Quality Standards for Adult Hearing Rehabilitation Services

Appendices

Appendix 1

Group Membership

Name	Role	Representing
Adam Beckman	Head of Audiology Services	British Academy of Audiology Plymouth Hospitals NHS Trust
Angela Bonomy	National Audiology Manager	NHS Scotland
Katy Bullock	Public Partnership Officer	NHS Quality Improvement Scotland
Adrian Carragher	Head of Audiology	NHS Ayrshire & Arran
Adrian Davis	Director	MRC Hearing and Communication Group
Hugh Davis	Consultant	MRC Hearing and Communication Group
John Day	Audiologist	Welsh Assembly Government
Jo Edwards	Lecturer in Audiology	Queen Margaret University
Martin Evans	Consultant	MRC Hearing and Communication Group
Theresa Fail		Department of Health
Delia Henry	Director	RNID Scotland
Phil Holt	Senior Audiologist	MRC Hearing and Communication Group
Marian Hoyle	Senior Lecturer in Audiology	Bristol University
Bill McKerrow	ENT Consultant	NHS Highland
Karen Shepherd	Audiological Services Manager	Ormerods
Pauline Smith	Audiologist	British Academy of Audiology
Kevin Wyke	Assistant Director	NHS North West

Appendix 2: Evidence Base

Standard 1

Designed for Life: a new strategy for health and social care in Wales. In May 2005, the Welsh Assembly Government.

Standard 2

Benefits of Good Communication:

Reese JL. Hnath-Chisolm T. Recognition of hearing aid orientation content by first-time users. American Journal of Audiology. 2005 Jun; 14(1): 94-104.

Alywahby NF. Principles of teaching for individual learning of older adults. Rehabilitation Nursing. 1989 Nov-Dec; 14(6): 330-3.

Greenberg PB. Walker C. Buchbinder R. Optimising communication between consumers and clinicians. Medical Journal of Australia. Vol. 185(5)(pp 246-247), 2006.

Harris M. RNID for deaf and hard of hearing people: a simple cure. Working with Older People. 2005 Jun; 9(2): 37-9.

Iezzoni LI. O'Day BL. Killeen M. Harker H. Improving patient care. Communicating about health care: observations from persons who are deaf or hard of hearing. Annals of Internal Medicine. 2004 Mar 2; 140(5): 356-62, I-68

Harris M. Bayer A. Tadd W. Addressing the information needs of older patients. Reviews in Clinical Gerontology. 2002 Feb; 12(1): 5-11.

DiSarno NJ. Informing the older consumer -- a model. Hearing Journal. 1997 Oct; 50(10): 49, 52.

Information strategy older people, Department of Health, March 2002.

Hines, J (2000) Communication problems of hearing-impaired patients. Nurs Stand. 14(19):33-7

Features of Effective Information:

Toolkit for producing patient information, Department of Health, 2003. www.nhsidentity.nhs.uk/patientinformationtoolkit/patientinformationtoolkit.pdf

EXTRACT: "Patients with hearing difficulties: Use written information."

Measures to Avoid Discrimination:

Disability Discrimination Act, 1995.

'You Can Make a Difference' - Improving hospital and primary care services for disabled people. Guidance from the Disability Rights Commission & Department of Health, June 2004. www.dh.gov.uk/publications

Living well in later life - A review of progress against the National Service Framework for Older People, Department of Health, March 2006.

Participation of Significant Others:

Preminger, Jill E. Should significant others be encouraged to join adult group audiologic rehabilitation classes?. Journal of the American Academy of Audiology. 14(10):545-55, 2003 Dec.

University of Louisville School of Medicine, Program in Audiology, Louisville, KY 40292, USA.

Standard 3

British Society of Audiology ( BSA) Procedure: Pure tone air and bone conduction threshold audiometry with and without masking and determination of uncomfortable loudness levels (2004).

ISO 8253-1:1989 Acoustics. Audiometric test methods - Part 1: Basic pure tone air and bone conduction threshold audiometry.

Standard 4

Kochkin S. (1999) Reducing hearing instrument returns with consumer education. Hear Rev. 6(10):18-20.

Fully Equipped (2002). Assisting independence. Audit Commission

Wilson, C, Stevens, D (2003) Reasons for referral and attitudes toward hearing aids: do they affect outcome? Clin Otolaryngol Allied Sci, 21(2): 142-6

Stevens, D (1996) Hearing rehabilitation in a psychosocial framework. Scand Audiol Suppl. 43:57-66

Stevenson, G (2006) Informed consent. J Perioper Pract. 16(8):384-8

Hagihara, A, Odamaki, M, Nobutomo, K, Tarumi, K (2006) Physician and patient perceptions of the physician explanations in medical encounters. J Health Psychol, 11(1):91-105

Greene, MG, Adelman, RD, Friedmann, E, Charon, R (1994) Older patient satisfaction with communication during an initial medical encounter. Soc Sci Med. 38(9):1279-88

McCarthy, PA, Montgomery, AA, Mueller, HG (1990) Decision making in rehabilitative audiology. J Am Acad Audiol. 1(1):23-30

Standard 5

Souza, PE, Yueh, B, Sarubbi, M, Loovis, CF (2000) Fitting hearing aids with the Articulation Index: impact on hearing aid effectiveness. J Rehabil Res Dev. 37(4):473-81

Gatehouse, S, Stephens, SDG, Davis, AC, Bamford, J (2003) Good Practice Guidance for Adult Hearing Aid Fittings and Services. Needs Assessment Report on NHS Audiology Services in Scotland. Appendix 5

British Society of Audiology & British Academy of Audiology: Guidance on the use of real ear measurement to verify the fitting of digital signal processing hearing aids (2007).Guidelines for the Audiological Management of Adult Hearing Impairment. (Audiology Today, Vol 18:5, 2006)

Hawkins DB. (1987) Clinical ear canal probe tube measurements. Ear Hear 8(Suppl. 5):74S-81S.

Hawkins DB, Alvarez E, Houlihan J. (1991) Reliability of three types of probe tube

microphone measurements. Hear Instrum 42:14-16.

Hawkins DB, Montgomery A, Prosek R, Walden B. (1987) Examination of two issues

concerning functional gain measurements. J Speech Hear Disord 52:56-63.

Humes L, Kim E. (1990) The reliability of functional gain. J Speech Hear Res 55:193-197.

Stuart A, Durieus-Smith A, Stenstrom R. (1990) Critical differences in aided sound-field thresholds in children. J Speech Hear Res 33:612-615.

Fully Equipped (2002). Assisting independence. Audit Commission

Improving Access to Audiology Services in England (2007). Dept of Health

Best Practice Standards for Adult Audiology. (2001) RNID

Pilot Study: Efficacy of Recalling Adult Hearing Aid Users for Reassessment after 3 Years within a Publicly-Funded Audiology Service - accepted for publication by IJA, October 2008

Bilateral Amplification:

Noble, W. & Gatehouse, S. 2006. Effects of bilateral versus unilateral hearing aid fitting on abilities measured by the Speech, Spatial, and Qualities of Hearing Scale ( SSQ). International Journal of Audiology. 45, 172-181.

Mencher, G.T. and Davis, A. 2006. Bilateral or unilateral amplification: Is there a difference? A brief tutorial. International Journal of Audiology. 45 (Supplement 1): S3-S11.

Dillon H, 2001. Hearing Aids. Boomerang Press: Turramurra, Australia p370-403

Standard 6

Chisholm, TH, Abrams, AB, McArdle, R (2004) Short and long-term outcomes of adult audiological rehabilitation. Ear Hear. 25(5): 414-77

Cox R, Alexander G. (1995) The Abbreviated Profile of Hearing Aid Benefit. Ear Hear 16:176-

186.

Cox, R.M., and Alexander, G.C. "The International Outcome Inventory for Hearing Aids ( IOI- HA): psychometric properties of the English version." International Journal of Aud. 41(1): 30-35 (2002).

Dillon H, James A, Ginis J. (1997) The client oriented scale of improvement ( COSI) and its

relationship to several other measures of benefit and satisfaction provided by hearing aids. J

Am Acad Audiol 8:27-43.

Gatehouse S. (1999) The Glasgow hearing aid benefit profile: derivation and validation of a patient-centered outcome measure for hearing aid services. J Am Acad Audiol 10:80-103

Gatehouse, S (1999) A self-report outcome measure for the evaluation of hearing aid fittings and services. Health Bull. (Edinb). 57(6):424-36

Gatehouse, S (2003) Rehabilitation: identification of needs, priorities and expectations, and the evaluation of benefit. Int J Audiol. 42 Suppt 2:2S77-83. Review

Dillon, H, James, A, Ginis, J (1997) Client Oriented Scale of Improvement ( COSI) and its relationship to several other measures of benefit and satisfaction provided by hearing aids. J Am Acad Audiol. 8(1):27-43

Saunders GH, Jutai, JW (2004) Hearing specific and generic measures of psychosocial impact of hearing aids. J Am Acad Audiol. 15(3):238-48

Stark, P, Hickson, L (2004) Outcomes of hearing aid fitting for older people with hearing impairment and their significant others. Int J Audiol. 43(7):390-8

Valente et al (2005)

Ventry I, Weinstein B. (1982) The hearing handicap inventory for the elderly: a new tool. Ear

Hear 3:128-134.

Standard 7

Fully Equipped (2002). Assisting independence. Audit Commission

HPC - Standards of Proficiency of registered Practitoners - http://www.hpc-uk.org/publications/standards/index.asp?id=42

Scottish Consumer Council (2005) The NHS and You. Health Rights Information Scotland Leaflet.

Department of Health (2004) The NHS Knowledge and Skills Framework and the Development Review Process. Department of Health Publications.

Standard 8

Group Interventions/peer support/sharing experiences:

D.B. Hawkins. Effectiveness of counseling-based adult group aural rehabilitation programs: A systematic review of the evidence. Journal of the American Academy of Audiology. Vol. 16(7)(pp 485-493), 2005.

Dr. D.B. Hawkins, Audiology Section, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224; United States.

Chisolm TH. Abrams HB. McArdle R. Short- and long-term outcomes of adult audiological rehabilitation. Ear & Hearing. Vol. 25(5)(pp 464-477), 2004.

T.H. Chisolm, University of South Florida, Commun. Sci. and Disorders PCD1017, 4202 E. Fowler Avenue, Tampa, FL 33620; United States.

Preminger, Jill E. Should significant others be encouraged to join adult group audiologic rehabilitation classes?. Journal of the American Academy of Audiology. 14(10):545-55, 2003 Dec.

University of Louisville School of Medicine, Program in Audiology, Louisville, KY 40292, USA.

Brewer DM Considerations in measuring effectiveness of group audiologic rehabilitation classes. Journal of the Academy of Rehabilitative Audiology. 2001; 34 53-60.

Associate Professor, Speech and Hearing Science, George Washington University, 2201 G St NW, Room 421, Washington DC 20052

Lesner SA. Thomas-Frank S. Klingler MS. Assessment of the effectiveness of an adult audiologic rehabilitation program using a knowledge-based test and a measure of hearing aid satisfaction. Journal of the Academy of Rehabilitative Audiology. 2001; 34 29-39.

Professor, School of Speech-Language Pathology and Audiology, University of Akron, Akron, Ohio

J. Abrahamson, Olin E. Group audiologic rehabilitation. Seminars in Hearing. Vol. 21(3)(pp 227-233), 2000. Teague Veterans' Center, Temple, TX 76504; United States

K S. Taylor, W E. Jurma. Study suggests that group rehabilitation increases benefit of hearing aid fittings. The Hearing Journal 1999 Vol. 52 No. 9.

Service User Groups:

Dibb B, Yardley L How does social comparison within a self-help group influence adjustment to chronic illness? A longitudinal study. Social Science & Medicine. Vol. 63(6)(pp 1602-1613), 2006.

University of Southampton, Southampton, Hampshire SO17 1BJ; United Kingdom.

Krajnc S. Krajnc M.The impact of a community-based self-help group for the elderly on their quality of life [Slovene]. Obzornik Zdravstvene Nege. 2005; 39(3): 221-7

Volunteer Schemes:

Kapteyn, T S. Wijkel, D. Hackenitz, E. The effects of involvement of the general practitioner and guidance of the hearing impaired on hearing-aid use. British Journal of Audiology. 31(6):399-407, 1997 Dec. Department of Otorhinolaryngology, University Hospital, Vrije Universiteit, Amsterdam, The Netherlands.

Carson AJ. Evaluation of the To Hear Again Project. Journal of Speech-Language Pathology and Audiology. 1997 Sep; 21(3): 160-6. University of British Columbia, School of Audiology and Speech Sciences, 5804 Fairview Avenue, Vancouver, BC V6T 1Z3,

Dahl MO. To Hear Again: a volunteer program in hearing health care for hard-of-hearing seniors. Journal of Speech-Language Pathology and Audiology. 1997 Sep; 21(3): 153-9.

Western Institute for the Deaf and Hard of Hearing, Vancouver, British Columbia.

Faulkner, Mark (1); Davies, Sue (2). Social support in the healthcare setting: the role of volunteers. Health & Social Care in the Community. 13(1):38-45, January 2005.

(1)Department of Community Ageing Rehabilitation, Education and Research, University of Sheffield, Rotherham, UK (2)Department of Community Ageing Rehabilitation, Education and Research, The University of Sheffield, Sheffield, UK.

Welsh Assembly Government (2002) Building Strong Bridges: Strengthening partnership working between the Voluntary Sector and the NHS in Wales. Cardiff: Welsh Assembly Government

Seeking the Views of Service Users:

Welsh Assembly Government and OPM. 2003, Signposts 2: Putting Public and Patient Involvement into Practice in Wales. Cardiff. Welsh Assembly Government

Joint Working:

National Service Framework for Older People in Wales. March 2006. Welsh Assembly Government, Cardiff.

Audit Commission Report 'Fully Equipped': the provision of equipment to older

or disabled people by the NHS and social services in England and Wales 2000, para 137-138.

Nies, Henk Managing effective partnerships in older people's services. Health & Social Care in the Community. 14(5):391-399, September 2006.

Division on Care, NIZW/Netherlands Institute for Care and Welfare, Utrecht, the Netherlands

Lyon D. Miller J. Pine K. The Castlefields Integrated Care Model: the evidence summarised. Journal of Integrated Care. 2006 Feb; 14(1): 7-12.

GP, Castlefields Health Centre, Runcorn.

Brown L. Tucker C. Domokos T. Evaluating the impact of integrated health and social care teams on older people living in the community. Health and Social Care in the Community. 2003 Mar; 11(2): 85-94

Standard 9

.

Appendix 3: The Individual Management Plan ( IMP)

A Usable Interpretation of Individual Management Plans within Adult Rehabilitation
Questions and Answers
What is an Individual Management Plan?

Individual Management Plans are a set of agreed needs and actions that aim to improve a person's participation in life by reducing the disabling effects of a hearing impairment. When first developed it will be a list of the needs you and the patient have agreed need to be addressed and a list of the actions you are going to take in an attempt to address these needs.

Who has them?

They will probably be developed for all patients entering a new care pathway. These may be patients who have accessed audiology services before (audio reviews) or they may be new patients (Direct Referrals or ENTHA referrals).

Who develops them?

The Audiologist and patient will develop the Plan together using the information gathered during the assessment and following explanation and discussion about the care options. A list of agreed needs and actions will be recorded. A copy will be given to the patient as part of their information booklet.

What do they look like?

Initially you will develop and record the needs and actions

Management Plan Agreed Needs: a list of the issues that you and the patient have agreed need to be addressed/managed/rehabilitated Actions: a list of the actions you going to do or what are you going to ask somebody else to do to actually attempt to meet these needs

And then as you begin to deliver the Plan you will add:

Completed Actions: a list of the actions you actually do at each stage Outcomes: a summary of the effects of the actions - have they met needs

What do you mean 'agreed needs'?

What is it that you and the patient have agreed that needs to be addressed or managed or rehabilitated. This will be based on in-depth history, discussion, hearing impairment, condition of ext/ ME, expectations etc.

They will be broad statements of need but will be specific to an individual

Examples: " Improve comfort of ear mould " Better understand the effects and implications of sensorineural HL " Investigate conductive hearing loss " Improve hearing for speech in noisy environments " Improve patients confidence in group social situations

What do you mean 'actions'?

What are you going to do or what are you going to ask somebody else to do to actually attempt to meet these needs. They will be specific and directive, probably written in the future tense and attached or relevant to one or more of the needs.

Examples: Need: Improve comfort of ear mould Possible actions you may decide upon: " File and polish earmould to remove uncomfortable ridge " Take new impression of right ear and order replacement ear mould " Take new impression of right ear and order earmould made from softer material " Guide patient on correct insertion of ear mould and provide written information/diagrams to support

What do you mean 'completed actions'?

These are the actions you (or other audiologists/agencies) actually do at each stage (as opposed to plan to do). They will be directly linked to actions (very similar) and probably written in past tense.

Action: Take new impression of right ear and order earmould made from softer material Completed Action: Took new impression of RT ear (2108 microflex) and arranged for fitting appointment

What do you mean 'outcomes'?

These will be a summary of the effects of actions and will enable you to evaluate if the actions have met the needs? Ideally these will be supported by a more formal overall outcome measure.

They will be linked to needs and may often reference specific actions. They will probably be written in the present tense.

Need: Improve comfort of ear mould Action: Take new impression of right ear and order earmould made from softer material Completed Action: Took new impression of RT ear (2108 microflex) and arranged for fitting appointment Outcome: New earmould good fit and patient reports softer material much more comfortable than previous earmoulds.

When is a management plan completed and how do we record this?

The management plan is complete when there are no outstanding actions and when outcomes indicate that needs have been met. 'Management plan complete' will be added as a final statement to the bottom of the management plan and the patient will be discharged to maintenance and support services.

You need to consider how you include outcomes or effects of referral to external agencies that may not have been delivered at final follow up appointments.

What happens then?

Some patients will then be discharged to the maintenance and support services where they are able to access audiology for repairs and maintenance and can self refer for reassessment (at this point they would re-enter a new care pathway and would have a new management plan developed).

Appendix 4: Adult Rehabilitation Patient Pathway

An Example of How the Individual Management Plan Fits within an Audiology Adult Rehabilitation Patient Pathway

Appendix 5: Example of an Individual Management Plan ( IMP)

CASE 1 - Journal entry including Individual Management Plan
Direct Referral

History - Service User reported:

General

Service User attended alone. Self referred via GP. Main difficulties hearing at work over last 12 months.

Physical

Vision corrected with glasses

Mobility and dexterity good

Social

Lives with wife and two teenage sons. No problems with hearing telephone ring or callers at door. Tend to shop and bank on-line so no recent problems hearing for these scenarios. Alarm clock and smoke alarm OK

Employment

Fitter by trade - worked on shop floor for 15+ years - no problems. Recently promoted to supervisor - job now involves: training/presenting, management meetings, Q&A sessions with people he supervises/line manages. Hearing problems seem to be mainly at work and since change in role. Management meetings of about 12 people around table - people vary and sometimes struggles. Monday morning meetings with staff are difficult - poor env and lots of people talking/asking questions at once. Problematic as people used to be friends and concerned they think he's changed since promotion.

Training sessions in lecture theatre difficult. Has to go back and pass on info and worried he's not understood properly

Lifestyle and associated hearing disabilities

Mainly socialises with family. No signif problem - family tend to understand and adapt.

Enjoys attending concerts about 6/year. Goes with same group of friends. Used to go to pub after but struggling more in this environment recently and tending to go straight home.

Medical

Sudden/progressive: had minor difficulties for a long time (?since childhood). Seems to have become worse since change in job but really only at work and with unfamiliar groups of people. No real change at home.

Asymmetric: no

Fluctuating: no

Otalgia/ ME pathology/surgery: no

Ext ear pathology/irritation: no

Tinnitus: yes - bilaterally all the time but doesn't notice if busy or distracted. Sometimes keeps awake at night or there if wakes up at night. Recognises it may be linked to 'worry/stress'.

Rotational vertigo: no

Family History: dad wore HA since middle age

Noise exposure: at work but wore hearing protection. At concerts (~6/year)

Head Injury: no

General Health: well

Expectations

Expects to be told he has a hearing loss but hopes hearing can be improved (surgery/medication). See ECHO for further details.

Otoscopy

NAD

Audiometry

Mild mid freq SNHL

Questionnaires

GHABP complete What are the scores?

ECHO scores What is the scale here? Is 6.0 high?

Scores	Average
Overall	5.3
Sub Scale
Positive effect	6.0
Service and cost	5.5
Negative Features	5.0
Personal Image	4.7

Management Plan

Agreed needs: Improve ability to hear colleagues when at training sessions; management meetings and Monday morning meetings at work. Build confidence in hearing ability so that you can begin to go out socially with music friends again. Manage expectations about hearing aid use. Reduce the negative impact of tinnitus.

Planned Actions: Trial bilateral digital hearing aids with directional programme. Refer to voluntary sector employment advisor for support within workplace. Complete tinnitus handicap inventory and consider referral to hearing therapist following trial of hearing aid. Provide verbal and written information about the potential benefits and limitations of hearing aids

Completed Actions: Took bilateral impressions and arranged hearing aid fitting appointment. Completed tinnitus handicap inventory. Referred to RNID employment advisor. Discussed expectations, benefits and limitations of hearing aids. Supported by written info in blue book.

Information booklet

Given to patient.

Final Follow Up

Copy of Management Plan

Agreed needs: Improve ability to hear colleagues when at training sessions; management meetings and Monday morning meetings at work. Build confidence in hearing ability so that you can begin to go out socially with music friends again. Manage expectations about hearing aid use. Reduce the negative impact of tinnitus.

Planned Actions: Trial bilateral digital hearing aids with directional programme. Refer to RNID employment advisor for support within workplace. Complete tinnitus handicap inventory and consider referral to hearing therapist following trial of hearing aid. Provide verbal and written information about the potential benefits and limitations of hearing aids

Completed Actions: Took bilateral impressions and arranged hearing aid fitting appointment. Completed tinnitus handicap inventory. Referred to voluntary sector employment advisor. Discussed expectations, benefits and limitations of hearing aids. Supported by written info in blue book. Fitted bilateral hearing aids with dir prog; added further written info to booklet; discussed expectations further; hearing therapy appt arranged; voluntary sector employment advisor has made contact with pt. Tinnitus advice and information provided by hearing therapist. Activated telecoil prog bilaterally; voluntary sector employment advisor has visited work place and advised;.
Outcomes: Hearing in most situations has improved as has confidence in hearing ability. Location for Monday morning meetings changed and now managing well. Unable to evaluate full benefit in training centre at work yet - telecoils activated today - good benefit during training sessions at work using loop system; now meeting friends in local pub regularly; information about HL and tinnitus and increased confidence in hearing at work has reduced stress and negative impact of tinnitus. Pt has a positive and realistic approach to hearing aid use and benefit. Supported by GHABP

Management plan complete

People present at appt

Pt attended alone

Service User reports

Continuing to use both hearing aids regularly. Slightly more use out of work than at previous FU. EM no longer causing discomfort

Data logging

Data logging supports patient reports

Hearing Aid Adjustments

1.1.1 R - none

1.1.2 L - none

Other rehabilitation comments

Discussed longer term management of hearing aids and access to services. Gave further written info to support this for pt information booklet.
GHABP parts 1&2

	% raw score		% raw score
Initial disability	59	Residual Disability	6
Handicap	75	Benefit	72
Use	88	Satisfaction	84

Service satisfaction questionnaire completed and given to reception

Appendix 6: List of useful websites

www.baaudiology.org

www.dh.gov.uk

www.mrchear.man.ac.uk

www.nhshealthquality.org

www.phis.org.uk

www.rnid.org.uk

www.scotland.gov.uk

www.thebsa.org.uk

www.18weeks.scot.nhs.uk

http://www.vds.org.uk/tabid/232/Default.aspx

http://iiv.investinginvolunteers.org.uk

Appendix 7 - Glossary

• Higher Frequency sounds- are high in pitch, like the right hand end of a piano, or a violin rather than the left hand end of a piano or a double bass.
• Lower frequency sounds- are low in pitch, like the left hand end of a piano, or a double bass rather than the right hand end of a piano or a violin.
• Threshold of hearing-the lowest intensity of sound that a person can detect, measured using a standard procedure and usually at a range of pure tones at various frequencies.
• Thresholds of uncomfortable loudness-the lowest intensity of sound that a person finds uncomfortably loud, measured using a standard procedure and usually at a range of pure tones at various frequencies.
• Dynamic range-the difference between threshold of hearing and uncomfortable loudness level.
• Reduced dynamic range- usually occurs when threshold of hearing is poor, but threshold of uncomfortable loudness is normal.
• Air conduction testing- threshold of hearing measured with earphones that sit over the ears. The sound therefore passes through the outer, middle and inner ear.
• Bone conduction testing- threshold of hearing measured with a bone vibrator sitting on the bone (mastoid process) behind the ear. The sound therefore bypasses the outer and middle parts of the ear, and goes directly to the inner ear.
• Sensorineural- a type of hearing loss caused by damage in the inner ear or auditory nerve, rather than in the middle ear.
• Potentiometer- A piece of electronic circuitry which can be physically altered to alter the characteristics of the circuit, e.g. the amount of amplification at high frequencies.
• DSP Digital Signal Processing. A means by which computer programming can alter the characteristics of the circuit, e.g. the amount of amplification at a particular frequency in a hearing aid.
• Compression. When the range of intensities of sound that are audible and comfortable to a normally hearing listener are "squashed" into a smaller range for a hearing impaired listener.
• Compression characteristics. Ways of defining how much, and how quickly a normal range of sounds are "squashed"
• Acoustical characteristics. Ways of defining a sound, or the way a sound is processed.
• Tympanometry. A test whereby a small tip sits in the outer part of the ear canal and measurements are made of the moving parts of the middle ear.
• Real ear measurement. When a thin tube, connected to a microphone, is inserted into the patient's ear canal, enabling measurements of sound to be made from within the ear canal. These measurements are usually made both with, and without a hearing aid in place, in order to measure exactly what the hearing aid is doing.
• Hearing Impairment- When hearing is below that defined as normal. There are defined levels of severity of hearing impairment (mild, moderate, severe, profound) based on pure tone threshold measurement.
• Deaf- Usually profound hearing impairment, people who refer to themselves as Deaf (with a capital D) regard deafness as a way of life rather than a disability.
• Deafblind- a person has a combination of hearing and visual impairment, and is therefore unable to use one to compensate for the other.
• Deafened - a person who loses their hearing (or acquires a hearing impairment), as opposed to a person who is born with impaired hearing
• CPD Continuing Professional Development. Ongoing education and training for a registered professional, usually as part of a structured scheme, by which they maintain clinical competence.
• Review - an appointment at which the patient's rehabilitative needs are reassessed and their IMP recommences. Basic hearing aid repairs (maintenance) or straightforward replacement of faulty hearing aids do not constitute a review although they may highlight the need for one to be arranged.
• Audiovestibular medicine - The medical specialty concerned with the investigation, diagnosis and management of adults and children with disorders of balance, hearing, tinnitus, and auditory communication - including speech and language disorders in children.

• COSI Client Oriented Scale of Improvement. A validated interview tool to measure listening needs at assessment and outcomes after intervention, see Dillon et al 1997.
• GHABP Glasgow Hearing Aid Benefit profile. A validated interview tool to measure initial disability and handicap at first assessment, followed by use of hearing aids, benefit and satisfaction with hearing aids and residual disability at follow up. See Gatehouse, 1999.
• GHADP Glasgow Hearing Aid Difference profile. A validated interview tool to measure use of existing hearing aids and disability at re-assessment, followed by use of hearing aids, and comparative disability, benefit and satisfaction with new hearing aids at follow up. See Gatehouse, 1999
• IOI- HA International Outcome Inventory for Hearing aids. A validated questionnaire, available in many different international languages, to measure outcomes after intervention with hearing aids. See Cox and Alexander, 2002.

Appendix 8 - AASSQ Adult Audiology Service Satisfaction Questionnaire

Please complete the questionnaire below to help us improve Audiology services. Indicate your level of satisfaction for each item with a tick. Please base your responses on all of the appointments you have received over the last few months.

Overall, how satisfied are you with:

	Very satisfied	Satisfied	Somewhat Dissatisfied	Very dissatisfied
Accessibility
Your experience communicating with the Audiology Service?
The time you waited for your appointments?
The time you waited at your appointments?
The location of your appointments? (How accessible from your home)
The postal hearing aid repair and battery replacement service?
Surroundings
The signage directing you to the Audiology department?
Your welcome at reception?
The appearance of the waiting room?
The appearance of the clinic rooms?
The comfort of the clinic rooms?
Information
The information you received with the appointment letters?
The written information you received at your appointments?
The information in the waiting room?
Staff
The professionalism of the reception staff?
The professionalism of the audiologist?
Care & Treatment
The opportunities to discuss any problems or difficulties?
Any explanations you were given?
The assessment and management of your hearing needs?
The appropriate involvement of your significant other?
Overall
The audiology service you received?
Please state below one improvement you would make to the Audiology Service or please add any comments? . . .

Section below for completion by Audiology staff:

Clinic ________________________________________________

Date ______________

Type of Appointment _________________________________________________________

Comments: