of electrical stimulation-based interventions for tinnitus. Standardisation will facilitate comparability of research findings and synthesis of datasets.

Authors declare no conflict of interest

74. Hearing aid outcomes assessed using Ecological Momentary Assessment (EMA)

Helen Whiston1, Melanie Lough1, Dr Gabrielle  Saunders1

1University Of Manchester

Introduction:

Retrospective questionnaires are typically used to measure hearing-aid outcomes. However, they rely on recall and lack contextual resolution. Ecological Momentary Assessment (EMA), a method in which questions are answered in real-time via mobile technology, can overcome these limitations but requires access to a mobile device and a willingness to answer questions while conducting daily activities.

Hearing aid technology now allows EMA data to be linked directly to soundscape data logged by the hearing aid. It is thus possible to simultaneously collect subjective and objective information about listening experiences and the sound environment, providing the potential for a better understanding of real-world listening difficulties.

In this study we examined users’ experiences with EMA and the associations between self-report and hearing-aid logged sound data.

Method:

Participants were 40 experienced hearing aid users. All participants wore two pairs of study hearing aids for two weeks each. Several times each day, participants completed an 8-item EMA survey that asked about the listening environment, listening satisfaction, etc.  Data was  logged by the hearing aid at the time of survey submission. On study completion participants undertook an exit interview in which they described their experiences during the study.

Results:

The median number of completed EMA surveys was 86 over their four-week trial. Participants reported data collection via EMA to be easy and unobtrusive. Associations between the EMA surveys and soundscape information was multifaceted and illustrated the complexity of real world listening.

Discussion:

In general participants reported being willing to complete EMA surveys but noted a variety of situations in which EMA surveys could not be completed (e.g. driving, playing a musical instrument, some social settings). The finding that associations between EMA self-report and data logged information was complex and emphasizes the need to combine both sources of information when trying to understanding real world listening.

No conflicts of interest to declare.

75. How should we define and measure hearing aid use success? Perspectives of adults who have hearing aids and hearing healthcare professionals

Sian Calvert1,2, Dr Emma Broome1,2, Jean Straus1, Ashika Shah3, Dr Helen Henshaw1,2

1National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, 2Hearing Sciences, Mental Health and Clinical Neurosciences, University of Nottingham, 3School of Medicine, University of Nottingham

Introduction: Hearing loss, affecting one in five adults in the UK, can be managed using hearing aids; however, the number of adults utilising hearing aids is far lower than the number who could benefit from them. Previous measures of hearing aid use, e.g. the number of hours the hearing aid(s) are switched on, may not align with individuals’ perspectives of what ‘successful’ use means. Consequently, clinical trials focused on improving use, may not be person-centred. Defining ‘successful’ use can ensure that future health research and policy reflect the needs and priorities of those who access and use healthcare. This study aims to define success when using hearing aids from different perspectives.

Methods: A three-stage priority setting process was separately undertaken with 113 hearing aid users and 51 hearing healthcare professionals.

1) Responses to an open-ended question regarding what hearing aid use success means were grouped according to meaning and summarised as ‘indicative’ statements which conveyed the key concept of the statements in that grouping.

2) All indicative statements were reflected to respondents in a second survey, which asked them to rank their top 10 most important statements.

3) The 15 highest ranked indicative statements from the second survey were presented at a consensus workshop, where the top 5 statements to describe hearing aid success were prioritised by consensus, using Nominal Group Technique.

Results: The top 5 indicative statements from each workshop will be identified as priority factors indicating ‘successful’ hearing aid use.

Discussion: The findings will be disseminated using professional illustrations, making them engaging and widely accessible to key stakeholders and the public, to raise awareness and initiate discussions around outcomes important to hearing aid users and healthcare professionals. These are vital factors to consider in future decision-making in audiology services and clinical trials.

No conflict of interests to declare

76. RNIDs health behaviour change campaign. Using behaviour change theories to encourage people to check their hearing and further help

Crystal Rolfe1

1RNID

Introduction: It take an average of 10 years to get help for hearing loss and there and millions of people who could benefit from hearing aids who do not have them. This impacts on physical and mental health and is the largest modifiable risk factor for dementia.

Method: working with behaviour change consultants evidence has been gathered on the barriers and enablers to taking action. This has been strengthened by new qualitative research we have commissioned on the topic. Building on previous work using the behaviour change wheel, we have used behaviour change theories such as the stages of change model and the EAST framework to design interventions linked to our hearing check.

Results: early indications are that this method is acceptable to people. We will be designing the campaign for launch in autumn taking a test and learn approach.

Discussion:

We would like to discuss what we have learned and get audiologists views for further iterations of the campaign

No conflicts to declare.

77. A retrospective review of changes in perceived tinnitus severity post cochlear implantation

Ms Isabelle  Jones1, Mrs Hazel Walters1, Mr Joshua HallyMilne1, Andrew Soulby1

1Guy’s And St. Thomas’ Nhs Foundation Trust

Introduction

Individuals with severe to profound hearing loss often (approximately 80%) have associated tinnitus which can be intrusive and affect their quality of life. Like hearing aids, CIs are often able to provide some tinnitus relief when worn. However, CI surgery can rarely worsen existing or introduce new tinnitus. It is therefore valuable to explore subjective perceptions of tinnitus in people with CIs in order to provide evidence based counselling.

Method

We conducted a retrospective review of Tinnitus Handicap Inventory (THI) scores recorded pre-operatively and at 9-months post-CI. Case notes for all adult patients implanted between 06/2018 and 06/2021 at St. Thomas’ were reviewed and all patients with THI completed at both time points were included. Descriptive statistics and t-testing will be used to report and assess for significance of changes on the completed dataset.

Results

  • Thus far data from 45 patients have been analysed (23F).
  • In patients who reported mild or worse tinnitus pre-operatively their THI score dropped by an average of -14.1.
  • In patients who reported no or slight tinnitus pre-operatively their THI score increased by an average of 1.6.
  • Pre-CI 31% had moderate or worse THI score, at 9-months 20% did.
  • Four patients reported catastrophic tinnitus pre-CI, three reported their tinnitus was unchanged post-CI, all three cases were following sudden hearing loss.
  • Nine patients reported no tinnitus pre-CI, two developed tinnitus post-CI and in both cases this was mild.

Discussion

  • Patients who report no or slight tinnitus appear very unlikely to develop intrusive tinnitus as a result of CI.
  • On average patients with some level of intrusive tinnitus experience reduction in tinnitus approaching one scale on the THI.
  • Patients with catastrophic tinnitus following sudden hearing loss did not appear to receive significant tinnitus relief from CI.

No authors have any conflicts of interest to declare.

78. Option to reduce ABR Referral Rates from NHSP

Mrs Esther Tomkins1, Mrs  Bernadette Parker1

1University Hospitals Coventry And Warwickshire Nhs Trust

Objectives:

To assess the success of a change in protocol in reducing demand for Neonate Diagnostic ABR tests following the introduction of new screening equipment.

Methods:

Retrospective data analysis of referral rates pre and post the introduction of the new equipment and the change in protocol

Results:

The demand for Neonatal Diagnostic ABR tests was reduced as a result of the change in protocol ensuring effective and efficient use of resources across the pathway

Discussion:

The new screening equipment was more sensitive to noise in the wards resulting in a sudden and unsustainable increase in demand for neonate diagnostic ABR tests.  The change in protocol for screening did not impact the coverage rate of the NHSP but did reduce the increase in demand back to sustainable levels.  This will potentially have reduced parental anxiety associated with onward referral for diagnostic tests.

Conclusions:

The protocol being used maintains NHSP coverage with a steady referral rate for Neonate Diagnostic ABR testing.  This has resulted in effective and efficient use of staff resource whilst reducing parental anxiety.

No conflicts to declare.

79. Organising Departmental Service Improvement in practice using the project management tool Trello

Bridget Akande1

1Guy’s & St Thomas’ NHS Foundation Trust

Introduction:

Given the tight scheduling requirements of NHS Audiology departments, lean project management strategies offer a way to deliver service development goals without impacting clinic delivery. St Thomas’ Hearing Implant Centre has been trialling a resource called Trello since October 2021 to try and improve the efficiency of introducing service improvement ideas. Trello has supported our existing service development meetings by allowing us to visualise task completion, track project progress and increase staff engagement.

Methods:

A member of the trust’s transformation board team provided training, informing the team about Trello and its potential uses. They also facilitated the first few sessions. Our process now schedules fortnightly 20 minute virtual huddles within the adult implant team.

Within huddles:

  • Team members suggest service improvement ideas, which are recorded as tickets
  • Tickets are graded and allocated into categories depending on the complexity of delivering them. These categories are: new ideas, quick wins, plan-do-study-act, escalations/risks and sustaining the work
  • There is an opportunity at the end to record any celebrations since the last meeting.

Results:

By using Trello for the past 8 months, we’ve been able to complete the following percentage of actions in each category; sustaining the work:75%, escalation/risks:33%, PDSA:40% and quick wins:18.75%.

Discussion:

Utilising the Trello board has been a valuable addition to our routine service improvement meetings within the adult implant team. Identified positives include: the short time allocation required, the clear visualisation and tracking of progress and the boost in team morale and engagement from completing effective improvements.

Conclusions:

Our Team has found Trello particularly useful for small improvement ideas ‘quick wins’, which would not otherwise be discussed or implemented as a team. Areas for improvement include, the integration of its use with our previously existing service improvement meetings for longer or more complex projects.

80. Investigating the influence of hearing loss and hearing aid use on emotional states in everyday listening situations using ecological momentary assessment

Jack Holman1, Dr  Defne  Alfandari Menase1, Professor Graham Naylor1

1University Of Nottingham Hearing Sciences – Scottish Section

Introduction:

Despite previous research into the psychosocial impact of hearing loss, comparatively little detail is known regarding the hearing and hearing-aid related emotional states experienced by people with hearing loss. We aimed to investigate differences between the reported emotional states of people with and without hearing loss in different listening situations and the impact of hearing aid use.

Methods:

We used smartphone based ecological momentary assessment (EMA) to investigate emotional responses (valence, arousal & discrete emotions) and situational factors (e.g., location, noise) in daily-life listening situations. Two groups of participants completed eight smartphone surveys per day over the course of ten full days. The surveys queried momentary listening activity and emotions. A group of 26 people with hearing loss who own hearing aids were instructed to wear and not wear their aids on alternate days. A control group of 20 people with normal hearing also completed the surveys without any change to their everyday life.

Results:

People with hearing loss reported higher emotional valence and arousal, as well as a higher proportion of positive discrete emotions, when wearing their hearing aids compared to not wearing hearing aids. Additionally, hearing aid use positively impacted socioemotional factors. There was no significant difference between responses of those wearing hearing aids and responses from the group with no hearing loss. Amongst other findings we discovered interesting insights arising from the format of the study.

Discussion:

The results suggest that hearing loss negatively impacts the emotions experienced in everyday life. However, hearing aid use can improve the affective experience of listening situations to similar levels as those reported by people with no hearing loss. Finally, we introduce preliminary data from the next stage of the project: a study investigating emotional states in everyday listening situations before and after first-ever hearing aid fitting.

No conflicts of interest

81. Newborn diagnostic auditory assessment from NHSP during COVID lockdowns in England

Auboney Dineen1, Dr Sudhira Ratnayake1, Mrs Jane Hilliard1, Mrs Neera  Chopra1, Mrs Maureen O’Hare1, Prof Soumit Dasgupta1

1Alder Hey Childrens Nhs Foundation Trust

Introduction

During the COVID pandemic, England had 3 national lockdowns from 23rd March 2020 to March 2021 (Brown & Kirk-Wade, 2021) and the national Audiology organisations issued numerous interim guidelines.

Alder Hey Children’s Hospital cover 2 Newborn Hearing Screening Programme (NHSP) areas and undertake diagnostic Auditory Brainstem Response (ABR) tests for Isle of Man. During the COVID lockdowns, our Audiology service adopted a modified interim departmental pathway for these neonates with approval from the hospital’s ethical and COVID taskforce. This audit assesses the auditory outcomes, audiological management and medical aetiology of these newborns.

Methods

A retrospective case-note review was undertaken of all newborns who had at least one diagnostic auditory assessment (Transient-evoked Oto-acoustic Emissions – TEOAE and/or ABR) during the 12-month period of COVID lockdowns. The Audit was registered with the Governance and Quality Assurance Department.

Results

442 newborns had at least one auditory assessment. NHSP referrals included 107 “bilateral well-babies”, 275 “unilateral well-babies”, 16 “bilateral NICU-babies” and 31 “unilateral NICU-babies”. There were 13 NHSP contraindications. 325 neonates had normal TEOAE. 90 underwent diagnostic ABR (with or without initial TEOAE).

There were 12 neonates with permanent deafness (9 bilateral and 3 unilateral) – 7 had bilateral mild sensorineural deafness (SNHL) due to Vohwinkle Syndrome (1), Congenital CMV with Cystic Fibrosis (1), Autosomal Recessive Genetic Deafness (2) and unknown aetiology (3). 2 had severe-profound deafness and were referred for Cochlear Implantation. There was one complex Trisomy 21 baby with temporary unilateral conductive deafness.

Discussion

By adopting a modified interim pathway, it was possible to safely deliver a diagnostic auditory NHSP pathway without compromising time-critical auditory interventions or treatment for congenital CMV.

References

Brown J and Kirk-Wade E. (2021). Coronavirus: a history of ‘Lockdown laws’ in England. House of Commons Library. https://commonslibrary.parliament.uk

No conflict of interest.

 

82. Campaigning for change: Audiologists wanted!

Franki Oliver1

1RNID

Introduction

We are RNID, a UK charity making life more inclusive for deaf people and those with hearing loss or tinnitus. We do this through providing information, connecting people, and campaigning. Our campaigns have delivered huge social change both to wider society and within healthcare over the years, including in audiology. This includes: Modernising Hearing Aid Services, campaigning to ensuring all health services are accessible to people who are deaf or have hearing loss, to recently helping to change the criteria for cochlear implants. We also have ongoing campaigns to fight cuts to hearing aids on the NHS and recently have been working around lack of access to NHS wax removal.

Methods

We’ll focus on our key recent campaigns and how research, influencing, and campaigning translates into tangible change. As well as areas that we are still working on, such as access to services and early intervention.

Results

We’ll look at some of the priorities for campaigning that have been called for by our communities, both relevant to audiology and health care more generally. We’ll also look at some specific findings from recent campaigns, such as around wax removal.

Discussion

How can you as an audiologist help us carry out our work? We’ll discuss ways on how to get yourself, your department and your patients involved in ensuring people continue to have access to high quality health and audiology services, take action on their hearing loss earlier, and ultimately make life more inclusive for people who are deaf, have hearing loss or tinnitus.

No conflicts to declare.

83. How’s what sound? Perceptual shortcomings in current hearing-aid personalisation

William M Whitmer1,2, David McShefferty1, Benjamin Caswell-Midwinter3, Graham Naylor1

1Hearing Sciences – Scottish Section, Division of Mental Health & Clinical Neuroscience, University of Nottingham, 2Institute of Health and Wellbeing, University of Glasgow, 3Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School

In the personalisation of hearing aids, it has long been common practice for the clinician to adjust gain away from prescription based on feedback from the patient. Underlying this personalisation process, though, are several assumptions about the perception of those adjustments, from the adjustments being adequately large enough and the stimuli adequately long enough to elicit a reliable preference to the feedback being reliable within and across patients. Through a series of psychophysical studies, we have explored the viability of those assumptions.

In the first study, we examined the role of duration in the scale of gain adjustments necessary to elicit reliable preferences from patients. Twenty-nine hearing-aid users judged whether varied adjustments in broad frequency bands away from their individual settings were better, worse or no different when listening to speech segments of varying duration. The necessary gain adjustment to elicit a preference decreased and became more reliable with increasing stimulus duration, but the effect was limited, and the scale of the adjustment at longer durations was still larger than suggested by current guidelines. That is, speaking longer can lead to better fits, but only by so much.

In the second study, we examined the assumption of reliable patient feedback in fine-tuning, within and across patients. Twenty-eight online participants with minimal-to-mild hearing loss described (open-response) the difference of gain adjustments away from median prescription settings. While participants generally used some terms associated with hearing-aid gain, their usage, outwith “quiet” and “loud,” lacked reliability within or across participants. That is, particular descriptors were not associated with any particular adjustment.

These findings highlight some of our misassumptions in the personalisation of hearing aids, casting doubt on the efficacy of current fine-tuning practice and indicating that alternative approaches to personalising hearing-aid settings may be a more viable use of valuable clinical time.

No conflicts of interest to declare.

84. Development and recording of vestibular rehabilitation videos for children.

Dr  Rosa Crunkhorn1, Miss Debbie Cane2, Miss Debbie Cane2

1Guys and St Thomas, 2Manchester University NHS Foundation Trust, 3Manchester University

Introduction

Dizziness and/or balance issues affect up to 5.3% of children (Li, C.M. et al 2016), and between 30-70% of children with hearing loss (Wiener-Vacher et al, 2018). Paediatric vestibular disorders are often underdiagnosed or overlooked.

For some children, vestibular problems can have a huge impact. With appropriate vestibular rehabilitation (VR) children have been shown to make significant improvements in both reading ability and motor development. (Rine, R.M. 2018).

In the UK, there are marked inequalities in access to VR services for children, level of care provided, and few information resources on VR exercises for parents and their children.

Aims

This project aimed to increase access to VR for children, by producing a range of evidence-based videos. Stage 1 aimed for the videos to be used as part of a customised programme following specialist assessment. In stage 2, the aim is to make these videos widely available – safely signposted from a variety of non-specialist health care professionals.

Methods

Following a travelling fellowship (from the Winston Churchill Memorial Trust), a plan for VR exercise resources was made. Feedback was sought from multidisciplinary colleagues, and the videos were then recorded and edited by Manchester University’s Media Services, with funding from the Meniere’s Society.

Results

Thirty short videos were developed and recorded including information and safety videos, videos covering a range of VR exercises (gaze stability, postural stability, dynamic and reactive balance exercises) and relaxation videos. These were divided into exercises appropriate for preschool, key stage 1 and 2 children.  Feedback (from clinicians/ parents/children) will be obtained, after which it is hoped to expand availability of the videos as a free resource.

Conclusions

We have developed a set of paediatric VR video resources which we hope will provide a freely available evidence-based resource accessible for all children with balance issues.

No conflicts to declare.

85. Barriers and Facilitators to Providing Hearing Healthcare to People with Dementia Living in Long-Term Care: Interviews with Care Staff

Ms Hannah Cross1, Professor Christopher, J Armitage4, Professor Piers Dawes1,2, Professor Iracema Leroi3, Dr Rebecca, E Millman1

1Manchester Centre for Audiology and Deafness, University of Manchester, 2School of Health and Rehabilitation Sciences, University of Queensland, 3Global Brain Health Institute, Trinity College Dublin, 4Manchester Centre for Health Psychology, University of Manchester

Objectives: Hearing loss among care home residents with dementia is common. It can lead to communication difficulties, poorer quality of life and exacerbated agitation. Hearing care and support in care homes is vital but requires improvement, as hearing device use is low and environments can be loud and overstimulating. This study explored the barriers and facilitators to providing hearing care to residents with dementia according to care home staff.

Methods: Semi-structured interviews were conducted with staff (n= 10). Interviews were informed by the Theoretical Domains Framework and the COM-B Model. Analysis included first coding instances of the Theoretical Domains via content analysis and mapping these to the COM-B Model, followed by thematic analysis to further explore staffs’ barriers and facilitators to providing hearing support.

Results: Five Theoretical Domains were identified. Staff believed hearing care to be beneficial to residents with dementia (Beliefs about Consequences) but reported lacking adequate knowledge of hearing loss and hearing aids (Knowledge). There were poor collaborations between care homes and audiology services (Environmental Context and Resources), leading to distrust of audiologists (Optimism). There was also reported apprehension about the effectiveness of hearing aids for residents with dementia (Optimism). Despite staff feeling responsible for hearing care as someone in the caring profession, there was lack of ownership of hearing care within the care homes (Social/ Professional Role and Identity).

Discussion & Conclusions: Providing hearing support to residents with dementia remains a complex issue, with wide-ranging and interacting barriers. Interventions should ideally target the multiple domains identified in this study to improve effective and suitable provision, using relevant intervention functions e.g., Training, Education, Environmental Restructuring, and Incentivisation.

No conflicts of interest to declare.

86. The self-efficacy of hearing-aid self-adjustment: a sound-matching study

Janin Benecke1, William M. Whitmer1,2

1Hearing Sciences – Scottish Section, Division of Mental Health & Clinical Neuroscience, University of Nottingham, 2Institute of Health and Wellbeing, University of Glasgow

Introduction:

Self-adjustment can bolster hearing-aid personalisation, but requires interfaces that are easy, efficient and effective. Studies have shown that individual sound quality criteria may be influenced by numerous methodological factors, such as the chosen stimulus, initial parameter settings and number of controls. We here employed a method-of-adjustment sound-matching task to assess how these factors can fundamentally affect the accuracy and reliability of self-adjustments.

Methods:

In an online study, three participant groups (older hearing-aid users, older general public, younger and older ‘expert’ listeners) repeatedly adjusted stimuli (speech, music, outdoor noise and speech in noise) altered in frequency gain response to match unaltered (reference) stimuli using three interfaces: 1) a single slider controlling both bass and treble, 2) separate bass and treble sliders and 3) separate bass, mid and treble sliders. Participants also reported task demand, performance, effort, and frustration for each interface using the NASA Task Load Index.

Results:

Results will be discussed in terms of how the interface, stimulus, initial differences and participant group affect sound-matching accuracy, time taken and reliability, as well as the self-perceived efficacy of each interface. Behavioural data as well as time-series data will be further explored for patterns relating to individual accuracy. Further, correlations of measured performance to self-reported performance, effort and frustration will be evaluated.

Discussion:

By examining performance on a sound-matching task, we can provide insights into the operational and perceptual aspects of frequency-gain adjustments, helping to improve hearing aid personalisation. The potential application of the sound-matching task to determine candidature for self-adjustment will be discussed. A future within-participant study will assess the relationship of sound-matching performance to self-adjusted preferences.

This research is funded by GN Hearing A/S.

87. Coproduction of text message content to support NHS audiology patients when they are first prescribed hearing aids

Emma Broome1, Mrs Katrina Copping1, Dr Sian Calvert1, Dr Helen Henshaw1

1National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre

Introduction

In the UK, approximately 12 million people have permanent hearing loss, and 355,000 adults are fitted with hearing aids each year via the NHS. However, the non-use and infrequent use of NHS-prescribed hearing aids is high.  There can be many barriers to overcome when hearing aids are first prescribed and patients tell us that they would benefit from additional support.

The NHS-approved text-message service ‘Florence’ can help patients self-manage many different long-term conditions.  However, it has not yet been used by patients with hearing loss. We are working in partnership with patients to coproduce a Florence intervention protocol for new hearing aid users, using qualitative participatory techniques.  The intervention protocol, designed in accordance with the Medical Research Council guidance for the development and evaluation of complex interventions, will use health behaviour theory to improve patients’ capability, opportunity and motivation to use hearing aid(s) when they are first prescribed.

Methods

This qualitative study comprises a two-stage intervention development process:

  1. People with hearing loss and their communication partners will coproduce and refine text-message content using PhotoVoice, a qualitative participatory method that documents and reflects reality. A workshop with audiologists will ensure that intervention content is aligned to clinical care.
  2. The Florence protocol will be piloted with patients to gather feedback on the text-message content, language and framing, via semi-structured interviews.

This approach to intervention development will ensure that the Florence intervention addresses issues important to new hearing aid users.

Results

The coproduced Florence protocol will be iteratively refined to ensure that it is accessible, engaging and aligned to patient’s needs.

Discussion

The findings of this study will ensure that the Florence protocol is fully functional and can be successfully implemented within future studies and trials of intervention effectiveness and cost-effectiveness to benefit patients and the NHS.

No conflicts of interest to declare.

 

88. Hearing Loss and Patient Reported Experience (HELP): Using patient experience to improve audiology

Helen Pryce1, Georgina Burns-O’Connell1, Rebecca Knibb2, Amanda Hall1, Melanie  Ward3, Rosemary Greenwood4, Bristol Medical School, University of Bristol Sian Noble5, Jonathan Banks6, Laura Turton7, Jean  Straus8

1Department of Audiology, Aston University, 2Department of Psychology, Aston University, 3Hearing Therapy and Audiology department, Virgin Care and Health, St Martin’s Hospital, 4Research Design Service, University Hospitals Bristol and Weston NHS Foundation Trust, 5Bristol Medical School, University of Bristol, 6Applied Research Collaboration West (NIHR ARC West), University of Bristol, 7Audiology Department, NHS Tayside, Kings Cross Health and Community Care Centre, 8Patient and Public Representative

Βackground: One in two of us will have a significant hearing loss in older life, and this can affect every aspect of communication and daily life. There is no cure, but people with hearing loss are offered a hearing aid. Little is known about the patient experience of using hearing aids so there is a risk they are prescribed to people who cannot and do not want to use them. People stop using hearing aids because they find practical management and adapting to new sound difficult. For some, managing the aids is more difficult than managing hearing loss without hearing aids.

Aim: To improve knowledge of patient experience of hearing loss and hearing services (audiology).

Design: Three linked studies. The first study will develop a clear conceptual framework to describe the trade-offs and efforts required when coping with hearing loss with and without support from hearing services. A review of the existing literature will be conducted along with qualitative interviews.  The second will develop a Patient Reported Experience Measure (PREM) based on information gained in the first study, followed by validity and reliability testing. Finally, the third will implement the PREM in contrasting clinical locations and assess whether a measure would be taken up and used by services and whether it would help services decipher how they could adjust to meet patient needs. People who experience hearing loss will be consulted throughout the course of this three-year project.

This presentation will introduce this three-year study and present preliminary findings from the first study.

There is no conflict of interest to report.

89. What is the burden of tinnitus?

Georgina Burns-O’Connell1, Nicolas Dauman2, Georgina Burns-O’Connell1

1Department of Audiology, Aston University, 2Department of Psychology, RRPSY-CAPS, University of Poitiers

Background: Living with tinnitus creates work for the person. People have to cope with the stresses associated with hearing the tinnitus sound. Tinnitus is distracting – causing cognitive efforts to attend to other sounds. It can create emotional distress and be a lonely experience. In addition to work relating to experiencing tinnitus, patients are also expected to undertake treatment work. The efforts patients make are referred to as the burden of treatment theory.  For example, tinnitus patients are expected to undertake help-seeking activities, and to learn about tinnitus and the different management techniques. As with most chronic health conditions, most of the workload of tinnitus treatment is assigned to the patient. Even though patients are doing burdensome work, it is often not acknowledged due to the clinical focus being aimed at the outcome measures, rather than the efforts by patients to achieve those outcomes. This work is important because clinicians negotiate the work that patients are given for tinnitus treatment, but they may be unaware of the burden being experienced by the patient.

Aim: To understand the burden of illness and the burden of treatment for people living with tinnitus.

Design: A qualitative approach was used to explore how illness and treatment burden is experienced by tinnitus patients. In 2017-8, interviews were conducted with 38 participants who had sought help in a variety of UK clinical services. These data were collected with the purpose to understand the experience of help-seeking (see Pryce et al., 2018). In the present study, we used reflexive thematic analysis to explore the interview data and develop insights into the cumulative burdens relating to the experience of tinnitus.

In this presentation, the findings from this qualitative study will be presented and the burden of illness and treatment experienced by those living with tinnitus will be discussed.

There are no conflicts of interest to report.

 

90. Do hearing aids improve audiological outcomes in children with unilateral hearing loss (UHL)? A systematic review

Amanda Hall1, Dr Hannah Cooper2, Dr Katherine Mumford3

1Aston University, 2UCL, 3Family Hearing Resource Centre

Introduction:

Although hearing aid fittings for children with UHL are routinely verified using paediatric prescription formulae, there are no standardised outcome measures for validating these fittings. This means that audiologists are unable to determine whether hearing aid fitting is optimal for an individual child and whether changes to hearing aid settings will result in improvement or detriment of performance.

This study aims to review and synthesise the literature on the types and results of outcome measures (speech and questionnaires) used to evaluate hearing aid benefit in children with unilateral hearing loss. The research question is: For children with permanent unilateral hearing loss, does a hearing aid or other type of auditory amplification device lead to improved audiological outcomes?  The findings will be used to inform development of a clinic protocol for assessing benefit of hearing aid fittings in children with UHL.

Methods:

The Web of Science, PsyInfo and Pubmed databases were searched for articles relating to unilateral hearing loss, hearing aids, children and their synonyms. Studies which presented auditory related outcomes in children with UHL, with and without hearing devices were included. A risk of bias assessment was conducted of relevant studies, and data were extracted from relevant papers on the type of hearing device, the outcome measure used, the speech testing protocol used (where relevant), and aided versus unaided results.

Results and discussion:

Searching across the three databases gave 934 hits. Titles and abstracts were reviewed according to inclusion/exclusion criteria. The findings of the relevant papers will be presented and synthesised, according to the different protocols used to assess outcomes. Recommendations will be made as to a protocol for assessing hearing aid fittings in children with unilateral hearing loss.

No conflicts of interest to declare.

91. Using the science of health behaviour change to help overcome barriers to hearing aid use

Helen Henshaw1,2, Dr  Emma  Broome1,2, Ms Jean Straus1,2, Dr Sian Calvert

1NIHR Nottingham Biomedical Research Centre, 2Hearing Sciences, Mental Health and Clinical Neurosciences, University of Nottingham

Introduction: Theories and models to predict health-related behaviours are powerful tools in health research. This is particularly true for long-term conditions without cure (such as the majority of hearing losses), whereby methods to understand, predict and conceptualise patients’ behaviours are critical for informing effective self-management interventions. New UK Medial Research Council (MRC) guidance recommends that the development of new complex interventions should be based on both research evidence and theory of the problem to be addressed.

Methods: Using a person-based approach, a digital intervention (called GAIN) is being developed to help adults with hearing loss overcome common barriers to the use of hearing aids. Development is being guided by the Behaviour Change Wheel (BCW), a holistic framework for the generation of behaviour change interventions, with a ‘behaviour system’ at its hub (COM-B).

Results: Semi-structured interviews with a diverse range of adults with hearing loss (n=24) identified multiple barriers to the use of hearing aids. A behavioural analysis was used to inform the theoretical selection of targeted Behaviour Change Techniques (BCTs) to address each identified barrier. In-depth discussions with the target population were used alongside published evidence and expert stakeholder opinion to generate ‘guiding principles’ for how the intervention components should be targeted, framed, and delivered. A logic model explains how the intervention is expected to work, and how each intervention component is understood to contribute to the target outcome of improved hearing aid use.

Discussion: Intervention development is ongoing. ‘Think Aloud’ interviews with patients will be used to iteratively review and refine intervention content throughout development, offering a deep understanding of the psychosocial context of the target population and their views of the intervention. Future research will examine the feasibility of a randomised controlled trial (RCT) of the interventions’ effectiveness and cost-effectiveness both for patients, and for the NHS.

There are no conflicts of interest

92. Developing a UK Action Plan for adult hearing loss and tinnitus research

Amanda Hall1, Dr Kathryn Fackrell2, Dr Bhavisha Parmar3, Dr Giorgos Dritsakis3, Research Action Plan Working Group

1Manchester University, 2Nottingham University, 3UCL

Introduction:

In December 2020, the Department of Health & Social Care (DHSC) held a roundtable discussion on hearing loss (HL) and tinnitus research, focusing on how to further develop research capacity and capability to improve patient outcomes. The main action agreed at the event was the development of a 5 year UK Research Action Plan for HL and Tinnitus Research which will set out the conditions to grow and sustain HL and tinnitus research in the UK. It will do so by identifying actions to build research infrastructure and establish a research culture, build capacity within the NHS to support research, grow capability including the next generation of research leaders and clinical academics and increase opportunities for patients and the public to be involved and participate in research.

Methods:

The action plan development started in March 2022. The project is led by a multi-stakeholder working group including funders and patients and is funded by the UCLH, Nottingham and Manchester Biomedical Research Centres. The project has 3 phases: (a) exploring the current research landscape, (b) exploring the research landscape of the next 5 years and (c) developing recommendations on how to achieve this. A range of methods will be used including stakeholder and research process mapping, review of previously identified research priorities and the evidence for addressing them, online surveys, followed by interviews and focus groups and a consensus meeting to develop the final list of actions.

Results:

The work is due to be completed by end 2022. We will present findings and an update of the work to date.

Discussion:

This action plan has the potential to transform the HL and tinnitus research landscape and improve the pipeline from research priorities to patient benefit.

No conflicts of interest to declare.

93. Practice Listening and Understanding Speech (PLUS): Feasibility of providing auditory-cognitive training alongside hearing aids in the NHS

Helen Henshaw1,2, Dr  Mengfan Wu1,2, Dr Emma Broome1,2, Dr Antje Heinrich3

1NIHR Nottingham Biomedical Research Centre, 2Hearing Sciences, Mental Health and Clinical Neurosciences, University of Nottingham, 3Manchester Centre for Audiology and Deafness (ManCAD), School of Health Sciences, University of Manchester

Listening with hearing loss is cognitively challenging, whether due to hearing levels alone, or with the addition of hearing amplification. Auditory training has been shown to result in improvements in untrained measures of speech perception and cognition for people with hearing loss and hearing aid users. Evidence suggests that the transfer of learning to these improvements in untrained outcomes may be driven by improvements in higher-order cognitive control processes (executive functions). A meta-analysis (Lawrence et al., 2018) suggests the largest benefits to cognition for people with hearing loss may be achieved via interventions that combine both auditory and cognitive approaches (auditory-cognitive training).

Two bespoke auditory-cognitive training (ACT) interventions have been developed with patients and the public, designed to target and enhance executive functions through; 1) the refinement of perceptual and cognitive skills (phoneme discrimination n-back training), and 2) the development of cognitive control processes when listening to speech (competing-talker training). The interventions were iteratively refined through extensive at-home usability testing with hearing aid users, via; Think Aloud interviews (n=8), at-home trials (n=8), semi-structured interviews (n-8), and training diaries (n=15).

The ACT interventions will be provided to first-time hearing aid users across two NHS audiology services to assess the feasibility of conducting a future multicentre trial of ACT clinical and cost-effectiveness. The feasibility study has been designed to assess:

  • How best to provide ACT interventions to NHS audiology patients, and the cost of doing this
  • How many patients agree to take part in the feasibility study, and how many will be needed for the trial
  • What patients and clinicians think about the ACT interventions and the trial processes
  • How long it takes to collect and analyse all of the research data.

The feasibility study will help ensure that the trial provides high-quality evidence and value for money.

There are no conflicts of interest.

94. Verbal and non-verbal auditory sequential memory test: Performance of an app

Cláudia  Reis1, Luísa Passadouro1, Carla Silva1, Cristina Nazaré1, Patrick Franco2, Margarida Serrano1

1Instituto Politécnico de Coimbra, Estesc – Coimbra Health School, Audiology, 2Sensing Evolution (Evollu)

Introduction: Audiology area also benefits from the digital evolution that facilitates access to information for the public, but also for the audiologist himself. Evollu is a company that, together with the academy, is developing apps that can be used both for self-care and by the audiologist as a counseling aid or even as information collection tools. The objective of this study was to verify if the performance of tests of verbal memory and non-verbal memory performed with an app is identical to the performance of the same tests performed by the clinical method.

Methods: Three age groups, 5 years old, 9 years old, and young adults were evaluated with sequential memory tests. To the 5-year-old group, 3 sequences of 3 verbal stimuli (pa, ta, ca) and 3 nonverbal (rattles, drum, bell) were applied; 3 sequences of 4 verbal stimuli (pa, ta, ca, fa) and 4 nonverbal stimuli (rattles, drum, bell, maracas) were applied to the 9-year-old group and young adults. All subjects were normal hearing.

Results: There were identical results between the tests performed by the app and those performed by the clinical method, in the three age groups, and in both tests.

Discussion: This app proved to be valid for performing sequential memory tests in the age groups studied. The apps can be a reliable method of self-care and referral to the health professional and can also facilitate the clinical intervention by audiologists.

This work is co-financed by the European Regional Development Fund (ERDF), through the partnership agreement Portugal2020 – Regional Operation Program CENTRO2020, under the project CENTRO-01-0247-FEDER-047083 A4A: Audiology for All.

References: Pereira, L D (Org.) ; Schochat, E (Org.) . (2011) Testes Auditivos Comportamentais para Avaliação do Processamento Auditivo Central. 1ª. ed. Barueri: Pró-Fono, v. 1. 82p .

No conflict of interest

95. Hearing outcomes of children with Down syndrome in the first 6 years of life: an evaluation of two UK Audiology services.

Amanda Hall1, Keir Cox2, Lucy French3, Karen Willis4

1Aston University, 2University Hospitals of Leicester NHS Trust, 3University Hospitals Bristol and Weston NHS Trust, 4Nottingham University Hospitals NHS Trust

Introduction:

Children with Down syndrome are at increased risk of ear and hearing problems.  Cross-sectional studies of hearing during infancy, pre-school and primary years show high prevalence of OME and hearing loss.  There are few longitudinal studies, so it is uncertain how hearing loss develops and changes during the early years of life. There is a need for more data on the natural history of hearing to inform clinical decisions around frequency of assessments and timing of provision of interventions for those with hearing loss. This study aims to describe the hearing outcomes of children with Down syndrome in the first 6 years of life, across two NHS Audiology services in England.

Methods:

This is a service evaluation, reporting on the process and outcomes of children with Down syndrome attending two NHS Audiology services in Bristol and Nottingham, UK. All children with Down syndrome from both services born between 2008 to 2014 were included. The audiology records of each child were examined, and information on hearing and interventions extracted and categorised.

Results:

Data from 117 children are included in the evaluation. Approximately 15% of children had hearing loss identified from the newborn hearing screen, most commonly unilateral or bilateral conductive loss. On the first behavioural hearing test up to age 1, hearing thresholds were measured successfully in only around 20% of children. There were very few children who had satisfactory hearing throughout the first 6 years of life, with fluctuating conductive hearing loss common. There was a difference in timing and type of provision of interventions across the two services. The number of children not brought to appointments increased with age.

Discussion:

Recommendations will be made regarding behavioural assessment of children in the first year of life and interventions for fluctuating conductive hearing loss.

No conflicts of interest

96. Experiences, challenges and what is needed when caring for adults with hyperacusis

Kathryn Fackrell1,2, Ms Carol MacDonald3, Ms Nic Wray1, Dr Veronica Kennedy4, Ms Linda Stratmann1, Dr Derek Hoare1,2

1National Institute of Health Research Nottingham Biomedical Research Centre, 2Hearing Sciences, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, 3Department of Psychology, University of Stirling, 4Department of Paediatric Audiology, Bolton NHS (National Health Service) Foundation Trust

Introduction: It is estimated approximately 14% of the general population experience hyperacusis. It can be complicated and challenging to live with, and people can become distressed, anxious, and often isolated. These problems are exacerbated the lack of information and accessible support. Digital health interventions can provide the perfect platform to improve accessibility to education, support and self-help strategies. In order to develop a meaningful intervention that reflects the experience of intended users, it is also essential to understand the experiences of healthcare professionals (HCPs) who care for adults with hyperacusis. This study therefore aimed to explore HCPs experiences and challenges of caring for adults with hyperacusis, and understand information and support requirements that could be provided through a digital intervention.

Methods: Semi-structured interviews were carried out with 12 HCPs who care for patients with hyperacusis in clinical practice within the UK (5 audiologists, 2 clinical scientists, 2 hearing therapists, 2 general practitioners, and 1 CBT psychologist). Data were analysed using thematic analysis.

Results: HCPs experience of caring for patients with hyperacusis ranged from less than 1 year to 45 years, with 6 HCPs having more than 10 years’ experience. Between 1 and 12 patients with hyperacusis were seen on average per month. Preliminary thematic analysis identified themes around ‘perception of impact of hyperacusis’, ‘building rapport’ ‘the right management strategy’, ‘challenging safety behaviours’ and ‘accessible training’.

Conclusions: The themes provide key insights into the experiences and challenges of caring for adults with hyperacusis. Preconceptions influenced how receptive patients were to trying the strategies or reducing safety behaviours. Critically, HCPs highlighted the importance of building rapport, understanding and empathy with the patients to overcome this. These insights are not only important for the development of the digital intervention, but also for the whole of healthcare.

No conflict of interest

97. An Evaluation of the Cochlear BAHA 5 SuperPower (BAHA5SP) and Power Bone Anchored Hearing Devices (PBAHD); Cochlear BP110 and Oticon Ponto Pro Power.

Feraz Ahmed1

1NHS Scotland, 2Queen Margaret University

Introduction:

Percutaneous bone conduction devices are an important rehabilitation option for hearing impaired individuals with conductive or mixed hearing loss whom unable to wear conventional hearing aids. Historically, BAHDs come in two strengths depending on an individual’s hearing loss: standard and power devices providing gain for individuals with a Bone Conduction (BC) hearing loss of 45-55dB. The question does arise as to what happens if a long-term wearer of a BAHD starts to develop a further hearing loss due to presbycusis would the comparison of current PBAHD devices with the new Cochlear BAHA 5SP provide a solution to the difficulties faced?

Method:

The aim of the study was to investigate how the BAHA 5SP benefits those patients that were aided with PBAHD such as Cochlear BP110 or Oticon Medical’s Ponto Pro Power. This study did this by evaluating information retrospectively collected from 16 participants, by comparing objective aided outcomes in the form of aided SF audiometry, aided speech tests from AB word lists (HOSRT scores) and aided SNR loss scores from QUICKSIN, equating to their PBAHD and their BAHA 5SP. Subjective information in the form of global scores and subscales from the APHAB questionnaire and SSQ were compared.

Results

A significant benefit was observed in all objective measurements with average improvements of 20.9dB aided SF thresholds, 18.9dB aided HOSRT and 11.5dB SNR Loss. A significant improvement of 3.40 in SSQ scores and 66.6 improvement in the global APHAB scores for BAHA 5SP was found. The BAHA 5SP provided improved EC scores of 52.3, BN scores of 70.3 and RV scores of 70.7 in APHAB subscales.

Conclusion

In conclusion the Cochlear BAHA 5SP sound processor is significantly beneficial and more favourable compared to Cochlear BP110 and Oticon Ponto Pro Power BAHD.

No conflicts of interest

98. Promoting sensory health and awareness in dementia

Jenna Littlejohn

1Manchester Centre for Audiology and Deafness (ManCAD), 2Deafness Support Network (DSN)

Despite hearing loss being a major risk factor for dementia and presenting an unmet need for people living with dementia, awareness of the overlaps between the conditions remains low amongst clinicians and the general public. The aim of this package of works was to understand where identification and management of sensory loss best fits into the dementia diagnostic pathway, and what information is needed to help support this.

Working in partnership with multi-disciplinary clinicians and those with lived experience, through a series of semi-structured interviews, we discuss the best ways to ensure sensory loss is recognised at the earliest stages, considering both knowledge and service model structures.

An early output includes the generation of a ‘easy read’ patient facing guide for understanding the links between sensory loss and dementia, why they are important and how to best support somebody living with sensory loss and dementia. The hope is this free guide will be used widely amongst health care professionals when discussing sensory loss/ dementia with their patients across a variety of settings such as general practice, audiology and dementia care. Together with examples for systematic changes, this increase in awareness of the general public may help start the movement towards better recognition and management of sensory loss in the context of people living with dementia.

No conflicts

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