BSHAA //SOcthlo&beear/aNrionirvnenmsgbiiergn20gh19 ts £4.95
people
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Inside
4 President’s page
6 The CEO says…
Editor’s Note 10 Membership news
14 Professional development day
Welcome to the October issue of your BSHAA member magazine. There’s lots 16 People news
inside that I hope you’ll find useful and informative. 19 Industry news
Chief executive David Welbourn discusses the issue of regulation around wax
removal, and the role of the CQC. I know this has been a hot topic recently.
Jasmine Opuku-Ware investigates the take-up of hearing care by people from
ethnic minorities.
Also inside, Dr Jenny Nesgaard Pedersen tells us about her work with the Hear 26 Thinking Outside the Booth
To Aid foundation, a non-profit organisation carrying out fantastic work in 30 The disparities in the uptake of
Zimbabwe and neighbouring countries, and Anne Marie-Dixon gives us an
overview of cochlear implants and how you can ensure the patients you see are hearing intervention by ethnic
well informed about them, and how you can refer them to your local cochlear minorities
implant centre.
33 Cochlear implants in the
We take a look back at our professional development day that was held in
London last month and look ahead to the BSHAA elections. There’s an interview
with BSHAA member Tony Kay, who’s become the new president of the British
Tinnitus Association, and we pay tribute to BSHAA Fellow Jo Farquhar, who
tragically passed away in September.
The deadline for the December issue of BSHAA People is Monday 11 November, independent sector
so please do let me have any news, articles and other contributions by then. I’d 37 Recruitment advertising
love to hear from you.
Jamie Summerfield
BSHAA People editor / [email protected] october 2019
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President’s Page
Can professional
societies thrive in
the 21st century?
// ANDREW At the end of September, I gave a Having been on BSHAA Council since 2014,
COULTER presentation at the Irish Society I have been involved in lots of activities
of Hearing Aid Audiologists’ that seemed to everyone to flow seamlessly
PRESIDENT, BSHAA autumn education day in Dublin. The when in fact there were lots of robust
> [email protected] theme of my session was the role of discussions going on behind the scenes. It’s
professional societies and how they can important to remember that professional
4 BSHAA PEOPLE | OCTOBER 2019 thrive in the 21st century. societies’ Councils and committees are
made up of normal members of a Society
When you talk about professional societies, who put their hand up and said: “I’ll help
this is what many people think (and I must out. I want to get involved and shape the
admit that I certainly did): wood-panelled Society and the wider profession.”
rooms filled with professionals with many,
many years of experience. Probably almost Through participation
entirely male. And the same people comes strength
who’d been there for decades.
So, what does it take to have a strong
Often, when I have meetings with BSHAA profession and therefore a strong
and there are other societies meeting in the professional Society? The rule of thumb
same location, they do fall into the ‘Pale, is that the more members you have from
Stale and Male’ category and don’t reflect within your profession, the stronger your
the modern society in which they serve voice is. Although this voice only remains
their members. However, in audiology – strong when your members actively
although we do have some distance left participate in their profession.
to go in terms of properly representing
the diversity of our memberships – this is I know that I’ve written about this many
often far from the reality. times, but I believe passionately that
participation in your profession should be
Unfortunately, membership of professional a key aspect of your daily practice. The
societies in all professions (unless they relationship between you and your
are statutory bodies) is not as strong as profession should not be transactional and
it once was. The rise of digital and online limited to attending meetings, and it
communities has created a new space in should definitely not be ‘top down’. As a
which professionals can network, learn professional, you have a responsibility to
and feel that they are a part of their have an active role and therefore
professional world. strengthen the voice of all of those
working in the audiology field. We as
However, I believe there is a general lack professionals should be working as a
of understanding of what the role of a team, pulling in the same direction to
professional society should be as we head push the profession forward.
towards the third decade of the 21st
century. In the UK, we have suffered from
professional societies pulling in different
In reality, professional societies are full of directions at times. This often boiled
people who dedicate a lot of their time down to differing viewpoints and outlooks
and energy to their profession, unpaid and on hearing care provision. The work
with no self-interest, and often working that has been going on that could result
behind the scenes on projects, advice or in a national College of Audiology, and
guidance that often they are not at liberty that I’ve been delighted to play an active
to discuss openly.
role in, is an exciting prospect and could But it’s only by working together that Evolving your approach as a professional
deliver a powerful collective voice. The we can ever hope to make the impact and as a professional Society is no longer a
fine detail of the structure is still to be that is desperately needed on behalf of choice. Taking too long to make decisions,
developed and we will involve members all the people in the UK who need help in this world of instant communication,
in the process as it develops. with their hearing. Having a strong voice is not possible and professional societies
means being supported by clinicians who must continue to progress. They can only
Having a strong voice, a strong profession are engaging fully with their profession do this with full support of members as a
and supported professionals is important and their professional society. minimum and full participation of members
when you consider the significant disruption within the profession as an essential.
that is on the horizon and getting closer. In The forces of disruption and the rapid
many cases, that disruption is here right now. changes brought about by technology Audiology is a small profession and one that
mean that it is more important than ever has historically suffered from disparate
One example is the potentially huge to tackle this head on. The alternative is to voices that has made a strong, unified
disruption coming to the hearing aid stand helpless in the middle of the voice difficult to achieve. I believe that
industry, which may transform provision fast-flowing river and risk being swept away. professionals working together in Societies
of hearing solutions for us all. A strong for the betterment of patients and
profession can act as a lighthouse to guide Let’s be honest, the fact that things professionals, all speaking in unison, is the
us through difficult times. A stark example change is one of the few certainties in life. best way for us all to lead the profession. We
of an imminent threat to the ‘normal’ way However, I know there’s a good chance can only do this if all members participate
of doing things is over-the-counter (OTC) that you’re thinking, “I just wish that things and collectively grow membership.
hearing aids. The legislation for this category would stay the same for a year or two.
of product is set to be finalised in the next Even a month or two would be good!”. BSHAA elections
12 months in the United States, and if you
think that every single manufacturer isn’t When I think back to when I first trained As this issue of BSHAA People went to
working on some way of accessing that as an audiologist, you adjusted hearing print, nominations were open for the
market, then you’re kidding yourself. aids with screwdrivers, digital was new, 2019 Council elections. Being elected
products came out once every four or to Council is one of the most important
We all know, as audiologists, that an OTC five years and they all launched all at the ways that BSHAA members can contribute
product will not perform as well as a same time. Life was simpler. We didn’t to shaping the work of the Society and
well-fitted, REM’d hearing aid with have smart phones. An iPhone would the wider profession. The nominations
comprehensive aftercare. There is ample have been bordering on magical. window closed on 14 October, and I
evidence of the impact that a qualified hope that many members put themselves
professional adds to the equation. We are now faced with ever-changing forward for election. Council is most
Technology alone is never the answer. technology, service provision, delivery effective when we have a diversity of
However, how can we communicate this models and customer expectations, to voices, experience and practice settings,
vital message about the difference that we name a few. In six months’ time we will and this year we were very keen to
as hearing care professionals make unless no doubt have something else on the encourage members at the beginning of
it’s done on a large scale, with a consistent horizon that could potentially change how their audiology careers to get involved. I
message and – importantly – through we do our jobs day to day. hope that many did.
working together – as professionals and
as professional societies – to deliver So how do we deal with this? We can all Online voting of the membership will take
maximum impact. plough our own fields and spend a lot of place in November. Please do cast your vote
time working out ways around the when the time comes. It is so important that
If you feel that your profession needs to ever-changing environment that we Council members have a strong mandate
move faster, or in a completely different all work in. This is labour-intensive, for their work. Members will be sent online
direction, then make sure you have an time-intensive and carries significant risks voting instructions on 8 November so, if
active role in driving that profession if we get it wrong. Working collectively to you still need to renew your membership
forward. Audiology is a relatively small understand the future and to make sure for 2019/20, make sure you do this by the
profession. In the UK, the total number of that we are ready for most eventualities is end of October so that you can vote.
audiologists is estimated at about 6,000. the most efficient way forwards.
When you compare this to the number of If you decided not to stand for election
nurses in the UK (over 600,000), audiology Supporting members to Council this time but would like to get
is often not high on legislators’ minds. involved in the Society’s work, then you
I believe that one of the key roles of a can join one of the Council committees
Working together professional society is to support members as a volunteer member. This is a good
as their profession changes, to make sure way to dip your toe into the water and
Having a confident profession that can they have the skills and the reflective gain some experience before standing for
communicate clearly and concisely on knowledge to thrive. But professional election. If you’re interested, send me an
important points can truly amplify its societies must also take decisions to drive email at [email protected] r
voice and start to shift the public policy to the profession forwards, all the while
where it needs to be. All the professional engaging members who relish in change
societies in the UK have made steps, while at the same time bringing along
sometimes significant ones, in this area. those, who – for perfectly valid reasons –
are perhaps resistant or fearful of it.
BSHAA PEOPLE | OCTOBER 2019 5
The CEO says…
Building
// DAVID However we choose to express it, practitioners who understand
WELBOURN one of the fundamental priorities professionalism in a radically different
for a professional body is to way, and for whom allegiance is more
CEO, BSHAA understand the demand upon the often given to fluid and agile networks,
> [email protected] profession and to ensure that mechanisms rather than relatively static organisations
are in place to ensure that appropriate or institutions.
6 BSHAA PEOPLE | OCTOBER 2019 expertise is available to respond effectively
to that demand. In posh circles, this whole My own reflection on one particular topic
process of matching supply and demand is trending within social networks has
often referred to as capacity building. highlighted the importance of probing
deeper into the changing needs of capacity
Like many similar terms, jargon like this building, in order to develop new insight
hides so much of the important detail, as a fundamental priority to strengthen
that it is almost as if it has been designed the professionalism within audiology.
to build a wall of mystery around the
subject, thereby protecting the preserve It seems to me that the current discourse
of those who make their living advising taking place largely on social media about
organisations and leaders how best to build wax removal, perfectly exemplifies this
relevant plans and invest appropriately challenge between generations and
to achieve the goals demanded by this approaches. It has been clear for some
particular piece of jargon. time that audiologists are increasingly
taking on wax removal as part of their
The other, equally cynical interpretation extended practice, and this seems to
of the use of jargon like this, is that it have become an even hotter topic since
allows people to hide their ignorance of the NICE guidance on hearing loss made
what is really involved. strong reference to this, and there is eager
anticipation of the BSA guidance document
Heaven forfend that audiology should to which BSHAA has contributed.
ever be accused of relying on jargon for
either of these unseemly tactics! But the aspect of this that appears to be
the most controversial arises from the
With that suitably cautionary introduction, absence of any relevant regulation, and
why am I seeking to explore this subject the topic which divides the generations
of capacity building in this column? It is a arises from this lack of registration. The
theme arising initially from an important traditionalists would look to their profes-
discussion at our Membership Committee. sional body to spearhead discussion about
We were reviewing the fundamental regulation, expecting questions to be
challenge facing all professional bodies: to asked and addressed on their behalf. I’ve
provide valued services to long-standing provided a more detailed explanation of
members, at the same time as being CQC’s remit in the inset panel.
relevant to new generations of emerging
capacity
The more modern response is to turn immediately to social media Understanding
assuming that someone else out there has the answer to your CQC’s Role
question, and all will be resolved by an emergent consensus from
the exchange of views. This type of exchange works extraordinarily The responsibilities of CQC are set out in legislation
well and speedily within the constructive nature of professional in the Health and Social Care Act 2008 (Regulated
networks, provided there is an unequivocal answer. When no Activities) Regulations 2014. When we look under
such clarity exists, chaos ensues as differences of opinion bounce the skin of the authority granted to Hearing Aid
backwards and forwards, and there is no recognised source of Dispensers to practice autonomously and balance this
authority to pronounce. authority with an understanding of risks arising during
that practice, in the context of CQC powers, we find
Somehow, the mechanisms of the professional bodies’ authoritative an interesting story. The core practice of an HAD is
voice negotiating behind the scene, needs to be blended with the explicitly excluded from CQC interest. When it comes
undoubted power that social media offers much of the time. to treatment of a disease, disorder or injury, the list of
Audiology is not alone in wrestling with this dilemma, but like clinicians brought under CQC legislation is itemised,
other professions, we are undoubtedly weakened if the profession with HADs outside the scope of CQC. There is only
itself is divided into those who look to their professional body for one part of CQC legislation which could bring wax
too much (engaging too little with their colleagues), and those removal by HADs (or those to whom they have
from newer generations who only engage with colleague networks delegated activities) into the remit of CQC, and that is
and do not recognise the value of the quiet leadership offered by if wax removal is defined as surgical intervention. This
their professional body. is an interpretation far removed from the intention of
the legislation, or the practical reality.
The specific case that has caught my attention is the thorny topic
of whether or not CQC has a role to play in regulation of wax It is worth remembering that CQC is responsible for
removal, and what the consequences might be to the profession regulating organisations, not individuals, though that
if wax removal services were brought under the remit of CQC responsibility does extend to ensuring that organisations
legislation. The social media dialogue is undoubtedly chaotic, and understand their duties for those clinicians they
I’m sure many have become more, rather than less confused by employ and hold them to account in line with this.
the failure to achieve a definitive position.
The CQC legislation is clear that audiology practised
It seems to me that this is only a difficult issue to resolve, because by HADs lies beyond their scope of interest.
of the lack of formal regulation for wax removal combined with
lack of a minimum standard of training, and an increasing shift
towards use of hearing care assistants, or equivalent to undertake
wax removal. Like all professionals, audiologists are concerned
primarily about the safety of their clients, and there is a widely
disparate view within the profession of how much knowledge and
training is required to undertake wax removal safely.
➜
BSHAA PEOPLE | OCTOBER 2019 7
// the CEO Says (continued)
➜
The dilemma of regulation When a professional reaches the edge of their training, they
have a DUTY to draw upon professional colleagues, and the
I have no hesitation on behalf of BSHAA of stating my belief whole body of knowledge within their profession, to determine
that audiologists are amongst the best placed to offer wax whether or not to proceed with caution and peer support. If
removal, because of their educational background and practical they choose to proceed, this must be under strictly managed
experience. Undoubtedly, this experience needs to be risk assessment and all the elements of best practice around
“topped-up” by relevant training and practice before going record keeping and other tools of their profession. Here is an
solo, but the basic understanding and care offered in their interesting dilemma – being bound by your scope of practice,
audiology practice forms the solid foundation from which to but having permission to develop your profession into uncharted
extend practice. As a Hearing Aid Dispenser, individuals are territory under special circumstances – typically when doing
authorised for autonomous practice on the basis of this nothing risks greater harm, than responsible innovation.
training and practical clinic time spent before qualifying. Once
they have gained this authority to practice, and been registered This same duty to seek the experience and support of colleagues,
by HCPC to do so, they are personally and professionally and to draw deeply on the wisdom of the profession must
responsible for understanding, developing and extending their be honoured, not only when pushing the boundaries of the
scope of practice with time, and must always maintain profession, but also when pushing the boundaries of your own
competence through their commitment to Continuing scope of practice. Where a professional seeks to extend their
Professional Development. They are also totally responsible own personal practice wider within the known professional
for assessing the competence and scope of practice of anyone bounds, then that same professional judgement must be
they employ and supervise as assistants. Through effective exercised – this time to evaluate the range of training options,
supervision they must continue to retain confidence and how well they fit with their own needs, and whether the quality
accept clinical accountability for the work which they delegate. and depth of training really does ground them sufficiently to
extend their practice. It is not consistent with professional
BSHAA’s view as the professional body for HADs, is therefore values to assume that a poorly delivered or inferior training
clear, that although wax removal must be viewed as an course qualifies an individual to extend their practice –
extended form of practice, the authority granted under HCPC professional judgement plays a major role firstly in selecting
regulation forces HADs to consider their scope of practice in the course, and later in assessing to what extent that training
the context of their knowledge, understanding and practical has indeed adequately extended your scope of practice.
experience. They are therefore duty bound to undertake wax
removal only when it lies within their scope, and if they Similarly a professional must be thorough in assessing the
delegate such responsibility to other team members, they do competence, understanding, and ability of anyone to whom
so, again, only with due consideration of their and the scope of they delegate aspects of their practice. Whether assessing their
practice of their staff. own scope of practice, or that of a colleague over whom they
have supervision, a professional must always exercise responsible
My greatest concern here is that the emphasis and confusion professional judgement, always by drawing on the guidance,
created by unresolved dialogue on social media challenges this wisdom, and practice-norms of their whole profession.
interpretation of legislation, because it points to lack of trust
and confidence in the authority, practice and competence of Building capacity
fellow professionals. This thought alone points to a significant
weakness within the world of audiology, that we are seeking When I set out on the theme for this issue of BSHAA People, I
to resolve with the conversations about a possible college of was originally thinking about the challenge of bridging between
audiology – a body intended to unite the profession and create informal professional networks and membership of formal
a stronger, more confident authoritative voice. professional bodies. The whole question: “to regulate or not
to regulate wax removal” rudely interrupted my original theme,
Extending practice of exploring how we might strengthen that bridge, but allowed
me to illustrate why we need to be more adept at supporting
This example also provides opportunity to emphasise the and encouraging members of the profession to understand the
important way in which a professional differs from a mere wide range of approaches to working with colleagues.
employee. However simple it is to ask the question, there is
very little definitive written about precisely what it means to It therefore seems appropriate to sow the seeds for further
be a professional. I keep reiterating what I discovered when conversation about the way BSHAA can support various elements
researching this subject for some guidance I was commissioned of capacity building, rather than to explore in depth in the
to prepare on the subject of professional revalidation. When space remaining. Right at the beginning of this article I touched
an ordinary employee reaches the edge of their training, they on the nature of jargon and the risk of misunderstanding. If
MUST stop – they have no authority with which to proceed. BSHAA is going to succeed in building capacity within audiology
8 BSHAA PEOPLE | OCTOBER 2019
which bridges generations and attitudes to membership and their practice could be improved and are willing to share any
networks, it is important to be clear about terminology which particular strengths they have developed, in order to improve
is often confusing and misunderstood. the profession as a whole. Partnering in audit requires a
willingness to be vulnerable and has no place for being defensive.
I often come across people referring to coaching, mentoring and It demands high levels of trust and is driven by a desire to learn.
audit as important ways for more experienced audiologists to It must be conducted without any fear of blame or retribution.
give back to the profession by helping others within audiology It is good practice for each party to observe and audit the
to grow professionally. Although often used interchangeably, practice of the other on a mutual basis, and potentially for any
these terms are not equivalent – each offers a distinctive way improvement actions to be planned and followed through jointly.
for professionals to add to the professional corpus (that body
of knowledge and wisdom that makes up the profession). Each Squarely alongside these three corner stones of professional
is a part of the membership and professional development collaboration, sits the informality of networking via social
service which BSHAA wants to enhance to help our members media. As the trend towards mobile technology and on-line
continue to grow in their professionalism. social engagement takes a firmer grip on everyday life, it is
only natural that it becomes a valuable component of building
Coaching is an important concept in which an experienced professional capacity. In contrast to the formality and planning
coach works with an individual to improve their performance of coaching, mentoring and clinical audit, the professional use
and attain their potential, by drawing out latent talent and of social media is unplanned and many-to-many. Answers to
understanding that lies within their existing scope of practice. simple questions, guidance on techniques of good practice,
It often looks at behaviours and barriers in attitude which get and an ability to make contact with “someone who knows” is
in the way of attaining an ideal performance. Perhaps the most both unprecedented and invaluable. The power of distributed
obvious example of coaching in action is in the world of sport knowledge, and the ease with which it can be accessed enables
where the coach helps analyse performance and finds those professions to advance into new territory more quickly.
areas in which performance can be improved by technique. Caveat emptor – let the buyer beware. The risks are also
The coach does not teach any knew knowledge or skill, but clear, as evident in the changing face of geopolitics arising
simply refines the application of what is already there. In particularly from the ease with which networks become
audiology, there is ample room for coaching to build confidence, polarised when individuals are attracted to those networks
hone clinical technique and improve client engagement. mirroring their own views. One of the traits of professionalism
Coaching is a one-way relationship. is the open-mindedness with which counter views need to be
entertained and considered thoughtfully. The failure to resolve
Mentoring is a very different relationship between two people issues such as the CQC question posed above, are part of the
in which both benefit but in very different ways. The mentor risks of over-reliance on social media. Like all techniques of
is always the more experienced, and generally holds a position capacity building, it adds enormous value, but must be consumed
of significantly greater power or authority, and the mentored in moderation and as part of a diverse approach to building
individual (I hate the American word mentee which I refuse bridges throughout the profession and beyond.
to use) is seeking help to clarify their future aspiration within
the profession, generally with the aim of supporting their Capacity building in audiology will take many forms and will
future ambition. The mentor’s powerful position is able to hopefully be undertaken jointly across the whole sector. As a
open doors to experiences which would normally remain professional body, we need to continue seeking new ways of
closed to the individual until they had gained significantly more bridging between formal membership and informal networks,
experience. Job shadowing is a very common component in and we must find new ways to encourage individuals to
any mentoring relationship but is not essential. The value to develop their professionalism through a variety of approaches,
the mentor lies in being able to work closely with someone including coaching, mentoring, audit and social networking;
with much less experience, but whose experience has been each with their own unique benefits to individuals and the
gained in a very different climate of both education and social profession as a whole. r
attitudes. The mentor should develop better empathy and
understanding of their more junior colleagues, and will gain Stop press. HCPC has just published encouraging guidance on
new insight into the changing culture, so that they are able extending your scope of practice: https://www.hcpc-uk.org/
to adapt and shed out-of-date practices. True mentoring is a news-and-events/blog/2019/can-i-do-that-thinking-through-your-
valuable contribution to building bridges between generations. scope-of-practice/
Participating in joint clinical audit is a relationship between
equals, in which both parties seek an independent opinion from
an experienced peer of the quality and strength of their clinical
practices. They are seeking to understand any areas in which
BSHAA PEOPLE | OCTOBER 2019 9
// membership
BSHAA 2019 elections
– make sure you vote
Nominations closed on Monday 14 October for the 2019 Remember that it is a requirement of membership that we
Council and Vice President elections. Online voting will take have your up-to-date email address, so if this has changed
place between 8 and 29 November. All members who have recently, please update your details on the BSHAA website at
paid their renewal subscription by 31 October will be eligible www.bshaa.com/My-Details
to vote electronically.
The election will be conducted online and overseen by Civica
There are six vacancies to be filled on Council, and members Election Services (formerly Electoral Reform Services), the
will also be electing the Society’s new Vice President, who will leading provider of independent election services.
go on to become BSHAA’s next President in 2021.
BSHAA President Andrew Coulter urges members to take
How to cast your vote part in the elections. He said: “It’s time for you to help shape
the future of your Society by electing six Council members and
You will receive an email on Friday 8 November with our new Vice President. Please make sure you get involved
instructions on how to vote, and the personal statements and by reading the candidates’ statements and using your vote. It’s
photographs of all who are standing for election. Candidate important that Council members receive a strong mandate
information will also be in the members’ section of our from the membership.” r
website at www.bshaa.com/Members-Area
Still need to renew your BSHAA membership?
If you haven’t renewed your membership yet, please renew as soon as possible. To be
eligible to vote in the 2019 Council and Vice President elections, you must have renewed
by 31 October. This is also the deadline for saving money on your membership fee by
signing up for direct debit payment.
The 2019/20 membership fees are: 2. Pay by BACS
HCA member – £115 Please include your membership number with the
electronic transfer details.
Qualified member | Fellow | Associate – £230
Account number: 42707627
Student member – free of charge Sort code: 09-06-66
BIC: ABBYGB2LANB
How to pay your membership fee IBAN: GB89 ABBY 0906 6642 7076 27
1. Pay by direct debit by 31 October and take 3. Send us a cheque
advantage of a reduced membership fee
Please make cheques payable to BSHAA and make sure to
HCA members – £105 instead of £115. write your name and membership number on the back of
Sign up at www.bit.ly/bshaahca2019 the cheque. Post your cheque to Kim Girling, BSHAA,
c/o EBS, City Wharf, Davidson Road, Lichfield WS14 9DZ
Qualified member | Fellow | Associate – £199 instead
of £230. If you’re a student member, please email
Sign up at www.bit.ly/bshaa2019 [email protected] to renew your free membership.
Members who are no longer in a company scheme need
to renew using one of the methods above to maintain their
BSHAA membership. r
10 BSHAA PEOPLE | OCTOBER 2019
News
Jo Farquhar
BSHAA Fellow Jo Farquhar tragically passed away on In 2016, Jo wrote a wonderful Last Word column for
Monday 9 September, aged just 59. Jo was a staunch BSHAA People, where she wrote about her life-changing
supporter of BSHAA, a regular at our events and a brilliant move to Scotland, and how being in a more isolated
ambassador for her profession. community changed the way she practised.
She had been a member of BSHAA since 1991 and had “It meant having to completely alter the manner of my
more than 40 years’ experience as an audiologist, in the communication with patients and how I care for them,”
NHS, private and charity sectors. In fact, in 2018 she she wrote. “Moving to Buckie has helped me to seriously
celebrated 40 years of caring for people’s hearing. reflect on the needs and challenges of working on the
same latitude as Norway, which is definitely not the same
Her career began on 26 September 1978 when she started as working in South Wales or London! We get very little
her training as a student physiological measurement snow on the Moray coast but when we do it is significant.
technician (audiology) at Addenbrooke’s Hospital in However, just 10 miles inland travel is difficult, particularly
Cambridge. She moved from South Wales to Scotland in during January to March.
2008, to Buckie – a small town on the Moray Firth coast
– and started Moray Hearing in June the following year. “That said, it is not unusual for people to drive four or
five hours to get to my office. I have patients on the most
In 2014, the business moved to its current premises, which northern tip of Scotland (beyond John O’Groats) and others
were officially opened by Stewart Stevenson, Member of come from the Western Isles (Skye, Lewis and Harris) or
the Scottish Parliament. Jo said at the opening event: “I up from Fort William and Spean Bridge.”
firmly believe we should be taking the same care of our
hearing as we do of our eyes. People are prepared to have Jo’s passing has been felt keenly by the BSHAA community,
their eyes tested every two years – the same should be and by all those who knew and loved her and met her
true of their hearing.” regularly at BSHAA’s Congress and other events. Brenda
Quinn-Hays, said: “Jo was a great pal, irreverently funny,
She was passionate about the vital importance of hearing incredibly knowledgeable in all things audiological but above
and would regularly attend community and charity events all a kind, wonderful, funny, empathetic human being.”
to spread the message in her community.
Professor David Baguley said: “Jo was much loved in the
audiology world and will be much missed by many, and by
me personally.”
BSHAA President Andrew Coulter said: “Jo was a stalwart
of the Society and a passionate, committed audiologist.
The reaction of many, many members shows the incredibly
high regard in which she was held, and her loss at such
a young age is tragic. I would like to thank Jo for all she
did for the Society, and all that she did for our profession,
through the exceptional care she provided, to the support
and help she gave to others, and through her passionate
commitment to advancing the standing of audiology and
the importance of the work we do.”
Jo’s funeral was held on 19 September and her family
asked for donations to the charity Trees For Life instead of
flowers.
Trees For Life is a conservation charity dedicated to
establishing new forests in the Scottish Highlands. You
can make a donation in Jo’s memory via the Trees For Life
website at www.treesforlife.org.uk r
11BSHAA PEOPLE | OCTOBER 2019
// membership
Sharing the learning
and insights…
Although there’s nothing like attending one of our events in person, to
catch up with fellow members and to ask questions of speakers, we always
ensure that the learning and insights from our events are available for all
members.
Video recordings of the presentations from this year’s Congress, that took
place in June at the Ricoh Arena in Coventry, are available on our website.
You can find them at www.bshaa.com/Congress-2019-videos and you will
need to be logged in to access them.
Professional development day slides and
audio
Our professional development day on 7 September saw a range of
presentations on the theme of ‘Hearing, Health and Well-being’.
Slides and audio recordings of most of the day’s sessions will be available
for members on our website soon.
To access member-only content on our website, just go to
www.bshaa.com/Members-Area
Webinar directory
Video recordings of all our professional
development webinars are available for
members to view on our website at
www.bshaa.com/webinars. The directory
is a real treasure trove of learning, with a
huge range of topics and speakers, including
our latest webinar that took place on 26th
September with Dr Douglas Beck (pictured)
on hidden hearing loss and how to manage
patients with ‘normal’ audiograms.
All the resources above will give you over 50 hours of high-quality
professional development opportunities!
What would you like to see at our 2020 events?
We are currently planning BSHAA professional development events for the
next couple of years, and we need your input. We’re looking at creating
a member panel to make sure that our events in 2020 and beyond cover
the topics and issues that are most relevant and interesting to you, and
that they deliver real value for delegates. If you would like to be involved,
please send an email to [email protected] r
12 BSHAA PEOPLE | OCTOBER 2019
News
Have you signed up for
big savings?
As a BSHAA member you can sign up to our Wider Wallet Here are some of the latest deals and discounts this month:
scheme and start saving money immediately with access to a
huge range of discounts and offers. CC Save 7% at Costa and 9% at Starbucks
CC Boost your spending power with discounts on day-to-day CC 10% off bookings at cottages.com
costs including supermarket shopping, high-street stores,
DIY, motoring and family finance CC Up to 10% off at Argos
CC Maximise your leisure time with special offers on travel, CC 15% off car hire
theme parks, family outings and experience days
CC Up to 10% off supermarket shopping at Asda, Tesco and more.
CC Experience wellbeing with relaxing spa breaks, free health
screening and great value health insurance Want to make even more savings?
If you haven’t signed up yet, it’s easy. To access our Wider Wallet Your BSHAA Wider Wallet membership is totally free of
Member Benefits Hub, simply visit www.bshaa.widerwallet.com charge but, if you choose to, you can upgrade at any time to a
and enter the access code WW3333N. After a simple registration premium membership. This costs just £1.50 a month, or £15
process, you’ll have immediate access to all the offers and for annual premium membership, and gives you access to lots
discounts – and this great new benefit won’t cost you a penny. of extra discounts and services, including:
There are hundreds of offers available for you, with new ones CC special rates at over 2,500 gyms and health clubs nationwide
added to the website every week. So head to the website,
register and start saving money. If you use Wider Wallet CC enhanced high street offers to save you even more on your
regularly, the savings you can make could well pay for your regular shopping
BSHAA membership.
CC a confidential advice helpline covering employment issues
and more r
13BSHAA PEOPLE | OCTOBER 2019
// membership
Hearing, health and well-being
in the spotlight at professional
development day
Our 2019 professional Nori Graham, vice president of the National Alzheimer’s
development day in Society, discussed hearing and cognition. She delivered lots
September was another of useful tips for managing patients living with dementia, and
sold-out event in central assured delegates that she would be pressing for a hearing
London at etc.venues in test to be a standard component of a dementia diagnosis.
Liverpool Street.
BSHAA Council member Anna Pugh told delegates that
If you couldn’t make the people living with diabetes are three times more likely to
event, slides and audio have problems with their hearing. “We need to be grabbing
recordings from most of the opportunity”, she said, to be working with CCGs and
the day’s sessions will be healthcare networks to push the importance of good hearing
available on the BSHAA website soon so that you can access care for people living with diabetes.
the learning and insights from the day.
Andrew Hugill from Leicester University summarised for
If you were with us on the day, the BSHAA CPD reference is delegates his soon-to-be published research on the experiences
8884. Seventeen CPD points are available for the main plenary, of musicians with Meniere’s disease and other hearing
plus an extra two points if you attended the breakfast workshop. impairments. Andrew – a professional musician – was
diagnosed with Meniere’s himself in 2009, an experience
The theme of this year’s event was Hearing, Health and which sparked his commitment to research this area and
Well-being and was organised by Council member Samantha spurred him to set up Aural Diversity, an innovative music
Dixon (pictured above) and BSHAA’s education consultant Jay project for aurally diverse musicians.
Jindal.
Gareth Smith, consultant clinical scientist (audiology) at
After a breakfast session from BSHAA chief executive Professor Southend University Hospital investigated the literature on
David Welbourn on using local population data to inform unexplained sensorineural hearing loss, and Paula Cook guided
services, Elizabeth Adesugba looked at disruption and how members through effective earwax removal treatment.
BSHAA members can thrive despite the challenges of hearables
and over-the-counter aids. “Engage in your profession,” she Professor David Baguley discussed the new Why is there
said. “Become an advocate for your profession.” no cure for tinnitus? paper that he’s co-authored with BTA
14 BSHAA PEOPLE | OCTOBER 2019
News
Top row left to right: Anna Pugh; Yovina Khiroya; Professor David Baguley; Paula Cook. Centre photograph: Andrew Hugill addresses the professional
development day. Bottom row left to right: Sue Falkingham; Nori Graham; Elizabeth Adesugba; Gareth Smith. Facing page: scenes from the
exhibition space and breakfast
chief executive David Stockdale and others. There’s more Thank you to all the delegates who joined us for the event,
information about this important new paper elsewhere in and to all our sponsors – GN Hearing, Interacoustics,
this issue of BSHAA People. Prof Baguley told patients of Phonak, Sivantos, Starkey and Widex – for helping us to
the compelling evidence for mindfulness-based cognitive make the professional development day happen. Post-event
behavioural therapy, alongside audiological care. “Combining feedback was overwhelmingly positive.
audiology and psychology is challenging,” he said, but is
something that works for helping patients to manage their What would you like to see at our
tinnitus. If you’re interested in finding out more about CBT, 2020 events?
make sure you watch a recording of an in-depth workshop
on the practice from this year’s Congress. It’s available on We are currently planning BSHAA professional development
the BSHAA website for members, along with most other events for the next couple of years, and we need your
workshops from the event and all keynote presentations. input. We’re looking at creating a member panel to make
sure that our events in 2020 and beyond cover the topics
There were technology presentations from Starkey’s Sue and issues that are most relevant and interesting to you,
Falkingham and Yovina Khiroya from Phonak, and lawyer and that they deliver real value for delegates. If you would
Andrew Humphrey updated members on GDPR. Delegates like to be involved, please send an email to
could also continue the learning over lunch with a workshop [email protected] r
from Interacoustics.
15BSHAA PEOPLE | OCTOBER 2019
// membership // people
// MEMBERSHIP If it’s not written down, it didn’t happen…
by Jill Humphreys
How many times have members aids. There was an initial 30-day trial reasonable for the client to expect an
heard BSHAA utter these words? Too period which was verbally extended unspecified ‘rolling’ extension.
many times to count, I would say, and to 60 days.
I need to emphasise them again. Actions you need to take
Court finding
There has been a court case recently CC Any extension period should be
where had this been done the judge The court agreed that the audiologist followed up in writing, with an
would have awarded in the company’s had done absolutely everything possible end date
favour. Instead, the Company had to to support the client and the aids
provide a refund, pay court costs and were fit for purpose for what should CC A record is added to the client’s
the expert opinion costs. be realistic expectations. However, notes that an end date to the
the court maintained that the fact extension period had been given
Brief Facts that 16 months had passed did not to the client
overrule the contractual law under
The client was fitted in April 2016 – which the verdict was given. CC Refer to the BSHAA Guide to
yes, 2016! BSHAA received a Record Keeping. Part 2 deals
complaint in August 2018 when a The court accepted the audiologist’s with practical steps that you can
refund was requested on the basis notes as a true record – but the take to avoid potential complaint
that the client alleged they were extension was not included in the issues. The Guide has been written
unaware of the end date of the trial notes. Had a letter been given to the taking into account situations
period and the aids were no good. client confirming the end date, or an that have arisen during BSHAA’s
end date had been included in the review of cases under the
The client had two periods of five notes as having been provided to the Customer Care Scheme.
months where there were no issues. client, the judge would more than
The client would not take any of the likely have accepted that an end date You can find this guidance – and all
audiologist’s advice on use of had been agreed with the client. In other BSHAA guidance documents
programmes and cleaning, and the absence of either, the judge ruled for members – on our website at
constantly switched between using that the extension to 60 days was www.bshaa.com/Members/
one aid and two, and with NHS agreed verbally and it was BSHAA-guidance r
// PEOPLE Angela Pelosi appointed director
of global audiology at Phonak
Angela Pelosi has been appointed to the position of director of global audiology
at Phonak. Angela brings over 20 years of experience in audiology, specialising
in the clinical fields of paediatrics, adults with complex hearing losses, clinical
development and training.
Over the past 15 years at Sonova, she has led audiology, sales and marketing
teams at Phonak Australia and Unitron, driven FM/Roger business development,
and most recently led the Paediatric, Power and BTE category groups.
Angela replaces Ora Buerkli, who joined the company 35 years ago as the first
audiologist at Phonak. Ms Buerkli will continue as senior advisor for Phonak
until the end of November. r
16 BSHAA PEOPLE | OCTOBER 2019
News
BSHAA member Tony Kay becomes new
British Tinnitus Association president
Tony Kay, BSHAA member and head of audiology services Tony Kay and Kim Moss from Aintree Tinnitus Support Group after the
at Aintree University Hospital NHS Foundation Trust, has group achieved BTA Gold Standard
become the new President of the British Tinnitus
Association (BTA). becoming the first NHS audiology service to be fully accredited
by the United Kingdom Accreditation Service’s Improving
David Stockdale, BTA chief executive said: “We are delighted Quality in Physiological Services (IQIPS) in 2013. Also,
to have someone as passionate as Tony is about supporting becoming a member of the BTA’s Professional Advisors
people with tinnitus as our president. Tony not only leads Committee and, now, the association’s president. I’m both
an excellent service within Aintree, he also gives his time honoured and humbled to have been bestowed this
and expertise generously out of working hours, having set prestigious role.
up the Aintree Tinnitus Support Group, and served us on
both the BTA’s Professional Advisers’ Committee and the What are you hoping to achieve during your
British Society of Audiology’s Tinnitus & Hyperacusis Special term in office?
Interest Group.
I hope that I will be an effective ambassador for the BTA,
“Tony brings a wealth of clinical expertise in tinnitus and and for individuals with tinnitus. I hope to support the BTA
experience of management of this complex condition. We with their strategy, continue to raise the profile of tinnitus
are looking forward to having his input and insight as we and its impact on people, and give the benefit of my clinical
continue to develop our own support services.” and managerial expertise
Tony – who takes over as president from Prof David Baguley How do you think BSHAA and the BTA can work
– said: “I am both humbled and honoured to have been closer together?
appointed to the prestigious role of president of the British
Tinnitus Association and I am looking forward to fulfilling my I think we should all work together to improve the quality
duties and further supporting the aims of the BTA.” of life and outcomes for our service users. BSHAA members
should signpost individuals with tinnitus to the BTA and local
BSHAA president Andrew Coulter added: “Huge BTA approved tinnitus support groups. Perhaps developing
congratulations to Tony for becoming the BTA’s new president. effective tinnitus training programmes for BSHAA members
The honour is rich reward for his experience and commitment to further enhance awareness is a possible initiative.
to the management of tinnitus. I wish him all the best in his
role and look forward to working closely with him.” What do you see as the main challenges and
opportunities for our profession over the next
If you would like to find out more about the group, please few years?
contact [email protected] or Colette Bunker at the
BTA at [email protected] or 0114 250 9933. An increasingly elderly population with hearing, tinnitus
and balance problems is certainly a challenge for us all. Our
Q&A with Tony Kay opportunity as a profession is to continue to improve and
develop effective streamlined services to cope with the
Could you give us a quick summary of your demand and continue to improve the quality of life of the
career to date? people we treat. r
I qualified as an audiologist in 1984 and I’m currently head
of audiology services at Aintree University Hospital NHS
Foundation Trust. My main clinical interests are tinnitus and
hyperacusis. I became a registered Hearing Aid Dispenser
in 1995 and I have experience of working as an independent
hearing aid dispenser and treating patients with tinnitus in
both the NHS and private sectors.
What are you most proud of?
I’m most proud of my family – my wife Sue (who’s put up
with me for 35 years – and counting – of marriage), my
children and grandchildren. Several things spring to mind
that I’m proud of about my career. Developing an effective
and supportive tinnitus service and tinnitus support group is
particularly pleasing, as was Aintree’s audiology services
17BSHAA PEOPLE | OCTOBER 2019
// industry // product // people
// PEOPLE BSHAA member Paula Cook named
UK Audiologist of the Year
BSHAA member Paula Cook has been named as the top Heather went on to explain that although Paula’s and Aston
hearing professional in the United Kingdom as part of a Hearing’s generosity and kindness was one of the reasons
search for Europe’s best audiologist. behind her nomination for Audiologist of the Year, it was
Paula’s background and reasons for entering the profession
Paula – of Aston Hearing in Amersham, Buckinghamshire – that really hit home.
was awarded the title of UK Audiologist of the Year 2019 on Heather explained: “Paula’s previous career, prior to becoming
3 October. She was set to compete against other audiologists an audiologist, had been working for the fire brigade, but
for the coveted title of European Audiologist of the Year, when her first child was born she focused her attention on
which was due to be announced on 16 October. being a mum. She was a beautiful little girl but was difficult to
manage and had very challenging behaviour. She kept going
The annual competition is organised by Rayovac in partnership back to her GP but it wasn’t until her child was three that
with Audio Infos magazine, the European Hearing Instrument she was diagnosed with severe hearing loss. By this time,
Manufacturers Association (EHIMA) and the European Paula had a second child. His hearing was also tested and it
Federation of Hard of Hearing People (EFHOH). Now in its transpired they both had the same genetic hearing loss.
twelfth year, the competition honours the top hearing “From that moment on Paula fought for her children. She
professional in each participating country, nominated by their became involved in every way possible to ensure they
patients, who have received excellent levels of support, received the best care and technology available. She was
service and care from their audiologist. such a regular in the audiology department that they offered
her a job and that was that – her career in audiology began.
Paula was nominated by her client Heather Cooper, who Audiology is not a career for Paula, it is a lifelong vocation.”
retired to Turkey several years ago but stayed in touch
through social media. “I kept in regular contact with them,” Paula (pictured above) has been bowled over by the award.
Heather said: “It was reassuring as, when they learned of my She said: “This is completely surreal for me. I was shocked
change in situation, they kindly offered to help in any way to be nominated and then to be chosen for the award, for
possible to keep me hearing – even from afar.” what I consider to be a complete privilege, to have happened
upon a career that has become my vocation in life. When I
Following a serious fall when Heather injured her back, she received the devastating news of my children Ellen and
contacted the clinic for advice. With a broken bone in her Michael’s diagnosis, I could never have imagined the path it
back and in a great deal of pain, Heather had contacted a would have taken us all on, but when I received the news I
neighbour, Dora, for help and the two had become friends. was with them both and it felt like the award was for the three
However Dora, was profoundly hard of hearing and this had of us, a culmination and recognition of our amazing journey.”
become a source of great frustration to them both. Speaking on behalf of the panel of judges, Stefan Zimmer, the
secretary general of EHIMA, said: “Picking a winner from so
Eager to help a client of Aston Hearing for 17 years, Paula many detailed and heart-warming nominations is never easy.
arranged to take her summer holiday at a resort near Heather’s What we are looking for is those hearing care professionals
new home. Having arranged for her audiology equipment to who are going above and beyond merely expected levels of
be taken by plane, she visited the pair and assessed Dora’s care in their practice. Paula was a clear winner in this regard.” r
hearing, fitting her with hearing aids from the clinic’s stock to
save on cost.
Heather said: “Paula was so kind and appreciated that Dora
would find the introduction of sound at this stage of her life,
having very poor hearing for the past 25 years, quite difficult.
We took it slowly, but all our fears diminished as soon as she
fitted the hearing aids – Dora’s face broke into the biggest
smile I have ever seen. Then came the tears and emotions
from all of us. We wandered down to the beach and Dora
looked astonished: ‘I can hear the sea. I feel I’ve been born
again’ she said.
“I was beyond delighted for Dora and so excited for the
future and our friendship. At this point Paula had another
surprise and presented me with a new pair of hearing aids
too – the same as Dora’s, so we were both able to support
each other with our new aids.”
18 BSHAA PEOPLE | OCTOBER 2019
News
// INDUSTRY Crisis text line for Deaf people launched
On World Suicide Prevention Day in Access to mainstream crisis mental The technology powering the Crisis
September, a new free text message health services for Deaf people is Text Line is from the US and the
service to support Deaf people who almost non-existent, and yet Deaf anonymised data gives a unique
are in crisis was launched. people are twice as likely to insight into mental health trends
experience mental health problems within the Deaf community and will
Owned by Mental Health Innovations than hearing people, facing therefore help improve people’s lives
and with the support of The Royal communication barriers and who have struggled to gain immediate
Foundation, Shout is the UK’s first difficulties accessing healthcare. support in the past.
free 24/7 confidential text service.
The exciting new partnership between SignHealth is the Deaf health charity
SignHealth and Shout now provides a led by Deaf people for Deaf people.
unique opportunity for Deaf people It is dedicated to making sure Deaf
to reach out anywhere, at any time. people get the same access to
healthcare and health information as
Deaf people who need help with hearing people.
urgent issues such as suicidal
thoughts, abuse or assault, self-harm, There is more information at
bullying or relationship issues will www.signhealth.org.uk r
now be able to access support
immediately by texting the word
DEAF to the number 85258.
Call for bursary scheme to train
more Teachers of the Deaf
The National Deaf Children’s Society has called on the The Society is calling for the Department for Education in
Government to invest in Teachers of the Deaf. England to invest in a bursary scheme for new Teachers of
the Deaf. They estimate that £1.3 million would pay for over
The Society reports that there has been a 12% fall in the 160 teachers to be trained. Working with the British
numbers of Teachers of the Deaf in England since 2011 – at Association of Teachers of the Deaf, the Society has
a time when the number of deaf children is going up, and submitted a proposal for the Children and Families Minister
when far too many are still underachieving compared to to consider.
their hearing peers.
You can find more information at www.ndcs.org.uk r
Ian Noon, chief policy adviser at the National Deaf
Children’s Society (pictured right), said: “Teachers of the
Deaf should be seen as being at the forefront of early
intervention for deaf children. No-one else has as much
expertise and specialism to provide deaf-specific advice to
families on language and communication in the early years.
Or to provide advice to early year settings and mainstream
teachers on what effective inclusion looks like.
“With deafness being relatively less common, most mainstream
early year settings and schools may only occasionally come
across a deaf child. It’s unrealistic and naive to expect
mainstream early year settings and schools to retain specialist
knowledge around deafness.”
19BSHAA PEOPLE | OCTOBER 2019
// industry // product // people
// INDUSTRY Hearing aids linked to lower risk
of dementia, depression and falls
Older adults who get a hearing aid for a newly diagnosed a hearing aid for their hearing loss, compared with 9.8% of
hearing loss have a lower risk of being diagnosed with African-Americans and 13.6% of whites.
dementia, depression or anxiety for the first time over the
next three years, and a lower risk of suffering fall-related Nearly 37% of people with hearing loss who lived in the
injuries than those who leave their hearing loss uncorrected, north-central part of the country, as designated by the Census
a new study has found. Bureau, used a hearing aid, compared with just 5.9% of
people in the mountain states.
Yet only 12% of those who have a formal diagnosis of
hearing loss actually receive the devices, even when they When the researchers looked at the path that patients who
have insurance coverage for at least part of the cost, the received hearing aids took over three years, compared with
study shows. It also reveals gaps in hearing aid use among those who didn’t get the devices, significant differences emerged.
people of different racial and ethnic backgrounds, geographic
locations and genders. In all, the relative risk of being diagnosed with dementia,
including Alzheimer’s disease, within three years of a hearing
The findings, made by a University of Michigan team using loss diagnosis was 18% lower for hearing aid users. The risk
data from nearly 115,000 people over 66 with hearing loss of being diagnosed with depression or anxiety by the end of
and insurance coverage through a Medicare HMO between three years was 11% lower for hearing aid users, and the
2008 and 2016, are published in the Journal of the American risk of being treated for fall-related injuries was 13% lower.
Geriatrics Society.
The study also confirms previous studies’ findings that
Unlike traditional Medicare, Medicare HMOs typically cover people with hearing loss had much higher rates of dementia,
some hearing aid costs for members diagnosed with hearing depression and fall injuries than the general population.
loss by an audiologist.
The reasons for this are complicated, and can include loss of
Elham Mahmoudi, MBA, Ph.D., the University of Michigan social interaction, loss of independence, loss of balance and
Department of Family Medicine health economist who led less stimulation to the brain. Some researchers also believe
the study, said the study confirms what other studies have that the loss of nerve impulses from the ear to the brain, and
shown among patients studied at a single point in time – but loss of cognitive ability leading to dementia, could be part of
the new findings show differences emerging as time goes on. the same aging process.
“We already know that people with hearing loss have more The study only included individuals who billed their insurance
adverse health events, and more co-existing conditions, company for part of the cost of their hearing aid, Mahmoudi
but this study allows us to see the effects of an intervention notes. The coming of FDA-approved over-the-counter hearing
and look for associations between hearing aids and health aids in 2020 for people with mild to moderate hearing loss
outcomes,” she said. “Though hearing aids can’t be said to could make the devices much more accessible for many
prevent these conditions, a delay in the onset of dementia, people. But those new devices could also complicate
depression and anxiety, and the risk of serious falls, could researchers’ ability to study the effects of hearing aids on
be significant both for the patient and for the costs to the other health outcomes, if people do not use insurance
Medicare system.” coverage and researchers can’t tell if they have one.
Mahmoudi and her colleagues at the University of Michigan “Correcting hearing loss is an intervention that has evidence
Institute for Healthcare Policy and Innovation looked at behind it, and we hope our research will help clinicians and
anonymous insurance data to perform the study, and looked people with hearing loss understand the potential association
at the data for each person with hearing loss one year before between getting a hearing aid and other aspects of their
their diagnosis, and three years after, so they could see only health,” Mahmoudi added.
newly diagnosed dementia, depression, anxiety and fall injuries.
She notes that Medicaid in the state of Michigan is now
They intend to keep studying further data from this population, covering hearing aid testing, fitting and purchase, since a
to see if the differences in health outcomes continue beyond policy change in 2018, and that it will be important to study
three years. impacts in this population as well. r
The study shows that men with hearing loss were more likely Editorial note – Medicare is the state funded support of
to receive a hearing aid – 13.3% compared with 11.3% of healthcare for over 65s in the USA, and its partner, Medicaid,
women. Only 6.5% of people of Latino heritage received is the state funding of care for the most needy.
20 BSHAA PEOPLE | OCTOBER 2019
News
WHO reviews cognitive decline evidence,
including managing hearing loss
The World Health Organisation (WHO) has reviewed and published both at the individual and population level.
the evidence on risk reduction strategies for cognitive decline and
dementia, including details on the management of hearing loss. “Hearing impairment has debilitating consequences on functional
ability and social and emotional welfare. Deteriorations in hearing
WHO researchers found evidence to support that hearing loss impact on individuals’ ability to communicate with others, which
increases the risk of cognitive decline. However, they state that more in turn can result in feelings of frustration, isolation and loneliness.
evidence is required to show how hearing aids and the treatment Older adult populations who already experience the isolating effects
of hearing loss might help reduce the incidence of dementia or the of age-related factors such as diminished mobility, driving cessation,
disease’s rate of progression. death of partners or living alone are particularly vulnerable to
these psychosocial impacts.
This evidence is certainly emerging, however, including the latest
findings from the University of Michigan, reported opposite. “Another significant effect of hearing loss is that of increased risk of
cognitive decline or dementia.”
The WHO review document states: “Hearing loss is a prevalent
age-related disorder. As the fourth leading cause of years lived You can read the full summary on the management of hearing loss
with disability in the global population, it is estimated to affect one on pages 396 to 400 of the WHO review document at
in three adults aged 65 and older, with this statistic growing annually. www.bit.ly/WHOdementia1 r
The implications of hearing loss, however, are often underestimated
New ‘Managing Hearing Loss at Work’ resources from the Ida Institute
The Ida Institute has launched a new resource to provide security. But being open about hearing loss improves communication
information for people with hearing loss to support their and is a benefit to everyone in the workplace. If the dialogue about
communication needs at work. the needs of the person with hearing loss fails, many countries
Hearing loss in the workforce is common and as people get have laws in place to protect the person with hearing loss.”
older, the likelihood of developing a hearing loss increases. This is The Managing Hearing Loss at Work resource includes a list of
especially relevant as more people delay retirement. Almost 25% organisations and the different protections and accommodations
of people in their 60s who are still working are estimated to have available around the world. Ida has identified local organisations in
some degree of hearing loss. more than 30 countries that offer information and support.
Despite its prevalence, many people with hearing loss are Ida has also assembled several supporting materials – including
uncomfortable raising the subject with their employers or videos, articles and a poster – with tips and experiences from
colleagues. According to a survey among 1,000 people conducted people with hearing loss on how to make conversations easier in a
by Action on Hearing Loss, more than 50% of people surveyed busy workplace.
have delayed telling co-workers about their hearing loss. Find the ‘Managing Hearing Loss at Work’ resources at
An Ida Institute spokesman said: “This could be because they are www.bit.ly/workresource r
concerned about stigma, or because they fear for their job
Staffordshire ‘rejects merger of six local CCGs’
The Health Service Journal has reported to hold to account” and in his view it was CCG areas across the county. North
that GPs in Staffordshire have rejected a “clear that the proposed merger is Staffordshire CCG had been heavily
merger of six local Clinical Commissioning primarily driven by the national NHS criticised – including by BSHAA – for its
Groups (CCGs). England team and after careful policy which ran counter to the available
consideration we have concluded that evidence.
Local Medical Committee chair Paul there is no potential net benefit for either
Scott advised GPs to reject the merger. patients or general practices”. Merging CCGs and forming Integrated
He is quoted as saying: “Much has been Care Systems (ICSs) across England was a
made of the potential benefits of having As part of the preparations for the key part of NHS England’s Long Term Plan
a single CCG in Staffordshire, yet few if potential merger, there were fears locally – now informally part of NHS
any of these arguments hold true or are that North Staffordshire CCG’s policy of Improvement – which noted ICSs would
at best speculative”. He said a single large not providing hearing aids for people with be “central to the delivery” of it. r
commissioning group “will be even harder mild hearing loss would be extended to all
21BSHAA PEOPLE | OCTOBER 2019
// industry // product // people
// INDUSTRY Pioneering research into the lives
of deaf teenagers
An exciting new research project which is being delivered by The READY research project aims to track over 500 deaf
a combined research team from the Universities of Manchester young people (aged 15 to 18 at point of entry) annually for
and Edinburgh will look at the life experiences of deaf young five years as they face crucial turning points in their lives and
people between the ages of 15 and 18. develop their aspirations and identities. There is a real data gap
around this age group of deaf young people and their experiences
The Recording Emerging Adulthood in Deaf Youth (READY) – READY will gather data not just on attainment, employment
study – commissioned by the National Deaf Children’s Society and lifestyle but also on wellbeing, risk and protective factors
– will be the first prospective, observational longitudinal on the way to deaf young people achieving their potential.
study of deaf young people in the 15 to 18 age range, whether
in the UK or internationally. The project is looking for deaf young people from a variety
of backgrounds – anyone between the ages of 15-18, with
A great deal of research effort has focused on the early any kind of permanent hearing loss, living in England,
development of deaf children and their school years, whether Scotland or Wales can apply to take part.
in terms of language acquisition, pedagogical practices, family
support, literacy or socio-emotional development. Far less There is more information at
attention has been paid to the years following compulsory www.sites.manchester.ac.uk/thereadystudy r
education and the diverse pathways deaf children may take
into young adulthood.
We understand very little about which features in deaf
children’s early life and school age years may influence not
just their educational and vocational outcomes but also their
social developmental outcomes as young adults. This is
important because if we can understand more about what
enables deaf young people to achieve the key developmental
milestones of young, autonomous adulthood we are better
able to tailor support and resources earlier on in their
developmental journeys.
Hearing is enhanced by vagus nerve stimulation,
new research discovers
Potential therapeutic benefits for a range of conditions This is the first study to document both cortical and subcortical
including tinnitus have been glimpsed thanks to new plasticity following VNS-sound pairing, thus further
research involving vagus nerve stimulation (VNS) in rats. confirming positive clinical implications for such a paradigm.
Previous research has already indicated that extensive “This method can change even the earliest levels of the
auditory training can alter the neural response to the auditory system, which has been viewed as the most
trained sound throughout the auditory pathway, while this difficult to change,” said study co-author Michael Kilgard.
VNS-sound pairing paradigm has been successfully used
both pre-clinically in patients with tinnitus. “Future studies,” the paper states, “are needed to dissect the
functional consequences of the effects of VNS in each auditory
The vagus runs from the cranium to the gut and is a key region. This defines testable hypotheses for future human and
nerve in the autonomic nervous system. In rats, this nerve animal studies to characterize plasticity throughout the auditory
was stimulated while they were exposed daily, for 20 days, pathway and functional consequences in the context of disease.
to sounds at specific frequencies. From the responses to
these tones in the exposed rats and a control group, the Funding for the study included a National Institute of
researchers in this latest study concluded that VNS-tone Deafness and Other Communications Disorders Grant to
pairing significantly increased the response to the paired the research leader, Crystal Engineer.
tone frequency. In other words, auditory processing of
those tones was improved. The full article can be read in the Journal of Neurophysiology
at www.bit.ly/VNSresearch r
22 BSHAA PEOPLE | OCTOBER 2019
News
Why is there no cure for tinnitus?
A new paper titled ‘Why is there no cure for tinnitus?’ was David Baguley gave an excellent summary of the paper at the
published in Frontiers In Neuroscience in September. BSHAA professional development day in London on 7 September.
You can read a report of the event elsewhere in this issue.
The paper draws together views and opinions from a range of
perspectives on how we can move forward with research and The paper sets out the need for an objective measure of tinnitus and
where we’ve got to so far. The British Tinnitus Association (David the need to sub-type tinnitus, backed up by the latest evidence which
Stockdale) and Action on Hearing Loss (Ralph Holme) represent shows why these are needed. It also includes a detailed analysis of
the patient voice in the paper. Industry is represented by Charles where current research has got to – and where it needs to go next.
Large from Autifony Therapeutics, which has the experience of
undertaking a recent pharmaceutical trial. Paper authors also You can read the paper free of charge at www.bit.ly/nocuretinnitus r
include Professor David Baguley and Don McFerran.
NICE publishes draft guideline on tinnitus assessment and management
NICE published its draft guideline on the assessment and management of tinnitus in September. You can see it at www.bit.ly/tinnitusdraft
A consultation on the draft closes on 1 November. As a registered stakeholder, BSHAA will be analysing the guideline and economic
model in detail on behalf of members and the sector and submitting a response to the consultation. BSHAA members who would like to
submit comments to inform our response can send them to [email protected]. If you have any queries about the consultation, you
can also email NICE directly at [email protected] r
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23BSHAA PEOPLE | OCTOBER 2019
// industry // product // people
// INDUSTRY UK hearing aid unit sales drop following
Brexit safety stock purchases
The British and Irish Hearing Instrument dominance of RITE (receiver in the ear) many of our members manufacture
Manufacturers Association (BIHIMA) technology, now representing 75% of outside the UK – means our industry
has released their Q2 2019 results of all sales. is in a robust position, even in these
its members, painting a picture of both uncertain political times when many
growth and decline in the UK and Irish Interestingly, having shown a huge other markets are under threat. We are
hearing care markets. decline in recent years, BTE (behind encouraged by the continued growth
the ear) devices have shown a slight of the UK private sector, as well as by
The key finding is that NHS sales dropped improvement in 2019, holding at around the precautionary measures taken by
by 24% from Q1 2019, a figure partially 3% of market share. However, there the NHS in their stock purchases. We
explained by the fact there had been an has been a marked decrease in the anticipate the NHS market will return
unusually high volume of sales in the numbers of ITE (in the ear) products to full strength in the near future.”
previous quarter, up 34.7% on Q1 2018, sold, down to 11.4% in Q2 2019 from
as the NHS stockpiled in first quarter in 15.5% in the same quarter last year. BIHIMA releases the results of its
preparation for a no deal Brexit. This members every quarter. There is more
caused an inevitable drop off in Q2, BIHIMA chairman Paul Surridge said: information at www.bihima.com r
with NHS units down to 329,801. “The security of our supply chains –
The results from Ireland show a similarly
sharp drop-off from the beginning of
the year, with the number of units sold
dropping by 18%, from 16,200 in Q1
2019 to 13,169 in Q2.
However, UK private sales continued
their strong performance with hearing
instrument sales up 4.4% on Q1, from
82,573 to 86,250 units sold.
BIHIMA also tracks the trends in the
styles of technology being selected by
patients in the private sector. The Q2
results demonstrate the continued
Apple announces hearing study
Apple is teaming up with the University customers already make a part of their by improving our understanding of
of Michigan to study factors that affect everyday life”. It was due to be available users’ listening behaviours. With over a
hearing health. as a free download in the App Store this billion young people around the world
autumn. who could be at risk of hearing loss due
The Apple Hearing Health Study is the to unsafe listening, WHO is addressing
first of its kind to collect data over time DuBois Bowman, dean of the University this challenge through raising awareness
in order to understand how everyday of Michigan School of Public Health, said: and setting new standards for safe
sound exposure can impact hearing. The “We are excited about this unique listening. The knowledge gained through
study data will also be shared with the opportunity to partner with Apple to this study will contribute to future public
World Health Organisation (WHO) as a determine how everyday activities affect health action in this field.” r
contribution to its Make Listening Safe our hearing. The information gleaned
initiative. from this partnership will be critical for
us to address the public health impact of
People will be able to take part in the various noise exposures on hearing loss.”
study and agree for data to be submitted
from their devices through Apple’s new Dr Shelly Chadha, technical officer of
‘Research’ app. Apple says the app prevention of deafness and hearing loss
“democratises how medical research is at WHO, added: “We are pleased to
conducted by bringing together academic note the announcement of the Apple
medical institutions, healthcare Hearing Study which will contribute
organizations and the Apple products towards our Make Listening Safe initiative
24 BSHAA PEOPLE | OCTOBER 2019
News
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Hearing and optical associations champion
parallels between the sectors
For some years, audiology has had a close relationship with Stuart Burn said: “We had a very productive meeting with Paul,
optometry, with an increasing number of optical practices who I’ve known for many years during his time at Sight Care. The
electing to offer their patients audiology services as a part of two professions, optics and hearing, have similar goals and we are
their clinical offering. keen to explore how the two manufacturing organisations could
collaborate to raise awareness of sight loss and hearing loss in the
Paul Surridge, previously CEO of the Sight Care Group and future. The FMO is currently reviewing its programme of activity
now chairman of BIHIMA (the British Irish Hearing Instrument and working with BIHIMA on joint projects seems an obvious fit.”
Manufacturers Association) met recently with the incoming
chairman of the Federation of Manufacturing Opticians (FMO), Paul Surridge Stuart Burn
Stuart Burn, and his colleagues to talk about areas of commonality,
and how the two organisations could collaborate in the future. Congress video on hearing and vision
Paul said: “There are many parallels between optics and audiology We had an in-depth session at the 2019 BSHAA Congress in
and having spent almost 20 years in the former at Sight Care, I June led by Mel Gregory, the strategic lead for hearing care
recognise that more can be done to promote the optical/hearing across Leightons and The Hearing Care Partnership. Titled
care agenda. The two manufacturing organisations have a lot to Hearing and Vision: What’s the connection?, the interactive
contribute to the debate.” workshop explored the synergies between hearing and vision;
considered the health benefits of joined care; what it takes to
The meeting was held at FMO offices in London and covered a deliver services in a holistic and person-centred way; and the
wide agenda. Optrafair and the possibility of audiology having a considerations in the delivery of an effective business model.
greater presence at the event was a key topic, with both sides
agreeing to explore opportunities to reflect the closeness of A recording of the workshop is available on the BSHAA
the sectors. website at www.bshaa.com/Congress-2019-videos, alongside
other workshops from the opening day, and all of the
Paul Surridge added: “Optrafair is an excellent event and the presentations from day two. r
FMO has innovative plans for its future. We’ll be keen to see
how those plans evolve and if BIHIMA members and audiologists
could be encouraged to attend in greater numbers.”
Recent studies have laid bare the number of people in Europe
that suffer from undiagnosed hearing loss, a recent report from
Hear-It highlighted that over three million people in the UK
live with an untreated hearing loss, which costs the economy
an estimated £25.5 billion a year. Similarly, partial sight loss
affects around two million people in the UK, and this is expected
to rise to 2.4 million by 2024 according to Vision UK.
25BSHAA PEOPLE | OCTOBER 2019
Thinking
Outside the Booth
// DR JENNY NESGAARD In 2013 two Danish audiologists started It became clear that many parents of
a clinic where the need is greater in hearing-impaired children could not access
PEDERSEN the field of audiology. Since then 600 the services due to cost and distance to
children and youths in Zimbabwe have the facility. These children in many cases
HEAR TO AID CEO received free hearing care and had to drop out of school due to their
> www.heartoaid.org rehabilitation through amplification. 2019 difficulties following along in the
saw the formation of a foundation trust classroom setting.
(Hear to Aid) aimed at raising awareness
and funding for the growing project. Initially the clinic owners would waive
clinic fees and hearing aid costs on a case
Introduction by case basis, for children aged 18 and
below where hearing aids were needed
Zimbabwe is a landlocked country in but no funds were available. This was in
Southern Africa with 14 million inhabitants part made possible using donated devices
(Review, 2019). Estimates from 2011 received from a major hearing aid
suggest 47% of the population are living manufacturer and in part at the personal
below the poverty headcount ratio of cost of the clinicians. These activities saw
US$3.2 per day (Knoema, 2011). The 600 children and youths tested and
World Health Organization (WHO) managed for free in the Harare clinic to
estimates up to 7.4% have disabling date. In 2018 outreach clinics were
hearing loss in the Southern African region carried out in the outskirts of Harare
(Organization, 2012). For Zimbabwe this specifically for hearing impaired children
estimate would equate to a minimum of from low income families. All children
260,000 (and up to 980,000) people living were tested and received new unused
with disabling hearing loss. Access to health donated digital hearing aids suited for their
care and audiology services is simply specific hearing loss. Three such clinics
unaffordable for most. The country has a have been carried out in the past 12
shortage of qualified staff/specialists in months. For many the cost of transport
most fields, there are currently under 15 to the city was a barrier to accessing the
audiologists in the whole country. care. In 2019 clinics in the rural areas
were added, enabling more children to
Jenny Nesgaard Pedersen and Nicolai access the help in their own hometowns
Brogaard Pedersen moved permanently and villages.
from Denmark to Zimbabwe early 2015.
Prior to their move quarterly clinics were Hear to Aid
carried out by them in Harare. They
founded a Harare based full-service 2019 saw the formation of a formal
audiology clinic in 2013. In-clinic a full foundation trust aimed at raising awareness
range of audiology services is provided and funding for the growing project in
including new-born hearing screening, Zimbabwe. For the project to maintain
auditory brainstem response audiometry, momentum and for more children to
play audiometry and visual reinforcement receive care on an on-going basis – funding
audiometry as well as vestibular assessment, would be necessary. Hear to Aid
tinnitus management and adult onset comprises of the two original Danish
hearing loss testing and rehabilitation. clinicians and four additional board
26 BSHAA PEOPLE | OCTOBER 2019
members. On the board are audiologists from Denmark and the
United States, as well as a health care professional from the United
Kingdom and an advocate from Zimbabwe. Under leadership of
the board decisions will be made on outreach activities, equipment
purchases and more. Several partnerships have been entered for
the purposes of fundraising for the project, and it is hoped that
these initiatives will raise awareness and provide some funding
for clinics in 2020 and onwards. This in turn will enable greater
cadence on the clinics and increase the number of children and
youths that can access the care and in time access education as a
result of the rehabilitation.
Team meeting with the chief prior to carrying out clinical days in one of the
rural areas in western Zimbabwe
From left to right: Local partner representative (Love for Africa), Deputy Chief,
Chief of Hwange Region, J Pedersen, N Pedersen
Hearing aid being prepared during rural clinic in an open field Special instrumentation became necessary to deal with the
challenge of access to electricity. A special telehealth audiometer
Rural Clinics was purchased as part of a donation from the GN Foundation.
The equipment runs on the laptop battery and allows testing of
Providing clinical days outside of the Harare clinic and in the rural air conduction, bone conduction and speech (no language material
areas can be challenging. Most locations do not have electricity, at present for the local Zimbabwean languages). The equipment
and if they do it is only available at night (the country is experiencing is designed to attenuate environmental noise during testing and
daily load shedding with electricity turned off from 5am to 10pm). monitors noise levels alerting the clinician if a datapoint may be
Running water is a challenge and temperatures reach 40+ degrees elevated.
Celsius in the summertime. A frequent occurrence has been
language barriers with the majority of the rural population speaking A battery pack is used to keep the audiometry laptop running and
a native language and no English. There are also protocols that to run the drill for producing a temporary mould for each child.
must be observed in addition to our registration to practice With the battery pack the laptop can carry out testing for up to 8
audiology. Authorization must be sought from the local chief hours in the absence of electricity.
before carrying out a clinic in the area he governs.
Temporary moulds are made based on an impression of the child’s
ear(s). This mould is intended to last until the permanent mould
has been produced and forwarded. All fittings are carried out with
custom made moulds in either hard acrylic or soft silicone. Extra
planning is needed to manage infection control at these makeshift
clinical sites. Gloves are used together with hospital grade
sanitizing wipes. ➜
27BSHAA PEOPLE | OCTOBER 2019
➜ Thinking Outside the Booth
Touring a small medical facility in the rural community
To date the language barrier has been managed with the assistance The longest standing partnership has been with the GN Foundation.
of our local point of contact in the different regions, towns and Support has been on-going for over six years. The partnership has
villages. They make available someone able to translate the different included countries outside Zimbabwe with Dr Pedersen traveling
languages we encounter into English and vice versa. This is crucial to other African countries to carry out clinics on behalf of the
for understanding the history of each child and communicating use GN Foundation. Within Zimbabwe and for Hear to Aid the GN
and care for a hearing instrument. Water and a small meal are usually Foundation has assisted with clinic costs (mould and impression
organized for those attending the clinics as wait times can be long materials, hire of appropriate rooms, lunch supplies and more) and
in the heat, and few have the means to bring a packed meal. most noteworthy has been the donation of hearing aids. This support
has been instrumental in changing the lives of many children and
Partnerships youths in Zimbabwe.
The Hear to Aid activities have been well received by the local Conclusion
community. This has resulted in some new partnerships in 2019.
Love for Africa creates travel and experience packages for tourists There is an African saying “it takes the whole village to raise a
wishing to experience the beautiful nature and historical sites in child”. This has proven true for the endeavours to supply
Zimbabwe. The partnership with Hear to Aid has resulted in the rehabilitative services that are sustainable and on-going for the
introduction of ‘travel with purpose’ packages. These packages hearing-impaired children of low-income families in Zimbabwe
offer safaris and interactions with nature in combination with the and neighbouring countries. The work is ongoing, and more is
chance to assist with the rural audiology clinics. On purchasing a needed, but the first steps have been taken with much support
travel with purpose package 15% of the purchase amount goes to and encouragement along the way. The process has challenged
the foundation to help further the foundation activities. these clinicians to think outside the booth and find ways to offer
quality care based on best practice in a setting where the usual
A second partnership is with Patrick Mavros and sons. The Mavros structure is missing. These children have the same need for quality,
family are Zimbabwean and their African inspired jewellery lines evidence-based care as children from higher income families and
are loved worldwide, their flagship store is in London. Patrick Mavros economies. It is hoped that the years to come will see an increase in
senior was moved by the activities of Hear to Aid to create a special the number of families receiving support for their hearing-impaired
line of jewellery in aid of the foundation activities. The jewellery children. Hearing is just the beginning – structures will need to
line was launched in May of 2019 at the London store. 50% of be put in place to assist these children and youths in re-entering
proceeds from the line go to foundation activities.
28 BSHAA PEOPLE | OCTOBER 2019
Audiometry using special telehealth audiometer for air conduction and bone Ear mould impressions taken for temporary moulds and for permanent mould
conduction production later at Harare lab
the school setting to receive an education that will allow References
employment later in life. But hearing is a start, and without
access to this first step their futures would look less bright. Knoema. (2011). Zimbabwe – Poverty headcount ratio at $3.2 a day
based on purchasing-power-parity in constant prices of 2011.
For further information on the foundation and to donate to Retrieved from
the cause visit www.heartoaid.org. Follow Hear to Aid activities https://knoema.com/atlas/Zimbabwe/Poverty-rate-at-dollar32-a-day
on www.instagram.com/heartoaid and www.facebook.com/
heartoaid For information on travel with purpose packages Organization, W. H. (2012). WHO global estimates on
(15% goes to the cause) visit www.loveforafrica.org. To prevalence of hearing loss Retrieved from
purchase the Hear to Aid line of African design jewellery https://www.who.int/pbd/deafness/WHO_GE_HL.pdf
(50% goes to the cause) visit www.patrickmavros.com. r
Review, W. P. (2019). Zimbabwe population 2019.
Bio Retrieved from
Dr Jenny Nesgaard Pedersen studied audiology at the
Institute of Sound and Vibration Research (ISVR) at the
University of Southampton and holds an audiology doctorate
from NOVA Southeastern University, Florida. Jenny worked
8 years in research and development at one of the world
leaders in hearing aid technology and lectured for seven
years at the University of Copenhagen on topics of technical
audiology before opening a full-service audiology practice in
Harare, Zimbabwe.
Additionally she is the founder and CEO of the Hear to Aid
foundation, a non-profit organization helping children and
youths with hearing impairment in Zimbabwe and
neighbouring countries.
29BSHAA PEOPLE | OCTOBER 2019
The disparities in the uptake
of hearing intervention by
ethnic minorities
// JASMINE Iwas first drawn to write this article on in her family. I was delighted at the
OPOKU-WARE the very first day I started my placement opportunity to provide intervention for
in the audiological field. As a black someone from my ethnic background –
Audiologist woman, I constantly navigate life trying something I hadn’t had the opportunity to
> [email protected] to find myself in others – I look out for do for a notably long time. As standard, I
people who look like me. The people provided a comprehensive test and she
30 BSHAA PEOPLE | OCTOBER 2019 who came in for hearing appointments accepted hearing devices were the
and who were fitted with hearing devices solution. She was thoroughly impressed
certainly did not look like me. I initially by the sound quality of the RIC
put this down to the fact I was working demonstration devices and wanted the
in the North, perhaps a less diverse area exact same solution. It came to the time
from my London home. I thought surely of display of style, and I advised her to
the situation will differ when I returned to look in the mirror to gain an understanding
London, the most diverse city in the UK. of the aesthetics of the RIC product. I
held my breath as I awaited her response.
When I first started my working career, I
was first placed in what would be Her response was one that I rarely see
considered diverse areas in London – from a white patient. As she looked in the
Lewisham and Croydon. Yet again, I was mirror and viewed the “clear” receiver
surprised at the lack of diversity of those against her dark skin, disappointment
people attending hearing appointments. spread across her face. She was instantly
Nonetheless, there was an increase in the disappointed by the visibility of the device.
diversity of the patients I saw. I quickly This particular patient who initially came
noticed that there was a significantly in motivated to gain help with her hearing
higher reluctance of the uptake of hearing left without a solution; she left without a
devices from those of ethnic minority solution as she felt there wasn’t one
backgrounds. I would always probe what aesthetically catered to her. Many will
was the reasoning of this reluctance. have the thought, “Well why not use the
The reasons differed but the overriding receiver dyeing system?”. But the
responses were, “It’s just something that frustration comes when, for some, these
is not done”, “I don’t want to wear that receivers have the cosmetic appeal straight
in my ear”, “What will my family think out the box and for others a greater level
of this?”. I looked down at the “pink” modification is required for the ultimate
custom hearing device I was automatically cosmetic appeal. It provoked me to think:
provided as demonstration against my what role do manufacturers play in
dark skin; and I looked at my reflection making the market more appealing to
with the “clear” receiver that is obtrusive ethnic minorities?
down the side of my face and I found
understanding. Wallhagen (2010) conducted a study in
the US surrounding the effects of stigma
What catapulted me into writing this on the use of hearing devices. Wallhagen
article was a recent appointment I had expressed that stigma was related to
with a black woman. She was a professional three interrelated experiences: alterations
woman in her early 50s whose main in self-perception, ageism, and vanity. Vanity
issues were hearing conversations in work as a contributing factor to the deterrence
meetings. She wanted to tackle the issue of the use of hearing devices was through
with her hearing early, breaking the trend the perception that hearing aids would
that was present in previous generations make participants appear unattractive.
Participants emphasised that there is an importance of hiding the I want to discuss how race can be a tumultuous factor in contributing
hearing aid and not drawing attention to one’s ears for there to to health inequalities in the UK. This aspect has been studied in the
be a consideration of hearing devices. Wallhagen admittedly noted US and therefore I will make reference to studies and findings that
that research is also needed on cultural aspects contributing to have been concluded from this lens. Research exposes that race
the experience of hearing loss and usage. The recruitment for the and ethnicity remain powerful predictors of variations in health
study involved a range of hearing centres, but few people from status (Braithwaite & Taylor, 1992; Furino 1992; Livingston, 1994;
ethnic minorities were in the final sample for the study. Do we draw Zane et al, 1994).
the conclusion that from this study there is a lower prevalence of
hearing loss among African Americans, or does it provoke a greater A study from Kung et al. (2008) concluded that for most of the 15
need for understanding of the differing cultural views on hearing leading causes of death – including heart disease, cancer, stroke,
loss and hearing aid uptake? diabetes, kidney disease and hypertension – African Americans
have higher death rates than whites. Research on health inequalities
Hearing impairment causes substantial challenges in the lives of pertaining to race have been conducted and it is worth focusing our
those affected; if untreated, hearing impairment can have negative attention on how this can be translated in the audiological field.
social and health impacts in both adults and children. In the UK,
hearing loss is thought to impact the lives of one in six of the A study from Nieman et al (2015) concluded that amongst older
population. Estimates show that 14.5 million people in the UK, Americans with hearing loss, black older adults were 58% and
approximately 20% of the population, will have a hearing loss Mexican American older adults were 78% less likely than white
by 2031. In 2010, the number of hearing aid users in the UK was older adults to report regular hearing aid use. These findings were
approximately 3.2 million (iData, 2011). Although the number of after controlling for age and degree of hearing impairment. Other
those affected by hearing impairment is steadily rising, the uptake studies also confirm that minority older adults were less likely to
of hearing aids is relatively low. There are various factors other use hearing aids (Bainbridge & Ramachandran, 2014; Tomita et
than stigma that deter people from the use of hearing devices. al., 2001). The results from Bainbridge & Ramachandran, which
Reasons include a lack of public awareness and education about studied hearing aid use among older United States adults, found
the effects of a hearing impairment and how to cope with the the quantity of hearing aid use among white people was over
effects of this (Knudsen et al., 2010), and the insufficient and twice that of black, Hispanic or other (including multiracial) people
restricted management of hearing impairment as part of general (35.4% vs. 17.1%, (p<0.05). There is a duty to investigate why
healthcare provision (Meyer & Hickson, 2012; Schneider et al., 2010). this is the case and if clinicians – but also if manufacturers and
General hearing health research is largely centred around a white hearing aid dispensing companies – have a role of responsibility
demographic. There is little to no research about understanding towards these disparities.
the uptake of hearing devices among ethnic minorities (Cruickshanks
et al., 1998; Gates et al., 1990; Nash et al., 2013). Clinician bias manifests in preconceived notions about the
probability of an existing disorder or illness due to socioeconomic
The discussion of health inequalities in the UK is largely conceptualised background or racial or cultural conditions. When a clinician is
into focusing on socioeconomic factors. Although there are various biased, this can be in an unconscious way, but it could result in
types of inequality that can represent a fundamental cause, the misdiagnosis and inaccurate treatment recommendations. However,
greatest research focus has been on inequalities based on when an individual is judged according to their race, which results
socioeconomic status. Certainly, low economic status is regarded as in bias, it is quite plainly considered discrimination. I urge clinicians
the central cause of introducing health inequalities but it is worth to be introspective and challenge the current thoughts they may
exploring other factors that can cause this issue. Nazroo (2003) have when a patient who is from a minority background enters the
found that when the health status of ethnic minority communities consultation room. Have we noticed that there is this disparity
and white communities in the same socioeconomic position are present about the uptake of hearing intervention of those from
compared, individuals from minority ethnic groups still display ethnic minority backgrounds? Does this alter the level of care and
poorer health. Nazroo argued there is an additional factor of attentiveness towards minorities because of these preconceived
ethnicity that surges the exposure of ethnic minorities to poor ideas we have about whether they would be a variable dispense?
health, stating this additional component is a complex one. One A study from O’Sullivan and Schofield (2018) surrounding the
factor is explored by Annandale (2014) – racial prejudice. cognitive bias in clinical medicine provided various suggestions on
➜
31BSHAA PEOPLE | OCTOBER 2019
➜
The disparities in the uptake of hearing
intervention by ethnic minorities
how we can “unbias” ourselves – one simple but effective strategy iData (2011) European Markets for Hearing Aids and Audiology
is “slowing down.” They noted an improvement in diagnostic Devices: DATA_EUHD11_RPT
accuracy when clinicians adapted slowing down and consciously http://www.idataresearch.net/idata/report_view.php?ReportID=896
deliberating on problems, regardless if there was any specific Kanner, Allen and Renee “Globalisation, Corporate Culture and
underlying bias present. Freedom” Psychology and Consumer Culture (2004) 49-63
Knudsen LV, Oberg M, Nielsen C, Naylor G, Kramer S. (2010)
Is it time to also question if the industry – through advertising, Factors influencing help seeking, hearing aid uptake, hearing aid
website pages and marketing materials – are marketing to all use and satisfaction with hearing aids: a review of the literature.
ethnic groups or is there a focus on one ethnic group? Do these Trends Amplif. 14(3):127–154
subtle but powerful choices manufacturers and hearing dispensing Kung, H. C., Hoyert, D. L., Xu, J., & Murphy, S. L. (2008). Deaths:
companies make have an effect on the uptake of hearing devices Final data for 2005. National Vital Statistics Reports, 56(10), 4–26
for minorities, and what responsibility do these companies have Livingston IL (1994) Handbook of Black American Health: The
in changing the statistics we currently have around the uptake of Mosaic of Conditions, Issues and Prospects, Westport, CT:
hearing devices in minority communities? We are inundated with Greenwood
messages everywhere we look, from TV commercials, magazine Meyer, C., & Hickson, L. (2012). What factors influence
articles or billboards on the street. These advertisements tell us help-seeking for hearing impairment and hearing aid adoption in
what we should do, how we should think, but these advertisements older adults? International Journal of Audiology, 51, 66–74
also tell us who they are marketing to. Companies establish who Nash SD, Cruickshanks KJ, Huang GH, Klein BE, Klein R, Nieto FJ,
their target market is and then focus their marketing material Tweed TS. (2013) Unmet hearing health care needs: The Beaver
towards their audience. Dam off-spring study. American Journal of Public Health.
103:1134–1139
The purpose of this observation is not to accuse those working Nazroo, J.Y. (2003) The structuring of ethnic inequalities in health:
in the industry of being racially prejudiced, but to suggest that the economic position, racial discrimination and racism, American
operation of services may discriminate against ethnic minority Journal of Public Health, 93, 2, pp. 277–84
groups due to embedded social norms, values and practices which Nieman. C, Marrone. N, Szanton. S, Thorpe. R, Frank. R. LinJ
can then have an impact on the journey of individuals from ethnic Aging Health. (2015) Feb; 28(1): 68–94
minorities’ hearing health. O’Sullivan E, Schofield S. (2018) Cognitive bias in clinical medicine.
J R Coll Physicians Edinb; 48:225–32
We as hearing healthcare professionals living in a multicultural Schneider. J, Gopinath. B, Karpa. M, McMahon. C, Rochtchina. E,
world, who want to provide greater personalised care for all our Leeder. S, Mitchell. P. (2010) Hearing loss impacts on the use of
patients, should call for more research and interest in the community and informal supports, Age and Ageing, Volume 39,
profession to make sure we are catering to the diverse group of Issue 4. 458–464
patients we see. r O’Sullivan E, Schofield S. Cognitive bias in clinical medicine. J R
Coll Physicians Edinb. 2018; 48:225–32
Bibliography Tomita M, Mann WC, Welch TR. Use of assistive devices to
address hearing impairment by older persons with disabilities.
Annandale E (2014) The Sociology of Health and Medicine: International Journal of Rehabilitation Research.
A Critical Introduction. Cambridge: Polity Press 2001;24(4):279–290
Wallhagen M.I. (2010) The stigma of hearing loss. Gerontologist.
Bainbridge KE, Ramachandran V. Hearing aid use among older U.S. 50:66–75
adults: The National Health and Nutrition Examination Survey, Zane NWS, Takeuchi DT, Young KNS (1994) Confronting Critical
2005-2006 and 2009-2010. Ear and Hearing. 2014; 35:289–294 Health Issues of Asian and Pacific Islander Americans. Thousand
Oaks, CA. 105
Braithwaite, R. L and Taylor, S. E. 1992. Health Issues in the Black
Community, San Francisco, CA: Jossey-Bass Publishers
Cruickshanks KJ, Wiley TL, Tweed TS, Klein BEK, Klein R,
Mares-Perlman J, Nondahl DM. (1998) Prevalence of hearing loss
in older adults in Beaver Dam, Wisconsin: The epidemiology of
hearing loss study. American Journal of Epidemiology. 148:879–886
Furino, A (1992) Health Policy and the Hispanic, Boulder, CO:
Westview
Gates GA, Cooper JC, Jr., Kannel WB, Miller NJ. (1990) Hearing
in the elderly: The Framingham cohort, 1983-1985. Part I. basic
audiometric test results. Ear and Hearing. 11:247–256
32 BSHAA PEOPLE | OCTOBER 2019
It’s time to talk about
cochlear implants
in the independent sector
The British Academy of Audiology (BAA) wants all adults with severe to profound deafness to be well-informed about
Cochlear Implants so individuals can make a fully informed decision about the best way to treat their deafness.
Audiologists are the main gatekeepers to Cochlear Implants (CIs): identifying candidates and counselling clients for a
referral requires awareness, training and confidence. This article aims to highlight the benefits of CIs, discuss the new
NICE candidacy guidance, and support independent sector audiologists to refer their clients for an implant.
I welcome your comments or suggestions on this topic. If you need any help or support with any of the suggestions made
in this article please contact me: [email protected]
// ANN-MARIE Introduction: awareness, knowledge, and confidence to
DICKINSON identify candidates and make referrals for
The new NICE guidance – ‘Cochlear assessment. Allen at al., (2018) found that
SPECIALIST AUDIOLOGIST, WITHINGTON implants for children and adults with severe Audiologists often felt there wasn’t the time
COMMUNITY HOSPITAL, MANCHESTER to profound deafness’ – was published or the opportunity during appointments
UNIVERSITY NHS FOUNDATION TRUST AND on 7 March (NICE, 2019). The uptake to discuss CI referral. Audiologists felt
VICE-CHAIR OF THE BRITISH ACADEMY OF of Cochlear Implants (CIs) by adults is that discussing CI referral required
AUDIOLOGY SERVICE QUALITY COMMITTEE disheartening: 74% of estimated eligible specialist knowledge and counselling skills.
children aged 0–3 have received CIs, and They felt these skills were not sufficiently
[email protected] 94% have received a CI by the age of 17. taught at undergraduate level but instead
However, less than 7% of estimated had to be gained in the workplace through
eligible adults receive one (Raine et training and support.
al., 2016; Raine, 2013). This is despite
evidence showing large, life-changing The rise of high-street hearing service
benefits post-implantation (Ng et al., providers and the advent of Any Qualified
2016; Gaylor et al., 2013), the magnitude Provider (AQP) mean independent sector
of which cannot begin to be achieved hearing services are more involved in
through the use of hearing aid technology supporting adults with S&P deafness than
alone (Simpson et al., 2018; Akinseye et ever before. Awareness of CIs amongst
al., 2018). independent sector Audiologists is currently
unknown and requires research.
Often, individuals with severe and profound
(S&P) deafness are looking for a ‘technology How much better is a
fix’ from their hearing aids but because of CI compared to hearing
damage to the cochlea this simply can’t be aids?
achieved; dead or damaged hair cells
cannot send good-quality signals to the Outcomes with CIs vary but are generally
brain. Indeed, frequency-lowering positive and can be lifechanging. An
technology has been shown to be annual report by The Richard Ramsden
particularly ineffective at improving Centre for Hearing Implants in Manchester
high-frequency aided audibility for showed average sentence recognition
individuals who are CI users or CI scores in quiet jumped from 9%
candidates, resulting in little or no benefit pre-implantation to 68% post-implantation
(Hopkins et al., 2014; Hillock-Dunn et al., in their 71 adult clients implanted in the
2014; Perreau et al., 2013; Park et al., financial year 2018-19 (MFT, 2019).
2012; McDermott & Henshaw, 2010). Survey responses revealed that 96% of
adults gained ‘great benefit’ from their
A recent study by Bierbaum et al., (2019) implant and 100% would recommend a
found that the main barrier to CI referral
in Australia and the UK among Health ➜CI to a friend or family member with a
Care Professionals (HCPs) was a lack of
similar hearing problem (MFT, 2019).
33BSHAA PEOPLE | OCTOBER 2019
➜
cochlear implants in the independent sector
A study by Ng et al. (2016) found that 86% of implanted adults The most reliable approach to assess CI candidacy would be to
reported that their CI provided access to communication leading perform a PTA and an aided AB word test. Both assessments are
to progression in education and improved career opportunities. simple and well used in hearing services, but what if the AB word
Self-reported listening confidence improved at home, at work and list is not available? Evaluating ‘adequate benefit’ from hearing aids
socially. Respondents reported less reliance on others and can be done through the use of outcome questionnaires and/or
described families becoming ‘reconnected’ (Ng et al., 2016). individualised goals and listening needs. If carefully verified
A recent study by Hughes et al. (2018) found that adult CI users up-to-date hearing aids are not helping your client meet realistic
described reduced listening effort and felt more in touch with their goals (e.g. effectively managing a phone conversation, socialising with
own social world, termed ‘social connectedness’. friends, taking an active role in meetings) and their PTA falls within
NICE guidelines, then an implant assessment will be worthwhile.
Severe and profound deafness costs the UK over £30 billion per
annum in terms of health and social care, and lost earnings; costs How can you refer?
which could be significantly reduced with the right treatment
(Archbold et al., 2014). There are 23 centres around the UK and Ireland. Co-ordinator
contact details and centre addresses can be found on the BCIG
CIs have been available for over 25 years and there are currently website: www.bcig.org.uk/type/contact-centre/. Referrals can be
around 17,000 UK users of them (AoHL, 2016). Candidacy criteria made direct to your local CI centre. Centres often provide report
has recently been relaxed, so more adults than ever before are templates/forms so it’s easy to know what information to include
now eligible for a CI. in a referral. Appendix 2 shows an example of a report referral
template. Get to know your local centre: set up links and referral
The new NICE guidance pathways (if you need any support with this contact BCIG and/or
BAA SQC).
To be eligible for a CI, adults must have worn hearing aids regularly
and be motivated, positive and willing to use an implant. They must Fears about the operation, and associated recovery and rehabilitation,
also have S&P deafness and fail to derive adequate benefit from can act as a barrier for eligible adults (Bierbaum et al., 2019). It’s
hearing aids, as defined by NICE (2019): important to reassure clients about the operation; implantation
involves routine surgery with minimal side effects (often day
1. S&P deafness: ‘pure-tone audiometric threshold equal to or surgery or a one-night stay in hospital). Recovery from surgery
greater than 80 dB HL at 2 or more frequencies (500 Hz, takes around two weeks and rehabilitation with an implant typically
1,000 Hz, 2,000 Hz, 3,000 Hz and 4,000 Hz) bilaterally without requires eight hospital visits over a nine-month period (MFT, 2019).
acoustic hearing aids’
Discussing implants with clients is not easy for an Audiologist/HAD
2. Inadequate benefit from acoustic hearing aids: ‘a phoneme with limited, or no, experience of CIs. The BAA service quality
score of 50% or less on the Arthur Boothroyd (AB) word committee have produced guidance to empower you to have the
test presented at 70 dBA’ conversation (www.bit.ly/BAAtime). We have also made a short
animated video to raise awareness of CIs among the general public
If your client has S&P deafness and struggles to live life to the full and HCPs (soon to be shared on Facebook/Twitter). Please share
with hearing aids, then an assessment for a CI will be worthwhile. with your colleagues and help us to spread the message. Training
Adults with long-term deafness, British Sign Language users, older and support on candidacy and referral is also provided by
adults and adults with mental and/or physical health conditions can organisations and implant manufacturers such as:
benefit greatly from a CI. Don’t delay – the sooner an implant is
provided the greater the benefits! CC British Cochlear Implant Group: www.bcig.org.uk
Adults should be ‘optimally aided’ prior to referral but it’s CC National Cochlear Implant Users Association: www.nciua.org.uk
important that excessive fine tuning doesn’t delay a referral. For
a definition of optimally aided, as agreed by BAA Service Quality CC Advance Bionics™: www.bit.ly/AdvBionics
Committee and British Society of Audiology, Adult Rehab Group,
see Appendix 1. CC Cochlear™: www.bit.ly/Cochlear1
Figure 1: Age at implantation for adults implanted at the Richard Ramsden CC Med-El™: www.bit.ly/CIMedel & www.hearpeers.com
Centre for Hearing Implants during 2018-2019 financial year (MFT, 2019),
showing that older adults are suitable for referral. Take home messages:
CC CIs are safe, cost-effective interventions that work: they
reduce the economic burden of S&P deafness and transform
lives.
CC The uptake of CIs amongst adults is low (<7%). Hearing
healthcare professionals are the main gatekeepers to CIs, yet
awareness, knowledge and confidence discussing CIs has been
shown to be poor. Training and support can improve referral
rates.
CC It is important that all adults with S&P deafness are
well-informed about Cochlear Implants so that every eligible
adult can make a fully informed decision about the best way to
treat their deafness. Do you discuss CIs with your clients?
34 BSHAA PEOPLE | OCTOBER 2019
Appendix 1: Bibliography for definition:
DEFINITION OF ‘OPTIMALLY AIDED ’: Experienced adult hearing American Academy of Audiology: www.bit.ly/2kChSFL
user with severe-to-profound deafness. BAA SQC & BSA ARIG,
agreed July 2019. American Speech Language Hearing Association:
www.bit.ly/2lP21Ul
Cochlear implants should always be considered as a priority
for adults with severe-to-profound deafness; however, it is British Society of Audiology: www.bit.ly/2lXK4Tr
important to ensure adults are optimally aided so they can
get the best possible outcomes with their hearing aids. Hearing Aids for music: www.musicandhearingaids.org/resources
1. Real Ear Measures (REMs) used to confirm the Simpson, A., Bond, A., Loeliger, M., Clarke, S. (2018) Speech
electroacoustic properties of the hearing aid and ear-mould intelligibility benefits of frequency-lowering algorithms in adult
in the ear i.e. frequency response, output and compression. hearing aid users: a systematic review and meta-analysis,
NAL-NL2 target may be a start-point when prescribing International Journal of Audiology, 57:4, 249-261, DOI:
output but previously used settings/prescriptions are equally 10.1080/14992027.2017.1375163.
as important (dependent on the benefit gained from the old
settings). Appendix 2:
Report Template for a Referral
2. Amplitude compression ratios kept low (<2), to minimise
the alteration of speech cues. Dear CI centre,
3. Volume controls offered, especially to experienced users of Re: client name, address, DOB, NHS number.
VCs (consider a remote control if dexterity problems).
Please would you assess this client for a Cochlear implant? Please
4. Comfortable, deep and well-fitted ear moulds that form an find their details of their hearing loss and hearing aids below.
acoustic seal such that feedback does not occur (and
feedback managers that limit gain are not required). Hearing loss: Please find a copy of all available PTAs enclosed (to
show progression of hearing loss/periods of significant deterioration).
5. Telecoil loop and potential for wireless connectivity
(directly or via streamer), so loop systems and assistive Duration deafness:
listening devices can be used in challenging listening situations
i.e. background noise and/or listening over a distance. Aetiology (if known):
6. Hearing aid settings can be optimized and fine-tuned based on Details of ear surgery:
subjective-feedback and speech tests. Subjective feedback
should always be the gold standard as speech tests do Current hearing aids: Make and model. Date fitted.
not represent real-world listening situations. Users may
require a period of acclimatisation to accurately report on Current hearing aid settings: Verification, programmes/volume,
sound-quality and provide subjective feedback. features enabled.
You may also wish to consider additional hearing aid features that Hearing aid use since onset of deafness: How often are hearing
may provide benefit although effect on overall performance may aids worn? How long have hearing aids been used? Have optimally
only be small: fitted hearing aids been trialled for at least three months in the
last two years? If not, why not? (This is a pre-requisite prior to
7. Directionality, noise-reduction, and music programme implantation).
selected and adjusted based on client preference and listening
needs. Outcome with hearing aids:
8. Frequency-lowering selected, verified and validated to Speech test score (optional), outcome questionnaire scores
ensure; a) aided audibility is improved, b) speech quality is not (optional), informal self-report outcome; e.g. Client cannot
impaired, and c) the client obtains a measurable benefit. perform their job effectively / Client is unable to communicate with
family and friends / Client feels distressed, isolated and depressed
Other points to consider: because of their residual disability / Client does not feel able to
look after their own children safely / Client cannot
9. Does the user have realistic expectations about what effectively manage a conversation on the phone.
amplification can deliver for their level of hearing? Make sure
this is explored at (re)assessment before proceeding with hear- General health: Are they seeing any specialists for any health
ing aid fitting when goals and management plan are agreed. problems?
10. Is the user able to consistently use the hearing aid(s) confidently Any other important information: This could include any fears
or would they benefit from further advice, practice or support? they discussed with you about implants e.g. surgery, loss of residual
hearing. This could also include a brief summary of the client’s
11. Hearing aids are only a part of the rehabilitation of hearing. It is motivation for obtaining a CI - what do they hope the implant will
also important that people are given all support possible in improve?
maximising their ability to manage their hearing loss. This may
include support and signposting for: Assistive Listening Devices, Please let me know the outcome of your assessment.
lip-reading classes, Access to Work, communication training for
family/friends/carers, Hearing dogs, Deaf-awareness training/ Best Wishes,
support in the workplace.
Copy to: GP & Client ➜
35BSHAA PEOPLE | OCTOBER 2019
➜ cochlear implants in the independent sector
Acknowledgements: grounded theory to establish content validity for a new client -reported outcome
measure’ Ear and Hearing, vol. 39, no. 5, pp. 922-934. www.bit.ly/2mfm1zC
This article was written on behalf of the BAA Service Quality Hopkins, K., Khanom, M., Dickinson, A., Munro, K. (2014) Benefit from non-linear
Committee for BSHAA members. Many thanks to my colleagues frequency compression hearing aids in a clinical setting: The effects of duration of
on the committee for their support and helpful suggestions. Many experience and severity of high-frequency hearing loss, International Journal of
thanks to Shahad Howe and Unai Martinez de Estibariz for reviewing Audiology, 53:4, 219-228, DOI: 10.3109/14992027.2013.873956.
this article and providing helpful comments and suggestions. McDermott, H. & Henshall, K. (2010). The Use of Frequency Compression by Cochlear
Implant Recipients with Postoperative Acoustic Hearing. Journal of the American
References Academy of Audiology, 21(6), 380-389.
MFT (2019) The Richard Ramsden Centre for Hearing Implants. Annual report 2018-19.
Action on Hearing Loss (2016) Cochlear implants policy statement. Available at www.bit.ly/ramsden1
Available at www.actiononhearingloss.org.uk Ng, Y., Lamb, B., Harrigan, S., Archbold, S., Athalye, A., Allen, S. (2016) Perspectives of
Akinseye, G., Dickinson, A., Munro, K. (2018) Is non-linear frequency adults with cochlear implants on current CI services and daily life, Cochlear Implants
compression amplification beneficial to adults and children with hearing loss? International, 17:sup1, 89-93, DOI: 10.1080/14670100.2016.1157314.
A systematic review, International Journal of Audiology, 57:4, 262-273, DOI: NICE (2019) Cochlear implants for children and adults with severe to profound
10.1080/14992027.2017.1420255. deafness. Technology appraisal guidance [TA566]. Publication date: 7 March 2019.
Allen, S. Jones, L., Gregory, M. (2018) Addressing the low uptake of cochlear Available at: https://www.nice.org.uk/guidance/ta566
implants amongst adults: audiologists’ views of the barriers and facilitators for referral. Park, L. R., Teagle, H. F., Buss, E., Roush, P. A. & Buchman, C. A. (2012). Effects of
The Ear Foundation. www.bit.ly/2kOIvaf frequency compression hearing aids for unilaterally implanted children with acoustically
Achbold S, Lamb B, O’Neill C, Atkins J. (2014) The Real Cost of adult hearing loss amplified residual hearing in the nonimplanted ear. Ear and hearing, 33(4), e1-e12.
(2014) The ear Foundation. Available at www.bit.ly/EarFound2 Perreau, A. E., Bentler, R. A. & Tyler, R. S. (2013). The contribution of a frequency-
Bierbaum, M., McMahon, C., Hughes, S., Boisvert, I., Lau, A., Braithwaite, J., & compression hearing aid to contralateral cochlear implant performance. Journal of the
Rapport, F. (2019). Barriers and facilitators to cochlear implant uptake in Australia and American Academy of Audiology, 24(2), 105-20.
the United Kingdom. Ear and Hearing. www.bit.ly/2lXJHZ3 Raine, C. (2013) Cochlear implants in the United Kingdom: Awareness and utilization,
Chundu, S., Buhagiar, R. (2013) Audiologists’ knowledge of cochlear implants and their Cochlear Implants International, 14:sup1, S32-S37, DOI: 10.1179/1467010013Z.000
related referrals to the cochlear implant centre: Pilot study findings from UK, Cochlear 00000077.
Implants International, 14:4, 213-224, DOI: 10.1179/1754762812Y.0000000025. Raine, C., Atkinson, H., Strachan, D., Martin, J. (2016) Access to cochlear
Gaylor, J., Raman, G., Chung, M., Lee, G., Rao, M., Lau, J., Poe, D. (2013) Cochlear implants: Time to reflect, Cochlear Implants International, 17:sup1, 42-46, DOI:
Implantation in Adults A Systematic Review and Meta-analysis. JAMA. Otolaryngol 10.1080/14670100.2016.1155808.
Head Neck Surg. 2013;139(3):265-272.doi:10.1001/jamaoto.2013.1744 Simpson, A., Bond, A., Loeliger, M., Clarke, S. (2018) Speech intelligibility benefits
Hillock-Dunn, A., Buss, E., Duncan, N., Roush, P. A. & Leibold, L. J. (2014). Effects of of frequency-lowering algorithms in adult hearing aid users: a systematic review
non-linear frequency compression on speech identification in children with hearing and meta-analysis, International Journal of Audiology, 57:4, 249-261, DOI:
loss. Ear and hearing, 35(3), 353-65. 10.1080/14992027.2017.1375163.
Hughes, SE, Hutchings, H, Rapport, FL, McMahon, C & Boisvert, I (2018) ‘Social WHO (2017) Global costs of unaddressed hearing loss and cost-effectiveness of
connectedness and perceived listening effort in adult cochlear implant users: a
interventions. Available at https://www.who.int/deafness/en/ r
recruitment advertising
36 BSHAA PEOPLE | OCTOBER 2019
recruitment advertising
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