Hearing loss in adults, assessment and management: summary of NICE guidance
BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2219 (Published 22 June 2018) Cite this as: BMJ 2018;361:k2219
Hearing loss: triaged referral
A summary of new NICE guidelines
All rapid responses
The article ‘Assessment and management of hearing loss’ (BMJ 30 June 2018) encourages clinicians to take measures such as reducing background noise in waiting rooms, clinics and care homes.
Muzac and TV is now ubiquitous in hospitals, especially in outpatient waiting areas. Requests to turn it off, or just to reduce the volume, are met with resistance on the grounds that it protects others from hearing private conversations. This is, of course, a myth: people raise their voices to speak above the heightened background.
When my husband, who has hearing problems, was admitted to our local hospital for something unrelated, he was subjected to the TV in the ward (not a day room) all day, every day – not conducive to a speedy recovery. Many of us dread being admitted to a ward where such torture is inflicted and there is no escape.
As clinicians we must be cognizant that the whole patient space, not just the consulting room, should have therapeutic aspects, and be prepared to press this with management and others who believe they know best what is needed in a hospital environment.
Competing interests: No competing interests
As an older patient with SOME hearing loss, may I please make a few points?
1. We (Anand JK and Court I) conducted a survey of old peoples’ homes.
The exercise was funded by Marks and Spencer.
Readers might care to read the paper and see if our work merits duplication elsewhere.
Ref: BMJ 1989 May 27;298(6685):1429-30
2. It is quite possible that anosmia or hypoosmia might accompany mild hearing loss of the conduction type (personal experience as a patient). Of course an aged patient may also have a degree of sensori-neural variety.
I would plead that BEFORE fitting hearing aids, the audiologist/ audiometrician might do three things:
a) clear the external auditory canal of wax
b) ask an otorhinolaryngologist to examine the posterior nasal passage and nasopharynx for catarrh and look at the drum as well for signs of middle ear catarrh
c) treat pathology found
and THEN check the PATIENT’s ability to understand speech.
From personal experience as a patient, I would say that fluticasone proprionate suspension 1mg/ml might relieve the catarrh sufficiently to improve the conduction loss to obviate the need for a hearing aid! In SOME patients for SOME period at least.
Competing interests: No competing interests
Re: Hearing loss in adults: getting earwax removed is a problem
Earwax is unglamorous, but clear ears make a huge difference to many patients’ hearing and so to their social functioning. It is good that NICE has addressed the problem. But given that the evidence on how best to manage it is so weak and the options so limited, there is little in the guidelines to overcome the current barriers faced by patients who may have earwax.
Firstly, no-one, not even a doctor with an otoscope, can see down their own auditory canal. Someone who knows what they are doing and seeing has to check whether there is a problem with wax. And this may be needed every few months.
Secondly, getting to see a suitable health professional is rarely straightforward. Some GP practices may have a slick service for earwax removal. If they do they need to publicise it, because getting your earwax removed in general practice can be a frustrating exercise. First an appointment with a GP to check your ears (non-urgent, so in three weeks time, maybe). Then another wait for an appointment with the nurse who is trained to remove it. That’s two visits. And electronic irrigators or microsuction devices are costly. How many practices have them?
A few NHS walk-in clinics appear to offer ear syringing but it requires an effort to find out if they do (I’ve tried). Private clinics charge around £80.
Hospital audiology services require a referral and I wonder how many are geared up to open access so patients who feel their wax may be building up can get their ears checked, and removal of the wax if necessary.
No surprise that people turn to self-help. Amazon offers Hopi candles, ear picks, olive oil drops and a variety of devices for actively removing wax including syringes. How safe are these? How effective?
If you run an efficient and effective service, please let us all know how you do it!
Competing interests: No competing interests