Clinical Practice Guideline (Update): Earwax (Cerumen Impaction) Executive Summary

The American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue of Otolaryngology–Head and Neck  Surgery featuring the updated Clinical Practice Guideline: Earwax (Cerumen Impaction). | Otolaryngology– Head and Neck Surgery

This clinical practice guideline is as an update, and replacement, for an earlier guideline published in 2008 by the American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF).1 An update was planned for 5 years after the initial publication date and was further necessitated by new primary studies and systematic reviews that might suggest a need for modifying clinically important recommendations. Changes in
content and methodology from the prior guideline include the following:

  • addition of a consumer advocate to the guideline update group (GUG)
  • 3 guidelines, 5 systematic reviews, and 6 randomized controlled trials (RCTs)
  • emphasis on patient education and counseling with new explanatory tables
  • expanded action statement profiles to explicitly state quality improvement opportunities, confidence in the evidence, intentional vagueness, and differences
    of opinion
  • enhanced external review process to include public comment and journal peer review
  • new algorithm to clarify decision making and action statement relationships
  • 3 new key action statements on managing cerumen impaction that focus on primary prevention, contraindicated intervention, and referral and coordination
    of care.

Full reference: Schwartz, S.R. et al. (2017) Clinical Practice Guideline Update): Earwax (Cerumen Impaction) Executive Summary. Otolaryngology– Head and Neck Surgery. Vol. 156 (no. 01) pp. 14–29

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Diagnosing, Treating Benign Paroxysmal Positional Vertigo

Updated guidelines on the diagnosis and treatment of benign paroxysmal positional vertigo (BPPV) suggest a series of in-office maneuvers, rather than expensive imaging tests or medications, offer a faster route to diagnosis and cure | ED Management

  • Typically, patients with BPPV present with symptoms of intense dizziness that may be accompanied by nausea, vomiting, or an intense feeling of disorientation or instability.
  • A very specific diagnostic step called the Dix-Hallpike maneuver can enable physicians to quickly spot the signs of BPPV.
  • When the diagnosis is positive for BPPV, canalith repositioning maneuvers typically can resolve the symptoms.
  • When BPPV is suspected, guideline authors urged providers to stay away from vestibular suppressive medications, which produce a host of side effects and can contribute to a delay in diagnosis.

Full reference: Bhattacharyya, N. et al. (2017) Diagnosing, Treating Benign Paroxysmal Positional Vertigo. ED Management. Online issue: 1st August 2017

Onward Referral of Adults with Hearing Difficulty Directly Referred to Audiology Services

New Direct Referral Guidance from BAA

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Image source: BAA

This document is intended to guide Audiologists in service planning and in making referrals for a medical or other professional opinion.

Along with “Guidelines for Primary Care: Direct Referral of Adults with Hearing Difficulty to Audiology Services (2016) 1 ”, this document replaces the earlier guidelines (BAA 20092 , TTSA 19893,4 ) and has been approved by the Board of the British Academy of Audiology.

This document comprises a set of criteria which define the circumstances in which an Audiologist in the UK should refer an adult with hearing difficulties for a medical or other professional opinion. If any of these are found, then the patient should be referred to an Ear, Nose and Throat (ENT) department, to their GP or to an Audiologist with an extended scope of practice. The criteria have been written for all adults (age 18+), but local specifications regarding age range for direct referral should be adhered to.

This document is intended to be used in conjunction with “Guidelines for Primary Care: Direct Referral of Adults with Hearing Difficulty to Audiology Services (2016) 1 ”. Audiology services are expected to make reasonable efforts to make local GPs aware of this guidance and support their understanding of its application.

Read the full report here

Evidence-based guidelines for recommending cochlear implantation for young children: Audiological criteria and optimizing age at implantation

Leigh, J.R. et al. International Journal of Audiology. Published online: 4 May 2016

Objective: Establish up-to-date evidence-based guidelines for recommending cochlear implantation for young children.

Design: Speech perception results for early-implanted children were compared to children using traditional amplification. Equivalent pure-tone average (PTA) hearing loss for cochlear implant (CI) users was established. Language of early-implanted children was assessed over six years and compared to hearing peers.

Study sample: Seventy-eight children using CIs and 62 children using traditional amplification with hearing losses ranging 25–120 dB HL PTA (speech perception study). Thirty-two children who received a CI before 2.5 years of age (language study).

Results: Speech perception outcomes suggested that children with a PTA greater than 60 dB HL have a 75% chance of benefit over traditional amplification. More conservative criteria applied to the data suggested that children with PTA greater than 82 dB HL have a 95% chance of benefit. Children implanted under 2.5 years with no significant cognitive deficits made normal language progress but retained a delay approximately equal to their age at implantation.

Conclusions: Hearing-impaired children under three years of age may benefit from cochlear implantation if their PTA exceeds 60 dB HL bilaterally. Implantation as young as possible should minimize any language delay resulting from an initial period of auditory deprivation.

Read the abstract here

NHS audiology – adult hearing services guidance

A series of guides have been published to help the NHS increase access, quality and choice in adult hearing services whilst making the most of available resources

The guides, published this week, advise how stakeholders in NHS hearing care can work together to deliver the goals in the Five Year Forward View – including putting patients first, improving access and follow-up, delivering more care out-of-hospital and making better use of limited resources. Most importantly the guidance sets the stage to take preventative health more seriously by thinking of hearing care as a public health, rather than medical, challenge.

The series of guides aimed at commissioners, providers, health and wellbeing boards and Healthwatch are available online from the National Community Hearing Association