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.

Bernadette Fulton:

Bernadette Fulton: And I'm delighted to welcome Laura Turton, a clinical audiologist from the UK, who's our special guest speaker for this episode. Laura is deputy head of the department at the NHS in Tayside in Scotland, and was the editor of the recently published guidelines on best practice. Today, we'll be talking about the importance of the assessment for the audiological management of clients with severe and profound hearing loss. This is something that Laura, I do know that you are passionate about this. Can you tell me why?

Laura Turton:

Laura Turton: First of all, the assessment is by far my favorite type of appointment. I don't know why that is. I just find it really satisfying to get a really good start in the pathway. And I remember when we were talking about all the different sections, I was like, I hope I end up with the assessment part for this guidelines. I just think that if you start badly, then it's very difficult to be able to recover from that. And if you collaborate with your patient really early on and it's treated as a partnership, then you can really achieve some good expectations and good outcomes.

Bernadette Fulton:

Bernadette Fulton: One of the things that you mentioned in the guidelines, I think it's a topic that's probably underestimated in hearing care, is the importance of a treatment plan. And you said this has been well used by the NHS in the past. I think about a treatment plan as being something that hospitals use for acute medical conditions. Is it really applicable for hearing loss?

Laura Turton:

Laura Turton: Yeah, completely. I think that it solidifies in a physical way. It's something that you often agree or is implied with the patient. But I think that it allows you to remain focused with each of your patients as to what you're doing and for them to also recognize the bits that they are doing. So if there's elements of self-management and that's recorded, then there's a level of accountability for both of you that allows you to follow it through.

Laura Turton:

Laura Turton: So it isn't a one-off thing. It's something that you repeatedly come back to at different points in the pathway and the journey, but it allows you to record and modify and check expectations and have something that they can physically take away that says, this is what we said we were going to do. This is what we've done over time. This is how you think you have achieved at the end of it. And there's something quite satisfying about having that all recorded all in one place.

Bernadette Fulton:

Bernadette Fulton: So you said earlier that the NHS have actually used treatment plans for quite a long time, but do they use them for all of their hearing-impaired clients, or do you think there's something special about using the plan for adults with severe to profound hearing loss?

Laura Turton:

Laura Turton: My experiences they're used with everybody and whether that's for somebody who has normal hearing and tinnitus, or whether it's someone who has severe to profound hearing loss, it's something that was pioneered by North Wales NHS Trust and has then been accepted pretty much throughout the whole of the UK. I think that the nice thing about it for severe to profound hearing loss is it's a way of being able to remember that there are vast interventions that you can offer your patients that maybe aren't applicable for mild to moderate hearing losses.

Laura Turton:

Laura Turton: And so being able to have a place that reminds you of all these different interventions as part of that discussion, I think could be very helpful, particularly if you're not seeing someone with severe to profound hearing loss that regularly. It's a nice place to be able to keep that information so that you can then discuss all of those treatment interventions without too much worry that you might miss out on things.

Bernadette Fulton:

Bernadette Fulton: So if I were one of the audiologists who doesn't see these clients very frequently, as part of the assessment should I be doing special tests that I maybe don't routinely do with most of my clients who have mild to moderate hearing loss? And what sort of additional things should I be doing in the assessment?

Laura Turton:

I think that you need a slightly extended amount of time. So we do a 75-minute assessment [inaudible 00: 05:40] and a 60 minute assessment with patients for severe to profound hearing loss, because you're doing a history that starts from the very beginning. And you're taking your time to be able to go through stuff that maybe you would fly through a little bit quicker if they had a mild to moderate hearing loss. Because you're almost trying to be a detective and work out are there any kind of things that come up in that history that will help you help come together with your treatment plan later on.

Laura Turton:

Laura Turton: You are looking at diagnostic information as you would with anybody doing a pure tone audiogram, and we would recommend that you also do uncomfortable loudness levels because of understanding the dynamic range and the implication that might have around amplification and that kind of thing. You would benefit greatly from doing some kind of speech testing, because it allows you to be able to consider other interventions such as cochlear implant assessments in the future.

Laura Turton:

Laura Turton: And also, just to get an understanding, I've quite often done speech testing and thought, wow, you are really, really struggling a lot more than I had realized. And I've got to a point in the appointment where I'm not certain how much you've even picked up of me because of how poorly you're doing on your speech testing.

Laura Turton:

Laura Turton: But then you also need to look wider around non-auditory assessments, so you need to also consider is there eyesight problems, is there problems with cognition? Is there dexterity issues, all of those kind of things, as well as then being able to understand their needs and their wants and where they're struggling with their hearing. And if you get those foundations right, and that leads to a nice comprehensive treatment plan, then I think that it puts you in the best possible position to be able to support them going forward.

Bernadette Fulton:

Bernadette Fulton: In the clinic where you're seeing two-thirds of your clients have severe to profound hearing loss, what does a comprehensive treatment plan look like in your clinic?

Laura Turton:

Laura Turton: So ours is quite different at the moment to other centers. There are some that you can get within the patient management system. We've stayed away from that slightly and we use a document that we've created here that just summarizes for them a little bit about the issues that they've discussed with us, about the severity of hearing loss and some of their test results.

Laura Turton:

Laura Turton: And then it leads into, and we then had a conversation with you about what you wanted to manage your hearing loss going forwards, and then it lists everything. And we delete out all the ones that they're not interested in, or we maybe make a comment next to it saying, might consider this in the future, but not at present. And then we would print that first half out for them if they wanted a copy of it to take away.

Laura Turton:

But later on, there are other sections around if we fitted amplification, if we've referred them any of the clinics for cochlear implant assessment, for example, or [Bahar 00: 09:01] assessment or something like that. And then we have at their final follow-up what their outcomes were and how satisfied they are as part of that clinic. And that's something that we've developed here based on seeing some of the other ones that the NHS uses.

Bernadette Fulton:

Bernadette Fulton: So I think the British association of audiology has recently suggested that the question of cochlear implants should be routinely visited during the assessment appointment and return appointments. And it should be revisited `even if, for example, if in your original comprehensive treatment plan, you've said tick yes, we spoke about cochlear implant referral, but nothing really more than that. Then would the plan also remind you to ask again?

Laura Turton:

Laura Turton: It can do. We use a tool within our patient management system called a hot key. And as part of our hot key, it says at every assessment, is this patient suitable for a cochlear implant. And if they are, have you discussed it with them, and if you haven't discussed it with them, why not? And that was based on the British Academy of Audiology and BCIG, the British Cochlear Implant Group suggestion around that, so that we could ensure that we had a prompt.

Laura Turton:

Laura Turton: But again, you've got to remember that deaf identity and whether it's appropriate to go back. So there is flexibility around being appropriate and also being confident in being able to re-offer it again in the future. Because just because somebody has said no once doesn't mean that a future assessment, they actually haven't changed their mind for whatever reason.

Bernadette Fulton:

Bernadette Fulton: It was interesting to me too, that you mentioned that you do get additional time in the appointment. It's a longer appointment than a routine appointment, but the other thing is in the comprehensive treatment plan that it might include management that's quite, time-consuming, like could be some communication training, could be some ... I always get acronyms mixed up, but tinnitus management using cognitive behavioral therapy. They're really outside the scope of a fast and very busy time-pressured clinic. How is that managed in the treatment plan?

Laura Turton:

Laura Turton: It's not necessarily managed in our treatment plan in our clinic, it's that we run clinics parallel, if you like. So we have our busy routine clinics that are seeing patients on a regular basis that don't have severe to profound hearing loss, and they are managed on a tighter timescale that we base our appointment times on recommendations from the British academy of audiology. However, when you compare, I think the recommendation is 45 minutes for an assessment. You just can't do everything that's appropriate for these patients in 45 minutes.

Laura Turton:

Laura Turton: And initially, we stuck to that and we said okay, well we'll see what we can do in that time. But it became inefficient because patients were coming back for more regular follow-ups and coming back to our open repair clinics because they were struggling. And it's because we hadn't addressed some of these things. So we then started to trial it where we were heavier on appointment time, but that led to them not coming back more regularly. And because of that, we felt that it was more efficient to put the time in at the beginning, manage that pathway better so that we weren't then having to get them back for follow-up.

Bernadette Fulton:

Bernadette Fulton: So you really have been able to show that if you put the time that's required in early to making a plan, to getting people on the pathway to really follow up on that plan, that you actually see a reduction in the return appointments. So their satisfaction and their needs are really better met.

Laura Turton:

Laura Turton: Absolutely. And you've addressed all the way through realistic expectations, linked to the choices that they've made around intervention. So if they've only chosen to have a high powered hearing aid upgraded that they recognize that probably some of the problems that they're having at the moment are not going to have been addressed. If they've taken a wider view of that, potentially they have an opportunity to do that. And all of that needs that time.

Bernadette Fulton:

Bernadette Fulton: So for example, the NHS is fairly unique in the world because it's free to the client and universal right throughout the UK. If you are running audiology service as a business, can you imagine improvement from a business point of view from putting that extra time in?

Laura Turton:

Laura Turton: Absolutely. I think it depends on your business model and how you do it, but if you are selling it as a kind of a package, including the rehabilitation and additional assistive listening devices and things like that, taking the time to be able to do that and explain the benefits of the technology that they're having. But also they're not getting people who are contacting you and saying, you know what? I thought that this is what I was going to be able to achieve. And I can't, so I either want a refund, or I want you to see me again and fine tune.

Laura Turton:

Laura Turton: Because there is a perception by some patients, no matter their degree of hearing loss, that there is that magic button in the software that if you just press it, then they're going to hear better.

Bernadette Fulton:

Bernadette Fulton: I need that button. I need that button.

Laura Turton:

Laura Turton: I know. If only it was there. But if you do have that, then it's going to make your business far more efficient and you're not going to get the ... I'm sure you'll get the odd one, but you shouldn't have as many repeat calls for, "Please see me and just make that tiny tweak, and that tweak is going to make all the difference for me."

Bernadette Fulton:

Bernadette Fulton: It's probably really hard because I know you see so many adults with severe to profound hearing loss, but can you think of someone that you saw who having a comprehensive treatment plan just was really effective? Can you give an example?

Laura Turton:

Laura Turton: So we had a patient that hadn't been back to see us for years and years and years. I think it was about six or seven. So it was on a model of hearing aids that we just didn't have in stock anymore, but was also in that time, we'd changed manufacturers and we no longer did this manufacturer at all. And we had trialed them with the new manufacturer that we were on at the time, and they were really struggling. So we kind of stopped everything and went, okay, we're going to go back to basics and we're going to start an assessment again, and went through the full assessment process and then came up with their bespoke treatment plan. And that included getting the previous manufacturer in to help us fit their product because we didn't do it. It helped us also look wider at remote microphones. It helped us be reminded of cochlear implant assessments.

Laura Turton:

Laura Turton: And also, because this person was quite young and was really struggling with quality of life, we looked at things like access to work, and we looked at things like peer support volunteer, support that we have here. And actually, it just helped really refocus us with a patient who was struggling terribly to be able to adapt to the manufacturer that we were fitting at that time.

Laura Turton:

Laura Turton: And actually, she's been very successful and she'd probably do her reassessment again now, but she's not come back again and again, and again. She was one of those where literally, if you said her name in the department, everybody went, "Oh, no, she's back again" because she was struggling so much.

Bernadette Fulton:

Bernadette Fulton: Yeah, I think we all have those ones.

Laura Turton:

Laura Turton: I think sometimes, yeah. It helped us take stock with her and come up with a different way of managing her.

Bernadette Fulton:

Bernadette Fulton: So just to recap the key messages from our discussion today, the best practice for clients with severe to profound hearing loss is a little bit different from a routine history taking that we usually do, that the assessment should include ... Well, of course the diagnostic information, but also look at the non-auditory needs assessments, and you mentioned about dexterity and other problems that the person may have.

Bernadette Fulton:

Bernadette Fulton: And also talking about their communication needs themselves and being prepared to go back and reassess from the beginning to really find out what's at the bottom of this ongoing issue that they might be presenting with. So the aim is to improve outcomes by developing a comprehensive treatment plan that's, to use your word, bespoke, that's just particular for that individual. Laura, do you have a closing message for our listeners today?

Laura Turton:

Laura Turton: I think just that person-centered care generally is so important with people with severe to profound hearing loss and that if you can start well, then hopefully you can finish well.

Bernadette Fulton:

Bernadette Fulton: Thank you so much for joining us today, Laura, and I think many of us will be inspired to improve the assessment practices that we have with severe to profound hearing loss, by trying to make a comprehensive treatment plan. And if you would like to know more about the Guidelines for Best Practice in the Audiological Management of Severe to Profound Hearing Loss, please download a copy. They're available from the Phonak Pro website on www.phonakpro.com, and look for severe to profound hearing loss.

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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