The Audiologist - A Phonak podcast

The Audiologist - A Phonak podcast

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Speaker 1:

Speaker 1: The Audiologist, a Phonak podcast.

Bernadette Fulton:

Bernadette Fulton: Welcome to The Audiologist, a podcast series created by Phonak to offer audiologists and people interested in audiology new perspectives on hearing health topics. This series of podcasts is all about adults with severe to profound hearing loss. At the microphone is audiologist Bernadette Fulton. I'm audiology manager for severe to profound hearing loss at Phonak International Headquarters in Switzerland. With me today is Laura Turton, our clinical audiologist who's the deputy head of department at the NHS in Tayside Scotland. She specializes in severe and profound hearing loss and was the editor of the Guidelines for Best Practice. She's here to tell us about how she approached the task, but first Laura, can you tell us a little bit about yourself?

Laura Turton:

Laura Turton: I've worked as an audiologist for 20 years and when I was about eight years in, I decided I was going to do a master's, which in the UK, isn't a requirement to be able to practice. And as part of my dissertation, I was working with somebody and they just suggested that my dissertation was on severe to profound hearing loss because there wasn't very much research out there about it, and that was really my introduction to it.

Laura Turton:

Laura Turton: After having then completed by masters, I then set up a clinic specifically for severe to profound hearing loss because that linked in with my masters, but also that seemed to just start to be an initiative that was happening in the NHS in the UK at that time. And then, outside of my clinical experience, and I've set up three severe to profound clinics over my career, is that I also left for a period of time and worked for a charity that dealt specifically with people who had a sudden severe to profound hearing loss, that was acquired typically from a virus or from a head injury or something like that, and the rehabilitation that they required for the fact that this was often a very quick experience.

Laura Turton:

Laura Turton: So, I've seen it from a few different angles and it's just a population that's really interested me and it's become really apparent that doesn't necessarily interest as many either clinicians or researchers, which has made it even more interesting to be able to be involved in things.

Bernadette Fulton:

Bernadette Fulton: Just a follow-up question on that. You talked about setting up a specialized clinic for severe and profound hearing loss. Were you creating a model that's been duplicated in the NHS in the UK?

Laura Turton:

Laura Turton: Potentially. I would say that one of the coauthors, Judith Bird probably pioneered it a little bit quicker than I did. And so, then I went to go and visit Judith and said, "Can I observe some of your clinics?" And it became apparent that some of the things we'd brought in, they'd already got in place. So, that was very comforting to know that what we'd prioritized, another clinic had already prioritized. And I know she was getting a lot of requests for people to go and observe her clinic and so, she started sending them to us as well. And again, that affirmed for me that we were doing quite a good job, that somebody else was happy to direct other people who wanted to shadow to the clinics that we were involved in.

Bernadette Fulton:

Bernadette Fulton: Did you know that guidelines for mild to moderate hearing loss often fall short when treating severe and profound hearing loss? Has that been your experience in the past, Laura?

Laura Turton:

Laura Turton: Yeah, absolutely. There seems to be a lot of guidance out there around generic hearing loss, but when you look at it, it just doesn't fit people with severe to profound hearing loss because of their needs, because of the fact that they're quite unique in what they're hoping to achieve. And so, that yeah, any guidance that's already out there just doesn't seem to do enough for us.

Bernadette Fulton:

Bernadette Fulton: When you looked at the evidence, were you surprised at the paucity of the research and the evidence in that area and why do you think it's like that?

Laura Turton:

Laura Turton: So, I'm not a researcher but when I've had conversations with researchers, they have said there do seem to be these little pockets of things that just don't seem to get touched quite so much. My interpretation as a clinician is, that the exciting bit of severe to profound hearing loss for research, seems to be cochlear implantation because there's such a difference between pre-implantation and post-implantation. So, there seems to be an awful lot that's gone around there and that's where researchers focused. Outside of that though, very little has been looked at.

Laura Turton:

Laura Turton: And I was aware of that because some of the other projects that I've worked on and things that I've looked at, but I hadn't realized it was quite to the level it was. Particularly around hearing aid research and the fact that really, anything that was relevant, specific patients with severe to profound hearing loss was analog technology a lot of the time, and we were going back years and years and years. So, that was definitely surprising, the difference between mild to moderate hearing loss and the research that's been done for severe to profound hearing loss.

Bernadette Fulton:

Bernadette Fulton: Yeah. I think one of the important things that I noticed was that the majority of adults with severe to profound hearing loss, in fact, the vast majority rely on hearing aids and don't actually go on to have cochlear implants.

Laura Turton:

Laura Turton: Yeah. So, the fact that it's approximately 6% of adults go through for a cochlear implant assessment, but it's 95% of children up to the age of 17 go through. Yeah, there's a big difference, and that really is why I got involved in this population because I don't fit cochlear implants. I'm not part of a hospital that has a cochlear implant center. And it seemed that this population was getting a really raw deal with the treatment and the assessment and their whole pathway really. And it seemed to be, well, if you don't want to go for a cochlear implant, then here's a pair of high-powered hearing aids, off you go. And actually, there needs to be a much broader view of that.

Bernadette Fulton:

Bernadette Fulton: Do you think the guidelines will make a difference for those people wearing hearing aids?

Laura Turton:

Laura Turton: I really, really hope so. I hope that there is an awareness of the guidelines for people, so that actually they're able to use them because I think that we've created something that's quite easy to follow, that the recommendations are often quite simple. Most of them are going to be able to be put into practice without too much of a change of service. So, I think it's more does your audiology practice know that they exist? And as long as they know it exists, I really hope that they're then looked at and used because I think that only very small changes will have such a big impact for this population.

Bernadette Fulton:

Bernadette Fulton: Following the publication of the guidelines, what changes would you like to see in audiological management? And for example, have you implemented any changes in the clinic where you work?

Laura Turton:

Laura Turton: So, I'd like to see that there is bespoke care for someone with severe to profound hearing loss, that it is person-centered, and that alongside that, some of the other recommendations that are made in the publication, for example, recognizing that you're probably going to need to invest a little bit more time. But that investment of time is well worth it, because it potentially stops people coming back on regular repeat follow-up visits, because they're unsatisfied with the treatment outcomes that they're getting.

Laura Turton:

Laura Turton: Whether that is in a specialist clinic for places or whether that is just that the audiologist has the ability to go, "Okay, my next patient has severe to profound hearing loss therefore, this is the type of appointment that I need to deliver." I don't think that matters, but I think it is important that if you have a severe to profound hearing loss, that you can have an expectation that you will be thoroughly assessed in a person-centered way, where you can help shape your care in collaboration with your professional and choose the treatment options that are relevant to you. And therefore, that you have realistic expectations set, and that you're supported in a number of ways that's more than just high powered hearing aids.

Laura Turton:

Laura Turton: In my clinic, we used the guidelines as an audit and just said, "Are we achieving all these recommendations?" And I think there was ... There's 153 recommendations and we weren't achieving six.

Bernadette Fulton:

Bernadette Fulton: Wow.

Laura Turton:

Laura Turton: So, we went back and we had a look at those six. And things like, one of the recommendations around remote microphones is the ability to trial them in clinic and we didn't have that as an option. So, we're currently purchasing some so that we can trial them both within the clinic and also then on loan for patients, so that they can try them in their real life situations as well.

Bernadette Fulton:

Bernadette Fulton: When we were discussing how things had changed in your clinic, in a previous occasion, I think you said something about tablets.

Laura Turton:

Laura Turton: Yeah. So, we've done a lot around deaf awareness recently, mainly because of some social media posts from deaf advocates. Who've just said, "Since face coverings have come in, it's highlighted the challenges, particularly in audiology departments." So, we've looked at a number of different things like, if you are going to get your patient from reception and they have a severe to profound hearing loss, we now have vibrating pagers, a bit like you get in restaurants.

Laura Turton:

Laura Turton: So, when we come and get you, we press the doorbell part, they have a vibrating pager, and they're aware that we're calling them at the same time. And we have tablets in the rooms with us for live captioning, as well as clear face masks and things like that. So, we've tried to build in a toolkit of things to make communication as accessible as possible.

Bernadette Fulton:

Bernadette Fulton: So, just to recap what we've discussed, the messages from today, is clients who have severe to profound hearing loss will just not get the benefits they need from the routine care we provide for people with mild to moderate hearing loss, they really need a bespoke solution. And the guidelines do point to new research that's needed to establish effective evidence-based practice for the vast majority of adults with severe to profound hearing loss, who continue to use hearing aids. And the guidelines are really an important step towards best practice and anyone who's interested can get their own copy. Laura, do you have a closing message or anything to add to what I've just summarized?

Laura Turton:

Laura Turton: I think that for some people, because they don't see patients with severe to profound hearing loss on a regular basis, it can seem quite a daunting prospect in knowing what to do for them, from the technology side and from signposting them to all relevant interventions that can also support them. And I would just say that, those guidelines are a really nice first step in understanding this population a little bit more.

Laura Turton:

Laura Turton: And one of our hopes was that it reduces that anxiety and that fearfulness of seeing this population, because they're 7% of the clinical population. So, actually, it's quite a lot of patients and when you think about it in percentage terms and how many patients you might see in your practice throughout the year. And it would be really good to just be able to see better outcomes with these patients, where they're achieving a better quality of life.

Bernadette Fulton:

Bernadette Fulton: Thank you so much, Laura, thank you for joining us today and thank you, especially for your work in making the Guidelines for Best Practice, a reality. If you would like to learn more or obtain a copy of the Best Practice Guidelines, they can be downloaded from the Phonak Pro website, which is www.phonakpro.com. And then, look for severe to profound hearing loss. Goodbye, everyone.

Speaker 1:

Speaker 1: The Audiologist, a Phonak podcast.

About this podcast

‘The Audiologist’ is a podcast series created by Phonak to offer audiologists and people interested in audiology new perspectives on hearing health topics.

As the world’s leading hearing aid manufacturer, we regularly collaborate with top audiology experts from around the world. We launched this podcast to share their inspiring views and insights from the industry and the latest on research and learning. You will learn from the very best in their respective fields.

So, join us and our guest speakers for a fascinating journey reflecting on the past, present and future of audiology.

by Phonak

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