Quality Standards for Adult Hearing Rehabilitation Services

2. Adult Hearing Rehabilitation Services

2.1 Introduction to Adult Hearing Rehabilitation Services

Hearing problems arise from defects in either the middle or the inner ear. The former lead to conductive hearing losses and the latter to sensorineural hearing losses. Almost one in five of Scotland's adult population suffers from a measurable deficit in hearing which is likely to lead to difficulties in understanding speech, particularly in noisy backgrounds. The population prevalence of hearing impairment increases exponentially with increasing age. Changes in population demographics will, therefore, have important implications for future services. Additionally, population prevalence halves with every 10dB increase in hearing level. This leads to large numbers of people in the population with moderate to severe hearing problems and smaller numbers with severe and profound hearing losses, though the latter do of course have a much more severe impact. While around one in six adults could benefit from current NHS hearing services, only one third of candidates attend for management, leading to substantial un-met need in the population.

Audiology departments supply services to manage disability associated with hearing impairment. This includes, in addition to hearing aid provision, support and counseling usually delivered within a team of professionals working in association with other agencies/voluntary sector organisations e.g. in some local teams this may involve care from Hearing Therapists and Speech and Language Therapists. It should also include onward referral for those with significant residual disability to appropriate services such as agencies providing assistive listening devices, courses on non-verbal communication, cochlear implants and bone anchored hearing aids.

The services which should be offered by audiology departments with suspected hearing impairment include:

• Appropriate hearing testing, with screening for other causes of hearing impairment and onward referral as appropriate;
• Evaluation of the audiological needs of the service user;
• Agreement with the service user on the best aiding device(s) for their problems, and discussion about the likely effect of such devices on their ability to hear;
• Fitting of aids to provide sufficient and appropriate amplification;
• Training service users in the use and maintenance of their aid(s), and provision of rehabilitative support to ensure that they can use them effectively;
• Providing information on other sources of help, support, equipment and assistive devices, or referral to organisations which can provide these as appropriate;
• Ongoing repair and maintenance of hearing aids (including provision of batteries and replacement tubing).

The scope of this document does not include specialist hearing rehabilitation services but does cover the services provided for the majority of clinical activity. Examples of care pathways are shown in the Do Once and Share care pathways ( www.mrchear.man.ac.uk ) and those shown in good practice documents such as Transforming Adult Hearing Services (Department of Health, England. Good practice in transforming adult hearing services for patients with hearing difficulty. June 2007).