Hundreds more people with severe to profound deafness will be eligible for cochlear implants each year, due to updated NICE guidance. Update comes after a review of the definition of severe to profound deafness which is used to identify if a cochlear implant might be appropriate.
Severe to profound deafness is now recognised as only hearing sounds louder than 80dB HL at 2 or more frequencies without hearing aids. A cochlear implant works by picking up sounds which are turned into electrical signals and are sent to the brain. This provides a sensation of hearing but does not restore hearing.
Currently around 1,260 people in England receive cochlear implants each year. These updated recommendations could lead to a 70% increase in that number, to 2,150 people, once a steady state is reached in 2024/25.
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)
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
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.
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.
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.